Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Showing posts with label high altitude. Show all posts
Showing posts with label high altitude. Show all posts

Monday, July 13, 2026

High-altitude hypoxic cues and cerebral ischemic tolerance: an evidence-graded translational framework for stroke research

 

 Your competent? doctor already told you of the benefits of living at a high altitude, right? NOPE? So, you finally figured out you DON'T have a functioning stroke doctor, didn't you?
high altitude (12 posts to December 2013)

High-altitude hypoxic cues and cerebral ischemic tolerance: an evidence-graded translational framework for stroke research


  • 1. Clinical Medical College, Qinghai University, Xining, Qinghai, China

  • 2. Research Center for High Altitude Medicine, Qinghai University, Xining, Qinghai, China

Abstract

High altitude exposes the brain to heterogeneous hypoxic, hemodynamic, rheological, inflammatory, and healthcare-access conditions. This heterogeneity makes altitude biologically informative for stroke research, but it does not justify treating natural altitude exposure as a single protective or harmful state. In this structured narrative review, we searched and organized the literature to ask which altitude-associated hypoxic cues resemble or reveal mechanisms compatible with cerebral ischemic tolerance, and what level of evidence supports that claim. We separate long-term adaptation, short-term acclimatization, chronic or excessive environmental hypoxia, and experimental hypoxic conditioning; define direct, supportive, and indirect evidence tiers; and integrate neurovascular-unit biology with multi-omics and stroke pathophysiology. Experimental hypoxic preconditioning remains the clearest direct evidence that a defined sublethal hypoxic stimulus can induce a time-limited tolerant state. In contrast, human high-altitude epidemiology, physiology, and genetics mainly constrain the clinical context and nominate candidate pathways rather than prove stroke-specific protection. We also emphasize that chronic hypoxia can be maladaptive through endothelial dysfunction, oxidative stress, erythrocytosis, thrombogenicity, blood–brain barrier impairment, and microvascular injury. Across neurovascular-unit cell types, a transparent evidence-weighting framework prioritizes endothelial biology because of its direct connection to BBB stability, effective reperfusion, hemorrhagic transformation risk, and no-reflow, while neurons, astrocytes, microglia, oligodendrocyte-lineage cells, and pericytes require different degrees of causal and human validation. We argue that the most productive path forward is not to label altitude as protective, but to use altitude-related biology to prioritize testable, stroke-facing hypotheses regarding BBB stability, microvascular patency, metabolic support, inflammatory thresholds, white-matter resilience, and biomarker-defined conditioning windows.

More at link.

Thursday, February 26, 2026

Tuesday, August 19, 2025

Is this the world’s best longevity diet?

 But Dar-es-Salaam is only 60 feet above sea level. Foothills of Mount Kilimanjaro range in altitude from approximately 2,600 feet (800 meters) to 6,000 feet

Make sure you question your doctor on the benefits of high altitude living vs. the diet.

High altitudes for Training the Brain to Survive Stroke.

Long lived Georgia O'Keefe at 7000 feet;

HOW TO LIVE TO (NEARLY) 99 IN FULL HEALTH…

Is this the world’s best longevity diet?

Move over Medi – there’s a new heritage diet in town. It’s from Tanzania, and I’m very lucky to have just visited that glorious country. So I was fascinated to read new research naming the diet of northern Tanzania as one of the healthiest in the world.

Researchers from the Netherlands and Tanzania evaluated the diet traditionally eaten by arable farmers in the foothills of Mount Kilimanjaro. They consume many fibrous, polyphenol-rich plants and a fermented banana beer called mbege. Fibre intake can be up to 90g a day, three times more than that recommended here in the UK. And Brits only average around half that amount. The fibrous Tanzanian diet has a hugely beneficial impact on gut health, and is linked to better immunity and reduced inflammation.

POP-UP KITCHENS

To assess the benefits of the diet, the researchers conducted a neat experiment where they established pop-up kitchens in the foothills of Kilimanjaro and in the capital, Dar-es-Salaam. For two weeks the urban kitchen served meals of cassava, plantains, beans, green vegetables and mbege to study participants used to a Western-style, ultra-processed diet Meanwhile, the rural kitchen dished out pizza, chips, fried chicken and beef stew with pasta. Participants in the study used to the traditional diet saw inflammatory markers in their blood increase, and their responses to infection decrease, when they swapped to the western diet. They also gained weight. In contrast, those who switched from a modern diet to a traditional one saw inflammation, and blood markers linked to metabolic syndrome, decrease.

If you’d like to know more about the study’s findings, there’s a great Zoe podcast about it, with Tim Spector and the Dutch lead author Dr Quirijn de Mast, which you can find here.

