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:

The Benefits of Ginger for Osteoarthritis

If ginger is so effective against migraines and also helps with the pain of menstrual cramps, what about osteoarthritis? I explore this in my video Ginger for Osteoarthritis.

An all too common disorder, osteoarthritis produces chronic pain and disability. The first major study, published in 2000, showed no benefit of ginger extract over placebo, but that study only lasted three weeks. The next study, in 2001, lasted six weeks and, by the end, was able to show significantly better results compared to placebo. However, because the placebo did so well, reducing pain from the 60s down to the 40s on a scale of 1 to 100, ginger reducing pain further down into the 30s was not especially clinically significant, so an editorial in the official journal of the American College of Rheumatology concluded that “ginger should not be recommended at present for treatment of arthritis because of the limited efficacy.”

Since that time, there have been a few other trials that showed more impressive results, such that ginger is now considered “able to reduce pain and disability” in osteoarthritis. How does it compare to other treatments? Since osteoarthritis is a chronic disease, it’s especially important to weigh the risks versus the benefits of treatment. The commonly used anti-inflammatory drugs can carry serious cardiovascular and gastrointestinal risks. For example, nearly half of the osteoarthritis patients on drugs like ibuprofen were found to have major injuries to the lining of their small intestines. That risk can be reduced by taking additional medication to counteract the side effects of the first drug.

Ibuprofen-type drugs reduce our stomach lining’s ability to protect itself from stomach acid, so blocking acid production with a second drug can lower the risk. However, ginger can actually improve stomach lining protection. Indeed, at the kinds of doses used to treat osteoarthritis—about a quarter- to a half-teaspoon a day—ginger can be considered not just neutral on the stomach, but beneficial. So, ginger can be as pain-relieving as ibuprofen but without the risk of stomach ulcers.

What about topical ginger treatment, as in externally applying a ginger-soaked cloth or patch to the affected joint? In a controlled study, compress versus patch, both showed remarkable and lasting pain relief for osteoarthritis sufferers. What was missing from the study, though, was a control group: There was no placebo patch. I don’t care if ginger has been applied externally to painful joints for a thousand years. The placebo effect has been shown to be remarkably effective in osteoarthritis in providing pain relief. So, until there’s a controlled study on topical ginger, I’m not going to believe it.

There wasn’t such a study until… 24 men stuck ginger slices on their scrotum.

Men with inflamed testicles applied six to ten paper-thin slices of ginger “over the affected testes,” and, evidently, the ginger group healed nearly three times faster than the control group. Unfortunately, the original source is in Chinese, so I can’t get further details, as is the only other controlled study on topical ginger I could find, whose title apparently translates to “Evaluation of point plaster therapy with ginger powder in preventing nausea and vomiting occurred after platinum-based interventional chemotherapy.” We know ginger powder taken orally can be a miracle against chemo-induced vomiting, but what about stuffing it in your belly button?

The external application of ginger powder to the so-called point of Shenque, which is the navel, was compared to the control group, who got potato powder in their belly buttons instead. The ginger group evidently had significantly less nausea and vomiting. Unfortunately, only the abstract is in English, so I can’t tell how effectively the researchers blinded the patients to the treatment. Presumably, it would be easy to tell whether or not you were in the ginger or placebo group simply by the smell, but perhaps the researchers controlled for that? Until we know more, I would suggest those who want to try ginger use it in the stomach, rather than on the stomach.


What other dietary interventions can help with arthritis? See, for example:

What else can ginger do? Check out:

If the placebo effect is really that powerful, should doctors prescribe them? They already do. See my video The Lie That Heals: Should Doctors Give Placebos? for more on this.

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:

The Benefits of Wakame Seaweed Salad on Blood Pressure

I used to think of seaweed as just a beneficial whole-food source of minerals like iodine, for which it is the most concentrated dietary source. Indeed, just a daily half-teaspoon of mild seaweeds, like arame or dulse, or two sheets of nori should net you all the iodine you need for the day. But, the intake of seaweeds is advised not only as a whole-food source of iodine, but also, evidently, “for the prevention of lifestyle-related diseases, including cancer, cardiovascular and cerebrovascular disease….” Based on what?

As I discuss in my video Wakame Seaweed Salad May Lower Blood Pressure, the reasoning is that the Japanese live long and eat seaweed, so there is speculation that seaweed might have “influence on life expectancy,” based on suggestive reports. But when we see long lists of the supposed benefits a particular food is purported to have, such as “compounds found in [seaweed] have various biological activities including anticoagulant, anti-viral, antioxidant, anti-allergic, anti-cancer, anti-inflammatory, anti-obesity, and neuroprotective properties,” we need to know if they are based on clinical data, meaning studies with actual people, or so-called preclinical data, that is, from test tubes and lab animals. I mean, what are we supposed to do with a study talking about the effects of “seaweed-restructured pork diets” on rats? Those researchers tried to use seaweed, as well as other ingredients, to “improv[e] the ‘image’ of meat product.” Researchers also tried to add grape seeds to meat, they tried flaxseeds, they tried walnuts, they tried purple rice, and they even tried “thong-weed.”

When you look at epidemiological studies, where you compare the diets and disease rates within a population, you see that Japanese pre-schoolers who eat seaweed tend to have lower blood pressures, suggesting “seaweed might have beneficial effects on blood pressure among children.” That could make sense given all the minerals and fiber in seaweed, but cause and effect can’t be proven with this kind of study. Perhaps other components of the diet that went along with seaweed eating that made the difference.

It’s even harder to do these kinds of studies on adults, since so many people are on high blood pressure medications. University of Tokyo researchers took an innovative approach by comparing the diets of people on different intensities of medication: low-dose of a single blood pressure drug, high-dose of a single drug, and multiple drugs. And, although they all had artificially normalized blood pressure “as a result of effective medication,” those who ate the most fruits and sea vegetables tended to be the ones on the lower dose of a single drug, supporting a dietary role for seaweed. An interesting finding, but why not just put it to the test?

A double-blind, crossover trial found that seaweed fiber lowered blood pressure, apparently by pulling sodium out of the system. Real seaweed couldn’t be used in the study, because the subjects wouldn’t be able to be fooled with a placebo, but why not just put whole powdered seaweed into pills? That was finally attempted ten years later. Compared to doing nothing, subjects receiving a daily dose of dried wakame powder in capsules had beautiful drops in blood pressure. The researchers, however, desalinized the seaweed, taking out about two-thirds of the sodium naturally found in it. So, we still don’t know if eating seaweed salad is actually going to help with blood pressure. What we need is a randomized, controlled trial with plain, straight seaweed. No one had ever done that research, until…they did!

Six grams of wakame, with all of its natural sodium, led to a significant drop in blood pressure, especially in those who started out with high pressure. The subjects experienced only minor side effects and ones that could be expected with increasing fiber intake. A nice thing about whole-food, plant-based interventions is that we sometimes get good side effects, such as the resolution of gastritis (stomach inflammation) some subject had been having, as well as the disappearance of chronic headaches. 


What other foods might help with high blood pressure? See:

For more on preventing and treating hypertension, one of our leading killers, see:

Want more on seaweed and iodine? Check out:

My video Salt of the Earth: Sodium and Plant-Based Diets further addresses the sodium question.

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: