When runners experience muscle soreness or inflammation from training and racing, they’re usually quick to reach for over-the-counter drugs like ibuprofen and acetaminophen. Indeed, these analgesic drugs are the most commonly-used drugs in the United States, with sales of more than 4.3 billion dollars in 2018.

But regular use of these drugs can lead to a host of negative side effects, including gastrointestinal bleeding, ulcers, and an increased risk of heart attack and stroke. For endurance athletes, the risks are even greater: according to a 2017 study in the Emergency Medicine Journal, athletes who ingest pain relievers are at greater risk for hyponatremia, rhabdomyolysis and renal failure. Racing is already so taxing on the body, but adding analgesics to the mix makes it even more so.

It’s understandable, then, that some athletes are seeking out safer alternatives to pain medications. But “natural” doesn’t always mean safe or effective – after all, the supplement industry is infamously unregulated, and evidence doesn’t always exist to support the claims made on a bottle or box. So when it comes to analgesic alternatives, what’s fact and what’s crap? Here’s what the research has to say:

CBD oil bottles being used as natural medicine
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CBD

Despite its status as the best-selling herbal supplement in the United States, there isn’t much scientific evidence on the safety or efficacy of cannabinol, or CBD, for endurance athletes. That’s changing, thanks to researchers like Dr. Joanna Zeigler, a former professional triathlete and Olympian who now studies cannabis applications for athletes. “CBD has flooded the market and has been touted for all sorts of uses,” Zeiger says. “The truth is, though, that many of the claims made by CBD proponents have not been rigorously studied.” Athletes who ingest CBD also run the risk of consuming THC, CBD’s controversial (and in some cases, illegal) cousin. Since both compounds are derived from the cannabis plant, athletes should assume their CBD product contains THC as well—a 2017 study published by the American Medical Association found THC in 21 percent of CBD products, some of which were high enough to produce intoxication or impairment. An additional way to avoid THC is to buy CBD-isolate products, says Scott Douglas, author of The Athlete’s Guide to CBD. Douglas agrees with Zeiger to buy only from companies that pay for third-party testing of their products and that make the test results easy to find.

Verdict: When it comes to evidence, CBD is still the wild west—we simply don’t know the safety or efficacy of short- and long-term supplementation. If you want to test on yourself, proceed with caution and start with the lowest dose possible. To minimize the risk of THC-contaminated product, Zeiger advises athletes purchase CBD products from companies that are transparent about their testing protocol, and disclose a Certificate of Analysis.

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Willow Bark

The bark of the white willow tree contains salicin, which is chemically similar to aspirin. People once chewed the bark of the tree itself to release its anti-inflammatory properties; today, it’s available as a dried herb to be used in tea or in capsule form. Though there is some evidence to suggest willow bark is effective in reducing the pain of musculoskeletal injuries, there’s more proof of adverse effects. Stomach upset, ulcers, nausea, vomiting, and stomach bleeding are potential side effects of all compounds containing salicylates—much like the side effects of taking aspirin.

Verdict: If the aim is to avoid the side effects of over-the-counter medications, willow bark doesn’t fit the bill.

ginger tea in a cup used as a natural painkiller
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Ginger

Used in Asian medicine for centuries, ginger has been shown to have pain-relieving properties similar to ibuprofen and acetaminophen, and can be effective in treating muscle pain when taken daily. Though a wide body of evidence exists for ginger supplementation in patients with arthritis, research specific to runners is still new, with the first systemic review taking place in 2015. Its conclusion hasn’t changed much since then: “While ginger taken over 1–2 weeks may reduce pain from eccentric resistance exercise and prolonged running, more research is needed to evaluate its safety and efficacy as an analgesic for a wide range of athletic endeavors.”

Verdict: There isn’t enough to say with certainty that ginger supplements in concentrated pill form are 100 percent safe for runners; however, general studies done on ginger supplementation report few side effects. For the extra-cautious, ginger in its natural form (a root that is easily grated into food and teas) is a smart and easy way to incorporate this superfood into an anti-inflammatory diet.

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Turmeric

A lot of claims about turmeric make it sound like a wonder drug. In fact, one team of researchers from MD Anderson Cancer Center called it “Indian solid gold,” stating that curcumin, the compound that gives turmeric its yellow color, packs powerful antioxidant and anti-inflammatory properties. This has been backed up in recent years with studies specific to athletes, including 2015 research that found a reduction of delayed onset muscle soreness (DOMS) in athletes who supplement with curcumin-containing capsules. But other studies have uncovered a risk to those who supplement: lead poisoning. According to a warning from public health researchers, turmeric supplements are “intentionally adulterated with lead to enhance its weight, color, or both,” and consumption can lead to an increased risk of heart and brain disease in adults and children.

Verdict: If you’re seeking “Indian solid gold,” opt for whole-food forms over supplement pills. Cooking with fresh and dried turmeric root can be a culinary adventure—try adding it to your soups, stir-fries, and salads.

natural medicine remedy--essential oils in a diffuser
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Essential Oils

Essential oils are used in many different ways: Some people inhale them through aromatherapy, while others massage the oil into the skin. When it comes to pain relief, scholarly research is scant on the efficacy of essential oils, mostly focusing on their use in massage settings. Even the studies on aromatherapy for sleep quality (and therefore maximal recovery and reduced pain) are conflicting—though some qualitative studies suggest inhalation of oils like lavender may create deeper sleep, a 2015 study found essential oil inhalation had no impact on sleep quality in athletes before competition.

Verdict: Inhalation or topical application of essential oils probably won’t hurt you—but it probably won’t help you, either. If you feel like upgrading your massage with aromatherapy, go for it. It’s the massage itself that really brings the relief.