Two Things You Can Do To Improve Stroke Survival Chances
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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
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Statin and Antidepressant Side Effects
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Questions and Answers at 10almonds
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
This newsletter has been growing a lot lately, and so have the questions/requests, and we love that! In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
Side effects of statins, are they worth it? Depression, are antidepressants worth it?
About statins, that depends a lot on you, your circumstances, and—as it happens—your gender. We covered this in a main feature recently, but a short answer is: for most people, they may not be the best first choice, and could even make things worse. For some people, however, they really are just what’s needed.
- Factors that make them more likely better for you: being a man, or having atherosclerosis
- Factors that make them more likely worse for you: being a woman in general
Check out the main feature we did: Statins: His & Hers?
As for antidepressants? That depends a lot on you, your physiology, your depression, your circumstances, and more. We’ll definitely do a main feature on that sometime soon, as there’s a lot that most people don’t know!
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Track Your Blood Sugars For Better Personalized Health
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There Will Be Blood
Are you counting steps? Counting calories? Monitoring your sleep? Heart rate zones? These all have their merits:
- Steps: One More Resource Against Osteoporosis!
- Calories: Is Cutting Calories The Key To Healthy Long Life?
- Sleep: A Head-To-Head Of Google and Apple’s Top Apps For Getting Your Head Down
- Heart Rate Zones: Heart Rate Zones, Oxalates, & More
About calories: this writer (it’s me, hi) opines that intermittent fasting has the same benefits as caloric restriction, without the hassle of counting, and is therefore superior. I also personally find fasting psychologically more pleasant. However, our goal here is to be informative, not prescriptive, and some people may have reasons to prefer CR to IF!
Examples that come to mind include ease of adherence in the case of diabetes management, especially Type 1, or if one’s schedule (and/or one’s “medications that need to be taken with food” schedule) does not suit IF.
And now for the blood…
A rising trend in health enthusiasts presently is the use of Continuous Glucose Monitors (CGMs), which do exactly what is sounds like they do: they continually monitor glucose. Specifically, the amount of it in your blood.
Of course, these have been in use in diabetes management for years; the technology is not new, but the application of the technology is.
A good example of what benefits a non-diabetic person can gain from the use of a CGM is Jessie Inchauspé, the food scientist of “Glucose Revolution” and “The Glucose Goddess Method” fame.
By wearing a CGM, she was able to notice what things did and didn’t spike her blood sugars, and found that a lot of the things were not stuff that people knew/advised about!
For example, much of diabetes management (including avoiding diabetes in the first place) is based around paying attention to carbs and little else, but she found that it made a huge difference what she ate (or didn’t) with the carbs. By taking many notes over the course of her daily life, she was eventually able to isolate these patterns, showed her working-out in The Glucose Revolution (there’s a lot of science in that book), and distilled that information into bite-size (heh) advice such as:
10 Ways To Balance Blood Sugars
That’s great, but since people like Inchauspé have done the work, I don’t have to, right?
You indeed don’t have to! But you can still benefit from it. For example, fastidious as her work was, it’s a sample size of one. If you’re not a slim white 32-year-old French woman, there may be some factors that are different for you.
All this to say: glucose responses, much like nutrition in general, are not a one-size-fits-all affair.
With a CGM, you can start building up your own picture of what your responses to various foods are like, rather than merely what they “should” be like.
This, by the way, is also one of the main aims of personalized health company ZOE, which crowdsourced a lot of scientific data about personalized metabolic responses to standardized meals:
Not knowing these things can be dangerous
We don’t like to scaremonger here, but we do like to point out potential dangers, and in this case, blindly following standardized diet advice, if your physiology is not standard, can have harmful effects, see for example:
Diabetic-level glucose spikes seen in non-diabetic people
Where can I get a CGM?
We don’t sell them, and neither does Amazon, but you can check out some options here:
The 4 Best CGM Devices For Measuring Blood Sugar in 2024
…and if your doctor is not obliging with a prescription, note that the device that came out top in the above comparisons, will be available OTC soon:
The First OTC Continuous Glucose Monitor Will Be Available Summer 2024
Take care!
