Three weeks before her 55th birthday, my friend Lindy had a stroke. As a result, I wanted to know what causes some young women to have strokes and what risk factors exist for women of any age. Through my investigation I became more aware of how vulnerable we all are to risks that can frequently be reduced.
There are known lifestyle choices that can increase your risk for having a stroke. Some may surprise you; some you may know or suspect and could be ignoring. But even one risk factor is enough to land you in the hospital. When you combine two or more, you’re pushing the odds. I know a lot of people beat the odds, but many people don’t. Even with Lindy’s youth, strength, and determination, the road to wellness after a stroke is a challenge.
What is a stroke?
Stroke is the third leading cause of death in most Western countries and, in many cases, it’s avoidable. A stroke is really a “brain attack” that occurs when blood flow to the brain is interrupted by a blood clot or burst blood vessel. This results in a lack of oxygen to the brain, which, in turn, causes some brain cells to die. Fortunately, healthy brain cells often take over the job of those that have died, and recovery can be quite good — or a stroke can leave the person with permanent damage. Depending on what part of the brain is affected, disabilities may include speech problems, paralysis, and even dementia.
There are several kinds of stroke. One is a hemorrhagic stroke, which results in bleeding in the brain. When this happens, the blood that accumulates in the brain may cause pressure on some of the tissues, interfering with brain activity. When the blood supply to the brain is reduced, some brain cells lose their food supply and die.
An embolism causes another type of stroke. This is the most common type, accounting for 70 to 80 percent of all strokes. It typically occurs at night or early morning when blood pressure is lowest and is frequently preceded by a mini-stroke (a transcient ischemic attack, or TIA). Embolisms occur when a blood clot or another particle that can form in a blood vessel in the heart — like a piece of arterial plaque — moves through the bloodstream and gets stuck in an artery to the brain, blocking the blood flow. Strokes can also occur if small blood clots form during rapid heartbeat (atrial fibrillation).
Stroke Risk Factors
Genetics: Naturopath Tori Hudson, ND, says if your father had a stroke before age 50 or your mother before age 65, you may have a genetic predisposition to stroke. While you can’t change your genetics, a genetic factor means you need to work even harder to reduce other risks.
High cholesterol is a risk, especially with low HDL (high density lipoproteins — the healthy fat). HDL helps pick up pieces of cholesterol in the blood and recycles them in the liver. So if your HDL is low, it means your body is not able to collect as much cholesterol from the plaque in your arteries. To raise your HDL, keep your animal fat intake low and your fats from fish oil, raw walnuts, and flax higher. A normal weight program and regular aerobic exercise (like walking or biking) for at least half an hour, five days a week, lowers HDL.
Smoking pretty much doubles your risk and, when combined with any other risk factor, it increases your chance for stroke more than the two combined. Breathing second-hand smoke also increases stroke risk. If anyone in your family smokes, ask them to smoke outdoors.
The Framingham Heart Study discovered that people who smoked two packs of cigarettes a day had twice the risk for stroke as those who smoked half a pack daily. The more a person smoked the greater their risk. When they stopped smoking, their risk started to decrease within two years. Five years after stopping, ex-smokers had the same low risk as a non-smoker. As difficult as it may be, I implore you to stop smoking.
Alcohol can either increase or decrease your risk for stroke, depending on how much you drink. Studies have shown that one or two drinks a day may be protective in a similar way as taking aspirin, since both reduce the clotting ability of platelets. The less clotting, the fewer blood clots there are to get stuck in arteries.
But heavy drinking has the opposite effect. One reason is that it tends to increase blood pressure. Heavy drinking can also reduce platelets and thin the blood too much. Perhaps the most important reason to keep alcohol consumption low is heavy drinking or binge drinking can cause a rebound effect after you stop. At this point, blood gets thicker and platelets increase dramatically, skyrocketing your risk for stroke.
Young women with migraines have a three times greater risk for stroke than those who never have them, says a study reported in Therapy Weekly (May 1, 1999). Forty percent of strokes in young women were associated with migraines. However, when blood pressure was under control and they stopped smoking (or didn’t smoke), their risk was reduced to no more than that of anyone else. This study also found that oral contraceptives added to stroke risk for women with migraines.
Cocaine causes blood vessels to constrict and reduces blood flow to the brain by up to 30 percent. It prevents blood vessels from relaxing, which can lead to narrower arteries. We think these blood-vessel changes increase blood pressure and block or reduce blood flow to the brain.
All you need for a cocaine-related stroke is for one blood clot to form when blood vessels constrict and then pop free to clog up an artery. If you’ve used cocaine with no serious side effects, consider yourself lucky. If you use it, it’s time to stop, especially if you have been a smoker. Why? Smoking increases vascular fragility and, with cocaine use, increases the risk for stroke.
An anti-stroke diet
The first step in preventing stroke is lowering your risks. The next step is a diet high in protective nutrients. Your body needs magnesium and potassium, (found in a diet high in beans, whole grains, fruits, and vegetables) to keep blood vessels from becoming fragile.
Eating whole grains lowers your risk for stroke, says the Nurse’s Health Study, a 12-year study of 75,000 women. This study found that even when women ate saturated fats (animal fats) and trans-fatty acids (margarines), those who ate more whole grains had fewer strokes than those who ate refined flours and white rice.
