Strokes are sometimes referred to as "brain attacks" (instead of "heart attacks") because they 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 brain damage can occur. Without proper and timely treatment, a stroke can be lethal.
According to the National Institute of Neurological Disorders and Stroke, an estimated 795,000 strokes occur each year in the U.S.2 It's the fifth leading cause of death, killing an estimated 142,000 annually. It's also a leading cause of long-term disability in the U.S.3
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, according to the National Stroke Association.4,5 Estimates suggest 10 percent of all strokes occur in people under the age of 50.6
The recent death of Luke Perry at 52,7,8,9,10 a popular actor on the 1980s television show "Beverly Hills 90210" and many others, has brought renewed attention to the risks of stroke, especially among younger adults and the middle-aged.
Analyses reveal 9 in 10 strokes are preventable by addressing lifestyle factors such as high blood pressure, obesity, hyperglycemia, hyperlipidemia, kidney dysfunction, smoking, unhealthy diet and sedentary behavior.11 There's also evidence showing your vitamin D12 and magnesium13 status play a role, and alcohol consumption in middle-age appears to be a significant risk factor.14 As noted in one study:15
"Data from longitudinal studies have shown that some of the most powerful lifestyle modifications to lower risk of stroke include reducing elevated blood pressure, cessation of smoking, daily physical activity and maintenance of a healthy diet and weight. It has been demonstrated that even a modest change in lifestyle risk factors are achievable and have a substantial effect on risk.
Genetic background, information on risk factors and behaviors, and presence of subclinical conditions provide the most realistic appraisal of an individual's future vascular risk. For the community at large, improving health behaviors provides the best approach to reducing risk of stroke and its recurrence."
Signs and Symptoms of Stroke
Nine out of 10 strokes are ischemic strokes,16 which result from an obstruction in a blood vessel supplying blood to your brain. Research17 shows about 15 percent of ischemic strokes occur in "young adults and adolescents." The other form of stroke is known as a hemorrhagic stroke, which is when a blood vessel actually ruptures.
Strokes can be particularly devastating because they often occur without warning, and the longer your brain goes without oxygen, the greater your risk of lasting damage. This is one area where emergency medicine excels, as emergency medications can dissolve the clot that is blocking blood flow to your brain.
In order to be effective, however, you typically need to get help within three hours18 — the sooner the better. Research also shows primary stroke centers have lower mortality than other hospitals,19 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. If any of these occur, call for immediate emergency medical assistance (in the U.S., call 911).20
Remember, you need to get to the hospital as quickly as possible. When suspecting a stroke, don't drive to the hospital. Call for an ambulance, as this will ensure the most rapid assistance, and every minute counts.
- 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
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 mini-stroke, 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. A helpful acronym to memorize is FAST:
F: Face drooping
A: Arm weakness
S: Speech impairment
T: Time to call 911!
Risk Factors That Raise Stroke Risk in Middle-Aged and Younger Adults
According to Dr. Lee H. Schwamm, director of the comprehensive stroke center at Massachusetts General Hospital, and Dr. Lawrence R. Wechsler, chairman of the department of neurology at the University of Pittsburgh School of Medicine, the risk factors for stroke among patients under the age of 50 differ from those in older patients, and include the following:21
Arterial dissection causing a blood clot — Causes of arterial dissection, which is when the lining of an artery tears, can occur during sudden neck movements, including sports injuries to the neck and jolting that can occur when riding a roller coaster
Hole in the heart (patent foramen ovale) — An estimated 1 in 4 people has this condition, which raises your odds of a stroke, as it can allow a blood clot to cross through your heart and into your brain
Heart defects or disturbed heart rhythm
Narrowing of the arteries caused by stimulants or drugs, causing a sudden lack of oxygen to your brain
Aneurism or arteriovenous malformation
Vitamin D and Magnesium Deficiencies Raise Your Risk of Stroke
Certain nutrient deficiencies can also play a role. Two important ones are vitamin D and magnesium. According to research presented at the 2010 American Heart Association's (AHA) annual Scientific Sessions, vitamin D deficiency doubled the risk of stroke in Caucasians, but not in African-Americans.22 That said, low vitamin D has been linked to arterial stiffness in black teens,23 which is a risk factor for stroke.
Chinese researchers have also found a correlation between magnesium intake and stroke risk.24 After looking at more than 1 million people across nine countries, those who consumed the most magnesium had a 12 percent lower stroke risk. According to this study:
"No significant association was observed between increasing dietary magnesium intake (per 100 mg/day increment) and the risk of total CVD [cardiovascular disease] or CHD [coronary heart disease].
However, the same incremental increase in magnesium intake was associated with a 22 percent reduction in the risk of heart failure and a 7 percent reduction in the risk of stroke."
Lead study author Fudi Wang, Ph.D.,25 pointed out that while current U.S. guidelines recommend a daily magnesium intake of 300 mg for men and 270 mg for women, deficiencies are still common.
Indeed, research26 suggests 45 percent of American adults do not get the recommended dietary allowance (RDA) amount of magnesium from their diet, and teen statistics27 published in 2014 suggest nearly 92 percent of teenagers between 14 and 18 do not meet the estimated average requirement for magnesium from food alone. The most likely reason for this is because they do not eat fresh vegetables on a regular basis.
