Stroke in the news: Beau Biden, Bret Michaels

Stroke is the leading cause of disability in the U.S., and the third leading cause of death. Almost 800,000 people in the U.S. have a stroke each year. Although stroke is usually perceived as a condition that afflicts older Americans, it occurs in people of all ages. About 25% of strokes occur in people under the age of 65, and 10-15% occur in those under age 45.1

At the age of 41, Beau Biden, Delaware Attorney General and son of U.S. Vice President Joe Biden, suffered what was called a mild stroke. Joe Biden himself suffered from a hemorrhagic stroke due to a ruptured brain aneurysm in 1985 at the age of 45.2

Bret Michaels, of the band Poison and a contestant on The Celebrity Apprentice, suffered a subarachnoid hemorrhage (a type of hemorrhagic stroke) at age 47.3

What is a hemorrhagic stroke?

Most strokes, about 85%, are ischemic strokes, in which blood flow to the brain is blocked either by a clot or atherosclerotic plaque. The remaining 15% of strokes are hemorrhagic strokes, caused by bleeding in the brain due to the rupture of a blood vessel. This may be the rupture of a small, damaged artery or an aneurysm. Hemorrhagic stroke is even more devastating than ischemic stroke – the rapid bleeding into the brain compresses the neural tissue, most often resulting in permanent damage or death.1

What makes the small blood vessels of the brain susceptible to rupture?

Hemorrhagic stroke, on average, affects younger people than ischemic stroke does, and the most common cause of hemorrhagic stroke is high blood pressure.4  Elevated blood pressure places stress on the walls of the small delicate vessels in the brain, and is the foremost risk factor for both ischemic and hemorrhagic strokes. Small vessels contain a much thinner layer of muscle, or no muscle layer at all, making them more susceptible to the effects of elevated pressure.

How to protect yourself from hemorrhagic stroke: Avoid salt!

High blood pressure is the most important risk factor for hemorrhagic stroke, and Americans have a 90% lifetime probability of having high blood pressure. The most effective way to keep blood pressure in a favorable range is to avoid the huge amounts of excess salt that most Americans consume. Stroke mortality is significantly higher in Japan and exceptionally high in certain areas of China where salt intake is high, in spite of low-fat diets.5 It is also well established that Third World countries that do no salt their food are virtually immune to hypertension and strokes.

High-salt consumption may be potentially more dangerous for vegans, vegetarians, and others who have earned low cholesterol levels by eating otherwise healthful diets. Many vegans believe that their low cholesterol levels and decreased atherosclerosis risk make them exempt from all types of cardiovascular disease, but this is not the case. Unlike heart disease, cholesterol is not an important risk factor for hemorrhagic stroke. In fact, low cholesterol levels are associated with increased risk of hemorrhagic stroke. A number of studies both in Japan and in the West have illustrated that fewer animal products and a low serum cholesterol were associated with increased risk of hemorrhagic stroke.6 The plaque-building process that results in atherosclerosis and premature death may in some way actually protect the fragile blood vessels in the brain from rupture due to high blood pressure. A high-salt diet may dramatically increase the risk of hemorrhagic stroke in vegans because they can live longer than the general population and not die from a heart attack first. Of course, excess sodium increases both heart attack and stroke death in all diet styles, but in vegans, a high-salt diet may be even more dangerous. To protect against heart attacks, ischemic strokes, and hemorrhagic strokes, you must dramatically curtail salt consumption. 

Excess salt is more dangerous than most people realize. In addition to high blood pressure and stroke, salt contributes to kidney disease, heart diseaseosteoporosis, ulcers, and stomach cancer.7 Avoiding salt is an essential component of a health-promoting, disease-preventing diet.

To learn more, read my articles and newsletters about salt, hypertension, and reducing blood pressure.


1. Centers for Disease Control: Stroke.

American Heart Association: Stroke.

5. Kono S, Ikeda M, Ogata M. Salt and geographical mortality of gastric cancer and stroke in Japan. J Epidemiol Community Health. 1983 Mar;37(1):43-6.

6. Iso HM, Stampfer MJ, Manson JE, et al. Prospective study of fat and protein intake and risk of intraparenchymal hemorrhage in women. Circulation 2001;103:856.

