The purpose of this review is to briefly examine selected evidence suggestive of nutrition, particularly plant-based nutrition, being a determinant of stroke incidence and mortality. Absolute stroke incidence and mortality is significantly increasing.
Hemorrhagic stroke has traditionally been a larger percentage of strokes in the developing world, notably in Asia, as documented in Japan over the past 50 years. Of all the risk factors, hypertension is likely the most significant. Observational studies have found that vegetarian diets are associated with a 6. Clinical trials of vegetarian or vegan diets of at least 6 weeks duration resulted in mean decreases of 4.
A high sodium to potassium ratio has been associated with increased risk of stroke. In addition to hypertension, people consuming plant-based diets have been shown to have lower risks of being diagnosed with diabetes [14] — [17] and hyperlipidemia. In addition to diet's effect on cardiometabolic risk factors, optimal nutrition plays a central role in the pathogenesis of atherosclerosis via multiple mechanisms. Studies have demonstrated that animal protein, [23] — [25] excessive added sugars [26] and saturated fat, [27] which are all hallmarks of a highly processed, animal-based Western diet, increase low-density lipoprotein LDL cholesterol.
Inflammation is integral to atherosclerosis and vegetarians have been shown to have lower C-reactive protein CRP [28] — [31] and dietary interventions rich in unrefined plant foods have been shown to reduce CRP. This process is dependent on gut microbiota, [40] which is sufficiently different in vegans such that vegans do not produce as much TMAO from a L-carnitine challenge eating a steak.
Though often related to atherosclerosis, cardioembolic causes of stroke are clearly distinct from atherosclerotic heart disease. In multiple studies, obesity has been found to be associated with a significantly increased risk of atrial fibrillation, in part due to morphological cardiac changes, including left ventricular structural abnormalities and left atrial enlargement.
In addition to the benefits of plant-based diets for risk of hypertension and diabetes, as mentioned above, plant-based diets have been linked to healthier weights, [48] — [51] which in turn may simultaneously reduce the incidence of sleep apnea, a disorder tightly correlated with obesity. Various foods have been studied in relation to stroke risk, though the research is relatively limited and inconsistent. Nevertheless, fruit and vegetable consumption has been found to be protective. The benefit found with fruit and vegetable consumption is consistent with several studies and meta-analyses that found an inverse correlation between the consumption of various nutrients in fruits and vegetables, including dietary folate, [54] vitamin C, [55] flavonol, [56] fiber [57] and stroke risk.
Similarly, whole grains have been found to be protective against cardiovascular mortality in general. Conversely, increased meat consumption has been shown to correlate with increased stroke risk. Nutrition research has traditionally been focused on nutrients or single foods, but more recently overall dietary patterns have become a greater focus. The Mediterranean diet is perhaps most researched. Study subjects are given a point for adhering to the Mediterranean diet in the following nine intake categories: Generally, a Mediterranean diet is a much more plant-rich diet than is the standard American diet.
In one Dutch cohort followed for 10—15 years, those with the highest adherence to the diet had an adjusted RR of incident stroke of 0. Vegetarian and vegan diets have not been well researched in relation to stroke risk, but studies that have been done find no reduction in stroke incidence in populations consuming them.
In addition, plant-only diets not supplemented with vitamin B12 may lead to B12 deficiency which may undermine the otherwise advantageous profile of plant-based nutrition. Multiple anticoagulants are now in common use by patients with atrial fibrillation, including warfarin, dabigatran, apixaban, edoxaban, and rivaroxaban. Warfarin, the most common anticoagulant historically, is a vitamin K antagonist as it blocks vitamin K-dependent clotting factors.
A plant-based diet and stroke
Providers have often cautioned against patients on warfarin consuming high levels of vitamin K. Unfortunately, foods high in vitamin K, including green leafy vegetables, are a particularly rich source of antioxidants and nutrients likely to benefit cardiovascular disease. An alternate management strategy, which is likely to be more beneficial, is to advise increased vitamin K intake and keep it relatively high, monitoring and adjusting warfarin closely during the period of increasing vitamin K. This approach allows atrial fibrillation patients, who so often have atherosclerotic heart disease, to consume green leafy vegetables.
