Introduction

Eating a healthy diet can help to reduce the risk of having a further stroke.

The stroke risk factors related to diet include high blood pressure, raised cholesterol, being overweight, excess alcohol, and diabetes.

Food groups such as fruit, vegetables and wholegrains can be protective against stroke whilst having a high fat and salt intake can increase the risk of stroke.

By making the following changes to your diet, you may reduce your risk of having another stroke.

The dietary information in this booklet is suitable for people with diabetes. Please speak with a healthcare professional if you have any questions or concerns.

Reduce your salt intake

A diet high in salt is the single biggest dietary risk factor for stroke.

Too much salt in your diet may cause high blood pressure, which increases the risk of stroke.

It is recommended that people should aim to have less than 6g salt (2.4g sodium) per day.

Around 75% of the salt we eat is already in the food we buy and the other 25% is added at the table or in cooking.

Try to:

• Choose fresh food and produce where possible.
• Eat less processed food, such as, sausages, bacon, ham, ready meals, savoury snacks, crisps, salted nuts, and take-aways.
• Use herbs and spices to flavour your meals instead of adding salt.
• Choose no added salt or reduced salt versions of foods where possible e.g. gravy, stock cubes, yeast extract, baked beans, ketchup, soy sauce and use ingredients such as oyster sauce and monosodium glutamate (MSG) sparingly.
• Check the salt content of food from their labels and choose foods with less than 1.25g salt (0.5g sodium) per 100g food.

Levels of salt in food should be labelled as salt or sodium on food packaging. Use the table below to help identify which foods have a higher or lower amount of salt.

Level of salt	Sodium per 100g	Salt per 100g
Low	0.1g or less	0.25g or less
Medium	0.2g – 0.4g	0.5g – 1g
High	0.5g or more	1.25g or more

Eat less saturated fat

Reducing saturated fat intake reduces cholesterol more than anything else in the diet.

Cholesterol is a fatty substance found in everyone’s blood. A high cholesterol level causes fatty deposits to form in blood vessels. If this happens in the brain, it can cause a stroke.

An ideal total cholesterol level is below 5mmol/L. The LDL (bad) cholesterol should be below 3mmol/L.

You can help to reduce your cholesterol levels by eating less saturated fat and hydrogenated vegetable fats (trans fat).

These are found in:

• Butter, cream, full fat milk and cheese.
• Fatty meat and meat products, such as, sausages, processed meat and pies.
• Cakes, biscuits, and pastries.
• Lard, ghee, coconut, and palm oil.

Try to:

• Use rapeseed or olive oil in cooking instead of animal fats.
• Change butter or margarine to a spread high in poly-unsaturated fats e.g. sunflower or olive spreads.
• Use leaner cuts of meat such as chicken, turkey, or low fat mince.
• Cut the visible fat off meat and remove any skin.
• When eating dairy products, choose lower fat versions.
• Use healthier cooking methods: grill, boil, bake, steam or poach instead of frying.
• Use skimmed or semi-skimmed milk instead of full fat.

It is important to remember that some fats are good for our health, including monounsaturated and polyunsaturated fats.

These can be found in nuts and seeds, oily fish, avocados, and some oils (olive and rapeseed).

Have plenty of fruit and vegetables

Eating 5 or more portions of fruit and vegetables a day can reduce the risk of stroke by a third. They also contain fibre, vitamins, and minerals which benefit our digestive system and overall health.

A portion (80g) looks like:

• One slice of pineapple or melon, or half a mango.
• One apple, pear, orange, banana, peach.
• Two small fruits, like plums, apricots or satsuma.
• A handful of grapes, cherries, strawberries, or dried fruit.
• Two to three tablespoons of vegetables.
• A cereal bowl of mixed salad.
• One small glass (150ml) of fruit juice (any more than this does not contribute to your five a day due to the high sugar and low fibre content).

