Does Plant-Based Diets Protect Against Heart Disease?

 

A friend of mine who is a participant in my WhatsApp chat group sent us this news -  that the world's first vegetarian bodybuilder Varinder Singh Ghuman died of a heart attack in Amritsar. He was an actor who played the lead role in the Punjabi film 'Kabaddi Once Again' and worked with Salman Khan in 'Tiger 3'. Ghuman was chosen by Arnol Schwarzenegger to represent his products in Asia. He was widely known as the world's first vegetarian bodybuilder, yet he died of a heart attack. He had gone to Amritsar's Fortis Hospital to undergo a minor operation for a bicep injury. Since it was a minor operation, he was supposed to return today. However, Ghuman suffered a cardiac arrest and died. He was 42.  The details is in this link: 

https://www.indiatoday.in/movies/regional-cinema/story/punjabi-actor-varinder-ghuman-dies-due-to-heart-attack-in-amritsar-2800656-2025-10-09.

Another friend of mine, a medical doctor then asked me how could a vegetarian die of heart disease when vegetables are full of antioxidants that protects a person from free radical damage?

Below written in blue is my answer and opinion on whether or not a vegan or vegetarian diet can protect a person against heart attack and heart disease. 

Plant-Based Diets and Heart Disease: 

Lessons from the Death of Vegetarian

Bodybuilder Varinder Singh Ghuman 

Abstract

The unexpected cardiac death of Varinder Singh Ghuman, a high-profile vegetarian professional bodybuilder and actor who suffered cardiac arrest after a routine shoulder procedure, has prompted questions and myth-checking about diet, fitness and cardiovascular risk. This article explains why plant-based diets lower but do not eliminate cardiovascular risk, outlines other biological and external contributors to heart attacks (genetics, inflammation, arrhythmia, perioperative events and possible performance-enhancing drug effects), and discusses specific concerns in elite bodybuilding. Let  me synthesize current evidence on vegetarian and vegan dietary effects on cardiovascular risk factors, summarize what is known about perioperative cardiac arrest, review the cardiovascular harms associated with anabolic-androgenic steroids (AAS), and end with a public-health message and a brief biblical reflection on mortality and stewardship of the body. The central message: diet matters, but so do many other determinants of heart health. PM

 

Introduction

 

When a public figure widely celebrated for physical strength dies suddenly from a heart attack, the public reaction is immediate and searching: How could this happen? For some, the surprise is compounded when that person follows a vegetarian or vegan diet, because plant-based eating is commonly associated with protection against chronic disease. But as physicians, scientists and public communicators, we must resist simplistic causal leaps. Cardiovascular disease is multi-factorial: genes, inflammation, arrhythmogenic risk, perioperative stressors, medication or supplement use (legal and illicit), and the quality of the diet itself all influence outcomes. The recent reports that Varinder Singh Ghuman suffered cardiac arrest after a routine surgical procedure and could not be revived have been confirmed by multiple news outlets and by his treating hospital. India Today+1

 

What the reports say (briefly)

According to hospital and media statements, Ghuman, a winner of national bodybuilding titles, an actor with film credits, and widely described in media as a professional vegetarian bodybuilder,  had visited a private hospital in Amritsar for treatment of a shoulder/biceps injury. After a routine procedure he experienced a sudden cardiac arrest and died despite resuscitation efforts. Official statements from the treating hospital expressed regret; detailed autopsy or toxicology results were not publicly released at the time of reporting. India Today+1

 

Plant-based diets and the cardiovascular evidence base

 

Multiple cohort studies, systematic reviews and meta-analyses show that healthy plant-based diets are associated with lower blood pressure, lower low-density lipoprotein (LDL) cholesterol, lower body mass index and reduced incidence of cardiovascular events compared with typical Western diets. Meta-analyses in recent years report modest but consistent reductions in cardiovascular risk and improvement in lipid profiles among vegetarians and vegans when diets emphasize whole grains, legumes, fruits, vegetables, nuts and minimally processed foods. PMC+2PMC+2