On our trip to northern Tanzania, were weren’t offered mbege – sadly – I’d like to try it! But we did eat huge amounts of locally-grown spinach, which was rich, fibrous stuff, more like kale than the pappy baby spinach we buy in the supermarket at home. We also had lots of bean and lentil dishes. Most meals started with soup and salad – nourishing, hydrating and blood-sugar balancing.

HERITAGE DIETS

So why do we know so much about the Mediterranean diet and so little about the Tanzanian one? The Mediterranean diet has been so well studied and documented over the last 60 years or so, that it’s easy to think that it’s the ONLY diet associated with longevity. I’ve had coaching clients in India worry that they’re not following the Medi diet closely enough, only to realise that in fact their own traditional diet is exceptionally healthy. So perhaps it’s time to look past the Medi diet – good though it is – and seek inspiration from heritage diets worldwide.

One traditional diet I suspect few of us would want to follow is that of the Maasai, nomadic tribespeople who live in the north-west of Tanzania and southern Kenya. We were lucky enough to visit a village in the Serengeti – pictured above, with their permission. Of course, I had lots of questions for our guide about diet and longevity. Their diet couldn’t be more different to that studied by Dr Quirijn de Mast and his team.

MILK, MEAT AND BLOOD

The Maasai are pastoralists, tending herds of goats and cattle as they move between villages across region. They don’t grow crops and, as a result, their diet is based on milk, meat and blood. Our guide told me that his first two meals each day are usually a mix of cows’ blood and goats’ milk. I can’t imagine what that tastes like. The evening meal consists of a maize porridge called ugali, and beef stew. Roots and tree bark are eaten as medicine rather than food. Heavy in saturated fat and cholesterol, it doesn’t fit our idea of a ‘healthy’ diet, but the Maasai have low rates of heart disease, high blood pressure and diabetes. Why? They have genetic adaptations that enable efficient cholesterol metabolism and regulation, as well as a lifestyle that involves walking for up to 10 hours a day.

The chief of the village we visited is 97 years old, so something must be working!

RELATIONSHIPS, AND RECIPES

We’re taking our usual summer break for the rest of August. If you’d like something to listen to in the meantime, I talked to Lucy Cavendish on her podcast, How to Have Extraordinary Relationships, about our relationship with our brains. It’s the most important one we’ll ever have.

If we don’t take care of our brains – and make brain health a priority – we’re doing ourselves a fundamental disservice, as well as increasing our risk of cognitive decline.

Saturday, July 2, 2022

Breath: The New Science of a Lost Art by James Nestor

 Lots of very good stuff in here, better to read and digest this yourself. But it really is your doctor's responsibility to consolidate this into stroke protocols.

Or you can listen to this 26 minute documentary.

The Lost Art of Breathing

"After recovering from pneumonia for the third time, journalist James Nestor took decisive action to improve his lungs. He questioned why so many humans -- and only humans -- have to contend with stuffy noses, snoring, asthma, allergies, sinusitis and sleep apnea, to name but a few. James hears remarkable stories of others who have changed their lives through the power of breath. His deep dive into the unconscious and oft-ignored act of human respiration offers us all a way to breathe easier." More in this BBC special. { read more }

But a few highlights:

  1. Joseph Wolpe psychiatrist, rediscoverd carbon dioxide therapy for anxiety; Breath page 176

  2. A mixture of 5% carbon dioxide and the rest oxygen made popular by Yalt physiologist Yandell Henderson; Breath page 174-5.  Was used with great success to treat strokes, pneumonia,asthma,and asphyxia in new born babies.

  3. Whenever the body is forced to take in more air than it needs, we'll exhale too much carbon dioxide, which will narrow the blood vessels and decrease circulation,especially in the brain; Breath page 163.  With just a few minutes, or even seconds of overbreathing, brain blood flow can decrease by 40 percent.

  4. Porges found a less invasive way to stimulate the vagus nerve; Breath page 150.  Willing ourselves to breath slowly will open up communication along the vagal network and relax us into a parasympathetic state. Breathing really fast and heavy on purpose flips the vagal response the other way, showing us into  stressed state.

  5. Tummo for vagal nerve stimulation by Dr. Stephen Porges; Breath page148.

  6. Wim Hof breathwork: Breath page 156.  To practice the technique, start by finding a quiet place and lying flat on your back  with a pillow under your head. Relax the shoulders, chest and legs. Take a very deep breath into the pit of your stomach and let it out just as quickly. Keep breathing this way for 30 cycles. If possible breath thru the nose. At the end of 30 breaths, exhale to the natural conclusion, leaving about a quarter of the air in your lungs, then hold that breath for as long as possible. Once you've reached your breath hold limit,take one huge inhale and hold it for another 15 seconds. Very gently, move that fresh breath of air around the chest and to the shoulders, then exhale and start heavy breathing again. Repeat the whole pattern 3 or 4 rounds and add in some cold exposure(cold shower, ice bath,naked snow angels) a few times a week.  This flip flopping is the key to Tummo's magic.

