How to Get the Benefits of Aspirin Without the Risks

For people without a personal history of cardiovascular disease, aspirin’s risks may outweigh its benefits, but aspirin may have additional benefits. “We have long recognized the preventative role of daily aspirin for patients with atherosclerotic [heart] disease; however, it now appears that we can hatch 2 birds from 1 egg. Daily low-dose aspirin may help prevent certain forms of cancer, as well, as I discuss in my video Should We All Take Aspirin to Prevent Cancer? In an analysis of eight different studies involving more than 25,000 people, “the authors found a 20 percent decrease in risk of death from cancer among those randomized to daily aspirin…” The researchers wrote, “[T]he search for the most efficacious and safe treatments for malignant disease remains an enormous and burdensome challenge. If only we could just stop cancer in its tracks—prevent it before it strikes. Perhaps we can.” Indeed, perhaps we can with salicylic acid, the plant phytonutrient that’s marketed as aspirin.

How does aspirin affect cancer? The Nobel Prize for Medicine was awarded to the team who discovered how aspirin works. Enzymes named COX (cyclooxygenase) take the pro-inflammatory, omega-6, fatty-acid arachidonic acid our body makes or we get directly in our diet (primarily from eating chicken and eggs), and turns it into inflammatory mediators, such as thromboxane, which produces thrombosis (clots), and prostaglandins, which cause inflammation. Aspirin suppresses these COX enzymes. Less thromboxane means fewer clots, and less prostaglandin means less pain, swelling, and fever. However, prostaglandins can also dilate the lymphatic vessels inside tumors, allowing cancer cells to spread. So, one way cancer tries to kill us is by boosting COX activity.

We think one way aspirin can prevent cancer is by counteracting the tumor’s attempts to pry open the lymphatic bars on its cage and spread throughout the body. Indeed, reduction in mortality due to some cancers occurred within two to three years after aspirin was started. That seems too quick to be accounted for by an effect only on tumor formation . Cancer can take decades to develop, so the only way aspirin could work that fast is by suppressing the growth and spread of tumors that already exist. Aspirin appeared to cut the risk of metastases in half, particularly for adenocarcinomas, like colon cancer.

Given this, should we all take a daily baby aspirin? Previous risk-benefit analyses did not consider the effects of aspirin on cancer, instead just balancing cardiovascular benefits with bleeding risks, but these new cancer findings may change things.

If daily aspirin use were only associated with a reduction of colon cancer risk, then the benefits might not outweigh the harms for the general population, but we now have evidence that it works against other cancers, too. “[E]ven a 10% reduction in overall cancer incidence…could tip the balance” in favor of benefits over risks.

How does the cancer benefit compare? We know that using aspirin in healthy people just for cardiovascular protection is kind of a wash, but, by contrast, the cancer prevention rates might save twice as many lives, so the benefits may outweigh the risks. If we put it all together—heart attacks, strokes, cancer, and bleeding—aspirin comes out as protective overall, potentially extending our lifespan. There is a higher risk of major bleeding even on low-dose aspirin, but there are fewer heart attacks, clotting strokes, and cancers. So, overall, aspirin may be beneficial.

It’s important to note that the age categories in that study only went up to 74 years, though. Why? Because the “risk of bleeding on aspirin increases steeply with age,” so the balance may be tipped the other way at 75 years and older. But, in younger folks, these data certainly have the research community buzzing. “The emerging evidence on aspirin’s cancer protection highlights an exciting time for cancer prevention…”

“In light of low-dose aspirin’s ability to reduce mortality from both vascular events and cancer to a very notable degree, it is tempting to recommend this measure…for most healthy adults…However, oral aspirin, even in low doses, has a propensity to damage the gastroduodenal mucosa [linings of our stomachs] and increase risk for gastrointestinal bleeding; this fact may constrain health authorities from recommending aspirin use for subjects deemed to be at low cardiovascular risk”—that is, for the general population. “Recent meta-analyses estimate that a year of low-dose aspirin therapy will induce major gastrointestinal bleeding (requiring hospitalization) in one subject out of 833…”

If only there were a way to get the benefits without the risks.

