Maintaining a healthy diet is important for everyone, but people with chronic obstructive pulmonary disease (COPD) need to be especially aware of how their diet affects their health. That is because food, which is the fuel for all body activities, literally can affect the body's ability to breathe, and the right mix of nutrients can make breathing easier.
When someone has COPD, a diet full of healthy foods:
Helps maintain a healthy weight;
Provides the body with the energy it needs to breathe;
Supplies enough calories to keep muscles strong;
Helps the body fight infections by strengthening the immune system.
Conversely, a poor diet that does not meet or exceeds the body's nutritional requirements, causing a COPD patient to be under- or overweight, can make COPD symptoms worse and decrease the body's ability to function.
Respiratory professionals who deal with COPD patients need to understand nutrition and the importance of diet in the management of COPD in order to offer effective and comprehensive patient education and care.
Issues of being underweight
Unplanned weight loss affects 40% to 70% of COPD patients, most commonly due to loss of appetite because food doesn't taste good or people become too tired to make meals, chew, swallow and/or breathe. Also, some medications can cause loss of appetite or interfere with the body's absorption of nutrients.
At the same time, people with COPD often have increased nutritional needs. A person with COPD who is struggling to breathe may burn up to 10 times as many calories breathing as a healthy person.
When COPD patients are underweight:
They may be more likely to get an infection;
They may become weak and tired more often;
The muscles that control their breathing may weaken.
Good nutrition can help ensure that muscles like the diaphragm, which helps pull in and push out air during normal breathing, stay strong and active. If a COPD patient doesn't consume enough calories to fuel the diaphragm, it will become weak and the person will have trouble breathing and become tired easily.
Weight loss becomes a problem, indicating poor long-term prognosis, when the body mass index (BMI) falls to less than 21% below normal.
Some COPD patients can't meet their nutritional requirements with regular foods, so their physician may recommend a medical nutritional product or nutrition therapy with a registered dietician (RD) to help restore weight and nutritional wellbeing.
In general, people who need extra calories and nutrients to gain weight should try to eat:
High-calorie, high-nutrient beverages;
High- protein, high-calorie foods;
Foods with vitamins and minerals;
Medical food supplements, if prescribed.
They should stay away from foods that may fill them up but are low in nutrients and calories, such as diet foods, diet sodas, plain beverages, clear broths. Additionally, the use of supplemental oxygen around meal times is recommended.
Issues of being overweight
Being overweight can make lung disease symptoms worse and increase chances of developing other medical problems. Increased weight also adds to the body's oxygen demands.
Obesity is defined as BMI 20% above normal and has detrimental effects on lung function by increasing the workload on respiratory function during activity.
When COPD patients are overweight:
Their heart and lungs must work harder;
Their body may demand more oxygen;
Their breathing may become more difficult, especially if weight is carried around the middle.
Many people who are overweight carry the extra weight around their stomach or in the upper part of the body. This added weight can make it difficult to breathe, which strains the heart and lungs.
According to a recent article in COPD Digest, morbid obesity can cause doctors to under or mis-diagnose COPD and/or other medical conditions, and losing weight can improve COPD symptoms. The article describes a COPD patient who, after losing 173 lbs., went from severe, stage-4 COPD to mild/moderate COPD; her oxygen saturation levels are now normal at rest and in room air, and her care team has realized that the patient also has acute anemia, which previously may have been missed because of her extreme weight. To lose weight, the patient walked, rode a stationary bike and cut out processed foods.
General tips for healthy eating and management of COPD
It is clear that eating a balanced diet and maintaining a healthy weight are important parts of managing COPD. In addition to providing the body with the fuel it needs to function, proper nutrition also helps the body's immune response and helps it to metabolize medications properly.
In general, it is recommended that COPD patients try to eat small, frequent meals, which can reduce shortness of breath caused by an extended stomach pressing on the diaphragm. Small meals also reduce reflux as well as the amount of oxygen required to chew and digest. Patients should eat slowly, breathe evenly, chew foods well, and rest and relax if needed. Additionally, patients that use oxygen should wear their cannula during and after eating so that digestive muscles have the oxygen they need to digest food. [4,8,9]
People with COPD should try to:
Eat protein, which produces antibodies that help fight infection;
Drink a lot of fluids, especially water, to help thin lung secretions, clear the lungs, help the immune system fight infection, and prevent dehydration. Oxygen therapy can be drying, and fluids will help keep the body hydrated. (However, if medicines, sodium or COPD are causing fluid retention, or if a patient has other health problems like chronic heart failure, a physician may recommend a fluid-restricted diet);
Eat foods with vitamins and minerals, including calcium, magnesium, phosphorous and potassium. Many COPD patients take steroids, which can increase the need for calcium. Certain nutrients, such as omega-3 fatty acids, may help reduce inflammation and improve lung function;
Increase consumption of fresh foods;
Increase consumption of high-fiber foods, such as, vegetables, cooked beans and dried peas, whole grains, cereals, pasta, rice and fresh fruit. Fiber helps move food through the digestive tract, helps to control blood glucose, and may even reduce cholesterol level. Some healthcare experts recommend 20 to 35 grams of fiber a day to maintain bowel function.[1,2,3,4,10]
Gas can make people with COPD uncomfortable, so it may be best for them to limit foods that may cause gas, such as:
Other foods to restrict or avoid include:
Salt (sodium), which makes the body retain water, can increase swelling and make breathing more difficult;
Alcohol, which has no nutritional value, depresses the body, may slow breathing and can cause problems in coughing up mucus;
Caffeine, which can interfere with some medicines;
Chemicals and food additives, which can cause inflammation.[2,4,10]
A patient's diet can't cure COPD, but a good one that helps maintain healthy weight and obtain needed nutrients can help them to feel better. Because diet does play a significant role in the management of COPD, an RD may be a valuable addition to the healthcare team, especially one who specializes in COPD. However, every member of the healthcare team should understand how diet may affect COPD in an attempt to see and treat each patient as a whole, medical person with a multitude of issues.
1. Living with COPD: Nutrition, American Lung Association, http://www.lung.org/lung-disease/copd/living-with-copd/nutrition.html
2. COPD Health Center, http://www.webmd.com/lung/copd/copd-diet-avoiding-weight-loss-staying-healthier
3. Nutrition Tips for Someone with COPD, COPD Foundation, http://www.copdfoundation.org/Portals/0/123745%20COPD%20Nutrition%20Tips.pdf
4. Nutrition and COPD, UAB School of Medicine, http://www.uab.edu/medicine/pulmonary/lung-health-center/patient-education/learn-about-copd/214-nutrition-and-copd
5. Robinson, KJ. 2012. Pulmonary Rehabilitation: Improving Patient Outcomes in COPD. Lung Health Professional Magazine, 3:3.
6. Nutrition Therapy for Chronic Obstructive Pulmonary Disease, American Dietetic Association, http://www.adancm.com/vault/editor/Docs/COPDNutritionTherapy_FINAL.pdf
7. Battling Obesity to Take Control of COPD. Summer 2012. COPD Digest, 8:3.
8. COPD Lifestyle Management, http://www.nationaljewish.org/healthinfo/conditions/copd-chronic-obstructive-pulmonary-disease/lifestyle-management/nutrition/
9. COPD: Nutrition, Oxygen and Exercise, UPMC, http://www.upmc.com/patients-visitors/education/breathing/pages/nutrition-oxygen-exercise.aspx
10. Good Nutrition and Healthy Eating Habits, Fall 2012. COPD Digest, 8:4