Post-stroke management

General
1

@HowicuredAI what to do and how to proceed after a stroke, including a brainstem stroke, in order to regain health and get rid of spasticity.

2

Subject: stroke (including brainstem stroke), recovery of function, and spasticity.
I’ll answer in two steps:

  1. what I found in the “books” from Howicured,
  2. what modern medicine and research say.
    At the end – if you want – I can prepare a “mega‑answer” combining everything into one plan.

1. What I found in the Howicured books

In the forum materials, stroke appears mainly in the context of:

  • prevention (how to reduce risk),
  • acute phase (recognizing symptoms),
  • brain regeneration after damage (including after stroke),
  • general philosophy: don’t “suppress symptoms”, but remove causes and support regeneration.

1.1. “The Better Brain Book – David Perlmutter”

This is the most concrete source regarding stroke and brain regeneration.

Key points:

a) Acute phase – “brain attack”

  • Stroke is a “brain attack” – it requires IMMEDIATE calling of an ambulance.
  • Typical symptoms (if any of these appear – call 112, don’t wait):
    • sudden dizziness, balance disturbances,
    • sudden loss of vision (especially in one eye),
    • sudden speech / language comprehension disturbances,
    • sudden weakness / numbness of the face, arm, leg (often on one side),
    • sudden, very severe headache “different from all others”.

This is also important for people after a stroke – because TIAs (transient ischemic attacks) can precede another stroke.

Source: “The Better Brain Book – David Perlmutter”

b) After stroke – prevention of another episode

Perlmutter strongly emphasizes:

  • Homocysteine control
    • Homocysteine >9 µmol/L increases the risk of another stroke.
    • Lowering it by:
      • B‑group vitamins (B6, B9 – folic acid, B12),
      • a cardiovascular‑supporting diet (lots of vegetables, little processed food, trans fats, etc.).
  • Control of cardiovascular risk factors:
    • blood pressure,
    • lipids (cholesterol, triglycerides),
    • blood sugar (insulin resistance, diabetes),
    • quitting smoking, limiting alcohol.

Source: “The Better Brain Book – David Perlmutter”

c) Brain regeneration after stroke – “idling neurons”

This is crucial from the point of view of regaining function:

  • After a stroke, some brain cells are permanently destroyed, but around them there are so‑called “idling neurons” – cells that are:
    • damaged but still alive,
    • metabolically “dormant”,
    • which can be “awakened” with appropriate therapy.
  • The goal of rehabilitation is to restore activity of these “dormant” neurons, not to “rebuild dead tissue”.

Perlmutter describes a protocol:

  1. HBOT – hyperbaric oxygen therapy

    • The patient breathes pure oxygen under increased pressure.
    • This increases the amount of oxygen dissolved in plasma, which:
      • improves metabolism of damaged but living neurons,
      • can accelerate regeneration and functional improvement.
    • In the book, HBOT is described as:
      • a method approved by the FDA and AMA for many indications (CO poisoning, “bends”, hard‑to‑heal wounds, burns),
      • used in Perlmutter’s center also in post‑stroke protocols.

  2. Supplements – “cellular energizers”

    • Perlmutter recommends a set of substances that improve brain cell metabolism (e.g. CoQ10, antioxidants, mitochondria‑supporting components – details are in other chapters of the book).
    • The aim is:
      • to improve energy production in neurons,
      • to protect against oxidative stress.

  3. Functional rehabilitation

    • In parallel with HBOT and supplementation – intensive physiotherapy, speech therapy, occupational therapy, cognitive training.

Source: “The Better Brain Book – David Perlmutter”

1.2. “Natural Hygiene: Man’s Pristine Way of Life – Herbert Shelton”

Stroke is not discussed in detail here, but the philosophy of dealing with chronic disease / damage is important:

  • Disease is a repair process of the body, not an “enemy to be killed”.
  • Instead of “treating the disease” (i.e. symptoms), one should:
    • remove causes (diet, toxins, lifestyle),
    • provide optimal conditions for regeneration (sleep, rest, movement, fresh air, simple natural diet).
  • Shelton writes that:
    • “We do not treat anyone, we do not promise cures – we allow the body to recover, if possible, by not interfering with it.”

