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Stroke 26 August 2009

Each year more than 40,000 Australians suffer a stroke. One third of these are fatal. Another third are permanently disabled. It is estimated by 2016 there will be 70,000 new stroke cases per year. Money and attention is being focused on the early recognition and treatment of stroke. More attention needs to be paid on preventing stroke particularly for people with risk factors and those who have previously suffered a transient ischaemic attack (TIA). A TIA is essentially a small stroke which completely resolves within 24 hours. For someone recovering from a TIA, the risk of recurrent stroke, heart attack or death approaches 50% over 10 years.

While surgical procedures such as a carotid endarterectomy (removing a blockage from the carotid artery) are effective prevention in severe cases, the main benefit and prevention will come from nutritional strategies and lifestyle changes. After a first stroke, statistics show that 22% of men and 25% of women die with the year. This article will give you tools to both avoid having a stroke and also be able to focus on being in the 75-78% who do well after 12 months.

Strokes occur when a part of the brain is deprived of its blood supply and therefore oxygen. Strokes can either be:

1. Ischaemic — a small piece of plaque or blood clot breaks off from an artery somewhere else in the body and travels to the brain where it gets stuck in a small artery. It therefore deprives that part of the brain into blood supply. The clot either stays there and that part of the brain dies or the clot breaks up, blood flow was restored in full recovery occurs (a TIA). Any artery in the body can be a source of the debris. The carotid arteries in the neck are the most frequent source.
2. Haemorrhagic — a blood vessel in the brain bursts causing bleeding into brain and death of brain tissue.

Risk factors for stroke include hypertension, diabetes, metabolic syndrome, atrial fibrillation, TIA’s, and smoking.

Tests

1. Plaque in the carotid arteries is now easy to identify. Ultrasound of the carotid arteries is very accurate. If plaque booked more than 70% of the vessel wall there are unstable elements in the park then stroke risk may be high enough to justify surgery. If plaque is less severe, preventative measures should be aggressively pursued. The ultrasound can also show the thickness of the carotid artery lining that doesn’t yet contain plaque. This is called the carotid intima media thickness and is a risk factor for plaque formation. Studies have shown that if the carotid intima media thickness is greater than 1 mm then risk of stroke is increased. Carotid ultrasound is harmless, painless and easily obtained.
2. Fibrinogen— a blood clotting protein which promotes carotid plaque.
3. C-reactive protein (CRP) — a measure of inflammation which if elevated is a risk factor for stroke.
4. Homocysteine.
5. Lipid profile — lowering cholesterol and LDL if elevated reduces the risk of strokes.
6. Lipoprotein a — a fat carrying protein in the blood which causes arterial plaque to grow.
7. Blood pressure — risk of stroke and heart attacks start to increase at a blood pressure of 115/75.
8. Blood sugar and insulin levels — elevated blood sugar (diabetes) and insulin (metabolic syndrome) are both risk factors for stroke.

Lifestyle Changes and Supplements to Reduce Plaque

1. Follow the general Principles on this website.
2. Stop smoking.
3. Avoid obesity.
4. Lower Homocysteine.
5. Pharmaceutical grade fish oil. Epidemiological studies have shown a strong relationship between fish intake and reduced risk of stroke. Higher intakes of omega-3 fatty acids from fish are associated with less carotid artery plaque. The plaque that was present was more stable and therefore less likely to rupture and fragment. Essential fatty acids have also been shown to be important during the repair of brain tissue damaged by stroke. Fish oils reduce inflammation, decrease platelet stickiness (sticky platelets block atherosclerotic blood vessels) and lower triglycerides and fibrinogen. Remember the quality of fish oils varies tremendously and it is imperative that you use pharmaceutical grade. Alpha-linolenic acid from flaxseed oil is a good alternative.
6. Coenzyme Q10 — reduces blood pressure.
7. DHEA – improves glucose tolerance and insulin resistance.
8. N-acetyl cysteine – reduces lipoprotein a.
9. Gingko biloba—has been shown to enhance stroke recovery. It is an antioxidant and inhibitor of platelet aggregation. Use with caution when taking anticoagulants.
   Magnesium.
10. Selenium—low levels are associated with an increased risk of stroke. Take 200 mcg per day.
11. Vitamin C—has been shown to reduce atherosclerotic plaque and fibrinogen levels. High serum vitamin C has also been shown to be associated with reduced ischaemic and haemorrhagic strokes. I suggest at least 2000 mg/day.
12. Garlic—reduces risk of atherosclerosis by decreasing total and LDL cholesterol, increasing HDL, reducing triglyceride and fibrinogen levels. It also reduces blood pressure and inhibits platelet stickiness.
13. Green tea.
14. Melatonin—a powerful scavenger of free radicals that can cross the blood bran barrier and may help protect against further free radical induced brain injury.
15. Chelation Therapy— to remove heavy metals and calcium from arterial walls and thus reduce atherosclerosis.