Mechanisms explaining these benefits include lower intake of saturated fats, higher intake of fiber and antioxidants, improved endothelial function, and more favorable gut-microbiome metabolites. However, the term “plant-based” is wide: a diet of whole foods is different from a diet relying on processed vegan snacks and fried foods. Recent meta-analyses emphasize that quality matters, healthful plant-based patterns confer benefit, while unhealthful plant-based patterns do not. ScienceDirect+1

 

Why a vegetarian (or vegan) person can still have a heart attack, a doctor friend asked me to explain 4 days ago.

A lower risk is not zero risk. Several categories of explanation are important:

1. Diet quality and composition. A diet labelled “vegan” can still be rich in refined carbohydrates, trans-fats (from hydrogenated oils), sodium, and added sugars, all of which increase cardiovascular risk when consumed in excess. Conversely, a carefully planned plant diet that includes sources of omega-3s, adequate protein, and micronutrients is more protective. PMC+1

2. Nutrient gaps. Strict vegans are at risk for deficiencies in vitamin B12, vitamin D, long-chain omega-3 fatty acids (EPA/DHA), iron (either deficiency or, rarely, excess from supplements), and possibly iodine. Elevated homocysteine from B12 deficiency and low omega-3 status have been linked to adverse cardiovascular outcomes and arrhythmic risk. Many guidelines therefore recommend monitoring and supplementing when appropriate. NCCIH+1

3. Genetic predisposition and non-dietary risk factors. Familial hypercholesterolemia, inherited cardiomyopathies, congenital electrical disorders (e.g., long QT syndromes), and familial clotting disorders can produce coronary events or sudden death despite an otherwise healthy lifestyle. These are not prevented solely by diet.

4. Inflammation and immune-mediated disease. Chronic inflammatory conditions (autoimmune disease, chronic infection) contribute to atherosclerotic progression independent of diet.

5. Cardiac structural or electrical disease. An enlarged heart (hypertrophy), cardiomyopathy, scarring from prior myocarditis, or primary arrhythmic conditions can precipitate sudden cardiac arrest without classical atherosclerotic plaque rupture.

6. Perioperative events and acute triggers. Surgery, even a minor procedure, can trigger cardiac events through anesthesia-related hemodynamic changes, electrolyte disturbances, pulmonary embolism, massive sympathetic surge from pain or stress, or intraoperative arrhythmia. The incidence of perioperative cardiac arrest is low but real: modern series report rates in the low per-10,000 procedure range with higher risk in older patients and those with elevated ASA (American Society of Anesthesiologists) physical status. PubMed+1 

7. Drugs, supplements and illicit substances. Performance-enhancing drugs used in bodybuilding, notably anabolic-androgenic steroids (AAS), growth hormone, erythropoiesis-stimulating agents, stimulants and certain “cutting” agents,  have been associated with hypertension, dyslipidemia, left ventricular hypertrophy, accelerated atherosclerosis, pro-thrombotic states and sudden cardiac death. Even if a subject publicly states a vegetarian diet, that does not rule out exposure to cardiotoxic compounds. The strong signal in the literature is that AAS use increases cardiovascular risk and contributes to fatal events in athletes and bodybuilders. PMC+1

 

The specific cardiovascular concerns in elite bodybuilding. 

 

Extreme cardiac remodeling. Intense strength training and associated hemodynamic loads can produce concentric and eccentric hypertrophy. While adaptive in athletes, pathological enlargement (particularly when combined with hypertension or drug effects) may predispose to arrhythmia or heart failure.

High-protein diets and supplements. These are usually well tolerated, but some protein supplements can be adulterated or contaminated.

