Stroke

Stroke

Here's a quote from one of the thousands of letters I have received over the years, written by people disillusioned enough with their physicians to seek an alternative: "My husband, age 57, suffered a stroke a year ago. The doctors believe he still has a blood clot somewhere in his brain, though they can't seem to dissolve it. He is currently taking many, many drugs, but they don't seem to be doing much to help him. Can you suggest anything herbal he might take?"

That's the usual loaded question, the one that always prompts me to remind everyone that I'm a botanist, not a doctor. Strokes are very serious--the nation's third leading cause of death--and anyone who has had one should certainly be under a physician's care and follow their doctor's advice.

With that said, however, there are, indeed, quite a few herbal approaches to preventing stroke and stroke recurrence, at least the type caused by blood clots in the brain (ischemic strokes).

Brain "Attack"

Approximately 500,000 Americans have strokes annually. Eighty percent of those strokes are ischemic: A blood clot lodges in a brain artery, cutting off the supply of oxygen and nourishment to part of that essential organ. Wherever the blood clot forms, the area around it dies or becomes damaged, and the body function controlled by that area becomes impaired. While such a stroke often causes death, it might lead instead to severe disability, such as loss of the ability to speak or paralysis of part of the body.

Ischemic strokes are often preceded by mini-strokes known as transient ischemic attacks (TIAs). TIAs last anywhere from a few seconds to several hours and cause stroke symptoms that eventually resolve on their own. Those who suffer TIAs typically make full or almost full recoveries. But TIAs indicate a real risk of future catastrophic stroke and often signal the start of aggressive preventive treatment.

The other 20 percent of strokes are hemorrhagic. In this kind of stroke, a cerebral blood vessel bursts, and the result is the same as in ischemic stroke--impairment of the part of the body that the damaged area controls.

Whether you're talking about mainstream or herbal medicine, stroke prevention and treatment are tricky, because many of the approaches that help prevent ischemic stroke may actually increase the risk of the less common but equally disabling or deadly hemorrhagic stroke.

To prevent the more common ischemic stroke, physicians try to prevent arterial blood clots by prescribing anticoagulant (blood-thinning) medication. But when that is done, the risk increases that any bleeding in the brain won't stop, thus increasing the risk of hemorrhagic stroke. So stroke prevention involves a complicated balancing act.

Green Pharmacy for Stroke

Because the vast majority of strokes are ischemic, most of the suggestions in this chapter relate to preventing cerebral blood clotting. But I reiterate that hemorrhagic strokes are also a possibility, especially for those with a personal or family history of hemorrhagic stroke or aneurysm (a dangerously dilated blood vessel).

If you have high blood pressure, which is the major risk factor for stroke, see a doctor and have it treated. (You can also enlist the help of the herbal alternatives suggested in the chapter on high blood pressure on page 254.)

Please remember: It's important to follow any stroke-preventive medical advice that comes from your doctor. In fact, if you've had a stroke or know that you are at risk, it would be a really good idea to discuss any stroke-preventing herbs that you'd like to try with your doctor.

That said, here are a number of good herbal approaches to stroke prevention and treatment that you should be aware of.

Garlic (Allium sativum). Garlic is the best anti-clotting herb. According to my database, it contains more anticoagulant compounds than any other herb--nine, to be exact. It is a major herb for heart attack prevention because of its blood-thinning effect and its ability to help control high blood pressure. These same effects also help prevent ischemic stroke.

If I were at risk for stroke, I'd increase my use of garlic in cooking and also take garlic capsules, which are available at health food stores and many drugstores. Garlic's close relatives, onions, scallions, leeks, chives and shallots, have similar benefits.

On the other hand, if I had reason to be concerned about hemorrhagic stroke, I'd steer clear of garlic and its other anti-clotting herbal relatives. (If you're not absolutely sure which category you fall into, ask your doctor to help you make this decision.)

Garlic A powerful healing herb, garlic was used to treat infected wounds and amebic dysentery during World War I.

Ginkgo (Ginkgo biloba). Ginkgo is widely used in Europe to treat complications of stroke, including memory and balance problems, vertigo and disturbed thought processes. Many studies show that this herb increases blood flow to the brain. Varro Tyler, Ph.D., dean and professor emeritus of pharmacognosy (natural product pharmacy) at Purdue University in West Lafayette, Indiana, endorses this herb as a stroke treatment in his excellent book, Herbs of Choice.

Ginkgo also helps reduce fragility of the capillaries, the tiny blood vessels that fan throughout your body, which can help prevent hemorrhagic stroke. In Europe, many elderly people take ginkgo regularly. I wouldn't be surprised if this herb doesn't soon become increasingly popular with elderly folks in the United States as well.

To take this herb, you'll need to buy a standardized extract. Ginkgo extracts are widely available in health food stores and drugstores. You can try 60 to 240 milligrams a day, but don't go any higher than that. In large amounts, ginkgo may cause diarrhea, irritability and restlessness.

Pigweed (Amaranthus, various species) and other foods containing calcium. A six-year Harvard study of more than 40,000 health professionals showed that compared with those who consumed the least calcium, those who got the most had just one-third the risk of succumbing to heart attack. Personally, I believe these results also apply to ischemic strokes, because they are biologically so similar to heart attack.

Pigweed is an excellent plant source of calcium, with 5.3 percent on a dry-weight basis. According to my calculations, about one-third of an ounce of fresh pigweed leaves would provide 500 milligrams of calcium. (The Daily Value is 1,000 milligrams.)

You can use the young leaves in salads or steam the more mature leaves like spinach. You might also try pigweed pesto. To make the sauce, prepare your favorite pesto recipe, but use pigweed instead of basil.

