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
- 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.
- 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.
- 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.
- 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.
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.
- Ice cream
- Granola bars
- Nachos with cheese
- 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.”
1 cup whole milk
1 cup ice cream (1-2 scoops)
1 package Carnation Instant Breakfast
Pour all ingredients into a blender. Mix well.
Makes one serving; 550 calories per serving
|Chocolate Peanut Butter Shake
1/2 cup heavy whipping cream
3 Tbls creamy peanut butter
3 Tbls chocolate syrup
1-1/2 cups chocolate ice cream
Pour all ingredients into a blender. Mix well. Makes one serving; 1090 calories per serving
2 cups whole milk
2 tablespoons vegetable oil
1 package instant pudding
3/4 cup non-fat, dry
Blend milk and oil. Add pudding mix and mix well. Pour into dishes (1/2 cup servings)
Makes four 1/2 cup servings; 250 calories per serving
|Great Grape Slush
2 grape juice bars
1/2 cup grape juice or 7-up
2 tablespoons corn syrup
1 tablespoon corn oil
Pour all ingredients into a blender. Mix well
Makes one serving; 490 calories per serving
f you are having difficulty maintaining a healthy weight, try some of these calorie boosters:
|Egg yolk or whole egg
||Before cooking, add egg yolk or whole egg to foods such as meat loaf, rice pudding, or macaroni and cheese.
(To prevent illness, avoid the use of uncooked eggs)
|Non-fat powdered milk or undiluted evaporated milk
||Add to beverages (including milk) or to these foods:
- creamed soups
- scrambled eggs
- mashed potatoes
- hot cereal
|Cream cheese or shredded, melted, sliced, cubed, or grated cheese
||Add to sandwiches, snacks, casseroles, crackers, eggs, soups, toast, pasta, potatoes, rice or vegetables, or serve as a snack.
|Vegetable oils, mayonnaise, butter, margarine, or sour cream
||Add margarine or mayonnaise to sandwiches; add any of these items to bread, casseroles, soups, eggs, cooked cereals, pasta, potatoes, rice, vegetables, pudding.
|Peanut butter (creamy or crunchy)
||Spread on bread, crackers, apples, bananas, or celery. Or add to cereal, custard, cookies, or milk shakes.
|Nut dust (grind any type of nuts in a blender or food processor
||Add to puddings, gravy, mashed potatoes, casseroles, salads, yogurt, cereals
(limit to one serving per day
sugar, jelly, jam preserves
winter squash, cold cereal, fruit salad
Nutrition & Eating
One of the best things you can do if you have chronic obstructive pulmonary disease (COPD) is try to maintain a healthy weight. This will help your immune system work efficiently and make it easier to breathe and to move around.
You can be too thin
Many people with COPD especially those with emphysema don’t weigh enough. It’s thought that people with COPD require 10 times as many calories to breathe as healthy people. And because they may lack the energy to cook or eat substantial meals, people with COPD often can’t keep up with that demand. They may lose between 10% and 50% of their ideal body weight over the course of their illness.
At the other end of the spectrum, extra pounds can put stress on your lungs, especially if they sit around your mid-section. The good news is that even a modest weight loss can help you breathe better. And healthy weight loss is slow no more than 2 pounds a week.
What’s in a healthy diet?
Here’s what the U.S. Department of Agriculture (USDA) recommends that most adults eat each day:
- 6-8 servings of grains, such as cereals, bread, rice, potatoes, and pasta (1 serving = 1 ounce or ½ cup cooked grain, 1 cup cold cereal, 1 slice bread).
- 4-6 servings of vegetables (1 serving = ½ cup, cooked or raw)
- 3-4 servings of fruit (1 serving = ½ cup or one medium fruit)
- 1-2 servings of protein, including beef, pork, poultry, dried peas or beans, nuts, and eggs (1 serving = 2 ounces meat or fish, 2 eggs, ½ cup cooked dry beans or tofu, 2 tablespoons of nut butter, or 1 ounce nuts or seeds)
- 3 servings of dairy products, such as milk, cheese, and yogurt (1 serving = 1 cup)
Tips for eating a healthy diet
These tips are general guidelines only. Ask your doctor for specific dietary recommendations that take your specific health issues into account. You may want to ask your doctor to recommend a dietitian, who can help you devise a healthy eating plan just for you.
