Are you hypertensive or/and diabetic? If the answer is yes, then you have higher risk of having a stroke. But researchers have found eating primarily plant-based foods, such as fruit, vegetables, whole grains, legumes and nuts; replacing butter with healthy fats, such as olive oil; using herbs and spices instead of salt to flavour foods; limiting red meat to no more than a few times a month; drinking red wine in moderation, which is optional; regularly engaging in physical activity; and of course keeping your blood pressure under control would lower the risk of getting a stroke. CHUKWUMA MUANYA writes.
A stroke is a sudden loss of brain function. It is caused by the interruption of flow of blood to the brain (ischemic stroke) or the rupture of blood vessels in the brain (hemorrhagic stroke). The interruption of blood flow or the rupture of blood vessels causes brain cells (neurons) in the affected area to die.
The effects of a stroke depend on where the brain was injured, as well as how much damage occurred. A stroke can impact any number of areas including your ability to move, see, remember, speak, reason and read and write.
Stroke is the second leading cause of death and the leading cause of adult disability worldwide. It is estimated that at least 16,000 new stroke cases are recorded annually in Nigeria.
Stroke risk factors, according to a study published in the Nigerian Medical Journal included hypertension (82.7 per cent), obesity (32.6 per cent), diabetes (23.5 per cent), hyperlipidemia/high lipid levels (18.4 per cent), atrial fibrillation/ most common abnormal heart rhythm (9.2 per cent), and cigarette smoking (7.7 per cent).
The researchers from the National Hospital, Garki, Abuja; College of Medical Sciences, University of Maiduguri, Borno State; and the University of Abuja Teaching Hospital, Gwagwalada, Abuja recommend among other things improved public awareness of vascular risk factors, smoking-cessation campaigns, and aggressive control of hypertension.
However, according to updated American Heart Association (AHA)/American Stroke Association (ASA) guideline published in the American Heart Association’s journal Stroke, eating Mediterranean or Dietary Approaches to Stop Hypertension (DASH)-style diets, regularly engaging in physical activity and keeping your blood pressure under control can lower your risk of a first-time stroke.
According to Wikipedia, the Mediterranean diet is a modern nutritional recommendation originally inspired by the traditional dietary patterns of Greece, Southern Italy, and Spain. The principal aspects of this diet include proportionally high consumption of olive oil, legumes, unrefined cereals, fruits, and vegetables, moderate to high consumption of fish, moderate consumption of dairy products (mostly as cheese and yogurt), moderate wine consumption, and low consumption of meat and meat products.
Lead author of the study and professor and chairman of neurology at the Mayo Clinic in Jacksonville, Florida, United States, James Meschia, said: “We have a huge opportunity to improve how we prevent new strokes, because risk factors that can be changed or controlled — especially high blood pressure — account for 90 percent of strokes.”
Meschia added: “Talking about stroke prevention is worthwhile. In many instances, stroke isn’t fatal, but it leads to years of physical, emotional and mental impairment that could be avoided.”
The updated guidelines recommend these tips to lower risk:
*Eat a Mediterranean or DASH-style diet, supplemented with nuts.
*Don’t smoke. Smoking and taking oral birth control pills can significantly increase your stroke risk. If you’re a woman who experiences migraines with aura, smoking raises your risk of stroke even more than in the general population.
*Mediterranean-style or DASH-style diets are similar in their emphasis on fruits, vegetables, whole grains, legumes, nuts, seeds, poultry and fish. Both are limited in red meat and foods containing saturated fats, which are mostly found in animal-based products such as meat, butter, cheese and full-fat dairy.
*Mediterranean-style diets are generally low in dairy products and DASH-style diets emphasize low-fat dairy products.
*Avoiding secondhand smoke also lowers stroke and heart attack risks, according to the guidelines.
*Monitor high blood pressure at home with a cuff device.
*Keep pre-hypertension from becoming high blood pressure by making lifestyle changes such as getting more physical activity, eating a healthy diet and managing your weight.
