ArticleLiterature Review

Risks and benefits of salicylates in food: a narrative review

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Abstract

Salicylates are generally present in plants as part of their defense system against pathogens and environmental stress. Major dietary sources of salicylates were found in spices and herbs, such as curry and paprika (hot powder). Several studies suggest that these natural salicylates offer health benefits in the human body, such as antidiabetic, anticancer, antiviral, and anti-inflammatory properties. However, despite their advantages, salicylates can be harmful to people with allergies, and high doses of salicylates may cause respiratory alkalosis and gastrointestinal bleeding. Additionally, salicylates can interact with certain drugs, such as nonsteroidal anti-inflammatory drugs and warfarin. This narrative review aimed to consolidate recent information on the content of salicylates in food based on the literature, while also highlighting the benefits and risks associated with salicylate consumption in humans. Based on the literature review and analysis of results, it can be concluded that the dietary intake of salicylates in vegetarians can be relatively high, resulting in concentrations of salicylic acid in the blood and urine that are comparable to those observed in patients taking a low dose of aspirin (75 mg). This suggests that a diet rich in salicylates may have potential benefits in preventing and treating some diseases that require low doses of aspirin.

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... Similarly, in a study by Hammad et al. (2021) [54], salicylic acid was found among the phenolic acids present in the highest concentration in an apple pomace extract. Salicylic acid is another polyphenol with a defensive role in plants and with health benefits for the human body, like antidiabetic, anticancer, antiviral, and anti-inflammatory effects [55]. ...
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A method is developed for qualitative analysis of ginkgolic acids in the leaves and fruits of Ginkgo biloba by high-performance liquid chromatography (HPLC)-electrospray ionization-mass spectrometry technique. Negative ionization mode is successful in obtaining a very abundant deprotonated molecule [M - H]-. The mass detection sensitivity is higher than ultraviolet detection but relies heavily on the concentration of acetic acid in the HPLC eluent, which consists of acetonitrile-water-acetic acid. The method is also very specific for the analysis of ginkgolic acid with no interferences from the sample matrix.
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Background This study aimed to determine the incidence, as well as evaluate risk factors, and impact of gastrointestinal bleeding on outcomes and resource use in patients admitted for salicylate poisoning. Methods We used the National Inpatient Sample to construct a cohort of patients hospitalized primarily for salicylate poisoning from 2003-2014. We compared clinical characteristics, in-hospital treatments, outcomes, and resource use between salicylate poisoning patients with and without gastrointestinal bleeding. Results Of 13,805 hospital admissions for salicylate poisoning, gastrointestinal bleeding occurred in 482 (3.5%) admissions. The risk factors for gastrointestinal bleeding included older age, history of atrial fibrillation, and cirrhosis. After adjusting for difference in baseline characteristics, patients with gastrointestinal bleeding required more gastric lavage, gastrointestinal endoscopy, invasive mechanical ventilation, red blood cell transfusion. Gastrointestinal bleeding was significantly associated with increased risk of anemia, circulatory, liver, and hematological failure but was not significantly associated with increased in-hospital mortality. The length of hospital stay and hospitalization cost was significantly higher in patients with gastrointestinal bleeding. Conclusion Gastrointestinal bleeding occurred in about 4% of patients admitted for salicylate poisoning. Gastrointestinal bleeding was associated with higher morbidity and resource use but not mortality.
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The study aimed to determine the salicylates content in 112 products available on the European market. Quantitative determination of free and conjugated forms of salicylic acid (SA) in food was performed using reversed phase high-performance liquid chromatography (RP-HPLC) with fluorescence detection. The salicylates contents ranged from 0 to 1675.79 (µg/100 g). The results of this study confirm the presence of salicylates in food products, as well as a broad content diversity of these compounds depending on the species, variety and method of processing of food items. The results can be very helpful for nutritionists, dieticians in planning low-salicylates or high-salicylates diets.
