Dr. Andrew’s Stroke Survival Guide

This is Dr. Nadine Andrew. She’s a Senior Research Fellow in the Department of Medicine at Monash University. She’s the Research Data Lead for the National Center of Healthy Aging. She is lead investigator on the NHMRC-funded PRECISE project… The most comprehensive stroke data linkage study to date! In short, she knows her stuff.

We’ve talked before about how sample size is important when it comes to scientific studies. It’s frustrating; sometimes we see what looks like a great study until we notice it has a sample size of 17 or something.

Dr. Andrew didn’t mess around in this regard, and the 12,386 participants in her Australian study of stroke patients provided a huge amount of data!

With a 95% confidence interval because of the huge dataset, she found that there was one factor that reduced mortality by 26%.

And the difference was…

Whether or not patients had a chronic disease management plan set up with their GP (General Practitioner, or “family doctor”, in US terms), after their initial stroke treatment.

45% of patients had this; the other 55% did not, so again the sample size was big for both groups.

Why this is important:

After a stroke, often a patient is discharged as early as it seems safe to do so, and there’s a common view that “it just takes time” and “now we wait”. After all, no medical technology we currently have can outright repair that damage—the body must repair itself! Medications—while critical*—can only support that and help avoid recurrence.

*How critical? VERY critical. Critical critical. Dr. Andrew found, some years previously, that greater levels of medication adherence (ie, taking the correct dose on time and not missing any) significantly improved survival outcomes. No surprise, right? But what may surprise is that this held true even for patients with near-perfect adherence. In other words: miss a dose at your peril. It’s that important.

But, as Dr. Andrew’s critical research shows, that’s no reason to simply prescribe ongoing meds and otherwise cut a patient loose… or, if you or a loved one are the patient, to allow yourself/them to be left without a doctor’s ongoing active support in the form of a chronic disease management plan.

What does a chronic disease management plan look like?

First, what it’s not:

• “Yes yes, I’m here if you need me, just make an appointment if something changes”
• “Let’s pencil in a check-up in three months”
• Etc

What it actually looks like:

It looks like a plan. A personal care plan, built around that person’s individual needs, risks, liabilities… and potential complications.

Because who amongst us, especially at the age where strokes are more likely, has an uncomplicated medical record? There will always be comorbidities and confounding factors, so a one-size-fits-all plan will not do.

Dr. Andrew’s work took place in Australia, so she had the Australian healthcare system in mind… We know many of our subscribers are from North America and other places. But read this, and you’ll see how this could go just as much for the US or Canada:

❝The evidence shows the importance of Medicare financially supporting primary care physicians to provide structured chronic disease management after a stroke.

We also provide a strong case for the ongoing provision of these plans within a universal healthcare system. Strategies to improve uptake at the GP level could include greater financial incentives and mandates, education for patients and healthcare professionals.❞

See her groundbreaking study for yourself here!

The Bottom Line:

If you or a loved one has a stroke, be prepared to make sure you get a chronic health management plan in place. Note that if it’s you who has the stroke, you might forget this or be unable to advocate for yourself. So, we recommend to discuss this with a partner or close friend sooner rather than later!

“But I’m quite young and healthy and a stroke is very unlikely for me”

Good for you! And the median age of Dr. Andrew’s gargantuan study was 70 years. But:

• do you have older relatives? Be aware for them, too.
• strokes can happen earlier in life too! You don’t want to be an interesting statistic.

Some stroke-related quick facts:

Stroke is the No. 5 cause of death and a leading cause of disability in the U.S.

Stroke can happen to anyone—any age, any time—and everyone needs to know the warning signs.

On average, 1.9 million brain cells die every minute that a stroke goes untreated.

Stroke is an EMERGENCY. Call 911 immediately.

Early treatment leads to higher survival rates and lower disability rates. Calling 911 lets first responders start treatment on someone experiencing stroke symptoms before arriving at the hospital.

Source: https://www.stroke.org/en/about-stroke

What are the warning signs for stroke?

