Aspirin, COX-2 and Inflammation - Benefits and Side Effects

Willow trees contain salicin, which is related to aspirin.
Willow trees contain salicin, which is related to aspirin. | Source

When aspirin was first created it was hailed as a wonder drug for inflammation, pain and fever. It's still a very useful medication today. It has many health benefits and is a staple in many people's medicine cabinets. However, some people have moved to a different medication because aspirin has drawbacks as well as advantages.

Aspirin relieves inflammation due to its ability to inhibit an enzyme in the body called COX-2. Unfortunately, aspirin also inhibits the COX-1 enzyme. This inhibition can lead to stomach irritation and bleeding problems. Aspirin increases bleeding by decreasing the formation of blood clots. The reduction of blood clots may actually be helpful in people with cardiovascular disease. Aspirin may also be helpful in reducing the risk of some types of cancer, although this benefit is still being investigated.

A weeping willow tree in the spring
A weeping willow tree in the spring | Source

Salicin in Willow Bark - The Forerunner of Aspirin

Aspirin is chemically related to salicin, a chemical found in the inner bark of willow trees and also in some other plants. Willow bark has been used to treat pain and fever since ancient times. Salicin is turned into salicylic acid in our digestive tracts.

In the 1800s, scientists isolated salicin from willow trees. They converted it to salicylic acid, which was used as a medicine. However, the salicylic acid often caused severe stomach pain. German chemist Felix Hoffman, who worked for the Bayer company, is credited with the creation of aspirin in 1897. He converted salicylic acid into acetylsalicylic acid, also known as ASA or aspirin. Aspirin was found to cause less stomach pain than salicylic acid while still relieving other body pains and fever.

Types of White Blood Cells (Colorized)

Inflammation is a helpful process, provided it's short lived. During inflammation, white blood cells travel to the injured area to fight infection.
Inflammation is a helpful process, provided it's short lived. During inflammation, white blood cells travel to the injured area to fight infection. | Source

Inflammation

Inflammation is a normal body response to injury. When tissue is damaged by an infection, chemicals, physical trauma, heat or radiation, inflammation begins. Extra blood flows to the injured area, causing fluid to leak out of the blood vessels, resulting in heat, redness, swelling and pain. The blood and fluids contain white blood cells and proteins that destroy infectious organisms, such as bacteria and viruses. Inflammation helps to seal off the injured area from the rest of the body. In addition, damaged cells are destroyed and the repair of injured tissues begins.

Inflammation is uncomfortable but is normally a temporary process. This short-lived inflammatory response is known as acute inflammation. Acute inflammation subsides as pathogens are killed and body tissue is repaired. However, acute inflammation in certain parts of the body, such as in the brain, is very dangerous. Inflammation that lasts a long time (chronic inflammation) can also be serious and may lead to a variety of health problems.

The Heart and Blood Vessels

Extra blood flows to injured areas during the inflammatory response.
Extra blood flows to injured areas during the inflammatory response. | Source

How Aspirin Reduces Inflammation

There are several versions of the COX (cyclooxygenase) enzyme. The best known forms of the enzyme are COX-1 and COX-2. COX-1 is found in most of our cells. COX-2 is much less common but is found in increased amounts in inflamed areas.

The COX enzymes stimulate the body to make chemicals called prostaglandins. Different prostaglandins produce different effects. Some maintain normal body function, but others cause inflammation, pain and fever. COX-2 stimulates the production of inflammatory prostaglandins. Aspirin inhibits the manufacture of COX-2, thereby decreasing inflammation.

A red blood cell, an activated platelet and a white blood cell; activated platelets play an important role in blood clotting
A red blood cell, an activated platelet and a white blood cell; activated platelets play an important role in blood clotting | Source

Side Effects of Aspirin Use

Aspirin inhibits the COX-1 enzyme as well as the COX-2 enzyme. COX-1 stimulates the production of prostaglandins that maintain the mucus layer inside the stomach. This mucus layer protects the stomach lining from being attacked by the hydrochloric acid and digestive enzymes that are present in the stomach cavity. Without enough mucus in the stomach, a person taking aspirin may develop an inflamed stomach lining (gastritis) and ulcers (sores) on the lining.

