Thinking, moving our bodies, speaking, and experiencing emotions are all controlled by our amazing brains. Besides coordinating our actions, the brain also acts as a storage unit for our memories (1). Brains make us who we are, so they are essential to protect.
Our brains require a constant flow of blood-borne oxygen to function properly. Anything that compromises blood flow to the brain is a potentially life-threatening situation. A stroke is a medical condition where parts of the brain are severely deprived of oxygen because of low or no blood flow, resulting in brain cell death. There are many types of stroke, but the most common types are ischemic and hemorrhagic. Ischemic strokes occur when blood flow to some portion of the brain is blocked or even completely halted. Hemorrhagic strokes happen when there is bleeding into parts of the brain where it usually would not be, coupled with oxygen deprivation.
Strokes are one of the leading causes of death for adults in the United States and a major contributor to severe disability (1). You might ask, "If a risk factor is out of my control, such as a family history of stroke, is my fate determined?" Another frequent question is, "How do I avoid having a stroke as my relatives did?" Let's examine what conditions increase the risk for strokes and, better yet, how to reduce your risk.
Stroke Risk Factors
A family history of strokes can increase the risk of experiencing one yourself, especially if an immediate family member had one before age 65. Other factors that increase stroke risks and can not be controlled include (2-4):
Age (generally, the risk increases with age)
Race (risk is higher in African-American populations)
Sex (males have a lower risk than females)
Previous event - stroke, heart attack/cardiovascular events, or transient ischemic attack (TIA)
Factor V Leiden genetic mutation (or other mutations affecting blood clotting)
Structural abnormalities of the heart valves
The risk factors above may not seem to be within our control. However, plenty of things are within our control - including prevention, treatments, and the risk factors below. Acting on the prevention suggestions below can help reduce the risks associated with genetic factors.
Regarding heart issues that may contribute to stroke risk, the Temecula Center for Integrative Medicine (TCIM) has produced articles about cardiovascular events, coronary artery disease, and regenerative medicine for heart failure. Please explore those articles and the section on arterial disease (below) for additional information if you have been diagnosed with a cardiovascular condition.
Some of the risk factors within our control, things we can change, are (5, 6):
Smoking (greatly increases the risk of stroke)
Hypertension (high blood pressure is the leading cause of stroke)
Diabetes (damages blood vessels and is statistically associated with other conditions that increase the risk of stroke, such as heart disease, high blood pressure, and cholesterol)
Diet (can affect the risk of narrowed arteries, blood pressure, and obesity)
Lack of exercise
Certain medications
Unfortunately, some medications are associated with an increased risk of stroke (7). Note, it's crucial to never withdraw from medicines without consulting the prescribing doctor, as some medications are dangerous if quit suddenly. A dialogue with your doctor discussing a cost-benefit analysis of a risk-enhancing medication (versus life without the prescription) may be worthwhile. Doctors can help factor in family history, personal health history, diet, and lifestyle information into evaluating this medication.
Connection: Arterial Diseases Linked to Stroke Risks
Arterial diseases (or "artery diseases") are a group of health conditions that negatively affect the arteries. These blood vessels carry oxygenated blood away from the heart to the rest of the body. Unfortunately, having an arterial disease can increase the risk of stroke. A few studies show that one-third of stroke patients have some form of heart disease (8). Not only do arterial diseases have an overlap of similar causes, but arterial diseases can directly cause a stroke.
Here are three examples of the link between arterial diseases and stroke risks:
1) Atherosclerosis (also known as "hardening of the arteries)- Characterized by plaque buildup on the arteries' inner linings. Inflamed endothelial linings of arteries become a gathering place for cholesterol, blood cells, and fat, which stick together, forming a "plaque” (9). Plaques can gradually get tougher and stiffen over time, decreasing the flexibility of the blood vessel and "hardening" them. Hardened plaque pieces can break off and get lodged in a vessel leading to the brain, blocking blood flow and increasing the risk of stroke.
2) Carotid artery disease - Characterized by plaques that block blood flow to the head and brain via the carotid arteries, depriving the brain of oxygen (10). As the plaques build in the carotid arteries, the flow of oxygenated blood to the brain is reduced, increasing the risk of stroke. Also, plaques or clots formed here can travel to the brain, increasing the risk of a specific type of severe stroke (8).
3) Coronary artery disease (also known as coronary heart disease)- Typically caused by plaques clogging the arteries that supply the heart with oxygenated blood. The slow buildup of plaques or a sudden blockage by plaque or blood clots can weaken the heart, causing a heart attack (11).
