Nutritional Guidelines for People with COPD

This article provides basic information to help you make healthy food choices. Planning what you eat and balancing your meals are important ways to manage your health. Eating healthy often means making changes in your current eating habits. Changing your eating habits will not cure COPD, but it can help you feel better. A registered dietitian can provide in-depth nutrition guidance, tailor this educational information to meet your needs, and help you create and follow a personal action plan.

Food is the fuel your body needs to perform all activities, including breathing. Your body uses food for energy as part of a process called metabolism. During metabolism, food and oxygen are changed into energy and carbon dioxide. You use energy for all of your activities - from sleeping to exercising.

metabolism
food and oxygen--------> energy+ carbon dioxide

Food provides your body with nutrients (carbohydrates, fat, and protein) that affect how much energy you will have and how much carbon dioxide is produced. Carbon dioxide is a waste product that leaves your body when you breathe out (exhale). If there is too much carbon dioxide in your body, you might feel weak.

Breathing requires more energy for people with chronic obstructive pulmonary disease (COPD). The muscles used in breathing might require 10 times more calories than those of a person without COPD.

Good nutrition helps the body fight infections. Chest infections are illnesses that often lead to hospitalization for people with COPD, so it is important to reduce your risk of infection by following a healthy diet.

Maintain a healthy body weight. Ask your health care provider or registered dietitian what your "goal" weight should be and how many calories you should consume per day.

If you are overweight, your heart and lungs have to work harder, making breathing more difficult. In addition, the extra weight might demand more oxygen. To achieve your ideal body weight, exercise regularly and limit your total daily calories.

In contrast, being underweight might make you feel weak and tired, and might make you more likely to get an infection. People with COPD use more energy while breathing than the average person. Therefore, the pulmonary (breathing) muscles in someone with COPD might require up to 10 times the calories needed by a person without COPD. It is important for you to consume enough calories to produce energy in order to prevent wasting or weakening of the diaphragm and other pulmonary muscles.

Monitor your weight. Weigh yourself once or twice a week, unless your doctor recommends weighing yourself more often. If you are taking diuretics (water pills) or steroids, such as prednisone, you should weigh yourself daily since your weight might change. If you have an unexplained weight gain or loss (2 pounds in one day or 5 pounds in one week), contact your doctor. He or she might want to change your food or fluid intake to better manage your condition.

Drink plenty of fluids. You should drink at least 6 to 8 eight-ounce glasses of non-caffeinated beverages each day to keep mucus thin and easier to cough up. Limit caffeine (contained in coffee; tea; several carbonated beverages such as cola and Mountain Dew; and chocolate) as it might interfere with some of your medicines.

Some people with COPD who also have heart problems might need to limit their fluids, so be sure to follow your doctor's guidelines.

Include high-fiber foods — such as vegetables, cooked dried peas and beans (legumes), whole-grain foods, bran, cereals, pasta, rice, and fresh fruit — in your diet. Fiber is the indigestible part of plant food. Fiber helps move food along the digestive tract, better controls blood glucose  levels, and might reduce the level of cholesterol in the blood.

The goal for everyone is to consume 20 to 35 grams of fiber each day. An example of what to eat in one day to help you get enough fiber includes: eating 1 cup of all-bran cereal for breakfast, a sandwich with two slices of whole-grain bread and 1 medium apple for lunch, and 1 cup of peas, dried beans, or lentils at dinner.

Control the sodium (salt) in your diet. Eating too much salt causes the body to keep or retain too much water, causing breathing to be more difficult. In addition to removing the salt shaker from your table:

• Use herbs or no-salt spices to flavor your food.
• Don't add salt to foods when cooking.
• Read food labels and avoid foods with more than 300 mg sodium/serving.
• Before using a salt substitute check with your doctor. Salt substitutes might contain other ingredients that can be just as harmful as salt.

Wear your cannula while eating if continuous oxygen is prescribed. Since eating and digestion require energy, your body will need the oxygen.

Avoid overeating and foods that cause gas or bloating. A full stomach or bloated abdomen might make breathing uncomfortable. Avoid the foods that cause gas or bloating. Some foods that cause gas for some people include:

• Carbonated beverages
• Fried, greasy, or heavily spiced foods
• Apples, avocados, and melons
• Beans, broccoli, Brussels sprouts, cabbage, cauliflower, corn, cucumbers, leeks, lentils, onions, peas, peppers, pimentos, radishes, scallions, shallots, and soybeans

Follow your doctor's other dietary guidelines. If you take diuretics (water pills), you might also need to increase your potassium intake. Some foods high in potassium include oranges, bananas, potatoes, asparagus, and tomatoes.

