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Stroke prevention

MagazineApril 2009 (Vol. 20 Issue 1)Stroke prevention

Q) I have recently suffered a 'mini-stroke', or transient ischaemic attack (TIA)

Q) I have recently suffered a 'mini-stroke', or transient ischaemic attack (TIA). Although a series of tests found nothing wrong, my doctor is keen to put me on aspirin to reduce my risk of a full-blown stroke. After reading a number of negative things about aspirin-including WDDTY's recent cover story-I'd much rather find an alternative way to prevent stroke. What do you suggest?-D.E., Hertfordshire

A) You're right to be wary of aspirin, considered by the medical profession to be the gold standard of pre-ventative stroke therapy. As you already know, our cover story 'Death by aspirin' (WDDTY vol 18 no 10) exposed the dangers of these drugs, including evidence that it might actually increase the risk of stroke.

However, TIAs are a serious event. They occur when the blood supply to parts of the brain is temporarily interrupted or blocked, and should be considered a warning of a future full-blown stroke. For this reason, all possible causes of a TIA should be ruled out and, if you do decide to opt for a drug-free approach, you should do so only with the supervision of a qualified practitioner.

Natural ways to prevent stroke

As you give no indication of your state of health in general, we can only offer you some general information on stroke prevention. Ultimately, identi-fying and addressing your particular risk factors for stroke-such as high blood pressure, cardiovascular disease and/or a sedentary lifestyle-is the best way to prevent it.

Nevertheless, here are some steps that anyone can take to reduce the risk of stroke:

- Eat plenty of fruit and vegetables. Research shows that these have a protective effect against the two main types of stroke: ischaemic (the most common type, caused by a blocked artery to the brain); and haemorrhagic (caused by a sudden rupture of an artery). According to one review, consuming more than the recommended five servings of fruit and vegetables a day (one serving = half a cup) can cut the risk of stroke by 26 per cent. Those who eat three to five servings a day reduce their risk by 11 per cent (Lancet, 2006; 367: 320-6).

- Exercise regularly. Sedentary individuals have almost twice the risk of stroke compared with those who are active (Am J Epidemiol, 1996; 143: 860-9). Vigorous exercise early in life protects against stroke later on, irrespective of other 'risk' factors such as social class, smok-ing, alcohol consumption, family history, hypertension or diet. Continued vigorous exercise later in life reduces the risk still further. In nearly 11,000 men, age 58 years on average, those who exercised moderately (equivalent to one hour of brisk walking five days a week) had a 46-per-cent lower stroke risk than those who took little or no exercise (Stroke, 1998; 29: 2049-54).

- Maintain a healthy weight. Obesity is a known risk factor for stroke. It can also contribute to other risk factors such as high blood pressure, diabetes, high cholesterol and obstructive sleep apnoea (where the sufferer temporarily stops breathing). Abdominal fat appears to be important (especially in men) as well as the overall body mass index (BMI) (Arch Intern Med, 2007; 167: 1420-7; Stroke, 2003; 34: 1586).

- Limit alcohol. Moderate alcohol consumption-no more than two drinks per day-can protect against ischaemic stroke, while heavy drinking has the opposite effect (JAMA, 1999; 281: 53-60).

- Stop smoking. Cigarette-smoking is a known risk factor for stroke (Arch Intern Med, 1999; 159: 733-40). Indeed, second-hand smoke can dramatically increase the risk of stroke even in non-smokers (Am J Public Health, 1999; 89: 572-5).

- Eat more wholegrains. Women who eat more than one wholegrain food every day can reduce their risk of stroke by 35 per cent more than those who eat no wholegrains (JAMA, 2000; 284: 1534-40).

- Increase your intake of 'good' fats. Evidence is mounting in favour of fish-rich in omega-3 fatty acids-as a way to prevent stroke (Prev Med, 1999; 28: 520-9; JAMA, 2002; 288: 3130-6).

If you're worried about mercury, however, another way to increase healthy fats and oils in your diet is to eat a few walnuts a day. These-along with flaxseed, soybean and canola oils-are an excellent source of essential omega-6 alpha-linolenic acid (ALA). Research shows that for every 0.13 per cent increase in ALA in the blood, the risk of stroke dropped 37 per cent (Stroke, 1995; 26: 778-82).

- Take supplements. B vitamins may be especially useful as they can help to reduce homocysteine, which has been linked to stroke (Stroke, 2002; 33: 2351). A placebo-controlled trial showed that supplementing with even low levels of the appropriate B vitamins (1 mg of folic acid or B9, 10 mg of B6 and 400 mcg of B12) can significantly lower homocyst-eine levels within six weeks (Am J Clin Nutr, 1993; 57: 47-53).

In another study, folic-acid supplementation reduced the risk of stroke by 18 per cent (Lancet, 2007; 369: 1876-82).

Antioxidants may also be bene-ficial. A supplement combining beta-carotene, selenium, vitamin E, vitamin A and zinc reduced the rate of stroke deaths by 29 per cent

(Ann Intern Med, 2006; 145: 372-85).

- Try herbs. Garlic thins the blood and speeds up clotting, and just 800 mg/day of garlic powder for four weeks, or adding a fresh clove of garlic daily to your diet, will significantly reduce blood-clot risk (Eur J Clin Pharmacol, 1993; 45: 333-6; Arzneim Forsch, 1993; 43: 119-22; Prostagl Leukotr Essent Fatty Acids, 1995; 53: 211-2). Use high-quality garlic-powder supplements, and avoid oil extracts as they are the least effective form of garlic (Clin Exp Pharmacol Physiol, 1995; 22: 414-7).

Ginkgo biloba is another power-ful blood-thinner. A single 600-mg oral dose of Ginkgo significantly reduced platelet aggregation (Haemostasis, 1989; 19: 219-23). Lower doses (120-240 mg/day) may be just as effective.

Ginger may also help: 5 g/day of raw ginger for just a week brought about a 37-per-cent drop in the blood-clotting agent thromboxane (Prostagl Leukotr Essent Fatty Acids, 1989; 35: 183-5).

- De-stress yourself. Stress is a major contributing factor to hyper-tensive disease and stroke. Qi gong, an ancient Chinese form of exer-cise, has been proven to lower blood pressure (Zhongguo Zhong Xi Yi Jie He Za Zhi, 1993; 13: 413-4, 388-9) and dramatically slash stroke risk. Qi gong emphasizes a tranquil mind, relaxed body and smooth breath-ing. In one long-term study involving 18-22 years of follow-up, 19 per cent of those practising Qi gong died of stroke compared with 42 per cent among the controls

(J Tradit Chin Med, 1986; 6: 235-8).

Drugs that can cause stroke

- Sumatriptan

- Beta-blockers

- Nifedipine

- Chemotherapy

- Oral contraceptives

- Oral anticoagulant therapy

- Excessive use of nasal decongestants

- Blood-pressure-lowering drugs

- Phenylpropanolamine

- Anabolic steroids.

For more information, see WDDTY vol 7 no 6.

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