Red meat, fiber and stroke risk

Stroke is a leading cause of disability and death in the United States. About 795,000 people in the U.S. have a stroke each year. A stroke occurs when blood flow to a portion of the brain is interrupted, preventing oxygen and nutrients from reaching brain tissue; ischemic strokes, the most common type, are usually caused by a blood clot obstructing an artery leading to the brain. Elevated blood pressure is the chief risk factor for stroke; elevated blood pressure accounts for 62% of strokes.1,2 There have been countless studies on dietary factors and their relationship to stroke risk; within the past few years, new meta-analyses have strengthened these dietary links to stroke. In particular, higher fiber intake is associated with reduced risk, and higher red and processed meat intake is associated with increased risk.

Fiber and stroke:

Beans

Fiber and fiber-rich foods are known to be beneficial for colon health and healthy blood glucose regulation. For stroke prevention, the blood pressure-lowering effects of fiber and fiber-rich foods are thought to be primarily responsible. Elevated blood pressure is the primary risk factor for stroke, and greater intake of high-fiber foods (like beans) is consistently linked to lower blood pressure.3   Foods that are higher in fiber tend to have a lower glycemic load, which limits the rise in insulin after a meal; elevated insulin levels contribute to elevated blood pressure. Also, high-fiber foods are usually rich in phytochemicals and minerals like potassium and magnesium, which help to keep blood pressure in a healthy range.4-10  In addition to reducing blood pressure, high fiber foods improve several factors relevant to atherosclerotic plaque formation, such as cholesterol and triglyceride levels.11-13

A recently published meta-analysis on fiber intake and risk of stroke analyzed data from six prospective studies, including over 300,000 subjects.14 In this analysis, for every 10 gram increase in daily fiber intake, there was a 12% reduction in risk. A previous analysis of data from ten studies found that each 10 gram/day increase in fiber intake was associated with a 24% decrease in risk of death from heart disease.15 Ten grams is the approximate amount of fiber contained in 2/3 cup of beans or lentils, 2 cups of cooked collard greens, or 2 ½ cups of blueberries. The average daily intake of fiber in the United States is a meager 16 grams,16 but a Nutritarian diet, depending on one’s calorie needs, provides about 60-80 grams of fiber daily.  I want to make it clear it is the use of high fiber, whole foods that enable this degree of protection against stroke, not adding fiber to a standard American diet.  It is more than just the fiber in fiber-rich foods that offers protection.

Red/processed meat and stroke:

Red and processed meats are calorie-dense, micronutrient-poor, saturated fat-rich foods. Another major concern regarding red and processed meats when it comes to heart disease and stroke is heme iron. The human body absorbs heme iron, the form of iron found in animal foods, more readily than nonheme iron from plant foods. Iron is an essential mineral that transports oxygen in the blood and has many other crucial functions, but can promote free radical damage, called oxidative stress when excess is present. .  As a result, high body iron stores are associated with increased risk of chronic diseases that have an oxidative stress component: for example, diabetes, heart disease, and dementia.17-21 When it comes to increasing stroke risk, heme iron promotes oxidation of LDL cholesterol and elevated blood pressure. Several previous studies have found that higher heme iron (or red and processed meat) intake was associated with higher blood pressure, and higher non-heme iron intake (or plant food intake) was associated with lower blood pressure.22-26  Again, it is not merely the high iron in meats, many other factors play a role including their hormonally-induced growth-promoting effects that promote atherosclerosis. 

Another recent meta-analysis reported on five studies of red and processed meat and stroke risk, and found substantial risk increases in ischemic stroke risk (the most common type of stroke):  for each 100 gram daily increment red meat eating daily, there was a 13% increase in risk, and a 13% increase in risk for every 50 grams daily of processed meat. Processed meats are nutrient-poor and high in heme iron like red meat, but have additional sodium, which is likely why the authors found a steeper association with stroke.27

These studies add to the already huge body of evidence showing that whole plant foods are health-promoting, while red and processed meats are disease-causing.

Between the excessive amounts of protein and heme iron, new findings on detrimental effects of red meat compounds Neu5GC28  and carnitine, and the volume of evidence linking red and processed meats to cancer and premature death,29-36 there is no question – these are dangerous foods. People who still desire to eat meat, should think of it as a condiment, only to be used a few times a week in small amounts.  

