'Stroke Belt': The public health menace of the deep-fried Southern diet

File this in the "we needed science to tell us this?" folder, perhaps, but a University of Alabama nutritional epidemiologist reported Thursday that the traditional Southern diet of fried foods and butter-infused everything else (think Paula Deen) washed down with sweet iced tea significantly raises the risk of stroke. "Fatty foods are high in cholesterol, sugary drinks are linked to diabetes, and salty foods lead to high blood pressure," notes the researcher, Suzanne Judd. That may not be news, but Judd says she is releasing the first large-scale study on the links between strokes and the regional cuisine known nationwide as "comfort food."

The prompt for the study is the Deep South's unwelcome distinction of having the highest rate of strokes in the country — 20 percent higher than the national average. Strokes are the No. 4 cause of death in the U.S., and diet has long been suspected as the main culprit in mapping out the "Stroke Belt." Judd's big study purports to prove that link. How big a factor is Southern food? People who eat it about six times a week have a 41 percent higher chance of stroke than those who eat Southern once a month.

Here's how the study defined Southern food: Fried chicken and fish, processed meat, gizzards and other animal organs, and sweet tea or other sugar-sweetened beverages. The researchers came up with four other meal categories to aid their research: Convenience (Mexican and Chinese food, pizza, burgers, and pasta), plant-based (fruits and vegetables but also cereal, fish, poultry, nuts, and whole-grain bread), sweets (pretty much what it sounds like, including sweet breakfast pastries), and alcohol (a category that also, inexplicably, includes green leafy vegetables, nuts and seeds, and coffee).

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The nationwide study tracked 20,239 people 45 and older from 2003 to 2007. About half of those surveyed were black. Here are the key numbers: Of the nearly 500 strokes suffered, 138 were among the 4,977 people who ate the most Southern food while 109 were among the 5,156 people who ate the least of it. The opposite was true for people prone to eating the "plant-based" diet — there were 122 strokes among those 5,076 people, versus 136 among the 5,056 people who rarely ate veggies, baked fish and chicken, and whole grains. Plant-based eaters were 21 percent less likely to have a stroke than the rest of the population. The results largely held even when Judd and her team controlled for age, income, smoking, obesity, and exercise.

What does this have to do with the South? Well, people do eat "Southern" diets all over the U.S. — Delaware, Illinois, and Michigan were among the top states — but about two-thirds of those who favor such food live in the southeastern states. "The biggest surprise was that there was a Southern pattern," Judd says. Blacks were five times more likely than whites to eat Southern-heavy diets, and about twice as likely to have a first stroke and also to die of stroke.

It's not all doom and gloom for comfort-food aficionados, though, says Nick Wasson at ABC News. "The Southern diet is not all bad — and some staples of Deep South cuisine may even cut stroke risk." It just may take a little adjustment in how you prepare it. Take "collard greens, for example," says Judd. As long as you don't go too heavy on the bacon or ham, "just having a little more whole grains, fruits and vegetables, and lean protein sources — chicken without the skin, fish that isn't fried — gives you an across-the-board 20 percent reduction in stroke risk."

Sources: ABC News, HealthDay News, The Los Angeles Times, MyHealthNewsDaily, NPR, San Francisco Chronicle