Q: I’m 52 and take a baby aspirin as I have been lead to believe it will help me from having a heart attack or stroke. Can I take white willow bark and get the same prevention? and will I be at less risk for ulcers?
A: It would seem that taking aspirin or its natural equivalent, white willow bark, would be a straight forward medical decision. After all who wouldn’t want to prevent a heart attack of stroke? How risky is taking a baby aspirin anyway? Turns out the decision for those without established vascular disease is complicated.
Aspirin works in two ways. It is an anti-inflammatory agent and it also is what we call a platelet greaser. Platelets are important little packets of clotting agents circulating in the blood. They sense when an injury occurs and stick to the damaged tissue. This triggers a blood clot to form. Aspirin binds to the platelets and prevents them from sticking to the blood vessel wall, effectively “greasing” them. If no clot can form then a heart attack nor a stroke can begin. Since aspirin binds permanently to the platelet you do not need to take much, a baby aspirin will do (81mg). This is how low dose aspirin prevents heart attack and stroke. But if bleeding starts in the stomach or in the brain then it may not stop quickly enough because of those aspirin-greased platelets. This is how aspirin puts you at risk for bleeding in the stomach and other places in the body.
Because of this risk there is considerable debate about who should take aspirin in the first place. Those who will have the most benefit are those who have established disease of the blood vessels and are low risk for bleeding. These people benefit markedly from low dose (81mg) aspirin. It is much more mixed benefit and harm if you do not have heart disease or other vascular disease. Studies show those with an elevated risk of heart disease who take low dose aspirin do have a small reduction in heart attack and stroke. These people also have a troubling increase in serious bleeds of the gut, the brain, urinary tract and nose. These bleeding incidences were over twice as common as the number of heart attacks prevented. So if you are at an elevated risk of heart disease but do not have heart disease aspirin seems too risky to advise taking daily.
There is, however, another benefit to aspirin that might tip the balance in favor of taking low dose aspirin. Aspirin seems to prevent cancer formation and it’s metastasis (spread from its origin to another site in the body). This cancer prevention effect is still being hotly investigated. The benefit was most obvious for colon cancer and other adenocarcinomas which includes breast, ovary, stomach, lung and liver among others. So if you are at high risk for cancer either because of family history or you have already been diagnosed with cancer and are at risk for its re-occurrence, you may consider low dose aspirin or white willow bark, especially if you have additional heart disease or stroke risk.
White willow bark is very similar to aspirin. It is rich in salicin, closely related to the synthetic acetylsalicyclic acid, or aspirin. Salicin works in the same way as aspirin. To take an equivalent of a baby aspirin you would need to take an extract of white willow bark with 240mg of salicin. Though we do not have studies that show that this amount of white willow bark helps to prevent heart attack of stroke it is likely to do so. Likewise, it is likely to put you at risk for serious bleeding, just like aspirin.
Aspirin may prevent two important “badies”: cancer and heart attack. Despite these benefits you should consider low dose aspirin or white willow bark carefully. In particular people on either should avoid taking non-steroidal anti-inflammatory medicines like ibuprofen and naproxicin. Likewise you should avoid either if you have gout, ulcers, diabetes, kidney disease or an allergy to aspirin. You’ll want to be clear about your risk for cardiovascular disease, cancer, and bleeding. You’ll want to discuss the importance of being monitored for bleeding and interactions either may have with other medicines. Be sure to discuss the risks and benefits with your physician as this is anything but but a straight forward medical decision.
Nexus September/October 2012