Stick with low Aspirin dose

Dear Dr. Roach: My newspaper recently ran an article on the pros and cons of a daily Aspirin for protection against both heart disease and colon cancer. This is not a new topic, I realize, and I know that the benefits of daily Aspirin apply only to certain segments of the population.

Here’s my question: If a person doesn’t experience any stomach or bleeding issues, does a much higher dose of Aspirin daily also convey the same possibly protective effects? I already take an average of nine 325-mg generic Aspirin tablets daily for leg pain. I’m in the 50-59 age group, and there is heart disease on both sides of my family, so I’m hoping this dose confers some cardiac benefit.

I would love to find a cure for the deep ache I get in my legs — usually just the right calf. I’ve had these since I was a child, and I’ve reconciled myself to the fact that I will have them for the rest of my life, but the Aspirin I take has never caused me stomach pain or excessive bleeding, and it works for the pain.

T.P. The studies showing that taking Aspirin protects the heart mostly have been done using 81 mg daily or 325 mg every other day. However, the mechanism of the action, preventing platelets from forming a clot, is even stronger at higher doses, so it would make sense that higher doses would be at least as effective.

However, they are much more likely to cause bleeding, even if most people can take higher doses without problems.

So it’s recommended you take the minimum effective dose to get the benefit with the least harm. In your case, however, I think you are likely getting all the benefit there may be.

I say “may be” because recent studies have failed to replicate the protection seen in earlier studies. I still believe that Aspirin is useful in people at higher-thanaverage risk for heart disease.

More and more evidence is coming out that the same low dose of Aspirin helps protect against several forms of cancer, especially of the colon. However, I don’t yet recommend it just to protect against cancer, but I will continue to pay careful attention to ongoing studies on Aspirin and will revisit this topic when more research becomes available.

Dear Dr. Roach: In a recent test, my blood vitamin D level was good, at 43, but my calcitriol level was low at 16. I do have hyperglycemia, but how do I increase my calcitriol level? I take no medications.

J.I. If you don’t have kidney or parathyroid hormone problems, then calcitriol isn’t the right blood test to determine your bone health relative to vitamin D. Calcitriol is an activated form of vitamin D, and it best reflects calcium intake. I suspect low calcium intake when I see a high calcitriol. Since calcitriol removes calcium from the bones, it may worsen osteoporosis.

If you haven’t had your kidneys and parathyroid hormone level (which also affects calcium movement in the kidney and bones) checked recently, then do so.

If those are OK, then be sure to get enough calcium, especially from dietary sources like leafy green vegetables.