[ silence ] >>hello and welcome to the spinal cordinjury model system forum. i'm jeanne hoffman, i'mone of co-investigators on the northwest regionalspinal cord injury model system in the department ofrehabilitation medicine. the forums, the videorecordings and all of our media, online media content, aremade possible by a grant from the nationalinstitute on disability
and rehabilitation research. tonight we are verypleased to have two speakers who will be talkingabout everyday nutrition for individuals withspinal cord injury. tonight we have the pleasure of having vickeri bartonwho's an associate director of nutrition and servicesat harborview medical center and susie kim who's aoccupational therapy clinical specialist.
she's also at harborviewmedical center. so we're grateful tohave them tonight. they're each going to do apresentation, we'll then open it up for questions so we'd preferif you could hold your questions to the end if that's all right. thank you and welcometo vickeri. รข >>so of course just 15seconds of stage fright but luckily i don'thave to remember my name
because i was just introduced. my name is vickeri, i have beenat harborview medical center for almost 30 years now and ihave always worked with people who have a spinal cord injury. for the first 20 yearsi was in the trauma unit when people just firstcame in with their injury as an inpatient and then in thelast 10 years or so i've worked on the outpatient setting oncepeople are more in the community and coming back for their annualevals and kind of, you know,
chronic issues that come on. so i've been with thisgroup for a long time. so, again thank you for invitingme back actually to speak. i spoke, it was aboutfive years ago here. anyway, tonight we'regoing to talk about a number ofnutrition issues. there's not any one thing, let'ssee if this is going to work, oop, there we go, not anyone issue that is specific to nutrition in spinalcord injury other
than once you have a spinalcord injury there's kind of collection of issuesthat other people have too but they kind of cometogether, like i said, it's kind of a little group ofthings to be concerned about or at least to address orat least to know about. so why is nutrition importantafter a spinal cord injury? there's seems to bemore increased concerns about diabetes, elevatedcholesterol, gaining too much weight,you know, you don't want
to gain too much weight,it affects your mobility, it affects your transfers, itaffects your skin condition and, you know, it also becauseyou've taken weight off of your bones concerns foryour bone health are a problem also too. so, when i was askedto talk the, let's see, the consumer advisory board, isanybody a member of that here for the spinal cord injury? okay, sent a list of things
that they thought wouldbe good to talk about. and they included nutritionalneeds about protein, vitamins and minerals, how todetermine caloric needs, heart disease risk factors,decreased mobility risk factors, low grade inflammatoryresponse in spinal cord injury and cholesterol, nutritionas far, in regards to skin and bowel and bladder, fluidand fiber needs, osteoporosis and understandingnutrition labels. so just a reallysmall list of things
to cover in about 30 minutes. but first of all i wantto say good questions. i could tell that it was agroup that has been on top of what's the latest researchand what's come out as far as nutrition andspinal cord injury. so condensing that a littlebit, tonight we'll be talking about calorie and protein needs,weight management guidelines, spinal cord injuryand heart disease as it affects riskfactors, spinal cord injury
and bone health andthen what to do as far as to help skin,bone, bladder issues. does that sound like stuffyou want to hear about? is that why you're here? okay, all right. not so everyday nutritiontopics, if we have time i'll talk alittle bit about nutrition and pressure sores and thenany recommendations as far as diet supplementation,okay, as far as, you know,
pills that you buykind of thing. okay, so after i'm done talkingthen susie's going to come up and talk a little bit about howyou implement these nutrition goals that we have foryou, how can you implement in the kitchen, eating out,shopping, that kind of thing. so that will be kind of ourcombination for the hour or so and we'll leave plentyof time for questions because i'm sure you'regoing to have plenty. one of the other things that iwas asked by the group is to,
did i know anything about theamerican dietetic association evidenced based libraryspinal cord injury guidelines. and there were guidelines thatcame out in 2009 and the intent of the dietetic associationwas to create guidelines to tell other dieticianshow to help mange people with spinal cord injury andwhat their nutrition issues are. so i said, yeah, i do knowabout those because i was one of the five people in thenation that helped write them. so i do know a few things.
so, again, they're guidelinesthe dietetic association has a library, it's allevidence based, based on scientific researchor review of articles. the articles are then gradedto see whether they are valid or the strength of the researchthat maybe it does apply to a number of people. or maybe the peoplethey evaluated, there was such asmall population that it may be mean a lot.
but anyway, that'sgoing over each article, those articles are then compiledand guidelines are created. and they have a numberof different topics like pediatric weightmanagement, diabetes, renal disease, but spinal cordinjury is one of them also. and so, luckily becausethe paralyzed veterans of america helpedcontribute to the cost of maintaining this librarythe public can get into it. okay, so i wanted to justshow you very quickly i hope
that you can go in andyou can go to guidelines [ pause ] and go down the,scan down this list and down here is spinalcord injury, okay, and under executive summary if you go there it's listedall of the guidelines. and i just kind of wanted to show you brieflywhat they look like. okay, so this is just a summary.
