Nutraceutical-based Integrative Medicine: Adopting a Mediterranean Diet Pyramid for Attaining Healthy Ageing in Veterans with Disabilities

Abstract

Veterans with disability represent a big burden worldwide and often require long-term rehabilitation. Unhealthy dietary and lifestyle habits, including smoke and alcohol abuse, are common in veterans. In the context of integrative medicine approaches, the "complementary and alternative medicine" has been suggested for the management of chronic diseases. However, the potential risk of interaction between herbal products, dietary supplements and drugs must be considered in veterans. The Mediterranean diet has been suggested as a natural, non-pharmacological nutraceutical for healthy ageing. Although there is a broad consensus on the positive effect of plant foods consumption, the presence of glucosinolates, flavonoids and furanocoumarins in some plant foods and beverages must be taken into consideration owing to their potential interfering with drugs metabolism and bioavailability. Albeit seasonality could ensure the maintenance of the single dose of phytochemical below that at which adverse effects in some individuals genetically predisposed or unpleasant drug interactions in diseased subjects can occur, a personalized nutrition is recommended in veterans who are under treatment for comorbidities. Furthermore, sports practice can lead veterans with motor disabilities and mental impairments to excel in some disciplines, giving rise to the phenomenon of the Paralympics and the development of "recreational therapy". Moreover, outdoor lifestyle, through vitamin D synthesis, and conviviality, improving socialization, could account for the Mediterranean lifestyle health benefits. In this work, we propose for veterans a Mediterranean Pyramid, which could be the basis for integrative medicine for veterans with disabilities, patient-centered approaches and interprofessional (including physical medicine and rehabilitation clinicians, pharmacists and nutritionists) interventions.

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

“…A systematic review of dietary interventions in adults with SCI emphasized the potential of diet in conjunction with exercise in minimizing CVD risk [69] , whereas the "Consortium for Spinal Cord Medicine" noted success in weight loss using the Med-D in the DPP [63] . Med-D has been suggested for Veterans with disabilities [70] , patients with chronic kidney disease (CKD) [71] and individuals with chronic pain [72] . Furthermore, Allison et al [73] , recently reported that in individuals with SCI, a 3-mo anti-inflammatory diet similar to the Med-D plus supplementation decreased fat intake and proinflammatory dietary components (trans fatty acids, caffeine and sodium) and increased protein intake and some nutrients with established anti-inflammatory properties, including vitamins A, C, and E, and omega (ω)-3 polyunsaturated fatty acids (PUFA), with no change in CHO or energy intake [73] .…”

“…A systematic review emphasized the potential of diet in conjunction with exercise in minimizing CVD risk in SCI [69] , whereas the Consortium for Spinal Cord Medicine did not recommend a single nutritional intervention but noted success in weight loss using the Med-D in the DPP [63] . Med-D has been suggested for Veterans with disability [70] , patients with CKD [71] and individuals with chronic pain [72] .…”

“…Therefore, caution has been recommended when simultaneously consuming grapefruit juice during treatment with these drugs [89] . Other citrus fruit juices, cruciferous vegetables (broccoli, cabbage, and daikon radish sprouts), soy foods (soy milk, veggies slices, tofu, and roasted soy nuts), tea and cranberry and pomegranate juices can induce adverse food-drug interactions and should be avoided in individuals in treatment for comorbidity [70,90] . Individuals with SCI are at increased risk of developing symptomatic UTI [91] .…”

“…For all the above-mentioned reasons, we propose a Med-D-based and exercise pyramid for individuals with SCI ( Figure 1). This should be integrated with the previous indications for veterans [70] , the available recommendations/suggestions for individuals with SCI with or without NBD [14,36,50,63,69,73] , CKD [71] , chronic pain [72] and IBS (including low FODMAP) [18] , and the exercise guidelines for adults with SCI [101] , along with the position statement on exercise and SCI of Exercise and sports science Australia [102] . This approach is likely to be effective in improving muscle strength, flexibility and cardiorespiratory fitness, and to obtain cardiometabolic benefits.…”

“…In order to have a complete energy expenditure assessment, all other activities performed during the day which cannot be actually measured should be taken into account converting the data using at least three-days of activity. Various questionnaires for energy expenditure can be used, including Ainsworth's tables [117] , Dietary advice from the previous indications for veterans [70] , individuals with spinal cord injury with or without neurogenic bowel dysfunction [14,36,50,63,69,73] , chronic kidney disease [71] , chronic pain [72] and irritable bowel syndrome [18] . 1 Limit/avoid: Potential undeliverable effects [11,36,79,[94][95][96] ; 2 Exercise recommendations, derived from the integration of two recent papers [101,102] devoted to adults with spinal cord injury, are aimed to improve muscle strength, cardiorespiratory fitness, flexibility and cardiometabolic health.…”