What you should eat if you encounter spinal cord injury?

What you should eat if you encounter spinal cord injury?

By
Dr Leow Chee Seng
MBA (UPM), DBA (UBI), FBIH (UK), MMIM (Mal), MIHRM (Mal), MIM-CPT (Mal),CAHRP (Consultant) Mal), Certified E-Commerce Professional (Mal),Certified Professional Trainer (MIM, PSNB),Certified Stress Management (IACT, USA),Certificate Qualitative Research (Georgia, USA), Certificate in Homeopathy Medicine (Mal)
Practicing Cognitive, Behavioural Therapist
Practicing Nutrition Consultant

Yale Consultancy Sdn Bhd
Nutrition Therapy Unit
73-3, Amber Business Plaza,
Jalan Jelawat 1,
Batu 3 1/2,
56000 Kuala Lumpur
www.yaleconsultant.cm
Email: nutrition@yaleconsultant.com

INTRODUCTION

Adequate nutrition and balanced nutrition is everyone concerned, not just those with a spinal cord injury. A well-balanced diet provides the nutrients your body needs to run properly and carry out normal body processes. It also provides energy and keeps your immune system strong.

When you have a spinal cord injury, not following a balanced diet increases your chance for developing pressure sores. A poor diet will also hinder your body’s ability to heal sores and fight infection, and you will become fatigued more easily.

Being overweight is another concern because excess weight makes transfers more difficult. In addition, excessive pressure and rubbing on skin puts you at risk for pressure sores. Obesity is associated with diabetes, high blood pressure, and increased levels of blood fats. A spinal cord injury does not necessitate a huge change in diet, unless your diet before your injury was not adequate.

Defining A Well-Balanced Diet:
According to the 2005 Dietary Guidelines for Americans, a well-balanced or “healthy” diet is one that:
· Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products;
· Includes lean meats, poultry, fish, beans, eggs, and nuts; and
· Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars.

According to the New Food Guide Pyramid, more specific recommendations have been made for each of the food groups:
Grains
Eat at least 3 oz of whole grain bread, cereal, crackers, rice, or pasta every day
Look for “whole” before the grain name on the list of ingredients
Vegetables
Eat more dark green veggies
Eat more orange veggies
Eat more dry beans and peas
Fruits
Eat a variety of fruit
Choose fresh, frozen, canned, or dried fruit
Go easy on fruit juices
Oils
Make most of your fat choices from fish, nuts, and vegetable oils
Limit solid fats like butter, stick margarine, shortening, and lard
Milk
Go low-fat or fat-free
If you don’t or can’t consume milk, choose lactose-free products or other calcium sources
Meat and Beans
Choose low-fat or lean meats and poultry
Bake it, broil it, or grill it
Vary your choices--with more fish, beans, peas, nuts, and seeds

FOOD SUPPLIES 6 KEY NUTRIENTS

Carbohydrates
-Source of energy (calories)
-Supplies fiber to aid in elimination
-Consume more complex carbohydrates (starches and fiber) and less simple (sugar) carbohydrates

Sources: Breads, cereals, fruit, vegetables, crackers, pasta, oats, barley, legumes
Protein
-Composed of 8 essential amino acids
-Builds and maintains healthy body cells
-Provides antibodies to fight infections
-Helps prevent skin breakdown

Sources: Meat, fish, poultry, eggs, dried peas, legumes, soybeans, nuts, cheese

Fat
-Source of energy (calories)
-Supplies essential fatty acids
-Provides and carries vitamins A, E, D & K
-Protects vital body organs
-Consume in moderation

Sources: Butter, margarine, oils, salad dressings, meats, nuts

Vitamins
-Function in the absorption and utilization of food
-Act as biochemical catalysts in all the body cells
-Water soluble (B and C) or fat soluble (A, D, E and K)

Sources: Fruits, vegetables, grains

Minerals
-Help build blood, bones and teeth
-Regulate body fluids
-Aid in vital body functions such as those of the nerve and muscles