if you go into this websiteyou can go, you can drill down and drill down and drill down toquite a few layers but we went through different topicslike spinal cord injury, assessment of energyneeds in the acute phase like when you first come intothe hospital right after injury. and then we give the guidelines about how you shouldbe assessed, how many calories you need,how much protein you need, so there's guidelines for eachphase of acute, rehab phase
and the community phase on anumber of different topics. so, the intent is not for you toread every single word on here but the fact that these are allthe different areas of care, nutrition care forspinal cord injury that we wrote recommendationsfor. in fact there's two pages. so again, you can go in andlook at those if you want to know how the cliniciancaring for you, what they should berecommending, okay.
but today, for tonight'spurpose, you know, we're going to talk a littlebit more general terms. but just so you knowthat's what that is. so some of the guidelines then that we had were howmuch should weigh after a spinal cord injury. and i can tell you thatthe data is pretty weak. i mean, that's what wesaid was pretty weak. there's not a lot of articlesout there but it suggests
that if you're paraplegicthat you should weight five to ten percent less thanthe metropolitan life table. and i handed out,there's a handout that had the metropolitanlife tables which are kind of the best known idealbody weights, okay? and so, i, on it is a tableof the regular guidelines and then you would justsubtract five to ten percent if you're paraplegic andyou would subtract 10 to 15% if you have tetraplegia.
you know, metropolitan lifetables, it is an insurance table that was originallycreated to say, if you are over this weight,our general population, then, you know, above thisweight you will tend to have more health risk factors and that's how they determinelife insurance values, okay. so metropolitan, but it's thekind of the standard that's used when you hear ideal body weight,it's this insurance table, okay? so, like i said, it'skind of weak data
but that's what i havealways used to assess people. now what health professionalsare going to now is assessing the bmiwhich is body mass index. anybody heard of that? okay. so it's reallykind of a combination of what's your heightand your weight is and what you should be, okay? and what we said inthe guidelines is that for a spinal cord injuryyou shouldn't use the bmi.
it doesn't accurately assesswhat's the healthiest weight for you because you've lostsome muscle and, you know, so it's usually in our charts, in our electronic recordswe'll put in height and weight and it will calculate thebmi for me automatically and then i erase thatbecause i don't want it in any of the charts on somebodywho has a spinal cord injury. there has been somemore recent evidence, kind of evaluating what is anappropriate body mass index
for people with spinalcord injury and this is not in our evidence based library,it's a more recent article from 2009 but it suggests where obesity is typicallydefined as a bmi over 30. that for spinal cord injury,and you're probably not going to hear this, but it maybe more like 22, okay? because you are taking away somemuscle mass, if you replace it with body fat then, you know,you're going to want to be lower in terms of helping reduceany other health risks
or cardiovascular risks, okay? so at this point i wouldsay if you have somebody that tells you whatyour bmi is say, i know that's not reallyappropriate for somebody with a spinal cord injury, theydon't know what a good bmi is, what's a healthy one, what's one that would indicateyou're overweight or whether you have reachedkind of an obesity level. and there's just onestudy and this is only
like i think 70 people orso but it's, the healthier, it's going to be alittle lower range. and there are somestudies going on, you know, around the nation trying todetermine how can we define, what's a healthyweight for you, okay. so calorie recommendations. again, an area where there'snot a lot of good evidence about how many calories doyou need for just maintenance, for weight gain,for weight loss,
but one of the studiesthat's included in our evidence library suggests that if you haveparaplegia you need about 28 calories perkilogram body weight, okay. and i would say that's probablymore using your ideal body weight and not your actual bodyweight if you are overweight, okay, probably somewherein a blend between that. if you have tetraplegiayou're more like about 22, 23 calories per kilogram bodyweight for maintenance, okay.
again, not a lot of studies outthere but this is, you know, this is what we haveso far, okay? protein recommendations. now these are fairly welldefined in the evidence. protein needs, if you don't haveany wounds then you have the same needs as someone withouta spinal cord injury which is about .8 to 1 grams perkilogram of body weight. so if you weigh 70 kilosyour need is 70 grams per day for protein for maintenance.
if you have wound healingor you were just injured or you have a pressuresore then that can go up to about two grams perkilogram body weight, okay. usually i assess ifsomebody comes in with like a stage four pressureulcer or something maybe 1.5 to a little bit more thenthat grams of protein. so if you're 70 kilogrambody weight then i'm going to be recommending that youneed like about 110 grams of protein to help heal.
and we can talk aboutthat a little bit more. but i'll tell you mostpeople are not eating that. okay, so there's a little bit about what your weight shouldbe, how not to use the bmi, weight control then is alwaysa big question and something that i address withmany of my patients. and usually we kind of go overthe same kind of guidelines as far as, you know, allowplenty of time to plan and shop for your meals because planning
at the last minute meansyou'll eat anything in sight. so, try to spend some timethinking about what you're going to eat, mindful eating. don't skip meals. eat routinely, twoor three meals a day. when i have people come inand say, well i have coffee for breakfast and then i, youknow, i have my morning program, go through my bowelprogram and everything and then i might havehalf a sandwich for lunch
and then i have a big dinner. so i really only eat once a dayand you will never lose weight on that kind of routine becausethat one big dinner is huge, you know, and then you kindof keep snacking all the way to the time you go to bed. so it's better to eat routinely, spread out your foodthroughout the day so that you can controlyour appetite when you do get tothe next meal.
