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Folic Acid Can Reduce Stroke Risk

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  • People with high blood pressure who took a folic acid supplement had a 21 percent lower stroke risk than those taking medication alone
  • Folic acid is a synthetic type of B vitamin used in supplements and fortified foods, while folate is the natural form found in foods
  • Folate may lower stroke risk by keeping your homocysteine levels in check

Folic Acid Can Reduce Stroke Risk

March 30, 2015 | 55,411 views
| Available in EspañolDisponible en Español

By Dr. Mercola

Folic acid supplements are most widely known for their benefit to pregnant women; folic acid has been found to reduce the risk of certain birth defects, including neural tube defects.

A new study suggests that folic acid may have a benefit besides this, particularly for your heart. 

While recent research indicates that supplementation with folic acid is particularly beneficial for your heart, I recommend adults increase your folate levels through your diet instead for heart and brain health support.

Generally speaking, the ideal way to raise your folate levels is to eat plenty of fresh, raw, organic leafy green vegetables.

Folic Acid Cuts Stroke Risk

Stroke, which is akin to a heart attack in your brain, is the fifth leading cause of death in the US.1 Obstructed blood flow to your brain is known as an ischemic stroke, which represent about 75 percent of all strokes. When an artery that feeds your brain with blood actually ruptures, it's called a hemorrhagic stroke, and this is a far more lethal situation.

Each year, about 800,000 Americans die from strokes, which amounts to about one person every four minutes.2 High blood pressure is a major risk factor for stroke, so researchers tracked stroke risk in more than 20,000 adults with high blood pressure.

All of the participants were taking a high blood pressure drug (enalapril or Vasotec). Half of them also received a daily folic acid supplement. After 4.5 years, those taking the folic acid supplement had a 21 percent lower stroke risk than those taking the medication alone.3

According to the researchers, the benefit would likely be seen among people without hypertension as well. Further, the findings are in line with previous studies that have found benefits from folate use among adults with high blood pressure and low folate levels.

Research published in 2007 also found that folic acid supplementation significantly reduced the risk of stroke by 18 percent.4 Dr. Suzanne Steinbaum, a preventive cardiologist at Lenox Hill Hospital in New York City, told Medicine Net:5

"If all that is required to prevent the greatest health threat worldwide is a vitamin, then we need to consider checking patients' blood levels of folic acid and supplementing if needed."

How to Increase Your Folate Levels Naturally

However, perhaps an even better strategy would be to increase your folate levels via your diet. There is good reason to consider getting your folate naturally from food. 

Further, in order for folic acid to be of use to your body, it must first be activated into its biologically active form – L-5-MTHF. This is the form that is able to cross the blood-brain barrier to give you the brain benefits noted.

However, nearly half of adults have difficulty converting folic acid into the bioactive form because of a genetic reduction in enzyme activity. For this reason, if you take a B-vitamin supplement, make sure it contains natural folate rather than synthetic folic acid.  Children seem to convert folic acid more easily.

Dietary wise, vegetables, without question, are your best form of folate. My nutrition plan describes a naturally vegetable-packed and folate-rich diet. Asparagus, spinach, turnip greens, and broccoli are all good sources, as are beans, including lentils and garbanzo beans.

In addition to lowering your risk of stroke, folate can help keep your homocysteine levels in check. High blood levels of homocysteine may lead to blood clots in your arteries, increasing your risk of heart attack and stroke.

Folate Is Beneficial for Your Brain Too

Elevated homocysteine levels are also linked to brain shrinkage and an increased risk of Alzheimer's disease, which may explain why B vitamins, including folate, have been found to support brain health. In a 2010 study, participants received relatively high doses of B vitamins, including:7

  • 800 micrograms (mcg) folic acid -- US RDA is 400 mcg/day
  • 500 mcg B12 (cyanocobalamin) – US RDA is only 2.4 mcg/day
  • 20 mg B6 (pyridoxine hydrochloride) -- US RDA 1.3-1.5 mg/day

The study was based on the presumption that by controlling the levels of homocysteine, you might be able to reduce the amount of brain shrinkage, which tends to precipitate Alzheimer's.

Indeed, after two years those who had received the vitamin-B regimen suffered significantly less brain shrinkage compared to those who had received a placebo. In those who had the highest levels of homocysteine at the start of the trial, their brains shrank at half the rate of those taking a placebo.

Another study took this research a step further, showing not only that B group vitamins may slow brain shrinkage but that it may specifically slow shrinkage by as much as seven-fold in brain regions specifically known to be most impacted by Alzheimer's disease.8

Among participants taking high doses of folic acid and vitamins B6 and B12, blood levels of homocysteine were lowered as was the associated brain shrinkage – by up to 90 percent. Again these studies used synthetic folic acid supplements, however folate from fresh vegetables is likely a better source.

