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Everyday Nutrition for Individuals with Spinal Cord Injury

April 12, 2011

A presentation by Vickeri Barton, RD, Associate Director of Nutrition Services at Harborview Medical Center and Susie Kim, OTR/L, Occupational Therapy Clinical Specialist at Harborview Medical Center. Click here to read the report.

 

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Report: Everyday Nutrition for Individuals with Spinal Cord Injury

 By Vickeri Barton, RD, CD, Registered Dietitian, Associate Director of Nutrition and Services, Harborview Medical Center and Susie Kim, OTR/L, Licensed Occupational Therapist, Harborview Medical Center .
Presented on April 11, 2011 at the University of Washington Medical Center.

Table of Contents

Why is nutrition important after a spinal cord injury? 

Nutrition is important for individuals with SCI both because of the increased risks of developing several specific medical complications as well as the physical challenges of shopping and meal preparation. Medical concerns include:

How much should you weigh after a spinal cord injury?

Spinal cord injury results in changes in body composition so there is a lower percentage of muscle tissue. For this reason, healthy weight guidelines for  the general public have to be adjusted for people with SCI. One common guideline is the Metropolitan Life Desirable Weight Tables. To apply this guideline to the SCI population, research evidence suggests that  individuals with paraplegia should weigh 5-10% less than the guidelines and those with tetraplegia, 10-15% less.

Body mass index

More  important than weight alone is how much fat you have on your body. Body Mass Index (BMI) is a measure of body fat based on a person’s height and weight and is now used more often than weight alone to determine if someone is obese or overweight. However, like general population weight charts, the general population BMI charts are not appropriate to assess body mass in persons with SCI due to their lower muscle mass.  Currently there is not an adjusted SCI BMI guidelines or chart available , Recent research suggests  that a BMI of 22 should be used to define obesity in persons with SCI while obesity in the general population is typically defined as a BMI over 30. [1]

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Calorie needs 

Persons with SCI have reduced metabolic activity due to denervated muscle and therefore need fewer calories than non-paralyzed individuals. General guidelines suggest that persons with paraplegia need about 28 calories per kilogram (kg) of your ideal body weight.  If you have tetraplegia, you need  about  23 calories per kg of ideal body weight (the weight you should be).  To determine your weight in kg, divide your weight in pounds by 2.2. For example, if you have tetraplegia and your ideal weight is 175 lbs., divide that number by 2.2, which equals 79 kg. Multiply 79 kg by 23 calories, and you get about 1,800 calories per day. These are only general guides, however, and do not account for differences in age, gender or activity levels. You will need to make adjustments based on your own experience with gaining or losing weight.  

Protein recommendations 

People with SCI have the same protein needs as the general population unless  there is a pressure sore present. Wound healing requires a big increase in protein consumption. If you do have a pressure sore, it is very important to get adequate protein in order to heal.  For most people it is hard to get enough protein unless they add a couple of high-protein snacks or meals to their daily diet.

See Short-Term Nutrition Therapy for People with Skin Breakdown (ADA).

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General guidelines for weight control

Physical Activity is Important

Evidence suggests that appropriate physical activity can improve blood lipid parameters and weight in persons with spinal cord injury. Try to be active in any way you can, whether it's wheelchair sports, swimming, electrical stimulation exercises, or simply going down to the local mall in the morning and wheeling up and down with the mall- walkers. 

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Factors associated with heart disease risk in SCI

Keeping your cholesterol  and other blood fats, waist circumference and C-Reactive Protein within normal parameters can help reduce your risk for heart disease.

Diet recommendations to decrease cholesterol:

See also Heart Healthy Eating (ADA).

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Bone health

Persons with SCI are at higher risk for osteoporosis (loss of bone density) due to lack of weight bearing on lower limbs. Decreased bone density increases the risk for fractures. Recommendations:

See also Osteoporosis Nutrition Therapy (ADA)

Neurogenic bowel 

Neurogenic bladder

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Nutrition Supplements

You don't need any additional supplements unless you have a deficiency that has been documented by a blood test. If your results are normal and you're eating a good diet with a variety of foods, you don’t need any supplements. In spite of this, many people take supplements anyway. Learn about the safety and effectiveness of different supplements at the National Institutes of Health Office of Dietary Supplements ( http://ods.od.nih.gov/) or the Natural Medicines Comprehensive Database  (http://naturaldatabase.therapeuticresearch.com/). See also Dietary Supplements: What You Need to Know (NIH).

