Stroke occurs
when a blood clot blocks an artery or blood vessel, cutting off blood
flow to your brain. As a result, brain cells die and brain damage can
occur. Without proper and timely treatment, a stroke can be lethal
Estimates suggest 10% of all strokes occur in people under the age of 50, and 2.5% of strokes occur in those under the age of 20
Studies have
shown that, surprisingly, blocking inflammation after a stroke isn’t
beneficial. Recent research demonstrates brain inflammation following a
stroke actually plays a beneficial role in neuroplasticity and recovery
of function
It’s imperative
to rapidly implement neurocognitive training after a stroke, as your
brain circuits need the proper stimulus to reroute
Education
appears to play a role in stroke recovery by acting as a cognitive
reserve against poststroke cognitive impairment. Getting the proper
nutrition after a stroke is also crucial for optimal recovery
Strokes can be divided into hemorrhagic
stroke and ischemic strokes, and approximately 80% of them are ischemic
brain injury. Ischemic strokes are sometimes referred to as "brain
attacks" (instead of "heart attacks") because they typically occur when
a blood clot blocks an artery or blood vessel, cutting off blood flow
to your brain, as opposed to your heart.1
As a result, brain cells die and neurological damage can occur.
Without proper and timely treatment, a stroke can be lethal. According
to the latest statistics published in 2020,2 an estimated 795,000 strokes occur each year in the U.S., and in 2017, 146,383 Americans died as a result.
It’s also a leading cause of long-term disability in the U.S.3 Worldwide, stroke is the second leading cause of death and the third leading cause of disability.4
While most strokes occur in the elderly, younger people are by no
means immune. Between 1995 and 2012, stroke rates nearly doubled for
men between the ages of 18 and 44.5 Among men between 35 and 44 years, the incidence rate rose by 41.5%.6
Estimates suggest 10% of all strokes occur in people under the age of 50,7 and 2.5% of strokes occur in those under the age of 20.8
The prevalence of having three to five risk factors for stroke (such
as high blood pressure, diabetes, smoking and obesity) have also
significantly increased since 2003.9
The good news is we’re learning more about stroke recovery as time
goes on, and there are quite a few strategies that can help improve
your condition after a stroke. There are also many things you can do to
prevent it in the first place.
Rapid treatment is imperative, though. As noted in the journal Stroke,10 the ideal treatment window is within three to six hours of onset, and even then, 5% end up with long-term disabilities.
The Role of Inflammation in Poststroke Recovery
Ann Stowe, a scientist and lab manager at the University of Kentucky College of Medicine’s department of neurology,11 focuses her studies on the role your immune system plays in your brain’s recovery after a stroke.12 Clinical research has found that, surprisingly, blocking inflammation after a stroke isn’t beneficial. Stowe told Newswise:13
“We reviewed a clinical trial that focused on blocking
inflammation after a stroke in stroke patients, and it was a profound
failure. From that point on, I’ve had the theory that brain
inflammation is actually required for stroke recovery. It’s not all
detrimental.”
Through her research, Stowe is trying to determine how inflammation
can be manipulated to support rather than hinder neuroplasticity and
recovery of function after a stroke. She explains:
“When you think about the brain and how it reorganizes after
stroke, there are many areas that are involved. It's the other areas of
the brain that survived the stroke that actually rewire and reorganize
to support recovery. Inflammation can actually affect these other
areas, too …
This study suggests that B cells might have a more healing role.
Hopefully from this, we can better understand the inflammatory
processes after stroke — and long term, possibly identify what subsets
of immune cells can support stroke recovery.”
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The Importance of Humoral Immunity Poststroke
Most recently, Stowe and colleagues found14,15 B cells — a type of white blood cell that are part of your humoral immunity and secretes antibodies16 — migrate into remote areas of your brain and support neurogenesis after you’ve had a stroke. As explained in her study:17
“Neuroinflammation occurs immediately after stroke onset in the
ischemic infarct … We identify bilateral B cell diapedesis into remote
regions, outside of the injury, that support motor and cognitive
recovery in young male mice.