Pigweed is not the only good herbal source of calcium. Here are some others, in descending order of potency (on a dry-weight basis) lamb's-quarters, stinging nettle, broadbeans, watercress, licorice, marjoram, savory, red clover shoots, thyme, Chinese cabbage (bok choy), basil, celery seed, dandelion and purslane.

Willow (Salix, various species). Willow bark is herbal aspirin, and low-dose aspirin--half of a standard tablet to a whole tablet a day--has been shown in several studies to reduce the risk of ischemic stroke by about 18 percent. (Low-dose aspirin also cuts heart attack risk by about 40 percent in men and 25 percent in women.)

You can take the little white aspirin pills, if you like. I personally prefer the herbal route: teas made from willow bark, meadowsweet or wintergreen. I add a teaspoon or two of any of these dried herbs to either hot herbal teas or cold lemonade and drink two to three cups a day. (I must confess, though, that I tend to be lazy and often take my own low-dose aspirin in pills.)

Again, willow bark and the other aspirin-like herbs should only be used to prevent and treat ischemic stroke. They are powerfully anticoagulant and may increase risk of hemorrhage, including hemorrhagic stroke. In fact, the Physicians Health Study, the large scientific study that showed aspirin's ability to prevent heart attack, showed a slight increase in risk of hemorrhagic stroke from taking aspirin daily. The increase was small and not statistically significant, but if you're at risk for this type of stroke, consult your doctor before taking aspirin or any aspirin-like herbs. (You probably also should avoid them if you're allergic to aspirin.)

Carrot (Daucus carota). In a Harvard study of 87,245 female nurses, consumption of carrots (and to a lesser extent, spinach) significantly reduced stroke risk. Women who ate five servings of carrots a week suffered 68 percent fewer strokes than those who ate carrots less than twice a month.

Carrots are rich in beta-carotene and other carotenoids, all members of the vitamin A family. Other studies show that people can reduce their risk of stroke by as much as 54 percent if they eat lots of fruits and veggies that are rich in beta-carotene and vitamins C and E.

The message is clear: Eat more carrots. I munch them as snacks, include them in my vegetable soups and juice them, too, sometimes with garlic.

English pea (Pisum sativum). It turns out that nearly all legumes contain genistein, which appears to be a cancer-preventive nutrient. Scientists now believe that a diet high in genistein-rich tofu, a soy product, is an important reason that Asian women have such a low rate of breast cancer.

In addition to guarding against cancer, genistein also appears to have a significant anti-clotting effect, meaning that it may also help prevent ischemic stroke and heart attack. I like English peas more than I like soybeans, so this relatively new information was welcome news to me. I also eat lots of other beans and legumes. I suggest that you do, too.

Pineapple (Ananas comosus). Pineapple contains a compound known as bromelain that is best known for its ability to break down proteins. It's a key ingredient in meat tenderizers. But bromelain also has an anti-clotting action that might help prevent ischemic stroke and heart attack. The bottom line: Eat more fresh pineapple.

Scurfy pea (Psoralea corylifolia). These peas also contain genistein. After four long years of searching and researching, I finally have data to show that scurfy peas, consumed as a food (and reputed to be an aphrodisiac) in Asia, contain much more genistein than soybeans. I thank my colleague, Peter Kaufman, Ph.D., at the University of Michigan in Ann Arbor, for helping me to determine the genistein content of scurfy peas.

Bilberry (Vaccinium myrtillus). Bilberries and their close relatives, blueberries and huckleberries, contain compounds known as anthocyanidins. Good European studies show that these compounds help prevent blood clots and also break down plaque deposits lining the arteries. In addition, some evidence suggests that bilberries help to maintain capillaries.

For all of these reasons, bilberries and their relatives might help prevent ischemic stroke without increasing the risk of hemorrhagic stroke. Medical anthropologist John Heinerman, Ph.D., author of Heinerman's Encyclopedia of Fruits, Vegetables and Herbs, says that one glass of huckleberry juice taken twice a week can help prevent stroke. I'm not as convinced as he seems to be, but these berries are delicious, and if they do help prevent stroke, so much the better.

Evening primrose (Oe-nothera biennis). The oil of this herb is rich in gamma-linolenic acid (GLA), which has potent anti-clotting and blood pressure­lowering actions. I think it's probably quite useful in the prevention of stroke and heart disease. Borage oil is also rich in GLA. You can purchase both of these oils at health food stores. To use them, follow the package directions.

Ginger (Zingiber officinale). This is another herb with proven anti-clotting ability. In one Indian study, taking about two teaspoons of ginger a day for a week neutralized the blood-clotting effect of 100 grams of butter. (But please don't think you can continue to eat butter if you up your ginger intake. Butter is very high in cholesterol, which contributes to strokes.)

You might try using more ginger in cooking, or you could brew ginger tea using one to two teaspoons of fresh grated root per cup of boiling water. Steep until cool.

Spinach (Spinacia oleracea) and other foods containing folate. A good deal of evidence shows that nutritional approaches can help prevent stroke. Studies at Tufts University in Boston and the University of Alabama in Birmingham, for example, have demonstrated that folate can help prevent both heart disease and stroke. Compared with people who consumed little folate, those who ingested the most were only half as likely to show narrowing of the carotid artery, the artery that leads to the brain.

Folate is not plentiful in plants, but according to my database, spinach, cabbage, endive, asparagus, papaya, okra and pigweed all have this important nutrient, so the more of these veggies you get in your diet, the better.

Turmeric (Cucurma longa). Many studies show that the compound curcumin, which is found in this herb, helps prevent the formation of blood clots.

Turmeric is a key ingredient in most curry spice blends. You might consider eating more curry dishes or even ma king your own turmeric capsules. Many health food stores sell empty gelatin capsules.