Nutrition & Supplements

Illustration by Doug Davis

Illustration by Doug Davis

Wheelers deal with a variety of common maladies — ranging from inflammatory pain to constipation — and often come to rely on prescription drugs or over-the-counter remedies. However, both of these approaches have drawbacks and dangers, some of which can be bypassed or mitigated with proper nutrition and/or supplements.

Perhaps the best advice comes from dieticians, who point to the importance of a healthy diet in the first place, so as to not need supplements, which can be a poor substitute for proper nutrition.

So rather than popping yet more pills, why not strive for a diet that provides as much necessary nourishment and needs as little supplementation as possible, as well as a lifestyle that emphasizes health and stress management?

Some supplements, however, may actually help. But it’s best to remember that the dietary supplement market is relatively unregulated, free to make nearly unlimited claims of benefits and curative powers often accompanied by all-encompassing disclaimers such as “not intended to diagnose, treat, cure, or prevent any disease.” Manufacturers of these products are not required to run studies to determine product safety or efficacy, nor are their contents analyzed or claims approved by the FDA. So before turning to supplements, ask yourself these questions:

•    Why do I need this supplement?
•    How do I know that this supplement is safe?
•    How does it interact with the drugs or food I am consuming?
•    How do I know that it works?

What about herbal supplements and botanicals? They form the basis of many modern medicines. Eighty percent of the world’s population continues to use traditional therapies, a major part of which are derived from plants. But herbal supplements and over-the-counter medications or prescription drugs can combine to cause adverse side effects. Just because an herbal supplement is extracted from a “natural” source does not render it any less potent than any other chemicals you may ingest.

With this in mind, here are five major problem areas of everyday health for wheelers, and how proper nutrition and/or careful use of supplements can provide benefits:

Urinary Tract Infections
A growing concern is antibiotic overuse, which can lead to resistant bacteria. More and more urologists are advising treatment with antibiotics only when clinical symptoms are present — persistent headache, fever, chills, etc. — or other clear signs of infection.

Which foods are good for the bladder? Thirty years ago, an acid-ash diet was commonly prescribed to acidify the bladder. However, since then, some
bacteria have been found to thrive in acidic urine. Now urinary tract care is all about fluids. Xio Acosta, a Craig Clinic registered nurse, suggests drinking 64 ounces a day, but cautions against caffeine and mineral-rich sports drinks. Carbonation and NutraSweet are also contraindicated. Acosta recommends water or water-based beverages such as lemonade, herbal tea or even Tang.

What about cranberry juice? Most brands are so packed with sweeteners as to render them ineffectual. Cranberry extract may be an alternative but evidence is conflicting. A 2006 Australian study found cranberry extract to be effective in preventing UTIs. But three other double-blind, placebo-controlled studies failed to find cranberry extract helpful. On the other hand, a subsequent study found that the use of cranberry extract tablets over six months significantly reduced the risk of infection.

Many wheelers pay homage to D-Mannose, a simple plant sugar that bonds with UTI-fostering bugs and renders them too slippery to adhere to the bladder wall, much the same as cranberry is thought to work. Acosta says it’s also effective in dealing with sediment in the bladder.

Frequent UTIs may cause in-dwelling catheters to become encrusted with built-up mineral deposits and can become “colonized” with bacteria. George Kreye, a retired doctor and quad living in Littleton, Colo., after nearly constant infections and antibiotics, began regularly flushing his bladder through his supra-pubic foley catheter. “I use a 50cc syringe filled with a 10-1 solution of generic white vinegar and water to flush the bladder and clear the mucous out,” Kreye says. He says he’s been doing this in the shower for the past10 years and it has cut his infections in half.

Constipation and Bowel Regulation
Here is where diet far outweighs the benefits of supplements. Most practitioners and dieticians advocate a combination of a balanced diet and adequate hydration. Fiber can help relieve constipation and can be easily added to the diet with fruits, vegetables, whole-grain cereals, brown rice and other whole grains and whole grain breads, beans and non-processed foods. Red meat is no friend to regularity. Antibiotics or pain killers can make bowel problems even worse.

“You have to be regular to stay regular,” Acosta says. “Maintain consistency and use some type of stool softener regularly. We like a regular intake of high fiber foods (cited above) along with high-fiber bars, plain old oatmeal and whole grain cereal, supplemented with senna and Fibercon.”