Those who remember my video Aspirin Levels in Plant Foods already know there is. The aspirin phytonutrient salicylic acid isn’t just found in willow trees, but throughout the plant kingdom, from blackberries and white onions to green apples, green beans, and beyond. This explains why the active ingredient in aspirin is found normally in the bloodstream even in people not taking aspirin. The levels of aspirin in people who eat fruits and vegetables are significantly higher than the levels of those who don’t. If we drink just one fruit smoothie, our levels rise within only 90 minutes. But, one smoothie isn’t going to do it, of course. We need to have regular fruit and vegetable consumption every day. Are these kinds of aspirin levels sufficient to suppress the expression of the inflammatory enzyme implicated in cancer growth and spread, though? Using umbilical cord and foreskin cells—where else would researchers get human tissue?—they found that even those low levels caused by smoothie consumption significantly suppressed the expression of this inflammatory enzyme on a genetic level.

Since this aspirin phytonutrient is made by plants, we might expect plant-eaters to have higher levels. Indeed, not only did researchers find higher blood levels in vegetarians, but there was an overlap between people taking aspirin pills. Some vegetarians had the same level in their blood as people actually taking aspirin. Vegetarians may pee out as much of the active metabolite of aspirin as those who take aspirin do, simply because vegetarians eat so many fruits and vegetables. “Because the anti-inflammatory action of aspirin is probably the result of SA [salicylic acid, the active ingredient in aspirin], and the concentrations of SA seen in vegetarians have been shown to inhibit [that inflammatory enzyme] COX-2 in vitro, it is plausible that dietary salicylates may contribute to the beneficial effects of a vegetarian diet, although it seems unlikely that most [omnivores] will achieve sufficient dietary intake of salicylates to have a therapeutic effect.”

Aspirin can chew away at our gut. With all that salicylic acid flowing through their systems, plant-eaters must have higher ulcer rates, right? No. Both vegetarian women and men appear to have a significantly lower risk of ulcers. So, for the general population, by eating plants instead of taking aspirin, we may not only get the benefits without the risks, we can get the benefits with even more benefits. How is this possible? In plants, the salicylic acid can come naturally pre-packaged with gut-protective nutrients.

For example, nitric oxide from dietary nitrates exerts stomach-protective effects by boosting blood flow and protective mucus production in the lining of the stomach—“effects which demonstrably oppose the pro-ulcerative impact of aspirin and other NSAIDs.”

The researcher notes that while “[d]ark green leafy vegetables…are among the richest dietary sources of nitrate…it may be unrealistic to expect people to eat ample servings of these every day,” so we should just give people pills with their pills, but I say we should just eat our greens. People who’ve had a heart attack should follow their physician’s advice, which probably includes taking aspirin every day, but what about everyone else? I think everyone should take aspirin—but in the form of produce, not a pill.


To see the pros versus cons for people trying to prevent or treat heart attacks and stroke, see my video Should We All Take Aspirin to Prevent Heart Disease?.

Does the COX enzyme sound familiar? I talked about it in my Anti-Inflammatory Life Is a Bowl of Cherries video.

Where does one get “dietary nitrates”? See Vegetables Rate by Nitrate and Veg-Table Dietary Nitrate Scoring Method. I also discuss nitrates in Slowing Our Metabolism with Nitrate-Rich Vegetables and Oxygenating Blood with Nitrate-Rich Vegetables.

Do some plant foods have more aspirin than others? Definitely. In fact, some foods have the same amount as a “baby” aspirin. Check out Plants with Aspirin Aspirations.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

How to Lower Your Sodium Intake

Reduction of salt consumption by just 15 percent could save the lives of millions. If we cut our salt intake by half a teaspoon a day, which is achievable simply by avoiding salty foods and not adding salt to our food, we might prevent 22 percent of stroke deaths and 16 percent of fatal heart attacks—potentially helping more than if we were able to successfully treat people with blood pressure pills. As I discuss in my video Salt of the Earth: Sodium and Plant-Based Diets, an intervention in our kitchens may be more powerful than interventions in our pharmacies. One little dietary tweak could help more than billions of dollars worth of drugs.

