Diet‐Driven Modulation of the Gut Microbiome to Enhance Neuroplasticity and Cognitive Recovery After Ischemic Stroke

Cognitive impairment and limited neuroplastic recovery remain major contributors to long-term disability following ischemic stroke. Increasing evidence suggests that stroke-induced disruption of the gut-brain axis, characterized by microbiome dysbiosis and altered microbial metabolite signaling, may influence post-stroke inflammation, synaptic remodeling, and cognitive outcomes. Diet is a key modifiable determinant of gut microbiome composition and metabolic output, yet its role in post-stroke neuroplasticity has not been comprehensively synthesized. This narrative review examines dietary interventions with mechanistic or translational relevance to ischemic stroke recovery, including Mediterranean dietary patterns, ketogenic diets, high-fiber and prebiotic-enriched diets, probiotic and synbiotic supplementation, and intermittent fasting or caloric restriction. We summarize evidence linking diet-induced microbiome modulation to neuroinflammatory regulation, short-chain fatty acid signaling, microglial activity, mitochondrial function, and synaptic plasticity. Shared and diet-specific pathways are discussed, along with current limitations of the evidence base and barriers to clinical translation. Collectively, available data support a biologically plausible role for targeted dietary modulation of the gut microbiome as an adjunctive strategy to enhance cognitive recovery and neuroplasticity after ischemic stroke. Further well-designed clinical studies integrating microbiome profiling, neuroimaging, and cognitive outcomes are needed to define therapeutic potential and guide implementation in stroke rehabilitation. Among these dietary interventions, Mediterranean, high-fiber, and prebiotic-enriched diets currently have the strongest available evidence, while ketogenic and intermittent fasting approaches remain the least supported based on existing clinical and translational evidence.