Nutrition and Diet
Nutrition is critical in the management and treatment of patients who have suffered a stroke. Often, we do not consider our nutritional status until an event has occurred which highlights its importance. Such is often the case for patients following a stroke. A person’s nutritional status can directly impact on functional status and future quality of life. Malnourished patients with acute stroke have increased frequency of infections and pressure sores compared with adequately nourished patients. Malnutrition is also associated with a worse outcome and slower rate of recovery from stroke.
Added to this are the complications that can arise as a result of a stroke, some of which can create further difficulties in meeting nutritional requirements such as mechanical feeding difficulties and swallowing problems. More information about swallowing can be found in the Speech and Language Therapy section of this website.
Nutrition immediately post stroke – ‘acute phase’
After a stroke, weight changes may occur for many people and it is important to monitor this as it may impact on recovery. Some people lose weight because they eat a lot less than normal due to difficulties with swallowing, loss of appetite, taste changes, low mood, physical difficulties with feeding oneself and psychosocial problems associated with eating amongst others. It is important at this time to assess a person’s underlying nutritional status while dealing with problems quickly to speed up recovery, prevent pressure sores and help to build up the support system. The dietician may recommend food fortification, taking extra snacks and/or special supplementary drinks and puddings, making the diet high in energy and protein. For some people, in order to meet both nutritional and fluid requirements, nutritional support via tube feeding is used in the short or long term. If overweight, weight loss in the longer term may be advised however, it is not appropriate to make deliberate efforts to lose weight in the initial period after a stroke.
‘Dysphagia’ is a term to describe difficulties with swallowing.
People can experience difficulties with swallowing fluids or solids, or both. A normal swallow will ensure no food or drinks enter the wind pipe or lungs but for someone suffering from dyspagia, this may not be the case. People at risk should be assessed and monitored carefully to avoid complications arising from dysphagia, such as occurrence of chest infections.
Anyone identified as having swallowing difficulties should ideally be reviewed by a speech and language therapist (SALT) who will recommend the most appropriate diet consistency. The dietitian will then be able to give dietary advice based on SALT recommendations. If the therapist decides that a person is unable to swallow safely or they are unable to eat enough to meet their nutritional requirements, some or all nutrition can be delivered through a feeding tube. The feeding tube is a thin tube passed from the nasal passage down to the stomach through which special liquid feed is delivered. The tube is used for short time durations, usually from a couple of days up to a few weeks.
A gastrostomy tube (sometimes known as a PEG tube – for percutaneous endoscopic gastrostomy) is a tube that is inserted through the abdomen directly into the stomach for feeding. This is used when tube feeding is required for a longer duration. This is usually used as a longer-term measure.
Mechanical and physical difficulties do exist for some stroke patients. For some, the most limiting factor affecting their oral intake is a physical difficulty such as sitting in the correct position or holding cutlery. It is important that any such difficulties are identified and through some meal time assistance and/or the input from an Occupational Therapist (OT), useful steps are taken to make meal times more manageable and enjoyable.
Nutrition in the Rehabilitation phase – weight gain/loss
Weight loss, particularly if it happens fast, in the period following a stroke, is not desired as it would usually indicate a loss of muscle as well as fat stores. It is important to keep muscle for rehabilitation; in fact, you need to be building up muscle to regain independence. If you have lost a lot of weight, it is important to reach and maintain a healthy weight. The dietary aims at this stage are to help resume as near normal eating habits as possible, ensure nutritional adequacy, address any persisting nutritional problems (for exmaple under or over weight) and minimising the risk of another stroke.
Those who are aiming to regain weight lost and those with eating difficulties or a persisting poor appetite, should continue with a high energy and protein diet as advised by the dietician in the initial stages after their stroke.
Some people gain weight after their stroke, often due to reduced mobility and eating differently to their usual diet. At this stage, those who are overweight should aim to adopt a diet that will gradually bring weight down to a ‘healthy’ level as being overweight can make mobilising more difficult and is a risk factor for further illnesses.
It would be advised that some sort of physical exercise would be adopted as part of your new lifestyle. A doctor or Physiotherapist may be able to advise further on this.
The dietitian applies his/her knowledge of food, nutrition and related topics to help in the management of illnesses and to prevent disease.
The dietician will:
- Assess a persons’ nutritional status and help to ensure dietary needs are met by calculating their nutritional requirements, monitoring food eaten and then educating on the type of food and drink most appropriate for a persons needs.
- Intervene as early as possible to minimise the risks of deterioration of nutritional status and help prevent ill health.
- Where necessary, advise on how to correct or prevent dietary problems and at all times tailor the advice and treatment plan to the individual, accounting for, for example, specific complications as a result of a stroke and any risk factors.
- If necessary, arrange the ordering of special meals and nutritional supplements, and/ or for the more dependent patient, may arrange nutritional support in the form of tube feeding.
- Monitor the patient’s progress and outcome on nutritional support or therapeutic diet while liaising with the team.
- Educate the patient and where necessary, family members/carers, through providing accurate and practical advice and written information.
- Educate on the interpretation of public health eating messages in the relevant context and assist in the training of other health workers on nutritional issues.