Pulmonary Rehabilitation Dietary Advice

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Pulmonary Rehabilitation Dietary Advice

• By Stephanie Lee-Barrett
• Dietitian
• Colchester General Hospital

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Facts About COPD Diet

• Diet and Nutrition should be an important part of
  treatment
• Breathing requires more energy with COPD
• Muscles involved may require 10x more calories
  than those without COPD
• Good nutrition will help reduce hospitalisation
  from chest infection

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• The eatwell plate

Bread, rice, potatoes, pasta
Fruit and vegetables
Milk and dairy foods
Meat, fish, eggs, beans
Foods and drinks high in fat and/or sugar
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General Dietary Advice

• Enjoy variety of foods
• Limit salt intake
• Drink plenty of fluids 6-8 glasses/day
• Include high fibre foods e.g. veg, fruit,
  wholegrain foods, cereal, pasta, rice
• Eat several small meals per day

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Body Mass Index (BMI)

• Used to measure if an individual is a healthy
  weight, underweight or overweight
• BMI Weight (kg)
• Height (m²)
• Fit into certain categories
• 16-19 Underweight
• 20-25 Normal weight
• 26-30 Overweight
• 31-40 Obese

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Dietary Advice if you are Underweight
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Underweight

• Weight loss
• Loss of respiratory muscle strength
• More energy required
• to breathe
• Increased difficulty breathing and
  increased risk of infection

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Poor appetite

• Have regular meals snacks
• Eat anything fancied
• Eat from a smaller plate
• Avoid filling up on veg, salads, fizzy drinks
• Sip nourishing high energy fluids e.g. milk, hot
  choc, malt drink, milkshake
• A short walk before meals may increase appetite
• A small amount of alcohol can stimulate appetite

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Slow Eater

• Try eating small amounts little often
• Consider a plate warmer insulated mug
• Do not hurry over meals, eat slowly and chew
  foods well

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Short of Breath While Eating/ After Meals

• Eat more slowly
• Choose foods that are easy to chew - softer foods
• Try eating 5-6 small meals/day
• Try drinking liquids at the end of your meals.
• Eat while sitting up to ease pressure on the lungs

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Too Tired to Eat Later in Day

• Choose foods that are easier to prepare
• If possible ask family members to help with meal
  preparation
• Freeze extra portions
• Rest before eating
• Try eating main meal early in the day

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Feeling of fullness quickly

• Eat smaller meals more frequently, rather than
  one or two big meals
• Try not to fill up on fluid whilst eating.

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Food Fortification

• Fortified milk - add 4tbsp skimmed milk powder to
  1pint full cream milk
• Add butter/margarine/ghee/cream/cheese to mash
  potatoes, vegetables and sauces
• Add cream/ice cream/custard to puddings and fruit
• Use sugary foods (unless diabetic) -
  jam/sugar/syrup/honey added to cereals and
  puddings

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Quick Snack Ideas

• Sandwiches - cheese/egg/meat with pickles/sauces
• Toast- cheese/beans/ egg/fish
• Toasted crumpets with cheese
• Convenience meals

• Jacket potato with cheese/beans/tuna mayo
• Crackers or digestive biscuits with butter and
  cheese
• Mousse/yoghurt/jelly/ trifle/fromage frais
• Fruit loaf/malt loaf with butter

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Nutritional Supplements

• If the discussed ideas do not help to improve
  your intake, nutritional supplements may be used
• Complan and Build-up are available to buy over
  the counter.
• Others are available on prescription from your
  GP.
• Variety of flavours (sweet and savoury).
• Often preferred chilled
• Can be incorporated into recipes e.g. milk
  pudding, ice cream, custard, milkshakes, mousses.

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Dietary Advice if you are Overweight
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Overweight

• Consequence of
• high energy intake from food
• reduced exercise tolerance
• steroid use
• Extra weight increases workload of heart and
  lungs to supply oxygen around body
• Excess fat in abdominal area makes it difficult
  for the lungs to expand fully

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Starchy Foods

• Include at each meal
• Main source of energy
• Starchy foods are filling
• Choose wholemeal wholewheat varieties
• Myth that starchy foods are fattening

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Fruit and Vegetables

• Rich in vitamins and minerals
• Help protect against infection
• Aim for 5 portions per day
• Fresh, frozen, canned or dried

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Meat, Fish and Alternatives

• Provides protein, vitamins minerals
• Recommend 2 servings/day
• Avoid roasting or frying in large amounts of
  oil/fat
• Try healthier cooking methods
• Choose lean meat
• Remove visible fat skins from meat and poultry.

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Milk and Dairy Products

• Provides protein and calcium
• Recommend 3 servings/day
• Use semi-skimmed milk instead of full cream milk
• Use low fat cheeses e.g. Cottage cheese, edam,
  half fat cheddar
• Try low fat yoghurts
• If on long term steroids - it is important you
  have enough calcium.

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Fatty and sugary foods

• Try using sweeteners
• Choose lower calorie sugar free/no added sugar
  drinks
• Keep sweets, puddings, cakes, chocolate,
  take-aways, pies and pastries as a treat
• Try tinned fruit in natural juice rather than
  syrup.

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Hints for weight control

• Think of the benefits of weight loss
• Make healthier changes to your diet
• Fill up on fruit and veg
• Have regular meals
• Avoid foods which are high in fat and sugar. Aim
  for
• lt3g total fat /100g product
• lt5g added sugar/100g product
• Set realistic, achievable target lose
  (1-2lbs/week).
• Do not crash diet. Consider keeping a food diary

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Alcohol

• high in calories and should be kept within
  sensible limits.
• Women 14 units per week
• Men 21 units per week
• Aim for 2-3 alcohol free days.
• A unit of alcohol is
• Half a pint of beer, cider or larger (medium
  strength)
• 1 small glass of wine (125ml)
• 1 small glass of sherry
• 1 measure of spirits

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Summary.

• Good nutrition helps reduce infections
• Need energy to help you breathe
• If underweight - choose high protein/calorie
  foods - important have enough energy
• If overweight - choose low fat/low sugar foods,
  eat more fruit/veg
• Refer to relevant diet sheets - examples of menu
  plans and snack ideas