Archive for stroke
Awareness of the Risks of Heatstroke and Dietary Supplements
This article points to the finding that amphetamine derivatives and creatine may contribute to dehydration and heatstroke in football players. Although creatine does appear to be one of the few “wonder meathead supplements” (as opposed to whey protein, chromium, DHEA and androstenedione) that actually have research supporting their use in athletic and fitness training, caution should always be observed. I am strongly against their use in anyone younger that 18 (i.e. out of high school). Prior to this age the system is still growing and potentially more sensitive to insults and/or abnormal muscle growth that may affect tendons and ligaments in the future.
The Neurosurgeon in Sport: Awareness of the Risks of Heatstroke and Dietary Supplements
Insulin resistance and risk for stroke
I’m sure that none of you who regularly read Updates had your eyes bulge wide on this one, this article does bother me a little. First, it is in a neurological journal, which is fine–all specialist should become familiar with the effect of increased insulin resistance because it truly cuts across all organ systems. However, I have a serious beef with the conclusion of this article that suggests that new drugs can be used to affect insulin resistance. Well, we know from several well designed studies that insulin sensitivity can be dramatically impacted through lifestyle changes (exercise, avoidance of refined grains for whole grains and intake of lots of fresh fruits and veggies). This article, which may be some neurologist’s first exposure to this concept, neglects to mention one of the most powerful tools to treat insulin resistance.
Neurology — Abstracts: Kernan et al. 59 (6): 809
HRT and Associated Risk of Stroke in Postmenopausal Women
Sorry…just felt the need to beat a dead bush (too much of an animal lover to beat a dead dog…). Still wondering why this stuff is even available, let alone prescribed…
Hormone Replacement Therapy and Associated Risk of Stroke in Postmenopausal Women
Effect of Estrogen Plus Progestin on Stroke in Postmenopausal Women
Ditto on the above with an increased risk of ischemic stroke. Hey, this isn’t me making this stuff up just to make it look bad!!
JAMA — Abstracts: Wassertheil-Smoller et al. 289 (20): 2673
Effects of low-dose warfarin and aspirin versus no treatment on stroke in a medium-risk patient population with atrial fibrillation.
This article touches on what I consider a controversial topic. The chronic use of warfarin in a patient with atrial fibrillation produces a “small beneficial effect” on stroke and major vascular events. The question is, does a “small beneficial effect” justify the continued use of warfarin that would prohibit intake of foods (green, leafy veggies, ginko, ginseng, high dose Vit E, fish oils) that have a huge beneficial effects across the spectrum of multiple chronic diseases? This is a question that only a patient and their prescribing physician can answer, evaluating the risk for other chronic diseases vs ischemic stroke.
There have been many bad recommendations perpetuated over the years about how much cholesterol per day you should take in. Do eggs count? This confusion has been created by national organizations (American Heart, American Cancer, American Diabetic Association) combined with mainstream media’s interpretation of the medical research. The research, on the other hand, has been extremely consistent with what has been good and bad for you. Some examples include:
Eat fish because it’s good for you, then don’t eat fish because it’s loaded with pesticides (pesticides are in farm raised, which you should not have been eating in the first place).
- Avoid salt to protect your heart then don’t worry because it might not help (the evidence was never strong in the first place).
- Cut back on fat to protect your heart then take fish oils (the right type of fats have always been good for us).
- Hormone replacement therapy for women was essential, then it causes heart disease and cancer (it was NEVER a good idea to screw around with Mother Nature’s original plan).
The list is obviously longer, but you get the idea. So what about the egg story? Eggs contain cholesterol, so they’re bad for us, right?
Only if you mistakenly believe that the cholesterol in our diet plays a strong role in the cholesterol in your bloodstream. You can keep avoiding eggs.
For the rest of you, eggs can be part of a healthy lifestyle, which is confirmed in this particular study. Researchers looked across multiple studies to get an idea of just how much eggs played a role in the risk of heart attack or stroke. Here’s what they found:
- An average of one egg per day had no effect on heart disease (Tweet this).
- For stroke, one egg per day lowered the risk of stroke by 9%.
- However, in diabetics, those with the highest intake of eggs had a 54% increased risk of heart disease.
- This same group, though had a 25% lower risk of hemorrhagic stroke.
So, the old myth that eggs are bad for your cholesterol and your heart just don’t hold true, although the story may be different for diabetics.
Here are some important considerations:
- I always steer patients towards “veg-a-fed” or “omega-3″ eggs. These chickens are fed flax seed, which raises the omega 3 content, a known protector of the heart.
- The yolk of eggs is very high in carotenoids like lutein and zeaxanthin. They are actually good for you.
- If you choose to cook them in a pan, use olive oil, not Pam or anything like that.
- Better yet, liven the dish up with spices, jalapenos, peppers and any other veggies you’re comfortable with. You increase the phytonutrient value with hardly any caloric increase.
As for why the response may be different in diabetics, I could make some educated guesses as to why this finding occured, but it is still my gut feeling that, in the presence of the 4 factors noted above, the effect of egg intake on the heart would be at worst, neutral, and at best, protective.
