It is an effective pain reliever and has been linked to reduced risk of a number of health conditions, including heart attack, stroke and cancer. But is aspirin really the "wonder drug" many health experts claim it is?

Earlier this month, it was announced that researchers from the UK would be embarking on the biggest clinical trial of aspirin to date - the Add-Aspirin phase 3 trial - investigating whether the drug is effective for preventing cancer recurrence through a study of around 11,000 people.

The announcement has caused much excitement in the medical world, with many health experts claiming the trial could be "game-changing" if the drug is found effective, offering a non-expensive strategy to improve survival for cancer patients.

Cancer is just one in a long line of illnesses that aspirin may combat. But in the midst of potential health benefits comes a number of risks, a fact some health professionals believe is often overlooked.

"Because it's been around a long time people think 'it must be safe and it can't do me any harm,'" Prof. Peter Weissberg, medical director of the British Heart Foundation in the UK, told The Independent. "They are taking it 'just in case,' but it's much more dangerous than some other drugs which people get concerned about, like statins."

In this Spotlight, we take a closer look at the potential health benefits of aspirin, as well as the risks associated with the drug.
Aspirin: one of the most commonly used drugs worldwide

Aspirin is a drug that was developed by German research chemist Felix Hoffman, of pharmaceutical company Bayer, in 1897.

Hoffman created aspirin by developing a process to synthesize acetylsalicylic acid (ASA) - a synthetic derivative of a compound called salicin, which is found naturally in plants such as the willow tree.

Early clinical trials of aspirin found it was an effective treatment for pain, fever and inflammation. It is believed the drug produces these effects by inhibiting the production of pain-producing chemicals called prostaglandins. As such, aspirin is commonly used to help ease headache, muscle pain, toothaches and common colds, as well as swelling in arthritis.

More recently, however, researchers have discovered aspirin may also be an effective blood thinner, preventing the formation of blood clots in the arteries by blocking the production of a prostaglandin called thromboxane, which plays a key role in blood clotting.

As such, studies have shown daily aspirin therapy may lower the risk for heart attack and stroke, and it is often recommended for adults at high risk for these conditions.
The possible risks of aspirin use

However, as with any drug, there is a risk for side effects with regular aspirin use.

One of the most severe side effects of regular aspirin use is gastrointestinal bleeding, which can raise the risk of developing a stomach ulcer. If one already has a stomach ulcer, taking aspirin could cause further bleeding and be potentially life-threatening.

Aspirin may also interact with other drugs and increase risk of internal bleeding, particularly drugs with anti-clotting properties, such as warfarin, apixaban and dabigatran. Taking aspirin with some dietary supplements, such as evening primrose oil and fish oil, may also raise internal bleeding risk.

Some individuals are allergic to aspirin, with people who have asthma most at risk. An allergic reaction to the drug may cause swelling of the lips, mouth or throat, breathing problems and a skin rash.

Other side effects of aspirin include headache, nausea and vomiting, tinnitus and bruising.

Some studies have linked aspirin use with increased risk for other health conditions. In 2013, for example, a study published in JAMA Internal Medicine suggested long-term use of the drug may increase the risk of age-related macular degeneration - the primary cause of blindness among older adults.

Previous research has also linked aspirin use to greater risk for Reye's syndrome - a rare disorder characterized by swelling in the brain and liver, most common among children and teenagers.

Despite these potential risks, however, aspirin has become one of the most widely used over-the-counter drugs around the globe; more than 100 million standard aspirin tablets are produced every year.

But people are not just using the drug to relieve the odd headache or cold. It seems aspirin is growing in popularity as more people are taking the drug regularly with the aim of preventing numerous health conditions for which studies have suggested it is effective against.
Aspirin and heart health

As mentioned previously, one of the many benefits of aspirin is believed to be its ability to prevent the formation of blood clots.

Last year, Medical News Today reported on a study by researchers from Australia that found individuals with venous thromboembolism (VTE) - a condition comprised of deep vein thrombosis (blood clots in the legs) and pulmonary embolism (in which a blood clot breaks off and travels to the lungs) - saw a 42% reduction in blood clot recurrence with a 100-mg dose of aspirin daily.

This and numerous other studies hailing the anticoagulant properties of aspirin have led to recommendations that people at high risk for heart attack or stroke may benefit from daily aspirin therapy.

The American Heart Association (AHA), for example, recommend daily low-dose aspirin - under the instruction of a health care provider - for heart attack survivors and others at high risk of heart attack.

Getting enough calcium and vitamin D is essential to building strong, dense bones when you're young and to keeping them strong and healthy as you age. The information included here will help you learn all about calcium and vitamin D - the two most important nutrients for bone health.