Performance-enhancing regimens. Evidence links supraphysiologic AAS exposure to adverse remodeling, endothelial dysfunction, thrombosis and arrhythmia. Multiple case reports and series document sudden cardiac death temporally associated with AAS use. PMC+1

 

Importantly, we do not have public evidence that any one of these factors applied to Mr. Ghuman specifically; this is a synthesis of known risks in the population and the plausible contributors in similar cases. Responsible reporting must distinguish known facts (he died of cardiac arrest after a procedure) from speculation (e.g., about drug use) until official toxicology or autopsy results are published. India Today+1

 

Perioperative cardiac arrest: mechanisms and incidence

Perioperative cardiac arrest is uncommon but carries high mortality. Causes include:

1. Myocardial ischemia from plaque rupture or supply–demand mismatch

2. Massive pulmonary embolism

3. Anesthetic complications (hypoxia, massive aspiration)

4. Severe electrolyte disturbances and arrhythmias

5. Hemorrhage and hypovolemia

6. Acute anaphylaxis

7. Large observational studies and systematic reviews put perioperative cardiac arrest incidence in modern series at roughly 2–6 per 10,000 anesthetics, with higher rates in emergency surgery and in patients with significant pre-existing disease. Outcomes depend on rapid recognition and high-quality resuscitation. Again, a minor procedure does not make a person immune to these rare but catastrophic events. PubMed+1

 Omega-3s, B12 and other modifiable gaps in plant-based diets

Two recurring nutritional themes merit attention:

1. Omega-3 (EPA/DHA) and cardiac outcomes. Long-chain omega-3 fatty acids (EPA/DHA) are concentrated in oily fish; strict vegans often have lower blood levels. While the magnitude of benefit shown in trials is modest and heterogeneous, pooled analyses suggest modest reductions in coronary events with EPA/DHA supplementation in at-risk populations. Plant-based ALA (alpha-linolenic acid) converts inefficiently to EPA/DHA in many people; clinical guidance often recommends algae-derived EPA/DHA supplementation for vegans who are at cardiovascular risk. NCCIH+1 

2. Vitamin B12 and homocysteine. B12 deficiency, common when animal products are absent, it elevates homocysteine, a biomarker associated with vascular risk. Routine screening and replacement are inexpensive and effective preventive measures. PMC

 

These are practical and addressable gaps; their correction improves population-level risk profiles but will not eliminate genetically driven or acute non-atherosclerotic causes of cardiac arrest.

My public health message to all: clarity without fear. From a public-health standpoint this case supports several clear recommendations:

1. Promote high-quality plant-based diets rather than simply “plant-only” diets: emphasize whole grains, legumes, vegetables, nuts, seeds and limited processed food. This is the pattern associated with the strongest cardiovascular benefits. PMC+1 

2. Screen and supplement appropriately. For people on strict plant diets: check vitamin B12, vitamin D, iron indices when indicated, and counsel about omega-3s (consider algae-based EPA/DHA supplements). PMC+1

3. Acknowledge non-dietary cardiovascular risks. Family history, unexplained exertional syncope, palpitations, or a history suggestive of illicit substance use warrant cardiology evaluation, ECG, and where appropriate imaging. Statements like “I eat healthy, I can’t get heart disease” are dangerous; vigilance matters. PubMed

4. Targeted education for athletes and bodybuilders. The fitness community needs honest, non-judgmental public health messaging about the risks of anabolic steroids and other performance-enhancing agents, routine cardiac screening for elite athletes, and regulation and quality control of supplements. Health systems should make confidential help available for those seeking to stop harmful substances. PMC+1

5. Perioperative assessment is essential. All patients, even those appearing fit, should undergo appropriate pre-operative screening tailored to the procedure and personal risk factors. Hospitals should continue to strengthen protocols for early recognition and management of perioperative emergencies. Association of Anaesthetists

 

Case reflection and responsible inference

 

In high-profile deaths the temptation to reduce the story to a single cause, “vegetarianism failed” or “steroids killed him”,  is strong. Science demands evidence based support. In Ghuman’s case the confirmed facts are: a well-known vegetarian bodybuilder underwent a procedure and suffered cardiac arrest at the hospital. We do not yet have a publicly released autopsy, toxicology or full perioperative report. Until those data are available, the proper stance is one of careful hypothesis: plausible contributors include an unrecognized structural cardiac problem, an arrhythmia, a thromboembolic event, perioperative physiological stress, or exposure to cardiotoxic substances, alone or in combination. By discussing these mechanisms frankly, clinicians and the public can learn how to reduce future risk without leaping to unjustified conclusions. India Today+1

Practical advice for readers (summary checklist)

If we follow a vegetarian or vegan diet: arrange periodic checks for blood pressure, fasting lipids, vitamin B12 and (if indicated) omega-3 status.

