Apples and Oranges: the Mediterranean Diet for Stroke Patients Linda Means, MS, RD, LD October 26, 2017

Disclosure No Disclosures

Objectives Describe the key components of the Mediterranean Diet 10/26/2017 Objectives Describe the key components of the Mediterranean Diet Identify the health benefits associated with the Mediterranean Diet Identify the modifiable risk factors for ischemic stroke

Hypertension (HTN) HTN or high blood pressure (BP)is one of the most prevalent forms of cardiovascular disease HTN occurs in approximately (1) of every (3) adults in the US Untreated HTN can lead to myocardial infarction, stroke, renal failure, and death

Modifiable Risk Factors High blood pressure is the main modifiable risk factor for ischemic stroke Excess weight Physical inactivity Unhealthy eating patterns

Research Has Shown Higher levels of sodium intake are associated with an increased risk of stroke Higher levels of potassium intake are associated with lowering BP A meta-analysis of prospective studies concluded that intake of fresh, processed, and total red meat amount is associated with an increased risk of ischemic stroke

Diet Pattern to Lower BP Randomized trials show that diets such as the Mediterranean and DASH style diets reduce stroke risk A meta-analysis of more than 1.5 million adults demonstrated that following a Mediterranean Diet was associated with a reduced risk of cardiovascular mortality

Key Components of the Mediterranean Diet Eat primarily plant-based foods, such as fruits and vegetables, whole grains, legumes, and nuts Replace saturated fat and trans fat with healthy fats, such as olive or canola oil Use herbs and spices instead of salt to season foods Limit red meat to no more than a few times per month Eat fish and poultry at least twice per week Drink red wine in moderation (optional) Include being physically active

Fruits and Vegetables Eat a variety of fruits and vegetables; whole and fresh are best Aim for minimally processed items without added sugars or salt

Nuts Nuts are good sources of fiber, protein, and healthy fats Nuts are high in calories, so consume in moderation (limit to a handful per day) Avoid candied, honey-roasted, and heavily salted varieties

Grains Choose fiber-rich whole grains for most grain servings Make at least half of the grains consumed each day whole grains ( the whole grain will be the first ingredient listed on the food label)

Healthier Fats Focus is not on limiting total fat consumption but on choosing healthier fats Replace saturated fat and trans fat ( such as butter, stick margarine, animal fat, hydrogenated fat) with healthier fats such as olive and canola oil

Fish – at Least Twice a Week Choose fatty fish containing omega-3 fatty acids, such as mackerel, lake trout, herring, albacore tuna, and salmon

Red Meat Limit red meat to a few times per month Choose lean cuts of meat and limit portion sizes Avoid sausage, bacon, and other high fat, processed meats

Dairy Choose fat-free or lowfat dairy products to reduce intake of saturated fat Limit intake of higher fat dairy products such as whole or 2% milk, cheese, and ice cream

Sodium Choose foods with less sodium and prepare foods with little or no salt Aim for no more than 2300 mg of sodium per day = 1 teaspoon of salt Reducing daily intake of sodium to 1500 mg/day is desirable as it can lower BP even more

Alcohol Alcohol, in moderation, has been associated with a reduced risk of heart disease in some research studies The Mediterranean Diet typically includes a moderate amount of wine, usually red wine More than this amount may increase the risk of health problems Check with your physician before adding alcohol to your daily meal plan

Moderation as Defined by the AHA No more than 5 ounces of wine daily for women No more than 10 ounces of wine daily for men under age 65

Healthy Weight – AHA Guidelines Achieve and maintain a healthy weight Engage in regular exercise 3-4 times per week, for an average of 40 minutes each time, of moderate to vigorous activity

Summary The Mediterranean Diet is a healthy and enjoyable way to eat 10/26/2017 Summary The Mediterranean Diet is a healthy and enjoyable way to eat Make gradual changes in your eating pattern until you have included all of the key components of the Mediterranean Diet

References Meschia JF, Bushnell C, Boden-Albala B, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the AHA/American Stroke Association. Stroke. 2014; 45:3754- 3832. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the AHA/American Stroke Association. Stroke.2014; 45:2160-2236. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics- 2016 update: a report from the AHA. Circulation. 2016: 133(4)e38-e360.

10/26/2017 References Lennon SL, DellaValle DM, Rodder SG, et al. 2015 Evidence Analysis Library based nutrition practice guidelines for the management of hypertension in adults. Journal of the Academy of Nutrition and Dietetics. 2017; 117:1445-1458. Thompson AM, Eshelbrenner CL, Reynolds K, et al. Antihypertensive treatment and secondary prevention of cardiovascular disease events among persons without hypertension: a meta-analysis. JAMA. 2011; 305:913-922. Healthy Living- Mediterranean Diet; AHA. http.//heart.org/HEARTORG/HealthyLiving/HealthyEating/Mediterran ean_Diet_UCM_:306004_Article.jsp#.WcQzrWfruJa. Accessed 9/21/17.