Sources: Fruits, vegetables, meats, legumes, nuts
Water
-Essential for life
-Major element of every cell in the body-Necessary for all processes of digestion
-Carrier of nutrients and waste

Sources: Water, tea, juices, diet soda, Jello, soups, cranberry juice

2005 DIETARY GUIDELINES ACCORDING TO FDA (FOOD DIETARY ALLOWANCE)
ADEQUATE NUTRIENTS WITHIN CALORIE NEEDS
· Consume a variety of nutrient-dense foods and beverages within and among the basic food groups while choosing foods that limit the intake of saturated and trans fats, cholesterol, added sugars, salt, and alcohol.
· Meet recommended intakes within energy needs by adopting a balanced eating pattern, such as the U.S. Department of Agriculture (USDA) Food Guide or the Dietary Approaches to Stop Hypertension (DASH) Eating Plan.
WEIGHT MANAGEMENT
· To maintain body weight in a healthy range, balance calories from foods and beverages with calories expended.
· To prevent gradual weight gain over time, make small decreases in food and beverage calories and increase physical activity.
PHYSICAL ACTIVITY
· Engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and a healthy body weight.
o To reduce the risk of chronic disease in adulthood: Engage in at least 30 minutes of moderate-intensity physical activity, above usual activity, at work or home on most days of the week.
o For most people, greater health benefits can be obtained by engaging in physical activity of more vigorous intensity or longer duration.
o To help manage body weight and prevent gradual, unhealthy body weight gain in adulthood: Engage in approximately 60 minutes of moderate- to vigorous-intensity activity on most days of the week while not exceeding caloric intake requirements.
o To sustain weight loss in adulthood: Participate in at least 60 to 90 minutes of daily moderate-intensity physical activity while not exceeding caloric intake requirements. Some people may need to consult with a healthcare provider before participating in this level of activity.
· Achieve physical fitness by including cardiovascular conditioning, stretching exercises for flexibility, and resistance exercises or calisthenics for muscle strength and endurance.
FOOD GROUPS TO ENCOURAGE
· Consume a sufficient amount of fruits and vegetables while staying within energy needs. Two cups of fruit and 2½ cups of vegetables per day are recommended for a reference 2,000-calorie intake, with higher or lower amounts depending on the calorie level.
· Choose a variety of fruits and vegetables each day. In particular, select from all five vegetable subgroups (dark green, orange, legumes, starchy vegetables, and other vegetables) several times a week.
· Consume 3 or more ounce-equivalents of whole-grain products per day, with the rest of the recommended grains coming from enriched or whole-grain products. In general, at least half the grains should come from whole grains.
· Consume 3 cups per day of fat-free or low-fat milk or equivalent milk products.

FATS
· Consume less than 10 percent of calories from saturated fatty acids and less than 300 mg/day of cholesterol, and keep trans fatty acid consumption as low as possible.
· Keep total fat intake between 20 to 35 percent of calories, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils.
· When selecting and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low-fat, or fat-free.
· Limit intake of fats and oils high in saturated and/or trans fatty acids, and choose products low in such fats and oils.
CARBOHYDRATES
· Choose fiber-rich fruits, vegetables, and whole grains often.
· Choose and prepare foods and beverages with little added sugars or caloric sweeteners, such as amounts suggested by the USDA Food Guide and the DASH Eating Plan.
· Reduce the incidence of dental caries by practicing good oral hygiene and consuming sugar- and starch-containing foods and beverages less frequently.
SODIUM AND POTASSIUM
· Consume less than 2,300 mg (approximately 1 teaspoon of salt) of sodium per day.
· Choose and prepare foods with little salt. At the same time, consume potassium-rich foods, such as fruits and vegetables.
ALCOHOLIC BEVERAGES
· Those who choose to drink alcoholic beverages should do so sensibly and in moderation—defined as the consumption of up to one drink per day for women and up to two drinks per day for men.
· Alcoholic beverages should not be consumed by some individuals, including those who cannot restrict their alcohol intake, women of childbearing age who may become pregnant, pregnant and lactating women, children and adolescents, individuals taking medications that can interact with alcohol, and those with specific medical conditions.
· Alcoholic beverages should be avoided by individuals engaging in activities that require attention, skill, or coordination, such as driving or operating machinery.
FOOD SAFETY
· To avoid microbial foodborne illness:
o Clean hands, food contact surfaces, and fruits and vegetables. Meat and poultry should not be washed or rinsed.
o Separate raw, cooked, and ready-to-eat foods while shopping, preparing, or storing foods.
o Cook foods to a safe temperature to kill microorganisms.
o Chill (refrigerate) perishable food promptly and defrost foods properly.
o Avoid raw (unpasteurized) milk or any products made from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, unpasteurized juices, and raw sprouts.