  7. 5.5 breaths per minute  blood flow to the brain increased; Breath page 83.   

  8. Breathing way less delivered the benefits of high altitude training at 6500 feet; Breath page 95.   Other names are hypoventilation, hypoxic training,Buteyko training, normobaric hypoxia training.  

Why you want high altitudes:

High altitudes for Training the Brain to Survive Stroke.

Long lived Georgia O'Keefe at 7000 feet;

HOW TO LIVE TO (NEARLY) 99 IN FULL HEALTH…

If you want to sign up for his newletter: mrjamesnestor.com/breath

Monday, September 13, 2021

AHA issues recommendations for patients with CVD planning high-altitude activities

Make sure you question your doctor on the benefits of high altitude living.

But then since you do not have a cardiovascular disease(stroke has been called neurological by the WHO since 2006) this may not apply to you.

High altitudes for Training the Brain to Survive Stroke.

Long lived Georgia O'Keefe at 7000 feet;

HOW TO LIVE TO (NEARLY) 99 IN FULL HEALTH…

The latest here:

AHA issues recommendations for patients with CVD planning high-altitude activities

Because sudden cardiac death can occur in patients with CVD traveling to higher altitudes, experts recommended in a new American Heart Association scientific statement that patients with CVD consult a physician before travel.

“Many people and health care professionals are familiar with symptoms of acute mountain sickness like headaches, dizziness, nausea and weakness. However, they may be less aware of the stress placed on the body — and particularly the heart and lungs, when people with cardiovascular disease travel to mountainous regions where there is a reduction in oxygen availability compared to sea-level conditions. If people are not prepared, they may be at an increased risk of adverse events in these types of environments,” William K. Cornwell III, MD, MSCS, FAHA, assistant professor of cardiology at the University of Colorado School of Medicine and chair of the scientific statement writing group, said in a press release. “This concise overview of how altitude impacts patients with cardiovascular disease provides additional information to help guide clinicians in advising their patients on best practices for safe travel to higher altitudes and mountainous regions.”

Considerations for patients with CVD planning high-altitude activities
Because sudden cardiac death can occur in patients with CVD traveling to higher altitudes, experts recommended in a new AHA scientific statement that patients with CVD consult a physician before travel. Data were derived from Cornwell WK 3rd, et al. J Am Heart Assoc. 2021;doi:10.1161/JAHA.121.023225.

According to the statement, high-altitude exposure is associated with lower blood-oxygen content caused by reduced atmospheric pressure and partial pressure of oxygen, creating a hypoxic environment. High-altitude activities can require increased oxygen demand, which is a challenge to overcome in relatively oxygen-deprived environments.

In the presence of acute hypoxia, individuals can experience systemic arterial vasodilatation, hypoxic pulmonary vasoconstriction and activation of peripheral chemoreceptors. These physiological responses can have downstream effects, including sympathetic activation, which increases BP and cardiac output, as well as hyperventilation and pulmonary hypertension, the committee wrote.

Effects of high-altitude activities

“More than 100 million people travel to mountainous environments yearly for work or pleasure. Mountain activities frequently involve exercise, which, when combined with environmental changes such as temperature, humidity, pressure and oxygen availability, place unique challenges on the cardiovascular system,” the committee wrote. “Medical resources are frequently limited, which may compromise outcomes following adverse events. Therefore, it is incumbent on clinicians to understand the unique physiologic challenges associated with exercising in hypoxic environments.”

The committee identified the following CVD states that, if identified in a patient planning high-altitude travel, increase risk for CV events at high altitude:

In patients with CAD, atherosclerosis can cause paradoxical vasoconstriction of coronary vessels in response to increased oxygen demand from exercise combined with altitude-related hypoxia. Moreover, acute hypoxia may exacerbate angina symptoms.

In hypertension, high-altitude exposure causes an initial reduction in BP associated with hypoxia-related systemic vasodilation; however, the initial reduction is counteracted by chemoreflex-mediated vasoconstriction, causing BP elevation. This risk in BP is primarily driven by increased oxygen content due to high-altitude acclimatization.

In patients with rhythm disorders or at risk for sudden cardiac death, acute hypoxia may trigger an arrhythmic event. According to the statement, prior observational studies showed that more than 50% of sudden cardiac deaths at altitude occur within the first day of exposure.

