What to Eat for Stroke Prevention

What to Eat for Stroke Prevention
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More than 90% of stroke risk is attributable to modifiable risk factors.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Strokes are one of the leading causes of death and disability in the world, the most common cause of seizures in the elderly, and the second most common cause of dementia and a frequent cause of major depression. In short, stroke is a burdensome—but preventable––brain disorder.

According to the Global Burden of Disease Study, the largest study of risk factors for human disease in history, funded by the Bill and Melinda Gates Foundation, more than 90% of the stroke burden is attributable to modifiable risk factors, though some are easier to modify than others. For example, about 10% of all healthy years of life lost due to stroke may be due to ambient air pollution. So, yeah, technically that’s a modifiable risk factor; you could just move out of the city to some place with cleaner air. But perhaps easier to just quit smoking, which accounts for 18% of the stroke death and disability––about as much as diets high in sodium. Diets high in salt are as bad as smoking when it comes to stroke burden, but not as bad as inadequate fruit and vegetable consumption. Yes, there’s also other things, like sedentary lifestyles, which is not as bad as not eating enough whole grains, but of the 89% of stroke death and disability that’s attributable to modifiable risk factors, fully half appears to be due to just not eating enough fruits and veggies.

Fruit… and vegetable consumption is associated with lower risk of about a dozen different diseases, and stroke is way up there. There appears to be a linear dose-response relationship, a straight-line relationship between more fruits and vegetables and lower stroke risk, suggesting that the risk of stroke decreases by 32% for every 200-gram increase in fruits—that’s just like one apple a day, and 11% lower risk for each equivalent amount of vegetables. Particularly potent: citrus fruits, apples and pears…and dark green leafy vegetables, one of which you can drink: the green leaves of green tea. Drinking three cups of green tea a day is associated with an 18% lower stroke risk.

But association doesn’t necessarily mean causation. Have there ever been any vegetables put to the test in randomized controlled trials? Yes. Garlic is so potent you can stuff garlic powder into a capsule or compress it into a tablet, so you can put it head to head against a sugar pill. And…garlic beat out placebo for the prevention of CIMT progression (meaning the thickening of the major artery walls in the neck going up to the brain, a key predictor of stroke risk), which continued to worsen in the placebo group, but not the garlic group that had been taking just a quarter teaspoon of garlic powder a day. That would cost about a penny a day, and just make your food yummier anyway.

Okay, but has there ever been an interventional trial that actually followed people out to prove that a certain food reduced strokes? Yes, nuts. The PREDIMED study showed that an ounce a day of nuts, which is what I recommend in my Daily Dozen, cut stroke risk nearly in half. But wait, PREDIMED? Wait a second, wasn’t that the study that was retracted? The PREDIMED trial is one of the most influential randomized trials ever, yet in 2018 it was retracted––only to be later republished, after making the necessary corrections, due to irregularities in their randomization procedures. The original paper was withdrawn, but in their reanalysis, they found the same results. The same 46% fall in stroke risk in the added nuts group, dropping the 10-year risk of stroke from about 6% down to 3%.

The good news is that stroke risk can be reduced substantially by an active lifestyle, cessation of smoking, and a healthy diet. All we have to do now is educate and convince people on the benefits that can be expected from healthy lifestyle and nutrition.

Please consider volunteering to help out on the site.

Video production by Glass Entertainment

Motion graphics by Avocado Video

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Strokes are one of the leading causes of death and disability in the world, the most common cause of seizures in the elderly, and the second most common cause of dementia and a frequent cause of major depression. In short, stroke is a burdensome—but preventable––brain disorder.

According to the Global Burden of Disease Study, the largest study of risk factors for human disease in history, funded by the Bill and Melinda Gates Foundation, more than 90% of the stroke burden is attributable to modifiable risk factors, though some are easier to modify than others. For example, about 10% of all healthy years of life lost due to stroke may be due to ambient air pollution. So, yeah, technically that’s a modifiable risk factor; you could just move out of the city to some place with cleaner air. But perhaps easier to just quit smoking, which accounts for 18% of the stroke death and disability––about as much as diets high in sodium. Diets high in salt are as bad as smoking when it comes to stroke burden, but not as bad as inadequate fruit and vegetable consumption. Yes, there’s also other things, like sedentary lifestyles, which is not as bad as not eating enough whole grains, but of the 89% of stroke death and disability that’s attributable to modifiable risk factors, fully half appears to be due to just not eating enough fruits and veggies.

Fruit… and vegetable consumption is associated with lower risk of about a dozen different diseases, and stroke is way up there. There appears to be a linear dose-response relationship, a straight-line relationship between more fruits and vegetables and lower stroke risk, suggesting that the risk of stroke decreases by 32% for every 200-gram increase in fruits—that’s just like one apple a day, and 11% lower risk for each equivalent amount of vegetables. Particularly potent: citrus fruits, apples and pears…and dark green leafy vegetables, one of which you can drink: the green leaves of green tea. Drinking three cups of green tea a day is associated with an 18% lower stroke risk.

But association doesn’t necessarily mean causation. Have there ever been any vegetables put to the test in randomized controlled trials? Yes. Garlic is so potent you can stuff garlic powder into a capsule or compress it into a tablet, so you can put it head to head against a sugar pill. And…garlic beat out placebo for the prevention of CIMT progression (meaning the thickening of the major artery walls in the neck going up to the brain, a key predictor of stroke risk), which continued to worsen in the placebo group, but not the garlic group that had been taking just a quarter teaspoon of garlic powder a day. That would cost about a penny a day, and just make your food yummier anyway.

Okay, but has there ever been an interventional trial that actually followed people out to prove that a certain food reduced strokes? Yes, nuts. The PREDIMED study showed that an ounce a day of nuts, which is what I recommend in my Daily Dozen, cut stroke risk nearly in half. But wait, PREDIMED? Wait a second, wasn’t that the study that was retracted? The PREDIMED trial is one of the most influential randomized trials ever, yet in 2018 it was retracted––only to be later republished, after making the necessary corrections, due to irregularities in their randomization procedures. The original paper was withdrawn, but in their reanalysis, they found the same results. The same 46% fall in stroke risk in the added nuts group, dropping the 10-year risk of stroke from about 6% down to 3%.

The good news is that stroke risk can be reduced substantially by an active lifestyle, cessation of smoking, and a healthy diet. All we have to do now is educate and convince people on the benefits that can be expected from healthy lifestyle and nutrition.

Please consider volunteering to help out on the site.

Video production by Glass Entertainment

Motion graphics by Avocado Video

Doctor's Note

Okay, to recap: exercise, whole grains, fruits, and vegetables—especially citrus, apples, pears, and dark green leafy vegetables—green tea, garlic, and nuts. These are all things we should strive to include in our daily routines. Besides smoking and salt, is there anything else we should avoid? That’s the subject of my next video: What Not to Eat for Stroke Prevention.

For more info on protective foods, see my previous videos on stroke, including:

If you haven’t yet, you can subscribe to my videos for free by clicking here.

115 responses to “What to Eat for Stroke Prevention

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  1. I know my comment is not in relation to this video but I need a way to reach out to the community. I reversed my heart disease 9 years ago by following WFPB and life style changes. I have a much more important job now. I am trying to help my wife who has been diagnosed with stage 3 lung cancer. She has now had a CT scan, biopsy related to findings of the CT scan and a PET scan. We learned Friday that the PET scan found zero cancer anywhere except in a 2.3″ tumor on her lung. This was better than what the doctors originally thought they would find. My wife has followed a semi-WFPB diet for the last few years but has been very disciplined for the last 4 weeks. She does not want to go the chemo and radiation route based on friends we have that went that route only to end up dead. We are looking for a doctor/partner/adviser to help us with reversing this cancer with diet and lifestyle changes. I have been looking many places over the last few weeks with very little success. I have been a subscriber of Nutrition Facts for many years and know the community is very good in trying to help.
    Thank you all in advance!!!

    1. There are many past cancer topics under the search. There also is Cancer Centers of America that does do more than the typical cancer therapies. I myself would never trust anything so serious to an internet message board where anyone with a computer calls themselves a doctor on health boards, a priest on religious boards, and an alleged active duty marine on any political boards knowing there is no verification.

