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Aspirin (acetylsalicylic acid)



Aspirin may not normally be thought of as a 'herbal' remedy, but in fact it was originally derived directly from compounds found in the willow genus of shrubs and trees (Salix). Willow bark has been known at least since ancient Greek times as a pain moderator, but the the active ingredient, salicin, was not isolated until the end of the 19th century. Aspirin is the name given by the phamaceutical company Bayer, who derived the stabilised form, acetylsalicylic acid and marketed it from 1899 onward.

Aspirin poster - Bayer


It was quickly found that as well as being a very effective pain killer, aspirin also has anti-inflammatory properties, and it is now considered to belong to a group of compounds known as nonsteroidal anti-inflammatory drugs (NSAIDs). Its mode of action is not the same as synthetic pain killers, and it does not pose the same danger of liver damage.

However there is another risk associated with regular aspirin consumption, which is internal bleeding. Small internal bleeds occur naturally, but are usually quickly sealed by platelets - small sticky particles in the blood which are 'activated' by bleeding and quickly form blood clots. Aspirin intereferes with this process, reducing the tendency of the blood to clot.

It may also provoke the formation of bleeding stomach ulcers in a small number of people. This side effect can be minimised by taking 'enteric-coated' pills which have a coating which allows them to pass through the stomach to the small intestine before being absorbed into the bloodstream. Side effects are rare and generally minimal, but in the unlikely event that you start taking aspirin and notice upper abdominal (tummy) pains, or notice blood in the stools, then stop taking aspirin immediately and consult your doctor.

The anti-clotting action of aspirin is quite long-lived, as affected platelets do not recover, and blood clotting is not restored to normal until new platelets are formed in the absence of aspirin. This elevated risk of internal bleeding tends to decline over time (after a few years) and in the majority of cases is non-serious. About 25% of the population are partially resistant to the anti-clotting effect, while around 5% do not seem to show any reduction in clotting effects at all.

New Uses for Aspirin

Protection from stroke and heart attack

This property (reduction of blood clotting) was suspected for some time to be potentially useful for the minimising of chances of further strokes in those experiencing this deadly malfunction, that is due to blood clots reaching the brain's blood supply network. Similarly, there was mounting evidence by the mid eightees that aspirin could also reduce the incidence of recurrent heart attacks and also lower the risk of myocardial infarction, or MI in patients with unstable angina. In a randomized, double-blind, placebo-controlled trial of 22,071 apparently healthy men, a statistically extreme 44% reduction in the risk of a first myocardial infarction (MI) resulted in the study being terminated early. Dr. Charles Hennekens, the lead author of the study, later conducted a meta-analysis of this and four other aspirin trials and found an overall 32% reduction in cardiovascular problems.

These findings were adopted relatively quickly, and a daily low dose of aspirin is now accepted as a standard preventive treatment for high blood pressure or angina, and for those with a history of heart attacks or strokes. According to meta studies, a regular low dose (75 or 81 mg per day) of aspirin significantly reduces the risk of death from cardiovascular diseases by about 25% and reduces mortality from other causes by about 15%, without significant associated risks. Although the protective effect may take some years to establish, many people now choose to self medicate with daily low dose aspirin.

Aspirin as an anti-cancer drug

It has been suspected by clinicians that long term use of aspirin may also reduce the incidence of some cancers (particularly bowel cancer), or even reduce the spread of any that do occur, although a long period of latency (c.10 years) was thought to apply to this anti-cancer activity.

A series of studies in The Lancet suggest that taking low-dose daily aspirin daily for between three and five years reduces the chance of being diagnosed with cancer at that time by 19 per cent, rising still higher with extended intake to a massive 37% reduction in cancer risk after five years.

According to the studies, those who start taking low dose (75mg - 300mg) aspirin daily in their 60s appear to benefit just as much as those who start taking it earlier. Low-dose aspirin also appeared to reduce the likelihood that cancers, particularly of the bowel, would spread (metastasise) to other parts of the body - by more than half in some instances.

These results if confiirmed would mean the cheap generic drug aspirin out-performs the latest and most effective anti-cancer drugs currently available, and by a huge margin.

The researchers estimate that taken together, the figures mean that for every five patients treated with aspirin, one metastatic cancer would be prevented. This of course is in addition to the significant reduction of risk of death resulting from aspirin's anti-clotting effects.

Dr Peter Rothwell, one of the lead researchers, said the effect of aspirin on the spread of cancer was unique and might be useful in treatment. "It's certainly time to add prevention of cancer into the analysis of the balance of risk and benefits of aspirin. So far, all the guidelines have just been based on the prevention of strokes and heart attacks."

"This research really shows that the cancer benefit is as large, if not larger, than the benefit in terms of preventing heart attacks and strokes. It does change the equation quite drastically. Previously, no drug has ever been shown to reduce metastasis as a specific effect," he said. "It opens up a completely new therapeutic area."

Unfortunately the studies do not at present discriminate between very low dose (c.75mg/day) and low dose (c.300mg/day) intake of aspirin, but there are indications in the study that the benefits are dose-dependent, as might be assumed. As the risks of increased ulceration and bleeding are also dose-dependent, more work is required to establish the exact risk benefit picture, but for those at increased risk through family history it is likely that the benefits probably massively outweigh the risks. It should also be noted that some recent US studues have not show similar anti-cancer benefits of aspirin.





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