Reduce Risk of Stroke (CVA) and Restore Brain Health After a CVA

Brain Infarct

Most strokes occur when there is a lack of blood & oxygen flow in the brain, which results in inflammation, swelling and tissue damage. These “cerebrovascular accidents (CVA’s),” are from lack of blood flow or “ischemic.” 

  • The cornerstone of treatment for acute ischemic stroke remains reperfusion therapy with recombinant tissue plasminogen activator (rt-PA)–For which you must get to a hospital emergency room within several hours of the onset of symptoms.

  • E-medicine has a great article that lays out what emergency room doctors do to minimize acute stroke damage:  http://emedicine.medscape.com/article/1159752-overview  

  • For those who develop disabilities after their CVA, 80% of the damage is due to the “secondary effects” in an area named the “penumbra.”

Penumbra

In the penumbra, there is brain and tissue swelling which constricts the surrounding blood vessels and causes the cells to “go to sleep” as it stops or slows the exchange of nutrients and oxygen in this area.  If the cells are not “rescued,” they will die.

So, the next step is to rescue the penumbra area:

  • As an example of how these cells will be rescued in the future, doctors have injected growth factor-secreting adult stem cells in the penumbra and found dramatic recoveries in many individuals. However, this treatment will have to undergo FDA trials before it is available. 

In the meantime, other treatments aimed at the penumbra include:

  • An IV “cocktail” of antioxidants to reduce the free radical damage and ongoing inflammation in the penumbra. 

    Antioxidants, Rachel Shirley et al. 2014, 3, 472-501; Oxidative Stress and the Use of Antioxidants in Stroke 

  • Intravenous Nerve Growth Factors & Stem Cells: 

    • Granulocyte-colony stimulating factor (G-CSF) actually helps mobilize stem cells from the bone marrow while others like nerve growth factor (NGF) which supports neuron growth and survival, suppresses inflammation, and also promotes angiogenesis or new blood vessel formation. Neupogen® (Filgastrim) is a manmade protein similar to granulocyte-colony stimulating factor (G-CSF) which stimulates production and mobilization of bone marrow stem cells with their NGF’s. 

    • Stem Cell-Rich Bone Marrow Aspirate Concentrate (BMAC): Dr. Steenblock began harvesting and infusing stem cell rich BMAC along with FDA approved pharmaceutical stem cell activators to successfully treat persons with CVA’s. BMAC’s secrete “Nerve Growth Factor” among others.

  • Hyperbaric Oxygen (HBO), one of whose experts is Dr. David Steenblock–In a review of his work with over 2000 patients 95% of these patients had significant improvements in at least one area of their disabilities. If HBO is available acutely, it must be used in a strict regimen that he describes.

  • Evaluate the health of your blood vessels (See Appendix) and watch improvements as you use recommendations from the following:  

  • Exercise, Dietary and Supplement-Induced Nerve Growth Factors (NGF’s):

Dopamine Cell, Microglia and vessels supplying nutrients

Dopamine Cell, Microglia and vessels supplying nutrients

Stimulate brain cells to release NGFs  from brain receptors: The top supplements include:

     

1. Whole Coffee Fruit Concentrate Powder showed a 140% increase in BDNF – a brain growth factor.  (Ref: DMID: 23312069)

2. Blueberry extract

3. Lion’s Main

  •  Active physical and occupational therapy because brain circuits can be created in healthy parts of the brain to compensate for damage.

  • Monitor your blood pressure and make sure it stays close to the measures your doctor recommends. 

  • Test to determine if you have genetic predispositions for a stroke with a 23andMe saliva kit and/or a Hemex blood test.  For instance, you may have any number of clotting abnormalities that would place you at risk for a stroke at a young age. (Appendix Two) 

  • Stop and reverse atherosclerotic plaque forming in brain vessels as it is composed of the same elements of plaque formation in heart disease: See 

    “Use Naturals and/or Medications to Reverse Heart Disease” on Home Page

  • Other techniques to reduce the clotting of your arteries

1. Dr. Philip Lee Miller recommends:

Clot Dissolvers: Nattokinase, Lumbrokinase or Serrapeptase 

Ideally, you want to prevent soluble fibrinogen from converting to insoluble fibrin molecules that crosslink with each other and add a kind of mesh over the clot. You want to:

Thrombin

  • Reduce thrombin, platelet activation, fibrinogen, fibrin,  and plasmin activator inhibitor (PAI-1) and; Plasmin

  • Increase plasmin and TF.