References:

1. He FJ, MacGregor GA: A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens 2009;23:363-384.
2. Go AS, Mozaffarian D, Roger VL, et al: Heart Disease and Stroke Statistics--2013 Update: A Report From the American Heart Association. Circulation 2013;127:e6-e245.
3. Papanikolaou Y, Fulgoni VL, 3rd: Bean consumption is associated with greater nutrient intake, reduced systolic blood pressure, lower body weight, and a smaller waist circumference in adults: results from the National Health and Nutrition Examination Survey 1999-2002. J Am Coll Nutr 2008;27:569-576.
4. Landsberg L: Insulin-mediated sympathetic stimulation: role in the pathogenesis of obesity-related hypertension (or, how insulin affects blood pressure, and why). J Hypertens 2001;19:523-528.
5. Streppel MT, Arends LR, van 't Veer P, et al: Dietary fiber and blood pressure: a meta-analysis of randomized placebo-controlled trials. Arch Intern Med 2005;165:150-156.
6. Houston MC: The importance of potassium in managing hypertension. Curr Hypertens Rep 2011;13:309-317.
7. Houston M: The role of magnesium in hypertension and cardiovascular disease. J Clin Hypertens (Greenwich) 2011;13:843-847.
8. DeFronzo RA, Cooke CR, Andres R, et al: The effect of insulin on renal handling of sodium, potassium, calcium, and phosphate in man. J Clin Invest 1975;55:845-855.
9. Chiasson JL, Josse RG, Gomis R, et al: Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial. JAMA 2003;290:486-494.
10. Jenkins DJ, Kendall CW, Augustin LS, et al: Effect of Legumes as Part of a Low Glycemic Index Diet on Glycemic Control and Cardiovascular Risk Factors in Type 2 Diabetes Mellitus: A Randomized Controlled Trial. Arch Intern Med 2012:1-8.
11. Bazzano LA, Thompson AM, Tees MT, et al: Non-soy legume consumption lowers cholesterol levels: a meta-analysis of randomized controlled trials. Nutrition, metabolism, and cardiovascular diseases : NMCD 2011;21:94-103.
12. Brown L, Rosner B, Willett WW, et al: Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr 1999;69:30-42.
13. Anderson JW: Dietary fiber prevents carbohydrate-induced hypertriglyceridemia. Curr Atheroscler Rep 2000;2:536-541.
14. Chen GC, Lv DB, Pang Z, et al: Dietary fiber intake and stroke risk: a meta-analysis of prospective cohort studies. Eur J Clin Nutr 2013;67:96-100.
15. Pereira MA, O'Reilly E, Augustsson K, et al: Dietary fiber and risk of coronary heart disease: a pooled analysis of cohort studies. Arch Intern Med 2004;164:370-376.
16. King DE, Mainous AG, 3rd, Lambourne CA: Trends in dietary fiber intake in the United States, 1999-2008. J Acad Nutr Diet 2012;112:642-648.
17. Luan de C, Li H, Li SJ, et al: Body iron stores and dietary iron intake in relation to diabetes in adults in North China. Diabetes Care 2008;31:285-286.
18. Rajpathak SN, Crandall JP, Wylie-Rosett J, et al: The role of iron in type 2 diabetes in humans. Biochim Biophys Acta 2009;1790:671-681.
19. de Oliveira Otto MC, Alonso A, Lee DH, et al: Dietary intakes of zinc and heme iron from red meat, but not from other sources, are associated with greater risk of metabolic syndrome and cardiovascular disease. J Nutr 2012;142:526-533.
20. Ahluwalia N, Genoux A, Ferrieres J, et al: Iron status is associated with carotid atherosclerotic plaques in middle-aged adults. J Nutr 2010;140:812-816.
21. Brewer GJ: Iron and copper toxicity in diseases of aging, particularly atherosclerosis and Alzheimer's disease. Exp Biol Med 2007;232:323-335.
22. Kiechl S, Willeit J, Egger G, et al: Body iron stores and the risk of carotid atherosclerosis: prospective results from the Bruneck study. Circulation 1997;96:3300-3307.
23. Steffen LM, Kroenke CH, Yu X, et al: Associations of plant food, dairy product, and meat intakes with 15-y incidence of elevated blood pressure in young black and white adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Clin Nutr 2005;82:1169-1177; quiz 1363-1164.
24. Tzoulaki I, Brown IJ, Chan Q, et al: Relation of iron and red meat intake to blood pressure: cross sectional epidemiological study. BMJ 2008;337:a258.
25. Wang L, Manson JE, Buring JE, et al: Meat intake and the risk of hypertension in middle-aged and older women. J Hypertens 2008;26:215-222.
26. Miura K, Greenland P, Stamler J, et al: Relation of vegetable, fruit, and meat intake to 7-year blood pressure change in middle-aged men: the Chicago Western Electric Study. Am J Epidemiol 2004;159:572-580.
27. Chen GC, Lv DB, Pang Z, et al: Red and processed meat consumption and risk of stroke: a meta-analysis of prospective cohort studies. Eur J Clin Nutr 2013;67:91-95.
28. Padler-Karavani V, Yu H, Cao H, et al: Diversity in specificity, abundance, and composition of anti-Neu5Gc antibodies in normal humans: potential implications for disease. Glycobiology 2008;18:818-830.
29. WCRF/AICR Expert Report, Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective.: World Cancer Research Fund; 2007.
30. Lunn JC, Kuhnle G, Mai V, et al: The effect of haem in red and processed meat on the endogenous formation of N-nitroso compounds in the upper gastrointestinal tract. Carcinogenesis 2007;28:685-690.
31. Kuhnle GG, Story GW, Reda T, et al: Diet-induced endogenous formation of nitroso compounds in the GI tract. Free Radic Biol Med 2007;43:1040-1047.
32. Pan A, Sun Q, Bernstein AM, et al: Red Meat Consumption and Mortality: Results From 2 Prospective Cohort Studies. Arch Intern Med 2012.
33. Sinha R, Cross AJ, Graubard BI, et al: Meat intake and mortality: a prospective study of over half a million people. Arch Intern Med 2009;169:562-571.
34. Major JM, Cross AJ, Doubeni CA, et al: Socioeconomic deprivation impact on meat intake and mortality: NIH-AARP Diet and Health Study. Cancer Causes Control 2011;22:1699-1707.
35. Key TJ, Fraser GE, Thorogood M, et al: Mortality in vegetarians and nonvegetarians: detailed findings from a collaborative analysis of 5 prospective studies. Am J Clin Nutr 1999;70:516S-524S.
36. Fraser GE: Associations between diet and cancer, ischemic heart disease, and all-cause mortality in non-Hispanic white California Seventh-day Adventists. Am J Clin Nutr 1999;70:532S-538S.


