By Dr. Mercola
According to the National Stroke Association,1 stroke is the number one cause of long-term disability and the fourth leading cause of death in the United States. The most common type of stroke is called "ischemic stroke," which results from an obstruction in a blood vessel supplying blood to your brain. Once you suffer a stroke, the damage, should you survive it, can be absolutely devastating.
Thankfully, up to 80 percent of strokes are preventable. According to researchers,2 lifestyle factors such as diet, exercise, body mass index, blood sugar levels, blood pressure, and smoking can have a direct bearing on your individual risk.
There's also compelling evidence showing that your vitamin D status, grounding, stress, and use of statin drugs and hormone replacement therapy and/or birth control pills play a role.
Even Small Changes in Habits Can Make a Big Difference
Daniel Lackland, a professor of neuroscience at the Medical University of South Carolina and a spokesman for the American Heart Association, has developed a scale of lifestyle factors that have a bearing on stroke risk, called the "Life's Simple Seven" scale, 3 which includes:
- Get active
- Control your cholesterol
- Eat better
- Manage your blood pressure
- Lose weight
- Reduce your blood sugar, and
- Stop smoking
The really good news here is that even minor changes can reduce your stroke risk. As reported by the featured NPR article:4
"[The] scientists dug into a large study that tracked 30,239 people to see how much improvement it takes to prevent stroke....The good news is it doesn't take much to make a difference.
Each risk factor for stroke was scored from 0 to 2, with 0 being crummy, 1 kind of OK, and 2 terrific. Even a one-point improvement in the total score across all seven factors significantly reduced stroke risk.
Each improvement of a point on the 14-point scale meant an 8 percent reduction in stroke. 'The neat thing of this finding is that anything makes a difference... If you make a small change, you make an improvement,' Lackland says. 'If you make a bigger change, you make a bigger improvement.'
Some changes can give you a really great payoff. The study showed that reducing your systolic blood pressure by 20 millimeters (regardless of how high your blood pressure currently is) decreases your risk of stroke by 50 percent. Reduce it by another 20 mm, and you cut your individual risk in half yet again. Not smoking, or quitting smoking equated to a 40 percent lower risk.
Beware of Flawed Dietary Recommendations
First, with regards to cholesterol and stroke risk, what we're looking for is a proper balance. Proper balance between these ratios is best achieved through a healthy diet, as outlined in my Nutrition Plan, and exercise. It's well worth noting that cholesterol-lowering drugs known as statins have been found to boost stroke risk.
Total cholesterol will tell you virtually nothing about your disease risk, unless it's exceptionally elevated (above 330 or so, which would be suggestive of familial hypercholesterolemia, and is, in my view, about the only time a cholesterol-lowering drug would be appropriate). Two ratios that are far better indicators of heart disease risk are:
- Your HDL/total cholesterol ratio: HDL percentage is a very potent indicator of your heart disease risk. Just divide your HDL level by your total cholesterol. This percentage should ideally be above 24 percent. Below 10 percent, it's a significant indicator of risk for heart disease
- Your triglyceride/HDL ratios: This percentage should ideally be below 2
When it comes to diet, you'd be well advised to scrutinize the standard recommendations,5 which include cutting down on saturated fats and dietary cholesterol.
It's important to understand that cholesterol is in fact essential for your good health, as it carries out essential functions within your cell membranes, and is critical for proper brain function and production of steroid hormones. Vitamin D is also synthesized from a close relative of cholesterol: 7-dehydrocholesterol. In fact, we now have evidence showing that cholesterol deficiency has a detrimental impact on virtually every aspect of your health.
For example, there's reason to believe that low-fat diets and/or cholesterol-lowering drugs may cause or contribute to Alzheimer's disease, and violent behavior, due to adverse changes in brain chemistry.
Furthermore, studies have shown that dietary cholesterol has little to do with raising your serum cholesterol. For example, although egg yolks are relatively high in cholesterol, numerous studies have confirmed that eggs have virtually nothing to do with raising your cholesterol. For instance, research published in the International Journal of Cardiology showed that, in healthy adults, eating eggs every day did not produce a negative effect on endothelial function (an aggregate measure of cardiac risk); nor did it increase cholesterol levels.
But that's not all. One 2009 study6 discovered that proteins in cooked eggs are converted by gastrointestinal enzymes, producing peptides that act as ACE inhibitors—common prescription medications for lowering blood pressure, which would actually lower your stroke risk!
Most Saturated Fats Are Actually Good for You
The same can be said for saturated fats, which provide the building blocks for cell membranes and a variety of hormones and hormone like substances in your body. They also act as carriers for important fat-soluble vitamins A, D, E and K. Dietary fats are also needed for the conversion of carotene to vitamin A, for mineral absorption, and for a host of other biological processes. When you eat saturated fats as part of your meal, they also slow down absorption so that you can feel satiated longer.
It's important though to understand that not all saturated fats are the same. There are subtle differences that have profound health implications, and if you avoid eating all saturated fats, your health will likely suffer. There are in fact more than a dozen different types of saturated fat, but you predominantly consume only three: stearic acid, palmitic acid and lauric acid.
