Nutrition for Someone with COPD
What we eat affects our health. Good nutrition is important for everyone, and it’s especially important if you have COPD. Food is the fuel your body needs in order to perform all activities, including breathing.
Always check with your health care provider or a registered dietitian before making any changes to what you eat.
Eating Well is a Balance
Our bodies require water and a source of energy – food – regularly. We also need vitamins and minerals that our bodies cannot produce. We find these in the foods we eat.
If you have COPD, or even if you don’t, eating well is a balance. It’s important to make sure you eat enough of the foods that provide the energy, vitamins, and minerals your body needs. You must also make sure you don’t eat too much of some foods. Too much fat, salt, sugar, and sometimes even too much of some vitamins and minerals can be unhealthy.
The literature on diet and COPD is limited but there are a few references you may wish to read:
- A healthy (mostly plant-based) diet is associated with less depression in COPD
Dinparast, F., Sharifi, A., Moradi, S. et al. The associations between dietary pattern of chronic obstructive pulmonary disease patients and depression: a cross-sectional study. BMC Pulm Med 21, 8 (2021). https://doi.org/10.1186/s12890-020-01383-5
A diet rich in antioxidants (mostly fresh, hard fruits and some vegetables), has been recommended for COPD patients in Role of Diet in Chronic Obstructive Pulmonary Disease Prevention and Treatment (Scoditti et al. Nutrients. 2019;11(6):1357. doi: https://doi.org/10.3390/nu11061357)
An earlier study suggested a positive impact of a diet rich in fiber on COPD. This study a https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-020-01383-5#citeasnd other small trials in COPD were reviewed by Michael Greger, MD, in the 2012 blog "Treating COPD with Diet".
A healthy diet is primarily based on whole, unprocessed food, low in saturated fats, trans fats, cholesterol (koe-less-tur-all), salt, and added sugars.
The United States Department of Agriculture (USDA) 2015-2020 ChooseMyPlate guidance says a healthy diet is one that includes these 5 food groups:
- Grains (including wheat, rice, oats, cornmeal, barley or another cereal: whole grains or refined grains)
- Dairy (fat-free or low-fat milk and milk foods or a plant-based source of calcium such as fortified soy milk or tofu, dark green leafy vegetables with many vegetarian options listed in this USDA link).
- Protein lean meats, poultry (chicken and turkey), fish, beans, eggs, and nuts.
The proportion is shown in the image below:
The 2019 Canadian government food guide has removed dairy from its “plate” adding low fat dairy to the protein group, focusing on Plant-based proteins and fats based on their association with lowered risk of heart disease, cancers, diabetes, and obesity and suggesting water as the beverage of choice. The Canadian plate also includes proposed portions for each food type.
Canada’s food guide resources
For those of you interested in a plant-based diet, including those of you experiencing problems with airway mucus after eating dairy as noted on COPD360social, ideas for protein and calcium rich foods and recipes can be found at the following links:
Calories are the fuel that helps your body work. Calories come from the grains, vegetables, fruits, proteins, and fats you eat. How many calories a person needs each day depends on many things. These include their age, their disease condition, how much they exercise, and if they need to lose or gain weight. Combine healthy choices from across all food groups while paying attention to calories.
What is a Healthy Weight for You?
In order to know what a healthy diet is for you, first ask yourself: "Am I at a healthy body weight? Do I weigh more than I should? Less than I should? Or am I 'just right?'"
If you have COPD, being underweight can be a serious problem. A person with COPD needs an extra 430-720 calories a day, just to do the work of breathing!
Being overweight can be a serious problem, too. It may keep your lungs from expanding as much as they should. You may be more likely to develop other medical conditions such as sleep apnea, high blood pressure, or diabetes. Being overweight can increase your body’s demand for oxygen. It can also put extra stress on your muscles and joints, leading to pain and problems walking.
If You Weigh Less Than You Shouldplus
Even having mild COPD can increase your chance of being underweight.
When the number of calories you are taking in is too few to meet your energy needs, your body breaks down fat and muscle. This causes muscles to become weak. This also causes weight loss. A bad cycle begins. The muscles used to breathe are weakened. This causes shortness of breath. This causes a decrease in appetite. This causes more weight loss. And the cycle continues.
If you are underweight, you should increase the number of calories you eat each day.
To add more calories to your diet:
- Mix a teaspoon of olive oil into hot foods.
- Use peanut butter in sandwiches and snacks.
- Use honey or date syrup for sweetening food and beverages.
