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Comment by idclip | Hacker News Reader

I take aspirin protect, made by bayer. Grandad and dad had heart issues, so my dr started me a while ago on it as to curb the risks.

An aspirin a day will also make your nose bleed after a few weeks. Albeit not profusely but if you blow your nose, you will see blood.

take one every 3rd say. Unless its a very small dosage with delayed release.

Aspirin should not be messed with, make sure you eat before you take a pill, or itll tear a hole in your stomach. Ive made that mistake once a decade ago.

Please consult your doctor before grabbing off-the-counter aspirin.

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I'm wondering what other HN users think of the merits of reducing the omega-6 to omega-3 ratio as an alternative to aspirin (in certain cases).

Aspirin works by irreversibly inactivating the COX enzyme [0], which is involved the Arachidonic Acid Cascade [1], which at the same time is affected by the aforementioned essential fatty acid ratio.

COX enzyme inactivation supresses the production of thromboxanes, which explains your bleeding.

[0] https://en.wikipedia.org/wiki/Mechanism_of_action_of_aspirin [1] https://en.wikipedia.org/wiki/Essential_fatty_acid_interacti...

Edit: Added last parragraph

I think it's better to reduce total PUFA consumption, than to dilute out omega-6's with omega-3's. Both types of oils are unstable at body temperature.

Human operating temperature is much closer to a cow (or coconut) than to an artic fish.

Is that you Peat?

http://raypeat.com/articles/articles/unsaturatedfats.shtml

> Human operating temperature is much closer to a cow (or coconut) than to an artic fish.

Why is that relevant?

Im infering that the chemistry of said oils vary enough between the two temps to matter

Its the implication

Great links. Thanks.

> An aspirin a day will also make your nose bleed after a few weeks. Albeit not profusely but if you blow your nose, you will see blood.

Should depend on dose and physiology: for low doses (below ~4g) the half life of aspirin is 2 to 4.5h depending on the person. If you saturate the metabolic pathway however the half-life shoots up to 15~30h.

> take one every 3rd say. Unless its a very small dosage with delayed release.

The study was done with 80mg aspirin daily (sometimes called "baby" aspirin). Standard adult dose around here is 500mg.

My experience is with 100mg delayed release over 10 years.

And jesus, 500mg? Holy crap

As far as I know, the over the counter 500mg dose is sold over here as a painkiller, it's certainly not meant for long term preventative use.

Sounds pretty damn irresponsible to me.

Im glad my dr is a sane one. I dont see anyone needing high doses unless your dealing with a mayocardial infarction where high doses of aspirin are administired to prevent damage to the heart.

> the over the counter 500mg dose is sold over here as a painkiller, it's certainly not meant for long term preventative use.

Most def', but if you ask for aspirin without specifying any further that's what you get (that's what I'm given every time anyway). I'm not sure you can even get 75~80mg, 100mg seems to be the lowest dose available (for long-term use after infarction & stuff, and for toddlers).

In the US and UK one can get ~80mg (75, 81) OTC, at any drug store / chemist.

The "childrens' aspirin" often used by aspirin regimen patients is 81mg (though the general advice is to not give children aspirin due to Reye Syndrome[1]), 500mg daily would cause gastric distress for many people (certainly me).

1: https://en.wikipedia.org/wiki/Reye_syndrome#Aspirin

The story doesn't end there: aspirin is an irreversible inhibitor of a platelet aggregation pathway.

So its effects last longer than the circulation of free aspirin in the bloodstream.

Its effects last until the enzymes in that pathway get regenerated. The enzymes' turnover is over a period of several days.

A standard dose (tablet) of 250mg and 300mg seem common in Europe, 325mg in the US. 500mg is "extra strength". E.g. https://www.walgreens.com/search/results.jsp?N=2000010035&Nt....

75mg daily here...

[Edit: sorry, mine's clearly not a "standard" dose]

Around where?

It's 300mg in US and UK, for occasional painkiller use. https://en.wikipedia.org/wiki/Aspirin

You need to clarify. Are you taking a low-dose aspirin? I've been taking an 85mg one once a day for 5+ years. Never had a single problem you outline.

Yes low dose, 100mg, hard caps with extended release.

which is slightly stronger than the 75mg "micro" dose.

It can still mess you up.

https://m.apotheken-umschau.de/Medikamente/Beipackzettel/ASP...

Same here. I was prescribed low dosage Bayer (81mg) four years ago due to heart issues. Never had a problem with bleeding or clotting for that matter.

> An aspirin a day will also make your nose bleed after a few weeks

will? With 100% certainty? You are unnecessarily scaring people away from something that most assuredly does not cause bleeding in myself and many others.