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Bioactive food chemicals are substances present in food that are capable of interacting with living cells causing changes in physiological functions. Salicylic acid (SA), a plant hormone involved in plant immune response, is one such bioactive food chemical. Aspirin, a commercially available SA, might play beneficial roles in cardiovascular health and colon cancer. It may also cause urticaria, angioedema, asthma, and gastrointestinal symptoms in SA-sensitive individuals. Dietary SA might exert similar beneficial effects and/or may induce similar symptoms in hypersensitive individuals. Food-related SA sensitivity in relation to gastrointestinal symptoms is not well documented besides a few self-reported questionnaires and the knowledge that low doses of aspirin (equivalent of high dietary intake) can cause gastrointestinal injury. The only direct evidence that suggests benefits of reducing dietary SA was reported in asthmatic individuals. Although SA sensitivity in relation to gut symptoms in susceptible individuals is accepted by clinicians, the detection of this disease remains a challenge because of the complicated nature of dietary challenges and the risk of oral aspirin provocation tests in patients with severe hypersensitivity reactions. Given the non-IgE mediated nature of the disease, in vitro assays like basophil activation may have failed to produce reliable results. However, given the simplicity of this assay, further studies need to be formulated to firmly establish its reliability. Formulation of proper dietary strategies for symptom control is also impossible given the controversial and scant nature of the data on SA content of food. This issue needs to be resolved to formulate proper dietary strategies for effective symptom control.
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Aim To compare amounts of salicyluric acid (SU) and salicylic acid (SA) excreted daily in the urine of non-vegetarians and vegetarians not taking salicylate drugs, and patients taking 75 or 150 mg aspirin/day. Methods Urine excreted over 24 hours was collected from volunteers in the four groups. The volumes were recorded and the concentrations of SU and SA were determined electrochemically after separation by high performance liquid chromatography. Results Significantly more SU was excreted daily by vegetarians (median, 11.01; range, 4.98–26.60 μmol/24 hours) than by non-vegetarians (median, 3.91; range, 0.87–12.23 μmol/24 hours), although amounts were significantly lower than those excreted by patients taking aspirin. Median amounts of SU excreted by patients taking 75 and 150 mg/day of low dose aspirin were 170.69 (range, 13.15–377.18) μmol/24 hours and 165.17 (range, 5.61–429.12) μmol/24 hours, respectively. The amount of SU excreted by patients taking either 75 or 150 mg of aspirin/day was not significantly different. Significantly more SA was excreted by vegetarians (median, 1.19; range, 0.02–3.55 μmol/24 hours) than by non-vegetarians (median, 0.31; range, 0.01–2.01 μmol/24 hours). The median amounts of SA excreted by vegetarians and the patients taking aspirin were not significantly different. Conclusions More SU and SA is excreted in the urine of vegetarians than in non-vegetarians, consistent with the observation that fruits and vegetables are important sources of dietary salicylates. However, significantly less SU was excreted by vegetarians than patients taking aspirin, indicating that the daily intake of bioavailable salicylates by vegetarians is considerably lower than that supplied by a single 75 or 150 mg dose of aspirin.
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The incidence of complex noncommunicable diseases has strongly increased over the last several decades in the US, Europe and other parts of the world that have adopted a western lifestyle (M. Ezzati, E. Riboli, Science­ 2012, 337, 1482–1487; S. Smyth, A. Heron, Nat. Med.­ 2006, 12, 75). Despite considerable investment in the development of new types of drugs, options for the treatment of many common diseases remain inadequate. If current trends prevail, the rising incidence of disorders such as obesity and type 2 diabetes mellitus (T2DM) will soon result in an unsustainable burden on society (World Health Organization Technical Report Series­ 2000, 894, i–xii, 1–253). Given the difficulty of treating fully developed complex disorders, new strategies for early intervention and prevention of common diseases are of great interest. Dietary natural products with beneficial effects, such as the recently described antidiabetic and lipid-lowering amorfrutins, could pave the way for efficiently treating and preventing metabolic and other complex diseases (C. Weidner, et al. Proc. Natl. Acad. Sci. USA­ 2012, 109, 7257–7262).
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The salicylic acid concentration in a range of fresh and canned fruit and vegetables was determined using a sensitive spectrofluorimetric technique. Concentrations in fresh fruit ranged from 0.02 mg kg-1 in kiwifruit to 0.10 mg kg-1 in New Zealand grapefruit, and in fresh vegetables from 0.01 mg kg-1 in cabbage to 0.10 mg kg-1 in whole kernel sweet corn. In canned products, salicylic acid levels ranged from 0.01 mg kg-1 in pears to 0.82 mg kg-1 in cream-style sweet corn. Canned sweet corn and some tomato products had higher levels than the corresponding fresh vegetables. Evidence was obtained to suggest that, in the case of whole kernel sweet corn, the application of heat increased the concentration of free salicylic acid.
