This article is a transcribed edited summary of a video Bob and Brad recorded in May of 2021. For the original video go to https://www.youtube.com/watch?v=JGBOjUCYPfQ
Brad: So today we're going to talk about the title how does aspirin work? And today's guidelines. This is going to be very interesting for people 50 and over, but everyone will have a good interest in it. We're going to explain how it works and the new guidelines, which is interesting to me, because it changed how my mother takes her medication.
Chris: Yeah, it sure does.
Brad: Right. So, before we go any further, Chris do you have anything else to mention about this aspirin? Because what I'd like to do is go through a little history because aspirin has been around forever. When I was a kid, that's all there was. I mean, I never heard of Tylenol, you know, in the sixties. All these others, like Ibuprofen, were not there. If you had a problem, it was aspirin.
Chris: Everybody did aspirin back in the day.
Brad: But I understand it goes back a little bit further than the 1950s.
Chris: A little bit further.
Brad: Then we can touch on that because some people might be interested.
Chris: Absolutely. Well, aspirin has been around for thousands of years, but it hasn't been in the form you know, the aspirin tablet that we see today. Ancient Egyptians and Sumerians like 4,000 years ago, were chewing on Willow bark. And so Willow bark, the components of it, naturally have salicylate in it, which is the anti-inflammatory component of aspirin.
Brad: Okay.
Chris: So basically, they knew through trial and error, that if they chewed on the bark of this plant, and they had a headache or a fever it actually gave them relief, and it's documented.
Brad: Oh wow.
Chris: So ancient Egyptians documented it, Hippocrates, the father of modern medicine. He actually used to use a tea that he would give to pregnant mothers to help to relieve their pains with childbirth and labor. And he also used it for fevers and headaches.
Brad: So, that had aspirin, that tea?
Chris: Well, it was Willow bark, so it had the salicylate in it. There are a variety of different plants that actually contained salicylate. So it's not just Willow bark, but that is probably one of the more common ones that have been used for years and years. I mean, you're talking about thousands of years, and then as we fast forward into the 1700s and the 1800s, you had interested pharmacists and scientists that would just kind of tweak it and go, well why does this work? In the mid-1800s, an enterprising pharmacist actually isolated the active compound. And then a few years later, they could actually make it in tablet form. So they knew exactly what it was. And then by 1897, Bayer, which is a famous company in Germany, they got the patent in 1899. Essentially patented it, and was the first to produce it.
Brad: So, Bayer was a pharmacist or a doctor?
Chris: Bayer was a scientist. It was a huge German pharmaceutical company. But, that was based on a doctor, and they invented this and they used to actually market it exclusively to pharmacists. They actually did them in powder packets back then before they made tablets.
So their marketing ploy at the time was to give it to pharmacists and doctors and they would give it out to their patients for fevers and aches and pains.
Brad: So, then it continued to be a common use treatment, and then, how does it work? I mean, we talked a little bit about it. So you said it comes for this plant?
Chris: It is the granddaddy of all NSAIDs, non-steroidal anti-inflammatory drugs.
Brad: So anti-inflammatory, if you want to simplify it.
Chris: Yep. So actually it works for fevers as well. So it's antipyretic, would be another name for that. Basically, you can use it for headaches. You can use it for toothache. You can use it if you sprain your knee or your ankle. You can use it for fevers if you're over the age of 18. If you're below the age of 18 that can cause very serious Reye's Syndrome, which you may or may not have heard of. That's a pretty fatal brain and liver condition that can be brought on by the use of aspirin after a virus.
Brad: So is there an age component with that.
Chris: Yeah, you really don't want to use aspirin under the age of 18. So at least if you're using it to treat a fever or if you've recently had a viral infection. Reye's Syndrome is very rare but very difficult to treat. Oftentimes it's even with the best best-trained minds it looks a lot like meningitis, at least in the early get-go. So it's something that we have to be careful with.
Brad: But I'm thinking, you know, when I was a kid it was always talked about. But I mean, in the last 20 years, my daughter, 20 years ago, I don't even know if aspirin was an option. The doctors never said to use aspirin. It was usually some other thing.
Chris: Yeah. It was either Tylenol or ibuprofen at that point or acetaminophen.
