Consumers have been using Aspirin for more than 100 years as a remedy for pain, headaches in particular. Daily low-dose aspirin was recommended in more recent years, as a way to reduce the risk of heart attack and other cardiovascular events. However, this therapy has its own risks, and the risks are serious.
This week’s post discusses natural alternatives to aspirin. For more than 100 years aspirin has been used as a remedy for pain, and headaches in particular. In addition, in more recent years, daily low-dose aspirin was recommended as a way to reduce the risk of heart attack and other cardiovascular events. Because aspirin thins the blood, it shows some benefit in preventing heart attack and stroke. It does this by preventing platelet aggregation, especially in atherosclerotic individuals.
However, this therapy has its own risks, and the risks are serious. In addition to the risk of excessive bleeding in the event of an injury, others include gastric ulcer, hearing loss, cerebral bleeding, and Crohn’s disease. Furthermore, other risks include influenza mortality, Reye syndrome and helicobacter pylori (H. pylori) infection. Fortunately, several natural alternatives are available which provide similar, and sometimes superior, cardiovascular protection.
Consequently, this blog focusses on the risks associated with regular low-dose aspirin consumption and discusses natural alternatives. Keep reading to learn more about natural alternatives to aspirin!
HISTORY OF ASPIRIN
To begin, before we get into the knitty-gritty of aspirin and its alternatives, let’s get a little background info on the history of aspirin. Natural forms of salicylic acid have been used for thousands of years. Salicylic acid is the active ingredient in modern-day aspirin. Moreover, we most commonly find Salicylic acid in the leaves and bark of the willow tree. In addition, it is also present in jasmine, beans, peas and clover.
Willow bark has been used at least as far back as the ancient Egyptians, who used it as a remedy for aches and pains. Later, Hippocrates wrote about using willow bark and leaves to relieve pain and fevers. Thousands of years after Hippocrates, French pharmacist Henri Leroux isolated salicylic acid in 1829. As a result, by the end of the 19th century, Bayer pharmaceutical corporation had begun distributing acetylsalicylic acid as a powder to physicians. Consequently, the drug was a hit, and in 1915 Bayer began selling aspirin as over-the-counter tablets (1).
ASPIRIN FOR HEART ATTACK PREVENTION
In comparison today, for pain and fever, more people now reach for acetomenophin (Tylenol), ibuprofen (Advil) and naproxen (Aleve). Aspirin is no longer used as widely. But in the 1990s, aspirin found a new use as a preventative treatment for heart attack and stroke prevention. However, because of the risks associated with even low-dose aspirin, this preventative measure is only recommended today in certain scenarios when directed by a physician (2). Fortunately, several natural substances confer similar, and sometimes superior protective effects without the risks associated with aspirin!
RISKS OF ASPIRIN USE
Important to note, even relatively short-term daily use of aspirin has been demonstrated to result in negative side effects. One 2009 study administered either low-dose aspirin or a placebo daily for 14 days to a group of healthy volunteers. The study found that 80% of the aspirin group developed small bowel pathology, compared to 20% in the control. The authors specify that the difference between the two groups was not significant. However, they conclude that low-dose aspirin was associated with mild inflammation of the small intestine (3).
NATURAL ALTERNATIVES TO ASPIRIN
Several natural alternatives are readily available that provide comparable, and in some cases superior cardiovascular protection. Consequently, these natural aternatives are used without the risks associated with aspirin. Most of these substances work by reducing platelet aggregation, or the clumping together of platelets in blood to form a blood clot.
Platelet aggregation can lead to stroke, infarction, or other cardiovascular event and is of particular concern in individuals with atherosclerosis. When atherosclerotic plaque narrows blood vessels, platelet aggregation becomes a larger concern. This is due to narrowing blood vessels which can more easily become blocked by aggregated platelets.
In the following sections we will present research about specific natural substances. These natural substances have been demonstrated to reduce risk of cardiovascular events. They do this by reducing platelet aggregation and also supporting the vascular endothelium.
