Stroke — it could become rare

Philip J. Goscienski, M.D.

September 2008

There are two kinds of stroke and both types are almost entirely preventable. It's no exaggeration to say that we could eliminate about 9 out of 10 of them if we were to return to some of the lifestyle habits of our ancestors. That doesn't mean living in huts or caves and eating raw meat. We only have to re-learn what our great-grandparents did barely a hundred years ago.

Some strokes, as noted in an earlier column, are hard to avoid. They are the ones that result from a defective blood vessel and bleeding into the brain, a hemorrhagic stroke. Like an automobile inner tube — remember those? — an artery within the brain develops a weak spot in the wall and starts to bulge, becoming a balloon-like structure called an aneurysm. It simply bursts when the wall of the aneurysm can't resist blood pressure. Hemorrhagic stroke may also occur when blood vessels within the brain are malformed and eventually spring a leak.

Even though hemorrhagic strokes appear to be related to unavoidable defects that we are born with, lifestyle is a factor. Smoking is linked to the development of these balloon-like aneurysms. High blood pressure makes rupture of the weakened blood vessel more likely. There is a common perception that blood pressure rises with age. That just isn't true. It's abundantly clear from studies on hunter-gatherer groups that humans are simply not genetically programmed to develop high blood pressure just because they get older.

The type of stroke that is the third leading cause of death today, called ischemic stroke, was almost unknown only a century ago. It occurs when a blood clot partly or completely blocks the delivery of oxygen and nutrients to brain cells. A major cause is atherosclerosis, the accumulation of fatty deposits on the walls of blood vessels within the brain or in other parts of the body.

In Western societies atherosclerosis affects the vast majority of the population so it's no surprise that it leads to more than half of deaths, far exceeding those due to cancer. This is a condition that begins in early childhood but it takes decades before it reveals itself in a heart attack or a stroke.

The solution to eliminating ischemic stroke and a large percentage of hemorrhagic strokes is to increase Americans' levels of physical activity, to eliminate the use of tobacco, to increase the consumption of fruits and vegetables and to wean our population off its high-sugar, high fat, high salt and high refined carbohydrate diet. Clearly a Utopian view but nothing short of that will free us from the threat of unsustainable healthcare costs that the youngest generation will inherit.

Stroke is a costly disease with a poor return on the dollar. Its victims seldom return to a normal life but often stay alive for many years. Their proper care is complicated and demands close personal attention. We can't afford not to do something about it.

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at