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Semin Neurol 2017; 37(03): 259-266
DOI: 10.1055/s-0037-1603470
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Nutrition in Stroke Prevention

J. David Spence
1   Divisions of Neurology and Clinical Pharmacology, Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada
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Publication History

Publication Date:
31 July 2017 (online)

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Abstract

Nutrition is far more important to the prevention of stroke than most physicians realize. Key issues include a Mediterranean diet, the interaction of the intestinal microbiome, impaired renal function and diet, missed metabolic B12 deficiency, and the lowering of homocysteine with B vitamins to prevent stroke. The Cretan Mediterranean diet is high in olive oil, whole grains, fruits, vegetables, and legumes, and is close to a vegetarian diet. Compared with a low-fat diet, it reduced stroke by over 40%, and is clearly the best diet for diabetes. Metabolic B12 deficiency is very common (∼ 30% of stroke patients age > 70 years) and frequently missed because it is not excluded by a total serum B12 level in the reference range. B vitamins to lower homocysteine do prevent stroke, but their benefit was obscured in early studies because of harm from cyanide in cyanocobalamin among participants with renal impairment. Methylcobalamin should be used instead of cyanocobalamin.

Keywords

nutrition - stroke prevention - Mediterranean diet - dietary cholesterol - eggs - vitamin B12 - homocysteine - intestinal microbiome - renal impairment
 

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