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Stroke Prevention

A chapter on strokes would not be complete, if nothing would be mentioned about stroke prevention. Physicians are very limited with what they can do when a stroke has happened as brain tissue has often been lost and scarring sets in following a stroke. Looking at tooth decay it is certainly important to think about the cause of plaque formation, tooth decay and eventual tooth loss. After identifying the risk factors the next step is to cut out sugar consumption, brush your teeth and floss them regularly. Many of you know that and those of you who do this regularly likely still have their own teeth.

What does that have to do with prevention of strokes? The same preventative thinking works in stroke prevention. I have mentioned earlier and in other parts of the Net Health Book that there are preventable risk factors that lead to stroke. For ease of reference I have listed them in tabular form here again (modified from Ref.12).

Risk factors important for stroke prevention

Diabetes: premature hardening of arteries, best prevented by close diabetic control.

Dietary factors: low fat, low refined carbohydrate diet, which is good for your teeth and is also good for the rest of your body. Another dietary factor is magnesium. It has been shown in many studies that a lack of magnesium, particularly when it leads to a magnesium blood level of less than 1.7 mg/dL leads to high blood pressure, which in turn causes strokes. Several studies have shown that nuts and olive oil reduce stroke risk.

Inactivity: the blood needs to circulate and HDL-cholesterol needs to be built up by regular exercise (at least 30 minutes of a brisk walk every day, but better still 45 to 55 minutes daily).

Hypertension: don’t get it and if you have it use medicine and life style changes to keep it under close control; use the DASH diet to get hypertension under control naturally.

Hyperlipidemia: high blood fats in your blood cannot be good for your heart or brain arteries. If you have this, see your doctor and get medicine to control it closely.

Obesity: this did not happen overnight. You tackle this by attacking inactivity, dietary factors and mental attitude all at the same time. It can be done. Get support, cut out the main offenders to get started (like sugar and starchy foods); also make sure you do not have hypothyroidism, which is treatable.

Smoking: this is a habit due to addiction to nicotine. It may go much deeper than you think. Smoking can be an escape from stresses in life. Whichever way works for you, you need to get off cigarettes and other addicting stuff. Smoking leads to narrowing of the small vessels in the brain, particularly in the middle cerebral artery, leading to ischemic stroke. But nicotine also elevates blood pressure, which can contribute to hemorrhagic stroke when arterial pouches are present.

Cocaine use and alcoholism: has been linked with hemorrhagic stroke (Ref.12).

Prevent depression and you prevent strokes:

What’s good for the heart is good for the brain: Dr. Perlmutter (Ref. 15) reviewed that risk factors for heart disease are identical as risk factors for brain disease.

 Stroke Prevention

Stroke Prevention (Apple Versus Pizza)

Dr. Philip A. Teal from the Vancouver General Hospital (Director of the British Columbia Centre for Stroke and Cerebrovascular Disease) gave a talk at a conference  entitled “Stroke Prevention.”

He stated that about 80% of strokes are preventable through life style changes by paying attention to what I summarized for you above. He also said that they found in BC that about 40 % of all strokes originated from diabetes, hyperlipidemia and high blood pressure that were not adequately controlled and from smoking that had not been stopped. In other words they were entirely preventable. The other 40% of preventable causes are lifestyle decisions regarding food intake and inactivity. These BC vital statistics are identical in the US and in many other parts of the world. Many people have enough will power to change this on their own. Others need to do it under the guidance of a YMCA program or other equivalent program. Like brushing your teeth, limiting your sugar intake and flossing your teeth, which are very simple steps to take, you need to pay attention to your body, particularly the arteries that go to the brain and heart. Whatever I suggested in the table above is good not only for your brain, but also for your heart. It’s a “two-for-one-deal”.

In those patients where a transient ischemic attack has taken place urgent tests of the carotid arteries are needed, as a high percentage may have severe narrowing of the arteries predisposing them to the development of a stroke in the near future. Carotid endarterectomy can be done for this with a success rate of stroke prevention of 70 to 80 % (with proper selection of the patients who will benefit).

Vitamin C can prevent strokes and heart attacks

A study from Copenhagen has shown that heart attacks and strokes can be prevented by vitamin C from vegetables, fruit and supplements:

Secondary stroke prevention

Those who had a stroke can do “secondary prevention” by taking a baby aspirin daily to thin the blood and this can be combined with extended release clopidrogel or dipyridamole. Ask you family doctor or specialist about this. Risks and benefits of medications have to be assessed in each patient according to the circumstances. As you know aspirin (ASA) can cause severe stomach bleeding in a small number of patients.
In Ref. 14 a study is described where 36,686 Finnish participants aged 25 to 74 years were followed for 13.7 years by a Chinese research team. They had no cardiovascular disease or stroke in the beginning of the study, but 1478 developed strokes during the study (1167 ischemic and 311 hemorrhagic). 5 life style factors were analyzed, namely being a non smoker, having a BMI of less than 25.0, whether or not they engaged in light to moderate physical activity, consumed vegetables at least three times per week and whether they had light or moderate weekly alcohol consumption. The risk of developing stroke was analyzed depending on these 5 health factors. When two, three, four or five of these factors were present, a 33%, 40%, 50% or 70% lower risk for ischemic stroke was found while for ischemic stroke the risks were 37%, 51%, 51% and 60%. This is an important study as it demonstrates how beneficial life style factors are in preventing strokes.

Here is a link to 17 causes of hardening of arteries; avoiding these causes will help to prevent strokes:

Minerals that help with stroke prevention

More than 180,000 nurses were enrolled in two independent Nurses Health Studies and followed between 22 and 30 years. They found that potassium, calcium and magnesium supplementation significantly lowered stroke risk.


1. KH Lee et al. Arch Neurol 2000 Jul 57(7): 1000-1008.

2. S Schmulling et al. Stroke 2000 Jul 31(7): 1552-1554.

3. D Jackson et al. Clin Rehabil 2000 Oct 14(5): 538-547.

4. ML Hackett et al. Neurology 2000 Sep 12; 55 (5): 658-662.

5. K Tsutsumi et al. J Neurosurg 2000 Oct 93( 4): 550-553.

6. IS Spetzler Surg Neurol 2000 Jun 53(6): 530-540.

7. G Lot et al. Acta Neurochir (Wien) 1999; 141(6): 557-562.

8. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 174.

9. Noble: Textbook of Primary Care Medicine, 3rd ed.,2001, Mosby Inc.

10. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

11. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright 2004 Elsevier

12. Ferri: Ferri’s Clinical Advisor 2013, 1st ed. Copyright 2012 Mosby, An Imprint of Elsevier. Acute Ischemic Stroke, Hemorrhagic Stroke and Subarachnoid hemorrhage.

13. Cleveland Clinic: Current Clinical Medicine, 2nd ed. Copyright 2010 Saunders, An Imprint of Elsevier. Section 10. Neurology. Stroke treatment.

14. : Zhang Y, Tuomilehto J, Jousilahti P, Wang Y, Antikainen R, Hu G. Lifestyle factors on the risks of ischemic and hemorrhagic stroke. Arch Intern Med. 2011 Nov 14;171(20):1811-8. Epub 2011 Sep 12.

15.  David Perlmutter, MD: “Grain Brain. The Surprising Truth About Wheat, Carbs, And Sugar-Your Brain’s Silent Killers.” Little, Brown and Company, New York, 2013.

Last modified: January 27, 2016

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.