PYCNOGENOL
Pycnogenol is a standardized extract of maritime French pine bark. It has antioxidative and anti-inflammatory effects. It is also high in phenolic acids, catechin and taxifolin (4). Pycnogenol is hard to spell but quite effective at reducing cardiovascular risk factors.
One study assessed the effects of Pycnogenol and also aspirin on platelet function in cigarette smokers. Cigarette smokers are at increased risk of cardiovascular disease and hypertension. Impressively, a single dose of 200mg of Pycnogenol remained effective at preventing smoking-induced platelet aggregation for six days! In addition, some other study groups showed benefit from either 100-125mg Pycnogenol or 500mg aspirin, when taken after smoking (5).
POLICOSANOL
Policosanol is another great natural alternative to aspirin. It is a a wax extract primarily made from sugar cane. Also, it is known for its ability to reduce blood cholesterol levels without the dangerous side-effects of statin drugs. In addition, policosanol inhibits blood clotting as effectively as aspirin, but without the dangerous side-effects. One study compared the effects of policosanol with aspirin in reducing platelet aggregation in 43 healthy volunteers and found similar benefits (6).
OMEGA-3 FISH OIL
The omega-3 fatty acids in fish oil are also helpful in reducing platelet aggregation. A 2013 study compared the effects of aspirin monotherapy and combined fish oil and aspirin in type 2 diabetics. In comparison to aspirin alone, researchers found that the addition of 4g of fish oil per day reduced platelet aggregation. Furthermore, this study also observed that the addition of fish oil to aspirin treatment further reduced NF-κB (7). In addition, the authors of another study suggest that higher dose fish oil may deliver more significant results in CVD patients (8).
TURMERIC AND CURCUMIN
Curcumin is a primary constituent of the Ayurvedic spice turmeric. It appears to prevent platelet aggregation as well. The authors of an in vitro study suggest that curcumin’s anti-inflammatory effects may result, at least in part, from its effects on eicosanoid biosynthesis (9). Additionally, another similar study found similar results. (10).
DARK CHOCOLATE
In good news for chocolate lovers, the flavonoids in cocoa powder also appear to inhibit platelet aggregation. One study found that cocoa-rich dark chocolate inhibited platelet aggregation induced by collagen but not ADP in healthy volunteers (11). Another similar study evaluated the effects of dark chocolate in a group of otherwise healthy cigarette smokers. The conclusion, dark chocolate significantly improved flow-mediated dilation two hours after ingestion, and the benefits lasted six hours.
In addition, total antioxidant status increased significantly after dark chocolate consumption. Endothelial and platelet function both significantly improved compared to the control group. In addition, there were no changes observed in glucose or lipid markers. The authors conclude that the benefits are likely due to the antioxidant properties of cocoa flavonoids (12).
It’s interesting to note, both of these studies on dark chocolate used white chocolate, which contains little to no cocoa, as a control. The first study also included a milk chocolate group, which demonstrated a small but statistically insignificant improvement. These data support the hypothesis that the cocoa flavonoids confer the observed benefits, as dark chocolate is high in cocoa, milk chocolate is significantly lower, and white chocolate has little to no cocoa. In other words, the higher the cocoa content, the more impressive the results. Consequently, it’s important to stress that patients not substitute milk or white chocolate for dark.
DAN SHEN
Another is Dan Shen. It is a powerful Chinese herb also known as Salvia Miltiorrhiza. Dan Shen is well known for its cardiovascular benefits, which we have written about previously. To learn about Dan Shen in more detail, check out this post. Here we’ll review the high points of how Dan Shen impacts platelet aggregation. In addition, here are some resources that explain the benefits of Dan Shen: (13), (14), (15).
