Tag Archive for: stroke

Bottoms Up!

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As we approach the holiday season, do we have to skip the fruit juice punch or the pumpkin spice lattes? How about eggnog? Let’s take a look at the study on the risks of various drinks, and determine the relevance and the practical risk of what you drink.

Does What You Drink Really Matter?

Here are some of the issues I found with the study.

The data used a food frequency questionnaire as well as additional surveys to collect all the data. I’ve talked enough about the problems with the food frequency questionnaire, and the INTERSTROKE Study didn’t use any better techniques.

In prior papers from the INTERSTROKE study, the researchers identified 10 risk factors that accounted for 90.7% of the Population Attributable Risk (PAR) worldwide for a first-time stroke. The PAR together with the percentage contribution of each factor is as follows:

  • Prior history of hypertension or blood pressure of 140/90 or higher: 47.9%
  • Lack of regular physical activity: 35.8%
  • Apolipoprotein (ApoB) to ApoA1 ratio: 26.8%
  • Diet assessed by the modified Alternative Healthy Eating Index: 23.2%
  • Waist-to-hip ratio: 18.6%
  • Psychosocial factors: 17.4%
  • Current smoking: 12.4%
  • Cardiac causes: 9.1%
  • Alcohol consumption: 5.8%
  • Diabetes mellitus: 3.9%

What a person drinks would be a small contributor to the diet assessment. It’s legitimate, but there are bigger issues in my opinion.

Finally, looking at the actual risk of stroke in the U.S. and Canada, it’s 0.9% if you’re 18–44 years old, it’s 3.8% at 45–64 yrs, and it’s 7.8% if you’re over 65. That’s the risk without modifying any risk factors in the PAR. What a person drinks would be a very small contributor to that risk. I think working on BP and exercise first makes a lot more sense.

The Bottom Line

Does what you drink matter? Unless you overconsume alcohol, probably not. Could you help yourself out? Yes. Drink seven or more cups of water per day—that’s just 60 ounces—and enjoy a cup or two of any type of tea per day; if you like iced tea, try Paula’s recipe on our website. And if all you’ve ever had is black tea, you need to branch out and try some more exotic varieties. Both water and tea lowered the odds ratio of a first stroke.

Other than that, try to strike a balance with what you drink. Spend more time getting your BP under control, and one of the ways to do that is to exercise. This is as good a time as any to begin. I know you can do it.

What are you prepared to do today?

        Dr. Chet

References:
1. International Journal of Stroke 2024, Vol. 19(9) 1053–1063.
2. Journal of Stroke 2024;26(3):391-402.
3. Lancet 2016 Aug 20;388(10046):761-75.
4. MMWR. May 23, 2024. 73(20);449–455.

What Am I Supposed to Drink?

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Why would someone ask that question? It was in response to a health news report on a couple of studies that suggested that if you drink too much fruit juice, any soda at all, or five or more cups of coffee, you’ll have an increased risk of a first stroke. Let’s take a look at the studies to see if we should change any of our drinking habits.

Based on the methodology, cases of first stroke were recruited from 142 centers in 32 countries between March 2007 and July 2015; at the same time, they recruited matched controls who did not have a stroke. They ended up with 13,462 subjects with stroke and 13,488 controls that did not have strokes. The mean age was close to 62 +/- 13 years. Besides biometric data including neural imaging, the researchers used a variety of surveys including food frequency questionnaires to determine all fluid intake.

After accounting for 15 potential factors that might skew the data, researchers calculated the odds ratios for water, soda, fruit juice, coffee, and tea intake. Teas of all types reduced the odds ratio for stroke, as did drinking seven or more cups of water per day. Any soda, fruit juice, or five or more cups of coffee per day raised the odds ratio, almost doubling the risk of a first stroke.

Should we be concerned? Let’s take a closer look at what this study really means on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. International Journal of Stroke 2024, Vol. 19(9) 1053–1063.
2. Journal of Stroke 2024;26(3):391-402.

