5 ms·

Ibuprophen is bad for your stomach, acetaminophen is bad for your liver, neither makes a good long term treatment. https://www.ncbi.nlm.nih.gov/books/NBK310269/

Ibuprophen is bad for your stomach, acetaminophen is bad for your liver, neither makes a good long term treatment. https://www.ncbi.nlm.nih.gov/books/NBK310269/ https://www.ncbi.nlm.nih.gov/books/NBK310269/ https://www.ncbi.nlm.nih.gov/books/NBK548162/ https://www.ncbi.nlm.nih.gov/books/NBK548162/

petesergeant 3y ago
The link you’ve posted says paracetamol is bad for your liver in overdose and “harmless” at normal low dose
- genocidicbunny 3y ago
  I like that you used the scare quotes around harmless because they're quite appropriate in this case. Even at normal doses, you're relying on your liver being able to rapidly enough metabolize toxic metabolites of the paracetamol and render them non-toxic. But those toxic metabolites are still produced, and still have some effect. There's a threshold to where those toxic effects become acute enough that you actually notice them, but the chronic effects still exist. That threshold also goes way down if you have any kind of hepatic dysfunction, like Hep, or diabetes, or if you drink a little too much, or perhaps partied a little too hard in your youth.
  - petesergeant 3y ago
    Quotes are also regularly used for directly quoting
    - genocidicbunny 3y ago
      Quoting a single word is pretty useless except draw attention to that specific word, rather than the entire context from which it's being drawn. It almost never feels like someone is genuinely quoting, more like trying to demonstrate specific wording out of context.
  - robbiep 3y ago
    Do you have any evidence for your claims? I ask because I just don't see what you are claiming in any of the conversations around the hospital, or indeed in the patient population that I am exposed to, many of whom have decades long exposure to 4g a day of paracetamol. The recommended dose of paracetamol/acetaminophen is built for the entire population. Which includes 80 year olds knocking back half a bottle of wine a day. Which is a staggeringly large percentage of 80 year olds who are actually on this cocktail day in, day out, and I am not aware of any evidence in the literature suggesting we try and cut back the enormous number of people aged 65 and above who are on this recommended max of 4g paracetamol a day, for decades. You're also giving significantly less credit to the liver than is due. Diabetes isn't hepatic dysfunction, and your liver reserve and regenerative functions are so large that unless you did permanent damage to your liver in a wildly mis-spent youth that would likely stretch over 10 years, it is very unlikely you came close to even touching the sides of your liver's capacity to totally blot that from your record (even if you show other physical and mental strains of this), unless you were using needles and managed to contract something that is going to stick around and has an affinity for the liver.
    - genocidicbunny 3y ago
      > Do you have any evidence for your claims? Purely anecdotal, I admit, but it's also coming from conversations with doctors and nurses that I know. I also know a few people that seem to have developed gastric and hepatic issues due to long-term usage of NSAIDs, although that association is pretty strongly duck-typed. > The recommended dose of paracetamol/acetaminophen is built for the entire population. But with what sort of margin of error? The metabolic pathway for paracetamol produces some pretty toxic metabolites, that's pretty irrefutable, so like I said, you're relying on your liver metabolizing those further to non-toxic compounds quickly enough that they can't do significant damage before they've been expelled. > Which includes 80 year olds knocking back half a bottle of wine a day. Which isn't really saying much. Someone's grandfather that I know is pushing 90, smokes 2-3 packs of unfiltered Camels per day, and goes through half a case of beer every day. I'm not entirely joking when I say he might outlive me. There's also the matter that there's not a whole lot of younger people knocking back said cocktail on a daily basis, there's a bit of a bias towards the older population due to the base reasons for why you would even be chronically consuming paracetamol. So if the effects of chronic usage take years, or decades, to show, they're less likely to show up in the older populations. Also, general organ damage is not always easily differentiated from drug-induced damage in people who are already likely to have general organ damage due to age. There's not much mention in literature because the effects do take a while to show up, and generally if you're chronically consuming paracetamol, there's probably more problematic comorbidities to deal with anyways. It works well enough, for enough people, with few enough side effects, that it's generally not treated as a problem. > Diabetes isn't hepatic dysfunction You're right, that was a bit of a shortcut on my part. T2 is often related to other issues that also affect the liver, which is why I made that leap. > your liver reserve and regenerative functions are so large This is highly variable both person-to-person, but also lifestyle-to-lifestyle. Again, anecdotal, but I have heard of both ends of the spectrum -- from a heavy alcoholic having the liver function of a 12 year old kid, to someone living 'clean' that had severe cirrhosis.

