Thomas L. Petty, M.D., et al

Good nutrition is important for everyone, and it is especially important if you have pulmonary disease. Shortness of breath can make eating difficult at a time when you need to eat well to maintain your strength. A well-nourished body helps you fight off infections and improves your rehabilitation process. Listed here are a few tips that may help you maintain good nutrition.

Practical Approaches to Nutrition in Patients with COPD

A general approach includes eating foods that you like, and finding ways to eat healthy things that you also like.

Balanced Diet

Most nutritionists recommend a balanced diet. A balanced diet contains calories from a combination of protein, fat (from animal or vegetable sources), and carbohydrates (sugars and starches). A balanced diet should also contain an adequate number of the essential minerals and vitamins. If you are too thin or losing weight, you should try to eat more. This usually means more frequent, small meals. The possible advantage of eating this extra food as protein or fat rather than carbohydrates is discussed below.

Foods to Avoid

There are no special foods you need to avoid. If you produce a lot of phlegm, some people find that milk and other dairy products tend to either make more phlegm or make it thicker. Try reducing dairy products for yourself, since this helps some people but not others. If you like milk and cheese, and this does not seem to make your phlegm worse, then drink and eat them. If you find an increase in phlegm production or phlegm thickness when you eat milk products, then you will want to avoid them. If foods cause a particular problem for you, then avoid them. For example, if a particular food causes you to have gas which may be uncomfortable and distend your stomach and cause you to eat less, then avoid these foods.

Water and Fluid Intake

Having a high water and fluid intake, in general, is helpful. It may be particularly important in patients with COPD with excessive phlegm production. Liberal drinking of water may allow the body to thin the mucus or phlegm, so that it is easier to cough out. Expensive bottled water has no benefit over tap water. The timing of fluid intake may be important to those patients who have to get up at night to urinate. Drinking more fluid earlier in the day may help avoid extra trips to the bathroom at night.

Fluid retention with swelling of the legs can be problem, particularly for patients with COPD and heart disease. Fluid retention is more a problem of excessive salt intake than excessive fluid intake. Salt causes causes you to hold the fluid in your body. If you limit salt in your diet, then the water that you drink will not be held in the body but will be eliminated in the urine or by perspiration. If you have fluid retention, the best therapy is limiting salt intake or combing that with a diuretic (“water pill”), not limiting the amount of water you drink. Chronic fluid retention may be more troublesome and should be discussed with your doctor.

Alcohol

Excessive amounts of alcohol can be harmful (for anyone). High alcohol levels can interfere with breathing, but small amounts of alcohol (for example, a drink before dinner or a glass of wine or beer with dinner), can enhance your appetite and may be beneficial. If you enjoy alcoholic beverages, use moderation and continue to enjoy them.

Other Considerations

Nutritional needs are tied to other aspects of your health, including your lung problems. Other aspects discussed in this book may allow you to preserve your energy and still maintain your activity. For example, learn to be more efficient (get things done with less work), using the muscles of breathing while you exercise can modify your nutritional needs. If you are losing weight, consider ways to reduce your work of breathing. Consider the use of oxygen if appropriate (if your blood oxygen level is low), and consider balancing the adverse nutritional effects of medications (especially corticosteroids), against the potential beneficial effects.

Anabolic corticosteroids (the same medicine used- or abused- by bodybuilders) and growth hormones have been tested in experimental animals and are beginning to be tested on humans. Studies in patients with COPD are beginning to suggest benefit. More studies are needed in analyzing the use of hormones.

Balanced nutrition is a part of good health. Nutritional needs are tied to other aspects of your health, including your lung problems. Discuss your nutritional concerns with your doctor, a dietician or a nutrition specialist. These specialists are available in most medical centers and medical communities. Try what makes sense to you. Natural foods and generic vitamins are generally as effective as more expensive alternatives. Try to find healthy foods which you also like. Follow the nutritional program that makes you feel the best. Eating should be a source of pleasure. Try to make eating one of your pleasures and not an ordeal.

Low Carbohydrate Diets and Food Supplements

If you eat the same amount of calories in the form of carbohydrates (sugar and starches) compared to fat or protein, you will produce relatively more carbon dioxide. Since you eliminate carbon dioxide by breathing, this means you will have to breathe more to get rid of carbon dioxide if your diet is high in carbohydrates. On the other hand, carbohydrates can be converted to energy more quickly than fat or protein. The greater carbon dioxide production from carbohydrate is not usually an important issue for patients with COPD and should not be a major factor in determining the balance between protein, fat, and carbohydrate food sources. An exception might be the patient with severe COPD under stress with an acute episode (acute exacerbation of chronic bronchitis).

The food industry has promoted the use of canned food supplements. Commercial food supplements targeted at patients with COPD are relatively low in carbohydrates and high in protein and fat. These commercial food supplements tend to be relatively expensive. The same effect, a higher intake of calories to counteract weight loss, can be achieved more economically by eating normal food. Food supplements may be useful in selected patients, but even then, less expensive alternatives are usually just as effective. Talk this choice over with your doctor.

Vitamins and Other Supplements

Most balanced diets contain enough vitamins to meet your basic needs. On the other hand, taking a multi-vitamin is safe and may be helpful.

COPD, especially the emphysema part, is a disease thought to involve so-called oxidant injury. This is injury to the body’s tissue (in this case, to the walls of the air sacs in the lungs), which is caused or enhanced by oxygen changing into toxic forms. The toxic forms of oxygen that can cause tissue injury are called free oxygen radicals. So, oxygen that is necessary for life has the potential for causing harm if free oxygen radicals are formed. Antioxidants counteract this effect by either removing or chemically changing the toxic free oxygen radicals. An antioxidant is a chemical or substance that has this ability to scavenge or detoxify these forms of oxygen. Vitamin A and vitamin E are known to have antioxidant effects. Coenzyme Q is also an antioxidant. There is no study that proves that these antioxidants help prevent the progression of lung disease or result in other beneficial or helpful effects. Taken in recommended doses, they are safe (very high doses may cause problems), and they may have some benefit.

Special combinations of antioxidants, other vitamins and minerals are available in health food stores but tend to be expensive and have no scientific research to support their widespread use at this time. If you choose to take antioxidants, we recommend the cheapest generic forms available, usually found in any drug store or supermarket.

Frequent, Small Meals

Because of the “war” between the big lungs pushing down and compressing the stomach and a large stomach distended with food or gas pushing up and compressing the lungs, eating frequent small meals (“grazing”) will be more comfortable and allow a greater daily food intake.

Diet and COPD

Food is the fuel for your breathing muscles. A diet composed of a variety of foods within each category is also necessary for maintenance and repair. Many people with COPD do not eat properly because they are short of breath while eating. A professional dietary plan will help immensely. Do not “burn” your breathing muscles for fuel! There are really very few “do not eat” items, and tasteful effective food supplements are available in case you simply cannot eat a nutritious diet. Discuss the possibility of a dietary consultation with your R.N. or physician.

Source:

Nutritional Information From: Frontline Advice for COPD Patients, 2002.

Thomas L. Petty, M.D., Editor

Reprinted with permission