Your Bottom Line

by David R. Gater, Jr., M.D., PhD.,
University of Michigan Model SCI Care System

Why is it so difficult to keep my weight under control?

Calories. Calories represent fuel in the body, and are stored as fat when your food intake is greater than your energy expenditure. After a spinal cord injury (SCI), almost all people will lose muscle and have a lower metabolism. Muscles are the primary part of our metabolism. Since muscle mass is lost in SCI, metabolism is lower. Therefore, this means you will burn fewer calories even if you do the same amount of work! Depending on the level of your SCI, resting metabolism may decrease by as little as 12% (low paraplegia) or by as much as 54% (high tetraplegia). Most people with SCI won’t burn enough calories in their daily activities to compensate for this lower metabolism, and will need to incorporate exercise into their daily habits. Aerobic (endurance) exercise burns more calories during the activity itself, whereas anaerobic exercise (lifting weights) builds more muscle mass, which burns more calories at rest. Both types of exercise are important for your health, community mobility and keeping excess weight (fat) under control.

Food contains calories (fuel) in the form of fats, carbohydrates and proteins. Per unit of weight, fat has twice the calories as a similar amount of carbohydrate or protein. So, even if you reduce the fat in your diet, you may still gain body fat if you are eating too many carbohydrates and proteins. The type of carbohydrate is also important, because ones causing a higher blood sugar response (high glycemic index) generally increases fat storage. Carbohydrates with high glycemic indexes include white bread, pasta, potatoes, full fat ice cream and (sorry!) chocolate bars. This doesn’t mean that all carbohydrates are bad, however!

Carbohydrates are an essential part of the diet, and those with low glycemic index (including wholegrain cereals, fruits, lentils and low fat fruit yogurt) are especially good for you. You should also be aware that most of the high protein/low carbohydrate diets can cause constipation, dehydration and kidney stress, and the initial weight loss is hard to maintain since it is mostly just lost water weight. Essential nutrients and minerals must also be maintained at appropriate levels to ensure optimal health. Most of us could do with smaller portion sizes and a little more exercise. This is especially important if you have an SCI.

From SCI access, a publication of the University of Michigan Model Spinal Cord Injury Care System