Stroke Prevention Strategies
Considering the vast majority of strokes are predicated on modifiable lifestyle factors, I strongly encourage you to take control of your health to reduce your risk. Conventionally speaking, many of the same risk factors that increase your risk of heart disease also increase your risk of stroke, such as:
High blood pressure
Elevated homocysteine level
Low levels of HDL cholesterol and high levels of LDL cholesterol
High level of TMAO
To address these and other risk factors, consider implementing the following prevention strategies:
Eat real food — A diet of unprocessed or minimally processed whole foods will protect your heart and cardiovascular health by minimizing toxins and synthetic ingredients while providing high-quality nutrients.
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.
Eat plenty of probiotic-rich foods — Metabolites produced by certain gut microbes have been linked to an increased risk of atherosclerosis, heart attack, stroke and early death.
Even among those with traditional risk factors, having low metabolite counts appear to protect against clot-related events. Probiotics found in fermented vegetables and cultured raw dairy products such as yogurt and kefir may help lower these metabolites.
Probiotics have also been found to lower your risk of high blood pressure, which is yet another risk factor for heart attack and stroke. The most significant benefit appeared to be among those whose blood pressure was higher than 130/85. In studies, probiotics containing a variety of bacteria lowered blood pressure to a greater degree than those containing just one type of bacteria.
Another animal study found the probiotic lactobacillus marinus effectively prevents salt-sensitive hypertension by modulating TH17 cells. (Other research has found high salt intake inhibits lactobacillus marinus, thereby contributing to hypertension.)
Boost your fiber intake — Researchers have found that for every 7-grams more fiber you consume on a daily basis, your stroke risk is decreased by 7 percent. This conclusion was drawn based on data from eight observational studies. Fiber is the nondigestible parts of plants, which can be either soluble or nonsoluble. Water soluble fiber was found to reduce stroke risk the most.
Avoid "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.
Exercise regularly — Strength training may be particularly important for heart health. Researchshows less than an hour of strength training per week can reduce your risk for heart attack and stroke anywhere from 40 to 70 percent, independent of aerobic exercise.
The fact that the cardiovascular benefits of weightlifting were independent of aerobic exercises such as walking and running means strength training is sufficient in and of itself. It alone will lower your risk of heart attack and stroke, even if you don't meet the recommended guidelines for aerobic activity.
The U.S. Centers for Disease Control and Prevention recommends at least 2.5 hours of moderate-intensity aerobic exercise each week, 75 minutes of vigorous-intensity activity, or a combination of both. I also strongly recommend standing and walking as much as possible on a daily basis.
Optimize your vitamin D level — Ideally, measure your vitamin D level twice a year and make sure you maintain a healthy level between 60 and 80 ng/mL (150 and 200 nmol/L) year-round, either from sensible sun exposure or oral supplementation, or both.
Optimize your magnesium level — Check your RBC magnesium level and track signs and symptoms of magnesium insufficiency to determine how much magnesium you need. Low potassium and calcium are also common laboratory signs indicating magnesium deficiency.
To raise your level, eat magnesium-rich foods and/or take a magnesium supplement, balanced with vitamins D3, K2 and calcium. While the RDA for magnesium is around 310 to 420 mg per day depending on your age and sex, some experts believe you may need around 600 to 900 mg per day.
Personally, I believe many may benefit from amounts as high as 1 to 2 grams (1,000 to 2,000 mg) of elemental magnesium per day. The reason why I believe the higher dose is warranted is because most of us have EMF exposures that we simply are unable to mitigate, and the extra magnesium should help lower the damage from that exposure.
Lower your stress — Stress is a general risk factor for stroke, and the higher your stress, the greater your risk. One 2008 study found that for every notch lower a person scored on their mental 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 Techniques). 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 and yoga, for example.
Address elevated TMAO levels — Studies have shown high levels of trimethylamine-N-oxide (TMAO) are associated with an increased risk of heart attacks and stroke, so measuring your blood level of TMAO could be a powerful predictive tool for assessing your stroke risk. In one analysis, high blood levels of TMAO increased the risk of dying from any cause fourfold in the next five years.
In a paper led by James DiNicolantonio, Pharm.D., who is also the coauthor of my latest 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.
Limit alcohol consumption — Research 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 percent 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."
Quit smoking — As one of the major risk factors for stroke, quitting smoking is an important consideration if you're concerned about your stroke risk.
Neuroplasticity Training Following a Stroke
If you, a family member, or close friend aren't able to navigate implementing the prevention recommendations above, then you need to know what to do immediately after you are in the hospital. With nearly 800,000 people having a stroke in the U.S. every year, there is a strong likelihood you will personally know someone who has a stroke.
I recently interviewed Bob Dennis about his excellent book, "Stroke of Luck: NOW! Fast and Free Exercises to Immediately Begin Mastering Neuroplasticity Following Stroke — Right Now!" and I would recommend everyone download a copy now. This is the book you want to have when you are in the ER 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. This interview should be published sometime in the near future, so if this is a topic that interests you, be sure to keep an eye out for it.