• For the Prevention of Strokes: ]]>Policosanol]]>, All Herbs and Supplements Used for ]]>High Cholesterol]]> , ]]>High Blood Pressure]]> , or ]]>Atherosclerosis]]>
• For the Treatment of Strokes: ]]>Glycine]]>, ]]>Vinpocetine]]>
• ]]>Acupuncture]]>, ]]>Aromatherapy]]>, ]]>Bilberry]]>, ]]>Beta-carotene]]>, ]]>Feverfew]]>, ]]>Fish Oil]]>, ]]>Folate]]>, ]]>Garlic]]>, ]]>Ginger]]>, ]]>Ginkgo]]>, Music Therapy, ]]>Quercetin]]>, ]]>Vitamin E]]>, ]]>White Willow]]>
• ]]>Chelation Therapy]]>
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 nature designed. 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 so-called transient ischemic attacks (TIAs), the blockage to blood flow is temporary, and symptoms rapidly disappear. However, in a true stroke, officially 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, 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 occur in time. 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 over 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 fight atherosclerosis and thereby reduce the risk of stroke. Also, physicians may recommend 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 stroke that has just occurred involves maintaining life during the immediate recovery period and limiting the spread of brain damage (if possible). Finally, physical and occupational therapists help the stroke survivor to adapt.
Principal Proposed Natural Treatments
There are a number of alternative options that may be useful for preventing or even possibly treating strokes. The best documented are those that fight atherosclerosis.
Meaningful evidence tells us 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. For detailed information, see the full articles on those topics.
See also the article on ]]>Chelation Therapy]]> for reasons to avoid this controversial alternative treatment.
Various herbs and supplements with blood-thinning properties have been suggested to be used instead of or along with aspirin as a means of preventing blood clots. The best evidence regards the supplement ]]>policosanol]]> , and, for that, reason it is discussed here. Additional options with less supporting evidence are outlined in the ]]>Other Proposed Natural Treatments]]> section below.
Several ]]>double-blind, placebo-controlled trials]]> indicate policosanol ]]>significantly]]> reduces the blood’s tendency to clot. ]]>1-6]]> In one such study of 43 participants, use of policosanol at 20 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. ]]>5]]> Furthermore, as described in the article on policosanol, this supplement appears to reduce cholesterol levels, making it potentially an all-around stroke-preventing treatment. However, while long-term use of aspirin has been shown to reduce stroke risk, there have not been any equivalent studies of policosanol. In addition, combined treatment with policosanol and aspirin (or related drugs) could conceivably thin the blood too much, resulting in dangerous bleeding events.
For more information, including dosage and safety issues, see the full ]]>Policosanol]]> article.
As we described above, 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.
In a single-blind, placebo-controlled trial, 30 participants who had just experienced a stroke received either placebo or ]]>vinpocetine]]> along with conventional treatment for 30 days. ]]>7]]> 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. ]]>7-10,36]]> However, at present this body of evidence remains far from conclusive. ]]>8]]> A recent review combining two relatively high quality studies involving 63 subjects was unable to determine whether or not vinpocetine provided any benefit for stroke patients. ]]>40]]>
Note : There are concerns that vinpocetine could interact harmfully with standard drugs used to thin the blood. For more information, including dosage and safety issues, see the full ]]>Vinpocetine]]> article.
The supplement ]]>glycine]]> has also been proposed as a treatment for limiting permanent stroke damage. However, at present the supporting evidence is largely limited to one moderate-sized Russian trial. In this double-blind, placebo-controlled study, 200 participants received glycine within 6 hours of an acute stroke. ]]>11]]> The results indicate that use of glycine at 1 g daily for 5 days led to less long-term disability than placebo treatment.
However, paradoxically, there are potential concerns that high-dose glycine could actually increase harm caused by strokes, and drugs that block glycine have been investigated as treatments to limit stroke damage. ]]>12,13]]> The authors of the Russian study on strokes described above make an argument that the overall effect of supplemental glycine is protective; nonetheless, until this controversy is settled, prudence suggests that you should not take glycine following a stroke except on physician advice.
For more information, including additional dosage and safety issues, see the full ]]>Glycine]]> article.
Other Proposed Natural Treatments
Evidence suggests that high consumption of fish or fish oil]]> reduces stroke incidence. ]]>14,15]]> This is believed to occur as a result of a number of 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, including ]]>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. ]]>16-18]]>
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, take in usual doses, doesn't appear to impair blood coagulation to the same extent as aspirin, ]]>19]]> and, for that reason, it is probably not equally effective.
