Signs of stroke include:
• Sudden, unexplained dizziness, trouble with walking, loss of balance, or unsteadiness
• Confusion, trouble speaking or understanding communication
• Unexplained weakness or numbness of the face, arms, or legs, or on one side of the body
• Loss of vision in one or both eyes
• Sudden, unexplained severe headache
A stroke is the loss of nerve function for at least 24 hours due to lack of oxygen. The time limit is specified to distinguish it from a transient ischemic attack (TIA), which does not cause permanent disability. A stroke can be the result of a lack of blood flow (ischemia) caused by blockage from a blood clot (embolism) or a hemorrhage (leakage of blood). Without oxygen, the nerve cells become damaged or die, and the affected area of the brain becomes unable to function. A stroke may result in an inability to move one or both limbs on one side of the body, inability to understand or formulate speech, or an inability to see on one side of the visual field. If the stroke is severe enough or occurs in a certain location, such as parts of the brainstem, it can result in coma or death.
Stroke is the leading cause of adult disability in the United States and the third-leading cause of death. Risk factors for stroke include old age, hypertension (high blood pressure), previous stroke or transient ischemic attack (TIA), diabetes, high cholesterol, cigarette smoking, and atrial fibrillation. High blood pressure is the most important risk factor for a stroke.
A stroke is diagnosed through a neurological examination and is usually confirmed with a CT or MRI scan.
Risk Factors for a Stroke |
|
RISK FACTOR |
SIGNIFICANCE |
High blood pressure |
Accounts for 35–50% of stroke risk |
Atrial fibrillation |
Risk of 5% each year to develop stroke |
Diabetes |
At least two to three times more likely to develop stroke |
Surgery |
Particularly carotid endartectomy (see the chapter “Cerebral Vascular Insufficiency”) |
Dietary factors |
High saturated fat intake; low consumption of fruit, vegetables, and omega-3 fatty acids |
Smoking |
Increases the risk of developing atherosclerosis |
High cholesterol |
Increases the risk of developing atherosclerosis |
One of the key factors in limiting the damage to the brain caused by a stroke is how quickly a person receives the drug form of the naturally occurring compound tissue plasminogen activator (rtPA). It must be administered within a few hours of a stroke to produce significant benefit. Unfortunately, only 1 to 3% of stroke patients receive rtPA treatment.
The results of stroke can affect patients physically, mentally, or emotionally, or in any combination of the three ways, and can vary widely depending on size and location of the lesion. Disability corresponds to areas in the brain that have been damaged.
The physical disabilities that can result from stroke include muscle weakness, numbness, pressure sores, pneumonia, incontinence, apraxia (inability to perform learned movements), difficulties carrying out daily activities, appetite loss, speech loss, vision loss, and pain.
Emotional problems after a stroke can result from direct damage to emotional centers in the brain or from frustration and difficulty adapting to new limitations. Poststroke emotional difficulties include anxiety, panic attacks, flat affect (failure to express emotions), mania, apathy, and psychosis.
Almost half of stroke survivors suffer poststroke depression, which is characterized by lethargy, irritability, sleep disturbances, lowered self-esteem, and withdrawal. Emotional lability, another consequence of stroke, causes the patient to switch quickly between emotional highs and lows and to express emotions inappropriately, for instance with an excess of laughing or crying with little or no provocation. While these expressions of emotion usually correspond to the patient’s actual emotions, a more severe form of emotional lability causes patients to laugh and cry pathologically, without regard to context or emotion. Some patients show the opposite of what they feel, such as crying when they are happy. Emotional lability occurs in about 20% of stroke patients.
Cognitive deficits resulting from stroke include perceptual disorders, speech problems, dementia, and problems with attention and memory. A stroke sufferer may be unaware of his or her own disabilities, a condition called anosognosia. In a condition called hemispatial neglect, a patient is unable to attend to anything on the side of space opposite to the damaged hemisphere.
Up to 10% of all stroke patients develop seizures, most commonly in the week subsequent to the event; the severity of the stroke increases the likelihood of seizures.