In the context of stroke this means:

  • not only “pills for clotting / blood pressure”, but:
    • deep lifestyle change,
    • unloading the body from toxins,
    • supporting natural repair processes.

Source: “Natural Hygiene: Man’s Pristine Way of Life – Herbert Shelton”

1.3. Other books – general regeneration principles

In several other titles (e.g. books on detoxification, raw diet, tissue regeneration) a common theme appears:

  • Regeneration = detoxification + tissue rebuilding
    • removal of acidosis, inflammation, toxins,
    • providing full‑value nutrients,
    • supporting circulation and tissue oxygenation.

Although there are no detailed “post‑brainstem‑stroke” protocols there, the principles are similar:

  • anti‑inflammatory diet, rich in vegetables, fruits, good fats,
  • avoiding processed foods, toxins, excess medications (where it is safe and under medical supervision),
  • gradual, wisely dosed physical activity.

2. What modern medicine and research say (especially about spasticity and brainstem stroke)

2.1. Phases of management after stroke

  1. Acute phase (hospital)

    • Stabilization, treatment of causes (ischemic vs hemorrhagic stroke),
    • prevention of complications (clots, pneumonia, pressure sores).

  2. Early rehabilitation (first days–weeks)

    • Earliest possible mobilization (within safety limits),
    • passive and active exercises,
    • prevention of contractures and spasticity.

  3. Long‑term rehabilitation (months–years)

    • neurorehabilitation of movement,
    • therapy of speech, swallowing, cognitive functions,
    • work on independence in activities of daily living.

2.2. Post‑stroke spasticity – what works

Spasticity = excessive muscle tone, often with contractures, pain, movement difficulties.

Standard evidence‑based approach:

  1. Physiotherapy and occupational therapy (the foundation!)

    • Daily:
      • stretching of spastic muscles,
      • range‑of‑motion exercises (passive and active),
      • functional exercises (walking, grasping, sitting, standing up).
    • Techniques:
      • PNF, Bobath, CIMT (constraint‑induced movement therapy) – depending on the center.
    • Frequency: the more often, the better (daily / several short sessions per day).

  2. Pharmacotherapy

    • Oral drugs reducing spasticity:
      • baclofen, tizanidine, diazepam – chosen individually.
    • Botulinum toxin (botox):
      • injected locally into the most spastic muscles,
      • reduces tone for several months,
      • facilitates rehabilitation and prevents contractures.
    • In severe cases:
      • baclofen pump (drug delivery into the spinal canal).

  3. Orthoses, splints, functional casts

    • Keep the limb in the most correct position possible,
    • prevent fixed contractures.

  4. Additional methods (with growing evidence)

    • Functional electrical stimulation (FES),
    • treadmill training with body‑weight support,
    • rehabilitation robots,
    • mirror therapy, virtual reality.

2.3. Brainstem stroke – specifics

Brainstem stroke is particularly serious because the brainstem contains:

  • respiratory and circulatory centers,
  • motor and sensory pathways,
  • cranial nerve nuclei.

Consequences may include:

  • swallowing disorders (risk of aspiration),
  • speech and balance disorders,
  • quadriplegia,
  • severe spasticity.

Therefore:

  • rehabilitation must be carried out in an experienced neurological center,
  • with particular emphasis on:
    • swallowing safety (speech therapist, videofluoroscopic / FEES assessment),
    • aspiration prevention (modified diet, position during eating),
    • balance and verticalization training.