 

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Interview with a Nutritarian: Helen

A year ago this month I received a phone call from my sister informing me that my mom had experienced a stroke and was en-route to the ER via an ambulance. Living five minutes from the hospital I made a mad dash there only to discover my mother intensely suffering in a triage unit. The next day would be her 86th birthday, but at that moment her future looked grim. 

Having older parents who have faithfully put their trust in their doctors’ instructions over the years, I’ve been with them through their heart attacks, bypass and stent surgeries, and ongoing maladies and procedures. I’ve witnessed the negative side effects of their multiple (and astronomically expensive) pharmaceuticals that filled their kitchen counter top. I’ve seen first hand the results of conventional disease management, yet this episode was different. As my mom lied there on the gurney, writhing in excruciating pain from a leg spasm, paralyzed on one side of her body, unable to speak clearly, and crying; I could tell that this was the ultimate nightmare that she didn’t want to be experiencing. However, thankfully my mom discovered that it’s never too late to improve one’s health by eating to live.

 

What was your life like before following Dr. Fuhrman’s nutritarian eating-style?

I was tired all the time, but I thought it was due to old age; not wrong food choices. Because my mother had diabetes, suffered a stroke at age 66, and my siblings and I cared for her in my parents' living room for two years before her death, I made a conscious decision to carefully follow everything that my doctors told me to do over the years; not knowing that it would lead me down a dangerous path. Plus, other women my age were also being instructed to do the same so I thought I was doing the right thing. There was no different way at the time. 

Around age 60 I developed diabetes and was put on an oral diabetes medication for a couple of years, and then the doctor put me on insulin. I followed the recommended meal plan, insulin calculations and dosages; and when my blood sugars kept rising I complied with increasing the units of insulin. I even carried a glucose meter and injections in my purse so I would never miss a shot. 

I also ate animal protein at every meal; it was a part of the food plan that the diabetic educators instructed me to follow: eggs with breakfast, lean meats with lunch and dinner, and a peanut butter sandwich before bed. Every endocrinologist that I went to said the sandwich before bed was important to prevent dangerously low blood sugars in the night. Even with carefully following instructions, my blood sugars were either too high or too low. I lived in fear of the lows, especially when I was out in public or during the night. I even took a sandwich and juice to bed with me, just in case. 

Then my blood pressure also climbed higher with each passing year so blood pressure medications were added to my growing list of medications. However, even with four medications, my cardiologist could never get it below 199/99.  I had two heart attacks and multiple stents put into my body over the years: four stents in my kidneys, seven in my legs, and four in my heart, but I never got well. By the time of my stroke, I also had congestive heart failure and weighed 215 lbs. (5'8") 

Even though you [Emily] improved your health through Eat to Live, I was too dependent upon my doctors’ instructions to feel safe to make such radical changes at my age. Plus, a part of me thought it was too late to change; what’s the use.

 

What changed your mind?

Having the stroke changed my mind.  I was paralyzed on the entire right side of my body. My leg went into an intense spasm that wouldn’t let up, even with medication to try to relax it. I couldn’t speak so that others could understand me. I couldn’t swallow my food. I couldn’t even swallow a drink of water without a special ingredient to thicken it. My hand was clutched tight and I couldn’t open it. I couldn’t use the toilet without help. I wore adult diapers.  I was suddenly trapped in a body that was immobile which required 24/7 nursing care; totally dependent upon others for everything. 