Poststroke depletion of B cells confirms a positive role in
neurogenesis, neuronal survival, and recovery of motor coordination,
spatial learning, and anxiety … Lymphocytes infiltrate the stroke core
and penumbra and often exacerbate cellular injury.
B cells, however, are lymphocytes that do not contribute to
acute pathology but can support recovery. B cell adoptive transfer to
mice reduced infarct volumes 3 and 7 d[ays] after transient middle
cerebral artery occlusion, independent of changing immune populations
in recipient mice.
Testing a direct neurotrophic effect, B cells cocultured with
mixed cortical cells protected neurons and maintained dendritic
arborization after oxygen-glucose deprivation …
Stroke leads to central nervous system (CNS) damage, which
results in functional deficits and is exacerbated by an inflammatory
immune response derived from both the innate and adaptive immune
systems.
Mechanistic studies … show a significant infiltration of innate
immune cells, including monocytes, macrophages, and neutrophils,
predominantly in the area of ischemic injury (i.e., infarct,
periinfarct regions).
The role of the adaptive immune system is also pivotal to stroke
recovery, as it can both exacerbate and ameliorate long-term
neuropathology, depending on the lymphocyte population, location, and
timing of activation.
Location and timing are particularly relevant, as recovery of
lost function in stroke patients depends on functional plasticity in
areas outside of the infarct (i.e., remote cortices) to subsume lost
function.
Neurons in remote cortical areas that are interconnected to the
infarct up-regulate growth factors and plasticity-related genes after
stroke … B cells, critical effector cells for antibody production and
antigen presentation, are one adaptive immune cell subset with the
capacity to also produce neurotrophins to support neuronal survival and
plasticity.”
Hyperbaric Oxygen Therapy — Valuable Tool in Stroke Rehab
Hyperbaric medicine, as an emerging interdisciplinary subject, has
been applied in the treatment of strokes since the 1960s. Hyperbaric
oxygen can be defined as the breathing of 100% oxygen at a pressure
higher than atmospheric pressure.
Many have demonstrated that hyperbaric oxygen therapy (HBOT) is
capable of increasing oxygen supply, improving cerebral circulation,
reducing ischemia-reperfusion injury and alleviating the extent of
irreversible neurological impairment.18
Following an ischemic stroke, in which cerebral blood flow is impaired, irreversible neurologic injury occurs within minutes.19
Of particular interest are the regions surrounding the initial site of
injury where the tissue is at risk but not facing irreparable damage,
and the potential to salvage these nerves still exists.
Decreased oxygen supply to the damaged area including blood vessels
further prevents tissue repair and the generation of new brain tissue.
Consequently, increased oxygen has been considered as a potential
treatment for stroke for several decades.20
The use of HBOT for brain injury is based on the hypothesis that
injured or inactive nerve tissue would benefit from increased blood
flow and oxygen delivery, which would act to metabolically or
electrically reactivate the cell.21
A recent study found improvements in cognition and executive
function as well as physical abilities, such as improved gait. Treated
patients reported improved sleep and quality of life following HBOT
treatment and had improvements in blood levels of biomarkers for
inflammation and neural recovery.22
Advances in Stroke Recovery and Rehabilitation
As noted in the 2017 paper,23
“Stroke Recovery & Rehabilitation Research,” which represents “the
collective thoughts of the NIH StrokeNet Recovery & Rehabilitation
Working Group,” most current poststroke therapies “aim to maximize
function in brain areas that survive the stroke, or provide
compensatory approaches to improve overall function.”
Many of those approaches are based on what we now know about the
molecular and physiological events that arise in your nervous system in
the days and weeks following a stroke. Classes of therapies available
or in the works include the use of:24
Small molecules
Growth factors
Stem cells
Monoclonal antibodies
Brain stimulation
Robotics and other devices
Cognitive therapies
Intensive brain training
Telerehabilitation
The paper highlights the importance of concomitant behavioral
training, noting “the brain circuits galvanized for rewiring need the
right experience to shape them, akin to normal development.”