petesergeant 3y ago

The link you’ve posted says paracetamol is bad for your liver in overdose and “harmless” at normal low dose

genocidicbunny 3y ago
I like that you used the scare quotes around harmless because they're quite appropriate in this case. Even at normal doses, you're relying on your liver being able to rapidly enough metabolize toxic metabolites of the paracetamol and render them non-toxic. But those toxic metabolites are still produced, and still have some effect. There's a threshold to where those toxic effects become acute enough that you actually notice them, but the chronic effects still exist. That threshold also goes way down if you have any kind of hepatic dysfunction, like Hep, or diabetes, or if you drink a little too much, or perhaps partied a little too hard in your youth.
- petesergeant 3y ago
  Quotes are also regularly used for directly quoting
  - genocidicbunny 3y ago
    Quoting a single word is pretty useless except draw attention to that specific word, rather than the entire context from which it's being drawn. It almost never feels like someone is genuinely quoting, more like trying to demonstrate specific wording out of context.
- robbiep 3y ago
  Do you have any evidence for your claims? I ask because I just don't see what you are claiming in any of the conversations around the hospital, or indeed in the patient population that I am exposed to, many of whom have decades long exposure to 4g a day of paracetamol. The recommended dose of paracetamol/acetaminophen is built for the entire population. Which includes 80 year olds knocking back half a bottle of wine a day. Which is a staggeringly large percentage of 80 year olds who are actually on this cocktail day in, day out, and I am not aware of any evidence in the literature suggesting we try and cut back the enormous number of people aged 65 and above who are on this recommended max of 4g paracetamol a day, for decades. You're also giving significantly less credit to the liver than is due. Diabetes isn't hepatic dysfunction, and your liver reserve and regenerative functions are so large that unless you did permanent damage to your liver in a wildly mis-spent youth that would likely stretch over 10 years, it is very unlikely you came close to even touching the sides of your liver's capacity to totally blot that from your record (even if you show other physical and mental strains of this), unless you were using needles and managed to contract something that is going to stick around and has an affinity for the liver.
  - genocidicbunny 3y ago
    > Do you have any evidence for your claims? Purely anecdotal, I admit, but it's also coming from conversations with doctors and nurses that I know. I also know a few people that seem to have developed gastric and hepatic issues due to long-term usage of NSAIDs, although that association is pretty strongly duck-typed. > The recommended dose of paracetamol/acetaminophen is built for the entire population. But with what sort of margin of error? The metabolic pathway for paracetamol produces some pretty toxic metabolites, that's pretty irrefutable, so like I said, you're relying on your liver metabolizing those further to non-toxic compounds quickly enough that they can't do significant damage before they've been expelled. > Which includes 80 year olds knocking back half a bottle of wine a day. Which isn't really saying much. Someone's grandfather that I know is pushing 90, smokes 2-3 packs of unfiltered Camels per day, and goes through half a case of beer every day. I'm not entirely joking when I say he might outlive me. There's also the matter that there's not a whole lot of younger people knocking back said cocktail on a daily basis, there's a bit of a bias towards the older population due to the base reasons for why you would even be chronically consuming paracetamol. So if the effects of chronic usage take years, or decades, to show, they're less likely to show up in the older populations. Also, general organ damage is not always easily differentiated from drug-induced damage in people who are already likely to have general organ damage due to age. There's not much mention in literature because the effects do take a while to show up, and generally if you're chronically consuming paracetamol, there's probably more problematic comorbidities to deal with anyways. It works well enough, for enough people, with few enough side effects, that it's generally not treated as a problem. > Diabetes isn't hepatic dysfunction You're right, that was a bit of a shortcut on my part. T2 is often related to other issues that also affect the liver, which is why I made that leap. > your liver reserve and regenerative functions are so large This is highly variable both person-to-person, but also lifestyle-to-lifestyle. Again, anecdotal, but I have heard of both ends of the spectrum -- from a heavy alcoholic having the liver function of a 12 year old kid, to someone living 'clean' that had severe cirrhosis.