After being discharged from the hospital, I was transferred to a nursing home for ongoing care and therapy. The night staff neglected to clip my call button onto my gown for me to reach it. I’d accidently wet myself during the night and couldn’t call anyone for help. I was totally at the mercy of someone discovering my situation early the next morning. Needless to say, my family transferred me to a stroke rehab facility that following day; but even with the best care, the total loss of independence was enough to change my mind. I was ready to do anything to get better if/when I would be discharged; no matter if my doctors approved it or not. * 

 

When did you start following Eat to Live?

After spending five weeks eating pureed meat and processed institutional foods, totally void of color, I was delighted to watch Dr. Fuhrman’s 3 Steps to Incredible Health that aired on our local PBS station the weekend after I returned home. Something “clicked” that day; plus I liked watching TV versus reading a book as my eyesight hadn't been good for the past couple of years. I totally understood what Dr. Fuhrman was talking about in his presentation. I began eating for health from that moment onward, and I’ve never looked back!

What’s happened since then?

I’ve been off insulin for over six months now, and after giving myself four shots a day for over twenty years it’s been wonderful to be totally free from them!  Also, with eating this way I don’t experience low blood sugars anymore so that all-consuming fear is gone.

I’ve lost about 65 lbs so far, and my blood pressure is never higher than 115/65. I’m down to just ½ dose of a blood pressure medication now, compared to four medications and continual, dangerously high blood pressures before following Eat to Live.

I’m more alert, I don’t tire so easily, and I even have the stamina to ride a stationary bike for 2 ½ miles/day; plus, I lift weights and do various exercises to continue to strengthen my arms, legs, back, and facial muscles. I noticed this past winter when I got a cold and cough that it only lasted for a couple of days. The same thing happened with a sore and infected toe; it healed quickly, when it used to take a long time for a wound to heal.   

Had I not followed high-nutrient eating this past year, there’s no way that my weakened muscles from the stroke could’ve supported the obese weight. It would be very difficult for me to get around with sixty-five extra pounds on my body. I use a walker for stability, but I can now walk in grocery stores, go to the mall with assistance, attend church and family events, and see my friends. I know that I would be completely homebound without following Eat to Live

 

Do you have any success tips to share?

 

  • Yes, keep it simple. You [Emily] had knee surgery at the same time that I started eating high-nutrient foods so I had to find an easy way to make it work on my own. Where there’s a will, there’s always a way. I kept the meals simple. I steamed enough vegetables to have on hand for several meals. I made a pot of lentils once a week. I made sure to include cooked mushrooms and chopped onions daily. Bob [her husband of sixty-five years and my dad] has always grown a big garden, and he helped me prepare the vegetables, but I haven’t made fancy recipes yet; that may come this next year.

 

  • However, the most important tip is that one’s health should come first above all other priorities. Health first; everything else second! That’s got to be the mindset or other things will crowd it out. My main occupation now is making time for my food preparation, daily exercises, and adequate rest.  If you are young, don’t wait until you are old to change your eating habits. If you are old, it’s never too late to change and get health restored. Don’t cheat yourself out of the best health that’s possible.

 

Congratulations Mom ~ I’m truly proud of you for overcoming a myriad of obstacles to contend for your health, no matter what. And happy eighty-seventh birthday this year!

[By the way, the top picture was taken the day after the stroke, on her 86th birthday.  She had a smile on her face only because the grandchildren were in the room with balloons and cards to celebrate her birthday.] 

 

  

* Helen has been medically supervised, via phone consultations, by Jay Benson, D.O. Dr. Benson is board certified in family medicine, specializing in nutritional medicine, and sees patients at Dr. Fuhrman’s Medical Associates in Flemington, New Jersey. 

"I could never do that!" part 2

Not long ago I wrote a post titled, I could never do that!  It was about the response I get when I tell others how I’ve lost weight, and their reaction to the idea of eating meals primarily composed of plant based nutrition. From the many Disease Proof readers that wrote comments, that post resonated deep within; solidifying the fact that most all of us could never live with the consequences of eating disease promoting foods.

The topic is beating passionately in my heart now as it's hit close to home. Recently my mother suffered a stroke, and I’ve been experiencing first hand the time, resources, and energy that will now be required to manage the debilitating disease. A stroke results in a sudden lifestyle change magnified by a hundred: immobility due to muscle paralysis, incontinence for some, inability to swallow normally resulting in slurred speech and the need for pureed foods and thickened liquids, multiple medications, therapy, lack of independence and freedom; just to name a few.

Lifestyle change. 

Interesting. 

Lifestyle change is the very reason why most continue to choose to eat the standard American diet; or worse yet, follow a quick weight-loss gimmick. It takes time, resources, focus, and energy to switch over to eating high-nutrient, plant based foods. 

  • One has to routinely wash and cut up lettuce leaves, fresh vegetables and fruits.
  • One has to cook a pot of soup instead of order take-out. 
  • Many have to suffer through a period of withdrawal to overcome toxic cravings for sugar, fat, processed foods, and salt.
  • Some feel socially isolated in a culture that’s fixated with eating for disease.
  • Some are even ridiculed for eating for health!
  • Many have to pack their own food if they eat away from home.
  • Most have to become serious students of nutrition to understand the science behind dietary recommendations, because knowledge is the motivation behind their changes.  

