Everyday Nutrition for Individuals with Spinal Cord Injuries

Everyday Nutrition for Individuals with Spinal Cord Injuries


[ Silence ]>>Hello and welcome to the Spinal Cord
Injury Model System forum. I’m Jeanne Hoffman, I’m
one of co-investigators on the Northwest Regional
Spinal Cord Injury Model System in the Department of
Rehabilitation Medicine. The forums, the video
recordings and all of our media, online media content, are
made possible by a grant from the National
Institute on Disability and Rehabilitation Research. Tonight we are very
pleased to have two speakers who will be talking
about everyday nutrition for individuals with
spinal cord injury. Tonight we have the pleasure of having Vickeri Barton
who’s an Associate Director of Nutrition and Services
at Harborview Medical Center and Susie Kim who’s a
occupational therapy clinical specialist. She’s also at Harborview
Medical Center. So we’re grateful to
have them tonight. They’re each going to do a
presentation, we’ll then open it up for questions so we’d prefer
if you could hold your questions to the end if that’s all right. Thank you and welcome
to Vickeri.  >>So of course just 15
seconds of stage fright but luckily I don’t
have to remember my name because I was just introduced. My name is Vickeri, I have been
at Harborview Medical Center for almost 30 years now and I
have always worked with people who have a spinal cord injury. For the first 20 years
I was in the trauma unit when people just first
came in with their injury as an inpatient and then in the
last 10 years or so I’ve worked on the outpatient setting once
people are more in the community and coming back for their annual
evals and kind of, you know, chronic issues that come on. So I’ve been with this
group for a long time. So, again thank you for inviting
me back actually to speak. I spoke, it was about
five years ago here. Anyway, tonight we’re
going to talk about a number of
nutrition issues. There’s not any one thing, let’s
see if this is going to work, oop, there we go, not any
one issue that is specific to nutrition in spinal
cord injury other than once you have a spinal
cord injury there’s kind of collection of issues
that other people have too but they kind of come
together, like I said, it’s kind of a little group of
things to be concerned about or at least to address or
at least to know about. So why is nutrition important
after a spinal cord injury? There’s seems to be
more increased concerns about diabetes, elevated
cholesterol, gaining too much weight,
you know, you don’t want to gain too much weight,
it affects your mobility, it affects your transfers, it
affects your skin condition and, you know, it also because
you’ve taken weight off of your bones concerns for
your bone health are a problem also too. So, when I was asked
to talk the, let’s see,   The Consumer Advisory Board, is
anybody a member of that here for the spinal cord injury? Okay, sent a list of things that they thought would
be good to talk about. And they included nutritional
needs about protein, vitamins and minerals, how to
determine caloric needs, heart disease risk factors,
decreased mobility risk factors, low grade inflammatory
response in spinal cord injury and cholesterol, nutrition
as far, in regards to skin and bowel and bladder, fluid
and fiber needs, osteoporosis and understanding
nutrition labels. So just a really
small list of things to cover in about 30 minutes. But first of all I want
to say good questions. I could tell that it was a
group that has been on top of what’s the latest research
and what’s come out as far as nutrition and
spinal cord injury. So condensing that a little
bit, tonight we’ll be talking about calorie and protein needs,
weight management guidelines, spinal cord injury
and heart disease as it affects risk
factors, spinal cord injury and bone health and
then what to do as far as to help skin,
bone, bladder issues. Does that sound like stuff
you want to hear about? Is that why you’re here? Okay, all right. Not so everyday nutrition
topics, if we have time I’ll talk a
little bit about nutrition and pressure sores and then
any recommendations as far as diet supplementation,
okay, as far as, you know, pills that you buy
kind of thing. Okay, so after I’m done talking
then Susie’s going to come up and talk a little bit about how
you implement these nutrition goals that we have for
you, how can you implement in the kitchen, eating out,
shopping, that kind of thing. So that will be kind of our
combination for the hour or so and we’ll leave plenty
of time for questions because I’m sure you’re
going to have plenty. One of the other things that I
was asked by the group is to, did I know anything about the
American Dietetic Association Evidenced Based Library
Spinal Cord Injury Guidelines. And there were guidelines that
came out in 2009 and the intent of the Dietetic Association
was to create guidelines to tell other dieticians
how to help mange people with spinal cord injury and
what their nutrition issues are. So I said, yeah, I do know
about those because I was one of the five people in the
nation that helped write them. So I do know a few things. So, again, they’re guidelines
the Dietetic Association has a library, it’s all
evidence based, based on scientific research
or review of articles. The articles are then graded
to see whether they are valid or the strength of the research
that maybe it does apply to a number of people. Or maybe the people
they evaluated, there was such a
small population that it may be mean a lot. But anyway, that’s
going over each article, those articles are then compiled
and guidelines are created. And they have a number
of different topics like pediatric weight
management, diabetes, renal disease, but spinal cord
injury is one of them also. And so, luckily because
the Paralyzed Veterans of America helped
contribute to the cost of maintaining this library
the public can get into it. Okay, so I wanted to just
show you very quickly I hope that you can go in and
you can go to guidelines [ pause ] and go down the,
scan down this list   and down here is spinal
cord injury, okay, and under executive summary [ pause ] if you go there it’s listed
all of the guidelines. And I just kind of wanted to show you briefly
what they look like.   Okay, so this is just a summary. If you go into this Website