What would that mean in the United States? Tens of thousands of lives saved every year. On a public-health scale, this simple step “could be as beneficial as interventions aimed at smoking cessation, weight reduction, and the use of drug therapy for people with hypertension or hypercholesterolemia,” that is, giving people medications to lower blood pressure and cholesterol. And, that’s not even getting people down to the target. 

A study I profile in my video shows 3.8 grams per day as the recommended upper limit of salt intake for African-Americans, those with hypertension, and adults over 40. For all other adults the maximum is 5.8 daily grams, an upper limit that is exceeded by most Americans over the age of 3. Processed foods have so much added salt that even if we avoid the saltiest foods and don’t add our own salt, salt levels would go down yet still exceed the recommended upper limit. Even that change, however, might save up to nearly a hundred thousand American lives every year.

“Given that approximately 75% of dietary salt comes from processed foods, the individual approach is probably impractical.” So what is our best course of action? We need to get food companies to stop killing so many people. The good news is “several U.S. manufacturers are reducing the salt content of certain foods,” but the bad news is that “other manufacturers are increasing the salt levels in their products. For example, the addition of salt to poultry, meats, and fish appears to be occurring on a massive scale.”

The number-one source of sodium for kids and teens is pizza and, for adults over 51, bread. Between the ages of 20 and 50, however, the greatest contribution of sodium to the diet is not canned soups, pretzels, or potato chips, but chicken, due to all the salt and other additives that are injected into the meat.

This is one of the reasons that, in general, animal foods contain higher amounts of sodium than plant foods. Given the sources of sodium, complying with recommendations for salt reduction would in part “require large deviations from current eating behaviors.” More specifically, we’re talking about a sharp increase in vegetables, fruits, beans, and whole grains, and lower intakes of meats and refined grain products. Indeed, “[a]s might be expected, reducing the allowed amount of sodium led to a precipitous drop” in meat consumption for men and women of all ages. It’s no wonder why there’s so much industry pressure to confuse people about sodium.

The U.S. Dietary Guidelines recommend getting under 2,300 milligrams of sodium a day, while the American Heart Association recommends no more than 1,500 mg/day. How do vegetarians do compared with nonvegetarians? Well, nonvegetarians get nearly 3,500 mg/day, the equivalent of about a teaspoon and a half of table salt. Vegetarians did better, but, at around 3,000 mg/day, came in at double the American Heart Association limit.

In Europe, it looks like vegetarians do even better, slipping under the U.S. Dietary Guidelines’ 2,300 mg cut-off, but it appears the only dietary group that nails the American Heart Association recommendation are vegans—that is, those eating the most plant-based of diets.


This is part of my extended series on sodium, which includes:

If you’re already cutting out processed foods and still not reaching your blood pressure goals, see:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

How Can Animal Protein Intake Increase Childhood Obesity Risk?

If pregnant crickets are exposed to a predatory wolf spider, their babies will hatch, exhibiting increased antipredator behavior and, as a consequence, improved survival from wolf spider attack. The mother cricket appears to be able to forewarn her babies about the threat when they are still inside her, so they would be pre-adapted to their external environment. This even happens in plants. If you grow two genetically identical plants—one in the sun, one in the shade—the sun-grown plant will produce seeds that grow better in the sun, and the shaded plant will produce seeds that grow better in the shade—even though they’re genetically identical.

What’s happening is called epigenetics, external factors changing gene expression.

Vole pups born in the winter come out growing thicker coats. Vole mothers are able to communicate the season to their babies in utero and tell them to put a coat on even before they’re born. We’re no different. You know how some people have different temperature tolerances, resulting in “battles of the bedroom”? Do you turn the AC on or off? Open the windows? It’s not just genetics. Whether we’re born in the tropics or in a cold environment determines how many active sweat glands we have in our skin.

What does this have to do with diet? As I discuss in my video Animal Protein, Pregnancy, and Childhood Obesity, can what a pregnant woman eats—or doesn’t eat—permanently alter the biology of her children in terms of what genes are turned on or off throughout life?

