Aspirin and Vitamin C

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Aspirin and Vitamin C
by Dr. Leo Galland

Aspirin (acetylsalicylic acid) has been around for over a hundred years and can be a useful drug for treating pain. Millions of people take low dose aspirin every day in an effort to prevent heart attacks or strokes. But aspirin can erode the lining of the stomach or intestines, causing internal bleeding, even at low doses.

Research on Aspirin and Vitamin C

Research studies done in Germany demonstrate that aspirin interferes with absorption of vitamin C and regular use of aspirin can deplete the gastrointestinal lining of vitamin C.





German researchers have shown that taking vitamin C along with aspirin can decrease the amount of stomach damage that aspirin produces in healthy humans and in patients with inflammation of the stomach caused by infection with Helicobacter pylori, a bacterium that causes ulcers.

No dietary supplement is guaranteed to prevent aspirin-induced gastrointestinal damage.

If you are taking aspirin, ask your doctor whether vitamin C might be good to take along with it.

REFERENCES AND ABSTRACTS

Eur J Pharmacol. 2004 Dec 15;506(2):169-77.Effect of vitamin C-releasing acetylsalicylic acid on gastric mucosal damage before and after Helicobacter pylori eradication therapy. Konturek PC, Kania J, Gessner U, Konturek SJ, Hahn EG, Konturek JW. First Department of Medicine, University Erlangen-Nuremberg, Germany.

The interaction between Helicobacter pylori (H. pylori) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as acetylsalicylic acid is still controversial. This study was designed to compare the effect of acetylsalicylic acid and vitamin C-releasing acetylsalicylic acid on the gastric mucosal damage and microbleeding before and after eradication of H. pylori in 10 young healthy volunteers. Acetylsalicylic acid induced significantly more gastric lesions and higher microbleeding than acetylsalicylic acid-vitamin C. After successful H. pylori eradication therapy, acetylsalicylic acid induced significantly higher mucosal lesions and microbleeding than before eradication. In contrast, after acetylsalicylic acid-vitamin C, gastric lesion index was significantly lower and eradication therapy failed to aggravate it. All H. pylori-positive subjects showed significant up-regulation of antioxidant enzyme (superoxide dismutase, catalase, glutathione peroxidase). Plain acetylsalicylic acid stronger than acetylsalicylic acid-vitamin C reduced gastric gene expression of these antioxidant enzymes. H. pylori eradication significantly decreased expression of these enzymes and this was further enhanced by plain acetylsalicylic acid, but not acetylsalicylic acid-vitamin C. Under plain acetylsalicylic acid therapy, the expression of proinflammatory cytokines was increased before and after eradication of H. pylori. We conclude that vitamin C combined with acetylsalicylic acid, unlike plain acetylsalicylic acid without vitamin C, protects gastric mucosa in man probably due the attenuation of oxidative stress and proinflammatory cytokines.

Int J Clin Pharmacol Ther. 2004 Sep;42(9):481-7.Effects of acetylsalicylic acid on ascorbic acid concentrations in plasma, gastric mucosa, gastric juice and urine–a double-blind study in healthy subjects.Schulz HU, Schürer M, Krupp S, Dammann HG, Timm J, Gessner U LAFAA Laboratory for Contract Research in Clinical Pharmacology and Biopharmaceutical Analytics GmbH, Bad Schwartau, Germany. lafaa_gmbh@t-online.de

OBJECTIVE: This study investigated concentrations of ascorbic acid (ASC) in gastric mucosa, gastric juice, urine and plasma in healthy subjects under steady state and fasted conditions with and without concomitant administration of acetylsalicylic acid (ASA). MATERIAL AND METHODS: This was a prospective, randomized, double-blind, parallel-group study in healthy subjects. It has assessed the effects of a 6-day administration of 0.8 g ASA or 0.48 g ASC, 3 times daily and the combination of both on concentrations of ASC in gastric mucosa, gastric juice, urine and plasma. Treatments were switched after 6 days without any washout for assessment of compartment sensitivity to changes in study medication resulting in an overall 14-day study period. Each of the 3 treatment groups consisted of 15 subjects. RESULTS: ASC concentrations were highest in the gastric mucosa (251+/-11 microg/g), followed by gastric juice (29+/-6 microg/ml), plasma (10+/-0.2 microg/ml), and urine (5+/-1 microg/ml). On day 7, ASC concentrations in gastric mucosa, plasma and urine had increased in those groups receiving ASC and decreased in the group receiving ASA only. All differences were statistically significant and indicate an interaction with ASA. In gastric juice, differences in ASC concentrations between the treatment groups were not statistically significant between baseline and day 7. ASC concentrations in plasma were strongly correlated with corresponding ASC concentrations in gastric mucosa (r = 0.34) and urine (r = 0.83), as were ASC concentrations in gastric mucosa with ASC in urine (r = 0.28). CONCLUSIONS: The gastric mucosa is the largest depot of ASC in the human body with ASC concentrations 25 times higher than in plasma. In healthy subjects, clinically relevant doses of ASA reduced ASC concentrations in gastric mucosa by about 10% within 6 days resulting from antioxidative defense mechanisms. In patients with long-term ASA treatment or conditions with additional risks such as elderly subjects with unfavorable dietary conditions and impaired antioxidative protection, a protective adjunct administration of ASC appears to be beneficial.

Int J Vitam Nutr Res Suppl. 1982;23:83-90.Vitamin C-aspirin interactions.Basu TK.
The effect of soluble aspirin on the availability of vitamin C has been studied in guinea-pigs and human subjects. In the human study, the concentrations of vitamin C in plasma, leucocytes and urine were found to be markedly elevated at various intervals following administration of a single oral dose of 500 mg of the vitamin. The vitamin C-associated increases, however, appeared to be blocked when the vitamin was given simultaneously with aspirin (900 mg). Similar findings were observed in guinea-pigs, where in addition faecal excretion of vitamin C was found to be significantly increased when the vitamin was administered together with aspirin. These results suggest that aspirin may impede gastrointestinal absorption of vitamin C. This hypothesis has been strengthened with in vitro studies using everted gut sac preparations where both the serosal/mucosal concentration gradient and the uptake of vitamin C per unit weight of intestine were markedly lowered by acetyl-salicylate. Such an interaction is relevant to the population where vitamin C intake is borderline.

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