University of Southern California Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy
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Nutrition and Weight

Probably one of the most frequent health tips you have heard from medical professionals is to make sure you're eating right. But with television, magazines, newspapers and bookstores full of conflicting information about what makes a good diet, and with people everywhere talking about carbohyrdrates, "good cholesterol" and "magic foods" (that is, foods that supposedly give a lot of benefit, like soy, blueberries, oatmeal, or olive oil), it's hard to know exactly what is good nutrition. It also may not be clear what good nutrition has to do with people with spinal cord injuries, or with pressure ulcers (which means the same thing as "pressure sores" or "bedsores"). Here are some basic facts, but please keep in mind that when it comes to nutrition, there is not one simple answer that applies to everyone.

What is good nutrition? Ideas about nutrition change as we understand more and more about how the human body works. An example is the way that elementary schools teach children about eating. Starting in 1956, students were taught about "The Four Food Groups," because it was thought that food could be divided into the simple categories of meat, fish, and poultry; dairy; fruits and vegetables; breads and grains. After redefining the four groups in 1991, a completely new concept came out just a few years later: the "Food Guide Pyramid," which includes ideas about how many servings of different kinds of foods should be eaten each day. Finding the right balance is a very individual matter, because everybody has their own personal preferences and needs. Just buying a diet book probably won't give you the right answers, because the special needs of people with chronic health problems are probably not taken into account. Besides, what is printed in fad diet books doesn't always have scientific facts backing it up; there might even be some authors who are just looking for a fast buck and who don't have enough training about nutrition to be a source of correct information.

For current U.S. Government recommendations about nutrition, try the ChooseMyPlate.gov website from the U.S. Department of Agriculture. Information about an alternative "Healthy Eating Plate" designed by the Harvard School of Public Health can be found at Healthy Eating Plate. This information, along with other very helpful nutritional and dietary information, can be found in the recommended book Eat, Drink, & Be Healthy, by Harvard Medical School professor Walter C. Willett, M.D. Another good source for learning about the right nutrition for you is your doctor, who can also refer you to a dietitian if you want a food plan designed especially for you.

What does nutrition have to do with people with spinal cord injuries? People with special needs often require special eating plans. For example, people who want to lose weight usually go on a diet that limits calories or certain kinds of foods, like high-fat snacks or carbohydrates. But there is a definite reason for people with spinal cord injuries to be aware of what they eat: a recent study found that people with spinal cord injury who get good nutrition and stay at a healthy weight, exercise, do general activities to prevent pressure ulcers (including pressure reliefs, skin checks, and staying clean and dry), keep a good attitude, improve their skills at problem-solving, and stop smoking and recreational drug and alcohol use are much less likely to develop a pressure ulcer 5 or more years after their injury than people whose lifestyle habits are not as healthy 1.

People with spinal cord injuries might need to reduce weight through diet if they are getting limited exercise. For example, both Brenda and Dave, who took part in our study, gained a great deal of weight by eating too many sweets, and being large caused them health problems; Dave even decided to have a gastric bypass operation. However, following a fad diet that does not recognize what a person with a spinal cord injury needs to stay healthy might be harmful. For example, foods that support good blood circulation, low cholesterol and healthy function of muscles and nerves are good for everyone to eat, but especially useful for people with spinal cord injuries. Check with your doctor, or with a dietitian or nutritionist, to see if your current eating patterns are healthy, or to get recommendations for changes.

What does nutrition have to do with pressure ulcers? People with spinal cord injuries who have become overweight might have additional pressure on their tailbone or bottom that could lead to a pressure ulcer. That might be a reason to take a new look at what you eat to see if you are getting good nutrition. But once you get a pressure ulcer, nutrition becomes an extremely important matter. For example, in the early stages of any wound, including a pressure ulcer, swelling might occur; vitamins C and E, the mineral selenium and amino acids (the building blocks of protein) help the body cope with this by aiding blood circulation 2 and keeping the correct balance of albumin (a protein found in plasma) in the blood 3. The process of rebuilding damaged skin uses vitamins A and C, zinc, copper, manganese and amino acids; damaged muscle and bone needs vitamins, protein and minerals including calcium to heal.

But popping a vitamin pill is not enough to supply what your body needs in this situation. Although protein is probably the single food component that matters most when a person is fighting a pressure ulcer, eating a balanced diet is still the key to success 3. A body that is healing a wound, just like a body fighting infection (which often comes with advanced stage pressure ulcers), needs plenty of energy, which comes from calories, and they come from food. A person also needs to keep hydrated, that is, have plenty of fluids in their body, by drinking enough water and other healthy beverages while they are recovering 3.

Sometimes people with ongoing health problems have difficulty absorbing nutrients (components of food that provide nourishment), so sometimes a doctor recommends they eat more than they are used to. For example, when our study participant Alley was in the hospital with an infected pressure ulcer, her doctor wanted her to have canned protein drinks in addition to her meals, even though she didn't feel hungry for all that food. In contrast, Frank feels positive about eating a high protein diet, because he accepts that it helps his skin to recover faster when there is redness, or to heal a pressure ulcer quickly when it is still at an early stage.

Eating right really does play a role in staying healthy, even though the exact definition of "proper nutrition" will be different for everyone. For example, our study participant Alma has always maintained a healthy weight by sticking to healthy food choices like salads, vegetables and chicken, which are all foods that she enjoys. Be careful about the claims made by the latest books or trendy diets, because they may not have scientifically proven facts behind them. The only way to find the right answer for yourself is to learn more about the subject, from health care professionals and from sources like the library or trusted websites on the Internet (like government agencies or hospital and medical school sites). Once you are an informed consumer, you will become sure that you are consuming the food that fits you best!

Some useful sites on the Internet for learning more about the hows and whys of good nutrition for people with spinal cord injuries include Skin: It's too Much Pressure!, offered by Craig Hospital, a well-respected rehabilitation facility in Denver, Colorado. A number of websites have good information about how weight can lead to pressure ulcers, and ideas for controlling weight, including Weight Management and Wellness of Individuals with SCI, on the Spinal Cord Injury Model System, maintained by the Unversity of Alabama at Birmingham, and Weight Gain and Cutting the Fat, both on the Craig Hospital website. If you are interested in articles that are more scholarly, Preventing Pressure Sores for People with SCI, on the website of The National Center on Physical Activity and Disability (NCPAD), discusses nutrition, fitness and other aspects of a healthy lifestyle in preventing pressure ulcer formation.

1 Krause, J. S., & Broderick, L. (2004). Patterns of recurrent pressure ulcers after spinal cord injury: Identification of risk and protective factors 5 or more years after onset. Archives of Physical Medicine and Rehabilitation, 85, 1257-1264.

2 Mathus-Vliegen, E. M. H. (2004). Old age, malnutrition, and pressure sores: An ill-fated alliance. Journal of Gerontology, 59A, (4), 355-360.

3 Consortium for Spinal Cord Medicine. (2000). Pressure ulcer prevention and treatment following spinal cord injury: A clinical practice guideline for health-care professionals. Washington, DC: Paralyzed Veterans of America.