Month: April 2017

  • By Dr. Kyle Vollmer, PT, DPT

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    First let me start by making sure it is known that I am not a registered dietitian and am in no way impersonating one. I hope to simply provide some facts from research and current recommendations on improving nutrition for patients with spinal cord injuries. I strongly recommend that any patient in this population who continues to struggle with adequate nutrition profiles seek the help and assistance of a registered dietitian for patient specific goals and adaptations.

    So why is nutrition such a vital component of spinal cord injury rehabilitation and lifestyle? The benefits that can be gained from adequate nutrition promote general health and improvements in function. These benefits include, but are not limited to: improvement in bowel and bladder management with decreased symptoms of neurogenic bladder, decreased likelihood of UTI, improved management of weight, potential prevention for wounds, combat of co-morbid factors such as Diabetes Mellitus Type II and heart disease, and improve bone health.

    Recommendations are currently pointing to a variety of normative numbers to maintain digestive and bone health, as well as specific nutritional intake numbers for general health. Currently, approximately 15-30g of fiber is recommended daily with 1.5L of water. This is ideal for promoting proper digestive health, however is a normative value and stool presentation should be monitored and these numbers adjusted accordingly based on looseness or hardness of stool. In order to maintain proper urinary health as well, 250mL (equivalent to approximately 8 ounces or 1 cup) of unsweetened cranberry juice is recommended daily while maintaining an active physical level. It is also generally recommended to maintain 3 meals throughout each day. Bone health recommendations follow guidelines based on Vitamin D and calcium, and it is currently suggested that Vitamin D supplements are needed or sunlight exposure to arms and legs of approximately 10-15 minutes daily and a calcium intake of approximately 1000-1200 mg/day.

    ​Then how many calories? Current guidelines on caloric intake are based on a person’s ideal body weight (IBW). This ideal weight is calculated based on height, frame, and injury level but is generally assumed to be based off of a non-injured individual of similar build. This recommendation is considered that paraplegic patients should be approximately 5-10% less weight and tetraplegic patients should be approximately 10-15% less weight than able-bodied individuals of similar build. Based on this data, paraplegic patients should be consuming approximately 28 calories per kilogram of IBW and tetraplegic patients should consume approximately 23 calories per kilogram of IBW. Within this recommendation, it is also suggested that protein intake should be between 0.8 and 1.0 gram per kilogram of IBW. This suggestion for protein intake is when there is NO presence of pressure ulcers. Should pressure ulcers be present, this intake should be adjusted to 1.2-1.5 grams per kilogram of IBW for Stage II ulcers and 1.5-2.5 grams per kilogram of IBW for Stage III/IV pressure ulcers in order to assist in healing and metabolic demands.


    Additional Resources

    References
    Broad E. Sports Nutrition for Athletes With Disabilities. International Sportmed Journal [serial online]. January 2001;2(1):1.

    Griffin L, Decker M, Hwang J, Wang B, Kitchen K, Ding Z, et al. Functional electrical stimulation cycling improves body composition, metabolic and neural factors in persons with spinal cord injury. J Electromyogr Kinesiol. 2009;19(4):614-22.

    Levine, AM, Nash, MS, Green, BA, Shea, JD, Aronica, MJ. An examination of dietary intakes and nutritional status of chronic healthy spinal cord injured individuals. Paraplegia. 1992;30:880-889.

    Monroe MB et al. Lower daily energy expenditure as measured by a respiratory chamber in subjects with spinal cord injury compared with control subjects. Am J Clin Nutr 1998; 68: 1223-1227.

    ​Chen H, Hsu P, Tzaan W, Lee A. Effects of the combined administration of vitamins C and E on the oxidative stress status and programmed cell death pathways after experimental spinal cord injury. Spinal Cord [serial online]. January 2014; 52(1):24-28. ​