Eat more protective fats, such as fish, raw walnuts, and flax oil, all high in essential fatty acids (EFAs), that support your immune system. Keep animal fats low by reducing your portions and having at least one or two meat-free days (except for fish). Olive oil and canola oil both acceptable, but they don’t contain EFAs. Make sure you get enough protective essential fats as well.
The amount of vitamin C in your blood may be a predictor of a low stroke risk, said Tetsuji Yokoyama, MD, who headed a study published in the journal, Stroke (Stroke:
Journal of the American Heart Association, October 2000).
Dr. Yokoyama, a research associate in epidemiology at the Medical Research Institute of Tokyo Medical and Dental University, helped evaluate the amount of vitamin C in the diets of over 1,000 women. Women who ate vegetables six to seven days a week had a 58 percent less risk for stroke than women who ate them twice a week.
Most fresh fruits and vegetables are high in vitamin C, but it’s a fragile vitamin, losing its potency when exposed to light, air, and heat. Cutting, processing, and bruising also reduces its levels in foods. If you drink a lot of water, you could also be depleting your body of vitamin C. Stress, smoking, and even smelling petroleum fumes can reduce absorption of this important vitamin.
Add to this the fact that your body doesn’t store vitamin C, but needs some every day, and you’ll see why it is so important to include fruits, vegetables, and possibly an additional supplement to reduce your risk for stroke. It may be the vitamin C, itself, that is protective, or other nutrients found in fruits and vegetables could have a protective effect. So eat your veggies daily, and consider taking an extra 500 to 1,000 mg of vitamin C as well.
Too much iron can increase the production of free radicals in your brain cells and the tiny blood vessels in your brain, according to neurologist Antoni Davalos, MD, who headed a study published in Neurology (April 25, 2000). If your iron levels are too high, your brain cells can release a brain neurotransmitter called glutamate that can trigger chemical reactions causing brain-cell death.
To see if your glutamate levels are high, have your ferritin (iron) level checked. Ferritin, a protein in the blood that contains iron, indicates how much iron is stored in bone marrow. Sixty percent of people with high ferritin levels were found to have high glutamate levels, said Dr. Davalos. He believes that if your ferritin level is higher than 275 ng/mL, you should lower your iron intake in food and supplements.
Stored iron normally increases as we age, but in a few people, it is very high. The next time you havea blood test, ask that your ferritin level be tested. It’s a simple and inexpensive aspect of stroke protection.
B vitamins can help lower homocysteine levels. Homocysteine is an amino acid that is normally generated when we digest protein. High levels of homocysteine can lead to a stroke. Homocysteine also increases your body’s production of plaque in the arteries. Plaque narrows the arteries and makes it more difficult for blood to flow to the brain. Enough of vitamins B6, B12, and folic acid can keep your homocysteine level low and your arteries open.
David Perlmutter, MD, who heads The Perlmutter Health Center in Naples, Florida, says that homocysteine levels should be from eight to 14 micromoles per liter, and ideally less than 10 micromoles per liter. In his book, BrainRecovery.com he cites a study that found 10 mg of vitamin B 6 , 400 mcg of vitamin B 12 , and 650 mcg of folic acid are enough to reduce homocysteine by 50 percent. Dr. Perlmutter gives nutritional advice for stroke recovery in this book. Other natural therapies can be found in Heart Disease, Stroke, & High Blood Pressure, by Burton Goldberg.
A life-changing event
A stroke is not necessarily a once-in-a-lifetime event. Many people have additional strokes after their initial episode. If you’ve had a stroke, it’s vital to prevent another. Taking medication like blood thinners and getting regular exercise is just part of preventing stroke reoccurrence. Lindy knows this, and has decided to eliminate all possible risk factors from her lifestyle. She knows that surviving one stroke is difficult enough. Those of you who have had strokes know this as well. Lindy and I hope that women who have not had strokes will take this subject seriously and make the necessary lifestyle changes. Just one risk factor can be enough to change your life forever.
Ockene, Ira S., MD, Nancy Houston Miller, RN. American Heart Association Task Force on Risk Reduction. A statement for health care professionals. For a reprint, call 800- 242-8721 and ask for reprint No. 71-0128.
Yokoyama, Tetsuji, MD. Stroke: Journal of the American Heart Association (AHA), October 2000 (1-888-4STROKE for AHA).
Hudson, Tori, ND. Women’s Encyclopedia of Natural Medicine, Keats Publishing, 1999.
Liu, Simin, MD, ScD, et al. “Whole grain consumption and risk of ischemic stroke in women,” JAMA, 2000, vol 284.
Haas, Elson M., MD. Staying Healthy With Nutrition, Celestial Arts, Berkeley, CA, 1992.
“Migraines in women,” Therapy Weekly, May 1, 1999.
Editorial: “Low dose oral contraceptives and stroke,” New England Journal of Medicine, July 4, 1996.
Study identifies mechanism for cocaine-induced stroke and other brain damage, National Institute on Drug Abuse, February 3, 1998.
Davalos, Antoni, MD. Neurology: American Academy of Neurology, April 25, 2000.
Perlmutter, David, MD. BrainRecovery.com, The Perlmutter Health Center, Naples, FL, 2000.
Goldberg, Burton. Heart Disease, Stroke & High Blood Pressure, Future Medicine Publishing, 1998 (800 333-HEAL).