Managing Your Nutritional Status

Nutrition and COPD impact one another greatly. A person’s nutritional status can influence the degree of severity of COPD, and COPD can create circumstances that make consuming an adequate diet difficult.

General Body Types Associated with COPD

Overweight

·        associated with chronic bronchitis

·        peripheral edema is common (water retention in feet and legs)

·        poor skin tone resulting from a lack of oxygen being distributed to the body tissues.

Underweight

·         associated with emphysema

·        prone to weight loss

·        poor appetite common

·        muscle wasting apparent - chest, arms and legs look boney.

Maintaining or Achieving a Desirable Body Weight

Being overweight increases the workload on your heart and lungs to supply oxygen to all areas of the body. Secondly, excess fat in the abdominal area crowds the diaphragm, making it difficult to fully expand the lungs. By losing weight through proper diet and exercise, the body’s muscle mass is increased. This makes breathing easier and the person will feel healthier and more energetic.

On the other hand, being underweight is a problem as well. Weight loss happens because of a combination of increased calorie needs and inadequate diet. As a result of poor diet the body’s muscle mass becomes depleted -- including the respiratory muscles. This makes breathing more difficult. The increased work of breathing creates a higher calorie need, which the person may not be able to meet, and then a cycle of weight loss and muscle wasting is continued.

Nutrition and Your Immune System

A diet deficient in calories, protein, vitamins, and minerals has a negative effect on immune function. The body’s cells that fight infection are made of proteins. Poor diet makes it difficult for the body to build new immune factors to fight infections and to repair damaged tissues. This scenario is common among people with COPD, and puts them at risk for developing respiratory infections. Decreased appetite and increased caloric needs may then start another debilitating cycle. For this reason and the ones above, the COPD patient must achieve a balance of good nutrition and exercise to stay as healthy as possible.

Nutritional Needs

·        Fluid - drink at least 8 cups of caffeine free fluid daily. Fluid keeps mucus thin and keeps your body hydrated.

·        Protein - for repairing and building cells. The amount you need depends on your nutritional status and should be determined by a dietitian. Generally, six ounces of protein per day and 2 cups of milk provide an adequate amount of high value protein.

·        Calcium- especially important for women and for individuals who are on steroid medication. Calcium builds bones and helps regulate blood pressure. You can get dietary calcium from dairy products, supplements, and vegetables. But note that the body does not readily absorb the calcium in vegetables.

·        Adequate calories - important even if you are trying to lose weight. You can ask your health care provider about an assessment of your nutritional needs if you are advised to diet.

·        Potassium - important for blood pressure control, muscle contraction, and nervous system function. Potassium is susceptible to depletion as a result of certain diuretic medications. Sources of dietary potassium include fruits, vegetables, dairy and meat.

·        Caffeine- Limit beverages containing caffeine. It causes the body to lose water and it increases the diuretic effect of medications such as theophylline .

Tips for Eating Well

·        Eat three small meals and three snacks - this will prevent you from becoming too full. Too much food at once distends the stomach and crowds the diaphragm making it more difficult to breathe.

·        Eat bigger meals earlier in the day rather than later in the evening.

 

·        Avoid lying down after meals.

 

·        Cook when feeling most energetic- make extra portions and freeze leftovers for easy frozen dinners.

·        Avoid gas-forming vegetables and limit carbonated beverages if prone to gas. See list of gas forming foods.

·        Keep fruit juice and water readily available in the refrigerator.

·        Rest before eating.

 

·        Choose foods that are easy to prepare.

 

·        Choose softer foods that are easier to chew if you become short of breath while eating.

 

·        Eat a variety of foods to ensure that you are getting adequate vitamins and minerals.

 

Bloating and Feelings of Fullness

Many people with C.O.P.D. say they feel bloated or full quickly after eating just a small amount of food. Rushed meals and shortness of breath during eating can cause air to be swallowed as you eat and cause bloating. Lack of exercise may also contribute to this problem.  Gas-forming foods may also cause discomfort.  Gas can cause the stomach to push upon the diaphragm against the lungs, making it harder to breathe.  The following is a lists of foods they may cause gas or bloating.

 

 

Avacados

Honeydew Melon

Beans

Leeks

Beer

Lentils

Broccoli

Nuts

Brussel Sprouts

Onions

Cabbage

Peas (split/black-eyed)

Cantaloupe

Radishes

Cauliflower

Raw Apples

Corn

Sauerkraut

Cucumbers

Soybeans

Garlic

Turnips

Green Peppers

Watermelon

 

Tips for Adding Calories

·        Have snacks handy.  Snack foods, cheese and crackers, and ice cream all make good snacks.

·        If you are a big fresh fruit and vegetable eater, eat the fruits and vegetables that are higher in calories.

·        Whenever you can, drink juices instead of water, coffee, or tea.  Water, black coffee, and tea have no calories.

·        Try adding the following foods to your diet, they provide more calories and less volume than most other foods. 

Butter or Margarine

A teaspoon of margarine or butter adds about 45 calories.  Mix it into hot soups, cooked cereals, rice, and soft boiled eggs.  When you eat a sandwich put butter on the bread in addition to other condiments.  Serve bread hot because more margarine or butter is used when it melts into it.