No doubt about it, there’s a radical price to pay to successfully switch over to thoroughly enjoy eating plant based nutrition. However, once the toxic cravings are gone, and the taste buds have changed, one never wants to return to SAD. In fact, the psychological trappings of food addiction and eating disorders disappear! It’s a small price to pay for a lifetime of freedom and wonderful health benefits for the rest of one’s life! 

As the old adage goes, “Pay the grocer or pay the doctor.”

 

Have you made the lifestyle change, or are you dragging your feet; waiting for a debilitating disease to radically change your life and make you its prisoner?

 

Let’s all continue to choose high nutrient foods that will reap the benefits of great health today and for years to come! It’s a small price to pay. 

 

What price are you willing to pay to enjoy great health?   

 

image credit:  flickr by taberandrew

 

Red meat consumption increases ischemic stroke risk

Stroke is the leading cause of disability in the U.S., and the third leading cause of death, killing 137,000 Americans each year.[1]

There are two types of stroke – ischemic and hemorrhagic. Most strokes (about 85%) are ischemic strokes, in which blood flow to the brain becomes blocked either by a clot or a ruptured atherosclerotic plaque. The minority of strokes are hemorrhagic strokes, caused by the rupture of a blood vessel leading to bleeding in the brain. Ischemic stroke, similar to a heart attack, is caused by atherosclerosis, whereas hemorrhagic stroke is primarily caused by vessel damage due to years of elevated blood pressure.

A recent study has found that the consumption of red meat, at quantities similar to the average American’s intake, is associated with a large increase in risk of ischemic stroke. Processed meats were also associated with ischemic stroke risk. [2]

In this study, dietary patterns of 34,670 Swedish women were recorded, and the incidence of stroke was recorded over the following 10 years. The women had no cancer or cardiovascular disease at the start of the study. Women who ate at least 3.6 ounces of red meat daily were 42% more likely to suffer an ischemic stroke, compared to those who ate less than one ounce per day. The average American eats 3 ounces of red meat daily, which in this study was associated with a 22% increase in risk. Also, women who ate 1.5 ounces or more of processed meat per day had a 24% increase in risk for ischemic stroke compared to those who ate less than 0.5 ounces per day.[3, 4]

In contrast, there is new evidence that dietary antioxidants, as measured by total antioxidant capacity (TAC) of the diet are protective against ischemic stroke.

Participants in the European Prospective Investigation into Cancer and Nutrition (EPIC), with the highest vs. lowest TAC had a 59% reduction in risk. Of course the foods with the highest antioxidant capacity are the nutrient-dense plant foods like green vegetables and berries. [5]

What is the connection between red and processed meats and ischemic stroke?

Atherosclerosis. First, red meat is a calorie-dense, protein-concentrated, saturated fat-rich food with a low content of micronutrients – these characteristics promote inflammation, weight gain and increased cholesterol levels, leading to formation of atherosclerotic plaque. As such, red meat consumption is associated with increased risk of ischemic heart disease and all-cause mortality. [6-9] Since atherosclerotic heart disease and ischemic stroke are so similar, it makes sense that red meat consumption would also increase stroke risk.

Blood pressure is another potential connection. Processed meats are usually high in sodium, which contributes to elevated blood pressure, the most important risk factor for both types of stroke; elevated blood pressure accounts for 62% of strokes.[10] Although salt intake is the dietary factor most known for increasing blood pressure, red meat intake is also associated with high blood pressure. Women who consumed 3.5 servings of red meat per week were found to have a 24% increase in risk of hypertension over a ten-year follow-up period.[11] A 7-year study of middle-aged men similarly found that meat intake was associated with larger increases in blood pressure, while vegetable and fruit intake were associated with smaller increases in blood pressure over time.[12]

Heme iron present in red meat is another factor, which may raise blood pressure and increase oxidative stress. Positive associations were found between heme iron (found only in animal foods) and blood pressure, and negative associations were found between non-heme iron (found in plant foods) intake and blood pressure. [13] Also, the heme iron in red meat can accumulate and cause free radical damage, which is known to contribute to the atherosclerotic process. [14]

These studies paint a clear picture – high nutrient, high antioxidant foods like vegetables and fruit are protective against stroke, and red and processed meats – low nutrient, low antioxidant foods - increase the risk of stroke.

