For the Prevention of Strokes:
All Herbs and Supplements Used for
High Blood Pressure, or
For the Treatment of Strokes:
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.
Meaningful evidence tells us that numerous herbs and supplements are helpful for improving the
cholesterol profile, which in turn should decrease
and help prevent strokes. Weaker evidence supports the use of other herbs and supplements for lowering
or for treating atherosclerosis in general. For detailed information, see the full articles on those topics.
See also the article on
for reasons to avoid this controversial alternative treatment.
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
double-blind, placebo-controlled trials
significantly reduces the blood’s tendency to clot.1-6 In 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
much, resulting in dangerous bleeding events.
For more information, including dosage and safety issues, see the full
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.
In a single-blind, placebo-controlled trial, 30 participants who had just experienced a stroke received either placebo or
vinpocetine along 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.7-10,36 However, at present this body of evidence remains far from conclusive.8 A 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 full Vinpocetine
glycine has 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
increase harm 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
Acupuncture is 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.20 Similarly 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.21 All 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.22 Also, 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.42 Finally, 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.23-26 In 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.45 Another, 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,
combined with lavender, rosemary, and peppermint
aromatherapy was more effective than acupressure alone for treating the shoulder pain caused by hemiplegic strokes.38 However, 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
Evidence suggests that high consumption of fish or
fish oil reduces stroke incidence.14,15,51
This is believed to occur as a result of a number of effects, including impairment of blood clots, improvement of cholesterol profile, and other unidentified means.
Many other herbs and supplements may also reduce the blood’s tendency to clot, and thereby help prevent strokes, including
vitamin E, and
white willow. However, the supporting evidence for these supplements remains weak at best, and the mere fact that they may thin the blood does not prove that they will reduce stroke risk. For example, while vitamin E is known to reduce blood clotting and is also a strong antioxidant, several large studies have failed to find vitamin E helpful for stroke prevention.16-18,46 A large systematic review that included 9 randomized trials and 118,765 subjects found that vitamin E may actually increase the risk of hemorrhagic stroke (bleeding in the brain).46
Although the review also found that vitamin E may reduce the risk of ischemic stroke (when blood flow to the brain is blocked), the relative seriousness of hemorrhagic stroke led the researchers to recommended against the widespread use of this vitamin.
The herb white willow has also been studied. This herb has been advocated as a substitute for aspirin because it contains salicin, a substance very much like aspirin. However, willow, take in usual doses, doesn't appear to impair blood coagulation to the same extent as aspirin,19
and, for that reason, it is probably not equally effective.
folate has shown a bit of promise for preventing strokes.39
Besides vitamin E, other antioxidants such as
have been proposed for stroke prevention, but there is no evidence that they are effective.
The semisynthetic substance citicholine (closely related to the nutrient
choline) has shown some promise for aiding recovery from strokes.35
In an interesting study investigating the effects of music therapy, stroke patients who listened to music of their own choosing in the early stages of their recovery demonstrated more improvement in memory and attention than those patients who listened to language (books on tape). Music listeners were also less depressed and confused than subjects who neither listened to music nor language.41
Transcranial direct current stimulation (tDCS) is related to a certain type of
magnet therapy (repetitive transcranial magnetic stimulation or rTMS). With tDCS, electrodes deliver a constant, low current. In one small study, 20 people who were in a rehabilitation program after having a stroke were randomized to receive tDCS to the head or sham treatment.47
Both groups also received physical and occupational therapy. Those in the tDCS group experienced an improvement in their motor function, suggesting that it may be a beneficial addition to an overall rehab program.
Traditional Chinese herbal medicine
(TCHM) is a holistic approach to healing that focuses on herbal combinations.
In a small, double-blind, placebo-controlled trial, use of the herbal combination Banxia Houpo Tang was tested for the treatment of impaired cough reflex in people who had suffered a
stroke.50 The results indicated that the herbal combination was more effective than placebo treatment for improving the coughing response. In another study, 140 people who recently had a stroke were randomized to receive the herbal formula sanchitongshu (200 mg three times daily) plus aspirin (50 mg once daily) or aspirin plus placebo.49
After one month of treatment, those in the herbal formula group had a greater improvement in their neurological deficits and activities of daily living compared to the aspirin plus placebo group.