and that's a lot morecomfortable way to try to manage your weight too. small portion sizes and, youknow, i think there's a lot in literature, in the newspaper, right now i thinkthere's something in the seattle times this week about how plate sizeshave increased over the last few decades or so. and, you know, whenyou go to a restaurant
and you pay good money youwant the most you can get but really you probably have about three servingson one plate. so when we're counselingpeople to lose weight we talk about the plate method, and idon't know if you're going be to see this or not, but weusually say look at your plate, half of it should be vegetables,a quarter of it should be kind of your meat or yourprotein and about a quarter of it should be kind ofyour starch like rice
or potato or whatever. and so we just think ofyour plate in terms of kind of quartering itup and eating a lot of fruits and vegetables, okay? we also talk in terms of portionsizes and we'll say, i'll go, it's my fist but most ofyou, this is one cup, okay? so this is about how much starchyou should have at any meal. it's kind of generousbut that's okay. you should have about threeounces of meat which is
about the palm of your handor a deck of cards, okay? so i'm going to say,you know, eat your palm, have one fist fullof mashed potatoes and then all thevegetables you want, okay? so think in terms of that, okay. it's the portion size,you know, hand language. other things, you know, eata variety of foods, protein, grains, fruits andvegetables, low fat, high fiber foods are good
and this involvesreading nutrition labels. does anyone feel like theyreally understand how to figure out how many caloriesare fat in any one food, the percent calories and fat? can you do that? i'm going on to thenutrition label. we'll talk a little bit aboutwatch your beverage calories. i have some people come in and tell me they drinka six pack of, you know,
mountain dew a day, that's theircaffeine habit but that's also like 900 calories whichis probably at least 50% of what you should beeating calorie wise per day. so just be aware that youcan really drink a lot of calories very quickly and,you know, we prefer water but at least switch todiet soda pop if you can. the other thing isweighing yourself. now i know working at aclinic where we have one of the few wheelchairassessable scales.
it's hard to find someplace toget yourself weighed routinely but if you can that's importantbecause it gives you feedback on whether you'redoing the right thing. if you're just getting weighedonce a year when you come in for your annual visit or,you know, whatever, you know, you don't really get alot of constant feedback on whether i'm eating toomuch or i'm eating too little. so i encourage you totry to find someplace where you get weighedat least once a month.
i have somebody who comes infrom downtown basically just to get weighed every month,just to get that feedback and that person hascontinually lost, you know, a good amount of weight. so like a c, you know, 6, 7tetraplegia who's lost 25, 30 pounds over one yearbut he needed that feedback to know whether hewas, you know, eating too much ortoo little, okay. okay, so back tothe nutrition label.
this all looks familiar right? and i think one of the mostimportant things to know from the nutrition labelis, okay it talks at the top about serving size, how manyservings are in a container. often times you'll thinkoh this is one serving because it's only, you know,a small entree or something but be aware that it mightbe two or three, okay. so read that. but it's also important,here's the total calories
and here's the caloriesfrom fat. so can you see thenumbers up there that it's almost half fatcalories, it's 50% fat. i think it's ice cream, it'sfunny because i had the label but not what it was but i'mpretty sure it's ice cream. but anything that's 50% fatis too high in fat, okay? you want to stick with foodsor 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 thingthat's very helpful to know, you have to sit downand figure it out, you have to do the math, okay. what does help is physicalactivity so just, you know, in our guidelines we includedthat being active anyway that you can whether it's, youknow, at the wheelchair sports, swimming, electricalstim sort of exercises or treadmill training or simplygoing down to the local mall
in the morning andwheeling up and down with the walkers, you know. being as active asyou can will help because the inactivity is whatcauses a lot of the concerns about nutrition andspinal cord injury. okay, weight gain, some ofyour cholesterol changes, your bone density is,has to do with, you know, the inactivity that'sgoing to happen. so moving along, okay, so spinalcord injury as far as does
that put you at higherrisk for heart disease. if you have gained weight,if you are getting a wider around the middle, yourweight circumference and if you're lipidvalues are starting to go up those put you more atrisk for heart disease. so at our annual visit wedo check your lipid profile, your cholesterol, yourtriglycerides each year and monitor what'sgoing on there. typically you want yourcholesterol to be under 200,
you want your triglyceridesto be less than 150, you want your ldl, lower densitylipids, the lousy cholesterol to be under 130 and your hdl, i always call it thehealthy cholesterol, you want it to be more then 40. but of note, in research and in practice youhardly ever see anybody who has an hdl that'sas high as 40. it is influenced byactivity and so most
of the patients i see have a hdlmore like 29 or 30 or so, okay. and then, you know, you needto watch the fat in your diet and try to be as active aspossible but don't be surprised, you're in there witheverybody else if you're less than 40, okay. that's just one of thethings that we kind of see. okay, so moving along. a little bit aboutc-reactive protein. it's a protein in your body thatis created when there's stress
in your body, okay, somekind of inflammation. and it has over thelast few years been tied with a risk for heart disease. i don't know if in spinalcord injury it's anymore than anybody else. but, so sometimes you'll haveyour c-reactive protein measured and if it's aboutthree you could be at higher risk forheart disease. but the main thing iwant to point out is is
that anytime you have any kindof stress, so if you a uti or you have a pressure sore, this c-reactive proteinis going to be up anyway. so anytime it's checkedyou need to look but do i have other sourcesof inflammation or infection that could be causing it togo up and not typically or, you know, this timeassociated with heart disease. so diet recommendations, if youare 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 forhealthy weight, stop smoking and again be as activeas possible, okay. i need to keep movingalong here. quickly, bone health. this is one thing i go overa lot with my patients is that because you'vetaken gravity off of your bones they are more atrisk at an earlier time for loss of bone density, okay.
