Stroke prevention

Stroke prevention and treatment with vitamins, herbs, supplements, natural remedies to prevent, by Ray Sahelian, M.D.

A Stroke can come in two major forms:
1) A blood clot in a blood vessel in the brain which reduces or stops blood flow to parts of the brain
2) A hemorrhage or bleeding in brain tissue.

When blood flow to the brain is disrupted by a stroke, brain cells can die or be damaged from lack of oxygen. Brain cells can also be damaged if bleeding occurs in or around the brain. The resulting neurologic problems are called cerebrovascular disorders because of the brain (cerebrum) and blood vessel (vascular) involvement.

Prevention of strokes – risk factors
Have a healthy diet, increase intake of fruits, vegetables, fish and certain herbs such as garlic. Eating oranges and other citrus fruits may help reduce stroke risk, perhaps due to compounds called flavanones. A Western diet rich in red meat, white flour and sugar increases the risk. Those with a higher intake of fiber have a reduced risk.
Try to reduce your body weight if you are overweight. Excess weight increases stroke risk and the heavier a person is, the greater their risk. Eating right before going to sleep also raises the risk.
Reduce hypertension naturally
Reduce cholesterol level with diet and supplements
Reduce or eliminate smoking
Reduce alcohol intake.
Aspirin is a much more cost-effective way to treat patients at risk of having a second heart attack or stroke than the new drug Plavix (clopidogrel). A daily baby aspirin, or even two or three times a week, is often recommended by doctors to help prevent heart attacks or stroke, but for people over 70 years old the benefits may be offset by bleeding risks. So, aspirin is best reserved for those younger than age 70 or 65. If you take fish oils and ginkgo, or other dietary supplements that reduce the risk for blood clots, you may need to take aspirin less often.
Women using low-dose oral contraceptives are at an increased risk for a heart attack or stroke while taking the pill — however the risk is reduced or disappears after discontinuation.
Reduce stress as much as possible. Any type of stress, including job stress, can make it more likely.
Reduce the use of NSAIDs, non-steroidal anti-inflammatory drugs.

Supplements or herbs that may be helpful to prevent stroke
Discuss with your doctor before making any changes to your regimen. Do not use natural blood thinners if you have had a hemorrhagic stroke.
Findings suggest that increased folic acid, vitamin B12, and vitamin E, C intake may be associated with decreased risk of stroke. Int J Preventive Med. 2013. B Vitamins and Antioxidants Intake is Negatively Correlated with Risk of Stroke in Iran.
Fish oils help thin the blood and improve circulation. Those who are vegetarian could instead take DHA which comes from algae. Krill oil is another option.
Ginkgo biloba improves circulation and thins the blood. Limit dosage to 40 mg a few times a week.
Vinpocetine acts as a vasodilator and allow more oxygen to be available for brain tissue. Limit dosage to 5 mg a few times a week.
Magnesium mineral could be of benefit.
Multivitamins with Vitamins B6, B12, and Folic Acid – one option is a capsule of Mind Power Rx every other day.

B Vitamins and stroke
A high-dose vitamin supplement may help reduce the risk of a second stroke, as well as death and cardiac events, according to a study published in the November 2005 issue of the journal Stroke. The supplement consisted of vitamins B9 (folate), B6, and B12, which are known to reduce blood levels of homocysteine — an amino acid linked to heart disease. In a previous report from the Vitamin Intervention for Stroke Prevention (VISP) study group, the combined vitamin therapy did not reduce recurrent stroke and cardiac events, but it turned out that the trial included patients who were not likely to benefit from the treatment. The VISP trial included patients with deficiency of vitamin B12 who were unlikely to respond to our treatment, as well as patients with renal failure, who would not respond as well to vitamin therapy. When the scientists re-analyzed the results in a subgroup of 2,155 subjects deemed most likely to respond to treatment, the combined vitamin therapy did appear to have a beneficial effect on recurrence of stroke and cardiac events. Specifically, the team compared results of low-dose vitamin versus high-dose vitamin therapy and found that high-dose vitamin supplements reduced recurrent stroke, death and heart disease by 21 percent. When they subdivided patients by baseline levels of vitamin B12, thus identifying those with difficulties absorbing the vitamin, the differences between the low-dose and high-dose groups became greater. In the modern age in which grains are fortified with folate, the response to vitamin therapy for lowering homocysteine largely depends on B12 levels of the patients. Higher doses of B12, in addition to other therapies, will be required to reduce homocysteine, and thus to reduce stroke and the combined end point of stroke, death, and heart attack.