you can go, you can drill down and drill down and drill down to
quite a few layers but we went through different topics
like spinal cord injury, assessment of energy
needs in the acute phase like when you first come into
the hospital right after injury. And then we give the guidelines about how you should
be assessed, how many calories you need,
how much protein you need, so there’s guidelines for each
phase of acute, rehab phase and the community phase on a
number of different topics. So, the intent is not for you to
read every single word on here but the fact that these are all
the different areas of care, nutrition care for
spinal cord injury that we wrote recommendations
for. In fact there’s two pages. So again, you can go in and
look at those if you want to know how the clinician
caring for you, what they should be
recommending, okay. But today, for tonight’s
purpose, you know, we’re going to talk a little
bit more general terms. But just so you know
that’s what that is. So some of the guidelines then that we had were how
much should weigh after a spinal cord injury. And I can tell you that
the data is pretty weak. I mean, that’s what we
said was pretty weak. There’s not a lot of articles
out there but it suggests that if you’re paraplegic
that you should weight five to ten percent less than
the Metropolitan Life Table. And I handed out,
there’s a handout that had the Metropolitan
Life Tables which are kind of the best known ideal
body weights, okay? And so, I, on it is a table
of the regular guidelines and then you would just
subtract five to ten percent if you’re paraplegic and
you would subtract 10 to 15% if you have tetraplegia. You know, Metropolitan Life
Tables, it is an insurance table that was originally
created to say, if you are over this weight,
our general population, then, you know, above this
weight you will tend to have more health risk factors and that’s how they determine
life insurance values, okay. So Metropolitan, but it’s the
kind of the standard that’s used when you hear ideal body weight,
it’s this insurance table, okay? So, like I said, it’s
kind of weak data but that’s what I have
always used to assess people. Now what health professionals
are going to now is assessing the BMI
which is body mass index. Anybody heard of that? Okay. So it’s really
kind of a combination of what’s your height
and your weight is and what you should be, okay? And what we said in
the guidelines is that for a spinal cord injury
you shouldn’t use the BMI. It doesn’t accurately assess
what’s the healthiest weight for you because you’ve lost
some muscle and, you know, so it’s usually in our charts, in our electronic records
we’ll put in height and weight and it will calculate the
BMI for me automatically and then I erase that
because I don’t want it in any of the charts on somebody
who has a spinal cord injury. There has been some
more recent evidence, kind of evaluating what is an
appropriate body mass index for people with spinal
cord injury and this is not in our evidence based library,
it’s a more recent article from 2009 but it suggests where obesity is typically
defined as a BMI over 30. That for spinal cord injury,
and you’re probably not going to hear this, but it may
be more like 22, okay? Because you are taking away some
muscle mass, if you replace it with body fat then, you know,
you’re going to want to be lower in terms of helping reduce
any other health risks or cardiovascular risks, okay? So at this point I would
say if you have somebody that tells you what
your BMI is say, I know that’s not really
appropriate for somebody with a spinal cord injury, they
don’t know what a good BMI is, what’s a healthy one, what’s one that would indicate
you’re overweight or whether you have reached
kind of an obesity level. And there’s just one
study and this is only like I think 70 people or
so but it’s, the healthier, it’s going to be a
little lower range. And there are some
studies going on, you know, around the nation trying to
determine how can we define, what’s a healthy
weight for you, okay. So calorie recommendations. Again, an area where there’s
not a lot of good evidence about how many calories do
you need for just maintenance, for weight gain,
for weight loss, but one of the studies
that’s included in our evidence library suggests that if you have
paraplegia you need about 28 calories per
kilogram body weight, okay. And I would say that’s probably
more using your ideal body weight and not your actual body
weight if you are overweight, okay, probably somewhere
in a blend between that. If you have tetraplegia
you’re more like about 22, 23 calories per kilogram body
weight for maintenance, okay. Again, not a lot of studies out
there but this is, you know, this is what we have
so far, okay?   Protein recommendations. Now these are fairly well
defined in the evidence. Protein needs, if you don’t have
any wounds then you have the same needs as someone without
a spinal cord injury which is about .8 to 1 grams per
kilogram of body weight. So if you weigh 70 kilos
your need is 70 grams per day for protein for maintenance. If you have wound healing
or you were just injured or you have a pressure
sore then that can go up to about two grams per
kilogram body weight, okay. Usually I assess if
somebody comes in with like a stage four pressure
ulcer or something maybe 1.5 to a little bit more then
that grams of protein. So if you’re 70 kilogram
body weight then I’m going to be recommending that you
need like about 110 grams of protein to help heal. And we can talk about
that a little bit more. But I’ll tell you most
people are not eating that. Okay, so there’s a little bit about what your weight should
be, how not to use the BMI, weight control then is always
a big question and something that I address with
many of my patients. And usually we kind of go over
the same kind of guidelines as far as, you know, allow
plenty of time to plan and shop for your meals because planning at the last minute means
you’ll eat anything in sight. So, try to spend some time
thinking about what you’re going to eat, mindful eating. Don’t skip meals. Eat routinely, two
or three meals a day. When I have people come in
and say, well I have coffee for breakfast and then I, you
know, I have my morning program, go through my bowel