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, the best-designed and largest studies have not been promising. ]]>20-22,37,42,43]]> For example, in a single-blind, placebo-controlled trial of 104 people who had just experienced strokes, 10 weeks of twice-weekly acupuncture did not prove more effective than fake acupuncture. ]]>20]]> 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. ]]>21]]> All participants received 20 treatments over a 10-week period. Neither acupuncture nor muscle stimulation produced any benefits. In addition, a 10-week study of 106 people, which provided a total of 35 traditional acupuncture sessions to each participant, also failed to find benefit. ]]>22]]> Finally, 92 patients who randomly received either 12 acupuncture treatments or comparable sham treatment over 4 weeks demonstrated the same level of improvement up to one year later. ]]>42]]> The few studies that did report improvements due to acupuncture were very small, and some did not use a placebo group. ]]>23-26]]>
In one study, ]]>acupressure]]> combined with lavender, rosemary, and peppermint ]]>aromatherapy]]> was more effective than acupressure alone for treating the shoulder pain caused by hemiplegic strokes. ]]>38]]> However, this study lacked a proper placebo group, and therefore means little.
In an interesting 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 (books on tape). Music listeners were also less depressed and confused than subjects who neither listened to music nor language. ]]>41]]>
For a discussion of homeopathic approaches to recovery from strokes, see the ]]>Homeopathy]]> database.
Herbs and Supplements to Use Only With Caution
If you are 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. ]]>27-29]]>
In addition, 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 has caused heart attacks and strokes. ]]>30-33]]> Certain preparations of ephedra may present an additional risk beyond ephedrine’s effects on the circulatory system: direct toxicity to nerves. ]]>34]]>
Finally, numerous herbs and supplements may interact adversely with drugs used to prevent or treat strokes. For more information on this potential risk, see the individual drug articles in the ]]>Drug Interactions]]> section of this database.
3. Carbajal D, Arruzazabala ML, Valdes S, et al. Effect of policosanol on platelet aggregation and serum levels of arachidonic acid metabolites in healthy volunteers. Prostaglandins Leukot Essent Fatty Acids. 1998;58:61-64.
4. Castano G, Mas R, Arruzazabala M, et al. Effects of policosanol and pravastatin on lipid profile, platelet aggregation and endothelemia in older hypercholesterolemic patients. Int J Clin Pharmacol Res. 1999;19:105-116.
5. Arruzazabala ML, Valdes S, Mas R, et al. Comparative study of policosanol, aspirin and the combination therapy policosanol-aspirin on platelet aggregation in healthy volunteers. Pharmacol Res. 1997;36:293-297.
10. Bonoczk P, Panczel G, Nagy Z. Vinpocetine increases cerebral blood flow and oxygenation in stroke patients: a near infrared spectroscopy and transcranial Doppler study. Eur J Ultrasound. 2002;15:85-91.
12. Sopala M, Schweizer S, Schafer N, et al. Neuroprotective activity of a nanoparticulate formulation of the glycineB site antagonist MRZ 2/576 in transient focal ischaemia in rats. Arzneimittelforschung. 2002;52:168-174.
13. Tatlisumak T, Takano K, Meiler MR, et al. A glycine site antagonist ZD9379 reduces number of spreading depressions and infarct size in rats with permanent middle cerebral artery occlusion. Acta Neurochir Suppl. 2000;76:331-333.
15. Marchioli R, Schweiger C, Tavazzi L, et al. Efficacy of n-3 polyunsaturated fatty acids after myocardial infarction: results of GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico. Lipids. 2001;36(suppl):S119-S126.
16. Yusuf S, Dagenais G, Pogue J, et al. Vitamin E supplementation and cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med. 2000;342:154-160.
18. Leppala JM, Virtamo J, Fogelholm R, et al. Vitamin E and beta carotene supplementation in high risk for stroke. A subgroup analysis of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Arch Neurol. 2000;57:1503-1509.
20. Gosman-Hedstrom G, Claesson L, Klingenstierna U, et al. Effects of acupuncture treatment on daily life activities and quality of life: a controlled, prospective, and randomized study of acute stroke patients. Stroke. 1998;29:2100A-2108.
25. Kjendahl A, Sallstrom S, Osten PE, et al. A one year follow-up study on the effects of acupuncture in the treatment of stroke patients in the subacute stage: a randomized, controlled study. Clin Rehabil. 1997;11:192-200.
36. Szilagyi G, Nagy Z, Balkay L, et al. Effects of vinpocetine on the redistribution of cerebral blood flow and glucose metabolism in chronic ischemic stroke patients: a PET study. J Neurol Sci. 2005;275-284.
Last reviewed April 2009 by EBSCO CAM Medical Review Board]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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