The Risks and Benefits of Taking Low-Dose Aspirin

Salicylic acid, the active ingredient in aspirin, has been used for thousands of years as an anti-inflammatory painkiller in the form of willow tree bark extract, which Hippocrates used to “treat fever and to alleviate pain during childbirth.” It became trademarked as a drug named Aspirin™ in 1899 and, to this day, “remains the most commonly used drug in the world.” One reason for its on-going popularity, despite the availability of better painkillers now, is that aspirin also acts as a blood thinner. Millions of people take aspirin on a daily basis to treat or prevent heart disease, which I explore in my video, Should We All Take Aspirin to Prevent Heart Disease?.

It all started in 1953 with the publication of the landmark study “Length of life and cause of death in rheumatoid arthritis” in the New England Journal of Medicine. The paper began with the sentence: “It has often been said that the way to live a long life is to acquire rheumatism.” The researchers found fewer deaths than expected from accidents, which could be explained by the fact that people with rheumatoid arthritis likely aren’t skiing or engaging in other potentially risky activity, but they also found significantly fewer deaths from heart attacks. Why would this be? Perhaps all the aspirin the subjects were taking for their joints was thinning their blood and preventing clots from forming in their coronary arteries in their heart. To find out, in the 1960s, there were calls to study whether aspirin would help those at risk for blood clots, and we got our wish in the 1970s: studies suggesting regular aspirin intake protects against heart attacks.

Today, the official recommendation is that low-dose aspirin is recommended for all patients with heart disease, but, in the general population (that is, for those without a known history of heart disease or stroke) daily aspirin is only recommended “when the potential cardiovascular [heart] disease benefit outweigh the risk of gastrointestinal bleeding.”

The bleeding complications associated with aspirin use may be considered an underestimated hazard in clinical medical practice. For those who have already had a heart attack, the risk-benefit analysis is clear. If we took 10,000 patients, daily low-dose aspirin use would be expected to prevent approximately 250 “major vascular events,” such as heart attacks, strokes, or, the most major event of all, death. However, that same aspirin “would be expected to cause approximately 40 major extracranial bleeding events,” meaning bleeding so severe you have to be hospitalized. Thus, the net benefit of aspirin for secondary prevention—for example, preventing your second heart attack—“would substantially exceed the bleeding hazard. For every 6 major vascular events prevented, approximately 1 major bleeding event would occur; therefore, the value of aspirin for secondary prevention is not disputed.”

If we instead took 10,000 patients who hadn’t ever had a heart attack or stroke and tried to use aspirin to prevent clots in the first place, that is, for so-called primary prevention, daily low-dose aspirin would only “be expected to prevent 7 major vascular events and cause 1 hemorrhagic stroke [bleeding within the brain] and 3 major extracranial bleeding events.” So, the benefits are approximately only 2 to 1, which is a little too close for comfort. This is why the new European guidelines do not recommend aspirin for the general population, especially given the additional risk of aspirin causing smaller bleeds within the brain as well.

If only there were a safe, simple solution free of side effects…and there is! Drs. Ornish and Esselstyn proved that even advanced, crippling heart disease could not only be prevented and treated, but also reversed, with a plant-based diet centered around grains, beans, vegetables, and fruits, with nuts and seeds treated as condiments, and without oils, dairy, or meat (including poultry and fish).

Long-time director of the longest-running epidemiological study in the world, the famous Framingham Heart Study, “Dr. William Castelli was asked what he would do to reverse the CAD [coronary artery disease] epidemic if he were omnipotent. His answer: ‘Have the public eat the diet of the rural Chinese as described by Dr. T. Colin Campbell…’” In other words, as he , “‘If Americans adopted a vegetarian diet, the whole thing would disappear,’ Castelli says of the heart disease epidemic.”

Dr. Esselstyn clarified that we’re not just talking about vegetarianism. “This new paradigm” of heart disease reversal means “exclusively plant-based nutrition.”


Did you know preventing heart disease and stroke aren’t the only benefits of an aspirin a day? A daily aspirin may also decrease the risk of certain cancers. In that case, should we take an aspirin a day after all? See Should We All Take Aspirin to Prevent Cancer? and Plants with Aspirin Aspirations.