Choose whole-food plant patterns over processed vegan convenience foods.

If we are an athlete pursuing extreme physique goals: disclose any supplement or drug use to your health provider; consider scheduled cardiology screening (ECG, echocardiogram) and avoid illicit substances.

Before elective surgery: disclose full medication and supplement history; ensure anesthetic and surgical teams are informed about any prior cardiac complaints, substance use, or supplement intake.

Public and clinical institutions: continue to expand harm-reduction programs targeted to athletes, and ensure perioperative safety protocols remain robust. PMC+1

 

Biblical reflection: strength, stewardship and the transience of life

As we analyze mechanisms and statistics, it is right and human to respond emotionally. The biblical tradition offers a salutary reminder of life’s fragility and the ethical duty of stewardship over the body. Scripture often places human strength alongside humility: great physical power does not exempt one from mortality. “Teach us to number our days, that we may apply our hearts unto wisdom” (Psalm 90:12) and Ecclesiastes repeatedly reflects on the ephemeral nature of earthly achievement. These passages do not condemn the love of health or disciplined living; rather, they invite perspective: our bodies are entrusted to us for a time, and within that time we owe care to ourselves and compassion to others. A responsible, faith-informed approach to health combines scientific prudence with gratitude and humility, seeking to preserve life while accepting that ultimate outcomes are not wholly within our control.

 

My final opinion is that, Varinder Singh Ghuman’s sudden death is a tragic reminder that no single lifestyle choice confers absolute protection. High-quality plant-based diets lower many cardiovascular risks, but diet is one thread in a complex fabric of determinants that includes genetics, inflammation, structural heart disease, perioperative events and possibly exposure to cardiotoxic agents. Public health responses should emphasize high-quality nutrition, targeted screening and education for athletes, and robust perioperative safety. Clinicians and the public alike should resist simplistic explanations, and instead use such events to learn and improve preventive care, while holding a compassionate space for grief and, for those who share that faith, a biblical perspective that invites humility and stewardship.

 

References

 

1. India Today — Varinder Ghuman suffered cardiac arrest after shoulder surgery, says hospital. (Oct 10, 2025).

2. Fortis Hospital / Times of India coverage — official statements and reporting on the event. The Times of India+1

3. Landry MJ, et al. Vegetarian dietary patterns and cardiovascular risk factors: systematic review and meta-analysis. (2024). (meta-analysis showing reductions in CVD risk factors with vegan/vegetarian patterns). PMC

4. Koch CA, et al. Vegetarian or vegan diets and blood lipids: a meta-analysis. (2023). (reduction in LDL and ApoB). PMC

5. Satija A, et al. Plant-based diets and cardiovascular health: review. (2018). (mechanisms and evidence linking plant diets and lower CVD risk). PubMed

6. Torrisi M, et al. Sudden cardiac death in anabolic-androgenic steroid users. (2020). (case series/review linking AAS to sudden death). PMC

7. Perry JC, et al. Anabolic steroids and cardiovascular outcomes. (2020 review). PMC

8. Nunnally ME, et al. Incidence and risk factors for perioperative cardiac arrest. (2015). (perioperative cardiac arrest epidemiology). PubMed

9. Armstrong RA, et al. Peri-operative cardiac arrest: epidemiology and clinical practice review. (2024). (modern incidence and causes). Association of Anaesthetists

10. National Center for Complementary and Integrative Health (NCCIH). Omega-3 supplements: what you need to know. (2020 review summary of trials). NCCIH

11. Dempsey M, et al. Influence of dietary and supplemental omega-3 fatty acids on cardiovascular outcomes. (2023). PMC

A Comment on Stroke by Mr Mark Ching Tat

 I received this letter from Mr Mark Ching Tat following my article on stroke and physiotherapy which he wanted to post it into the comment column.   