so if you fall out of yourchair you're more at risk for breaking a hip,breaking a leg or something. so we want you totry to maintain that bone densityas much as possible. and that involves theneating calcium, okay. so have many peopledexa scan done? oh i see a couple hands. and usually a coupleyears after injury that might be somethingyou want to checked
and you go have this x-ray test and it will tell howdense your bones are. whether you're fine, whetheryou have osteopenia meaning that you're losing some densityor if you have osteoporosis and you've actually losta lot of bone density. and there are ways to tryto prevent that and it is by eating calcium, eating dairyproducts, adequate vitamin d, again be active, limitcaffeine, stop smoking, there are some medications thathelp like fosamax, alendronate
and just try not to fall. good sources of calcium againare the best source is your dairy products, okay. now let's see, if you can eatthree dairy products a day like milk and cheese, icecream, not too much, yogurt, greek yogurt's great,then you're going to get enough calcium. it's also in dark leafy greenvegetables, canned salmon but you have to eat, you know,a truck load to get enough.
so try to get enoughgood calcium. if you are milk intolerant oryou just don't drink, you know, milk there are calciumsupplements that you can try, tums is actually avery inexpensive way usual dose is about 500milligrams twice a day. okay. nutrition andneurogenic bowel. main thing i want to emphasishere is eating enough fiber, talk about, you know,transit through bowel time. try to drink enough fluidsand eat enough fiber.
and we used to say eatmore fiber then this 15 to 20 grams per day. it was, i think therecommendations for americans is 25 to 35 gramsper day but we've actually found in some patients withspinal cord injury that more is not better and a moderate amount mightbe most well tolerated for you, okay. but fiber's important.
eat fruits and vegetables. as far as nutritionand neurogenic bladder, drink plenty of fluids. as far as the cranberryoption, the only study that has been proven to be effective iscranberry juice drinking about one cup threetimes a day, okay? cranberry tablets which iknow a lot of people take, overall the evidence doesnot prove that they work.
so if you're taking themand you're like yeah but then i never had a uti after that well thenkeep doing, you know. but if it's not working foryou you're part of the bulk of the evidence thatsays it doesn't work so don't spend yourmoney on that. it's one of those things where they found the food waseffective but trying to put it into a pill form somethinggot lost in the translation.
quickly, pressure sores,evidence you can go to the website for theamerican dietetic association, your calorie needs aregoing to be up some, your protein needs aregoing to be up quite a bit. that really may needup to two grams of protein per kilogrambody weight. and i usually evaluateone or two people with pressure sores every week. i go through a diet history withthem to see what they're eating
and inevitably they're eatingabout 40% of their needs, okay. you can't get enough protein in by eating oneor two times a day. you have got to be eatingthree, four, five times a day and very conscientious ofwhat your protein sources are. you know, meat and eggs andfish, milk, protein bars, carnation instant breakfast,ensure, whatever you want to use that fits your lifestyleor for the amount of time that your bed bound for,you know, trying to heal.
like i said it rarely do i seesomebody eating quite enough. and once we counsel them onyou need to increase here and let's do that duringthe day and they come back and they are starting to healassuming there's other factors that have been takencare of too. but it's very important. as far as other vitamins andminerals that you would need for wound healing, youdon't need anything if you don't have adeficiency documented
by a blood test, okay. so we usually check your vitaminc, your vitamin a, zinc levels. if they're fine,you don't need more. the point is moreis not better, okay. so, usually if you'reeating a variety of foods you wouldn'tneed any supplementation but if you're trying to healwe will check for you and see if there is something we cangive you that you should target. all right, nutritionsupplements.
just most people with spinalcord injury, in this one study of 77 people they weretaking multivitamins, calcium and vitamin d which aren't a badthree to choose if you need to. again, only if you havedeficiency would you really need them. and in the resourcesheet that i gave you in this there is a couplewebsites that are really good to evaluate whether some ofthe supplements that you want to take are of value or not.