Physiological responses to hypoxia, including sympathetic nerve activation, elevated systemic and pulmonary arterial pressures, tachycardia, increased lung fluid content and reductions in stroke volume, may worsen symptoms in patients with HF with reduced ejection fraction. In addition, HF therapies such as carvedilol, diuretics and acetazolamide may inhibit exercise tolerance at altitude. According to the statement, there are no published studies on altitude tolerance among patients with HF with preserved ejection fraction; however, patients with HFpEF are likely to have elevated pulmonary arterial pressure, hypertension and atrial fibrillation at sea level, so heart-rate and BP control at altitude may be important.

 

Monday, July 12, 2021

HOW TO LIVE TO (NEARLY) 99 IN FULL HEALTH…

I guess I could do Quito,Ecuador at 9350 feet

HOW TO LIVE TO (NEARLY) 99 IN FULL HEALTH…

We’ve written before about the remarkable power of art to fuel our brains. Not only does it nourish our imagination, but looking at art has been found to activate critical parts of our brain, helping fend off cognitive decline and dementia.  Actually making art brings additional benefits, reducing stress (and the inflammation kindled by stress) and amplifying our sense of wellbeing. But perhaps we can also learn from the lives of artists, many of whom live for above-average life spans with beyond-average health. How do they do this?

For my latest book, Windswept, (thank you to the 413 of you who tuned in to watch our webinar on walking!), I spent months researching one of my artistic and longevity heroines: Georgia O’Keeffe. O’Keeffe died quietly, a few months short of her 99th birthday.  And although she’d previously had breast cancer, she was disease-free other than failing eyesight.  Her long and healthy life was nothing to do with her genes – both her parents died in middle age. So what can O’Keeffe teach us about a life lived both well and long?

While investigating O’Keeffe’s walking routes I also spent time in her library, where I discovered a large number of health and longevity books.  It appears that, from her 60s onwards, O’Keeffe was fascinated by good health and determined to improve her own.  Her library included numerous cookery books but also books on vitamins, wholegrains, exercise, organic gardening as well as books with titles like ‘How to Live to 180’ and  ‘Cook Right – Live Longer.’

O’Keeffe knew a mere fraction of what we know today. For most of her life she had no access to exotic superfoods, supplements, sunscreen, personal trainers/gyms or HRT. And yet she had an instinctive understanding of what the body and soul need to survive and thrive. And – in my view – she looked utterly fantastic until the very end.

These are a few of the less-known things I learned about Georgia O’Keeffe, which may have helped:

She lived at altitude, spending most of her time in a ranch 7000 feet up. We’ve not written about altitude before but living at a reasonably high altitude (between 4,900 and 8000 feet) has been found to enhance health and longevity in men and – particularly – in women. A study of 10 million Americans found those living at altitude lived for 1-3 years longer than those living at sea level. And the higher the altitude the greater the longevity benefit. Risk of heart attacks fell dramatically at high altitude – particularly for women.

At altitude the air is thinner and contains less oxygen, encouraging our hearts to work harder. Researchers think this protects our hearts by making them work more efficiently.  Funnily enough, doctors worked this out two centuries ago, sending the sick and exhausted to rest in Alpine sanatoriums.

She grew her own organic fruit and vegetables. Having spent several years living in New York, O’Keeffe moved to a remote and isolated spot in New Mexico when she was in her mid-50s. Here she gardened, growing all her own organic fruit and vegetables, well away from the scourge of pollution and noise – both of which we’ve written about before. More and more research is linking pollution to poor health, while gardening is increasingly recognised as therapeutic in numerous ways.  I talked on our webinar  about the importance of getting our hands physically on nature – in soil, on tree trunks, among grass.

She rose at dawn every day, had a cup of herbal tea, then ran through a series of stretching exercises based on a practise called Mensendieck, proven in studies to improve motor function and reduce lower back pain. Starting each day with stretching exercises was something two of the nonagenarians in The Age-Well Project swore by.

We’re huge fans of setting our circadian clocks by waking at the same time every day, as O’Keeffe did. A long term study of 32,000 nurses found that “early risers” were up to 27% less likely to develop depression. A study published last month found that night owls who shifted their sleep/wake clocks to rise at 6am (O’Keeffe’s time) cut their risk of depression by a whopping 40%.   We talked on our webinar about the relationship between light and the feel-good hormone, serotonin. Research suggests that an abundance of daylight improves our mood.

