Nutrition Course Script

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Section 1 – Your Body Needs Healthy Food

1.1 – Good Food, Good For You!

Eating well helps you stay healthy, especially after a spinal cord injury.

Damage to the spinal cord can cause many systems in your body to work differently – like your digestive and urinary systems, bones, and skin.  Changes to these systems can in turn lead to other health problems.

The good news is many of these of these health conditions can be improved and even prevented by eating well!

If you’re aware of the different effects that foods have on our body, you can make wise choices.  This helps give you more control over your body and helps you live to your fullest potential.

Healthy eating doesn’t mean bland, boring, or bad tasting food.  In fact, a healthy diet includes a variety of tastes, and, as much as possible, foods that are fresh and natural.

If you want to see examples of fun, healthy recipes, click on the link that says “Cooking with Pascal” and you can watch celebrity chef Pascal Ribreau prepare 4 delicious dishes that are specially designed for the health needs of people with spinal cord injury.

In this course, as you learn how to prevent health problems by choosing the right foods, you’ll see how healthy eating can be a pleasurable experience.

1.2 – Digestive Health

A spinal cord injury can cause changes to the way your digestive system works.  Making the right kind of food and beverage choices can help you stay regular and avoid constipation, bowel accidents and other complications.

The key to digestive health is fibre; it’s important for a person with spinal cord injury to get enough fibre–at least 15 grams a day.  An apple contains about 4 grams of fibre, and a bran muffin contains about 5 grams, so you’ll need several servings of high-fibre foods to reach your daily requirement.  Fibre supplements such as psyllium and bran cereal can help.

Getting enough fluid is also important for your digestion.   If you don’t drink enough fluids you could have slower, more difficult bowel movements.

Certain medications like pain killers may cause constipation, while others, like some antibiotics, can result in stomach upset and diarrhea.

Overall, getting the right amount of fibre is a good way to help maintain your bowel routine and prevent digestive problems.

If you want an example of a delicious fibre-rich drink, check out Pascal’s smoothie recipe.

1.3 – Urinary Health

A person with a spinal cord injury needs to make sure they’re getting enough fluids, in order to help prevent urinary tract infections.  You want to aim for at least one and a half to two litres per day – that’s about 8 cups.

Water is definitely the best choice – it’s available everywhere and it’s cheap, refreshing and calorie-free!

Other sources of fluids include things like milk, fruit and vegetable juices, smoothies and herbal teas.  You can also get fluids from coffee, pop, ice tea and sport drinks, but try to avoid drinking beverages with too much sugar, caffeine or sodium.

Some people find that cranberry juice or cranberry supplements help them prevent urinary tract infections.  Just make sure you drink pure, unsweetened cranberry juice that doesn’t contain added sugar.

For a fun drink that’s good for your urinary health, have a look at Pascal’s mocktail recipe.

1.4 – Bone Health

After a spinal cord injury, your bones can become brittle and fragile and they can break more easily during everyday activities like stretching or doing simple transfers.  It’s important to keep your bones as strong and healthy as possible.

You can protect your bone health with a diet that includes plenty of calcium, vitamin D and magnesium.  You can find these in foods like dairy, nuts, seeds, whole grains, beans, fish and green leafy vegetables.

You may also want to consider calcium and vitamin D supplements.

You can also protect your bones by limiting alcohol, soft drinks, and caffeine, exercising regularly – including weight bearing activities – and avoiding smoking.

1.5 – Skin health

The food you eat has a big impact on the health of your skin.  People with spinal cord injury need to prevent skin breakdown and pressure sores, and a healthy diet can help.

Protein and foods high in vitamins A, C, E and zinc help to keep your skin healthy and strong.  You can find these nutrients in foods like carrots, squash, berries, citrus fruits, olives, green leafy vegetables, and sunflower and pumpkin seeds.

If you develop a pressure sore, you can increase your intake of these nutrients to help the healing process.

Drinking enough water is also important for your skin’s strength and appearance.

1.6 – Body Weight

After a spinal cord injury, your target body weight changes.  In general, your bone and muscle mass are decreased, so that your target body weight is now lower.  However you want to make sure that your body weight doesn’t get too low.

If you gain too much weight, you have a greater risk of:

•            Skin problems like pressure sores,

•            Heart disease and diabetes, and

•            Difficulty with transfers and self-care

If you lose too much weight, you have a greater risk of:

•            Skin problems,

•            Decreased muscle mass and strength, and

•            A weakened immune system.

1.7 – Related Health Concerns

People with spinal cord injury have a higher risk of developing, diabetes, heart disease and obesity.  This is because they typically use fewer muscle groups and burn less fat.

