stroke risk?

For those questions and discussions on the McDougall program that don’t seem to fit in any other forum.

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Re: stroke risk?

Postby FitTrey » Sat May 23, 2015 2:00 pm

This hypothesis seems to be about ischemic strokes because they say moderate alcohol consumption, low dose aspirin, green tea, and fish oil are practical measures to lower stroke risk, but I believe all of those increase the risk of hemorrhagic stroke.
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Re: stroke risk?

Postby Birdy » Sat May 23, 2015 2:50 pm

Arugula, yours is exactly the kind of response I was interested in and I appreciate you posting that information with links. It's reassuring information. Colonyofcells, thanks for your feedback too. Also, that's an interesting anecdote about Bill Harris, MD.

FitTrey, your point is correct that, "This hypothesis seems to be about ischemic strokes because they say moderate alcohol consumption, low dose aspirin, green tea, and fish oil are practical measures to lower stroke risk, but I believe all of those increase the risk of hemorrhagic stroke." It seems the key word is hypothesis. Arugula provided refernces with an analysis that addressed my original question. I'm going to take her (or his?) advice and not worry about it.

Jim, I appreciate your good intentions.
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Re: stroke risk?

Postby awest27 » Sat May 23, 2015 3:51 pm

You don't have to look any further than Dr. McDougall himself for stroke risk since he had a stroke at a very young age and managed to reverse his health and stay healthy since discovering this way of eating.
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Re: stroke risk?

Postby Birdy » Sat May 23, 2015 7:51 pm

Great point awest27 ! I think he suffered an ischemic stroke which is different from hemorrhagic, but it's still a "duh why didn't I think of that?"

Thanks!
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Re: stroke risk?

Postby dteresa » Sat May 23, 2015 8:03 pm

don't the Japanese have a high rate of hemorrhagic stroke? Traditional diets while high in vegetables and rice are also very very high in salt. And the Japanese are heavy smokers. And I too read that dr. Fuhrman says on a high fruit and vegie diet it is especially important to limit salt.

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Re: stroke risk?

Postby f1jim » Sat May 23, 2015 8:13 pm

They only have a high rate of hemmoragic stroke compared to their own history. Theirs is lower than ours. Also the Japanese diet is not vegan. It's more plant based than ours but certainly not vegan.
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While adopting this diet and lifestyle program I have reversed my heart disease, high cholesterol, hypertension, and lost 54 lbs. You can follow my story at https://www.drmcdougall.com/james-brown/
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Re: stroke risk?

Postby Steve » Sun May 24, 2015 6:07 am

I am not familiar with the different types of stroke. But I remember reading in the healthy heart McDougall book that when a thrombus occurs that if it is before the heart it is a Heart attack, but if it gets to the brain it's a stroke. So in this way preventing heart attacks and strokes are the same thing. The low fat vegan diet with as Dr Essy might shout, No Oil, is king. The type of stoke related to high blood pressure weakening the vessel walls over time should also respond favorably to the McDougall program as BP is less because the cholesterol plaques are not as engorged. Which brings me to the salt issue. I never was too concerned with salt until I turned 54 years old. I was doing McDougall but was ignoring advice regarding not buying tomatoes and beans with all the added salt . When I started the McDougall program my BP was in the 130s. Along with high cholesterol the BP dropped to very healthy levels in response to my duet change. Then all of a sudden when I was 54 my BP went from like 117/75 to the 120s then 130s then 140s to the 150s . I figured it was inevitable that I would join my omnivore twin brother in using BP meds. That maybe the McDougall program suggestions had forestalled the inevitable but not prevented it. While I was mulling this over I remotely viewed a McDougall advanced study weekend. Jeff Novick presented a talk that later became the DVD called "Should I Eat That". The DVD available on this website gave instructions of how to read labels on food and guidelines for fat, oil, salt and refined sugars. I thought maybe the salt guidelines would help with BP. Maybe I was no longer able to disregard the McDougall suggestion to buy only the no added salt tomatoes and beans. Well my 54 year old body responded and my BP returned to the teen aged levels. Also by following the recommendations I dropped 35 pounds within 3 months. So what I was following for BP got me to a very healthy weight too. I was confused that my weight dropped too. Then I noticed others posting similar results about the weight loss. So I PM'd Jeff Novick . Jeff explained that salt was the original flavor enhancer . Less salt less food. Jeff also shared that the person who filmed the advanced study weekend was thinner 6 months later at the next advanced weekend taping. The film guy also adopted the guidelines and also lost about 35 pounds. Now back to topic. I will soon be 60 tears old. Still do not need BP meds and when I behave with avoiding salt in foods still have youthful BP . Last week it was 118/78 in the doctors office. I ask the question if I had not tried to follow guidelines on sodium and allowed a BP of 150s/90 would I have been at a better risk of stroke? Kind of a silly question, but I probably would have been on BP meds these last five years .
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Re: stroke risk?

