Of all the maladies that may affect an individual over the course of his or her lifetime, stroke is perhaps the most devastating. While it is possible to suffer a mild stroke with few lasting symptoms, a stroke frequently leads to paralysis, inability to speak, or another complication that changes a person’s life forever. It is difficult to think of another affliction, other than a severe spinal cord injury, that can instantaneously bring an active, independent person to a state of total disability and dependence.

The medical term for a stroke is a cerebrovascular accident, which is commonly abbreviated CVA. It is a descriptive term, referring to damage to a blood vessel supplying blood to the brain. When the injury or damage occurs, the oxygen supply to an area of the brain may be compromised. Alternatively, an area of the brain may be compressed by blood that is spilling from the injury site. The result, in either case, is death of brain cells and loss of the functions controlled by them.

Over eighty percent of strokes are caused by ischemia – lack of oxygen to a part of the brain. Ischemia can be brought on either by a clot that forms in a narrowed blood vessel – a thrombosis - or by a clot that forms elsewhere in the body and travels to the brain – an embolism.

Hemorrhagic strokes are caused by the rupture of a blood vessel in or around the brain. Most hemorrhagic strokes result from either aneurysms (weak spots on arteries that bulge like a weak spot on an inner tube) or arteriovenous malformations (clusters of abnormally formed blood vessels). Antiplatelet drugs such as aspirin and Plavix also play a role in triggering hemorrhagic strokes.

Regardless of the cause, the signs, symptoms, and end results of a stroke are the same. The initial presentation of a stroke does not accurately reflect its severity. Symptoms will change over a period of 24 to 48 hours. In some cases the presenting symptoms will completely resolve, while in others they will markedly worsen.

It is important to recognize the initial onset of a stroke. Immediate action can limit its extent by administering tPA, a drug that can dissolve the clot that is causing an ischemic stroke or by surgically intervening to stop the bleeding and evacuate the blood that is causing a hemorrhagic stroke.

Signs and symptoms that suggest a stroke may be in progress include sudden onset of weakness on one side of the body, confusion, difficulty speaking or comprehending, loss of vision, difficulty walking or standing, dizziness, loss of balance, loss of muscle coordination, or a severe headache. Suddenness of onset is the key. Should one or more of these symptoms suddenly appear, every minute counts. The sooner intervention is begun the greater is the possibility of reversing or preventing the damage. For example, if tPA is not given within three hours of the onset of symptoms it will be of no benefit.

Occasionally, the body will be able to dissolve a clot using its intrinsic repair mechanisms. When this happens the symptom or symptoms will appear suddenly, but will begin to resolve within a matter of minutes. All effects will be gone within twenty-four hours. This is a transient ischemic attack (TIA), which is sometimes referred to as a “mini-stroke”.

At least one-third of the individuals who experience a TIA will subsequently sustain a full blown stroke. Therefore, a TIA should be viewed as a warning. A thorough search for conditions that could cause a stroke should be performed and corrective measures undertaken.

If a stroke does occur it is important to understand that while recovery progresses slowly, it progresses indefinitely. Someone who has suffered a stroke will have more function at six months than he or she had at three months. They will be better two years following the stroke than they were a year after the event. They will never stop improving.

Because stroke is life-threatening and often disabling, prevention is of paramount importance. Predisposing factors must be addressed and corrected before they can create the conditions that could result in a stroke. While some risk factors such as male sex, increasing age, and family history cannot be altered, most can be significantly modified or eliminated.

Blood pressure is one of the leading indicators of stroke risk. As blood pressure rises, arteries experience greater stress. Over time they may thicken, harden, or weaken, creating conditions that are likely to result in either an ischemic or hemorrhagic stroke.

Blood pressure is typically recorded with a top number and a bottom number. The top number, called the systolic, is the pressure in the arteries when the heart is pumping blood into the system. The bottom number, called the diastolic, is the pressure in the system while the heart is filling for the next beat. Risk increases as the systolic pressure rises above 140 millimeters of mercury (mmHg) or the diastolic pressure rises above 90 mmHg.

The diastolic pressure is the most significant, because it represents the pressure the arteries must endure constantly. The intermittently high systolic pressures can be handled more easily and will result in less damage than persistently high diastolic pressures. Diastolic blood pressures in the 70 to 80 mmHg range are ideal, provided that they can be accomplished without the use of medication.

Aggressive blood pressure management with medications can actually do more harm than good. Medical studies have demonstrated that when medications are used to control blood pressure, the optimum diastolic level is between 85 and 90 mmHg. As the diastolic pressure is driven below 85 mmHg with medications the risk of stroke and other complications actually increases.

In May, 2004, Dr. Franz Messerli reported his analysis of a study in which 22,000 people were treated for hypertension. The data showed that the level of diastolic blood pressure at which the fewest deaths and non-fatal heart attacks occurred was 84 mm/Hg. When the diastolic pressure was lowered to 70 mmHg the risk of death or heart attack was 20 % greater and when it fell to 65 the risk was 80 % greater. Diastolic pressures lower than 60 mmHg were associated with a fourfold greater incidence of death and heart attack than diastolic pressures of 84 mmHg.

