Recovering from a stroke

A stroke refers to a vascular event that leads to brain damage. Strokes are the leading cause of adult disability in the United States and the third leading cause of death. A stroke can be the result of a lack of blood flow caused by blockage from a blood clot, or a hemorrhage. Without oxygen, the brain cells become damaged or die so the affected area of the brain becomes unable to function. A stroke may result in an inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or an inability to see one side of the visual field. If the stroke is severe enough or occurs in a certain location such as parts of the brainstem, it can result in coma or death.

In most cases, a stroke is a consequence of atherosclerosis—hardening of the arteries. Risk factors for stroke include: hypertension (high blood pressure), previous stroke or transient ischemic attack (TIA), diabetes, high cholesterol, cigarette smoking and atrial fibrillation (heart abnormality). High blood pressure is by far the most important risk factor for a stroke.

Aiding stroke recovery

One of the key factors in limiting the damage to the brain caused by a stroke is how quickly a person receives medical treatment. The conventional medical treatment uses the drug form of the naturally occurring compound tissue plasminogen activator (rTPA). It must be administered within a few hours of a stroke to produce significant benefit. Unfortunately, only 1 to 3 percent of stroke patients receive rTPA treatment.

The results of stroke can affect patients physically, mentally, emotionally, or a combination of the three and vary widely depending on size and location of the lesion. Disability corresponds to areas in the brain that have been damaged.

For most stroke patients who suffer from post-stroke disability, recovery is a concerted effort that involves physical therapy (PT), occupational therapy (OT) and speech-language pathology (SLP). It is important to take advantage of all of these services as they can greatly aid the rehabilitation process.

Medical care is often focused on preventing another stroke and most often utilizes anti-coagulant therapy with warfarin (Coumadin) or one of the newer drugs or anti-platelet therapy with aspirin or clopidogrel (Plavix), ticlopidine (Ticlid), etc. All of these drugs are designed to prevent blood clots from forming and lodging in the brain to produce another stroke. These drugs are not, of course, used when the stroke is from a hemorrhage.

Precautions with coumadin and other anticoagulant drugs

Coumadin has been a mainstay in the medical prevention of clot formation, but it has many issues with breakthrough bleeding and other side effects plus patients must be constantly monitored by routine blood tests. The problem with bleeding while on these drugs is that relatively minor trauma—a fall or being hit—can cause severe internal bleeding, which can be deadly.

In the last few years, the FDA (U.S. Food and Drug Administration) has approved four new oral anticoagulant drugs— Pradaxa (dabigatran), Xarelto (rivaroxaban), Edoxaban (Savaysa) and Eliquis (apixaban). These drugs also cause bleeding, but do not require monitoring.

While the new oral anticoagulant drugs are touted as producing better results than Coumadin in preventing strokes, it may come at a price. And, not just its nearly $6,000 a year cost to the patient vs. the $200 per year for generic Coumadin, but the fact that they can cause serious spinal cord complications leading to permanent paralysis as well inflammation of the blood vessels (vasculitis), which can be minor or can cause serious problems such as blood clots, blindness, and organ damage.

Coumadin works by blocking the action of vitamin K. The newer drugs are direct inhibitors of clotting factors and vitamin K has no impact on their function. In people taking Coumadin, they need to avoid vitamin K supplements and foods such as green leafy vegetables, green tea and natto. Alternatively, a person can usually eat the same levels they are accustomed to as long as they just don’t increase their consumption. Physicians monitor the effects of Coumadin using a test known as the International Normalized Ratio (INR) and will adjust the dosage up or down as needed. In addition to high vitamin K-containing foods, other natural remedies may interact with Coumadin. It’s likely that you can continue using these products, but don’t change the dosage from what your body is accustomed to. INR values must be monitored appropriately. For example:

Coenzyme Q10 and St. John’s wort (Hypericum perforatum) may reduce Coumadin’s efficacy

Proteolytic enzymes, such as nattokinase and bromelain, and several herbs, including Panax ginseng, devil’s claw (Harpagophytum procumbens), and dong quai (Angelica sinensis), can increase Coumadin’s effects.