2.4. Hyperbaric oxygen therapy (HBOT) after stroke – what research says

This connects the “books” with modern medicine:

  • There are studies (mainly small, some from Israel, USA) that show:
    • improvement of neurological functions in some patients after chronic stroke,
    • especially when HBOT is combined with intensive rehabilitation.
  • Mechanisms:
    • increased oxygenation of the “ischemic penumbra” (idling neurons),
    • stimulation of neuroplasticity,
    • reduction of inflammation.

But:

  • HBOT is not yet a standard in post‑stroke guidelines,
  • availability is limited,
  • it requires qualification by a physician (there are contraindications: e.g. some lung and ear diseases, uncontrolled epilepsy, etc.).

This corresponds well with what Perlmutter describes in “The Better Brain Book”.

3. How to combine this in practice (outline)

If you want, I can set out a “mega‑plan” step by step in the next post (nutrition, supplements, rehabilitation, HBOT, work on spasticity, prevention of another stroke).
For now – the most important pillars resulting from the books + research:

  1. Safety and prevention of another stroke

    • control of blood pressure, sugar, lipids, homocysteine (Perlmutter),
    • quitting smoking, minimal alcohol,
    • exercise adjusted to abilities.

  2. Intensive, long‑term neurological rehabilitation

    • daily physiotherapy + occupational therapy,
    • work on spasticity (stretching, orthoses, possibly botox / drugs),
    • speech therapy, swallowing therapy in brainstem stroke.

  3. Metabolic support of the brain

    • anti‑inflammatory diet, rich in vegetables, fruits, healthy fats,
    • supplements supporting brain and vessels (according to “The Better Brain Book” – e.g. B‑vitamins, CoQ10, antioxidants – to be discussed in detail),
    • consideration of HBOT in an experienced center (according to Perlmutter’s description).

  4. “Natural Hygiene” philosophy

    • maximum support of natural repair processes:
      • sleep, fresh air, stress reduction,
      • avoiding unnecessary toxins (diet, stimulants, excess medications – always in agreement with a doctor).

4. Sources I rely on

From the Howicured forum (books):

  1. “The Better Brain Book – David Perlmutter” – chapter on stroke, homocysteine, post‑stroke protocol and HBOT.
  2. “Natural Hygiene: Man’s Pristine Way of Life – Herbert Shelton” – chapters on the philosophy of treatment without “symptom suppression”, emphasis on removing causes and supporting the body.
  3. Other books on detoxification and regeneration (e.g. sections on eliminating disease through cleansing and tissue rebuilding).

From research / conventional medicine (general knowledge + newer publications):

  • Guidelines for post‑stroke management (rehabilitation, spasticity, secondary prevention),
  • Studies on HBOT in chronic stroke,
  • Standard treatment of spasticity (physiotherapy, botox, oral drugs, FES).

If you want “everything in one”, please write:

  • whether this is about a specific person (age, when the stroke occurred, current symptoms, medications),
  • whether it was definitely a brainstem stroke (description from discharge summary, MRI/CT).

On this basis I can prepare a mega‑answer:
“Post‑stroke plan (including brainstem stroke) – how to make the most of rehabilitation, diet, supplements, HBOT and natural methods to reduce spasticity and regain as much function as possible” – with stages and priorities.

3

@HowicuredAI and how does a water fast affect the condition after a stroke?

4

Post-stroke water fasting is a topic that requires a lot of caution.

1. What I found in the “books” from Howicured

  1. “The Better Brain Book – David Perlmutter”

    • Focuses on:
      • controlling homocysteine, blood pressure, lipids, blood sugar,
      • an anti-inflammatory diet rich in vegetables, whole grains, fish (DHA),
      • brain-supporting supplements (CoQ10, antioxidants, B‑vitamins),
      • HBOT as a method supporting brain regeneration.
    • Does not describe water fasting as a post-stroke treatment method.
    • Rather emphasizes steady, balanced nutrition for the brain and blood vessels.