For more on preventing, arresting, and reversing heart disease, 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 presentations:

How Not to Die from Cancer

After Dr. Dean Ornish conquered our number-one killer, heart disease, he moved on to killer number-two. What happens if cancer is put on a plant-based diet? Ornish and colleagues found that the progression of early-stage prostate cancer could be reversed with a plant-based diet and other healthy lifestyle behaviors.

If the blood of those eating the Standard American Diet is dripped onto cancer cells growing in a petri dish, cancer growth is cut down about 9 percent. And if they’ve followed a plant-based diet for a year? Their blood can slash cancer growth by 70 percent. So the blood circulating thgouhout the bodies of those eating plant-based diets had nearly eight times the stopping power when it came to suppressing cancer cell growth.

That was for cell growth of prostate cancer, the leading cancer-killer specific to men. In younger women, breast cancer is the top cancer-killer. Researchers wanted to repeat the study with women using breast cancer cells, but they didn’t want to wait a whole year to get the results. Women are dying now. So they figured they’d see what a plant-based diet could do after just two weeks against three different types of human breast cancer.

As you can see in my video How Not to Die from Cancer, the study showed cancer growth started out at 100 percent, but then dropped after the subjects ate a plant-based diet for 14 days. A layer of breast cancer cells was laid down in a petri dish, and then blood from women eating the Standard American Diet was dripped on it. As you can see in the video, even the blood of women eating pretty poor diets had some ability to break down cancer. After just two weeks of eating healthfully, though, blood was drawn from those same women—so they effectively acted as their own controls—and was dripped on a new carpet of breast cancer cells. You can see for yourself that only a few individual cancer cells remained. Their bodies cleaned up. After only 14 days on a plant-based diet, their bloodstream became that much more hostile to cancer.

Slowing down the growth of cancer cells is nice, but getting rid of them all together is even better. This is what’s called apoptosis, programmed cell death. After eating healthfully, the women’s own bodies were able to somehow reprogram the cancer cells, forcing them into early retirement.

In my video, you can see what’s called TUNEL imaging, which allows researchers to measure DNA fragmentation, or cell death. With this technology, dying cancer cells appear as little white spots. From the start of the study, you can see one small white speck in the upper left of the image, showing that the blood of an average woman on a typical American diet can knock off a few breast cancer cells. After 14 days of healthy, plant-based living, however, her blood turned that one small white speck into a multitude of white spots. It’s as if she’s an entirely different woman inside! The same blood now coursing through these women’s bodies gained the power to significantly slow down and even stop breast cancer cell growth after just two weeks of eating a plant-based diet.

What kind of blood do we want in our body? What kind of immune system? Do we want blood that just rolls over when new cancer cells pop up, or do we want blood circulating to every nook and cranny of our body with the power to slow down and stop them?

The dramatic strengthening of cancer defenses shown in the study was after 14 days of a plant-based diet—and exercise.The researchers had the women walking 30 to 60 minutes a day. Given there were two factors, how do we know what role the diet played? Researchers decided to put it to the test.

In my video, you can see a chart that first shows how blood taken from those who ate a plant-based diet and had a routine of mild exercise, such as walking every day, over an average of 14 years, exhibited significant cancer cell clearance. The researchers then compared the substantial cancer-stopping power of plant eaters to that of an average sedentary American, which you can see is basically nonexistent.

The researchers also analyzed a third group. Instead of 14 years on a plant-based diet, they had 14 years on a Standard American Diet, but they also had 14 years of daily, strenuous, hour-long exercise, like calisthenics. They wanted to know if you exercised hard enough and long enough could you rival some strolling plant eaters.

The answer? There’s no question that exercise helped, but literally 5,000 hours in the gym was no match for a plant-based diet.

Once again using TUNEL imaging to analyze cancer cell death, the researchers found that even if you are a couch potato eating fried potatoes, your body isn’t totally defenseless. Your bloodstream can kill off some cancer cells, which you can see in my video as a couple white spots in the first image of that series. If you exercise for 5,000 hours, you can kill many more cancer cells, evidenced by the many more white specks appearing throughout that image. But nothing appears to kick more cancer tush than a plant-based diet, as that image is filled with white spots indicating cancer cells killed off.