Postby Steve » Sun May 24, 2015 6:31 am

Birdy, I forgot to mention I am an old timer with the board too. I remember getting the newsletter by US mail and the old McDougall board that was only one forum. You had to read everything back then. And of course I remember my heroes F1Jim and ScatoBob and what I call the great Troll wars. Jim, thanks for taking care of all of us.

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Re: stroke risk?

Postby Birdy » Sun May 24, 2015 11:15 am

Steve,
Really great post and very helpful information you shared. I'm going to cut my salt intake way down. I'm 64 and have taken medication for high BP for 5 or 6 years. Even with that, exercise and eating well, my blood pressure has crept way up. Obviously too, with my family history I've become concerned about stroke.

I'll look at Jeff Novick's posts too. Yesterday I searched Michael Greger's Nutrition Facts.org and found a lot of info:
http://nutritionfacts.org/topics/stroke/

Jim and I communicated by email yesterday. I too thank him for the good work he does on this board.

Thanks again for your post!
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Re: stroke risk?

Postby patty » Sun May 24, 2015 11:36 am

Mahalo for the topic:)

I too am still learning about heart disease and from Birdy’s question I just did sort of a cross reference so I could sorta grasp the larger picture of the different strokes or stages of a stroke.

Birdy shared this link from Dr. Fuhrman’s site:

http://www.drfuhrman.com/library/article5.aspx:

What You Need to Know About Vegetarian or Vegan Diets

Following a strict vegetarian diet is not as important as eating a diet rich in fruits and vegetables.

Although a low-saturated-fat vegan diet may markedly reduce risk for coronary heart disease, diabetes, and many common cancers, the real Achilles heel of the low-fat vegan diet is the increased risk of hemorrhagic (vessel rupture leading to bleeding) stroke. Apparently the atherosclerotic (plaque building) process that creates a local vascular environment favorable to coronary thrombosis (clot) and intravascular embolism (traveling clot) may be protecting the fragile blood vessels in the brain from rupture under years of stress from high blood pressure. Admittedly, hemorrhagic stroke is a very small percentage of the deaths in modern countries. It still is worth noting that if strict vegetarians are to have the potential to maximize their lifespan, it is even more important they avoid a high salt intake because salt intake increases blood pressure. Almost all of the soy based meat analogues and many other health food store (vegan) products are exceptionally high in sodium.


This is from “The McDougall Program for a Healthy Heart”:

Infants whose mothers ate a high-fat and cholesterol-rich Western diet while pregnant have been shown to have foam cells and fatty streaks at birth. It is common for such fatty streaks to appear in children as young as eight months. The fatty streak will disappear and the artery will heal—even in adults—if the cholesterol level drops sufficiently. How- ever, if more and more cholesterol and fat are consumed, the process continues. The fatty streaks grow. Muscle cells that are part of the media section of the artery proliferate into the intima, and cause the fatty streak to become larger and thicker, thus becoming a full-blown atherosclerotic plaque. The body attempts to form a cap over the plaque with tough fi-• brous scar tissue, a process called fibrosis.

As the plaques grow larger, they cause the arteries to narrow, and thus reduce the blood supply to the heart, a condition called ischemia. Even- tually, the ischemia can progress to cause angina pectoris, literally a "strangling" pain in the center of the chest due to the diminished blood flow to the heart. If the ischemia becomes so advanced that one of the coronary arteries is entirely blocked, part of the heart muscle can die and one experiences a myocardial infarction, or a heart attack.

Exploring the Inner Landscape with the Mind's Eye

In order to visualize the conditions inside your arteries, let's imagine for a few moments that you could shrink yourself to the size of a cell, and that you could travel safely inside the walls of an artery. You would see an awe- inspiring world of living cells, proteins, nutrients, and bubbles of cholesterol and fat—all of which float in the living ocean that is your blood. You would see artery walls that were smooth and healthy, and others that were in various stages of atherosclerosis, caused by those very same balls of fat and cholesterol that you see floating through the bloodstream.

From your imaginary vantage inside the artery, you recognize this process as both destructive and disgusting. The courageous immune cells are literally killing themselves by consuming these bubbles of LDL. Not only that, but the beautiful artery wall—once a mosaic of per- fectly arranged tiles—has become contoured and bulbous, as if it were afflicted with horrible boils.

