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There are many problems that stroke patients may experience when part of the digestive tract is affected and they try to eat.
Stroke patients are already exposed to stress when they realise that they've lost some of their bodily functions, so it's important to make it as easy as possible for them to eat to prevent malnutrition and anorexia.
In general, stroke victims suffer from different degrees of dysphagia which make chewing, swallowing, tasting and even seeing what they're eating, difficult or impossible. The food must be made soft enough for the patient to chew and swallow. The food should taste, smell and look appetising so the patient’s appetite can be stimulated.
Fruit
Fruits should be peeled and all pips removed. Fruit can also be liquidised with added milk, milk powder, powdered vitamin and mineral supplements, or essential fatty acid supplements (flaxseed oil is probably the easiest to use under these circumstances as salmon oil may impart a fishy taste to the fruit mix). Add honey to acid fruit to improve the taste.
Vegetables
Starchy vegetables (potatoes, butternut, winter squashes, sweet potato) can be peeled, cooked and mashed with a nutritive liquid like milk. If the person still finds it difficult to swallow, it may be necessary to make soups (butternut, potato, tomato, mixed vegetable, mushroom with milk, etc), which can be highly nutritious and also much tastier than eating limply boiled veggies. Avoid hard, stringy vegetables and keep things simple. Pureed vegetables for babies with a few added herbs can also provide some variety.
Meat and fish
Prepare meat and fish as usual and shred finely, taking care to remove all gristle, sinews and the skin and bones from fish. Serve finely shredded or minced meat and fish with sufficient gravy to make swallowing easier. If the patient isn't able to swallow minced meat or fish, these protein foods can also be liquidised with some added liquid (gravy, milk, diluted stock). Make sure that the food still tastes good and does not look unappealing.
Eggs
Some stroke patients with mild dysphagia are able to eat soft scrambled eggs, but in many cases the nutritive benefits of eggs (high quality protein, iron and B vitamins), may have to be added to other liquidised food. Take care that the food isn't too hot when you mix in the raw egg to prevent the protein from coagulating and forming hard particles which inhibit swallowing. Make traditional custard with fresh eggs and milk as a treat for your stroke patient to boost his nutrient intake and provide variety.
Milk and dairy products
Milk and yoghurt are probably the two most useful foods when it comes to keeping stroke patients with dysphagia healthy and well-fed, because they have such a high nutritive value (protein, calcium, vitamins and other minerals, and probiotics in yoghurt). Milk can be used on its own as a cold or hot beverage or added to fruit or vegetable smoothies, to soups, scrambled eggs and custard. Yoghurt makes an excellent dessert and is also most useful for helping dysphagia patients to ingest their ground up medications.
Grains and cereals
Breads and baked grains may be difficult to chew and swallow, porridges can usually be eaten especially if milk is added to dilute the porridge. Barley, rice and other soft cooked grains can be included in soup recipes and pureed or liquidised. Smooth porridges are suitable for patients with some swallowing ability. Passing porridges through a sieve can also help to remove husks or hard pieces that can prevent the patient from swallowing with ease.
Fats and oils
While stroke patients who are confined to bed or a wheelchair have reduced energy requirements, all patients need to ingest some mono- and/or polyunsaturated fats or oils, especially the so-called essential fatty acids as suggested under point (a) above. One teaspoon of monounsaturated margarine could for example be added to cooked vegetable dishes and monounsaturated oils like olive oil can be used in the preparation of soups and meat or fish dishes.
Liquid meal supplements
In some cases, stroke patients have such severe dysphagia that they are forced to rely on liquid meal supplements. Some patients find it easier to swallow the liquid meal supplement when it is cold, while others may prefer it lukewarm.
Vitamin and mineral supplements
Patients suffering from dysphagia can easily develop deficiencies of a variety of nutrients if they develop anorexia so it is important to ensure that they still receive a balanced diet that contains all the food groups or are using a fully balanced meal supplement.
Ask the doctor if the stroke patient you're caring for needs more vitamin or mineral supplements. Keep in mind that indiscriminate use of high doses of vitamins and minerals can also be harmful (e.g. too much Vitamin C can cause kidney stones in susceptible individuals, excess vVtamin A can cause hypervitaminosis A), so be guided by your dietician who will check the patient's diet and food intake and determine if certain nutrients are lacking.