program and everything and then I might have
half a sandwich for lunch and then I have a big dinner. So I really only eat once a day
and you will never lose weight on that kind of routine because
that one big dinner is huge, you know, and then you kind
of keep snacking all the way to the time you go to bed. So it’s better to eat routinely, spread out your food
throughout the day so that you can control
your appetite when you do get to
the next meal. And that’s a lot more
comfortable way to try to manage your weight too. Small portion sizes and, you
know, I think there’s a lot in literature, in the newspaper, right now I think
there’s something in the Seattle Times this week about how plate sizes
have increased over the last few decades or so. And, you know, when
you go to a restaurant and you pay good money you
want the most you can get but really you probably have about three servings
on one plate. So when we’re counseling
people to lose weight we talk about the plate method, and I
don’t know if you’re going be to see this or not, but we
usually say look at your plate, half of it should be vegetables,
a quarter of it should be kind of your meat or your
protein and about a quarter of it should be kind of
your starch like rice or potato or whatever. And so we just think of
your plate in terms of kind of quartering it
up and eating a lot of fruits and vegetables, okay? We also talk in terms of portion
sizes and we’ll say, I’ll go, it’s my fist but most of
you, this is one cup, okay? So this is about how much starch
you should have at any meal. It’s kind of generous
but that’s okay. You should have about three
ounces of meat which is about the palm of your hand
or a deck of cards, okay? So I’m going to say,
you know, eat your palm, have one fist full
of mashed potatoes and then all the
vegetables you want, okay? So think in terms of that, okay. It’s the portion size,
you know, hand language. Other things, you know, eat
a variety of foods, protein, grains, fruits and
vegetables, low fat, high fiber foods are good and this involves
reading nutrition labels. Does anyone feel like they
really understand how to figure out how many calories
are fat in any one food, the percent calories and fat? Can you do that? I’m going on to the
nutrition label. We’ll talk a little bit about
watch your beverage calories. I have some people come in and tell me they drink
a six pack of, you know, Mountain Dew a day, that’s their
caffeine habit but that’s also like 900 calories which
is probably at least 50% of what you should be
eating calorie wise per day. So just be aware that you
can really drink a lot of calories very quickly and,
you know, we prefer water but at least switch to
diet soda pop if you can. The other thing is
weighing yourself. Now I know working at a
clinic where we have one of the few wheelchair
assessable scales. It’s hard to find someplace to
get yourself weighed routinely but if you can that’s important
because it gives you feedback on whether you’re
doing the right thing. If you’re just getting weighed
once a year when you come in for your annual visit or,
you know, whatever, you know, you don’t really get a
lot of constant feedback on whether I’m eating too
much or I’m eating too little. So I encourage you to
try to find someplace where you get weighed
at least once a month. I have somebody who comes in
from downtown basically just to get weighed every month,
just to get that feedback and that person has
continually lost, you know, a good amount of weight. So like a C, you know, 6, 7
tetraplegia who’s lost 25, 30 pounds over one year
but he needed that feedback to know whether he
was, you know, eating too much or
too little, okay. Okay, so back to
the nutrition label. This all looks familiar right? And I think one of the most
important things to know from the nutrition label
is, okay it talks at the top about serving size, how many
servings are in a container. Often times you’ll think
oh this is one serving because it’s only, you know,
a small entree or something but be aware that it might
be two or three, okay. So read that. But it’s also important,
here’s the total calories and here’s the calories
from fat. So can you see the
numbers up there that it’s almost half fat
calories, it’s 50% fat. I think it’s ice cream, it’s
funny because I had the label but not what it was but I’m
pretty sure it’s ice cream. But anything that’s 50% fat
is too high in fat, okay? You want to stick with foods
or casseroles or frozen dinners that are more about 30%
fat at the most, okay? Any questions about that? Like I said, it’s funny because,
you know, they give you a lot of information but the one thing
that’s very helpful to know, you have to sit down
and figure it out, you have to do the math, okay. What does help is physical
activity so just, you know, in our guidelines we included
that being active anyway that you can whether it’s, you
know, at the wheelchair sports, swimming, electrical
stim sort of exercises or treadmill training or simply
going down to the local mall in the morning and
wheeling up and down with the walkers, you know. Being as active as
you can will help because the inactivity is what
causes a lot of the concerns about nutrition and
spinal cord injury. Okay, weight gain, some of
your cholesterol changes, your bone density is,
has to do with, you know, the inactivity that’s
going to happen. So moving along, okay, so spinal
cord injury as far as does that put you at higher
risk for heart disease. If you have gained weight,
if you are getting a wider around the middle, your
weight circumference and if you’re lipid
values are starting to go up those put you more at
risk for heart disease. So at our annual visit we
do check your lipid profile, your cholesterol, your
triglycerides each year and monitor what’s
going on there. Typically you want your
cholesterol to be under 200, you want your triglycerides
to be less than 150, you want your LDL, lower density
lipids, the lousy cholesterol to be under 130 and your HDL, I always call it the
healthy cholesterol, you want it to be more then 40. But of note, in research and in practice you
hardly ever see anybody who has an HDL that’s
as high as 40. It is influenced by
activity and so most of the patients I see have a HDL
more like 29 or 30 or so, okay. And then, you know, you need
