Dietary Intervention With the Modified Atkins Diet in Stroke Rehabilitation

Inclusion criteria

• Age 18-99
• First time unilateral hemispheric ischemic stroke. Not more than 12 weeks after acute stroke.
• Burke Stroke Rehabilitation Unit Inpatient.
• Preserved cognitive ability to understand commands and participate in outcome measures and to give informed consent. In patients with aphasia, cognitive ability to give consent will be determined by a physician.
• Upper extremity motor impairment with an UE Fugl Meyer score ≤ 56/66
• Independence in ADLS/ absence of major impairment prior to stroke

Exclusion criteria

• Hemorrhagic stroke
• Uncontrolled hyperlipidemia with LDL > 250 on admission
• Uncontrolled Diabetes mellitus with BS > 300 averaged over the first day of admission
• Nutritional risk as defined by BMI < 18.5 or by a score of 2 or higher on the Malnutrition Universal Screening Tool (scores BMI, % of unplanned weight loss in last 3-6 months and question whether patient is acutely ill)
• Decreased renal function with eGFR <30%
• Stage III and IV pressure ulcers
• Osteoporosis not sufficiently treated with oral Calcium and Vitamin D supplements
• CHF as defined by class III or worse
• Hypersensitivity/allergy to cholesterol lowering medications
• H/o kidney stones within last 1 year prior to stroke or medications predisposing to kidney stones such as Topamax, carboanhydrase inhibitors
• Inability to tolerate an oral diet and need for tube feeds
• Active enrollment in any other interventional studies at Burke; enrollment in observational studies or studies using TMS as a measurement may not pose exclusion criteria
• Cognitively unable to follow instructions.