SKIN INTEGRITY

Adequate pressure relief, good skin hygiene and proper nutrition are essential for decubitus ulcer prevention.

Nutritional Keys to Healthy Skin


Maintain Ideal Body Weight
Excess weight leads to increased pressure on the skin resulting in breakdown.
Being underweight increases the risk of pressure ulcer development due to inadequate skin covering over bony prominences


Eat a balanced diet of a variety of foods
Follow the Dietary Guidelines for Americans and use the Food Guidance System tool


Adequate Protein Intake
Protein is needed by the body for tissues maintenance and building. Without adequate protein intake, the body cannot fight off infections and wounds heal poorly.
Good food sources include: lean meat, fish, poultry, eggs, milk and milk products, cheese, dried beans and peas, and peanut butter
Try to incorporate 1 good protein source at each meal
Your protein intake will need to increase if you have a pressure sore


Fluid! Fluid! Fluid!
Dehydration can increase susceptibility to skin breakdown.
The goal is 10-12 cups of fluid each day. Half of this should come from water.
Caffeinated beverages and alcohol can aggravate dehydration because they act as diuretics
Aim for fluids that have 10 calories or less per 8 oz serving to prevent unnecessary weight gain.


Vitamins and Minerals
A diet with a variety of foods provides adequate levels of vitamins and minerals
Vitamins and minerals are important in the prevention and healing of skin wounds and anemia.
Skin breakdown results from inadequate oxygenation of the tissues. Anemia causes low levels of hemoglobin, which carries oxygen to the tissues. It can be caused by a deficiency of Vitamin B12, Folate, or Iron. Supplementation will be necessary.
During times of wound healing, supplementation of Vitamin C and Zinc may be indicated for additional support.

VITAMIN AND MINERAL SUPPLEMENTATION

A Multivitamin may be warranted to cover any areas that your diet may be lacking. Food is the best place to get your nutrients because many compounds naturally found in foods cannot be found in a supplement. Research has shown that a multivitamin is a cheap and safe way to ensure your diet is adequate.

Supplementation: Centrum, One-A-Day, Flintstones, Generic
Vitamin C is needed for collagen synthesis. It hastens healing of wounds and increases resistance to infection.

Food sources: Citrus fruits, tomatoes, peppers, broccoli and greens

Supplementation: 500 mg taken twice per day will help keep your urine acidic.
Zinc is necessary for connective tissue synthesis and immune system function.

Food sources: Meat, liver, eggs, legumes, milk and seafood

Supplementation: 15-40 mg of elemental zinc may be warranted for a couple weeks to help with wound healing. Taking too much zinc for a long period of time can reduce copper and iron absorption, decrease your immune system, and lower HDL-C (good cholesterol). Also, additional zinc will do nothing if you are not already zinc deficient.
Vitamin A assists formation and maintenance of skin and mucous membranes, thus increasing resistance to infections.

Food sources: Dark green and deep yellow vegetables, milk, liver and egg yolk

Supplementation: Do not supplement with more vitamin A than what is already contained in your multivitamin. Your best bet is to focus on vitamin A rich foods.

Folate is needed for DNA and RNA synthesis and the production of new cells.