I thought it would be better for me to post his comment as short article by him to share with readers rather than being inserted into the comment column. Here is what Mr Mark wrote to me in blue:  

Dr. Lim Ju Boo,  thanks for a detailed lesson on what stroke is all about and the ability of the brain that can perform a recovery in a such miraculous manner, while stimulating neuroplasticity through physiotherapy and acupuncture could further assist to rehabilitate a stroke patient or recover. 

Speaking from my own observation, the incidence of stroke seems to be high. Just for example , within the circle of each of our own family and friends there is bound to find at least three to five persons who had a stroke "attack". Depending on the type of stroke, treatment within the golden hour window after stroke is crucial to the chances of recovery. It is encouraging to learn also that there is hope in continual targeted treatment or therapy that could help to rehabilitate the patient or revover.

A friend in New Zealand passed away in a nursing home about three years ago was bedridden for five years after stroke, never recovered at all in mobility and speech. While someone here close to us had a stroke more than six years ago and one who had missed that golden hour of treatment still lives now assisted, as most of the time is immobile. 

At the NASAM or the National Stroke Association of Malaysia, Petaling Jaya, I had the opportunity to chat with one of the patients who had stroke not once but twice. He told me he had recovered fully after the first stroke but was slightly altered in his gait and walk but mobile after the second. He had followed the stroke rehabilitation programme at NASAM which is an integrated approach that includes physiotherapy, speech therapy, occupational therapy, emotional therapy, recreational and social activities as well as various complementary therapies such as yoga, meditation and sound therapy.

I would like to share the weblink of this useful organisation here below.

https://www.nasam.org/about-us/

A Wheelchair is Not for a Stroke Patient - Reactivating the Brain

I received this personal letter from Ms Sofea, a physiotherapist working at the Kuala Lumpur  Hospital. With her permission I reproduce what she wrote to me unedited in pink:  

Your most welcome, Dr Lim. Truth be told, we as physiotherapists often face challenges in our practice due to the bad system as how you mention earlier.
Even for dietician its so difficult for patient to have an access or to be referred to dietician and learn about nutrition.

To share a little story — two years ago, my mum had a minor stroke and was left with muscle weakness. She developed a circumduction gait, couldn’t carry her right arm forward, had mild balance disturbance, and poor bladder control.

Luckily, being a physiotherapist, I knew that for neurological cases, time is gold. You have to keep practicing to stimulate neuroplasticity and prevent muscle deconditioning. I told my family not to give her a wheelchair or walking aid, and I prescribed an exercise regime along with hydrotherapy at my condo.

Praise be to Allah, she recovered and returned to

her premorbid state. Before going back to Ipoh,

she could walk and perform her daily activities independently. I always tell my mum — I’m not forcing you to exercise or take your medication for me, but for yourself — so you can live your life well and in comfort.

People will eventually pass on, that’s true, but until that time comes, let’s live beautifully and meaningfully

 

Here is my reply to Ms Sofea 

Thank you Sofea for your letter. 

Yes, I too agree all you said. Let me explain a little bit more about the healthcare professions.  

 Healthcare professionals are any trained individuals who work in the medical field to promote health, prevention of disease and illness, and care of others with injuries and illnesses. They are not just medical doctors, but include paramedics, emergency medical technicians, nurses, dentists, pharmacists, physiotherapists, dietitians, medically-trained nutritionists, medical scientists, and many other specialized workers who use their skills, knowledge, and research-based practices to diagnose and treat patients while upholding ethical standards and acting in their patients' best interests.  

