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Preventing stroke

MagazineMay 2014 (Vol. 25 Issue 2)Preventing stroke

QI 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 your News Focus in February's issue, 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, despite its being considered the 'gold standard' of preventative stroke therapy by the medical profession. As reported in WDDTY's February 2014 issue, there's a very fine balance between possible benefits and risks,
and even evidence that it
might actually increase the
risk of stroke.

TIAs are serious events. They occur when the blood supply to parts of the brain is temporarily interrupted or blocked, and should be considered a harbinger of future full-blown stroke. For this reason, all possible causes of 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.

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

Here are some simple steps that anyone can take to reduce the risk of stroke.

Get more than your five-a-day

Eating lots of fruit and vegetables can protect against the two main types of stroke: ischaemic (the most common type, caused by a blocked artery to the brain); and haemorrhagic (caused by the sudden rupture of an artery).

According to the results of 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.1

Tomatoes may be especially helpful. They contain the carotenoid lycopene, a powerful antioxidant independently linked to a lower risk of stroke-at least in men, while 'white' fruit and veg like apples and pears are also great preventative options.2

Exercise regularly

Couch potatoes have almost twice the risk of stroke compared with active types,3so if it isn't already, make exercise a part of your life.

In a study of more than 11,000 men with a mean age of 58, those who exercised moderately (equivalent to an hour of brisk walking five days a week) had a 46 per cent lower stroke risk than those who took little or no exercise.4Women can also cut their stroke risk simply by walking at a brisk pace (three miles an hour or faster) for a couple of hours a week.5

Maintain a healthy weight

Obesity is a known risk factor for stroke, and it also contributes to other risk factors such as high blood pressure, diabetes, high cholesterol and obstructive sleep apnoea (where the sufferer temporarily stops breathing while asleep). As well as keeping an eye on your body mass index (BMI), based on your weight-to-height ratio, you should also watch the weight around your middle, which has been independently linked to increased stroke risk.6

Limit alcohol

Moderate alcohol intake-no more than two drinks per day-can protect against ischaemic stroke, while heavy drinking has the opposite effect.7

Stop smoking

If you smoke, quit; cigarette-smoking is a known risk factor for stroke, and even second-hand (passive) smoke can dramatically increase the risk.8

Opt for wholegrains

Women who eat more than one wholegrain food every day can reduce their risk of stroke by more than a third compared with those who eat no whole grains.9Wholegrain foods include wholewheat bread, brown rice, oats and buckwheat.

Eat chocolate

Snacking on just a couple of squares of polyphenol-rich dark chocolate a day (6.3 g) can significantly lower blood pressure, and may also slash your risk of stroke.10

Go for 'good' fats

Evidence is mounting in favour of fish-rich in heart-healthy omega-3 fatty acids-as a way to prevent stroke.11

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 excellent sources of essential omega-3 alpha-linolenic acid (ALA). Research shows that, for every 0.13 per cent increase in ALA levels in the blood, the risk of stroke drops by 37 per cent.12

Get your Bs

B vitamins may be worth taking as they can help reduce homocysteine, an amino acid linked to stroke.13A placebo-controlled trial showed that supplementing with even low levels of the appropriate B vitamins can significantly lower homocysteine levels within six weeks while, in another study, folic-acid supplementation reduced the risk of stroke by 18 per cent.14

Suggested daily dosages: 1 mg l-methylfolate (see page 21 for why this form is preferable to folic acid); 10 mg B6; 400 mcg B12

Try herbs

Garlic is a well-known heart-healthy herb; it thins the blood and can reduce your risk of blood clots.15

Use high-quality garlic-powder supplements, and avoid oil extracts as they may be the least effective form of garlic.16Alternatively, add a fresh clove of garlic to your daily diet.

Ginkgo bilobais another powerful blood-thinner. A single 600-mg oral dose of Ginkgo leaf extract significantly reduced platelet aggregation (clumping),17although lower doses (around 120-240 mg/day) may be just as effective.

Ginger can also help. Eating raw ginger for just a week brought about a 37 per cent drop in the blood-clotting agent thromboxane in one study.18

Suggested daily dosages: 800 mg garlic powder; 120-240 mg Ginkgo biloba; 5 g raw ginger

De-stress

Stress is a major contributing factor to high blood pressure and stroke, so take the time to relax. Try meditation, yoga or Qigong-an ancient Chinese form of exercise that's been proven to lower blood pressure and dramatically slash stroke risk.19Qigong emphasizes a tranquil mind, relaxed body and smooth, regular breathing.

Look after your teeth and gums

There's now good evidence linking oral health and heart health. Severe gum disease can double your risk of stroke.20

Get enough D

Vitamin D deficiency may play a role in heart disease and stroke.21Exposing your skin to sunlight is the best way to get your dose of D, and just 10-15 minutes two or three times a week (without sunscreen) is usually enough (see News Focus, page 18).22Alternatively, supplementing with 600-1,000 IU of vitamin D3 (the natural form) is a good idea for those who don't get much sunshine.

Drugs linked to stroke

Watch out for the following drugs, which have all been tied to stroke:

.Sumatriptan

.Beta-blockers

.Nifedipine

.Chemotherapy drugs
Oral contraceptives

.Anabolic steroids

.Oral anticoagulants

.Excessive use of nasal decongestants

.Blood-pressure-lowering drugs

.Phenylpropanolamine

references

1

Lancet, 2006; 367: 320-6

2

Neurology, 2012; 79: 1540-7; Stroke, 2011; 42: 3190-5

3

Am J Epidemiol, 1996; 143: 860-9

4

Stroke, 1998; 29: 2049-54

5

Stroke, 2014; 45: ATMP67

6

Arch Intern Med, 2007; 167: 1420-7; Stroke, 2003; 34: 1586-92

7

JAMA, 1999; 281: 53-60

8

Arch Intern Med, 1999; 159: 733-40; Am J Public Health, 1999; 89: 572-5

9

JAMA, 2000; 284: 1534-40

10

JAMA, 2007; 298: 49-60; Stroke, 2014; 45: 309-14

11

Prev Med, 1999; 28: 520-9; JAMA, 2002; 288: 3130-6

12

Stroke, 1995; 26: 778-82

13

Stroke, 2002; 33: 2351-6

14

Am J Clin Nutr, 1993; 57: 47-53; Lancet, 2007; 369: 1876-82

15

Eur J Clin Pharmacol, 1993; 45: 333-6; Arzneimittelforschung, 1993; 43: 119-22; Prostaglandins Leukot Essent Fatty Acids, 1995; 53: 211-2

16

Clin Exp Pharmacol Physiol, 1995; 22: 414-7

17

Haemostasis, 1989; 19: 219-23

18

Prostaglandins Leukot Essent Fatty Acids, 1989; 35: 183-5

19

Zhongguo Zhong Xi Yi Jie He Za Zhi, 1993; 13: 413-4, 388-9; J Tradit Chin Med, 1986; 6: 235-8

20

Arch Intern Med, 2000; 160: 2749-55

21

Curr Vasc Pharmacol, 2009; 7: 414-22

22

Am J Clin Nutr, 2004; 80: 1678S-88S

Send us your most pressing medical questions and we'll put them to our natural doctor:

letters@wddty.co.uk


Opening your heart

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