Food sources: green leafy vegetables, legumes, whole grain cereals

Supplementation: Do not exceed 1000 mcg of folic acid per day because this could mask a B12 deficiency. It is advised to have your B12 level checked before taking folic acid supplements if you are over 50 years old. If you supplement with extra folate, make sure your supplement also contains B12.

Iron assists in hemoglobin production, which is responsible for carrying oxygen to the cells of your body

Food sources: Meat, poultry, dried beans, fortified cereals

Supplementation: Do not take iron supplements unless advised by your health care professional because too much iron in supplement form may be harmful. If you do take iron supplements, take them with a vitamin C rich food and separate them from your calcium supplement or multivitamin by 2 hours.

Vitamin B12 is necessary for the synthesis and maintenance of nerve cells and red blood cells.

Food sources: Meat, eggs, cheese, fish, milk and milk products, brewer’s yeast

Supplementation: What you receive in your multivitamin should be adequate if you eat meat.
Vitamin D is necessary for the maintenance of strong bones. Vitamin D is naturally synthesized on the skin when exposed to sunlight. You may be at risk for deficiency if you do not receive adequate sun exposure.

Sources: Sun, fortified milk, fatty fish

Supplementation: If you are 50 years or older, 800-1000 IU’s of cholecalciferol may be warranted. You will probably find calcium and vitamin D together in a supplement such as Citracal or Catrate.

FLUIDS
Fluids are necessary to prevent dehydration, which increases your susceptibility to skin breakdown. Dehydration also increases your chances for urinary tract infections and kidney stones. A high fluid intake flushes the urinary tract of unwanted materials and bacteria in addition to keeping the urine dilute.

Your fluid intake should coincide with your bowel regimen; however, there are times when fluid needs may need to be increased. Fluid losses can be significant when pressure sores are present, therefore water and apple juice may be prescribed at that time. Cranberry juice is often given for good urinary tract health.

While on intermittent catheterization program, fluid intake is initially limited to prevent over-distention of the bladder, 120 cc every two hours. Fluid intake will be increased as voiding occurs reflexively and residual decrease. Once voiding occurs reflexively and the bladder is emptying sufficiently, fluid intake is no longer limited or restricted.
Recommended fluid intake is 3,000 cc of fluids (10-12 cups) daily with at least half of that coming from water. Although they count as fluids, caffeinated beverages and alcohol can aggravate dehydration because they act as diuretics. Only 4 oz of cranberry juice is needed per day to prevent UTI’s. If you have a UTI, then 16-32 oz may be taken to help it resolve.

Watch Those Liquid Calories
Sources of fluids:
Water Ice Cream
Coffee Popsicles
Soda Soup
Juice Tea
Milk Pudding
Gelatin Sherbet

Remember that fluids can be a significant amount of calories, which may result in unwanted weight gain. Drinks that contribute calories but are not very nutrient dense are really the ones to watch out for. For example, one cup of skim milk and 1 cup of regular soda have about the same calories, but soda does not have the same nutrient content of milk. Juices also contribute to fluid intake, but also contribute to calories (for example, 1 cup of cranberry juice as 260 calories...one with breakfast and another with dinner would add more than 500 calories per day!)

Calorie Cutting Tips
Ø Stick to drinks that contain 10 calories or less per cup (8 oz)
Examples: Crystal Light, Propel, Fruit2O, Diet Snapple

Ø Dilute your drinks with seltzer or water

Ø Dilute regular soda with diet soda

Ø Try diet beverages sweetened with Splenda

Ø Flavor water with lemon juice, cucumber, or lime juice

HERBS AND BOTANICALS

The use of complimentary and alternative medicine is on the rise, with about 1/3 of the US population having used such therapies within the past year. Recent surveys have shown that 16% to 18% (~15 million) of adults in the US use herbal or dietary supplements concurrently with prescription medicines, potentially putting them at risk for herb-drug interactions.

It is vital that you discuss herbal use with your healthcare team. This is even more crucial if you:
Ø Have diabetes
Ø Have high blood pressure
Ø Have heart disease
Ø Are taking medications
Ø Are having surgery

Herbals can increase or decrease the usefulness of some of your prescription medications. Some examples of herbals that interact with medicines include:
Ø Gingko
Ø Ephedra
Ø Ginseng
Ø St. John's Wort
Ø Echinacea
Ø Kava Kava

All herbal products need to be stopped 2-3 weeks before surgery. They can increase your heart rate, blood pressure, and risk of bleeding.

HOW TO BE SAFE:
v The term "natural" does not mean that the product is safe
v Herbal products should only be used for a few months at a time
v Follow the dosing guidelines. More is not better.
v Choose single herb products. Avoid mixtures
v Look for products marked with USP or Consumer Lab seals. These seals mean the products are tested for quality and content

v Stop all herbal products 2-3 weeks before surgery
v Report side effects to your health care team and the FDA
v Look for products with an expiration date
v Avoid foreign products unless quality is known
v Avoid companies making sensational claims

WEIGHT MANAGEMENT

Maintenance of "ideal body weight” is especially important to persons with spinal cord injury. How do you know if you’re within your “ideal body weight” range? You can use a tool called the Body Mass Index, or BMI. The BMI is a ratio that compares a person’s height to their weight. Here’s how to calculate your BMI:


BMI = (Weight, in pounds * 703) / (Height, in inches)2




A BMI of 19 or below classifies as “underweight,” and a BMI above 25 is considered “overweight.” There are dangers to being either above or below your ideal body weight range.

Being overweight decreases a person's energy level and ability to perform activities of daily living, thus decreasing independence. Excess weight can also cause increased pressure and irritation in skin areas where decubitus ulcers - pressure sores - may develop. Obesity is associated with diabetes, high blood pressure, and increased levels of blood fats.

Weighting less than the calculated "ideal body weight" or being underweight can pose problems as well for the spinal cord injured person. The risk of decubitus ulcer development increases due to inadequate skin covering over bony prominences. Being underweight increases susceptibility to fatigue and decreases resistance to infection.



Balancing diet (calorie intake) and exercise (Energy expenditure) is the key to weight control!

Suggestions to lose weight:

Limit the size of your food portions

Avoid second servings

Try not to skip breakfast or lunch and try to avoid overeating at dinner

Avoid using food as a way of dealing with boredom, anger, fatigue, or anxiety

Consciously choose food with a view to its nutritive value

Avoid keeping high-calorie, low-nutrient snacks around the house

Eat less sugar and sugary foods

Know the danger period during the day when you tend to overeat. Be prepared with other alternatives

Suggestions to gain weight:

Consume at least three balanced meals per day

If you have a decreased appetite, eat six small meals per day

Add extra margarine, peanut butter, jelly, or jam to bread and crackers

Use thick gravies and cream sauces

Eat high-calorie snacks between meals, such as dried fruit, nuts, ice cream, and milk shakes

TIPS FOR DINING OUT
As a beverage choice, ask for water or order fat-free or low-fat milk, unsweetened tea, or other drinks without added sugars.
Ask for whole wheat bread for sandwiches.
In a restaurant, start your meal with a salad packed with veggies, to help control hunger and feel satisfied sooner.
Ask for salad dressing to be served on the side. Then use only as much as you want.
Choose main dishes that include vegetables, such as stir fries, kebobs, or pasta with a tomato sauce.
Order steamed, grilled, or broiled dishes instead of those that are fried or sautéed.
Choose a “small” or “medium” portion. This includes main dishes, side dishes, and beverages.
Order an item from the menu instead heading for the “all-you-can-eat” buffet.
If main portions at a restaurant are larger than you want, try one of these strategies to keep from overeating:
Order an appetizer or side dish instead of an entrée.
Share a main dish with a friend.
If you can chill the extra food right away, take leftovers home in a “doggy bag.”
When your food is delivered, set aside or pack half of it to go immediately.
Resign from the “clean your plate club” – when you’ve eaten enough, leave the rest.
To keep your meal moderate in calories, fat, and sugars:
Ask for salad dressing to be served “on the side” so you can add only as much as you want.
Order foods that do not have creamy sauces or gravies
Add little or no butter to your food.
Choose fruits for dessert most often.
On long commutes or shopping trips, pack some fresh fruit, cut-up vegetables, low-fat string cheese sticks, or a handful of unsalted nuts to help you avoid stopping for sweet or fatty snacks.

BOWEL MANAGEMENT

Proper nutrition is essential in establishing an effective bowel regime. Loss of muscle tone, lack of exercise, and change in schedule and environment can contribute to problems with elimination.

Focus on High-Fiber Foods

What is fiber?

Fiber is the portion of plant material that humans are not able to digest. There are two kinds of dietary fiber, soluble and insoluble. Both are important for proper bowel function.

SOLUBLE FIBER:

● Soluble fiber dissolves in water,
forming a gel in the intestines.


● It may help lower the level of
cholesterol and may help control
the level of sugar in your blood.

Sources: oatmeal, barley, kidney beans, fruits and vegetables
INSOLUBLE FIBER:

● Insoluble fiber passes through the digestive
system almost intact, adding bulk to the stool
and acting as a sponge to absorb water.

● It may help prevent constipation as well as 2
intestinal diseases, diverticulosis and
hemorrhoids.

Sources: Wheat bran, whole grains, many vegetables and skins of fruit

Note: Fiber is not found in any animal products, such as meat, cheese or eggs.

How much fiber should I have each day?

20-35 grams/day is recommended. Some people can tolerate even more. If you don’t eat a lot of fiber now, increase fiber by small amounts (a few grams) each day. This will help to decrease uncomfortable symptoms of bloating, gas and diarrhea. Make sure to drink plenty of water as well, to prevent constipation.

High: 4 or more grams fiber/serving Medium: 2-4 grams fiber/serving

Food Amount Grams Food Amount Grams

All Bran ½ cup 9.7 Soybeans ½ cup 3.8
Prunes ½ cup 8 Carrots, raw 1 cup 3.8
Lentils ½ cup 7.8 Wheat germ ¼ cup 3.8
Flaxseed 2 T, ground 7 Apple 1 med 3.7
Artichoke 1 med 6.5 Popcorn 3 cups 3.6
Chickpeas ½ cup 6.2 Potato 1 w/skin 3.4
Figs ¼ cup 6 Almonds 1 oz (~24) 3.3
Kidney beans ¼ cup 5.6 Strawberries 1 cup 3.3
Bran flakes ¾ cup 4.6 Prunes ¼ cup 3

What foods are high in fiber?

How do I add fiber to my diet?

For breakfast:
Eat a high fiber cereal, like All-Bran, Bran Flakes, or Shredded Wheat
Add some raisins to your cereal or oatmeal

For lunch:
Use 100% whole wheat bread with sandwiches
Add kidney beans and chick peas to your salads
For dinner:
Eat a baked potato with the skin
Add spinach, corn, lima beans or Brussels sprouts to your plate
For snacks:
Choose raw fruits instead of fruit juice
Eat a bowl of popcorn, air-popped or popped in canola oil


Increase fluid intake

Why? Fluid helps soften the stool to facilitate ease of bowel movements. It is particularly important to increase fluid intake with a high fiber diet, or constipation may result. If you have diarrhea, you should still continue to drink plenty of fluids, as dehydration may result if you don't replace the fluid lost in the stool.
Try to get 10-12 cups of fluids each day.



Here are some examples:
Water (more than half of your fluid intake should be as plain water)
Ice chips
Herbal tea, milk
Sugar-free gelatin and popsicles
Caffeine-free coffee and tea
Calorie-free and “Diet” flavored waters, teas and juices

Getting plenty of fluids and fiber is very important for establishing a good bowel regime. It’s also important to try to eat consistently and regularly – try to eat similar foods at about the same times every day!

FOOD AND BOWEL MANAGEMENT
Vegetables and legumes that may cause gas include…
Beans ¨ Brussels sprouts ¨ Cauliflower ¨ Kohlrabi ¨ Onions
Peppers ¨ Radishes ¨ Sauerkraut ¨ Shallots ¨ Scallions ¨ Soybeans ¨ Peas
Turnips ¨ Broccoli ¨ Cabbage ¨ Corn ¨ Cucumbers ¨ Leeks ¨ Lentils Pimentos ¨ Rutabagas

And fruits…
Apples ¨ Cantaloupe ¨ Watermelon ¨ Avocados ¨ Honeydew melon


Food Groups and Their Effects on Bowel Management

Food Group
Foods that Harden Stools
Foods that Soften Stools
Milk
Milk, yogurt made without fruit, cheese, cottage cheese, ice cream
Yogurt made with seeds or fruit
Bread and Cereal
Enriched white bread or rolls, saltine crackers, refined cereals, pancakes, waffles, bagels, biscuits, white rice, enriched noodles
Whole grain breads and cereals
Fruits & Vegetables
Strained fruit juice, applesauce, potatoes without the skins
All vegetables except potatoes without the skin
Meat
Any meat, fish or poultry
Nuts, dried beans, peas, seeds, lentils, chunky peanut butter
Fats
None
Any
Desserts & Sweets
Any without seeds or fruit
Any made with cracked wheat, seeds or fruit
Soups
Any creamed or broth-based without vegetables, beans or lentils
Soups with vegetables, beans or lentils

CHOLESTEROL

Heart disease has increased in the spinal cord injured population. This is partially because the changes the body often undergoes following injury can lead to high cholesterol levels. The food we eat can have an impact on our cholesterol levels. Eating a diet high in healthy fats and fiber, low in unhealthy fats, and limited in refined carbohydrates and alcohol can help you achieve healthy blood cholesterol levels.


What is cholesterol?

Cholesterol is a white, waxy fat found naturally in your body and produced by your liver. Too much cholesterol in your blood can clog your arteries and eventually choke off the blood supply to you heart. This is why having high cholesterol is a leading risk factor for heart disease.

What do the numbers mean?

There are four terms associated with blood cholesterol. Here’s what they are:

HDL = High Density Lipoprotein
“Healthy” or “happy” cholesterol that helps remove the bad (LDL) cholesterol from the blood and takes it to the liver to be removed.
Higher is better; it’s raised by physical activity
>40 mg/dL is ideal for men, >50 for women

LDL = Low Density Lipoprotein
“Unhealthy” or “lousy” cholesterol that leads to clogged arteries
Lower is better; it’s lowered by eating healthy fats and raised by eating unhealthy fats
<100 mg/dL is ideal

TG = Triglycerides
A type of fat circulating in the blood
Related to Very Low Density Lipoproteins (VLDL), equal to VLDL x 5
Lower is better; they’re lowered by cutting back on refined sugars and alcohol
<150 mg/dL is ideal

TC = Total Cholesterol
Sum of HDL + LDL + VLDL
Lower is better, lowered by eating more healthy fats and fiber, fewer unhealthy fats, refined sugars and alcohol; and by doing more physical activity.
<200 mg/dL is ideal

CHOOSE MORE “HEALTHY FATS”

Monounsaturated Fats
Lower total cholesterol, but do not lower HDL levels
Sources: Canola and olive oils

Polyunsaturated Fats
Found in foods of plant origin
Lower your total cholesterol, LDL, and HDL cholesterol
· Sources: Corn, safflower and sunflower oils; soybeans

Omega-3 Fatty Acids
Type of polyunsaturated fats
Not made by the body (must come from food) so are called “essential”
Lower total cholesterol and triglycerides
May have other health benefits, such as reducing inflammation
· Sources: Fatty fish and shellfish such as sardines, mackerel, blue fin tuna, salmon, bluefish, trout, crab, mussels, lobster, shrimp, scallops, cod and founder


CHOOSE FEWER “UNHEALTHY FATS”


Saturated fats
Raise LDL cholesterol and total cholesterol
12-15 grams/day is a healthy limit
Sources: All animal foods (butter, red meat, ice cream, whole milk, cheese, etc.) and in palm oil, coconut oil, hydrogenated soybean and cottonseed oil, and cocoa butter.

Trans-Fats
Man-made fat formed when plant oils are hydrogenated (hardened)
Look for the words “partially hydrogenated oils” on a food’s ingredient list or “trans-fat” on the Nutrition Facts Label.
Try to keep intake of trans-fats to as little as possible (0 grams/day if you can)!
Sources: Processed foods like cookies, crackers, pastries and cereal bars and in deep fat fried foods.

Note: Dietary cholesterol is a substance found in all foods of animal origin such as meat, poultry, egg yolks, butter and dairy products. The cholesterol found in these foods does not have nearly as large an impact on blood cholesterol as saturated and trans-fats do. Just try to limit your intake of organ meats (like liver) to once per month, and egg yolks to 3 per week.

AIM FOR 25-30 GRAMS DIETARY FIBER EACH DAY

TRY TO CUT OUT REFINED SUGARS (IN THE FORM OF SODA AND JUICE) AND DRINK ALCOHOL IN MODERATION IF YOU HAVE HIGH TRIGLYCERIDE LEVELS.


STEPS YOU CAN TAKE TO LOWER HIGH CHOLESTEROL

Too much fat and cholesterol in your diet can lead to higher weight and obesity, and higher risk for heart disease. Both can make other diseases worse. Follow these steps to help you reduce the cholesterol in your diet.

♥ Use olive and canola oil in your cooking

♥ Use spreads that have no trans-fats (look at the food label)

♥ Broil, roast, boil, steam, grill bake or stir-fry foods instead of deep-frying

♥ Avoid fatty cuts of beef, pork, lamb, veal and goat; organ meat, cold cuts, hot dogs, sausage, bacon, pepperoni, spare ribs, and friend, breaded or oil-packed fish.

♥ Instead, choose chicken or turkey (white meat, no skin), pork tenderloin, “round” cuts of beef, or 90% fat-free or leaner hamburger

♥ Eat fish 2-3 times per week for those essential omega-3s

♥ Limit eggs to 2 to 3 a week or use only egg whites or egg substitutes.

♥ Choose low fat dairy products: Choose 1% or skim milk, fat-free yogurt, low fat or fat-free cheeses and cottage cheese, low fat or fat-free ice cream and frozen yogurt.

♥ Check the food labels on your crackers, chips, pies, cakes, cookies and other high-fat desserts – if they have trans-fats, avoid them!

♥ Eat more fruits and vegetables: Most are very low in fat and high in fiber. Fiber can help control blood cholesterol levels. Dry beans and peas are great too!

♥ Read food labels: Start reading food labels for grams of fat per serving. Try to limit fat intake to less than 50-60 grams per day, with only 12-15 coming from saturated fat.

SUMMARY

As you can see, the importance of good nutrition cannot be underestimated. Being nutrition conscious can help prevent potential complications and/or problems of spinal cord injury.

Following the Dietary Guidelines for Americans and using the Food Guidance System Tool is the best way to ensure the nutritional adequacy of your diet. Ideal body weight must be maintained for ease of transfers and mobility and prevention of pressure ulcer formation. Fiber and fluids facilitate proper elimination. Adequate fluid intake aids in preventing urinary infection and stones. An effective defense against high blood cholesterol is a calorically balanced eating pattern that is low in fat, saturated fat and dietary cholesterol, and high in complex carbohydrate. A nutrient rich diet plays a key role in pressure ulcer prevention and healing.

What you eat can have a tremendous influence on your health. A healthy diet is preventative medicine!

If you need further information, please walk into our nutritional therapy unit at

Yale Consultancy Sdn Bhd
Nutrition Therapy Unit
73-3, Amber Business Plaza,
Jalan Jelawat 1,
Batu 3 1/2 ,
56000 Kuala Lumpur