Good nutrition helps keep you in good health. If you have a spinal cord injury eating well is even more important, as it can help your body resist infection and maintain good skin, bladder and bowel habits. Healthy eating after your spinal cord injury Eating a healthy diet helps you to feel your best by:
- encouraging regular bowel habits
- keeping your weight within a healthy range
- helping your body fight infection
- keeping your skin in top condition
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.
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.
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.
- Individuals with SCI who do not have pressure ulcers need the same amount of protein as persons without SCI: 0.8 to 1.0 grams per kg of body weight per day.
- Individuals with Stage II pressure ulcers: 1.2g to 1.5g of protein per kg body weight per day.
- Individuals with Stage III and IV pressure ulcers: 1.5g to 2.0g of protein per kg body weight per day.
General guidelines for weight control
- Allow plenty of time to plan and shop for your meals. Waiting until the last minute or when you’re really hungry often results in overeating or choosing faster, less healthful meals. Thinking ahead and planning what you’re going to prepare and eat is called “mindful eating” and helps maintain weight control.
- Don’t skip meals; this leads to snacking and overeating later.
- Eat routinely, two or three meals a day. It’s better to spread out your food consumption throughout the day to control your appetite.
- Watch those portion sizes! Everything is oversized today, from the average dinner plate to the size of a meal in a restaurant. Portions in restaurant meals are often the equivalent of three meals! One serving of meat should only be three ounces, or about the size of a deck of cards. One cup of starch like rice or potato is a little smaller than your fist.
- Divide up your plate: half of it should be vegetables; a quarter of it should be meat or other protein; and about a quarter of it should be a starch or grain like rice or potato.
- Eat a variety of protein, grains, fruits and vegetables.
- Choose low fat, high fiber foods.
- Read nutrition labels closely. One of the most important things to learn from the nutrition label is how many servings are in a package, because the calories and other ingredients are given per serving. This is easy to miss. Check that tiny, 2-oz bag of potato chips and you may be surprised to find that it contains two servings, at 140 calories per serving or 280 calories per bag. Foods labeled “high fiber,” “whole grain” or even “low-fat” can still be very high in calories, so check the nutrition label carefully.
- Watch your beverage calories. It’s very easy to use up a large chunk of your daily calorie allotment in beverages. If your caffeine habit involves a six-pack of Mountain Dew a day, that’s 900 calories or 50% or more of your daily calorie needs. Water is the preferred beverage, but if you can’t live without soda pop, switch to the “diet” version.
- Weigh yourself as often as possible. It’s hard to find a place to get yourself weighed routinely, but it’s important to know if you are gaining or losing weight. If you’re just getting weighed once a year during your annual visit, you don’t get the feedback you need about whether you are eating too much.
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.
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.
Blood fats (lipids) goals:
- Total Cholesterol – less than 200 mg/dl
- Triglycerides – less than 150 mg/dl
- LDL (the “bad” cholesterol)– less than 130 mg/dl
- HDL (the “good” cholesterol)– more than 40mg/dl (Note, HDL is often lower than desired in persons with SCI due to decreased activity, and it is difficult to improve.)
- C-Reactive Protein (CRP) is created when there’s some kind of stress or inflammation going on in your body. Over the years elevated CRP has been associated with risk for heart disease. However, CRP can be elevated if you have a UTI or pressure sore, so it doesn’t always mean an increased heart disease risk. Guidelines for CRP and heart disease risk are:
- 1.0 mg/L and below = low risk
- Between 1.0 and 3.0 mg/>; = average risk
- 3.0 mg/> and higher = high risk
If you have elevated CRP, discuss with your physician or provider. CRP is not influenced by your diet or food intake.
Diet recommendations to decrease cholesterol:
- Limit total fat intake, especially saturated and trans fats.
- Use low fat cooking methods.
- Choose low fat dairy products
- Stop smoking.
- Be as active as possible.
Choose fish more often. Aim for a healthy weight.
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: DEXA scan (imaging technique) is recommended for assessment of bone density. Get adequate calcium in your diet:
- Adults 19-50 years: 1000 mg/day
- Adults >51 years: 1200 mg/day
- The best sources are in the diet (dairy products; dark, leafy green vegetables; tofu; canned salmon; calcium-fortified orange juice) rather than from supplements.
- Use supplements if you can’t get adequate calcium in your diet. Tums antacids are a good, inexpensive source of calcium. Calcium supplements may cause constipation.
- Get adequate Vitamin D: adults and Children over 1 years of age need 600 IU/day .
- Be active.
- Limit caffeine.
- Stop smoking.
- Medications such as Fosamax may be prescribed by your doctor.
- Practice good fall prevention: learn how to avoid falling from your wheelchair, bed and other places!
- Eat regular meals, spaced throughout day.
- Drink adequate fluids: 40 ml per kg body weight plus 500 ml, or at least 1.5 liters per day.
- Eat 15 – 20 grams of fiber per day (less than the recommended amount for the general population)
- Drink adequate fluids.
- While there is some evidence that drinking three cups of cranberry juice a day may be helpful in preventing urinary tract infections (UTIs), regular cranberry juice has a lot of calories from sugar; unsweetened cranberry juice is preferred.
- Although cranberry tablets have not been found in studies to be effective for preventing UTI, some individuals report benefits, so it may be worth a try.
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/).
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