Stroke

OVERVIEW
The prevalence for stroke In Nigeria is at 1.14 per 1000 people currently.
Stroke occurs when the blood flow to the brain is blocked or totally cut off. When this happens, the brain gets little or no oxygen and nutrients.

A stroke is a medical emergency which can cause lasting brain damage, long term disability and/or even death.

A stroke can also be termed ‘cerebrovascular accident’.
Strokes are preventable and can be managed.

WHAT CAN POSSIBLY CAUSE A STROKE?
Based on their causative mechanism, strokes are of two types:
1. Ischaemic stroke
2. Hemorrhagic stroke

– ISCHAEMIC STROKE: this stroke occurs when there is blockage of a blood vessel by a blood clot( embolus) thereby restricting the flow of blood to the brain.
Other factors like plaque build up (by excess fatty acids) and chronic inflammation might lead to ischaemic stroke.
– HAEMORHAGIC STROKE: sudden bleeding in the brain can lead to haemorhagic stroke. Bleeding happens when an artery in or on top of the brain bursts open (aneurysm). The leaked blood can cause the brain to swell thereby putting pressure on the brain and damaging brain cells.

AM I AT RISK OF DEVELOPING A STROKE?
There are risk factors that could lead to a stroke if not paid attention to and they include:
– High blood pressure
– Diabetes
– Heart and blood vessel diseases
– High LDL and cholesterol levels
– Viral infections
– Age
– Sex
– Race and ethnicity
– Family history and genetics
– Smoking.
– Anxiety
– Overweight and obesity,
– Overconsumption of alcohol, using illegal drugs, irregular physical activities, just to mention but a few.

WHAT ARE THE POSSIBLE SIGNS TO WATCH OUT FOR?
Signs and symptoms always appear almost quickly. The type of symptom depends on the type of stroke and the area of the stroke affected.
– Sudden numbness or weakness, especially on one side of the body
– Sudden confusion or trouble speaking
– Sudden trouble walking, dizziness or loss of balance
– Sudden severe headache with known cause

The FAST test is also a good way to identify a stroke
– FACE: ask the person to smile, does one side of the face drop?
– ARMS: ask the person to raise both arms, does one arm seem to be drifting downwards?
– SPEECH: ask the person to repeat a single phrase or speech and watch if their speech is slurred.
– TIME: once you notice any of these, take it as an emergency, get medical help.

COMPLICATIONS
Apart from numbness or weakness of one part of the body or even both parts, a stroke comes with a handful of complications which includes:
1. Loss of bladder or bowel control
2. Loss of bone density or strength
3. Loss of vision
4. Muscle weakness
5. Problem with language
6. Seizures

DIAGNOSIS
Strokes can be diagnosed by medical practitioners through computed tomography (CT SCAN), Magnetic resonance imaging and other imaging tests to look for narrowed vessels in the neck or an aneurysm.

WHAT ARE THE TREATMENT OPTIONS FOR A STROKE PATIENT?
Medicines called anticoagulants or blood thinners might be given by your doctor or procedures like thrombectomy might be performed ( it is used to remove the blood clot blocking your blood vessels).

DOES DIET PLAY ANY ROLE FOR POSSIBLE PREVENTION OF A STROKE ?
Some lifestyles and habits must be eschewed to help prevent a stroke and they include:
– Reduce salt intake to about 1500mg especially if you have a history of hypertension.
– Add more polyunsaturated and monounsaturated sources of fat. Examples include nuts, avocadoes etc
– Shun transfat from refined and processed foods
– Quit smoking
– Stay active
– Moderation on alcoholic drinks
– Manage diabetes well if present
– You can adhere to a DASH diet if you know you are hypertensive or have a history
– Consumption of potassium rich food has been noticed to help prevent against a stroke. Examples of potassium rich food includes banana, potatoes, nuts etc.

TAKE HOME
Strokes develop suddenly most times without prior warning. As much as you can, make sure you maintain a healthy lifestyle so you can prevent the onset of stroke.

