Managing the Risk Factors for Strokes

Stroke is not just a disease of the elderly. It can affect young people too. Though older people are at a higher risk of a stroke, an unhealthy lifestyle is an even bigger contributing factor for the disease.

Eating a healthy diet can minimize your risk of a stroke, but it’s also important to understand other risk factors to increase your chances of keeping a stroke at bay.

One day a friend told me dejectedly that his mother had had a stroke. A blood vessel had ruptured in her brain, leading to a hemorrhagic stroke. He said that his mother was perfectly normal one moment, but almost completely immobilized the next, after the stroke hit. Later on, she couldn’t even perform the simplest tasks, such as taking a shower, feeding herself, or going to the bathroom. My friend found the drastic change in her hard to accept.

Aside from feeling sad for his mother, her sudden collapse had led my friend to worry about his own health.

My friend was a big meat eater and partial to heavily seasoned food. I vividly remember several years ago when we dined together the deeply satisfied look on his face after he had gulped down the last drop of a curry soup from a large bowl. He told me at the time that he had put on so much weight as he had gotten older that it was no longer healthy. Hearing him confess his dilemma, I advised him to watch his diet and go easy on greasy and heavily seasoned foods.

He responded: “I simply can’t resist the temptation of delicious food, especially when it is right under my nose. For me it’s always ‘Dive in and worry about losing weight later.’”

Who could have predicted that his attitude about food would take an about-face when his mother suffered a stroke? He asked me, a dietician, in all seriousness: “Are strokes hereditary? What am I to do if I suffer a stroke too when I get old? What food should I avoid? What food can I eat?” His about-face took me by surprise.

Since I became a dietician, when the topic of how to prevent stroke or other chronic illnesses comes up, the focus has almost always been on “how to eat right,” as if a stroke is completely preventable as long as one eats right.

And when it comes to eating right, the questions most often posed to me are: “What should I eat?” and “What should I avoid?” It is as though food is divided into two kinds: the kind that will induce chronic illness—the so-called “bad food,” and the kind that will make you healthy—the so-called “good food.”

It is, however, a misconception to think that you will keep a stroke at bay if you eat only the so-called good food.

Not the exclusive province of the old

Another misconception about stroke is that it only affects older people. Take my friend for example. He worried about being hit by a stroke in his old age. Sadly, strokes are not the exclusive province of the old; one of my friends was younger than 35 years old when he had a stroke. Though older people are indeed more susceptible to a stroke, an unhealthy lifestyle is an even bigger contributing factor. The best way to protect yourself from a stroke is to understand your risk and how to control it.

One time during a talk about how to prevent a stroke, I mentioned that the risk factors of a stroke can be classified into two categories: uncontrollable and controllable. The examples I gave for the uncontrollable kind included family history, age, and sex (males are more susceptible).

A member of the audience said to me jokingly, “No one can become young again; I can’t go back to being a 20-year-old. I can’t change my sex either. Does that mean that my fate is sealed?” He was only half right, of course. Though one cannot control one’s age or sex, there are reversible factors, including high blood pressure, high cholesterol, diabetes, heart and blood vessel diseases, obesity, drinking, and smoking.

By focusing on mitigating the risk factors under our control, we can take steps to lower our chances of having a stroke. They include undergoing regular checkups to determine our risk and what to do next, eating healthy, exercising regularly at a moderate intensity, and quitting smoking.

During another talk of mine, a member in the audience asked if vegetarians were immune from stroke. I was puzzled by the expression on his face when he posed the question, so I inquired as to why he had asked it. He told me that he was the lay disciple of a Buddhist monk who had recently suffered a stroke. Thinking that vegetarians were immune from strokes, he began to suspect his master had been eating foods he shouldn’t have.

I told him eating vegetarian is not a sure guarantee against a stroke. If a vegetarian consumes too many high-fat and salty foods, he or she is as susceptible as a meat eater to obesity, high blood pressure, and diabetes—the medical conditions that can increase one’s risk for a stroke. In addition to diet, genetic factors can also contribute to a stroke.

I advised my audience to adopt a correct understanding of what might lead to a stroke and adjust their lifestyle habits accordingly to reduce their risk of having a stroke.