- Drink smoothies made with nut butters and fruits. Try adding protein powder or egg substitutes for more protein and added calories.
- Keep high-calorie snacks around: olives, walnuts, raw almonds, and dried fruits.
- Add flaxseed oil or olive oil to cottage cheese or non-dairy cream cheese with fruit.
Other Causes of Weight Loss
The most common reason people with COPD lose weight is that they lose their appetite. Some say they eat less because food does not taste as good as it used to. Others say they get too tired to make meals. For some, chewing, swallowing, and breathing all at the same time is just too much work. Chewing and swallowing adds to the feeling of shortness of breath.
Feeling bloated from swallowing air and not getting enough exercise can make you feel like not eating. Sometimes medicine side effects cause loss of appetite. Some medicines can cause problems with your body absorbing nutrients from food.
To improve your appetite:
- Make mealtime as pleasant as possible. Listen to relaxing music.
- Do not talk about stressful topics at the table.
- Eat healthy snacks throughout the day. Keep them handy.
- When you know you should eat but are not hungry, eat some of your favorite foods.
If You Weigh More Than You Shouldplus
The best way to lose weight and keep it off is to do it little by little. Extreme dieting is not healthy and can be hard to maintain. It can also be harmful by not giving you important nutrients you would get in a balanced diet.
Eating fewer calories will help you lose weight. This is easier to do when eating six small meals each day. By eating every few hours, the smaller meals will help fight hunger and cravings.
Increase your activity level. People with moderate to severe COPD can exercise effectively. You can learn about this in pulmonary rehabilitation (pull-mon-air-ree re-ha-bill-ii-tay-shun).
Better Eating Tips for Anyone with COPD
To make foods easier to chew:
- Cook vegetables until they are soft.
- Mince or grind meats.
- Dip breads in liquid.
- Eat pasta, mashed potatoes, thick soups, creamed soups, and casseroles.
- Try fruit smoothies or milk shakes (there are many non-dairy options).
To decrease shortness of breath:
- Try to rest 30 minutes before meals.
- Use pursed-lips breathing.
- Sit upright and lean forward with your elbows on the table. Put your feet on the floor. This will give you the greatest expansion of the lungs.
- Ask your health care provider, if you are on continuous oxygen, if you should increase your flow rate during meals. Do not adjust your oxygen flow without talking with your health care provider.
- Relax before and after meals. Anxiety causes shortness of breath.
To reduce tiredness:
- Check out “Meals on Wheels” in your community. This service (or one like it) can provide you with a nutritious, low-cost meal. This will keep you from having to prepare a meal.
- Eat six small meals each day instead of three big ones. Digestion requires energy. Energy requires oxygen. If you eat smaller meals, you use less oxygen.
- Eat your larger meals earlier in the day.
- Rest before eating, but don’t lie down after meals.
- Use easy-to-make recipes.
- Ask family or friends to help with making meals.
- Avoid sweets, cookies, cakes, and pies – simple carbohydrates – these can cause you to hold in too much carbon dioxide. This can cause tiredness.
To reduce bloating:
- Try not to rush your meals.
- Do not eat when you are short of breath. This can cause you to swallow air. This will make the bloating worse.
- Drink fluids one hour before and one hour after a meal. This will decrease the amount of food in the stomach at one time.
- Avoid foods such as onions, cabbage, sauerkraut, broccoli, Brussels sprouts, and beer.
- Eat less fried, fatty food. High-fat foods are digested slowly, causing a feeling of bloating.
- Avoid lactose. It may cause bloating. It is found in milk, yogurt, cottage cheese, and fat-free sherbets.
- Avoid being constipated (con-sti-pay-ted) by adding lots of fiber and fluid to your diet.
Important Components of Your Diet
Protein is important for people with COPD. It produces antibodies (ant-tee-bodies) that fight infection. The main sources of protein are beans, peas, nuts, soy products (such as tofu, tempeh), eggs, dairy, fish, and animal meat.
To Get More Protein in Your Diet:
- Add skim milk or non-dairy calcium rich protein powder to hot beverages, cereal, eggs, soups, casseroles, gravies, and ground meat or legume dishes. This will add extra protein and calcium to your diet.
- Add chopped, high-protein foods (nuts, legumes/beans, poultry, meats, or cheese) to soups, casseroles, and vegetables.
- Blend finely chopped hard-boiled egg or egg substitute into a sauce, gravy, or soup.
- Include high protein snacks such as pasteurized eggnog, instant breakfast, and puddings in your diet.