As a result, people with spinal cord injury often have higher levels of “bad” cholesterol, called LDL, and lower levels of “good” cholesterol, called HDL.  They can also have higher levels of triglycerides, which are fat globules that circulate in the blood.

Nutrition plays a key role in preventing and controlling these risks.

You can protect yourself by eating:

  • Good fats – which you’ll learn more about later,
  • Fibre–rich foods like whole grains, beans, and fresh fruits and vegetables,
  • Foods rich in magnesium and potassium like beans, almonds, dates and bananas, and
  • Antioxidant-rich foods like berries, sweet potatoes and spinach.

You can also protect yourself by avoiding:

  • Refined grains like white bread, white pasta and white rice,
  • Trans fats, which are found in many processed foods, and
  • Foods that are high in salt and refined sugar.

Pascal’s recipes for rainbow beet salad and seared trout are good examples of dishes that contain essential nutrients like antioxidants and omega-3s.  They’re good for your heart, your joints, and other body systems.


Section 2 – Building Blocks of Health

2.1 – Building Blocks of Health

Food is what gives your body energy.  It also provides all the essential vitamins and minerals your body needs. A balanced diet includes good fats, proteins and carbohydrates.

After a spinal cord injury, your body’s requirements for certain nutrients change.  While your diet should remain balanced, it’s important to be extra sure that you get enough fiber, fluid, vitamins, calcium, proteins and healthy fats.

In this section, we’ll learn about the different kinds of nutrients you need to stay healthy, and how you can get the right amount of these nutrients from the food you eat.

2.2-Fibre & Carbs

Carbohydrates are the body’s main and preferred fuel source.   You should aim to get half of your calories from carbohydrates.

There are two types of carbohydrates:  Simple and Complex.

Simple Carbohydrates are sugars.  The most healthy sources of these are found in milk, whole fruits, maple syrup and honey, which also contain many essential nutrients.

You should limit your intake of fruit juices and sugar-containing beverages because they don’t provide as many nutrients and have been linked to the development of obesity and diabetes.

Complex carbohydrates are starches.   The best sources are found in whole grain breads, whole grain pasta, brown rice and vegetables.  Complex carbohydrates are a great source of energy and nutrients, as well as fibre.

As we’ve already seen, fibre is an important part of your diet.  It helps to move your food through your digestive system, and it can also reduce blood sugar and cholesterol, lowering the risk of diabetes and heart disease.

Fibre is found in vegetables, whole grains such as oats and barley, and the skin of most fruits, like apples.

So aim for complex carbohydrates as much as possible, and be sure to include these healthy sources of energy in your diet everyday!

2.3 – Protein

Your body uses protein to build and repair tissue.

The recommended daily requirement is 1 gram of protein per kilogram of body weight. For most people, this means between 40 and 65 grams a day.

Protein sources include beans, soy, meat, fish, poultry, eggs, nuts, seeds and dairy foods like cheese and yogurt.

If you want a simple guide, use your own protein meter—the palm of your hand.  The size of the palm of your hand equals about one serving of protein, and you need 2 to 3 servings every day.

You may need to increase your daily protein intake by fifty percent if you have a pressure sore, or if you are trying to build muscle or gain weight.

It’s important not to exceed the recommended daily intake of protein.  Too much protein may contribute to the development of kidney stones.

Click on the link for a tool that will help you figure out how to get your daily requirement of protein.

2.4 – Fats

There’s a lot of misinformation about fats and many people are afraid of eating fat because they think it will make them overweight and unhealthy. What’s important for you to know is that fats are divided into good fats and bad fats.  We need to eat the good fats to maintain our health!

GOOD FATS are found in foods such as olive oil, avocados, fish, nuts and seeds.  Many of these sources, especially fish, contain healthy Omega 3’s. Good fats boost our health because they help reduce inflammation, lower bad cholesterol and help decrease the risk of heart disease and stroke.

BAD FATS are TRANS FATS. These are artificial fats. They are often hidden in many processed, packaged foods like salad dressings, cookies, cakes, ice cream, chips and fried foods.  These are the worst type of fat and should be completely avoided.  You can avoid these bad fats by reading food labels carefully.

You should also limit your intake of saturated fats.  These are found in animal sources like meats and cheese.

The fat content of foods can depend on how the food is prepared: a chicken breast has 4 grams of fat when it’s roasted, but 13 grams when it’s fried.

Fat can also hide in unexpected places: a tablespoon of salad dressing can contain up to 8 grams of fat, and a slice of cake or pie can contain more than 15 grams of fat.

So don’t be afraid of fat, just focus on making good choices by eating the good fats and avoiding the bad ones!