Will, would, not really looking for an internet scaddadle, downvote me if wish

Daily aspirin use causes gastric distress ib many others, too.

My main point still stands, aspirin should taken with extreme care, and people reading stuff like this often think its a good idea to self medicate. Id rather they err(?) on the side of caution. Even though youre technically right. => "inappropriate use of aspirin MAY(would/could) lead to gastric bleeding"

You can get tiny dosage pills, I use 75mg ones -- easily available at the supermarket in the uk. No node bleeding with that, even if you do risk bleeding a bit more than usual if you cut yourself.... Small price to pay for the 'feature' of thinning the blood, I suppose?

I used to take those (for over a year), but my nose bleeds were difficult to stop and when I got an aneurysm at the bottom of my mouth I thought what if this happens in my brain? So I stopped taking the Aspirin.

Ouch sorry to hear that. And youre right, the thought of aspirin exacdrbating a brain aneurism are also something i think about too

NSAIDs greatly increase your chances of ulcers and gastritis even if you take them on a full stomach.

To elaborate, they don't damage your stomach via contact, they inhibit COX which is an enzyme that contributes to gastric mucosal protection and regeneration.

So it doesn't matter whether you eat with them or not, largely, unless what you're eating with them is an antacid or proton pump inhibitor.

Oh wow, thank you, that's pretty interrsting

But wait, there's more! There are at least two COX pathways; COX-1 is involved in protection of stomach lining, COX-2 is responsible, in part, for pain signalling.

Aspirin inhibits both pathways. Other NSAIDs do the same, although they typically have less of an effect on COX-1.

There is something on the unnoficial market which may inhibit only COX-2, a sort of holy grail in the last few decades of medicine: kratom[0].

0.https://www.ncbi.nlm.nih.gov/pubmed/21513785

Damnit im trying to finish a project! Now i have to read that link :P

Right, there is some evidence that COX-2 selective inhibitors may be safer for patients with inflammatory bowel disease like Crohn's and Ulcerative Colitis. Currently, those patients are generally advised to not take an NSAIDs.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4034022/

Ah, but interestingly, inhibiting either cox pathway independently doesn't damage mucosa. you have to inhibit both, simultaneously, and the limiting factor is the one that is the least inhibited. So it's not just "COX-2 good, COX-1 bad", it's actually "Either pathway is fine to inhibit selectively as long as you don't inhibit both"

Anecdotally, Kratom use can also lead to long, opiate like withdrawls (weeks of hyperalgesia, no fun). Other short term opiate like side effects like nausea are common as well. I would definitely recommend against self-experimentation unless you are prepared for lengthy withdrawl symptoms.

Hopefully more research can be done into its constituent chemicals before it is banned in the US. The DEA already tried, and its illegal in several states.

Is there any risk of the thinner blood leaving you predisposed to complications in the event of an unrelated traumatic injury?

..analagous to how Amber died in season 4 of House?

Yes, that's the main reason aspirin isn't recommended more widely. (Stomach and liver harm are the other big reasons.)

It's not necessarily external trauma, but major bleeding events, especially internal, are more prevalent and severe on aspirin. The NNT/NNH breakdown suggests that heart attack and stroke prevention narrowly beats out increased bleeding, but it's not unambiguous.

(Normally you handle this by recommended preventatives to people at high risk so you get a better ratio. This sometimes works with aspirin, but older people are often at high risk for stroke and bleeding, so the problem sticks around.)

I don't know how cancer prevention factors in - it might push aspirin into clear net-positive territory - but regardless you're right about blood thinners creating trauma risk.

> Yes, that's the main reason aspirin isn't recommended more widely. (Stomach and liver harm are the other big reasons.)

Liver is paracetamol — aside from Reye Syndrome[0] — aspirin is metabolised via the kidneys and I believe even overdoses does not overload the kidneys[1], however aspirin inhibits excretion of uric acid which is why it's contra-indicated to people suffering from gout or kidney diseases.

[0] https://en.wikipedia.org/wiki/Reye_syndrome linked to both aspirin and liver toxicity

[1] in fact one part of aspirin overdose protocol is urinary alkalinization: increasing urinary pH from ~5 to ~8 increases renal elimination of salicylate by 10~20x

Ah, thanks. I knew I'd heard of aspirin-liver related crises, but I hadn't realized Reye Syndrome happened outside of normal metabolism!

>Are more prevelent

As for the internal bleeding risks.

https://books.google.com/books?id=j-XQ1UqLdAQC&pg=PT41&lpg=P...

