The More You Know: John Singleton’s Death Proved We Don’t Know Nearly Enough About How Strokes Work

May 3, 2019  |  

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From the outside looking in, John Singleton looked perfectly healthy, so his death at the age of 51 this week from a stroke, for many, was a major shock. However, according to his family, Singleton had been dealing with hypertension, and high blood pressure is a “silent killer” according to experts due to its connection to strokes and heart attacks. His family put out a warning to Black women and men out there to use the director’s untimely death as a reason to go get their blood pressure checked and to take it more seriously.

“Like many African Americans, Singleton quietly struggled with hypertension,” a representative said in a statement released this week. “More than 40 percent of African American men and women have high blood pressure, which also develops earlier in life and is usually more severe. His family wants to share the message with all to please recognize the symptoms by going to Heart.org.”

And while some people felt that everything happened too fast in Singleton’s case, when you don’t know what’s been brewing inside of people’s bodies, it’s impossible to say whether or not someone should or shouldn’t be able to recover from something as damaging as a major stroke.

Nisha Jackson, Ph.D., hormone and health specialist and author says that in an effort to not have the same outcome as the director, it’s important to change your diet, reduce your stress levels, and overall, curb inflammation in the body.

“You can’t just step out and say, I’m just going to reduce my stress. But how you help your body manage the stress, I believe is the answer,” Jackson said over the phone. “Do everything you can to avoid a stroke. I believe all men, after 40, should be on an aspirin daily. And they should know that if you eat these foods consistently or you drink this much alcohol in a week, it will cause inflammation, and eventually, it will lead to something.”

We talked in depth with Jackson about the circumstances surrounding Singleton’s passing, what we need to be aware of to curb our own risks, and how important your health history is in determining whether or not you can survive something as major as a stroke.

MadameNoire: John Singleton’s family said he suffered from high blood pressure. For people who aren’t aware, what role does that play in causing an interruption to blood flow to the brain?

Anytime you have high blood pressure, and this goes into a much larger subject, but blood pressure is really just an inflammatory response. So when you have constriction of the vessels in the brain, or around the heart, or anywhere in your body, you’re going to have less blood flow. If it’s more restricted and it causes more stress to the body, it’s going to restrict blood flow to vital organs. The more global way of thinking about it in the body is as inflammation, and inflammation is caused by diet, from high stress, from lack of sleep, it’s a little bit genetic, but mostly, it’s lifestyle related. If you put someone in a category of being overweight, having high stress, not sleeping well so they’re not getting the recovery hormones while they’re sleeping, they’re not regenerating, they have an inflammatory diet of processed foods with sugars that make their glucose levels go up and down during the day and make their insulin levels go up, that’s pretty classic America today. You put all that together, plus you put some genetics in there too, you’re going to end up with an inflammatory state, which is going to predispose you to a stroke. It’s like the perfect storm for a stroke.

The great news about all that is it’s almost preventable. There’s so much you can do to mitigate your risk by focusing on all the things that reduce inflammation and then keeping your brain as balanced as possible. There’s many ways you can do that, but from a prevention standpoint, what everybody should be looking at but most people aren’t, is modifying your diet so at least 50 percent of your diet is vegetables. Lean proteins, vegetables, nuts and seeds — nuts and seeds give you the hormones that you need because all hormones come from fat. Hormones help sustain life and they’re anti-inflammatory. So, there’s a lot of things you can do, including meditation, at least seven hours of sleep a night, restorative deep sleep. Just the cortisol connection with stress, when your cortisol level is imbalanced due to stress, that causes inflammation. So you can see with [John Singleton], he probably had a lot of those things going on. Overweight, genetics there for sure, high stress, probably not consistent sleeping, alcohol and an inflammatory diet — that’s just how people live today. That’s also why we’re seeing an increase in all sorts of cancer and strokes, too.

