Taking an aspirin a day has been recommended by the medical profession (and, not surprisingly, by aspirin manufacturers) for some time now.
The idea is that blood clots can develop in the veins, which can break free and travel to the heart and brain, causing a heart attack or a stroke. Aspirin slows blood clotting, which should then reduce the incidence of these types of heart attack and stroke.
But health care is rarely that simple. For example, a recent article in the Archives of Internal Medicine reviewed several large studies on low-dose aspirin therapy for people without heart disease. While the article found a 10 percent drop in non-fatal heart attacks, there was no reduction in deaths with aspirin therapy. Also, the reviewers estimated that to prevent one minor heart attack, 120 people would have to be on aspirin therapy for a year. This is called the number needed to treat, or NNT.
However, aspirin therapy has a side effect — it stresses the lining of the stomach and can cause heartburn, gastroesophageal reflux disease, even bleeding. The reviewers found that there was one serious bleeding event in every 73 people who used aspirin therapy. This is called the number needed to harm, or NNH.
This means that low-dose aspirin therapy is almost twice as likely to cause damage as it is to help prevent a heart attack. According to the authors, “routine use of aspirin for primary prevention is not warranted and treatment decisions need to be considered on a case-by-case basis.”
Unfortunately, the following scenario is not unusual in my practice. A patient comes to our practice for low back pain. In reviewing her health history and medication use, I see she has been on aspirin therapy for some time, usually on her doctor’s recommendation. Several months after starting aspirin therapy, she developed heartburn, and was prescribed one of the popular acid-blocking drugs for heartburn, such as Prilosec or Prevacid. The patient did not suddenly develop heartburn or reflux on her own; it was as a result of the aspirin therapy.
Several months of aspirin use, even the low dosages in “baby aspirin,” is enough to stress the lining of the stomach. Giving the patient a drug to reduce acid production makes them feel better, but does nothing for the cause of the problem. After a few years of this, many patients need stronger and stronger doses of the acid blocker, and in some cases they end up on two different drugs, trying to treat a problem caused by the aspirin.
To further complicate matters, the acid blockers stop a very important first step in digestion. The acid in the stomach is essential for protein and calcium digestion, as well as killing bacteria and viruses. Long-term acid-blocker use is associated with increased risk of osteoporosis, serious stomach infections, irritable bowel syndrome and “rebound acid hypersecretion,” where the stomach over-produces acid in an attempt to make up for the effects of the drug. This is the result when a nutritional problem is treated with drug therapy.
Why are blood thinners recommended? To prevent clots. Why would a healthy person need to take steps to prevent clots? Because excessive clotting is associated with our modern diets, which are quite different from what our ancestors ate. We now eat far more grains; even the animals we eat are fed grains. We also consume a lot of vegetable oils, which our ancestors did not. Another dietary culprit for increased clotting risk is trans fats, which are common in margarine, fried foods, baked goods, and most prepared foods, even pizza. These dietary changes have a direct effect on our bodies, including increased risk of clotting.
Are there natural alternatives to aspirin therapy? Absolutely. First, the usual dietary rules of eating more veggies, less processed food, and choosing only grass-fed meats will naturally cause blood to clot less. There are also supplements and herbs to maintain normal blood clotting. Omega-3 supplements and the “whole food” type of supplements are designed to help make up for our modern diets, counteracting the tendency to form clots. There are also herbs that provide a blood-thinning effect, including Ginkgo.
Consult with an herbalist before trying herbs, however. Herbs are generally far safer than most drugs, but they are not totally free of side effects. The biggest precaution is that they do not mix well with some prescription medications. Ginkgo, for example, should not be taken with drugs for anxiety or depression.
It is an admirable goal to try to reduce heart attacks and strokes. But from a wellness perspective, our bodies can usually take care of themselves, provided they are given the proper nutrients, exercise and rest. So the wellness recommendation is not to take a daily dose of a dangerous drug, but to educate yourself on the causes of these health problems and change your lifestyle accordingly. If there is a problem with clots, consider natural treatments before the more aggressive drug therapies.
Dr. Michael Noonan practices chiropractic, acupuncture and other wellness therapies in Old Town.