      1. I think it’s kind of like going and paying thru the nose with so called doctors of western medicine. When you to there office and when you explain your having shooting pain in your back and the md’s reply is did I get a new bra. I will go with the message boards.

    2. Jeff, I hope you can find a good doctor for your wife. Definitely make sure she eats plenty of cruciferous veggies and green tea.

      https://nutritionfacts.org/video/lung-cancer-metastases-and-broccoli/
      https://nutritionfacts.org/topics/lung-cancer/

      Also make sure she takes enough vitamin D for optimal blood levels. https://clincancerres.aacrjournals.org/content/early/2018/07/20/1078-0432.CCR-18-0483.1

      Not sure if my dad’s experience will be of any help, but he had radiation treatments only on the cancerous spot in his lung. These treatments didn’t bother him much and gave him 2 years of no cancer. However the cancer returned and the second round of radiation treatments left him tired and out of breath and the cancer spread anyway.

      1. Hi Jeff,
        Sorry to read about your wife’s diagnosis but congrats on your progress. Unfortunately there isn’t a good resource for Cancer in general.
        I would guess it varies from cancer to cancer. Just to make you aware of two resources for you to look into:
        First is The Moss Reports… comprehensive and a bit pricey. I have reviewed the one on Colon CA but he has done one on Lung Cancer.
        Second is Keith Block MD out of Skokie, Ill. I heard him speak once at a McDougall Advanced Study Weekend. He is a practicing oncologist and I had two patients who have benefited from a distance consultation with him. He is the author the book, Life Over Cancer.
        Hope this is helpful… best wishes and good luck.
        Don Forrester MD (retired Family Physician)
        Sacramento, CA

        1. I just want to say a big “Thank you” for such a warm and informative reply to Jeff. Enjoy your retirement but please continue sharing your knowledge! (I’m a retired nursing professor and I still enjoy learning and teaching.)

    3. Jeff, Dr Neal Barnard, a well-known Plant-based doctor who heads up the Physicians Committee for Responsible Medicine (PCRM), has a list of PB doctors on his website:

      “Looking for a plant-based health care professional in your area? Find A Doctor can help! We offer a worldwide database for patients seeking active physicians and other health care professionals who promote plant-based nutrition as part of their treatment.

      To get started, search for a health care provider by region, specialty, or telehealth appointment capability using your zip code, state, or specific address to find providers near you.”

      https://www.pcrm.org/findadoctor

      This might be a good start. Wish you well in your search and health outcomes of your wife.

      1. Beware of doctors and always stay sceptic about what they claim. Doctors can impress you and lead you to an adhesion to what they think, but the real healing power lies in your own mind-body, not in the intellect of doctors.

      1. Disclaimer: not medical advice – merely informational. For medical advice, see your locally licensed physician(s).

        Jeff,

        Congratulations on your successful reversal of heart disease via diet and lifestyle.

        All the best your wife and yourself in this difficult time.

        Diet and lifestyle can be a successful preventative treatment and even primary treatment and/or an excellent adjunct treatment in many diseases, particularly those slowly developing diseases that have the greatest association with obesity: cardiovascular, diabetes – even some cancers such as prostate. A quick search of the Internet will give you an overwhelming amount of information along these lines, much of it legitimate.

        Some medical conditions – the more rapidly developing issues – trauma, infectious disease, acute stroke – and most cancers – are more the primary province of medical treatment – with diet and lifestyle as only minor adjunct. That is why you will not find the same sort of Internet information on these issues on the Internet – and what you find will have a much higher ratio of bogus information / legitimate information.

        I.e., you don’t treat extensive trauma from an acute automobile accident with diet or acupuncture. You do what you need to do – and you do it now.

        Diet and lifestyle changes – and other non-conventional routes – have little or nothing to offer when it comes to the primary treatment of lung cancer.

        On this one, the best route is likely for your wife to follow the wisdom of your wife’s physicians. Sooner rather than later.

        Including the decision on whether or not to treat medically. Your wife may wish to know all options – and the consequences of various decisions. Her physicians can likely detail to her the probable consequences of various forms of action – or inaction – the medical literature in their field is filled with such information, and they are likely tracking this information meticulously. Or your wife may not desire such information – different people differ on just how much they actually want to know about such matters, for understandable reasons. Her physicians are likely sensitive to such issues: this is what they do.

        If your wife’s physicians determine that medical treatment at this stage would likely be helpful – your wife would likely be best served going that route. Delay while trying other things may result in unnecessary negative consequences.

        If you get these things medically – early – it can make all the difference. Delay while giving it a trial of diet and lifestyle, well . . .

        Consider the lesson of Steve Jobs. A different disease – a different treatment – but the lesson of delay while seeking alternaitve treatment rings clear:
        https://www.forbes.com/sites/alicegwalton/2011/10/24/steve-jobs-cancer-treatment-regrets/#6c9f10847d2e

        If you wife has confidence in her physicians, it may be best for her to leave the matter in their hands.

        If your wife does not have confidence in her physicians in this matter, it may be best for her to get a second opinion from a different crew of physicians.

        Additionally – a good source of information can be any nearby lung cancer patient support group that your wife can find. You may wish to encourage your wife to join one of these groups as soon as possible if one is available – the cancer support nursing staff can likely direct you if there is such a group in your area. These groups are not just “touchy-feely.” A group of similar patients will have its own collective knowledge as to the best physicians – and the best radiation therapy equipment – in your area – financial issues – things you and I might never think of like buying wigs if appropriate, those sorts of things – and help your wife understand about any physical difficulties and offer emotional support and such – things that only someone facing a similar situation to your wife can know.

        Another thought – your experience with the successful dietary/lifestyle treatment of heart disease cannot be transferred to your wife’s experience with lung cancer. Apples and oranges.

        And I echo Reality bites’ concern about getting information on this over the Internet. This is a time for direct consultation and action.

        All the best –

        Vivamus

    4. Jeff,

      Is she trying immunotherapy?

      https://www.aacr.org/patients-caregivers/progress-against-cancer/confronting-stage-3-lung-cancer-immunotherapy-durvalumab-imfinzi/#:~:text=Cancer%20With%20Immunotherapy-,Confronting%20Stage%203%20Lung%20Cancer%20With%20Immunotherapy,stage%203%20lung%20cancer%20progressing.

      I also wonder if you have looked into Tumor Treating Fields depending on which type she has.

      https://www.onclive.com/view/investigators-test-tumor-treating-fields-in-lung-cancer

      (I honestly don’t know the difference between a tumor treating field and just using an ICES-PEMF. I do know that Bob from Micropulse did say that he was getting positive results with people from the cancer community, but that hasn’t been studied and I just don’t understand the difference between his electromagnetic field and the tumor treating fields, but you might be able to ask Bob at Micropulse and he will answer. His device only really has a study for pain so far, but that is because the studies cost so much. He will not make any claims whatsoever and he will answer your questions. But your wife might quality for a professional tumor treating field. Again, depending on which type she has.)

      Also, one that excited me conceptually is photodynamic therapy.

      https://www.mayoclinic.org/diseases-conditions/lung-cancer/expert-answers/photodynamic-therapy/faq-20058330

      No matter what, talking to a cancer clinic for other options than chemo and radiation might be worth looking into.

      There are studies that people who seek medical care at places that are cancer centers are more likely to survive than people who go to non-specialist doctors.

      I don’t know about the cost, but there also may be studies and I would definitely look into those.

      1. My friend’s husband was diagnosed with esophageal cancer during covid.

        It ended up benefiting them that is was covid because his wife got to stay home and take care of him and received unemployment, plus, the $600 per week.

        He was so far advanced that they couldn’t do surgery, but they are doing immunotherapy and so far, he has zero side effects and is able to eat normally. They are really happy about it. They said that they were so happy that he couldn’t have the surgery and he feels so good still that they are just excited that immunotherapy was just approved for it so they had an option that they are excited about.

