• Michelle Routhenstein, RD

Foods that Prevent Stroke

There are many foods that prevent stroke. In order to understand why these foods prevent stroke, we must first address the different types of stroke, stroke risk factors, and primary and secondary stroke prevention.


Table of Content:

1. Different types of strokes

2. Strokes in the young

3. Stroke Risk Factors

4. Is stroke preventable? Is secondary stroke preventable?

5. Foods That Prevent Stroke

6. Conclusion

7. References

Different types of strokes

A stroke is when the blood flow to your brain is blocked. And when blood flow is blocked to your brain, your brain cells start to die.

The U.S. Centers for Disease Control and Prevention state that stroke is the third leading cause of death and is the #1 cause of serious, long-term disability in the United States. On average, someone has a stroke every 40 seconds.

There are three types of strokes:

a) Ischemic strokes are the most common, accounting for 87% of all strokes. Ischemic strokes occur when a blood vessel supplying blood to the brain is obstructed.

This is most often due to atherosclerosis, the accumulation of plaque in your arteries that narrows and damages blood vessels. (I talk more about atherosclerosis here).

Ischemic strokes can also be caused by a blood clot traveling from another part of the body to the brain. About 15% of these types of strokes are caused by atrial fibrillation (Afib). (I talk more about Afib and prevention of Afib attacks here).

b) Hemorrhagic Stroke is when a blood vessel in the brain ruptures and blood is spilled into surrounding tissues. This can be caused by:

· an aneurysm, where a blood vessel is weakened and causes an enlargement that can rupture and cause a stroke

· anteriovenous malformation where the blood vessels are abnormally formed and may cause a hemorrhagic stroke

· Very high uncontrolled blood pressure which can weaken blood vessels in the brain and cause bleeding in the brain.

c) Transient ischemic attack is a stroke that lasts a few minutes and can happen when blood supply to the brain is temporarily blocked. Symptoms are the same as stroke, but do not last as long. Since it is short, many people often ignore it which isn’t advised.

All these strokes have the same symptoms and the National Stroke Association uses the acronym FAST to help recognize symptoms of a stroke. FAST also plays an important role – the faster the stroke is identified and treated, the better chance of reducing long term, severe disability.

F for Face: this is to assess drooping on either side of the face.

A for Arms: this is to assess if you can keep your arms lifted or if one lowers on its own.

S for Speech: this is to assess trouble talking or slurring of speech.

T for Time: Call 9-1-1 immediately if any of these symptoms occur.

Other symptoms may include sudden confusion, difficult walking or seeing, and severe headaches.

Strokes in the young

Strokes can occur at any age. Strokes in the young compromise 10-15% of all stroke patients, and their death and long term disability risk from stroke is even higher. Studies show that primary prevention to reduce stroke risk factors are imperative and integral in both adults over and under 65 years of age.

The three most common risk factors of stroke in the young are current smoking, dyslipidemia and hypertension.

Stroke Risk Factors

There are modifiable and unmodifiable stroke risk factors.

Unmodifiable stroke risk factors include:

· Age

· Gender

· Race and ethnicity

· Family history of stroke or transient ischemic attack

There are many stroke risk factors that are controllable through science based lifestyle medicine. These modifiable stroke risk factors include:

· High Blood Pressure

· Uncontrolled blood sugar levels

· High LDL cholesterol

· Overweight or Obesity

· Lack of physical activity

· Unmanaged stress and depression

· Unhealthy Diet

· Inflammation from chronic disease

· Use of nonsteroidal anti-inflammatory drugs (NSAIDS)

· Smoking

Is Stroke Preventable?

The Centers of Disease Control indicate that up to 80% of strokes are preventable through science based lifestyle medicine. Research has shown that the most common stroke, ischemic stroke, is preventable through optimization of lifestyle and nutrition.

Foods That Prevent Stroke

Below you will find a list of several foods that prevent stroke and foods that help stroke recovery. This list is not exhaustive and there are many other foods that need to be incorporated for primary and secondary stroke prevention.

  • Water

  • Apples

  • Chickpeas

  • Beets

  • Quinoa

  • Kefir

  • Flaxseeds

Water: Adequate water intake helps the heart pump blood more easily, and given the heart pumps about 2,000 gallons of blood a day, water is vital for optimal heart health.

Research shows that majority of the elderly who presented with stroke in hospitals were dehydrated (measured by plasma osmolarity), and those who were dehydrated had a worse outcome.

This may be because when you are dehydrated, your blood thickens and it reduces your blood volume, causing the heart to overwork. Thickened blood increases risk of blood clots, which increases your risk of stroke.

High blood pressure is also more prevalent in those who are chronically dehydrated because when your body’s cells are deprived of water, the brain sends a signal to the pituitary gland to constrict the blood vessels = high blood pressure. High blood pressure is a very prominent stroke risk factor.

Staying hydrated is crucial for optimal heart health, and primary and secondary stroke prevention. Some people may require a fluid restriction and the specific amount will vary per person. Some factors I consider in my thorough evaluation are: your height, your weight, your physical activity level, your medical history, and your medication list. For personalized nutrition, learn more about my 1:1 individualized services here.

