Spina bifida is one of the most common birth defects in the United States. Spina bifida results from an abnormality of the formation of the neural tube, which forms the spinal cord. There are four categories of spina bifida based on the type of abnormality - Spina Bifida Occulta, Spina Bifida Cystica (myelomeningocele), Meningocele, and Lipomeningocele. Spina Bifida Occulta is the least severe and also the most common type of spina bifida. Myelomeningocele is the most significant form of spina bifida.

One of the goals of Spina Bifida Awareness Month, which occurs in October, is to enhance the lives of those people affected by it. Proper nutrition is one way in which this is accomplished. Spina bifida affects people differently, so there are no "rules" or standards that hold true for everyone. There are, however, common secondary conditions that many people with spina bifida face. Knowing how to properly manage those secondary conditions by eating healthy and staying active can greatly improve quality of life.

Obesity
Obesity is very common in our society. The Centers for Disease Control and Prevention estimate that approximately 34% of U.S. adults age 20 and over are obese. For those with spina bifida, the statistics are even more alarming. Fifty percent of children who have spina bifida are overweight, and in adolescence and adulthood, more than 50% are considered to be obese.

Obesity often occurs in people with spina bifida due to a sedentary lifestyle. Because of their disability, people with spina bifida tend to be more restricted in their movement and therefore lead a very inactive life. Unfortunately, obesity further limits mobility, which therefore perpetuates inactivity and weight gain. Extra weight also increases the amount of pressure on the skin, which increases the already high risk of skin breakdown.

Being more active is one way in which people with spina bifida can manage their weight. While traditional forms of exercise are sometimes not feasible, there are many exercises in which people with spina bifida can partake. The following factsheets are wonderful resources for increasing physical activity for people with spina bifida:

• http://www.ncpad.org/222/1443/Spina~Bifida~-~Physical~Activity~Guidelines
• http://www.ncpad.org/416/2237/Teens~on~the~Move~~An~Exercise~Video~for~Teens~with
  ~Spina~Bifida

In addition to being more active, it is important that people with spina bifida pay attention to what they eat. Ideally, proper nutrition should begin in childhood, but it is never too late to start making healthy changes. Helpful nutrition tools can be found at www.choosemyplate.gov. This site is used to help Americans apply the 2010 Dietary Guidelines using the MyPlate tool. 

Basic nutrition tips for weight management include:

• Increase intake of whole grains.
• Increase intake of fruits and vegetables.
• Increase intake of fat-free and low-fat dairy products.
• Choose lean sources of protein (fish, poultry, tofu, legumes, and lean red meat).
• Eat breakfast.
• Limit intake of sugary sodas and fruit drinks.
• Limit intake of saturated and trans fat.
• Limit restaurant eating.
• Stay hydrated by drinking water throughout the day.

Constipation
Constipation is a very common problem for people with spina bifida, generally as a result of the lack of movement due to their disability. Ensuring that there is an adequate amount of fiber in the diet can significantly help with bowel management. When fiber is increased in the diet, however, it is also very important to increase water intake. Water helps move food through the digestive tract, thus helping fiber perform its functions.

Fiber is classified into two categories. Insoluble fiber helps promote regular bowel function and also aids in keeping the intestines at a balanced pH level. Soluble fiber dissolves in water to form a gel-like material. It slows digestion, helps your body absorb vital nutrients from foods, and helps to decrease cholesterol levels.

The best sources of insoluble fiber are wheat bran, whole-grain products, and vegetables. The best sources of soluble fiber are oats, beans, dried peas, and legumes. Fruits, vegetables, and barley are good sources of both insoluble and soluble fiber.

Skin breakdown
Pressure sores, also known as bedsores or decubitus ulcers, are an all-too-common health concern for wheelchair users. Anyone who does not regularly change position is at risk for developing skin breakdown or pressure sores. They usually form in areas on the body where bones are closest to the skin, such as hips, back, ankles, elbows, and heels.