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The oxidation of arachidonic acid in vertebrate tissues is briefly compared to the oxidation of linolenic acid in plants. Both give rise to bio-active molecules containing cyclopentane rings, the prostaglandins and jasmonic acid respectively. Both oxidations are inhibited by salicylic acid, aspirin and other non-steroidal, anti-inflammatory drugs. Aspirin is known to inhibit the cyclising enzyme, cyclo-oxygenase in animal tissues. By contrast it is thought to inhibit allene oxide synthase (AOS) rather than the analogous cyclising enzyme in plants. This conclusion is based on studies of an unusual isoform of AOS, and it is suggested that a search should be made for aspirin-acetylatable proteins in extracts of the leaves of temperate crop plants. The possible reaction of aspirin with the unusual AOS produced by sea corals is briefly considered.
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Dietary salicylates inhibit cycloxygenase-2 and may therefore have anti-inflammatory properties similar to those of aspirin. Individuals that are sensitive to aspirin may also be intolerant to non-acetylated salicylates and could benefit from a low salicylate diet. A total of 76 foodstuffs comprising fruit (16), fresh and prepared vegetables (13), herbs and spices (12), flavourings and sauces (9), beverages (20) and miscellaneous foods (6) were analysed using gas chromatography with mass spectrometric detection and 13C carboxyl SA as internal standard. Thirty-seven of the samples contained detectable SA, the highest levels being found in dried herbs (up to 28.6 mg/kg), whereas only one sample (curry sauce) contained detectable ASA at 0.34 mg/kg. Limits of detection for both SA and ASA were matrix-dependent and ranged from 0.008 to 0.23 mg/kg. The results show many inconsistencies with previous data and highlight the need for analysis of a wider range of foods and drinks that are currently available.
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Methyl salicylate 2-O-β-D-lactoside (DL0309), is a molecule chemically related to salicylic acid that is isolated from Gaultheria yunnanensis (FRANCH.) REHDER (G. yunnanensis). G. yunnanensis, a traditional Chinese herbal medicine, is widely used for treating rheumatoid arthritis, swelling, pain, trauma, and chronic tracheitis. In the present study, we explored the mechanism whereby DL0309 exerts anti-inflammatory effects, using the model of lipopolysaccharide (LPS)-treated RAW264.7 cells. We examined the effects of DL0309 on LPS-induced nuclear factor-kappaB (NF-κB) activity by Western blot analysis, cell imaging analysis and an electrophoretic mobility shift assay (EMSA). Production of pro-inflammatory cytokines was also measured. Our observations indicate that DL0309 suppressed production of nitric oxide (NO), reactive oxygen species (ROS) and the pro-inflammatory cytokines, such as tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β), in a concentration-dependent manner. The phosphorylation of IKK-β and degradation of IκB-α by LPS were both inhibited by DL0309 in the cytoplasm. The increased protein level of NF-κB by LPS in the nucleus was also reduced by DL0309. Consistent with these results, we found that DL0309 prevents the nuclear translocation and DNA binding activity of NF-κB. Finally, our results demonstrate that DL0309 exerts anti-inflammatory effects, by inhibiting the production of pro-inflammatory cytokines and suppressing of the activation of the NF-κB signaling pathway in LPS-treated macrophage cells. Therefore, DL0309 may have therapeutic potential for treating inflammatory diseases by regulating the NF-κB pathway and pro-inflammatory cytokine production.
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In short-term trials, aspirin is associated with gastrointestinal bleeding. However, the effect of dose and duration of aspirin use on risk remains unclear. We conducted a prospective study of 87,680 women enrolled in the Nurses' Health Study in 1990 who provided biennial data on aspirin use. We examined the relative risk (RR) of major gastrointestinal bleeding requiring hospitalization or blood transfusion. During a 24-year follow-up, 1537 women reported a major gastrointestinal bleeding. Among women who used aspirin regularly (≥2 standard [325 mg] tablets/week), the multivariate RR of gastrointestinal bleeding was 1.43 (95% confidence interval [CI], 1.29-1.59) when compared with nonregular users. Compared with women who denied any aspirin use, the multivariate RRs of gastrointestinal bleeding were 1.03 (95% CI, 0.85-1.24) for women who used 0.5 to 1.5 standard aspirin tablets/week, 1.30 (95% CI, 1.07-1.58) for women who used 2 to 5 tablets/week, 1.77 (95% CI, 1.44-2.18) for women who used 6 to 14 tablets/week, and 2.24 (95% CI, 1.66-3.03) for women who used more than 14 tablets/week (P(trend)<.001). Similar dose-response relationships were observed among short-term users (≤5 years; P(trend)<.001) and long-term users (>5 years; P(trend)<.001). In contrast, after adjustments were made for dose, increasing duration of use did not confer a greater risk of bleeding (P(trend) = .28). Regular aspirin use is associated with gastrointestinal bleeding. Risk seems more strongly related to dose than duration of aspirin use. Efforts to minimize adverse effects of aspirin therapy should emphasize using the lowest effective dose among both short- and long-term users.
