Supplements After Hemorrhagic Stroke
Most dietary supplements are not recommended after hemorrhagic stroke, as they provide no proven benefit for reducing disability or improving functional recovery, and some may increase bleeding risk. Focus instead on a whole-food Mediterranean diet rather than supplementation.
Evidence Against Routine Supplementation
The most recent and highest-quality guidelines explicitly recommend against most supplements:
Vitamin C, vitamin E, selenium, antioxidants, calcium (with or without vitamin D), and multivitamins are not effective for stroke prevention or recovery and should not be routinely used 1.
Long-chain omega-3 fatty acids (fish oil) are not effective for reducing stroke risk 1 and may actually worsen motor function after hemorrhagic stroke, with animal studies showing significantly impaired forelimb dexterity despite increased cerebral blood flow 2.
B-vitamin supplementation (including folic acid, B6, and B12) has uncertain benefits for stroke prevention, with evidence rated as "not well established" 1.
Routine oral nutritional supplements do not improve survival or functional outcomes in stroke patients who are adequately nourished on admission 1.
When Supplementation May Be Appropriate
Nutritional supplementation should only be considered in specific circumstances:
Oral nutritional supplements are recommended only for stroke patients identified as malnourished or at risk of malnutrition using validated screening tools 1.
Energy and protein supplementation may improve activities of daily living in malnourished patients, though evidence quality is very low and individual assessment is essential 3, 4.
Supplements should provide approximately 360 ml of 1.5 kcal/ml with 20 g protein daily if used 5.
Critical Safety Concerns
Common pitfall: Assuming supplements are harmless—they carry real risks after hemorrhagic stroke:
Omega-3 fatty acids may worsen motor outcomes after intracerebral hemorrhage and increase bleeding risk 2.
Oral supplements increase risk of diarrhea (OR 4.29) and metabolic complications including hyperglycemia/hypoglycemia (OR 15.6) 4.
Beta-carotene may increase stroke risk according to low-quality evidence 1.
Recommended Approach Instead of Supplements
Focus on whole-food dietary patterns rather than isolated supplements:
Follow a Mediterranean-type diet high in vegetables, fruits, whole grains, fish, nuts, and olive oil, with low red meat intake 1.
Consume a variety of natural and whole foods at each meal, avoiding highly processed foods 1.
Limit sodium intake to no more than 2000 mg daily 1.
Maintain free sugar intake below 10% of total daily calories 1.
Choose lean meats and plant-based proteins low in saturated fats and cholesterol (<200 mg daily) 1.
Assessment Requirements
Before considering any supplementation:
Screen for malnutrition using validated tools within the first days after stroke 1.
Consult a nutrition specialist (dietitian with stroke experience) to develop an individualized nutrition care plan if malnutrition is identified 1.
Assess for dysphagia, as 30-50% of acute stroke patients have swallowing difficulties requiring modified feeding approaches 1.