STROKE
A stroke, which is also called a brain attack, is sudden loss of brain function that develops when an artery supplying oxygen-rich blood to the brain becomes blocked or ruptures. Without adequate blood flow, brain cells begin to die within minutes. Areas of the brain commonly affected by stroke are those that control movement, speech, vision, and sensation. Stroke is a medical emergency that requires immediate treatment to minimize damage to the brain and disability.
There are two types of stroke: ischemic and hemorrhagic. About 80 percent of all strokes are ischemic strokes. They occur when blood clots or other particles block arteries to your brain and cause severely reduced blood flow (ischemia). This deprives your brain cells of oxygen and nutrients, and cells may begin to die within minutes. Hemorrhagic stroke occurs when a blood vessel in your brain leaks or ruptures. This can result from a number of conditions that affect your blood vessels, such as uncontrolled high blood pressure (hypertension) and weak spots in your blood vessel walls (aneurysms).
Stroke is a major cause of death in Canada, but your chance of surviving a stroke today is much greater than it was a few decades ago. About half of all people who have a stroke recover to some degree, although about one-third of first strokes are fatal, so early detection and prevention are critical. The various factors known to increase your risk of stroke are outlined below. Many of them are lifestyle related and within your control.
SIGNS & SYMPTOMS
• Confusion or memory loss
• Problems with spatial orientation or perception
• Sudden difficulty speaking, seeing clearly, or understanding speech
• Sudden dizziness and loss of balance and coordination
• Sudden massive headache, which may be accompanied by a stiff neck, facial pain, and pain around the eyes
• Sudden numbness, weakness, or paralysis of your face, arm, or leg, which often occurs on one side of your body
Unfortunately, some people have no warning signs of a stroke and it happens suddenly. Some people may have a mini-stroke called a transient ischemic attack (TIA) before a major stroke. A TIA is a temporary interruption of blood flow to a part of your brain. It causes the same signs and symptoms as a stroke, but it lasts for a short time (few minutes to hours) and then disappears. A TIA represents a serious risk that a full-blown stroke may follow.
RISK FACTORS
Age: More common in older adults
Diabetes is a major risk factor for stroke because it increases the risk of high blood pressure and atherosclerosis; diabetes also interferes with your body’s ability to break down blood clots, increasing your risk of ischemic stroke.
• Estrogen therapy: Taking birth control pills or estrogen therapy for menopause increases your risk; the risk is higher for smokers and those over 35 years.
• Family history: Having a parent or sibling who had a stroke or TIA
• Gender: Strokes affect men and women about equally, but women are more likely to die of stroke than are men.
• Heart disease: Having congestive heart failure, a previous heart attack, an infection
of a heart valve (endocarditis), an abnormal heart rhythm (atrial fibrillation), aortic or mitral valve disease, valve replacement, or a hole in the upper chambers of the heart will increase risk.
• High blood pressure weakens and damages blood vessels in and around your brain, leaving them vulnerable to atherosclerosis and hemorrhage.
• High homocysteine level: This amino acid occurs naturally in your blood, but when it is elevated, it increases the risk of heart and blood vessel damage.
• High LDL cholesterol and triglycerides increase your risk of atherosclerosis; in contrast, high levels of HDL (good) cholesterol reduce your risk of atherosclerosis by removing cholesterol from your body through your liver.
• Obesity increases the risk of high blood pressure, heart disease, atherosclerosis, and diabetes, all of which increase your risk of a stroke.
• Personal history: Having one TIA or stroke increases the risk of another one.
• Race: Blacks are at greater risk of stroke partly due to a higher prevalence of high blood pressure and diabetes.
• Smoking contributes to plaques in your arteries and makes your heart work harder by increasing your heart rate and blood pressure; it also reduces oxygen delivery to your tissues, including the brain.
• Stress increases blood pressure, cholesterol, and risk of atherosclerosis, all major risk factors for stroke.