*Reduce the amount of sodium in your diet; sodium is found mostly in salt.
*Visit your healthcare provider annually for blood pressure evaluation.
*If your medication to lower blood pressure doesn’t work or has bad side effects, talk to your healthcare provider about finding a combination of drugs that work for you.
The writing committee reviewed existing guidelines, randomized clinical trials and some observational studies.
The DASH diet is a dietary pattern promoted by the U.S.-based National Heart, Lung, and Blood Institute (part of the National Institutes of Health, an agency of the United States Department of Health and Human Services) to prevent and control hypertension.
The DASH diet is rich in fruits, vegetables, whole grains, and low-fat dairy foods; includes meat, fish, poultry, nuts, and beans; and is limited in sugar-sweetened foods and beverages, red meat, and added fats. In addition to its effect on blood pressure, it is designed to be a well-balanced approach to eating for the general public. It is now recommended by the United States Department of Agriculture (USDA) as an ideal eating plan.
Also, another study had shown that Mediterranean diet reduces genetic stroke risk.
Scientists say they have discovered that the Mediterranean diet may prevent a genetic risk of stroke since it appears to interact with a particular gene variant usually associated with type 2 diabetes.
Researchers from the Jean Mayer USDA Human Nutrition Research center on Aging (USDA HNRCA) at Tufts University, United States and the CIBER Fisiopatología de la Obesidad y Nutricion in Spain, conducted the study, which was published in the journal Diabetes Care.
The research team analyzed 7,018 men and women involved in the Prevencion con Dieta Mediterranea (PREDIMED) trial. The trial, carried out over a five-year period, looked at whether a Mediterranean or a low-fat controlled diet had an effect on the risk of cardiovascular disease, stroke and heart attack, and whether genetics played a part in this.
Prior to the trial, participants were also required to complete food frequency questionnaires, in order to see how closely participants followed a Mediterranean diet.
The study focused on a particular variant found in the Transcription Factor 7-like 2 (TCF7L2) gene. The variant is commonly involved in glucose metabolism and can lead to the development of type 2 diabetes. The researchers say this gene variant’s link to heart disease has previously been unclear.
Around 14 per cent of the PREDIMED participants were found to be homozygous carriers, meaning they possessed two copies of this gene variant.
Of these homozygous participants who were also following the Mediterranean diet, results of the analysis revealed a reduced number of strokes. José Ordovás, director of the Nutrition and Genomics Laboratory at the USDA HNRCA, explained: “Being on the Mediterranean diet reduced the number of strokes in people with two copies of the variant. The food they ate appeared to eliminate any increased stroke susceptibility, putting them on an even playing field with people with one or no copies of the variant.”
However, Ordovás adds that homozygous carriers who were following the low-fat diet did not have the same results, with a three times increased risk of having a stroke compared with participants with only one or no copies of the gene variant.
Delores Corella, of the CIBER Fisiopatologia de la Obesidad y Nutriciόn, said, however, results showed that when adherence to the Mediterranean diet was high, having two copies of the gene variant bared no significance on fasting glucose levels.
She added: “The same was true for three common measures of cardiovascular disease risk: total blood cholesterol, low density lipoprotein and triglycerides. Conversely, these risk factors were considerably higher in homozygous carriers with low adherence to the diet.”
Previous research has also revealed that following a Mediterranean diet can benefit health. A study from the University of Alabama at Birmingham suggested that following a Mediterranean diet may improve memory and thinking.
Researchers from Spain have suggested the diet may help protect the health of bones.
The researchers in the current Spanish study would like to see more studies to determine how our genes and the Mediterranean diet work together.
Yet another study has examined the association between adherence to a Mediterranean diet and risk of stroke, depression, cognitive impairment, and Parkinson disease.
The study published in Annals of Neurology is titled “Mediterranean diet, stroke, cognitive impairment, and depression: A meta-analysis.”