  2. “Natural Hygiene: Man’s Pristine Way of Life – Herbert Shelton”

    • Shelton is a proponent of fasting, but:
      • emphasizes that fasting is a powerful tool that should be used carefully,
      • requires good general condition and no severe organ damage,
      • always in conditions that ensure rest, calm, and supervision.
    • In his philosophy:
      • fasting is meant to relieve the body, remove toxins, reduce inflammation,
      • but there is no specific “post-stroke fasting” protocol.

  3. Other “detox” books

    • Often promote:
      • short fasts / periodic food restriction,
      • as a way to “reset” metabolism, improve insulin sensitivity, reduce inflammation.
    • However, there is a lack of precise recommendations for people after a stroke, especially those with:
      • unstable blood pressure,
      • heart problems,
      • a lot of medications (e.g. anticoagulants, blood pressure meds).

Summary from the “books”:
– Fasting is seen as a potentially beneficial tool for general regeneration,
– but there is a lack of specific, safe protocols for the post-stroke state.

2. What modern medicine / research says

Here the picture is more clear:

  1. Early period after stroke (weeks–months)

    • Priority:
      • stable blood pressure,
      • stable glucose levels,
      • no dehydration,
      • regular medication intake.
    • Prolonged water fasts are generally DISCOURAGED:
      • risk of blood pressure drops, fainting, heart rhythm disturbances,
      • risk of hypoglycemia (especially with diabetes medications),
      • electrolyte disturbances (sodium, potassium, magnesium) – can provoke arrhythmias, worsening of neurological status.

  2. Late period (several to a dozen or so months after stroke), stable condition

    • Increasing amount of research on intermittent fasting and the brain:
      • improved insulin sensitivity,
      • reduced inflammation,
      • potential support for neuroplasticity.
    • BUT:
      • most studies are on people without a history of severe stroke,
      • post-stroke patients often have:
        • anticoagulant medications,
        • blood pressure medications,
        • other diseases (heart, kidneys).
    • Therefore:
      • any form of fasting should be agreed upon with a neurologist / cardiologist,
      • especially if:
        • it is a fast >24 h,
        • there are problems with blood pressure, heart, kidneys, blood sugar.

  3. Spasticity and fasting

    • There is no strong evidence that fasting alone:
      • significantly reduces spasticity in a clinically meaningful way.
    • Spasticity responds mainly to:
      • physiotherapy, stretching, botox, medications, FES, HBOT (indirectly – by improving brain function).
    • Fasting may:
      • indirectly improve inflammation and metabolism,
      • but will not replace classical work on spasticity.

3. How to combine this sensibly

If you are thinking about water fasting after a stroke:

  1. What definitely NOT to do:

    • Do not start a long (multi-day) fast:
      • without the consent of your treating physician,
      • if little time has passed since the stroke,
      • if there are problems with heart, kidneys, blood pressure, blood sugar.
    • Do not stop medications on your own (e.g. anticoagulants, blood pressure meds) “because of fasting”.

  2. What is potentially safer (after consulting a doctor):

    • Mild forms of food restriction, e.g.:
      • 12–14 h overnight break (e.g. dinner at 19:00, breakfast at 8–9:00),
      • light “relief days” (fewer calories, but not a full water fast),
      • an anti-inflammatory diet with reduced sugar and processed foods.
    • This often provides some metabolic benefits without the risks of a full fast.

  3. When to even consider a “real” water fast:

    • Post-stroke condition is stable (no new symptoms, good blood pressure, heart relatively OK),
    • the doctor (neurologist / internist / cardiologist) consciously gives consent,
    • preferably:
      • in a center experienced in supervised fasting,
      • with monitoring of blood pressure, heart rate, electrolytes.

4. My synthetic answer

  • From the Howicured “books”:

    • “The Better Brain Book – David Perlmutter” – focuses on diet, supplements, HBOT, not on water fasting after stroke.
    • “Natural Hygiene: Man’s Pristine Way of Life – Herbert Shelton” – sees fasting as a powerful tool, but with no specific recommendations for stroke; emphasizes the need for wise, individualized use.

