THE SURGE OF THROMBOTIC STROKE

I had a stroke on October 10 2013. The experience cannot be wished anyone no matter how evil that one is. When I was in the hospital following the stroke, I made an interesting observation from my cubicle at the Accident and Emergency Unit, which was situated at the end of the block and had a window overlooking the last entrance to the hospital, Mother of Christ Specialist Hospital Enugu. I could see the entry-park and arrivals.  I frequently saw middle-aged prosperous-looking people, often alighting from flashy, glitzy, swanky cars, limping out or being carried out. They were recovering from stroke or have just had stroke. I beheld an extrapolation to a much larger scale, of the observation I had hitherto made in my own small practice and from the general population: stroke is no more a rare occurrence, has been increasing in geometric progression, mostly afflicting an age group younger than previously, a group with certain lifestyles that are related to the nature of their jobs, dietary patterns and stress levels.

A stroke occurs if the blood supply to part of the brain is interrupted or severely reduced, depriving brain tissue of oxygen and other nutrients. Within minutes, brain cells begin to die. Strokes are called either “Haemorrhagic Stroke” when caused by rupture of a brain artery, due mainly to hypertension, or “Ischaemic Stroke” when brain artery is blocked. Ischaemic type is called “Embolic Stroke” when a blood clot (or other embolus) from elsewhere causes the blockage in the brain artery; and when the blockage is caused by a local clot-forming process in the brain artery it is called a “Thrombotic Stroke”.

Honestly, it was and still is like a dream. And I really was extremely surprised because I never thought I could ever be a candidate for stroke since I have never had hypertension (I still don’t have it) and I have always been on typical Nigerian diet regimes. I now know better, however.

I was even an unbeliever; and I preached that the current Cholesterol Scare in Nigeria was unnecessary, to say the least. I wondered why our people were so easily indoctrinated by the Diaspora guys who were living with Americans and Europeans that were suffering from malnutrition. I spoke from facts because ALL the numerous cholesterol results people brought to me were basically normal: no single significantly high cholesterol level and only about 0.01% were around the threshold – like my own. I believed we had normal diets and they had malnutrition from too much consumption of animal products, and were suffering the cardiovascular consequences. I was actually right.

I, however, also spoke from ignorance of the facts of the most current trends in Medical Research and how the Medical Community is now focusing great energy on cholesterol and targeting a particular type of cholesterol causing the current great surge of this type of stroke worldwide. The target now is on LDL type of cholesterol, the sole culprit.

Cholesterol is produced naturally by all animal cells especially in the liver. Cholesterol is essential for animal life. It is required to build and maintain cell membranes and it protects the nerves. Within cells, cholesterol is the precursor molecule in several biochemical pathways particularly for the synthesis of vitamin D and the steroid hormones. In the liver it is involved in the production of bile salts which make fats soluble in the digestive tract and aid in the intestinal absorption of fat molecules as well as the fat-soluble (A, D, E, and K) vitamins.

In view of these very important benefits, cholesterol ought not be this notorious; so much so that a multitude of various shades of people now produce a multitude of various shades  of medications to fight and annihilate cholesterol. Of course a multitude of unverified claims, very often by such manufacturers that do not have an iota of idea what cholesterol is.

Cholesterol cannot dissolve in blood. Proteins in the blood carry it where it needs to go. These carriers are called lipoproteins. Each form of lipoprotein has different preferences for cholesterol, and behaves differently with the cholesterol it carries. Lipoproteins pick up and carry cholesterol through the blood.

There are two relevant kinds of cholesterol: cholesterol carried by HDL (high-density lipoprotein) and the one carried by LDL (low-density lipoprotein). There are two other types, carried by two other types of lipoprotein. HDL-cholesterol is often called the “good” kind of cholesterol because HDL helps remove unneeded cholesterol from the body and also reduces LDL, the carrier of bad cholesterol. LDL is the “bad” lipoprotein and is a particular risk factor for stroke and heart disease.

Why LDL Cholesterol is Bad

High amounts of LDL cholesterol lead to plaque growth and atherosclerosis. The process is as follows1:

 

  • Some LDL cholesterol circulating through the bloodstream tends to deposit in the walls of arteries, from as early as childhood or adolescence.

 

  • White blood cells swallow and try to digest the LDL, possibly in an attempt to protect the blood vessels. In the process, the white blood cells convert the LDL to a toxic (oxidized) form.