For a discussion of homeopathic approaches to recovery from strokes, see the
If you are at risk for a stroke, it might be advisable to avoid excessive intake of
iron. Some evidence suggests that high iron levels may increase stroke risk and worsen strokes that do occur.27-29
In addition, people susceptible to stroke should exercise great caution regarding the herb
ephedra. Ephedra contains ephedrine, a drug that raises blood pressure and stimulates the heart, and has caused heart attacks and strokes.30-33 Certain preparations of ephedra may present an additional risk beyond ephedrine’s effects on the circulatory system: direct toxicity to nerves.34
Finally, numerous herbs and supplements may interact adversely with drugs used to prevent or treat strokes. For more information on this potential risk, see the individual drug articles in the
section of this database.
Arruzazabala ML, Valdes S, Mas R, et al. Effect of policosanol successive dose increases on platelet aggregation in healthy volunteers.
Arruzazabala ML, Mas R, Molina V, et al. Effect of policosanol on platelet aggregation in type II hypercholesterolemic patients.
Int J Tissue React.
Carbajal D, Arruzazabala ML, Valdes S, et al. Effect of policosanol on platelet aggregation and serum levels of arachidonic acid metabolites in healthy volunteers.
Prostaglandins Leukot Essent Fatty Acids.
Castano G, Mas R, Arruzazabala M, et al. Effects of policosanol and pravastatin on lipid profile, platelet aggregation and endothelemia in older hypercholesterolemic patients.
Int J Clin Pharmacol Res.
Arruzazabala ML, Valdes S, Mas R, et al. Comparative study of policosanol, aspirin and the combination therapy policosanol-aspirin on platelet aggregation in healthy volunteers.
Arruzazabala ML, Molina V, Mas R, et al. Antiplatelet effects of policosanol (20 and 40 mg/day) in healthy volunteers and dyslipidaemic patients.
Clin Exp Pharmacol Physiol.
Feigin VL, Doronin BM, Popova TF, et al. Vinpocetine treatment in acute ischaemic stroke: a pilot single-blind randomized clinical trial.
Eur J Neurol.
Bereczki D, Fekete I. Vinpocetine for acute ischaemic stroke.
Cochrane Database Syst Rev.
Lohmann A, Dingler E, Sommer W, et al. Bioavailability of vinpocetine and interference of the time of application with food intake.
Bonoczk P, Panczel G, Nagy Z. Vinpocetine increases cerebral blood flow and oxygenation in stroke patients: a near infrared spectroscopy and transcranial Doppler study.
Eur J Ultrasound.
Gusev EI, Skvortsova VI, Dambinova SA, et al. Neuroprotective effects of glycine for therapy of acute ischaemic stroke.
Sopala M, Schweizer S, Schafer N, et al. Neuroprotective activity of a nanoparticulate formulation of the glycineB site antagonist MRZ 2/576 in transient focal ischaemia in rats.
Tatlisumak T, Takano K, Meiler MR, et al. A glycine site antagonist ZD9379 reduces number of spreading depressions and infarct size in rats with permanent middle cerebral artery occlusion.
Acta Neurochir Suppl.
Iso H, Rexrode KM, Stampfer MJ, et al. Intake of fish and omega-3 fatty acids and risk of stroke in women.
Marchioli R, Schweiger C, Tavazzi L, et al. Efficacy of n-3 polyunsaturated fatty acids after myocardial infarction: results of GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico.
Yusuf S, Dagenais G, Pogue J, et al. Vitamin E supplementation and cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators.
N Engl J Med.
Collaborative Group of the Primary Prevention Project (PPP). Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general practice.
Leppala JM, Virtamo J, Fogelholm R, et al. Vitamin E and beta carotene supplementation in high risk for stroke. A subgroup analysis of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study.
Krivoy N, Pavlotzky E, Chrubasik S, et al. Effect of Salicic cortex extract on human platelet aggregation.
Gosman-Hedstrom G, Claesson L, Klingenstierna U, et al. Effects of acupuncture treatment on daily life activities and quality of life: a controlled, prospective, and randomized study of acute stroke patients.
Johansson BB, Haker E, von Arbin M, et al. Acupuncture and transcutaneous nerve stimulation in stroke rehabilitation: a randomized, controlled trial.
Sze FK, Wong E, Yi X, et al. Does acupuncture have additional value to standard poststroke motor rehabilitation?
Naeser MA, Alexander MP, Stiassny-Eder D, et al. Real versus sham acupuncture in the treatment of paralysis in acute stroke patients: a CT scan lesion site study.
J Neuro Rehab.