It is very unfortunate the public thinks only medical doctors are health-care professionals, and doctors seldom refer cases beyond their training and expertise to other healthcare professionals like physiotherapists, chiropractors, osteopaths who are far more expert in manipulative medicine than a doctor who is more orientated towards drug-based medicine and surgery that hardly could cure any of those chronic lifestyle diseases such as cardiovascular diseases, cancers, type 2 diabetes, and chronic respiratory diseases. These conditions, also known as noncommunicable diseases (NCDs), are linked to lifestyle factors like unhealthy diets, physical inactivity, tobacco use, and harmful alcohol consumption. Diseases such as type 2 diabetes. cardiovascular, gout, obesity and all diseases related to the ways we live and eat that would best be referred and managed by a dietician using dietotherapy  than being  treated by a doctor using drugs which are actually chemicals. How do chemicals treat, remove or heal a chronic disease due to unhealthy  eating or health-damaging lifestyles is extremely difficult for me as a clinician, nutritionist and a research medical scientist to understand. But doctors seldom want to refer  cases outside their training and expertise to other healthcare professionals. They want all the patients for themselves.  Even among the doctors  they are very reluctant to refer their patients to other specialists, because a patient referred is a customer lost. This has been going on for many, many decades already.

See link here among many others I have written

1. https://scientificlogic.blogspot.com/2025/09/a-patient-cured-is-customer-lost.html

2. https://scientificlogic.blogspot.com/2025/09/the-pitfalls-of-polypharmacy-in.html

As you rightly pointed out it is just due to bad system in a hospital or in the healthcare system if not selfishness of a doctor at the expense of the patient. Even in such a major hospital like the Kuala Lumpur Hospital where you work, all the departments are separate and compartmentalized, and seldom would  a doctor from one department wishes to refer his / her patient to a specialist or doctor in another department. They just keep the same patient for themselves for “follow-up” in their own department. We all are aware of this.  In a stroke patient for example, doctors would treat the  patient by first diagnosing the stroke type (ischemic or hemorrhagic) with imaging like CT or MRI scans, then using medications to dissolve clots or perform mechanical thrombectomy to remove them for ischemic strokes. For hemorrhagic strokes, treatment involves controlling the bleeding, reducing ICP - Intracranial Pressure (fluid pressure in the brain), and sometimes surgery to repair the vessel. After this treatment very few doctors would refer their patients for rehabilitation therapies to  help patients regain abilities and adjust to any permanent changes.  

Having said all that, that is where physiotherapy comes in. In fact, physiotherapy should be the first line of treatment as soon as possible, especially for mild stroke as shown in your mother’s case. You did a good and a correct job.

That’s where I like to explain further here where you left out under this title:

Reawakening the Brain: Harnessing Neuroplasticity to Restore Function After a Stroke 

A Wheelchair is not for a Stroke Patient

Summary

After a stroke, many patients are discouraged from active rehabilitation and instead confined to a wheelchair. Yet, neuroscience reveals that the human brain possesses a remarkable capacity for self-repair and reorganization,  a property known as neuroplasticity. Far from being static, the brain continuously adapts, forms new neural connections, and even reorganizes entire functional networks in response to training, therapy, and experience. Stimulating this natural adaptability is the cornerstone of stroke recovery with the rewiring of the brain to be done as soon as possible. 

Understanding Neuroplasticity

Neuroplasticity is the brain’s lifelong ability to modify its structure and function by creating new neural connections or strengthening existing ones. It operates through two fundamental processes:

Synaptic potentiation: 

strengthening frequently used neural pathways, enhancing signal transmission efficiency. 

Synaptic pruning: eliminating unused or inefficient connections to improve the brain’s overall network performance.

These processes enable the brain to adapt to new experiences, acquire skills, and recover from injuries. Neuroplasticity occurs on both microscopic 

(cellular) and macroscopic (network) levels, influencing everything from individual synapses to entire cortical regions.