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Measles cases are rising—here’s how to protect your family
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The U.S. is currently experiencing a spike in measles cases across several states. Measles a highly contagious and potentially life-threatening disease caused by a virus. The measles-mumps-rubella (MMR) vaccine prevents measles; unvaccinated people put themselves and everyone around them at risk, including babies who are too young to receive the vaccine.
Read on to learn more about measles: what it is, how to stay protected, and what to do if a measles outbreak happens near you.
What are the symptoms of measles?
Measles symptoms typically begin 10 to 14 days after exposure. The disease starts with a fever followed by a cough, runny nose, and red eyes and then produces a rash of tiny red spots on the face and body. Measles can affect anyone, but is most serious for children under 5, immunocompromised people, and pregnant people, who may give birth prematurely or whose babies may have low birth weight as a result of a measles infection.
Measles isn’t just a rash—the disease can cause serious health problems and even death. About one in five unvaccinated people in the U.S. who get measles will be hospitalized and could suffer from pneumonia, dehydration, or brain swelling.
If you get measles, it can also damage your immune system, making you more vulnerable to other diseases.
How do you catch measles?
Measles spreads through the air when an infected person coughs or sneezes. It’s so contagious that unvaccinated people have a 90 percent chance of becoming infected if exposed.
An infected person can spread measles to others before they have symptoms.
Why are measles outbreaks happening now?
The pandemic caused many children to miss out on routine vaccinations, including the MMR vaccine. Delayed vaccination schedules coincided with declining confidence in vaccine safety and growing resistance to vaccine requirements.
Skepticism about the safety and effectiveness of COVID-19 vaccines has resulted in some people questioning or opposing the MMR vaccine and other routine immunizations.
How do I protect myself and my family from measles?
Getting an MMR vaccine is the best way to prevent getting sick with measles or spreading it to others. The CDC recommends that children receive the MMR vaccine at 12 to 15 months and again at 4 to 6 years, before starting kindergarten.
One dose of the MMR vaccine provides 93 percent protection and two doses provide 97 percent protection against all strains of measles. Because some children are too young to be immunized, it’s important that those around them are vaccinated to protect them.
Is the MMR vaccine safe?
The MMR vaccine has been rigorously tested and monitored over 50 years and determined to be safe. Adverse reactions to the vaccine are extremely rare.
Receiving the MMR vaccine is much safer than contracting measles.
What do I do if there’s a measles outbreak in my community?
Anyone who is not fully vaccinated for measles should be immunized with a measles vaccine as soon as possible. Measles vaccines given within 72 hours after exposure may prevent or reduce the severity of disease.
Children as young as 6 months old can receive the MMR vaccine if they are at risk during an outbreak. If your child isn’t fully vaccinated with two doses of the MMR vaccine—or three doses, if your child received the first dose before their first birthday—talk to your pediatrician.
Unvaccinated people who have been exposed to the virus should stay home from work, school, day care, and other activities for 21 days to avoid spreading the disease.
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Mimosa For Healing Your Body & Mind
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Today we’re looking at mimosa (no relation to the cocktail!), which is a name given to several related plant species that belong to the same genus or general clade, look similar, and have similar properties and behavior.
As a point of interest that’s not useful: mimosa is one of those plants whereby if you touch it, it’ll retract its leaves and shrink away from you. The leaves also droop at nighttime (perfectly healthily; they’re not wilting or anything; this too is just plant movement), and spring back up in the daytime.
So that’s what we mean when we say “and behavior” 😉
Antidepressant & anxiolytic
Mimosa bark and leaves have long been used in Traditional Chinese Medicine, as well as (albeit different species) in the North-East of Brazil, and (again, sometimes different species) in Mexico.