Symptoms of Stroke
It's essential to be familiar with the signs of stroke because some medical interventions can reduce damage to brain tissue if administered quickly enough. If the following symptoms occur in you, alert the nearest person to call 9-1-1 or call yourself if you can. Do not attempt to drive. If someone near you displays these symptoms, get them to the hospital as quickly as possible, and do not delay (12):
Garbled speech, lack of language comprehension or expression
Affected sight - blurry vision, blackout, or double vision
Severe headache - vomiting, dizziness, or vertigo may accompany the headache
Uncoordinated movement - difficulties walking, holding items
Sudden Weakness - affecting the function of an arm or leg on one side of the body
Sudden onset of confusion or altered consciousness
Stroke Diagnosis & Treatments
Time is of the essence, so seeking diagnosis and treatment from a hospital as soon as possible after the stroke will reduce the severity of negative repercussions and possibly reduce treatment and recovery time. Neuroprotective drugs may be administered, or life support devices may be used, depending on the severity of the stroke (4). It is critical to immediately seek medical attention at the nearest emergency room if you suspect you may be having a stroke.
Stroke treatments depend on what type of stroke occurred. Once the type of stroke has been diagnosed, treatment can begin.
1. Hemorrhagic strokes are caused by bleeding into areas of the brain where blood should not be, so treatment focuses on stopping the bleeding (usually by doing surgery). Reducing blood pressure with specific medications can reduce blood flow pressure into the brain, reducing the volume of displaced blood. Repairing the brain blood vessels that are leaking allows the blood to flow properly again, bringing life-giving oxygen back to the cells that require it.
2. Blockages cause ischemic strokes, so treatment focuses on reducing the clot, plaque, or other blockages through medications or surgery. If a person can get into a hospital within 3 or 4 hours of this type of stroke, particular medications can reduce the blood clots, reducing the overall damage to brain tissues. Afterward, the focus becomes thinning the blood so that clots are less likely to form. Typically, preventing clots in the future is done by taking blood-thinning medications.
3. A transient ischemic attack (TIA) is also known as a "mini-stroke." In this case, blood flow to the brain is only interrupted for a few minutes, typically less than five minutes (1). There is no way for an observer of this type of attack to differentiate it from a full-blown stroke, so the same recommendation applies: get to a hospital quickly.
Supplemental & Integrative Treatments for Stroke
After a stroke, it's essential to get immediate treatment, as noted above. Guidance from a doctor about recovery and ongoing therapies is highly recommended. Customized recovery programs can be crafted, considering the stroke's specific type and severity. It is encouraging, however, to note that many integrative treatments are general enough to apply to most recovery programs. The following therapies have multiple broad benefits.
1) Cardiometabolic Diet / Functional Nutrition - Functional nutrition is a customized dietary approach considering a person's medical history, test results, stress level, and exercise frequency. This approach can be tailored to a specific person and aimed at the health of both the heart and the metabolism (cardiometabolic).
A modified Mediterranean diet is an example diet that fits the "cardiometabolic" description. It emphasizes whole foods, healthy fats (such as olive oil), and a high volume of fresh, fibrous greens and vegetables. Sugars and processed foods would be minimized on this diet. Foods containing Omega 3 fatty acids, such as the fats found in salmon, help thin the blood slightly, which prevents blood clotting and soothes inflammation of the artery linings. Various herbs and substances can also thin the blood, reduce inflammation, or act as an anticoagulant, such as turmeric, ginger, garlic, and vitamin E (13).
It is critical to meet with a healthcare practitioner skilled in functional nutrition so that your diet can be customized to combat post-stroke symptoms and aid in preventing future health issues. Also, if taking any medications, a knowledgeable healthcare practitioner can prevent contraindications between medicines and nutritional supplements.
2) Acupuncture - Acupuncture involves the insertion of very thin, unobtrusive needles in particular spots in the body to achieve some health results. A skilled acupuncturist can stimulate blood circulation to an injured body region, which would greatly aid in healing. One study showed that the balance between free radicals and antioxidants (oxidative stress) could be restored by acupuncture, which could limit or reduce the amount of damage by ischemic stroke (14).
3) Hyperbaric Oxygen Therapy (HBOT) - HBOT delivers oxygen to the patient under conditions of atmospheric pressure in a special chamber. This therapy super-oxygenates the body's cells, which can use oxygen for detoxification or repair. Numerous studies now show that HBOT can improve movement controlled by the brain and some cognitive functions (15).