She ate three home-cooked meals a day, starting with a large breakfast that often included meat, nuts and yogurt. As we get older our bodies benefit from extra protein and B12.  Her daily portion of meat would have ensured she got both sufficient protein and sufficient B12. Her daily yogurt provided a good dose of probiotics, and an intriguing study from 2020 links daily yogurt consumption to a reduced risk of breast cancer – scientists speculate that one of the causes of breast cancer may be inflammation triggered by harmful bacteria. The bacteria in yogurt could dampen this inflammation, apparently. Another reason to have a spoonful of yogurt every day.

O’Keeffe – who loved cooking and often went to bed with a cookery book – then ate a light lunch. Soufflé and salad with foraged herbs was a favourite. She ate her last meal at 5pm – fruit and cheese.  An early supper ensured she fasted for 15 hours each night. And yes, we’ve written about the importance of a long overnight fast too. And we all know the importance of eating plentiful vegetables every day. She avoided sugar and, being a farmer’s daughter, canned and froze her own garden produce for the long, cold New Mexican winters.

O’Keeffe ate cheese every day. She never broke a bone – and her daily piece of calcium-rich cheese bought from the next door farm, where she also bought her (organic) milk and butter, may have helped.

She was out in the sun every day – New Mexico has 300 days of sunshine a year (yes, I know… sigh). Without any Factor 50, her body lapped up plenty of Vitamin D. Research from Sweden has found that women who get more sun live longer – we wrote about the astonishing power of sunlight here.

She walked her dogs every day, lengthy walks and climbs that had her much-younger visitors puffing and panting. She walked long distances all her life, much of it up and down hills – which, as I explained on our webinar, works every muscle in the lower half of our body. We’ve also extolled the age-well benefits of dogs on several occasions: good for your gut, your serenity, and so much more. Let’s not forget cats – a recent study published in Current Biology found that cats form deep social bonds with their owners, possibly deeper than those formed by dogs. They just express themselves in a different way. As cat owners will already know….

O’Keeffe was an avid reader. When her sight went, she got someone to read to her for an hour every night. We’ve written about why readers live longer in our book and recently at Noon.

She also loved travelling, which is to say she regularly exposed herself to novelty. Aged 72, O’Keeffe embarked on a world tour, spending weeks in India, Japan, Taiwan, Thailand, Cambodia, Pakistan, the Middle East and Rome. Two years later she rafted for seven days down the Colorado River.  At the age of 87 she toured Morocco on a donkey, impelled by her intense curiosity and sense of wonder. She took her last Big Trip aged 96, to Costa Rica. Studies of superagers show many of them to be keen travellers: neuroscientists think travel could enhance our cognitive health because of the way in which new environments force our brains to work harder.  After months of map-reading, talking to strangers and grappling with alien local customs as I followed in the footsteps of my Windswept Women, I can vouch for this.

O’Keeffe exposed herself to heat and to cold. Her pueblo bungalow had no central heating, and she recounts being hot in the summer and cold in the winter– but she loved the elements. She loved the wind, she adored storms, she had no truck with a bit of cold, often camping high in the desert where nightly temperatures plunged below zero.  We say: keep taking those inflammation-busting cold showers!

O’Keeffe possessed grit – something else we wrote about in The Age-Well Project and a trait possessed by all the women I researched for Windswept. Grit (or resilience) enables us to learn and move on from set-backs. It doesn’t mean we bounce back. It means we learn, recover, accommodate our pain/grief/loss and then move forwards as older, wiser, and changed human beings.  O’Keeffe had to recover from numerous set-backs, including the early deaths of both parents, nervous breakdowns in which she was hospitalised, an unfaithful husband, wounding reviews, cancer and a mastectomy. And much more besides.

Incidentally, psychologists often attribute ‘grit’ to cognitive flexibility – a capacity to be open-minded and adaptive. Cognitive flexibility has been linked to both creativity and longevity as well as resilience. Read more about cognitive flexibility here.

Finally, and perhaps most importantly, O’Keeffe had a profound sense of purpose. She knew she wanted to be a painter from the age of 12.  She made huge sacrifices to become a painter, ultimately dedicating her life to her work. As she said ‘I’ve always known what I wanted – most people don’t’. She didn’t rate happiness, saying it comes and goes.  It was work that made her pulse race. Every day she lugged canvases and paints outside, often painting for 14 hours a day.  When her sight went, she turned to ceramics, working to the very end.

We can’t all be successful artists. But we can cultivate a sense of purpose and meaning. We can all seek out interests that give us joy and spark our curiosity. And we can all walk, stretch, fast over-night, eat a balanced diet and develop our grit. Some can even handle the odd cold shower.

And doesn’t O’Keeffe look splendid? With her single breast, without hair dye, make-up, botox or fillers, she reminds us all how to live comfortably in our own skin.