Ann Neurol. 2010. B-vitamins reduce the long-term risk of depression after stroke: The VITATOPS-DEP trial.Almeida OP, Marsh K, Alfonso H, Flicker L, Davis TM, Hankey GJ.School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, Perth, WA, Australia.
The consumption of certain B-vitamins through diet or supplementation decreases the total plasma concentration of homocysteine (tHcy) and may enhance response to standard antidepressant treatment. The purpose of this research was to determine if treatment with B-vitamins reduces the hazard of poststroke depression compared with placebo. Randomized, double-blind, placebo-controlled trial of tHcy-lowering treatment with daily folic acid (2 mg), vitamin B6 (25 mg), and vitamin B12 (0.5 mg) for 1 to 10.5 years in survivors of stroke. Long-term treatment of poststroke survivors with folic acid, B6, and B12 was associated with a reduction in the hazard of major depression in our patient population. If these findings can be validated externally, B-vitamin supplementation offers hope as an effective, safe, and affordable intervention to reduce the burden of poststroke depression.

In addition to its effects on homocysteine, an amino acid linked to heart disease, folic acid may protect against a certain type of stroke. Specifically, investigators found that folate, a B vitamin found in green leafy vegetables, fruits and dried beans, appears to lower the risk of hemorrhagic stroke, a stroke caused by bleeding in the brain.

Ginkgo biloba for stroke treatment
 Extract from the leaves of the ginkgo tree offers promise to minimize brain damage caused by a stroke. Mice given daily doses of ginkgo biloba extract before having a stroke induced in the laboratory suffered only about half the damage as animals not given it. Mice that did not get ginkgo before a stroke but were given it five minutes after a stroke sustained nearly 60 percent less damage in the day after the stroke than those not given ginkgo. And mice given ginkgo 4 hours after a stroke had about a third less damage than those not given ginkgo. The researchers said ginkgo may offer the same benefits in people — which would be particularly important because not much can be done to protect the brain after a stroke. Sylvain Dore of Johns Hopkins led the study. This was reported in the journal Stroke in 2008.

Signs and symptoms
The most common stroke signs and symptoms include:
Sudden numbness, weakness, or paralysis of the face, arm or leg – usually on one side of the body
Loss of speech, or trouble talking or understanding speech
Sudden blurred, double or decreased vision
Dizziness, loss of balance or loss of coordination
Seizures, fainting or blacking out

How a stroke or transient ischemic attack affects the body depends on precisely where in the brain the blood supply was cut off or where bleeding occurred. Each area of the brain is served by specific blood vessels. For example, if a blood vessel in the area that controls the left leg’s muscle movements becomes blocked, the leg will be weak or paralyzed. If the area that senses touch to the right arm is damaged, the right arm will lose feeling (sensation). The loss of function is greatest immediately after a stroke. However, some function is usually regained because, while some brain cells die, others are only injured and may recover.

Stroke – TIA
Insufficient blood supply to parts of the brain for brief periods causes transient ischemic attacks, temporary disturbances in brain function. Because the blood supply is restored quickly, brain tissue doesn’t die, as it does in a stroke. A transient ischemic attack is often an early warning sign of a stroke.

Cause of Stroke
 In Western countries, strokes are the most common cause of disabling neurologic damage. High blood pressure and atherosclerosis — hardening of the arteries from fatty buildup — are the major risk factors for strokes. The incidence of strokes has declined in recent decades, mainly because people are more aware of the importance of controlling high blood pressure and high cholesterol levels. Job stress can significantly increase the risk of stroke in men.
   With prescription drugs Vioxx and Bextra already pulled from the market, a study has raised disturbing questions about the heart safety of long-term use of over-the-counter pain relievers such as Advil, Motrin and Aleve. Smokers in Norway who took such drugs for at least six months had twice the risk of dying of a heart attack, stroke or other heart-related problem.
Binge drinking more than triples a man’s risk of dying from a stroke as published in the journal Stroke, September 2009.
Atrial fibrillation (AF), the most common form of abnormal heart rhythm, increases the risk of stroke by several times.
People who suffer with migraines headaches are more likely to suffer a stroke caused by a blood clot. American Journal of Medicine, online May 20, 2010.
Downing a few drinks or contracting an infection such as the flu increases the short term risk.