Image

Atherosclerosis develops over a lifetime, beginning in early childhood. Dam- age from the foods we eat and products of cigarette smoke injure the inside linings of the artery. The resulting sores are known as plaques. The disease generally progresses because the healing processes cannot catch up with the daily injury. Unstable plaques often rupture, causing the formation of a blood clot which partially or completely occludes an artery. Eventually, scar tissue will replace the thrombus, resulting in a fibrous plaque, which may also completely occlude the artery.

Heart Attacks: The True Story

As I mentioned earlier, there are many misconceptions about heart dis- ease, but one of the most widespread is the notion that most heart attacks occur when a cholesterol plaque grows so large that it blocks off an artery entirely. It's true that sometimes a plaque can become large enough to block off a vessel, and thus cause a heart attack, but most heart attacks are not caused this way. Moreover, this belief is actually dangerous be- cause it lulls people into a false sense of security. Those who think that arteries are closed by a slow-growing plaque often comfort themselves by saying, `T ye got time to change my diet because my arteries must be at least partially open so that blood can get to my heart." What these people don't realize is that almost all heart attacks occur in people whose arteries are significantly open. The fact is that small plaques cause the most deadly heart attacks and strokes.

The atherosclerotic lesions contain cholesterol and fat that collect in pools and make the plaque highly unstable. These unstable plaques can— and often do—burst open, or rupture, thus forming an open wound within the artery wall. Blood platelets and clotting proteins rush to the wound and form a blood clot—called a thrombus—over the open plaque. That clot can enlarge instantaneously, becoming so big that it causes blood flow to the heart or brain to be completely shut off The result . is a heart attack or a stroke. Ninety-five percent of heart attacks are caused by this process, called coronary thrombosis. Ironically, thrombosis .occurs most often in the smaller plaques, those that are not, by themselves, large enough to block the artery entirely or cause any symptoms.

Image

Atherosclerotic plaques are filled with semiliquid, fatty, and necrotic mater- ial. An unstable plaque can develop a tear (fissure) in the surface, allowing the contents to rupture into the flowing blood. This rupture acts as a catalyst for the blood to clot, forming a thrombus that partially or completely oc- cludes the artery, causing a heart attack or a stroke. The highest risk of rup- ture is with tiny fat-filled plaques. Small, but lethal, plaques usually cause no symptoms, thus offering no warning of the impending disaster.

Thus, the key events that lead to a heart attack are:
• The presence of high total cholesterol and LDL cholesterol in the blood 

• The initial injury to the lining of the artery wall 

• The formation of unstable, cholesterol-filled, fat-filled plaques 

• The rupture of the plaque 

• The formation of a clot over the open plaque 

• The clot closing off blood flow to the heart or brain, causing a 
heart attack or stroke

Developing Backup Circulation

Sometimes people have stable plaques that gradually grow large enough to close off an artery, but they do not damage the heart muscle because there has been adequate time for backup circulation to grow to that area of the heart muscle, thus taking over the circulation that was lost when the original vessel closed. Arteries can be 100 percent closed, yet the presence of these backup arteries—called collateral circulation, or simply collaterals—provides enough blood and oxygen to sustain the life of the muscle.
Whether or not a plaque forms in the first place, and creates a throm- bus in the second, depends to a great extent on a person's diet. The most important factors are what you eat, the level of cholesterol in your blood, whether or not you smoke, and whether or not you have indica- tions of heart disease such as angina pectoris (chest pain). As we will see in the next chapter, fat—especially saturated fat derived from animal. foods—accelerates the creation of these clots, or thrombi.

A Disease of All Ages

As I said in Chapter 1, this is not a disease of old people. Rather, it be- gins very early in life, usually in infancy. That's why the National Heart Lung and Blood Institute (NHLBI) now recommends that all children two years of age and older adopt a diet low in fat and cholesterol.

Anyone who suffers a heart attack or stroke and winds up in the hospital is urged to adopt the diet of the American Heart Association (AHA), which is lower in fat and cholesterol than the typical American diet. Unfor- tunately, as we will see later on, the AMA's diet is still too high in fat and cholesterol to protect you against the disease. If you have already suffered a heart attack or stroke, that diet may insure that you suffer another one.

As grotesque and lethal as atherosclerosis is, it is nevertheless re- versible. If followed properly, the McDougall Program for a Healthy Heart can cure heart and artery disease at its source.


Dr. Esselstyn “Prevent and Reverse Heart Disease”

Most of America’s health dollars are spent on the late stages of heart disease, strokes, hypertension, diabetes, and the common Western cancers of the breast, the prostate, and the colon. Like heart disease itself, these others are part of the bitter harvest of the toxic American diet. And like traditional treatments for heart disease, their treatment is not preventive. Having your breast cancer amputated, your malignant prostate gland radically removed, or your cancerous colon resected is painful, disfiguring, and costly—and too often does not resolve the underlying problem.