so if you want to takecinnamon or you're taking, oh what's another one,echinacea or something like that you can go tothem and you put that in and it will tell youwhether it's effective or likely effective or noteffective at all, if it's safe. so, this is good. the one is by nih, nationalinstitute of health, the other one, nationalmedicine comprehensive database, it used to be free butnow i'm afraid it might be
a subscription. but it's a very good source too. okay, that's it for thebasic nutrition area. and now susie's going to talkto about how to implement some of these things intoyour everyday living. and at the end then we'llanswer anymore questions, okay? all right, thank you. >>so i'm going to talk alittle about what, you know, what could be stopping youfrom making this change.
there's all this nutritionalinformation you got and it's a lot ofinformation and how do you kind of implement it in a practicalmanner into your lifestyle. so, you know, there'sa lot of reasons. obviously a lot of peopletell me convenience, a lot of people tellme about access, cost. there seems to be some thoughts that it costs a lotmore to eat healthier. and i mean there's a lotof debate about that.
obviously preparingit and for some taste. so i'm going to startfrom the beginning like where we get this food? there's a varietyof different areas so i'm just goinghighlight a couple of places, the grocery store, online,farmers market, gardens and of course eating out. so the most important thing and i think vickerimentioned it earlier is really
planning ahead. that tends to help you the most. planning ahead and making a list because there's nothing moreintimidating then going in front of the grocery store and seeingthis like row of vegetables and be like well what am isupposed to do with this? so by planning ahead, gettingonline, getting cookbooks, i think there's a fewup here, all right, getting some cookbookstoo and going through them
and just finding simple recipes. i say go simple, don't try to make a gourmetmeal your first step out because there's usuallytoo much butter in it. but like, go really,really simple. just try to add one newvegetable or one new thing in. i mean like, you can have asmany vegetables as you want, so try to make it really simple. most of the larger stores theyhave assistance if you need it,
it's fantastic for that. they'll send a shopperaround with you to kind of grab things if you need it. the trick of thetrade i say is try to purchase what you can carrybecause then you don't end up over purchasing and that'skind of a hard too because you, it can be reallyintimidating to all of a sudden buy all thesevegetables and then at the end of the week see yourselfthrowing them
out because they've gone bad. and then you feel likewell this is too difficult or you feel guilty and soinstead of kind of turning it to that just go really simple. one thing great about a grocerystore 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 thenewspapers on sunday's to see where there's a deal.
i, you know, i know there'sa lot of things out there but i kind of wanted toshow you guys a couple of things that are available. there are these luggageriggers that can go in the front that you could put a basket on. i found this on amazonfor like $14.00, the bag, it's a collapsible bag soit's not really noticeable but it's great becauseeveryone's carrying their own grocery totes too.
so you don't look like, itdoesn't look any different. a lot of the bagsthat stores even offer because they're no longergoing plastic, those are great, they have large handles,they can hook on behind your wheelchairor backpacks, i see a lot of backpacksalready so they're fantastic. and at the grocerystore they're great, they'll like pack it up for you. they do carry, like this bagright here, it's insulated
which is kind of nicebecause then, i mean, if you have a long busride or drive or anything like that you're small littleice cream could make the trip home. so the question was, whatwere these bags called? and they're just collapsiblebaskets, yeah, perfect. and there's a lotprettier designs too. so i'm not sure if youguys are very familiar, we're really lucky basicseattle area amazon started
grocery thing. so it's called fresh.amazon.comand some parts of safeway also offersit 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 letsyou take your time. so it's really superconvenient for that factor. i mean, you can't fight thedeliveries to your doorstep,
that's pretty convenient. they accept credit cards, theydon't have a lot of coupons but i'm going to be honest, the prices are prettyreasonable especially due to the size of things. i don't know if you guys arefamiliar, there's a lot of, in this area there's a lot ofco-ops and individual farms that will, that also do doorto door delivery or weekly or monthly packagesso you get, you know,
vegetables that they'vekind of picked out. so you get a little variety ofvegetables and you try things that you never thoughtyou would ever try too. i, since moving to seattlei've become a big fan of brussels sprouts, i've nevertried them before until now. you can also get fresh milk and then also meatproducts for your protein. so, again i kind of just want tojust show you guys a little bit. like with amazon theycome in these boxes
and so they also havethese safety clips to say that you know, no one's kind ofmessed with them and you have to break them whichis kind of nice. they are a little deep and theyget delivered to your home. some of the other smallco-ops they require you to provide the ice box. so i kind of wanted to show youthis is a great little ice box, it has wheels, it'snot super deep, depending on how manypeople you're feeding
and these vegetablesare for, i mean, you could obviously go bigger. it's kind of nice because ithas a telescoping hand also if you need to hook ontosomething, it could get modified if you needed tohook onto your wheels or if you just neededto carry it in. and if you had the arm strength, although you should bepreserving your shoulders, you could pick it up andbring it into your home.