Brad: Sure, right, right. But that's not because of this Reye's Syndrome?
Chris: No, they just stopped using it probably in the mid-seventies. They just said, if you have a fever, don't use aspirin if you're a child below the age of 18. When I had my teeth extracted when I was like 11 years old, the doctor or the dentist just told me to take two aspirin. I still remember it. I mean, it was like two, and it was kind of a running joke always, take two aspirin, call me in the morning.
Brad: Right, right. I remember that.
Chris: And so, you know, we're old enough to actually remember some of those things. But, at the same time, it's certain, you know I mean the drugs got 120 years plus track record. So, it's unbelievably safe. It's unbelievably effective. The WHO, World Health Organization, listed it top of their list as one of the most essential drugs that everybody should have.
Brad: Still today?
Chris: Yup and a buddy of mine had a Pharmacy Professor that said, if you're trapped on a desert island, this is what you want to have with you, is aspirin. Because it's going to help if you have a fever, it's going to help if you had pain, a headache. So it actually does a lot of different things and oddly enough, there are the coronary effects, so it helps to thin your platelets and minimizes your risk for heart attack and stroke and it actually may help to prevent colorectal cancer. So there are a lot of things that aspirin does. It's a very versatile Jack-of-all-trades drug.
Brad: So then, keeping that in mind, now they say like, for my mother, using it to prevent any heart problems or CVA or stroke. And they said stop that. That the new research says it's not good.
Chris: It's because of her age, specifically So, we're talking about, about the 81 milligrams dose?
Chris: Yep. That is low-dose aspirin, which therapeutically, most doctors now are going to recommend the 81 milligrams or the 325 milligrams is used effectively as well, but more often than not, you're going to see it as an 81 milligram.
Brad: Yeah.
Chris: And you notice the reason that we kind of selected these for a couple of different reasons. This is just plain old, normal, regular strength 325-milligram aspirin. This is low-dose, 81 milligrams aspirin. In the old days, they used to call it baby aspirin. You'll notice that it says safety coated. So, the 81 milligrams seem to be more efficient at helping keep the platelets from agglutinating or getting sticky and clogging up your arteries. So, this is why it works. It works a little bit better than the 325 mg one does.
Brad: But not anymore because if you get over what age and they say not to use it?
Chris: So, basically aspirin, the guidelines are now between 50 and 70. So the reason for that is, that there is a risk of bleeding with aspirin. And so I've seen that personally firsthand, with my mother-in-law. She had a hemorrhagic stroke and she was a regular aspirin user. So, whether or not it was the essential causative factor that caused her brain to bleed or not?
It certainly didn't help.
Brad: If you're over 70 doctors are probably going to say, drop the baby aspirin?
Chris: With discretion. So, it depends on your risk factors. That's where all of this comes down to. So they're looking for stomach ulceration, which is a GI bleed, or other bleeds, or if you burst a blood vessel. Because this slows down the clotting effects which is why it's so protective for your heart. For heart attack and stroke, especially as we age, we all get atherosclerotic plaque that builds up in our arteries around the heart. And so, if we can basically just think of like when you take aspirin, you have thromboxane, you have cyclooxygenase, these are all things that help with the stickiness or the slickness of platelets. And when we take aspirin it makes those platelets slick so it's kind of like coating them with WD 40 to get them to squirt through.
Brad: So you don't get a clot.
Chris: So it doesn't clot. So it allows blood to move more freely. So it minimizes the risk of ischemic damage done. Let's say it's in your heart, the cardiac muscle, or obviously in the brain with a stroke. But then there are the two types of strokes. So there's the bleeding stroke, which is rare, like 3% of the strokes. And the other ones are all due to a clot. So that 97% is what aspirin does so well at protecting against.
Brad: But if you're over 70 then there's a gray zone?
Chris: After 70, it's a very gray area. The risks for bleeding is much, much higher at that point. And so right now, the newest guidelines on the studies that were done at Florida Atlantic, University of Wisconsin, Madison, and also Harvard, Brigham, and Young Women's Hospital. So those three schools all kind of came together and did a significant amount of research.