COLEUS FORSKOHLII
Another is Coleus Forskohlii, an herb in the mint family that is grown in Nepal, Thailand and India. One of the primary active constituents is known as forskolin, which is a diterpene and a potent cAMP stimulator. In animal studies, forskolin has been demonstrated to reduce platelet aggregation (16). This appears to be due to its ability to activate platelet adenylate cyclase (17).
PEONY
And lastly, two forms of the peony plant, Paeonia Lactiflor and Paeonia Suffruticosa, both positively impact platelet aggregation and blood coagulation (18). Two paeonia constituents, paeonal and paeoniflorin have demonstrated anticoagulant (19) and antiplatelet effects (20). Furthermore, paeonia suffruticosa inhibits fibrosis and thromboxane A2 (TXA2) activation of platelets (21).
IN CONCLUSION
In conclusion, several natural substances appear to offer similar benefits to reduce the risk of blood clot, stroke and other cardiovascular events. These natural substances do so without the risks associated with daily aspirin consumption. These options are worth keeping in mind for patients who are concerned about their heart health but are also concerned about taking low-dose aspirin every day.
Therefore, when we recommend supplements for reducing platelet aggregation, we look at the ones we’ve reviewed in this article. We see whether there are additional reasons why certain ones of these would have additional benefits for other reasons.
For example, pycnogenol (or grape seed extract, which is similar in its activity) is a strong antioxidant. So, if we suspect oxidative stress on top of wanting to reduce platelet aggregation, we might recommend 100-200mg pycnogenol per day. We would add to that some 80% or greater dark chocolate since that also has antioxidant activity.
If, on the other hand, someone has signs of inflammation, we might instead recommend curcumin in a highly bio-available form (Theracurmin, Meriva, or BCM-95). And also Peony root, especially if there is also pain. We may also use omega 3 fish oil, especially if fish intake is less than 1-2 pounds of cold-water fatty fish per day.
Additionally, if someone has high cholesterol, we might use policosanol 20mg twice daily and possibly also some curcumin.
When blood flow is poor, we would choose Dan Shen together with pycnogenol or grape seed extract.
Also, if there is low testosterone or a goal of weight loss, we might choose Coleus Forskohlii.
In many cases, we prefer to use a combination of some of these supplements together with nutrition, lifestyle, stress-management, and mindfulness practices, as oftentimes multiple issues are occurring simultaneously.
RESOURCES
- Landau, Elizabeth. “From a Tree, a ‘Miracle’ Called Aspirin.” CNN, Cable News Network, 22 Dec. 2010, www.cnn.com/2010/HEALTH/12/22/aspirin.history/index.html.
- “Can an Aspirin a Day Help Prevent a Heart Attack?” U S Food and Drug Administration Home Page, Office of the Commissioner, 16 Feb. 2016, www.fda.gov/ForConsumers/ConsumerUpdates/ucm390539.htm.
- Endo, Hiroki, et al. “Incidence of Small Bowel Injury Induced by Low-Dose Aspirin: A Crossover Study Using Capsule Endoscopy in Healthy Volunteers.” Digestion, vol. 79, no. 1, 2009, pp. 44–51., doi:10.1159/000204465.
- Rohdewald, Peter Jörg. “Review on Sustained Relief of Osteoarthritis Symptoms with a Proprietary Extract from Pine Bark, Pycnogenol.” Journal of Medicinal Food, 2017, doi:10.1089/jmf.2017.0015.
- Pütter, M., et al. “Inhibition of Smoking-Induced Platelet Aggregation by Aspirin and Pycnogenol.” Thrombosis Research, vol. 95, no. 4, 1999, pp. 155–161., doi:10.1016/s0049-3848(99)00030-4.
- Arruzazabala, M.l., et al. “Comparative Study Of Policosanol, Aspirin And The Combination Therapy Policosanol-Aspirin On Platelet Aggregation In Healthy Volunteers.”Pharmacological Research, vol. 36, no. 4, 1997, pp. 293–297., doi:10.1006/phrs.1997.0201.