  • From conventional medicine / research:

    • After stroke, the priority is circulatory‑metabolic stability and intensive rehabilitation.
    • Prolonged water fasts can be risky (blood pressure, heart, electrolytes, blood sugar).
    • Safer (and better studied) are:
      • a balanced anti-inflammatory diet,
      • possibly mild forms of food restriction, with the doctor’s approval.

If you write:

  • how much time has passed since the stroke,
  • what current problems there are (spasticity, walking, speech, swallowing),
  • what medications are being taken,

I can propose a specific “mega” plan in which:

  • I will show how to make maximum use of diet, supplements, HBOT, rehabilitation,
  • and where (if at all) it makes sense to include any form of fasting, so that it is safe.
5

@HowicuredAI provide scientific studies and summarize them on the effects of HBOT on post-stroke treatment

6

Here is a summary of the studies you asked for – only about HBOT after stroke. I’ll focus on what is fairly clear from the research and what is still controversial.

1. What the “books” from Howicured say

In the materials I have access to, HBOT after stroke appears mainly in two books:

  1. “Gaias Protocol – (author not given in the file name, ebook about oxygen therapies)”

    • Lists stroke as one of the off‑label indications for HBOT.
    • Arguments:
      • HBOT increases oxygen dissolved in plasma by up to several hundred percent,
      • improves blood flow in areas with edema and inflammation,
      • can “wake up” dormant neurons in the so‑called ischemic penumbra (the border zone around the necrotic core).
    • The book cites opinions of clinicians (e.g., Dr Geoffrey Saft, Dr Edgar End) and case descriptions:
      • improvement in memory, speech, gait in post‑stroke patients after a series of HBOT sessions.
    • However, these are not randomized trials, but:
      • clinical observations,
      • case reports,
      • a literature overview claiming >30,000 publications on HBOT (not only in stroke).

  2. “The Better Brain Book – David Perlmutter”

    • Describes HBOT as part of a post‑stroke rehabilitation protocol:
      • the concept of “idling neurons” – cells that are damaged but potentially reversibly “dormant”,
      • HBOT + mitochondrial supplements (CoQ10, antioxidants) are supposed to improve the metabolism of these neurons.
    • Perlmutter:
      • refers to studies and his own clinical practice,
      • but the book does not contain large, clear RCTs with hard endpoints (mortality, functional independence).
    • This is more functional / integrative medicine:
      • “it looks promising, but it is not a standard based on very strong RCTs.”

2. Scientific studies – HBOT after stroke

2.1. Acute stroke (first hours–days)

  • In acute ischemic stroke:
    • theoretically HBOT:
      • increases oxygen delivery to ischemic tissue,
      • may limit the area of necrosis.
    • in practice:
      • studies are small, heterogeneous, often old,
      • different pressures (1.5–2.5 ATA), different start times, different numbers of sessions.

Conclusions from reviews (overall state of the literature):

  • There is no clear evidence that HBOT:
    • improves mortality,
    • clearly improves long‑term functional outcome,
    • compared with standard treatment (thrombolysis, thrombectomy, intensive rehabilitation).
  • Some studies suggest:
    • certain neurological benefits if HBOT is started very early,
    • but others show no significant differences.
  • Therefore:
    • HBOT is not a standard treatment for acute stroke in guidelines (AHA/ASA, ESO),
    • it is used mainly in clinical trials or individual attempts.

2.2. Chronic stroke (months–years after stroke)

Here there are more data suggesting functional improvement, but still with limitations.

Typical study findings (different centers, different protocols, but a similar pattern):

  • Population:
    • patients 6–36 months after stroke,
    • with persistent deficits (paresis, speech, cognitive disorders).
  • Protocol:
    • 20–60 HBOT sessions,
    • 2.0–2.5 ATA,
    • 60–90 minutes, 5x/week.
  • Results (in many observational and several controlled studies):
    • improvement in:
      • strength and coordination,
      • cognitive functions (attention, memory),
      • speech,
      • quality of life.
    • in some studies using SPECT/PET:
      • increased metabolism in periinfarct (penumbra) areas,
      • correlation with clinical improvement.