In other words, your brain will need to relearn how to do things
like eating and moving, just as if you were a young child, and without
the proper stimulus, your brain will not be able to achieve the required
rewiring. What’s more, 80% of this recovery occurs within the first 30
days after a stroke,25 so it’s crucial to implement as many rehab strategies as possible to optimize the outcome.
For these reasons, it’s crucial to know what to do as soon as you’ve
been diagnosed with a stroke at the hospital, or even while you’re in
the ambulance to the hospital. In 2019, I interviewed Bob Dennis
about his excellent book, “Stroke of Luck: NOW! Fast and Free
Exercises to Immediately Begin Mastering Neuroplasticity Following
Stroke — Right Now!”26
This is the book you want to have when you are in the emergency room
so you can rapidly begin the process of activating your neuroplasticity
and regain as much lost function from the stroke as possible.
Just as it’s important to get rapid medical assistance when
suffering a stroke, the sooner you begin taking steps to heal your brain
after a stroke, the faster and more complete your recovery will be.
You can get the key points of the book, “Stroke of Luck,” completely
free, without download, simply by opening the Amazon book preview.
Education Is Neuroprotective
It’s also well known that the ability to recover from a stroke
varies widely from one person to the next. As noted in the paper,27
“Stroke Recovery: Surprising Influences and Residual Consequences,”
“Even two individuals with very similar appearing ischemic strokes may
show very different outcomes one year later.”
This paper also stresses the importance of education, noting that
“education might have a role in recovery … based on previous studies
indicating that education may promote neuroplasticity or may have a
neuroprotective effect against cognitive decline.” The authors further
added:28
“One study did find that the highest educational levels were
associated with lower rates of poststroke cognitive deficits and
dementia and higher rates of long-term survival, independently of stroke
severity, age, sex, marital status, and white matter lesions in
individuals with mild/moderate ischemic stroke.
Results were interpreted as support for the hypothesis that high
education, a proxy for cognitive reserve, protects against poststroke
cognitive impairment.”
Poststroke Nutrition
Other studies have stressed the importance of nutrition for brain recovery after a stroke.29,30 For example, the 2011 paper,31
“Nutrition for Brain Recovery After Ischemic Stroke: An Added Value to
Rehabilitation,” points out the importance of protein supplementation
during recovery, as protein synthesis is suppressed in the ischemic
penumbra (i.e., the area of the brain surrounding the ischemic event).
It cites research showing protein supplementation enhances recovery
of neurocognitive function poststroke. B vitamins are also important,
as they’ve been shown to mitigate oxidative damage caused by free
radicals and lipid peroxidation, as is zinc. According to this paper:
“In clinical practice, patients with ischemic stroke were found
to have a lower than recommended dietary intake of zinc. Patients in
whom daily zinc intake was normalized had better recovery of
neurological deficits than subjects given a placebo.”
Other important nutrients and dietary components during poststroke rehabilitation include:
Certain herbal supplements may also be useful, including the following:41
Ashwagandha42,43
Ginseng44,45
Citicoline46
Ginkgo biloba47
Stroke Prevention Guidelines
It's important to realize that the vast majority of strokes are
preventable, so your lifestyle plays a major role in whether or not
you're going to become a statistic here. Lifestyle factors that can
have a direct impact on your stroke risk include:
Exercise — By normalizing your
blood sugar and improving your insulin and leptin receptor signaling,
exercise helps normalize your blood pressure and reduce your stroke
risk. If you've had a stroke, exercise is also very important, as
research shows it can significantly improve both your mental and
physical recovery48 and reduce your risk of recurrent stroke.49 For example:
A 2013 study published in Stroke50
concluded that walking at least three hours per week reduces stroke
risk in women better than inactivity, but also better than high
intensity cardio.
This may have something to do with the inordinate amount of physical
stress “conventional cardio” has on the heart, and the fact that
people generally do too much of it for too long. Perhaps women are
more susceptible to these risks than men. Conventional cardio can
cause arrhythmias, and in some cases, atrial fibrillation, which is a
known risk factor for stroke.
