Final project stroke prevention-diet-vitamins-and-minerals (1)

Stroke Prevention diet & Stroke Management 1
STROKE PREVENTION DIET & STROKE MANAGEMENT
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Table of Contents
Introduction................................................................................................................................3
Physiological and Metabolic Causes of Stroke..........................................................................3
Symptoms of the Primary Diagnosis .........................................................................................4
Diet and Lifestyle That Need To Be Modified ..........................................................................4
Stroke Treatment Plan................................................................................................................5
Vitamins and Minerals for Stroke Prevention and Treatment ...................................................6
Physiology to the Contraindications and/or Toxicities............................................................10
Specific Recommendations for Follow up Care......................................................................11
Recommend Additional Testing ..........................................................................................12
Outcome Measures That Can Be Objectively Assessed......................................................12
Conclusion ...............................................................................................................................12
References................................................................................................................................14

Introduction
A stroke occurs when blood flow to the brain or part of the brain is cut or
limited. This causes the brain to stop receiving oxygen, and within a few minutes the neurons
begin to die (Jenkins et al., 2018). There are three main types of strokes, and they include
thrombotic, embolic, and hemorrhagic stroke. Thrombotic stroke is caused by a thrombus or
clot in one of the many arteries that transport blood to the brain. Embolic stroke is caused
when a clot is formed in the brain thus making blood flow to areas where the arteries are
narrower. Hemorrhagic stroke is caused when a blood vessel in the brain ruptures (Liber et
al., 2018). In the case of hemorrhages, there are some clear causes that are behind their
appearance. One of the most frequent is having high blood pressure. The World Health
Organization (WHO) states that in every year, stroke affects more than 15 million people. Of
the 15 million, 5 million end up dying, and 5 million became fully disabled (WHO, 2019).
Stroke is a serious disease and needs to be a global response towards the disease.
Physiological and Metabolic Causes of Stroke
Over the years, many elements that affect the onset of stroke have been identified.
The most frequent causes include Obesity or overweight, lack of physical exercise,
exaggerated consumption of tobacco, alcohol, and drugs, high cholesterol level, diabetes,
cardiovascular diseases, genetic heritage, and consuming medications that contain estrogen.
Interestingly, men and, especially, African Americans have a higher chance of having a
stroke.
Treatable factors that cause stroke include high blood pressure, cigarette, diabetes,
alcohol, high cholesterol, drugs (cocaine), atrial fibrillation, heart problems, blood disorders,
migraines, oral contraceptives, carotid disease, sedentary lifestyle, obesity and infectious
processes (Iacoviello et al., 2018). Untreatable factors include family history, having had
stroke in the past, silent infarcts in neuroimaging, and age among others (Boden-Albala,

Southwick, & Carman, 2015). Arterial Hypertension is the most frequent risk factor since it is
present in most patients who suffer a stroke. High cholesterol increases the risk of clogging
arteries, including those that go to the brain so that it can cause a stroke.
Symptoms of the Primary Diagnosis
Some of the symptoms that may indicate the existence of stroke include difficulty
speaking and understanding what other people say, difficulty or even paralysis of some parts
of the body, usually the face, arms and legs, vision problems, difficulty in swallowing liquids
and food, memory loss, changes in behavior, difficulty controlling emotions, and intense
headache.
It is essential to make a diagnosis as quickly as possible because acting quickly is key
to achieving good results. The emergency doctor and his/her team have to reveal what kind of
stroke the patient is facing and what areas of the brain are damaged. Besides, other
possibilities have to be tested, such as the existence of a brain tumor or an allergic reaction to
a medication.
The first thing is to do the physical exam and perform a blood test to have more
information about the clots and rule out possible infections. A computerized tomography
(CT) scan is also usually done that can help detect if there is a tumor and a magnetic
resonance imaging (MRI) that will determine the affected brain tissue.
Diet and Lifestyle That Need To Be Modified
In primary stroke prevention, nutritional research has considered three major areas:
individual nutrients, food groups, and dietary patterns. The best prevention is to have a
healthy life plan and follow some simple tips including: controlling high blood pressure and
hypertension, avoiding stress, controlling the level of cholesterol, avoiding cigarettes,
controlling blood cholesterol and blood glucose, and avoiding sedentary lifestyle and obesity,