2.5 – Vitamins A, D, E, K

Vitamins & Minerals don’t provide energy but they are essential for all of our body’s systems to function optimally.

VITAMIN A keeps your skin strong and helps prevent pressure sores.  Good food sources include dark-coloured vegetables, organ meats, fish and fish oil.

VITAMIN D helps the body use calcium.  This vitamin is essential for healthy bones, which helps protect us from osteoporosis.  Food sources are fish and fortified milk. Our body also converts vitamin D from sunlight.  It is very difficult to get enough of this vitamin from our diet, so a supplement is highly recommended.

VITAMIN E protects our skin and is a powerful antioxidant, which means it helps protect our body from heart disease.  Vitamin E is found in nuts and oils.

VITAMIN K helps with blood clotting.  You can find it in foods such as green leafy vegetables.  Caution: keep your intake consistent or talk to your health care provider if you are on blood thinners.

Vitamins D, E, K and A are fat soluble and are stored in the body.  Therefore, excess amounts will build up and could potentially reach toxic levels. Be careful that you don’t exceed the recommended levels.

2.6 – Vitamins B & C, Calcium & Sodium

B VITAMINS are needed to produce energy and form blood cells.  The best sources are whole grains, milk, fruits and vegetables.

VITAMIN C is necessary for the immune system and skin health.  Foods rich in vitamin C include citrus fruits, green and red peppers and dark green leafy vegetables.

CALCIUM is critical for bone health to help prevent osteoporosis.   Good food sources are dairy products, dark green leafy vegetables and nuts, especially almonds.

Caution: too much calcium may contribute to the development of kidney stones.  The recommended daily amount is between 1,000 and 1,500 milligrams.  If you have any questions about your calcium intake, talk to your health care provider.

SODIUM or salt helps regulate fluid balance and blood pressure.  The typical Canadian diet contains more salt than we need since it’s present in most commercially prepared foods.  Be careful not to eat too much.

2.7 – Water & Fluids

Now you know about the different kinds of nutrients you need to stay healthy, but that’s not the end of the story.  Water is also key!

Its crucial to drink water often to stay hydrated. Insufficient fluid intake contributes to many health problems for people with spinal cord injuries, such as pressure sores and bladder infections.

The amount of water and other fluids that you drink may be limited by your bladder program, but in general you should get at least one and a half to two litres of fluids every day.

If drinking plain water doesn’t appeal to you, try adding freshly squeezed lemons, limes or oranges.

2.8 – Food Groups & the Food Guide

In the previous sections we covered the nutrients you need after a spinal cord injury.  One way to help ensure you get a healthy, balanced diet is to check out Canada’s Food Guide.  It explains in detail the four food groups that make up our diet.

Here’s a quick summary.

The first group is fruits and vegetables. These are important sources of vitamins, minerals and fiber.  Most of us don’t eat enough so we should make them a priority.

The next group is grain products, which give us energy and fiber.

The third group is milk and milk alternatives, which provide us with calcium.

The last group is meat and meat alternatives. These are important sources of protein and energy.   Try to choose leaner cuts to reduce your fat intake.

You can find more information on the food guide by clicking on the link at the top of the page.


Section 3 – Good Food Choices

3.1 – Eat Healthy Every Day

Now that you know what nutrients you need, what’s the best way to get them into your everyday diet?

Here are some practical ways to get you started.

As much as possible, try to make your meals at home.  You can use fresh ingredients and control portion sizes, and you’ll save money too.

On the days when you are running from place to place and don’t have the time for home cooked meals, you can still eat healthy.  Many grocery stores have takeout meals, including a wide variety of salads, sushi and hot meals.  The best choices are made fresh, with fewer additives and preservatives.

When you go grocery shopping, pay attention to the labels.  The shorter the ingredient list, the healthier it is for you!  Watch out for salt, sugar, and trans-fats.  For an interactive guide to label-reading, click on the link at the top of the page.

Use Canada’s Food Guide to help you plan ahead – it really does save you time, effort and money.

Finally, we can be creatures of habit and tend to eat our favorite foods over and over.  Be creative and adventurous – try something new, like a new ingredient or flavour.  You’ll get more variety in your diet, and you may be pleasantly surprised!

 3.2 – Meal Planning

It can be challenging at first to plan out healthy meals, but with a little advance preparation it becomes easier over time.

Here are some ways to help you plan your weekly menus:

Start by looking at your schedule for the week and planning your meals in advance.  Use a weekly calendar to help you plan what to buy and what to prepare.

When you go grocery shopping, write out a list of items you need to buy. When you don’t have a list, you might be more likely to grab foods that aren’t as healthy.

Make allowances for your time commitments.  On some days, you may not have time to cook, so you can prepare something in advance or make extra the day before so you have left-overs on hand.

