SCI Conditions Improved by Nutrition

SCI Conditions Improved by Nutrition

Posted by AskNurseLinda on Dec 23, 2018 3:41 pm

After spinal cord injury the nutritional needs of your body might change. Lack of activity can lead to weight gain as well as eating out of boredom. There are some secondary conditions that might develop that will change your nutritional needs. These might include dietary changes to accommodate a slow-moving bowel, pressure injury, diabetes and bone density.

After spinal cord injury, the bowel tends to work more slowly. The cause could be from the spinal cord injury itself as well as due to lack of activity. In fact, lack of activity due to a sedentary lifestyle will slow the bowel with or without a spinal cord injury from disease or trauma. Add in some needed medications with constipating side effects and the bowel slows even more. That is a lot to be up against for bowel functioning.

Movement will help the muscles function more efficiently. Moving your legs cause a chain reaction of movement to the abdominal muscles as they all work together. If you can, move your lower body. Actively move the body parts that you can and physically move your legs and other body parts with your arms where you cannot. If you are challenged in moving your lower body use passive movement, part by part, by having someone else move your extremities for you.

After spinal cord injury or other paralysis, your body is capable of movement but the signal to do so is not getting through. The fact that your body is capable of movement, is something many do not consider. Take a moment to think about this. Often people stop thinking about their body moving. They just think about the fact that it doesn’t.  Once you consider body movement from the aspect that it still works, but not under the command of your brain, the idea of physically moving your body becomes more important. You need to move, but now in a different way. Manually moving your body will create the activity your body craves.

A diet change with added roughage will give the bowel the ability to push food through.  It is easier for the bowel to move food along in digestion when bulk is present as opposed to watery, smooth, highly processed foods. Roughage is easier to move that smooth liquid. For some individuals, a little fruit, nuts or beans will help the bowel function. However, be careful in management of your bowel with these foods. A little can help, a lot is diarrhea. Sometimes, you can eat fruit at every meal without consequences and then for no reason, the diarrhea appears.  Moderation is the key.

If you find you need additional roughage, you can add a bulk former. These are usually marketed as bulk forming laxatives because they do cause the bowel to work but not as quickly or harshly as quick acting laxatives. They come in a variety of flavors including no flavor at all. You can choose to drink them or eat them as a cookie or even to swallow as a pill. There are so many choices that you will find one method that works for you. If you get weary of one way to take the fiber, you can change formulations.

Gravity is a third factor in evacuating the bowel.  People generally sit when they have a bowel movement. This is because it is the best way to empty the bowel.  Often individuals stop using the toilet and have a bowel movement in bed. If you must do this because of your medical condition, evacuation will work physiologically when on your left side. However, if possible, try sitting on a toilet or commode. Gravity will assist in bringing stool out of your body. If you have not tried sitting, work with your home health professional or healthcare professional to obtain the proper equipment, technique and ability. You might need some help in getting this process started to avoid complications such as hemorrhoids, pressure injury or other issues.

Pressure injury is another secondary complication of spinal cord injury. The best treatment for pressure injury is to ensure you do not get one in the first place. When you do not move your body, a sore can develop from the inside of your body. The pressure injury will be more developed inside your body by the time you see a change on the surface of the skin. Typically, this sore will develop over a part of your body that has a pointy end. This is called a boney prominence.

There are many of these danger areas within your body. When on your back areas include the back of the head, shoulders, each vertebra of the spine, sacrum (top of the butt fold), and heals. On your side boney prominences are cartilage of the ear, shoulders, elbows, wrists, knuckles and finger joints, the side of the knee, and ankles. When on your stomach areas include forehead, nose and chin, ribs, top of the hip bone called the iliac crest, and knees. If you wear splints, pressure can develop where the straps cross your body or if the splint rubs anywhere.

Pressure injury can take a long time to heal. Increasing protein in your diet can help heal pressure injuries. Adding 1-1.5grams of protein per kilogram of weight per day is the typical formula for protein consumption when a pressure injury is present. You will need to check with your healthcare professional for your individual need of protein addition to your diet. Children and the elderly will have slightly different protein needs. Depending on your personal health condition, adjusting protein at the recommended rate not be beneficial to you.

Individuals who are at a higher risk for pressure injury such as those who are underweight or overweight might need to add protein to their diet. You may need to monitor your overall caloric intake. Being under or overweight are both risk factors for pressure injury but in different ways. Pressure is dispersed when muscle is full and present. Underweight individuals have less muscle mass which creates more pressure. Overweight individuals have more fat over their boney areas which causes constriction of blood flow creating more pressure. Protein builds muscle which will help disperse pressure.

Protein is helpful for building muscle but other protections against pressure injury should be used as well. Turning yourself in bed and performing pressure releases is essential. Inspect your skin over your entire body to look for the slightest areas of redness in light pigmented individuals and dark or ashy areas in dark pigmented individuals. Occasionally, you might not see skin color change, but you might feel warmth, especially over boney prominences. Also, do not forget that pressure injury can occur when manual pressure in applied such as where a splint strap is place or where equipment, clothes or shoes may rub when performing activity. Increased pressure is added when areas are rubbed or messaged.

The risk of diabetes is higher in individuals with spinal cord injury. It is also true for people who have sedentary lifestyles who do not have spinal cord injury. Diabetes Type I is usually diagnosed in childhood. Diabetes Type II is typically developed as an adult. Type II is more commonly developed in individuals with spinal cord injury. This is because of lack of movement especially in the long muscles in the thighs.

You might be suspicious of diabetes if you often feel thirsty. Frequent urination is another symptom, but this is hard to assess if you are performing intermittent catheterization. Other symptoms include a sore or pressure injury that is difficult to heal, dehydration, increased appetite and weight gain. Age and family history of diabetes are risk factors that are you cannot control. Many of these symptoms will be difficult to spot with a spinal cord injury. A laboratory test ordered by your healthcare profession will provide a definitive diagnosis.
Diet plays a key role in developing and treating diabetes. Challenging your pancreas with sugars and carbohydrates increases your risk of diabetes. This is one of the reasons why eating a well-balanced diet containing a variety of foods is important. There is also evidence that a sluggish bowel can affect the absorption of food affecting diabetes risk.

If you have developed diabetes but even before, carefully monitor your diet to make sure it is well balanced and does not contain an abundance of sweets and carbohydrates. Carbohydrates are complicated sugars. You do need some carbohydrates to keep your body effectively functioning but just a small amount.

The best plan is to try to prevent the development of diabetes. You can do this by maintaining a healthy diet and adding activity to your life. Use your yearly nutritional consult provided by most payors to help develop a plan before diabetes develops. There are also helpful websites that can guide your diet. Some dietary trackers will calculate the amount of calories, sugar, carbohydrate, protein and fiber in the foods you eat. Stick with a well-developed nutritional website such as MyPlate. As indicated above, add activity to your life. Start slow but aim for at least 20-30 minutes per day. Don’t expect this level right away. Work up to a daily routine. Add fiber to your diet or through bulk formers to help process food through your bowel.

Another diet affected secondary complication of spinal cord injury is bone density. When weight is not placed on the bones, they tend to lose calcium which develops osteopenia or osteoporosis. Osteopenia is an early development of osteoporosis. This is condition where the bones develop small tunnels within the bone. When enough damage has occurred, the bones become brittle and break easily. Most people think of osteoporosis developing with older women, but it can be seen in people with sedentary lifestyles as well.

Your bone density can be evaluated by a test called a bone density scan. This is a fairly simple procedure where you lay on a padded exam table while a wand goes over the top of your body. The density of the wrist bone, lumbar vertebrae and hip is measured against national norms. It is important that you have this test once per year, so the density of your bones can be evaluated and, if needed, be corrected, before any significant problems arise.

Calcium builds bones. However, calcium should be taken only with the recommendation of your healthcare provider. For some people taking to much calcium can lead to other issues from electrolyte imbalance to kidney stones. Calcium does not need to be taken if your diet includes a moderation of dairy or salmon and sardines, seeds and some vegetables. Do not over react to the need for additional calcium unless you are instructed to do so. There are also medications that can be taken for severe calcium loss.

Vitamin D activates calcium absorption. It is also easily obtained from a healthy diet by eating the same foods that contain calcium. Vitamin D has a variety of benefits including cancer prevention. If you want to improve your Vitamin D on your own, sit in the sun for 10-15 minutes per day. Your body can make its own Vitamin D just by doing this. If your Vitamin D is low, you might need supplements. You can take Vitamin D supplements if your healthcare provider indicates this would be to your benefit. Taking extra amounts of some vitamins will not harm your body as any extra is removed automatically by the body through urine. However, Vitamins, A, D, E and K are stored in your body and are not removed in urine. These vitamins will collect and build to toxic levels if too much is taken.

Standing can help put weight through the long bones of your body which will make your bones stronger. If you can obtain a standing frame with gliders to use your arms to reciprocally move your legs, you will also add activity to your effort. Standing frames can typically be obtained with insurance or Medicaid funding for individuals with spinal cord injury. You must have a normal bone density to begin this therapy. Therapy to learn to use the equipment and prepare your body for standing as well as learning how to check for pressure injury due to the newly created pressure areas to your skin will be necessary.

As you can see a balanced diet and activity are the keys to maintaining health for these secondary complications of spinal cord injury.  These two items are a theme throughout. Modifying your lifestyle to include a healthy diet and activity will improve or delay the onset of these complications and keep you body in the best shape. The effects are beneficial whenever you begin, even if you have one or some of these complications. It is never too late to start. Nurse Linda

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