I also happened to like aspirin especially baby aspirin and take it often (not every day though). My question is does taking it with a meal (as opposed in an empty stomach) mitigate the risk of internal bleeding (not worried about unexpected trauma or accidental injury as I NEVER engage in activities that have even remotely a chance of being hurt). Plus, would taking it with food (a baby aspirin) reduce its effectiveness?
@Kelman my doc told me if I took it with a meal it would reduce the chance of a gi bleed… but I just checked AI before passing this along, and it turns out my doc was wrong!
https://www.perplexity.ai/search/does-taking-baby-aspirin-with-ugGgEmneSAebTZqw3j7J6A
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Keep it in mind, because once you have atrial fib, you have to deal with it forever. I thought the dose was 2 grams?
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@KarlT I’m glad you mentioned this because I never knew it was a forever thing.
Now seems to be a good time to ask something I’ve always wondered about.
On the nutrition labels, it will usually say the total omegas and then it shows the breakdown of epa and/or dha.
For example
1000mg omegas
500 epa
200 dha
I’ve always assumed when figuring out a good dose, and keeping it under the risk threshold, that we only look at epa/dha, but should we be looking at the total omega number?
My understanding is the A. Fib risk is based on total fish oil. I have reduced my dose to 1 gram per day.
If someone develops A. Fib, they may always have it or intermittently have it, but it is assumed that it occurs at least once in awhile making the patient at risk for strokes, and may need to be on blood thinners.
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Thank you for this @KarlT
It gets so overwhelming… my omega index dropped to 5, so I just upped my dose and it seems I upped it too much for afib safety.… darned if I do and darned if I don’t… everything is such a balancing act!!
People who have a fib can wear a monitor and prove they don’t go into it again and not be on blood thinners.
One of my med school class mates went into a fib at 25. He did not go on blood thinners. I think they blamed sleep deprivation and caffeine but that isn’t a common thing for a 25 year old to do no matter what. He had a clean Cath at 53 or so.
If a fib can be blamed on something reversible or situational (like a good number of lung surgeries cause it), then the evidence to go on blood thinners is lessened. There are all sorts of algorithms but none are permanent blood thinners.
If you drove your omegas too high and went into a fib, I have to imagine that would be a reason to monitor but not necessarily blood thinners.
Lots of bariatric patients revert out of a fib with weight loss and come off blood thinners. Lots also get ablated with the same result. A fib isn’t great but is isn’t permanent necessarily.
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Here are the recommendations from the American Society of Anesthesiologists (of which I am a memeber) which I asked ChatGPT to summarize:
The American Society of Anesthesiologists (ASA) advises that many herbal supplements and non-prescription vitamins should be stopped before surgery, particularly when there is risk of bleeding or interaction with anesthesia. Their guidance is summarized in anesthesia and perioperative safety recommendations used by anesthesiologists and surgical teams.
General ASA recommendation
- Stop most herbal supplements 1–2 weeks before surgery.
- The reason is that supplements can:
- Increase bleeding risk
- Alter blood pressure or heart rate
- Interact with anesthetic drugs
- Change blood glucose or drug metabolism
A 7–14 day discontinuation window is commonly recommended so active compounds clear from the body and clotting function returns to baseline.
Supplements ASA and perioperative guidelines commonly recommend stopping
1. Supplements that increase bleeding risk
These are most relevant when the surgery has moderate–high bleeding risk.
Stop ~1–2 weeks prior unless instructed otherwise.
- Garlic
- Ginkgo biloba
- Ginseng
- Fish oil / omega-3
- Vitamin E
- Ginger
- Feverfew
- Dong quai
- Turmeric (often included due to antiplatelet effect)
These agents can inhibit platelet aggregation or coagulation, increasing intra-operative blood loss.
2. Supplements that interact with anesthesia or sedation
Typically stopped 1–2 weeks before surgery.
- St. John’s wort
- Valerian
- Kava
- Goldenseal
- Echinacea
These can potentiate or alter anesthetic drug metabolism, causing prolonged sedation or drug interactions.
3. Supplements affecting cardiovascular or metabolic stability
Also typically stopped 1–2 weeks pre-op.
- Ephedra (ma huang) – cardiovascular stimulation
- Licorice – blood pressure and potassium effects
- High-dose vitamin C – potential anesthetic metabolism effects
Typical perioperative stopping schedule (commonly used)
| Time before surgery | Action |
|---|---|
| 14 days | Stop most herbal supplements |
| 7 days | Stop vitamin E, fish oil, and most bleeding-risk supplements |
| 5–7 days | Stop NSAIDs (ibuprofen, naproxen) |
| 3–5 days | Some shorter-acting herbs (e.g., St. John’s wort in certain protocols) |
Actual timing depends on the specific supplement half-life and surgical bleeding risk.
Key ASA practical recommendation
Patients should provide a complete list of all supplements, herbs, vitamins, teas, and over-the-counter products to the anesthesiologist during the pre-operative evaluation so an individualized plan can be made.