Sallstrom S, Kjendahl A, Osten PE, et al. Acupuncture in the treatment of stroke patients in the subacute stage: a randomized, controlled study.
Complement Ther Med.
Kjendahl A, Sallstrom S, Osten PE, et al. A one year follow-up study on the effects of acupuncture in the treatment of stroke patients in the subacute stage: a randomized, controlled study.
Hu HH, Chung C, Liu TJ, et al. A randomized controlled trial on the treatment for acute partial ischemic stroke with acupuncture.
Sempos CT, Looker AC, Gillum RE, et al. Serum ferritin and death from all causes and cardiovascular disease: the NHANES II Mortality Study.
Davolos A, Castillo J, Marrugat J, et al. Body iron stores and early neurologic deterioration in acute cerebral infarction.
Danesh J, Appleby P. Coronary heart disease and iron status: meta-analyses of prospective studies.
Haller CA, Benowitz NL. Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids.
N Engl J Med.
Samenuk D, Link M, Homoud MK, et al. Adverse cardiovascular events temporally associated with Ma Huang, an herbal source of ephedrine.
Mayo Clin Proc.
Bruno A, Nolte KB, Chapin J. Stroke associated with ephedrine use.
Theoharides TC. Sudden death of a healthy college student related to ephedrine toxicity from a ma huang-containing drink.
J Clin Psychopharmacol.
Lee MK, Cheng BW, Che CT, et al. Cytotoxicity assessment of Ma-huang (Ephedra) under different conditions of preparation.
Davalos A, Castillo J, Alvarez-Sabin J. Oral citicoline in acute ischemic stroke: an individual patient data pooling analysis of clinical trials.
Szilagyi G, Nagy Z, Balkay L, et al. Effects of vinpocetine on the redistribution of cerebral blood flow and glucose metabolism in chronic ischemic stroke patients: a PET study.
J Neurol Sci.
Wayne PM, Krebs DE, Macklin EA, et al. Acupuncture for upper-extremity rehabilitation in chronic stroke: a randomized sham-controlled study.
Arch Phys Med Rehabil.
Shin BC, Lee MS. Effects of aromatherapy acupressure on hemiplegic shoulder pain and motor power in stroke patients: a pilot study.
J Altern Complement Med.
Wang X, Qin X, Demirtas H, et al. Efficacy of folic acid supplementation in stroke prevention: a meta-analysis.
Bereczki D, Fekete I. Vinpocetine for acute ischaemic stroke.
Cochrane Database Syst Rev.
Sarkamo T, Tervaniemi M, Laitinen S, et al. Music listening enhances cognitive recovery and mood after middle cerebral artery stroke.
Hopwood V, Lewith G, Prescott P, et al. Evaluating the efficacy of acupuncture in defined aspects of stroke recovery: A randomised, placebo controlled single blind study.
2008 May 13.
Xie Y, Wang L, He J, Wu T. Acupuncture for dysphagia in acute stroke.
Cochrane Database Syst Rev.
Lee MS, Shin BC, Kim JI. Moxibustion for stroke rehabilitation: systematic review.
Stroke. 2010 Apr;41(4):817.
Wu P, Mills E, Moher D, et al. Acupuncture in poststroke rehabilitation: a systematic review and meta-analysis of randomized trials.
Schürks M, Glynn RJ, Rist PM, Tzourio C, Kurth T.
Effects of vitamin E on stroke subtypes: meta-analysis of randomised controlled trials.
Lindenberg R, Renga V, Zhu LL, Nair D, Schlaug G.
Bihemispheric brain stimulation facilitates motor recovery in chronic stroke patients.
Kong JC, Lee MS, Shin BC, Song YS, Ernst E.
Acupuncture for functional recovery after stroke: a systematic review of sham-controlled randomized clinical trials.
He L, Chen X, Zhou M, et al. Radix/rhizoma notoginseng extract (sanchitongtshu) for ischemic stroke: a randomized controlled study.
Iwasaki K, Cyong JC, Kitada S, et al. A traditional Chinese herbal medicine, banxia houpo tang, improves cough reflex of patients with aspiration pneumonia.
J Am Geriatr Soc.
Larsson SC, Orsini N. Fish consumption and the risk of stroke: a dose-response meta-analysis.
Zheng GQ, Zhao ZM, Wang Y, et al. Meta-analysis of scalp acupuncture for acute hypertensive intracerebral hemorrhage.
J Altern Complement Med.
Last reviewed July 2012 by
EBSCO CAM Review Board
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