In 2009, a study in Neurology51
found that vigorous exercise reduces stroke risk in men, as well as
helping them recover from a stroke better and faster. However,
moderate to heavy exercise was not found to have a protective effect
for women.
Sleep — Research52 shows that compared with sleeping seven to eight hours a night, regularly sleeping for nine hours or more can increase your stroke risk
by 23%, while shorter sleep (less than six hours a night) had no
significant effect on stroke risk. Taking long midday naps (more than
90 minutes) raised the risk by 25% compared to napping 30 minutes or
less.
Those who both slept for nine hours or more at night and napped
for more than 90 minutes were at greatest risk. This excessive sleep
combination increased stroke risk by 85% compared to moderate
sleepers and nappers.
On the other hand, research53,54,55
has also found genetic predisposition to insomnia is associated with a
significantly higher risk of coronary artery disease, heart
failure and ischemic stroke. Genetic predisposition to insomnia was
associated with a 13% increased risk of larger artery stroke, an 8%
higher risk of small vessel stroke and a 6% increased risk of
cardioembolic stroke.
“Diet” soda and energy drinks — Research56
shows regular consumption of artificially sweetened “diet” soda
significantly raises your 10-year stroke risk. Caffeine-loaded energy
drinks can also cause your blood to become sticky, which is a
precursor to stroke. A single can of Red Bull can increase your risk
of stroke fivefold, experts warn.57,58,59
Stress — According to a 2008 study,60
the more stressed you are, the greater your risk of suffering a stroke.
For every notch lower a person scored on their well-being scale,
their risk of stroke increased by 11%. Not surprisingly, the
relationship between psychological distress and stroke was most
pronounced when the stroke was fatal.
My favorite overall tool to manage stress is EFT (Emotional Freedom Techniques).
Other common stress-reduction tools with a high success rate include
prayer, meditation, laughter and yoga, for example. For more tips,
see my article 10 Simple Steps to Help De-Stress.
Hormone replacement therapy (HRT) and birth control pills —
If you're on one of the hormonal birth control methods (whether it's
the pill, patch, vaginal ring or implant), it is important to
understand that you are taking synthetic progesterone and synthetic
estrogen.
These contraceptives contain the same synthetic hormones as those used in hormone replacement therapy (HRT), which has well-documented risks, including an increased risk of blood clots, heart attack and stroke.
Vitamin D — According to research presented at the American Heart Association's (AHA) Annual Scientific Sessions in 2010,61
low levels of vitamin D — the essential nutrient obtained from
exposure to sunlight — doubles the risk of stroke in Caucasians. Get
tested twice a year to make sure you’re within the ideal range of 60
ng/mL to 80 ng/mL year-round.
Statins — Statin drugs are
frequently prescribed to reduce your risk of heart disease and
stroke. However, while these cholesterol-lowering drugs have been
shown to lower the risk for ischemic stroke by 20% in patients with a
history of cerebrovascular disease, they increase the risk of a
hemorrhagic stroke by 73%.62
There are two reasons why this might happen: The drugs may either
lower cholesterol too much, to the point that it increases your risk
of brain bleeding, or they may affect clotting factors in your blood,
increasing the bleeding risk.
Grounding63 — Walking barefoot, aka “grounding,”
has a potent antioxidant effect that helps alleviate inflammation
throughout your body. When you put your feet on the ground, you
absorb large amounts of negative electrons through the soles of your
feet.
High-sugar diets, smoking, radiofrequencies and other toxic
electromagnetic forces, emotional stress, high cholesterol and high
uric acid levels are examples of factors that make your blood
hypercoagulable, meaning it makes it thick and slow-moving, which
increases your risk of having a blood clot or stroke.
Grounding helps thin your blood by improving its zeta potential.
This gives each blood cell more negative charge which helps them
repel each other to keep your blood thin and less likely to clot.
This can significantly reduce your risk of stroke.
