The number of strokes suffered by American women aged 35 to 54 years old has tripled in the most recent federal health survey. The previous survey done back in 1988 to 1994 found that about 0.5% of middle-aged women had suffered a stroke. However, that shot up to nearly 2% of women the same age in the 1999 to 2004 survey. Doctors warned this marks a disturbing increase in strokes because it occurred despite the fact more women in the second survey were taking drugs to lower their blood pressure and cholesterol levels. These drugs have been shown to help reduce the risk of stroke and other cardiovascular events. So why the spike up in strokes?One clue to the increased stroke risk was that the average middle-aged American women’s  waist  has increased 2 inches compared to just 10 years ago. Average BMI increased from 27 to 29 during that time. Dr. Amytis Towfighi from the University of Southern California reported this disturbing trend at the International Stroke Conference held recently in New Orleans. Traditional stroke risk factors like smoking rates, heart disease, and diabetes did not increase nearly enough to account for this disturbing trend. Previous studies have shown that increased belly fat is linked to the development of the metabolic syndrome, which appears to increase the risk of stroke more markedly in women than men. The results of this survey found that nearly 60% of the middle-aged women now had a waist greater than 35 inches.Metabolic syndromeThe metabolic syndrome is known to promote the development of cardiovascular disease and often leads to the development of type 2 diabetes. It is associated with increased abdominal fat, blood pressure, increased inflammation, and more blood clotting, all of which can increase the risk of stroke. During the 1990s the food industry increased the number of fat-free and low-fat products on the market. Many were loaded with refined carbohydrate.A recent study showed that when middle-aged people with the metabolic syndrome lost weight over a 14-week period those using mostly whole grains lost more abdominal fat and experienced a significant reduction in the inflammatory protein CRP. Those who lost a little more weight consuming a similar diet but with refined grains replacing whole grains lost less abdominal fat and saw no significant drop in their CRP level. The group consuming mostly whole grains also experienced a trend to improve insulin sensitivity.1Whole grains importantWhole grains contain a lot more fiber and magnesium than refined grains and both may help improve insulin sensitivity. Another dietary factor that might reduce inflammation is betaine. Betaine is found in large amounts in whole wheat but refined flour has far less. A recent study in Europe showed people who consumed the lowest levels of betaine/choline were more likely to have higher levels of CRP and several other inflammatory bio-markers in their blood compared to those whose diets contained the most betaine/choline. These compounds are involved in the metabolism of homocysteine and low levels increase the level of homocysteine in the blood. Elevated homocysteine levels may contribute to inflammation and cardiovascular disease. Low levels of betaine/choline can result in a fatty liver, which is often seen in people with the metabolic syndrome.2Bottom Line:More research is needed to determine how switching from refined grains to whole grains helps prevent or reverse at least several of the metabolic abnormalities frequently seen in overweight people with the metabolic syndrome. In the meantime people should be encouraged to limit refined grains and choose mainly whole grains.By James J. Kenney, PhD, RD, FACN.References:1. Am J Clin Nutr 2008;87:79-902. Am J Clin Nutr 2008;87:277-8Impact of Stroke• About 160 to 175 thousand people die from strokes in the US each year out of close to 800 thousand strokes but a lot of those who survive are never the same.• Stroke is the number one reason Americans check into a nursing home for the rest of their  lives.  There are over 600 thousand nonfatal strokes in the US each year and a large percentage of those leave patients so debillitated physically and/or intellectually they  can no longer live on their own.• Stroke is the number 3 cause of death behind diseases of the heart and cancer.• Of every 5 deaths from stroke, 2 occur in men and 3 in women. Strokes are more common in men, but death from stroke is more common in women. (Source: strokeassociation.org)Risk Factors for Stroke:• The ones you can’t control: age, heredity, sex, prior stroke or heart attack• Some of the risk factors you CAN control: high blood pressure, type 2 diabetes, smoking, heart disease, high cholesterol, poor diet, inactivity. Your best bet now is to take control of what you eat so you are eating a more heart-healthy diet AND?you get a little more physical activity.