Nattokinase decreases the conversion of fibrinogen to fibrin, and it increases the body’s plasmin (which degrades fibrin clots). In a 2009 study, two months of nattokinase reduced fibrinogen. A 2014 study found that a single oral dose of nattokinase improved fibrinolysis and blood flow. Nattokinase stimulates the conversion of plasminogen to plasmin which degrades the fibin clots, and it reduces plasminogen activator inhibitor I (PAI-1). The thrombolytic power of nattokinase may be stronger than plasmin.

  • You and your practitioner may also want to “thin,” or reduce the “stickiness” of your blood. This can be dangerous, as you do want the blood to be too thin as it might cause bleeds–So work closely with your practitioner if you are pursuing this path.

There is very good evidence that an 81 mg dose of aspirin a day will help reduce ischemic stroke. Aspirin thins your blood  to make it less “sticky.”

Ginkgo Biloba: exerts its action primarily as an anti-platelet and anticoagulant. It inhibits platelet aggregating factor. It is also an antioxidant, may have vasodilatory effects, and has been used for cognitive enhancement. A high dose can cause excess blood thinning and bleeding. Because of its action, Ginkgo should not be combines with aspirin or NSAIDs. It will have an unwanted synergistic effect.

High Potency Fish Oils: These prevent the aggregation of red blood cells that can lead to the formation of a clot. One image to describe them is that they act like Teflon to prevent this aggregating effect. Scientists noted stroke induced brain damage was lessened by a diet rich in DHA type Omega-3 fatty acids. The dose one expert recommends is one tablespoon of high potency fish oils daily. One tablespoon of high potency fish oil will yield approximately 4300 mg of EPA, approximately 3000 mg of DHA and 1000 mg of other Omega-3 fish oils.

If you choose fish instead of oil or capsules for your Omega-3 fatty acid intake, make sure the fish is free of high levels of mercury and PCB’s: Check the easily available lists on the internet to help your decisions.

Studies demonstrate that the omega-3 oils are often far too low in many stroke patients.

In addition to their anticoagulant effect, omega-3 oils:
a) Enhance brain function;
b) Prevent cardiovascular events;
c) Are antidepressant;
d) Improve skin elasticity; and
e) Lower blood pressure.

Vitamin E isomers: like fish oil, vitamin E prevents red blood cell aggregation. It also lowers blood viscosity or “stickiness.” Vitamin E exists as a family of tocopherols and tocotrienols, and experts recommend mixed tocopherols including the alpha, beta, gamma and delta from of vitamin E. Some prefer “natural” over synthetic vitamin E. Synthetic vitamin E is a tocophery, while natural vitamin E is a tocopherol.

Not as well studied are herbs that may be helpful to thin the blood such as Bilberry , feverfewgarlic , ginger , quercetin , and white willow. However, the supporting evidence for these supplements remains weak and needs further study, and the mere fact that they may thin the blood does not prove that they will reduce stroke risk.

Other Strategies:

A. Policosanol has a nice study with policosanol at 20 mg per day proving approximately as effective as 100 mg of aspirin

In addition, when the two treatments were taken in combination, the effect was greater than with either treatment alone. See Appendix One

B. Nrf2 Stimulators: These stimulate the naturally occurring Nrf2 regulator of gene “Transcription,” or production as shown in the picture below. 

You can see below that Nrf2 stimulators decrease inflammtion, restore redox (or oxidative stress) homeostasis, improve neurovascular coupling and reinstate the nerve cells “steady state.”

Ginseng Nrf2 Stroke Protection

Take Ginseng and other Nrf2 stimulators (As seen in  “Nrf2 for Gene Antioxidants” under the tab “Change Gene Production” along the top row of Home Page) 

C. Optimize your Vitamin D levels. The majority of patients with acute stroke are deficient in Vitamin D.  Vitamin D deficiency is also associated with post-stroke hip fractures.

D. Increase Brain Nerve Growth Factors (NGFs)

E. Vinpocetine is an herb that improves memory and overall mental well-being. It works by increasing blood flow to the brain, enhancing the brain’s use of oxygen, and protecting the brain from free radical damage. It is very popular in Europe and Japan where it’s available by prescription only.