one of the thingsyou can do with that because it is a fairlydeep box, you can kind of create an elevated platformin order to have access to it. the delivery day is usuallyset so you're pretty familiar with it so for some of youwho have some assistance or need some assistance it'sperfect because you kind of pick and choose the daysthat you have that and they can help you putaway the things especially if they're perishable.
i think it's a fantasticresource for large staples, staple items like, youknow, is it much more cost, it's cost efficient, i'm notsure exactly what the term would be. >>[inaudible]. >>thank you, costeffective if you buy larger. but then it's not reallypractical if you're carrying it, you know, it makes it alittle more challenging. so it's kind of nice whenit gets delivered and then
if you need additionalassistance when you know someone's comingin and you can downsize them to more practicalcontainers for you to use on a day to day basis. so there's farmers markets too. i mean we have a lot of themhere in the seattle area. they offer a variety of things. but the biggest thing, it's anice social event, there's a lot of people around, it's nice
to see everythingand see it up close. they, my biggest recommendationis to get to know the vendors. they're pretty, if you're loyal to them they're prettyloyal to you. they'll put aside, ifthey know you're coming, they'll put aside like, the hotcommodity i found is fresh eggs. those go really quickly but ifthey know you're coming down, they'll put it aside foryou because they know. i mean, it's a relationshipthat's developed.
they also love to trade. it's a very strong community. it's perfect for smallamounts so you don't, you know, you don't tend to feel likeoh my gosh, it's such a deal that bulk item, it's such adeal i've got to purchase it. you know, they'll only havelike a little bits of parsley so it's not likeyou're going to be like, oh i have to buy the whole pack. it's pretty, picked prettyripe so it's really flavorful.
so if that was a concernit's great for that but you do really have tomake something pretty soon. most often it's cash only. the hours are fantastic becausetypically they're 10:00 to 2:00, so it's usually aftereverything, all the self care and everything that's neededso it's a nice social time too. gardens. i don't know ifyou, you know, there's, it could be yourown personal garden, it could be your friends garden,
small potted plants canalso be a little garden. you could create an herbgarden, those are nice and you can elevate those tokind of increase the, you know, if you wanted to improvethe flavor of something. you know, basil grows reallywell indoors, tomatoes grow like crazy, another thingwould be pea patches. if you don't have yourown personal space a lot of neighborhoodshave pea patches. there's a pretty large onein magnuson and a couple
of other larger ones ithink in rainier beach too. so you could have elevatedplanting beds to put up and then you could also putstone and hard patch gravel for the footpath to make it alittle bit easier because except for probably mainly the powers, those front casters canget stuck fairly easily if they're prettysmall in the gravel. so, you know, you can kind ofprepare because you can kind of pick and choose to acertain point with pea patches.
you can kind of make a request. there are some that are alittle more accessible out there so you can make some request. and if you have somefriends around, you know, to just make sure thatpath is more accessible for you that would be great. one of the great things aboutgardens is it gives you a, you know, you tend togrow a lot of things so it gives you a bigopportunity to experiment
and try different things. even if, you know, if you didn't like it one way youcan try it a different. so i'm going to talk alittle bit about eating out. obviously it's probablythe most convenient because it's already prepared. it takes out a big section ofwhat you have to think about, what you have to do withit or they don't tend to have nutritionallabels on them either
so it's a nice littleactivity of, well i didn't know,i know what's good. so here's a couple ofwebsites, this website for nutritional information, dietfacts.com/fastfood.aspoffers a lot of nutritional informationfor even fast food and different restaurants. you can put in like chickensalad and then it will kind of offer up chickensalad at mcdonalds
and all this other stuff. so then you can look at thenutritional information. and i'll tell you,once you start looking at that nutritional information,it's pretty, you know, the next time aroundmaybe not at that moment, if you're really cravingit, i understand that but the next time aroundyou may think, you know, i saw what it was likeat mcdonalds compared to what it was likeat burger king,
maybe i'll try burgerking next time. or even after looking at that,like this favorite restaurant, well maybe i don'thave to eat the fish and chips every singletime i'm there. you know, maybe i'll tryto break it up a little bit and have some salad or split it. for some of you guys who havesmart phones and you really want to know in the moment,there is a couple of apps, restaurant nutrition and lose it
that offer the nutritionalinformation or the caloric informationespecially the fat calorie information is available. i'm just going to showyou guys real quick. this is kind of whatit looks like, this is the nutritional one. so you could search by foodand then or then or search by restaurants and thenit will give you the whole nutritional facts.
and as vickeri said,kind of the calories from fat is what you're goingto be paying attention to. so this really kind ofmade it really convenient to become more nutritionallysavvy but i think the most importantthing is to pay attention to is obviously, you know,the calorie from fat. but you can punch in a lotof different things and find out a lot of different thingsabout different restaurants, so. now, we're going to get to thekicking it up, the prep work.