Calcium is a mineral that is necessary for life. In addition to building bones and keeping them healthy, calcium helps our blood clot, nerves send messages and muscles contract . About 99 percent of the calcium in our bodies is in our bones and teeth. Each day, we lose calcium through our skin, nails, hair, sweat, urine and feces, but our bodies cannot produce new calcium.

That’s why it’s important to try to get calcium from the food we eat. When we don’t get enough calcium for our body’s needs, it is taken from our bones.

    Too many Americans fall short of getting the amount of calcium they need every day and that can lead to bone loss, low bone density and even broken bones.

How Much Calcium Do You Need?

The amount of calcium you need every day depends on your age and sex.

Women

Age 50 & younger
    

1,000 mg* daily

Age 51 & older
    

1,200 mg* daily

Men

Age 70 & younger
    

1,000 mg* daily

Age 71 & older
    

1,200 mg* daily

*This includes the total amount of calcium you get from food and supplements.


    How Much Calcium Do You Need?

    Use the International Osteoporosis Foundation's Calcium Calculator to find out.

Sources of Calcium
Calcium-Rich Food Sources

Food is the best source of calcium. Dairy products, such as low-fat and non-fat milk, yogurt and cheese are high in calcium. Certain green vegetables and other foods contain calcium in smaller amounts. Some juices, breakfast foods, soymilk, cereals, snacks, breads and bottled water have calcium that has been added. If you drink soymilk or another liquid that is fortified with calcium, be sure to shake the container well as calcium can settle to the bottom.

    A simple way to add calcium to many foods is to add a single tablespoon of nonfat powdered milk, which contains about 50 mg of calcium. About two-to-four tablespoons can be added to most recipes.

Reading Food Labels - How Much Calcium am I Getting?

To determine how much calcium is in a particular food, check the nutrition facts panel of the food label for the daily value (DV) of calcium. Food labels list calcium as a percentage of the DV. This amount is based on 1,000 mg of calcium per day. For example:

    30% DV of calcium equals 300 mg.
    20% DV of calcium equals 200 mg of calcium.
    15% DV of calcium equals 150 mg of calcium.

Calcium Supplements

The amount of calcium you need from a supplement depends on the amount of calcium you get from food. Aim to get the recommended daily amount of calcium you need from food first and supplement only if needed to make up for any shortfall. If you get enough calcium from the foods you eat, then you don’t need to take a supplement. In fact, there is no added benefit to taking more calcium than you need in supplements and doing so may even have some risks.  

In general, you shouldn’t take supplements that you don’t need. Calcium supplements are available without a prescription in a wide range of preparations (including chewable and liquid) and in different amounts. The best supplement is the one that meets your needs based on convenience, cost and availability. When choosing the best supplement to meet your needs, keep the following in mind:

    Choose brand-name supplements with proven reliability. Look for labels that state “purified” or have the USP (United States Pharmacopeia) symbol. The “USP Verified Mark” on the supplement label means that the USP has tested and found the calcium supplement to meet certain standards for purity and quality.
    Read the product label carefully to determine the amount of elemental calcium, which is the actual amount of calcium in the supplement, as well as how many doses or pills to take. When reading the label, pay close attention to the “amount per serving” and “serving size.”
    Calcium is absorbed best when taken in amounts of 500 – 600 mg or less. This is the case when you eat calcium rich foods or take supplements. Try to get your calcium-rich foods and/or supplements in smaller amounts throughout the day, preferably with a meal. While it's not recommended, taking your calcium all at once is better than not taking it at all.
    Take most calcium supplements with food. Eating food produces stomach acid that helps your body absorb most calcium supplements. The one exception to the rule is calcium citrate, which can absorb well when taken with or without food.
    When starting a new calcium supplement, start with a smaller amount to better tolerate it. When switching supplements, try starting with 200-300 mg every day for a week, and drink an extra 6-8 ounces of water with it. Then gradually add more calcium each week.
    Side effects from calcium supplements, such as gas or constipation may occur. If increasing fluids in your diet does not solve the problem, try another type or brand of calcium. It may require trial and error to find the right supplement for you, but fortunately there are many choices.
    Talk with your healthcare provider or pharmacist about possible interactions between prescription or over-the-counter medications and calcium supplements.

What is Vitamin D and What Does it Do?

Vitamin D plays an important role in protecting your bones and your body requires it to absorb calcium. Children need vitamin D to build strong bones, and adults need it to keep their bones strong and healthy. If you don't get enough vitamin D, you may lose bone, have lower bone density, and you're more likely to break bones as you age.
How Much Vitamin D Do You Need?