REFERENCES:
• ttps://www.gmjournal.co.uk/nutritional-management-of-stroke
• https://www.health.harvard.edu/diseases-and-conditions/tomatoes-and-stroke-protection
• https://www.nhlbi.nih.gov/health-topics/stroke

OVERVIEW
According to recent studies, it has been shown that 64% of people with type 2 diabetes also suffer from hypertension.
This companionship is actually an ungodly one but sadly, in most cases where adequate management is not adhered to, the combo is just inevitable.
Many underlying pathophysiological mechanisms are associated with the duo, with a few seemingly plausible ones like: sodium-fluid retention, insulin resistance in the nitric-oxide pathway and stiffening of arteries.
Diabetes and hypertension are strongly interrelated and always predisposes individuals to other cardiovascular complications like atherosclerosis and arteriosclerosis.
In this article, we would throw light on both diseases, how to manage them, their symptoms and how to prevent one leading to the other.

IDENTIFYING DIABETES?
Diabetes is a complex condition that impairs the body’s ability to metabolize/use blood sugar in the body.
Globally, more than 422 million people are living with the disease. Currently, 1 out of every 17 adults are living with this disease in Nigeria.
Uncontrolled diabetes, either with medication or diet, or a combination of both therapies would lead to other disease complications like stroke and heart diseases.
There are three types of diabetes and they include: type 1 diabetes, type 2 diabetes and gestational diabetes.

• TYPE 1 DIABETES: this is referred to as juvenile diabetes; more common among younger people. It occurs when the body fails to produce insulin. Sadly, people living with this type of diabetes have to stay on insulin for the rest of their lives to stay alive.

• TYPE 2 DIABETES: this is the most common type of diabetes. It affects how the body uses insulin. The cells in the body do not respond to insulin effectively as they would always do in time past before the onset of this type of diabetes.
Less common types of diabetes include monogenic diabetes and cystic fibrosis-related diabetes.

HOW CAN I GET DIABETES?
The risk factors for type 2 diabetes include:
• If you are overweight (when your BMI is above 25 kg/m2)
• If one of your parents or ancestors has diabetes
• having a high-density lipoprotein (HDL) cholesterol level lower than 40 mg/dL or 50 mg/dL
• If there is an occurrence of high blood pressure in your family lineage
• having gestational diabetes or giving birth to a child with a birth weight of more than 9 pounds
• a history of polycystic ovary syndrome (PCOS)
• being of African-American, Native American, Latin American, or Asian-Pacific Islander descent
• being more than 45 years of age
• having a sedentary lifestyle

HOW WILL I KNOW THAT I HAVE DIABETES?
Type 2 diabetes always presents with symptoms and they include:
– excessive hunger
– excessive thirst
– excessive passing of urine; especially in the night time
– blurry vision
– you easily get tired
In some cases, symptoms might not be noticed on time.

Type 2 diabetes can be diagnosed also if an individual’s blood sugar levels are above 70-90 mg/dl. Normally, to test for diabetes, blood samples are needed. But recently, your tears could be used to test for blood glucose levels.

IDENTIFYING BLOOD PRESSURE
Hypertension is a common condition in which there is a long-term force of blood against your artery walls. This could also predispose the individual to other heart health problems.
Previous studies have recorded that hypertension (commonly called) is more prevalent in men than in women.

CAUSES OF HYPERTENSION
There are a number of risk factors which could lead to hypertension and they include:
• Age.
• Family history (hereditary)
• Ethnic background.
• Obesity and being overweight.
• Lack of physical exercise or activity.
• Smoking.
• Alcohol intake.
• Poor diet and high cholesterol.
There are no symptoms noticed with hypertension; reason why it is called the “silent killer”
People usually find out that they have hypertension when a doctor takes their reading with a sphygmomanometer.
An individual would be said to have hypertension if blood pressure levels are above 140/90 mmHg, in severe cases blood pressure levels might get to 180/120mmHg.