"These results translate into an absolute rate increase with aspirin above placebo (the incidence of cases of major GI bleeding attributable to low-dose aspirin) of 0.12% per year (95% CI: 0.070.19% per year).[20] Based on this value, 833 patients (95% CI: 5261429 patients) would need to be treated with low-dose aspirin instead of placebo to cause one major GI bleeding episode during a 1-year period (i.e. the NNH is 833)"

> it might push aspirin into clear net-positive territory

It's pretty clearly in the net positive territory. Reduces sunburn, reduces obesity, can stop a heart attack or stroke immediately, cures hangovers, and reduces cancers.

Oh yes. You /will bleed/ more.

Has no effect on healing as far as i can see, and i cut myself now and then regularly. (i cook alot) but i heal quickly. Now if i ever cut into a large blood vessel... Yeah ill be in trouble.

If you consider doing dental work though, please let your dentist know.

Hospitals ask about aspirin if they want to do surgery.

Everybody keeps mentioning Bayer. Have they had any innovation in the aspirin concept or is their marketing that effective?

Marketing is effective

Bayer was the company that originally developed aspirin, it was their trademark. At the time it was one of their two main products, the other being heroin.

what a coincidence, heroin a day reduced cancer risk 100%

They own the trademark "Aspirin" in many countries. In others that's a generic term.

I was prescribed omeprazole to protect the stomach along with my meds 75mg aspirin included.

You may want to take a calcium citrate supplement too, as long term omeprazole use has been linked to calcium depletion.

I take a 325mg uncoated aspirin every morning on an empty stomach and have not seen any of those complications.

Totally agree that everyone should consult their doctor before beginning any daily medication whatsoever.

Yeah it seems some people can withstand it better than others

Id be hesitant to take anything over my 100mg

What about non digestion-system intake ? just curious

- sublingual - intramuscular - anal

I don't know for aspirin but the method of intake may not matter: e.g. non steroidal anti-inflammatory drugs such as ketoprofen induce aggression of the gastrointestinal system in ways unrelated to ingestion, hence why on the short run you're encouraged to eat (which will somehow dilute the natural gastric acid) right after having taking the medication (which takes ~0.5hrs to reach peak blood concentration[1]but falls gradually afterwards), or on the long run you may be encouraged to take proton pump[0] inhibitors, which come with their own side effects. (Disclaimer: not a medic, only remotely a chemist, but had to deal with this for extended durations).

It's an awfully complex equation of chemical actions and risks vs benefits. Be safe, nothing about this is magic and can have serious consequences.

[0]: https://en.wikipedia.org/wiki/Proton_pump#In_humans

[1]: four doses of ketoprofen: https://www.drugs.com/pro/images/c2c99853-1268-4998-a44b-2bf... (from https://www.drugs.com/pro/ketoprofen.html)

my idea was to avoid doing a full round trip around the vascular system and just drop a small amount of aspirin so it would reach some organs but not the digestive system.

I "appreciate" the complexity of our systems, but do you suggest that even without physical proximity to your stomach aspirin can trigger cascades that can harm it ?

Considering its an acid.. I imagine it would hurt.

If you are getting nose bleeds, you might benefit from getting more calcium in your diet. Upping my consumption of calcium put a stop to my nosebleeds.

>itll tear a hole in your stomach. Ive made that mistake once a decade ago.

I know somone suffering from this mistake right now. Did this resolve on its own for you?

I made sure i avoided spicy and acidic food (read also anything sweet. Sweet potato/yams is ok) st, even "well seasoned" stuff. Herbs and abit of salt were ok amd even beneficial. did moderate sports activities, but that hurt like hell. Walking 30 minutes a day should be enough. Keep hydrated, make sure the food is soft - avoid processed foods and fizzy drinks and coffee at al cost. Sugarless herbal tee is all i drank in the morning, two full cups.

Drank small doeses of anti acids before bed.

I did a gastroscopy a year after that and it had healed.

Smoking can exacerbate the condition and i quit for the duration.

Mind you i was young at the time. The body heals itsself you just have to get out of the way.

Im sorry for your friend, i still remeber the pain. Walking felt like being contonuisly stabbed in the stomach every 3rd step.

Edited with more info

thank you. passed this info on.

The comment below me is also very helpful - joghurt is really good for it. Esp goat joghurt, but its taste is not too good

I remember reading something about dental hygine too. Acidic mouth -> bacteria -> somehow effects the stomach too as we swallow our salyva

Yogurt Containing Lactobacillus gasseri Mitigates Aspirin-Induced Small Bowel Injuries: A Prospective, Randomized, Double-Blind, Placebo-Controlled Trial.

https://www.ncbi.nlm.nih.gov/pubmed/28052291

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