Bottoms Up!
As we approach the holiday season, do we have to skip the fruit juice punch or the pumpkin spice lattes? How about eggnog? Let’s take a look at the study on the risks of various drinks, and determine the relevance and the practical risk of what you drink.
Does What You Drink Really Matter?
Here are some of the issues I found with the study.
The data used a food frequency questionnaire as well as additional surveys to collect all the data. I’ve talked enough about the problems with the food frequency questionnaire, and the INTERSTROKE Study didn’t use any better techniques.
In prior papers from the INTERSTROKE study, the researchers identified 10 risk factors that accounted for 90.7% of the Population Attributable Risk (PAR) worldwide for a first-time stroke. The PAR together with the percentage contribution of each factor is as follows:
- Prior history of hypertension or blood pressure of 140/90 or higher: 47.9%
- Lack of regular physical activity: 35.8%
- Apolipoprotein (ApoB) to ApoA1 ratio: 26.8%
- Diet assessed by the modified Alternative Healthy Eating Index: 23.2%
- Waist-to-hip ratio: 18.6%
- Psychosocial factors: 17.4%
- Current smoking: 12.4%
- Cardiac causes: 9.1%
- Alcohol consumption: 5.8%
- Diabetes mellitus: 3.9%
What a person drinks would be a small contributor to the diet assessment. It’s legitimate, but there are bigger issues in my opinion.
Finally, looking at the actual risk of stroke in the U.S. and Canada, it’s 0.9% if you’re 18–44 years old, it’s 3.8% at 45–64 yrs, and it’s 7.8% if you’re over 65. That’s the risk without modifying any risk factors in the PAR. What a person drinks would be a very small contributor to that risk. I think working on BP and exercise first makes a lot more sense.
The Bottom Line
Does what you drink matter? Unless you overconsume alcohol, probably not. Could you help yourself out? Yes. Drink seven or more cups of water per day—that’s just 60 ounces—and enjoy a cup or two of any type of tea per day; if you like iced tea, try Paula’s recipe on our website. And if all you’ve ever had is black tea, you need to branch out and try some more exotic varieties. Both water and tea lowered the odds ratio of a first stroke.
Other than that, try to strike a balance with what you drink. Spend more time getting your BP under control, and one of the ways to do that is to exercise. This is as good a time as any to begin. I know you can do it.
What are you prepared to do today?
Dr. Chet
References:
1. International Journal of Stroke 2024, Vol. 19(9) 1053–1063.
2. Journal of Stroke 2024;26(3):391-402.
3. Lancet 2016 Aug 20;388(10046):761-75.
4. MMWR. May 23, 2024. 73(20);449–455.
