Eat well

It goes without saying, or at least it should, that good health depends on good nutrition. Food affects how we look and feel, and how our bodies work. Eating right provides energy, boosts our immune system, keeps us at the proper body weight, and keeps all body systems in harmony. Eating wrong can cause weight gain, diabetes, heart disease, cancer and other "ailments of civilization."

Eating well is even more essential for persons who are paralyzed. Because of changes that occur to the body after trauma or disease, it's more important than ever to understand the role nutrition plays in maintaining health.

After a spinal cord injury, most people lose some weight. The injury puts stress on the body as it uses its energy and nutrients to repair itself. Stress ramps up the metabolic rate; the body burns calories faster. Moreover, many newly injured people are not able to eat a regular diet. As muscles atrophy, the weight loss continues – for about a month. Later, the problem isn't too few pounds, it's too many. People living with SCI are more prone to inactivity, and thus don't burn calories. That's the pathway to obesity.

Compared to the general population, people with spinal cord injuries are prone to two diet-related problems: heart disease and diabetes. For reasons that are not fully understood, blood chemistry becomes impaired: insulin tolerance is too high. (The body produces more and more of the hormone insulin to transport energy to the body tissues. This is one of the pathways to diabetes.) Meanwhile, "bad" cholesterol and triglycerides are too high, and "good" cholesterol is too low.

Moderation

There are no clear guidelines for people living with SCI to manage their metabolic profile. The advice is what doctors say to everyone: moderate your lifestyle; don't eat so much; get some exercise; don't smoke; don't get heavy.

For some it isn't just the food, it's the way the food is presented. People with amyotrophic lateral sclerosis and other conditions who have problems swallowing must regulate the consistency and texture of foods. Food should be softer and cut into smaller pieces that can slide down the throat with minimum chewing. If food or drinks are too runny, some of the liquid can run into the airway to the lungs and cause coughing. If food is too dry, such as toast, it tends to irritate the throat and causes coughing. This problem can often be solved by adding butter, jam, etc. Foods that may be easier to manage include custards, sherbet, puddings, plain yogurt, canned fruit, applesauce, crustless toast with butter, dark chicken, salmon, thick soups, scrambled eggs, and mashed potatoes. Avoid extra-spicy or acidic foods, soft bread, cookies, crackers, dry cereal, graham crackers, peanut butter, lettuce, celery, rice, and fruits and vegetables with skin or seeds (peas, corn, apples, berries).

Bowel management is directly related to diet. Since the messages from the brain that control the muscular movements of the bowel are out of order, it's difficult for food to move through the intestinal system. A high fiber diet – 25-35 grams of fiber every day – and plenty of fluids is recommended. True, that's a lot of fiber. Where does it come from? Vegetables, fruits, nuts, popcorn. Some people take supplements, such as Metamucil. What to avoid: high-fat foods. They don't easily move through the system.

For some people with paralysis due to disease, diet and nutrition become almost a religious issue, though certainly not without some confusion, and controversy. There are many adherents, for example, of special diets for people with multiple sclerosis. The National Multiple Sclerosis Society recommends the standard food pyramid, with a low-fat, high-carbohydrate program with a variety of grains, fruits and vegetables. The Swank MS diet, originated by an Oregon doctor almost 50 years ago, prescribes a strict no-fat, no-dairy routine. Roy Swank has claimed to reduce the frequency and severity of recurrences in his MS patients by cutting out animal fat – this being the one essential first step for anyone with MS, he says.

Roger MacDougall, an Oscar-nominated Hollywood writer in the 1950s, had a severe case of MS – his legs were paralyzed, he was almost blind, he had no voice. Using a high-protein, low-carbohydrate diet that has become known as the "Paleolithic diet," he says he got completely better. "I have not been cured. I am simply experiencing a remission – but a remission which I firmly believe to be self-induced." MacDougall's premise is that until the advent of agriculture, 10,000 years ago, we were all hunter-gatherers and ate meats and nuts and berries from natural sources; we have not evolved to deal with the processed food products of modern agriculture and thus we can become allergic to certain types of foods – wheat and other glutens, refined sugar and high-fat meat. He suggests that these allergies can lead to autoimmune disease, such as MS, arthritis, etc. MacDougall's answer: eat like a caveman. Or at least eat more sporadically. The latest diet trend: Eat what you want for five days, fast for two. There might well be something to that: scientists know that rats, mice, and worms that eat very little live longer than those that eat normal diets. The same may be true for humans – people who carefully regulate their calories and eating patterns may stay healthier and extend their life span. It is always best to consult with your healthcare team before beginning any diet or fast.

This project was supported, in part by grant number 90PR3002, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.