Nutrition for COPD
Unfortunately, there is no specific diet for preventing or improving pulmonary disease that we know of. The traditional Mediterranean diet is usually recommended, at least partly because it is high in fish oils, which may help protect against muscle loss among other things. Reducing your salt (or sodium) intake is also recommended if you have shortness of breath. However, modifications are needed for individual problems.
In patients with severe emphysema, the lungs may be enlarged by air trapping and the diaphragm becomes flattened (see our Essentials article on Why Learn New Breathing Techniques?). A full stomach makes it even more difficult for the diaphragm to contract properly, which impedes breathing and increases shortness of breath. That is why five small meals a day are recommended, with small snacks in between, though not too close to meals. If fact, this is a good tactic for anyone wishing to control their weight gain. Spreading your eating out throughout the day helps you to feel less hungry and reduces the urge to ‘cheat’ and eat more calories than you need at each meal.
Patients with COPD should avoid gas-forming foods and beverages. This is especially important at bedtime. When lying down to rest or sleep, the stomach is not lowered by gravity, as it is during the day, so the effects that a full stomach has on the diaphragm become worse, especially if the patient is also overweight. Sometimes raising the head of the bed or using an extra pillow can help, especially for the patient with gastroesophageal reflux disease (GERD).
Extra weight also makes exercise more difficult and can lead to more shortness of breath.
For the very underweight patient with a poor appetite, high-calorie nutritional drinks, purchased in drug stores as well as grocery stores, are often recommended between meals. Ice cream can be added to improve the taste. High-calorie foods like avocados, previously avoided, can now be added to a meal. Between-meal snacks like trail mix or unsalted nuts are easy to carry around in a baggie to snack on between meals. If you notice that you are losing weight despite not eating differently (uncontrolled weight loss), it is very important to make an appointment to see your physician. There might be something else going on with your health that needs urgent attention. If you don’t have the energy to make your own meals, there are many companies where meals, even low sodium ones, can be ordered for delivery to the home.
Some patients are advised to drink more water to thin out mucus and prevent dry mouth but, again, check with your physician first to make sure he or she agrees this is best for you.
Most importantly, let your physician decide if you are overweight or underweight! And don’t be offended by what you hear. Physicians use something called the body mass index (BMI), which considers your expected weight for someone of your height, to gauge whether you are at more or less risk of your symptoms worsening. This is an important part of how they decide to treat you. So do listen to your doctor if they ask you to lose or put on weight! Many pulmonologists recommend that their patients stay as much as 10 pounds overweight, depending on the patient’s size, as a protective cushion in case they get a lung infection and are admitted to a hospital (an “exacerbation” of COPD). During an exacerbation, the body puts its energy into fighting the infection, and it is good to have some energy reserves to draw upon.
Patients with severe bronchitis or bronchiectasis may produce large amounts of sputum, often triggered by the smell of food. Their coughing at meals, as well as the production of large amounts of sputum, is embarrassing as well as deleterious to nutrition. This can be helped with controlled coughing. Your physician or pulmonary rehabilitation specialist can introduce you to techniques to control coughing and about stimuli that often trigger these problems.
During pulmonary rehabilitation, we found an increase in fitness leads to a decrease in mucus production. So this is as another incentive to do more exercise and get fitter.
Food preferences of various nationalities need to be taken into consideration when recommending a diet. In pulmonary rehabilitation class, all patients fill out a food diary so therapists gain a better idea of what is being eaten on a daily basis. For severe weight problems, a physician may request a dietary consult with individual counseling.
If you have a scale, weigh yourself regularly, preferably when you first get up. Don’t wear shoes and weigh yourself in the same clothes each day, or lack of them. A sudden gain of 5 pounds or more is likely to be fluid retention rather than weight gain.
I hope you can see why this subject requires a lot of discussion in a rehabilitation program, even if there is no particular diet specific for COPD!
To learn more about the Mediterranean Diet go to https://www.helpguide.org/articles/diets/the-mediterranean-diet.htm
Best wishes,
Mary Burn RN, BS
PERF Executive Vice President