        My brother recently finished immunotherapy. Maybe he had it. Maybe not. His was a blinded study, but he did get a rash and the doctors think he probably had the immunotherapy and it did give him more peace-of-mind.

    5. Your wife faces a difficult journey……Stage 3 cancer is beatable BUT, a WFPB diet is great for cardiovascular disease prevention and treatment, and perhaps preventative for some cancers. Please continue with traditional medicine as her primary treatment and add WFPB medicine as an ADJUNCT.
      As others have already written, find a WFPB physician into her care…..I have seen far too many souls try to treat cancer with diet……only to die. In the fional analysis, it is HER decison.

      1. Jeff, You might look at the Medical Lifeworks website in Clearwater, FL. Very compelling. You would have to come to Florida, possibly for several weeks, and it’s a little pricey, but . . . . also, as a supplemental thing, look at the culturedfoodlife.com. Also, check out Budwig Clinic. They are in Spain but Dr. Budwig did heal cancer. Gerson is an option, in San Diego, but their diet is a TON of work, plus several coffee enemas a day (which are important.) I could go on and on about this subject. If a family member had cancer, and I had some $$ to spend, I would go to Budgwig in Spain or Medical Lifeworks in Clearwater. Where do you live?

    6. Jeff, Can you please tell me how you know that you reversed your heart disease? I will be happy to help you look for an alternative physician for your wife. Where do you live? (sjohnston94129@gmail.com)

    7. Jeff, your wife might try to fast for a few days (5-7 days), slowly diminishing the food intake into the é-3 days before and then gently refeeding with whole plant foods starting with raw vegetable and fruits after the fast.

      Fasting can be very hard for the body and more if one’s vitality is already diminished. There are commercial options out there for “mimicking fasting”, but what one found is doing well is a modified fast allowing a bit of carbohydrate intake, like fresh vegetables and fruits juice from an extractor(about 25 cl) diluted in water and a vegetable broth everyday, plus source water ad libitum. This is what is known as the “buchinger method” as far as the nutrition part goes.

      But personally, one found out that plain source water with a little bit of honey added to it does the trick and allows to avoid hypoglycemia for people who do not support well fasting. Then, it is important to be at complete rest, but one just has to listen to one’s body too.

      You can find contraindications and medications to be supervised while fasting in this expert panel consensus guidelines:

      Fasting Therapy – an Expert Panel Update of the 2002 Consensus Guidelines
      https://www.karger.com/Article/Fulltext/357602

      1. May one add that fasting has been shown to be a good adjunct to chemotherapy, and also for particular cancers when the fast is supplemented with a bit of vitamin C (at least in animal studies).

        1. One may note that cancers cells are probably of bacterial origin:

          Cancer cells arise from bacteria
          https://cancerci.biomedcentral.com/articles/10.1186/s12935-018-0699-4

          and that, but it depends on the type of bacteria, to add some vitamin C to honey may enhance its antibacterial activity:

          “It is likely that a combination of honey with Vit C may trigger the intracellular production of reactive oxygen species in bacterial cells, but the exact cellular mechanisms warrant further investigations.”

          Vitamin C Enhances the Antibacterial Activity of Honey against Planktonic and Biofilm-Embedded Bacteria
          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7070301/

          1. So, fasting with plain source water including a little bit of honey and a little bit of lemon juice in it might be benefitial as an adjunct to cancer therapy, while diminishing the risk of hypoglycemia in vitally diminished patients.

    8. You might also want to bear in mind that exercise appears to be associated with significantly increased chances of survival among older women with lung cancer:

      ‘higher total physical activity levels were associated with lower lung cancer mortality for both overall NSCLC and adenocarcinoma. In conclusion, physical activity may be protective for lung cancer incidence and mortality in postmenopausal women, particularly in non‐obese women.’
      https://onlinelibrary.wiley.com/doi/full/10.1002/ijc.30281

      1. Of course, after the fast, a good “regimen of life” including good nutrition, good sleep, good rythm of life, good environment, good relationships and resolution of common stress factors as well as regular physical exercice help to enhance survival.

    9. Look into the Essiac Tea Users group on Facebook. I know one member has cleared her lung cancer with the tea – and I believe also WFPB diet.

      1. I do not recommend Gerson therapy. My friend of 30 years went there for his pancreatic cancer. Died a couple of months after returning from the program. No improvement whatsoever. Every other patient that was at the program, with whom he kept in touch, also dead. I asked about whether Gerson program kept in touch with their patients and followed them to see if they improved, stayed the same, died, etc. And the answer is that no, Gerson center does not follow any of their patients. They have been doing their protocol for decades and have NO DATA to show that it works, is harmless, or anything. I would not go to Gerson, ever.

  2. I assume by stroke Dr. Greger is referring to ischemic stroke — arterial blockage caused by atherosclerotic deposits, or plaques.

    We recently discovered a second kind of stroke, thrombotic stroke, caused by a blood clot which blocks an artery In the brain. In my husband’s case, it was due to atrial fibrillation, which he never knew he had. No symptoms, no evidence on an EKG 6 months before he suffered the stroke. And his only risk factor for a-fib is: advanced age. Nothing we can do about that.

    But we did read at least one very recent study that a-fib made worse by drinking alcohol, even in moderate amounts (it increases the risk of a recurrence, and decreases the time to a recurrence). So, now he drinks NA (non-alcoholic) beer, one serving with dinner. I don’t drink at all, and haven’t since I learned that alcohol increases the risk of breast cancer by 17% — even at moderate drinking levels.

    We are doing what we can. I’ve no idea if eating whole plant foods earlier would have made any difference, but I wish I’d started eating this way a long time ago.

    Oh, yes, we did learn in the cardiac ICU that the Apple Watch can detect a-fib; even the cardiologists were impressed. It also detected an abnormal heart rhythm in my daughter the nurse; she was surprised. (Apparently, it’s not uncommon and not serious. So she said.)

    1. Dr J.

      That is interesting that the Apple Watch can detect a-fib.

      There is also an App where it might detect COVID before you have symptoms. It has been tested, but they are doing a wider study of it now.

      1. Deb,

        I can’t believe that an app could detect Covid-19 before you even have symptoms. That sounds like nonsense.

        Do you have any credible references to support your statement? If so, can you provide links to them?

        Thanks.

      2. Perhaps we should require every politician to wear an Apple Watch if it can detect a fib.

        The darn things would probably sound an alarm every time politicians opened their mouth..

    2. Regarding non-alcoholic beer.

      I just had a worker go off of that because he just recently suddenly needed blood sugar meds. He is elderly and has never been on meds ever before in his life and was looking to see what might be causing it and he looked at the non-alcoholic beer and his rhubarb for the pie he wanted to make said, “Looks like these need to go.”

      I had that talk yesterday.

      He is good at getting rid of things and I did talk him through the studies and he is someone who gave up smoking in 1 day. Threw out the pack, rather than finishing it. Gave up regular alcohol the same way. Gave up milk and cheese and gave up most sweets. All without almost any process at all.

    3. Dr J, John Hopkins has an interesting blurb on types of strokes. https://www.hopkinsmedicine.org/health/conditions-and-diseases/stroke/types-of-stroke

      Thrombotic strokes are a type of ischemic stroke.

      What I fear is a hemorrhagic stroke. I recently had troubles at the dentist with bleeding. I am not on blood thinners other than a portion of a baby aspirin daily, and I do eat lots of greens and veg. Once every couple of years I go to the lab for a ‘clotting test’ to make sure all is well.

      1. ‘A vegetarian diet rich in nuts, vegetables, and soy has been linked to a lower risk of both ischemic and hemorrhagic stroke, new research suggests.

        In two large cohorts of more than 13,000 individuals, investigators found a vegetarian diet was associated with a 60% to 74% decreased risk of ischemic stroke and 65% lower risk of hemorrhagic stroke.

        “The take-home message is that lifestyle, especially healthful diets such as vegetarian diets, are important in the prevention and management of stroke,” senior author Chin-Lon Lin, MD, chief executive officer, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan told Medscape Medical News.

        The study was published online February 26 in Neurology.’

        https://www.medscape.com/viewarticle/926113
        https://n.neurology.org/content/94/11/e1112

        1. “Buddhist Tzu Chi Medical Foundation” ?