Do you have a longevity hero or heroine? Please do share with us in the comment box or on social media. We’d love to hear.

And if you missed the webinar, you can watch it here.

Alternatively if you’d rather listen while you walk, you can hear me discussing Windswept with the wonderful Catie Friend here.

Annabel

 

 

Wednesday, February 21, 2018

20,000 steps at 9,500 feet - 10 miles

I was in Ecuador for the past week. Flew in on Monday, Feb. 12, on Tuesday we walked from our hotel to the Old Town area, did have to stop several times to catch our breath during the day.  Didn't have enough time to get acclimated to the altitude, the second night there I got absolutely no sleep.  Further posts coming on the beach excursion.

Maybe you want to live there for this reason:

High altitudes for Training the Brain to Survive Stroke.

Monday, April 3, 2017

Patients can fly, go to high altitudes with precautions after MI

You'll have to ask your doctor if they know one damn thing about this travel after a stroke.

Patients can fly, go to high altitudes with precautions after MI

Most patients after an MI and other cardiac conditions can return to high altitudes, including air travel, after a few weeks, according to information presented at the American College of Cardiology Scientific Session.

Once high altitude, defined as over 2,500 meters (8,200 feet), is attained, a patient can experience “fairly significant” physiological changes. Most mountains are high altitude, and airplanes fly around 30,000 to 40,000 feet, but the cabins are pressurized to 2,400 meters.
John P. Higgins
Effect of high altitudes
“Altitude does require more work from the [CV] and respiratory systems,” John P. Higgins, MD, MPhil, MBA, FACC, FACP, FAHA, director of exercise physiology at Memorial Herman Sports Medicine Institute in Houston, chief of cardiology at Lyndon B. Johnson General Hospital in Houston and associate professor of cardiovascular medicine at the University of Texas Medical School in Houston, said in his presentation. “People with mild to moderate stable [CVD] can go with the right precautions and preparation to altitude. However, those that have [instability], high risk or a recent procedure should delay travel and be guided by their provider.”
Higgins said bodies work most efficiently at sea level, where the barometric pressure is around 760 mm Hg. At sea level, the partial pressure of inspired oxygen is 149 mm Hg and in-arterial saturation in blood is 98%. In higher altitudes, the partial pressure of the inspired oxygen decreases. At 8,000 feet, or where airplanes are pressurized, the barometric pressure is an estimated 564 mm Hg, the partial pressure of inspired oxygen is 108 mm Hg and in-arterial blood saturation is 60%.
“A healthy individual should have a saturation of 90% or more and be able to handle that without any problems,” Higgins said.
A short-term effect of going to a higher altitude is hypobaric hypoxia, where the body increases its minute ventilation and tidal volume, which causes hypoxic pulmonary vasoconstriction. The body’s cardiac output is increased to compensate for it, Higgins said.
Waiting periods
Higgins reviewed the recommended amount of time before patients can return to higher altitudes and air travel. Patients with CAD and prior MI who are stable experience angina symptoms at lower workloads. Those who had non–STEMI or STEMI should wait 2 weeks before flying or going to a location of high altitude, but if they had a complicated case of MI, 6 weeks is recommended. Patients with a recent diagnosis of ACS who were not revascularized are recommended to have a maximum stress test prior to air travel, but if they are revascularized with PCI and have no complications, they can wait a couple of days. Patients who recently underwent CABG should wait 10 days for gas to be reabsorbed, he said.

More at link.

Tuesday, February 14, 2017

Intermittent hypobaric hypoxia preconditioning protects against acute severe hypoxic damage in brain

So prior to your stroke you would need to be pretreated with this. So start planning your stroke now. Or you could just live at a higher elevation. But the reduction in nitric oxide levels does not seem like a good thing.

High altitudes for Training the Brain to Survive Stroke.

Intermittent hypobaric hypoxia preconditioning protects against acute severe hypoxic damage in brain

D. Coimbra-Costa1, N. Alva1, T. Carbonell1, R. Rama1
1. Biologia cel.lular, Fisiologia i Immunologia, Universitat de Barcelona, Barcelona, Catalonia, Spain.