THE FIVE WARNING SIGNS
Stroke is a medical emergency. It is so important to recognize the warning signs and call 9-1 -1. These signs are:
1. Weakness: Sudden loss of strength or sudden numbness in the face, arm, or leg, even if temporary.
2. Trouble speaking: Sudden difficulty speaking or understanding or sudden confusion, even if temporary.
3. Vision problems: Sudden trouble with vision, even if temporary.
4. Headache: Sudden severe and unusual headache.
5. Dizziness: Sudden loss of balance, especially with any of the above signs. (Source: Heart and Stroke Foundation of Canada)
DOCTOR’S ORDERS
Recognizing the early signs and getting immediate medical attention can greatly improve survival and recovery. Treatment depends on the type of stroke. For an ischemic stroke (caused by a blood clot), a doctor can administer a clot-busting drug called TPA (tissue plasminogen activator). This drug can improve your chances of a full recovery, but it is effective only if given within three hours of initial symptoms. This drug does not work for hemorrhagic stroke, and can actually worsen the problem.
If you are at risk of ischemic stroke, your doctor may give you anti-coagulant drugs, such as warfarin (Coumadin) or anti-platelet drugs such as aspirin, clopidogrel (Plavix), or ticlopidine (Ticlid). There are procedures that can open up an artery narrowed by plaque. A carotid endarterectomy involves an incision in your neck to expose your carotid artery and remove the plaques. Angioplasty is another option. This involves insertion of a balloon-tipped catheter into the obstructed artery to open it up.
Surgical procedures can be done for the treatment and prevention of hemorrhagic stroke. Aneurysm clipping involves placing a tiny clamp at the base of the aneurysm to keep it from bursting. This can also prevent rebleeding of an aneurysm that has recently hemorrhaged. There are other procedures that can seal off or remove the aneurysm.
Stroke is a medical emergency that requires medical treatment. The strategies outlined here can aid recovery and help prevent stroke. Do not stop taking any medication unless advised by your doctor.
Dietary Recommendations
Foods to include:
• Boost fibre intake by eating lots of whole grains, vegetables, fruits, beans, nuts, and seeds, which will help lower cholesterol levels, improve blood sugar control (essential to prevent diabetes), and help with weight management. Colourful fruits and vegetables contain an-tioxidants that help reduce the risk of atherosclerosis and heart disease. Apples, oranges, tomatoes, and bananas are a particularly good source of potassium, which can help lower blood pressure.
• Cold-water fish contain beneficial omega-3 fatty acids that help reduce cholesterol, inhibit blood clot formation, and reduce the risk of heart disease. Try to eat three servings per week of fresh cold-water fish such as salmon, trout, herring, mackerel, and tuna. To reduce consumption of toxins, choose wild (not farmed) fish.
• Drink green tea, which contains antioxidants and has modest effects in lowering blood pressure and cholesterol.
• Garlic helps reduce cholesterol, thin the blood (prevent clots), and has antioxidant properties.
• Margarines, salad dressings, and spreads that contain phytostanols (plant substances), which help lower cholesterol.
• Nuts (almonds and walnuts) help lower cholesterol levels. Nuts contain fibre and nutrients such as vitamin E, alpha-linolenic acid, magnesium, potassium, and arginine, which are important for heart health. Although nuts are high in calories, some studies have found that increasing nut consumption by several hundred calories per day does not cause weight gain.
• Olive oil is a monounsaturated fat that can help reduce blood clots and lower LDL cholesterol. Add it to your salads and recipes in place of other vegetable oils.
• Soy products (tofu, soybeans, miso, and soy protein powder) can help lower cholesterol and triglycerides. Substituting as little as 20 g per day of soy protein for animal protein can significantly lower cholesterol.
• Yogurt and fermented milk products can help lower cholesterol.
Foods to avoid:
• Foods high in cholesterol should be minimized (organ meats, egg yolks, and whole milk products). Aim for no more than 300 mg of dietary cholesterol daily. One egg yolk contains 213 mg of cholesterol. Egg whites do not contain any cholesterol and are a good source of protein.
• High alcohol intake can increase your blood pressure and contribute to the development of heart disease and stroke. Limit alcohol to one or two standard drinks a day.
• High-glycemic foods (white bread and refined starches) raise blood sugar levels and increase the risk of diabetes. See Appendix B for more information.
• Salt causes water retention and increases the pressure inside your arteries. Reducing salt intake reduces blood pressure in most people. Aim for no more than 2,500 mg daily. Avoid adding salt to foods and minimize eating processed and fast foods such as deli meats, snacks (chips, pretzels), french fries, and burgers.
