An Aspirin a Day?

Q:

I take one regular aspirin a day. I’ve been told that this medicine is compromising my intestinal function. Should I discontinue the aspirin or is there a benefit to staying on it?

A: Aspirin is an old and trusted medicine that works as a mild analgesic by thinning the blood, which makes the platelets less sticky. Aspirin is an effective minor pain reliever and muscle relaxant for many people. However, it can also severely irritate the mucous membranes in the gastrointestinal (GI) tract, including the throat, esophagus, stomach, small and large intestines, and rectum. Aspirin can cause bleeding anywhere along the GI tract. Bleeding from aspirin or other NSAIDs (nonsteriodal anti-inflammatories) is one of the top reasons people go to the emergency room in the U.S. They have severe abdominal pain, or have become untenably weak from chronic low-level bleeding. Often, people are not aware of GI bleeding. If you regularly use aspirin (or Aleve, ibuprofen, Tylenol, etc.), you must check your stool for hidden (occult) blood every year. Your doctor or public health clinic can give you a simple ColoCARE kit that you can easily use at home to check for bleeding in your GI tract.

If you have been told to take an aspirin a day for heart health, this may be outdated advice. For women, it has been definitively disproven to prevent the first heart attack. Having said that, a baby aspirin a day may prevent a stroke for women with a strong family history of stroke and no family history of gastrointestinal cancers. Oddly, the aspirin a day adage may prevent men-especially men under the age of 65 who have already had one heart attack-from suffering a second heart attack. But aspirin does not seem to prevent strokes in men of any age.

Many strokes are triggered by chronic atrial fibrillation, which causes the blood flow around the cardiac muscles to be somewhat spasmodic. This sometimes causes temporary pooling of the blood, which can allow a small clot of platelets or fibrin to clump together. If this small clump gets into the general circulation and lodges in a tiny blood vessel in the brain, impeding oxygen delivery, a stroke results, which can kill a swath of brain cells around the impedance. This sequence of events can sometimes be prevented by using aspirin or other blood thinners. However, blood thinning has a downside, which is, as you can guess, too-easy bleeding.

While most strokes are embolic (because of a clot), some are hemorrhagic (because of a bleed). Depending on your age and flexibility, blood thinning may be a bad risk for you. For example, if you have compromised balance or eyesight, and consider yourself at risk for slipping and falling, using a blood thinner is probably a bad idea. Internal bleeding would not be a pleasant way to die.

If you have a strong family history of strokes and are willing to check for aspirin-induced bleeding every year, a baby aspirin (81 mg, not the full-strength 325 mg) may be reasonable for you. However, there are other ways to prevent stroke. For example, eating raw foods daily or taking digestive enzymes with your high-protein meals will help keep the level of enzymatic activity in your body high. Enzymes are your natural clot-busters-they prevent clot formation altogether. Pineapple (especially the core, which usually gets thrown away) is exceptionally high in enzymes, as are papaya seeds. You can take these in capsule form with meals to help digest food or away from meals to reduce inflammation and potential clot formation. About 500-1,000 mg daily of protein-digesting enzymes is almost always a safer choice than aspirin for stroke prevention.

You could also use aspirin infrequently, only at times when you will be in a prolonged seated position, such as on a long flight or car ride. A common place for clots to form is behind the knees when bent. It’s a good idea to stand and walk around a bit every few hours when traveling.

One simple gauge as to whether or not your blood is overly thinned is to keep track of your bruising. If you frequently observe bruises on your body that you have no recollection of incurring, it’s likely your blood is too thin and you are at risk for excessive bleeding. However, if you take a baby aspirin a day and have no stomach irritation, no evidence of bruises on your arms and legs, and pass the annual ColoCARE test, you are probably fine with a baby aspirin.

The take-home message here is to get individualized treatment. What is good for you is not necessarily good for your neighbor. Make sure to work with a health care professional, who can provide optimal, individualized, therapeutic recommendations-which may not match pharmaceutical advertising.