Therapeutic Considerations
For most stroke patients who suffer from poststroke disability, recovery is a concerted effort that involves physical therapy, occupational therapy, and speech-language therapy. We recommend taking advantage of these services, as they can greatly aid the rehabilitation process.
Medical care is often focused on preventing another stroke and most often utilizes anticoagulant therapy with warfarin (Coumadin) or antiplatelet therapy with aspirin or clopidogrel (Plavix), ticlopidine (Ticlid), and so on. These drugs are designed to prevent blood clots from forming and lodging in the brain, where they can produce another stroke. These drugs are not, of course, used when the stroke is from a hemorrhage.
From a natural medicine perspective the goals are similar, but more focused on maximizing blood flow and nutrition to the damaged areas. In addition, acupuncture has shown significant benefits in aiding stroke recovery.
The general guidelines offered in the chapter “Cerebral Vascular Insufficiency” are valid here. In particular, ginkgo biloba extract is very important in stroke recovery. Ginkgo biloba extract increases blood flow to the brain, improves the production of energy within nerve cells, and favorably affects blood viscosity (thickness), resulting in improved blood flow characteristics within the brain.1 We also recommend coenzyme Q10, as it may help improve energy production within the recovering brain cells.
There are a number of dietary and supplements to reduce the aggregation of platelets as well as reduce the formation of fibrin and thereby prevent blood clots from forming. The general dietary factors that reduce platelet aggregation and promote fibrin breakdown (fibrinolysis) are discussed in the chapter “Heart and Cardiovascular Health.” These factors include omega-3 fatty acids, antioxidant nutrients, flavonoids, flavonoid-rich extracts (e.g., grape seed and pine bark extract), nattokinase, and garlic preparations standardized for alliin content. Fish oil supplementation can definitely be used in combination with aspirin and other platelet inhibitors,2 but if several natural antiplatelet agents are used at the same time or if nattokinase is used, it is important to avoid the use of antiplatelet drugs (including aspirin). There are case reports of hemorrhagic strokes that occurred when a natural agent (e.g., nattokinase) was combined with an antiplatelet drug.3 However, aspirin alone is also associated with similar case reports, so it is hard to gauge the significance of an interaction. Nonetheless, the caution not to mix antiplatelet therapies applies.
The drug Coumadin works by blocking the action of vitamin K. Since green leafy vegetables and green tea contain high levels of vitamin K, you should avoid increasing your intake of these foods while taking Coumadin. You can usually eat the same levels you’re accustomed to—just don’t increase your consumption. Your physician will monitor your blood clotting ability and will change your dose up or down as needed. In addition to foods high in vitamin K, other natural remedies may interact with Coumadin. For example:
• Coenzyme Q10 and Saint-John’s-wort (Hypericum perforatum) may reduce Coumadin’s efficacy
• Proteolytic enzymes, such as nattokinase and bromelain, and several herbs, including Chinese ginseng (Panax ginseng), devil’s claw (Harpagophytum procumbens), and dong quai (Angelica sinensis), can increase Coumadin’s effects.
• It’s likely that you can continue using these products, but don’t change the dosage from what your body is accustomed to. Clotting values must be monitored appropriately.
• Garlic (Allium sativum) and ginkgo biloba extracts may reduce the ability of platelets to stick together, increasing the likelihood of bleeding. However, neither appears to interact directly with Coumadin. We generally tell people taking Coumadin to avoid these products at higher dosages (more than the equivalent of one clove of garlic per day for garlic or more than 240 mg per day of ginkgo extract) but not to worry if they are just on the typical support dose of garlic or ginkgo.
• Iron, magnesium, and zinc may bind with Coumadin, potentially decreasing its absorption and activity. Take Coumadin and products that contain iron, magnesium, or zinc products at least two hours apart.
To reduce the likelihood of bleeding and easy bruising with Coumadin, we recommend taking 150 to 300 mg of either grape seed or pine bark extract per day.