Stroke is a heterogeneous collection of disorders with varying mechanisms; nevertheless, hypertension, atherosclerosis, or atrial fibrillation, or often a combination of all three, are key components of most strokes. Increasing intake of fruits, vegetables, whole grains and minimizing or avoiding intake of meat and processed foods has been associated with decreased prevalence of obesity, hypertension, dyslipidemia, and diabetes. Intervention studies have demonstrated benefits from very low-fat, high-fiber plant-based diets in the treatment of these conditions.
In addition, this dietary pattern has been shown to have the ability to halt or reverse atherosclerosis via multiple mechanisms. Even though findings are limited and inconsistent regarding nutrition's effects on specific stroke subtypes, observational studies of stroke incidence and mortality support eating more fruits and vegetables and less meat. While interventional research is even scarcer, a Mediterranean diet has proven beneficial.
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Given the demonstrable benefits of plant-based nutrition on stroke risk factors and the limited supporting observational and interventional research, further investigations of the ability of plant-based diets with minimal or no animal-based foods and processed foods to prevent stroke is strongly justified. In the absence of further research, those patients at high risk of stroke, particularly ischemic stroke, should be educated about plant-based nutrition with adequate B12 as a potentially powerful disease risk modifier.
National Center for Biotechnology Information , U. Journal List J Geriatr Cardiol v. Author information Article notes Copyright and License information Disclaimer. Copyright Institute of Geriatric Cardiology. The work must be attributed back to the original author and commercial use is not permitted without specific permission.
Introduction Stroke is a leading cause of death and disability in the United States and globally. Odds ratios associated with risk factors for all stroke in men and women over 55 years old adapted from reference [12]. Open in a separate window. Associations of plant-based nutrition with various risk factors for stroke. Effects of foods and dietary patterns Various foods have been studied in relation to stroke risk, though the research is relatively limited and inconsistent.
Nutrition and anticoagulation Multiple anticoagulants are now in common use by patients with atrial fibrillation, including warfarin, dabigatran, apixaban, edoxaban, and rivaroxaban. In contrast, patients who didn't change their diets had a per cent increase in angina attacks. Most GPs prescribe cholesterol- lowering statins if you're at risk of heart attacks, so why change your diet if you can simply pop a pill?
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A better question to ask might be: In a Brazilian study, researchers gave ten men and women meals containing Brazil nuts and found that a single serving of four nuts almost immediately improved their cholesterol levels compared with those who ate no nuts at all. In the group which ate the nuts, levels of LDL 'bad' cholesterol were 20 points lower just nine hours after the meal. But be aware that these nuts can be high in selenium, so don't regularly eat more than one or two on a daily basis. Numerous studies show that many of our Western epidemics of chronic disease, including coronary heart disease, simply didn't occur in Chinese or rural African populations who ate plant-based diets.
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But when you look at populations from these countries who came to live in the West, disease rates skyrocketed as they adopted our meat-based, sugar-laced, junk- food diet. So what did the Africans and Chinese have in common? If you are worried about your heart health, it is certainly worth considering cutting down on your consumption of meat — and it's not only for the fat content, meat also appears to harbour endotoxin-laden bacteria, which can trigger inflammation in your arteries, even when food is fully cooked.
You should also start striving to meet my Daily Dozen recommendations see box below , which will help improve your heart's health. Even if your parents died from heart disease, you should be able to eat your way to a healthy heart.
How your spice rack could stop you having a stroke, you can cut your blood pressure with.........
You share 50 per cent of your genes with each parent, so if one dies of a heart attack, you might have inherited some of that susceptibility. However, one reason why certain diseases tend to run in families may be that diets tend to run in families, too. You can choose to stop hurting yourself and let your body's natural healing process succeed. High blood pressure is the number-one risk factor for death and disability worldwide, killing nine million people each year. It puts strain on your heart, can damage sensitive blood vessels in the eyes and kidneys and can cause bleeding in the brain.
Many doctors consider increased blood pressure a natural result of ageing, just like grey hair and wrinkles — after all, more than one in four adults in the UK has high blood pressure. But we've known for nearly a century that blood pressure can remain stable throughout life, or even decrease after middle-age. Commonly prescribed blood pressure pills can reduce the risk of heart attack by 15 per cent and the risk of stroke by about 25 per cent, but in one robust study, three portions of whole grains a day were shown to help people achieve this same benefit without medication. Patients who consumed a few spoonfuls of flaxseeds every day for six months lowered their blood pressure to a degree that could be expected to result in 46 per cent fewer strokes and 29 per cent fewer instances of heart disease over time.