Always try to stock the basics in your fridge and cupboards, things like milk, eggs, cheese, whole grain breads, whole grain pasta, canned goods and frozen vegetables.  Even if you feel like you have nothing to eat – with a couple of eggs, cheese and some vegetables, you can easily whip up a healthy omelette!

Finally, try going on-line and exploring recipes that interest you!

Once you get into the routine of healthy meal planning, it becomes second nature—not a task so much as a joy!

You can find more information on menu planning by clicking on the link at the top of the page.

3.3 – Eating at Home

When you eat at home, you’re in control–you can choose the ingredients you use and the size of your portions.  You can also experiment, by trying out different foods, challenging your taste buds & your cooking skills. Eating and cooking at home is one of the simplest ways to eat healthy – here’s how!

First of all, control your portion size.  You should eat enough to satisfy your appetite, but you may find that you can fill up with portions that are smaller than what you get in a restaurant.

Try to eat slowly, especially if you want to prevent weight gain.  It takes your brain 20 minutes to realize that your stomach is full.

Eat smaller meals more frequently.

Try not to eat while you’re watching TV, because you may tend to eat more when you’re not paying attention.

Don’t eat 2 hours before bedtime.  Your metabolism slows down during sleep, so you’re putting more stress on your body to digest, when all it wants to do is rest.

Speaking of sleep, make sure you get 7-8 hours a night to help avoid weight gain and other health complications.

And finally, breakfast is important!  The first meal of the day helps kick start your metabolism.

You are important, so treat yourself to a proper sit-down dinner.  Take the time to savour the flavours of the meal you worked hard to make.

3.4 – Healthy Snacks

Snacking is as important as planning and eating a healthy balanced breakfast, lunch or dinner.  With so many processed, packaged snacks available, it can be easy to make bad choices.

Here are some tips to keep in mind next time you get the munchies:

Smoothies aren’t just for breakfast – they make a great healthy snack any time of day.  Just mix yogurt, frozen berries, a banana, protein powder and some ground flax seed.

Fruits and vegetables are a fantastic snack.  Prepare them ahead of time and keep them in baggies in the fridge so they’re always ready for you to grab.  Yogurt is a great veggie dip!

Popcorn is a great source of fibre.  Air popped is the healthiest way to prepare it, because you can avoid having too much salt and butter.  If microwave popcorn is easier for you, buy the plain kind, with no artificial flavourings.  And instead of butter, try flaxseed oil.

If you like chips and dip, try toasted whole grain pita bread and a healthy dip like hummus.

You can also make your own trail mix using your favorite nuts, seeds, and dried fruits.

3.5 – Eating Out

Restaurant food can have many hidden calories, bad fats and refined sugars.  When you eat out, use this opportunity to try something new and healthy.

Here are some tips to help ensure your dining experience is a healthy one:

Remember your vegetables!  Order a salad with the dressing on the side, so you can control the amount.  Salads can also help you fill up, so that your main meal can be a smaller portion.

Don’t be afraid to ask your server about portion sizes, nutritional information, and how the food is prepared.  You can also try replacing unhealthy side dishes with salads or vegetables.

Instead of a sugary dessert, order a fruit salad.

You can always share your main course, or have an appetizer and salad instead of a main course.

Going out to eat is a fun experience – and it can be a healthy one too.

3.6 – Bon Appetit

This course has given you the tools you need to make healthy food choices.

You’ve learned about the special health needs of people with spinal cord injury, you’ve looked at the different building blocks that make up a balanced diet, and you’ve seen some practical tips that can help you make healthy choices on a daily basis.

Making the right food choices will help you stay healthy and live to your maximum potential.

Don’t worry about changing your entire diet all at once.  Focus on one meal at a time.  And remember to let your taste buds guide you.

Bon Appetit!

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Course contents
Section 1 – Your Body Needs Healthy Food
1.1 – Good Food, Good For You!
1.2 – Digestive Health
1.3 – Urinary Health
1.4 – Bone Health
1.5 – Skin Health
1.6 – Body Weight
1.7 – Related Health Concerns

Section 2 – Building Blocks of Health
2.1 – Building Blocks of Health
2.2 – Fibre and Carbs
2.3 – Protein
2.4 – Fats
2.5 – Vitamins A, D, E, K
2.6 – Vitamins B & C, Calcium & Sodium
2.7 – Water & Fluids
2.8 – Food Groups & The Food Guide

Section 3 – Good Food Choices
3.1 – Eat Healthy Every Day
3.2 – Meal Planning
3.3 – Eating at Home
3.4 – Healthy Snacks
3.5 – Eating Out
3.6 – Bon Appetit