so, i'm just going to go down, so now that you've brought allthis food home one of things, i don't know if you guyshave ever used, you know, the simple tray like thiswith a border happens to be a great lap tray and also if access is an issueit's a perfect prep table because you can put a cuttingboard, a wooden cutting board in there and then you canuse this as a cutting table. what's ideal too is if it'swooden then it could also be
used kind of like as a trivet if you're carrying any hotitems 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 familiarwith i am bonnie? so she is a c5, c6 tetraplegic, check it out because sheoffers a lot of, you know, she kind of showsdifferent ways to make her,
how she made herkitchen accessible and different tricksof the trade. and i, you know, consideringyou can see her hand function, she does most ofher own cooking. she has about 57 videos. it's on the handouttoo, so if you guys want to check it out inyour 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 seenother people who've used it and said they really enjoyed it. the kind of tools for prep. there's a lot of commercialthings available these days which is fantastic andobviously there are a lot of things available online. xoxo makes a variety ofwide handled cooking items that would be great. one thing that's great aboutthem, they're also plastics
so if they need to be melteddown and molded in some way to make it more personal to you and more useful thenthat can be done. a lot of bowls are made thatare bigger and have grips on the bottom so they don'ttend to spill as much. and i already talkedabout the lap tray. so we're winding up. so a couple of things thati found is really sold, because if you can't spend alot to make huge accommodations
in your home like redoa whole new kitchen to make it accessible, one of the most convenientthings are actually electric griddles and skillets. have you guys seen them? they're more portable and youcan place them on any table that you do have access to. and so you can cookthings up fairly easily. you can boil water onthem, you can, you know,
if you want to make pasta orif you want to do vegetables or stir fry make, you can bringit a little bit closer to you without the risk of burningyourself or reaching over. the microwave, very popular. you can reheat prettymuch anything and push buttons canbe built up if needed. and they make some oldermicrowaves with knobs if that's something that'sa little more interesting. the door handles, there's a lotof different designs available
that the door handles area lot easier to reach. the ones that stickout a little bit more so you can kind of get in there. you can add or build somethingup to that to pull on it because biceps, if that's whatyou got, then you can just kind of hook in there and pullon it to bring it open. toaster ovens, oh i lovetoaster ovens because again, you can bring that a lot closer. you really decrease therisk of burning yourself,
whatever utensil you use toeat it with, you can open that toaster ovendoor, pull it back and grab whateveryou're going to eat. so it's fantasticfor smaller meals. if throughout the dayif you're supposed to be eating a little morefrequently and you don't, you really enjoy hot mealsversus cold meals, then that's, it's a nice resourceto have versus heating up your whole oven for,you know, one item.
or putting on allthe protective wear that i usually recommendpeople wear when they're usinga conventional oven to protect their forearms. if you're lifting with internalrotation to pull out something, you know, i usually makesome recommendations to wear very long sleevesthat are available. there's barbeque sleevesusually is what i recommend but they're really heavy.
okay, here are someof our resources. and so now we're opento some questions. tips to make nutritional drinks,blended drinks more nutritional. >>so like a smoothie andone thing with a blender, i know that they talk aboutthe immersible blender, does anybody have those? i can't rememberwhat brand it is but it's actually easierinstead of having the one where you have the, youknow, jug that you put on top
and blenderize, it'sjust, you know, and watch the bladeonce you turn it on, but you can justimmerse it into a cup and blenderize things up too. so that's a morehandy type style. smoothies, you know,if you go to jam... >>jamba juice. >>jamba juice, there we go, youknow, that is a meal practically and usually they're a fruit anda juice and maybe a yogurt base
which actually ispretty nutritional. i mean, you could put in alittle bit of bran flakes to get more fiber with yourorange juice and yogurt and strawberries and have,well it's about a meal because you've gotprotein and fruit in there. so that's not a bad idea. i mean, you, i alsowork with people who have fractured mandibles sotheir whole diet is blenderized but we have them blenderizechili and cans of progresso,
you know, soup orsomething like that. i mean, you can blenderizealmost anything kind of thing and be fairly nutritious. i wanted to go overjust, susie brought up there were somecookbooks here. it's always fun when weget ready to do a talk to see what's new out there andso i did go looking for recipes for people with spinalcord injury and there are a couplebooks out there by chefs
who are paraplegic, okay. i wouldn't say therecipes are easy. they are not, oh i'm justgetting home and i want to fix something in 20 minutes. this one's called,cooking with cory, and he's from britishcolumbia and it's just really, it's just a fairly new bookand it's just beautiful as far as the pictures but we're notall going to be making black and blue tuna sushi with chililime mayo tonight i don't think.
