Natural treatments for strokes

DEFINITION: Treatment of cell death in the brain caused by a sudden loss of blood supply.

PRINCIPAL PROPOSED NATURAL TREATMENTS:

•For prevention: Policosanol, all herbs and supplements used for high cholesterol, high blood pressure, or atherosclerosis

•For treatment: Glycine, vinpocetine

OTHER PROPOSED NATURAL TREATMENTS: Acupuncture, aromatherapy, bilberry, beta-carotene, feverfew, fish oil, folate, garlic, ginger, ginkgo, music therapy, quercetin, vitamin E, white willow

HERBS AND SUPPLEMENTS TO USE ONLY WITH CAUTION: Ephedra, iron

OTHER NATURAL TREATMENT TO AVOID: Chelation therapy

Introduction

Strokes occur when part of the brain suddenly loses its blood supply and dies. The underlying cause is generally atherosclerosis, a condition in which the walls of blood vessels become thickened and irregular. As atherosclerosis progresses, blood flow through important arteries becomes restricted to a much smaller passage than is normal. This narrow passage can then suddenly become blocked, often by a blood clot. When this happens, brain cells downstream of the blockage are suddenly deprived of oxygen (cerebral ischemia). Brain cells require a constant supply of oxygen to survive. Within seconds, they begin to malfunction, and within minutes, they die.

In transient ischemic attacks (TIAs), the blockage to blood flow is temporary, and symptoms rapidly disappear. However, in a true stroke, called a cerebral vascular accident (CVA), the blockage lasts long enough to cause cell death in a significant section of the brain. Less commonly, strokes are caused by bleeding into the brain, which is known as a hemorrhagic stroke.

The symptoms of a stroke depend on the area of the brain affected. Paralysis of one limb or one side of the face is common. Loss of speech or sensation may also occur. Much of the loss that occurs in a stroke is permanent, but some recovery usually does eventually occur. There are two main causes of this recovery. The first involves the body’s ability to grow new blood vessels. Nerve cells on the margins of the dead area may cling to survival, functioning imperfectly on whatever oxygen drifts to them. Eventually, new blood vessel growth enables the nerve cells to recover perfectly.

The second cause of recovery involves the brain’s remarkable ability to adapt to difficult circumstances: To a lesser or greater extent, surviving parts of the brain can take over tasks once performed by brain cells that have died.

Conventional treatment for a stroke has several phases, but the most important is prevention. Stopping smoking, losing weight, reducing cholesterol levels, and controlling blood pressure prevent atherosclerosis and reduce the risk of stroke. Also, physicians may recommend the use of blood-thinning drugs, such as aspirin, to prevent the blood clots that so frequently are the final step to a stroke. Furthermore, if there is evidence that the main blood vessels leading to the brain are seriously narrowed, surgery or angioplasty may be considered to widen those vessels.

Treatment of a recent stroke involves maintaining life during the immediate recovery period and limiting the spread of brain damage (if possible). Finally, physical and occupational therapists help stroke survivors adapt.

Principal Proposed Natural Treatments

There are several alternative options that may be useful for preventing or even possibly treating strokes. The best documented are those that fight atherosclerosis.

Stroke prevention. Meaningful evidence indicates that numerous herbs and supplements are helpful for improving the cholesterol profile, which in turn should decrease atherosclerosis and help prevent strokes. Weaker evidence supports the use of other herbs and supplements for lowering blood pressure or for treating atherosclerosis in general.

Policosanol. Various herbs and supplements with blood-thinning properties have been suggested for use instead of or with aspirin to prevent blood clots. The best evidence regards the supplement policosanol.

Several double-blind, placebo-controlled trials indicate policosanol significantly reduces the blood’s tendency to clot. In one such study of forty-three people, the use of policosanol at 20 milligrams (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, this supplement appears to reduce cholesterol levels, making it potentially an all-around stroke-preventing treatment. However, while the long-term use of aspirin has been shown to reduce stroke risk, no equivalent studies of policosanol have been done. In addition, combined treatment with policosanol and aspirin (or related drugs) could conceivably thin the blood too much, resulting in dangerous bleeding events.

Stroke treatment. Cells at the margin of a stroke may cling to life until new blood vessels form to supply them with full circulation. Certain herbs and supplements might facilitate this by increasing blood flow or, alternatively, by reducing brain-cell oxygen requirements. Although the evidence remains preliminary, two supplements have shown some promise for this purpose: vinpocetine and glycine.

Vinpocetine. In a single-blind, placebo-controlled trial, thirty people who had just experienced a stroke received either a placebo or vinpocetine with conventional treatment for thirty days. Three months later, evaluation showed that participants in the vinpocetine group were significantly less disabled.