to watch the fat in your diet and try to be as active as
possible but don’t be surprised, you’re in there with
everybody else if you’re less than 40, okay. That’s just one of the
things that we kind of see. Okay, so moving along. A little bit about
C-Reactive Protein. It’s a protein in your body that
is created when there’s stress in your body, okay, some
kind of inflammation. And it has over the
last few years been tied with a risk for heart disease. I don’t know if in spinal
cord injury it’s anymore than anybody else. But, so sometimes you’ll have
your C-Reactive Protein measured and if it’s about
three you could be at higher risk for
heart disease. But the main thing I
want to point out is is that anytime you have any kind
of stress, so if you a UTI or you have a pressure sore, this C-Reactive Protein
is going to be up anyway. So anytime it’s checked
you need to look but do I have other sources
of inflammation or infection that could be causing it to
go up and not typically or, you know, this time
associated with heart disease. So diet recommendations, if you
are at risk for heart disease and your cholesterols up,
watch your fat intake, do low fat cooking methods,
low fat dairy products, eat more fish, aim for
healthy weight, stop smoking and again be as active
as possible, okay. I need to keep moving
along here. Quickly, bone health. This is one thing I go over
a lot with my patients is that because you’ve
taken gravity off of your bones they are more at
risk at an earlier time for loss of bone density, okay. So if you fall out of your
chair you’re more at risk for breaking a hip,
breaking a leg or something. So we want you to
try to maintain that bone density
as much as possible. And that involves then
eating calcium, okay. So have many people
DEXA scan done? Oh I see a couple hands. And usually a couple
years after injury that might be something
you want to checked and you go have this x-ray test and it will tell how
dense your bones are. Whether you’re fine, whether
you have osteopenia meaning that you’re losing some density
or if you have osteoporosis and you’ve actually lost
a lot of bone density. And there are ways to try
to prevent that and it is by eating calcium, eating dairy
products, adequate vitamin D, again be active, limit
caffeine, stop smoking, there are some medications that
help like Fosamax, alendronate and just try not to fall. Good sources of calcium again
are the best source is your dairy products, okay. Now let’s see, if you can eat
three dairy products a day like milk and cheese, ice
cream, not too much, yogurt, Greek yogurt’s great,
then you’re going to get enough calcium. It’s also in dark leafy green
vegetables, canned salmon but you have to eat, you know,
a truck load to get enough. So try to get enough
good calcium. If you are milk intolerant or
you just don’t drink, you know, milk there are calcium
supplements that you can try, Tums is actually a
very inexpensive way to get enough calcium. Usual dose is about 500
milligrams twice a day. Okay. Nutrition and
neurogenic bowel. Main thing I want to emphasis
here is eating enough fiber, talk about, you know,
transit through bowel time. Try to drink enough fluids
and eat enough fiber. And we used to say eat
more fiber then this 15 to 20 grams per day. It was, I think the
recommendations for Americans is 25 to 35 grams
per day but we’ve actually found in some patients with
spinal cord injury that more is not better and a moderate amount might
be most well tolerated for you, okay. But fiber’s important. Eat fruits and vegetables. As far as nutrition
and neurogenic bladder, drink plenty of fluids. As far as the cranberry
option, the only study that has been proven to be effective is
cranberry juice drinking about one cup three
times a day, okay? Cranberry tablets which I
know a lot of people take, overall the evidence does
not prove that they work. So if you’re taking them
and you’re like yeah but then I never had a UTI after that well then
keep doing, you know. But if it’s not working for
you you’re part of the bulk of the evidence that
says it doesn’t work so don’t spend your
money on that. It’s one of those things where they found the food was
effective but trying to put it into a pill form something
got lost in the translation. Quickly, pressure sores,
evidence you can go to the Website for the
American Dietetic Association, your calorie needs are
going to be up some, your protein needs are
going to be up quite a bit. That really may need
up to two grams of protein per kilogram
body weight. And I usually evaluate
one or two people with pressure sores every week. I go through a diet history with
them to see what they’re eating and inevitably they’re eating
about 40% of their needs, okay. You can’t get enough protein in by eating one
or two times a day. You have got to be eating
three, four, five times a day and very conscientious of
what your protein sources are. You know, meat and eggs and
fish, milk, protein bars, Carnation Instant Breakfast,
Ensure, whatever you want to use that fits your lifestyle
or for the amount of time that your bed bound for,
you know, trying to heal. Like I said it rarely do I see
somebody eating quite enough. And once we counsel them on
you need to increase here and let’s do that during
the day and they come back and they are starting to heal
assuming there’s other factors that have been taken
care of too. But it’s very important. As far as other vitamins and
minerals that you would need for wound healing, you
don’t need anything if you don’t have a
deficiency documented by a blood test, okay. So we usually check your vitamin
C, your vitamin A, zinc levels. If they’re fine,
you don’t need more. The point is more
is not better, okay. So, usually if you’re
eating a variety of foods you wouldn’t
need any supplementation but if you’re trying to heal
we will check for you and see if there is something we can
give you that you should target. All right, nutrition
supplements. Just most people with spinal
cord injury, in this one study of 77 people they were
taking multivitamins, calcium and vitamin D which aren’t a bad
three to choose if you need to. Again, only if you have
deficiency would you really need them. And in the resource
sheet that I gave you in this there is a couple