RELATIONSHIP BETWEEN HYPERTENSION AND DIABETES
The duo often occurs together and might even share common causes which include:
– Obesity
– Inflammation
– Oxidative stress
– Insulin resistance
As blood glucose accumulates in the body, some vital organs that help to maintain fluid balance are affected. Organs like the kidneys are more affected because they play an important role in making sure there is no fluid retention which leads to high blood pressure.
There are three ways in which high glucose levels in the blood can increase blood pressure:
• The blood vessels lose their ability to stretch.
• The fluid in the body increases, especially if diabetes is already affecting the kidneys.
• Insulin resistance which may involve processes that increase the risk of hypertension.
It is important to note that the duo could pose huge health complications which includes:
1. heart attack or stroke
2. decreased kidney function, progressing to dialysis
3. problems with the blood vessels in the eyes, leading to vision loss
4. peripheral vascular disease

CAN THIS BE PREVENTED?
Yes! Lifestyle factors are very crucial in the management of both diabetes and hypertension.
These lifestyle factors should be adhered to strictly in order to prevent the onset of the duo
1. A HEALTHY DIET: people who already live with diabetes or hypertension should seek advice from their dietitian to help manage their symptoms in order to avoid an escalating situation.
This advice would include:
– eating plenty of fresh fruits and vegetables
– focusing on high-fiber foods, including whole grains
– limiting (not avoiding) the amount of added salt and sugar
– avoiding or limiting unhealthful fats, such as trans fats and
– avoiding the intake of refined carbs.
2. AVOID ALCOHOL AND SODA DRINKS: high alcohol intake increases the risks of developing these diseases. Surprisingly, people always have the mind-set that alcoholic drinks are healthier options when compared to soft drinks. Both are actually not recommended if these diseases are present.
3. STOP SMOKING: smoking tobacco increases the risk of high blood pressure and diabetes. Smoking could lead to poor blood flow and could damage the heart and lungs.
4. MAINTAIN A HEALTHY WEIGHT: losing weight is actually helpful in preventing the onset of diabetes and hypertension. Losing 3-5% of your weight can improve blood sugar readings.
5. BE ACTIVE: at least 150 minutes of intense exercise could help lower blood pressure levels and blood glucose levels as it helps in good blood circulation.
Note that only diet would not help in the management of diabetes and hypertension or the duo. Medications also are important factors in the management.
Also note that herbs, supplements and concoctions won’t help to eradicate this duo but might even pose greater health risks to the individual.

TAKE HOME
High blood pressure and type 2 diabetes often occur together and tend to share same risk factors.
It’s very important to pay attention to lifestyle modifications if you are living with both diseases or just one of them.
In the management, it’s important to have a doctor and dietitian co-manage your symptoms as diet and medication play a huge role in the management of these diseases.

1. SOURCES: https://www.medicalnewstoday.com/articles/317220#outlook
   https://www.webmd.com/diabetes/high-blood-pressure#:~:text=Diabetes%20damages%20arteries%20and%20makes,heart%20attack%2C%20and%20kidney%20failure.
   https://www.tandfonline.com/doi/abs/10.1080/20786204.2004.10873136

DIET TRENDS

The previous year came with quite a handful of FAD diets, we don’t know what this year would bring us but lets take a review on those diets that got so much attention last year, shall we?

No carbs? No food? Which plans work best for weight loss and overall health

When it comes to diets and diet trends, the choices can be dizzying. With so many ways to lose weight, and so many online influencers and supplement peddlers out there, it’s hard to decipher which methods are healthy and actually work.

1. Ketogenic diet

The ketogenic diet is an extremely low-carbohydrate, high-fat diet. The goal of the diet is to maintain a state of ketosis, which means that by eating fewer carbs, the body’s fat-burning system relies mainly on fat instead of sugar for energy.