- Eat foods from each of the basic food groups: fruits and vegetables, dairy products, cereal and grains, and proteins.
- Limit salt intake. Too much may cause you to retain fluids, and this may interfere with breathing.
- Limit caffeine. It may interfere with medicines and make you jittery.
- Avoid foods that produce gas or make you feel bloated.
- Try to eat your main meal early, so you have energy for activities.
- Avoid eating too close to bedtime. Lying down after eating puts pressure on your lungs and may make it harder to breathe.
- Choose foods that are easy to prepare.
- Avoid foods (like chips or soda) that have little or no nutritional value.
- Eat 6 small meals instead of 3 large ones, so you don’t overfill your stomach and make breathing harder.
- If you are using supplemental oxygen, wear it while you eat and after meals, too, to help with digestion.
The Best Diet For COPD
COPD: Nutrition Tips
Talk with your COPD medical team about the nutrition plan that is best for you. They may recommend that you see a nutritionist, who can work with you to develop a meal plan to best meet your needs and monitor your progress along the way.
In general, people who have COPD should consider the following to maintain an optimal weight:
- Monitor calories: If you are overweight, you can lose weight by eating fewer calories. But don’t eat so few calories that you feel fatigued and hungry all of the time. If you need to focus on maintaining your body weight, talk with your medical team or nutritionist about the foods you should be eating to keep the weight on.
- Avoid fad diets: “Fad diets are not appropriate for COPD patients,” says Make. Make recommends that COPD patients eat a healthful, balanced diet instead of going on fad diets to control weight.
- Focus on protein: Work with your medical team and/or nutritionist to determine the amount of protein you need. “A lot of people do not get enough protein in their diet,” says Make. Make says that protein is particularly important for COPD patients who are exercising as part of their pulmonary rehabilitation plan.
- Watch your portions: “We tell our COPD patients to eat small meals frequently, rather than large meals,” says Make. Eating several small meals throughout the day instead of two or three large meals can help lessen shortness of breath.
- Get balanced: Focus on consuming fruits, vegetables, dairy products, whole grains, and lean proteins.
- Limit salt: Consuming excessive sodium can lead to fluid retention, which can worsen your shortness of breath.
- Remember your oxygen: If your medical team recommends it, use supplemental oxygen during and after meals to aid in digestion.
A healthy diet is an important part of a COPD patient’s treatment plan. Eating the right foods can help manage your symptoms, make you feel better overall, increase your energy level, and give your body the fuel it needs to fight infection. It takes energy to breathe when you have COPD, so feed your body well.
Muscle Weakness, Weight Loss, and Nutrition in Chronic Obstructive Pulmonary Disease (COPD) People with severe COPD often lose too much weight. Too much weight loss causes your body to break down muscle and makes you weaker. This can lead to even more shortness of breath and even less activity. Over time, you become so weak that you need to depend on others for daily living.
Some people with COPD weigh too little for good health. People who are very underweight, especially those with emphysema, are likely to die sooner than people with COPD who are at a normal weight.1
The reasons for the weight loss and loss of muscle in COPD are not completely understood. But experts believe that it happens because of a combination of things. These may include:
- Using up more energy and nutrients, perhaps because it takes more energy to breathe or do any physical activity.
- A frequent need for oral corticosteroids. This medicine increases the breakdown of muscle tissue.
- Less interest in food. People who have COPD may eat less because they are depressed, which can cause a lack of interest in eating. Taking certain medicines can also cause this lack of interest.
- Too little oxygen. COPD may be causing too little oxygen to get into your blood. This can keep your body from using food properly.
- Poor eating habits, which can also cause weight loss.
- A full stomach may press on your diaphragm and make it harder to breathe. Holding your breath while chewing or swallowing may be uncomfortable if you are already short of breath.
- Older adults who are alone much of the time may not eat right.
- The cost of food may cause poor eating habits in people who have a limited income.
Avoiding weight loss
Eating well is important for:
- Keeping up your strength and your weight and staying active.
- Keeping your immune system strong. That helps you fight the lung infections common in those who have COPD.
A register dietitian can help you learn how much and what kinds of food you need to eat to stay as strong as you can.
Guidelines for nutritional management of pulmonary disease
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.
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 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.
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.
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.