Websites that are really good to evaluate whether some of
the supplements that you want to take are of value or not. So if you want to take
cinnamon or you’re taking,   oh what’s another one,
Echinacea or something like that you can go to
them and you put that in and it will tell you
whether it’s effective or likely effective or not
effective at all, if it’s safe. So, this is good. The one is by NIH, National
Institute of Health, the other one, National
Medicine Comprehensive Database, it used to be free but
now I’m afraid it might be a subscription. But it’s a very good source too. Okay, that’s it for the
basic nutrition area. And now Susie’s going to talk
to about how to implement some of these things into
your everyday living. And at the end then we’ll
answer anymore questions, okay? All right, thank you.>>So I’m going to talk a
little about what, you know, what could be stopping you
from making this change. There’s all this nutritional
information you got and it’s a lot of
information and how do you kind of implement it in a practical
manner into your lifestyle. So, you know, there’s
a lot of reasons. Obviously a lot of people
tell me convenience, a lot of people tell
me about access, cost. There seems to be some thoughts that it costs a lot
more to eat healthier. And I mean there’s a lot
of debate about that. Obviously preparing
it and for some taste. So I’m going to start
from the beginning like where we get this food? There’s a variety
of different areas so I’m just going
highlight a couple of places, the grocery store, online,
farmers market, gardens and of course eating out. So the most important thing and I think Vickeri
mentioned it earlier is really planning ahead. That tends to help you the most. Planning ahead and making a list because there’s nothing more
intimidating then going in front of the grocery store and seeing
this like row of vegetables and be like well what am I
supposed to do with this? So by planning ahead, getting
online, getting cookbooks, I think there’s a few
up here, all right, getting some cookbooks
too and going through them and just finding simple recipes. I say go simple, don’t try to make a gourmet
meal your first step out because there’s usually
too much butter in it. But like, go really,
really simple. Just try to add one new
vegetable or one new thing in. I mean like, you can have as
many vegetables as you want, so try to make it really simple. Most of the larger stores they
have assistance if you need it, it’s fantastic for that. They’ll send a shopper
around with you to kind of grab things if you need it. The trick of the
trade I say is try to purchase what you can carry
because then you don’t end up over purchasing and that’s
kind of a hard too because you, it can be really
intimidating to all of a sudden buy all these
vegetables and then at the end of the week see yourself
throwing them out because they’ve gone bad. And then you feel like
well this is too difficult or you feel guilty and so
instead of kind of turning it to that just go really simple. One thing great about a grocery
store obviously you can use both cash or credit cards,
whichever is easier. And they also accept coupons,
so that kind of helps out. And you can comb the
newspapers on Sunday’s to see where there’s a deal. I, you know, I know there’s
a lot of things out there but I kind of wanted to
show you guys a couple of things that are available. There are these luggage
riggers that can go in the front that you could put a basket on. I found this on Amazon
for like $14.00, the bag, it’s a collapsible bag so
it’s not really noticeable but it’s great because
everyone’s carrying their own grocery totes too. So you don’t look like, it
doesn’t look any different. A lot of the bags
that stores even offer because they’re no longer
going plastic, those are great, they have large handles,
they can hook on behind your wheelchair
or backpacks, I see a lot of backpacks
already so they’re fantastic. And at the grocery
store they’re great, they’ll like pack it up for you. They do carry, like this bag
right here, it’s insulated which is kind of nice
because then, I mean, if you have a long bus
ride or drive or anything like that you’re small little
ice cream could make the trip home. So the question was, what
were these bags called? And they’re just collapsible
baskets, yeah, perfect. And there’s a lot
prettier designs too. So I’m not sure if you
guys are very familiar, we’re really lucky basic
Seattle area Amazon started grocery thing. So it’s called fresh.amazon.com
and some parts of Safeway also offers
it so I don’t know if you guys are very familiar. It’s fantastic because,
you know, it lets you really plan ahead but it also lets
you take your time. So it’s really super
convenient for that factor. I mean, you can’t fight the
deliveries to your doorstep, that’s pretty convenient. They accept credit cards, they
don’t have a lot of coupons but I’m going to be honest, the prices are pretty
reasonable especially due to the size of things. I don’t know if you guys are
familiar, there’s a lot of, in this area there’s a lot of
co-ops and individual farms that will, that also do door
to door delivery or weekly or monthly packages
so you get, you know, vegetables that they’ve
kind of picked out. So you get a little variety of
vegetables and you try things that you never thought
you would ever try too. I, since moving to Seattle
I’ve become a big fan of Brussels sprouts, I’ve never
tried them before until now. You can also get fresh milk and then also meat
products for your protein. So, again I kind of just want to
just show you guys a little bit. Like with Amazon they
come in these boxes and so they also have
these safety clips to say that you know, no one’s kind of
messed with them and you have to break them which
is kind of nice. They are a little deep and they
get delivered to your home. Some of the other small
co-ops they require you to provide the ice box. So I kind of wanted to show you
this is a great little ice box, it has wheels, it’s
not super deep, depending on how many
people you’re feeding and these vegetables
are for, I mean, you could obviously go bigger. It’s kind of nice because it
has a telescoping hand also if you need to hook onto
something, it could get modified if you needed to
hook onto your wheels or if you just needed