 

References:
1. U.S. Centers for Disease Control: Stroke. Available from: http://www.cdc.gov/stroke/.
2. Larsson, S.C., J. Virtamo, and A. Wolk, Red meat consumption and risk of stroke in Swedish women. Stroke; a journal of cerebral circulation, 2011. 42(2): p. 324-9.
3. Reuters: Red meat raises women's stroke risk: study. The Montreal Gazette.
4. U.S. Department of Agriculture. Loss-adjusted Food Availibility: Spreadsheets. Available from: http://www.ers.usda.gov/Data/FoodConsumption/FoodGuideSpreadsheets.htm#meat.
5. Del Rio, D., et al., Total antioxidant capacity of the diet is associated with lower risk of ischemic stroke in a large Italian cohort. The Journal of nutrition, 2011. 141(1): p. 118-23.
6. Preis, S.R., et al., Dietary protein and risk of ischemic heart disease in middle-aged men. Am J Clin Nutr, 2010. 92(5): p. 1265-72.
7. Sinha, R., et al., Meat intake and mortality: a prospective study of over half a million people. Arch Intern Med, 2009. 169(6): p. 562-71.
8. Jakobsen, M.U., et al., Major types of dietary fat and risk of coronary heart disease: a pooled analysis of 11 cohort studies. Am J Clin Nutr, 2009. 89(5): p. 1425-32.
9. Fraser, G.E., Vegetarian diets: what do we know of their effects on common chronic diseases? The American journal of clinical nutrition, 2009. 89(5): p. 1607S-1612S.
10. He, F.J. and G.A. MacGregor, A comprehensive review on salt and health and current experience of worldwide salt reduction programmes. J Hum Hypertens, 2009. 23(6): p. 363-84.
11. Wang, L., et al., Meat intake and the risk of hypertension in middle-aged and older women. Journal of hypertension, 2008. 26(2): p. 215-22.
12. Miura, K., et al., Relation of vegetable, fruit, and meat intake to 7-year blood pressure change in middle-aged men: the Chicago Western Electric Study. American Journal of Epidemiology, 2004. 159(6): p. 572-80.
13. Tzoulaki, I., et al., Relation of iron and red meat intake to blood pressure: cross sectional epidemiological study. Bmj, 2008. 337: p. a258.
14. Brewer, G.J., Iron and copper toxicity in diseases of aging, particularly atherosclerosis and Alzheimer's disease. Experimental Biology and Medicine, 2007. 232(2): p. 323-35.

 

Erroneous information on hemorrhagic stroke from The New York Times

The New York Times is a well-respected publication, and its readers expect accurate information from both the publication and its associated web content. So I was stunned to read not only incorrect but potentially dangerous information in the New York Times Hemorrhagic Stroke In-depth Prevention Report, part of the Times Health Guide. A large section of the report was devoted to anti-platelet and anti-coagulant medications, when these drugs do not prevent hemorrhagic strokes – in fact, they have the opposite effect; they increase the risk of death from hemorrhagic stroke.  The information on anti-coagulants in the NYT report refer only to ischemic stroke, not hemorrhagic stroke.   Anticoagulants should not have been mentioned here, unless as something to avoid.  In fact, prior aspirin use has furthermore been cited as a predictor of death from hemorrhagic stroke.[1] Also, any anti-platelet or anti-coagulant medication (not only aspirin) will carry a risk of bleeding, and therefore is not an appropriate preventive measure for hemorrhagic stroke.   

The report also fails to communicate the fact that ischemic and hemorrhagic stroke do not share the same risk factors. Although high blood pressure is the foremost risk factor for both ischemic and hemorrhagic strokes, other common risk factors for ischemic stroke are not risk factors for hemorrhagic stroke – especially high LDL cholesterol. In fact, studies have found that low saturated fat and animal protein intake and low serum cholesterol, which would reduce risk of heart attacks and ischemic stroke, are associated with increased risk for hemorrhagic stroke.[2]  Although the report mentioned that statin use may increase the risk of hemorrhagic stroke, it failed to explain that low cholesterol does not protect against hemorrhagic stroke, and may increase one’s risk of hemmorhagic stroke, especially in the presence of high blood pressure.  

For prevention of hemorrhagic stroke, keeping blood pressure in a safe range is of paramount importance. This is especially important for those who already are eating athero-protective diets, rich in whole plant foods and minimizing animal products and processed foods to reduce risk of heart disease, ischemic stroke and cancer. A health-promoting diet, salt restriction, and exercise – not anti-coagulant medications – should be emphasized, as lifestyle strategies to maintain favorable blood pressure reduce the risk of hemorrhagic stroke.

I hope that my comments will prompt The New York Times to revise and correct its report on hemorrhagic stroke prevention.

More information on hemorrhagic stroke.

 

References:

1. Saloheimo P, Ahonen M, Juvela S, et al. Regular aspirin-use preceding the onset of primary intracerebral hemorrhage is an independent predictor for death. Stroke. 2006 Jan;37(1):129-33.

2. Iso H, Stampfer MJ, Manson JE, et al. Prospective study of fat and protein intake and risk of intraparenchymal hemorrhage in women. Circulation. 2001 Feb 13;103(6):856-63.

Iso H, Sato S, Kitamura A, et al. Fat and protein intakes and risk of intraparenchymal hemorrhage among middle-aged Japanese. Am J Epidemiol. 2003 Jan 1;157(1):32-9.