- Have nut butter, bean dips, nuts, cottage cheese, or other cheese as snacks to add additional protein and calories.
Drinking enough fluids is important for people with COPD. Fluids help thin and clear out lung secretions. Fluids keep you hydrated and prevent constipation. Water may be the best fluid for your health, but fruit juices, decaffeinated coffee, and tea are also good choices. Milk provides needed nutrients.
A Fluid-Restricted Diet:
Your health care provider may put you on a fluids-restricted diet. Ask your health care provider or dietitian to help you plan what to eat and drink. Fluid retention can be caused by medicines. It can also be caused by your COPD, and sometimes it is caused by eating too much salt.
Salt (or sodium)plus
Too much salt in your diet can cause you to retain fluids. It can also increase your blood pressure and shortness of breath.
To Reduce Salt in Your Diet:
- Do not add salt while making food or to food served at the table.
- Read labels and ingredients on all foods. Avoid those that contain salt.
- Read the sodium content on food labels. Look for products with less than 140 mg sodium per serving or labeled "low sodium."
- Cured, smoked, and canned meats, bologna, frankfurters, ham, and salami
- Regular canned vegetables, soups, and vegetable juices
- Salted snacks (nuts, pretzels, chips)
- Regular frozen meals
- Foods in brine (pickles, olives, sauerkraut, feta cheese)
- Regular processed cheeses
- Seasoned salt, meat tenderizer, MSG, soy sauce, barbeque sauce
Calcium (cal-see-um) helps with lung function, muscle contraction and blood clotting. Calcium also plays an important role in keeping your bones strong, helping the immune system, and transporting nerve impulses.
Many people with COPD take corticosteroid (kort-tee-coe-stair-royd) drugs. These drugs can speed up the loss of calcium in both men and women. Osteoporosis (ah-stee-oh-pah-row-sis), a condition of weak bones, can occur. Talk with your health care provider about the risk of osteoporosis.
Dairy products, dark green leafy vegetables (broccoli, kale, cabbage and watercress), dried fruits, nuts, seeds, pulses (peas, beans and lentils) are all good sources of calcium. Calcium is not easily absorbed. Vitamin D helps. Make sure your diet includes good sources of Vitamin D.
Dairy and Symptoms of Mucus Production
Many people believe that drinking cow’s milk will create extra mucus in their nose, throat, and lungs. This is not entirely true. The fats in milk can leave a soft, filmy coating in your throat and mouth. This may make you feel like you have extra mucus in your throat. Milk is an important part of a good diet. It contains calcium, protein, vitamins A, D, and B-12 and riboflavin. We do not know enough about COPD and dairy but there are numerous alternatives to dairy foods that provide the important nutrients found in milk.
Based on recent literature and studies primarily in asthmatics, there is some evidence that a dairy-free diet reduces mucus production.
A 2018 reference for non-dairy diet in asthma is Frosh A, Cruz C, Wellsted D, Stephens J. Larnyngoscope.2019;129(1):13-17. doi: https://doi.org/10.1002/lary.27287.
Magnesium (mag-knee-zee-um) is the “fuel” that makes muscles work. It is also an important mineral that is involved in blood clotting, muscle contraction, and protein production. A low level of magnesium weakens the muscles, including the breathing muscles.
Dark green vegetables are rich natural sources of magnesium. Magnesium may also be found in whole grains, beans, peas, lentils, tofu, and some seafood. Chocolate contains some magnesium. Foods made from refined flours (like white bread) have 80 percent less magnesium than whole grain flours.
Potassium (poe-taa-see-um) is required for muscle contractions. It is very important for the heart muscle. High or low levels of potassium can cause an irregular heartbeat. Foods high in potassium include milk, yogurt, winter squash, tomatoes, apricots, cantaloupe, bananas, oranges, prunes, carrots, potatoes, raisins, spinach, and dates.
The Relationship Between Medications and Nutrients
Some COPD medicines can have an effect on your nutritional needs. In addition, the foods you eat can change a medication’s effectiveness.
Diuretics (die-you-reh-ticks) help you get rid of extra fluids, but sometimes also get rid of too much potassium from the body. If you are taking diuretics, your doctor will check your potassium levels.
For more information about the relationship between medications, nutrients, and food, talk with your health care provider.
Good Nutrition is Key to Managing Your Lung Disease
A good, nutritious diet is important for anyone. But it is essential for someone with COPD. Keeping a healthy body weight supports your lungs as they work. Good nutrition gives your body the energy it needs do the work of breathing and staying active. Good nutrition can help you have a better quality of life.