Effective dietary strategies to aid recovery and improve nutrition in stroke patientsDecember 17, 2024
Some people who have had a stroke are unable to swallow their food or drink fluids correctly because of weakness in their throat muscles. This can lead to food going into the lungs instead of the stomach causing pneumonia. It can also lead to not eating and drinking enough to get adequate nutrition. In some cases, while recovering from a stroke, people need a feeding tube until they can start swallowing on their own.
a) If you have swallowing problems: Any problems with your swallowing should be picked up while you were in hospital, but if you think that you might have problems that have not been addressed, it is important to speak to your doctor/health care professional about this. An experienced speech and language therapist can advise on the types of foods and textures of food that are best for you to eat. They might recommend a soft or pureed diet, which can be easier to swallow and you might need to add a special powder to drinks to thicken them too (thickeners). Your speech therapist will also monitor your progress. The good news is that for most people swallowing problems are temporary and the issues resolve. Mostly improvements are seen in the first few weeks after a stroke, although for some people it takes a longer period of time. Tips for eating pureed food If you can only eat pureed food, this can affect the range and nutritional content of your diet. Usually liquid will need to be added to the food when it is being blended to get the right consistency, which will dilute the mixture, making it lower in energy for the same weight. You might also find that you get tired while eating, which can mean that you consume less food, so it is important to make every mouthful count.
Cut foods into small pieces if chewing is a challenge. Make food easier to chew and swallow by changing the texture. Mince, chop, grate or mash. In some cases, food may need to be pureed (blended). Stay away from any foods that are either sticky or dry like peanut butter or normal cooked rice/glutinous rice (pulut), as these will be very difficult to swallow even if they can be chewed. b) If you have lost weight after your stroke: Some people will find it difficult to meet their nutritional requirements after a stroke for some time and weight / muscle losses including tiredness or easily fatigue are common problems. If you were underweight before your stroke, this should have been picked up in hospital. It is important to address this as being underweight or malnourished can affect how well you do after a stroke. Being underweight can affect your strength and ability to work on rehabilitation goals, as well as putting you at greater risk of infections. If you have seen a dietitian you should also have been given some advice on how to make the most of your meals. If weight loss is a problem, a nutrient dense diet can be useful to add extra calories (depending on your texture requirements) like healthy oils, cheese , full-fat dairy products or coconut milk and extra protein (soft: tofu, eggs, fish, beans). Small frequent nutrient dense meals are also a good idea if you struggle to eat big meals or feel full/ tired easily. You might also have been prescribed high calorie, high protein balanced and complete oral nutritional supplement drinks or powders. If that is the case, then it is important to consume as recommended. Strict monitoring – fluid/ blood pressure/ blood sugars/ weight/ muscle strength/ fatigue/ water retention. Monitor signs and symptoms of choking/ aspiration. Priority eating – proteins first. Food to limit or avoid
Diets high in saturated fats are linked to high cholesterol and an increased risk of cardiovascular disease. Saturated fats tend to be solid at room temperature and are found in animal products like meat, cheese, egg yolks, butter and ice cream, and some vegetable oils (palm kernel, coconut). To cut the saturated fat in your diet, make the following substitutions:
Diets high in trans fats are also associated with high cholesterol and increased risk of cardiovascular disease. Trans fats are formed when an unsaturated vegetable oil is turned into a more saturated one through a process called hydrogenation. Food products that contain partially hydrogenated vegetable oils should be avoided. Trans fats are found in anything made with partially hydrogenated fats (e.g., many processed foods including cookies, crackers, fried snacks and baked goods, and canned frostings), vegetable shortening and most fried foods. Choose the following substitutions to limit the trans fat in your diet. Look for foods that are labeled trans fat free or those that use liquid vegetable oils instead of hydrogenated ones in their ingredients.