It's already been well established that stearic acid (found in cocoa and animal fat) has no adverse effects on your cholesterol levels, and actually gets converted in your liver into the monounsaturated fat called oleic acid. The other two, palmitic and lauric acid, do raise total cholesterol. However, since they raise "good" cholesterol as much or more than "bad" cholesterol, you're still actually lowering your risk of heart disease. Sources of healthy fats include:
✓ Butter made from raw grass-fed organic milk
✓ Raw dairy
✓ Organic pastured egg yolks
✓ Coconuts and coconut oil
✓ Unheated organic nut oils
✓ Raw nuts, such as almonds or pecans, and seeds
✓ Grass-fed meats
Trans fats, on the other hand, should clearly be avoided. They are known to promote inflammation, which is a hallmark of most chronic and/or serious diseases, not just strokes and heart disease. For example, in one 2010 study,7 post-menopausal women who consumed the most daily dietary trans fat had a 30 percent higher incidence of ischemic strokes. So please, understand that while most health journalists and "experts" will lump saturated fats and trans fats together, they have markedly different health impacts, and the vilification of saturated fat, which arose from an unproven hypothesis from the mid-1950s, is a myth that has since been firmly debunked by nutritional science.
Fiber May Also Be Important for Stroke Prevention, Study Shows
In related news,8, 9 researchers have found that for every seven-grams more fiber you consume on a daily basis, your stroke risk is decreased by seven percent.10 This conclusion was drawn based on data from eight observational studies. Fiber is the non-digestible parts of plants, which can be either soluble or non-soluble. Water soluble fiber was found to reduce stroke risk the most. Soluble fiber can also help propel food, sugars, cholesterol and fats cleanly through your digestive tract, and aids in the formation of beneficial bacteria in your gut, which is a critical aspect of optimal health. Healthful sources of soluble fiber include:
- Chia seeds
- Vegetables such as broccoli and Brussels sprouts
- Root vegetables and tubers, including onions and sweet potatoes
While conventional recommendations call for 25 grams of fiber daily, I believe most people need upwards of 32 grams a day. Most Americans get nowhere near this amount. According to the New York Times:11
"...the current average fiber intake in the United States is about 13 grams a day for women and 17 for men. Increasing these amounts by seven grams a day would bring them close to the recommended levels of 21 to 25 grams for women and 30 to 38 for men. 'Seven grams a day increase is an achievable goal,' Dr. Burley said. 'You're talking about... increasing vegetable and fruit by two portions a day.'"
Ideally, your diet will have foods high in both soluble and insoluble fiber, such as:
- Psyllium seed husk, flax and chia seeds
- Green beans
- Dried beans
Other Stroke-Prevention Guidelines
It's important to realize that the vast majority—up to 80 percent, according to the National Stroke Association—of strokes are preventable, so your lifestyle plays a major role in whether or not you're going to become a statistic here. Exercise is clearly at the top of the list in terms of recommendations, as maintaining a regular fitness program will go a long way toward improving your insulin and leptin receptor signaling.
I recommend a comprehensive program that includes Peak Fitness exercises along with super slow strength training, Active Isolated Stretching and core work. If you've had a stroke, exercise is also very important, as research shows it can significantly improve both your mental and physical recovery.12 Besides exercise and the specific dietary factors already discussed above, other lifestyle factors that can have a direct impact on your stroke risk include:
• Processed meats: Certain preservatives, such as sodium nitrate and nitrite found in smoked and processed meats have been shown to damage your blood vessels, which could increase your risk of stroke. I recommend avoiding all forms of processed meats, opting instead for organic, grass-fed or pastured meats
• Diet soda: Research presented at the American Stroke Association's International Stroke Conference in 2011 showed that drinking just one diet soda a day may increase your risk of stroke by 48 percent. Ideally, strive to eliminate all soda from your diet, as just one can of regular soda contains nearly twice my recommended daily allowance for fructose in order to maintain good health and prevent disease.
• Vitamin D deficiency: According to research presented at the American Heart Association's (AHA) Annual Scientific Sessions in 2010,13 low levels of vitamin D—the essential nutrient obtained from exposure to sunlight—doubles the risk of stroke in Caucasians. To get your levels into the healthy range of 50-70 ng/ml, appropriate sun exposure is your best bet. If sun exposure is not an option, a safe tanning bed (with electronic ballasts rather than magnetic ballasts, to avoid unnecessary exposure to EMF fields) can be used.
As a last resort, a vitamin D3 supplement can be taken. Research suggests the average adult needs to take 8,000 IU's of vitamin D per day in order to elevate their levels above 40 ng/ml, which is the absolute minimum for disease prevention. If you opt for a supplement, you also need to make sure you're getting sufficient amounts of vitamin K2, as it works synergistically with vitamin D and activates matrix GLA protein, which inhibits arterial calcification.
• Stress. According to a 2008 study,14 the more stressed you are, the greater your risk of suffering a stroke. The researchers actually found that for every notch lower a person scored on their well-being scale, their risk of stroke increased by 11 percent. 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 Technique). It's a handy, free tool for unloading emotional baggage quickly and painlessly, and so easy that even children can learn it. 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 -- something that is clearly not advantageous if you want to maintain optimal health. 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, stroke, heart attack, and breast cancer.
• Statins. Statin drugs are frequently prescribed to reduce your risk of heart disease and stroke. However, research shows that these cholesterol-lowering drugs actually increase your risk of a second stroke if you've already had one. 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.
Chances are greater than 100 to 1 that you do not need a statin drug. Seventy-five percent of your cholesterol is produced by your liver, which is influenced by your insulin levels. Therefore, if you optimize your insulin level, you will automatically optimize your cholesterol. For a refresher on how to do this, please see my recent article, Statin Nation: The Great Cholesterol Cover-Up.
• Grounding. Walking barefoot, aka "grounding," has a potent antioxidant effect that helps alleviate inflammation throughout your body. The human body appears to be finely tuned to "work" with the earth in the sense that there's a constant flow of energy between our bodies and the earth. When you put your feet on the ground, you absorb large amounts of negative electrons through the soles of your feet.
In today's world, this is more important than ever, yet fewer people than ever actually connect with the earth in this way anymore. 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 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 1.5-2 hours, if possible.