having a balanced diet, and consuming preventive medications such as anticoagulants are
general measures to prevent a stroke.
Following a healthy diet that prioritizes eating whole foods, fruits and vegetables,
moderating sodium intake, cholesterol-rich foods, and saturated fats, and controlling sugar
consumption are some of the habits that should be part of the routine. There are foods, for
example, high in omega 3 and 6 and vitamin E, which work as natural antioxidants and help
prevent microvascular disease, as well as others that increase good cholesterol, helping to
prevent stroke.
Stroke Treatment Plan
The treatment of stroke is different in the case of an ischemic (with artery block) or
hemorrhagic (with hemorrhage in the brain) stroke. In the first case, the essential thing is to
recover the normal flow of blood to the brain. For this, medicines are used that help destroy
the clots. A rapid intervention improves survival options and reduces complications. The
introduction of a catheter allows the medication to be taken directly to the clot (Park et al.,
2016). This catheter can also manipulate the clot and remove it, especially when it is
large. To do this, a balloon is inflated that helps expand the artery, and, on occasion, a
balloon is placed so that the artery remains open.
In the case of a hemorrhagic stroke, the key is to control and stop the
bleeding. Medications are used to reduce intracranial pressure), lower blood pressure, and
prevent seizures. From the control of the hemorrhage, it is necessary to watch that the body
can absorb the blood. Sometimes the doctor has to resort to surgery to stop the accident. The
severity and gravity of the situation depend on the number of affected tissues and their
situation in the brain (Jenkins et al., 2017). When the right side of the brain is affected by
stoke, it will be the left side of the body that will lose its functionality. The patients

subsequently need a rehabilitation plan, which will be tailored. The dietary treatment plan
and the food that a stroke patient should consume are explained below.
Vitamins and Minerals for Stroke Prevention and Treatment
Vitamin B: Vitamin B9, called "folate" in natural foods, is often found as folic acid
(synthetic) in dietary supplements. Supplementation is important in pregnant women and
even before conception. Supplementation with vitamins of group B reduces the risk of stroke.
Vitamins of group B represent a family of molecules often serving as enzymatic cofactors.
Group B vitamins include thiamine (B1), riboflavin (B2), niacin (B3), pantothenic acid (B5),
pyridoxine (B6), biotin (B8), folate (B9), and cobalamines (B12). These vitamins are found
in whole grains, eggs, fish, and yeast among others.
Vitamin B12: Vitamin B12, known as "the energizing vitamin" is involved in the
metabolism of proteins, fats, and carbohydrates, transforming them into energy and favoring
a regular body development. Vitamin B12 is found in foods of animal origin and in particular
in animal organs and mollusks (Tian et al., 2017). It is also present in egg yolk, in meat and
poultry, in fish in fermented cheeses and powdered milk.
An increase is determined by the lack of B vitamins (especially folic acid, but also
vitamins B6 and Vitamin B12). In particular, folic acid is necessary for the methylation of
homocysteine and its transformation into methionine. A deficiency causes
hyperhomocysteinemia, a cardiovascular risk factor. Folic acids are indispensable for the
synthesis of some amino acids, the synthesis of purines and pyrimidines (nitrogenous bases
present in DNA), for the reproduction and normal growth of cells, in particular, blood cells.
Folic acid is found in fresh milk (but is destroyed half after a few minutes of boiling),
in pasteurized milk, in potatoes, carrots, spinach, green beans, asparagus, wheat germ, yeast,
liver, chicken meat, eggs, in green leafy vegetables (broccoli, spinach and Roman), but also
in oranges, beans, rice (Larrson, 2017). A folic acid deficiency leads to an increase in

homocysteine levels, the expression of hyperomocysteine damage occurs in some
consequential steps: thickening of the intima (internal vessel of blood vessels), increased
platelet turnover and platelet activation, endothelial dysfunction (the endothelium is a
particular type of epithelial tissue that lines the inner surface of the blood vessels of the
heart), activation of leukocytes, oxidation of LDL, increased formation of foam cells by lipid
deposition in the vessel wall, and the proliferation of smooth muscle cells. All these lead to
an increase of up to 2-3 times the risk of ischemic heart disease.
Homocysteine is the result of the degradation of the amino acid methionine, a
constituent of proteins. Homocysteine is normally recycled to methionine through the action
of vitamins B9 and B12, and cysteine via B6. But in some people, because of a diet deficient
in B vitamins, or for genetic reasons, this recycling of homocysteine is bad, and it
accumulates. Thus, higher levels of homocysteine are found in strict vegetarians because of a
low B12 diet and can result in stroke. Homocysteine can be reduced by taking vitamins B6,
B9, B12 (or betaine). However, trials that used B vitamins to lower homocysteine have so far
rarely shown net clinical benefit. If the excess of homocysteine probably represents a health
risk, the lack of homocysteine is also a health risk. The reason is that homocysteine allows
the synthesis of cysteine, which itself serves as a starting point for the manufacture of
glutathione, taurine, sulfate. Glutathione is a major cellular detoxifier involved in the removal
of unwanted substances (pesticides, carcinogens). Taurine is involved in detoxification
reactions in the liver and the synthesis of bile. The elimination of steroid hormones, phenolic
compounds, drugs, uses sulfates. Diabetes (types 1 and 2) can promote
hyperhomocysteinemia if there is an insulin deficiency since insulin is involved in the
degradation of homocysteine. Low levels of homocysteine can be overcome by taking
methionine, taurine, or N-acetylcysteine.