to carry it in. And if you had the arm strength, although you should be
preserving your shoulders, you could pick it up and
bring it into your home. One of the things
you can do with that because it is a fairly
deep box, you can kind of create an elevated platform
in order to have access to it. The delivery day is usually
set so you’re pretty familiar with it so for some of you
who have some assistance or need some assistance it’s
perfect because you kind of pick and choose the days
that you have that and they can help you put
away the things especially if they’re perishable. I think it’s a fantastic
resource for large staples, staple items like, you
know, is it much more cost, it’s cost efficient, I’m not
sure exactly what the term would be.>>[Inaudible].>>Thank you, cost
effective if you buy larger. But then it’s not really
practical if you’re carrying it, you know, it makes it a
little more challenging. So it’s kind of nice when
it gets delivered and then if you need additional
assistance when you know someone’s coming
in and you can downsize them to more practical
containers for you to use on a day to day basis. So there’s farmers markets too. I mean we have a lot of them
here in the Seattle area. They offer a variety of things. But the biggest thing, it’s a
nice social event, there’s a lot of people around, it’s nice to see everything
and see it up close. They, my biggest recommendation
is to get to know the vendors. They’re pretty, if you’re loyal to them they’re pretty
loyal to you. They’ll put aside, if
they know you’re coming, they’ll put aside like, the hot
commodity I found is fresh eggs. Those go really quickly but if
they know you’re coming down, they’ll put it aside for
you because they know. I mean, it’s a relationship
that’s developed. They also love to trade. It’s a very strong community. It’s perfect for small
amounts so you don’t, you know, you don’t tend to feel like
oh my gosh, it’s such a deal that bulk item, it’s such a
deal I’ve got to purchase it. You know, they’ll only have
like a little bits of parsley so it’s not like
you’re going to be like, oh I have to buy the whole pack. It’s pretty, picked pretty
ripe so it’s really flavorful. So if that was a concern
it’s great for that but you do really have to
make something pretty soon. Most often it’s cash only. The hours are fantastic because
typically they’re 10:00 to 2:00, so it’s usually after
everything, all the self care and everything that’s needed
so it’s a nice social time too. Gardens. I don’t know if
you, you know, there’s, it could be your
own personal garden, it could be your friends garden, small potted plants can
also be a little garden. You could create an herb
garden, those are nice and you can elevate those to
kind of increase the, you know, if you wanted to improve
the flavor of something. You know, basil grows really
well indoors, tomatoes grow like crazy, another thing
would be pea patches. If you don’t have your
own personal space a lot of neighborhoods
have pea patches. There’s a pretty large one
in Magnuson and a couple of other larger ones I
think in Rainier Beach too. So you could have elevated
planting beds to put up and then you could also put
stone and hard patch gravel for the footpath to make it a
little bit easier because except for probably mainly the powers, those front casters can
get stuck fairly easily if they’re pretty
small in the gravel. So, you know, you can kind of
prepare because you can kind of pick and choose to a
certain point with pea patches. You can kind of make a request. There are some that are a
little more accessible out there so you can make some request. And if you have some
friends around, you know, to just make sure that
path is more accessible for you that would be great. One of the great things about
gardens is it gives you a, you know, you tend to
grow a lot of things so it gives you a big
opportunity to experiment and try different things. Even if, you know, if you didn’t like it one way you
can try it a different.   So I’m going to talk a
little bit about eating out. Obviously it’s probably
the most convenient because it’s already prepared. It takes out a big section of
what you have to think about, what you have to do with
it or they don’t tend to have nutritional
labels on them either so it’s a nice little
activity of, well I didn’t know,
I know what’s good. So here’s a couple of
Websites, this Website for nutritional information, dietfacts.com/fastfood.asp
offers a lot of nutritional information
for even fast food and different restaurants. You can put in like chicken
salad and then it will kind of offer up chicken
salad at McDonalds and all this other stuff. So then you can look at the
nutritional information. And I’ll tell you,
once you start looking at that nutritional information,
it’s pretty, you know, the next time around
maybe not at that moment, if you’re really craving
it, I understand that but the next time around
you may think, you know, I saw what it was like
at McDonalds compared to what it was like
at Burger King, maybe I’ll try Burger
King next time. Or even after looking at that,
like this favorite restaurant, well maybe I don’t
have to eat the fish and chips every single
time I’m there. You know, maybe I’ll try
to break it up a little bit and have some salad or split it. For some of you guys who have
Smart phones and you really want to know in the moment,
there is a couple of apps, restaurant nutrition and lose it that offer the nutritional
information or the caloric information
especially the fat calorie information is available. I’m just going to show
you guys real quick. This is kind of what
it looks like, this is the nutritional one. So you could search by food
and then or then or search by restaurants and then
it will give you the whole nutritional facts. And as Vickeri said,
kind of the calories from fat is what you’re going
to be paying attention to. So this really kind of
made it really convenient to become more nutritionally
savvy but I think the most important
thing is to pay attention to is obviously, you know,
the calorie from fat. But you can punch in a lot
of different things and find out a lot of different things
about different restaurants, so. Now, we’re going to get to the
kicking it up, the prep work. So, I’m just going to go down, so now that you’ve brought all
