Updated 30 July 2014

Eating problems experienced by stroke patients

Loss of function of any part of the body can make eating, chewing, and swallowing of food difficult or even impossible in stroke survivors.

Strokes are among the most serious, debilitating and common manifestations of blood vessel disease in our country. It has been documented that strokes combined with hypertension or high blood pressure, are by far the most common cause of illness and incapacity in our black population.

What is a stroke?

A stroke, which is also called a cerebrovascular accident, occurs when a part of the brain is acutely deprived of its blood supply and thus also of nutrients, particularly glucose, and of oxygen (Mahan et al, 2012). Brain tissue that is deprived of glucose and oxygen dies and this loss of vital parts of the brain then translates to loss of those functions that were being controlled and triggered from the brain via the central nervous system.

Depending on where a stroke occurs in the brain, the patient may lose motor functions (i.e. movement of any part of the body) and/or sensory functions (e.g. sight, hearing, speech, taste, feeling) and/or cognitive capacity (memory, ability to form or express ideas, and other devastating losses) and/or suffer from changes in mood.

The crucial point of the above description is loss of brain cells due to nutrient and oxygen deprivation because the blood supply is cut off to a specific part of the brain when the blood vessel is blocked by a clot (thrombus) or other factors such as the rupture of a blood vessel when an aneurism bursts or blockage of small blood vessels when the blood becomes so sticky that it can no longer flow. The latter can, for example,  happen in hyperglycaemia (extremely high blood sugar levels in diabetics), thus blocking tiny blood vessels in the brain.

High incidence

In the USA, stroke is regarded as the 3rd most common cause of death and the most common cause of disability (Mahan et al, 2012).

In South Africa, it is relatively difficult to try and establish what the current incidence of stroke is. According to “Stroke in South Africa” by Connor and Bryer (2005) in the Medical Research Council’s publication on “Chronic Diseases of Lifestyle in South Africa”, statistics from the year 2000 indicate that “stroke was found to be the 4th most common cause of death, accounting for 6% of all deaths in 2000.” Women were more likely to die from stroke than men. It is, however, probable that these figures will have increased in the 13 years since the compilation of this report.

How strokes affect food intake

Food intake in stroke survivors is complicated by which bodily functions are affected by paralysis due to the stroke. Loss of function of any part of the body can make eating, chewing, and swallowing of food difficult or even impossible.

If a person has lost the use of his dominant hand or arm this will prevent self-feeding until the patient has learned how to use his other hand. With physiotherapy and patience such patients can learn to use their still mobile limb to compensate for the loss of their dominant hand and/or arm.

If the stroke has affected the patient’s sight (a condition such as hemianopsia where one half of the field of vision is obliterated), then she must be taught to turn her head to compensate for this disability. For example, the patient may only eat half of the food on a plate because she is only able to recognise half of the contents of the plate as actual food. Care must be taken to monitor food intake and to identify how physical disability caused by a stroke affects the patient’s eating and also how much food she consumes at each meal (Mahan et al, 2012).

The loss of the ability to chew and/or swallow is much more difficult to treat. Stroke survivors who are no longer able to chew food need to be given a soft or semi-liquid diet so that they do not exhaust themselves trying to chew foods such as meat, bread, tough vegetables, whole fruits, etc. When a patient can also not swallow (dysphagia), food intake is severely impaired and use must be made of enteral feeding (via a tube) or parenteral feeding (delivery of nutrients into the bloodstream) (Mahan et al, 2012).


Probably the most challenging aftereffect of a stroke in relation to food intake is dysphagia. According to Mahan and her coauthors (2012), symptoms of dysphagia can include all or some of the following:

  • Drooling, chocking and coughing during or after meals
  • Inability to suck liquids through a straw
  • A change in voice quality (the voice may become gurgly)
  • Storing food in the cheeks (patients may not even be aware of this phenomenon)
  • Lack of a gag reflex which can lead to choking
  • Chronic upper respiratory infections

Because of all these complications, patients may develop malnutrition and anorexia which can endanger their health even further.

What you can do to help

The first and most important contribution that can be made by family members and friends of a stroke patient are to be observant of how they are coping with the eating process. Staff members in most of our hospitals are overworked to such a degree that they do not have the time to sit and observe each patient to try and determine if they are able to eat solids or semi-solids or if they require liquid diets.

So watch what is happening when your loved ones start eating again after a stroke. Make notes if necessary and arrange a meeting with the medical team which should, but may often not, include a neurologist and/or physician, nurses, a dietitian and ward assistants who usually assist with feeding impaired patients, so that you can transmit your observations to the team and ask them to arrange for an assessment of the degree of dysphagia the patient is suffering from.

Once this has been determined it is possible to select an appropriate diet for the stroke patient with dysphagia to ensure that he or she can obtain the best possible nutrition care despite problems with eating.

Next week we will consider the different types of diet and feeding methods that should be used depending on the degree of dysphagia your loved one is suffering from.

References: (Connor M, Bryer A (2005). Stroke in South Africa. In ‘Chronic Diseases of Lifestyle in South Africa’ Chapter 14, pp:195-203. ; Mahan LK et al (2012). Krause’s Food and the Nutrition Care Process,13th Edition. Elsevier, USA)


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