This concept is actually nothing new. There’s a lot of research, going back to the early 1900s, that ketogenic diets help with certain neurologic conditions like epilepsy in children. But it’s relatively a new strategy for weight loss.

Benefits

If your weight loss goals are more immediate, a ketogenic diet may be able to help you achieve those results. It’s been shown to be very effective for short-term weight loss — more so even than low-fat diets.
Additional benefits may include preventing certain types of chronic disease. There’s been some suggestion that there may be benefits as far as other brain disorders such as Parkinson’s disease, Alzheimer’s disease, multiple sclerosis and even brain cancer. No definitive studies to prove this yet though.

Setbacks

Some health experts believe eating a large amount of fat and protein from animal sources can increase your risk of heart disease and certain cancers.
On the ketogenic diet, you can, for instance, eat all the bacon, red meat and sausages you want; that obviously goes against what we’ve always known to be healthy, we have to be careful about the effect of this diet on people with liver, kidney and heart disease.
The diet is also really strict. It’s an extreme diet, cutting out almost all carbohydrates, which may in turn risk the gut microbiota. That means giving up or limiting conventionally healthy foods like fruit, whole grains and some vegetables which help keep the gut healthy.
Very low-carbohydrate diets may also be associated with more side effects than a low-fat diet, including headaches, fatigue and bad breath.

2. Whole30 diet
The Whole30 diet is a commercial diet marketed as a  30-day nutritional reset.; so they claim.
During those 30 days, you are to avoid sugar, alcohol, grains, legumes and dairy. The diet does permit meat, seafood, eggs, veggies, fruit, and natural fats like vegetable oils, coconut oil and tree nuts.

Benefits

What’s nice is that the Whole30 has a built-in support system on social media. That can be helpful for people who need to keep themselves accountable. Also, there’s no counting or restricting calories.

Setbacks

The company behind the Whole30 diet claims that it can improve or “cure” many medical problems, such as asthma, depression and Lyme disease, but the claims are unfounded; there’s no independent research to verify them.

3. Low-FODMAP diet

Some people are sensitive to certain carbohydrates that are poorly absorbed in the intestines and can cause bloating. These carbs are known as fermentable oligo, di, monosaccharides and polyols — or FODMAPs — and are found in certain grains, vegetables, fruits and dairy products.

A low-FODMAP diet is often recommended for people with irritable bowel syndrome (IBS), a common disorder that causes symptoms like cramping, abdominal pain, bloating, gas, and diarrhea and/or constipation.

Benefits

Studies demonstrate a definite improvement in IBS symptoms in people who use the low-FODMAP.
Many patients with IBS who have done really well on this diet and even go into remission has been recorded.

Setbacks

The low-FODMAP diet is not a weight loss diet. It’s really just for people with IBS.So the studies haven’t shown any benefit for people who don’t have IBS.
It’s also not very easy to follow because the list of low-FODMAP foods is not intuitive. For example, broccoli is a low-FODMAP food, and cauliflower is a high-FODMAP food. So you have to have the list of foods with you at all times.

4. Intermittent fasting diet (time-restrictive eating)
Intermittent fasting is a term for an eating pattern that cycles between periods of eating very little or nothing, and eating regular meals.

Some people intermittently fast for 16 hours a day and then eat all their food in an eight-hour time span; others fast for 24 hours at a time, maybe twice a week. This plan isn’t specific about which foods to eat, but rather when you should eat them.

Benefits

The intermittent fasting diet works well for people with busy schedules because it doesn’t really require planning.
It is quite easy to adhere to if you are very diligent; because it doesn’t restrict and food groups at all.

Setbacks

In a 2018 U.S. News & World Report article where 40 diets were ranked, intermittent fasting was one of the lowest on the list.
The criticism is mostly based on the fact that there’s no guide on what to eat during the nonfasting days. People could end up eating really unhealthily on those days; I had to speak to someone once, and he said he uses 2 sharwama and a bottle of coke to break his fast without putting into consideration the items in the shawarma and their calories.

