Keeping Your Marbles
The quick answer: Hippocrates first observed that what's good for the heart is good for the brain. Living the Healthy Changes helps to protect your brain from the twin threats of dementia and stroke.
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Preventing dementia, including Alzheimer’s disease
We went to a funeral the other day for one of the loveliest people you could hope to know. Her name was Nancy and she left us at a relatively young age. Nancy was in her mid ‘60s, just entering what should have been her golden years. But in truth, Nancy had left us some time before, for she died of Alzheimer’s disease. Alzheimer’s, the most common form of dementia, is growing at a frightening rate. This post is dedicated to the memory of Nancy, and the proposition that the Word of Wisdom Living lifestyle can reduce the risk of dementia, as well as stroke.
A 2005 Columbia University study found four risk factors that were highly predictive of Alzheimer’s disease (AD). Per the study, your risk of AD is 240% greater if you have three of these four conditions:
- Smoking,
- Diabetes,
- Hypertension,
- Heart disease.
A 2010 study, also at Columbia, found a strong link between HDL cholesterol—known fondly as the “good” cholesterol, though in fact we need all the forms of cholesterol, just in the right ratio—and the risk for AD. Those with higher HDL levels (>55 mg/dL) had 60% less risk of AD than those with lower levels. How do we improve our level of HDL? Here is a summary:
- Get regular aerobic exercise (more is better).
- Lose excess weight.
- If you smoke, stop. (Is there no end to the ways tobacco harms the body?)
- Eliminate manmade trans fats (eat nothing hydrogenated).
- Eat whole foods (lower glycemic index plus more fiber and nutrients). A diet high in sugar is a special risk for AD—those who consume the most sugar have a six-fold greater risk vs. those who eat the least.
- Eat fish (rich in the essential fat, omega-3).
- Get adequate B-complex vitamins (including niacin).
The last protective action—getting adequate B-complex vitamins—brought to mind a study of AD among Catholic nuns reported in the book, Amazing Grace. In a prior post we discussed the link between the B vitamin folic acid and spinal cord birth defects, particularly spina bifida.
Amazing Grace found a similar protection for folic acid against AD. It’s most interesting to learn how vitamins that are protective at birth also protect our brain at the end of our lives.
There was also a link between AD and homocysteine, a normal chemical which can be harmfully high when folic acid and other B vitamins are deficient. In the post on heart disease, elevated homocysteine was an important risk factor. In fact, if you look over the lifestyle habits that protect from heart disease, you find the same constellation that is protective of dementia. Because tradition is one of the three sources of wisdom for this blog, we should now honor the ancient physician Hippocrates who said:
“Food that is good for the heart is likely to be good for the brain.”
A Personal Story
May I tell a story? In 1991 I took a position with a new medical device company called Target Therapeutics. With the help of leading doctors, this company founded a new field of medicine called interventional neuroradiology. Basically we provided doctors with miniature catheters and other tools to treat structural brain disorders by working from inside the blood vessels. (This was much less invasive than surgery by cracking open the cranium.) At first we provided catheters for diagnosis but our fame came from an innovative treatment for treating aneurysms. Yet all the time our big goal—a task still unfulfilled—was better treatment of strokes.
My work here brought an unexpected moment of closure. When I was just three years old—this is the short version of the story—I fell out of a moving car and suffered a brain injury that might have proved fatal. The concussion caused a slow-developing hemorrhage that put increasing pressure on my brain. As the clot grew over weeks, I became less active, sleeping more and more. Because the progress was slow, the doctor involved was not concerned. My parents were frightened, however, and through a serendipitous chain of events my Mom got into the office of a neurosurgeon in San Francisco. This was during the early years of neurosurgery but the doctor immediately saw the problem and arranged a life-saving surgery not available where I lived. (Yes, that's me in the picture above, wearing a protective cap during recuperation.) Years later, while working at Target Therapeutics and observing the use of our products I visited that same hospital where my life had been saved as a child. I think it was this moment of closure that sparked a continuing interest in promoting brain health. For this reason, I call your attention to stroke prevention and treatment.
Treating Stroke
Stroke is the 3rd leading cause of death in the US, causing 160,000 deaths each year. Because breast cancer has been so well advertised we should note that more women die of stroke than breast cancer. In fact, strokes are much more easily avoided—up to 80% of strokes are preventable. It’s a tragedy that our society is not more effective at preventing, or quickly treating, strokes.