BE FAST for Stroke

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So what did the Society of NeuroInterventional Surgery (actual brain surgeons) add to the mix? They added the acronym BE, which then makes the entire acronym BE FAST.

What do the new letters stand for?

B: loss of balance. I didn’t see any details about how to test that. It may be self-evident that someone cannot stand upright without tilting to one side or the other. Or it may be the while holding their arms to test their arm strength, they can be moved side to side to see how they respond.

E: loss of eyesight in one eye or blurry vision.

I think adding balance and eyesight are a good idea for the lay public. A physician or other healthcare professional may know to look for balance and eyesight symptoms, but it may not be as obvious to you and me. Here’s the whole list:

BE FAST

B: loss of balance

E: loss of or blurry eyesight

F: face drooping

A: arm weakness

S: speech difficulty

T: time to call 911

Commit those to memory and if you feel that you or someone you care about might be having a stroke, assess those symptoms and most important, take action immediately if necessary. I can’t stress that enough because the sooner treatment begins, the less function a person loses.

Enjoy your holiday weekend, and safe travels if you’re hitting the road. We’ll be back next week.

What are you prepared to do today?

        Dr. Chet

Reference: https://getaheadofstroke.org/call911/

Suspect a Stroke? Act FAST

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The other day, for no particular reason at all, I got really dizzy for a moment. I wasn’t spinning in circles or doing anything else that might have caused it, so I did what I always do: I acted FAST and looked for signs and symptoms of a stroke. The American Heart Association (AHA) has taught that acronym for years, but recently a group of neurosurgeons added more to it. Today, we review the original acronym FAST. What does it mean?

F: face drooping. Does one side of your face seem to be pulled down? If you smile—a really, really big smile—are you smiling equally on both sides of your face?

A: arm weakness. Typically, you would stand with your arms raised out to the side and parallel to the ground. You can check to see if one arm does not quite make it to parallel with the ground or if it drifts back down. I also grabbed a stick and squeezed as hard as I could.

S: speech difficulty. Try repeating a simple phrase to see if you can remember it and if it sounds clear. For some reason I chose the old “How much wood could a woodchuck chuck…” Not the easiest thing to try to repeat a couple of times, but I did.

T: time to call 911. Do you call if you just have one sign or symptom? Yes! Do you still call if these symptoms seem to resolve themselves shortly? Yes! I didn’t have any symptoms, but I still told Paula. I was going to do a song and dance, but I never could in the first place, so it wouldn’t have gone well.

The reason time is so important is that with today’s medical technology, the sooner treatment begins, the better the outcome to regain all functions. AHA says, “stroke patients who are treated with the clot-busting drug IV r-tPA Alteplase within 90 minutes of their first symptoms were almost three times more likely to recover with little or no disability.”

What did the brain surgeons want to add? I’ll tell you on Thursday. It’s Memorial Day weekend and you may need the information if you’re attending any gatherings.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.stroke.org/en/about-the-american-stroke-association/stroke-awareness-month

Taking Biotin? Tell Your Doctor

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Biotin is a B vitamin often used for skin health among other benefits; it’s involved in many metabolic processes in the body. Due to its chemical nature, it’s used as a coenzyme in several tests. One of those tests is for troponin, a protein released from the heart into the bloodstream during a heart attack. There are no large trials that have tested the effects of biotin on troponin testing, but a physician or lab tech needs to know if you’re taking extra biotin.

The amounts in multi-vitamins appear to cause no issues, but adding the biotin in products to improve hair, skin, and nails could be enough to impact the test. Did it in our subject’s case? Maybe. We don’t know for sure.

As we approach this long holiday weekend, take a minute to add up all the biotin you’re taking in supplements. If it’s more than one gram, and if you end up in the ER because of a suspected heart attack or stroke, tell the lab tech. It doesn’t impact your having a heart attack; it impacts the test as to whether you may have damage to your heart as a result of a heart attack. You don’t want that test to be inaccurate because it’s important to arriving at the correct diagnosis.

