Nutrition – individual and relevant to everyday life

The aim of a healthy diet is not only to ensure you get the nutrients you need, but also to provide delicious food that you enjoy eating and that improves your quality of life.

During the different rehabilitation and life phases of people with a spinal cord injury, it is important to avoid nutritional deficiencies and the associated complications. As dietary requirements are individual and may vary over the course of rehabilitation or due to a complication, the supply of nutrients must also be adapted on a case-by-case basis.

Malnutrition

This is caused by an excessively low intake of nutrients. Your body is lacking certain nutrients. Obese people can also be malnourished, e.g. in terms of a specific nutritional deficiency (frequently: protein, minerals and vitamins).

Possible causes

• Lack of appetite
• Swallowing disorder (dysphagia)
• Psychological stress
• Increased requirements due to disease or medical complications (e.g. wounds)
• Stress metabolism

Possible consequences

• Reduction in general well-being
• Loss of muscle mass and resulting loss of strength, with an ensuing risk of restricted mobility
• Reduced immune defence, susceptibility to diseases / infections
• Poor skin condition, risk of pressure sores, poor wound healing
• Difficult bowel management

Being overweight and weight gain after a recent spinal cord injury

Being overweight can have considerable effects for people with a spinal cord injury.

Possible causes

• Reduced movement
• Loss of muscle mass
• Reduced basal metabolic rate due to the loss of muscle mass
• Psychological factors, such as loneliness, frustration, stress, etc.

Possible consequences

• More complicated transfers, restricted mobility
• Wheelchair or other individually adapted aids no longer fit
• Pressure sores
• Reduction in general well-being
• Secondary metabolic diseases such as type 2 diabetes or lipid metabolic disorders

Preventing malnutrition and being overweight

Daily food intake should be as varied and as balanced as possible. A balanced diet consists of at least three portions of vegetables, two portions of fruit, three portions of dairy products and one portion of meat, fish, egg or tofu a day. The plate template can provide help for everyday meals. It is recommended that every meal consists of three components with plenty of vegetables and/or salad and always includes a protein component and a starchy side dish based on activity levels. As people with a spinal cord injury often have lower levels of muscle mass, their body also requires less energy. To avoid becoming overweight, it is important not to eat excessive quantities of high-energy foods with a high carbohydrate content, such as starchy side dishes, sweets or high-fat foods. A belt, tape measure or the fit of certain items of clothing can be used to check weight developments without scales.

Rule of thumb: Using the plate template can help balance the ratio of the individual components. Salad as a starter, side salads and fruit-based desserts instead of conventional desserts can help to increase the proportion of vegetables, salad and fruit.

Digestive problems

The connection with nutrition has already been referred to several times in the previous sections on bowel management. The following will look in more detail at the impact of nutrition on bowel management.

Possible causes

• Reduced bowel activity because of the spinal cord injury
• Reduced movement
• Existing food intolerances
• Side effects of medication
• Spasticity and pain
• Psychological, social and cultural aspects

Possible consequences

• Bloating
• Constipation
• Diarrhoea
• Faecal incontinence
• Irregular or changing bowel movements
• Feeling unwell

High-fibre foods such as fruit, vegetables, dried fruit, wholegrain products, pulses, nuts and seeds can have an effect on bowel management.

Preventing digestive problems

Due to reduced intestinal activity and movement, people with a spinal cord injury may tend towards constipation, digestive irregularities, faecal incontinence or bloating. A healthy, balanced diet forms the basis of functioning bowel management.

To prevent constipation or dehydration of the body due to diarrhoea, ensure that you drink plenty of fluids (1.5 – 2 litres of unsweetened drinks a day).
Dietary fibre, in particular, has a significant influence on digestion. Fresh fruit and vegetables, dried fruit, wholegrain products, pulses, oats, nuts and seeds contain a high percentage of dietary fibre. A daily intake of small quantities of swelling agents and fibre products such as linseed or chia seeds can increase stool volume and thus improve peristalsis. Here, it is particularly important to drink plenty at the same time so that the dietary fibre can swell and perform its function. The quantity and intake frequency of dietary fibre always needs to be individually adapted, increased gradually, and should not exceed 20 – 25 g dietary fibre a day.

In general, adapting nutrition is not adequate to manage what is known as neurogenic intestinal dysfunction (digestive problems caused by the paralysis). Medical support with oral and / or rectal laxatives is used to establish an evacuation schedule that is as regulated as possible.

Pressure sores

The development of a pressure sore may be connected to nutrition.

Pressure sores are exacerbated by:

• Deficiency of specific nutrients (frequently protein, zinc, vitamin D, vitamin C)
• Being overweight / underweight

If these nutrients are lacking or you are underweight or overweight, this may have a significant effect on wound healing and the pressure sore.

The consequences of this may include:

• Poor wound healing
• Pain
• Immobilisation
• Prolonged stay in hospital
• Possibly surgery

Preventing pressure sores and supporting wound healing

In order to prevent pressure sores and to provide optimal support for wound healing, the body requires an adequate or even an increased intake of certain nutrients. In the case of a pressure sore, for example, the body has increased protein requirements. Foods that are particularly high in protein and can be well utilised are all of animal origin. This means that lean meat, dairy products and eggs, in particular, contain high levels of animal protein. However, plant-based foods, such as pulses, nuts, soy and other meat replacement products also contain considerable amounts of protein.

In order to prevent a pressure sore and to optimise wound healing, it is important to ensure that every main meal contains a protein component. This can also be replaced by or supplemented with a commercially available protein product or protein-enriched food products.

Levels of other vitamins and trace elements that may help to support wound healing should be tested in a laboratory and, in the case of a deficiency, supplemented.

High-protein foods such as meat, fish, tofu, eggs, dairy products and pulses

Nutrition in old age

Metabolism, taste preferences and feelings of thirst change with increasing age. As a rule, energy requirements (calorie requirements) decrease, while nutrient requirements (in particular vitamins and minerals) remain the same or even increase (e.g. protein). This means that there is an increased risk of a nutrient deficiency (malnutrition) or fluid deficiency. Intentionally selecting foods and eating regularly throughout the day are very important aspects here.

Nutritional therapy and counselling

Nutrition for people with a spinal cord injury is based on the same principles recommended for people without a spinal cord injury.

A nutritional specialist can provide support in the case of problems or questions. In nutritional therapy and counselling, your nutritional state is established and you receive individual and professional support in implementing nutrition adapted to your needs.