- Block RC, Abdolahi A, Smith B, et al. Effects of Low-Dose Aspirin and Fish Oil on Platelet Function and NF-kappaB in Adults with Diabetes Mellitus. Prostaglandins, leukotrienes, and essential fatty acids. 2013;89(1):9-18. doi:10.1016/j.plefa.2013.03.005.
- Mcewen, Bradley, et al. “Effects of Omega-3 Polyunsaturated Fatty Acids on Platelet Function in Healthy Subjects and Subjects with Cardiovascular Disease.” Seminars in Thrombosis and Hemostasis, vol. 39, no. 01, 2013, pp. 025–032., doi:10.1055/s-0032-1333309.
- Srivastava, K.c., et al. “Curcumin, a Major Component of Food Spice Turmeric (Curcuma Longa) Inhibits Aggregation and Alters Eicosanoid Metabolism in Human Blood Platelets.”Prostaglandins, Leukotrienes and Essential Fatty Acids, vol. 52, no. 4, 1995, pp. 223–227., doi:10.1016/0952-3278(95)90040-3.
- Shah, Bukhtiar H, et al. “Inhibitory Effect of Curcumin, a Food Spice from Turmeric, on Platelet-Activating Factor- and Arachidonic Acid-Mediated Platelet Aggregation through Inhibition of Thromboxane Formation and Ca2 Signaling.” Biochemical Pharmacology, vol. 58, no. 7, 1999, pp. 1167–1172., doi:10.1016/s0006-2952(99)00206-3. Resources, continue.
RESOURCES, Cont.
11. Innes, Andrew J., et al. “Dark Chocolate Inhibits Platelet Aggregation in Healthy Volunteers.”Platelets, vol. 14, no. 5, 2003, pp. 325–327., doi:10.1080/0953710031000123681.
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13. Park JW1, Lee SH, Yang MK, Lee JJ, Song MJ, Ryu SY, Chung HJ, Won HS, Lee CS, Kwon SH, Yun YP, Choi WS, Shin HS. 15,16-dihydrotanshinone I, a major component from Salvia miltiorrhiza Bunge (Dansham), inhibits rabbit platelet aggregation by suppressing intracellular calcium mobilization. Arch Pharm Res. 2008 Jan;31(1):47-53.
14. Ning Wang’, Hon-wet Luo’2, Masatake Niwa3, and fang: A New Platelet Aggregation Inhibitor from Salvia miltiorrhiza; Department of Phytochemistry, China Pharmaceutical University Received: Nanjing, Jiangsu, People’s Republic of China; April 25, 1988
15. Jiang-Qin Liua, Tze-Fun Leea, Margaret Miedzyblockib, Godfrey C.F. Chanc, David L. Bigamb, Po-Yin Cheung; Effects of tanshinone IIA, a major component of Salvia miltiorrhiza, on platelet aggregation in healthy newborn piglets; Journal of Ethnopharmacology Volume 137, Issue 1, 1 September 2011, Pages 44–49
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17. Siegl AM, Daly JW, Smith JB. Inhibition of aggregation and stimulation of cyclic AMP generation in intact human platelets by the diterpene forskolin. Mol Pharmacol 1982;21:680- 687.
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19. Akamanchi, K.g., et al. “Synthesis and In-Vitro Evaluation of Platelet Aggregation Inhibitory Activity of Paeonol and Its Analogues.” Pharmacy and Pharmacology Communications, vol. 5, no. 5, Jan. 1999, pp. 323–329., doi:10.1211/146080899128734910.
20. Zhu M1, Tang Y, Duan JA, Guo J, Guo S, Su S, Shang E, Qian D, Ding A.
Roles of paeoniflorin and senkyunolide I in SiWu decoction on antiplatelet and anticoagulation activities. J Sep Sci. 2010 Nov;33(21):3335-40. doi: 10.1002/jssc.201000340.
21. RR Watson; Complementary and Alternative Therapies and the Aging Population: An Evidence-Based Approach, Academic Press April 28, 2011.
