1. Nutrition and Stroke Prevention

2. 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

3. 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).

4. 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

5. 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

6. 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 mmHg
Reduce intake of canned and processed foods to reduce Na

7. 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

8. 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

9. 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

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

11. 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

12. Dash Diet & Mediterranean Diet

13. 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

14. 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 ​

15. 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​

16. 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

17. 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

18. 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

19. References
causes/syc
Glance-Heart-Disease-and-Stroke-Statistics-2018.pdf
Furie K, Rost N. Overview of secondary prevention of ischemic stroke. UpToDate 2018
Mount D, Potassium and hypertension. UpToDate 2018
DC1/Executive_Summary.pdf