When you have conditions and issues like this, does it make the likelihood of having a massive stroke higher than a stroke that’s mild and less debilitating? Sometimes people just have their arms paralyzed, things like that, while others, in Singleton’s case, end up dying. If you can answer, what causes some strokes to be more complex and massive compared to others?

Everybody’s storm is a little bit different. Some people, even though you walk into the doctor’s office, “Oh, your blood pressure is modestly elevated,” it’s been modestly elevated and poorly controlled for a couple of months or a couple of years. You don’t really look like a train wreck, but you don’t really know because you can’t look at someone and say, “What’s their quality of sleep? How high is their stress? How is it physically affecting them?”

All physicians do today is they just look at the vital signs and they’re looking at the blood tests, but that doesn’t tell how much at risk that person is because they may have some very toxic lifestyle habits that wouldn’t show up on a piece of paper until they actually have something much bigger like a massive stroke. So it’s not like, “Oh well, if you do this, this and this, you’l have a minor stroke. But if you do this, this and this, you’ll have a minor one.” Everybody’s chemistry is different. It really depends on the person and when you put all of those factors together and stir them up in a big pot, you’re either going to get something minimal or you’re going to get something major.

In cases of massive strokes, what’s the potential for recovery? If one ends up in a coma, why does that happen?

A lot of the time it’s an induced coma just to get the brain to heal. Again, that has to do with what their age is and how much they have to fight with, what their immune system is like and how quickly they intervened with the stroke — medically speaking. There are so many factors that would determine someone’s outcome, and every single person’s outcome is different. You can’t really say what the probability of recovery is because it depends on so many factors. But early detection obviously, what the person’s physical and hormonal state was in terms of the whole endocrine system, what was their state when they had the stroke, and what was their physical immunity at the time of the stroke matters. The immune system has to help a person recover, and that has a lot to do with how much damage to the vessels has already been done over time. So if you take a 75-year-old man who’s lived very poor, as in reckless in terms of diet and not taking care of themselves, maybe they’re 50 pounds overweight or 70, you take that person with that makeup and compare them with a 55-year-old male who has a stroke that for the most part leads a pretty healthy lifestyle but has a lot of stress, obviously the outcomes are going to be dramatically different. The 55-year-old has something to fight with. The 75-year-old could still recover, but there’s more damage that’s been done over a longer period of time.

I asked that because John Singleton was only 51 and some, online, not people necessarily with a lot of medical background, felt everything happened entirely too fast. He had the stroke last week, he was responsive, then next thing we hear he’s in a coma and the family says they are pulling the plug. So to everyday people, that sounded quick, but as you noted, we don’t know what his body had been through before. As the family said, he had high blood pressure.

You would think, “Certainly they could have done something!” But you don’t really know what the person started out with and how severe the damage was just to start with. That’s the hard part that people don’t often understand, you have to work with whatever you have. Some people have a lot more damage than they ever knew they had.

Lastly, what are symptoms people should know about in terms of a transient ischemic attack? That is, these early warning signs that let you know a stroke could be imminent. What should we be on the lookout for?

The most important thing is for people to be able to get in and have an evaluation, especially after the age of 40, 40-45. Have a full inflammatory check. You can ask for that. Then, start adapting some of the anti-inflammatory lifestyle changes that should be made.

Certainly, the early signs of stroke that you never want to deal with include sudden dizziness and trouble with your balance or coordination. With some of my patients, the first sign is just a really unusual headache;  numbness or weakness in their arms or legs. Unfortunately, that’s a sign that’s a little bit later. There’s also confusion, trouble understanding things, trouble seeing out of one or both eyes, it’s very different from anything you would have ever experienced before. Those would be the early signs that you would want to say, “Oh, it’s just a matter of time.” You’ve got to get yourself to the hospital if you have those symptoms. Some people go and all it is is a low blood sugar attack, but that’s okay if it’s nothing. However, if it’s really unusual and it’s not improved by you eating something or getting up and drinking a full glass of water, or just getting up and doing something immediately, you’re on the way to the ER.

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