Steps toward healthier eating

Having the right nutrition information is the first step toward healthy eating, but changing your eating habits can be difficult.  Convenience, access, cost, preparation and taste preferences are all factors in how and what we eat. Healthier eating may take some adjustment, but it can be done, and it doesn’t have to cost more. Try to make changes gradually.

Plan ahead

Deciding what to buy before going shopping is the best way to save time and money and make healthy choices.  This means planning your meals ahead of time and making a shopping list based on those meals.

Recipes

It’s easy to find recipes on the Internet that are healthy and appealing for all kinds of palates and appetites. If you’re new to cooking, start with simple recipes. There are numerous online recipe indexes (allrecipes.com, foodnetwork.com) that can be searched by ingredients, convenience (quick-and-easy, make-ahead), diet (low-fat, vegetarian, low-sodium, diabetic), cuisine (Italian, Mexican), cooking method, occasion, season  and so on. A Google search with the word “recipe” in it will bring up many choices. (Also see Resources section, below.)

Where to buy

Grocery stores
Most of the larger stores provide assistance if you need it.  They'll send a shopper around with you to grab things off the shelf.  They take both cash and debit/credit cards as well as coupons.

Try to purchase only what you can carry. That way you don't end up over-purchasing and having to throw things out that go bad at the end of the week. Carrying bags or baskets of various sizes, shapes and materials can help you get your groceries home. Some carriers can hook on your wheelchair handles, others can be carried on luggage riggers in front.  Insulated bags are also available for transporting frozen items that need to survive a long bus ride home. Search for “collapsible grocery tote” on Amazon.com for several different options.

Online groceries delivered to you
What could be more convenient than shopping for your groceries online and having them delivered to your door? Online grocery shopping is a growing industry. Amazon Fresh  (http://fresh.amazon.com/) delivers to several zip codes in the Seattle area. Safeway (http://shop.safeway.com/)  is another program with wider geographic coverage. A Google search can help you find local online grocers in your area.

Farms and co-ops
Local farms and food co-ops are also getting into the online ordering business, making deliveries either to your door or a neighborhood pickup location. They often specialize in local, organic produce, meats, cheeses, fish, and baked goods, as well as sustainably produced packaged goods such as coffee and chocolate.

Farmers’ markets
Many towns and cities have regular farmers markets where you can buy local, fresh produce and other farm products. Farmers’ markets are colorful social events, and one of the great benefits is the opportunity to get to know the farmers.     

Gardens 
Growing your own food is fun and cheap. If you have yard space, raised beds can be built that are accessible for wheelchair users. Many people grow vegetables and herbs in pots on their deck or patio, and these can be positioned on tables or benches that are easy to reach. Community gardens, called “P-Patches” in Seattle, are available for use by residents of many cities. Some programs offer elevated planting beds for gardeners with disabilities and paved pathways for wheelchair accessibility.

Eating out
Eating out (or buying takeout) is undeniably convenient,  but it’s also the most expensive and  least healthy way to eat. Restaurant portions are much larger than we need, so we tend to overeat when we go out. Restaurant food, especially the fast-food variety, is notoriously high in fat, calories and sodium. In the past we could pretend we didn’t know how many calories we were consuming at restaurants, but now we don’t have that excuse. Many restaurants now post their nutritional information on site, and you can find nutritional content of foods from hundreds of chain restaurants at http://www.dietfacts.com/fastfood.asp.  Smart phone apps can tell you instantly how many calories are in the meal you are about to order.  Restaurant Nutrition provides nutrition information about many restaurant meals. Lose-It is a weight-loss app that helps you track calories and exercise and provides information about most foods as well as many restaurant meals. Being aware of what you’re eating can help you make healthier choices.

Food preparation

Tools and resources for making things easier:

Cookbooks

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Resources

 

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References

Laughton GE, Buchholz AC, Martin Ginis KA (2009). Lowering body mass index cutoffs better identifies obese persons with spinal cord injury. Spinal Cord. Oct;47(10):757-62.

Gibson AE, Buchholz AC, Martin Ginis KA (2008). C-Reactive protein in adults with chronic spinal cord injury: increased chronic inflammation in tetraplegia vs paraplegia. Spinal Cord. Sep;46(9):616-21

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