Yano K, Reed DM, MacLean CJ. Serum cholesterol and hemorrhagic stroke in the Honolulu Heart Program. Stroke. 1989 Nov;20(11):1460-5.

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Stroke in the news: Beau Biden, Bret Michaels

Stroke is the leading cause of disability in the U.S., and the third leading cause of death. Almost 800,000 people in the U.S. have a stroke each year. Although stroke is usually perceived as a condition that afflicts older Americans, it occurs in people of all ages. About 25% of strokes occur in people under the age of 65, and 10-15% occur in those under age 45.1

Yesterday, at the age of 41, Beau Biden, Delaware Attorney General and son of U.S. Vice President Joe Biden, suffered what is being called a mild stroke. As of now, there is no available information as to what type of stroke he suffered. Joe Biden himself suffered from a hemorrhagic stroke due to a ruptured brain aneurysm in 1985 at the age of 45.2

Bret Michaels, of the band Poison and a contestant on The Celebrity Apprentice, suffered a subarachnoid hemorrhage (a type of hemorrhagic stroke) in April at age 47. He was released last week to a rehabilitation facility.3

What is a hemorrhagic stroke?

Most strokes, about 85%, are ischemic strokes, in which blood flow to the brain is blocked either by a clot or atherosclerotic plaque. The remaining 15% of strokes are hemorrhagic strokes, caused by bleeding in the brain due to the rupture of a blood vessel. This may be the rupture of a small, damaged artery or an aneurysm. Hemorrhagic stroke is even more devastating than ischemic stroke – the rapid bleeding into the brain compresses the neural tissue, most often resulting in permanent damage or death.1

What makes the small blood vessels of the brain susceptible to rupture?

Hemorrhagic stroke, on average, affects younger people than ischemic stroke does, and the most common cause of hemorrhagic stroke is high blood pressure.4  Elevated blood pressure places stress on the walls of the small delicate vessels in the brain, and is the foremost risk factor for both ischemic and hemorrhagic strokes. Small vessels contain a much thinner layer of muscle, or no muscle layer at all, making them more susceptible to the effects of elevated pressure.

How to protect yourself from hemorrhagic stroke: Avoid salt!

High blood pressure is the most important risk factor for hemorrhagic stroke, and Americans have a 90% lifetime probability of having high blood pressure. The most effective way to keep blood pressure in a favorable range is to avoid the huge amounts of excess salt that most Americans consume. Stroke mortality is significantly higher in Japan and exceptionally high in certain areas of China where salt intake is high, in spite of low-fat diets.5 It is also well established that Third World countries that do no salt their food are virtually immune to hypertension and strokes.

High-salt consumption may be potentially more dangerous for vegans, vegetarians, and others who have earned low cholesterol levels by eating otherwise healthful diets. Many vegans believe that their low cholesterol levels and decreased atherosclerosis risk make them exempt from all types of cardiovascular disease, but this is not the case. Unlike heart disease, cholesterol is not an important risk factor for hemorrhagic stroke. In fact, low cholesterol levels are associated with increased risk of hemorrhagic stroke. A number of studies both in Japan and in the West have illustrated that fewer animal products and a low serum cholesterol were associated with increased risk of hemorrhagic stroke.6 The plaque-building process that results in atherosclerosis and premature death may in some way actually protect the fragile blood vessels in the brain from rupture due to high blood pressure. A high-salt diet may dramatically increase the risk of hemorrhagic stroke in vegans because they can live longer than the general population and not die from a heart attack first. Of course, excess sodium increases both heart attack and stroke death in all diet styles, but in vegans, a high-salt diet may be even more dangerous. To protect against heart attacks, ischemic strokes, and hemorrhagic strokes, you must dramatically curtail salt consumption. 

Excess salt is more dangerous than most people realize. In addition to high blood pressure and stroke, salt contributes to kidney disease, heart diseaseosteoporosis, ulcers, and stomach cancer.7 Avoiding salt is an essential component of a health-promoting, disease-preventing diet.

To learn more, read my articles and newsletters about salt, hypertension, and reducing blood pressure.



References:

1. Centers for Disease Control: Stroke. http://www.cdc.gov/stroke/

American Heart Association: Stroke. http://www.americanheart.org/presenter.jhtml?identifier=4755

5. Kono S, Ikeda M, Ogata M. Salt and geographical mortality of gastric cancer and stroke in Japan. J Epidemiol Community Health. 1983 Mar;37(1):43-6.

6. Iso HM, Stampfer MJ, Manson JE, et al. Prospective study of fat and protein intake and risk of intraparenchymal hemorrhage in women. Circulation 2001;103:856.

Yano K, Reed D, MacLean C. “Serum Cholesterol and Hemorrhagic Stroke in the Honolulu Heart Program.” Stroke 1989;20(11): 1460-1465.

