Stroke: the need for reorientation

After a stroke, nutrition plays a key part in the health and well-being of survivors. Following stroke nutrition guidelines improve stroke recovery and establish ongoing healthy habits. Patients who experience a stroke face new nutritional challenges. Some patients struggle to get enough of the food and nutrients they need, which results in malnutrition. One study found that about one-fifth of patients with acute stroke are malnourished when admitted to the hospital. Poor nutrition can reduce a person’s muscle strength, resistance to infection, and ability to heal wounds.

The effects of stroke on nutrition

A patient’s nutrition may worsen due to stroke-related symptoms and impairments. These could include:

• Dysphagia (difficulty swallowing)
• Low appetite, often caused by medications or side effects
• Memory issues, such as not recalling the last time they ate
• Reduced consciousness and time awake
• Reduced mobility
• Weakness in the arm or face

Interdisciplinary approach to stroke therapy

To address these challenges, patients after stroke can benefit from rehabilitation, including a multidisciplinary team consisting of occupational therapists, dieticians, speech therapists, physical therapists and the treating specialist doctor:

• Physical therapy: support in the acute phase with postural and trunk control, independent sitting and walking, as well as muscle building – all these are important factors that enable independent eating and are essential for functioning digestion
• Occupational therapy: assistance with arm activity, accompaniment while eating, advice on aids to restore muscles and coordination while consuming food when eating as usual is no longer possible due to paralysis
• Speech therapy: help with swallowing disorders (dysphagia), with (re)learning speech, etc., to become more confident and coordinated again when eating and drinking
• Dietology: advice on food and creation of a diet plan or development of dietary guidelines to supply the body with sufficient nutrients

All these disciplines can be used to influence and support nutrition after a stroke to approach therapy in an interdisciplinary and holistic way – of course always in consultation with the treating physician.

Stroke food and nutrition tips

People who have had one stroke are at risk for another stroke in the future. About 25% of the patients in a stroke unit have had a previous stroke. By following stroke nutrition guidelines, stroke survivors can reduce their risk of having another stroke. For example, one study found healthy lifestyle choices, including good nutrition and cardiovascular exercise, can reduce the risk of stroke by approximately 80%.

First, stroke patients should work with medical providers to determine their full range of nutritional needs. For example, a patient with dysphagia should focus on improving safe swallowing. It may also help to know what positions are safest to eat in, the best consistency of foods, and other strategies patients can use to eat and drink safely. These recommendations are unique for every patient.

Some nutrition tips to reduce a person’s risk of stroke

 The American Heart Association (AHA) recommends getting most of your food from plants. Choose whole foods more often than processed foods.

Include low-fat dairy products, fish, legumes, and lean meats

 In addition to plant-based foods, the AHA recommends getting protein from low-fat sources. These foods include non-fat and low-fat dairy, fish, and lean meats such as chicken and turkey. And legumes (beans, lentils, and peas) have protein, fiber, and vitamins and minerals. Consider choosing lean meats over red meat, which has higher amounts of fat and cholesterol.

Match your energy intake to your energy needs

 Food has calories, which the human body turns into energy. Some stroke patients have higher calorie needs after a stroke. This is because acute illness and recovery can demand more energy. A dietician can help patients understand how many calories they need each day and help them meet that goal.

Limit foods that increase stroke risk

The AHA recommends limiting foods, including:

• Alcohol (no more than one drink a day for women, two drinks a day for men)
• Cholesterol (found in red meats, whole milk, and fried foods)
• Processed foods (such as cereal, bacon, and bread)
• Salt (less than 6g a day, which is one level teaspoon)
• Saturated fat (found in butter, cheese, and ice cream)
• Sugar

A lack of proper nutrition can affect a patient’s survival and ability to regain function after stroke. Patients can improve their health and well-being by working with medical professionals and following stroke nutrition guidelines.

Literature:

Nutrition and Risk of Stroke, 2019.

Risk Factors and Treatment at Recurrent Stroke, 2008.

Nutrition after Stroke, 2000.

AHA Dietary Guidelines, 2000.