Women and Men

Under age 50
    400-800 international units (IU) daily**

Age 50 and older
    800-1,000 IU daily**

 **Some people need more vitamin D. According to the Institute of Medicine (IOM), the safe upper limit of vitamin D is 4,000 IU per day for most adults.
Sources of Vitamin D

There are three ways to get vitamin D:

    Sunlight
    Food
    Supplements

Sunlight

Your skin makes vitamin D from the ultra-violet light (UVB rays) in sunlight. Your body is able to store the vitamin and use it later. The amount of vitamin D your skin makes depends on time of day, season, latitude, skin pigmentation and other factors. Depending on where you live, vitamin D production may decrease or be completely absent during the winter.

Because of concerns about skin cancer, many people stay out of the sun, cover up with clothing and use either sunscreen or sunblock to protect their skin. The use of sunscreen or sunblock is probably the most important factor that limits the ability of the skin to make vitamin D. Even an SPF (sun protection factor) of 8 reduces the production of vitamin D by 95 percent. Because of the cancer risk from the sun, most people need to get vitamin D from other sources, including eating foods rich in vitamin D and taking vitamin D supplements.
Food

Vitamin D is naturally available in only a few foods, including fatty fish like wild-caught mackerel, salmon and tuna. Vitamin D is also added to milk and to some brands of other dairy products, orange juice, soymilk and cereals.

Check the food label to see if vitamin D has been added to a particular product. One eight ounce serving of milk usually has 25% of the daily value (DV) of vitamin D. The DV is based on a total daily intake of 400 IU of vitamin D. So, a serving of milk with 25% of the DV of vitamin D contains 100 IU of the vitamin.

It is very difficult to get all the vitamin D you need from food alone. Most people need to take vitamin D supplements to get enough of the nutrient needed for bone health.
Supplements

If you aren't getting enough vitamin D from sunlight and food, consider taking a supplement. But, before adding a vitamin D supplement, check to see if any of the other supplements, multivitamins or medications you  take contain vitamin D. Many calcium supplements also contain vitamin D.

There are two types of vitamin D supplements. They are vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Both types are good for bone health.

Vitamin D supplements can be taken with or without food. While your body needs vitamin D to absorb calcium, you do not need to take vitamin D at the same time as a calcium supplement. If you need help choosing a vitamin D supplement, ask your healthcare provider or pharmacist to recommend one.

    How Much Vitamin D Should You Supplement?

    To figure out how much vitamin D you need from a supplement, subtract the total amount of vitamin D you get each day from the recommended total daily amount for your age. For example, a 55 year old woman who gets 400 IU of vitamin D from her calcium supplement should take between 400 and 600 additional IU of vitamin D to meet the 800 - 1,000 IU recommended for her age.

Vitamin D Deficiency: Are You at Risk?

Vitamin D deficiency occurs when you are not getting the recommended level of vitamin D over time. Certain people are at higher risk for vitamin D deficiency, including:

    People who spend little time in the sun or those who regularly cover up when outdoors;
    People living in nursing homes or other institutions or who are homebound;
    People with certain medical conditions such as Celiac disease and inflammatory bowel disease;
    People taking medicines that affect vitamin D levels such as certain anti-seizure medicines;
    People with very dark skin;
    Obese or very overweight people; and
    Older adults with certain risk factors.

Talk to your healthcare provider if you meet any of these risk factors or  think you might be at risk of vitamin D deficiency. If you have osteoporosis and also have a vitamin D deficiency, your healthcare provider may temporarily prescribe a higher dose of vitamin D.

