Diet plays an important role in post-stroke recovery. Research shows that having one stroke puts you at an increased risk of having another. Rebuilding your life after a stroke can be an overwhelming challenge, but with the right diet, you can significantly ease the burden on your body.

Firstly, swallow function may be affected after a stroke. This is known as dysphagia, which is a medical term for trouble swallowing. Dysphagia can occur due to a number of factors post-stroke. Muscles involved in swallowing may be weaker or paralyzed. Changes in sensation or coordination and damage to nerves that control swallowing may occur. 

Dysphagia can lead to a number of complications including dehydration, malnutrition, aspiration (when food or liquid enters the lungs), and pneumonia. Therefore, it’s important to identify and address these early on in stroke recovery.

A speech-language pathologist (SLP) assesses and treats dysphagia with exercises to build strength and strategies to improve swallow. An SLP will recommend modifications to food and liquid textures to help swallow safely. 

That said, a nutritious and balanced diet is always important to aim for, regardless if you’ve had a stroke or not, according to Johna Burdeos, RD with over 20 years of experience in clinical nutrition.

Post-stroke Nutrition Guidelines

There are some general guidelines specifically for post-stroke nutrition: 

1. Eat a variety of nutrient-dense foods. Focus on consuming various fruits, vegetables, lean proteins such as chicken, fish, eggs, and legumes, and healthy fats such as olive oil, avocado, nuts, seeds, and fatty fish like salmon. These nutrient-rich foods support overall health and recovery.
2. Eat more foods rich in magnesium. Magnesium helps to reduce the risk of developing high blood pressure, therefore the risk of stroke or stroke recurrence. Magnesium-rich foods include leafy greens, beans, seeds, avocados, brown rice, quinoa, etc.
3. Increase fiber intake. Many people following the Standard American Diet don’t get enough fiber. Fiber-rich foods such as fruits, veggies, nuts, and seeds (particularly walnuts, chia, and flax which also contain healthy fat) and whole grains can help lower cholesterol levels which thereby supports heart health and reduces the risk of cardiovascular events (stroke, heart attack).
4. Eat omega-3 fatty acids: Found in fatty fish like salmon and mackerel, nuts, and seeds. These foods can help reduce inflammation and improve brain function after a stroke.
5. Eat berries: Berries are rich in antioxidants, which can help protect the brain from oxidative stress and improve cognition.
6. Eat leafy greens: Leafy greens like spinach and kale are rich in nutrients and antioxidants. They’re high in folate, a nutrient that research has shown to help lower homocysteine (an amino acid) levels in the body. High homocysteine can damage vessels and increase the risk of cardiovascular events. Leafy greens also provide an impressive amount of vitamin K—over 100% of the daily value for example in a one-cup serving of raw spinach. Vitamin K has been shown in some research to support heart health. 
7. Eat flavonoid-rich foods. Flavonoids are powerful phytonutrients (plant compounds) that exhibit antioxidant activity. They provide anti-inflammatory effects, basically supporting bodily functions (including cognition) whilst protecting them from everyday stressors and toxins. Foods high in flavonoids include bell peppers, red and purple grapes, apples, citrus fruits, berries, tea -particularly green, white, oolong, and black tea, dark chocolate, and soy products like tofu, soy milk, and edamame.

Foods to Avoid

• Avoid foods that cause high blood pressure. There is a strong connection between high blood pressure and stroke. When we eat foods that contain too much sodium, the balance of our body’s natural sodium is thrown off. This results in an increase in pressure on our blood vessel walls. When blood pressure gets too high, a stroke can happen. Foods to avoid include processed deli meats, canned soups, pizza, broths, chips, and just about all frozen dinners. 
• Avoid artificial sweeteners. According to Traci D Mitchell, an MS in Health & Nutrition Education and a stroke survivor “I know this may sound controversial, but I’m convinced this is why I had a stroke. When I had my stroke, I was drinking all the diet sodas in the world. I also drank Crystal Light (remember that?) and added aspartame to my coffee. It turns out there is a correlation between artificial sweeteners and stroke. Anecdotally, I’ve had clients lose a significant amount of weight just by giving up their Diet Cokes.”. Some great research has shown that even relatively modest amounts of artificially sweetened beverages (1 to 2 cans a week), place women 50+ at an increased risk.

In addition to limiting sodium post-stroke, limit high saturated fat foods such as red meat. Processed meats, whole-fat dairy, coconut and palm oils, and baked foods like cookies and cakes. High saturated fat intake is linked to increased cholesterol levels–particularly LDL (bad) cholesterol and this can increase the risk of cardiovascular events. 

Post-Stroke Diet for Your Age:

Firstly, cooking skill level and support must be considered. Regardless of age, the above-mentioned nutrition guidelines apply. But ultimately, people have free will as to how much or how little they want to follow these guidelines.  

Someone who is younger may be more tech-savvy and know how to navigate the internet to get healthy recipe ideas, get groceries delivered, as well as order from the meal delivery services which offer heart-healthy menus. A younger person may have more energy to cook for themselves. 

Now, as people age, they require greater assistance and support for an extended period, as they tend to experience physical frailty and manage multiple chronic conditions in addition to a stroke or heart attack. In this regard, the involvement of family and friends is crucial, as caring for an elderly loved one alone may prove challenging. The only alternative is placing the elderly individual in a nursing home.

 Elderly people may be more set in their ways about their eating habits. Nutrition guidelines may be more difficult to follow. As such, family and supportive members should do their best to incorporate those nutrient-rich foods whilst honoring the elderly person’s wishes. It will not be perfect but it’s a bit of a balancing act. Many elderly people often rely on nutrition supplement shakes to help fill nutrient gaps. Changes in appetite (generally a decline), swallowing, and chewing function can happen as we age. This must all be considered when preparing meals for an elderly person. 

Sample anti-inflammatory one-day meal plan

BREAKFAST

1/2 c Old Fashioned Oats + 1/4 c Walnuts + 1/2 c Berries + Cinnamon + 1 tsp. Maple Syrup

LUNCH

Leafy Green Salad + 1/3 c Chickpeas + 1/2 Avocado + 1/2 c Carrots + 1/2 c Bell Peppers + 1 Tbsp. Sunflower Seeds + Balsamic Vinegar and a sprinkle of sea salt

DINNER

Vegetable Curry: 2 c Broccoli + 2 c Cauliflower + 1 Potato, diced + 1/2 Yellow Onion + 2 c Unsweetened Almond Milk + 2 C Water + 3 heaping TBSP Green Curry Paste (salt to taste after cooking).

Add all ingredients to a stock pot cover and cook for 30 to 45 minutes over medium heat. Serve over a bed of brown rice or quinoa.

SNACKS

1 or 2 a day

• A couple of squares of dark chocolate
• 1 Banana + 1 Tbsp. Unsweetened Peanut Butter
• 1 Apple + 1 Tbsp. Unsweetened Peanut Butter
• 1/4 c Hummus + 1 cup Carrots

About the author:

• Johna Burdeos, RD. She is a registered dietitian with over 20 years of experience in clinical nutrition–including providing nutrition care to patients post-stroke in the hospital and nursing home settings.
• Traci D Mitchell, an MS in Health & Nutrition Education plus a Mayo Clinic Health & Wellness Coach. She also happens to be a stroke survivor (she had a stroke at 28).

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