Acute severe hypoxia (SH) causes an increase in oxidative stress and apoptosis in the brain. In contrast, intermittent hypobaric hypoxia (IHH) can increase brain antioxidant capacity and result in neuroprotection, as we previously reported (Costa et al., 2013). Thus, the present work uses IHH as preconditioning against damage potentially induced by SH. Adult rats were divided into four groups: 1) controls; 2) SH group, subjected to 6 h of acute hypoxia at 7% oxygen; 3) IHH group, exposed to 380 mmHg (equivalent to an altitude of 4000 m) in a hypobaric chamber, 4 h/day for 8 days; and 4) combined IHH-SH group, subjected to acute SH (7% oxygen) for 6 h after the last IHH exposure. Animals were anesthetized with isoflurane inhalation and then sacrificed.The brains were extracted and compared to controls.The study was approved and authorized by the Institutional Committee of Animal Care and Research of the University of Barcelona. The experimental protocol follows the European Community guidelines. SH induced oxidative stress in the brain, as indicated by increased levels of oxidized proteins, lipid peroxidation, inducible nitric oxide synthase (iNOS) expression and nitric oxide metabolites. This acute hypoxic also resulted in glutathione depletion and increased glutathione peroxidase. As for the apoptosis parameters studied, SH increased cytochrome c in the brain, and the activity of caspase 3 in the brain cortex and hippocampus. The IHH preconditioning protocol induced the expression of HIF-1 without causing oxidative stress or apoptosis, and induced expression of neuroprotective proteins such as EPO and VEGF. The IHH reduced nitric oxide levels by 28%, the content of oxidized proteins by 30% and lipid peroxidation values by 48%. It also better preserved the ratio of oxidized/reduced glutathione in brain tissue. Our study thereby demonstrates that IHH is a useful way to prepare the brain to tolerate the effects of SH better, maintaining antioxidant activity and mitochondrial function, and promoting the expression of neuroprotective factors.

Where applicable, experiments conform with Society ethical requirements

Saturday, January 23, 2016

Remote ischemic preconditioning in the prevention of ischemic brain damage during intracranial aneurysm treatment (RIPAT): study protocol for a randomized controlled trial

If you are getting an aneurysm fixed what is your doctor doing to precondition the brain in case a stroke occurs? ANYTHING AT ALL? Does your doctor even know anything about this?

Neurovascular Mechanisms of Ischemia Tolerance Against Brain Injury

 

Novel cellular mechanisms for neuroprotection in ischemic preconditioning: a view from inside organelles

 

Can Blood-Pressure Cuffs Work? Novel Ways to Limit Stroke Damage

 

High altitudes for Training the Brain to Survive Stroke.

Remote ischemic preconditioning in the prevention of ischemic brain damage during intracranial aneurysm treatment (RIPAT): study protocol for a randomized controlled trial 
Selma Tülü1, Miriam Mulino1, Daniel Pinggera1, Markus Luger2, Philipp Würtinger3, Astrid Grams4, Thomas Bodner5, Ronny Beer5, Raimund Helbok5, Raffaella Matteucci-Gothe6, Claudia Unterhofer1, Elke Gizewski4, Erich Schmutzhard5, Claudius Thomé1 and Martin Ortler1*

1 Department of Neurosurgery, Medical University of Innsbruck, 35, Anichstrasse, Innsbruck 6020, Austria
2 Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck 6020, Austria
3 Central Institute for Medical and Chemical Laboratory Diagnostics, Medical University of Innsbruck, Innsbruck 6020, Austria
4 Department of Neuroradiology, Medical University of Innsbruck, Innsbruck 6020, Austria
5 Department of Neurology, Medical University of Innsbruck, Innsbruck 6020, Austria
6 Department of Public Health and Health Technology Assessment, UMIT Health and Life Sciences University, Hall in Tirol, Austria
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Trials 2015, 16:594  doi:10.1186/s13063-015-1102-6
The electronic version of this article is the complete one and can be found online at: http://www.trialsjournal.com/content/16/1/594

Received:8 March 2015
Accepted:3 December 2015
Published:29 December 2015
© 2015 Tülü et al.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.


Abstract

Background

The treatment of intracranial aneurysms may be associated with cerebral ischemia. We hypothesize that pre-interventional remote ischemic preconditioning (RIPC) reduces ischemic cerebral tissue damage in patients undergoing elective intracranial aneurysm treatment.

Methods/Design

This study is a single-center, prospective, randomized, double-blind explorative trial. Patients with an unruptured intracranial aneurysm admitted to Innsbruck Medical University Hospital for coiling or clipping will be consecutively randomized to either the intervention group (= RIPC by inflating an upper extremity blood-pressure cuff for 3 x 5 min to 200 mmHg) or the control group after induction of anesthesia. Participants will be randomized 1:1 to either the preconditioning group or the sham group using a random allocation sequence and block randomization. The precalculated sample size is n = 24 per group. The primary endpoint is the area-under-the-curve concentration of serum biomarkers (S100B, NSE, GFAP, MMP9, MBP, and cellular microparticles) in the first five days after treatment. Secondary endpoints are the number and volume of new ischemic lesions in magnetic resonance imaging and clinical outcome evaluated with the National Institutes of Health Stroke Scale, the modified Rankin Scale, and neuropsychological tests at six and twelve months. All outcome variables will be determined by observers blinded to group allocation. This study was approved by the local institutional Ethics Committee (UN5164), version 3.0 of the study protocol, dated 20 October 2013.

