Background/Aims: Dietary modification is a cornerstone of cardiovascular disease prevention, yet its role in stroke care remains inadequately studied. We aimed to systematically review RCTs evaluating the effects of dietary interventions on post‑stroke outcomes: disability, neurological function, cognition, mood, quality of life, and stroke recurrence.
Methods: MEDLINE, Embase, Scopus, CINAHL, and CENTRAL databases were searched for RCTs published up to 02/02/2026. Eligible studies investigated orally administered dietary interventions (single foods, food groups, or dietary patterns) delivered to adult stroke survivors for ≥4 weeks. Abstracts and full-texts were screened independently by two researchers, with disagreements resolved through discussion.
Results: Of the 20,033 records screened, eight RCTs examining different interventions [Mediterranean diet with and without avocados, meal replacement weight‑loss program, salt substitution (2 studies), trigona honey, soy milk] met the inclusion criteria (n=15,996 participants). Participants had ischaemic stroke (3 studies), haemorrhagic stroke (1 study), or mixed stroke types (3 studies). Neurological function (NIHSS) improved with ketogenic diet, and potassium‑ and magnesium‑enriched salt substitution, which also reduced stroke recurrence. Disability (modified Rankin Scale) improved with ketogenic diet and Trigona honey supplementation, while a weight‑loss programme showed no effect. The ketogenic diet was also associated with improvements in cognition, mood and quality of life. A Mediterranean‑style diet improved quality of life without affecting mood, and Trigona honey improved cognitive outcomes.
Conclusions: High‑quality evidence evaluating dietary strategies to enhance stroke recovery is strikingly limited. Emerging findings suggest targeted dietary interventions may meaningfully improve patient‑centred outcomes, but well‑designed RCTs are warranted to inform rehabilitation practice.