Most strokes are ischemic, meaning a clot blocks an artery in the brain, cutting off the flow of blood and life-giving oxygen to brain cells. A minority of strokes is hemorrhagic, meaning a blood vessel bursts, usually due to an aneurysm, and leaks into the brain cells. Avoiding high blood pressure is the first protection against stroke.
It’s important to remember that when a stroke occurs, it takes 4-8 hours for brain cells to die—a much longer treatment window than in heart attacks. Therefore, recognizing the signs of a stroke and quickly getting to a major hospital—one with a certified stroke center and interventional neuroradiologists trained in methods of treatment—is essential to survival. I repeat: essential! (If you don't know the best hospital, get to the biggest one and inquire.)
Borrowing from the success our society had in alerting people to the signs of heart attacks, it’s helpful to see strokes as brain attacks, and be aware of the signs. Because the brain is separated into two halves, stroke symptoms usually affects one side of the body. As a public service, the American Stroke Association posts these stroke signs to watch for:
- Sudden numbness or weakness of the face, arm, or leg, especially on one side,
- Sudden confusion, trouble speaking or understanding,
- Sudden difficulty speaking,
- Sudden trouble seeing in one or both eyes,
- Sudden trouble walking, dizziness, loss of balance or coordination,
- Sudden, severe headache, with no apparent cause.
If someone you know shows these symptoms, respond quickly.
One other fact about strokes—strokes can be “tiny”, and these are called “transient ischemic attacks” or TIAs. With TIAs the above symptoms may pass, but there can be loss of brain cells and the accumulation of TIAs is one cause of dementia. It’s equally important to see a doctor about TIAs because treatment can prevent a more devastating stroke, as well as progressive dementia.
Preventing Stroke
We should follow Hippocrates’ advice; the following protect both the heart and the brain: Manage your blood pressure, avoid the use of tobacco and alcohol, eat a healthy diet, get plenty of exercise, avoid or control diabetes, and watch out for TIAs. One more thing (I hope this isn't too much information): be aware that the heart problem of atrial fibrillation can increase your stroke risk by 500%! For more information, visit the website of the National Stroke Association.
Please comment: We’re not used to thinking of the brain when we discuss diet and other lifestyle improvements. Have the posts this week helped you to know how to hang on to your marbles?
Thursday, July 21, 2011 at 10:40PM | by Skip Hellewell | 10 Comments | Share Article | in longevity, prevention | Email Article
Reader Comments (10)
Thank you so much for addressing stroke prevention. In December of '09 at age 53, my dad had a massive stroke that because he lived by himself, went untreated for 12+ hours. He moved in with me 5 weeks post stroke and I cared for him in addition to my 6 week old baby and 2 other young children. I've been journaling what this experience was like on my blog. I fear that the situation I was in will become more and more common as the problems of obesity, etc. continue. There is no infrastructure for services for those suffering from strokes at such a young age, and there is little planning in place on the part of the victim because no one anticipates this happening so early in life. My dad is now disabled, but has to go through a waiting period to gain access to medicare instead of being able to already have that insurance coverage. He is now living in an assisted living facility, much younger than his peers there, but it is the most appropriate choice for his care. I hope that the tides can change in America regarding preventive care so the problem or premature health problems does not continue to increase.
Christina, you're a good spokesperson for the tragedy of stroke. I suppose it's because there's no big drug or procedure to sell, but stroke does not get enough attention. They have a terrible effect— leaving people in such a helpless condition—yet most are easily prevented. Thanks for speaking up.
I doubt that most of us have made the connection, healthy life style, healthy brain. I have noticed that when I eat the right foods, and stay away from anything processed, I feel more alert, more focused and my attitude towards every thing is more positive. I also think it's important to note that it isnt just our body and mind that are being fed when we eat a healthy diet, but also our souls. Three of my grandparents died because of serious health problems associated with heart diease, cancer and strokes. They all died in their sixties. I thought that was when people died, until I met my husband's grandparents. They are very active and live a independent lifestyle, grandpa just turned 90, and grandma is 81. They are both examples of a healthy life equals a heathy brain and a long life.
My 85 year old aunt and 94 year old uncle live in Cedar Rapids, Iowa. Aunt Dorothy is a retired nurse practitioner and Uncle Newt a retired high school history teacher. Each have had knee replacements, my uncle both knees, but they still go to the gym 6 days a week and work out. They keep busy by volunteering their time to various organizations, and eat healthily. I'm just turning 53 and finally realized that I have these wonderful examples of how to do things right, in my very own family. Thank you for helping me make the right choices, it appears that my aunt and uncle are bit ahead of the curve so to speak, so it is time for me to catch up!