Proper nutrition is one of the keys to treatment and can help lead to a quicker recovery. Several key nutrients have been identified as being important for healing wounds:

• Protein
  Protein plays a vital role in building and repairing body tissues. The Recommended Daily Allowance (RDA) for protein is 0.8 gm/kg of body weight per day. For people who have a pressure sore, research shows that approximately 1.5-3 gm/kg is more appropriate, depending upon the severity of the wound. However, taking in too much protein increases protein synthesis, which puts a burden on the kidneys and liver and can lead to dehydration.

  How to Calculate Protein Needs:

  1. Weight in pounds divided by 2.2 = weight in kg
  2. Weight in kg x 0.8gm/kg = protein requirement for general health
  3. Weight in kg x 1.5-3gm/kg = protein requirement for wound healing

  The best food sources of protein include:

  • Meat, poultry, and fish
  • Dairy products (milk, cheese, and yogurt)
  • Eggs

  Other sources of protein include tofu, soy, legumes (i.e. peas, beans), and peanut butter. For vegetarians, vegans, and/or those who do not eat meat, fish, eggs, or dairy products, it is important to eat a variety of these other foods in order to get enough protein.

• Vitamin A
  Vitamin A is a fat-soluble vitamin that is stored in the liver. Vitamin A helps in the early inflammatory phase of wound healing and in the formation of scar tissue. It also helps speed the healing of wounds. High doses of vitamin A, however, can be toxic, especially when taken in supplement form. The RDA for vitamin A for adults is 5,000 IU.

  The best food sources of vitamin A include:

  • Carrots
  • Liver
  • Sweet potatoes
  • Red peppers
  • Kale
  • Collard greens
  • Swiss chard
  • Turnips

• Vitamin C
  Vitamin C also plays an important role in wound healing by supporting collagen synthesis. Collagen helps to strengthen wounds and therefore leads to quicker recovery. Vitamin C is a water-soluble vitamin, so the body cannot store it. It is unlikely that high doses of vitamin C will lead to toxicity. There is still an RDA for vitamin C of 60mg for adults, as excessive amounts can lead to GI distress.

  The best food sources of Vitamin C include:

  • Citrus fruits and juices
  • Cantaloupe
  • Kiwi
  • Strawberries
  • Papaya
  • Tomatoes and tomato products
  • Potatoes
  • Dark green vegetables

• Zinc
  Zinc is a mineral that aids in wound healing by supporting the development of collagen and helping to synthesize protein. A deficiency can lead to abnormalities in white blood cell function, which increases the risk of wound infection. Too much zinc, however, can actually hinder wound healing and cause nausea. The RDA for zinc is ~15mg/day.

  The best food sources of zinc include:

  • Beef and lamb
  • Organ meats (such as liver)
  • Peanuts and peanut butter
  • Legumes

• Fluid
  It is important to keep your body well-hydrated to promote good skin turgor, which is essential for the prevention of skin breakdown. Dehydration is one of the risk factors for developing pressure sores. In general, approximately eight 8-ounce glasses of fluid per day are necessary for proper hydration. Less fluid may be required for those on fluid restrictions. More fluid may be needed for very active individuals. The best choices for fluids are water and juices, as beverages that contain caffeine can lead to dehydration.

Weakened bones
Depending on how people are affected by spina bifida, some individuals may experience osteoporosis and risk of fracture in the bones of weakened limbs.

Adequate intake of calcium and vitamin D has shown to greatly reduce the chances of developing osteoporosis later in life. It is important for people with spina bifida to get an adequate intake of both calcium and vitamin D.

The best sources of calcium and vitamin D are:

• Milk and foods made with milk, such as cheese, yogurt, pudding, custard, ice milk, ice cream, and cream soups
• Low-fat yogurt and cottage cheese with added calcium
• Cheeses (the more firm the cheese, the more calcium it contains); look for lower-fat versions to decrease intake of saturated fat
• Canned fish, such as sardines and salmon
• Tofu and soy milk
• Almonds, dried beans and peas, and dark-green leafy vegetables
• Juices fortified with calcium and vitamin D

By leading a healthy lifestyle, people with spina bifida (and people with disabilities in general) can lead active and fulfilling lives. Proper nutrition can play a vital role in reducing the incidence and severity of secondary conditions. However, please note that nutrition is not a substitute for medical care.

Resources:
The Spina Bifida Association of America
http://www.spinabifidaassociation.org