Why Are So Many Young People Having a Stroke?
High homocysteine is one significant but avoidable reason
In 2023, the World Stroke Organization reported that by 2050 the number of people dying from stroke was expected to increase by 50%, and the under 55s were those most likely to be affected.
It’s bad enough now: there are currently five million deaths a year. That’s a lot of people dying from a largely preventable disease.
What is stroke?
Stroke, sometimes called a cerebrovascular accident, occurs when the blood supply to part of the brain is blocked, either by a clot (ischaemic stroke) or by a burst artery (haemorrhagic stroke). A temporary clot can cause a transient ischaemic attack (TIA). When stroke happens, brain cells that are deprived of blood become damaged, or die.
Stroke strikes fear. But these are not indiscriminate, random attacks, carried out by an invisible foe with a recently acquired taste for youth. The tragedy is that most strokes are avoidable.
What causes stroke?
Stroke is now the second leading cause of death globally, after coronary heart disease. The rate of stroke among young and middle-aged people has been rising steadily in the US for the past 30 years; approximately 10%-15% of strokes occur in adults aged 18-50. The risk factors are the same for all ages and include high blood pressure, diabetes, smoking and stress, though 12% of strokes in the young are caused by recreational drugs.
Then there’s what is vaguely referred to as “poor diet”. What that means is open to debate, considering that so many people have no idea what constitutes a good diet. One of the main players in the diet debate, one that rarely makes it onto the main stage of public awareness, is something called homocysteine.
Homocysteine (Hcy) is a sulphur-containing amino acid that the body makes during a process called methylation. Excessive total Hcy – homocysteinemia - damages vascular structures and is a major marker of various health conditions, including stroke.
“High homocysteine levels are prevalent among ischemic stroke patients and this elucidates that homocysteine has a role in the thrombus formation and is a risk factor for the development of the stroke.”
The brain is particularly sensitive to high Hcy. In one study published in the journal Stroke, levels of Hcy were measured in a total of 3,799 patients admitted to hospital for acute ischemic stroke. They were monitored for over 48 months, and those who at the beginning of the study had the highest Hcy levels were those most likely to die from stroke during the follow-up period. Those with the lowest Hcy were those least likely to die.
Is high Hcy a factor among young people with stroke? It looks that way. A study of 71 hospital patients with a mean age of 35.6 years revealed that just over half had hyper-homocysteinemia. According to the researchers, this study showed a “strong” association between high homocysteine and ischaemic stroke, confirming something that has been observed previously in similar studies.
What causes raised homocysteine?
Homocysteine is created by the demethylation of the essential amino acid methionine. Methylation is a biochemical process, whereby a methyl group (one carbon atom bonded to three hydrogen atoms) is transferred to other structures such as DNA, hormones, and neurotransmitters, modifying their activity and allowing them to function efficiently.
Methylation is something that occurs billions of times every second. But the process can and does go wrong: without an adequate supply of certain nutrients, methylation is impaired. Those nutrients are vitamin B12 and folate.
When methylation is impaired, homocysteine starts to accumulate.
The best sources of folate include beef and lamb’s liver, leafy green vegetables, such as spinach and broccoli, beans, avocado, eggs, and crab meat.
Vitamin B12 is the tricky one, the one most likely to be missing from diet.
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