 

  • More white blood cells and other cells migrate to the area, creating steady low-grade inflammation in the artery wall.

 

  • Over time, more LDL cholesterol and cells collect in the area. The process creates a bump in the artery wall called a plaque. Plaque is made of cholesterol, the body’s cells, and debris.

 

  • The process continues, growing the plaque and slowly blocking the artery.

 

  • Thrombotic Stroke can happen as the result of these unhealthy blood vessels clogged with a buildup of fatty deposits and cholesterol causing these enlarging bumps. The body regards these buildups as multiple, tiny and repeated injuries to the blood vessel wall. So the body reacts to these injuries just as it would react to bleeding from a wound; it responds by forming clots.

 

Two types of thrombosis can cause stroke: large vessel thrombosis and small vessel disease (or lacunar infarction.), the former would obviously cause a more devastating effect as it affects a larger part of the brain supplied by a larger artery.

Another great danger other than slow blockage is a sudden rupture of the surface of the plaque; a blood clot can form on the ruptured area, and that can lead to stroke or heart attack.

Achieving lower cholesterol levels is the best way to protect your body from Stroke and heart attack. If you want to lower cholesterol, you need to know your HDL level, your LDL level, and your total cholesterol level too (obtained from the total of all the types including HDL and LDL). Total cholesterol may be normal while this dangerous LDL cholesterol is high, depending on the levels of the other types, and that is what happened in my own case.

If you want to see the levels of all types do “Lipid Profile” in a good laboratory. A high LDL in the test means a high LDL-Cholesterol and spells Danger.

Fortunately, you have several actions you can take to help you get back in the cholesterol safety zone. These four actions can all work separately, or work together, to lower cholesterol, and keep it under control. These are in the areas of

  1. Diet
  2. Exercise
  3. Weight Loss
  4. Stress Management
  5. Medications

Diet:

The body gets cholesterol in two ways: by making it and by obtaining it from food. Most of the cholesterol we eat comes from animal fats found in foods such as meat, milk, butter and other animal products. One of the easiest ways to lower cholesterol is to lower your intake of certain kinds of fats.

Just as there is “good” cholesterol and “bad” cholesterol, there are “good” fats and “bad” fats. To keep our cholesterol low, most of our dietary food intake should be the good kinds like vegetable fats (monounsaturated fats and polyunsaturated fats), and omega-3 fattyacids, found mostly in fish.

To lower LDL cholesterol, it is essential to avoid or reduce saturated fats, which are usually found in animal products like meats, eggs, and dairy, and trans fats, which are formed when hydrogen is added to vegetable oil to make it solidify, so it becomes suitable for what food products manufacturers intend to do with it.

Animal fats are usually solid at room temperature, while vegetable fats are liquid at room temperature. Trans fats are also solid at room temperature. Palm oil can solidify at room temperature because it contains saturated fats but these are naturally-occurring and belong to the varieties that are good2. Palm oil has several other nutritional benefits.2,3,4,

Subscribe, therefore, to the healthy fats found in vegetable oils, nuts, avocados, and salmon, and cut back on higher-fat foods like red meat, whole milk, and of course, those tempting chips and pastries from fast food joints and snack shops.

Exercise:

Regular physical activity is key to keeping your cholesterol low. Studies have found that even moderate exercise is enough to boost HDL (good) cholesterol and lower LDL (bad) cholesterol. Exercise, in combination with a healthy diet, is very important. There is an increase in good HDL cholesterol (and a decrease in LDL and total cholesterol) for those who walk or jog about 8 miles a week. Lack of exercise is what must have partly caused my own problem. No time to even walk a few meters; always driving around to even the shortest of distances, most other times busy in the Clinic.

If you are rich enough you could even buy some equipment and exercise in your home and this will help if you do not have enough time. Aerobic exercises are more helpful, it has to be noted5.

Weight Loss:

Both a healthy diet and regular physical exercise can lead to another important tool for lowering cholesterol: weight loss.

Excess weight tends to increase your LDL cholesterol level. If you are overweight and have high LDL cholesterol, losing weight may help you lower it. Weight loss also helps to lower triglycerides (another form of fat in your blood and one which you should aim to keep very low) and raise HDL (“good”) cholesterol levels. I also gained a great amount of weight over a few years. This may have been contributory, joining with stress and lack of exercise.

