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Spinal Cord Injury

  1. Where can I find a dietitian works with spial cord injuries? Answer
  2. I am a recovering quadriplegic and am working out in the gym 6 days a week. I feel that I do not have the energy based on what I am eating. Answer
  3. I experience a lot of pain in my right arm and wrist. Answer
  4. Do you have any hints for patients with spinal cord injuries dealing with body composition and assessment of nutritional / metabolic status of paraplegics? Answer
  5. I am a quadraplegic and am concerned with my weight and wish to lose weight. Answer
  6. I have compared your information about foods that tend to be constipating with some other sources. Answer
  7. I am a quadriplegic. What is a normal body weight for a 6 foot 1 inch tall male with a medium frame? Answer

Where can I find a dietitian who works with spinal cord injuries?

The Dietetics in Physical Medicine and Rehabilitation dietetic practice group of the American Dietetic Association specializes in working with patients with spinal cord injuries. You can find a dietitian at the American Dietetic Association. Include your zip code or city / state, the type of service (individual consultation) and expertise you want.

Thank you for your most informative page. I have used it to inform myself and others who can use this valuable unbiased information.

I am a recovering quadriplegic (central chord syndrome C3,6,7) and am working out in the gym 6 days a week. 3 on, one day off. I do upper body one day, lower the next and on day three combine aerobics and back. My problem: I feel that I do not have the energy based upon what I am eating. I am eating about 50 grams fat/day, 1500 - 2000 calories/day. What should I be eating in the A.M. vs. P.M.?

I have heard that I shouldn't eat certain foods at certain times because it will cause me to have a low of energy in the afternoon, causing me to be weaker in afternoon or evening.

You're welcome. Sounds like you have a great exercise program and are dedicated to maintaining your flexibility and strength.

Have you used the Healthy Body Calculator to determine how many calories and grams of fat to eat based on your weight goals? Unfortunately, I have not been able to find good data for persons with spinal cord injuries and any effect it may have on metabolism.

Limit carbohydrates (in particular starches and high sugar foods that have a high glycemic index) mid day and eat more low fat protein (meat, poultry or fish) for more energy. Have you considered working with an physical therapist who does strength training with spinal cord injured people?

I am a C6 quad. I was injured in 1996. Since my accident I experience a lot of pain in my right arm and wrist. Doctors have tried everything to help me with this pain with no success now doctors are recommending a spinal cord stimulator. My question is do they work and do you know anyone who has had this procedure. Thank You!

My expertise is in nutrition, not pain. If you are unsure of whether or not to proceed, perhaps you should get a second opinion.

Do you have any hints for patients with SCI (spinal cord injuries). Are there any sites you know of containing that kind of information? I have only found two publication so far dealing with "body composition" and "assesment of nutritional and metabolic status of paraplegics". Any help from your side would be highly appreciated! Greetings from Switzerland!

Well I have been looking for similar info and haven't found any yet. So if you find something good, please forward to me as I would like to include assessment for persons with spinal cord injuries in my Healthy Body Calculator. I don't feel that ambulatory weight and calorie estimates are appropriate.

What are your needs / application for body composition and assessment of nutritional and metabolic status of paraplegics?

I am a quadriplegic living in a health care center in Arizona. I am concerned with my weight and wish to lose weight. I am 32 years old and weigh 220 pounds and six feet tall, but the dietitian here is concerned with my protein level. She has me on a protein powder and a supplement called Pulmo-Care which has 355 calories per can and I am on a 1,200 calorie diet. Do you have any suggestions or information that would be of any help?

Since your dietitian has access to your medical chart and I don't, I would recommend you follow her instructions for a protein powder. You probably need the extra protein because the proteins in your blood are low or it is helping to cure pressure sores.

Pulmo Care is lower in carb which won't increase your oxygen needs. Are you on a respirator? Ask the Dietitian why you are on the protein powder and Pulmo Care.

A 1200 calorie diet plus 355 calorie supplement plus? Calories in protein supplement should prevent additional weight gain which would not be healthy. Additional weight would also increase your transfer weight (someone moving you from wheelchair to bed) and pressure on boney points i.e. heels, hips, tailbone, shoulder and back of head.