Stroke Prevention
It is much less costly in terms of money, time, and suffering to prevent a disease rather than address it afterward. Having a stroke is emotionally stressful because it can be a life-or-death situation, but you don't know how severe the problem is at the onset. Though a stroke requires quick thinking and a fast trip to a well-equipped hospital for the best results, not all strokes have severe repercussions.
However, addressing the known risk factors is highly recommended to reduce the risk of having a stroke. While the recommendations below may not guarantee a stroke-free life, they can help improve your odds.
1) Early detection is one of the best things you can hope for. Having a knowledgeable doctor armed with an understanding of your family and personal health history, who has access to advanced testing, will be your best ally. An extensive yearly physical (such as TCIM's executive physical) designed to pick up early clues of chronic illnesses and identify risk factors for serious diseases gives you time to work on your health and turn it around before the issues get too severe.
During the executive physical, our doctors will determine if additional, more specific testing is warranted. For example, we can perform a non-invasive ultrasound of the arteries of the neck, called the carotid intima-media thickness test (CIMT), which can reveal atherosclerosis (hardening of the arteries) and plaques. Another revealing test is plethysmography, which helps examine the health of artery endothelial linings. The results of these tests can help the doctor determine the risk of stroke more precisely.
2) Cardiometabolic Diet / Functional Nutrition - As noted above in the section about treatments, customized functional nutrition approaches that focus on the heart and metabolism can help improve symptoms. Indeed, cardiometabolic diets and nutritional supplements can not only treat but help prevent chronic conditions such as atherosclerosis and high blood pressure, which lead to increased stroke risk. A healthcare practitioner trained in functional nutrition can help craft delicious meals that have the medicinal qualities of combating inflammation and blood coagulation.
3) Exercise has many health benefits. Exercising can help prevent obesity, alleviating risks for many obesity-related chronic illnesses. Regular exercising, even just cycles of walking fast and slow (HIIT walking), can burn off excess blood sugar, increase "good" HDL cholesterol, and reduce triglycerides in the blood (16). Consistent physical activity reduces stroke risks (17). Combining a healthy diet with exercise can minimize the genetic risks of stroke (18).
4) Attempt to reduce or eliminate the known risk factors as much as possible. For example, quitting smoking can offset the risk of strokes due to genetics (18). With the help of a healthcare practitioner, you can attempt to reverse diabetes and other chronic illnesses that increase the risk of stroke.
An Example of Early Detection of a Stroke Risk Factor (Atherosclerosis)
During an executive physical at TCIM, getting an image of your carotid arteries may help us detect atherosclerosis, which is the hardening of the arteries or the presence of plaque in the arteries. The "carotid intima-media thickness" (CIMT) test is an ultrasound scan of the carotid arteries on either side of the neck, which lead to the head and brain. Two layers of the carotid artery walls, the intima and media, can be visualized, and their combined thickness measured using ultrasound.
The CIMT is a non-invasive scan that only requires the patient to expose their neck for the test. The results compare the thickness of the patient's artery wall to the average measurements taken from people of varying ages. We can then say, "You may be 67, but your artery wall thickness is similar to that of a 55 yr old." It's a ballpark way of determining how much your arteries have aged versus your biological age.
The CIMT test will also show any plaque buildup in the arteries. It's a very beneficial test for helping TCIM doctors assess how seriously and aggressively we should treat elevated cholesterol scores.
If your assessed artery age is at your biological age or lower, diet, exercise, and nutritional supplements are usually adequate to address elevated cholesterol scores and lower stroke risk. If your assessed artery age is much higher than your biological age or there is a lot of plaque, greater preventative measures should be taken. Just diet and exercise may not help lower the risk of stroke or heart attack to an acceptable level. Medication may be needed to significantly decrease the risk of heart attack and stroke.
Time for an Executive Physical
We cannot stress how important an in-depth exam such as the executive physical can be to your health and longevity. These advanced exams allow us to catch the early beginnings of chronic illnesses and potentially life-threatening events such as heart attacks or strokes. For those who have a potential stroke in the future due to genetics, decades of smoking, or other risk factors, we can create a personalized plan to improve your health and help greatly reduce your risks. Please call us to schedule an appointment if it's been more than a year since you've had an in-depth physical.
Jonathan Vellinga, MD is an Internal Medicine practitioner with a broad interest in medicine. He graduated Summa cum laude from Weber State University in Clinical Laboratory Sciences and completed his medical degree from the Medical College of Wisconsin.
