Originally published in Heart, Health & Nutrition, November 2012
Death rates from stroke have declined over the years, but the human and economic toll strokes render is still staggering. More than three quarters of a million Americans are affected each year, of which about 134,000 die. The deficits encountered by survivors make stroke a leading cause of functional disability.
There are, of course, two kinds of strokes. The most common type is called an ischemic stroke and occurs when a blood vessel supplying blood to the brain becomes narrow due to plaque formation. A clot may form and block the artery (thrombotic) or break off from elsewhere in the brain or body and create a blockage (embolic). If blood flow stops for more than a few seconds, the brain cells served by the specific vessel can die, causing permanent damage.
In comparison, a hemorrhagic stroke occurs when a weakened part of a blood vessel bursts, resulting in blood spilling into the adjacent brain tissue. When affected brain cells die, the functions controlled by those cells, which are often related to communication, memory, and movement, are compromised.
Despite all that modern medicine can do to promote rehabilitation after a stroke, doctors agree that the best medicine for stroke is to prevent one from occurring in the first place. This is an important task – one that can be initiated with the comprehensive stroke prevention plan I've outlined here.
Know the Risks
A big part of preventing a stroke is being aware of your own stroke risks. Some of the main factors that increase your risk of stroke include:
- Family history
- Advancing age
- High blood pressure (over 140/90 mm Hg)
- Obesity and physical inactivity
- Arterial disease (the presence of plaque, determined by objective testing)
- Atrial fibrillation (A-fib)
- Valvular heart disease
- Tobacco use and excess alcohol
- History of mini-strokes
- Use of illegal drugs, such as cocaine and methamphetamine, which can cause blood vessel spasm and stroke even on the first use
- Elevated CRP, homocysteine, fibrinogen, and Lp(a), which indicate inflammation
- Less than 30mg/dL HDL cholesterol
While a few of these risk factors are out of your control, most can be addressed with the diet, diagnostic, supplementation, and lifestyle advice that follows.
Stroke prevention is squarely centered on a heart-healthy diet, because foods that are good for your heart are also good for your brain. No doubt, you already know the basics of such an eating plan:
- Maximize your intake of organic fruits and vegetables, fish, and chicken for all the health-boosting antioxidants and healthful fats they contain.
- Minimize your intake of sugar and refined carbohydrates, not only to keep your weight in check but also because these are largely ignored sources of arterial inflammation.
In particular, however, potassium and magnesium deficiencies – which are quite common – can cause cardiac arrhythmias, including A-fib, a risk factor for stroke. Magnesium is found in green leafy vegetables and whole grains. Potassium-rich foods include figs, bananas, raisins, and avocados, as well as potatoes, yogurt, and whole grains.
A major Harvard study in 1998 of male health professionals identified potassium, magnesium, and fiber (found in whole grains) as significant anti-stroke factors, so it makes sense to eat a diet rich in all three nutrients. And if you have healthy kidneys, getting as much as 4 grams of potassium per day from food and supplements offers major stroke-prevention benefits. But note that I do not ordinarily recommend taking supplemental potassium for elderly patients with kidney impairment (unless monitored by a physician), because the kidneys may have trouble processing it, and that could harm cardiac function.
Take the Tests
Arterial disease is usually not limited to one area, such as a specific coronary artery. Instead, damage there often means you have problems elsewhere, possibly in the head and neck as well. So getting regular cardiac checkups is a crucial step in preventing stroke.
As part of your cardiac evaluation, ask your doctor to listen to your carotid arteries with a stethoscope. If sounds of obstruction are present, get an ultrasound analysis called carotid imaging. The carotids are the main vessels on each side of the neck that carry oxygen-rich blood from the aorta and heart into the brain. Ultrasonic images can identify plaque formation or abnormal thickening of the arterial tissue, both signs of atherosclerosis. Without imaging proof, a doctor will be unlikely to know the extent of carotid disease, since there are often no symptoms. The first symptom could be a full-blown stroke.
Stop the Clots
When it comes right down to it, clots cause strokes.
Clots form for many reasons and both people with and without cardiovascular disease can develop thick, clot-disposed blood due to toxins, pollution, stress, and inflammation. But those with A-fib are at an increased risk for clot formation.
A-fib is a common arrhythmia resulting from irregular electrical stimulation of the heart's two upper chambers, the atria. The aging process and leaky heart valves are main causes. High blood pressure, coronary artery disease, alcoholism, and elevated thyroid function can also contribute. In this condition, particularly if persistent, the risk of forming clots increases significantly. Clots can then spill out of the heart, into the aorta, and up into brain. A-fib creates a five-fold higher risk of stroke. About a third of strokes over the age of 65 are associated with A-fib.
For years doctors have treated A-fib with Coumadin, a proven blood thinner that saves lives. I, too, have always regarded Coumadin as a key to clot and stroke prevention that is critical for the majority of chronic A-fib patients with some structural heart disease and risk factors such as elevated inflammatory markers, positive family history, high blood pressure, past cardiac events, diabetes, leaky heart valves, previous heart failure, and a dilated (enlarged) left ventricle. Recently, however, new blood-thinning drugs have become available.
Although I have no clinical experience using them, I have studied Predaxa, the most popular of the new arrivals. In the case of Predaxa, I strongly advise any elderly patient taking it to discuss with their doctor the possibility taking less than the standard dosage because of the risk of bleeding that has been associated with that amount.
