Stressed Stroke Caregivers

I read a study recently in Biological Research for Nursing titled "Depressive Symptoms and Diurnal Salivary Cortisol Patterns Among Female Caregivers of Stroke Survivors". Big title, but the study results struck a chord with me. If you look after a stroke patient, you have an increased likelihood of being depressed.

The study looked at the markers for stress in caregivers - cortisol levels, anxiety, insomnia - and could see increased levels in caregivers versus the general population. On average, in their study, caregivers for stroke patients worked about fifty hours a week providing that care. For many of them, that's over and above any job that they have, or any time taken to look after themselves.

On a personal note, I can see how this wears on the caregiver. My wife said she would lie awake at night listening to me breathe - hoping it wouldn't stop. And constantly being concerned about travelling up and down stairs. Or unloading the dishwasher. Or going down the street on my own.

I was fortunate. Within a few months I was able to look after myself for the most part, and my wife didn't have the immediate stress of going back to work. Many don't have that luxury.

Their patients cannot manage on their own - from going to the washroom, to having a bath or shower, to feeding themselves, basically everything I now take for granted (and my wife no longer lies awake listening to me breathe).

The point of all this is lets make sure that we recognize the tremendous strain and stress put on the caregivers in our society. We need to look out for their best interests, as well as for those of their patients.

Vitamin D Reduces Stroke Risk

A study out of Honolulu, Hawaii, published in the AHA Journal - Stroke, looked at the stroke incidence of 8006 Japanese-American men over the course of 34 years (a longitudinal study - or "repeated observations of the same variables over long periods of time").

What they found was that over the 34 years, 960 of the subjects became stroke sufferers. What researchers discovered when examining the variables in the data, is that Vitamin D levels in the stroke patients were, on average, significantly lower than in those who didn't have a stroke:

"Age-adjusted rates of incident stroke were significantly higher in the lowest dietary vitamin D quartile compared with the highest. Using Cox regression, adjusting for age, total kilocalories, body mass index, hypertension, diabetes mellitus, pack-years smoking, physical activity index, serum cholesterol, and alcohol intake, those in the lowest quartile had a significantly increased risk of incident strokewith the highest as the reference. We found no significant associations between dietary vitamin D and hemorrhagic stroke"
Note that some paranthetical comments were removed in this quote.

As luck would have it, I have ramped up my Vitamin D intake to 4000IU/day to try and combat my insomnia issues (I heard it might help - so at this point I'm trying everything). Regardless of how it changes my sleep, I may now continue to take it based on this information..

The Reason Behind My Stroke - Occam's Razor Edition

There's something called Occam's Razor, used often in science and philosophy. The thinking goes something like this:

"other things being equal, a simpler explanation is better than a more complex one " 

Ptolemy, almost two thousand years ago, stated:

"We consider it a good principle to explain the phenomena by the simplest hypothesis possible"

In my case, I was a young man of 49 in otherwise excellent health when I had my stroke. It was preceded by open heart surgery three years earlier - where some small but dangerous plaque-filled blockages were found. I was a vegetarian, slim, a person who exercised all the time, who had fantastic blood cholesterol profiles.

But the stroke happened anyway.

The neurologists, cardiologists, internists, and my family doctor doctor all shrugged their shoulders after every test came back negative (CAT scans, MRI's, Spinal Taps, and litres of blood-work). "Bad luck" is what they said. I lived with this diagnosis for two years, always searching for a better, simpler explanation.

I believe I have found it. 

The Occam's Razor Version Of My Stroke

Not a single health professional in my journey through the system ever specifically asked what I ate. I think this will turn out to be the key.

I became vegetarian about thirteen years earlier, ironically to avoid the fate of my father and grandfather - who both suffered heart attacks in their sixties.

For the first several years I shunned meat in any form. During the last few years I became more flexible, starting to encorporate fish about once a week, and would have red meat about once a month.

One thing ran common along those thirteen years, though. I made up for the lack of fat in my diet (because everyone knows that low-fat was the pinnacle of good health!) with a significant increase in carbohydrates. Specifically, starchy carbohydrates. Things like whole-wheat bread, whole-wheat cereal, and potatoes. If I ate a carb, it was a "healthy" one.

It got so that my daughter often commented "Dad, you eat a lot of carbs".

Through nothing more than serendipity, I stumbled upon a link on the internet one day that talked about the dangers of carbs. I read further and found lots of information - a lot of it a part of a Paleo Diet thread I followed for a while. I also read the books by Gary Taubes and downloaded essays from famous heart surgeons.

The process as I now understand it, is that carbs (specifically, grains) cause an increased, frequent, damaging insulin response when you eat them. This constant assault by a hormone that was never meant to be exercised this often causes stress and damage to the insides of our arteries, causing the plaques that we desperately want to avoid. It is the root of something we now call "metabolic syndrome". I had the low HDL (even with statins and niacin, never above 1.2 mmol/litre - or 46 mg/dl in USA) that's a significant marker of this syndrome, even though my weight was OK.

Cholesterol isn't the bad guy it has been made out to be. A specific kind of fat in the blood (very low density lipoproteins or VLDL) are the bad guys. And they're brought on by, you guessed it, excess carbohydrates. These same carbs lower our protective, good cholesterol - HDL. Total cholesterol and LDL have almost nothing to do with heart disease and stroke. It's the inflammation in our systems caused by the frequent insulin spikes, in combination with the VLDL particles that cause the problems.

So the Occam's Razor explanation for my heart disease and subsequent stroke, despite an excellent lifestyle and blood cholesterol profile, is now the very best explanation that I can come up with for what's happened to me.

"Too many carbs, and grains specifically, lead to metabolic syndrome - which eventually can lead to heart disease and stroke".

But knowing (or hoping I know) what happened and why is only half the issue. The other half is "so what am I going to do about it?".

The Solution

The solution is quite easy. Cut the carbs as much as I can. From about 60-70% of the calories I consumed, to about 20% (100 grams/day = 400 calories). This is best accomplished with a modified Paleo-style diet. 

I have been on this diet for about four months now, and have seen the following changes:

1. Through no plan of my own, my weight has dropped to 145-150lbs. It has been as high as 185lbs. Interestingly when I was exercising intensely and eating a strict vegetarian diet I could only get my weight down to 152lbs. I cannot run any longer (after affect of the stroke), so am unable to get any intense exercise. But the weight just falls off.
2. My bloodwork now looks unusual by traditional standards. Total cholesterol and LDL are high. But so is HDL - higher than it's ever been. Triglycerides are the lowest they've ever been. The new thinking is that this ratio (HDL/Trig) is the important one - and mine is now fantastic.
3. I now eat meat almost every day. And a tremendous amount of fat. It all seems quite outrageous.
4. I am off all drugs. After seeing the bloodwork, I have re-incorporated 1000mg of fish oil (for inflamation) and 500mg of niacin (to raise HDL even further if possible) into every day.  

I'm a little sheepish to say that I was probable the author of my own health troubles. I took what was at the time the best information I could get and used it. It turns out (read Taubes' books) that the information was wrong. And we're still sticking to it. 

Not me. I want to live!