Another function of COX-1 is to stimulate blood platelets to make thromboxane A2. This chemical triggers platelets to stick together around a wound, starting the clotting process. Since aspirin inhibits the production of COX-1, it also inhibits blood clotting. Wounds on the stomach lining and elsewhere may bleed more freely during treatment with aspirin.

Aspirin may have other effects in the body. It can cause kidney problems, since COX-1 is needed for normal kidney function. In addition, up to twenty percent of adults with asthma experience an asthma attack when they take aspirin. Aspirin can also cause tinnitus (ringing or other sounds in the ears in the absence of external sounds) or make existing tinnitus worse. In children with a viral disease, aspirin use may cause Reye’s syndrome, a very dangerous condition in which the brain and liver swell.

Aspirin may help to keep the heart healthy.
Aspirin may help to keep the heart healthy. | Source

Aspirin and Heart Attacks

Aspirin’s ability to reduce blood clotting can be a harmful side effect of the medication. It may be a helpful feature in some people, however. These include people at risk for developing blood clots in the heart, resulting in a heart attack, or blood clots in the carotid arteries traveling up the neck to the brain, which could lead to a stroke. Some doctors recommend that patients who have an increased likelihood of developing these disorders take a low dose of aspirin every day.

Some people with peripheral artery disease, or PAD, take aspirin to help their disorder. PAD usually affects arteries travelling to the legs. It's a condition in which an artery is narrowed by fatty deposits on the arterial lining. The narrowed passageway for blood flow increases the chance of a blood clot forming.

Aspirin and Cancer - Reports from Research Organizations

The National Cancer Institute has created a webpage about the link between aspirin and cancer risk.

The Fred Hutchinson Cancer Research Center website has a report on the links between aspirin, genetics and cancer risk.

Cancer Research UK has a webpage describing the link between chronic inflammation and cancer. It also speculates that aspirin may reduce cancer risk because it fights inflammation.

Aspirin and Cancer Risk

There is another possible benefit of aspirin which may be related to its ability to decrease inflammation. Aspirin may reduce the risk of some types of cancer, especially colorectal cancer. The picture is far from clear, however. In addition, as the video below points out, we shouldn’t expect aspirin to protect us from getting cancer if we perform activities known to promote the disease, such as smoking.

In March 2015, the Fred Hutchinson Cancer Research Center published their analysis of ten large population studIes. They concluded that regular aspirin intake is protective against colorectal cancer in most people. However, 9% of people in their study who had a particular genetic makeup received no benefit from taking aspirin with respect to cancer risk. In 4% of people with another type of genetic makeup, aspirin actually increased the risk of colorectal cancer. The center concludes that more research is needed and that they can't yet make a blanket recommendation that we all take aspirin to prevent cancer.

It will be interesting to see if researchers discover how aspirin works to protect people from cancer (if in fact it does) and whether this protection results from its ability to reduce inflammation, as Cancer Research UK speculates. There is evidence linking chronic inflammation to cancer development. It will also be interesting to discover why aspirin's action seems to depend on genetics.

Aspirin May Help to Prevent Cancer

Alternatives to Aspirin

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) are a group of chemicals that include aspirin and ibuprofen. Like aspirin, ibuprofen inhibits both COX-1 and COX-2. Acetaminophen (paracetamol) is not an NSAID. It's used to treat pain and fever, but unlike aspirin and ibuprofen, it only weakly inhibits the COX-2 enzyme and is not anti-inflammatory. Acetaminophen is believed to exert its effects by acting on the central nervous system.

New drugs have been created that inhibit COX-2 but not COX-1. These drugs don’t create stomach problems since they don’t inhibit the COX-1 enzyme. Unfortunately, some of them have been found to cause serious health problems, including an increased risk of heart attack, stroke and liver damage, and have been withdrawn from the market.

A Dietitian Discusses the Anti-Inflammatory Diet

Omega-3 fatty acids in foods such as wild salmon are a very healthy addition to an anti-inflammatory diet.
Omega-3 fatty acids in foods such as wild salmon are a very healthy addition to an anti-inflammatory diet. | Source

An Anti-Inflammatory Diet and Inflammation

Over the long-term, an anti-inflammatory diet can help to decrease chronic inflammation and reduce the need for anti-inflammatory medications. In an anti-inflammatory diet, foods known to increase inflammation should be avoided, or at least limited. These foods include saturated fats, refined grains, sugar and alcohol. Artificial trans fats and hydrogenated fats should be eliminated from the diet.