          Is there not a conflict of interest in this study ? Buddhism is well-know to promote a plant-based diet for millenias now.

          1. Oh, yes. Like the Seventh Day Adventists, they have an ideological/religious interest in promoting ‘vegetarian’ diets. Although in this case, vegetarian diets included dairy and eggs.

            So we have to bear that in mind. On the other hand, there are some advantages. In the West, many people adopt ‘vegetarian’ diets because of a health shock of some kind and may therefore be, as a group, possibly more unhealthy than equivalent non-vegetarians. That usually isn’t a factor when people adopt a diet for religious religions. It removes one potential confounding factor. Also

            ‘vegetarians and nonvegetarians were from the same religious group and abstain from alcohol and tobacco; this would minimize confounding associated with religion and related lifestyle, and strengthen internal validity, while providing a unique opportunity to examine the effect of plant-based diet among people who do not drink alcohol, which is rare in most Western studies.’
            https://n.neurology.org/content/94/11/e1112

            I’d encourage people to read the journal article and judge for themselves.

            1. “the effect of plant-based diet among people who do not drink alcohol, which is rare in most Western studies”

              Thanks for the quote, that is interesting. Would that also explain the vitamin b12 deficiency observed in vegans in Western countries ? Alcohol can be a culprit by creating a dysbiosis and by inhibiting the gut bacterias that actually produce many vitamins including vitamin B12.

              1. So they speculate

                ‘Interestingly, our study found that the inverse association between vegetarian diet and overall stroke risk is more pronounced in the subgroup consuming less than the RDA of vitamin B12, but not the subgroup with adequate intakes (p interaction = 0.046). Supplementation with high-dose cyanocobalamin (a form of vitamin B12) increases the risk of stroke among individuals with reduced renal function.46 Although we have no data on the type of vitamin B12 supplements (cyanocobalamin, methylcobalamin, or hydroxocobalamin) to clarify whether the attenuation of protection is related to cyanocobalamin, it is unlikely to be the major reason as the percent of vegetarians with abnormal renal function is small (1.8% in vegetarians meeting the RDA for vitamin B12). Vitamin B12 may be a surrogate marker for animal product consumption and this may account for some attenuation. Due to small sample size, this finding needs to be interpreted with caution and confirmed in other studies.’
                https://n.neurology.org/content/94/11/e1112

              2. ‘Results: After adjusting for body mass index (BMI), a significant 5% decrease was observed in mean serum vitamin B12 concentrations from 0 to 30 g of alcohol/day (461.45±30.26 vs 440.25±30.24 pg/ml; P=0.03). Mean serum HCY concentrations tended to increase by 3% from 0 to 30 g of alcohol/day (9.44±0.37 vs 9.73±0.37 μmol/l; P=0.05). Alcohol intake had no significant effects on serum folate or MMA concentrations.

                Conclusions: Among healthy, well-nourished, postmenopausal women, moderate alcohol intake may diminish vitamin B12 status.’
                https://www.nature.com/articles/1602002

    1. Looking at the list, this is one of the topics when eating low fruit is such a high modifiable risk factor.

      I have been having such trouble getting my fruit in. Mostly, I love citrus enough to eat it every day, but there hasn’t been organic citrus at all and most of the citrus that has been there has not looked good enough to eat. The organic apples haven’t looked all that great either yet, but that season will be coming.

      I do like bananas and I did buy some grapes, but I have only been eating a few. Watermelon and kiwi are ones I do eat more often.

      Berries have been on-again, off-again for me. I was loving blackberries, but then I get a batch that tasted sour.

      Watermelon, bananas, and kiwi

      Better than nothing, I guess.

      I wish I could cross over into liking berries.

      I did get myself to eat them, but I never got myself to really have a psychological sense of liking them. Even when the blackberries tasted good to me, they don’t cross over into “Wow, I would like some blackberries.”

      I can’t even get myself to put any type of berries in my oatmeal or in a salad or in anything at all.

      I can get myself to eat them, but when produce becomes too expensive, and I cut back on how much I buy, they are the first to forget to jump into my shopping cart.

      1. ‘I can’t even get myself to put any type of berries in my oatmeal or in a salad or in anything at all.’

        Yes you can. You just choose not to do so. Accept responsibility for your choices or make different choices;

        As the marketing slogan says, just do it. Or not. It’s your decision.

  3. This was a very important topic and I’m so impressed with the information provided.
    A cardiologist is wearing one of the Apple watches and recommended it to her patients, esp for A-fib. She also tells them to email her the strips that show a-fib for review. (Expensive but worth it.). There is the other device $89 that has the approval of cardiologist more so then the watch. This is not a wearable device but the screen is significantly larger then the watch. It rests on your thigh while thumbs hold the device for an really good reading. These both have been compared with the office MD ecg machine. These devices are becoming more important now due to the staying in restrictions and the doctors are happy with virtual visits, and checking your EKG strip that way too by FaceTime. I’m not selling anything so don’t beat this old lady up. (Smile).

  4. He’s a brilliant man but what a horrible speech pattern. So much so I can’t listen to him. He must have been told by family and friends – “to tell a story.” Awful inflections.

  5. Quoting studies by Bill And Malinda gates- both non doctors with a passion for depopulating the world and killing millions via their vaccines- Really? Who gave you tips on inflection- voice lessons?

    Thanks- DISQUALIFIED!

    1. I was also taken back when I heard the study by “Bill and Melinda Gates Foundation”. This outwardly ‘for the greater good’ foundation / Bill Gates is nothing but evil. He falls under the Monsanto category!

      1. Meme Riggers and BChristine,

        Do you think that Bill and Melinda Gates performed the study themselves?

        The video actually says it was a study of risk factors for human disease FUNDED by the Bill and Melinda Foundation.

        Did you bother to actually look at the cited publication? I’m guessing not, because that would be too much work, and wouldn’t feed into your pet tinfoil conspiracy beliefs. If in fact you could even understand how to figure out who the authors are, and where they are employed.

        But I did; the study was done by a group of scientists:

        Valero L Feigin 1 , Gregory A Roth 2 , Mohsen Naghavi 2 , Priya Parmar 3 , Rita Krishnamurthi 3 , Sumeet Chugh 2 , George A Mensah 4 , Bo Norrving 5 , Ivy Shiue 6 , Marie Ng 2 , Kara Estep 2 , Kelly Cercy 2 , Christopher J L Murray 2 , Mohammad H Forouzanfar 2 ,

        Global Burden of Diseases, Injuries and Risk Factors Study 2013 and Stroke Experts Writing Group
        Affiliations

        1 National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand. Electronic address: valery.feigin@aut.ac.nz.
        2 Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
        3 National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand.
        4 Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
        5 Department of Clinical Sciences, Neurology, Lund University, Lund, Sweden.
        6 Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, UK; Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.

        So, all these scientists at different illustrious institutions are all wrong — and you are right? Pray tell, what is your level of expertise? Where did you receive your education, and what level did you achieve? What research experience do you have?

        I’m waiting.

        But I expect that you are trolls. If so, I’m sorry for engaging you.

  6. Just wanted to let you know, that there is a severe errata in the German edition of How not to Die. The green light shows “unprocessed foods” (instead of unprocessed PLANT foods) and the yellow light shows “processed plant foods” (and forget unprocessed animal foods). I have already sent a note to the German editor, but just in case you want to follow up directly with them. The traffic light summary is now completely misleading! Regards,

  7. I’ve added more citrus to my diet since being informed it may be good for heart health and stroke prevention. I enjoy eating fruit. Puzzling to me is the Dr. Greger video saying that vegans have a high rate of strokes. To be sure I’m eating lots of veggies including beans and dark green leafies.

    1. Dan,

      He did a webinar on it and it is available. It was worth it.

      It is not the same type of stroke that meat-eaters tend to have and they have a whole lot of strokes.

      For vegans, there are things involved like not taking B12 and eating too much sodium.

