National Hospital for Neurology and Neurosurgery Healthy eating after a spinal cord injury Department of Nutrition and Dietetics
If you would like this document in another language or format, or require the services of an interpreter, contact us on 0203 448 3215. We will do our best to meet your needs. Contents Why is healthy eating important? 3 Managing constipation 4 Pressure ulcers 5 Eating a balanced diet and the eatwell plate 6 Where can I get more information? 13 How to contact us 14 Where to find us 16 2
This booklet has been written by the Department of Nutrition and Dietetics at UCLH. The aim of the booklet is to provide you with information about healthy eating after spinal cord injury. It can also help you to maintain a healthy weight or lose weight. This booklet is intended for patients, their family or carers under the care of the team at UCLH requiring general dietary advice. It is not intended for patients with unwanted weight loss. If you are experiencing undesirable weight loss please ask the team to refer you to the dietitian for a full assessment. Why is healthy eating important? Healthy eating is important for everyone. Following a spinal cord injury you may be more likely to experience the following: An initial weight loss. This can be due to the body s response to trauma or a reduced appetite due to treatment and surgery. Bowel problems such as constipation. This can be caused by not being as mobile as previously or food moving more slowly through your gut. 3
Increased risk of pressure ulcers due to immobility, poor circulation and lack of sensation; Long term weight gain. This is mostly caused by decreased activity and reduced muscle which may mean you need to eat less than you did previously to maintain your weight. Managing Constipation To help with opening your bowels regularly it is important to have adequate fibre and fluid in your diet. You should aim for eight glasses of fluid per day; this can include tea, water, squash and juice. Any increase in fibre in the diet should be done gradually to prevent side effects such as bloating or loose bowels. Good sources of fibre include: Wholegrain foods such as breakfast cereals and wholemeal or granary breads; Fruits and vegetables; Beans, lentils and pulses. Please note that if you have an individual bowel management programme you may be given individualised advice on fibre and fluid intakes. 4
Pressure ulcers Pressure ulcers are areas of soft tissue damage. These are usually caused when parts of the body are in contact with surfaces such as a bed or wheelchair for a long time. They commonly occur in areas such as the ankles and the sacrum (bottom). Maintaining a healthy weight is one way to help reduce the risk of pressure ulcers. Extra weight can cause more pressure on the skin and increase the risk of skin breakdown. Protein is needed to help with wound healing. If you have a mild pressure ulcer, take extra care to make sure you are getting the recommended amounts of dairy and protein foods that are detailed in this booklet. If you have more severe pressure ulcers you should be referred to the dietitian for dietary assessment as you may need to increase the amount you are eating and drinking to help the healing process. 5
Eating a balanced diet The best way to help prevent excess weight gain and maintain a healthy weight is by eating a balanced diet. The Food Standards Agency (FSA) has created the eatwell plate (see page 7). This shows the five food groups in the diet with the size of the portion on the plate representing the proportion that food group should make up in our diets. The model is not supposed to represent individual meals, rather a reflection of your intake over a day or week. As well as having a balanced diet it is also important to think about the total amount of energy/calories that you eat and drink. If you take in more energy than your body is using then your weight will increase and you may become overweight. Each food group from the eatwell plate is discussed in more detail in the following pages. We have also included some weight loss tips if you are trying to lose weight. 6
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Bread, rice, potatoes, pasta and other starchy foods (carbohydrates) This food group also includes breakfast cereals, noodles, cous cous, chapatti and oats and is important for providing energy, fibre and vitamins. You should include at least one starchy food with each meal. Wholegrain varieties are good choices as they are usually digested more slowly and contain more fibre than white and refined foods. Good choices include: Wholegrain breakfast cereals and oats, for example porridge, muesli, shredded wheat; Granary, seeded or wholemeal breads, chapatti and pitta; Whole-wheat pasta. Weight loss tip: Although we should have some carbohydrate at each meal it is important to watch portion size. Try not to fill more than a quarter to a third of your plate with carbohydrate. Try not to have more than one type with each meal, for example avoid garlic bread and pasta together. 8
Fruits and vegetables This food group provides essential vitamins and minerals as well as fibre. You can use fresh, frozen, tinned or dried aiming for a minimum of five portions each day. A portion is 80 grams which looks like: One apple, banana, pear or other similar sized fruit; One tablespoon dried fruit; Three tablespoons cooked vegetables or small bowl of salad. Weight loss tip: Vegetables are generally low in calories so filling up with them can help with weight loss. Try to fill at least a third to a half of your plate with vegetables. 9
Milk and dairy foods This food group provides calcium, protein and other vitamins. Two to three servings a day are needed for adequate calcium intake. A serving is: 200mls milk; 150grams or one small pot of yoghurt; 30grams cheese about the same size as a small matchbox or three tablespoons of cottage cheese; Weight loss tip: Dairy foods can be high in fat and saturated fats which can affect weight and cholesterol levels. To reduce fat intake: Choose skimmed semi skimmed or one percent milk; Choose low fat or light yoghurts; Choose reduced fat cheese or cottage cheese; Reduce intake of cheddar and high fat cheeses, try grating or choosing a stronger cheese to help use less. 10
Meat, fish, eggs, beans and other non dairy protein sources These foods are a good source of a variety of vitamins and minerals as well as providing protein used for repair and growth in the body. We should aim for two servings a day. A serving is: Palm sized portion of meat or chicken; Three tablespoons cooked chickpeas, beans or other pulses; 140grams fish about the size of a computer mouse; Two eggs; One tablespoon of unsalted nuts. Weight loss tip: Some protein foods can be high in fats. To minimise this try the following: Choose lean cuts of meat and mince (less than 10 percent fat); Remove chicken skin and visible fat on meat and bacon; Try to grill meat and fish instead of frying; 11
Limit intake of pies, sausages, salami and other fatty meats; Poach or boil eggs rather than frying. Foods and drinks high in fat and sugar This food group includes cakes, biscuits, butter, cream, oil, sweets and sugary drinks. We should try to eat only small amounts of these foods as they provide little nutrients other than sugar and fat and too much can cause weight gain. Weight loss tip: To reduce intake try the following: Have fun sized chocolate bar or two squares dark chocolate instead of normal sized bar; Choose diet or sugar free drinks; Spread butter thinly on toast and measure oil with a teaspoon when cooking; Avoid deep fried foods; Try alternative snacks such as low fat yoghurt, fruit or a small portion of unsalted nuts (30grams). 12
More weight loss tips: Do not skip meals as this makes you more likely to snack or have bigger portions later; Use a smaller plate for meals to help with portion control; Eat slowly so your brain has chance to register you are full to prevent overeating at meals; When buying ready made meals compare the food labels to help you pick those containing less calories and fat. Avoid high sugar drinks such as Coca-Cola, lucozade, fanta or large amounts of fruit juice. Choose water or sugar free alternatives instead. Where can I get more information? For recipe ideas, meal plans and guidance on reading food labels visit: www.nhs.uk/livewell 13
How to contact us The Department of Nutrition and Dietetics The National Hospital for Neurology and Neurosurgery Box 91 London WC1N 3BG Direct Line: 020 3448 3215 Switchboard: 0845 155 5000 / 020 3456 7890 Fax: 020 7380 9811 Website: www.uclh.nhs.uk/nhnn 14
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Where to find us Publication date: 2013 Date last reviewed: April 2016 Date next review due: April 2018 Leaflet code: UCLH/SH/NHNN/ University College London Hospitals NHS Foundation Trust 2013 16