You don't mention whether or not you receive physical therapy. Passive range of motion (someone moving your arms, legs, torso) can help maintain muscles and prevent contractures (muscle shortening due to disuse). As a resident in a health care facility, you should be receiving some maintenance physical therapy. If you aren't in some PT, ask your nursing staff what they could schedule for you on a daily basis.

Thanks for your response. I replied to let you know about some of the conflicting advice out there. I have compared your information about foods that tend to be constipating with some other sources.

One source is a spinal cord injury manual written by the staff of the Kessler Rehabilitation Hospital, where Christopher Reeve went through rehab. Foods that they recommended avoiding included bananas, cheese, white rice, and white bread. They also mentioned that dairy products and meat could tend to cause hard stools.

Another source was a spinal cord injury manual, titled "Yes, You Can", published by the Disabled Veterans of America ( I'm not totally positive on the publisher). Foods to avoid in this book included bananas, cheese, white potatoes without their skins, meats, and dairy products. In both of these books apples were on the list of good foods for regularity.

One source that I found on the Web was the University of Washington Rehabilitation Hospital. Their site offers some tips for a successful bowel program. Their list of foods to avoid included bananas, cheese, white bread, and white potatoes. Other tips included eating whole grains, bran, fruits, vegetables, Metamucil, drinking lots of water and getting some exercise. The spinal cord manuals also made similar suggestions.

In consulting with the dietitian at my local hospital, she hadn't heard that apples and bananas were constipating. She said that some people do run into problems with dairy products.

As you can see, some of the advice that I have gotten can be confusing. I will have to continue my experimenting with various foods to see what works best for me. Thanks again for your time.

Here are some Web addresses that you might find interesting. University of Washington Rehabilitation Hospital in Seattle Washington and Craig Hospital in Denver Colorado. This site has information about spinal cord injuries and aging with them.

Good to hear back from you and thanks a lot for websites. I am very familiar with the University of Washington Rehabilitation Hospital and have communicated with a dietitian there. Will check out Craig Hospital.

First there is some confusion about bananas and apples. These foods are not constipating. Here's how this idea got started. For children and adults with diarrhea, dietitians often prescribe a BRAT diet which stands for banana, rice, apple and tea, but some people think the T stands for white toast. Anyway, the apple part is usually apple juice, but also refers to scrapped apple without the peel or applesauce. You see, apple is a good source of pectin which is used to gel fruit juice into jelly. Pectin works the same way with loose stool in gelling the liquid contents to a more solid form thereby stopping the diarrhea. BTW, pectin is a soluble fiber found in fruits. You can buy pectin in the grocery store in a liquid form or as Kayopectate medicine for diarrhea which has pectin as an ingredient. Hope this is not too graphic for you. Since diarrhea is not your current concern and constipation is, I would not recommend bananas, rice or tea on any regular basis. However, wild rice (actually a grass seed) would be OK. Peeled apples or applesauce would be OK in that they would contribute soluble fiber which helps retain more water in even constipated stool. Soluble fiber works both for diarrhea (gelling loose stool) and constipation (increasing water in constipated stool).

I have heard from people that various foods including cheese or dairy products constipate them, but this is attributed to individual opinion rather than research due to the variability of people's intestines.

More than you ever probably wanted to know about apples, pectin or soluble fiber, but...

I am 24 year old C 5-6 (cervical 5th and 6th vertabrae) quadriplegic and have a couple of questions. First, what is a normal body weight for a 6 foot 1 inch tall male with a medium frame?

Right after my injury, four and a half years ago, I was warned not to gain a bunch of weight due to the decrease in physical activity. Unfortunately I took this warning to an extreme, slowly losing weight over a couple of years until I began to have a pressure sore problem. The pressure sore eventually needed surgery to fix, at which I weighed 116 pounds. While in the hospital I worked my way back up to 125. Two years later, I now stand at about 130. Is this a healthy weight for someone in my position?

