Lower Stroke Risk With Folate
and Stress Reduction

Over 30% of American adults have high blood pressure, defined as a systolic blood pressure above 140 mmHg and/or a diastolic blood pressure above 90 mmHg.

The link between high BP and stroke
High blood pressure (or hypertension) is the single most important risk factor for stroke. It causes about 50% of ischemic strokes and also increases the risk of hemorrhagic stroke. The strain hypertension places on all your blood vessels makes them weaken and predisposes them to damage. Your heart also has to work harder to keep your blood circulating. Once your blood vessels weaken they are more likely to block.  This then can lead to ischemic stroke, meaning a stroke caused by a restriction in blood supply to the brain.

If you have high blood pressure, one fairly simple, natural and inexpensive way to reduce your risk of stroke is by consuming foods rich in folate. This is the important B vitamin that exists naturally in foods; folic acid is the synthetic form that is found in supplements or foods fortified with the vitamin. Both reduce stroke risk, but there are reasons to believe ingesting folate and folic acid in foods is a better bet than taking folic acid supplements.

Whole and fortified foods
Folate occurs naturally in many foods, but especially green leafy vegetables, beans, and citrus fruits. In the U.S., most grain products are fortified with folic acid as well. These include wheat flour, cornmeal, pasta, and rice. It is nutritionally sound to in general consume whole foods to absorb their vitamins, rather than taking supplements in pill form. And clinical trials in the U.S that compared people who took folic acid supplements with those who took placebos showed no benefit from taking folic acid supplements.

One likely explanation is that supplements are most helpful for people who don’t get enough folate in their diets. Nearly a quarter of Americans fell into that category before 1998. But beginning that year, food companies were required to fortify grain products with folic acid. Within a year, the percentage of people with low folate levels dropped dramatically.

In China, by contrast, one recent study found that folic acid supplements produced a real stroke prevention benefit; the conventional interpretation of the difference in outcomes from supplements between the two countries is that China does not mandate fortification of foods like grains with folic acid. The study subjects in China, therefore, likely started with much lower baseline folate levels.

Examine your gluten-free diet
The cardiovascular benefits of folate have been known for decades. Studies begun in the 1970s like the Harvard’s Nurses’ Health Study and the Health Professionals Follow-up Study have shown that people who said they consumed more folate had fewer strokes and heart attacks than those who reported consuming less. Folate, along with other B vitamins, helps break down homocysteine, an amino acid that may damage the inner walls of arteries. Such damage can boost the risk of a stroke or heart attack.

The new findings from China, which were published in JAMA, are most relevant for people in countries without folate fortification. Still, they’re a good reminder to take a close look at your diet to make sure you’re getting enough of this crucial nutrient. People who have cut out grains from their diet, in particular, should be sure they are consuming plenty of green leafy vegetables, beans, and citrus fruits, which of course offer many other nutritional benefits, including fiber, potassium and phytonutrients.

Food Sources of Folate Micrograms (mcg)
Breakfast cereal, fortified with 25% of the DV, 3/4 cup  100
Spinach, frozen, boiled, ½ cup 131
Great Northern beans, boiled, ½ cup  90
Asparagus, boiled, 4 spears 89
Broccoli, chopped, frozen, cooked, ½ cup   84
Rice, white, long-grain, parboiled, enriched, cooked, ½ cup   77
Spinach, raw, 1 cup   58
Green peas, frozen, boiled, ½ cup  50
Orange, 1 medium 48
Egg noodles, enriched, cooked, ½ cup 50
Mango, raw, ½ cup   35

Lower your stress
The pillars of a healthy lifestyle such as not smoking, exercising most days of the week, and eating nutritious foods all help prevent and treat hypertension. Another way to fight hypertension and the elevated stroke risk that accompanies it is to reduce your stress.

Your blood pressure comes down when you practice the relaxation response—even when simply breathing deeply for several minutes to calm your body. Regular practice of the relaxation response could help you reap truly lasting health benefits.

There are many ways to elicit the relaxation response. Techniques include breath focus; body scan; guided imagery; mindfulness meditation, yoga, tai chi, and qi gong; and even repetitive prayer. The trick is to find a method you are comfortable with and to make your stress reduction practice part of your routine.

For some people, medication (in addition to lifestyle changes) is necessary to get blood pressure to a healthy level. Even so, stress management can be a helpful addition. In fact, a randomized, controlled trial of older adults showed that an eight-week program of relaxation response plus other stress management techniques lessened the amount of medication some of the participants needed to control their blood pressure.

Harvard Health Blog, 2015

World Heart Federation, “Stroke and Hypertension,”

USDA National Nutrient Database for Standard Reference,

Harvard Healthbeat, March 2015

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