Nutrition and COPD

All Things Considered

Primary Goals of Medical Nutrition Therapy

Preserve lean body mass Prevent involuntary weight loss Maintain nutritional status Improve quality of life

Role of Nutrition

Improves energy Helps fight inflammation Improves immune function Helps retain muscle mass and

strength Helps retain bone mass Helps slow progression of the disease

Nutrition Concerns

Malnutrition Weight status Nutrient dense - Quality counts! Adequate fluids (helps thin mucus) Coping with COPD symptoms

Unplanned Weight Loss

An individual without lung disease uses about 100 calories per day expanding and contracting the muscles involved with breathing

Unplanned Weight Loss

An individual with COPD could use between 420 – 730 (or more) calories per day for the work of breathing

Unplanned weight loss affects as many as 40-70% of COPD patients

Malnutrition

Studies report that in individuals with COPD, the prevalence of lower BMI (under 20 kg/m2) may be as high as 30% and the risk of COPD-related death doubles with weight loss.

Body Composition

In individuals with stable COPD, studies report that even for the 70% of patients with BMI greater that 20 kg/m2, body composition differs from healthy controls.

Fat-free (muscle) mass index and bone mineral density are lower in individuals with COPD.

COPD Symptoms Contribute to Weight Loss

Shortness of breath Fatigue (too tired to cook) Loss of appetite Feeling bloated after eating Food tastes different

Shortness of Breath CO2 retention associated with food comes

from eating excess calories in general. Most individuals with COPD need smaller

nutrient-dense meals, more often Digestion requires energy. Energy requires

oxygen. Smaller meals use less oxygen. Learn to “graze” throughout day Strategic snacking – no room for “junk”

Shortness of Breath Often difficult to chew, swallow, and

breathe at the same time Try to rest for 30 minutes before meals Good body posture at table Easily prepared and easy to chew foods Eat 6 small meals per day If on continuous oxygen therapy, may

need to increase oxygen flow rate during meals (Check with doctor first)

Fatigue

Eat larger meals earlier in the day 6 small meals per day Prepare greater amounts of food

when feeling “up”. Freeze to eat later.

Prepare simple foods and recipes Enlist family, friends or community

agencies to help with meals

Feeling Bloated Factors: Swallowing air, not drinking

enough fluids, and not enough exercise Try not to rush meals Eat several small meals throughout day Drink fluids 1 hour before or after meals Avoid foods that cause gas and bloating Eat less fried, fatty foods Avoid constipation – gradually increase fiber

and fluid in diet and remember to move

If Individual is Underweight:

May be more likely to get an infection

May become weak and tired more often

May weaken the muscles that control breathing

Weight Gain or Maintenance

Small meals and snacks throughout day

Nutrient-dense, High calorie, High protein

Role of fat Overall nutritional quality of foods May use commercial nutrition

supplements (Not a meal replacement)

If Individual is Overweight: Heart and lungs must work harder Increased weight increases oxygen

needs Breathing may become more difficult,

especially if weight is around middle Weight may decrease ability to expand

chest well for breathing Increased risk of developing other

health problems

Weight Loss Wizard

We wish we had a magic wand!

Guidelines to Lose Weight

Lose weight gradually and sensibly Become more active Eat fewer calories Eat nutrient-dense, balanced diet Follow healthy nutrition guidelines – such

as the DASH diet or Choose My Plate Monitor or record food intake

DASH to Health

• Dietary Approaches to Stop Hypertension (DASH) eating plan is balanced, nutrient-dense, and fiber and mineral-rich.

• DASH is consistently ranked tops in independent comparisons of nutrition and diet plans.

Important Nutrition Guidelines for COPD

Protein Fluids Less Sodium Calcium Magnesium Phosphorus Potassium

Protein Most individuals with COPD have reduced

body muscle mass compared to normal Protein is key component of muscle and

antibodies to help fight infection Balanced diet is the real deal Include protein source at every meal (fish,

poultry, meat, eggs, dairy products, legumes, nuts, nut butters, soy products)

Tips to Increase Protein Snack on peanut butter, bean dips, nuts,

yogurt, boiled eggs, cheese or cottage cheese, instant breakfast, puddings

Add skim milk powder to milk, cereals, cream soups, casseroles, and sauces

Add cheese to sandwiches and vegetables Add chopped meats, cheese, or legumes

to soups and casseroles

Fluids Helps thin and clear lung secretions Helps prevent bloating and constipation Oxygen therapy is drying Choose caffeine-free, non-carbonated

beverages Goal: at least 8 cups liquids per day To reduce fullness at meals, drink more

between meals & sip throughout day

Reduce Sodium

Fluid retention makes breathing difficult

Choose more fresh, unprocessed foods

Use less packaged, prepared foods Read food labels for sodium values Use more herbs, spices and salt-free

seasonings to add flavor

Calcium

Helps with lung function, muscle contraction, and blood clotting

Helps make bones strong Important for healthy immune

system Helps transport nerve impulses Corticosteroids may increase

calcium loss

Calcium Food Sources

Dairy products are best source (milk, yogurt, cheese, ice cream)

Other foods sources: tofu, almonds, broccoli, leafy greens, legumes

Calcium-fortified foods Vitamin D is essential for calcium

absorption

Magnesium Normal muscle and nerve function Healthy immune system Bone health Energy metabolism Protein synthesis Heart rhythm Normal blood pressure Blood sugar and insulin regulation

Magnesium Food Sources Nuts Dark green vegetables Whole grains Legumes (beans, peas, lentils, peanuts) Soybeans and tofu Some seafood (Whole grains have about 80% more

magnesium than refined grains)

Potassium

Protective effect against hypertension (helps the body to excrete sodium)

Helps regulate water and mineral balance throughout the body

Required for muscle contractions Very important for the heart muscle Diuretics decrease potassium

Potassium Food Sources Banana, kiwi, apricot, nectarine Dried fruit (prunes, raisins, dates, figs) Milk and yogurt Potato (either white or sweet) Tomato (raw or cooked) Dried cooked beans (navy, black, lentil, limas,

pinto, black-eyed peas, etc.) Leafy greens (spinach, kale, Swiss chard) 100% bran cereals Fish: halibut, tuna, cod, snapper

What is the Role of Fat?

Insulation, circulation, hormone balance

Helps meet increased energy needs (Fat has twice the calories of protein or carbohydrates)

Transports fat-soluble vitamins Increases satiety

Unsaturated Fats are Healthy Fats

Olive oil, canola oil, and other vegetable oils

Nuts, seeds, nut butters Fatty fish – salmon, mackerel,

tuna, sardines Avocados Olives

Good Carbs and Fiber

Fiber only found in plant foods Nutrient dense Best sources: whole fruits and

vegetables, dried beans, whole grains, nuts & seeds

Eating for color = Nutrient density Whole grains – Try something

different

Choose Your Plate

5 - 6 small meals per day Balance between carbs, proteins,

and fats Simple and fresh Nutrient dense Variety of colors and textures Drink plenty of fluids

Fill Your Plate With Color!