The study reads: “Twenty-two eligible studies were included (11 covered stroke, nine covered depression, and eight covered cognitive impairment; only one pertained to Parkinson’s disease).
“High adherence to Mediterranean diet was consistently associated with reduced risk for stroke, depression, and cognitive impairment. Moderate adherence was similarly associated with reduced risk for depression and cognitive impairment, whereas the protective trend concerning stroke was only marginal.
“Subgroup analyses highlighted the protective actions of high adherence in terms of reduced risk for ischemic stroke, mild cognitive impairment, dementia, and particularly Alzheimer disease. Meta-regression analysis indicated that the protective effects of Mediterranean diet in stroke prevention seemed more sizeable among males.
“Concerning depression, the protective effects of high adherence seemed independent of age, whereas the favorable actions of moderate adherence seemed to fade away with more advanced age.”
The researchers concluded: “Adherence to a Mediterranean diet may contribute to the prevention of a series of brain diseases; this may be of special value given the aging of Western societies.”
Researchers have also found that Mediterranean diet rich in fruits, vegetables, fish, legumes and heart-healthy fats can help lower the risk of developing chronic kidney disease by 50 per cent.
In addition, such a diet that restricts consumption of red meats, processed foods and sweets can reduce the risk of experiencing rapid kidney function decline by 42 per cent, the findings showed.
The study was published in the Clinical Journal of the American Society of Nephrology.
Co-researcher from Columbia University Medical Centre in the United States, Minesh Khatri, said: “There is increasing evidence that poor diet is associated with kidney disease.”
For the study, the researchers examined the associations of varying degrees of the Mediterranean diet on long-term kidney function in an observational, community-based prospective study.
In their analysis of 900 participants, who were followed for nearly seven years, every one-point higher in a Mediterranean diet score, indicating better adherence to the diet, was associated with a 17 per cent lower likelihood of developing chronic kidney disease.
Dietary patterns that closely resembled the Mediterranean diet were linked with a 50 percent lower risk of developing chronic kidney disease and a 42 per cent lower risk of experiencing rapid kidney function decline.
Bananas ‘cut stroke risk for women after menopause’: Foods high in potassium found to reduce chance by up to a quarter
A new study suggests that eating bananas could cut the risk of strokes in post-menopausal women, a study suggests. Foods high in potassium could help lower the chance by as much as a quarter, it found.
Researchers studied 90,137 postmenopausal women, aged 50 to 79, for an average of 11 years. They looked at how much potassium they consumed, and whether they had strokes or died during the study.
Participants were stroke-free at the start and their average dietary potassium intake was 2,611mg a day.
The World Health Organisation’s daily recommendation for women is 3,510mg or more. Only 16.6 per cent of those studied met or exceeded that.
Results of this study, published in the American Heart Association journal Report, are based on potassium from food, not supplements. A medium-sized banana contains around 430mg.
Women who ate the most potassium were 12 per cent less likely to suffer stroke in general and 16 per cent less likely to suffer an ischaemic stroke (where blood to the brain is cut off) than women who ate the least.
Among women who did not have high blood pressure, those who ate the most potassium had a 27 per cent lower risk of ischaemic stroke and 21 per cent reduced risk for all stroke types.
Of the women with hypertension, those who ate the most potassium had a lower risk of death, but potassium intake did not lower their stroke risk.
Researchers suggested that higher dietary potassium intake may be more beneficial before high blood pressure develops. They also found that women who ate the most potassium were 10 per cent less likely to die early than those who ate the least.
The study’s senior author Sylvia Wassertheil-Smoller, of the Albert Einstein College of Medicine in New York, said: “Our findings suggest that women need to eat more potassium-rich foods. You won’t find high potassium in junk food. Some foods high in potassium include white and sweet potatoes, bananas and white beans.”
However, she warned that having too much potassium can be dangerous to the heart, and that people should check how much of the mineral they should consume.