Garlic (Allium sativum) and ginkgo (Ginkgo biloba) extracts may reduce the ability of platelets to stick together, increasing the likelihood of bleeding. However, neither appears to interact directly with Coumadin. Generally people taking Coumadin should avoid taking these products at higher dosages (more than the equivalent of one clove of garlic per day for garlic or more than 240 mg per day of ginkgo extract) but not to worry if they are just on the typical support dose.

Iron, magnesium and zinc may bind with Coumadin, potentially decreasing its absorption and activity. Take Coumadin and iron/magnesium/zinc-containing products at least two hours apart.

To reduce the likelihood of bleeding and easy bruising with Coumadin, consider taking 150 to 300 mg of either grape seed or pine bark extract daily.

Nattokinase: Nature’s clot buster

Nattokinase is a protein digesting enzyme isolated from natto— a traditional Japanese food prepared from fermented soybeans—that has potent “clot busting.” It has shown significant potential in improving stroke recovery. Nattokinase works by breaking down fibrinogen, a component of blood clots and atherosclerotic plaque. This mechanism is much different than anticoagulants like Coumadin and the newer version.

A blood clot forms when blood platelets, fibrinogen and red blood cells aggregate in the presence of clotting factors. A blood clot, or thrombus, serves as a plug to heal an injury such as a cut. Internally, blood clots aid in blood vessel repair. In atherosclerosis, there is damage to the lining of the artery so there is a tendency to deposit fibrin and begin clot formation. If a blood clot continues to grow it can block off the artery or break off and cause a stroke or heart attack. Nattokinase can help break down a clot by breaking down the fibrin mesh that holds the clot together. It does this by increasing the activity of the compound plasmin—the body’s natural clot buster—rather than any direct action. Aspirin and fish oils prevent clot formation by reducing the stickiness of blood platelets while the drug Coumadin blocks clotting factors.

In clinical studies nattokinase has been shown to:

• Dissolves excess fibrin in blood vessels to which improves circulation, causes clot dissolution, and reduces risk of severe clotting.

• Reduces LDL (bad) cholesterol and increases HDL (good) cholesterol.

• Reduces blood viscosity, improves blood flow and lowers blood pressure.

Typical dosage is 100 to 200 mg daily. Nattokinase should be used with caution when taking anticoagulant or anti-platelet drugs. That said, it should be considered the No. 1 alternative in people who cannot tolerate or take these drugs.

Natural approaches in stroke recovery

From a natural perspective the goals are similar, but more focused on maximizing blood flow and nutrition to the damaged areas. In other words, the primary goal is to improve blood flow by making the blood vessels (arteries) healthier. Diet is particularly important. Stroke patients, especially those with significant blockage of the arteries supplying the brain, typically have a dietary pattern (high saturated fatty acids; low fruit and vegetables and omega-3 fatty acid consumptions) that may have been a key factor leading to their stroke.

There are a number of natural products that help improve the health of blood vessels and blood flow to the brain. Obviously, nattokinase is a strong candidate. Also important in stroke recovery is Ginkgo biloba extract (GBE) as it increases blood flow to the brain, improves the production of energy within nerve cells, and favorably affects blood viscosity (thickness) resulting in improved blood flow characteristics within the brain. The recommended dosage for GBE is 240 to 320 mg daily.

Two highly bioavailable forms of the nutrient choline have shown effects in aiding stroke recovery: citicoline (CDP-choline) and glycerophosphocholine (GPC). Of these the research on GPC is a bit stronger. In six published clinical trials GPC has been given to almost 3,000 stroke patients. The single largest trial included 2,044 patients. At the end of the six-month trial, the investigators found GPC significantly helped more than 95 percent of patients and was without side effects.

Overall, GPC was judged by 78 percent of investigators as “very good” or “good,” by 17 percent as “moderate,” and by just five percent as having “poor” or “no” efficacy. Choose one of the following: citocholine: 1,000 to 2,000 mg daily or GPC 600 to 1,200 mg daily. There are no known interactions with citocoline or GPC with Coumadin or anti-platelet drugs.

Final comments

Clinical studies have shown that acupuncture can often help stroke patients perform better in self-care, require less nursing and rehabilitation therapy, and possibly cut health care costs. Acupuncture stimulates nerve cell re-growth and facilitates improved nerve cell function. VR


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