Enabled Life

From MyPlate to My Plan

Dieticians Outline Nutritional Priorities, Kitchen Tips and Menus to Get You on the Right Track

• By Elisha Bury
• Nov 01, 2012

With all the nutrition advice flying around, the myriad of new diets and science that seems to change direction on a dime, how can you know what your body truly needs to be healthy? Fortunately, smart nutrition choices are not hard to make as long as you know the basics.

For starters, using a chair doesn’t necessarily mean your nutritional needs are different. But maybe you aren’t sure what those needs are. Fortunately, the U.S. Department of Agriculture has created a graphic, MyPlate, that can help you visualize what each meal should look like.

Not surprising, half of your plate should contain fruits and vegetables. A quarter of the plate should be protein, and the other quarter should be whole grains. On the side, a small portion (a cup) should be dairy.

In addition, a simple equation to maintain your current weight is calories in should equal calories out.

Nutritional Priorities

Sounds pretty simple, right? But what happens when your condition throws you a curve ball?

“The guidance for nutrition is very individualized,” says Michelle Mock, RD, a nutritionist at the Initiative for Women with Disabilities, Elly & Steve Hammerman Health & Wellness Center at NYU Langone Medical Center in New York.

In fact, why you use a wheelchair could make a big difference regarding what you should eat.

Mock say sometimes she talks with women about weight management, a concern for people who are sedentary. Being overweight increases the risk for various comorbidities including diabetes, cardiovascular disease, gallbladder disease and cancer.

In addition, less activity, specifically not doing weight-bearing exercises, can also mean a greater risk for developing bone conditions such as osteoporosis, says Ruth Frechman, MA, RD, CPT, spokeswoman for the Academy of Nutrition and Dietetics and author of “The Food Is My Friend Diet.”

Osteoporosis might also be a concern if medication for another condition interferes with calcium absorption, Mock says.

According to Frechman, finding modified exercises to increase weight-bearing and watching calcium intake is a good way to address osteoporosis. Also, a supplement of calcium and vitamin D might be needed.

For some, a consequence of immobility might involve bowel and bladder issues, such as constipation and bladder control. Fiber is key to keeping the GI tract running smoothly. Frechman says to “make sure [to] get 25-30 grams of fiber a day.”

If you have bladder control issues, “that increases your risk of developing urinary tract infections,” Mock says. “So it’s a good idea to drink, drink, drink—drink a lot of liquids, especially clear liquids.”

On the other hand, if you have a condition such as multiple sclerosis (MS), you might be losing weight because you don’t feel well or you have swallowing difficulties, Mock says. “Then I would increase the caloric needs.”

In addition, Frechman says eating small, frequent meals can help with swallowing issues.

For those with MS, reducing inflammation is a priority. One way to do that is by adding omega-3 fatty acids from fatty fish, Frechman says.

Another way is to eat a lot of fruits and vegetables, Mock says. She specifically recommends raw fruits and veggies because they pack more nutrients.

Age might determine your nutritional needs and focus. For example, Mock advises three groups of women in the Initiative for Women wellness program: adolescents, adults and seniors. For teens, Mock talks mostly about basic nutrition and making wise choices when dining out. For adult women who live independently or are planning to live independently, “we would be looking more at reading food labels, developing different types of menus, recipes, things like that,” she says. For older women, Mock focuses more on chronic health issues.

Counting Calories

If you happen to fall into the weight management category, you’re not alone. Most Americans these days are watching their waistlines. In fact, many of the people with spinal cord injury that Mock sees have issues with weight management.

When it comes to weight loss, you need simply to go back to that earlier equation and make a change: calories in must be less than calories out.

“The average intake is 2000 [calories], and they may find if they have extra weight, then they would have to eat less. They may want to go with an 1800-calorie plan, maybe even the 1600-calorie plan, just to make sure that what they are eating is balanced with variety,” Frechman explains.

Mock agrees. “If I was working with just a normal weight person, I might say they should get 30 calories per kilogram body weight. But it’s really hard dealing with weight management issues that are also compounded with the wheelchair. Then I could lower that down to 20 to 25 calories per kilogram.”

Controlling calories is a matter of making smarter food choices.

“They have to make the most of their calories—get the most nutrients they can out of the least amount of calories,” Frechman says.Frechman is talking about nutritional density or the amount of nutrients packed into a meal. You could, for example, choose a doughnut for breakfast and get 500 calories. However, that doughnut will not have many of the essential nutrients your body needs. On the other hand, you could choose a 500-calorie breakfast that might contain eggs, toast, sausage, orange juice and milk. For the same amount of calories, you get a breakfast that provides plenty of protein, grains, fruit and dairy—more of what you need each day—and you’ll fill fuller longer.

