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Stroke

Eating and drinking after a stroke

Many people who have had a stroke can find it difficult at first to swallow normally - they may cough or choke in the early days of their recovery. Difficulty with swallowing (or dysphagia) happens after a stroke because the brain doesn't activate muscle reflexes at the back of the throat quickly enough, so that food or liquids pass down the throat into the larynx and/or lungs - in other words they can 'go down the wrong way'. It can be frightening when swallowing doesn't work automatically, but many things can be done to help, and most people recover their swallow in a couple of weeks.

Tests for swallowing

Usually, people who have had a stroke are watched carefully as they swallow for the first time and will only be given a small sip of water to see what happens. Tests are usually carried out by a Speech and Language Therapist.

 

Describes a simple test to see if she was able to swallow soon after her stroke whilst she was in...

Describes a simple test to see if she was able to swallow soon after her stroke whilst she was in...

Age at interview: 79
Sex: Female
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Did they have to test you to see whether you were swallowing OK?

Oh yes, yes, they did. 

Some people might wonder how that happened. How did they test you?

Well, they, they, they would give me a sip and would say, 'Now swallow it slowly and if there's any problem swallowing don't take' and I was just doing exactly what they were telling me and I was OK. 
 

Speech and Language Therapists will also give advice about how and what to swallow such as softened food and thickened drinks. 

 

Describes how therapists helped her and gradually gave her thicker foods and drinks as her...

Describes how therapists helped her and gradually gave her thicker foods and drinks as her...

Age at interview: 55
Sex: Female
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Swallowing therapy. They'd get a wee bit of water and try to get you to drink it but told you to pull your chin in when you were doing it, you know like that. Because it helps for it to go down easier and it did. So that's the first think I can remember of it, but it was really, they were really good girls because I say I couldn't, I couldn't eat, I couldn't drink, couldn't do anything. Couldn't talk, they were really excellent. Must have been because I'm here sitting talking today, you know what I mean. So, your diet built up gradually. It started of it was quite watery, quite, like soups and things like that and then they started putting the Thick and Easy in and that thickens things up for you so you can maybe, like a mashed potato or, you know, a wee bit of something more solid and just built me up bit by bit until I was up at , number D where I could take soft mashable, what they class as soft mashable, foods. And I was having no bother at all with it, you know. But really, really good. 

If problems with swallowing continue, the person may be asked swallow a small amount of fluid containing barium - a substance that shows up under x-ray - which helps medical professionals find out exactly what is happening as the liquid goes down the throat. 

The Stroke Association has a useful leaflet on ‘Swallowing problems after stroke’ and so do Chest, Heart and Stroke Scotland.

Changes to diet

It is important for people recovering from a stroke to be well nourished so those who find it hard to swallow will be advised by dietitians and may be given pureed foods and specially thickened drinks. 

 

Has to have drinks thickened with a commercial thickener to avoid liquid trickling into his lungs...

Has to have drinks thickened with a commercial thickener to avoid liquid trickling into his lungs...

Age at interview: 62
Sex: Male
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Wife' But his speech was affected because of the ataxia, it's the muscles round the mouth not being able to move properly that's the cause. And swallowing's affected, so we had to, he has to have everything thickened now. 

Husband' Eating tends not to be a problem but swallowing drink is difficult.

Wife' Well, to start with, you had to have your food mashed up.

Husband' Yes. But not now.

Wife' No. 

Husband' Now I think the problem basically is that if a drink hasn't, isn't thickened I tend to cough a lot. If liquid trickles down from my mouth into my lungs, they can't do anything about it, so they, they insist that all my drinks are thickened because then my mouth knows to shut the valve to the lungs and, and it means basically I can't drink fizzy drinks because thickener doesn't work in them. 

How do you find having to have the thickened drinks?

Husband' Well, you, it's like so much, you learn to get used to it. I would, would prefer not to but in another sense I think if [my wife] is happy to add the thickener, it's better to accept it because actually it doesn't put any more pressure on [my wife] and they said they'd try and do some more tests sometimes and I had a couple of tests early on with a barium meal and they took x-rays of my throat to see what I was swallowing and they decided that it didn't change. I'll probably at some stage need another test but until then I'm quite happy to put up with it. It is a problem more because my wife needs to remember it whenever we go out.

