Category Archives: Stroke

Stroke Falls to 5th Leading Cause of Death in U.S.

For most of my medical career, stroke was the third leading cause of death in the U.S., behind heart disease and cancer. Just a few years ago, chronic lower respiratory tract disease surpassed stroke.

Stroke continues to fall in rank and fell recently to fifth place, overtaken by accidents (unintentional injuries).

Even non-fatal strokes can be devastating.

Reduce your risk of stroke by maintaining normal blood pressure, not smoking, exercise regularly, living at a healthy weight, limiting your alcohol consumption, don’t get diabetes, and limit your age to 55. It’s also important to seek medical attention if you have a TIA (transient ischemic attack).

I also think the Mediterranean diet helps.

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

Two diet books in one

Mediterranean Diet Linked to Lower Stroke Risk in Women

…but we knew that already. A new study involving California teachers confirmed prior findings. The Mediterranean diet reduced ischemic stroke risk by up to 18%. Ischemic strokes are your typical strokes, much more common than bleeding in the brain (hemorrhagic strokes).

Stroke is the 4th or 5th leading cause of death in the U.S. Why not lower your risk by following the Mediterranean diet?

MedPageToday has the details.

Steve Parker, M.D.

Even If You Already Have Cardiovascular Disease, the Mediterranean Diet Helps

…to prevent future events—like heart attacks and strokes—and to prolong life. Details are at the American Journal of Clinical Nutrition.

Do Fruits and Vegetables Prevent Disease? Which Ones?

Potential answers are in the American Journal of Clinical Nutrition (2012).  I quote:

For hypertension, coronary heart disease, and stroke, there is convincing evidence that increasing the consumption of vegetables and fruit reduces the risk of disease. There is probable evidence that the risk of cancer in general is inversely associated with the consumption of vegetables and fruit. In addition, there is possible evidence that an increased consumption of vegetables and fruit may prevent body weight gain. As overweight is the most important risk factor for type 2 diabetes mellitus, an increased consumption of vegetables and fruit therefore might indirectly reduces the incidence of type 2 diabetes mellitus. Independent of overweight, there is probable evidence that there is no influence of increased consumption on the risk of type 2 diabetes mellitus. There is possible evidence that increasing the consumption of vegetables and fruit lowers the risk of certain eye diseases, dementia and the risk of osteoporosis. Likewise, current data on asthma, chronic obstructive pulmonary disease, and rheumatoid arthritis indicate that an increase in vegetable and fruit consumption may contribute to the prevention of these diseases. For inflammatory bowel disease, glaucoma, and diabetic retinopathy, there was insufficient evidence regarding an association with the consumption of vegetables and fruit.

It bothers me that vegetables and fruits are lumped together: they’re not the same.

All of my diets—Advanced Mediterranean, Low-Carb Mediterranean, and Ketogenic Mediterranean—provide plenty of fruits and vegetables.

Berry Science, or Berriology

Mmm, mm, good! And they’re low carb

The Mediterranean diet was originally found to be a healthy diet by comparing populations who followed the diet with those who didn’t.  The result?  Mediterranean dieters enjoyed longer lifespans and less heart disease, cancer, strokes, diabetes, and dementia.

Over the last 15 years, researchers have been clarifying exactly how and why this might be the case.  A study from Finland is a typical example.

The traditional Mediterranean diet provides an abundance of fresh fruit, including berries.  Berries are a rich source of vitamin C and polyphenols, substances with the potential to affect metabolic and disease processes in our bodies.

The Finnish researchers studied 72 middle-aged subjects, having half of them consume moderate amounts of berries, and half consume a placebo product over 8 weeks.  Compared with the placebo group, the berry eaters showed inhibited platelet funtion, a 5% increase in HDL cholesterol (the “good” cholesterol), and a 7-point drop in systolic blood pressure.

What does platelet function have to do with anything?  Platelets are critical components of blood clots.  Blood clots can stop life-threatening bleeding, but also contribute to life-threatening strokes and heart attacks.  Inhibition of platelet function can decrease the occurence of blood clots that cause heart attacks and strokes.  That’s why millions of people take daily aspirin, the best known platelet inhibitor.

Cardiovascular disease is a group of conditions that include high blood pressure, heart attacks, poor circulation, and strokes.  Berry consumption in this small Finnish study resulted in favorable changes in blood pressure, HDL cholesterol, and platelet function.  These changes would tend to reduce the occurence and severity of cardiovascular disease.

So berries don’t just taste good, they’re good for us.  If price is a concern, focus on the berries that are in season or use frozen berries.

Steve Parker, M.D.

Reference: Erlund, I., et al, Favorable effects of berry consumption on platelet function, blood pressure, and HDL cholesterol.  American Journal of Clinical Nutrition, 87 (2007): 323-331.

Fat or Fit: Which Is Healthier?

Men live longer if they improve or maintain their fitness level over time, according to research out of the Cooper Clinic in Dallas, Texas. Part of that improved longevity stems from reduced risk of death from cardiovascular disease such as heart attack and stroke.

Compared with men who lose fitness with aging, those who maintained their fitness had a 30% lower risk of death; those who improved their fitness had a 40% lower risk of death. Fitness was judged by performance on a maximal treadmill exercise stress test.

Body mass index over time didn’t have any effect on all-cause mortality but was linked to higher risk of cardiovascular death. The researchers, however, figured that losses in fitness were the more likely explanation for higher cardiovascular deaths. In other words, as men age, it’s more important to maintain or improve fitness than to lose excess body fat or avoid overweight.

Steve Parker, M.D.

Reference: Lee, Duck-chul, et al. Long-term effects of changes in cardiorespiratory fitness and bodly mass index on all-cause and cardiovascular disease mortality in men. Circulation, 124 (2011): 2,483-2,490

Tuna Preserves Brain Blood Flow In People Over 65

Among people over 65, consumption of tuna/other fish is associated with preserved blood flow to the brain, according to a 2008 research report in the journal Neurology.

“Silent” brain infarcts – tiny strokes that are not obvious – are very common with advancing age. If a group of people 65 and older is MRI scanned and found to have no strokes, MRI scans performed five years later will show tiny strokes in 20% of them. Almost 90% of these new strokes are simply incidental findings without clinically evident stroke or transient ischemic attack.

As the authors point out:

Subclinical infarcts and white matter abnormalities are considered to be of vascular origin, presumably resulting from occlusion of small arteries in the brain and subsequent ischemia.

These subclinical strokes, along with brain white matter abnormalities, are not benign. They are associated eventually with impairment in thinking and behavior, and with higher risk of future obvious stroke.

Eating tuna or other broiled or baked fish tends to raise plasma omega-3 fatty acid levels and is associated with lower stroke risk and dementia and Alzheimer disease. Researchers wondered if fish consumption affected the risk of subclinical brain infarcts or other subclinical brain abnormalities.


Scientists studied 3,660 participants over 65 years old in the Cardiovascular Health Study, by MRI scanning, lab testing, physical exam, and food frequency questionnaire. Five years later, 2,313 were rescanned. Hospital and clinic records were reviewed. Participants were men and women in four U.S. communities. Fish intake was classified as to whether tuna, other broiled or baked fish, and fried fish or fish sandwiches (fish burgers). In a subset of participants, blood levels of omega-3 fatty acids were measured.

Conclusions of the Scientists

Among older adults, modest consumption of tuna/other fish, but not fried fish, was associated with lower prevalence of subclinical infarcts and white matter abnormalities on MRI examinations. Our results add to prior evidence that suggest that dietary intake of fish with higher eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA] content, and not fried fish intake, may have clinically important health benefits.

…the results of the present article support the growing evidence that the type of fish meal consumed is important for obtaining the health benefits of fish consumption.


The fish with higher omega-3 fatty acids, such as EPA and DHA, are the cold-water fatty fish such as albacore tuna, salmon, trout, sardines, anchovies, herring, halibut, sea bass, swordfish, and mackerel. These are sometimes referred to as dark meat fish or oily fish. These are the same types of fish most closely associated with lower rates of coronary artery disease and sudden cardiac death.

The types of fish used in fish sticks, fish burgers, and other fried fish meals are typically low in omega-3 fatty acids.

If you choose to eat fish for the health benefits, aim for two servings per week of cold-water fatty fish. The Friday night all-U-can-eat fried catfish buffet doesn’t cut it.

Steve Parker, M.D.

Reference: Virtanen, J.K., et al. Fish consumption and risk of subclinical brain abnormalities on MRI in older [U.S.] adults. Neurology, 71 (2008): 439-446.