Enjoy the July Fourth holiday, check out the audios on sale for men and women, and I’ll be back next week.

What are you prepared to do today?

        Dr. Chet

Still in Doubt? Check It Out Again

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In the last Memo, I said we weren’t done with the person who had waited three days. We spoke again after a couple of days, and she still had the same pain profile: back and chest, not as intense. She’d had a heart catheterization that came back clear: no blockages in any of her coronary arteries. Still the discomfort bothered her.

I’ve talked to many people over the years who were going through the same thing. I always recommend they go to the ER immediately. She had done that, albeit a couple of days later, and the diagnosis was indeterminate. She did have extremely high blood pressure which had come down with treatment in the hospital, but like most people, she disliked some of the side effects and didn’t want to take the meds. As we talked, she mentioned that she also had dizziness going up a flight of stairs and her vision was blurry. That was it—that’s a symptom of a stroke, so I recommended she go back to the ER if someone was there to drive her.

They ran more tests including and MRI of her head. No blockages or evidence of a stroke; her blood pressure was still way too high, but that could be managed at home. Still there was a diagnosis of a heart attack based on enzyme levels even though the ECG didn’t show it. She is working on lifestyle changes to get off blood pressure medications if possible.

But the enzyme level triggered something in my memory, and I’ll tell you about that on Thursday. Make sure you read it before the holiday weekend begins. Remember, the audios Dr. Chet’s Health Tips for Women with Dr. Pam and Health Tips for Men are still on sale through the Fourth of July.

What are you prepared to do today?

        Dr. Chet

Three Freaking Days!

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When it comes to health, my experience has shown that women tend to take a little better care of their health than men do. I checked back to when I began to use the phrases, “Never, never, ever, ignore chest pain” and “When in doubt, check it out!” It was about 20 years ago. And yet I’m still surprised when people don’t do it.

In fact, it happened within the past two weeks. A reader called me about some health issues. She wasn’t a stranger; we had talked before about her issues. This time it was an inquiry about discomfort in the chest and back—not really pain, but not nothing either. Doing some yoga and deep breathing seemed to help. I always tell people that the safest, most conservative approach is to go check it out at the emergency room. That’s the only way you know for sure. We left it at that.

Finally, a couple of days later, the discomfort got worse and moved toward her left arm. She finally went to the ER—three freaking days after the symptoms began. At least she didn’t wait ten days like my friend Jim.

I understand the hesitation; I’ve faced it myself. No one wants to seem alarmist or silly, and not everyone has health insurance to cover the costs. Still it’s better to be alive with a hospital bill than with a damaged heart or worse for delaying.

The Bottom Line

Let me be very clear about this: when it comes to your heart or your head, when in doubt, check it out. Delaying may make things worse.

Or the problem may turn out to be nothing. You thought we were done with this person? Nope, but I’ll save it for next week.

Women’s hearts are different and the symptoms related to heart disease may be different. This may be a great time to pick up Dr. Chet’s Health Tips for Women with Dr. Pam. As an incentive, I’m lowering the price on the MP3s to $4.95 for Health Tips for Men and Health Tips for Women through the Fourth of July.

What are you prepared to do today?

        Dr. Chet

When In Doubt, Check It Out

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Father’s Day reminded me of some of the wonderful men I’ve known who’ve passed on. The one I miss the most is my best friend Jim even though he’s been gone over 20 years. I can’t help but believe he might still be with us if had done just one thing: check it out.

Jim started having chest pain at Thanksgiving Dinner; he told his wife that he was just tired and stressed from the holidays. He actually went to work on the following Monday, but as the week went on, he felt worse and worse. He was having a heart attack for nine days! By the time his family insisted on calling an ambulance on the following Saturday, it was too late. He died in the ER.

