Healthy Eating And Stroke

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Healthy eatingand strokeStroke Helpline: 0303 3033 100or email: helpline@stroke.org.ukEating a healthy, balanced diet can help reduce your risk of astroke. This guide suggests some simple ways you can changeyour diet to reduce your blood pressure, stay a healthy weight,and lower cholesterol.If you have had a stroke or transientischaemic attack (TIA or mini-stroke),you should be given some advice abouthealthy eating. People with swallowingproblems should have advice from aspeech and language therapist anddietitian on healthy and safe ways toeat and drink. If you have trouble eatingenough to keep your weight up, ask yourGP or dietitian for help. If you need toreduce your weight, you can get advicefrom your GP, and there are some greatresources online such as NHS OneYou andNHS Choices.Five healthy eating tips to help reduceyour risk of stroke1. Fruit and vegetables should make up athird of your daily diet. Eat at least fiveportions a day.2. Starchy foods should make up anotherthird of your daily diet. Go for morewholegrains in foods like brown rice,wholegrain bread and breakfast cereals.3. Aim to eat some protein every day.Healthy sources of protein can be found infish, pulses, nuts and seeds, lean meat andmeat alternatives like tofu and texturedvegetable protein.4. Cut down on full-fat milk, cream andcheese, fatty meat, processed meats, andsolid fats like butter and margarine.The costs of printing this guide have been paid for byLoSalt. The Stroke Association retains independenteditorial control over all content.If you take some types of medication that affectpotassium levels, reduced sodium salts may not besuitable for you. Check with your GP for advice.For more information visit stroke.org.uk5. Limit salt to a teaspoon day (or 6g). Thisincludes hidden salt in ready-made andprocessed foods.Look inside this guide for some practicaltips for changing your diet.1

Healthy eating and strokeFruit and vegetablesEating five or more portions of fruit andvegetables a day can reduce your risk ofstroke by up to 30%. Every extra portionyou eat reduces your risk even further. Trygradually increasing the number of portionsyou eat. You could start taking a piece offruit to work, add a salad to your lunch or trymaking a simple homemade vegetable soup.What is a portion of fruit or vegetables? One portion weighs 80g. For fruit, this could be an apple or twoplums, a handful of berries, or threeheaped tablespoons of fruit salad 30g or one heaped tablespoon of driedfruit counts as a portion. A glass of fruit juice (150ml) counts as amaximum of one daily portion. This isbecause it is low in fibre and contains a lotof natural sugars, which may affect bloodsugar levels. For vegetables, one portion is threeheaped tablespoons whether raw, cookedor tinned. A dessert bowl of salad countsas one portion.What are the benefits?Vitamins and mineralsFruit and vegetables contain a range ofvitamins, minerals and nutrients.These include antioxidants such as vitaminsA, C and E and beta-carotene, which work toprevent damage to your arteries. You don’tneed to take supplements to get enoughantioxidants unless they are prescribed byyour doctor. It’s a good idea to try to eata range of foods containing the vitaminsyou need. To get more antioxidants, aim toeat a variety of different coloured fruit andvegetables. You could try carrots, apricots,berries, broccoli or red peppers.2The mineral potassium can help preventhigh blood pressure. Eating more fruit andvegetables is a good way to increase yourpotassium levels. Bananas, nuts, mushroomsand potatoes are rich sources, but allvegetables and fruit contain potassium.Over-the-counter potassium supplementsshould only be taken on medical advice,as they can be harmful if you have kidneyproblems or take some types of bloodpressure medication.Tips for eating five a day Replace crisps and chocolate with healthysnacks, like a piece of fruit, raw carrotsticks with some humous, or some driedfruit and unsalted nuts. Choose a colourful variety of fruits andvegetables. This will help you to get arange of vitamins and minerals includingantioxidants. Think about green leafyvegetables, orange and red fruit andvegetables like carrots and peppers, anddark purple foods like aubergines andblueberries. Potatoes are classed as astarchy food, not a vegetable, but the skinprovides useful fibre and potassium. Canned fruit and veg count towards yourfive a day. Choose fruit in juice rather thansyrup, and vegetables in water without saltor sugar. Frozen vegetables and fruit are full ofthe same nutrients and fibre as fresh. Tryadding some frozen berries to porridge,or frozen chopped vegetables to a homemade pasta sauce.Call the Stroke Helpline on 0303 3033 100