How do you like your eggs?
Homocysteine and Risk of Ischemic Heart Disease and Stroke
This meta analysis finds an 11% increase in ischemic heart disease and 19% increase in stroke. While the authors were not jumping up and down about these results, I strongly disagree. First, one single solitary factor raised risk more than 10%. A single, solitary, VERY modifiable risk factor. (As far as cost, my office offers a 2,000 mcg B12 and 800 mg folic acid for about $8/month…that would equal to about $3,840 for forty years’ worth…hardly the cost of diagnosing CVD). Remember, Western medicine rarely gets beyond the idea of “one cause, one cure.” Natural approaches to CVD would attack multiple angles, with efficacy rising with a more broad scope approach.
Lastly, this review accepts what is currently accepted as “normal” for homocysteine levels. It is highly possible (and we see it in many other lab values) that “normal” values are actually too broad. That would result in patients with “high normal” homocysteine that contributes to their CVD but would actually have counted against association.
Heart disease, stroke and cancer remain our #1 killers, and yet each is avoidable. But, to prevent stroke, you must make a conscious effort to do these things.
We all want our bodies and brains to last about the same amount of time. However, this does not happen without a conscious effort at protecting both. Luckily, this is not really all that difficult.
One of the surest ways to rapidly short-circuit the brain is a stroke. Brain attack. Transient ischemic attack (TIA). The end result can vary from full recovery to significant disability to death.
The good thing is that this event is heavily preventable.
Before we go further, however, I do need to clarify that we are talking about ischemic stroke–the kind that occurs when a blood vessel gets blocked and the brain tissues fed by this blood vessels begin to die off from lack of oxygen. This is a much different animal than a hemorrhagic stroke, where a blood vessel ruptures and the blood pours into an area of the brain, damaging the tissues affected. Most of what we know about preventing strokes deals with the ischemic variety.
So what do we know can help prevent strokes?
- Diets high in olive oil have been shown to lower the risk of stroke.
- Dark chocolate.
- A pro-diabetic lifestyle
This list is, of course, much longer. But I wanted to add a 4th item.
Lycopene. That red pigment of the carotenoid family found in items like tomatoes, watermelon and grapefruit.
This particular study looked at how much of an effect the intake of lycopene had on the risk of stroke. Overall, those men with the highest levels of lycopene in their bloodstream had a 59% lower risk of ischemic stroke and a 55% lower risk of all types of stroke.
That’s pretty powerful stuff. Interestingly, one of the components of the Mediterranean diet that is believed to play an important role is the lycopene content from the tomatoes as well as the olive oil content. Olive oil, being fat soluble, will help our bodies absorb more lycopene from the diet. This kind of nicely ties in together several aspects of lifestyle that lower the risk of stroke.
Incidentally, studies have shown that the inclusion of a the tomato peel actually increases the lycopene level in the bloodstream. Just FYI…
So what’s your favorite way to get more lycopene in your diet?
Many have the mistaken idea that living a healthy lifestyle is painfully boring. These same people are likely not aware of the volume of chocolate research…
I had a discussion with a new patient recently who said she liked sweets too much to be healthy. I asked how she would feel about a regular routine of dark chocolate mixed with sweeter fruits like cranberries, blueberries or strawberries. Didn’t sound too bad to her.
Like many other people, we have an altered perception of what is good and bad for us. Do any of these misconceptions sound familiar?
- Nuts are fattening.
- Diet soda will help me from gaining weight.
- Milk does a body good.
- I need to exercise 45 minutes 3 times per week.
Of course there are many more, but these were the first few that popped into my head.
Dark chocolate has been shown time and time again to be very good for us, along with its cousin, cocoa. Both are derived from the cacao plant and so have similar positive effects on health. Most of their power seems to be focused around protecting our blood vessels (aka vascular health). Lest you think vascular health doesn’t have the pizazz of heart disease and stroke, remember that almost ALL heart attacks and strokes begin with a problem in the blood vessels. Protect the blood vessels and you protect everything.
Especially the brain. Nothing destroys the brain more that poor vascular health. This is why conditions like prediabetes are so bad for the brain–the prediabetic state absolutely destroys the health of your blood vessels. Do this for too long and the cells of the brain begin to lose the vital blood flow they need to function optimally. These changes begin to show up as white matter changes.
Just in case you don’t think the chocolate research is really this strong as it relates to vascular health, this particular article looks at the risk of having a stroke as it relates to healthy chocolate.
- Overall, high chocolate consumption was associated with a lower risk of stroke.
- The highest group of chocolate consumers averaged 62.9 g/week (just under a good sized bar).
- The highest group had a 19% lower risk of all types of stroke.
While 19% is not dramatic, make sure you take this into perspective. It’s chocolate.
One last comment, which I’m sure you’re already aware of. We’re not talking about the sugar-laden, dairy containing milk chocolate here. The protective compounds in milk chocolate are almost absent, while they remain very high in dark chocolate. The higher the cacao content, the better.
How do you like to eat your chocolate?