The University of Newcastle, Australia

A delicious way to prevent stroke and other chronic diseases

By exploring the impact of nutrition on our health, Dr Lesley MacDonald-Wicks is shedding new light on how what we eat influences our risk of chronic diseases such as stroke.

If we are what we eat, are there foods that could help prevent chronic disease? An Advanced Accredited Practicing Dietitian and esteemed nutrition researcher, Dr Lesley MacDonald-Wicks wants to know what role our diets play in mitigating disease risk factors associated with chronic diseases such as stroke and mental illness.

“As a dietitian, I want to facilitate meaningful change in the way people eat. I believe this is important in prevention, and important in the treatment and management of chronic disease. People should be able to enjoy a wide variety of food in their everyday life.”

Lesley’s latest research is focused on reducing stroke rates. Strokes affect around 15 million people every year, according to the World Health Organisation, and the fact that stoke is largely preventable is consistent globally.

Lesley and her research team are exploring how lifestyle changes can prevent strokes from happening—both in the first instance, as well as subsequent strokes.

“Disability and death associated with stroke could be largely prevented with changes to some key lifestyle behaviours. The goal is to combine new research knowledge with relevant support to create long-term change.”

Eating our way to better health

In collaboration with research peers a new diet and physical activity telehealth trial project was launched in 2019. ENAbLE aims to improve the eating patterns of those who have had a stroke, to help prevent them from having a subsequent stroke. The project is based on the Mediterranean diet, which is starting to receive global attention thanks to its array of health benefits.

“There is good evidence that the Mediterranean diet can reduce stroke.

“For ENAbLE, we have ensured that the core conditions of the Mediterranean diet are maintained, but in a way that is appropriate for Australians.

“The eating pattern we are advocating consists of plenty of fruit, vegetables, legumes, wholegrains, nuts and seeds. It includes generous amounts of olive oil, and moderate amounts of fish, red meat and dairy.”

Lesley asserts that, according to research, around 80 per cent of strokes are preventable and 40 per cent of those who have had a stroke will have a second stroke. With such shockingly high prevalence rates, nutrition-based solutions could have widespread benefits for Australian public health.

“This research has the potential to change lives by preventing first and second stroke. Developing healthy lifestyle behaviours and habits could contribute to a significant reduction in the burden of stroke in the Australian population.”

Lesley is careful to ensure that people with experiences of stroke have their voices heard and reflected in the research. ENAbLE has been designed using telehealth to make it easier for people to engage with the project.

“We have asked local stroke survivors to meet with us and co-design the physical activity and diet interventions in ENAbLE.

“We want to ensure the specific lived experience of those who have had a stroke are considered, so that the interventions are relevant to them. To help stroke survivors engage with the project, we must take into account the particular ability and the fatigue of those with stroke that we wish to help, which is why co-design and telehealth are important parts of the research design”

While Lesley and her peers are passionate about creating a program that improves local stroke rates in the Hunter region, they are also hoping ENAbLE can inform global research and progress.

“Our research is relevant to all countries in the world, including developed and developing nations. The lessons we learn in our community, and in our country, will be translatable to the larger global community to assist in preventing stroke across the world.

“However, we live and want to make change here in Australia. That is why we have specifically looked to make our interventions applicable to Australians. So our research focus is local, but our research relevance is global.”

Good communication is key to success

Lesley acknowledges that improving lifestyle behaviours is a difficult undertaking. To create long-term change, people need to be equipped with education, knowledge and skills to make new diet behaviours a consistent part of their lives.

“Behaviour change methods need to be implemented to facilitate the initial change process, but then we must support people to maintain those changes over time. Without that support, the invention won’t be effective.

“I hope to better understand what assists people to make changes to their lifestyles and diets. Eating is a very personal activity. It is how we celebrate. How we commiserate. It defines much of our culture. It is important to us. So changing eating behaviour is challenging.”

Lesley explains that one of the most successful ways to facilitate lasting change is to build a positive therapeutic relationship between the clinician and client.

“This relationship is developed through effective communication, and the clinician’s interpersonal skills are vital to the successful development of that relationship. We know that lifestyle changes are difficult. That’s why clinicians and researchers must have the necessary skills in communication and facilitating change—to enable people to make these changes stick.”

In her role as Senior Lecturer in the School of Health Sciences (Nutrition and Dietetics), Lesley is committed to equipping her Bachelor of Nutrition and Dietetics students not only with nutrition knowledge and know-how, but with the communication skills that will help them build rapport with their clients. To do this, she utilises a program called Healthy Conversation Skills, developed in the UK.

“The program helps to facilitate the use of open discovery questions that will support the development of a meaningful therapeutic relationship between clinicians (researchers) and clients.

“When I teach students, I want to develop in them the successful communication and facilitation skills to allow their clients to make changes to their eating behaviours. By upskilling our undergraduate and postgraduate students, we can have an impact.

“I am excited to develop the clinicians and researchers of the future.”