A Trifecta for Optimal Health!
“I wish I could lose weight as easily as I lose my keys, pen, cell phone, temper, and even my mind” –Unknown.
Unwelcome pounds have a way of unexpectedly creeping on. Especially when living with a spinal cord injury or other disability (SCI/D). Most of us are well aware of this occurrence, but what do we do about it? This additional weight can be harmful if we roll out the welcome mat and allow it to hang around as those pounds can increase the risk for cardiovascular disease, diabetes, and high cholesterol. One study performed by the National Institute of Health found the overall prevalence of diabetes was increased by 20%, cardiovascular disease was 16% higher, and cholesterol was elevated in individuals with an SCI/D compared with the general population.
It can happen to anyone…
Patty Kunze, of The Rollin' RNs, states, “Even though I’m a Registered Nurse, I’m not invulnerable to developing diabetes. I had a family history of diabetes but I was symptom-free, therefore, worry-free. Things changed after my accident. As a T4 complete para, my physical mobility was greatly reduced when I started using a power wheelchair. I also wasn’t exercising or paying attention to what I was eating. In 2020 I got the wake-up call when my yearly lab results revealed an elevated Hemoglobin A1C of 9.1%.” According to the CDC, a Hemoglobin A1C test is a simple blood test that measures average blood sugar levels over the past 3 months. It's one of the most commonly used tests to diagnose prediabetes (A1C values of 5.7% to 6.4%) and diabetes (A1C value of 6.5% or higher). This test is important because higher A1C levels are linked to diabetes complications such as chronic kidney disease, heart disease, foot problems, nerve damage, and vision loss. “As a Registered Nurse, I understood the ramifications of developing these complications and now mine was 9.1% indicating I did have diabetes! It was time for me to rethink what I was doing to my body and to formulate a plan with the focus being good nutrition, healthy weight, and physical activity. The trifecta for optimal health.”
I was not alone in my quest for optimal health. Any of us living with a spinal cord injury or other disability (SCI/D) need to be more mindful of becoming overweight since we are prone to additional risks such as shoulder problems, pressure sores, difficulty with transfers, and potentially outgrowing our wheelchair.
What is a healthy, optimum weight for someone with a spinal cord injury? Due to a decrease in muscle mass and bone density, the general rule is to subtract 5-10% from general weight guidelines for paraplegia, and 10-15% for quadriplegics. Next, calculate your daily calorie intake based on your targeted weight. The formula for paraplegias: 27.9 calories x body weight in kg. (1 kg = 2.2 lbs.) And for those with quadriplegia: 22.7 calories x body weight in kg. For example, a para with a target weight of 150 would need approximately 1902 calories while a quad with a target weight of 150 would only need 1547 calories. Keep in mind this formula is based on your target weight but it doesn’t account for gender, age, or activity level which can change calorie needs.
I figured out a plan that worked for me to get my diabetes under control. “Following that high A1C level, my physician prescribed Metformin, an oral medication used to reduce high blood sugar, and blood sugar monitoring throughout the day. Knowing what needed to be done, I immediately emptied my pantry of 'fast-acting carbs' such as pasta, rice, potatoes, and white bread, and I started reading food labels for calories and carb content. (There are some great apps available that make it easy to do this). I also increased my water consumption and decreased sugar-sweetened beverages and juices, (If you don't like the taste of plain water, add some sugar-free crystals or slices of fruit to enhance the flavor) and I started minimal 2 lb. weight exercises. Within six months of these changes, my Hemoglobin A1C was down to 6.2. Over time, I coordinated a plan with my physician to eliminate the diabetes medication and continued to maintain a healthy diet. Another six months later, my A1C value decreased to 6.0 and just recently down to 5.6. All with a healthy diet, no medication, and exercise. Win-win all around. Healthy meals with increased protein and snacks of fresh fruits and/or vegetables are my go-to now. It can be done when there is a goal in sight along with good communication with your healthcare provider.”
Persons with an SCI should periodically review their eating habits, adjust portion size, and eat healthily. Even though calorie requirements are less due to reduced muscle mass and decreased physical activity, the body’s need for vitamins, minerals, and protein remains the same. Think less but better! Eat smaller portions and never eat past feeling full. Many of us, while growing up, were taught to finish our plate and it was a rule I was still following. That in part had a lot to do with the extra pounds I had gained. I started using a lunch plate instead of a dinner plate also. It’s smaller and your brain will think your plate is full. I try to fill ½ of my plate with non-starchy vegetables such as broccoli, asparagus, or green beans, ¼ with protein, and the other ¼ with carbohydrates. I also learned to eat slower. According to Livestrong.com, it may take up to 20 minutes for your brain to register that your stomach is full. By maintaining these small changes in my daily routine, I have been able to keep my weight and diabetes in check.
There’s been a great deal of interest in our SCI support groups around the topic of using intermittent fasting (IF) as a method to combat weight gain and maintain it. Intermittent fasting is an eating pattern that cycles between periods of eating and not eating (fasting). It doesn’t specify which foods you should eat but rather when you should eat them. And that’s just the tip of the iceberg lettuce! There’s a lot of information to break down regarding this topic and we, The Rollin’ RNs have already done this for you in a previous article. So, if you’d like to know more about IF and if it would be an option for you, please check out our article here. One person in our SCI support group had this to say about IF: “I have had my best luck with intermittent fasting (combined with calorie counting). I find it much easier than traditional dieting because no food is off-limit and you can cater it to fit your schedule. It takes a few days to get your body used to it, but once you get the swing of it, the weight falls off, you feel more energized, and you even have some perks such as improved bowel movements.”
Physical activity creates strength, mobility, improved endurance, and overall well-being. Any form of physical activity increases metabolism and enriches our health. Previously, there was an over-reliance on the need to increase physical activity and exercise to lose weight. But for someone with paralysis of the body’s largest muscles, it is quite difficult to reduce body fat through increased physical activity only. The most effective way to lose weight, and this applies to all people, is to reduce energy intake. In other words, EAT LESS! That said, any physical activity will facilitate weight loss. This includes everyday activities such as rolling around in a manual wheelchair, transfers, and household chores like making the bed or vacuuming. All these activities increase metabolism nearly as much as shorter workouts at the gym. So don't discount the power of moving! There are also some fun, effective, and free seated classes available online and on YouTube. So, check them out if you like to work out! The key is to find out what works best for you.
When discussing weight for those with an SCI, the topic of “quad belly” or “quad gut” needs to be mentioned. It's a common occurrence for many people living with an SCI. For starters, quad belly or quad gut does not only happen to quadriplegics. The protrusion of the abdomen and intestines due to a lack of abdominal muscles can occur in anyone, including paraplegics who have an injury above the level of the abdomen. It is most noticeable when sitting in your wheelchair from the weight of the organs being pushed outwards. Even people with the smallest of frames and at their optimal weight can have and worry about a quad belly. To assist in disguising a quad belly, correct body posture, wearing a good abdominal binder, and loose clothing can be helpful. However, from our own experience, disguising it can still be a challenge so learn to embrace your appearance and smile.
We, The Rollin’ RNs, believe in the three key components to optimal health: good nutrition, healthy weight, and physical activity. If we maintain this trifecta in our daily life and allow them to become a routine, a wholesome lifestyle can be obtained and easily maintained. As with anything else related to SCI, the name of the game is to stay one step ahead. And, in doing so will benefit you in the long "roll."
It’s all good, so keep on rollin’.
Patty Kunze, BSN, RN and Roberta Palmer, RN
The Rollin’ RNs ™