Ask The Pharmacist: Pain killers and drug mugging

Suzy Cohen

It’s a catch 22 if you are in pain and worried about opiates because then you will be switched to an NSAID drug like ibuprofen, naproxen, indomethacin, celecoxib or others. These medications are phenomenal for reducing inflammation and relieving swelling and pain. The trouble is that they are strong drug muggers of folate, your natural vitamin B9 nutrient. That in and of itself, is enough for you to consider supplementing with natural folate.

A glass of water, next to a jar of pills.

A folate deficiency compromises your ability to repair DNA, which can raise your risk for cancer. This can increase neuropathic nerve pain making you super uncomfortable in your own skin. Tingling, pins and needles, ant-bite sensation, hot water sensations and more can cause you mental and physical pain that is sometimes unimaginable. 

Painkillers in the NSAID category are known to negatively impact cardiovascular function, especially in middle-aged to older folks. This is in part due to the increase in homocysteine, which is due to the folate deficiency. You need adequate amounts of folate to break down homocysteine, and the drug mugging (nutrient depletion) of folate causes a buildup in homocysteine which should be perceived as “acid” on your heart, blood vessels and brain.

A buildup of homocysteine, will create more sulfur in your gut that leads to a “sulfur burp” which means you have a lot of belching and yet your digestive function tests are fine.
Homocysteine is toxic to your brain, it’s not just about heart disease. It’s a dangerous poison to your brain and no amount of folic acid fixes it. In fact, folic acid, the synthetic form of folate can occupy the receptors on your cells, and cause less of the real deal (folate) to get on the cell receptor, and then into the cell.
Homocysteine is a stunt-double for glutamate, which is an excitotoxin. You might think of MSG in the same way as you do glutamate. Symptoms like anxiety, insomnia, mood instability, dark depression, brain fog, brain zaps, migraines, ADHD, hypnic jerks and bone pain are all tell-tale signs of hyperhomocysteinemia. This means that your homocysteine is higher than 15 µmol/L.

It can be problematic for people in opiate and benzodiazepine withdrawal because the high homocysteine acts like an excitotoxin in the brain. You need to reduce homocysteine. I’ve written a longer version of this article, and I’ll email it to you if you’d like it. Just sign up for my free newsletter, so I have you in my email database, and I’ll send out to you on Tuesday. In the meantime, the following nutrients are critical to reducing homocysteine: Vitamin B2, B9, B12 and B6 as well as zinc, magnesium, choline and betaine. 

You’ll want to eat less meat and more salads and green veggies. Greens are very high in natural folate (vitamin B9) which drives the methylation pathway, which breaks down homocysteine. The problem with meat is that it’s very high in methionine, an amino acid that results in more homocysteine.

So let the side dish be meat, and the main dish be greens. 

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Suzy Cohen is a registered pharmacist. The information presented here is not intended to treat, cure or diagnose any condition. Visit