Article
The nuclear factor NF-kappaB pathway has long been considered a prototypical proinflammatory signaling pathway, largely based on the role of NF-kappaB in the expression of proinflammatory genes including cytokines, chemokines, and adhesion molecules. In this article, we describe how genetic evidence in mice has revealed complex roles for the NF-kappaB in inflammation that suggest both pro- and anti-inflammatory roles for this pathway. NF-kappaB has long been considered the "holy grail" as a target for new anti-inflammatory drugs; however, these recent studies suggest this pathway may prove a difficult target in the treatment of chronic disease. In this article, we discuss the role of NF-kappaB in inflammation in light of these recent studies.
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We developed a specific and sensitive HPLC method with fluorescence detection for the determination of free acetylsalicylic acid, free salicylic acid, and free salicylic acid plus salicylic acid after alkaline hydrolysis (free-plus-bound) in foods. Acetylsalicylic acid was detected after postcolumn hydrolysis to salicylic acid. With the method for free acetylsalicylic acid and salicylic acid, recovery was 95-98␏or acetylsalicylic acid added to foods and 92-102␏or salicylic acid. Recovery of added salicylic acid was 79-94␏or the free-plus-bound salicylic acid method. The limit of detection was 0.02 mg/kg for fresh and 0.2 mg/kg for dried foods for all substances. We did not find acetylsalicylic acid in any of 30 foods previously thought to be high in salicylates. The contents of free-plus-bound salicylic acid and of free salicylic acid ranged from 0 to 1 mg/kg in vegetables and fruits and from 3 to 28 mg/kg in herbs and spices. Thus the tested foods did not contain acetylsalicylic acid and only small amounts of salicylic acid. Our data suggest that the average daily intake of acetylsalicylic acid from foods is nil and that of salicylic acid is 0-5 mg/day.
Article
For more than 200 years, the plant hormone salicylic acid (SA) has been studied for its medicinal use in humans. However, its extensive signaling role in plants, particularly in defense against pathogens, has only become evident during the past 20 years. This review surveys how SA in plants regulates both local disease resistance mechanisms, including host cell death and defense gene expression, and systemic acquired resistance (SAR). Genetic studies reveal an increasingly complex network of proteins required for SA-mediated defense signaling, and this process is amplified by several regulatory feedback loops. The interaction between the SA signaling pathway and those regulated by other plant hormones and/or defense signals is also discussed.
Article
Aspirin is a well-known nonsteroidal anti-inflammatory drug (NSAID) that may potentiate some acute allergies and causes adverse immunological reactions collectively referred to as aspirin intolerance. Aspirin intolerance is accompanied by increased leukotriene (LT) synthesis, and high levels of serum IgE are a risk factor for NSAID sensitivity. Here we demonstrate that aspirin modulates LTC(4) secretion in mast cells. Therapeutic levels of aspirin and salicylates (<or=0.3 mM, i.e., the concentrations observed in vivo in the use of antipyretic analgesic) increased IgE-mediated LTC(4) secretion. Aspirin-induced stimulation was accompanied by increased Ser-505 phosphorylation of cytosolic phospholipase A(2), which occurred independently of extracellular signal-regulated protein kinase-1/2 and p38 mitogen-activated protein kinase pathways. Aspirin also increased IgE-mediated Ca(2+) influx, whereas aspirin at concentrations of >or=0.3 mM dose-dependently reduced Ca(2+) store emptying and Ca(2+) release-activated Ca(2+) channel activation. Instead, aspirin facilitated a dihydropyridine receptor-mediated Ca(2+) influx, resulting in increased LTC(4) secretion. This novel action of aspirin may play roles in exacerbation of immediate allergy and aspirin intolerance.