Apples: In this large population study, white fruit and vegetable consumption decreased the risk of stroke by 9% for every 25gm/day increase of these specific foods. The white fruits/vegetable primarily included apples and pears.

Why may this be? Apples are a rich source of dietary fiber and a flavanol called quercetin.

Quercetin has been shown to:

· Improve endothelial function (what lines the insides of the heart and blood vessels) which allows for better blood flow and therefore decreases blood pressure.

· Increase nitric oxide production, allowing for blood vessel dilation and therefore better blood flow.

· Lower oxidative stress, allowing for lower inflammation and better blood flow.

Optimizing your arterial function is imperative in primary and secondary stroke prevention.

Chickpeas are a rich source of vitamin B6. Vitamin B6 (along with folate and B12) are needed to avoid high levels of homocysteine. Research has shown that high levels of homocysteine, a common amino acid in the blood, can be a risk factor for early development of heart disease and stroke.

High levels of homocysteine accelerates atherosclerosis formation and negatively impact the endothelium (the tissue that lines blood vessels, heart and lymphatic vessels) and smooth muscle cells, which can negatively change the arteries' structure and function. Atherosclerosis is the main cause of ischemic stroke, the most common form of strokes.

Beets are jam packed with Potassium and folate which are cardioprotective.

In a meta-analysis, a statistical analysis that combines the results of multiple scientific studies, of eleven studies that included 247, 510 male and female participants, Potassium levels were assessed and it was found that consuming 1600mg more Potassium per day was associated with 21% lower risk of stroke.

In another study, research showed that post menopausal women who ate the most potassium had 27% lower risk of ischemic stroke (most common type of stroke) and a 21% reduced risk for all stroke types, compared with women who ate the least potassium.

Potassium reduces stroke by lessening the effects of salt, positively influencing blood pressure, and by adding heart healthy nutrients found in potassium rich foods. For instance, many foods that are high in potassium also contain fiber.

Fiber consumption helps lower risk of hemorrhagic stroke. In this systemic review and meta-analysis of eight cohort studies, consuming 7gm/day of fiber reduced risk of stroke by 7%. For example, one 2 inch beet has 3gm of dietary fiber. Another meta-analysis showed that for those who consumed 3-5 daily portions of dietary fiber, their risk of ischemic and hemorrhagic stroke was reduced by 26%.

The amount of Potassium you need will differ based on your past medical history, medication list, and laboratory findings. For personalized nutrition, learn more about my 1:1 individualized services here.

Quinoa:

In a meta-analysis of 7 prospective studies of 241,378 participants, an additional 100mg per day of magnesium from food was associated with an 8% decreased risk of total stroke, especially ischemic stroke.

It has also been found to be especially important in secondary stroke prevention. This may be because of the integral role Magnesium plays in positively influence the electrical signals of the heart, which allows the heart to properly fill up with blood before it contracts –which helps optimize proper blood flow to the rest of the body.

Magnesium also influences the movements of potassium, sodium, and calcium across cell membranes. Studies show that Potassium in muscles will not normalize unless Magnesium is sufficient.

1 cup of quinoa has 118mg of Magnesium, 30% of recommended dietary intake.

The amount of Magnesium you need will differ based on age, gender, other food intake, medication list, laboratory findings, and past medical history. For personalized nutrition, learn more about my 1:1 individualized services here.

Kefir: Kefir is a rich source of Vitamin D and probiotics which all play a role in heart function and primary and secondary stroke prevention.

Research shows that Vitamin D levels are low in the majority of people who experience a stroke and therefore Vitamin D deficiency may be one of the risk factors for stroke. More research is needed to explain why and confirm the exact link between the two, but it is still important to ensure adequate consumption or supplementation before and after an acute stroke for prevention and optimal recovery.

The amount of Vitamin D will differ based on your current Vitamin D levels, your skin tone, ethnicity, past medical history, and weight. For personalized nutrition, learn more about my 1:1 individualized services here.

Flax Seeds

Flaxseeds are a rich source of alpha-linolenic acid (ALA), a plant based omega-3 fatty acid, lignans, and phytosterols which has been shown to reduce inflammation. Flax seeds decrease several proinflammatory agents in the body, which reduces inflammation associated with plaque build up in the arteries. Reducing inflammation and atherosclerosis reduces your risk of heart attacks and stroke.

Because flaxseeds contain both soluble and insoluble fiber, it may also help with bowel regularity. The Ohsaki cohort study looked at about 45,000 men and women aged 40-79 years old over a 13 year time period to assess their bowel movement frequency and risk of dying of cardiovascular disease. Those who defecated 1 time every 2-3 days had a 21% increased risk of dying from cardiovascular disease. And those who defected 1 time or less every 4 days had a 39% increased risk of dying from heart disease, especially from stroke. Having regular bowel movements is imperative to primary and secondary stroke prevention.