Kind of, relaying these new guidelines. So it's not to say that if you're under the age of 50, you can't use aspirin. I mean, a lot of people can safely use aspirin for a sprained knee, sprained ankle, you have a headache, you have a fever. If you're over the age of 18 in that fever category, it's very effective stuff. It works, as you know, but there are risks with aspirin too. One of the most common ones is usually stomach ulceration. So, it's always important, you've noticed this one has a safety coating, the coating was designed to protect your stomach against stomach ulceration. So it doesn't dissolve in the gut. It dissolves in your intestines.
And that's where it absorbs.
Brad: It kind of bypasses that part?
Chris: Yeah. But the controversy with that now is that they actually think that that's not that great either because you may not get as much benefit from the aspirin when you need it in a hurry. So particularly like if you're having a heart attack if you call 911, "hey, I think I'm having a heart attack." Those 911 operators are trained to ask some specific questions, like, are you on a blood thinner? Is there anything else? They may actually have you chew a couple of aspirin before the ambulance gets there. And that difference can save your life.
Brad: Oh wow.
Chris: So, it's important. And if you had a safety-coated tablet that slows down the absorption. It's not going to do as much good. So that's where some of that controversy is.
Brad: So, the 325 milligrams, that's your standard-dose aspirin? And that's what you would take, one or two of those if you had a fever, or had some swelling?
Chris: Yep. One to two every four to six hours apart. Yeah. That's kind of how that would be dosed for pain and inflammation or fever.
Brad: But if you have a history of like GERD or heartburn, then aspirin is not a good choice.
Chris: Yeah, when it comes down to "what do I, I'm between the age of 50 and 70, what do I do?" You want to discuss this with your doctor. Your doctor is going to have the most intimate knowledge about your medical history so that we can assure that what we're giving you is going to be the most essential thing. You can certainly talk it over with your neighborhood pharmacist. They're going to be happy to share their thoughts, but at the end of the day, your doctor is going to be the one that says. "Well, you know, Brad, you're newly diabetic, and you're a smoker and you don't exercise much". This is anti-Brad, but I mean, it's just one of these things where, in that case, maybe a daily aspirin. We're going to pretend you're 38 years old, maybe a daily aspirin would be effective for you, but your doctor should be the one making that choice. Because there is that bleed risk.
Brad: Sure.
Chris: Which actually can have some very severe complications. Usually, for the younger patient it's going to be mostly GI, but also older patients too. Just the way that our bodies work because we don't coat the stomach as well as they used to, so a higher risk for ulcerations. So we have to be careful. What do we tell people when they take aspirin to use it safely? You want to make sure they take it with at least eight ounces of water. That's probably one of the most important things you can do with aspirin. And probably to take it with a little snack or a meal that will also help to buffer and make it absorb a little bit more easily to the stomach. So that's how you try and minimize the risk for GI disorder, but really, it's that eight ounces of water. Then you probably don't lay down and recline because, that you can get some of the refluxing action and then they can sit, and it can start to cause some damage. It is a mild acid.
Brad: So if you take it before bed, take it an hour or so before bed?
Chris: At least an hour before you lay down. But the key to any time you're taking a daily dose of anything is consistent timing. So we want to take it at about the same time. And you know, the interesting thing about aspirin, it begins to work within an hour of it being put in your body. And it lasts, it has an effect on platelets for 10 days.
Brad: Wow. So that's where you would prevent the heart problem or the stroke?
Chris: Yup. That's the most common use these days, people typically gravitate more towards acetaminophen or Tylenol, or ibuprofen for headaches. You know, Motrin, Advil, that type of thing. It's just because they're faster acting. Ibuprofen does have platelet effects but not to the extent of aspirin. So they kind of gravitate to those more just because they're a little bit more gentle on the stomach less side effect prone, but still incredible stuff.
Brad: So if we have someone, you know, older like me or even older were aspirin was their go-to thing and they're healthy. They don't have any problems. They could still go ahead and use it without any problem?
Chris: Oh yeah. I think you could feel very confident in the product itself. So the things to watch out for, you don't want to take it if you're on a blood thinner, you don't want to take it if your doctor tells you not to, you don't want to take it if you have asthma, because sometimes it can trigger bronchial spasms. It could be due to the allergic component of aspirin. It's still kind of a hotly debated topic. But that said, those are a couple of precautionary things that would, maybe we would tell you to be careful with and or to avoid.