L-carnitine is a derivative of the amino acid, lysine. Its name is derived from the fact that it was first isolated from meat (carnus) in 1905. Only the L-isomer of carnitine (Figure 1) is biologically active. Carnitine is a substance that helps the body turn fat into energy. Your body makes it and stores it in the skeletal muscles, heart, brain, and sperm.
Usually, your body can make all the carnitine it needs. Some people, however, may not have enough carnitine because their bodies cannot make enough or can’t transport it into tissues so it can be used.
Some of the conditions carnitine may help treat are:
1- Heart Conditions
• Angina -- Some good evidence shows that carnitine can be used along with conventional treatment for stable angina. Several clinical trials show that L-carnitine can help reduce symptoms of angina and improve the ability of people with angina to exercise without chest pain. Do not self-treat chest pain with carnitine, however. See your health care provider for diagnosis and conventional treatment, and take carnitine only under your health care provider's supervision.
• Heart attack -- A few studies have found that carnitine may help when used with conventional medicines after a heart attack, but not all studies agree. Some small studies suggest that people who take L-carnitine supplements soon after a heart attack may be less likely to have another heart attack, die of heart disease, have chest pain and abnormal heart rhythms, or develop heart failure. However, other studies have shown no benefit. Treatment with oral carnitine may also improve muscle weakness. Carnitine should be used along with conventional medication under your health care provider supervision.
• Heart failure -- A few small studies have suggested that carnitine can help reduce symptoms of heart failure and improve exercise capacity in people with heart failure. However, more and larger studies are needed to know for sure.
2- Peripheral Vascular Disease
Decreased blood flow to the legs (called Peripheral Vascular Disease or PVD) from atherosclerosis or hardening of the arteries -- where plaque builds up in the arteries -- often causes an aching or cramping pain in the legs while walking or exercising (called intermittent claudication). Several studies show that carnitine can help reduce symptoms and increase the distance that people with intermittent claudication can walk.
3- Diabetic Neuropathy
Diabetic neuropathy happens when high blood sugar levels damage nerves in the body, especially the arms, legs, and feet, causing pain and numbness. Some small preliminary studies suggest acetyl-L-carnitine may help reduce pain and increase feeling in affected nerves. It is also possible that carnitine can help nerves regenerate. More research is needed.
4- Exercise Performance
Although carnitine is often taken to boost exercise performance, more research is needed
5- Weight Loss
Some studies do show that oral carnitine reduces fat mass, increases muscle mass, and reduces fatigue, which may contribute to weight loss in some people.
6- Alzheimer's Disease and Memory Impairment
Several early studies showed that acetyl-L-carnitine, might help slow down the progression of Alzheimer's disease, relieve depression related to senility and other forms of dementia, and improve memory in the elderly. People should take carnitine for Alzheimer's and other forms of dementia only under the supervision of their health care provider.
7- Kidney Disease and Dialysis
Because the kidneys make carnitine, kidney disease could lead to low levels of carnitine in the body. If you have kidney disease, your health care provider may prescribe carnitine -- but you shouldn’t take it without medical supervision.
8- Male Infertility
Low sperm counts have been linked to low carnitine levels in men. Several studies suggest that L-carnitine supplements may increase sperm count and mobility.
9- Erectile Dysfunction
Preliminary studies suggest propionyl-L-carnitine may help improve male sexual function. One study found that carnitine improved the effectiveness of sidenafil (Viagra) in men with diabetes who had not previously responded to Viagra. In another study, a combination of propionyl-L-carnitine and acetyl-L-carnitine improved the effectiveness of Viagra in men who had erectile dysfunction after prostate surgery. More studies are needed.
10- Hyperthyroidism
Some research suggests that L-carnitine may help prevent or reduce symptoms of an overactive thyroid, such as insomnia, nervousness, heart palpitations, and tremors. A larger, better-designed clinical trial is needed.
Dietary Sources
Red meat (particularly lamb) and dairy products are the main food sources of carnitine. It can also be found in fish, poultry, wheat, asparagus, avocados, and peanut butter.
Available Forms
Carnitine is available as a supplement in a variety of forms.
• L-carnitine: the most widely available and least expensive
• Acetyl-L-carnitine: Often used in studies for Alzheimer's disease and other brain disorders
• Propionyl-L-carnitine: Often used in studies for heart disease and peripheral vascular disease
Avoid D-carnitine supplements. They interfere with the natural form of L-carnitine and may produce unwanted side effects.
How to Take It
Pediatric
Don’t give carnitine supplements to a child without your child's health care provider's supervision.
Adult
Recommended doses of L-carnitine vary depending on the health condition being treated. The usual dose is between 1 - 3 g per day.
Precautions
You should take L - carnitine only under the supervision of a knowledgeable health care provider.
Side effects are generally mild. High doses (5 or more grams per day) may cause diarrhea. Other rare side effects include increased appetite, body odor, and rash.
Possible Interactions
Zidovudine -- In a laboratory study, L-carnitine supplements protected muscle tissue against toxic side effects from Zidovudine, a medication used to treat HIV and AIDS. More studies are needed to know whether L-carnitine would have the same effect in people.
Doxorubicin -- Treatment with L-carnitine may protect heart cells against the toxic side effects of doxorubicin, a chemotherapy medication used to treat cancer, without making the medication any less effective. Always talk to your oncologist before using any complementary or alternative therapy with chemotherapy.
Isotretinoin (Accutane) -- Accutane, a strong medication used for severe acne, can cause liver problems, as well as high cholesterol and muscle pain and weakness. These symptoms are like those seen with carnitine deficiency. Researchers in Greece showed that a large group of people who had side effects from Accutane got better when taking L-carnitine compared to those who took a placebo.
Thyroid hormone -- Carnitine may stop thyroid hormone from getting into cells, and theoretically may make thyroid hormone replacement less effective. If you take thyroid replacement hormone, talk to your health care provider before taking carnitine.
Valproic acid (Depakote) -- The anti-seizure medication valproic acid may lower blood levels of carnitine. Taking L-carnitine supplements may reduce the side effects of valproic acid. However, taking carnitine may increase the risk of seizures in people with a history of seizures.
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