When in doubt, check it out. That’s where the phrase came from, although the symptoms in Jim’s case were clear. It doesn’t apply only to chest pain or other symptoms of a heart attack. If you have blurry vision, a sudden headache, or your face is drooping, that could be a sign of a stroke. Even if the symptoms subside, you have to get them checked out. Better a trip in an ambulance than a hearse.

Jim left behind a family. His wife, three kids, and grandkids needed him desperately at times over the following years; I needed him, too. I want you to be safe and healthy, not the gaping hole left in the family photo. So when in doubt, check it out.

If you haven’t heard my Health Tips for Men, now might be a good time to purchase a copy. There’s more to Jim’s story and nine other health issues that impact men. But what about women? I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

Aspirin and Unintended Consequences

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We began the week considering a type of shortcut to health called biohacking. The polypill was a biohack to reduce the risk of CVD events, but there’s no research showing whether the polypill will ever prove to be effective. However, the results of the ASPREE trial may give us an idea whether the long-term trials should ever be attempted (1-3). Let’s take a look at the results of the ASPREE trial and the effects of an aspirin a day on healthy older adults.

In the first paper, the researchers evaluated the data to see if those who took the aspirin had less disability (1). In other words, did taking the aspirin convey benefits that reduced the risk of death, disability, or dementia? The data showed no differences between the aspirin and placebo group as it related to those outcomes.

In the second paper, the researchers examined the differences in all-cause mortality (2). What surprised the researchers was a slight increase in death from cancers in the group that took the aspirin; no specific type of cancer seemed to be impacted. Because aspirin has been shown to be beneficial in almost all other studies of cancer and mortality, the researchers said the results should be taken with a degree of caution.

In the final paper, researchers examined whether aspirin reduced the rate of CVD events and stroke (3) and found no difference, but the risk of hemorrhagic stroke was significantly higher in the aspirin group versus the placebo. This was the primary reason the study was terminated after five years.
 

The Problem

There were several problems with the study including the low adherence in both the aspirin and placebo group: if people didn’t take the pills, obviously that impacts the results. But the biggest question I have is a very simple one: who thought it was a good idea to give healthy people a medication every single day? Taking an aspirin for a headache or muscle ache is one thing. Taking it when you don’t need it is another.

The study demonstrated the logical fallacy of the polypill. “People won’t take care of themselves, so let’s put everyone on the medications that can reduce the risk of CVD.” No, let’s not. The results were unintended consequences that put the entire idea of biohacking into question.
 

The Bottom Line

When it comes to health, there are no real shortcuts. Biohacking, while a cute contemporary term, is fool’s gold. Yes, you can use your time and resources more efficiently to improve your health, but there are no shortcuts.

There is also one other obvious conclusion. Healthy people shouldn’t take medication. I take an 81 mg aspirin every day because I have had a stent and my doctor told me to. But I don’t take a statin any more because I changed my diet and lifestyle to keep my cholesterol normal. I control my blood pressure with diet and exercise. I don’t take medications I don’t need.

If you’re willing to do all you can to avoid medications and you still need medication to help you out, do it. But don’t take them to avoid doing the work. There are unintended consequences of taking the easy way out.

What are you prepared to do today?

Dr. Chet

 

References:
1. DOI: 10.1056/NEJMoa1800722.
2. DOI: 10.1056/NEJMoa1803955.
3. DOI: 10.1056/NEJMoa1805819.

 

The Mediterranean Diet and Stroke Risk

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As American Heart Month continues, let’s take a look at a recently published study on the Mediterranean diet and stroke (1); this study fits in nicely with Go Red campaign as well because it contained over 130,000 women educators who are part of the California Teachers Study. The study has followed these women since 1995, and over 300 articles have been published from data collected in this study.

Before I get into the nuts and bolts of the study, I want to make sure you understand what a stroke is: an interruption in blood flow to the area . . .

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