The senna acts as a stool softener, but is also a mild bowel irritant and serves to keep everything moving along. Fibercon helps to soften stool by adding bulk. Acosta also recommends acidophilus (yogurt) following a course of antibiotics. She cautions against harsh laxatives as being too disruptive and irritating to the bowel and recommends grapes, prunes or warm prune juice instead.

Strive for a combination of both soluble and insoluble fiber. Try snacking on fruit like apples and mandarin oranges, and opt for veggie-packed broth-based soups, salads piled with greens and smoothies with berries. If you don’t like the taste of vegetables raw, try roasting them to make them sweeter.

Magnesium supplements may help soften stool. Helpful fiber can be found in Metamucil and other psyllium-containing supplements, or other OTC aids such as Magic Cleanse or laxative teas.

Joint Pain (Inflammation)
The go-to supplement here seems to be glucosamine sulphate, often in combination with chondroitin. Glucosamine is thought to stimulate cartilage and help lubricate tendons, and some think chondroitin is as effective an anti-inflammatory as common non-steroidal anti-inflammatory drugs such as ibuprofen or naproxen. But studies are conflicting, with some finding the supplements aren’t any more effective than placebos and others suggesting they work fine for mild to moderate arthritis.

“Anti-inflammatory diets” may help decrease joint pain. They all have in common a focus on eating less-refined, less-processed foods. Also, cut margarines and shortenings out of your diet all together, and limit the amount of butter and high-fat cheese. Try to use olive oil instead, or look for organic safflower or sunflower oil. Eat foods that are high in omega-3 fats (salmon, mackerel, tuna and herring); also avocados, walnuts,
cashews and almonds.

Depend less on fatty meats and more on veggie proteins. Increase your fiber intake by eating more fruits (especially berries) and vegetables (especially beans, which are also a good source of protein). And speaking of veggies, choose organically-grown produce from all over the color spectrum, especially dark leafy greens and tomatoes. Dark chocolate, too, eaten in moderation, is nutritious, especially if it has a minimum cocoa
content of 70 percent.

Topical treatments to address symptoms include capsaicin cream, which blocks pain signals to the brain, creams containing the herb arnica, and mild movement therapy such as yoga, swimming, stretching, gentle wheeling and possibly mild weight lifting.

Edema/Wound Care
Lower extremity swelling contributes to the incidence of pressure sores and often inhibits healing. It is often treated with Lasix, which can cause its own problems. Begin combating edema by avoiding sitting in one place without moving for long periods. Also, monitor your intake of sodium, which contributes to water retention and edema. Nearly every food product that is processed or packaged, especially snack foods such as chips or nuts, are notoriously packed with sodium, as are most fast foods.

Eat foods high in B vitamins and iron such as green leafy vegetables and whole grains. Foods rich in B vitamins such as beets, asparagus and grapes can act as natural diuretics to help remove
excess water. Antioxidants can play a role in reducing fluid buildup; tomatoes and blueberries can also help. Horse chestnut extract may help reduce edema.

Most importantly, if you have a wound, whether upper or lower extremity, eat plenty of protein — the most important building block in our bodies. Wounds cannot heal without adequate protein. To know your body’s existing protein level, start by asking your doctor (or wound care specialist) to run a pre-albumin test. Next, have them calculate your body’s total nutritional needs with indirect calorimetry. This will tell you how much and what to eat for optimum wound healing (see “New Model for Wound Healing,” April 2013).

Heart Health
Extra pounds and high blood pressure — both common in the United States — are primary threats to heart health, especially in the spinal cord-injured population, for which aerobic exercise is difficult.

A 2009 study by the University of Washington’s Northwest Regional Spinal Cord Injury System advises those with SCI to keep close watch on cholesterol and triglyceride levels, factors which are known to clog arteries and increase risk of heart disease. The enemy is unhealthy animal fats and the omega-6 family of fats, which are contained in most vegetable oils (corn, safflower, peanut, cottonseed, soy) and all the processed and packaged food containing these oils. Trans-fatty acids come in all products containing “partially hydrogenated” vegetable oils — salad dressing, shortening, stick margarine, many baked items like cookies and cakes, even non-dairy creamer.

On the plus side, some fats are actually good for you, especially the omega-3 and omega-9 families of fatty acids. The omega-3 family (specifically fish oil) restores and maintains general health and can also reduce inflammation, act as a mild blood thinner, help maintain heart rhythm, and reduce blood pressure. Look to olive oil, avocados and macadamia nuts for healthy omega-9s.

