EPIC Study - interesting finding and recommendations

[CDreamer]

medscape.com/viewarticle/92...

As it’s medscape you do have to join to read but the highlights were:-

The EPIC-Oxford study recruited 48,000 people without stroke or ischemic heart disease and followed them for 20 years. Participants were divided into three groups: meat eaters, fish- but not meat eaters, and vegetarians.

Interestingly, and surprisingly, vegetarians had a 20% higher risk for stroke than meat eaters, mostly due to cerebral hemorrhage. In absolute numbers, this accounts for three more cases out of 1000 over 10 years.

I think the most likely explanation for why meat eaters have a higher risk for ischemic heart disease is LDL cholesterol. This could also explain the increased risk for cerebral hemorrhage, as it's known that very low LDL can [be associated with] a slightly higher risk for stroke.

New Guidelines on Preventing Secondary Stroke

The European Stroke Organisation offered guidelines on antithrombotic therapy for secondary stroke prevention in patients with atrial fibrillation in the European Stroke Journal.[2]

The most important recommendation is that antiplatelet therapy should no longer be used. The second recommendation is that vitamin K antagonists should be used compared with no treatment or with aspirin, and non–vitamin K antagonist oral anticoagulants are preferred over vitamin K antagonists. There is no recommendation about the timing of when to initiate treatment after ischemic stroke. Another important recommendation is that no bridging with low-molecular-weight heparin is needed until anticoagulation is started. At the moment, there is no recommendation on occlusion of the left atrial appendage in patients with contraindications for long-term anticoagulation, given that the ongoing trials are not yet finished.

Hans-Christoph Diener, MD, PhD, is a professor in the Department of Neurology at University Duisburg-Essen in Essen, Germany. He is widely published and best known for his contributions to stroke and headache medicine.

Now the comments regarding the study was that it was difficult to make any sense of the diet recommendations and the conclusions re LDL as vegetarians vary the amount of LDL in their diets and Lifestyle wasn’t taken into account, but it is quite an interesting debate.

Yesterday I attended a talk on how to age well and the highlights:-

Consume at least 3-4 tablespoons Good quality, extra-virgin olive oil a day. (Must be extra-virgin and not adulterated so finding a good, reliable one is essential).

Think vegetables first, protein source second - if you eat meat - make it very occasional and small quantity. If you don’t eat meat - you will need to supplement with B12.

Don’t eat wheat with every meal - eat lots of different whole grains - Amaranth, Oats, Spelt, Quinoa, CousCous, Red Rice, Brown Rice, Black Rice, Bulgar Wheat etc. (By wheat - cereal, biscuits, white bread, cakes, pastry etc._

Eat seeds & nuts & pulses but go carefully with pulses if not used to them and start with tinned lentils and small amounts.

Add fermented foods such as kefir, miso, Kumbucha, sauerkraut, kimchi, very hard cheeses or blue cheeses, sourdough bread.

I think taking the discussion beyond simple vegetarian v meat eaters is important and looking at more than just the LDL - and note that Neurologists like to see a higher fat intake than cardiologists. What everyone agrees is that ‘low fat’ is not helpful - we need to distinguish and to eat plenty of fats but of the right sort!

Amaranth by the way is an ancient grain, bit like quinoa rich in micronutrients such as magnesium, manganese, phosphorus & iron. It’s easily available in supermarkets and can be used to make bread.

[Coco51]

Thank you especially for the summary! That is really interesting. Especially, to me, the difference between cardiologists and neurologists on fat intake because of the risk of CH with lower fat diets. CH is always a concern ( to me ) when taking anticoagulants. Time for some more olive oil, nuts and interesting grains!

[BobD Volunteer]

Thank you CD for that very helpful summary. Think I better speak to my Italian friends about which olive oil is best. I aways get a litre bottle from one client each Christmas!

Without going too far into the meat v veg argument it does sound as though a little of everything is important. I drastically cut down on my meat intake about a year ago trying to have at least three meat free days a week. . Doubt I will live any longer as I suspect the previous many years indulgences will count far more but I did loose some weight.

I aam so glad that thesubject of antiplatelet use has once again been hammered home and just wish more people would understand this.

Anybody remember the Woody Allen film "Sleeper" ? Dietary fashions have ever been thus.

[CDreamer in reply to BobD]

All agree that eating a large variety of foods is important- lots of different foods rather than lots of one thing. This seems to be a consistent message now.

[Rosemaryb1349 in reply to CDreamer]

I can remember my Gt Granny (born around 1870 ish) saying "everything in moderation and moderation in everything".

[CDreamer in reply to Rosemaryb1349]

😄 mine too! Good advice too.

[JaneFinn]

Very interesting indeed - thanks CDreamer. (I’ve only read your extremely helpful highlights so far!) Xx

[dedeottie]

Very interesting indeed. Thanks for posting x

[Auriculaire]

One issue that does not seem to be much addressed in questions of whether to eat animal protein or not is quantity rather than frequency and quality. Many people eat too large portions of meat/fish/poultry. There is little education regarding how much (or rather little) protein is needed to supply daily needs. We eat animal ( mainly fish) protein every day but in very small amounts. I have read that a portion of meat or fish should not exceed the size of the palm of your hand. Well I have tiny hands and still would consider a piece of meat or fish the size of my palm too much for me. It annoys me to be given a portion in a restaurant 3 times the size of what I would eat at home as I hate waste . Quality is also important. Epidemiological food studies are not really helpful as they do not usually distinguish between meat and processed meat and never between industrially produced protein and organic pastured meat and dairy. Cows evolved to eat grass not GMO soy.

My husband's cousin died of a haemorrhagic stroke last year. To look at her you would have said she was the picture of health at 71. Slim and lithe ( she taught yoga) . I noticed on the few occasions she stayed with us that she seemed to have a marked aversion to eating anything fatty.

Another interesting feature of the Medscape report is the presentation of the stats in both relative and absolute forms. This is very important as relative risk presentation always gives a more dramatic impression of risk / benefit. But when you look at the absolute numbers - does it really make that much difference? Given the absolute risk figures and the fact that vegetarians had a slightly higher risk of haemorrhagic stroke ( harder to treat and often more fatal than ischaemic) is vegetarianism on health grounds alone such an attractive option? Personally I would say no. Vegetarianism for ethical reasons is a different matter.

[CDreamer in reply to Auriculaire]

Amounts of protein injested is important & one of the main critics of the study was that this wasn’t broken down - but it was started 20 years ago when less was known.

For the right sort of fats - 20 years ago we were in the midst of the ‘low fat’ craze. My neurologist likes a reasonable LDL - as long as the ratios are ok & triglycerides controlled. It’s the poor quality vegetable oils used in fried foods & processed foods which do the harm, then saturated fats which should be consumed in small amounts but beneficial oils rich in Omega3 are to be encouraged.

We can only go on what works for us & gives us a good Healthspan - new in word - rather than longevity with declining health.

[Auriculaire in reply to CDreamer]

Absolutely. I do think a more nuanced approach to diet is needed. As you point out ,20 years ago we were in the midst of the low fat craze. I fear the "plant based " diet is the next one. Having a vegan son in law I would say from experience that producing really appetising vegan or vegetarian food is more work intensive. But industrially produced vegetarian/ vegan ready meals are not going to be any more nutritious than meat/fish based ones and might even be less so. I think the biggest battle in nutrition is not that of meat versus non meat but of getting people to understand that they cannot be healthy if all they eat is rubbish produced in factories masquerading as food. To go back to cooking from scratch as our grandmothers had to do. And that having quality food produced ethically is more important than having the latest smartphone/ trainers/handbag etc etc.