Yano K, Reed D, MacLean C. “Serum Cholesterol and Hemorrhagic Stroke in the Honolulu Heart Program.” Stroke 1989;20(11): 1460-1465.

7. Tsugane S, Sasazuki S. Diet and the risk of gastric cancer. Gastric Cancer 2007;10(2):75-83

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Comments (11) Read through and enter the discussion with the form at the end
Joseph Rodriguez - May 12, 2010 3:42 PM

Beau Biden has been reported to be hospitalized at Thomas Jefferson University Hospital, where I'm completing my anesthesia training. Prior to this, I witnessed many stroke/brain attacks as an intensive care nurse. The general public has a poor understanding of the debilitating effects of stroke, and are often in wonder of how the daily functioning of their loved one can change.

Unfortunately, rather than using this as an opportunity to highlight the disease protection benefits of a plant-base diet, the media and American health system (including TJUH where I am) will use this as a chance to highlight 'advanced stroke care' - a strategy which produces questionable benefits, but does bring insurance money into the health system.

Joseph Rodriguez, SRNA.

StephenMarkTurner (formerly Steve) - May 12, 2010 4:30 PM

Can this also be construed as advice against an extremely low fat diet ie keep eating nuts, seeds and avocados?


teri - May 12, 2010 8:36 PM

make sure you take your nuts, seeds, avacado and flax!!!!!!!

Deana Ferreri - May 13, 2010 9:36 AM

Yes, you are correct. There is evidence that fat is protective against hemorrhagic stroke.

MIke Rubino - May 13, 2010 7:41 PM

Its interesting to me to watch the rich and mighty fall . Yet only a very few will speak up and blame the SAD for these happenings.

carfree - May 15, 2010 11:36 AM

I wonder if there's any corelation between the chances of hemorrhagic stroke and the fragility of blood vessels elsewhere. I tend to break vessels in my fingers fairly easily. It does concern me when it happens, although I don't know what can be done about it. I do eat a nutritarian diet and avoid salt. But as noted here, that may increase my risk somewhat by lowering cholesterol. Any opinion, Dr. Ferreri?

StephenMarkTurner (formerly Steve) - May 17, 2010 6:31 AM

I could help but notice this in the news this morning, in an article about "research on the best hangover cure". Some researcher suggested bacon sandwiches 'cause bacon is rich in protein. There is junk science, and then joke science I guess.

"Even famed British chef Jamie Oliver got on the bandwagon, telling the newspaper that when he's hungover, "I wouldn’t normally go for fried stuff, but in the case of a hangover I recommend a double portion of eggs and bacon."


Jane - May 20, 2010 11:11 AM

Can Dr. Furhman comment on the importance of enough healthy fats: nuts, seeds (especially flax) and avocao. I know three health professionals who were/are on a 80% vegan, low sodium, raw food diet and all three had stokes. In two cases the strokes were incapacitating.

Anna - October 15, 2010 1:07 PM

My mother died from hemorrhagic stroke. It was caused by abnormal blood vessel in the brain she was born with, but we did not know about untill the stroke. She died year and a half after the stroke in coma for the first several month completely bed ridden, paralized untill the end. From taking care of her thoughout that time I know first hand what stroke can do to a person. After my mother had a stroke the doctors told us that ubnormatily she had in the brain might very well be genetic and it possible that I may have the same thing. I have been thinking to get MTI and find out, but my problem was even if I do - what can I do about it? I do not want the brain sergery. So, thank you Dr. Fuhrman for the article. Avoiding the salt and eating nuts, seeds and avocados sound much better then craniotomy.

Amy - November 11, 2010 8:03 PM

Does anyone know how much sodium would be considered a "safe" amount?

Jim - August 22, 2011 2:36 PM

Interesting article, thank you. I had a hemorrhagic stroke in late February, and I'm struggling through recovery now. I'd be interested to know your take on aspirin therapy for hemorrhagic stroke survivors. I was amazed when my neurologist recommended aspirin to prevent ischemic stroke, when I've already had the hemorrhagic. I've been doing a lot of internet research, and see a lot of difference in opinion/study results.

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