A few other studies, some of poor design, also provide suggestive evidence that vinpocetine may be helpful for strokes. However, this body of evidence remains far from conclusive. A review combining two relatively high-quality studies involving sixty-three persons could not determine whether or not vinpocetine provided any benefit for persons who had a stroke. Also, there are concerns that vinpocetine could interact harmfully with standard drugs used to thin the blood.

Glycine. The supplement glycine has also been proposed as a treatment for limiting permanent stroke damage. However, the supporting evidence is largely limited to one moderate-sized Russian trial. In this double-blind, placebo-controlled study, two hundred people received glycine within six hours of an acute stroke. The results indicate that the use of glycine at one gram daily for five days led to less long-term disability than the placebo treatment.

However, paradoxically, there are potential concerns that high-dose glycine could increase harm caused by strokes, and drugs that block glycine have been investigated as treatments to limit stroke damage. The authors of the Russian study on strokes argued that the overall effect of supplemental glycine is protective; nonetheless, until this controversy is settled, one should not take glycine following a stroke except on a physician’s advice.

Other Proposed Natural Treatments

Evidence suggests that high consumption of fish or fish oil reduces stroke incidence. This is believed to occur as a result of several effects, including impairment of blood clots, improvement of cholesterol profile, and other unidentified means.

Many other herbs and supplements may also reduce the blood’s tendency to clot and, thereby, help prevent strokes. These herbs and supplements include bilberry, feverfew, garlic, ginger, ginkgo, quercetin, vitamin E, and white willow. However, the supporting evidence for these supplements remains weak at best, and the mere fact that they thin the blood does not prove that they will reduce stroke risk. For example, while vitamin E is known to reduce blood clotting and is also a strong antioxidant, several large studies have failed to find vitamin E helpful for stroke prevention.

Similarly, the herb white willow has been advocated as a substitute for aspirin because it contains salicin, a substance very much like aspirin. However, willow, taken in usual doses, does not appear to impair blood coagulation to the same extent as aspirin, and for that reason, it is probably not equally effective. The supplement folate has shown some promise for preventing strokes. Also, besides vitamin E, other antioxidants, such as beta-carotene, have been proposed for stroke prevention, but there is no evidence that they are effective.

Acupuncture is widely used in China for enhancing recovery from strokes. However, while some studies have suggested benefits, many well-designed, large studies have not been promising. For example, in a single-blind, placebo-controlled trial of 104 people who experienced recent strokes, ten weeks of twice-weekly acupuncture did not prove more effective than fake acupuncture. Similarly negative results were seen in a single-blind, controlled study of 150 people recovering from stroke, which compared acupuncture (including electro-acupuncture), high-intensity muscle stimulation, and sham treatment. All participants received twenty treatments in ten weeks, with neither treatment proving beneficial. Additionally, a ten-week study of 106 people that provided thirty-five traditional acupuncture sessions to each participant failed to find benefit. Finally, ninety-two persons who randomly received either twelve acupuncture treatments or comparable sham treatments for four weeks demonstrated the same level of improvement up to one year later.

The studies reporting improvements from acupuncture were small, and some did not use a placebo group. In a review of fifty-six trials (mostly written in Chinese), researchers found that 80 percent showed positive results. However, these studies' small size and variable quality make their results unreliable. In one study, acupressure combined with lavender, rosemary, and peppermint aromatherapy was more effective than acupressure alone for treating shoulder pain caused by hemiplegic strokes. However, this study lacked a proper placebo group. A review of nine trials found limited evidence supporting moxibustion (the application of heat to acupuncture points) in addition to standard care for stroke rehabilitation.

In some twenty-first-century studies, results were relatively positive. In one study, 128 adults with partial paralysis following a stroke experienced some improvement in motor skills and fewer muscle spasms. Another study found positive results for improving language skills, including understanding speech, communicating needs, and fewer instances of spontaneous speech.

In a 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 (that is, books on tape). Music listeners were also less depressed and confused than subjects who listened neither to music nor to language.

Herbs and Supplements to Use with Caution

If one is at risk for a stroke, it might be advisable to avoid excessive intake of iron. Some evidence suggests that high iron levels may increase stroke risk and worsen strokes that do occur.

People susceptible to stroke should exercise great caution regarding the herb ephedra. Ephedra contains ephedrine, a drug that raises blood pressure and stimulates the heart, and it has caused heart attacks and strokes. Certain preparations of ephedra may present an additional risk beyond ephedrine’s effects on the circulatory system: direct toxicity to nerves.

Finally, numerous herbs and supplements may interact adversely with drugs used to prevent or treat strokes, so individuals should be cautious when considering the use of herbs and supplements. For example, feverfew, garlic ginger, ginko, dong quai, evening primrose, and ginseng have blood-thinning effects. Following a stroke, individuals are usually prescribed blood thinners. Taking a supplement that also causes the blood to be thin may amplify the desired effect to a dangerous degree.

Bibliography

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