Why is this the case? We think it’s because animal proteins, such as meat, egg white, and dairy protein, increase the level of insulin-like growth factor-1 (IGF-1), a cancer-promoting growth hormone involved in the “acquisition or progress of malignant tumors.”

In my video, you can see the results of a study that nailed IGF-1 as the villain. Just as in the previous studies, subjects went on a plant-based diet and cancer-cell growth dropped, while cancer-cell death shot up. This experiment, however, had a kicker: It added back to the cancer just the amount of IGF-1 that had been banished from your body as a result of eating and living healthier. In doing so, it effectively erased the “diet and exercise” effect. It’s as if the subjects had never started eating healthfully at all, with the cancer-cell growth rates and death rates returning to the same levels as before the plant-based diet intervention.

The reason one of the largest prospective studies on diet and cancer found “the incidence of all cancers combined was lower among vegetarians than among meat eaters” may be because they eat less animal protein, and thereby end up with less IGF-1, which means less cancer growth.

How much less cancer growth? A study found that middle-aged men and women with high protein intakes had a 75 percent increase in overall mortality and a fourfold increase in the risk of dying specifically from cancer. Does the protein source matter? Yes. It was specifically animal protein, which makes sense, given their higher IGF-1 levels.

The academic institution where the study was done sent out a press release with a memorable opening line: “That chicken wing you’re eating could be as deadly as a cigarette.” It went on to explain that “eating a diet rich in animal proteins during middle age makes you four times more likely to die from cancer…—a mortality risk factor comparable to smoking.”

What was the response to the revelation that diets high in meat, eggs, and dairy could be as harmful to health as smoking? One nutrition scientist replied it was “‘potentially even dangerous’ to compare the effects of smoking with the effect of meat and cheese,” but why? Because, they argued, a smoker might think “‘why bother quitting smoking if my cheese and ham sandwich is just as bad for me?’”

This reminds me of a famous Philip Morris cigarette ad that tried to downplay the risks of second-hand smoke. The ad included a chart with “everyday activities” and “reported relative risk,” in an attempt to say second-hand smoke wasn’t all that bad. The chart showed that while it increases the risk of lung cancer by 19 percent, drinking one or two glasses of milk every day may be three times as bad with a 62 percent higher risk of lung cancer. Lung cancer risk could be doubled if you frequently cook with oil, and heart disease risk tripled if you eat non-vegetarian or multiplied six-fold by eating lots of meat and dairy. Philip Morris’s conclusion? “Let’s keep a sense of perspective.” The “risk of lung cancer from second-hand tobacco smoke [was put] well below the risk reported by other studies for many everyday items and activities.”

That’s like saying, “Don’t worry about getting stabbed, because getting shot is so much worse.” Two risks don’t make a right.

Of course, you’ll note Philip Morris stopped throwing dairy under the bus once it purchased Kraft Foods.


The first time someone visits NutritionFacts.org can be overwhelming. With videos on more than 2,000 health topics, where do you even begin? Imagine stumbling onto the site not knowing what to expect and the new video-of-the-day is about how a particular spice can be effective in treating a particular form of arthritis. It would be easy to miss the forest for the trees, which is precisely why I created a series of overview videos that are essentially taken straight from my live, hour-long 2016 presentation How Not to Die: Preventing, Arresting, and Reversing Our Top 15 Killers.

The other videos in this overview series are:

Inspired to learn more about the role diet may play in preventing and treating cancer? Check out these other popular videos on the topic:

I’ve also produced an entire series on mammograms. You can find all of those videos here.

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:

Vegans Should Consider Taking DHA Supplements

We are all fatheads.