Animal studies, in vivo studies, and clinical practice in humans, have found this to be effective, for example:
❝[Mimosa pudica extract] has anti-anxiety, anti-depressant and memory enhancing activities that are mediated through multiple mechanisms❞
Source: Effects of Mimosa pudica L. leaves extract on anxiety, depression and memory
Research is ongoing with regard to how, exactly, mimosa does what it does. Here’s a paper about another species mimosa:
(notwithstanding the genus name, it’s still part of the mimosa clade)
Anti-inflammatory & analgesic
In this case, mimosa has traditionally been used as a topical tincture (for skin damage of many kinds, ranging from cuts and abrasions to burns to autoimmune conditions and more), so what does the science say about that?
❝In summary, the present study provided evidence that the [mimosa extract], its fractions and the isolated compound sakuranetin showed significant anti-inflammatory and antinociceptive activities❞
Wound healing
About those various skin damages, here’s another application, and a study showing that it doesn’t just make it feel better, it actually helps it to heal, too:
❝Therapeutic effectiveness occurred in all patients of the extract group; after the 8th treatment week, ulcer size was reduced by 92% as mean value in this group, whereas therapeutic effectiveness was observed only in one patient of the control group (chi(2), p=0.0001). No side effects were observed in any patient in either group.❞
Very compelling stats!
Read more: Therapeutic effectiveness of a Mimosa tenuiflora cortex extract in venous leg ulceration treatment
Is it safe?
Yes, for most people, with some caveats:
- this one comes with a clear “don’t take if pregnant or breastfeeding” warning, as for unknown reasons it has caused a high incidence of fetal abnormalities or fetal death in animal studies.
- while the stem bark (the kind used in most mimosa supplements and most readily found online) has negligible psychoactivity, as do many species of mimosa in general, the root of M. tenuiflora has psychedelic effects similar to ayahuasca if taken orally, for example as a decoction, if in the presence of a monoamine oxidase inhibitor (MAOI), as otherwise MAO would metabolize the psychoactive component in the gut before it can enter the bloodstream.
That’s several “ifs”, meaning that the chances of unwanted psychedelic effects are slim if you’re paying attention, but as ever, do check with your doctor/pharmacist to be sure.
Want to try some?
We don’t sell it, but here for your convenience is an example product on Amazon 😎
Enjoy!
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Surgery won’t fix my chronic back pain, so what will?
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This week’s ABC Four Corners episode Pain Factory highlighted that our health system is failing Australians with chronic pain. Patients are receiving costly, ineffective and risky care instead of effective, low-risk treatments for chronic pain.
The challenge is considering how we might reimagine health-care delivery so the effective and safe treatments for chronic pain are available to millions of Australians who suffer from chronic pain.
One in five Australians aged 45 and over have chronic pain (pain lasting three or more months). This costs an estimated A$139 billion a year, including $12 billion in direct health-care costs.
The most common complaint among people with chronic pain is low back pain. So what treatments do – and don’t – work?
Opioids and invasive procedures
Treatments offered to people with chronic pain include strong pain medicines such as opioids and invasive procedures such as spinal cord stimulators or spinal fusion surgery. Unfortunately, these treatments have little if any benefit and are associated with a risk of significant harm.
Spinal fusion surgery and spinal cord stimulators are also extremely costly procedures, costing tens of thousands of dollars each to the health system as well as incurring costs to the individual.
Addressing the contributors to pain
Recommendations from the latest Australian and World Health Organization clinical guidelines for low back pain focus on alternatives to drug and surgical treatments such as:
- education
- advice
- structured exercise programs
- physical, psychological or multidisciplinary interventions that address the physical or psychological contributors to ongoing pain.
Pain education is central. Monkey Business Images/Shutterstock Two recent Australian trials support these recommendations and have found that interventions that address each person’s physical and psychological contributors to pain produce large and sustained improvements in pain and function in people with chronic low back pain.
The interventions have minimal side effects and are cost-effective.
In the RESOLVE trial, the intervention consists of pain education and graded sensory and movement “retraining” aimed to help people understand that it’s safe to move.