Atherosclerosis (hardening of the arteries) is also a leading risk factor for stroke. This is almost certainly what accounts for the greater incidence of stroke in individuals with diabetes or heart disease.

Atherosclerosis is preventable and, I believe, reversible. The key is not lowering cholesterol levels, as has been the focus for decades, but is preventing oxidation of LDL cholesterol and eliminating damage to the lining of arteries from cigarette smoke and homocysteine. I explained this in detail in the July, 2004 issue.

Cigarette smoking increases the risk of stroke in multiple ways. It accelerates the development of atherosclerosis by increasing oxidative stress and inflammation in the body, it decreases the amount of oxygen that can be carried to the tissues, and it promotes the development of polycythemia – an increase in the number of red blood cells that thickens the blood and decreases its ability to flow through small blood vessels.

Atrial fibrillation, a fluttering of the upper chambers of the heart, also increases the risk of stroke. Because the chambers are not beating regularly, clots can form along the chamber wall. A clot fragment can then break off and lodge in an artery supplying blood to an area of the brain causing an ischemic stroke. While coumadin is widely prescribed as a means of preventing embolic strokes in people with atrial fibrillation, its risks outweigh its benefits in all but a small subset of individuals, as I explained in the November, 2004, issue.

Cocaine can also trigger a stroke. It does so in two ways. Cocaine has a powerful vasoconstrictive effect, meaning that it causes blood vessels to contract and become smaller in diameter. This can restrict blood flow to the degree that an ischemic stroke occurs. Because vasoconstriction increases arterial blood pressure, hemorrhagic strokes are also more common with cocaine use.

Cocaine induced strokes tend to occur in younger people, being most common in men under the age of forty. The recovery rate is much poorer in strokes related to cocaine use than those caused by other factors.

Children with sickle-cell disease are also at increased risk for stroke. Approximately 10 % of children with the disease will experience a stroke. Maintaining a high level of hydration can help to decrease stroke risk. Nitric oxide is a substance that is needed to optimally relax and dilate blood vessels. Supplementation with L-arginine, an amino acid that increases levels of nitric oxide may be helpful.

For most individuals, stroke prevention is a matter of going back to the basics of drinking pure water, eating sensibly, remaining physically active, and taking appropriate nutritional supplements. The January, 2004, article Back to the Basics details the steps to be taken. The article is available at wellnessprotocols.com, if you would like to review it.

If blood pressure is elevated further steps should be taken to bring it under control. Alcohol intake should not exceed one drink per day for women and two drinks per day for men. If the blood pressure remains above 130/80 it is advisable to avoid alcohol intake completely for several weeks to determine what effect regular alcohol consumption is producing.

Sodium restriction has been emphasized as a way to lower blood pressure, but the problem is not so much sodium excess as it is inadequate intake of other minerals. Supplementation of calcium, magnesium, and potassium will also improve blood pressure in most cases. Capsicum (cayenne pepper), garlic, and Hawthorne berry are also helpful in reducing blood pressure.

Atherosclerosis should be addressed with antioxidant supplementation. The homocysteine level should be checked and B vitamins, dimethylglycine, and N-acetylcysteine supplementation added if the homocysteine level is above 7.2.

The most widely recommended means of stroke prevention in our society is the practice of taking an aspirin a day. This simply trades one risk for another, however. While an aspirin a day can lower the risk of an ischemic stroke, it actually increases the risk of a hemorrhagic stroke. This is because even a baby aspirin a day is enough to prevent platelets from clumping together to repair small leaks in blood vessels.

Since it is possible to normalize platelet function without destroying their ability to prevent bleeding, it is unnecessary to accept the increased risk of hemorrhagic stroke associated with the use of aspirin. Omega-3 fatty acids, which are obtained from cold water fish, are quite effective in normalizing platelet function. These oils are obtained from the belly fat, not from the liver. Liver oils of predatory fishes, such as sharks, should be avoided as they often contain high levels of mercury or other toxins.

Fish oil capsules typically contain 180 mg. of eicosapentaenoic acid (EPA) and 120 mg. of docasahexaenonic acid (DHA). Four capsules daily is adequate to prevent platelet clumping, but 8 to 12 capsules daily may be required to reverse platelet aggregation (clumping).

A recent study reported that polycosanol, which is derived from sugar cane, amplifies the effectiveness of omega-3 fatty acids in preventing platelet aggregation. Taking 30 mg. of polycosanol and four capsules of omega-3 fish oil may be an alternative to taking higher amounts of omega-3 oils in people who are at high risk for platelet aggregation and stroke.

Stroke can be devastating, but nearly all strokes can be prevented. Taking the steps recommended above will not only dramatically reduce stroke risk; doing so will dramatically reduce the likelihood of experiencing other health challenges.