Calcium. There would be a difference between calcium taken with food (milk and
dairy products) and supplements. Research shows a protective effect against stroke (total risk
reduction around 20%) for an intake of at least 300 mg of calcium per day with food (Lieber
et al., 2018). Milk and dairy calcium would act not only against low-grade systemic
inflammation but also (especially if derived from partially skimmed milk products) the risk of
hypertension.
Magnesium. Magnesium also has a protective effect against stroke, which is more
marked for the ischemic form than for hemorrhage. All major population studies (EPIC-
Netherlands, Health Professional Study Follow-up Study, and Nurses’ Health Study) agree in
identifying the need for a high daily magnesium intake: for every 100g more, in fact, the total
risk of stroke would be reduced by about 8% (Hsu et al., 2018).
Omega 3: Walnuts, for example, are a good source of Omega 3, help protect against
heart disease, and a wide range of inflammatory and non-inflammatory diseases. This dried
fruit, among other things, contains ellagic acid, a beneficial antioxidant for the immune
system that also appears to have anti-carcinogenic properties. Also present is melatonin, a
substance produced by the pineal gland that helps regulate the sleep-wake rhythm and has
antioxidant properties. Walnuts are precious sources of mineral salts such as magnesium,
calcium, potassium, etc. and vitamins, especially vitamin E. It is then a food particularly rich
in antioxidants (polyphenols), which reduces the risk of falling ill with various diseases.
Almonds are an excellent source of monounsaturated fats and proteins. They offer
several advantages: they help to stabilize blood sugars avoiding glycemic peaks, therefore
excellent for the prevention of diseases such as diabetes and to keep hunger at bay (Boden-
Albala et al., 2015). Rich in antioxidants, they are a precious source of calcium, magnesium,
and phosphorus and therefore contribute to good bone health. Also useful for controlling

cholesterol, it has been shown that those who eat almonds regularly have lower cholesterol
levels.
Vitamin C: Vitamin C is found mainly in raw vegetables and fruits. And especially in
kiwi, citrus fruits (oranges) and exotic fruits, red fruits, papayas, and strawberries as well as
in parsley, peppers, and broccoli. It is a powerful antioxidant needed for collagen synthesis,
iron absorption and a role in immunity. It reduces the sensitivity to certain allergens and plays
a key role in muscular and brain metabolism.
Nuts: These are sources of magnesium, a mineral that helps control blood pressure
and rich in unsaturated fats that improve the body's cholesterol profile. They can be
consumed pure during snacks, and the recommendation is a serving of 30g per day (Spence &
Hankey, 2017). Eating nuts, especially nuts (at least 5 'handfuls' per week for about 28 grams
each) can offer protection for diabetic patients, at least partially counteracting their high
cardiovascular risk. Diabetes increases more than twice the chances of encountering events
such as heart attack and stroke.
Whole Grains: These are foods high in fiber that help control cholesterol and glucose
levels. Whole foods should appear at every meal of the day, so one should add granola to
yogurt or vitamin, make porridge with oatmeal, and replace white rice and common bread
with whole versions at main meals and snacks. It is important to regulate water consumption
to aid digestion.
Cocoa: The flavonoids in cocoa help blood vessels to function better, which reduces
pressure on the heart. It is a source of catechin and epicatechin, which helps reduce platelet
aggregation and control blood cholesterol levels. Dark chocolate can be consumed in the 30g
serving.
Meat: Meat represents an important source of nutrients such as proteins of high
biological value, especially B vitamins and minerals such as heme iron, potassium, selenium,

