Diet in neurogenic bowel management: A viewpoint on spinal cord injury.

The aim of this review is to offer dietary advice for individuals with spinal cord injury (SCI) and neurogenic bowel dysfunction. With this in mind, we consider health conditions that are dependent on the level of lesion including skeletal muscle atrophy, autonomic dysreflexia and neurogenic bladder. In addition, SCI is often associated with a sedentary lifestyle, which increases risk for osteoporosis and diseases associated with chronic low-grade inflammation, including cardiovascular and chronic kidney diseases. The Mediterranean diet, along with exercise and dietary supplements, has been suggested as an anti-inflammatory intervention in individuals with SCI. However, individuals with chronic SCI have a daily intake of whole fruit, vegetables and whole grains lower than the recommended dietary allowance for the general population. Some studies have reported an increase in neurogenic bowel dysfunction symptoms after high fiber intake; therefore, this finding could explain the low consumption of plant foods. Low consumption of fibre induces dysbiosis, which is associated with both endotoxemia and inflammation. Dysbiosis can be reduced by exercise and diet in individuals with SCI. Therefore, to summarize our viewpoint, we developed a Mediterranean diet-based diet and exercise pyramid to integrate nutritional recommendations and exercise guidelines. Nutritional guidelines come from previously suggested recommendations for military veterans with disabilities and individuals with SCI, chronic kidney diseases, chronic pain and irritable bowel syndrome. We also considered the recent exercise guidelines and position stands for adults with SCI to improve muscle strength, flexibility and cardiorespiratory fitness and to obtain cardiometabolic benefits. Finally, dietary advice for Paralympic athletes is suggested.

World journal of gastroenterology. 2020 May 28 [Epub]

Marco Bernardi, Anna Lucia Fedullo, Elisabetta Bernardi, Diego Munzi, Ilaria Peluso, Jonathan Myers, Florigio Romano Lista, Tommaso Sciarra

Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome 00185, Italy., Federazione Italiana Pallacanestro In Carrozzina (FIPIC), Rome 00188, Italy., Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari "Aldo Moro", Bari 70121, Italy., Joint Veteran Center, Scientific Department, Army Medical Center, Rome 00184, Italy., Research Centre for Food and Nutrition, Council for Agricultural Research and Economics (CREA-AN), Rome 00178, Italy. ., VA Palo Alto Health Care System and Stanford University, Cardiology Division, Palo Alto, CA 94025, United States., Scientific Department, Army Medical Center, Rome 00184, Italy.