In the RESTORE trial, the intervention (cognitive functional therapy) involves assisting the person to understand the range of physical and psychological contributing factors related to their condition. It guides patients to relearn how to move and to build confidence in their back, without over-protecting it.
Why isn’t everyone with chronic pain getting this care?
While these trials provide new hope for people with chronic low back pain, and effective alternatives to spinal surgery and opioids, a barrier for implementation is the out-of-pocket costs. The interventions take up to 12 sessions, lasting up to 26 weeks. One physiotherapy session can cost $90–$150.
In contrast, Medicare provides rebates for just five allied health visits (such as physiotherapists or exercise physiologists) for eligible patients per year, to be used for all chronic conditions.
Private health insurers also limit access to reimbursement for these services by typically only covering a proportion of the cost and providing a cap on annual benefits. So even those with private health insurance would usually have substantial out-of-pocket costs.
Access to trained clinicians is another barrier. This problem is particularly evident in regional and rural Australia, where access to allied health services, pain specialists and multidisciplinary pain clinics is limited.
Higher costs and lack of access are associated with the increased use of available and subsidised treatments, such as pain medicines, even if they are ineffective and harmful. The rate of opioid use, for example, is higher in regional Australia and in areas of socioeconomic disadvantage than metropolitan centres and affluent areas.
So what can we do about it?
We need to reform Australia’s health system, private and public, to improve access to effective treatments for chronic pain, while removing access to ineffective, costly and high-risk treatments.
Better training of the clinical workforce, and using technology such as telehealth and artificial intelligence to train clinicians or deliver treatment may also improve access to effective treatments. A recent Australian trial, for example, found telehealth delivered via video conferencing was as effective as in-person physiotherapy consultations for improving pain and function in people with chronic knee pain.
Advocacy and improving the public’s understanding of effective treatments for chronic pain may also be helpful. Our hope is that coordinated efforts will promote the uptake of effective treatments and improve the care of patients with chronic pain.
Christine Lin, Professor, University of Sydney; Christopher Maher, Professor, Sydney School of Public Health, University of Sydney; Fiona Blyth, Professor, University of Sydney; James Mcauley, Professor of Psychology, UNSW Sydney, and Mark Hancock, Professor of Physiotherapy, Macquarie University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Brain Food? The Eyes Have It!
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Brain Food? The Eyes Have It!
This is Dr. Michael Greger, M.D. FACLM, of “Dr. Greger’s Daily Dozen” and “How Not To Die” fame, and he wants us to protect our brains (and while we’re at it, our eyesight).
And the secret is…
Lutein.
This is a carotenoid, which is super important for the eyes and brain. Not to be confused with carrots, which despite the name are usually not a good source of carotenoids!
They do however contain lots of beta-carotene, a form of vitamin A, but that (and the famous WW2-era myth born of deliberate disinformation by the British government) isn’t what we’re covering today.
We say “eyes and brain” but really, the eyes are just an extension of the brain in any case.
Pedantry aside, what Dr. Greger wants you to know about lutein is how important it is for the protection of your brain/eyes, both against cognitive decline and against age-related macular degeneration (the most common cause of eyesight loss in old age).
Important take-away info:
- Two things that hasten brain aging are inflammation and oxidative stress. Antioxidant and anti-inflammatory foods mitigate those.
- Researchers investigated eight different dietary antioxidants, including vitamins A and E. Only lutein was “significantly related to better cognition”.
- The macula in the middle of our retina is packed with lutein, and levels in the retina correspond to levels in the rest of our brain.
- Alzheimer’s patients have significantly less lutein in their eyes and in their blood, and a higher occurrence of macular degeneration.
- Dark green leafy vegetables are lutein superstars. A half cup of kale has 50 times more lutein than an egg.
Want to know more about the Dr. Greger’s Daily Dozen approach to health?
See the Website / Get the App (Android & iOS) / Get the Science Book / Get the Cookbook!
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