Nutrition and COPD

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Nutrition and COPD

• All Things Considered

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Primary Goals of Medical Nutrition Therapy

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

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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

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Nutrition Concerns

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

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Unplanned Weight Loss

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

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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

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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.

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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.

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COPD Symptoms Contribute to Weight Loss

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

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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

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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)

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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

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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

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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

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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)

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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

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Weight Loss Wizard

• We wish we had a magic wand!

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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

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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.

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Important Nutrition Guidelines for COPD

• Protein
• Fluids
• Less Sodium
• Calcium
• Magnesium
• Phosphorus
• Potassium

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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)

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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

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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

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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

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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

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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

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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

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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)

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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

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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

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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

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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

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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

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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

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Fill Your Plate With Color!