Our third and final student blog submission for our current crop of students comes from Holly. As you will see from her entry below, Holly is very thorough and she will make an excellent health care practitioner someday. Enjoy her entry on the benefits of proper nutrition post stroke.
The building blocks: Importance of Protein Post-Ischemic Stroke
By: Holly Durham
In Canada, a stroke occurs every 10 minutes. That results in 50,000 strokes every single year! Of these, 80% are ischemic, which means the blood flow to the brain was somehow interrupted (www.heartandstroke.com, 2013). As you might imagine, there is a lot of research happening to find cures and treatments for these incidents. Would you believe that this can be prevented and/or treated (alongside other modalities) with something as simple as nutrition? It seems simple but nutrition is actually quite complex and how it can assist in the rehabilitation of stroke patients is complicated, and still being researched but extremely interesting!
Individuals who have suffered a stroke will find themselves malnourished soon afterwards. This occurs for a few reasons:
1) Function of the arm and hand is typically compromised making food preparation difficult
2) Prolonged hospital stays lead to atrophy of the muscles leading to worse infections and disorders (Ha, Hauge, Bente Spenning & Iversen, 2010)
3) Dysphagia – the difficulty or inability to swallow resulting in minimal caloric intake – occurs in 80% of the stroke population (www.heartandstroke.com, 2013). The time immediately following a stroke is critical for protein, vitamin and mineral intake either through foods or through supplementation (http://www.nlm.nih.gov/medlineplus, 2013).
Protein is one of the most important nutrients to ingest post stroke, especially in ischemic stroke cases. When the blood flow is interrupted to the brain it disrupts homeostasis – or the body’s comfortable balance and state in which it is most efficient – which creates dysfunction in the glucose metabolism (Bouziana & Tziomalos, 2011). The fuel used to create energy for the body shifts from glucose – which is the primary fuel in healthy individuals – to protein. Protein is not a typical fuel that is used because it is not efficient to make energy and it is also the building blocks of the body. All of the protein stores then are emptied to produce energy, which inhibits protein synthesis (Bouziana & Tziomalos, 2011). When there is little to no protein synthesis occurring cell death is around the corner. Proteins are also important in assisting the transmission of signals through the central nervous system (CNS) to the rest of the body (Bouziana & Tziomalos, 2011). Rehabilitation clinics such as Aim2Walk are working to retrain the CNS and rest of the body to work together again. If patients are able to consume more amino acids, it will replenish some of the stores to help maximize the rehabilitation process and push the body’s capabilities to the limit (Ha, Iversen & Hauge, 2008).
To drive this point home here is a scenario. When Sally was 35 she had a stroke, which affected the entire right side of her body. Of course, being the average Canadian she was right hand dominant. Not only did Sally have to learn how to use her left hand for everything she only had that hand to rely on. Due to the minimal function and coordination, it was difficult for Sally to prepare healthy meals the way she used to. Instead she now went to the grocery store to pick out premade and processed meals that were easy to put into the microwave or oven, with very little preparation. Typically these premade foods are high in carbohydrates and low in protein. However, the body needs the protein in order to continue rehabilitating the pathways through the body and transmitting the signals through the CNS. Unfortunately Sally’s body is unable to use carbohydrates as fuel now so any protein that she does intake is used as fuel instead, which leaves minimal protein to continue building and rehabilitating the pathways through the CNS.
Carbohydrate stores do not get used up as fuel, and instead turn to fat (Ha, Iversen & Hauge, 2008).
Protein can be found amongst many different sources. The most common are meats, fish and poultry. However, there are alternatives that are healthy options, and are very important if a patient is vegetarian or vegan. Both of these lifestyles it is important to find sources that will supply the same nutrients found in meats, fish and poultry. Foods such as, beans, lentils, and eggs contain forms of protein as well as many leafy greens and dairy products. Dairy products all contain some form of whey protein, which is also beneficial. Ultimately, it is important to eat a balanced diet that will best suit your individual needs. Each body is unique and may have special requirements. Seeing a dietician, natural path or other health care professionals are recommended to ensure you are giving your body everything it needs to maintain a high quality of life.
Bouziana, S. B., & Tziomalos, K. (2011). Malnutrition in patients with acute stroke. Journal of Nutrition and Metabolism.
Ha, L., Hauge, T., Bente Spenning, A., & Iversen, P. O. (2010). Individual, nutritional support prevents undernutrition, increases muscle strength and improves QoL among elderly at nutritional risk hospitalized for acute stroke: A randomized, controlled trial. Elsevier Clinical Nutrition, 29(5), 567-573.
Ha, L., Iversen, P. O., & Hauge, T. (2008). Nutrition for elderly stroke patients. Elsevier Scopus, 128(17), 1946-1950.
Stroke. (2013). Retrieved March 27, 2013, from Heart and Stroke Foundation of Canada website: http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3483933/k.CD67/Stroke.htm
Swallowing disorders. (2013, February 14). Retrieved March 27, 2013, from MedlinePlus website: http://www.nlm.nih.gov/medlineplus/swallowingdisorders.html