Local herbs for hypertension, stroke-related diseases
Can a combination of waterleaf, guava leaf, garlic, scent leaf, avocado, bitter leaf, onion, pawpaw leaf be the elusive cure for hypertension, stroke and other cardiovascular ailments?
A recent study by Nigerian researchers published in Ethnobotanical Leaflets has unveiled 14 local plants that could be effectively used to manage hypertension, stroke and their complications.
The local plants according to the study titled: “Phytochemical Analysis of Medicinal Plants Used for the Management of Hypertension by Esan people of Edo State, Nigeria” include: Guava (Psidium guajava), West African Black Pepper or Ashanti pepper (Piper guineense, Uziza in Igbo and Ata iyere in Yoruba), mistletoe (Loranthus spectobulus), waterleaf (Talinum triangulare), Nigerian senna/negro coffee (Senna occidentalis), swizzle stick (Rauwolfia vomitoria, garlic (Allium sativum), onion (Allium cepa), pawpaw (Carica papaya), asthma herb (Euphorbia hirta), scent leaf (Ocimum gratissimum), avocado (Persea americana), cow-foot (Peperomia pellucida), and bitter leaf (Vernonia amygdalina).
The researchers from the Departments of Botany and Pharmacology and Therapeutics, and Medical Laboratory Sciences, Ambrose Alli University, Ekpoma, Delta State, wrote: “In the present study, the plants which were identified by various herbalists in Esanland for the management of hypertension were examined for alkaloids, inulins, flavonoids, cardiac glycosides, tannins and saponins. The results of the various phytochemical tests revealed that alkaloids, saponins, inulins, tannins, flavonoids and cardiac glycosides were present in the plants studied.
“Cardiac glycosides were present in all the species studied while alkaloids were present in all except A. sativum, A. cepa, O. gratissimum, P. americana. Saponnins are present in all except the seeds of Negro coffee (S. accidentalis), while tannins are present in all except bulbs of garlic (A. sativum). Flavonoids were absent in the leaves of scent leaves (O. gratissimum), pawpaw (C. papaya), pear leaves (P. americana) silver bush (P. pellucida), and climbing pepper (Piper guineensis).
“From the present study as well as interviews with the local herbalists. It could be concluded that plants that possessed tannins, cardiac glycosides and alkaloids are the most effective for managing hypertension and also providing protection for the heart. The general use of plants such as A. sativum, A. cepa, C. papaya, E. hirta, O. gratissimum, P. americana, P. pellucida, P. guajava, P. guineensis, V. amygdalina, R. vomitoria, L. spectobulus, T. triangulare, and S. occidentalis in the management of hypertension and other disease condition in Esanland has also been reported in other parts of Nigeria and West Africa.
“The different herbs encountered at the different herbal homes have different medicinal properties and many of them have multiple uses and hence used for the management of more than one ailment. Thus Esan people have used some of these medicinal plants for controlling and managing hypertension and other types of ailments over the years. Gill (1992), Anslem (2006) and Okoli et al (2007) have reported the effectiveness of garlic, leaves of avocado pear, pawpaw, bitter and mistletoe for the treatment of hypertension in Nigeria. Similarly, Ayitey - Smith (1989) has reported the use of avocado pear, and bitter leaf for the management of hypertension and other disease conditions in Ghana.
“Garlic has been confirmed to be very effective in the treatment of hypertension. The bulbs of garlic are blended with honey for the purpose of hypertension. The unripe rind of pawpaw is peeled and soaked in water and after three days, a cup is taken daily. The leaves are also used for treating hypertension. Leaves of avocado pear are cut into pieces, dried and made into tea, for the management of hypertension. Odugbemi (2006) has also documented the efficacy of the cotyledons of avocado pear seed for the treatment of hypertension. The cotyledons are cut into pieces, dried and grinded into powder. A dessertspoonful in 200ml hot water taken after meals gives relieve for the ailment.