If you are short of breath while eating or right after meals, try these tips:

• Clear your airways at least one hour before eating.
• Eat more slowly. Take small bites and chew your food slowly, breathing deeply while chewing. Try putting your utensils down between bites.
• Choose foods that are easy to chew.
• Try eating five or six small meals a day instead of three large meals. This will keep your stomach from filling up too much so your lungs have more room to expand.
• Try drinking liquids at the end of your meal. Drinking before or during the meal might make you feel full or bloated.
• Eat while sitting up to ease the pressure on your lungs.
• Use pursed-lip breathing.

If you are often too tired to eat later in the day, here are some guidelines:

• Choose foods that are easy to prepare. Save your energy for eating, otherwise you might be too tired to eat.
• Ask your family to help with meal preparations.
• Check to see if you are eligible to participate in your local Meals on Wheels program.
• Freeze extra portions of what you cook so you have a quick meal when you're too tired.
• Rest before eating so you can enjoy your meal.
• Try eating your main meal early in the day so you have enough energy to last you for the day.

Tips for improving your appetite

General guidelines

• Talk to your doctor. Sometimes, poor appetite is due to depression, which can be treated. Your appetite is likely to improve after depression is treated.
• Avoid non-nutritious beverages such as black coffee and tea.
• Try to eat more protein and fat, and less simple sugars.
• Eat small, frequent meals and snacks.
• Walk or participate in light activity to stimulate your appetite.
• Keep food visible and within easy reach.

Meal guidelines

• Drink beverages after a meal instead of before or during a meal so that you do not feel as full.
• Plan meals to include your favorite foods.
• Try eating the high-calorie foods in your meal first.
• Use your imagination to increase the variety of food you're eating.

Snack guidelines

• Don't waste your energy eating foods that provide little or no nutritional value (such as potato chips, candy bars, colas, and other snack foods).
• Choose high-protein and high-calorie snacks.
• Keep non-perishable snacks visible and within easy reach.

Dining guidelines

• Make food preparation an easy task. Choose foods that are easy to prepare and eat.
• Make eating a pleasurable experience, not a chore.
• Liven up your meals by using colorful place settings.
• Play background music during meals.
• Eat with others. Invite a guest to share your meal or go out to dinner.
• Use colorful garnishes such as parsley and red or yellow peppers, to make food look more appealing and appetizing.

Alcohol guidelines

Ask your doctor for specific guidelines regarding alcohol. Your doctor might tell you to avoid or limit alcoholic beverages. Alcoholic beverages do not have much nutritional value and can interact with the medicines you are taking, especially oral steroids. Too much alcohol might slow your breathing and make it difficult for you to cough up mucus.

Tips for gaining weight

• Drink milk or try one of the "High Calorie Recipes" listed below instead of drinking low-calorie beverages.
• Ask your doctor or dietitian about nutritional supplements. Sometimes, supplements in the form of snacks, drinks (such as Ensure or Boost) or vitamins might be prescribed to eat between meals. These supplements help you increase your calories and get the right amount of nutrients every day. Note: Do not use supplements in place of your meals.
• Avoid low-fat or low-calorie products unless you have been given other dietary guidelines. Use whole milk, whole milk cheese, and yogurt.
• Use the "Calorie Boosters" listed in this article to add calories to your favorite foods.

High-calorie snacks

• Ice cream
• Cookies
• Pudding
• Cheese
• Granola bars
• Custard
• Sandwiches
• Nachos with cheese
• Eggs 
• Crackers with peanut butter 
• Bagels with peanut butter or cream cheese
• Cereal with half and half 
• Fruit or vegetables with dips
• Yogurt with granola 
• Popcorn with margarine and parmesan cheese
• Bread sticks with cheese sauce

Eat a variety of foods from all the food groups to get all the nutrients you need.

High-calorie recipes to promote weight gain

If you are having difficulty maintaining a healthy weight, try some of these "Calorie Boosters."

If you are having difficulty maintaining a healthy weight, try some of these calorie boosters:

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 8/15/2008…#9451