Fats containing omega-3 fatty acids have been shown to reduce inflammation. Oily fish such as wild salmon and sardines are good sources of omega-3 fatty acids known as EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). Foods such as walnuts and flax seeds contain a different form of omega-3 fatty acid. Our bodies can convert this form into EPA and DHA, although in limited amounts.

Extra virgin olive oil contains oleocanthal, which produces a stinging sensation in the throat just like ibuprofen does. It also lowers the levels of COX-1 and COX-2 like ibuprofen, reducing inflammation. The amount of olive oil that is normally ingested each day is equivalent to a weak dose of ibuprofen, but it’s believed that over time the regular consumption of extra virgin olive oil can decrease inflammation. Other substances that have been shown to reduce inflammation are green vegetables, berries, herbs and certain spices, especially ginger and turmeric.

Chronic inflammation contributes to many health problems. Some of these problems include rheumatoid arthritis, asthma and inflammatory bowel disease. If you have a disorder that involves inflammation, it’s certainly worth following an anti-inflammatory diet. This diet is healthy for everyone, whether or not a person is experiencing inflammation. Following the diet may enable you to reduce or even eliminate medications and their side effects. Don't stop taking a medication without a doctor's advice, though.

Berries are an important component of an anti-inflammatory diet.
Berries are an important component of an anti-inflammatory diet. | Source

Taking Aspirin

DO NOT start taking daily aspirin for any reason without consulting your doctor. Some people experience unpleasant and potentially dangerous side effects from aspirin use. People with certain medical conditions shouldn't take aspirin. In addition, there are drugs that shouldn't be combined with aspirin. The dose of aspirin that's taken is also an important point to consider.

It's very interesting that such an old medication as aspirin still has important uses, despite the creation of newer drugs. Aspirin is not ideal for everyone, but for some people it's a very helpful medicine.

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Comments 10 comments

kashmir56 profile image

kashmir56 5 years ago from Massachusetts

Hi AliciaC thank you for this great and well researched hub on aspirin . Some of it i did not know.


AliciaC profile image

AliciaC 5 years ago from British Columbia, Canada Author

Hi, kashmir56. Thanks for your comment. I enjoy researching how medications work in the body.


MartieCoetser profile image

MartieCoetser 5 years ago from South Africa

When my children were small the dangers of Aspirin were not known, and I’ve broken their fevers – in particular caused by tonsilitis – within minutes with only half of an aspro. Now I shudder when I read about the dangers. Thank heavens my children survived that. Thanks, Alicia, for this informative and excellent hub about Aspirin.


AliciaC profile image

AliciaC 5 years ago from British Columbia, Canada Author

Hi, Martie. Thanks for commenting. It’s scary how a medicine that can be so helpful can sometimes be so dangerous. Reye’s syndrome is considered to be a rare disease, but it's potentially fatal.


breakfastpop profile image

breakfastpop 5 years ago

Very informative hub. Aspirin is a miracle drug that is so often taken for granted. Of course, like anything else it must be taken properly.


AliciaC profile image

AliciaC 5 years ago from British Columbia, Canada Author

Hi, breakfastpop. Thank you for your comment. You're right - aspirin is very helpful but must be used carefully.


Moon Willow Lake profile image

Moon Willow Lake 5 years ago

Thank-you for this detailed information, and for describing the willow tree's part in all this.


AliciaC profile image

AliciaC 5 years ago from British Columbia, Canada Author

Thank you for the visit and the comment, Moon Willow Lake.


BlissfulWriter profile image

BlissfulWriter 4 years ago

We must have a some amount good fats everyday to keep inflammation down. I like to get them from avocados, sardines, salmon, and olives. I also take omega-3 and krill-oil supplements.


AliciaC profile image

AliciaC 4 years ago from British Columbia, Canada Author

Yes, I eat omega-3 fish, avocados and olive oil too, BlissfulWriter. I don't take omega-3 supplements because I prefer to get my good fats from food. Supplements would be good in some situations, though. Thank you very much for the visit and the comment.

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