MyPlate provides an excellent example of a meal with nutrient density. “It would be a good idea to follow the MyPlate guidelines: a little bit of protein, a little bit of carb and then half the plate fruits and vegetables,” Frechman says.

Reading food labels can also help you pay attention to caloric intake. Each food label provides the total calories as well as the percentage of those calories that are from essential nutrients: carbohydrates, proteins, fats (you want the unsaturated and polyunsaturated kinds), fiber, vitamins and minerals. But be careful. Notice the amount of calories per serving and the amount of servings per container or you might get more calories than you realize.

Organizing the Kitchen

All of this nutrition advice sounds great, but you might be wondering how to prepare healthy food in an efficient manner from the height of a wheelchair. Frechman says organization is key.

“Organize the kitchen so that whatever they use most is right at arm level,” Frechman says. That means putting your appliances and frequently used tools such as blenders, can openers and cutting boards right on the counter.

Frechman also recommends investing in kitchen tools that cut down on prep time and can be operated from a seated position. For example, she recommends an indoor grill, such as the George Foreman grill, for cooking chicken, fish and even vegetables. “They could sit while they’re preparing the food,” she says.

Mock recommends “a rice cooker or a salad spinner or things like that, that are a luxury for us but actually are mandatory for somebody who is living with disabilities.” She frequently recommends a toaster oven, especially one with convection, because opening the oven door could be dangerous for someone using a wheelchair.

For someone with MS, Frechman recommends breaking up tasks to conserve energy. She says prepare food when you’re not tired, but save washing dishes for later. Just fill up the sink with soapy water, and let them soak. Also lining pans with tinfoil when cooking meats can make cleanup easier.

Mock says crockpots are another appliance that are great for energy conservation “because you can just throw the ingredients in with a little bit of water and leave it.”

Other handy kitchen tools include sticky drawer liners that can be placed underneath bowls to prevent them from flipping during one-handed prep, grabbers for reaching high cabinets, one-handed rolling pins, steamer baskets to easily lift food out of boiling water, a lap desk that attaches to the wheelchair, and a mirror to see when a pot of liquid is boiling, Mock says.

“Another thing that’s really helpful is, if it’s possible at all, to have counter height for the wheelchair,” Mock says. “But a lot of times that’s not possible to change your apartment or change things in the kitchen. So what I suggest is doing their cutting and prep on a table so that the table is right at wheelchair height so they don’t have to reach up.”

Perhaps the best time-saving tool, however, is planning. Frechman says that if you plan out each meal for the week, you can purchase everything you need beforehand and not have to think about what’s for dinner.

Smart Menus

For menu planning, Frechman leans toward quick and easy. She says to buy fruits and vegetables that are presliced to speed up preparation times.

Another quick and nutritious choice is to buy frozen vegetables, Mock says, because you can quickly toss them in a pasta primavera without having to do all of the prep work. Plus they stay fresher longer. 

To save even more time, Frechman recommends making large quantities of one-dish meals such as soups, steel-cut oatmeal and lasagna and portioning out meals for later in the week. Portions can also be frozen and reheated quickly in the microwave.

“Cook once; eat twice” is Frechman’s motto.

Below are a few of Frechman’s menu ideas:

• Whole grain pita with hummus – Buy whole grain pitas with already prepared hummus. Then add baby carrots and slice a cucumber for the vegetable.
• Hardboiled eggs – Made in advance, hardboiled eggs make a fast and nutritious snack.
• Sandwiches – Quick, easy and well-balanced, tuna sandwiches are a good way to squeeze in those omega-3 fatty acids.
• Whole grain cereal with fruits and nuts – Have this quick meal for breakfast, lunch or dinner. The milk and nuts provide protein, and fiber comes from the fruit. The cereal provides the whole grains.
• Smoothies – A great way to have a fast meal that covers all of the MyPlate categories is to make a smoothie. Add tofu, soy milk or yogurt for protein. Toss in any fruit or vegetable—and even raw oatmeal to cover grains. Frechman likes strawberry spinach smoothies with yogurt or tofu.
• Baked potatoes – Spuds are a great make-ahead meal that can be quickly reheated and topped with canned chili.
• Beans – These excellent sources of protein can be purchased canned and come in a wide variety, such as kidney, black and garbanzo. Add to salad or soup for a protein boost.

When planning the menu, don’t leave out beverages. Frechman says it’s important to keep hydrated—and not with fattening full-calories sodas.

“If you’re not very active, you might not feel thirsty, but you can still get dehydrated. So just keep a water bottle nearby,” she says.