Bottom line:
The ASA generally advises stopping herbal supplements and most non-essential vitamins 1–2 weeks before surgery, especially those that affect platelet function or coagulation (garlic, ginkgo, ginseng, fish oil, vitamin E) due to increased bleeding risk.
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Additionally we recommend withholding SGLT2 inhibitors since a fast is typically recommended for patients who will be undergoing general anesthesia or sedation, and there is a possibilty of euglygemic ketoacidosis in fasting patients or undergoing surgical stress.
We recommend withholding GLP1 agonists to decrease to risk of aspiration of gastric contents and subsequent pneumonitis. GLP1 agonists cause delayed gastic emptying times and the risk is for there to be retained gastric contents despite fasting.
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I had some excessive bleeding during my TURP procedure (coring out my prostate gland due to benign enlargement) despite stopping the Plavix I was taking, which meant I had to spend a miserable night in the hospital instead of going home after the procedure.
Turns out that ashwagandha also has blood thinning properties that I failed to investigate/anticipate, so I’d add that to the “stop list”, especially since it has grown so much in popularity in recent years.
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Thank you for sharing.
I think sometimes all of us might be a bit too arrogant, thinking we know better because we’re “into” this stuff. But a good lesson is to tell your doctors the truth, and to follow their instructions, especially for something critical like going into surgery. I’m sure it’s embarrassing to give them your massive list of supplements, self-prescribed medications etc - but it’s better than having some sort of adverse reaction or complication IMO. End of the day, you could be a drug addict, heroin user etc, and the doctors should still be going their best to help you, and this is information which they may need to know.
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I’m going in for cataract surgery in one eye. Regarding complications from supplements and off-label pharma, I always check with 2 different AIs to explore the possibilities of complications and of course this forum is invaluable. I appreciate the situation of physicians dealing with “nut cases” who take dozens of supplements and immune drugs (rapa) and hormones (E3). E3, its a female hormone, how is a physician supposed to have any idea what kind of weird effects it might have. I can understand a doc saying “Look unless you stop I can’t treat you. I can’t treat a person when I have no idea how these drugs/treatement will interact with E3 in a male” So my default position is to say I don’t take any supplements, etc, There could come a situation where I would but it would be a dire situation that I hope I never face. And I do not recommend anyone take this approach, it is dangerous, foolhardy, and arrogant, But I am not a compliant individual. I sail my own small ship on vast unknown oceans,
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There is rarely ANY blood loss in a standard cataract extraction. In fact, in many cases patients are allowed to continue routine anticoagulants preoperatively without any need to withhold them.
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This is interesting. I do take baby aspirin for primary prevention, but only because I have extraordinarily high lp(a). In my case, the benefit may outweigh the risk. But I will reduce my omega-3 and drop quercetin.
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Same here. No upside to disclosing your stack. But that puts increased responsibility on you - as it should be, you are in charge, the good and the bad. I had recent ACDF surgery. I literally stopped ALL meds and supplements, some 3 weeks before surgery, some just a week (statin). I carefully checked how long any given med stayed in the system, and gave myself a fat margin. Of course, I carefully researched all of them vs. surgery. So, as an example SGLT2i recommendation is to stop 3 days before the procedure. But SGLT2i effects can persist in the body up to 10 days. I gave myself 18 days break. Why so careful? Because as the surgeon and his team look over the list of meds on my file, I don’t want ANYTHING in my body that was not disclosed in my files, anything I took off label and not disclosed is long out of my system. That way they are fully informed without having a clue about my stack. Win-win. Btw., I’m equally careful coming back to my stack. Very careful and gradual return. As an example, I’m coming back to rapamycin only once 4 months have elapsed since the surgery - you have to ask yourself what impact the med will have on your particular surgery. Since I need my bones to fuse, I have to take a longer break on some meds, including rapa. You need to do the research, and proceed carefully with a substantial safety margin.
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Umm…I beg to differ. You would have to wear a permanent monitor and nobody does that.
Just realize that it’s not indicated.
Well to be 100% sure but life and medicine doesn’t work that way. You do a 30 day monitor or something like that.
I could be in a.fib right now - and I have no history of it. And I could die in a car accident in the next 30 min.
I suppose a wearable is another way to help give you more data. No one wants to trust these things like a medical device but I suspect they are at least 50% sensitive and that can be “permanently” worn.
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It’s not indicated, but the four studies that we do have suggest significant benefit for older individuals with high lp(a). But none were randomized controlled trials so nothing is proven. But if you have a blood clot, elevated lp(a) tends to enlarge it. Aspirin prevents platelets from sticking to the clot and further enlarging it. Or at least that’s the theory/hope.
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Hi: I take a very simular stack and a lot more. I sequence through them on a schedule. I use AI as well and have been involved in aging research for many years. Clinical researchers and biotech consultant. I am active on an invation only GRG board pluss a couple of others and have a websit you can review: Age-Regression.com. Glad your getting better. If you want to chat there are connectin links at the bottome of each page on my site.
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