The Foods to Avoid to Lower Stroke Risk

“Stroke remains one of the most devastating of all neurological diseases,” killing about 5 million people a year worldwide, and is “the leading cause of permanent disability in the USA.” But the good news is that about 80 percent of stroke risk may be due to basic lifestyle factors: primarily, improving our diet, stopping smoking, and getting regular exercise.

The best way to stop smoking, evidently, is to have a heart attack. Certainly, once dead, you can’t smoke. Of those who survive a heart attack, strong, repeated advice from their doctor may persuade up to two-thirds to quit and never smoke again in any form as long as they live. “Yes, quitting smoking is very difficult. It doesn’t matter; it has to be done. If you were walking along the lakeshore and one of your grandchildren is drowning, it doesn’t take will power to go into the lake; it just has to be done.” It’s like a healthy diet: Some things just have to be done. Getting up at night to feed a baby can be difficult, too, but it’s not a matter of having willpower—some things in life just have to be done. After all, what we regularly eat every day is indeed a matter of life and death.

For stroke prevention, that means eating a more plant-based diet, like a traditional Mediterranean diet centered around whole grains, fruits, vegetables, lentils, beans, and nuts, as I discuss in my video Best Foods to Reduce Stroke Risk. A vegetarian or vegan diet may also work, but it must be accompanied by a regular, reliable source of vitamin B12, meaning B12-fortified foods or supplements. “Unfortunately, recommending taking B12 supplements may meet opposition among vegetarians because misconceptions regarding this nutrient are prevalent. Many individuals still hold on to the old myth that deficiency of this vitamin is rare and occurs only in a small proportion of vegans…Future studies with vegetarians should focus on identifying ways of convincing vegetarians to routinely take vitamin B12 supplements in order to prevent a deficiency.” The research is clear on that.

What is it about plant-based diets that make them beneficial for stroke prevention? In my video How to Prevent a Stroke, I talked about the role of fiber, which potentially leads to about a 1 percent drop in risk for every 1 gram of fiber ingested per day. Or, even better: A 12 percent drop in risk is associated with every extra 10 grams of fiber a day. In fact, fiber from whole grains is associated with a lower chance of dying not only from heart attack and stroke, but also cancer, diabetes, and respiratory diseases, as well as a lower risk of dying from infections or other causes––in other words, a lower risk of dying prematurely from all causes combined. Why? Perhaps because of the anti-inflammatory effects of fiber, which could explain how it could help across the board. Or, it could be that eating fiber means eating fewer pro-inflammatory foods. Those who eat more whole plant foods, which are where fiber is found, may be eating less processed and animal foods. In fact, the study immediately preceding the meta-analysis of fiber was a meta-analysis on meat, which looked at red meat and processed meat, and found about a 10 percent increased risk for stroke associated with each three and a half ounce daily portion, which is about the size of a deck of playing cards, or about 10 percent increased risk for every “half-deck” of processed meat.

Perhaps this occurs because of the heme iron—the blood and muscle iron—in meat, or because of “its pro-oxidative properties.” (No association was found between stroke and non-heme iron, which is the type of iron that predominates in plants.) Or, perhaps it’s because of some of the toxic pollutants like PCBs that can build up in animal fats. We’ve known, for example, that living next to a toxic waste dump might increase stroke risk, but only recently have we realized that dietary exposure even at so-called safe levels might increase stroke risk—and increase it by as much as eight or nine times for those with the highest levels of these pollutants in their bloodstream.

For more on how to reduce stroke risk with diet, see:

What does vitamin B12 have to do with stroke? Watch my video Vitamin B12 Necessary for Arterial Health to find out.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

What’s the Secret to Latino Longevity?

Latinos living in the United States tend to have “less education, a higher poverty rate, and worse access to health care” and “represent the ultimate paradigm of healthcare disparities,” with the highest rate of uninsured, lowest rates of health screening and counseling, and poorest levels of blood pressure and blood sugar control, as well as “other measures of deficient quality of care.” So they must have dismal public health statistics, right? According to the latest national data, the life expectancy of white men and women is 76 and 81 years, respectively, and that of black men and women is shorter by a handful of years. And Latinos? Amazingly, they beat out everyone.

Latinos live the longest.