Time is of the essence

Right before the Chinese New Year holiday a few years ago, my mom, who was in her 80s and lived alone, came to my home for a short stay. A couple of days after she arrived, she told my husband and me she was experiencing a sudden blurriness in her right eye and weakness in her limbs. Her weakness was such that she couldn’t even stand or hold a pair of chopsticks in her hand. I immediately rushed her to the hospital, where she was diagnosed with an ischemic stroke. (An ischemic stroke is the most common type of stroke. It occurs when a vessel supplying blood to the brain is blocked.)

In this case, my husband and I took action immediately upon suspecting my mother had had a stroke. That’s because it’s critical for a stroke victim to get medical attention right away. Time lost is brain lost—every minute counts. Immediate treatment is essential to minimizing the long-term effects of a stroke and improving one’s prognosis.

That’s why it is so important that you and your family recognize the signs of a stroke, so you can take immediate measures should one occur. Common symptoms include a sudden weakness or numbness in the arm, leg, or face (usually on one side of the body); sudden trouble speaking or slurred speech; sudden trouble seeing in one or both eyes; headache or dizziness with no known cause; and sudden trouble walking or loss of balance.

For decades, my mother had led a healthy lifestyle. She had annual checkups, abstained from smoking and drinking, and kept her diet simple and food mildly seasoned. She maintained an exercise routine, getting up every day before it was light for walks outdoors or other workouts. She was popular with relatives and friends. When the news of her stroke spread, many people came to see her. Most of her visitors were surprised by what had happened. They couldn’t understand how such a health-conscious person as my mom could have suffered a stroke. Some of them even began to question the necessity of a healthy lifestyle—what’s the use of eating healthy and exercising regularly if a stroke was inevitable? Some even advised me to stop restricting my mom’s diet. They thought that I, as a dietician, must have had quite a say in her diet and had tried to control what she ate.

Later, I had a conversation with my mom alone. I said to her, “Some of our relatives said that you’d been vigilant about your diet for decades and yet you couldn’t escape the fate of a stroke. They said if you had known all along, you should have just eaten whatever you wanted to eat. What do you think?”

“It was their way of expressing their concern,” Mom said. “Don’t take to heart what they said. We can’t ask everyone to see eye to eye with us in everything. My personal feeling is that if I hadn’t tried my best to lead a healthy life, a stroke might have happened to me much earlier in my life than it did.”

I then asked if the stroke had changed her attitude about her diet choices and if she now felt that since she was advanced in years, she should just eat whatever she wanted. She answered with a smile: “No matter how old we are, we should all try to eat as healthy as possible.”

I knew of patients who ignored their stroke symptoms, thinking that they were just too tired and that they would be fine again after they rested up. Out of curiosity, I asked Mom, “You said on the day of your stroke that you suspected you had had a stroke. I figured you wouldn’t have known what to look for. What made you think you had had a stroke?”

Her answer surprised me. She said that she once visited a relative who had been hit by a stroke and saw how she lay paralyzed in her bed and had to depend on her child for all her needs. Her child had even quit her job to take care of her. The stroke had made things very difficult for them. “Looking at them, my heart really went out to them. At the same time, I couldn’t help thinking: ‘What if I end up like her?’”

My mom asked the child about the symptoms of a stroke and committed them to her memory. That’s why she wasted no time in seeking help when she noticed a sudden blurriness in her right eye and a sudden weakness in the right side of her body. Her vigilance had saved her.

Working hard on physical therapy

My mom worked hard on her physical and speech therapies to recover from the stroke. She also tried as much as possible to feed herself, brush her own teeth, and take care of her other needs. She needed some assistance from me in the beginning, but by and by was able to take care of everything on her own.

One day, when I asked her to leave a bowl she had used in the sink, she said to me, “Let me try to wash it myself.” Less than two minutes later, she said to me with a smile, “I’m done.” The happy smile on her face was no different from that of my daughter’s when she first learned how to fold clothes at three years old. I complimented Mom on having done a good job, and she said, “I don’t want to rely on others to take care of me. I must get better.”

Even though she was making very good progress, we knew that she still needed to be careful lest she have a second stroke. She needed to watch her diet, get regular exercise, take her meds, etc. to reduce the risk of another stroke occurring.

I remember a patient once said to me: “Everyone’s lifespan is predetermined. We should enjoy life and eat freely while we still can, and worry about restricting our intake of salt, oil, and sugar after we get sick.” Interestingly, I also have had a patient say to me: “Having lived to my age, I’ve eaten almost everything I wanted to eat. For the rest of my days, I’ll eat healthy and watch what I put into my mouth. I don’t want to become a burden to my children.”

I know whose example I want to follow.

January 2021