      This is an old video, but it is based on a study that showed that vegans need to watch how they eat, too.

      https://www.youtube.com/watch?v=tP_LIY8cjf4

      If I remember right, he might have crossed omega 3 off for preventing stroke in vegans.

      Sodium and B12 (for lowering Homocysteine) were still part of it.

      Boy, I am not sure if he mentioned all the oils often vegans still eat in the webinar.

      Hmmm, I think I have to review it.

      Sometimes I just implement things and forget the logic.

      1. Deb,
        I watched the video you posted. High levels of homocystine may be the problem. Homocystine can be lowered by eating flax and getting enough B-12.

        1. Dan C,

          Yes, but if you watch the webinar, Japan had a problem with too much sodium that kept them higher than many countries for Hemorrhagic stroke. They lowered sodium levels in a study and it worked.

          Dr. Greger’s video explained it better than I just did.

          I had read that study in PubMed a long time ago, but he helped me understand the Japan equation better.

          I still don’t understand why soy helps Miso, but not soy sauce.

          I have stopped having vegan dumplings entirely because some things need soy sauce.

          It is a real bummer for me because I like soy sauce, but I won’t argue with the science.

          The video will be coming soon enough.

          We might be in the stroke webinar right now.

          Some of us have to think about that.

          1. Deb,
            Thanks. Some of my canned food has salt in it. I try to buy no salt food. I don’t add salt unless I’m sweating heavily outside.

          2. Deb,
            In the transcript of this video I found that consuming too much salt is comparable to smoking risk when it comes to stroke risk.

    2. That’s a dubious association based on very small numbers of people. We have discussed that study before but this commentary may throw some light on the issue
      https://www.plantbasednews.org/opinion/-do-vegans-have-higher-risk-stroke

      A more recent study with a completely opposite finding for vegetarians includes an interesting discussion of the differences between its findings and those of yhe EPIC study.
      https://n.neurology.org/content/94/11/e1112

  8. I had a Hemorrhagic stroke 6 years ago and would like to know if the strokes Dr Greger is referring to here are hemorrhagic or ischemic, as it makes all the difference. The ischemic stroke is kind of the same disease as heart attack but in the brain. The vein gets clogged and does not allow blood flow. The hemorrhagic stroke happens when there is a rupture in the vein causing the blood to flow through the brain, Intensifying the pressure inside the head.
    The two strokes are quite different and should never be called by the same name! The only similarity is that they both happen in the head!

    1. I agree that I wish they had different names.

      I wonder if the Inuit/Eskimos, have better-differentiated names?

      Or the Greek?

      I would think the medical community could have used their lengthy, complicated naming system to have fixed it by now.

    2. Andrea Guardiano,

      I agree with you; I would like to know what kind of stroke is responsive to diet.

      There are actually two types of ischemic stroke: 1) Thrombotic (when diseased or damaged cerebral arteries become blocked by the formation of a blood clot within the brain — I thought it was atherosclerotic, but maybe that’s what this is; I looked it up) and 2) embolic (caused by a clot within an artery, but in this case the clot (or emboli) forms somewhere other than in the brain itself. Often from the heart, these emboli will travel in the bloodstream until they become lodged and cannot travel any farther.) http://www.strokecenter.org/patients/about-stroke/ischemic-stroke/

      And then there is hemorrhagic stroke, which you said you suffered.

      So, which types of stroke are affected by diet?

      1. Sorry Dr J, I posted a comment above about types of strokes but hadn’t seen your comment here. I should have read all the comments before posting.

        I am interested in this topic for my own reasons as well,
        and this link echoes Dr Greger ‘s info about lifestyle factors that put us at risk.
        https://www.drugs.com/health-guide/thrombotic-stroke.html

        For me, I have to continue eating heart -healthy with particular emphasis on keeping blood pressure low. Stress is not helping.

      2. Dr. J,

        I believe all types of strokes are affected by diet.

        The thrombotic stroke is linked to atherosclerosis and that is linked to diet. That is that you want fruit and fiber and low saturated fat, etc.

        https://link.springer.com/article/10.1007/s00125-006-0540-9

        Dr Greger did the webinar and the Japanese used to have very high incidence of Hemorrhagic stroke and that is linked to dietary things like sodium and B-12 and possibly wrong omega 3 to 6 ratio.

        Lowering the glutamate storm during stroke can be impacted by diet. Increasing brain plasticity after stroke and increasing oxygen and blood flow to the brain so that neurons that are still alive can function again can be impacted by diet.

    3. ‘The two strokes are quite different and should never be called by the same name!’

      That’s your opinion.

      The medical and scientific communities seem content to class both events as strokes. Just as they call both breast cancer and prostate cancer ‘cancer’.

      In any case. there is reason to think that dietary and lifestyle strategies that reduce the risk of one class of stroke also reduce the risk of the other class of stroke
      https://n.neurology.org/content/94/11/e1112

      1. Tom,

        Yes. They want the public to have simple names.

        I like H stroke and I stroke.

        It is very friendly. HI

        Also the I’s could be IT and IE stroke and I am inspired by the letters. Easy to understand at a glance.

        1. I think the one argument against combining them is that vegans have more H-strokes and meat-eaters have more I-Strokes and that confuses people.

          Vegans feel protected from strokes and they are protected from the 90% category but have more of the 10% category.

          Combining them causes confusion right there.

          When the news ends up saying that vegans have more strokes people become afraid of it and confused by it.

          Combining them makes it easier to understand the commonalities but harder to understand the risk factors.

          1. The media stories love to report bad news (especially about ‘vegans’) but it was just an associational study and the numbers of ‘vegans’ involved was tiny. The association could well have occurred by chance or the result of uncontrolled confounding variables. The Taiwanese study also commented

            ‘The strong inverse association between vegetarian diet and hemorrhagic stroke in our study contrasts the results of the recently published EPIC-Oxford study.36 Buddhist vegetarians in our population and the EPIC-Oxford vegetarians differ in alcohol consumption and use of allium vegetables. Nearly 80% of vegetarians in the EPIC-Oxford study drink varying degrees of alcohol but most participants in our studies avoid alcohol (about 6% of nonvegetarians and fewer than 1% of vegetarians were current drinkers at baseline). Alcohol consumption (as measured by γ-glutamyl transferase) has been suggested in a previous cohort study to modify the effect of low serum cholesterol (typical of vegetarians) on hemorrhagic stroke risk.37 The EPIC-CVD case cohort study also found a clear trend between increased alcohol consumption and stroke risk.38 While Western vegetarians use ample amounts of garlic and other allium vegetables, Asian Buddhist vegetarians avoid these vegetables. Allium vegetables are major sources of alliin/allicin, known to inhibit platelet function and induce bleeding.39 Whether these differences drive the discrepant findings warrants further investigation.’
            https://n.neurology.org/content/94/11/e1112

  9. There were over 7000 global Covid deaths today.

    We are less than a week away from 700,000 global deaths.

    That, and a Covid dog died today.

    Barb talked about stress and the virus, all of the protests, and now the economics are all so stressful.

    I have been pretty good up until today but the electric bill doubling and local stores struggling and the police issues are now going to cause a large tax increase at the town level. They talked about it tonight. The states are passing legislative that the town taxes will have to pay.

    I saw an article about apolice chief killing himselF yesterday and I think that is going to keep happening. Stress. Similar to the medical people killing themselves and the black community killing themselves and the poor people killing themselves.

    But Shopify developers are getting rich.

    The lockdown actually lowered the stress for me but rising prices is increasing it.

    I guess social isolation is something that I understand how to do but the global economy is too big to figure out.

  10. They are talking about how many parts of the police thing the towns have to cover with more taxes.

    More insurance for each officer for more law suits, more body cameras and huge expenses of keeping all of the information for a year, plus so many officers are retiring so pensions are going up and overtime to all of the other officers are going up.

    There was more, but the state defunding things suddenly means such a huge increase in spending and still no training.

  11. Plus, now law firms are going to be aiming at theM.

    Defunding is going to add a fortune to the price after moving the money out and the taxpayers are going to have to make up for both the money defender, plus the new expenses.

