Studies have shown that pycnogenol is 50–100 times more potent than vitamin E in neutralizing free radicals and that it helps to recycle and prolong the activity of vitamins C and E. Studies have shown pycnogenol to be effective in reducing blood pressure and reducing the risk of venous thrombosis by its effect on vascular endothelium. The usual dosage is 100–200 mg daily. Few side effects from the use of pine bark extracts have been reported, the most frequent being mild gastrointestinal effects such as diarrhea and upset stomach. Pycnogenol should not be taken by patients who are being treated with immunosuppressants or by those receiving corticosteroid drugs because it can enhance immune system function and interact with drugs that suppress the immune system.[46–84]
NSAIDs don’t just damage your gut lining. They affect your gut bacteria, too. A study of regular users found that different NSAIDs caused different changes in gut bacteria.[5] Ibuprofen and arthritis drug celecoxib (Celebrex), for example, increased pathogenic Enterobacteriaceae, a family of bacteria that includes E. coli, Salmonella, and a number of lesser-known bacteria that contribute to eye, skin, respiratory, and urinary tract infections.[6]
This herb has been shown to prevent the activation of the transcriptional factor NF-kB and it directly inhibits TNF-α production by up to 65-85%. It inhibits the expression of inducible genes associated with inflammation, specifically negating the expression of inducible nitric oxide synthase, and hence attenuates nitrous oxide production. Side effects may include nausea, although it has shown an impressive protective effect on indomethacin-induced enteritis in laboratory studies.
If you need stronger pain relief, talk to your doctor about a prescription topical NSAID. A prescription topical NSAID is stronger than OTC products. Topical NSAIDs also carry less risk of stomach upset, ulcers, or other problems than oral NSAIDs do. The only prescription topical NSAID currently available is called Voltaren (diclofenac). Talk to your doctor to find out if it’s right for you.
When anti-inflammatories are taken by mouth they work by blocking (inhibiting) the effect of chemicals (enzymes) called cyclo-oxygenase (COX) enzymes. COX enzymes help to make other chemicals called prostaglandins. Some prostaglandins are involved in the production of pain and inflammation at sites of injury or damage. A reduction in prostaglandin production reduces pain and inflammation.

Traditional wisdom says that NSAID pain relievers only damage your gut lining if you take them every day for a long time, but recent research disagrees. High-level athletes with stress-related intestinal damage tried taking ibuprofen to improve muscle soreness and recovery. Ibuprofen ended up damaging their gut lining even further after just a couple weeks; it increased inflammation and made their original pain issues worse.[3] In fact, a single dose of aspirin can significantly increase your intestinal permeability.[4]