Brad: That's pretty specific. So, again if you're generally healthy like I don't really have a doctor because I never go and, I've gone to have a physical and he doesn't know me that well. I mean, he just talked to me once in the last time I had a physical that doctor left and they keep running away on me. I don't know. They don't like me. But anyway, I personally would feel comfortable taking an aspirin if I sprained my ankle or had a fever. I would feel very relaxed.
Chris: Oh yeah. And it's phenomenal stuff. And again, it goes back to how versatile the drug is. So it can be utilized by many. I mean, the other thing I wanted to touch on too, just as a precautionary tale, there's some debate as to, let's say you're going to have a dental procedure or a surgical procedure. Because this does create a bleed risk. It stays in your body for 10 days. So, if it's a minor procedure most doctors and dentists are saying, you can keep taking it. So, that is A-Okay because they have special hemostatic gauze and gelatin-containing products that help to cause clotting.
Brad: And I'm sure if you're going to have a procedure, the doctor's going to say no aspirin so many days prior.
Chris: Correct. Yeah, you should always let your doctor know, "Hey, I'm on an aspirin regimen". So it is important for your long-term safety as well, to let everybody that's going to be involved with whatever aspect of healthcare know what you're on. So share it with your pharmacist, because it's over the counter in so many cases. Although we do see prescriptions for it, you should let everybody involved know.
Brad: Yep. So it looks to me like aspirin is here to stay.
Chris: I think so, it's not going anywhere. It's cheap, it's effective. I just had a case the other day at work where I had an uninsured patient who needed to take a prescription anti-coagulant. What was selected by the physician was uber expensive. I mean like 1600 bucks a month. No insurance, so that's a mortgage payment. And it was just something that couldn't be, so, aspirin to the rescue.
Brad: So did you make that decision or did you call the doctor?
Chris: We called the doctor and said, okay, this guy's uninsured, even with discount cards and things that every retail pharmacist works on that use to try and defer costs if they don't have insurance, and it just wasn't making anything reasonable for the gentleman. So as a result of that we just said, what about aspirin? The doctor said, "yeah, we're going to have a discussion about that." So, I think it was on the doctor's radar but we weren't privy to the conversation, We saw the price tag and we're like, ooh, this is going to be really hard on this person.
Brad: Sure. Yeah. Well wow. Good job.
Chris: So, I'm not special. I mean, every pharmacist does that, that's normal.
Brad: You know, I have to say outside of the aspirin thing, I've got a friend and he said, "yeah, Chris saved me a ton of money at the pharmacy, because he made some recommendations." And I didn't realize that that happened.
Chris: Oh yeah, yeah. It's just an aspect of our job. You know, if we can see a cost-saving alternative, and we can mention it to the doctor and if the doctor, more importantly, the doctor has to agree to it. We don't get to do those things. It's like; "hey, this is available." And sometimes the doctor will say, "oh yeah, I didn't even think about that. Yeah, let's do it." So that's usually the case and it works out slick for the patient. Everybody wins.
Brad: I say most excellent to that. All right. Very good.
Chris: Most excellent, indeed.
Brad: Aspirin, in a nutshell from 4,000, 6,000 years ago?
Chris: 4,000 years ago to today. To the day and it's all right in front of you.
Brad: And it's going to keep going.
Chris: That's right. Enjoy.
Brad: And hopefully you don't need any aspirin.
Chris: Have a good day guys. Thank you.
Visit us on our other social media platforms:
Bob and Brad also have a Podcast where we share your favorite episodes as well as interviews with health-related experts.
For this week’s Giveaway visit: https://bobandbrad.com/giveaways
Bob and Brad’s Products
Pain Management:
C2 Massage Gun (US) Fit Glide
Fitness:
Stretching:
Wellness:
Check out our shirts, mugs, bags, and more in our Bob and Brad merchandise shop
The Bob and Brad Community is a place to share your experiences, ask questions and connect with others regarding physical therapy and health topics.
Medical Disclaimer All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider.
Affiliate Disclaimer: Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We are highly selective in our products and try our best to keep things fair and balanced in order to help you make the best choice for you.
Comments