Discussion

This study uses the elective treatment of intracranial aneurysms as a paradigmatic situation to explore the neuroprotective effects of RIPC. If effects are demonstrable in this pilot trial, a larger, prospective phase III trial will be considered.

 

Monday, October 12, 2015

"Beeting" high altitude acclimatization with beet juice

Is our stroke strategy going to be updated to see if beet juice can precondition us to survive a stroke better?  If it can acclimatize us to high altitude then maybe it can mimic the altitudes necessary for preconditioning without having to live there. Or maybe you'd rather go to high altitudes for Training the Brain to Survive Stroke.
This would seem to be so much easier and faster than HBOT but we'll never know since our stroke associations will fail once again in even answering simple questions like this.
When will we have a stroke protocol that has natural foods delivering nitric oxide to us to increase the oxygen carrying capacity of our blood? This sounds extremely fucking important. Do not do this on your own.

"Beeting" high altitude acclimatization with beet juice

Ever since human beings first began climbing the world’s tallest mountains, they have struggled with a basic problem: altitude sickness, caused by lower air pressures which affect the ability of our bodies to take up oxygen.
Or, as actor Jason Clarke says in his role as the climbing guide Rob Hall in the recently released movie, Everest, “Human beings simply aren’t built to function at the cruising altitude of a 747.”
How well humans tolerate high altitudes is highly variable, but the best way to minimize the risk of developing acute mountain sickness (AMS) is acclimatization, or simply spending enough time up high to allow the body to make adjustments to lower oxygen levels.
But what if you could help your body acclimatize more quickly and thoroughly with the help of a natural substance – like beet juice? A team of Norwegian and Swedish researchers decided to see how nitrate-rich beet juice might affect acclimatization on a 39-day expedition to Kathmandu and at 3700 metres in the Rolwaling Valley, Nepal.
Nitric oxide key
One aspect of successful acclimatization is that the blood vessels are able to deliver enough oxygen throughout the body. But normal blood vessel function depends on the body’s ability to naturally produce a compound called nitric oxide (NO).
In healthy people at sea level, production of adequate amounts of NO is not a problem, but with the reduced oxygen availability at high altitude it is a challenge, simply because natural NO production requires oxygen.
But the body has a “back-up system” for NO production at altitude, and it is here that beet juice can help. The secret ingredient in beet juice is high levels of nitrate, which the body can then convert to NO.
Blood vessels work better
Previous research has shown that blood vessels tend to contract at high altitude, so researchers decided to see if they could improve blood vessel function at high altitude simply by having test subjects drink beet juice. They measured blood vessel function with a standard test of arterial endothelial function, a flow-mediated dilatation test (FMD) that uses ultrasound.
In a study recently published in Nitric Oxide: Biology and Chemistry, the researchers showed that consumption of organic nitrate-rich beet juice restored reduced blood vessel function at high altitude.
The researchers behind the study are from the K.G. Jebsen Center for Exercise in Medicine – Cardiac Exercise Research Group (CERG) at the Norwegian University of Science and Technology (NTNU) and the Environmental Physiology Group at Mid-Sweden University in Östersund, Sweden.
First-ever study
The researchers’ project is the first time anyone has studied if consumption of a nitrate-rich juice could have positive effects on blood vessel function at high altitude.
Both men and women were studied with ultrasound to check their blood vessel function, before and during the high altitude expedition. As expected, high altitude made blood vessels contract.
To test if beet juice could make the blood vessels relax again, the test subjects were investigated after drinking two types of beet juice with a 24-hour break between tests.
One of the juices contained high amounts of nitrate while the other type had no nitrate in it (placebo). Neither the study participants nor the researchers knew what type of beet juice each person drank before blood vessel function was measured, and the juices (nitrate-rich versus placebo) were given in a random order.
The study showed that beet juice with high amounts of nitrate made the blood vessels relax and return to normal function, while beet juice with no nitrate (the placebo) did not have any effect.
“Next time you plan a trip at high altitude, maybe it is worth carrying a bottle of beet juice in your backpack,” said the study’s corresponding author, Svein Erik Gaustad, from NTNU’s CERG. “It may be the extra boost your body needs to deliver enough oxygen to your tired muscles and keep you healthy when you are climbing a high mountain.”
http://gemini.no/en/2015/10/beeting-high-altitude-sickness-with-beet-juice/