so it's just a gorgeous book andi think the recipes look good but it's not a quickand dirty sort of book. there's another one you candownload called, erin's cookin, and again it was onewhere it was just a bunch of fairly simple recipes,i mean, simply produced or whatever but again, theyare, you know, roast pork loin with cherry mustard sauce. so good recipes but not quick. so then i went more tolooking for, you know,
a cookbook for toaster ovens. so you can go to amazon.com andstart looking for, you know, recipes that use a blender,recipes that use a toaster oven and probably find moreuseful quick type recipes when you kind oftake that avenue. rachael ray? that's everyday withrachael ray. yeah, i mean, you just needto look at what's in it and she does tendto cook healthfully
but then they'll be somethingwith a bunch of sour cream in it or, you know, nachosor something like that. so again, if she hasnutritional, i don't know if she has nutrition values onsome of her stuff, i'm not sure. >>i don't think so, not inher books, not in her recipes. >>yeah, they're notrequired so like if you get the american heartassociation kind of cookbooks, they have the nutrientinformation in there. sometimes, you know, i, being adietitian, i have 50 cookbooks
or something like that andwhat do i do anymore is i get on the internet and i google,you know, i have a piece of chicken tonight, what cani do with it with, you know, cilantro or something likethat and you google that and all the recipes will come up and sometimes they havenutrition information and sometimes they don't. one thing i wanted to commentabout nutrition information in restaurants, you live ina county that has mandated
that restaurants that haveover, i can't remember if it's 20 sites or 15 sites,they have to provide you calorie and nutrient information sousually that's available. take a look at it and oh mygosh, sometimes it's scary. you know, red robinor something. i think they don'tknow yet whether that has changed peoplesway that they're ordering or what they're choosing buti'll tell you starbucks, i mean, who doesn't love a sconeand a latte in the morning.
all of their pastry things wereabout 400 calories and i'm like, oh my gosh, and, you know, just in the last couplemonths they've come out with what is called thebite size, i don't know, some little cookie on a popsiclestick and little mini scones. i think people were readingthose original values and stopped buying and so nowthey're offering something that's just a taste butonly about 150 calories. so it does make a difference tohave that nutrient information.
a lot of times when we go out toeat again, we don't want to know because it's a special daybut we all eat out a lot and it's good to havethat information to kind of pace yourself, pace your day. oh sorry, hungrygirl.com right? >>hungrygirl.com and thenshe's got some cookbooks too. >>i'm not familiar withher either but i think if, it's all about, if you'regoing to make a big change, i think it is, goas easy and simple
as possible in the beginning. and then, you know, as you become morecomfortable in the kitchen. >>[inaudible] are complicated. >>yeah, as you becomemore comfortable in the kitchen tweak away. i totally believe in it,unless you're baking, it's the only thing that youreally have to follow to the t. >>there's another seriescalled, eat this, not that,
and it's like eat this notthat in the restaurant, eat this not that, you know,and it's got some recipes and those are kind of fun littlecolorful books you can get at costco about half price. they offer, you know,how to reduce calories in your favorite things too. another questioni wanted to follow up on was the smart phones. i see you over hereworking on one.
who else uses a smartphone or an ipad? okay so, really look on ourresource list there's a thing about rating the top tennutrition apps and look to see if any of those willwork for you. i find people using them i'llsay well, tell me what you ate? and they'll just holdup their smart phone and of course then i have togo like this so i can see it but it's really a neatlittle tool especially if you are diligentenough to put
into it everythingyou've eaten for a week, it's really a surprise and it does help modifyyour eating habits too if you're trying to loseweight in particularly. so, i mean, there'snothing like a person, they've eaten reallywell during the week, oh you look you've stayed to1,500 calories, you've stayed to 1,800 calories but oh,look at that saturday night, somehow you ate 4,000calories on the weekend
and they'll have it down ontheir little iphone or whatever and it does with thatfeedback slowly start to change behaviors goingmaybe one less margarita that saturday night will kindof help balance out or whatever. so it is a neat tool. i mean, i don't havean iphone yet either until i get a couple collegekids off my phone plan but i can't wait because i dothink there are some pretty neat little applications there.
another question is about eatingfrom the rainbow which is kind of way to look at eating,promoting more fruits and vegetables and arethere colors in the rainbow that are more importantto people with spinal cordinjury then others? i would say, not particularly. i see that, in fact it washanded out this evening, i think it was fromthe super food use list which i've actuallydone talks using
that kind of list before too. and a lot of the foodsthat are considered to help with anti-inflammation foodslike blueberries, nuts, fish, dark leafy green vegetables, calling them super foodsis one way to look at it but it really goes back toeating a variety of foods. fruits, vegetables, wholegrains, low fat protein. you know, there's been a lotof different kinds of diets over the years whetherit was an atkins diet
or a south beach diet and ican tell you as a dietitian for the last 35 years, i'm stillgoing yeah, but it's just fruits and vegetables and whole grains and low fat protein isa healthy way to eat. and, you know, that'sstill the main message. what's the value oftofu is the question? you know, i'm not surewhat the fat content is. it's a soybean. >>[inaudible] protein.
>>it is a soy oil soit's vegetable oil so it's not an animalfat which is good. you know, tofu is justanother option for protein so if you are vegetarianor a vegan and you want to avoid animal meats or dairyproducts then it's a good choice for you but there's noparticular reason to single it out as being extraspecial if you're fine with all the othersources of protein too. okay, anything else?
well thank you very much. >>thank you guys very muchand a round of applause. [ applause ]
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