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.

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.

Stroke Prevention

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.

Policosanol

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 significantlyreduces the blood’s tendency to clot.1-6In 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.

Stroke Treatment

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.

Vinpocetine

In a single-blind, placebo-controlled trial, 30 participants who had just experienced a stroke received either placebo or vinpocetinealong 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.7-10,36However, at present this body of evidence remains far from conclusive.8A 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 fullVinpocetine article.

Glycine

The supplement glycinehas 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 increaseharm 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.

Acupuncture

Acupunctureis 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.20-22,37,42,43,48

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.20Similarly 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.21All 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.22Also, 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.42Finally, a 2011 systematic review, which included 10 randomized trials and 711 patients who had a stroke, failed to find evidence that acupuncture (compared to sham treatment) helped with recovery.48

The few studies that did report improvements due to acupuncture were very small, and some did not use a placebo group.23-26In a review of 56 trials (mostly written in Chinese), researchers found that 80% showed positive results. However, the small size and variable quality of these studies makes it difficult to draw reliable conclusions about the benefits of acupuncture in the setting of a stroke.45Another, much smaller systemic review focusing on scalp acupuncture did find positive results.52 The review included 7 randomized trials that compared scalp acupuncture to conventional treatment in 230 stroke patients. Those who were in the acupuncture group had fewer neurological problems compared to the patients who had standard care. These kind of trials, however, cannot be blinded (patients know whether or not they are receiving acupuncture).

In one study, acupressure combined with lavender, rosemary, and peppermint aromatherapywas more effective than acupressure alone for treating the shoulder pain caused by hemiplegic strokes.38However, this study lacked a proper placebo group, and therefore means little. And, a review of 9 trials found limited evidence in support of moxibustion (application of heat to acupuncture points) in addition to standard care for stroke rehabilitation.44