Other Dietary Considerations for Stroke Prevention

Up to 80 percent of all strokes are preventable through lifestyle factors such as diet, exercise, maintaining a healthy weight, normalizing your blood sugar levels and blood pressure, and quitting smoking.9

For example, research published in 2013 found that if you're inactive, you have a 20 percent higher risk for having a stroke or mini-stroke (transient ischemic attack) than people who exercise enough to break a sweat at least four times a week.10

Recent studies also highlight the importance of getting sufficient amounts of vitamin C and iron, as well as potassium, in your diet. Fiber is also important. Researchers have found that for every seven-grams more fiber you consume on a daily basis, your stroke risk is decreased by seven percent.11

Fiber is the non-digestible parts of plants, which can be either soluble or non-soluble. Water-soluble fiber was found to reduce stroke risk the most, however, ideally your diet will have foods high in both soluble and insoluble fiber, such as:

  • Psyllium seed husk, flax, and chia seeds
  • Green beans
  • Cauliflower
  • Vegetables such as broccoli and Brussels sprouts
  • Almonds and berries

Most Strokes Can Be Prevented with a Healthy Lifestyle

In short, your lifestyle has a direct impact on your stroke risk, and even small changes can make a difference. To lower your risk further, here's what you should know:

  • Exercise will go a long way toward improving your insulin and leptin receptor signaling, thereby normalizing your blood pressure and reducing your stroke risk. I recommend a comprehensive program that includes Peak Fitness high-intensity interval exercises along with super slow strength training, Active Isolated Stretching, and core work. If you've had a stroke, exercise is also very important, as research shows it can significantly improve both your mental and physical recovery.12
  • Processed meats. Certain preservatives, such as sodium nitrate and nitrite found in smoked and processed meats have been shown to damage your blood vessels, which could increase your risk of stroke. I recommend avoiding all forms of processed meats, opting instead for organic, grass-fed, or pastured meats.
  • Diet soda. Research presented at the American Stroke Association's International Stroke Conference in 2011 showed that drinking just one diet soda a day may increase your risk of stroke by 48 percent. Ideally, strive to eliminate all soda from your diet, as just one can of regular soda contains nearly twice my recommended daily allowance for fructose in order to maintain good health and prevent disease.
  • Stress. The more stressed you are, the greater your risk of suffering a stroke. Research has found that for every notch lower a person scored on their well-being scale, their risk of stroke increased by 11 percent.13 Not surprisingly, the relationship between psychological distress and stroke was most pronounced when the stroke was fatal. My favorite overall tool to manage stress is EFT (Emotional Freedom Technique). Other common stress-reduction tools with a high-success rate include prayer, meditation, laughter, and yoga, for example. For more tips, see my article "10 Simple Steps to Help De-Stress."
  • Vitamin D: According to research presented at the American Heart Association's (AHA) Annual Scientific Sessions in 2010, low levels of vitamin D—the essential nutrient obtained from sun exposure—doubles the risk of stroke in Caucasians.14 While many opt for vitamin D3 supplements to raise their vitamin D level, I strongly recommend optimizing your levels through appropriate sun exposure or by using a high-quality tanning bed (i.e. one with electronic ballasts rather than magnetic ballasts, to avoid unnecessary exposure to EMF fields). Ideally, you'll want to maintain your vitamin D level within the range of 50-70 ng/ml year-round.
  • Hormone replacement therapy (HRT) and birth control pills. If you're on one of the hormonal birth control methods (whether it's the pill, patch, vaginal ring, or implant), it is important to understand that you are taking synthetic progesterone and synthetic estrogen -- something that is clearly not advantageous if you want to maintain optimal health. These contraceptives contain the same synthetic hormones as those used in hormone replacement therapy (HRT), which has well-documented risks, including an increased risk of blood clots, stroke, heart attack, and breast cancer.
  • Statins. Statin drugs are frequently prescribed to reduce your risk of heart disease and stroke. However, research shows that these cholesterol-lowering drugs actually increase your risk of a second stroke if you've already had one. There are two reasons why this might happen: the drugs may either lower cholesterol too much, to the point that it increases your risk of brain bleeding, or they may affect clotting factors in your blood, increasing the bleeding risk.
  • Grounding. Walking barefoot, aka "grounding," has a potent antioxidant effect that helps alleviate inflammation throughout your body. The human body appears to be finely tuned to "work" with the earth in the sense that there's a constant flow of energy between our bodies and the earth. When you put your feet on the ground, you absorb large amounts of negative electrons through the soles of your feet. Grounding helps thin your blood by improving its zeta potential. This gives each blood cell more negative charge which helps them repel each other to keep your blood thin and less likely to clot. This can significantly reduce your risk of stroke.

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