  12. I think I knew that wAs what defunding meant.

    We won’t appropriate money toward the police, then we will throw in legislation that will require that money back plus, double the defunded money, but they already allocated that money elsewhere and this new legislation will be demanded but not funded.

  13. But I am not going to have a stroke about it.

    I am just going to note how expensive defunding really is going to be.

    For my town, body cameras Costs and storing the information costs are going to go from non-existent to needing to keep 24/7/365 days a year information from every officer.

    Storing the information from a few best officers is already expensive.

  14. Ok, this is one of the worst when it comes to narration. The ‘speed up, slow down’ shtick was bad enough, but this is now ‘mumble in a low voice and then talk fast & loud.’ There are parts that are simply inaudible on the first hearing for the older people who need this. When I have to stop & translate the mumbled parts because dad can’t hear them & repeat the loud parts because they were too fast for him, it’s time to re-evaluate whether having a shtick is more important than transmitting information. The earlier videos in which Dr Greger just spoke normally were better.

    1. Or, you could simply read the transcripts Nel that is conveniently provided for you beneath each video.

      I enjoy Dr Greger’s videos very much.

  15. [ My father died of a cerebral hemorrhage at age 52. he was sedentary, smoked, drank. I am 84. ]

    “A stroke is a sudden interruption in the blood supply of the brain. Most strokes are caused by an abrupt blockage of arteries leading to the brain (ischemic stroke).”

    “A brain hemorrhage is a type of stroke. It’s caused by an artery in the brain bursting and causing localized bleeding in the surrounding tissues. This bleeding kills braincells.”

    Our better nutrition helps prevent both types of strokes!

    The Table in the video shows the letters “DALYs.” “The disability-adjusted life year (DALY) is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.”

    1. I am already laughing.

      The concept that vegans can’t think is already something invented by a meat-earer.

      I watched a documentary on the history of woman trying to become doctors and.a male doctor put it to the test with his small sample size and showed that women couldn’t possibly become doctors because of our periodicity.

      The vegan doctors do not seem to be lacking intelligence and.the doctors who think everyone needs meat don’t seem all that intelligent as compared to the long-lived plant-based eaters.

      However, it is still good to get enough B-12 to lower your homocysteine.

      And to not be a vegan junk food eater.

    2. LP,
      I read some of the article contained in your link. I do not have a strong grasp of the science of nutrition so I have to rely on my two brain cells. I follow Nutritionfacts.org closely, as you do. I also look at a wide variety of other sources. I also try to use some of my common sense–but I do not trust anything 100%. I am vegan mostly for ethical reasons as I have a soft spot for other sentient life. The better argument may be for health reasons, even though there are plenty of ways vegetarians can go wrong nutritionally. A strong argument also is the health of the environment. Living in a contaminated world cuts life expectancy independent of what one happens to be eating. Animal farming is highly detrimental to our environment on many levels, including the current pandemic.

      1. Thank you. Yes, I agree with what you say, but my enquiry was prompted by curiosity re possibility of needing to add more supplements to a Vegan diet other than B12 and Vit. D.

    3. It’s important to note that this site promotes whole food plant based (WFPB) diets not vegan diets as such. If people do choose to eat 100% vegetarian WFPB diets, Dr G recommends the use of supplements
      https://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/

      It’s perhaps also worth noting that the traditional Okinawan diet, famous for delivering exceptional healthy longevity, was severely deficient (according to modern thinking) in vitamins D and B12 at 2% and 27% respectively of presumed daily requirements. Their consumption of preformed DHA/EPA would also have been very low since animal foods comprised less than 4% of total calories. As I understand it, their minds were still sahrp in old age.
      https://www.researchgate.net/publication/5859391_Caloric_Restriction_the_Traditional_Okinawan_Diet_and_Healthy_Aging_The_Diet_of_the_World's_Longest-Lived_People_and_Its_Potential_Impact_on_Morbidity_and_Life_Span

      Consequently. I have my doubts about the speculations contained in the BBC thinkpiece. This article below goes into more detail about the problems with the BBC article.
      https://www.plantbasednews.org/opinion/bbc-article-bashing-veganism-inaccurate-biased-sensationalist

      Personally, I think it’s another example of omnivores ignoring the beam in their own eye to concentrate on the mote in the eye of ‘vegans’ There don’t seem to be too many demented vegans running around as far as I can see but there are huge numbers of older omnivores with Alzheimer’s etc …. and indeed omnivores of all ages with mental health problems

      ‘Problems with mental health are very common in the United States, with an estimated 50% of all Americans diagnosed with a mental illness or disorder at some point in their lifetime. Mental illnesses, such as depression, are the third most common cause of hospitalization in the United States for those aged 18-44 years old,’
      https://www.cdc.gov/mentalhealth/data_publications/index.htm
      .

      1. Tom,
        Thanks for all of the links. The CDC statistics on mental health show twice the need for mental health services (50 % of the population) than what was needed a few decades ago. I used to think 25 % was a lot. I’m aware that youth are severely affected. Likely, most stratas of society are also affected.

      2. Huge thanks for this detailed response! I am incredibly grateful. It will help me enormously to put a coherent argument to friends who are quoting the BBC article and will reassure those who are following a plant-based diet.
        Best wishes for the continued success of your invaluable efforts. Lynn

  16. In spite of following a really healthful whole-food, plant-based, oil-free diet for years, I had a mini-stroke last year. I’ve also had atrial fibrillation for years, and it appears that the large amounts of leafy greens (especially kale) and green tea that I love so much may have contributed to getting a stroke because of all that clot-encouraging Vitamin K they contain, which wouldn’t be a problem for someone without A-fib. I wish my doctor would have told me about that connection sooner. I still eat greens and drink green tea, but lots less, so that I don’t have to take higher doses of blood thinner, since the dosage is based on dietary levels of Vit. K.

    1. M Rodgers, were you eating nuts before the stroke ? And in what quantity ? I rather suspect more the nuts than the leafy greens, which are considered as “the healthiest food on Earth”

      Dr Michael Greger: “The most important thing is to eat real food that grows from the ground. Dark green leafy vegetables are the healthiest vegetables – in fact, the healthiest food period, with a great nutrient density than anything else we can put into our mouth. Translating to about a 20% drop in stroke and heart attack risk for each daily serving of greens.”

      https://www.wholefoodplantbaseddiet.com/prescription-nutrition-1-of-4-green-revolution/

      1. No nuts at all (a short-term weight-loss strategy). My blood thinner prescription is based on how much green tea, leafy greens, seaweed, and other foods high in vitamin K I eat. Because atrial fibrillation makes one more prone to stroke, these normally healthful foods can exacerbate that tendency when this condition is present, but that wouldn’t be a problem if the heart is functioning properly. Do you know of any research to the contrary?

    2. M Rodgers, vitamin K is both involved in coagulation, anticoagulation and bone health.

      A stroke can also be caused by bleeding within the brain, so it is not necessarily the result of a clot.

      Vitamin K is used as a medication to avoid bleeding:

      “Phytonadione (vitamin K) is used to prevent bleeding in people with blood clotting problems or too little vitamin K in the body. Phytonadione is in a class of medications called vitamins. It works by providing vitamin K that is needed for blood to clot normally in the body.”
      https://medlineplus.gov/druginfo/meds/a682659.html

      It might be that even the high amount of dark green leafy greens that you were eating was not sufficient to prevent the strokes caused by nuts consumption.

    3. I jumped over the sentence where you said you are taking a blood thinner…

      Blood thinners clearly are not helping with circulation… as they limit the body’s ability to regulate the circulation by itself when you give it good conditions (good nutrition, less stress, adequate rythm of life, adequate sleep, etc)

    4. And if your blood thinner was an antagonist of vitamin K, it is likely that you didn’t benefit from the effects of vitamin K from the dark leafy greens… So the combination of blood thinners + nuts might be the cause of the mini-stroke…

      1. M. Rodgers,

        Your physician and you likely have a much better understanding of your specific condition – and of the appropriate use of blood thinning medication and of Vitamin K – than does ab.

        I do not doubt that ab means well, but his ideas of appropriate clinical medical treatment are – how might one say it?

        Unusual.

        I would not entertain them seriously.