F. The spice Curcumin, or Turmeric can improve memory and concentration by increasing blood flow, neurotransmitter formation, and brain-derived neurotrophic factor (BDNF), which stimulates new brain cell production.

G. If the Gut is inflamed, the brain shares some of that inflammation through the Gut:Brain Communication. Reduce Gut inflammation, if present. See Gut and Immune Deficits.

H. Decrease Inflammation in your brain arteries: Measure (with an am lipid peroxide level test)

I. Restore healthier brain membranes and nerve signals with citicholine and others. See Memory Loss.

J. Measure and Optimize the Nutritional Status of Your Cells: Deficiency in essential nutrients including vitamins C, E, D, carotenoids, vitamin B12, vitamin B6, folate, antioxidants, essential fatty acids, and minerals (especially potassium and magnesium) can contribute to conditions known to increase the risk of experiencing a stroke.

Other, more controversial naturals include:

Galantamine Postischemia Provides Neuroprotection and Memory Recovery against Transient Global Cerebral Ischemia in Gerbils. J. Pharmacol. Exp. Ther., August 1, 2007; 322(2): 591 – 599.

Dimethylsulfoxide (DMSO) treatment reduces infarction volume after permanent focal cerebral ischemia in rats.  Neurosci Lett. 1997 Dec 19;239(2-3):125-7. Shimizu S, Simon RP, Graham SH.

Appendix: Utilize one of the following to determine your vessel health:

     1. CIMT is a noninvasive way to asses a patient’s cardiovascular health by measuring the thickness of the intima and media layers of the carotid artery.

  • CIMT accurately measures the presence of disease, vascular inflammation, risk of events, and progression or stabilization of the identified disease state.
  • there is a 96% correlation with findings from the CIMT and the presence of plaque in coronary arteries.
  • CIMT characterizes plaque based on the likelihood of predicting events. “Soft” plaque is more vulnerable and more likely to rupture than calcified plaque. Consider pharmacological and lifestyle therapy goals to reduce LDL-C and control other factors that promote the vascular inflammation process.
  • Repeat CIMT annually to monitor progression, stabilization, or regression of plaque and/or vascular inflammation.

    2. A Digital Pulsewave Analyzer detects peripheral artery flexibility and health. With this easy test, you can watch your progress as you and your health professional try different interventions to improve vessel health.

     3. Endothelial Function (EF) is a noninvasive test to assess the function of the endothelial lining of the arterial wall.

  • By temporarily occluding the blood flow through arm compression, EF measures the ability of the vasculature to normalize blood flow by a bio-sensor measurement of vascular compliance.
  • Decreased vasodilation shows the initiation of an inflammatory state and endothelial dysfunction which can lead to or accelerate the development of plaque.
  • Endothelial dysfunction is reversible through lifestyle therapy, lipid lowering medications, and disease state control like blood pressure and blood sugar. Repeat EF every six months to monitor changes in arterial endothelial function.

    4. CT and MRI scans are ordered to check for ischemic (too little blood flow) areas as well as strokes.

Appendix One:

Several double-blind, placebo-controlled trials indicate policosanol significantly reduces the blood’s tendency to clot. In one such study of 43 participants, use of policosanol at 20 mg per day proved approximately as effective as 100 mg of aspirin; in addition, when the two treatments were taken in combination, the effect was greater than with either treatment alone. Furthermore, as described in other citations on policosanol, this supplement appears to reduce cholesterol levels, making it potentially an all-around stroke-preventing treatment.

In an interesting study investigating the effects of music therapy, stroke patients who listened to music of their own choosing in the early stages of their recovery demonstrated more improvement in memory and attention than those patients who listened to language (books on tape). Music listeners were also less depressed and confused than subjects who neither listened to music nor language.

Appendix Two:

Hypercoagulability and anticardiolipin antibodies as risk factors for ischemic stroke in patients aged 46 or younger

M. Amiri, L.A. Kennedy, P.L. Sanders, L.M. Fink, S.M. Nazarian and J.W. Schmidley

Journal of Stroke and Cerebrovascular Diseases

Volume 8, Issue 4, July-August 1999, Page 276

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