Why Stimulating Neuroplasticity is Crucial After a Stroke

When a stroke damages part of the brain, the lost neurons cannot regenerate; however, surrounding healthy tissue can reorganize and take over the lost functions. This adaptive process, if properly guided, can restore speech, movement, and cognition. The main advantages include:

Compensating for permanent damage: Healthy neural circuits can assume the roles of destroyed ones, restoring lost motor or sensory functions.

Enhancing rehabilitation outcomes: The brain enters a “critical window” of heightened plasticity in the weeks to months following a stroke,  a period during which intensive therapy yields maximal gains.

Encouraging relearning and skill reacquisition:

Repetitive, goal-oriented tasks strengthen new pathways and reinforce desired behaviors. This principle forms the basis of constraint-induced movement therapy, gait retraining, and speech therapy. 

Preventing maladaptive plasticity: Without guidance, the brain may develop compensatory but inefficient patterns (e.g., learned non-use of a limb). Directed rehabilitation corrects these maladaptation and reinstates functional movement.

Boosting overall brain health: Stimulating neuroplasticity increases neurotrophic factors such as Brain-Derived Neurotrophic Factor (BDNF), which nourish neurons, support synaptic growth, and protect against further degeneration. 

Mechanisms of Neuroplasticity After Stroke

1. Structural Mechanisms

These involve physical changes in the brain’s architecture

Axonal sprouting: Surviving neurons grow new axonal branches that form alternative pathways around the damaged tissue.

Dendritic remodeling: Dendrites, the “receiving arms” of neurons, grow and reorient, increasing synaptic connections and communication potential.

Synaptogenesis: 

Formation of new synapses enables the establishment of fresh circuits necessary for relearning lost skills.

Neurogenesis: Although limited in adults, new neurons may arise in the hippocampus and migrate toward injured areas, aiding cognitive and memory recovery.

Angiogenesis: 

Formation of new blood vessels enhances oxygen and nutrient delivery, supporting neural repair and regeneration.

2. Functional Mechanisms

These describe changes in how the brain’s networks operate:

Cortical reorganization (remapping): Brain regions near the damaged area or in the opposite hemisphere take over lost functions. For example, motor tasks may shift to adjacent undamaged cortical zones.

Interhemispheric rebalancing: Stroke often disrupts the balance between hemispheres. Targeted therapies, such as mirror therapy or transcranial magnetic stimulation (TMS), can normalize this activity.

Reversal of diaschisis: Areas connected to the lesion but not directly injured may temporarily lose function; as communication is re-established, these regions regain activity.

Experience-dependent plasticity: The brain rewires in direct response to experience and practice. Meaningful, repetitive, and challenging tasks are the strongest stimuli for long-term adaptive change.

Clinical Implications: From Wheelchair to Rehabilitation

Encouraging stroke survivors to engage in active rehabilitation rather than permanent wheelchair dependence taps directly into the brain’s healing potential. Physiotherapy, occupational therapy, speech-language rehabilitation, and cognitive retraining all work by stimulating adaptive neuroplasticity.

Evidence shows that early, intensive, and task-specific therapy leads to better outcomes. Even years after a stroke, neuroplasticity can still be reactivated through new learning, physical activity, and environmental enrichment.

To optimize results, therapy should be as soon as possible for:

Repetitive and purposeful (e.g., practicing meaningful movements rather than passive exercise);

Progressively challenging to continually drive new learning

Emotionally engaging, since motivation and positive reinforcement enhance plastic changes.

Multisensory, combining movement, vision, sound, and touch to activate broader neural networks

Not just physiotherapy, but even acupuncture has been shown to greatly enhance neuroplasticity and brain activity and has speed up the recovery of stroke patients. By stimulating nerve pathways, acupuncture is thought to help the brain to reorganize its neuroplasticity.

Acupuncture has been shown to activate specific brain regions. Functional MRI studies have shown that needling acupuncture points can activate corresponding zones in the brain. By targeting specific areas with scalp or body acupuncture, practitioners can stimulate and "reprogram" damaged neural connections.