this food home one of things, I don’t know if you guys
have ever used, you know, the simple tray like this
with a border happens to be a great lap tray and also if access is an issue
it’s a perfect prep table because you can put a cutting
board, a wooden cutting board in there and then you can
use this as a cutting table. What’s ideal too is if it’s
wooden then it could also be used kind of like as a trivet if you’re carrying any hot
items you want to care of. So this is kind of nice,
I didn’t bring a whole lot of the other stuff, I’m sorry. I wanted to show you guys, are you guys familiar
with I am Bonnie? So she is a C5, C6 tetraplegic, check it out because she
offers a lot of, you know, she kind of shows
different ways to make her, how she made her
kitchen accessible and different tricks
of the trade. And I, you know, considering
you can see her hand function, she does most of
her own cooking. She has about 57 videos. It’s on the handout
too, so if you guys want to check it out in
your own time. It’s really quite useful. Some of the things she offers,
she didn’t offer this part but I’ve seen it, I’ve seen
other people who’ve used it and said they really enjoyed it. The kind of tools for prep. There’s a lot of commercial
things available these days which is fantastic and
obviously there are a lot of things available online. Xoxo makes a variety of
wide handled cooking items that would be great. One thing that’s great about
them, they’re also plastics so if they need to be melted
down and molded in some way to make it more personal to you and more useful then
that can be done. A lot of bowls are made that
are bigger and have grips on the bottom so they don’t
tend to spill as much. And I already talked
about the lap tray. So we’re winding up. So a couple of things that
I found is really sold, because if you can’t spend a
lot to make huge accommodations in your home like redo
a whole new kitchen to make it accessible, one of the most convenient
things are actually electric griddles and skillets. Have you guys seen them? They’re more portable and you
can place them on any table that you do have access to. And so you can cook
things up fairly easily. You can boil water on
them, you can, you know, if you want to make pasta or
if you want to do vegetables or stir fry make, you can bring
it a little bit closer to you without the risk of burning
yourself or reaching over. The microwave, very popular. You can reheat pretty
much anything and push buttons can
be built up if needed. And they make some older
microwaves with knobs if that’s something that’s
a little more interesting. The door handles, there’s a lot
of different designs available that the door handles are
a lot easier to reach. The ones that stick
out a little bit more so you can kind of get in there. You can add or build something
up to that to pull on it because biceps, if that’s what
you got, then you can just kind of hook in there and pull
on it to bring it open. Toaster ovens, oh I love
toaster ovens because again, you can bring that a lot closer. You really decrease the
risk of burning yourself, whatever utensil you use to
eat it with, you can open that toaster oven
door, pull it back and grab whatever
you’re going to eat. So it’s fantastic
for smaller meals. If throughout the day
if you’re supposed to be eating a little more
frequently and you don’t, you really enjoy hot meals
versus cold meals, then that’s, it’s a nice resource
to have versus heating up your whole oven for,
you know, one item. Or putting on all
the protective wear that I usually recommend
people wear when they’re using
a conventional oven to protect their forearms. If you’re lifting with internal
rotation to pull out something, you know, I usually make
some recommendations to wear very long sleeves
that are available. There’s barbeque sleeves
usually is what I recommend but they’re really heavy. Okay, here are some
of our resources. [ pause ] And so now we’re open
to some questions. Tips to make nutritional drinks,
blended drinks more nutritional.>>So like a smoothie and
one thing with a blender, I know that they talk about
the immersible blender, does anybody have those? I can’t remember
what brand it is but it’s actually easier
instead of having the one where you have the, you
know, jug that you put on top and blenderize, it’s
just, you know, and watch the blade
once you turn it on, but you can just
immerse it into a cup and blenderize things up too. So that’s a more
handy type style. Smoothies, you know,
if you go to Jam…>>Jamba Juice.>>Jamba Juice, there we go, you
know, that is a meal practically and usually they’re a fruit and
a juice and maybe a yogurt base which actually is
pretty nutritional. I mean, you could put in a
little bit of bran flakes to get more fiber with your
orange juice and yogurt and strawberries and have,
well it’s about a meal because you’ve got
protein and fruit in there. So that’s not a bad idea. I mean, you, I also
work with people who have fractured mandibles so
their whole diet is blenderized but we have them blenderize
chili and cans of Progresso, you know, soup or
something like that. I mean, you can blenderize
almost anything kind of thing and be fairly nutritious. I wanted to go over
just, Susie brought up there were some
cookbooks here. It’s always fun when we
get ready to do a talk to see what’s new out there and
so I did go looking for recipes for people with spinal
cord injury and there are a couple
books out there by chefs who are paraplegic, okay. I wouldn’t say the
recipes are easy. They are not, oh I’m just
getting home and I want to fix something in 20 minutes. This one’s called,
Cooking with Cory, and he’s from British
Columbia and it’s just really, it’s just a fairly new book
and it’s just beautiful as far as the pictures but we’re not
all going to be making Black and Blue Tuna Sushi with Chili
Lime Mayo tonight I don’t think. So it’s just a gorgeous book and
I think the recipes look good but it’s not a quick
and dirty sort of book. There’s another one you can
download called, Erin’s Cookin, and again it was one
where it was just a bunch of fairly simple recipes,
I mean, simply produced or whatever but again, they
are, you know, Roast Pork Loin with Cherry Mustard Sauce. So good recipes but not quick. So then I went more to
