Anti-Inflammatory Diet

All health care starts with diet. My recommendations for a healthy diet are here:
Anti-Inflammatory Diet and Lifestyle.
There are over 190 articles on diet, inflammation and disease on this blog
(find topics using search [upper left] or index [lower right]), and
more articles by Prof. Ayers on Suite101 .

Friday, January 23, 2009

Where’s the Aspirin?

Aspirin is the traditional anti-inflammatory agent. Many of us grew up with the quintessential doctoring phrase, “Take two aspirin and call me in the morning.” Aspirin stops inflammation in several ways. Like all drugs, it interacts with many different proteins/enzymes. In fact it interacts so intimately with the inflammatory system that it suggests that the process of inflammation may require an aspirin-like molecule to function normally.

Aspirin Binds to Multiple Enzymes of Inflammation

Aspirin is observed to reduce inflammation. That means that ingested aspirin tablet dissolve in the stomach and pass through the intestines into the blood stream and subsequently bath cells of the blood and the endothelium that lines the blood vessels. In order to reach the blood stream, the aspirin must pass through the intestinal cells. That passage requires binding to a protein transport molecule.

Cells responding to an inflammatory signal (NFkB, transcription factor is activated) synthesize enzymes that release unsaturated fatty acids (ARA, EPA, DHA) from membrane phospholipids (PLA2, phospholipase A2), form a cyclic epoxide from the fatty acid (prostaglandin H2 synthase 2, also called cyclooxygenase 2, COX-2).

Aspirin binds to the inhibitor that normally inactivates NFkB and prevents NFkB activation that is required for inflammation. Aspirin also binds to PLA2 and prevents fatty acid release and thereby blocks activation of inflammation. Aspirin also binds to COX-2 and blocks the production of inflammatory prostaglandins from ARA. But that is not all that aspirin does.

Inflammation Resolution Uses Aspirin-COX-2 Interaction

The strange interaction that makes aspirin suspicious is that aspirin doesn’t just interfere with the action of enzymes, it subtly changes their specificity. Thus aspirin chemically transfers its acetyl group (CH3-COOH-) to an amino acid in the active site of COX-2 to produce a new group of anti-inflammatory lipoxins from ARA, EPA and DHA.

This raises the question of whether aspirin is a natural dietary modulator of inflammation. Recall that aspirin was initially obtained from willow (Salix) bark. Unfortunately, the data are conflicting. Initial research indicated that grains (naturally inflammatory) lacked aspirin, but many herbs, spices and leafy vegetables (naturally anti-inflammatory) contained aspirin. Subsequent tests refuted this work. It would be consistent with observations that some dietary components are anti-inflammatory, but candidate acetyl donors have not been identified.

Speculative acetyl candidates may include the menthol relatives, such as menthyl acetate (figure). Peppermint oil, which contains mostly menthol with some menthyl acetate, is more effective in the treatment of inflammatory bowel disease than most pharmaceuticals prescribed to treat the condition. This anti-inflammatory activity may be due in part to the aspirin-like chemical structure and function of the menthyl acetate. Also note that acetic acid/vinegar is sometimes suggested as a cure-all. This activity may be a consequence of its formation of ester linkages with alcohols that have structures similar to menthol.

Large Dose Aspirin as Cancer Treatment

The potent anti-inflammatory effects of aspirin have been compromised, because inflammation is an essential developmental activity. Thus, the integrity of the gut, for example, requires modest production of inflammatory prostaglandins and a pill of aspirin can disrupt gut tissue. Large doses of aspirin cannot be given orally. Intravenous administration of large doses of aspirin, however, is possible and the impact on process that require inflammation is dramatic.

Anecdotal evidence indicates that large dose aspirin is able to disrupt cancers, because proliferation of cancer cells requires NFkB activation and other inflammatory responses. High doses of aspirin also cause other potentially dangerous complications, such as short-circuiting oxidative phosphorylation of mitochondria and increasing nitric oxide free radical production. Still, the impact of high dose aspirin on some diseases is so amazing that it is being actively and carefully pursued.


David said...

Dear Art,

Would you recommend taking one (or more) doses of aspirin daily to reduce inflammation? Would doing so amount to 'overkill' if one follows the Anti-inflammatory Diet fairly closely?

Dr. Art Ayers said...

I stay away from taking aspirin and other NSAIDs, because the enzyme that they inhibit, COX-2 is also needed to produce prostaglandins that are essential for normal renewal of the lining of the gut. Thus, NSAIDs contribute to leaky bowel syndrome, release of bacterial LPS and more systemic inflammation.

The Anti-Inflammatory Diet is much more effective and safer.

Thanks for your questions.

Laverne said...

Dear Art

I heard on a tv show that taking aspirins 81mg daily will stop imflammtion is this right?

Thanks Laverne

Dr. Art Ayers said...

See the post above. Aspirin and other NSAIDs inhibit development of the intestine wall. That't why they contribute to gut bleeding and ulcers. I do not recommend routine use of aspirin. It is more appropriate to eliminate the source of the inflammation and in most cases that is the result of diet, if the inflammation is chronic. Look at my suggestions for an anti-inflammatory diet and apply those first before using major interventions such as NSAIDs.

NSAIDs are not safe for routine use.

Thanks for your comments.

Brad Niemeyer said...

Dr. Ayers:

I'm gluten intolerant ( I test positive for anti-transglutaminase) and I deeply appreciate your blog.

I wonder are there any advantages to topical application of aspirin. I was thinking it might provide a way around the gut issues associated with aspirin.

Thanks for sharing your thoughts on inflammation

Mark E said...
This comment has been removed by the author.
Mark E said...

There are a lot of updated statistics for all of the cancers prevented by prophylactic aspirin use as well as cumulative risk for side effects. They are all summed up here if you want more resources: BreakingBio