Published online May 28, 2020. doi: 10.3748/wjg.v26.i20.2479
Peer-review started: December 31, 2019
First decision: March 26, 2020
Revised: April 14, 2020
Accepted: May 13, 2020
Article in press: May 13, 2020
Published online: May 28, 2020
The aim of this review is to offer dietary advice for individuals with spinal cord injury (SCI) and neurogenic bowel dysfunction. With this in mind, we consider health conditions that are dependent on the level of lesion including skeletal muscle atrophy, autonomic dysreflexia and neurogenic bladder. In addition, SCI is often associated with a sedentary lifestyle, which increases risk for osteoporosis and diseases associated with chronic low-grade inflammation, including cardiovascular and chronic kidney diseases. The Mediterranean diet, along with exercise and dietary supplements, has been suggested as an anti-inflammatory intervention in individuals with SCI. However, individuals with chronic SCI have a daily intake of whole fruit, vegetables and whole grains lower than the recommended dietary allowance for the general population. Some studies have reported an increase in neurogenic bowel dysfunction symptoms after high fiber intake; therefore, this finding could explain the low consumption of plant foods. Low consumption of fibre induces dysbiosis, which is associated with both endotoxemia and inflammation. Dysbiosis can be reduced by exercise and diet in individuals with SCI. Therefore, to summarize our viewpoint, we developed a Mediterranean diet-based diet and exercise pyramid to integrate nutritional recommendations and exercise guidelines. Nutritional guidelines come from previously suggested recommendations for military veterans with disabilities and individuals with SCI, chronic kidney diseases, chronic pain and irritable bowel syndrome. We also considered the recent exercise guidelines and position stands for adults with SCI to improve muscle strength, flexibility and cardiorespiratory fitness and to obtain cardiometabolic benefits. Finally, dietary advice for Paralympic athletes is suggested.
Core tip: Dietary advice for individuals with a spinal cord injury (SCI) and with neurogenic bowel dysfunction (NBD) must be carefully considered. This advice should include: (1) Energy and nitrogen balance; (2) Under/over-nutrition; (3) Comorbidities and polypharmacy; and (4) Micronutrient deficiency. Dysbiosis and low-grade inflammation, typical consequences of SCI, can be reduced by increasing both physical exercise and fibre intake, but particular fermentable carbohydrates and source of fiber, can sometimes increase NBD symptoms. Water intake is particularly important for NBD management and can be critical during and after exercise. Multi-disciplinary cardiovascular risk reduction programs, including tailored nutrition, strength, aerobic and flexibility training, and personalized dietary supplementation are recommended for individuals with SCI and NBD.