Remember:

• Fresh, frozen, and canned fruit and vegetables all count towards your 5 a day target.
• Choose canned fruit in juice, rather than syrup, and canned vegetables in water without added sugar or salt.
• When cooking vegetables try steaming rather than boiling to retain nutrients.
• Different coloured fruits and vegetables provide different micronutrients – the more variety the better!
• By eating a variety of fruit and vegetables you will consume a greater range of micronutrients.
• Remember white potatoes do not count towards your 5 a day but sweet potatoes do.

Eat more fish

Oily fish are a good source of omega-3 fats which help prevent blood vessel damage and blood clotting. This reduces the risk of certain types of stroke.

A healthy diet should include at least two portions of fish per week: one oily and one non-oily.

Oily fish includes mackerel, pilchards, trout, salmon, sardines, herring, swordfish, anchovies, sprats.

Non-oily fish includes cod, haddock, plaice, pollock, coley, dab, flounder, red mullet, gurnard, tilapia.

• 1 portion = 140g / 5oz of cooked fish.

For those who do not eat fish, omega-3 fats can be found in walnuts, flaxseed (linseeds), rapeseed oil, and omega-3 enriched eggs.

Eat plenty of wholegrain foods

Eat plenty of wholegrain food.

Eating wholegrain foods regularly reduces the risk of stroke and heart disease by up to 30%.

Wholegrains are found in wholemeal bread, wholemeal pasta, brown rice, breakfast cereals (e.g. bran flakes, Weetabix), wholemeal chapatti, oats, couscous, barley, quinoa and rye.

Processed alternatives, such as, white bread, pasta, rice and sugary breakfast cereals do not have the same benefits as wholegrains.

Monitor your alcohol intake

The risk of developing a range of illnesses, including stroke, increase with any amount of alcohol you drink on a regular basis.

The following recommendations will help to reduce this risk:

• Do not drink more than 14 units per week.
• Spread the units evenly over at least three days.
• Have several alcohol-free days per week.

A unit is:

• ½ pint standard strength lager, beer or cider (3-4% ABV)
• 1 pub measure (25ml) of spirits (40% ABV)
• 125ml wine (8% ABV)

Be aware that units change depending on the alcohol strength and volume served, for example:

• A 175ml glass of 13% wine =2.3 units
• A pint of 4% lager= 2.3 units
• A pint of 5% cider = 2.8 unit

Remember alcohol is high in calories so can contribute to weight gain.

Eat regular balanced meals

Aim to eat three regular meals a day and include a variety of foods.

The Eatwell Guide opposite shows the proportions of different foods to include.

Eat processed foods less often as these are often high in fat, sugar, and/or salt.

Aim to drink at least 6-8 glasses of fluid per day to help your body function normally.

Aim to be a healthy weight

Being overweight increases your risk of stroke.

Losing weight can reduce blood pressure and cholesterol, improve energy levels, and reduce risk of developing type 2 diabetes.

To lose weight, try to follow a healthy diet and increase your daily activity level.

If you are overweight, losing just a small amount of body weight can have positive effects on your health and stroke risk.

Patients in the Oxfordshire area who are overweight can self-refer to Achieve Oxfordshire. This is a weight loss service commissioned by Oxfordshire County Council.

To find out more information and to self-refer, please visit their website: www.achieveoxfordshire.org.uk.

If you need assistance with referring to this service, please speak with a healthcare professional.

Malnutrition and gaining weight

Not everyone who has had a stroke needs to lose weight. If you are underweight, please continue to follow the advice your dietitian or healthcare professional has given you.

Medications

Some medications can be affected by the foods we eat. If you take statin drugs, then you should avoid grapefruit juice. If you take Warfarin (a blood thinning medication) then you should avoid grapefruit and cranberry juice.

Diabetes

If you have diabetes, it is important to follow a healthy balanced diet to help control your blood glucose levels. The dietary information in this booklet is suitable for you to follow.

Texture-modified diets

Please note that if you are on a texture-modified diet (e.g., puree), not all the information in this leaflet will be appropriate for you. Please speak with a speech and language therapist for guidance on how these foods can be altered to suit your recommended diet texture.