• Saturated fat, which is present in animal foods (beef, pork, and dairy) and certain oils (palm oil), can raise cholesterol levels. Limit consumption of saturated fat to 10 percent of total calories. Read food labels carefully.
• Trans fatty acids, found in hydrogenated oils, which are present in most margarines, snack foods (chips), and deep-fried foods (french fries), can raise cholesterol levels and increase the risk of heart disease and stroke.
POTASSIUM LOWERS STROKE RISK
Studies have found an association between diets low in potassium and increased risk of stroke. Conversely high potassium intakes have been associated with a lower risk of stroke. Some of the protective effects of potassium lie in its ability to lower blood pressure. Foods high in potassium include bananas, potatoes, oranges, raisins, artichokes, avocados, spinach, nuts, seeds, lima beans, cod, chicken, and salmon.
Lifestyle Suggestions
• Don’t smoke, and avoid second-hand smoke. Smoking contributes to atherosclerosis, increases the risk of blood clots, reduces the oxygen in your blood, increases your blood pressure, and makes your heart work harder. In fact, smoking nearly doubles the risk of ischemic stroke.
• Lose excess weight. Losing even 5-10 percent of excess weight can lower cholesterol and blood pressure.
• Exercise regularly. Moderate-intensity activities, such as brisk walking, biking, or swimming, can reduce cholesterol and blood pressure and help with weight management. Aim for one hour daily. Not being active nearly doubles your risk of heart disease and stroke.
• Reduce stress levels. Stress increases the risk of heart disease and stroke. Try meditation, exercise, or yoga to promote calming and relaxation.
• Manage your blood sugar levels. If you have diabetes or are at risk for diabetes, work on improving your blood sugar levels with exercise and a low-glycemic diet.
• See your doctor regularly for checkups and to monitor your blood pressure, cholesterol, and blood sugar. Discuss the results with your doctor.
Top Recommended Supplements
Citicoline: A form of the B-vitamin choline that has neuroprotective properties, citicoline prevents brain damage due to lack of oxygen, helps restore key membrane components called phospholipids, and counteracts the effects of membrane-injuring molecules known as free radicals. Seven studies have shown that treatment with choline within 14 days of onset of ischemic or hemorrhagic stroke can significantly reduce death and disability. Dosage: 500-2,000 mg daily. This is a specialty supplement that is available through natural health care practitioners.
Fish oils: Lower triglycerides, raise HDL cholesterol, and reduce inflammation and blood clotting. Studies have shown that fish oils reduce the risk of stroke. Dosage: The typical dosage is 3-9 g total of EPA and DHA daily, although higher amounts have been used in some studies. Look for a product that provides at least 400 mg EPA and 200 mg DHA per dosage.
Policosanol: Several studies have shown that it can significantly reduce blood clotting (comparable to aspirin). It also lowers cholesterol. Dosage: 20 mg daily. Do not combine with other blood thinners such as aspirin unless advised by your health care provider.
Complementary Supplements
Aged garlic extract: Helps lower total and LDL cholesterol and triglycerides, reduces blood clotting, and prevents atherosclerosis. Dosage: 600 mg or more daily.
B-vitamins: Lower levels of homocysteine, an amino acid linked to increased risk of stroke in many studies. Folic acid, vitamin B6, and vitamin B1 2 can lower homocysteine levels, but studies have not yet demonstrated whether this will result in a decreased risk of stroke. Consider a B-complex or take a multivitamin that provides 50-100 mg of the B-vitamins.
Ginkgo biloba: Inhibits blood clotting and improves blood flow to the brain. It may be helpful for both the prevention and treatment of stroke (improving recovery). Dosage: 1 20-240 mg daily, standardized to 6 percent terpene lactones and 24 percent flavone glycosides.
FINAL THOUGHTS
To prevent stroke and aid recovery, consider the following:
1. Know the warning signs and seek immediate medical attention if you suspect a stroke.
2. Eat lots of fruits, vegetables, whole grains, beans, nuts, fish, soy, garlic, and yogurt, and drink green tea.
3. Minimize saturated fat, trans fats, sugar, and salt.
4. Get regular exercise, reduce stress, and don’t smoke.
5. Consider fish oils and policosanol for prevention, and citicoline to improve recovery.