Use the letters F.A.S.T. to spot a stroke and act quickly:

• F = Face Drooping—does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven?
• A = Arm Weakness—is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
• S = Speech Difficulty—is speech slurred?
• T = Time to call 911

Source: https://www.stroke.org/en/about-stroke/stroke-symptoms

Last but not least, while we’re sharing resources:

Download the PDF Checklist: 8 Ways To Help Prevent a Second Stroke

Wholesome Health

This is Dr. Sara Gottfried, who some decades ago got her MD from Harvard and specialized as an OB/GYN at MIT. She’s since then spent the more recent part of her career educating people (mostly: women) about hormonal health, precision, functional, & integrative medicine, and the importance of lifestyle medicine in general.

What does she want us to know?

Beyond “bikini zone health”

Dr. Gottfried urges us to pay attention to our whole health, in context.

“Women’s health” is often thought of as what lies beneath a bikini, and if it’s not in those places, then we can basically treat a woman like a man.

And that’s often not actually true—because hormones affect every living cell in our body, and as a result, while prepubescent girls and postmenopausal women (specifically, those who are not on HRT) may share a few more similarities with boys and men of similar respective ages, for most people at most ages, men and women are by default quite different metabolically—which is what counts for a lot of diseases! And note, that difference is not just “faster” or “slower””, but is often very different in manner also.

That’s why, even in cases where incidence of disease is approximately similar in men and women when other factors are controlled for (age, lifestyle, medical history, etc), the disease course and response to treatment may vary considerable. For a strong example of this, see for example:

• The well-known: Heart Attack: His & Hers ← most people know these differences exist, but it’s always good to brush up on what they actually are
• The less-known: Statins: His & Hers ← most people don’t know these differences exist, and it pays to know, especially if you are a woman or care about one

Nor are brains exempt from his…

The female brain (kinda)

While the notion of an anatomically different brain for men and women has long since been thrown out as unscientific phrenology, and the idea of a genetically different brain is… Well, it’s an unreliable indicator, because technically the cells will have DNA and that DNA will usually (but not always; there are other options) have XX or XY chromosomes, which will usually (but again, not always) match apparent sex (in about 1/2000 cases there’s a mismatch, which is more common than, say, red hair; sometimes people find out about a chromosomal mismatch only later in life when getting a DNA test for some unrelated reason), and in any case, even for most of us, the chromosomal differences don’t count for much outside of antenatal development (telling the default genital materials which genitals to develop into, though this too can get diverted, per many intersex possibilities, which is also a lot more common than people think) or chromosome-specific conditions like colorblindness…

The notion of a hormonally different brain is, in contrast to all of the above, a reliable and easily verifiable thing.

See for example:

Alzheimer’s Sex Differences May Not Be What They Appear

Dr. Gottfried urges us to take the above seriously!

Because, if women get Alzheimer’s much more commonly than men, and the disease progresses much more quickly in women than men, but that’s based on postmenopausal women not on HRT, then that’s saying “Women, without women’s usual hormones, don’t do so well as men with men’s usual hormones”.

She does, by the way, advocate for bioidentical HRT for menopausal women, unless contraindicated for some important reason that your doctor/endocrinologist knows about. See also:

Menopausal HRT: A Tale Of Two Approaches (Bioidentical vs Animal)

The other very relevant hormone

…that Dr. Gottfried wants us to pay attention to is insulin.

Or rather, its scrubbing enzyme, the prosaically-named “insulin-degrading enzyme”, but it doesn’t only scrub insulin. It also scrubs amyloid beta—yes, the same that produces the amyloid beta plaques in the brain associated with Alzheimer’s. And, there’s only so much insulin-degrading enzyme to go around, and if it’s all busy breaking down excess insulin, there’s not enough left to do the other job too, and thus can’t break down amyloid beta.

In other words: to fight neurodegeneration, keep your blood sugars healthy.

This may actually work by multiple mechanisms besides the amyloid hypothesis, by the way:

The Surprising Link Between Type 2 Diabetes & Alzheimer’s

Want more from Dr. Gottfried?

You might like this interview with Dr. Gottfried by Dr. Benson at the IMCJ:

Integrative Medicine: A Clinician’s Journal | Conversations with Sara Gottfried, MD

…in which she discusses some of the things we talked about today, and also about her shift from a pharmaceutical-heavy approach to a predominantly lifestyle medicine approach.

Enjoy!