Wife' I have to have my little pot of white powder in my handbag if we want to drink out anywhere. 

Husband' And like lots of these things, you know it's there and it is different but you learn I suppose to put up with it. 

 

Had initial problems swallowing and was given pureed food but he regained his swallow after about...

Had initial problems swallowing and was given pureed food but he regained his swallow after about...

Age at interview: 50
Sex: Male
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When, you said your speech was affected but was your eating also affected' while you were in the hospital?

Yeah, yeah. At first, I had to get a special diet because I couldn't swallow.

What sort of diet was that?

Everything was soft things. It was rubbish [laughter].

And did they have to do any tests on you to see whether you could swallow?

No the speech therapist, she done it and wanted to show once I could try it, I could swallow, she said, 'OK, your meals can be alright'. 

Mmm. OK. But before you were on liquidised food?

Yeah, yeah. 

And it wasn't very nice?

Ooh, no.

No. And how long did it take for that to come back?

About a couple of months. 

It must have been good that first time you could eat?

Oh yeah. [Ha Ha]

And did they have to bring it back gradually, the food?

Yeah. Bit by bit. Yeah. 

Many people we spoke to said they disliked pureed food - they didn't like either the look or the texture of the food once it was 'mushed up'. One man described how he lost weight in hospital because he found he couldn't manage to eat pureed food. 

 

He hated the look of his pureed Sunday lunch and says he preferred the chocolate his wife brought...

He hated the look of his pureed Sunday lunch and says he preferred the chocolate his wife brought...

Age at interview: 47
Sex: Male
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Can you explain the reason that you had to be on the liquid diet? 

Well, I saw the speech and language therapist who came along, put the stethoscope on my throat and asked me to swallow and I think I had to have a drink and assess my swallow reflex and it was my swallow that wasn't very good and I think the concern was if I had any solid food that, that it might get trapped and I might choke to death. So they said, no, I had to have a liquid diet, puree diet, so that was that, so that was the reason so I had to have this puree diet. So the plate would just have different coloured splodges around the plate basically, dependent on what it was that you were eating but I think the worst was Sunday lunch where you'd have a brown dollop of sludge on your plate which was my roast lamb I found out, then a green piece, piece which was the, the cabbage or the peas and grey which seems to be the colour of potatoes in that particular hospital and I would be eating, you would expected to eat that, but I used to take the lid off, put the lid back on and say, 'You can take that away, I'm not eating that'. I used to ask my wife to bring food in for me and my other visitors and they'd mostly bring chocolate bars and desserts from supermarkets.

When someone has a severe swallowing problem it may be necessary to feed him/her through a tube that goes through the nose, down the throat and into the stomach. One man said the naso-gastric tube made him sick. The medical staff stopped using it once he was able to swallow pureed foods. Another way of getting food into someone's system is through a gastrostomy tube (usually called a PEG tube) which is inserted directly into the stomach. 

 

She describes having a PEG tube inserted into her stomach but says it wasn't needed in the end.

She describes having a PEG tube inserted into her stomach but says it wasn't needed in the end.

Age at interview: 89
Sex: Female
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A peg and' they didn't feed me through that but they had set it up so as they could feed me through that if it was necessary' So thank God, it wasn't because I didn't fancy the idea, you know. 

So they never, you never had to be fed through that?

No, never. And I had it on for ages and ages and ages and then when I left the hospital' just had to come home' No, wait a minute I went to a nursing home and' I still had to have pureed food, you know, but it was a long, long time before I got, was able to eat anything solid, you know. And so I had this thing in here all the time. It's only about 2 weeks ago since I actually visited the hospital that I, this had been put in about' 6 months ago and then' I was' I was sent home and then I had to come back to have this thing sorted, you see and it was quite an operation it was really. Not very nice and they left me with precautionary tube in, you know. Well, it was in for about 6 months and never used because I got my voice back' and, so in the end, I, the last appointment I had at the hospital, I said, 'I want this out' and it was [laughs] don't know if you're interested but [laughs] he was a Greek doctor' and I, I said, 'I want this out', 'Oh', you see, he was horrified, you know. He said, 'I've never done that before'. I said, 'Well, I want it out because it's doing nothing and it's, it's just having, making it, things awkward for me' so there was two nurses standing by and they said, 'We'll take it out. We've done it before'. So they just'

Took it out?