Eating fried fish is more common in “stroke belt” states than other states. Frying fish causes a loss of omega-3 fatty acids fatty acids. The stroke belt states include North Carolina, South Carolina, Georgia, Alabama, Mississippi, Tennessee, Arkansas, and Louisiana. People living in the stroke belt states are more like to have a this problem and to die from it than people living in other states. Neurology, 2010.

Hemorrhagic stroke
Many young adults who suffer bleeding in the brain, a type of stroke, have risk factors that could be modified,. This suggests that these strokes might often be preventable. Risk factors for bleeding stroke included high blood pressure, diabetes, menopause, and current cigarette smoking. More than two alcoholic drinks per day, more than five caffeinated drinks per day, and caffeine in drugs were also associated with the risk of bleeding in the brain

Recovery from stroke
Stroke victims forced to use a weakened or partially paralyzed arm by having their working arm or hand restrained in a sling or mitt recover more quickly. In a study of 222 patients, those who underwent “constraint-induced” therapy within three to nine months of their strokes were more capable of performing an array of tasks in follow-up tests than those who were not forced to use their affected arm. Participants in the study were instructed to wear the restraint — either a sling or a cumbersome mitt — during waking hours for two weeks. They also underwent physical therapy for several hours on weekdays, during which they wore the restraint. Most had suffered an ischemic stroke, the most common type where blood flow is temporarily blocked to part of the brain.

The risk of a repeat stroke, which is more likely to be disabling or fatal than a first stroke, remains high long after the first episode unless major lifestyle and dietary changes are undertaken.

Risks and prognosis
Stroke patients have a significantly higher risk of fracturing a hip or thigh than people who have not had a stroke. One in four people who have a stroke will likely die within one year from any cause and about one in ten will have another one soon. The risks are higher for African-Americans compared to whites and increases with age and the number of other ailments a stroke patients has. Neurology, February 16, 2010.

Alternative to warfarin or Coumadin
A very good friend of ours who is male – 73 yrs old has had 2 strokes and was put on warfarin as a blood thinner to prevent the blood clots. He had bleeding on the brain due to the warfarin. He has now been told there is nothing they can do to stop the blood clots because blood thinners will cause bleeding. Is there any other supplement or natural alternative to help him deal with this? We live on Prince Edward Island in Canada (east coast).
Some of the supplements listed on the blood clot page (see the top of the page) are an option if his doctor approves.

Screening for possible stroke – is carotid artery testing helpful?
Screening for asymptomatic carotid artery stenosis causes more harm than benefit. Only a small proportion of all disabling, unheralded strokes is due to carotid artery stenosis. Noninvasive screening tests (duplex ultrasonography, magnetic resonance angiography) are prone to false-positive results, resulting in unnecessary treatment. Invasive screening by digital subtraction angiography can cause serious side effects. The benefits of surgical treatment with carotid endarterectomy are minor.

Incidence
Stroke incidence has increased in young to middle-aged adults since 1993, while rates have actually declined in elderly people. Risk factors for stroke – diabetes, obesity, high blood pressure and cholesterol – are occurring at younger ages. Dr. Brett M. Kissela presented his group’s findings today at the American Stroke Association’s International Stroke Conference in San Antonio, Texas in Feb 2010.

Stroke research studies
The results of a large urban multiethnic study show that high fat and high sodium diets are both risk factors for stroke, investigators with the Northern Manhattan Study (NOMAS) report.

Within three months after experiencing a transient ischemic attack, commonly known as a mini stroke, more than 14 percent of people suffer a major stroke.

For seniors, eating tuna or fish that’s been broiled or baked appears to lower stroke risk, but frying the catch of the day may increase it. Investigators found that people aged 65 and older who ordered frequent servings of tuna or other types of broiled or baked fish were up to 30 percent less likely than people who ate fish less than once per month to experience a stroke over a 12-year period.