“According to Odugbemi (2006) silver bush (P. pellucida) is also very effective in the treatment of hypertension. This is also in line with earlier reports by Ayitey-Smith (1989) in Ghana, and Anslem (2006) in Nigeria. P. guajava leaves are soaked in salt water, washed and squeezed and product made up with fresh water to give a greenish liquid that is taken, one glass two times daily for one week to increase blood level and offer protection against heart attack. According to Addae- Mensah (1989) and Odugbemi (2006), climbing black pepper has been confirmed to be very active in the treatment of hypertension.
“Also, the fresh leaves of V. amygdalina are chewed and swallowed or ground, or stirred in water, and the liquid taken, to manage hypertension (Ayitey-Smith, 1989 and Okoli et al 2007). Gill (1992) has reported that a typical herbal preparation for managing hypertension in South west Nigeria contains Gladiolus, Sanseveira and Citrus spp.”
Also, a recent study published in Journal of Neurological Sciences (Turkish), has demonstrated the beneficial potential of waterleaf in the enhancement of the brain activities and as pro-cognitive and neuro-protective agent.
The researchers concluded: “Consumption of waterleaf going by this investigation can be recommended as food supplement to protect the brain cells and provide numerous other functions that are beneficial to the body. Prior studies have shown that consumption of vegetables and other food supplements rich in polyphenols can reduce age-related neurological disorders.”
“In this investigation, we demonstrated the beneficial potential of waterleaf in the enhancement of the brain activities in Swiss albino mice and by extension, may be recommended as pro-cognitive and neuro-protective agent. It is recommended that further studies be carried out to corroborate these findings.”
Method of preparation
The bulbs of garlic are blended with honey for the purpose of hypertension. The unripe rind of pawpaw is peeled and soaked in water and after three days, a cup is taken daily. The leaves are also used for treating hypertension.
Leaves of avocado pear are cut into pieces, dried and made into tea, for the management of hypertension. The cotyledons of avocado pear seed are cut into pieces, dried and grinded into powder. A dessert spoonful in 200ml hot water taken after meals gives relieve for the ailment.
Guava leaves are soaked in salt water, washed and squeezed and product made up with fresh water to give a greenish liquid that is taken, one glass two times daily for one week to increase blood level and offer protection against heart attack.
Also, the fresh bitter leaves are chewed and swallowed or ground, or stirred in water, and the liquid taken, to manage hypertension.
Garlic
Garlic has long been used for a variety of cardiovascular conditions, especially hyperlipidemia. It has also been reported to have hypotensive action. It is thought to increase nitric oxide production, resulting in smooth muscle relaxation and vasodilatation. One of the primary active compounds that gives garlic its characteristic odor and many of its healing benefits is called allicin.
Meta-analysis of randomly chosen literary data has demonstrated that garlic is related to decrease of BP in patients with increased systolic pressure, but not in patients without increased systolic pressure.
Garlic preparations have been found to be superior to placebo in reducing BP in individuals with hypertension. The antioxidative and antihypertensive effect of garlic has been observed in 20 patients with hypertension compared to 20 patients with normal pressure, who have been receiving garlic pearls preparation for a period of two months.
The results have revealed decreased BP, significant reduction of 8-hydroxy-2-deoxyguanosin, level of nitric oxide, and lipid peroxidation, and an increased level of antioxidative vitamins (C and E). This study points to the beneficial cardioprotective action of garlic in essential hypertension.
In a pilot study made at Clinical Research Center of New Orleans, United States, on whether garlic could lower blood pressure, nine patients with severe hypertension were given a garlic preparation containing 1.3 per cent allicin. Sitting blood pressure fell with a significant decrease in diastolic blood pressure only five to 14 hours after the dose. Moreover, it was proven in a 2009 study that fresh garlic has more potent cardio-protective properties than processed garlic.
Soursop
Annona muricata is a member of the family of custard apple trees called Annonaceae and a species of the genus Annona, known mostly for its edible fruits Annona. The tree grows natively in the Caribbean and Central America.
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