Overeating, salt, the real culprits in stroke risk

More studies, ask you doctor about all the salt ones, they should know the suggested truth.
http://www.theheart.org/article/1330409.do?utm_campaign=newsletter&utm_medium=email&utm_source=20111221_EN_Heartwire

Perth, Australia - The overall quality of a person's diet and the balance between caloric intake and expenditure appear to be more important determinants of stroke risk than the actual foods and nutrients consumed, according to a new review published in the January 2012 Lancet Neurology special issue [1].

In general, the two biggest threats to health and risk of stroke are overeating and excess salt, author Dr Graeme J Hankey (Royal Perth Hospital, Australia) writes.

"These behaviors are a normal response by people to an abnormal environment," Hankey notes. "Our living environments have become more conducive to consumption of energy and less conducive to expenditure of energy in developed and increasingly in developing regions."

He writes that between 1970 and 2008, the incidence of stroke in high-income countries fell by 42%, probably due to increased public awareness about the dangers of high blood pressure, high cholesterol, and cigarette smoking.

But in poorer countries, the incidence of stroke actually increased by more than 100% during this period, and this rise coincided with food and lifestyle changes associated with industrialization and urbanization.

Small number of trials

For his analysis, Hankey reviewed trials and other studies assessing the link between nutrition or diet and the risk of stroke published between 1970 and October 2011. Collectively, he notes, the study findings were diverse and occasionally contradictory.

Hankey's review also revealed the following effects of individual foods and beverages on the risk of stroke:

• Fish—Three servings a day associated with a 6% lower risk of stroke.
• Fruits and vegetables—More than five servings a day associated with a 26% lower risk of stroke.
• Meat—Each daily serving associated with a 24% increased risk of stroke.
• Reduced-fat milk—Associated with a lower risk of stroke vs full-fat milk.
• Chocolate—High consumption associated with a 29% lower risk of stroke.
• Coffee—Three to four cups per day associated with a 17% lower risk of stroke.
• Tea—More than three cups per day associated with a 21% lower risk of stroke.
• Sugar-sweetened beverages—High intake associated with increased obesity, diabetes, metabolic syndrome, and coronary heart disease.
• Whole grains—High intake associated with a 21% lower incidence of cardiovascular events.
• Rice—Intake not associated with risk of stroke.(but what about prevention? here:

http://oc1dean.blogspot.com/2011/04/alpha-tocotrienols-and-stroke.html)

"Further research is needed to improve the quality of evidence relating to the association of many nutrients, foods, and dietary patterns with stroke risk," Hankey suggests. This requires adequately powered, large randomized trials, with carefully described patient populations and interventions. The outcomes of such trials should also distinguish first-ever and recurrent stroke, as well as ischemic and hemorrhagic stroke and their different etiologies.

Hankey also suggests that populationwide salt-reduction programs led by governments and with industry cooperation could be highly cost-effective. "In the USA, modest, populationwide reductions in dietary salt of up to 3 g per day . . . are projected to reduce the annual number of new cases of stroke by 32 000 to 66 000, similar to the benefits of populationwide reductions in tobacco use, obesity, and cholesterol levels," he writes.

Hankey said in an interview that he hopes his study will stimulate conclusive studies "by means of large, randomized controlled trials of the effect of dietary nutrients, foods, and patterns on stroke and its pathological and etiological subtypes." The current evidence associating dietary nutrients, foods, and patterns with stroke is generally suboptimal for providing reliable conclusions about causality, he reiterated.

"The effect of only a few supplements on stroke risk have been studied by means of large, randomized controlled trials, and all of those have shown no benefit of antioxidant vitamins, B vitamins, and calcium supplements in preventing stroke—despite large, more suboptimal, epidemiological studies claiming they should be beneficial," he said.

Best diet still uncertain

Asked to comment on this study, Dr Eugene Storozynsky (University of Rochester Medical Center, NY) said that he agrees with Hankey's conclusions.

"This is a good review of the literature as to what role diets and their components would have on reducing stroke, and what it tells us is that there still is a lot of uncertainty about the best diet. One study suggests benefit of a certain food or strategy; the other may come to the opposite conclusion," Storozynsky said.

The take-home message here is as Hankey notes, Storozynsky continued. "We need rigorously done randomized controlled trials to really monitor the long-term effects of diets and nutrients, rather than observational studies that look at individual factors, to see whether or not there is any benefit to adopting certain strategies."

Storozynsky also noted what he considers to be an important omission from Hankey's review. "This review did not look at the effect of exercise and how it affects nutrition or stroke results. Does routine daily exercise mitigate the effect of intermittent poor eating? Exercise definitely needs to be part of the equation," he said.