Upon graduation from medical school, he completed his Internal Medicine residency at the University of Michigan. Dr. Vellinga is board-certified with the American Board of Internal Medicine and a member of the Institute for Functional Medicine.
info@tcimedicine.com
951-383-4333
Sources:
1. About stroke [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2022 [cited 2023Mar30]. Available from: https://www.cdc.gov/stroke/about.htm
2. Stroke risk factors not within your control [Internet]. www.stroke.org. 2023 [cited 2023Mar30]. Available from: https://www.stroke.org/en/about-stroke/stroke-risk-factors/stroke-risk-factors-not-within-your-control
3. Chiasakul T, De Jesus E, Tong J, Chen Y, Crowther M, Garcia D, Chai-Adisaksopha C, Messé SR, Cuker A. Inherited Thrombophilia and the Risk of Arterial Ischemic Stroke: A Systematic Review and Meta-Analysis. J Am Heart Assoc. 2019 Oct;8(19):e012877. doi: 10.1161/JAHA.119.012877. Epub 2019 Sep 24. PMID: 31549567; PMCID: PMC6806047.
4. Risk factors for stroke [Internet]. Risk Factors for Stroke | Johns Hopkins Medicine. 2022 [cited 2023Mar30]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/stroke/risk-factors-for-stroke
5. Risk factors under your control [Internet]. www.stroke.org. 2023 [cited 2023Mar30]. Available from: https://www.stroke.org/en/about-stroke/stroke-risk-factors/risk-factors-under-your-control
6. Diabetes, heart disease, & stroke - NIDDK [Internet]. National Institute of Diabetes and Digestive and Kidney Diseases. U.S. Department of Health and Human Services; [cited 2023Mar30]. Available from: https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/heart-disease-stroke
7. Marto JP, Strambo D, Livio F, Michel P. Drugs associated with ischemic stroke. Stroke. 2021;52(10).
8. Arboix A. Cardiovascular risk factors for acute stroke: Risk profiles in the different subtypes of ischemic stroke. World J Clin Cases. 2015 May 16;3(5):418-29. doi: 10.12998/wjcc.v3.i5.418. PMID: 25984516; PMCID: PMC4419105.
9. What is atherosclerosis? [Internet]. National Heart Lung and Blood Institute. U.S. Department of Health and Human Services; [cited 2023Mar30]. Available from: https://www.nhlbi.nih.gov/health/atherosclerosis
10. Carotid artery disease [Internet]. Mayo Clinic. Mayo Foundation for Medical Education and Research; 2018 [cited 2023Mar30]. Available from: https://www.mayoclinic.org/diseases-conditions/carotid-artery-disease/symptoms-causes/syc-20360519
11. Coronary artery disease - coronary heart disease [Internet]. www.stroke.org. 2021 [cited 2023Mar30]. Available from: https://www.stroke.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/coronary-artery-disease
12. Stroke [Internet]. Mayo Clinic. Mayo Foundation for Medical Education and Research; 2022 [cited 2023Mar30]. Available from: https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113
13. 14 natural blood thinners for heart health [Internet]. Medical News Today. MediLexicon International; [cited 2023Mar30]. Available from: https://www.medicalnewstoday.com/articles/322384
14. Su XT, Wang L, Ma SM, Cao Y, Yang NN, Lin LL, Fisher M, Yang JW, Liu CZ. Mechanisms of Acupuncture in the Regulation of Oxidative Stress in Treating Ischemic Stroke. Oxid Med Cell Longev. 2020 Oct 24;2020:7875396. doi: 10.1155/2020/7875396. PMID: 33178387; PMCID: PMC7644298.
15. Hadanny A, Rittblat M, Bitterman M, May-Raz I, Suzin G, Boussi-Gross R, Zemel Y, Bechor Y, Catalogna M, Efrati S. Hyperbaric oxygen therapy improves neurocognitive functions of post-stroke patients - a retrospective analysis. Restor Neurol Neurosci. 2020;38(1):93-107. doi: 10.3233/RNN-190959. PMID: 31985478; PMCID: PMC7081098.
16. 7 great reasons why exercise matters [Internet]. Mayo Clinic. Mayo Foundation for Medical Education and Research; 2021 [cited 2023Mar30]. Available from: https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise/art-20048389
17. Kramer SF, Hung SH, Brodtmann A. The Impact of Physical Activity Before and After Stroke on Stroke Risk and Recovery: a Narrative Review. Curr Neurol Neurosci Rep. 2019 Apr 22;19(6):28. doi: 10.1007/s11910-019-0949-4. PMID: 31011851.
18. Stroke: Study finds that healthy lifestyle can offset genetic risk [Internet]. Medical News Today. MediLexicon International; [cited 2023Mar30]. Available from: https://www.medicalnewstoday.com/articles/genetically-at-risk-of-stroke-a-healthy-lifestyle-can-help