Acupuncture also repairs neural circuits.  Electroacupuncture (acupuncture with a low-level electrical current) has been shown in animal studies to promote the regeneration of damaged axons in the corticospinal tract, the main pathway for motor function.

Acupuncture stimulates the brain and spinal cord, which prompts the release of neurotransmitters and hormones. These chemicals can reduce pain, boost the immune system, and regulate various bodily functions. It  improves cerebral circulation by dilating blood vessels, which improves blood flow and oxygen supply to the damaged brain tissue, a critical factor in stroke recovery.

Studies suggest acupuncture may promote the dynamic repair of the neurovascular unit, the intricate network of blood vessels and nerve cells in the brain, which is essential for restoring neurological function after a stroke.  Acupuncture has been shown to promote the growth and formation of new neurons (neurogenesis) and stimulate the proliferation of neural stem cells, which are crucial for the repair and regeneration of damaged nerve tissue.

 The process of forming new blood vessels (angiogenesis) is supported by acupuncture, further enhancing blood flow and nutrient delivery to the brain.

Acupuncture may help protect vulnerable neurons and reduce the generation of damaging free radicals, a common issue after a stroke. 

Acupuncture can influence how cells communicate with each other within the brain, contributing to overall neurorestoration and functional recovery. 

It improves swallowing function: For post-stroke dysphagia (swallowing difficulty), acupuncture may work by enhancing sensory and motor nerve conduction to the swallowing motor cortex in the brain.

Acupuncture has been shown to work very effectively  in many other disorders. 

There was a very close friend of mine whom we know each other since our college days who later became a Professor and Head of the Department of Psychological Medicine at the University Hospital of the University of Malaya. Later he became a Consultant Psychiatrist to WHO on mental health. He told me for years he had a chronic pain. He consulted numerous rheumatologists including his own colleagues at the University Hospital, and was treated with all sorts of anti-inflammatory drugs, steroids, analgesics for years - all in vain. His chronic pain persisted. He was never treated holistically except being prescribed all kinds of drugs by rheumatologists. 

Finally he went to Tung Shin Hospital in Kuala Lumpur to consult a Traditional Chinese Physician who after only a few sessions of acupuncture, his years of chronic pain just went away permanently. He told me it was so cheap too, at only RM 35 per session. He told me he was very disappointed and disgruntled at his own western-trained medicine being a psychiatrist and a doctor himself. 

 He was a very close friend of mine who would confide in me all his personal problems.

Acupuncture has been shown to work even for cerebrovascular accident  (CVA - stroke)  

In short: 

The human brain is not a static organ, it is a dynamic, living system capable of profound reorganization. CVA recovery is not merely about surviving; it is about retraining the brain to live again. Encouraging patients to use their limbs, relearn speech, and engage in meaningful activity gives the brain the stimulation it needs to rebuild itself. Wheelchair confinement should be a last resort, not the default.

Neuroplasticity reminds us that rehabilitation is not just physical, it is the science of hope translated into motion.

Selected References

1. Cramer SC, Sur M, Dobkin BH, et al. (2011). Harnessing neuroplasticity for clinical applications. Brain, 134(6), 1591–1609.

2.  Krakauer JW, Carmichael ST, Corbett D, Wittenberg GF. (2012). Getting neurorehabilitation right: What can be learned from animal models? Neurorehabilitation and Neural Repair, 26(8), 923–931.

3. Nudo RJ. (2013). Recovery after brain injury: Mechanisms and principles. Frontiers in Human Neuroscience, 7:887.

4. Kleim JA, Jones TA. (2008). Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage. Journal of Speech, Language, and Hearing Research, 51(1), S225–S239.

5. Winstein CJ, Stein J, Arena R, et al. (2016). Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 47:e98–e169.

6. Johansson BB. (2011). Current trends in stroke rehabilitation: A review with focus on brain plasticity. Acta Neurologica Scandinavica, 123(3), 147–159.