Limiting cholesterol in foods is another important step to cholesterol regulation and stroke management, and can be achieved by:
Cutting back on salt and sodium in your diet. Cut down on sodium by following these tips:
Reduce intake of added sugar Excess intake of added sugar is associated with hypertension, obesity, type 2 diabetes, and dyslipidemia, which are all risk factors for stroke. Examples of added sugar are white sugar, brown sugar, honey, jam, gula melaka and sweetened/ packet/ tinned/ 3-in-1 drinks. Additionally, some survivors may struggle cutting back on sugar after a stroke. Fortunately, there are various fruits that contain natural sugar such as mangoes, apples, dates, watermelon and banana that can help satisfy sweet cravings. Alcohol is another type of drink that contributes to high blood pressure. Excessive drinking also increases a variety of stroke risk factors. Ask your doctor when it is safe for you to have an alcoholic beverage after a stroke and how much you are allowed to drink. Importance of caregiver support All family members, with or without pre-existing conditions, can join the diet as a part of living a healthy lifestyle and as a form of moral support for stroke patients. Create good safe eating environment. Variety and creative in food recipes/ modifications/ presentation/ palatable foods. Get help/ outsource services/ home catering/ home care and rehab. Set specific times for meals to form a routine. Sharing mealtime with your loved one will also help to make the activity more social and enjoyable. Be patient, and do not rush your loved one to finish eating. Serve food when your loved one has the most energy. This is typically earlier in the day. Encourage the patient to eat higher calorie and more substantial, nutrient-dense foods first. Other nutritional challenges in stroke management Constipation - It is common for stroke survivors to end up constipated due to limited mobility or damage in the part of the brain that controls bowels and continence. Ensure they receive plenty of hydrating snacks, fluids and adequate fiber if they are having irregular or infrequent bowel movements. Dehydration - Many stroke patients do not feel the thirst sensation, by then, they may already be dehydrated, so it is important to keep offering them fluids (especially so if they are unable to communicate) regularly to prevent complications. Provide them moist foods, such as stews/blended soups and foods/ dishes with sauces/ gravies. Provide at least 8 to 10 cups of fluids daily. These can include water, milk, juices, soups and other beverages (Try to cut down caffeinated drinks such as coffee/ tea and cola drinks as they tend to dehydrate the body). Offer hydrating jellies/ puddings/ fruits (watermelon/oranges) as a form of fluid. These tend to be better tolerated taste wise. Keep their mouth and lips moist by helping them with mouth care Fatigue/ sleep reversal/ body weakness - A lot of people experience this condition after a stroke due to the immense physical and mental changes they go through. This type of post stroke fatigue does not just go away after rest, it can last for weeks and months and make it harder for someone to recover and delay their rehabilitation, therefore it’s important to speak with their doctor to identify if your loved one is experience fatigue and how you can help to manage it. Give your loved one plenty of time to complete their tasks. Do not rush them. Help them understand that it will take time to get better. Keep a diary of good days and bad days. Make sure they do not exert themselves too much on days they feel better, otherwise they will end up exhausted later on. Help them with gentle exercises and social activities and take frequent breaks in between such activities. Establish a proper day, mealtime and night time routine. Malnutrition (especially after tube feeding transition/ dysphagia/ prolong hospital or nursing home stay) This serious condition occurs when your loved one suffers from a low appetite and food intake with weight loss as their caloric needs cannot be met. Usually dysphagia is a culprit that affects their ability to eat after a stroke. Malnourished people end up with more infections and trips to the hospital, therefore it is important to ensure that we identify and act early. Sometimes stroke survivors end up with a weaker sense of smell and taste. Therefore, strong-tasting food can help to stimulate appetite. Use flavorful oils, vinegar, soy sauce, curry, chilli to increase palatability. Promote protein at every meal ( e.g. pork, lamb, mutton, beef, chicken, turkey, quail, fish, cheese, yoghurt, nuts, legumes such as baked beans, soybean curd, soy milk, red/ green beans, eggs and tofu). Promote dairy products such as milk, cheese and yoghurt which are high in calcium and have protein. Avoid low-calorie, low-fat and low-sugar foods as these are “empty calories”. For a person with poor appetite, the goal is to prevent them from losing weight. If they are eating poorly, make sure that water is given between meals rather than before a meal, so that they do not feel too full to eat. Offer high-energy snacks throughout the day (e.g. puddings, jellies, buns, agar-agar, ice cream, egg custard, stewed fruit, local desserts like red and green bean soups, soybean curd. Add peanut butter, jam, honey, or blended dates (sieved) to their morning oats or porridge to bulk up the calories. Add margarine and oils, mayonnaise, cream, sour cream, full cream dairy products, powdered nuts/ seeds into their meals. Consider oral nutritional supplements if they are losing weight and consult a qualified experienced dietitian. Encouraging eating despite low appetite after a stroke In addition to difficulty chewing and swallowing, stroke patients may find eating difficult due to a lack of appetite. Here are a few ways family caregivers can make sure their loved ones eat:
Maintain or achieve a healthy body weight Another important strategy to reducing your risk of a stroke is to achieve a healthy body weight. Watching your portion sizes, eating foods high in fiber and low in fat, avoiding fad diets, increasing your activity, and keeping track of your eating habits are all ways to achieve a healthy body weight. Keep in mind that weight loss does not happen overnight, so establish realistic short and long-term goals from the start. Adopting a healthy eating habit does not mean that you have to pass on the more ‘sinful’ foods entirely. There is still room for occasional indulgences since a healthy dietary practice is based on an individual’s overall pattern of food consumption over an extended period of time and not on the intake of a single meal. Meal plans for stroke patients should be individualized based on individual calorie requirements and food preferences. |
EXPLORE FURTHER
|
How can stroke affect your eating and nutrition choices?Understanding the importance of nutrition in stroke prevention
|
|
Rising stroke risk in young adults: Prevention and treatmentLearn about the increasing risk of stroke in young adults
|
