In findings presented at the American Stroke Association’s International Stroke Conference, researchers at the University of Alabama at Birmingham found that those with the greatest adherence to a “Southern” diet had a 41 percent increased risk of stroke. Conversely, those who had a “plant-based” diet heavy in fruits, vegetables and beans had a 29 percent lower risk of stroke, according to the study.
Known as the Reasons for Geographic and Racial Differences in Stroke or the REGARDS study, researchers were trying to determine why Southerners have a 20 percent higher stroke risk and why stroke risk is higher among blacks.
“We thought diet was a likely target,” said Dr. Suzanne E. Judd, the lead researcher on the study and a nutritional epidemiologist at UAB.
Surveying more than 20,000 people nationwide about their eating habits, the analysis revealed five broad dietary patterns with one, the Southern diet, associated with higher risk of stroke and the plant-based with a lower risk of stroke. Blacks were much more likely to eat the Southern diet as well, which also adds to the racial disparity.
“It explains about 63 percent of the racial difference in stroke,” Judd said. “We’ve also looked at differences in hypertension because African Americans tend to have more hypertension than their white counterparts. Hypertension explains about 40-50 percent of the racial disparity and diet explains an additional 63 percent. The reason that those numbers overlap a little is obviously diet can lead to high blood pressure, which leads to a stroke.”
While fried food is a well-known dietary risk factor, the sweetened beverages should not be overlooked, she said.
“We’re hearing a lot more recently about the danger of sweetened beverages,” Judd said. “It’s important to minimize those as well.”
It is an eating pattern that Sunitha Zechariah sees often as clinical nutrition manager at University Hospital.
“That is the diet,” she said. “It is heavy with bacon and fried foods and sweets. That’s their everyday intake.”
And that is the problem – it is a steady dose of the diet, six or more times a week, that creates the problem where one or two times a month doesn’t seem to raise the risk, Judd said.
“It’s not a ‘never eat these foods,’ it’s just to minimize them,” she said.
That might be the next step, to try and persuade study participants to change.
“I definitely think it is a lifestyle intervention,” Judd said. “Because clearly we’re seeing from heart disease, we’re hearing it from cancer and now we’re hearing it from stroke that diet is an important factor in all of these diseases. So the big question becomes how do we get people to change their diet?”
That is easier said than done, Zechariah said.
“If someone is doing it six times a week, it is impossible to tell them, ‘Okay, tomorrow you’re not going to eat this any more,’ ” she said. Instead, the staff try to work with the patient to make small but meaningful changes to their lifestyle that they can live with.
“Instead of eating bacon five times a week, can you cut it down to two and add a fruit or a yogurt or oatmeal or some other healthier kind of breakfast?” she said.
It’s also important for patients to get active as well. Zechariah said.
“We emphasize exercise too,” she said. “That’s as important as this diet. It’s a package.”