My own research has concentrated on coronary artery disease, and how plant-based nutrition can prevent and also arrest and reverse it. But with every year that passes, there is more proof that a plant-based diet has similar salutary effects on other chronic diseases, as well. Take stroke, for example—the third leading cause of death in the United States. The evidence is overwhelming that if you eat to save yourself from heart disease, you eat to save yourself from stroke.

There are two types of stroke. In hemorrhagic stroke, the less common of the two, a blood vessel in the brain ruptures because of high blood pressure or a genetic weakness of the vessel wall known as an aneurysm. A plant-based diet cannot do anything to cure a genetic aneurysm. But it will definitely help reduce blood pressure, an important step in the right direction.

On the more common variety of stroke—ischemic or embolic stroke—there is even better news. These have the same origin as coronary artery disease. An ischemic stroke occurs when fat and cholesterol block blood vessels that carry oxygen and nutrients to the brain, just as they may block the coronary arteries that nourish the heart. An embolic stroke also deprives the brain of nutrients and oxygen, but in a slightly different way. When an artery sheds part of its diseased inner lining, that debris—called an embolus—is carried through the bloodstream until it gets wedged into a blood vessel that is too small for it to traverse. Now it blocks the flow of blood through that vessel. This may happen almost anywhere in the body, blocking blood flow to a kidney, an intestine, a leg, or some other organ. When it occurs in vessels that nourish the brain, it is a stroke.

In the 1990s, Pierre Aramenco, a physician from Paris, studied this process in Frenchmen who were at risk for vascular disease.2 Using ultrasound probes inserted through the esophagus, Dr. Aramenco measured the thickness of atherosclerotic debris growing on the inside of each patient’s ascending aorta, the giant artery that climbs directly from the heart and sends branches to the brain. He divided the men into three groups. One group showed 1 millimeter of debris on the lining of the aortic wall. The second had debris measuring between 1 and 3.9 millimeters thick. The third had more than 3.9 millimeters of debris. Dr. Aramenco followed the patients for three years. Not surprisingly, the group with the greatest amount of plaque growth shed the greatest number of emboli, and had the most strokes (see Figure 17 in insert).

Image

Figure 17Large arching vessel, or aorta, from the heart may fill with plaque debris, which in flaking off may travel, or embolize, to the brain, causing large or small strokes.

The buildup of fatty plaques in blood vessels can cause damage in many different ways. For example, when an aorta that contains plaque is clamped during coronary bypass surgery, plaque debris is loosened and enters the bloodstream as an embolus. Using ultrasound to monitor the middle cerebral artery in the brain, technicians can distinctly hear the embolizing plaque as it enters the brain. If the patient dies during surgery, the plaque debris may be found in the brain at autopsy.

This tragic sequence helps explain the fearful loss of cognition in coronary artery bypass patients.3 But neuroradiologists also report that using magnetic resonance imaging, they can detect little white spots in the brains of Americans starting at about age fifty. These spots represent small, asymptomatic strokes (see Figures 8 and 19 in insert). The brain has so much reserve capacity that at first these tiny strokes cause no trouble. But, if they continue, they begin to cause memory loss and, ultimately, crippling dementia. In fact, one recently reported study found that the presence of these “silent brain infarcts” more than doubles the risk of dementia.4

We now believe, in fact, that at least half of all senile mental impairment is caused by vascular injury to the brain. Not long ago, a Swedish study of five hundred eighty-five-year-olds found that fully one-third of them showed some form of dementia. A careful analysis revealed that in half of those with dementia, their mental impairment was due to a diseased arterial blood supply to the brain.5 Similarly, a study in the Netherlands focused on five thousand people between the ages of fifty-five and ninety-four.6 The researchers studied the circulation in the brains of all their subjects, then asked them to perform various written tests of mental acuity. The results were quite clear: those suffering from artery disease and thus impaired circulation in the brain performed less well on the tests than did those whose arteries were clean. Age made no difference. Arterial health was the variable that counted.

This should come as no surprise. Clogged arteries serving the brain and clogged arteries serving the heart are part and parcel of the same disease. The cause is the same: a buildup of fat and cholesterol and lethal damage to the delicate endothelial lining of the blood vessels. And the cure is the same, as well: adopting a healthful new way of eating that includes not a single ingredient known to damage vascular health.

Just as you are not doomed to heart disease as you grow older, you also are not doomed to mental deterioration. Most cases of stroke and dementia, like heart disease, need never occur. Your aorta, along with all your other arteries, can be as clean at ninety years of age as they were when you were nine.

Esselstyn Jr. M.D., Caldwell B. (2008-01-31). Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure (p. 98). Penguin Group. Kindle Edition.


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