        A thought – depending on the specifics of your condition – and I have no intention to pry – some cardiologists may choose to provide you with some options for the treatment of AFib above and beyond blood thinners. If you are already well-informed in such matters – then you likely know any such options well and whether or not they might apply to you. If you are not aware of the various options that may be available – you may wish to consult with a cardiologist who can fully inform you.

        Your call entirely.

        M. Rodgers.

        To your health!

        Vivamus

        1. Thanks for your response, Vivamus. I have not been given alternatives to blood thinners by my doctors, but I would be happy to hear about them; I try to be as medication free as possible. I’ve looked for information on treating a-fib with a 100% dietary approach (lots of anti-clotting foods like onions, garlic, ginger), but haven’t been able to find data on that subject. If you know of any research in that area, I’d be interested in hearing about it. My GP doesn’t like the idea since he feels it would be too hard to quantify amounts ingested. I’ll follow up with my plant-based cardiologist. Thanks for the suggestion.

          I haven’t seen ab’s post yet. I’ll look for it.

          1. Mary,

            Keeping the blood thinner levels – just right – can be a bit of a challenge, as you likely well know. Frustrating for a person on a Whole Foods Plant Based diet who wishes to eat fresh foods that vary with the seasons and who well knows the health value of all those foods that contain Vitamin K.

            The forbidden vegetables (or the precisely consistently eaten ones if you are trying to go that route).

            The problem with exact consistent eating of high Vitamin K vegetables is that, well – the kale in the supermarket may be great today, but pretty poor next week. How so you eat it consistently? Freeze it?

            These are all things a primary care physician can follow and direct you on appropriately.

            It sound like your G.P. has similar concerns to myself.

            Cardiologists are more attuned to the needs of individual AFib patients and what might help some and harm others.

            The nuances of treatment.

            Think of them as being violinists – you are their violin.

            They can advise you on current thought in regards to maneuvers to stop an AFib episode which may be helpful – Valsalva maneuver, etc. – tailored to your particular situation.

            In certain circumstances they may offer you cardioversion – pharmaceutical or electroconversion.

            There may be the option of surgical ablation and/or pacemaker placement.

            The specifics are individualized – the cardiologists know their stuff a whole lot better than primary care physicians – this is what cardiologists do – and the increased interventions may be appropriate in only the more advanced cases.

            Such options might be considered for the Whole Foods Plant Based diet patient who is very strongly motivated to return to a complete diet.

            The problem I would see is that, to get off anticoagulants for your AFIb via, say ablation/pacemaker – you would now need anticoagulants for your pacemaker.

            So you would be no further ahead of the game by going that route.

            Leaving you at the best level of treatment exactly as you are.

            Which is apparently what your physicians have figured out for you already.

            But – it may be good to be evaluated by a cardiologist and understand all the options available to you – and understand why or why not a cardiologist may deem the level of intervention that you are at as being best for you.

            I do not know where you are located – medical systems in different countries approach medical care in different ways.

            In the U.S there is a lot of emphasis on patient education and involvement in medical decision making.

            In more traditional medical settings, there is a more medical authoritarian model – where the physician simply does what he knows is best for the patient without a lot of discussion.

            Both models work just fine – appropriate to their culture – but a patient who is accustomed to one model of care will find the other model to be – disconcerting. And physicians who are accustomed to one model of care may not take well to suggestions from the other.

            With AFib and stroke risk – your best bet is appropriate cardiologist and primary care.

            Diet plays a supporting – and complicating role.

            I.e. – focus on all aspects of “healthy eating” may actually lead to anxiety and to unnecessary negative outcomes.

            Mary.

            Life is a pair-a-docs.

            You take care –

            Vivamus

  17. Corrections are welcome:

    Posts, above , got me thinkin’

    I know – dangerous.

    The following is primarily for hemorrhagic stroke (a “bleed”).

    Ischemic stroke (a “clot”) – the more common stroke – is for another day.

    —————————————————-

    Hemorrhagic stroke: Vitamin B12 and omega-3 / omega-6 ratios may certainly be factors. But there may be other important issues to consider.

    Hemorrhagic strokes I have seen typically involve a history of hypertension or of blood thinner (anticoagulants or antiplatelet therapy) usage. Commonly associated with low dose aspirin – probably because low dose aspirin therapy is so common.

    Blood thinners are typically prescribed for cardiovascular reasons. Also due to deep venous thrombosis / pulmonary emboli.

    And one more recent indication – which we will note at the end of this post.

    So – when I learn of someone self-medicating with low dose aspirin because they have decided that it sounds like a good idea from what they have read, here and there – I do what I can to dissuade them.

    When I check later – I may not have succeeded the first time, but I usually do succeed by the second or third. It may take years.

    Easier to accomplish now – the word is now out in the popular press.

    If a Physician has recommended blood thinners, of course – there are excellent risk vs. benefit reasons – Physicians know what they are doing – I respectfully stand down.

    Hemorrhagic stokes are another reason that I steer people away from the interventional cardiologist – as appropriate. Once you have that stent placed – or that repeat stent when the first stent fails (common – check the stats) – or once you face cardiac bypass surgery – you are commonly placed on some form of blood thinner(s) – often indefinitely.

    Even if you later clean up your act with diet and lifestyle – you are still stuck with the stent. And likely the need for blood-thinners long term.

    It is not uncommon to see some sort of bleeding episode over the next ten or twenty years – waking up from sleep coughing up blood – terrified wife – off to the E.R.! – hemorrhagic stroke – whatever – it varies.

    You will not see this in the peer-reviewed literature. You can quote paper after paper to me showing that this is not a significant concern.

    But I see it in reality.

    Low dose aspirin does beat dying of cardiac arrest – true. Your locally licensed Physician is the best judge of the balance of risks and benefits for you.

    Oh – note that these later hemorrhagic events never show up in the interventional cardiologists’ complication statistics. But they may never have occurred in the first place if the patient hadn’t had to be put on long term blood thinner therapy because of that stent or coronary bypass.

    The other problem I see after interventional cardiology is the general surgeon’s reluctance to later do major surgery while the patient is on long term blood thinners – so the patient is then withdrawn from the the blood thinners temporarily – and there may be a rebound effect – the patient is then at higher risk for ischemic stroke. I have seen it happen. Well – duh. I mean – what did you expect, guys?

    And then the patient – or what is left of the patient – is not a candidate for surgery, anyway.

    Not every patient. Of course not. Hey – you roll the dice.

    Sometimes they come up snake eyes.

    But you can load the dice in your favor by not getting in this situation in the first place.

    Ya sneaky devil.

    Again – a complication apparently associated with long term blood thinner issues originally created by the interventional cardiologist or coronary bypass surgeon – but never attributed to him in his complication stats.

    Be aware.

    I find far preferable to go the Dean Ornish route for cardiovascular disease in the first place when appropriate – clean up those arteries from the inside out via diet and lifestyle therapy – and not face the higher risks of hemorrhagic stroke or ischemic stroke down the road on top of the risks and expense and discomfort of coronary artery stenting or surgery.

    But maybe that’s just me.

    Emergency angiography does have its place – true. That can save lives. As do some other applications for angiography – every situation is specific, if not unique. But if you are facing such a decision on a non-emergent basis, consider calling up the Ornish folk. You will likely get a nurse who will give some guidance as to whether their approach may help you in your particular situation – or if you may be better off with conventional medical therapy – telephone number at the bottom of this url: https://www.ornish.com/

    A decision to be made carefully and individually – certainly not on a basis of a post like this.

    ——————-

    Avoiding hemorrhagic strokes:

    Get that blood pressure down. Symptomless hypertension – which is often described as being “invisible” – becomes very visible when the patient is supine on the CT scanner table and his brain is laid out there, slice by slice, on the screen, for all to see. Statistically, optimal BP seems to be in the 115/75 range or below (not on medication – medical lowering is a band-aid, not a cure). Pulse pressure is an interesting topic in itself. Anecdotally, I have seen plenty of LOLs with no medical BP interventions with blood pressures in the 90/60 range who seemed to be doing just fine, thank you very much (LOL informally meant “Little Old Lady” in this context long before it entered into the Internet lexicon – typically age, say 80s-90s, ~100 pounders). My goal for myself is 90/60 – knowing that I will never, ever get there, but it keeps me motivated – like my goal to one day settle down in Brigadoon https://www.youtube.com/watch?v=ZtE4e1_WMbI or Bali Ha’i https://www.youtube.com/watch?v=81NROmUb7o0 or Shangri-La. Decisions, decisions. Set goals appropriate to your own physiology and your own psychology.

