May is National Stroke Awareness Month. Stroke is part of the whole picture of “cardio-vascular” diseases. It is generally the result of changes in the vascular system (blood vessels – mainly arteries) that result from poor dietary habits, a sedentary lifestyle, aging, and genetics.
A stroke interrupts the blood flow, and thus oxygen delivery, to a part of the brain. When a part of the brain is denied oxygen, it dies. Lack of oxygen creates a deficit in that portion of the brain. These deficits can be in speech or understanding of speech, weakness or paralysis in a portion of the body, and problems processing information, awareness, judgment and/or memory. Stroke can also cause depression or difficulty controlling emotions. Severe stroke can cause coma and death.
Stroke is the second leading cause of death worldwide, with the highest prevalence in developed countries. It is thought to be due to industrialized societies’ dietary habits and inactivity compared with generations past. Together, stroke and Alzheimer’s disease are the fourth leading cause of death in the U.S.A.
The risk of stroke doubles in people over the age of 55. Chronic conditions, such as high blood pressure, elevated cholesterol, diabetes, and so forth, can increase that risk. It is thought that 80% or more of strokes can be prevented, mainly by lifestyle changes! The goal is to preserve the quality of life and cognitive function as people age.
There are two types of stroke, ischemic (caused by a clot) and hemorrhagic (caused by bleeding). Ischemic strokes comprise 85-90% of all strokes, with hemorrhagic strokes comprising the remaining 10-15%.
The clot in an ischemic stroke can originate in the brain’s blood vessels or from the arteries in the neck leading to the brain. It can also come from an artery that has been narrowed by atherosclerosis (plaque in the arteries) or movement of a clot from another part of the body, such as the heart.
With a hemorrhagic stroke, there can be actual bleeding into the brain’s tissue from the rupture of a blood vessel or bleeding into the subarachnoid space between the brain and its membrane covering.
Some risk factors for stroke are high blood pressure, elevated cholesterol, smoking, diabetes, excessive alcohol intake, physical inactivity, lack of variety in dietary intake, excessive weight around the waist and abdomen, prior stroke, atrial fibrillation, genetics, or illicit drug use (especially cocaine).
Stroke symptoms can vary depending on the type of stroke or where the blood vessel is blocked. Transient ischemic attacks (TIAs) are brief episodes of stroke-like symptoms that generally last less than 30 minutes, but often precede a full-fledged stroke.
If a person thinks they are having a stroke, IMMEDIATE medical attention should be sought within 60 minutes of the onset of symptoms. Symptoms can include sudden onset of severe headache, dizziness or confusion, weakness or paralysis on one side of the body, including the face, sudden severe numbness in any part of the body, visual disturbances including sudden loss of vision, difficulty walking, staggering, coordination problems, slurred speech, or an inability to speak or understand.
Prompt evaluation of a person presenting to the emergency room with a possible stroke is imperative. Generally, a CT scan or an MRI is done. A CT scan is typically performed before an MRI because it is the fastest way to get results. The physician needs to distinguish between the type of stroke, as they are treated differently. If the CT scan does not show bleeding into the brain, it is considered an ischemic stroke, and the person is a candidate for medication that can dissolve the clot. This kind of medication dissolves the clot, opening the blood vessel and restoring blood flow to the brain. It must be given within a few hours of the stroke symptoms. After recovery from the stroke, a person is often placed on long-term medication to prevent further blood clots from forming.
It is especially important to consider preventative measures to avoid stroke because a stroke can be extremely disabling. Here are several suggestions.
- The first thing is to control high blood pressure. For more detailed information, I refer you to my previous blogs on hypertension from February 2022. High blood pressure doubles or triples the risk of stroke. It is generally recommended that blood pressure be maintained at 120/80 or less. Ways of helping to decrease blood pressure are by decreasing the amount of salt in the diet, decreasing saturated and trans fats, eating 4 to 5 cups of fruits and vegetables a day, and switching to whole grains.
- Smoking cessation is important. Smoking constricts blood vessels, thickens the blood, and increases plaque in arteries.
- Losing weight and increasing activity aids in improving the vascular system.
- Controlling diabetes is important, as high blood sugars injure and stiffen arteries.
- Alcohol intake should be none to moderate. Despite the craze for red wine, alcohol in any amount might not be good for your body. Present recommendations are no more than one drink per day for a woman and two drinks for a man. One drink is considered 5 ounces of wine, 12 ounces of beer, or 1.5 ounces of hard liquor.
Some of the more interesting recent research revolves around the role of the microbiome (bacteria, fungi, viruses) of the gastrointestinal tract in the development of atherosclerosis (hardening of the arteries). This information is from an article by J.David Spence et al in the journal STROKE of 12/2020 entitled “Stroke Prevention in Older Adults“. The chemistry is a little complicated, but let me try to simplify it for you.
There are chemicals in some foods, especially in red meats (pork, lamb, veal, beef, venison, boar) and egg yolks. When the gut microbiome processes these chemicals, they produce a toxic chemical called trimethylamine. The liver then converts the toxic chemical (a process called oxidation) to create trimethylamine-N-oxide (known by the initials TMAO).
Elevated TMAO levels in the study predicted a 2.5-fold increase in three-year risk of stroke, heart attack, or vascular death. So, dietary changes for stroke prevention might include a decrease, or better yet, discontinuance of red meat and egg yolks in the diet and an increase in fruits, especially berries that are very rich in antioxidants, vegetables, beans, and whole grains. Certainly, the future will bring much more research in this area.
There are two main take-home messages for you and your dear friends and family. First, recognize the symptoms of stroke and know that time is of the essence in getting prompt medical care. Call 911, say, “I think I am having a stroke,” or “I have the symptoms of a stroke,” or “My husband/mother/friend is having a stroke.” Secondly, dietary and lifestyle changes are important in the prevention of stroke. Help yourself, your family, and your friends by encouraging an increased variety of fruits and vegetables in meals and a decreased intake of red meats and egg yolks.
Nothing in this blog is meant to replace medical care and advice by your practitioner.
