Does Diet Impact Cognition After Stroke?

TLDR:

• This study, a systematic review and meta-analysis, looked at the connection between diet and cognitive function in adult stroke survivors. It included 20 clinical trials and 14 observational studies.

• The meta-analysis revealed that energy-protein supplementation positively impacted global cognition. In contrast, B-vitamin supplementation (folic acid, B6, and B12) had a negative effect.

• Other dietary factors linked to improved cognitive outcomes were following the MIND and plant-based diets, and consuming more fruits, milk, coffee, vitamin E, and selenium. On the other hand, butter, sugar, and calcium supplements were associated with negative cognitive outcomes.

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Transcript:

Good afternoon, everyone. Dr. Wells here from Nutritional Physical Therapy. Hope you're having a great day.

Today we have a new article. This one's by Amant et al. in Advanced Nutrition 2025, titled Associations Between Diet and Cognitive Function in Stroke Survivors, A Systematic Review and Meta-Analysis.

I think this one's gonna be really good for our neurological specialized physical therapists and our OTs, speech therapists that work with patients that have had a stroke and kind of what do we do for them in terms of nutrition. I know in our nutrition courses, we talk a little bit about stroke recovery, how to optimize nutrition for stroke recovery, and some of the evidence just quite isn't there, right? It's sort of weak associations or suggestions. We obviously talk too about preventing strokes in the first place.

A lot of that is lifestyle-related and long-term behaviors in terms of dietary patterns, alcohol use, tobacco use, and exercise. But what's interesting is looking at cognitive recovery specifically after cerebral vascular insult, right? So this study, it's a systematic review meta-analysis, right? So it pulls in all these research studies. And in there, they found 20 clinical trials, 14 observational studies.

So I feel overall it's pretty decent. Things that seem to benefit those with cognition. One, energy protein supplementation.

So we see this often in our studies about particularly elderly and frail. They benefit from energy protein supplements, particularly like those protein energy drinks. Why is that? That extra energy, that extra protein helps them after whatever trauma that's happened, right? Whether it's a fall, whether it's a CVA.

In this case, it seems to help improve global cognition. Another factor that seems to help is an adherence to a Mediterranean or a DASH diet. So a DASH diet is a dietary approach to stop hypertension.

Both of those, the big focus is plant-forward diet, lots of fruits, dairy or low-fat type of dairy, coffee, and then usually rich in things like vitamin E and selenium. So that's code for seeds and nuts, right? So those that adhered towards that diet also had improvement in global cognition. Those that tended to focus on dietary patterns that were rich in butter, sugar, or had high amounts of calcium supplementation actually had negative effects on global cognition.

So that's interesting, because we would associate those dietary patterns as being more Western, right? Also butter, sugar tends to be a little bit more pro-inflammatory due to the saturated fat and obviously the glycemic effect of sugar. As for the calcium supplementation, some of that I think has to do with kind of the rewiring of neurons and things, the neuroplasticity and calcium's effects on that. They did find some sort of weird association with B supplementation, and that seems to be kind of a trendy thing, like maybe B supplements can help, like particularly B12, because we know it's neuroprotective, but they said it actually had a negative effect, but when they sub-analyzed that study, really what it was is that group also had a higher rate of medical interactions with other drugs related to epilepsy.

So it was kind of an outlier, and when they removed that sort of from the analysis, there was overall no major effect of B vitamin supplementation. So how does this impact therapists? How does it impact OTs, PTs? Well, what we need to be doing is making sure that those that have had a cerebrovascular accident, that they get those protein energy supplements, right? That's part of their dietary regime, and if it's not, we need to consult registered dietitians to get them in, get them assessed, and make sure that when that drink's on the table, hey, you just had a workout with me, drink that beverage, right? Moreover, when we're looking at their dietary patterns, and we know that neuroplasticity lasts several years, so we move out of that inpatient stage more to outpatient rehab or home health or just wellness down the road, right? One or two years down the road. We know neuroplasticity lasts 10 years.

We need to be focused on promoting that Mediterranean-style diet. High amounts of fruits, high amounts of vegetables, those nuts and seeds, those are important things. If you like this and you want more, check out our website at nutritionalphysicaltherapy.com. We've got some great courses for our therapists, and hope you have a great day.