Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2020; 26(20): 2479-2497
Published online May 28, 2020. doi: 10.3748/wjg.v26.i20.2479
Diet in neurogenic bowel management: A viewpoint on spinal cord injury
Marco Bernardi, Anna Lucia Fedullo, Elisabetta Bernardi, Diego Munzi, Ilaria Peluso, Jonathan Myers, Florigio Romano Lista, Tommaso Sciarra
Marco Bernardi, Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome 00185, Italy
Marco Bernardi, Italian Paralympic Committee, Rome 00191, Italy
Marco Bernardi, Anna Lucia Fedullo, Federazione Italiana Pallacanestro In Carrozzina (FIPIC), Rome 00188, Italy
Elisabetta Bernardi, Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari "Aldo Moro", Bari 70121, Italy
Diego Munzi, Tommaso Sciarra, Joint Veteran Center, Scientific Department, Army Medical Center, Rome 00184, Italy
Ilaria Peluso, Research Centre for Food and Nutrition, Council for Agricultural Research and Economics (CREA-AN), Rome 00178, Italy
Jonathan Myers, VA Palo Alto Health Care System and Stanford University, Cardiology Division, Palo Alto, CA 94025, United States
Florigio Romano Lista, Scientific Department, Army Medical Center, Rome 00184, Italy
Author contributions: Peluso I and Bernardi M developed the concept; Bernardi M, Fedullo AL, Bernardi E, Peluso I, Sciarra T and Lista FR contributed to the interpretation of data; Munzi D contributed to the acquisition of the papers (bibliographic research), and drafted the preliminary paper; Bernardi M, Fedullo AL, Bernardi E, Myers J and Peluso I wrote the manuscript; Myers J, Lista FR and Sciarra T made critical revisions of the manuscript; Bernardi M, Fedullo AL, Bernardi E, Munzi D, Peluso I, Myers J, Lista FR and Sciarra T approved of the version of the article to be published.
Supported by the Project AMAMP (2019-2021), No. M_D GCOM REG2019 0021673 03-12-2019, funded by Ministero della Difesa, Italy; and Prof. Myers J was funded as a visiting professor by Sapienza, University of Rome, No. Prot. n. 0081645 26-09-2019.
Conflict-of-interest statement: There is no conflict of interest associated with any of the authors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Ilaria Peluso, PhD, Research Scientist, Research Centre for Food and Nutrition, Council for Agricultural Research and Economics (CREA-AN), via Ardeatina 546, Rome 00178, Italy.
Received: December 31, 2019
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.

Keywords: Neurogenic bowel dysfunction, Body composition, Mediterranean diet, Food–drug interactions, Microbiota, Paralympic athletes

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.