and zinc (Spence, 2016). Besides, the meat provides vitamins of group B (B1, B3, B6, and
B12). For example, beef tenderloin has a high content of vitamin B1, and the pork shoulder is
a source of vitamin B3 and rabbit meat is rich in vitamin B6. The vitamin B12, for example,
is found exclusively in foods of animal origin. This vitamin contributes to the formation of
red blood cells and the proper functioning of the nervous system. Meat has beneficial
nutrients that could help reduce the chances of suffering a stroke, with the inclusion of meat
always within the context of varied and balanced diet in combination with the other food
groups that make up the Mediterranean Diet and always within the recommended amounts.
Fibers: Foods high in soluble fiber, such as flaxseed, lentils, and oats, help control
cholesterol levels. For each 7 g increase in daily fiber intake, there is a 7% reduction in the
chance of one getting stroke (Hsu et al., 2017). Diets that include these foods also reduce the
risk of atherosclerosis, which makes stroke possible.
One should try to avoid highly processed foods due to excess sodium. It is important
to maintain the balance between sodium and potassium, because the pair generates what we
call the body's water balance, with potassium being a good diuretic and sodium a good fluid
retainer. Potassium sources include salmon and seafood, avocado, boiled spinach, baked
potatoes, bananas, black beans, tomatoes, and papaya.
Physiology to the Contraindications and Toxicities
A recent study carried out by the University of Oxford has evaluated the association
between stroke and vegetarianism. Forty-eight thousand one hundred eighty-eight volunteers
divided into three groups were evaluated: (1) the first group were given meat and proteins,
the second group was only given fish, while the third group only included vegans. The
experiment showed that stroke was prevalent in vegans by 20% (Talaei et al., 2019). Experts
point out that this association could be attributed to the fact that this group had low levels of
certain nutrients (such as vitamin B12, vitamin D, essential amino acids, and omega-3

polyunsaturated fatty acids) (Talaei et al., 2019). In this sense, meat plays an important role
since it has exceptional nutritional characteristics, which help meet the needs of the
population in both energy and macro and micronutrients and also helps maintain brain health.
Specific Recommendations for Follow up Care
It is essential to raise awareness in the patient about the importance of adopting
healthy lifestyles and behaviors, to reverse behaviors that may be harmful to health, and that
of arteries. Specific recommendations for follow up care include strict blood pressure control,
stopping smoking, adopting a healthy diet, physical exercise under medical supervision, and
strict diabetes control. There is a tendency to increase incidence due to the risk factors created
by modern society: stress, anxiety and long sitting at work (Boden-Albala et al., 2015).
Ideally, there should be strong and aggressive prevention work, as virtually all factors are
treatable or preventable with changes in routine. The patient should also reduce the
consumption of fats, especially saturated and animal fats. Trans fats and coconut and palm
oils are also on the list. Avoiding fast food should be the number one priority for the patient.
The patient's motivation and collaboration are essential in this process. During
rehabilitation the patient must be stimulated to do all he can (washing, dressing, walking,
etc.) on his own to help recover muscle strength, autonomy, and even self-esteem. Family and
friends should offer the minimum indispensable help and encourage them to do it alone. It is
also very important to keep the old interests or find new ones and accept - and help to accept
- the fact that the improvement may at some point stop. From the above it is clear that the
family, the people who are most in contact with the patient (the caregiver), are involved from
the early stages of this therapeutic journey. Emotional support and complete acceptance are
essential for the person to find the courage to engage in rehabilitation, despite the disability.
It is important to encourage the patient to do what he/she can do.

Recommend Additional Testing
Laboratory parameters such as hemoglobin, plasma proteins, albumin, and transferrin
are readily available. However, their results should be interpreted with caution, as decreased
levels may occur under various conditions (hypercatabolism, for example) and are not
necessarily synonymous with poor nutritional status. More specific measures such as vitamin
estimates, bioelectrical impedance are used in research but not in daily clinical practice.
According to the recommendations of the European Society for Clinical Nutrition and
Metabolism (ESCNM), nutritional risk assessment should be performed at the time of
hospital admission (up to 48 hours after) and should include weight and height measurement
for BMI.
Outcome Measures That Can Be Objectively Assessed
Malnutrition is common in stroke patients and usually worsens during hospitalization.
It has a prevalence of 16% at hospital admission, which increases to 22% to 35% in about
two weeks and 50% in 2 to 3 months (Tian et al., 2017). Assessment of weight and height
may be impossible if the patient is immobilized. Special equipment for evaluating these
parameters does not exist in many units. More complex anthropometric measurements such
as arm circumference or triceps folds require lipocalibrator and trained professionals in this
type of measurement. These anthropometric measurements may also be altered due to arm
paralysis after stroke.
Conclusion
Prevention, rather than treatment, should be the focus in dealing with stroke.
Hippocrates was one of the first to understand the importance of healthy food, that is to say,
health food and health built right through food. To date, the theory of Hippocrates is more
validated than ever and represents a very important and crucial step in the prevention of
stroke. Bluefish, citrus fruits, green leafy vegetables, fruit, and extra virgin olive oil reduce