Took it out. Mm hmm. 

Do you remember having it put in? What was it like having it put in?

Well, it wasn't very nice because they had, they had to make a slit to push the tube in, you know, but it didn't bleed very much. It was really' but it was a terrible pest. However, I was determined to do all the things I was told to do. 

But a relief to get it out?

Yes. So it's out now. Not long. It's only a few weeks since it came out and it's great. 

Other kinds of eating difficulties following stroke

Other people found they had problems getting food from the plate into their mouths because they couldn't use one or both of their arms/hands well enough to hold a knife and fork. Several people told us that not being able to use cutlery properly and cut up their own food put them off going out for meals. Adapted cutlery can often overcome these problems. 

 

Describes how he chooses things that are easy to eat with one hand if he goes out to eat.

Describes how he chooses things that are easy to eat with one hand if he goes out to eat.

Age at interview: 58
Sex: Male
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How about, you know, going out socially, going out to eat, perhaps with the problems with your arm, you know, do you have any issue with that at all?

No, but I, people know that they have, they have to expect to cut my steak, I can't cut my steak.

Does it have any influence over what you choose to eat or?

Mmm, it does, it does. There's a particular, there's a steak and kidney pie on offer at a gastro pub fairly close by which can be eaten with a spoon [laughs], and so I don't have to get. I mean knife and fork are my great bugbear. Chopsticks aren't so bad, knife and fork really quite tricky [Laughs]. 

[Laughs] Not many people would say that about chopsticks [Laughs].

Well if you can manage chopsticks in the first place you only use your right hand after all and so it's easier for me. And obviously I haven't given up from every being able to use this again [slapping sound].

Others talked about finding it difficult to sit up straight enough to eat when they were in hospital. Numbness on one side of the mouth meant that people had to be careful when they were chewing and also when they were putting food into their mouths.

 

Paralysis on one side of his face means that chewing is difficult.

Paralysis on one side of his face means that chewing is difficult.

Age at interview: 59
Sex: Male
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Yes [laughs]. Yes. Yes. I'm alright. I can't speak but anything else very good. 

How about your eating? Were you able to eat OK?

No'The'

You had a'

Yes. (Illustrating - drop in right side of face)

' a drop.

Yes.

And did they have to put a tube in to feed you?

No.

No?

No. 

No?

No. The, the' I was alright.

You, you could eat.

Yes.

And maybe did they liquidise your food?

No.

No? [laughs]

I, I want' No. Oh yuk, oh dear. [Makes sound]

Proper food. [Laughs]

[Makes sound] Oh dear, oh dear. 

And how was your swallowing? 

Alright.

It was OK?

Yeah.

They, did they get you to swallow and '

No.

' do a test on you?

No. Mine is right.

But it just, just your face '

Yes.

' with chewing was difficult.

And this. (Illustrating hand weakness)

And that.

Changes in taste


Loss of taste, or dysgeusia, may occur following a stroke, but is far less common than other side effects of stroke. One woman experienced a change in taste following her stroke and was no longer able to eat certain foods.

 

Stella and her daughter talk about changes in taste and food preferences.

Stella and her daughter talk about changes in taste and food preferences.

Age at interview: 82
Sex: Female
Age at diagnosis: 81
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Deborah' Mum’s taste changed with the stroke. Whereas Mum would like Madras curries, Tabasco and hot sauce, [also] strong cheeses, those can’t be on the menu anymore. You find those too difficult to eat, don’t you?
 
Stella' Yes. The cheese is too sharp.
 
Deborah' Yes, so the stroke has affected Mum’s taste buds, and things that Mum used to love - like she used to love fish, Mum would eat meat and things - those are things that you don’t like to eat anymore.
 
Stella' No, I don’t eat those anymore, fish and meat, beef. We had roast beef the other day, the day before yesterday, but I couldn’t eat it. They were nice slices of meat but I couldn’t eat them.

Last reviewed June 2017.
Last updated June 2017.

 

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