Unfortunately I learned about stroke signs too late. We were walking home from church 12 years ago when my dad complained of numbness in his right leg. I knew the signs of a heart attack but his were different. Confused, we made it home where he began to have more serious symptoms--garbled speech, confusion, etc. My mom drove him to the ER where they waited 3 hours before being treated!! He was eventually hospitalized. He survived but the stroke left him paralyzed on his left side. He went downhill from there and just passed away this January.
Of course I have always been haunted by hindsight. Why didn't I know the symptoms of a stroke? Why didn't I call 911 sooner? Why didn't we send him on an ambulance? No doubt he would have been treated sooner, than arriving in a car. I should have known better.
Thanks for getting those warning signs out there Skip so that no one else has to live with those regrets.
This post kind of makes me sad. I am half adopted and didn't meet my biological dad and his family until I was 19. I am so glad that I tracked them down when I did, though, because my grandfather was diagnosed with Alzheimer's the following year. It's sad because I didn't get 19 years to learn about him, but I've at least had the last 5 years and that means a lot to me - and my 3 year old son, who adores his great-grandfather. To me, his Alzheimer's isn't noticeable because I didn't know him that well, but to his wife (they just celebrated their 50th anniversary) it's been very, very difficult.
But I am grateful that you posted this. Because I know I am at risk of developing Alzheimer's, and I can definitely see where some of these factors went into play with my grandfather (hypertension, diabetes, heart disease...) I know I'm also at an increased risk for stroke and heart disease because I just had a hysterectomy at age 24. Yikes. Strokes terrify me. Don't even want to think about that.
is there any relation between pregnancy and tias? while in early labor with my daughter my face went numb and i had some vision loss for about 10 or 15 minutes maybe. the doctor did not seem at all concerned about it (though i was - what a strange experience!) when i was younger i would get migraines starting with a similar loss of vision, but the face going numb was something new to me. also, a migraine never followed. i had actually forgotten about it until i read those symptoms.
Missy, whatever happened during your labor, you survived, so that's good. Women healthy enough to become pregnant typically have very low stroke risk, but risk is elevated during and following the pregnancy. Though atherosclerosis (plaque in arteries) is typically not a problem during the child-bearing years, the dynamics of body chemistry associated with pregnancy are problematic.
A special problem now, due to the growing practice of IVF, is less healthy women conceiving. Nature may have protected these less-healthy women in the past by making conception unlikely. Doesn't it seem wiser to improve health, rather than circumvent nature?
During the time I worked with medical devices for brain diseases such as stroke there was a stroke case at UCLA's hospital involving a woman who had just delivered a child and was still in the hospital. She suffered a major stroke but fortunately was in a leading hospital. One of our catheters was threaded into the cerebral artery that had suffered the stroke and the blood clot was dissolved. The woman was most fortunate, she walked out of the hospital in good health. This case caused a lot of excitement that ischemic stroke was more treatable that had been realized. Unfortunately, the development of a support system for prompt treatment of stroke, including public education, has been painfully slow. We must do better.
Concerning Missy's post – there are a few women (including myself) that have severe reactions to the hormones during pregnancy and in the birth control pill. I had terrible migraine headaches while I was pregnant and in between my second and third child my doctor encouraged me to take the pill. While on the pill I had a TIA or stoke like symptoms with the left side of my body going numb, vision loss, along with other symptoms as already discussed. Luckily the symptoms subsided relatively quickly. I went back to the doctor and she sent me to a neurologist who requested a CAT scan (no MRIs at the time). There was no sign of damage but I have questioned that because sometimes since that time my memory has not been quite as good.
My neurologist told me at the time it was all related to hormones and migraines. I have such severe vasoconstriction (related to migraines) that it causes the blood supply to be cut off. Therefore any form of hormone replacement, including the pill and therapy for menopause, is not advised. Also pregnancy is a huge risk factor.
My last pregnancy was 23 years ago and I'm sure that research has helped with this but I know it is not very common. After my 3rd child was born I changed doctors and he had not even heard of anything like my history and he had to do a lot of research to help me. In the end I didn't have any other children ( also due to other pregnancy complications).
My recommendation to Missy is to go back to her doctor and ask about this. I don't have a name for it but it not something to treat lightly. I was very lucky to have survived without any problems. I continue to have migraines that are hormone related but no other neurological problems.
Good luck with this and thanks to Skip for addressing very helpful and timely issues.
The tragedy of strokes recently recently hit us full force when one our dear friends had one at a relatively young age. We pray for his recovery. I did not know that you even had experienced it at a young age. Thanks for the useful information. Don Sessions