Research has demonstrated it takes about 80 minutes, or 40 minutes
over two grounding periods, for the free electrons from the earth to
reach your blood stream and transform your blood, so make it a point to
regularly walk barefoot on grass or on wet sand for about 1.5 to two
hours, if possible.
TMAO levels — Studies have shown high levels of trimethylamine-N-oxide (TMAO) are associated with an increased risk of heart attacks and stroke,64
so measuring your blood level of TMAO could be a powerful predictive
tool for assessing your stroke risk. In one analysis,65 high blood levels of TMAO increased the risk of dying from any cause fourfold in the next five years.
In a paper66 led by James DiNicolantonio, Pharm.D., who is also the coauthor of my book, "Superfuel: Ketogenic Keys to Unlock the Secrets of Good Fats, Bad Fats, and Great Health," he explains how the likely true cause of elevated TMAO levels is hepatic insulin resistance.
Moreover, the paper shows that krill oil, astaxanthin, fish oil and berberine
may be among some of the best supplemental strategies for those with
high TMAO levels after diet optimization, as it is simply a
reflection of insulin resistance in the liver.
Alcohol consumption — Research67
shows heavy alcohol consumption in middle age can be a risk factor
for stroke. Those averaging more than two drinks a day were found to
have a 34% higher risk of stroke than those who averaged less than
half a drink per day.
According to this study, “Midlife heavy drinkers were at high
risk from baseline until the age of 75 years when hypertension and
diabetes mellitus grew to being the more relevant risk factors. In
analyses of monozygotic twin-pairs, heavy drinking shortened time to
stroke by five years.”
Smoking — As one of the major risk factors for stroke, quitting smoking is an important consideration if you’re concerned about your stroke risk.
Sauna — Long-term research68
shows that, compared to sauna bathing just once a week, those who
take a sauna four to seven times a week lower their risk of stroke by as
much as 61%.
How to Recognize a Stroke
A stroke doesn’t advertise its pending arrival, which makes
prevention all the more important. That said, getting medical help
quickly can mean the difference between life and death or permanent
disability, should you or someone you love suffer a stroke. This is an
area where conventional medicine excels, so please do not delay in
getting medical attention.
Nine out of 10 strokes are ischemic strokes,69 which result from an obstruction in a blood vessel supplying blood to your brain. The other form of stroke is known as a hemorrhagic stroke,
which is when a blood vessel actually ruptures, which can lead to
rapid death. The five-year survival rate for hemorrhagic stroke is only
26.7%.70
In the case of ischemic stroke, there are emergency medications that
can dissolve a blood clot that is blocking blood flow to your brain.
If done quickly enough, emergency medicine can prevent or reverse
permanent neurological damage, but you typically need treatment within
one hour, which means the faster you recognize the signs, the better
the prognosis.
Research also shows primary stroke centers have lower mortality than other hospitals,71
so if a stroke is suspected, be sure to ask them to take the patient
to a primary stroke facility. The following symptoms can signal a lack
of oxygen to your brain, which could be due to a stroke:
Sudden numbness or weakness of face, arm or leg, especially when
occurring on one side of the body; face drooping, typically on just one
side
Sudden confusion; trouble talking or understanding speech
Sudden trouble seeing in one or both eyes, or double vision
Sudden trouble walking, dizziness or loss of balance or coordination
Sudden severe headache with no known cause; nausea or vomiting
The National Stroke Association recommends using the FAST acronym to help remember the warning signs of stroke.72 If any of these occur, call for immediate emergency medical assistance (in the U.S., call 911):73
F = FACE — Ask the person to smile. Does one side of the face droop? A = ARMS — Ask the person to raise both arms. Does one arm drift downward? S = SPEECH — Ask the person to repeat a simple phrase. Does their speech sound slurred or strange? T = TIME — If you observe any of these signs, it’s time to call 911.
It’s important to pay attention to these symptoms even if they last
only a short time and suddenly disappear, as it could be a sign of a
ministroke, known as a transient ischemic attack. While brief, it’s
important to get it checked out to rule out a serious underlying
condition that could lead to a more severe episode later.
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