NUTRITION

INTRODUCTION

How nutrition affects the human body

We love food and drink for their tastes and effects, and the sense of satisfaction after a good meal. However, diet also plays an essential, everyday role to our health. Food and fluid is broken down in the body into energy and nutrients (building blocks such as calcium or protein), or stored as fat to keep us warm or protect vital organs. The amount of energy your body needs is related to the amount of energy burned, mainly by the muscles.

Energy Balance and nutrition. © LivingWithSCI.ca

Some foods and fluids also play an important role in helping maintain other body processes. Fibre helps move broken down food waste through our small and large bowel until it is eliminated.  Water is absorbed from food or fluids and used throughout the body to lubricate, manage fluid balance and body temperature, and keep the bowel moving regularly.

For good health and wellbeing, it is important that the food and drink we enjoy meet our daily needs for energy, water and fibre, as well as provide us with nutrients and protein that our body needs to keep skin, bones, and other organs strong.

Maintaining health through diet (food and fluids) is a balance between energy and nutrient input, and energy output. You can imagine it as a scale with the amount of energy you take in through food in a day on one side, and the amount of energy you burn in the same day on the other. If energy consumed through diet is much higher than the energy burned through activity, that excess energy is stored as fat. Therefore, maintaining a healthy weight is about a balance of intake and output.

WHAT’S DIFFERENT NOW?

After a spinal cord injury, some of your body’s needs for energy and building blocks change. For example, after SCI some of your body’s largest energy-burning muscles are inactive due to paralysis, and therefore your body needs less energy each day.

Other muscles, including those that move food through the gut, are also affected by spinal cord injury, and move more slowly and inefficiently. This means food takes longer to transit through your gastrointestinal system and be eliminated than before your injury. You will need to rely much more on fluid intake and dietary fibre to keep your bowel moving as regularly as possible. (Read more about this in the Bowel Management chapter.)

Some complications of SCI, including pressure ulcers and loss of bone density, require specific changes to the diet in order to prevent or address these complications. Ultimately your diet and nutrition intake needs change after injury and it can take time to establish a new routine and learn what your body needs from your diet post-injury. It is helpful to consult a dietitian experienced in SCI and speak to your physiatrist about how you should change your diet to give your body what it needs.

WHAT CAN I DO?

Weight Management

Achieving or maintaining a healthy body weight lowers your risk for chronic diseases such as diabetes and heart disease. After SCI, you need fewer calories every day than you did before. Focusing on eating healthy, balanced meals can help you to maintain your weight without needing to count calories. The Healthy Plate and Healthy Bowl (Chinese version) are two tools you may find helpful in planning your meals.

The Healthy Plate and Healthy Bowl guides to meal planning. © Vancouver Coastal Health.

In addition, it is important to pay attention to the portions of food you are eating. Instead of measuring out each ingredient you are using or food you are eating, estimating portion sizes with your hands can be useful:

You can also check out Health Canada’s Food Guide on portion sizes or a full handy guide to serving sizes.

Some other tips to help with weight management include:

• Eat three meals a day – skipping meals can lead to overeating at the next meal.
• Hydrate with water – skip the sugar-sweetened beverages.
• Eat slowly to avoid overeating – take the time to savour and enjoy your food.

Energy Balance

Part of maintaining a healthy weight and many other benefits is being active throughout your day and week and getting regular moderate to vigorous physical activity, and regular activity that builds and maintains strength. In addition to helping maintain a healthy weight, exercise helps with pain, can improve bowel management by preventing constipation, decreases spasticity and can really help with your mental wellbeing.

While there is a common assumption that disabled people can’t or shouldn’t exercise, it’s important enough that there are well researched guidelines on physical activity after SCI. It’s not always easy to figure out how to get regular physical activity after spinal cord injury, but there are many great resources available to help you, including these tips for becoming active.

Fluid & Fibre

Both fluid and dietary fibre play key roles in keeping your bowel movements regular. Fibre is the components of plants that our bodies are unable to digest. It is found in foods such as fruits, vegetables, whole grains, and legumes. There are two different types of dietary fibre: soluble and insoluble fibre.

• Insoluble fibre is the fibre that provides “bulk” to stool, and helps to prevent or alleviate constipation. Foods rich in insoluble fibre include whole grains, wheat bran, nuts and seeds, fruits, leafy greens, and other vegetables.
• Soluble fibre on the other hand can help with managing loose stools, or diarrhea. It has additional benefits as it can reduce cholesterol levels, and can help control blood sugar for those with diabetes. Foods rich in soluble fibre include barley, oats, beans, lentils, and certain vegetables and fruits, such as apples, oranges, okra, and eggplant.

We do not yet know how much daily fibre to recommend for people with SCI. Guidelines recommend an initial intake of 15 grams per day, with a gradual increase up to 20-30 grams per day until bowel movements are regular. In some individuals with SCI, higher fibre intakes are not well tolerated, and may increase the amount of time between bowel movements. If this occurs, fibre intake should be reduced. It is very important that fibre and fibre supplements be consumed with plenty of water! 