Stress Management:

Stress is necessary to drive life. Excessive stress is, however, destructive; but, ultimately, the effect of any amount of stress you have depends on how you manage it. There is scientific evidence that poor stress management can cause increase in bad cholesterol levels6. A very good summary is shared by Dr Raja R. Gopaldas in that “scientific evidence” article just referred to:

“In modern-day life, stress is inevitable. Job stress, getting to work, and taking care of the family all contribute to stress. How we manage stress is important. There is no doubt that a constant state of emotional stress is directly linked with high cholesterol levels. Being happy is a fundamental requirement for every human being; so, avoid circumstances that make you unhappy! A daily meditation schedule of 15 to 20 minutes will help relieve stress, and 45 minutes of vigorous exercises (get your heart rate over 120) three times a week will help lower anxiety levels and stress. Ensuring that you get adequate sleep – about six to eight hours daily (no more or no less – both are detrimental) is important for everyone.”

Medications:

Some few people find they cannot lower cholesterol enough with lifestyle changes alone. There are genetic factors that affect cholesterol levels7. This is one of the reasons medications may come in.

Medications are indicated if the cholesterol levels are already raised, for any reason, and if your efforts at dietary control, exercise and weight-loss are not enough to bring about adequate control. There are several types of cholesterol-lowering medications, but the most commonly prescribed are statins. They are very effective in lowering LDL levels and increasing HDL levels in the majority of patients. There are other medications to lower cholesterol. These drugs act in slightly different ways: some lower LDL cholesterol, while others treat high levels of triglycerides and/or raise HDL cholesterol. Your doctor will help you decide on a medication – or combination. However, medication is helpful if you don’t continue to eat a high-fat diet. The effects of cholesterol-lowering drugs like are diminished if you do. Primarily, diet, exercise, weight loss are what you need to prevent you from having raised cholesterol.

There is a medication that is important, and is routinely taken by people above 40 years to help in preventing Stroke and heart attack whether or not there is raised cholesterol. It is Aspirin (special low-dose formulation) and the common type here in Nigeria are Vasoprin and Micropirin. One tablet is taken once a day.
Hypertension:

Remember that hypertension is a cause of a much more severe type of Stroke and causes heart disease too, among other problems. Take care of your blood pressure.

 

REFERENCES

1. What is Cholesterol? What are LDL and HDL, WebMD, https://sites.google.com/site/whatischolesterolhss/what-are-ldl-and-hdl

2. Palm Oil and Coronary Heart Disease (the long explanation) – Tocospan… http://www.epic4health.com/paloilandcor.html

3.  Chandan K. S., Cameron R., Savita K., Palm Oil–Derived Natural Vitamin E a-Tocotrienol in Brain Health and Disease, Journal of the American College of Nutrition, Vol. 29, No. 3, 314S–323S (2010)

4. Rice A.L, Burns J. B., Moving from Efficacy to Effectiveness: Red Palm Oil’s Role in Preventing Vitamin A Deficiency,Journal of the American College of Nutrition, Vol. 29, No. 3s1, 000–000 (2010)

5. Weil, R. Aerobic Exercises, MedicineNet.com, http://www.medicinenet.com/aerobic_exercise/article.htm

6. How Does Stress Contribute to Cholesterol? Everyday Health, http://www.everydayhealth.com/cholesterol/experts-how-does-stress-contribute-to-cholesterol.aspx

7.Better Health Channel, Genetic Factors and Cholesterol, https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/genetic-factors-and-cholesterol

 

Contributory Resources

  1. Shaw, G., Lower Cholesterol: Diet, Exercise, Weight Loss, Medications to Lower…

http://www.webmd.com/cholesterol-management/features/your-lower-c

 

  1. Chan, A., Cholesterol: Understanding and Managing HDL and LDL | LiveScience

http://www.livescience.com/34712-ldl-cholesterol-buildup-causes-hear

  1. Arefa, C., LDL Cholesterol: “The Bad Cholesterol”

http://www.webmd.com/cholesterol-management/ldl-cholesterol-the-b.. .

  1. Top five foods to lower your numbers – Mayo Clinic

http://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/

  1. Cholesterol Levels | Atherosclerosis 1. Cholesterol | High & Low Levels | Diet | NZ – … http://www.heartfoundation.org.nz/healthy-living/control-your-cholesterol

 

 

 

Advertisements

Leave a Reply