7. Tsugane S, Sasazuki S. Diet and the risk of gastric cancer. Gastric Cancer 2007;10(2):75-83

Vitamin D protects against death from heart disease and stroke

The evidence connecting Vitamin D deficiency with chronic disease continues to mount. Vitamin D deficiency has been linked to osteoporosis, multiple cancers, musculoskeletal diseases, thyroid disease, depression, and Type II diabetes. This is especially troublesome since several studies have found that most Americans are Vitamin D deficient.

Now, a long-term study has examined the connection between blood Vitamin D levels and death from cardiovascular disease – and the results were dramatic:

Serum Vitamin D levels were measured at the beginning of the study, and subjects were followed for 26 years. The researches found that those individuals with the highest blood levels of Vitamin D were 24% less likely to die from any cardiovascular disease, and 52% less likely to die from stroke.1

This new data supports results from the Framingham Heart Study, in which subjects were followed for 5 years – even after 5 years, those with low blood levels of vitamin D had a 60% greater risk of heart disease.2

How might Vitamin D affect cardiovascular health? Vitamin D localizes to most tissues and cells in the human body and is involved in several vital processes – to name a few - insulin production, immune cell function, inflammation, and heart contractility. Vitamin D deficiency could possibly lead to a pro-inflammatory environment, which would promote cardiovascular disease.3

How can you get adequate Vitamin D? Food sources of Vitamin D are scarce, and it is almost impossible for your body to produce sufficient Vitamin D from a safe amount of sun exposure, especially if you work indoors and don’t live in the tropics. So a Vitamin D supplement is your best bet. Remember – the standard dose of Vitamin D found in most multivitamins is not enough to assure adequate blood Vitamin D levels. In order to support all of Vitamin D’s important actions in the body, additional supplementation is necessary. Be cautious of Vitamin D supplements geared toward bone health – they may also contain excessive amounts of calcium, which can result in poor absorption of other minerals. Read more about calcium, vitamin D and bone health.

 

References:

1. Kilkkinen A et al. Am J Epidemiol. 2009 Oct 15;170(8):1032-9. Epub 2009 Sep 17. Vitamin D status and the risk of cardiovascular disease death.

2. Wang TJ. Circulation. 2008 Jan 29;117(4):503-11. Epub 2008 Jan 7. Vitamin D deficiency and risk of cardiovascular disease.

3. Holick MF. Am J Clin Nutr. 2004 Dec;80(6 Suppl):1678S-88S. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease.

 

Veggie Protein Lowers Blood Pressure

New findings in the journal Circulation reveal glutamic acid—a protein found in vegetables—reduces average systolic blood pressure by 1.5 to 3 points and diastolic pressure by 1 to 1.6 points.

The drop may seem teeny tiny, but overall it may lower death rates from stroke by 6% and heart disease related deaths by 4%.

Vegetable protein is 23% glutamic acid, while meat protein is only 18% glutamic acid.

However, researchers insist improving blood pressure does not come down to one single nutrient and urge people eat their vegetables, avoid fatty foods and not drink a lot of alcohol.

Now, you probably know this by now, but cutting salt is a major way to lower blood pressure. In March, a study discovered salt decreases an important blood pressure-lowering enzyme, which signals blood vessels to relax. Eek!

Via HealthDay News.

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Tummy Fat Linked to Liver Cancer

New findings in the journal Gut reveal too much fat surrounding internal organs increases risk of liver cancer recurrence after treatment. Scientists followed 62 people who received treatment for liver cancer. Of the participants, 27 had high amounts of belly fat and 35 had lower amounts. After one year, the high group had 15.9% risk of recurrence, while the low group only had 9.7% and three years later the figures were 75.1% and 43.1%, respectively; Reuters reports.

In April, a study claimed men with excess belly fat have a 15% higher risk of heart failure and women have a 30% higher risk. Too much abdominal fat seemingly affects everything. Other research has linked tummy fat to stroke, migraine headaches and even death risk.

In related news, the CDC reports Mississippi, Louisiana and Alabama continue to lead the nation in obesity, but no worries. Australia is officially fatter than the United States.

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Red Bull All Coked Up...

Red Bull might give you wings, but apparently it might also give you the frantic energy you need to build a barn at 2 o’clock in the morning. German authorities report finding trace of amounts of cocaine in Red Bull energy drinks. As a result, Red Bull is now banned in Germany. Official testing revealed 0.4 micrograms of booger sugar per liter of the drink. Experts say the dose was too small to do harm and Red Bulls insists the drink is harmless; the Associated Press reports.

Energy drinks are hardly harmless. They are high in caffeine and caffeine is a stimulant, which allows you to get by with less sleep, but lack of sleep promotes disease and premature aging. And recently, coffee was linked to shrinking breasts and even hallucinations. Eek!

Last year, an Australian study determined drinking Red Bull, as little as one can, can increase your risk of stroke. Even still, Red Bull managed to sell 3.5 billion cans in 143 countries in 2008.

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