A stroke that robbed a woman of her dreams may help pinpoint where and how dreams are born in the brain. Scientists found the stroke had damaged areas deep in the back half of the brain, which is involved in the visual processing of faces and landmarks. Writing in the Annals of Neurology, they said the finding suggests that this area was crucial for dreams.

Hormone replacement therapy (HRT) is associated with an increased risk of severe stroke. The results of individual trials have produced inconsistent results, explain Drs. Philip M. W. Bath and Laura J. Gray of the University of Nottingham, UK, in the British Medical Journal. Their goal therefore was to systematically review evidence from completed clinical trials analyzing the relationship between stroke and HRT. The team identified 28 trials that included nearly 40,000 women whose average age ranged from 55 to 71 years. The subjects were followed for about 1 to 7 years. The pooled data showed that, overall, the women who used hormone replacement had a 29 percent higher risk of stroke than those in comparison groups.

Eating dark chocolate may help lower blood pressure, boost normal responses to insulin to keep blood sugar levels down, and improve blood vessel function in patients with high blood pressure, according to new research findings. All of these effects would be expected to decrease the risk of heart attack and stroke. The report in the July, 2005 journal Hypertension is just the most recent to link dark chocolate with beneficial health effects. In an earlier study, consumption of the bittersweet candy reduced blood pressure and increased insulin sensitivity in healthy subjects.

More evidence that fish consumption reduces the chances of having a stroke comes from an analysis of results from several large studies. In fact, the findings suggest that the incidence of ischemic stroke might be significantly reduced by consuming fish as seldom as 1 to 3 times per month. Ischemic stroke refers to a blockage of blood supply to the brain, as opposed to hemorrhagic stroke, which is caused by bleeding in the brain.

Following a stroke, treatment with the anti-clotting drug Plavix (clopidogrel) can help prevent future strokes and heart attack. Plavix doesn’t work any better when given with the blood-thinner aspirin and, in fact, the risk of bleeding complications is increased.

Prospective study of plasma carotenoids and tocopherols in relation to risk of ischemic stroke.
Stroke. 2004.
We conducted a prospective, nested case-control analysis among male physicians without diagnosed cardiovascular disease followed-up for up to 13 years in the Physicians’ Health Study. Samples from 297 physicians with ischemic stroke were analyzed with paired controls, matched for age and smoking, for 5 major carotenoids (alpha- and beta-carotene, beta-cryptoxanthin, lutein, and lycopene), retinol, and alpha- and gamma-tocopherol. Baseline plasma levels of alpha-carotene and beta-carotene and lycopene tended to be inversely related to risk of ischemic stroke with an apparent threshold effect. As compared with men whose plasma levels were in the lowest quintile, the multivariate adjusted odds ratios (ORs) of ischemic stroke among men with levels in the second through fifth quintiles were 0.59 for alpha-carotene, 0.62 for beta-carotene, and 0.61 for lycopene. A tendency toward an inverse association was found for beta-cryptoxanthin, but the result was not statistically significant. No association was found for lutein, retinol, and tocopherols. Our data suggest that higher plasma levels of carotenoids, as markers of fruit and vegetable intake, are inversely related to risk of ischemic stroke and provide support for recommendations to consume fruits and vegetables regularly. stroke stroke of midnight stroke symptom sign of a stroke stroke prevention one stroke painting mini stroke.

Other supplements to consider
Inosine inhibits glutamate postsynaptic responses and reduces cerebral infarction.
Danshen used in China for stroke.

Stroke prevention
 Stroke is one of the feared conditions in old age and fortunately much can be done to reduce the risk. For one, how a food is prepared can make a difference. Seniors eating tuna or fish that’s been broiled or baked appears to lower stroke risk, but frying the catch of the day may increase it. Investigators found that people aged 65 and older who ordered frequent servings of tuna or other types of broiled or baked fish were up to 30 percent less likely than people who ate fish less than once per month to experience a stroke over a 12-year period. Diet has a strong influence on the stroke prevention. Forinstance, eating fresh fruits andvegetables reduces the risk. Nutrients thatmay play a rolein stroke prevention include fishoils, ginkgo biloba and vinpocetine.