2013-06-07

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:



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:

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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.

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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.

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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.

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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.

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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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