Immediately after injury, food intake declines as a result of physical and emotional trauma (pain, facial injury, Depression, stress, etc.). This decrease takes place at the same time that calorie needs are increasing due to healing. Nutritional status varies from one person to another, as does the extent of injury. Loss of weight and protein can occur quickly during the first month, as the body may not be able to keep up with the demands of healing. Protein deficiency can make it hard for the body to resist infection and to mend properly. Also, lack of sufficient weight indicates poor nutrient reserves which in turn may make it difficult to fight infections. Poor nutrient reserves also may result in and skin or gastrointestinal complications following injury. Dietary adjustments can be made, including alternative feeding methods to help improve/assure diet adequacy.
By one or two months post injury, weight and protein loss may be reversed as the appetite usually returns and food intake increases. As more time goes by however, with lack of use of certain muscles, permanent changes in muscle mass may take place, especially for patients with high spinal cord lesions. Muscle may be replaced with fat, water and connective tissue. That is, the body has less lean mass or muscle and more fat. Such changes in body composition result in lower energy needs since muscle uses energy and nutrients for maintenance. Since muscle is compact and heavier than non-muscle mass, a person with a SCI will look and feel heavier if he returns to his pre-injured weight. While level of injury, activity level and pre-injury weight will influence these figures, one's ideal weight may be 10-20 pounds lower after injury. An imbalance in calories consumed and those burned off will be revealed in changes in body size.
Weight gain comes not only with metabolic changes but also with return of appetite and old eating habits. Excess weight gain poses problems. Skin Breakdown is a concern since healthy skin must have good circulation which fat tissue lacks. If skin breakdown occurs in fatty tissues, healing is a greater concern. Additionally, self-help skills, mobility and even respiratory function can be impaired with obesity. Heart disease, stroke, and diabetes are also among health risks associated with being overweight.
General goals of stable long-term SCI patients are outlined below. A more individualized and complete diet plan may be developed with the assistance of a registered dietitian.
Intake of Calories should be moderate and be derived from nutrient dense foods.
Protein needs vary. Ample amounts are needed to maintain skin integrity and overall health, however excess protein can increase calcium loss from bones, contribute to obesity and overtax the kidneys. An amount of protein that meets at least the Recommended Daily Allowances (RDA) is suggested and the highest biological value protein is emphasized. Chief sources include meat, dairy, egg whites, and lentils/legumes.
Complex carbohydrates or high fiber foods may be encouraged to prevent constipation, which can result from decreased trunk muscle tone and activity. The fiber is typically not absorbed by the body and so must pass out as waste, thus promoting regular bowel function and often minimizing the need for stool softeners, and laxatives. Ample fluid for absorption by the fiber is recommended to ensure that soft, easy-to-pass stools are formed. Some of the best fiber sources are dried beans, whole grain cereals and breads, and wholesome fruits and vegetables. Because high fiber foods are low in calories and are filling, they are often a part of weight control diet, as well.
Fat is limited for weight control and general health considerations. Fat has over twice as many calories as do carbohydrates and protein. It is hidden in many foods and label reading is advised to help make wise food choices. Some low fat food choices include baked/broiled meat, skim milk, low fat cheeses and low fat salad dressings. Avoidance of fried foods, snacks such as chips, extra servings of margarine or butter, and gravies, and minimizing desserts and fatty fast food items is advised.
Vitamin and mineral requirements are usually the same as for other healthy individuals. Skin breakdown and certain other issues may increase requirements and should be handled on an individual basis. While a one-a-day type supplement may be a good idea when the diet is not well balanced, it is wise to seek the advice of a dietitian or physician before starting any supplement program.
Fluid requirements typically are 2-3 quarts daily to assure that the urinary tract is flushed and urine diluted. In this way, UTIs may best be prevented. Plain water is a healthy way to get fluid, noting that caffeine in coffee, tea and some carbonated beverages has diuretic properties (tends to increase the flow of urine), and extra calories in some drinks can be problematic. Although large quantities of cranberry juice are sometimes advised to prevent and treat UTIs, no specific studies have proven the benefits of this treatment, and the calories contributed by large amounts of any juice on a regular basis can be excessive.
Conclusion
While food should be enjoyed, it is also important to remember that food is "more than just something to eat." The actual foods consumed can have an impact on how a person functions and the level of health that can be attained. Additionally, exercise has many faces and should be streamlined to meet the personal needs of the individual.
The ingredients for a healthy lifestyle after SCI include a well-balanced diet and a flexible exercise program. It can be fun; it can help a person be more Functional, active and independent. But it still is a choice. What choice will you make?