To reap the full benefits of flaxseeds, they should be consumed ground. Once ground, it should be stored in the freezer to avoid oxidation and keep its potent antioxidant properties.

Conclusion


Nutrition has a vital role in primary and secondary stroke prevention. Eighty percent of heart attacks and strokes are preventable through science based nutrition and lifestyle medicine. As a Preventive Cardiology Dietitian, I devote my energy and time to the science based evidence and pack it into a personalized plan to help guide you to optimal health and longevity, free of chronic disease (or complications of any).

I work very closely with all my clients to achieve adequate macronutrient, vitamin and mineral intakes for their body to thrive - to reduce inflammation (the hallmark of most diseases), to optimize blood values, and most importantly for you to FEEL GREAT everyday so you can continue doing the things you love.

I am currently seeing clients virtually due to COVID-19. Usually, I see clients both in my NYC office and virtually. To learn more about my services, email me (michelle@entirelynourished.com) or book a 15 minute complimentary discovery call here.

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In Health & Happiness,

Michelle Routhenstein,

MS, RD, CDE, CDN

Preventive Cardiology Dietitian

Owner of Entirely Nourished, LLC

P: (646) 979-0328 A: 276 Fifth Avenue, Suite 704, New York NY 10001

E: Michelle@EntirelyNourished.com

http://www.entirelynourished.com 

Instagram: Heart.Health.Nutritionist




** This article is for informational purposes only and not a substitute for individualized medical advice or treatment. Always seek the advice of a qualified health professional with any questions you may have regarding your health. 




References

1. American Stroke Association. “Stroke Symptoms.” https://www.stroke.org/en/about-stroke/stroke-symptoms. Accessed April 25, 2020.

2. American Stroke Association. “Ischemic Stroke (Clots).” https://www.stroke.org/en/about-stroke/types-of-stroke/ischemic-stroke-clots Accessed April 25, 2020.

3. American Stroke Association. “Hemorrhagic Stroke (Bleeds).” https://www.stroke.org/en/about-stroke/types-of-stroke/hemorrhagic-strokes-bleeds Accessed April 25, 2020.

4. American Stroke Association. “TIA (Transient Ischemic Attack).” https://www.stroke.org/en/about-stroke/types-of-stroke/tia-transient-ischemic-attack. Accessed April 25, 2020.

5. D’Elia L, Barba G, Cappuccio F, Strazzullo P. “Potassium Intake, Stroke, and Cardiovascular Disease: A Meta-Analysis of Prospective Studies.” Jrnl American College of Cardiology. 2011: 57; 10: 12010-1219. Doi 10.1016/j.jacc.2010.09.070

6. DiNicolantonio, J. J., Liu, J., & O'Keefe, J. H. (2018). Magnesium for the prevention and treatment of cardiovascular disease. Open heart, 5(2), e000775. https://doi.org/10.1136/openhrt-2018-000775

7. He FJ, Nowson CA, MacGregor GA. Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet. 2006;367(9507):320-326.

8. Honkura K, Tomata Y, Sugiyama K, Wantanabe T, Zhang S, Sugawara Y, Tsuji I. “Defecation frequency and cardiovascular mortality in Japan: The Ohsaki cohort study.” Atherosclerosis (Mar 2016). 246; 251-256. Doi: 10.1016/j.atherosclerosis.2016.01.007.

9. Larsson S, Orsini N, Wolk A. “Dietary magnesium intake and risk of stroke: a meta-analysis of prospective studies.” The American Journal of Clinical Nutrition (Feb 2012) 95; 2: 362–366, https://doi.org/10.3945/ajcn.111.022376

10. National Heart, Lung, and Blood Institute. “Stroke.” https://www.nhlbi.nih.gov/health-topics/stroke. Accessed April 25, 2020.

11. Poole K, Loveridge N, Barker P, Halsall D, Rose C, Reeve J, Warburton E. “Reduced Vitamin D in Acute Stroke.” Stroke 2005: 243-245. Doi: 10.1161/01.STR.0000195184.24297.cl1.

12. Rowat A, Graham C, Dennis M. “Dehydration in Hospital-Admitted Stroke Patients: Detection, Frequency and Association.” Stroke 2012; 43; 857-859. Doi: 10.1161/STROKAHA.111.640821.

13. Seth, A., Mossavar-Rahmani, Y., Kamensky, V., Silver, B., Lakshminarayan, K., Prentice, R., Van Horn, L., & Wassertheil-Smoller, S. “Potassium intake and risk of stroke in women with hypertension and nonhypertension in the Women's Health Initiative.” Stroke45(10), 2874–2880. https://doi.org/10.1161/STROKEAHA.114.006046

14. Smajlović D. Strokes in young adults: epidemiology and prevention. Vasc Health Risk Manag. 2015;11:157–164. Published 2015 Feb 24. doi:10.2147/VHRM.S53203

15. Threapleton DE, Greenwood DC, Evans CE, et al. Dietary fiber intake and risk of first stroke: a systematic review and meta-analysis. Stroke. 2013;44(5):1360-1368.

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