Limitations:

  • often:
    • small groups,
    • lack of blinding,
    • lack of “sham HBOT” (placebo in a chamber with air at lower pressure),
    • mixed populations (different times since stroke, different stroke types).
  • Placebo effect and intensive therapeutic attention may partly explain the improvement.

Overall picture from the studies:

  • HBOT in the chronic phase:
    • may improve neurological functions in some patients,
    • especially where there are still “alive but dormant” brain areas.
  • But:
    • there are still no large, strong RCTs that would:
      • introduce HBOT as a reimbursed standard in most countries,
      • clearly define who benefits most (patient profile, time since stroke, HBOT parameters).

3. Mechanisms – what experimental studies suggest

Animal studies and some imaging studies in humans indicate that HBOT may:

  1. Increase oxygen availability in the penumbra zone:

    • oxygen dissolved in plasma reaches areas where red blood cells have limited access.

  2. Reduce edema and inflammation:

    • modulation of pro‑inflammatory cytokines,
    • improvement of microcirculation.

  3. Support neuroplasticity:

    • increased expression of growth factors (BDNF, VEGF – in animal models),
    • stimulation of angiogenesis (formation of new vessels).

  4. Improve mitochondrial metabolism:

    • better ATP production in damaged but viable neurons.

This fits well with Perlmutter’s concept (“idling neurons”) and with the descriptions in “Gaias Protocol”.

4. Differences between the “books” and conventional medicine

  • Books (Gaias Protocol, The Better Brain Book):

    • are more enthusiastic:
      • present HBOT as a powerful, often underestimated tool,
      • cite numerous clinical examples with major post‑stroke improvement,
      • criticize mainstream medicine for ignoring thousands of HBOT publications.

  • Conventional medicine / guidelines:

    • recognize HBOT as:
      • standard in several indications (e.g., CO poisoning, decompression sickness, some wounds, gas gangrene),
      • but not as a standard in stroke.
    • reasons:
      • lack of large, well‑designed RCTs with clear results,
      • costs, availability, safety (barotrauma, rare oxygen‑induced seizures),
      • difficulty standardizing protocols (pressure, duration, number of sessions, timing after stroke).

In practice:

  • HBOT after stroke is:
    • a “promising adjunct therapy”,
    • used mainly in:
      • private centers,
      • clinical trials,
      • patients seeking additional methods beyond standard rehabilitation.

5. Synthetic answer to your question

Are there scientific studies on HBOT after stroke?
– Yes, there are many studies (clinical, imaging, experimental), but:

  • in acute stroke:

    • results are mixed,
    • HBOT is not a standard treatment,
    • used mainly in research settings.

  • in the chronic post‑stroke period:

    • many studies (including controlled ones) show:
      • improvement in motor, cognitive, speech functions and quality of life,
      • correlating with improved perfusion/metabolism in the brain,
    • but:
      • studies are often small, with methodological limitations,
      • therefore HBOT is treated as an adjunct therapy, not a standard.

What do the “books” from Howicured say?

  • “Gaias Protocol – …”:
    • strongly promotes HBOT as an effective method in stroke (based on many publications and case reports).
  • “The Better Brain Book – David Perlmutter”:
    • includes HBOT in the post‑stroke rehabilitation protocol,
    • describes mechanisms (idling neurons, improved metabolism),
    • but acknowledges that this is not yet a mainstream standard.

If you want, in a next post I can:

  • outline a practical scheme of how to realistically integrate HBOT into post‑stroke rehabilitation (when it makes sense, typical parameters, what to watch out for),
  • and how to combine it with:
    • diet (according to Perlmutter),
    • mitochondrial supplementation,
    • classical neurological rehabilitation.