This has been called the Hispanic Paradox (now also known as the Latino Paradox), which I explore in my video, The Hispanic Paradox: Why Do Latinos Live Longer?. Latinos have a 24 percent lower risk of premature death and “lower risks of nine of the leading 15 causes of death,” with notably less cancer and heart disease. This was first noticed 30 years ago but was understandably was met with great criticism. Maybe the data were unreliable? No, that didn’t seem to be it. Maybe only the healthiest people migrate? Turns out the opposite may be true. What about the “salmon bias” theory, which “proposes that Latinos return to their home country…to ‘die in their home’” so they aren’t counted in U.S. death statistics? That theory didn’t pan out either.

Systematic reviews “confirm the existence of a Hispanic Paradox.” Given the strong evidence, it may be time to accept it and move on to figuring out the cause. The very existence of the “Hispanic Paradox” could represent “a major opportunity to identify a protective factor for CVD [cardiovascular disease] applicable to the rest of the population.” After all, whatever is going on “is strong enough to overcome the disadvantageous effect” of poverty, language barriers, and low levels of education, health literacy, quality of healthcare, and insurance coverage. Before we get our hopes up too much, though, could it just be genetic? No. As foreign-born Latinos acculturate to the United States, as they embrace the American way of life, their mortality rates go up. So, what positive health behaviors may account for Latino longevity?

Perhaps they exercise more? No, Latinos appear to be even more sedentary. They do smoke less, however the paradox persists even after taking that into account. Could it be their diet? As they acculturate, they start eating more processed and animal-based foods, and consume fewer plant foods—and perhaps one plant food in particular: beans. Maybe a reason Latinos live longer is because they eat more beans. Although Latinos only represent about 10 percent of the population, they eat a third of the beans in the United States, individually eating four to five times more beans per capita, a few pounds a month as opposed to a few pounds per year. That may help explain the “Hispanic Paradox,” because legumes (beans, split peas, chickpeas, and lentils) cool down systemic inflammation.

In my video, you can see the mechanism researchers propose in terms of lung health. While cigarette smoking and air pollution cause lung inflammation, which increases the risk for emphysema and lung cancer, when we eat beans, the good bacteria in our gut take the fiber and resistant starch, and form small chain fatty acids that are absorbed back into our system and decrease systemic inflammation, which not only may inhibit lung cancer development, but also other cancers throughout the body. Latinos have the lowest rates of chronic obstructive pulmonary disease (COPD) and lung cancer, and also tend to have lower rates of bladder cancer, throat cancer, and colorectal cancer for both men and women.

This “systemic inflammation” concept is also supported by the fact that when Latinos do get cardiovascular disease or lung, colon, or breast cancer, they have improved survival rates. Decreasing whole body inflammation may be important for both prevention and survival.

Asian Americans also appear to have some protection, which may be because they eat more beans, too, particularly in the form of tofu and other soy foods, as soy intake is associated with both preventing lung cancer and surviving it.

Hispanics also eat more corn, tomatoes, and chili peppers. A quarter of the diet in Mexico is made up of corn tortillas, and Mexican-Americans, whether born in Mexico or the United States, continue to eat more than the general population. Looking at cancer rates around the world, not only was bean consumption associated with less colon, breast, and prostate cancer, but consumption of rice and corn appeared protectively correlated, too.

Since NAFTA, though, the North American Free Trade Agreement, the Mexican diet has changed to incorporate more soda and processed and animal foods, and their obesity rates are fast catching up to those in the United States.

In the United States, Latinos eat more fruits and vegetables than other groups, about six or seven servings a day, but still don’t even make the recommended minimum of nine daily servings, so their diet could stand some improvement. Yes, Hispanics may only have half the odds of dying from heart disease, but it’s “still the number one cause of death among Hispanics. Therefore, the current results should not be misinterpreted to mean that CVD is rare among Hispanics.” Ideally they’d be eating even more whole plant foods, but one thing everyone can learn from the Latino experience is that a shift toward a more plant-based diet in general can be a potent tool in the treatment and prevention of chronic disease.

Data like this support my Daily Dozen recommendation for eating legumes ideally at every meal, and we have free apps for both iPhone and Android that can help you meet these dietary goals.