Mayonnaise

One tablespoon contains 100 calories.  Use it with salads, scrambled eggs, fruits, and sandwiches.  Use it instead of salad dressing in recipes, mayonnaise provides twice the calories of salad dressings.

Peanut Butter

One tablespoon contains 90 calories and this is a food high in protein.  Serve peanut butter with fruits such as apples, pears, and bananas.  Have it on toast with butter for breakfast, in sandwiches, stuff celery with it, and on crackers for snacks.

Cream Cheese

This has 100 calories per 1oz. And is also a food high in protein.  Try cream cheese on fruits, crackers, raw vegetables, with jelly on a sandwich, or in gelatin salads.

Sour Cream or Yogurt

One tablespoon of sour cream contains 70 calories.  Sour cream or plain yogurt can be used on vegetables, added to gravies, salad dressings, and creamy casseroles.  Try adding them to eggs for rich and fluffy scrambled eggs, soufflés, and omelets.

Whipped Cream

Use whipped cream to top pies, cakes, hot chocolate, fruit gelatin and other desserts.  You can also use cream in coffee instead of milk to boost calories.  Whipping cream has about 60 calories in one tablespoon.

Honey

Use honey whenever you usually use sugar, in coffee, teas, or cereal.  It has twice the calories of sugar.  Try honey, peanut butter, and butter together on toast.

Powdered Coffee Creamers

These add calories without volume.  Add them to gravy, cream soups, creamed vegetables, casseroles, hot cereals, and milkshakes.

Raisins, Dates, Other Dried Fruit, and Chopped Nuts

Add these to hot or cold cereals and fruit salads.  These make great high calorie low volume snacks.

 

Tips for Adding Protein

·        The major sources of protein in your diet are foods from the meat and milk groups.  If you are not getting enough of these protein foods, need more protein because of an infection, or need more protein to rebuild your muscles here are some tips to help you increase your protein intake.  Use the following ways to increase protein in your diet without increasing the amount of food you eat:

 

·        Add skim milk powder to increase protein.  Try adding it to hot milk or cold cereals, scrambled eggs, soups, gravies, casseroles, and ground meat (for hamburgers, meat loaf, etc.).  Especially if you do not drink milk, using skim milk powder in these ways will help you get the nutrients (calcium) in milk that you need.

 

·        Add ground meat or cooked chicken to soups and casseroles.

 

·        Add grated cheese to sauces, vegetables, soups, and casseroles.

 

·        Use peanut butter for snacks.  Peanut butter is an excellent source of protein and calories.

 

·        Choose dessert recipes that contain eggs, such as sponge cake, egg custard, bread or rice pudding, and eggnog.

 

·        Blend finely chopped hard-boiled eggs in sauces, gravies, salad dressings, and casseroles.  It will hardly be noticeable.

Loss of Appetite

A common problem anyone with lung disease experiences is loss of appetite.  It may be caused from fatigue, illness, stress, depression, or by any combination of these things - no one knows for certain. The more weight you lose, the less you feel like eating and the weight loss continues. Here are some hints that may help:

·        It may help to eat three small snacks each day (three smaller meals and 3 between meal snacks).

 

·        Keep healthy snacks available for nibbling.  For example, milkshakes, cheese, peanut butter, milk cereal, sandwiches, yogurt, custard, pudding, ½ cup ice cream, and low carbohydrate nutritional supplements.

 

·        If foods do not have much taste, try chewing gum or sucking on hard candy before meals.  This helps stimulate saliva in the mouth.

 

·        Some people feel hungrier in the morning and others tend to be hungrier at night. Take advantage of your “hungry” time and load up on the calories.

 

·        During your not so hungry times, try to eat your favorite foods.

 

Food Guide Pyramid

 

Line Callout 1 (No Border): Bread, Cereal, Rice, Pasta Group
6-11 Servings
Line Callout 1 (No Border): Milk, Yogurt, and Cheese Group 
2 -3 Servings
Line Callout 3 (No Border): Fats and Oils Group
Use Sparingly
Line Callout 1 (No Border): Meat, Poultry, Fish, Dry beans, Nuts Group 2-3 Servings

Line Callout 1 (No Border): Fruit Group 2 - 4  ServingsLine Callout 1 (No Border): Vegetable Group 3 - 5 Servings

 

 

Using the Food Guide Pyramid

Start with plenty of breads, cereals, rice and pasta; vegetables; and fruits. Then add 2 or 3 servings from the milk and dairy group, and 2 or 3 servings from the meat group. Each of these food groups contains some, but not all, of the nutrients you need. No one food group is more important than another -- for good health you need them all. Go easy on fats, oils, and sweets -- the food group at the small tip of the pyramid.

 

What Counts as a Serving?

Breads & Cereals

Vegetables

Fruits

Milk & Dairy

Meat

Oils & Sweets

1 slice of bread

1/2 cup cooked or raw cut vegetables

1 piece of fruit or melon wedge

1 cup of milk or yogurt

2 1/2 to 3 ounces of cooked lean meat, poultry or fish

Use very sparingly

1/2 cup of cooked rice or pasta

1 cup of leafy raw vegetables

3/4 cup of juice

1 1/2 to 2 ounces of cheese

1/2 cup of cooked beans

 

1/2 cup of cooked cereal

 

1/2 cup of canned fruit

 

 

 

1 ounce of ready to eat cereal

 

1/4 cup of  dried fruit