Fluid is equally important in promoting regular bowel movements, and helps keep you hydrated. Drinking enough fluid helps to keep stool soft and easier to pass. It is recommended that you consume at least 1.5 L of fluid everyday, however this may vary depending on your bladder routine.

Read more about fluid and fibre in the Bowel Management and Bladder Management chapters of LivingWithSCI.ca.

Wound Prevention

People with SCI are at higher risk for developing pressure injuries. Pressure injuries are injuries to the skin and its underlying tissue, and are often caused by prolonged or constant pressure on an area of the body.  Poor nutrition and dehydration are both risk factors for pressure injury development, since proper diet and drinking enough fluid helps to keep skin healthy. Read more on skin health and pressure injuries after SCI in the Skin Health chapter of this resource.

A diet that provides adequate amounts of calories, protein, vitamins, and minerals helps prevent pressure injuries. Eating three meals a day and always including a good source of protein at your meals can help you to get enough calories and protein throughout the day. Foods rich in protein include animal products such as meat, poultry, fish, eggs, milk, cheese, and yogurt, and also some plant foods such as tofu, beans, lentils, nuts, seeds, and soy beverages.

The vitamins and minerals most important in the prevention of pressure injuries are vitamin C, vitamin E, vitamin A, and zinc. A well-balanced diet rich in fruits, vegetables, and whole and fortified grain products will provide adequate amounts of these nutrients to help prevent the start of a pressure injury.

If you do develop a pressure injury maintaining a proper diet will be very important in your healing.  Taking in enough protein and fluid will help your body to repair.  Speak to a dietitian if you have a pressure injury to ensure that you are eating and drinking well.

Catch up on skin health and preventing pressure injuries after SCI in the Skin Health chapter of this resource.

Bone Health

Good nutrition is important in maintaining healthy bones. People with SCI are at a higher risk of developing osteoporosis, a condition  leading to low bone mass  leading to a higher risk of bone fractures. Getting enough calcium and vitamin D in your diet can help prevent osteoporosis: calcium keeps your bones strong, and vitamin D aids in calcium absorption.

The recommended amount of calcium to consume daily is as follows:

Adult Calcium Intake Recommendations. © Dietitians of Canada.

These are the recommended amounts for the general population. There is currently no evidence to suggest that people with SCI need a different amount of calcium. It is recommended that you meet your calcium needs through food sources, however if you are unable to consume enough calcium through your diet alone, your doctor or dietitian may recommend a calcium supplement. Foods rich in calcium include milk and dairy products, and fortified milk alternatives such as soy beverage. Smaller amounts of calcium are also found in tofu, nuts, dark leafy greens, and bony fish, such as salmon.

Vitamin D is found in fortified foods such as milk, and your body can also make vitamin D from sunlight, and your body can also use sunlight to make its own vitamin D. However, many Canadians are unable to get enough vitamin D from food and sunlight alone. Health Canada recommends that all adults over the age of 50 take a vitamin D supplement of 400 IU daily.

SELF MANAGEMENT AND PROBLEM SOLVING

Managing other complications of SCI through diet

Gas and flatulence: Because the movement of food through the gastrointestinal system is slower after SCI, and many individuals lose the ability to manage gas voluntarily as they did before, gas can become a source of some embarrassment or discomfort. You can manage gas through diet by reducing the gas-producing foods you eat, and by having a regular bowel routine.

• Reducing gas-causing foods in your diet – particularly beans, broccoli, cabbage, etc. Gas forms when bacteria in the gut and in the food we eat release gas as a byproduct of breaking down foods, particularly more fibrous foods like beans. Gas is more likely to form when food waste in the gut (called stool) takes longer to move through the gut (as is the case after SCI).
• Drinking enough water each day helps your gut move stool along as fast as is possible after SCI, giving less time for gas to form.

Dehydration: Water has so many important roles in being healthy after SCI. Those with injuries above T6 may have impaired autonomic function, and their bodies have trouble regulating internal temperature and do not sweat to cool the body by evaporation. Keep a spray bottle of water around to use in hot temperatures to artificially help the body cool via evaporation.

WHO CAN HELP ME?

CONCLUSION

A spinal cord injury can cause changes to the way your digestive system works.  SCI can also lead to other health problems like bowel issues, pressure sores and weak bones. Making the right food and beverage choices can help you stay healthy and prevent complications.

RESOURCES

• Nutrition & SCI (GF Strong Team) – “Cheat sheet” of nutrition, meal planning, and how it relates to SCI
• EatWell LiveWell with SCI – An excellent guide to help manage secondary complications after SCI through nutrition. Available online or by order.
• SCI Exercise Guidelines – A guideline with recommendations regarding the amount of physical activity required after SCI.
• SCI BC’s Nutrition & Recipes – Try out a recipe from one of SCI BC’s adapted cooking classes, each aimed at foods that improve health or wellbeing living with SCI.
• What you Need to Know about Vitamin D – UnlockFood.ca Dieticians of Canada