For more on the wonders of beans, split peas, chickpeas, and lentils, see my videos and love your legumes!:

What’s the best way to eat them? See Canned Beans or Cooked Beans? and Cooked Beans or Sprouted Beans?.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

The Best Food to Slowing Your Resting Heart Rate

Monitoring resting heart rate has strong advantages. Taking your pulse is cheap, takes little time, is understandable to people, and is something everyone can do at home to measure their progress to become an active participant in their own health management. “The accumulated weight of evidence linking elevated [resting] heart rate to cardiovascular and all-cause mortality”—that is, to a shortened lifespan—“even in apparently healthy individuals, makes a strong case for it to be considered in the assessment of cardiovascular risk.” 

Every ten-beat-per-minute increase is associated with a 10 to 20 percent increase in the risk of premature death. “There seems to be a continuous increase in risk with increasing heart rate,” at least for values above a beat a second. So, we can simply look at our watch or the timer on our smartphone, and, if our heart is beating faster than the seconds going by, especially when we’re sitting quietly, then we have to do something about it. This is particularly important when we start getting up to around 80 or 90 beats per minute. As I discuss in my video Slow Your Beating Heart: Beans vs. Exercise, men with no apparent evidence of heart disease who have a pulse of 90 may have five times higher risk of sudden cardiac death compared to those in the safety zone. To put it bluntly, their first symptom is their last. Indeed, resting heart rates around 90 beats per minute increase heart disease risk at a level similar to smoking.

If you ask most doctors, though, 90 is considered normal: The accepted limits of heart rate have long been set at 60 to 100 beats per minute. Where did that range come from? It was adopted as a matter of convenience simply based on the scale of the squares on EKG paper. It was an historical accident like the QWERTY keyboard that just became the norm. A heart rate of 60 to 100 doesn’t even represent the bell curve.

A group of cardiologists measured the heart rate of 500 people and concluded that 45 to 95 beats per minute was a better definition of normal, rounding to 50 to 90, which a survey of leading cardiologists concurred with. Now, we know that normal doesn’t necessarily mean optimal, but doctors shouldn’t be telling people with heart rates in the 50s that their heart rate is too low. In fact, these people may be right where they should be.

Certainly, a “heart rate higher than 80 beats per minute should ring an alarm bell,” but what can we do about it? Exercise is one obvious possibility. Ironically, we make our heart go faster so, the rest of the time, it beats slower.

“The public health benefits of physical exercise, especially for [heart] protection, are widely accepted.…Among the many biological mechanisms proposed to account for this risk-reducing effect is autonomic nervous system regulation of the heart”—that is, our brain’s ability to slow down the resting beat of our heart. If you put people through a 12-week aerobic conditioning program of cycling, StairMaster, and running on a treadmill, their resting heart rate can drop from around 69 to about 66—about a three-beat-per-minute drop. Of course, they have to keep it up. Stop exercising and resting heart rate goes right back up.

Exercise is only one way to drop our heart rate, though. The way to our heart may also be through our stomach. What if instead of three months of exercise, we did three months of beans, like a cup a day of beans, chickpeas, or lentils? The first randomized controlled trial of beans for the treatment of diabetes showed they did indeed successfully improve blood sugar control, dropping subjects’ average A1C level from 7.4 to 6.9. This study was “also the first to assess the effect of bean consumption on heart rate and indeed one of the few to determine the effect [on heart rate] of any dietary intervention.” This is particularly important in diabetics, since having a higher resting heart rate not only increases their risk of death as it does for everybody, but it also appears to predict greater risk of diabetic complications, such as damage to the nerves and eyes.

So, how did beans do in the study? They produced a 3.4 beat drop in heart rate—just as much as the 250 hours on a treadmill. We’re not sure why beans are as powerful as exercise in bringing down one’s resting heart rate. “In addition to the potential direct beneficial effects of vegetable protein and fiber”—all the good stuff in legumes—“there is also the potential displacement value of vegetable protein foods in reducing animal protein foods, which are higher in saturated fat and cholesterol.”

Regardless, we should consider eating pulses for our pulse.

What is that about a shortened lifespan? See my Finger on the Pulse of Longevity video.

Having “normal” risk factor values in a society where it’s normal to drop dead of preventable diseases like heart disease is not necessarily a good thing. Learn more with:

For more on the musical fruit, see:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: