Nutrition and Stroke Prevention

Overview A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die. A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimize brain damage and potential complications. The good news is that strokes can be treated and prevented https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113

Overview Ischemic (80%) Hemorrhagic Transient Ischemic Attack (TIA) A stroke may be caused by a blocked artery (ischemic stroke) or the leaking or bursting of a blood vessel (hemorrhagic stroke). Some people may experience only a temporary disruption of blood flow to the brain (transient ischemic attack, or TIA) that doesn't cause permanent damage. About 80 percent of strokes are ischemic strokes. Ischemic strokes occur when the arteries to your brain become narrowed or blocked, causing severely reduced blood flow (ischemia). https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113

Statistics Stroke accounts for 1 of every 19 deaths in the US Stroke kills someone in the US about every 3 minutes 45 seconds Stroke is a leading cause of serious long-term disability in the US In 2015, stroke deaths accounted for 11.8% of total deaths worldwide, making stroke the second leading global cause of death behind heart disease Statistics Someone in the US has a stroke about once every 40 seconds. • Stroke accounts for 1 of every 19 deaths in the US. • Stroke kills someone in the US about every 3 minutes 45 seconds. • When considered separately from other cardiovascular diseases, stroke ranks No. 5 among all cause of death in the US, killing nearly 133,000 people a year. • From 2005 to 2015, the age-adjusted stroke death rate decreased 21.7 percent, and the actual number of stroke deaths declined 2.3 percent. • Each year, about 795,000 people experience a new or recurrent stroke. Approximately 610,000 of these are first attacks, and 185,000 are recurrent attacks. • Stroke is a leading cause of serious long-term disability in the US. • In 2015, stroke deaths accounted for 11.8% of total deaths worldwide, making stroke the second leading global cause of death behind heart disease https://healthmetrics.heart.org/wp-content/uploads/2018/02/At-A-Glance-Heart-Disease-and-Stroke-Statistics-2018.pdf

Modifiable Risk Factors Hypertension Diabetes mellitus Smoking Dyslipidemia Physical inactivity Approximately 80 percent of strokes can be prevented. Though some stroke risk factors are uncontrollable, such as age and race, other risk factors are in your control and making small lifestyle changes can reduce your stroke risk. For example, hypertension, which is the leading risk factor, can be controlled by eating a healthy diet, regularly physical activity, not smoking, and by taking prescribed medications. Patients with diabetes mellitus have approximately twice the risk of ischemic stroke compared with those without diabetes. Impaired glucose tolerance may be a risk factor for ischemic stroke in patients with a history of transient ischemic attack (TIA) or minor ischemic stroke. It may also be a risk factor for carotid atherosclerosis, as illustrated by studies in nondiabetics showing that elevated serum hemoglobin A1C is associated with an increased risk of carotid plaque development. Furie K, Rost N. Overview of secondary prevention of ischemic stroke. UpToDate 2018

Lower BP ↓ Na Intake Rec: 1500mg ↓ Systolic BP ~2-8 mmHg Hypertension, which promotes the formation of atherosclerotic lesions, is the single most important treatable risk factor for stroke Reduced intake of sodium and increased intake of potassium as indicated in the US Dietary Guidelines for Americans are recommended to lower BP Reduction of dietary sodium to recommended levels lowers systolic blood pressure by approximately 2 - 8 mmHg Reduce intake of canned and processed foods to reduce Na www.andeal.org

Lower BP ↑ Potassium Rec: 4.7 g/d* *Provided they do not have a predisposition to hyperkalemia Lower BP A diet that is rich in fruits and vegetables and thereby high in potassium is beneficial and may lower the risk of stroke K has a strong inverse relationship between intake and blood pressure. A rec: 4-6 g/day has a natriuretic effect; inhibits renin release; relaxes smooth muscle lining of arterioles Other High Potassium food sources, Spinach, Swiss Chard, Black Beans, White Beans, Beets, Acorn Squash, Sweet Potatoes, Edamame Fresh Salmon, Avocado, Coconut Water Mount D, Potassium and hypertension. UpToDate 2018

Lipids Saturated fat <5-6% of total calories Reduce trans fats Use polyunsaturated and monounsaturated fats in small amounts Lipids Saturated fat: For example; a person who eats a 2000 calorie/day diet would limit saturated fat to 13 grams. Trans fat: From partially hydrogenated oils, No longer GRAS. Read food labels and ingredient list. Mono-unsaturated: olive oil, canola oil, peanut oil Poly-unsaturated: soybean oil, corn oil

Sugar Decrease added sugars Women: 6 teaspoons (25 gms) daily Added sugars is table sugar added to foods vs naturally occurring sugars like fructose in fruit and lactose in dairy

Omega 3 fatty acids Foods rich in Omega 3 fatty acids primarily include salmon, albacore tuna, mackerel, herring, and trout

Activity 30 minutes moderate intensity exercise 5 x week 25 minutes vigorous exercise 3 x week 25 minutes muscle strenghening activity 2 x week Activity

Dash Diet & Mediterranean Diet

Dash Diet Not your typical “limit sodium” diet.  Considered the ideal diet for most adults.​ Does provide limited Na+, but also relies on ↑ minerals, ↑ fiber, and lower fat​ Proven to work in preventing HTN or treating HTN​ The DASH diet has been studied in both normotensive and hypertensive populations and found to lower systolic and diastolic pressure more than a diet rich in fruits and vegetables alone The combination of low-sodium and DASH diet resulted in further decreases in blood pressure, comparable with those observed with antihypertensive agents. The DASH dietary pattern reduces systolic blood pressure by 8-14 mmHg www.andeal.org

Dash Diet For a 2000 kcal diet:​ 7-8 servings of whole grains​ 8-10 servings of fruits & vegetables​ 2-3 servings of fat-free or low-fat dairy products ​ www.andeal.org

Dash Diet No more than 6 oz. of lean meat​ ½ - 1 serving nuts/seeds/legumes​ 2-3 servings of fats/oils​ Sweets – ≤5/week​ www.andeal.org

Mediterranean Diet Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts Replacing butter with healthy fats such as olive oil and canola oil Using herbs and spices instead of salt to flavor foods A Mediterranean diet supplemented with nuts may be considered in lowering the risk of stroke http://stroke.ahajournals.org/content/strokeaha/suppl/2014/10/28/STR.0000000000000046.DC1/Executive_Summary.pdf

Mediterranean Diet Limiting red meat to no more than a few times a month Eating fish and poultry at least twice a week Enjoying meals with family and friends Drinking red wine in moderation (optional) A Mediterranean diet supplemented with nuts may be considered in lowering the risk of stroke http://stroke.ahajournals.org/content/strokeaha/suppl/2014/10/28/STR.0000000000000046.DC1/Executive_Summary.pdf

Summary Reduced intake of sodium and increased intake of potassium as indicated in the US Dietary Guidelines for Americans are recommended to lower BP A diet that is rich in fruits and vegetables and thereby high in potassium is beneficial and may lower the risk of stroke A DASH-style diet, which emphasizes fruits, vegetables, and low-fat dairy products and reduced saturated fat, is recommended to lower BP A Mediterranean diet supplemented with nuts may be considered in lowering the risk of stroke http://stroke.ahajournals.org/content/strokeaha/suppl/2014/10/28/STR.0000000000000046.DC1/Executive_Summary.pdf

References https://www.mayoclinic.org/diseases-conditions/stroke/symptoms- causes/syc-20350113 https://healthmetrics.heart.org/wp-content/uploads/2018/02/At-A- Glance-Heart-Disease-and-Stroke-Statistics-2018.pdf Furie K, Rost N. Overview of secondary prevention of ischemic stroke. UpToDate 2018 www.andeal.org Mount D, Potassium and hypertension. UpToDate 2018 http://stroke.ahajournals.org/content/strokeaha/suppl/2014/10/28/STR.000 0000000000046.DC1/Executive_Summary.pdf