Opinion: Dr.Ashok Hande
Are you at risk of brain stroke? 
Saturday, January 13, 2018

I recently had a young patient Madhavi (name changed), a graduate from a reputed business school . She had a stressful job with an MNC. She enjoyed hectic work schedule, the night shifts for a few initial days, but soon it started taking a toll on her health. She started forgetting assignments; and multiple mistakes in her work led to repeat scolding from the office superiors. She developed severe depression and mood swings. 

Her parents realised the gravity of the problem and asked her to quit the job. One day she experienced blurred vision and an unrelenting headache. It was followed by seizure and she became unconscious. She was rushed to a nearby hospital, where the doctors diagnosed her condition as brain haemorrhage due to high blood pressure.

My another patient, Sandeep (name changed),  too loved his job as a vice-president of an international bank. He was 55, risen to this post from a mere salesman. He was a contended family man, with two daughters studying abroad. He was a frequent traveller. He too enjoyed late night working and parties.

One day, his wife found him unconscious in the bathroom. He had a brain stroke and the cause was high blood pressure and obesity.

I have had many such patients in the past few years. Stroke is one of the leading causes of mortality and morbidity across the world. 

The National Stroke Association has created an easy acronym F A S T, which stands for F (facial asymmetry), A (arm weakness), S (speech difficulty) and T (time to call for an ambulance ). Other signs of a stroke include weakness on one side of the body, numbness of the face, unusual and severe headache, vision loss, numbness and tingling and unsteady walk

According to the WHO,  out of 56 million global deaths in 2012, 38 million or 68 % were due to non-communicable diseases (NCDs). The leading causes of NCD deaths were cardiovascular diseases (46% of all NCD deaths), which included an estimated 7.4 million due to coronary heart disease and 6.7 million due to brain stroke.

Between 1990–2013, an absolute number of disability-adjusted life years (DALYs) due to stroke have increased significantly. Unhealthy lifestyle contributes a lot to such a high incidence of brain stroke. Indian lifestyle with a carbohydrate-rich vegetarian diet and a sedentary lifestyle could be a contributing factor.

But brain stroke is preventable.

One must be aware of the symptoms of brain stroke. The National Stroke Association has created an easy acronym F A S T, which stands for F (facial asymmetry), A (arm weakness), S (speech difficulty) and T (time to call for an ambulance ). Other signs of a stroke include weakness on one side of the body, numbness of the face, unusual and severe headache, vision loss, numbness and tingling and unsteady walk. 

At times, symptoms of brain stroke go completely unnoticed (silent stroke); but many a time, it is overlooked and ignored. This results in delayed diagnosis and treatment. Patient must reach a stroke centre within three hours (golden period) of beginning of the symptoms. 

Engaging in healthy lifestyle habits could prevent nearly 80 per cent of first-time brain attacks in men. The five healthy habits include eating healthy, staying physically active, maintaining a healthy waist circumference, not smoking, and limiting your alcohol intake. Age makes people more susceptible to stroke. You can't reverse the years or change your family history, but there are many other stroke risk factors that can be controlled—provided you're aware of them. 
The tips to stave off brain stroke

Healthy diet: The foods you eat play a role in whether you gain too much weight and develop high cholesterol, both of which can increase your risk for brain stroke. This was revealed in an ongoing study on ‘Impact of nutrition on the outcome of stroke’ at Christian Medical College and Hospital. 

The study found that the people at high risk of stroke had high intake of either fat, or salt. 

A healthy diet must include whole grains, pulses, fruits and vegetables, foods low in saturated fats and cholesterol, and foods with moderate amounts of salt and sugar. 

Stay away from foods that are high in saturated fats — such as marbled cuts of beef, processed meats, and desserts like packaged cookies, cakes, and candies. The fat in these foods raises levels of bad cholesterol, which can lead to plaque in your arteries and cause blockage over time.

Adding a wide variety of seafood to one’s diet reduces chances of developing heart disease. 

Quit smoking: Smoking triggers a build-up of plaque in the arteries, and also increases the risk of blood clots in the arteries. These clots can block already narrowed arteries, leading to brain stroke. Quitting smoking always helps, no matter how long or how much you've smoked. Brain stroke risk associated with smoking begins to decrease soon after you quit, and for many people it continues to decrease over time.

Include physical activity: Inactive people are nearly twice as likely to develop stroke as those who are active. A lack of physical activity can worsen other  risk factors, such as high blood cholesterol and triglyceride levels, high blood pressure, diabetes and prediabetes, and overweight and obesity.  Children and teens should reduce TV time because it limits physical activity.  Even modest amounts of physical activity are good for the brain and heart. The American Heart Association (AHA) recommends that a person should be  physically active for at least 30 minutes each day. 

De-stress: Stress and anxiety may play a role in causing brain stroke. In many cases, highly stressful lifestyle is accompanied by alcoholism, smoking, inactivity, hypertension and diabetes. Stress raises the  blood pressure and the  risk of stroke. The most commonly reported trigger for a stroke is an emotionally upsetting event, especially one involving anger. In addition to exercise, a spiritual practice or meditation can help keep stress in check. A study presented at an AHA conference found that people with heart disease who meditated had nearly 50 percent less rates of stroke, heart attack, and death compared to those who didn’t meditate.

Manage your High Blood Pressure: High blood pressure is a huge factor, doubling or even quadrupling your stroke risk if it is not controlled. About one in three adults has high blood pressure, but many aren’t aware of it. Uncontrolled high blood pressure is one of the most deceptive risk factors for brain and heart  diseases because there aren’t any physical symptoms. Your goal should be to maintain a blood pressure of less than 135/85. This can be  achieved by  reducing the salt in your diet to no more than 1,500 milligrams a day (about half a teaspoon), eating 4 to 5 cups of fruits and vegetables every day, one serving of fish two to three times a week, and several daily servings of whole grains and low-fat dairy. 
Diabetes and Prediabetes: India has a huge population of diabetics.More than 65 percent of people with diabetes die of heart disease or stroke. Needless to say, strict control of blood sugar has its advantages.

Shed weight: The terms "overweight" and "obesity" refer to body weight that's greater than what is considered healthy for a certain height. More than two-thirds of adult population is overweight, and almost one-third is obese. 

Say no to alcohol: Alcohol contributes to a number of medical conditions that are risk factors for stroke like high blood pressure, diabetes, obesity, liver damage, dehydration and depression.

Manage high cholesterol: Low-density lipoprotein (LDL) is the "bad" cholesterol and high-density lipoprotein (HDL) is the "good" cholesterol. Too much bad cholesterol and not enough good cholesterol can result in plaque building up on the walls of the arteries. Over time, the arteries harden and become narrower, which can lead to heart attack or stroke. If diet and exercise aren’t enough to control your high cholesterol, your doctor can outline a plan that includes medication. Remember, like high blood pressure, high cholesterol doesn’t have symptoms.  A simple blood test will reveal your levels.


(The writer is neurosurgeon,Hiranandani Hospital, Vashi-a Fortis Network Hospital. Views expressed are personal)

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