This diet is also not recommended for people with diabetes because fasting could lead to low blood sugar that may require medication adjustment. People who have a history of eating disorders should also steer clear of this diet, and long-term compliance can be an issue as well.
Fad diets and going to extremes by cutting out major food groups — like carbs — simply aren’t sustainable strategies.

5. The Mediterranean diet

A Mediterranean diet emphasizes eating fruits, vegetables, whole grains, beans, nuts, olive oil and very little red meat.

Benefits

This diet was tied for No. 1 — along with the DASH diet below — for the best overall diet in 2018 by U.S. News & World Report in large part due to its many health benefits. Studies have shown reductions in fatal heart attacks, strokes, cancers, Parkinson’s and Alzheimer’s for people who follow a Mediterranean diet.

Setbacks

There are not any known health drawbacks. It should be noted with caution that some of the studies are short-term, and the exact reason for the health benefits is not clear.

6. The DASH diet

The DASH diet is designed to lower high blood pressure. The acronym in the name stands for Dietary Approaches to Stop Hypertension. It’s a diet rich in fruits, vegetables, legumes and low-fat dairy products, and low in snacks, sweets, meats, and saturated and total fat.

DASH also stresses limiting salt intake. Definitely, an intake of not more than 2,300 mg a day of salt, but ultimately you should strive to stay under 1,500 mg daily.

Benefits

Tied for No. 1 alongside the Mediterranean diet in U.S. News & World Report, a low-sodium DASH diet has been proven to decrease blood pressure. It also reportedly decreases LDL (“bad”) cholesterol, and possibly lowers the risk of stroke and heart disease.

Setbacks

Although the DASH diet was not developed specifically as a weight-loss diet, it may cause some weight loss (which could also be seen as a benefit). And some people might find that limiting salt makes food taste bland.
The good news is that there are plenty of other healthy options for flavoring, like herbs, spices and citrus juices.

7. The MIND diet

The MIND diet, which stands for the Mediterranean-DASH Intervention for Neurodegenerative Delay, developed at Rush University Medical Center, combines foods from the Mediterranean and DASH diets. It focuses on 10 food groups that support brain health, including leafy greens, berries, poultry, beans and nuts.

Benefits

The diet has been shown to benefit brain health and protect against dementia, according to a few studies.
In fact, the MIND diet can help lower the risk of Alzheimer’s disease by as much as 53 percent in people who adhere to the diet rigorously, and by about 35 percent in those who follow it moderately well.

It may also help substantially slow cognitive decline in stroke survivors, according to preliminary research presented at the American Stroke Association’s International Stroke Conference 2018.
Those are big reasons why MIND has been ranked No. 5 in U.S. News & World Report’s list of best diets for three consecutive years.
Setbacks

There aren’t any health risks with MIND, but like the Mediterranean diet, the food needed to follow the diet can be costly.
To diet or not to diet

Fad diets and going to extremes by cutting out major food groups — like carbs — simply aren’t sustainable strategies.
For long-term weight maintenance and overall health, you should adhere to the following sensible approaches to a healthy diet:
• Choose whole foods, such as whole grains, fruits and vegetables.
• Eat fewer processed or packaged foods, like hot dogs, chips or artificial sweeteners.
• Spend more time in the produce section of the grocery store rather than the packaged food aisles.
• Get more fiber, since the conventional diet is generally sorely lacking in fiber.
• Avoid foods with unrecognizable and unpronounceable words on the list of ingredients.
Diets are not one-size-fits-all, so what works for one person may not work for another. It’s best to figure out your individual weight loss goals and nutrition priorities by talking with your  registered dietitian.
And focus on making other lifestyle changes for yourself and your family, including getting plenty of sleep, exercising regularly and managing stress. All of those things will help not only with maintaining a healthy weight, but with your overall health and well-being with physical activity.

Really, the questions we should ask before embarking on any of these diets is if they are sustainable over a long period of time.