I have another factor that plays a role in my struggles to maintain and gain weight. My appetite is not the best and as with most people with spinal cord injuries, regularity is a problem. When I get constipated and the bloated feeling that comes with it, I don't feel like eating. To help avoid constipation I try to maintain a high fiber diet, eating lots of whole grains, bran, fruits, vegetables and legumes. Some sources I've found say that dairy products and meats tend to be constipating, so I've cut back on milk, cheese, hamburger, steak, chicken and other meat and dairy products. Now I wonder if I'm getting enough protein and calcium. I heard once that skim milk is less constipating than 2%, is that true?

In closing, if I am unhealthful weight, is there a way to gain weight that is not just a bunch of fat, given the fact that I can't exercise to build muscle like an able bodied person? Thanks for your time.

Thanks for asking some good questions about people with quadriplegia.

I have searched for nutritional assessment tools to use with spinal cord injuries, but haven't found any yet. It seems reasonable that you should weigh the same as an able bodied person of the same vertical height. So at 6'1", you should weight 170 - 186 pounds. With a medium frame, you should weight in the middle of this range or around 178. Check out your data by trying the Healthy Body Calculator at my site. If you include only very light activity hours, it would be close to your calorie needs as a quad. What did you weight before you were injured? Perhaps that is "healthy" weight for you?

The warning not to gain weight is sound because of decreased physical activity for quads. Also, your risk for heart disease, cancer and stroke would also increase if you gained a lot of weight same as a able bodied person. However, you went the other direction and you are underweight now.

Ouch that bed sore sounded painful. Muscle and fat overlay your skeletal system and cushion your bones from causing pressure sores. Infrequent movement with constant pressure on your skeletal system at points where your bones stick out could cause pressure sores even if you were at a healthy body weight. During the day, you need to periodically be shifted to different positions so the pressure is not constantly on your tailbone or hips and elbows. Also, passive massage of pressure points (back of the head, shoulder blades, hips, tailbone, elbows and heels) can help to improve circulation. I would suggest you contact your physical therapist for specific suggestions as pressure sores are difficult to heal and in the extreme need surgical remedies.

To improve your appetite, I would suggest regular meals and snacks. I assume someone else is assisting with food preparation. Ask them to prepare your favorite foods. If you don't have a problem with alcohol, a glass of wine can help stimulate a person's appetite before an evening meal. If you feel full quickly, you need more calorie concentrated foods and possibly should consider a supplement. Even a glass of Instant Breakfast, Sustacal or Ensure would help add the balanced nutrition you need between meals. At meals, add margarine to your potatoes, rice, pasta, bread and vegetables as well as switch to whole milk instead of low fat or skim. For now, forget about fat as you need calories and to gain weight. FYI, exercise, even passive stretching (range of motion) can help stimulate your appetite too.

Basically stool is mostly food that your body can't digest i.e. fiber. So when you decreased your food intake to lose weight, you also decreased the amount of stool passing through your intestines. Your switch to whole wheat breads, whole grain cereals, fresh fruits, vegetables is the recommendation for constipation. Remember to drink enough water as some fiber (insoluble) absorbs fluid in the intestinal tract and swells to act like Roto-Rooter. Usually fiber stimulates the paristaltic movement of your intestines and speeds up the time it takes to traverse your intestines. Again, exercise, even passive exercises, can stimulate the intestines to work faster.

Unless you have an allergic reaction (vomiting, diarrhea, cramping, rashes) to specific foods, I would not suggest you cut out any food as you are cutting out valuable nutrients. Some of the foods you have cut out happen to be the best sources of particular nutrients i.e. milk & cheese (calcium, riboflavin, vitamin D, vitamin B 12), hamburger, steak chicken and other meat (protein, iron, vitamin B 12, zinc). These foods do not necessarily cause constipation, but bananas, apples, rice and tea can. Do you eat lots of these foods?

No skim milk is not less constipating than low fat (2%) milk. In fact, milk is not considered to be a constipating food.

To add weight that is more muscle than fat, I would recommend you contact a physical therapist for recommendations on passive exercises that your care giver can provide daily. I think that regular exercise would help a lot to reduce pressure sores, constipation and support adding more muscle than fat while preventing muscle contractures (shortening of muscles due to inactivity).

Lastly, why not talk to a Registered Dietitian who could plan healthy meals for weight gain while including your food preferences?

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