Citicoline (CDP-choline) and glycerophosphocholine (GPC) are well absorbed and highly bioavailable sources of choline. In double-blind studies both have been shown to be useful in promoting recovery from a stroke.4
A 2002 analysis looked at four double-blind studies with oral citicoline for acute ischemic stroke.5 All were performed in the United States and used various doses of oral citicoline (500, 1,000, or 2,000 mg per day) or placebos. In all cases, citicoline was begun within 24 hours after stroke onset and continued for six weeks. At the three-month check-up, results indicated that citicoline improved by 29% the probability that the patient would recover the ability to participate in activities of daily living and by 42% the probability of recovering functional capacity. However, it did not increase neurological recovery to any significant degree. Nonetheless, these results are very encouraging, as any improvement over a placebo can have profound real-life benefits.6
GPC is even better studied, as it has been administered in six clinical trials to almost 3,000 patients suffering from a stroke.7–13 In all of these trials, the patients were started within 10 days after having a stroke. The trials consisted of two phases: during the first phase of 28 days, generally in a hospital, GPC was given intramuscularly at 1,000 mg per day. During the second phase, from day 29 to day 180, GPC was given orally at 1,200 mg per day (400 mg three times per day). The single largest trial was conducted at 176 centers in Italy and included 2,044 patients.8 At the end of the six-month trial, the investigators found that GPC significantly helped more than 95% of patients and was without side effects. Overall, GPC was judged by 78% of investigators as “very good” or “good,” by 17% as “moderate,” and by just 5% as having “poor” or “no” efficacy.
QUICK REVIEW
• Stroke is the leading cause of adult disability in the United States and the third-leading cause of death.
• High blood pressure is the most important risk factor of stroke.
• Ginkgo biloba extract increases blood flow to the brain, improves the production of energy within nerve cells, and favorably affects blood viscosity (thickness), resulting in improved blood flow characteristics within the brain.
• It is important to use natural products with caution when taking drugs that inhibit platelets or blood clotting.
• Citicoline and glycerophosphocholine are well absorbed and highly bioavailable sources of choline shown to be useful in promoting recovery from a stroke.
• Acupuncture can often help stroke patients perform self-care better, can mean that patients require less nursing care and less rehabilitation therapy, and can possibly cut health care costs.
There is some clinical research showing that acupuncture can facilitate recovery from a stroke. Specifically, acupuncture can often help stroke patients perform self-care better, can mean that patients require less nursing and less rehabilitation therapy, and can possibly cut health care costs. Possible mechanisms of its effects include stimulation of nerve cell regrowth, facilitation of improved nerve cell function, reduction of poststroke inflammatory reactions, and prevention of nerve cell death. Given its safety and possible benefits, acupuncture is very much worth the effort.14,15
TREATMENT SUMMARY
In most cases, a stroke is a consequence of atherosclerosis. That being the case, appropriate prevention of further strokes involves following the recommendations in the chapter “Heart and Cardiovascular Health.” It may also be appropriate to consult the chapter “High Cholesterol and/or Triglycerides” and the chapter “High Blood Pressure,” especially as hypertension is a major cause of stroke. The primary therapeutic goal in the recovery from a stroke is to enhance the blood and oxygen supply to the brain as well as improve nerve cell function.
• A high-potency multiple vitamin and mineral formula as described in the chapter “Supplementary Measures”
• Vitamin D3: 2,000 to 4,000 IU per day (ideally, measure blood levels and adjust dosage accordingly)
• Fish oils: 1,000 to 3,000 mg EPA + DHA per day
• One of the following:
Grape seed extract (>95% procyanidolic oligomers): 100 to 300 mg per day
Pine bark extract (>95% procyanidolic oligomers): 100 to 300 mg per day
Some other flavonoid-rich extract with a similar flavonoid content, super greens formula, or another plant-based antioxidant that can provide an oxygen radical absorption capacity (ORAC) of 3,000 to 6,000 units or more per day
• One of the following:
Citicoline: 1,000 to 2,000 mg per day
Glycerophosphocholine: 400 mg three times per day
CoQ10: 50 to 100 mg three times per day
• Ginkgo biloba extract (24% ginkgo flavonglycosides): 240 to 320 mg per day
• Garlic: the equivalent of 4,000 mg per day of fresh garlic