the likelihood of the onset of the disease by 20%. The right foods are the main weapons for
stroke prevention. Consuming 200 grams of fruit and vegetables per day decreases the risk of
stroke by 20-30%. Omega-3, fibers, potassium, magnesium, and vitamins such as B6 and B12
possess strong nutritional and protective capacities that make their intake essential through
foods such as bluefish, swordfish, trout and salmon at least twice a week with a dose of salt
reduced to a maximum of 5 grams per day. Equally important is the proper management of
emotional state and tension levels. On stroke, stress can also affect, which is why a
fundamental form of prevention must also pass through the psychological aspect. High levels
of stress activate the immune system triggering inflammatory processes that are very harmful
to the cardiovascular system. Among other things, there is excessive production of
catecholamines, which attack the arteries. This is a direct mechanism that can promote the
onset of stroke.

References
Boden-Albala, B., Southwick, L., and Carman, H., 2015. Dietary interventions to lower the
risk of stroke. Current neurology and neuroscience reports, 15(4), p.15.
Hsu, C.Y., Chiu, S.W., Hong, K.S., Saver, J.L., Wu, Y.L., Lee, J.D., Lee, M., and Ovbiagele,
B., 2018. Folic acid in stroke prevention in countries without mandatory folic acid
food fortification: a meta-analysis of randomized controlled trials. Journal of
Stroke, 20(1), p.99.
Iacoviello, L., Bonaccio, M., Cairella, G., Catani, M.V., Costanzo, S., D'Elia, L., Giacco, R.,
Rendina, D., Sabino, P., Savini, I. and Strazzullo, P., 2018. Diet and primary
prevention of stroke: Systematic review and dietary recommendations by the ad hoc
Working Group of the Italian Society of Human Nutrition. Nutrition, Metabolism, and
Cardiovascular Diseases, 28(4), pp.309-334.
Jenkins, D.J., Spence, J.D., Giovannucci, E.L., Kim, Y.I., Josse, R., Vieth, R., Mejia, S.B.,
Viguiliouk, E., Nishi, S., Sahye-Pudaruth, S. and Paquette, M., 2018. Supplemental
vitamins and minerals for CVD prevention and treatment. Journal of the American
College of Cardiology, 71(22), pp.2570-2584.
Larsson, S.C., 2017. Dietary approaches for stroke prevention. Stroke, 48(10), pp.2905-2911.
Lieber, A.C., Hong, E., Putrino, D., Nistal, D.A., Pan, J.S., and Kellner, C.P., 2018. Nutrition,
energy expenditure, dysphagia, and self-efficacy in stroke rehabilitation: a review of
the literature. Brain sciences, 8(12), p.218.
Park, J.H., Saposnik, G., Ovbiagele, B., Markovic, D., and Towfighi, A., 2016. Effect of B-
vitamins on stroke risk among individuals with vascular disease who are not on
antiplatelets: A meta-analysis. International Journal of Stroke, 11(2), pp.206-211.
Spence, J.D., 2016. Metabolic vitamin B12 deficiency: a missed opportunity to prevent
dementia and stroke. Nutrition Research, 36(2), pp.109-116.

Spence, J.D., Yi, Q. and Hankey, G.J., 2017. B vitamins in stroke prevention: time to
reconsider. The Lancet Neurology, 16(9), pp.750-760.
Talaei, M., Koh, W.P., Yuan, J.M., and van Dam, R.M., 2019. DASH Dietary Pattern,
Mediation by Mineral Intakes, and the Risk of Coronary Artery Disease and Stroke
Mortality. Journal of the American Heart Association, 8(5), p.e011054.
Tian, T., Yang, K.Q., Cui, J.G., Zhou, L.L., and Zhou, X.L., 2017. Folic acid
supplementation for stroke prevention in patients with cardiovascular disease. The
American journal of the medical sciences, 354(4), pp.379-387.

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