People with occasional A-fib episodes who have a small left atrium may not need Coumadin and can often be stabilized with more natural blood thinners.
Such natural blood thinners for clot prevention that you should talk to your doctor about include:
- Fish or squid oil (1 to 2 g daily)
- Garlic (1 to 2 g daily in capsule form)
- Nattokinase (100 mg daily)
- Bromelain, an enzyme derived from pineapple (600 mg daily)
- Aspirin (1 baby aspirin daily)
Just remember that patients who have persistent A-fib and are taking a pharmaceutical blood thinner need to be cautious about trying additional natural blood-thinning remedies because of the potential for compounded blood thinning that might cause bleeding.
One additional blood-thinning option for a select population is statin drugs. Statins have an anti-inflammatory effect, thin the blood, and make red blood cells more slippery. But because of their major side effects, I only recommend statins as an option for middle-aged men up to 75 with heart disease, low HDL, and who are not diabetic. For this group of people, the benefits outweigh the risks. However, do not take any statins if you have a history of microbleeding in the brain.
Supplement for Success
Natural blood thinners that boost clot prevention are just one type of supplement that can help you sidestep stroke. In fact, there is some new and extremely exciting research conducted by Ohio State researchers and led by Chandan Sen, Ph.D., documenting the striking neuroprotection and stroke-prevention properties of a member of the vitamin E family called alpha tocotrienol.
In one particularly notable 2011 experiment, Dr. Sen and his team found significant differences in stroke-induced canines given either a supplement high in alpha and other tocotrienols or a corn oil placebo for 10 weeks. The tocotrienols significantly reduced brain lesions and loss of white matter fiber connectivity while improving cerebrovascular collateral circulation in the area of the lesion. The results have paved the way for a clinical trial with humans at high risk for stroke funded by the Malaysian Government and the U.S. National Institutes of Health.
Alpha tocotrienol research is truly exciting. I have never come across any medication or supplement before with this much promise for impacting ischemia in the brain and, therefore, I recommend supplementing with 50 to 100 mg daily. Right now, however, finding an alpha tocotrienol supplement can be quite difficult. I am working with my own product-development team on such a product and hope to have one to offer within a year. In the meantime, ask at your health food store for broad-spectrum tocotrienol, hopefully containing mostly alpha, or try LifeExtension's Super-Absorbable Tocotrienols product.
In addition to alpha tocotrienol, there are a number of other supplements that can help support stroke prevention, including:
- CoQ10 (100 to 200 mg daily)
- L-carnitine (1 to 2 g daily, either as a broad-spectrum form or acetyl-l-carnitine)
- D-ribose (5 to 15 g daily, in divided doses)
- Magnesium (400 to 800 mg daily)
- Hawthorn berry (500 mg, two to three times daily)
- Vitamin C (at least 1 g, daily) and vitamin D (at least 1,000 IUs, daily). These two key nutrients, along with potassium, magnesium, and other minerals, are contained in my new ElectrolytePLUS Cardio drink.
Live the Lifestyle
The things you do – or don't do – on a daily basis can have a big impact on whether or not you ever experience a stroke. So making some modifications in your lifestyle are key to stroke prevention.
One particularly powerful lifestyle intervention to consider is Earthing. Connecting your body to the Earth's natural, gentle electrical energy by either going barefoot outside or sitting or lying on special conductive devices is a surprisingly powerful way to help thin blood, improve the anti-clotting properties of red blood cells, moderate arrhythmias, normalize blood pressure, and boost circulation – all of which are important in preventing stroke. I began reporting on the amazing benefits of Earthing in the June 2010 newsletter. Earthing was also the subject of a study I published recently in the Journal of Alternative and Complementary Medicine.
If you take a pharmaceutical blood thinner, however, do not use any Earthing product until you consult with your physician. There is the potential for excessive blood thinning. You'll need to monitor your INR closely and, with your doctor, consider lowering your medication dosage. To find Earthing sheets, mats, or bands, contact my staff at 800-228-1507 or go to grounded.com.
Other lifestyle components that can play a role in stroke prevention include:
- Exercise. It is important to be active and accumulate at least 30 minutes of moderate-level exercise most days of the week.
- Sunshine. Get at least 20 minutes of mid-day sun as often as possible to boost your vitamin D stores.
- Smoking. It doubles the risk of stroke because it reduces oxygen in the blood, causes the heart to work harder, promotes clots, and damages arterial tissue. So just quit.
- Drinking. Excessive alcohol intake is a risk factor for stroke, so drink moderately.
- Stress. Stress is a major cause of hypertension, which, in turn, is a major stroke risk factor. So work to reduce your stress level. Try meditation, yoga, or tai-chi.
Howard VJ, Kissela BM. How do we know if we are making progress in reducing the public health burden of stroke? Stroke. 2012;43(8):2033–2034.
Ascherio A, et al. Intake of potassium, magnesium, calcium, and fiber and risk of stroke among US men. Circulation. 1998;98(12):1198–1204.
Rink C, Sen CK, et al. Tocotrienol vitamin E protects against preclinical canine ischemic stroke by inducing arteriogenesis. J Cereb Blood Flow & Metab. 2011; 31(11):2218–2230
Chevalier G, Sinatra ST, et al. Earthing (grounding) the human body reduces blood viscosity – a major factor in cardiovascular disease. J Alt Complement Med. 2012 Jul 3. [Epub ahead of print.]