What happened to the children born during the 1944 – 1945 Dutch famine imposed by the Nazis? They had higher rates of obesity 50 years later. The baby’s DNA gene expression was reprogrammed before birth to expect to be born into a world of famine and conserve calories at all cost. But when the war ended, this propensity to store fat became a disadvantage. What pregnant women eat and don’t eat doesn’t just help determine the birth weight of the child, but the future adult weight of the child.

For example, maternal protein intake during pregnancy may play a role in the obesity epidemic—but not just protein in general. “Protein from animal sources, primarily meat products, consumed during pregnancy may increase risk of overweight in offspring…” Originally, researchers thought it might be the IGF-1, a growth hormone boosted by animal product consumption, that may increase the production of fatty tissue, but weight gain was tied more to meat intake than dairy. Every daily portion of meat intake during the third trimester of pregnancy resulted in about an extra 1 percent of body fat mass in their children by their 16th birthday, potentially increasing their risk of becoming obese later in life, independent of how many calories they ate or how much they exercised.  But no such link was found with cow’s milk intake, which would presumably boost IGF-1 levels just as high.

Given that, perhaps instead of IGF-1, it’s the obesogens in meat, chemicals that stimulate the growth of fatty tissue. “[E]merging evidence demonstrates that environmental factors can predispose exposed individuals to gain weight, irrespective of diet and exercise.” After all, even our infants are fatter, and we can’t blame that on diet and exercise. Animals are fatter, too, and not just our pampered pets—even rats in laboratories and subways are bigger. “The likelihood of 24 animal populations from eight different species all showing a positive trend in weight over the past few decades by chance was estimated at about 1 in 10 million” so it appears something else is going on—something like obesogenic chemicals.

One such candidate is polycyclic aromatic hydrocarbons (PAHs), which are found in cigarette smoke, vehicle exhaust, and grilled meat. A nationwide study of thousands found that the more children were exposed to PAHs, the fatter they tended to be. The researchers could measure the level of these chemicals right out of their urine. Exposure can start in the womb. Indeed, prenatal exposure to these chemicals may cause increased fat mass gained during childhood and a higher risk of childhood obesity.

If these pollutants sound familiar, I’ve covered them before in relation to increasing breast cancer risk in the Long Island Breast Cancer Study Project. So, perhaps they aren’t just obesogens, but carcinogens, as well, which may help explain the 47 percent increase in breast cancer risk among older women in relation to a lifetime average of grilled and smoked foods.

If we look at one of the most common of these toxins, smokers get about half from food and half from cigarettes. For nonsmokers, however, 99 percent comes from diet. The highest levels of PAHs are found in meat, with pork apparently worse than beef. Even dark green leafies like kale can get contaminated by pollutants in the air, though, so don’t forage for dandelion greens next to the highway and make sure to wash your greens under running water.

These are fat-soluble pollutants, so they need lots of fat to be absorbed. It’s possible that even heavily contaminated plant-based sources may be safer, unless you pour lots of oil on your food, in which case the toxins would presumably become as readily absorbed as the toxins in meat.

The good news is they don’t build up in our body. As I show in my video, if we expose people to barbecued chicken, they get a big spike in these chemicals—up to a hundred-fold increase—but our body can get rid of them within about 20 hours. The problem, of course, is that people who eat these kinds of foods every day could be constantly exposing themselves, which may not only affect their health and their children’s health, but maybe even their grandchildren’s health.

Being pregnant during the Dutch famine of the mid-1940s didn’t just lead to an increase in diseases among their kids, but even apparently their grandkids. What a pregnant woman eats now may affect future generations. “The issue of generation-spanning effects of poor conditions during [pregnancy]…may shed light on the epidemic of diabetes, obesity and cardiovascular disease,” which is associated with the transition towards Western lifestyles.


Epigenetics is the science of altering the expression of our genes. No matter our family history, some genes can be effectively turned on and off by the lifestyle choices we make. See, for example:

For more on “obesogenic” chemicals, see:

I previously touched on PAHs in Meat Fumes: Dietary Secondhand Smoke.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: