Category Archives: stroke

Low Vitamin B6 linked to Inflammation

Low levels of vitamin B6 in the body may be linked with a variety of inflammatory conditions, a new study suggests.

The study found that those with the lowest levels of B6 in their blood had the highest levels of inflammation. The reverse was also true. Those with the highest blood levels of vitamin B6 had the lowest levels of chronic inflammation and the lowest risk of inflammatory diseases.

Temporary inflammation, such as redness and swelling after an injury, is a powerful defence mechanism, triggering healing in the body. However, chronic inflammation is a destructive process, and has been identified as an emerging risk factor for a wide range of health problems, including heart disease, inflammatory bowel disease, stroke, rheumatoid arthritis and type 2 diabetes.

The study, published in the Journal of Nutrition, measured levels of vitamin B6 in 2,229 adults. The researchers also measured several different markers of inflammation, including homocysteine, cytokines and the inflammatory C-reactive protein (CRP).

While previous studies have also linked low blood levels of vitamin B6 with various signs of inflammation (2, 3), such as C-reactive protein (CRP), researchers say this is the first large-scale study to look at the relationship between this vitamin and a variety of inflammation indicators.

Lentils and Kidneys Beans contain B6
Lentils and Kidneys Beans contain B6 which may help toward healthy inflammation levels.

The results found that with the highest blood levels of vitamin B6 had 42% lower levels of inflammatory CRP compared to those with the lowest blood levels. This group also had 14% lower levels of homocysteine and 20% lower levels of cytokines.

The researchers also looked at the incidence of inflammatory conditions within the group. Again, those with the highest levels of B6 demonstrated a 21% lower rate of cardiovascular disease, and a 40% lower rate of diabetes.

The researchers are confident that “overall inflammation is inversely associated with [vitamin B6 blood levels]”. Until more research elucidates this link, it certainly seems sensible to ensure that your diet is providing you with an adequate intake of this vitamin.

If your diet is heavy in sugar, refined flour, alcohol and coffee, you are likely to have reduced levels of vitamin B6 in your body. A wholefoods diet including good sources of vitamin B6 such as chicken, turkey and beef will help to boost your levels. Vegetarians can get plenty of this vitamin in pulses such as lentils and kidney beans, and in other plant foods such as spinach, bell peppers and sesame seeds.

As B Vitamins tend to work together, it is usually advisable to supplement B6 as part of a balanced B-Complex formula.

Written by Nadia Mason, BSc MBANT NTCC CNHC



1. Sakakeeny L, Roubenoff R, Obin M, Fontes JD, Benjamin EJ, Bujanover Y, Jacques PF, Selhub J. (2012) Plasma pyridoxal-5-phosphate is inversely associated with systemic markers of inflammation in a population of U.A. Adults. J Nutr. 142(7):1280-5.

2. Shen J, Lai CQ, Mattei J, Ordovas JM, Tucker KL. (2010), Association of vitamin B-6 status with inflammation, oxidative stress, and chronic inflammatory conditions: the Boston Puerto Rican Health Study. Am J Clin Nutr 91(2):337-42.

3. Woolf K, Manore MM. (2008) Elevated plasma homocysteine and low vitamin B-6 status in nonsupplementing older women with rheumatoid arthritis. J Am Diet Assoc. 2008 Mar;108(3):443-53

4. Image courtesy of Witthaya Phonsawat


Citrus Fruit Lowers Risk of Stroke

In February I wrote about the link between magnesium intake and reduced risk of stroke. There is a growing amount of research in this area, and a new study has now uncovered new links between a special compound in citrus fruits and a lowered risk of stroke (1).

The research, published in Stroke: Journal of the American Heart Association, used data provided by almost 70,000 women to find links between diet and stroke risk.

Citrus Fruits can help fight the risk of Stroke
Citrus Fruits can help in the prevention of Stroke

Citrus fruits contain special compounds called flavanones, a special subclass of flavonoids which act as powerful antioxidants.

The data was gathered from the Nurse’s Health Study, which provided details of the diets of 69,622 women. The researchers found that women who ate high amounts of flavanones in citrus fruits had a 19 percent lower risk of ischemic stroke than women who consumed the least amounts.

Study leader Aedín Cassidy, Ph.D., professor of nutrition at the University of East Anglia  explains “Flavonoids are thought to provide some of that protection through several mechanisms, including improved blood vessel function and an anti-inflammatory effect.”

A typical serving of citrus fruit contains 45 to 50 mg of flavones. The women with the highest intake consumed more than 470 mg per day. While many of the women in the study consumed their flavanones in the form of orange juice or grapefruit juice, the researchers recommend that we should consume whole citrus fruits rather than sugary fruit juices.

These finding support a previous study which also found that citrus fruit and juice intake, but not intake of other fruits, protected against risk of ischemic stroke.

More studies are needed to confirm the association between flavanone consumption and stroke risk, in order to gain a better understanding of this link. In the meantime, there are several additional dietary measures than can help to protect against stroke.

Omega-3 fatty acids can help to keep blood vessels healthy and reduce the inflammation that is associated with ischemic stroke. Oily fish, ground flaxseeds, flaxseed oil and walnuts are all good sources of this essential fatty acid.

Garlic contains a chemical called allicin, which makes your blood less ‘sticky’, and so less likely to clot and cause a stroke. Flavour your food with plenty of fresh garlic – or if you don’t like the taste then try a garlic supplement.

Broccoli will help to boost your levels of folic acid. Other good sources of folic acid are spinach, asparagus and lentils. This B Vitamin lowers levels of homocysteine, an amino acid that can damage your arteries and increase your risk of stroke. The best way to cook broccoli is by steaming, as this helps to preserve the vitamin content.

Purple fruit and berries, such as blueberries, are rich sources of nutrients called proanthocyanidins, providing potent antioxidant and anti-inflammatory benefits. Try adding a handful of blueberries to your muesli or your morning smoothie.

Written by Nadia Mason, BSc MBANT NTCC CNHC


1. Aedín Cassidy, Eric B. Rimm, Éilis J. O’Reilly, Giancarlo Logroscino, Colin Kay, Stephanie E. Chiuve, and Kathryn M. Rexrode. Dietary Flavonoids and Risk of Stroke in Women. Stroke, February 23 2012

2. Joshipura KA et al. Fruit and vegetable intake in relation to risk of ischemic stroke. JAMA 1999. 282(13):1233-9


Dietary magnesium reduces risk of stroke

Recent research published in the American Journal of Clinical Nutrition has found new evidence of a link between magnesium intake and risk of stroke.

The research was conducted at the Karolinska Institute in Stockholm, Sweden. It took the form of a meta-analysis, whereby researchers collect and analyse data from many previous relevant studies. In all, the researchers took data from studies conducted from 1996 to 2011, involving more than 240,000 adults. Each study tracked adults from Europe, Asia or the United States, and lasted an average of 12 years. The data tracked how much magnesium each person took, and how many people suffered a stroke.

Leafy vegetables contain high levels of dietary magnesium
Leafy vegetables, such as cabbage, spinach and kale, contain high levels of dietary magnesium (2.)

The research team found that those with a higher level of dietary magnesium were less likely to experience a stroke. In fact, the risk of stroke was reduced by 8% for each additional 100 milligrams of magnesium a person consumed each day.

“Dietary magnesium intake is inversely associated with risk of stroke, specifically ischemic stroke”, concluded lead researched Susanna Larsson, adding that “the results suggest that people should eat a healthy diet with magnesium-rich foods such as green leafy vegetables, nuts, beans and whole grains.”

Larsson also maintains that the other dietary factors might also have influenced the findings. After all, those whose diets are high in magnesium-rich foods are also likely to have higher intake or absorption of other nutrients, such as dietary fibre and folate. Hopefully, further large controlled trials of magnesium supplementation will clarify the link.

There are of course a number of reasons why magnesium in particular may help reduce the risk of stroke. Strokes are said to be caused by conditions such as hypertension, atherosclerosis and diabetic complications, all of which are linked with low magnesium. This mineral is essential for keeping blood vessels strong and preventing blood from clotting. The UK recommended intake for magnesium is currently 270mg for women and 300mg for men, although it is estimated that many of us in the UK do not manage to reach these levels in our diet.

The best way to ensure that you are getting enough dietary magnesium is to follow the below guidelines:

• Eat a wide variety of vegetables daily, including greens such as kale, spinach and chard.
• Include beans, legumes, nuts and seeds as magnesium-rich sources of protein.
• Include a variety of wholegrains, such as oats, buckwheat, barley, rye and quinoa.
• Choose animal foods that are magnesium-rich, such as halibut and mackerel.

Written by Nadia Mason, BSc MBANT NTCC CNHC

(1.) Larsson S, Orsini N and Wolk A. Dietary magnesium intake and risk of stroke: a meta-analysis of prospective studies. American Journal of Clinical Nutrition. Feb 2012.

(2.) Image courtesy of Dan



Following dietary recommendations may save 33,000 lives a year in the UK

In 2011 a healthful resolution could be to increase the amount of vegetables and fruit you eat daily.  Following UK dietary recommendations such as eating at least ‘five a day’ (fruit and vegetable) and reducing salt intake might prevent 33,000 deaths a year according to research published online in the Journal of Epidemiology and Community Health (1).

Information for this research was taken from national data for the years 2005-2007.  The authors of this study built a model linking consumption of food components with biological risk factors (e.g. blood pressure, serum cholesterol level and obesity) and subsequent mortality (death) from coronary heart disease, stroke and cancer.  Data on deaths from coronary heart disease, stroke and cancers; figures on food and nutrient consumption; and in-depth high quality analyses of published evidence on the contribution of diet to serious illness and premature death was fed into the model.  The information was used to calculate the number of lives that could be saved if UK dietary recommendations on the consumption of fats, salt, fibre and fruits and vegetables were all met (1).

The results from the data analysis found that approximately 33,000 deaths per year would be avoided if UK dietary recommendations were met. The modelled reduction in deaths for coronary heart disease was 20,800, for stroke 5876 and for cancer 6481. Results found that over 15,000 of the deaths could be avoided due to increased consumption of fruit and vegetables.  According to the results, nearly 4,000 annual deaths could be prevented by sticking to the recommendations on dietary fibre, while those on fats and salt would save almost 7,000 and 7,500 lives respectively.  The authors conclude that “The developed model estimates the impact of population-level dietary changes and is robust. Achieving UK dietary recommendations for fruit and vegetable consumption (five portions a day) would result in substantial health benefits—equivalent benefits would be achieved if salt intakes were lowered to 3.5 g per day or saturated fat intakes were lowered to 3% of total energy”.

In this study the UK recommendations that were specifically being measured against were: the daily consumption of 440 g of fruits and vegetables; 18 g of fibre; a third of total energy to be provided by fats, with saturated fat comprising 10% of this; and a maximum 6 g of salt.  In 2007, none of the UK countries met any of these recommendations, with Scotland and Northern Ireland the furthest away from achieving them (1,2).

The results presented are not surprising to me.  Eating a healthy diet provides the body with vitamins, minerals, fibre, essential fats and bioflavonoids etc that are needed for health and to protect against disease.  Simply by increasing daily vegetable, fruit and bean/pulse intake may make a significant impact to health.  Increases can be made gradually e.g. adding a piece of fruit to your normal breakfast, including a side order of salad leaves at lunchtime and an extra portion of vegetables with your evening meal. 

(1)Scarborough P et al.  2010.  Modelling the impact of a healthy diet on cardiovascular disease and cancer mortality. J Epidemiol Community Health.   DOI: 10.1136/jech.2010.114520

(2)Press release.   BMJ-British Medical Journal (2010, December 15). Sticking to dietary recommendations would save 33,000 lives a year in the UK. ScienceDaily. Retrieved December 16, 2010, from­ /releases/2010/12/101215193054.htm



Written by Ani Kowal


A diet high in B vitamins might be linked to a lower risk of heart disease and stroke

A recent Japanese study (1) has found that eating more foods which contain the B-vitamins B6 and folate may reduce the risk of death from stroke and heart disease in women and may reduce the risk of heart failure in men.


There has been a lot of research interest in the links between B vitamins and risk of cardiovascular disease (stroke and heart disease) over the last decade.  The rationale behind this is that there is evidence to suggest that elevated homocysteine levels are a risk factor for heart disease.  As mentioned in previous posts, homocysteine is produced when the amino acid (the building blocks of protein) methionine is broken down in the body.  Normal levels of homocysteine are important to help build and maintain body tissues, however elevated concentrations in the blood can be harmful and have been associated with an increased risk of heart disease and other disorders.  At normal levels homocystein can be converted in the body into a harmless substance called cystanthionine.  The conversion of homocysteine into this harmless substance depends upon various B vitamins  (B6, B12 and folic acid).  Having good levels of these B vitamins appears to be a very good way of preventing high homocysteine levels and low levels of B vitamins have been associated with raised homocysteine levels.  The evidence, however is controversial and not yet solid.

In this study(1) over 23,000 men and 35,000  women, age 40 to 79 years, completed a specialised food frequency questionnaire. During an average of 14-years follow-up, there were 986 deaths from stroke, 424 from coronary heart disease, and 2087 from cardiovascular disease.  The researchers analysed the results and found that higher dietary folate and vitamin B6 intakes were associated with a reduced risk of death from heart failure for men and with a reduced risk of death from stroke, coronary heart disease, and total cardiovascular disease for women.  In this particular study no association was found between vitamin B12 intake and mortality risk.


The findings on the value of B vitamins were consistent with studies in Europe and North America.  The study only shows association, a direct causal link hasn’t been established, but evidence has shown that too much homocysteine may damage the inner lining of arteries and can promote the formation of blood clots (2).

Vitamin B6 is found in foods like potatoes, bananas, beans and chickpeas, avocados, fish and poultry.  Vitamin B12 is found mainly in meat, fish and poultry.  Eggs and cheese also contain B12 as does brewer’s yeast.  Many vegetarians and vegans have very low intakes of this vital nutrient and may wish to consider a multi-B vitamin supplement.  Folic acid is found in beans, green vegetables and wholegrains.  Supplements should never be seen as an alternative to a healthy diet and it is wise to check with you doctor before starting any new supplement regiment.  If you are thinking about taking a vitamin B supplement I would always suggest a broad spectrum supplement that supplies adequate, but not megadose, levels of all of the B vitamins (not single nutrient supplements), these vitamins work best together as a team

(1)Renzhe Cui et al.  2010.  Japan Collaborative Cohort Study Group. Dietary Folate and Vitamin B6 and B12 Intake in Relation to Mortality From Cardiovascular Diseases. Japan Collaborative Cohort Study. Stroke, 2010; DOI: 10.1161/STROKEAHA.110.578906

(2)Press release American Heart Association (2010, April 15). Diet high in B vitamins lowers heart risks in Japanese study. ScienceDaily. Retrieved April 17, 2010, from­ /releases/2010/04/100415161933.htm

Written by Ani Kowal


Low levels of vitamins and minerals may increase the risk of cardiovascular disease

From the 16th-19th June 2010 the World Congress of Cardiology Scientific Sessions were held in Neijing, China .  New data presented there (1) and released to the press via the World Heart Federation has demonstrated that multiple micronutrient levels can predict the risk of cardiovascular disease (heart disease and stroke).

The World Congress of Cardiology Scientific Sessions is the official congress of the World Heart Federation and is held every two years. Through the Congress the World Heart Federation offers an international stage for the latest developments in science and public outreach in the field of cardiovascular health. The World Congress of Cardiology places emphasis on the complementary nature of science and public outreach and strives to spread the message that through individual, community and patient-care interventions, the growing epidemic of cardiovascular diseases can be prevented(1)

The data (1) showed that reduced multiple micronutrient, vitamin and mineral, intakes were associated with a 1.4 times higher risk of death from cardiovascular disease (CVD) in White Americans, 1.3 times higher risk in African Americans and 1.6 times higher risk in Mexican Americans.  The study involved over 9, 400 participants aged 45 and older.  Dr. Longjian Liu, MD, PhD, FAHA, Associate Professor of Epidemiology, Drexel University School of Public Health, Philadelphia, USA said: “This study is the first to demonstrate that multiple micronutrients have significant predicting effects on the risk of CVD and all-cause mortality among White Americans and minority populations,”, he went on to add that “These data suggest that people should ensure that they are maintaining healthy micronutrient levels to help reduce their future risk of CVD.”  (1)

Vitamins and minerals (micronutrients) are vital for health and are involved in the efficient functioning of all body processes, including heart function.  Inflammation plays a major role in cardiovascular diseases and it seems that a good micronutrient status is important in keeping inflammation in the body low, probably by reducing oxidative stress  in the body.  Eating a wide variety of vegetables, fruits and wholegrains daily is important since they contain a huge array of vitamins, minerals and bioflavonoids (bioactive plant chemicals).  Many of the vitamins and bioflavonoids found in these foods act as antioxidants in the body and this may be one way that that prevent disease.  Antioxidants protect the body from attack by destructive molecules known as ‘free radicals’, they protect against ‘oxidative stress’ in the body.  It has been noted in previous studies (e.g. 2)Healthy subjects of any age with a high daily intake of fruits and vegetables have higher antioxidant levels, lower levels of biomarkers of oxidative stress, and better cognitive performance than healthy subjects of any age consuming low amounts of fruits and vegetables. Modification of nutritional habits aimed at increasing intake of fruits and vegetables should be encouraged to lower prevalence of cognitive impairment in later life(2)

Eating a healthful, balanced diet is important for the prevention of many conditions.  Providing the body with good, nutrient rich, food will help to ensure that all the nutrients needed for its efficient functioning are present.  Supplements can never be seen as an alternative to healthy eating but if you feel that your diet consistently falls short of nutrients you might wish to consider taking a high quality, low dose multivitamin and mineral supplement.  It is always best to check with a medical doctor prior to starting any supplementation regimen.  

About the World Heart Federation:
The World Heart Federation is dedicated to leading the global fight against heart disease and stroke with a focus on low- and middle-income countries via a united community of more than 200 member organizations. With its members, the World Heart Federation works to build global commitment to addressing cardiovascular health at the policy level, generates and exchanges ideas, shares best practice, advances scientific knowledge and promotes knowledge transfer to tackle cardiovascular disease – the world’s number one killer. It is a growing membership organization that brings together the strength of medical societies and heart foundations from more than 100 countries. Through our collective efforts we can help people all over the world to lead longer and better heart-healthy lives. For more information, please visit


(2) Polidori MC et al. 2009.  High fruit and vegetable intake is positively correlated with antioxidant status and cognitive performance in healthy subjects. J Alzheimers Dis. 17:4

Written by Ani Kowal


Study finds that walking may help protect women against strokes

This weekend I managed to get out for quite a few blissfully lengthy walks in my new home area of South Cambridgeshire.  Walking is a form of exercise that I really enjoy and studies keep cropping up which seem to suggest it has various health benefits too.  Recently (1) a study has found that walking may be important to protect against stroke in women.

The investigators involved in this particular study (1) mention that physical activity has been related, in many previous studies and papers, to a reduced risk of developing stroke.  In general, more active people seem to have around a 25-30% lower risk of stroke but the details regarding the type of activity and the amount needed are often unclear. 

In this research paper (1) data from over 35,000 women, who were aged 45 years or over, was evaluated.  The women were all healthy at the beginning of the study and the follow up lasted for around 12 years.  The amount and type of physical activity was noted at the start of the study and then again at 36, 72, 92, 125 and 149 months after.  By the end of the study period over 550 women had suffered a stroke: 473 cases were ischemic strokes, the most common type caused by a blockage or blood clot supplying blood to the brain, 102 were haemorrhagic, or ‘bleeding’, strokes and 4 strokes were of an undetermined type.  The investigators then looked at the data in order to see if there was a relationship between the risk of stroke and physical activity.

The results (1) showed that women who walked for two or more hours per week had a lower risk of stroke than those who walked for less than two hours per week.  Overall, the results suggested that the most active women were around 17% less likely to suffer a stoke over the follow-up period.  Women who walked two or more hours a week at any pace reduced their risk of any type of stroke by 30% when compared to women who did not walk.  Those women who walked at a rigorous pace of 3 miles per hour or faster had a 37% reduced risk of suffering from any type of stroke when compared to women who walked at a slower pace.  Walking seemed to be primarily associated with a lower risk of ischemic stroke.  The authors of the study concludeThis study shows a tendency for leisure-time physical activity to be associated with lower stroke risk in women. In particular, walking was generally associated with lower risks of total, ischemic, and hemorrhagic stroke”.

This current research was an observational study and does not prove that exercise or walking prevents against stroke, however, the data certainly does add to the current evidence that even moderate-intensity exercise such as walking briskly seems to be beneficial to reducing the risk of strokes.  The study primarily included well-educated, middle aged women but the authors note that there is no particular reason to believe that the results can’t be generalised across the wider population.  Personally I think that the study is important because walking is a very accessible form of exercise for many people and anything that can prevent against strokes, and other diseases, is certainly worthwhile.  The consequences of stroke, such as reduced mobility, speech difficulties and memory loss, are devastating so anything that helps to reduce the risk is of clinical importance. 

(1) Sattelmair JR et al.  2010.  Physical Activity and Risk of Stroke in Women. Stroke. 2010 Apr 6. [Epub ahead of print]

Written by Ani Kowal