Article
The adverse effect of topical methylsalicylate ointment on warfarin anticoagulation is studied in 11 patients. All patients had an abnormally elevated international normalized ratio after significant usage of topical methylsalicylate ointment as obvious from both the clinical history and a positive blood level of salicylate. Out of the 11 patients, 3 had bleeding manifestation; 2 with bruises and 1 with gastrointestinal bleeding. It is concluded that topical methylsalicylate ointment should be prescribed with care to patients on warfarin and excessive usage is to be avoided since potentially dangerous drug interaction could occur.
Article
Intake of acetylsalicylic acid reduces the risk of cardiovascular disease and is associated with a decreased risk for colorectal cancer. Amounts of salicylates in foods are thus of interest, but data are scarce and controversial. We gave 58 mumol (10.5 mg) pure acetylsalicylic acid or 66 mumol (9.1 mg) salicylic acid to six volunteers and recovered 77-80% in 24-h urine samples. Thus, urinary excretion is a valid indicator for intake of free forms of (acetyl)salicylic acid. To estimate the bioavailable salicylate contents of diets, we subsequently studied salicylate excretion in 17 volunteers from 14 countries and four continents who ate a wide variety of self-selected diets. Median 24-h urinary salicylate excretion was 10 mumol (range: 6-12 mumol). Values increased with the fiber content of the diet (r = 0.73), suggesting that vegetable foods are the main sources of salicylates. However, amounts of salicylates in a variety of diets are evidently low and probably insufficient to affect disease risk.
Article
To determine serum salicylic acid concentrations in non-vegetarians and vegetarians not taking salicylate drugs, and to compare these concentrations with those found in patients taking aspirin, 75 mg daily. Serum samples were obtained from vegetarians (n = 37) and non-vegetarians (n = 39) not taking salicylate drugs. Non-vegetarians and vegetarians were recruited from the community and from a Buddhist monastery, respectively, in Dumfries and Galloway, Scotland. Patients (n = 14) taking aspirin (75 mg daily) were recruited from the Dumfries diabetic clinic. Serum salicylic acid concentrations were determined using a high performance liquid chromatography method with electrochemical detection. Salicylic acid was detected in every serum sample analysed. Higher serum concentrations of salicylic acid were found in vegetarians than non-vegetarians: median concentrations of 0.11 (range, 0.04-2.47) micromol/litre and 0.07 (range, 0.02-0.20) micromol/litre, respectively; the median of the difference was 0.05 micromol/litre (95% confidence interval for difference, 0.03 to 0.08; p < 0.0001). The median serum concentration of salicylic acid in patients taking aspirin (75 mg daily) was 10.03 (range, 0.23-25.40) micromol/litre, which was significantly higher than that found in non-vegetarians and vegetarians. There was overlap in serum salicylic acid concentrations between the vegetarians and patients taking aspirin. Salicylic acid, a non-steroidal anti-inflammatory drug, is present in fruits and vegetables and is found in higher concentrations in vegetarians than non-vegetarians. This suggests that a diet rich in fruits and vegetables contributes to the presence of salicylic acid in vivo. There is overlap between the serum concentrations of salicylic acid in vegetarians and patients taking aspirin, 75 mg daily. These findings may explain, in part, the health promoting effects of dietary fruits and vegetables.
Article
Urine alkalinization is a treatment regimen that increases poison elimination by the administration of intravenous sodium bicarbonate to produce urine with a pH > or = 7.5. Experimental and clinical studies confirm that urinary alkalinization increases salicylate elimination, although the mechanisms by which this occurs have not been elucidated. The conventional view is that ionisation of a weak acid, such as salicylic acid, is increased in an alkaline environment. Since the ionisation constant (pKa) is a logarithmic function then, theoretically, a small change in urine pH will have a disproportionately larger effect on salicylate clearance. Hence, elimination of salicylic acid by the kidneys is increased substantially in alkaline urine. However, as salicylic acid is almost completely ionised within physiological pH limits, alkalinization of the urine could not, therefore, significantly increase the extent of ionisation further and the conventional view of the mechanism by which alkalinization is effective is patently impossible. Further experimental studies are required to clarify the mechanisms by which urine alkalinization enhances salicylate elimination.