Nutrition care for stroke patients: Prevention and management 

Dizziness, weakness, confusion, slurred speech, and facial drooping can all be signs of a stroke.  As one of the leading causes of death in the United States, this serious medical condition occurs when cerebral blood flow is disrupted by either a blood vessel blockage or bleeding in the brain.   

Several factors can increase stroke risk, including advanced age, smoking, and alcohol use. Additionally, comorbidities, like diabetes, cardiovascular disease, and hypertension, can increase stroke risk. Knowing the role of diet in disease prevention and management, nutrition education should be routinely integrated into the care of this patient population.   

Impact on nutrition 

Following a stroke, deficits affecting various body functions can range from minimal to significant. The most nutritionally significant is the potential impact on swallowing capability and physical function.  As part of a multidisciplinary team, the registered dietitian nutritionist (RDN), in collaboration with physical therapy, occupational therapy, and a speech-language pathologist (SLP), can assess each patient to determine specific needs and the best care approach for feeding. 

Dysphagia, or difficulty swallowing, is a common problem after a stroke.  Depending on the area of neurological injury, muscles used to swallow in the oral, pharyngeal, or esophageal phase may become weak or paralyzed.  Signs of dysphagia and aspiration include coughing with eating, a feeling of food being “stuck” in the throat or chest, a gurgly sounding voice, or a delay in normal eating time. After a stroke, an SLP can best determine if oral intake is safe, recommend texture modifications as needed, or recommend an alternative source of nutrition if necessary.  

A stroke may impair physical function and fine motor skills. Simple tasks, such as grabbing utensils, preparing a meal, or feeding oneself, can be difficult depending on the severity of deficits.  Physical and occupational therapy are important components of rehabilitation to regain these skills and other functionality.  To help meet nutritional needs, individuals may require additional support from facility staff, family, or caregivers, or the use of adaptive equipment during meals and snacks.    

Dietary patterns and stroke  

While multiple comorbidities can increase the risk of having a stroke, research has shown that specific dietary patterns can positively influence health.  The Mediterranean diet and the Dietary Approaches to Stop Hypertension (DASH) diet are the most studied.  Inclusion of a wide variety of fresh fruits and vegetables, whole grains, lean meats, some sources of unsaturated fat, and low-fat dairy is recommended as part of these approaches.

Additionally, they recommend limiting foods high in saturated or trans fat, added sugar, and sodium.  Experts highlight numerous benefits of the Mediterranean or DASH diets, such as improved blood pressure, serum cholesterol and lipid levels, and blood glucose.  

Diet recommendations: What should be included? 

Diet recommendations following a stroke should reflect individual goals and consider SLP recommendations for the most appropriate diet consistency. If a texture-modified diet is necessary, a balanced diet that includes a variety of nutrient-dense foods can still be encouraged. It is essential that interventions from the RDN include an emphasis on beneficial meal patterns and foods to promote long-term health. 

Sodium 

A lower sodium diet is recommended to decrease stroke risk. Excessive sodium intake is associated with stroke and hypertension, a major risk factor for stroke.  Without careful monitoring, dietary sodium intake from processed foods or added salt can quickly exceed the daily recommended limit of 1,500 to 2,300 mg.  

Nutrition education on lowering sodium intake should include information on reading food labels, preparing meals at home, replacing added salt with fresh herbs or spices for flavor, and limiting heavily processed meals/foods.  

Fiber 

Fiber-rich foods should be encouraged as part of a balanced diet following a stroke.  Consuming at least 5 to 10 grams per day of viscous fiber, a type of soluble fiber, is associated with reduced non-HDL cholesterol levels.  Insoluble fiber should also be recommended for gut health and regular bowel function

A recently published study also found a negative association between total dietary fiber intake and stroke.  A general recommendation for adults is to eat approximately 25-30 grams of fiber per day. Foods naturally high in fiber are nuts, fruits, vegetables, legumes, and whole grains.   

Fat 

When discussing dietary fat, RDNs should encourage the limitation of foods high in saturated fat and trans fat. Recommendations should also include preferential inclusion of foods rich in monounsaturated fats and omega-3 fatty acids. Of note, olive oil consumption has an inverse association with stroke risk.  

Vitamin D 

Evidence suggests that lower circulating Vitamin D levels are associated with ischemic stroke, however, further research examining the role of vitamin D supplementation in stroke rehabilitation or prevention is needed. RDNs can encourage food sources of vitamin D as part of a balanced diet.  

Foods naturally high in vitamin D most notably include certain types of fish: cod, halibut, herring, mackerel, salmon, sardines, sea bass, snapper, trout, or tuna. Other naturally high vitamin D foods include portabella mushrooms, ricotta cheese, and egg yolk.  

Conclusion 

More than 795,000 people in the U.S. have a stroke each year. And nearly 1 in 4 of those individuals have had a previous stroke. Given the high incidence, RDNs should feel equipped and empowered to provide nutrition education focused on stroke prevention. 

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References

Cleveland Clinic: Stroke. https://my.clevelandclinic.org/health/diseases/5601-stroke. Accessed March 2, 2025.  

U.S. Centers for Disease Control and Prevention. Stroke Facts. https://www.cdc.gov/stroke/data-research/facts-stats/index.html. Accessed March 2, 2025.  

American Stroke Association. Trouble Swallowing After Stroke (Dysphagia). https://www.stroke.org/en/about-stroke/effects-of-stroke/physical-effects/dysphagia. Accessed March 14, 2025. 

American Stroke Association. Improving Fine Motor Skills. https://www.stroke.org/en/about-stroke/effects-of-stroke/physical-effects/fine-motor-skills. Accessed March 14, 2025. 

Larsson S. Dietary approaches for stroke prevention. Stroke. 2017;48(10):2905-2911. doi: 10.11161/STROKEAHA.117017383. 

Nutrition Care Manual. Ischemic Stroke and Cerebrovascular Accident (CVA). https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&lv1=272984&lv2=8233&lv3=26454&ncm_toc_id=26454&ncm_heading=Nutrition%20Care#. Accessed March 12, 2025.  

National Lipid Association. Viscous Fiber and Your Cholesterol. https://www.lipid.org/sites/default/files/viscous_fiber_and_your_cholesterol.pdf  Accessed May 13, 2025.  

Lai S, Zhou G, Li Y, et al. Association Between Dietary Fiber Intake and Stroke Among US Adults: From NHANES and Mendelian Randomization Analysis. [published online ahead of print April 29, 2025]. Stroke. 2025. https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.124.049093?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org. Accessed May 13, 2025.  

Marek K, Cichon N, Saluk-Bijak J, et al. The role of vitamin D in stroke prevention and the effects of its supplementation for post-stroke rehabilitation: A narrative review. Nutrients. 2022;14(13):2761. doi: 10.3390/nu14132761. 

Nutrition Care Manual. High Vitamin D Foods List (2022). https://www.nutritioncaremanual.org/client_ed.cfm?ncm_client_ed_id=452. Accessed May 13, 2025.