This is one of the most potent changes ever to come from dietary intervention, and is two to three times more effective at lowering blood pressure than exercise not that you shouldn't do both. It's one reason why flaxseeds hold a vital place in my Daily Dozen overleaf. Sprinkle a spoonful over cereal, soups, salads and stews every day. Beetroot is a concentrated source of vegetable nitrates, which can lower blood pressure and improve blood flow.
In one study, men and women who ate g of baked beetroot before a race improved their running performance while maintaining the same heart rate and even reporting less exertion. And one little shot of beetroot juice has been found to allow free-divers to hold their breath for half a minute longer than usual. This has implications for blood pressure control. A study found people who drank a ml glass of beetroot juice daily for four weeks reduced the top number of their blood pressure by eight points. Better still, the benefits grew week by week, suggesting their blood pressure might have continued to improve even further.
The scientists concluded that 'nitrate-rich vegetables may prove to be cost-effective, affordable and favourable for a public health approach to hypertension [high blood pressure]'. The optimal dose appears to be ml, but beetroot juice is perishable, processed, and hard to find, so enjoy the vegetable roasted in as many meals as you can. For best results, whip up a rocket and beetroot salad. Rocket contains a whopping mg of nitrates per g serving, so together they create a powerful dish.
Heat 60ml water in a large frying pan over a medium heat. Add the onion and cook for about 5 minutes until softened. Stir in the garlic, then add the beetroot and mushrooms and sprinkle on the paprika, mustard powder, cumin, coriander and turmeric. Cook until the vegetables are soft and the liquid is absorbed — about 4 minutes. In a large bowl, mash the black beans well to break them up.
Add the cooked grains, flaxseeds and miso paste.
- Plant-Based Nutrition and Stroke Risk - Center for Nutrition Studies.
- A plant-based diet and stroke.
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Mash to combine, then add the oats and walnuts, then the cooked vegetables. Combine until the mixture holds together when pressed between your thumb and forefinger. Divide into six equal portions and use your hands to shape them into balls. Press the balls into patties and transfer them to a plate. Refrigerate for a minimum of 30 minutes.
Complementary and Alternative Treatments for Stroke
Line a baking sheet and arrange the burgers on top. Bake for 30 minutes, gently flipping the patties about halfway through. Serve in a bun with green leaves, and add extra salad toppings if you wish. Remove greens from beetroot and rinse, discarding large stems. Trim ends of beetroots, leaving skins on, and scrub well, cutting large ones in half lengthways. Line a baking dish with parchment and place beetroot and onions in a single layer. Season with oregano and cover tightly with foil. Roast for 30 minutes, then uncover, stir, and return to oven for 10 minutes until the beetroot is tender.
Meanwhile, finely chop the beetroot greens and transfer to a frying pan with 60ml of water. Cook over a medium heat until tender. Stir in vinegar and date sugar or syrup, then increase heat to medium-high and cook until the vinegar has reduced to a syrup. When the beetroot is ready, cut into wedges and discard the outer skins. Transfer to a serving dish, top with the greens, and add orange zest, tossing lightly to coat.
Sprinkle with pepper and serve. Chop garlic cloves in a food processor, then add the rocket and basil and blitz. Tip in the tahini, miso paste and vinegar, and blitz again until smooth. Stroke is a heterogeneous collection of disorders with varying mechanisms; nevertheless, hypertension, atherosclerosis, or atrial fibrillation, or often a combination of all three, are key components of most strokes.
Increasing intake of fruits, vegetables, whole grains and minimizing or avoiding intake of meat and processed foods has been associated with decreased prevalence of obesity, hypertension, dyslipidemia, and diabetes. Intervention studies have demonstrated benefits from very low-fat, high-fiber plant-based diets in the treatment of these conditions. In addition, this dietary pattern has been shown to have the ability to halt or reverse atherosclerosis via multiple mechanisms.
While interventional research is even scarcer, a Mediterranean diet has proven beneficial. Given the demonstrable benefits of plant-based nutrition on stroke risk factors and the limited supporting observational and interventional research, further investigations of the ability of plant-based diets with minimal or no animal-based foods and processed foods to prevent stroke is strongly justified. In the absence of further research, those patients at high risk of stroke, particularly ischemic stroke, should be educated about plant-based nutrition with adequate B12 as a potentially powerful disease risk modifier.
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