    How to get that BP down? Low sodium / optimal weight /mild exercise / diet appropriate to the individual. Check with your locally licensed physician. No need to mention quitting smoking to this crew.

    Sodium target is individual – best to consult your locally licensed Physician – if not on medications, 1500 mg/day is probably good, 1200 may be better – probably best not to go below 500mg / day. Sodium content in fresh food alone is probably insufficient – I have a story – a powerful story – but it is one for the after dinner conversation in a room with a fireplace – a real fireplace – burning down in the night. Japanese eat a diet very high in sodium – they put it in everything – even in noodles – look at the labels. The Japanese have a much higher risk of hemorrhagic stroke – and of gastric cancer (fermented foods, salted foods, smoked foods) than Americans. Big smokers! But the Japanese still live longer – which kinda shows you what Americans do to themselves. Populations near the Dead Sea – Bedouin? – I forget, now – levels of salt in the well water near the Dead Sea are very high, so population blood pressures are of interest – yet normal BPs. Whoda thunk it? Must be a genetic mutation and/or environmental adaptation – hey, it’s hot out there – I don’t know that anyone has ever followed up. Japanese do not seem to have that mutation. Might be a good thing for a molecular biologist to take on if you have a clever graduate student with a yen for adventure – caution him about the Bedouin girls, though – or about the girl’s eldest uncle, to be precise – he is ultimately responsible for her behaviour – please let me know how it goes.

    Optimal weight: I target a BMI of 21 or so. Seems to be a healthiest target. Whaddya know – I finally reached it after 20 years or so of trying. But losing weight is easy – keeping it off is hard. We will see. Life remains interesting. And tasty.

    Excercise: a half hour a day of walking is a reasonable target. Or anything that you will actually do. By observation – just in living life – Dance is the exercise that I associate with greatest longevity – it includes all the exercise component one associates with walking, with the addition of using much more of the body’s musculature than just walking – Dance is a much better workout – much more balance involved – social aspect – music – and you do it for a lot more than a half hour. Plus – it’s a lot more fun than walking. My favorite peer reviewed reference – Professors Lerner and Loewe: https://www.youtube.com/watch?v=hA9bEKKxTNU And Dance solves the problem of the long long silences when long-married couples go a-walking together – they may have run out of things to say to each other years ago – but with Dance, they speak to each other with their bodies – often quite eloquently, long after the words of love have fled and gone. Family members have been dancing together into their 90s – I think it helps keep them together to that age. Knees may eventually go – do not wear rubber soul shoes, they bear too much friction for the knees to take in dance movement – particularly while the lady is spun in circles – which is what Dance is all about, isn’t it? – that rips those knees apart with rubber-soled shoes. That’s why you hear about “dancing shoes” – it’s best to have good soul. I have also heard good things about glass slippers. And – balance eventually may go – hey, you are 95 years old, guy – grow up! – it happens! I have seen people enjoying dancing even when suffering from mild dementia (into their 90s) – the music starts and off they go! Then one day, they don’t want to go dancing any more – which is sad – you can feel them being called home. Overall, Dance is wonderful in ‘most every way I can think of – until we hit the current shelter-in-place era, that is – there were early reports of a number of square dance callers dead from the Novel Coronavirus – they died for their craft – whole square dance groups contracting it – imagine maintaining social distancing from other couples during square dancing. Oh well – dance must wait it’s time.

    ————————-

    So there we have it.

    Hemorrhagic strokes: High blood pressure, antiplatelet Rx / anticoagulants, B12, Omega-3 / oemga-6 ratios.

    Whole Food Plant Based diet.

    And others things we will learn, over time, as well.

    The rest is all – details.

    ————————–

    Oh – I mentioned another use of blood thinners.

    Reports are – interesting – out of the ICU in relation to anticoagulants for dealing with the clotting issue associated with the Novel Coronavirus.

    Significantly decreased mortality. Significantly increased morbidity.

    As to the question of antiplatelet aspirin therapy as adjunct for dealing with the Novel Coronavirus when treating a less severe case at at home? Hey – you are not the first one to ask that question! Last I looked, there were three studies in progress trying to determine the answer. In the meantime, the general recommendation is to not do so. There are times that you do not want to be your own guinea pig, no matter how smart you may think you are. Sit tight. We will see.

    All for now.

    Stay well –

    Vivamus

  18. I am so bummed.

    A young person just went to the hospital with traumatic brain injury and I tried to talk with their friend who told me about ways of preventing glutamate storms and sent them links about how and why to do it and why doctors meds don’t work and I offered my PEMF and Bergamot essential oil and B12 spray to bring down homocysteine.

    And they said, Deb, the doctors have got this.

    I hope so.

    I hope they try everything.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292622/

  19. My education is in Neurosciences and professional work is in brain injury rehabilitation of adults. The term “stroke” is an umbrella term for an injury to the brain. Just like coffee is used to describe both caffeinated and decaffeinated coffee which are similar but different. An ischemic stroke is caused by a blockage of ANY SORT that interrupts the downstream blood flow to subsequent parts of the brain. It can be caused by a thrombosis – blood clot – as well as any other material that may circulate in the blood stream which sometimes happens during various surgeries.
    A hemorrhagic stroke is the mechanical failure of the blood vessel itself which expresses blood flow into the brain which causes increased intracranial pressure and neuronal death from blood contamination in the brain. This is akin to a blowout in one’s bicycle inner tube. A hemorrhagic stroke MAY be caused by high blood pressure and also by any other weakness in the structure of the blood vessels in the brain.
    A hemorrhagic stroke may also be cause by a congenital malformation of the blood vessels in the brain called Atrioventricular Malformation (AVM). In this congenital brain malformation the blood vessels fail to grow out and into the far corners of the brain as is normal. But instead they stay tangled en mass – like a ball of tangled yarn – inside the brain. This particular malformation brings with it an inherent weakness in the lining of the blood vessels themselves which can explode into the brain at any time in life. It is akin to walking around with a bomb in the brain. There are specific surgeries than can help with this situation when the AVM is discovered but the more likely outcome is that the AVM has a venous failure causing a stroke.
    There are also TIA’s (transient ischemic strokes) which are idiopathic and other interruptions of blood flow such as cryptogenic stroke, also idiopathic.

    Any diet that is good for the heart in reducing cardiac disease is good for the ischemic stroke. Keeping one’s blood pressure in normal range is beneficial for hemorrhagic stroke. There is not much that can be done for AVM as the inherent weakness of the blood vessels is built into that persons genome. But any healthy diet would be supportive of AVM as well as general well being.

    I know Deb thinks that she is of expert knowledge on all topics on this site, but in following her discourse today I can assure these readers that she is not of expert information on stroke. She is simply ignorant.
    Thank you.

  20. My clopidogrel comes with a warning not to eat leafy greens and blueberries. Following your advice this is a big part of what I eat. Am I in danger? Does Dr Greger advise a different diet for people like me?

  21. What you need to know about taking an anticoagulant is that it is more the abrupt increase in Vit K foods that you need to avoid not consistent amounts. While I’ll encourage you to discuss this with your doctor and make it clear you want to continue consistently eating leafy greens and healthy blueberries. That may bring a change in the dietary advice you’re given. Dr. Greger has spoken on this, but I was not able to track down the exact video. Here is similar advice: ealth.harvard.edu/heart-health/ask-the-doctor-is-it-okay-to-eat-leafy-greens-while-taking-warfarin Hope this is helpful

  22. I do love and respect Dr Michael but the manner of his speaking has to be the most irritating ever and off putting to newbies to the nutrition field. I can’t believe he talks like this at home so why inflict it on us ?

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