Mackerel, salmon, and tuna are considered rich sources of the healthy omega-3 fats. Including one to three servings of these foods per week can help decrease cholesterol and harmful triglyceride levels. Increasing soluble fiber from sources such as oatmeal, apples, beans and lentils can help decrease LDL (bad) cholesterol levels. Exercise and activity helps increase HDL (good) cholesterol. A daily supplement of niacin has also been shown to raise HDL.

In the March Harvard Men’s Health Watch newsletter, Dr. Deepak Bhatt, chief of cardiology at Harvard Medical School, says proper diet can reduce blood pressure by 10 points (DASH diet, see resources). Key diet ingredients are plentiful fruits, vegetables, whole grains, low-fat or nonfat dairy products, low sodium and small portions of lean meat, poultry, fish and nuts. Also, potassium is especially important in controlling blood pressure.

Resources
• “Nutrition Guidelines for People with SCI” available at sci.washington.edu/info/forums/reports/nutrition.asp.
• DASH diet; www.mayoclinic.com/health/dash-diet/HI00047

 


Using Vitamins  and Supplements

Vitamin B:  Can help to calm mood; sources include lean meats, fish and seafood, green leafy veggies, potatoes, and fortified cereals.

Vitamin C:
•    Essential in formation of collagen (important to wound healing)
•    Can displace some high blood sugar and improve glucose metabolism
•    Reduces inflammation by counteracting free radicals which promote inflammation

Vitamin E: Reduces risk of coronary artery disease (fat-soluble antioxidant, blocking free-radical oxidation to cholesterol); helps prevent clotting and narrowing of coronary arteries.
•    Lowers C-reactive protein (leading marker of systemic inflammation) by 30-50 percent. CRP is associated with:
– Heart disease
– Blood sugar disorders (insulin resistance, diabetes)
– Dental disease
– Overweight and obesity
– Arthritis
•    Significantly reduces promoters of inflammation-related diseases such as:
– Arthritis
– Allergies
– Cancer

Glucosamine, Chondroitin and Vitamin C
•    Some clinical trials suggest glucosamine and chondroitin are effective in reducing pain and promoting cartilage pads that protect joints.
•    All three are building blocks of cartilage; cartilage production decreases with age.
•    Dosage: Glucosamine-1,500 mg/day; Chondroitin- 1,000 mg/day; Vitamin C- 500 mg/day.

Fish Oil  (Omega-3 fatty acids)
•    Will promote more pain-free joints, healthier heart and lower cholesterol, as well as reduce inflammation. Exercise caution if using blood thinners.

Olive Oil
• Use as go-to cooking oil, for marinades and in salad dressings.


Diet Through our Lifetime

20s: Emphasize calcium, at least 1,000 mg/day, from cereals, legume-type beans, leafy greens, almonds and canned salmon with bones.
30s: Look to foods containing healthy fats such as omega-3 fats and monounsaturated fats.
40s: Be vigilant about eating plenty of fruits and vegetables. Fiber is also important for the over-40 set, at least 20 grams/day (double the average diet). Augment the fruits and veggies with whole grains and legumes.
50’s: Vitamin D may reduce the risk of some cancers, heart disease and infectious diseases. Look to fortified milk, orange juice, and cereals and fish.
60s and Beyond: Vitamin B12, which helps your body make red blood cells and keep the brain and nervous system healthy.

 


What Healthy Foods Should I Eat?

• Eat a variety of fresh and whole (not processed) foods.
• Eat fish two or more times per week, especially cold-water fish like wild salmon, broiled, baked, grilled or fried in olive oil, not breaded or deep-fried.
• Eat meat from grass-fed animals, which contain large amounts of omega-3 fatty acids; grain-feeding almost eliminates the omega-3 and increases saturated fat. Steer clear of fatty red meat as much as possible.
• Aim for at least three servings of fruit and two of vegetables daily.
• To lose weight, reduce both carbs and calories
• Avoid or strictly limit sugars, especially high fructose corn syrup found in  soft drinks.
• Avoid/limit refined grains, especially “enriched” flour and white rice.
• Limit intake of dairy products.
• Snack on nuts and seeds, preferably raw or dry roasted (check the label)
• When thirsty, drink water and avoid beverages containing sugar, high-fructose corn syrup or other caloric sweeteners.

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