Healthy eating and strokeFibreWholegrainsFibre is vital for lowering cholesterol, keepingblood sugar levels stable, and managingyour weight. Adults should aim to eat 30g offibre every day.Wholegrains are linked to a lower risk ofstroke. They can also help us avoid type 2diabetes, heart disease and weight gain.Fibre is found in plant-based foods, not meator dairy. The amount of fibre in food canoften be found on the label. You may hear theterms insoluble and soluble fibre being used. Soluble fibre delays the time it takes foryou to digest food, making you feel fullerfor longer. It can regulate blood sugarlevels and help reduce cholesterol. It doesthis by binding to excess cholesterol andfatty substances in the gut, stopping themfrom going into your bloodstream. Onekind of soluble fibre is beta-glucan, whichis found in grains like oats, barley and rye.Fruit, vegetables, beans, pulses and peasare other good sources of soluble fibre. Insoluble fibre shortens the time it takesfor food to move through the bowel, andcan also improve the balance of goodbacteria in the gut. This can improve thehealth of your gut. To boost your intake,eat the skin on fruit and vegetables. Go forwholegrain varieties of starchy foods likepasta and bread, and cook potatoes withthe skin on.For more information visit stroke.org.ukTo make white flour or white rice, the brownouter skin of the grain is removed. Thisskin is where most of the fibre, vitaminsand minerals are stored. So that’s whywholegrain foods tend to contain morevitamins and minerals than refined productslike white bread and white pasta.Wholegrains are a good source of B-vitaminsand folic acid, as well as both types of fibre.Tips for eating more wholegrains Start off by adding wholegrains into someof your main meals. Try brown rice insteadof white, brown pasta and wholewheatcouscous. Look for wholegrain breakfast cereals. Choose wholegrain bread, and try breadmade with rye and other grains. Oats can help lower cholesterol. Oat bran,rye and barley all help too. Try eating acouple of oatcakes as a snack, or addingbarley into a stew.If you are unable to eat gluten or wheat,alternative grains include buckwheat, corn,rice, quinoa and millet.3

Healthy eating and strokeProteinFatYou need roughly two portions of proteinevery day. As a guide, one portion of proteinis the amount that will roughly cover thepalm of your hand. For most people, this isabout 70g of meat, 140g fish, or two mediumeggs.We all need some fat in our diet because itis a valuable source of energy and it helpsthe body absorb certain nutrients. It can alsoprovide substances called essential fattyacids that the body can’t make itself.Protein is found in food like meat, fish, eggs,pulses and beans, dairy products, nuts, andmeat alternatives like soya products.Aim to keep your intake of saturated fat lowby choosing lean cuts of meat and taking theskin off poultry.Aim for one or two servings of fish per weekincluding one of oily fish like mackerel,salmon or trout.Beans and pulses are a good alternativeto meat and fish. They also contain solublefibre that can help lower your cholesterol.Beans and pulses also contain vitamins andminerals, and three heaped tablespoonscan count as a maximum of one of yourfive a day.Nuts are a source of protein as well ashealthy fats. They are high in calories, so youonly need a small handful.Types of fat and what they do Unsaturated fats are mainly found in fishand in plant-based foods, like nuts andseeds or the oils that come from them.You may see words like ‘polyunsaturated’and ‘mono-unsaturated’ on food labels.Unsaturated fats tend to be oils, not solidfats. Eating small amounts of unsaturatedfats can help you reduce cholesterol, andavoid blocked arteries and blood clotswhich can cause strokes. Omega 3 and omega 6 fatty acids aretypes of polyunsaturated fat, known asessential fatty acids. They tend to be foundin oils from fish or plants. They play animportant role in the body, helping to keepartery walls healthy, and regulating bloodclotting. They play a part in loweringblood pressure and having a steady heartrate. They can help reduce the risk of astroke and heart attack by improvinglevels of ‘good’ cholesterol and reducing‘bad’ cholesterol. A good source is oilyfish, but they are also found in nuts andseeds such as walnuts and flax seeds, andsoya products. Saturated fats are usually solid, likebutter, lard or coconut oil. They can raisecholesterol in your blood, which can leadto blocked arteries and an increased riskof stroke.Saturated fats are mainly found in meatand dairy products, including fatty cuts ofred meats, many processed meat products(like sausages and meat pies), butter,cream and cheese. Palm oil, coconut oiland ghee are also high in saturated fat.4Call the Stroke Helpline on 0303 3033 100

Healthy eating and stroke A good way to reduce your risk of stroke isto reduce the amount of saturated fat youeat and replace it with small amounts ofunsaturated fats such as vegetable or nutoils. Some foods also contain healthy fats,like salmon, sardines and avocado. Trans fats are artificial fats which aremostly found in processed foods likecakes, biscuits and margarine. Trans fatscan raise the ‘bad’ cholesterol and reducethe ‘good’ cholesterol in your blood andincrease your risk of stroke and heartdisease. They are made from liquid oilsthat are turned into a solid fat by a processcalled hydrogenation. They are usuallycalled hydrogenated fats on food labels.Use the labelFood labels and packets are a good wayof knowing what the fat content is in foodbefore you buy it. Foods that have a high fat content havemore than 20g per 100g. Foods that have a low fat content have 3gor less per 100g. To cut out trans fat, avoid foods that havehydrogenated fat and hydrogenatedvegetable oil on the list of ingredients.What is cholesterol?Cholesterol is a vital substance in our bodies,but if there is too much in your blood it cancause heart disease and stroke. Cholesterol isa fatty material called a lipid, which is foundnaturally in your blood.Cholesterol is a major part of all our bodycells, the tiny ‘building blocks’ which we aremade of. It also plays a part in our digestiveand hormone systems.Where cholesterol comes fromYour body produces most of the cholesterolit needs in the liver. Eating too muchsaturated fat leads to the liver producingmore cholesterol than you need. This entersyour bloodstream, and can cause build-upsof fatty deposits in your arteries, known asatheroscerosis.Arteries can become narrowed and stiffbecause of the deposits. This can eventuallylead to a clot forming and travelling to thebrain, causing a stroke.You don’t need to avoid eating foods thatcontain cholesterol, such as eggs andseafood. But you should try to keep theoverall amount of fat you have low, especiallysaturated and trans fats.TriglyceridesTriglycerides are another type of fat foundin your blood. Triglycerides are made in yourliver but you can also find them in food likemeat and dairy. Like cholesterol, it can causedeposits in the arteries.‘Good’ and ‘bad’ cholesterolCholesterol moves around the body byattaching itself to proteins in the blood. Thismixture of cholesterol and protein is calleda lipoprotein, and there are two types. Eachtype has an important role, but it’s importantto have the right balance of both in your body.For more information visit stroke.org.uk5

Healthy eating and stroke‘Bad’ cholesterolLDL (low density lipoprotein) has the jobof moving cholesterol to where it’s neededin your cells. But if there is too much LDLcholesterol in your blood, it can end up asfatty deposits in your arteries, increasing yourrisk of stroke.‘Good’ cholesterolHDL (high density lipoprotein) has the jobof taking cholesterol away from the cellsand back to the liver where it is destroyed.Because of this, it is known as goodcholesterol, and you should aim to increaseyour levels of HDL. See ‘Tips for loweringyour cholesterol’.What causes high cholesterol?For many people, high cholesterol levels area result of eating too much saturated fat, andnot enough unsaturated fats. There are othercauses such as: smokingdrinking too much alcoholbeing overweightnot exercising enoughfamilial hypercholesterolaemiaFamilial hypercholesterolaemiaSome people also have high cholesterolbecause of an inherited genetic conditioncalled familial hypercholesteroleamia (FH).This is when you have a very high level ofcholesterol in your bloodstream which is notcaused by diet or lifestyle.In the UK, it is likely that about 120,000people have FH, but most don’t know theyhave it. If you have a history of early deathsfrom stroke or heart disease in your family itis vital to have a cholesterol test. FH can betreated with cholesterol lowering drugs. Ifyour cholesterol is over 7.5mmol/L you willbe assessed for FH.6How is cholesterol measured?Cholesterol levels are checked with a bloodtest. For one type of test (a full lipid profiletest), you can’t eat or drink anything otherthan water for 12–14 hours before the test. Ablood test can give information about yourdoctor what your total levels of cholesterol,lipoprotein and triglycerides.Cholesterol is measured in mmol/L, which isthe amount of cholesterol per litre of blood.Your total cholesterol level should be below5mmol/L. The LDL (bad cholesterol) shouldbe below 3mmol/L. This is the amount ofcholesterol per litre of blood.The balance of total cholesterol to HDLis worked out from your cholesterol leveldivided by your HDL level. This ratio shouldbe below four.How often you should get your cholesterollevels checked will depend on your age andwhether you have other health conditions. Yourdoctor will be able to advise you. It is importantto get your cholesterol checked every year ifyou are on cholesterol-lowering medication.If you are over 40, overweight or have afamily history of stroke, high blood pressureor other medical conditions such as heartdisease or diabetes, visit your GP or practicenurse to ask for a test.Your cholesterol results are used as part ofan assessment of your overall risk of strokeand heart attack. Depending on your otherrisk factors such as your weight, smoking,diabetes, high blood pressure and familyhistory, the doctor will advise you on ways toreduce your risk. This might include statins aswell as healthy eating and exercise.Cholesterol-lowering treatmentsThis guide can only give general information.You should always get individual adviceabout your own health and any treatmentyou may need from a medical professionalsuch as a GP or pharmacist.Call the Stroke Helpline on 0303 3033 100

Healthy eating and strokeStatinsStatins are the main type of medicationgiven to reduce the risk of stroke and heartattack. Statins reduce the levels of ‘bad’cholesterol being produced by the liver. Thishelps prevent fatty deposits (atherosclerosis)forming on the walls of your arteries. Theyalso reduce the chances of atherosclerosiscausing a stroke or heart attack.If you have had a stroke caused by a clot(ischaemic stroke) or a transient ischaemicattack (TIA or mini-stroke), you will beprescribed a statin to help prevent anotherstroke or TIA. The aim will be to reduce yourbad cholesterol by around 40%.Types of statinThere are many types of statins that yourdoctor can prescribe. More common onesare Simvastatin, Fluvastatin or Atorvastatin.Your doctor will decide which is the bestone for you. If you have had an intracerebralhaemorrhage you won’t normally be givena statin. Always read the information whichcomes with your medication or ask yourdoctor or pharmacist if you are unsure.If you have any concerns about side effects,your GP can advise you on different types ordifferent doses to try. If you are prescribedstatins, you will usually be advised to makesome lifestyle changes too, such as followinga low-fat diet and, if necessary, losing weight,giving up smoking or reducing the amount ofalcohol you drink. You may also need advicefrom a dietitian – your doctor may refer youto one.Other lipid-lowering drugsThere are other types of lipid-lowering drugsavailable to people with high cholesterol whocan’t take statins. However, these may notbe given to someone who has had a stroke.The main alternative to statins are selectivecholesterol absorption inhibitors such asEzetimibe, which may be given for familialhypercholesterolaemia (FH).For more information visit stroke.org.ukProducts that lower your cholesterolPlant sterols and stanols are naturally foundin a wide range of foods such as vegetableoils, nuts, seeds, whole grains, fruits andvegetables. They can help reduce cholesterolin your blood when taken as supplements.You can buy dairy products like yoghurtand cream cheese fortified with stanols andsterols. Although these can be expensive,eating some every day can help to lower yourcholesterol.You can use them alongside cholesterollowering medication, but don’t stop takingany cholesterol medication you may betaking. Although sterols and stanols canreduce cholesterol, they do not reduce yourstroke risk in the same was as statins.Tips for lowering your cholesterol Cut down on foods high in saturated fatsuch as: full-fat dairy: milk, cheese, cream,yoghurt and butter fatty meat, meat products and lard pastries, biscuits and cakes foods high in coconut oil, palm oilor ghee. Eat foods high in fibre such as oats, beans,peas, pulses, nuts, fruit and vegetables. Eat oily fish such as salmon, mackerel,sardines, trout or tuna. Eat five or more portions of fruit andvegetables a day. Use olive oil for salad dressings, or an oilthat is high in polyunsaturated fats likesunflower oil. Cholesterol from eggs, liver and kidneysand some seafoods has little effect onyour blood cholesterol levels. On top of diet, you can help reduce yourrisk of stroke by keeping active andexercising stopping smoking and cuttingback on alcohol.7

Healthy eating and strokeSugarSaltSome foods and drinks contain a lot ofadded sugar, but you may not always realisewhich ones. You can put on weight if youhave more sugar than your body needs.Excess calories are stored as fat. Thisincreases your risk of stroke, heart diseaseand type 2 diabetes.Why eat less salt?Eating a lot of salt can increase your bloodpressure. Salt contains sodium which helps tokeep your body fluids at the right level. If youhave too much salt, the amount of liquid yourbody stores increases and this raises yourblood pressure.Foods which often contain added sugarinclude:Salt and high blood pressureHigh blood pressure (hypertension) is thesingle biggest risk factor for stroke. It causesthe walls of your arteries to harden andnarrow, which increases the risk of bloodclots forming. A clot can travel to the brainand cause a stroke (ischaemic stroke). Fizzy drinks and squash. Ready-made pasta sauces. Popular cereals like muesli, cornflakes andgranola. Tomato ketchup and baked beans. Some foods sold as ‘low fat’ contain extrasugar.You should aim to eat no more than 30gof sugar a day (the equivalent of seventeaspoons of sugar). This may sound a lot,but one can of fizzy drink may contain morethan eight teaspoons.Check the labelFood labels will tell you how much sugaris in food. It may be listed as sugar or‘carbohydr

Healthy eating and stroke If you have had a stroke or transient ischaemic attack (TIA or mini-stroke), you should be given some advice about healthy eating. People with swallowing problems should have advice from a speech and language therapist and dietitian on healthy and safe ways to eat

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