looking for, you know, a cookbook for toaster ovens. So you can go to Amazon.com and
start looking for, you know, recipes that use a blender,
recipes that use a toaster oven and probably find more
useful quick type recipes when you kind of
take that avenue. Rachael Ray? That’s Everyday with
Rachael Ray. Yeah, I mean, you just need
to look at what’s in it and she does tend
to cook healthfully but then they’ll be something
with a bunch of sour cream in it or, you know, nachos
or something like that. So again, if she has
nutritional, I don’t know if she has nutrition values on
some of her stuff, I’m not sure.>>I don’t think so, not in
her books, not in her recipes.>>Yeah, they’re not
required so like if you get The American Heart
Association kind of cookbooks, they have the nutrient
information in there. Sometimes, you know, I, being a
dietitian, I have 50 cookbooks or something like that and
what do I do anymore is I get on the internet and I Google,
you know, I have a piece of chicken tonight, what can
I do with it with, you know, cilantro or something like
that and you Google that and all the recipes will come up and sometimes they have
nutrition information and sometimes they don’t. One thing I wanted to comment
about nutrition information in restaurants, you live in
a county that has mandated that restaurants that have
over, I can’t remember if it’s 20 sites or 15 sites,
they have to provide you calorie and nutrient information so
usually that’s available. Take a look at it and oh my
gosh, sometimes it’s scary. You know, Red Robin
or something. I think they don’t
know yet whether that has changed peoples
way that they’re ordering or what they’re choosing but
I’ll tell you Starbucks, I mean, who doesn’t love a scone
and a latte in the morning. All of their pastry things were
about 400 calories and I’m like, oh my gosh, and, you know, just in the last couple
months they’ve come out with what is called the
bite size, I don’t know, some little cookie on a popsicle
stick and little mini scones. I think people were reading
those original values and stopped buying and so now
they’re offering something that’s just a taste but
only about 150 calories. So it does make a difference to
have that nutrient information. A lot of times when we go out to
eat again, we don’t want to know because it’s a special day
but we all eat out a lot and it’s good to have
that information to kind of pace yourself, pace your day. Oh sorry, hungrygirl.com right?>>Hungrygirl.com and then
she’s got some cookbooks too.>>I’m not familiar with
her either but I think if, it’s all about, if you’re
going to make a big change, I think it is, go
as easy and simple as possible in the beginning. And then, you know, as you become more
comfortable in the kitchen.>>[Inaudible] are complicated.>>Yeah, as you become
more comfortable in the kitchen tweak away. I totally believe in it,
unless you’re baking, it’s the only thing that you
really have to follow to the T.>>There’s another series
called, Eat This, Not That, and it’s like eat this not
that in the restaurant, eat this not that, you know,
and it’s got some recipes and those are kind of fun little
colorful books you can get at Costco about half price. They offer, you know,
how to reduce calories in your favorite things too. Another question
I wanted to follow up on was the Smart phones. I see you over here
working on one. Who else uses a Smart
phone or an iPad? Okay so, really look on our
resource list there’s a thing about rating the top ten
nutrition apps and look to see if any of those will
work for you. I find people using them I’ll
say well, tell me what you ate? And they’ll just hold
up their Smart phone and of course then I have to
go like this so I can see it but it’s really a neat
little tool especially if you are diligent
enough to put into it everything
you’ve eaten for a week, it’s really a surprise and it does help modify
your eating habits too if you’re trying to lose
weight in particularly. So, I mean, there’s
nothing like a person, they’ve eaten really
well during the week, oh you look you’ve stayed to
1,500 calories, you’ve stayed to 1,800 calories but oh,
look at that Saturday night, somehow you ate 4,000
calories on the weekend and they’ll have it down on
their little iPhone or whatever and it does with that
feedback slowly start to change behaviors going
maybe one less margarita that Saturday night will kind
of help balance out or whatever. So it is a neat tool. I mean, I don’t have
an iPhone yet either until I get a couple college
kids off my phone plan but I can’t wait because I do
think there are some pretty neat little applications there. Another question is about eating
from the rainbow which is kind of way to look at eating,
promoting more fruits and vegetables and are
there colors in the rainbow that are more important
to people with spinal cord
injury then others? I would say, not particularly. I see that, in fact it was
handed out this evening, I think it was from
the super food use list which I’ve actually
done talks using that kind of list before too. And a lot of the foods
that are considered to help with anti-inflammation foods
like blueberries, nuts, fish, dark leafy green vegetables, calling them super foods
is one way to look at it but it really goes back to
eating a variety of foods. Fruits, vegetables, whole
grains, low fat protein. You know, there’s been a lot
of different kinds of diets over the years whether
it was an Atkins Diet or a South Beach Diet and I
can tell you as a dietitian for the last 35 years, I’m still
going yeah, but it’s just fruits and vegetables and whole grains and low fat protein is
a healthy way to eat. And, you know, that’s
still the main message. What’s the value of
tofu is the question? You know, I’m not sure
what the fat content is. It’s a soybean.>>[Inaudible] protein.>>It is a soy oil so
it’s vegetable oil so it’s not an animal
fat which is good. You know, tofu is just
another option for protein so if you are vegetarian
or a vegan and you want to avoid animal meats or dairy
products then it’s a good choice for you but there’s no
particular reason to single it out as being extra
special if you’re fine with all the other
sources of protein too. Okay, anything else? Well thank you very much.>>Thank you guys very much
and a round of applause. [ Applause ]