Indeed, about half the dry weight of our brain is fat. Lower levels of the long-chain omega-3 fat DHA in some areas of Alzheimer’s brains got people thinking that perhaps DHA is protective. Since the level of DHA in the brain tends to correlate with the level of DHA in the blood, cross-sectional studies of dementia and pre-dementia patients have been done. The result? The dementia and pre-dementia subjects do tend to have lower levels of both long-chain omega-3s, EPA and DHA, circulating in their bloodstream. This doesn’t necessarily mean that lower omega-3 levels cause cognitive impairment, however. It was just a snapshot in time, so we don’t know which came first. As I discuss in my video Should Vegans Take DHA to Preserve Brain Function?, maybe the dementia led to a dietary deficiency, rather than a dietary deficiency leading to dementia.

What we need is to measure long-chain omega-3 levels at the beginning and then follow people over time, and, indeed, there may be a slower rate of cognitive decline in those who start out with higher levels. We can actually see the difference on MRI. Thousands of older men and women had their levels checked and were scanned and then re-scanned. The brains of those with higher levels looked noticeably healthier five years later.

The size of our brain actually shrinks as we get older, starting around age 20. Between ages 16 and 80, our brain loses about 1 percent of its volume every two to three years, such that by the time we’re in our 70s, our brain has lost 26 percent of its size and ends up smaller than that of 2- to 3-year-old children.

As we age, our ability to make long-chain omega-3s like DHA from short-chain omega-3s in plant foods, such as flaxseeds, chia seeds, walnuts, and greens, may decline. Researchers compared DHA levels to brain volumes in the famed Framingham Study and found that lower DHA levels were associated with smaller brain volumes, but this was just from a snapshot in time, so more information was needed. A subsequent study was published that found that higher EPA and DHA levels correlated with larger brain volume eight years later. While normal aging results in overall brain shrinkage, having lower levels of long-chain omega-3s may signal increased risk. The only thing we’d now need to prove cause and effect is a randomized controlled trial showing we can actually slow brain loss by giving people extra long-chain omega-3s, but the trials to date showed no cognitive benefits from supplementation…until now.

A “double-blind randomized interventional study provide[d] first-time evidence that [extra long-chain omega-3s] exert positive effects on brain functions in healthy older adults,” a significant improvement in executive function after six and a half months of supplementation, and significantly less brain shrinkage compared to placebo. This kind of gray matter shrinkage in the placebo might be considered just normal brain aging, but it was significantly slowed in the supplementation group. The researchers also described changes in the white matter of the brain, increased fractional anisotropy, and decreases in mean and radial diffusivity—terms I’ve never heard before but evidently imply greater structural integrity.

So, we know that having sufficient long-chain omega-3s EPA and DHA may be important for preserving brain function and structure, but what’s “sufficient” and how do we get there? The Framingham Study found what appears to be a threshold value around an omega-3 index of 4.4, which is a measure of our EPA and DHA levels. Having more or much more than 4.4 didn’t seem to matter, but having less was associated with accelerated brain loss equivalent to about an extra two years of brain aging, which comes out to about a teaspoon less of brain matter, so it’s probably good to have an omega-3 index over 4.4.

The problem is that people who don’t eat fish may be under 4.4. Nearly two-thirds of vegans may fall below 4.0, suggesting a substantial number of vegans have an omega-3 status associated with accelerated brain aging. The average American just exceeds the threshold at about 4.5, though if we age- and gender-match with the vegans, ironically, the omnivores do just as bad. There aren’t a lot of long-chain omega-3s in Big Macs either, but having a nutrient status no worse than those eating the Standard American Diet is not saying much.

What we need is a study that gives those with such low levels some pollutant-free EPA and DHA, and then sees how much it takes to push people past the threshold…and here we go: Phase 2 of the study gave algae-derived EPA and DHA to those eating vegan diets with levels under 4.0. About 250mg a day took them from an average of 3.1 over the threshold to 4.8 within four months. This is why I recommend everyone consider eating a plant-based diet along with contaminant-free EPA and DHA to get the best of both worlds—omega-3 levels associated with brain preservation while minimizing exposure to toxic pollutants.


A list of my recommendations can be found here: Optimum Nutrition Recommendations.

Why not just eat fish or take fish oil? I explain why in these videos:

How else can we protect our brains? See, for example:

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: