Answers to Questions on Exercise & Nutrition after SCI

The information contained on this page is not intended nor implied to be a substitute for professional medical advice. Always ask your physician or other qualified health professional about any matter concerning your individual health. Always seek the advice of your physician prior to starting or changing any diet or exercise programs.

Question
Do those electronic ab belts work for people with no trunk control? Are they safe?

Answer
Ab belts will not improve trunk control, but they can help tone abdominal muscles if you do not have belly fat. These belts are similar to other electrical stimulation devices, and they help tone abdominal muscles by sending electrical signals to the muscles. However, most people with SCI have fat layers in their belly. These electrical signals do not penetrate through layers of fat. This means using these belts will not make much difference in your appearance because they do not help you lose weight. In general, though, they are safe for people who have sensation in the abdomen if used properly. However, you should not use the device unsupervised if you do not have sensation in your abdominal area.

Question
I was a healthy athlete before becoming a quad. What are healthy alternatives to controlling low blood pressure that doesn’t involve taking drugs/medication?

Answer
Abdominal binders and compression hose can be helpful to control low blood pressure. Increasing water intake can also help raise your blood pressure. It is important to note that while increasing water intake can be beneficial to maintaining your blood pressure, it can also have the additional side effect of increased urine output requiring more frequent catherizations. Also, do not discontinue medications unless instructed by your doctor.

Question
I have SCI and have too much gas in my stomach. It is bothering me too much. It gives me a lot of pain. How do I get rid of stomach gases?

Answer
Simethicone or Gas X should help reduce gases in your stomach. Also, try to eating a high fiber diet. Here are some examples: Vegetables (carrots, spinach, lettuce, asparagus, beets, mushrooms, turnips, broccoli, sweet potatoes, string beans), Legumes (lentils, black beans, peas, kidney beans), Nuts (sunflower seeds, almonds pecans), Fruits (apples, bananas, peaches, pears) , and grains (hot cereals-oatmeal, cream of wheat, brown rice, whole wheat past, bran muffins).

Question
I currently stand in a standing frame glider every day for 30 to 60 minutes. I eat healthy but have tons of atrophy in my legs. How can I maintain or increase bone density?

Answer
First, there are no exercise guidelines for promoting bone health. This is why it is very important to talk to medical professionals (Doctors or physical therapists) before you do any exercise. You could do more harm than good if you do exercises that are not appropriate for you.

A loss of bone density means your bones become more porous, or brittle. If you have a SCI, you experience a loss in bone density, mainly in areas where you are paralyzed. Brittle bones do break more easily, but overall, your chances of breaking a bone during regular daily activities are still fairly small.

There is mixed evidence as to whether or not bone mass that has been lost after injury can be reversed. Passive activities (tilt-table or standing frame like you are doing) may help minimize or prevent bone loss after injury, but it may not be effective in reversing bone loss. Activities that provide muscle contractions to paralyzed muscle (functional electrical stimulation (FES), electrical stimulation (ES), walking, and treadmill training) may put enough stress on bones to improve bone mass.

Question
I’ve tried watching what I eat and how much and have only gained about 1 lb a year. But after 30 years with my injury, I find myself 30 lbs heavier than I’d like. My arms are shot so exercise is limited for me (am a tetraplegic). Can I really lose weight with my diet only? Am keeping my calorie count to 1200 a day (female, eating whole foods mostly, and nothing but water after 6pm.

Answer
Your weight is largely dependent on your body’s metabolism. Your metabolism is the way your body converts the food you eat into the energy your body needs to function. People with SCI tend to have a lower metabolism. This means you need fewer calories than people without SCI. You have 3 basic options to lose weight.

1. Diet – there is a basic formula that most people can use is to adjust your calorie.

Formula for People with Paraplegia
1/2 Your Target Weight x 28 = Daily Calorie Intake to Reach Target Weight

Formula for People with Tetraplegia
1/2 Your Target Weight x 23 = Daily Calorie Intake to Reach Target Weight

If your target weight is 120 lbs (60×23), for example, your calorie count might be 1380 per day. If you are not losing weight, it helps to reduce your daily calorie intake by 200-300 calories. However, you can plateau with weight loss through calories alone, so you may not be able to lose weight without making other adjustments.

2. Choosing foods with higher protein and less carbohydrate would also accelerate your weight loss and improve your blood glucose and insulin levels. This may also boost your energy for daily activities.

3. Losing weight may also be easier by combining exercise with your diet. Even light arm exercises (arm cycling) can be beneficial, maybe 3 times per day for 10 minutes.

Question
Can you explain how fiber impacts my bowel program?

Answer
You need fiber, but you first need to know how much fiber you need each day. Here is rough guide for most people:

• 35g for men & 25g for women between the ages 19-50
• 30g for men & 21g for women over age 50

Next, you need to know the two types of fiber and the basic way they work in your body.

• Soluble Fiber slows down digestion and helps to firm stool. This is why soluble fiber gives you that feeling of being “full” and helps to prevent diarrhea. You get soluble fiber from apples, beans, blueberries, carrots, celery, cucumbers, dried peas, flaxseeds, lentils, nuts, oat bran, oat cereal, oatmeal, oranges, pears, and strawberries.
• Insoluble Fiber keeps digestion moving because it has more of a “laxative” effect, which helps prevent constipation. You get insoluble fiber from barley, broccoli, brown rice, bulgur, cabbage, carrots, celery, corn bran, couscous, cucumbers, dark-leaf vegetables, fruit, green beans, nuts, onions, tomatoes, wheat bran, whole grains, whole wheat and zucchini.

What you have to do is get a good mix of both soluble and insoluble fibers in your diet to keep your bowel program regular and predictable. This means if you have issues with constipation or your bowel program takes too long, you might reduce your intake of soluble fiber and increase your insoluble fiber. If you have issues with diarrhea or your stool is too soft, you might reduce your intake of insoluble fiber and increase your soluble fiber.

And if you do need to adjust your fiber intake, you need to do it gradually. You might try adjusting your intake by no more than about 2 gram per week – that is no more than 2g of soluble and 2g of insoluble each week until your bowel program is where you want it to be.

Question
What are the standards of cholesterol levels for people with spinal cord injury?

Answer
The short answer is that the “standards” are generally the same as the general population. However, there are some things to consider.

People with spinal cord injury should have a lipid profile every couple of years. It is done by your doctor, and it requires your blood to be drawn and tested to get your lipid profile.  The result include 4 parts of you cholesterol:

1. Total cholesterol – A total cholesterol score of less than 200 mg/dL is recommended.
2. LDL (low-density lipoprotein), the “bad cholesterol, is the main source of cholesterol buildup and blockage in the arteries. Less than 160mg/dL is recommended, but lower is better.
3. HDL (high-density lipoprotein), the “good” cholesterol, helps remove cholesterol from your arteries. Higher than 40 mg/dL is recommended, but higher is better.
4. Triglycerides are another form of fat in the blood. Less than 150 mg/dl is recommended, but lower is better.

You may have seen that cholesterol “standards” have been in the news over the last few months. In 2010, The Dietary Guidelines Advisory Committee advised adults to consume less than 300 milligrams per day of dietary cholesterol, which is about the amount in one egg. Now, many nutritionists think your daily cholesterol intake may not significantly impact total cholesterol blood levels.

Does this mean that you do not need to worry about your cholesterol anymore? Absolutely not!

The Rehabilitation Research and Training Center on Spinal Cord Injury produced a fact sheet on Cholesterol, Other Fats, and SCI. You can read the fact, but I will highlight a few key points.

• Genetics do play an important part in the lipid profile. If your parents or grandparents had medical histories of heart and vascular disease it is possible that you will have these problems too.
• About half of all persons with SCI have at least one component (total cholesterol, LDL, and triglycerides) of the lipid profile that falls outside of the desired range.
• About 20-50% of people with SCI have elevated levels of blood glucose that are typical of diabetics.
• If you are overweight, have elevated blood pressure or diabetes, have a personal or family history of heart disease, or use tobacco products, the LDL level may need to be below 130 mg/dL, and possibly below 100 mg/dL to minimize your risk of developing symptomatic heart or circulatory disease

Here are 3 areas you can explore to lower your LDL and raise your HDL.

1. Lose Weight. Being overweight is a risk factor for heart disease. Losing weight can help lower your LDL and total cholesterol levels, as well as raise your HDL and lower your triglyceride levels.
2. Eat Healthier. There are many ways to improve your diet, so talk to a doctor and nutritionist to see what you can do. The first step is to reduce the amount of trans-fatty acids (Trans fat) you eat. Trans fats are the worst type of fat you can eat. It raises your LDL and lowers your HDL.
3. Get Physical. Regular physical activity can help lower LDL and raise HDL. You may find it hard to believe, but most everyone with SCI can exercise in some way. You can ask a therapist to help you find exercises that are safe for you. You might also contact the National Center on Health, Physical Activity and Disability (NCHPAD). NCHPAD seeks to help people with disability and other chronic health conditions achieve health benefits through increased participation in all types of physical and social activities, including fitness and aquatic activities, recreational and sports programs, adaptive equipment usage, and more.

Question

What is the one single adjustment that I can make in my diet to benefit my health?

Answer
This is a tough question to answer because everything you eat and drink impacts your health. In general, though, people with spinal cord injury can probably benefit most by making water your drink choice. The reason is that you need to keep your body hydrated. It helps with preventing urinary tract infection, keeping your bowel program regular, and keeping your skin moist and supple.

On the other hand, those drinks that have alcohol, sugar and caffeine have the opposite effect. These types of drinks help dehydrate your body. This can put you at greater risk for having a urinary tract infection. Plus, you are more likely to have an irregular bowel program or a pressure ulcer.

There is no standard for how much water you need per day, but here at UAB we ask patients to drink about 64 ounces of water per day unless there is some medical issue that indicates the patient needs more or less water. For example, someone with congestive heart failure may need to limit fluid intake. Someone with a urinary tract infection, diarrhea, or constipation may need to increase water intake.

The UAB-SCIMS Information Network

The University of Alabama at Birmingham Spinal Cord Injury Model System (UAB-SCIMS) maintains this Information Network as a resource to promote knowledge in the areas of research, health and quality of life for people with spinal cord injuries, their families, and SCI-related professionals. Here, you will find our educational materials and information on research activities of the UAB-SCIMS along with links to outside (Internet) information. http://www.uab.edu/medicine/sci/