General healthy eating tips for COPD patients and smokers

Poor dietary intake of important nutrients is common among COPD patients and smokers. Most pulmonology professionals believe that improving dietary intake can contribute to a reduction in shortness of breath symptoms and in slowing the progression of lung disease.

However, there is no current standard recommended diet offered by physicians for smokers and people with COPD. This is because there are two widely divergent ways poor diet is evidenced in COPD patients and smokers (underweight/overweight) that necessitate different recommendations. Further complicating matters to provide general dietary advice is the wide range of medications used by COPD patients. Some of these medications prevent absorption of key nutrients or otherwise deplete key nutrients in the body.

Most COPD patients/smokers are underweight and in many cases are considered malnourished. Diet recommendations for this audience typically focus on increasing consumption of calorie dense foods to add weight and improve access to vital base nutrients. According to a recent article, (Shepherd A. The nutritional management of COPD: an overview. British Journal of Nursing. 2010; 19(9): 559-562), respiratory care professionals believe the main causes driving underweight/malnourished COPD patients include: 

• Difficulty chewing because of chronic shortness of breath
• Chronic mouth breathing which alters the taste of food
• Excess mucus production depressing appetite
• Coughing spasms which can lead to retching and vomiting
• Depression
• Lack of motivation/effort to prepare meals
• Side effects of medication

On the other end of the spectrum, there is a segment of COPD patients who are obese but, according to the same British Journal of Nursing article, researchers have far less understanding of what drives the connection between COPD and obesity. The diet recommendations for this audience tend to focus on reduction of overall caloric intake and substitution of high fat/high carbohydrate foods with foods that provide a greater proportion of protein compared to fat/carbohydrates.

 

However, whether underweight or overweight, there are some valuable healthy eating tips for those who suffer from chronic shortness of breath offered in the British Journal of Nursing article that we’ve categorized into two different groupings:

 

Before eating:

• Rest prior to meals if possible
• Avoid consuming fluids prior to meals to avoid bloating
• Choose foods that are easy to prepare to conserve energy for eating
• Choose foods are soft and easy to chew
• For foods that are not naturally soft/easy to chew - cut or blend food into smaller, softer pieces
• Avoid foods that cause gas and bloating, which can cause abdominal/diaphragm discomfort

While eating:

• Maintain an upright position during/after meals to assist in digestion & reduce abdominal pressure 
• Eat meals when energy levels are at their highest 
• Eat several small meals/snacks throughout the day instead of a couple large meals 
• Eat slowly and avoid swallowing air 
• Limit salt intake as this can cause fluid retention, making breathing more difficult
• Limit caffeinated beverages and sugary foods as both contribute to inflammation & anxiety 
• Drink fluids at the end of the meal

Separately, there is a significant and growing body of evidence that people with COPD and smokers have dramatically reduced levels of antioxidants in their bodies. The significant depletion of antioxidants is believed to be mostly related to the pro-oxidative effects of cigarette smoke. Further, a number of studies have shown that the majority of COPD patients and smokers do not consume foods rich in antioxidant content (colorful fruits and vegetables are the typical sources of antioxidants in a traditional diet). The combination of pro-oxidative stress created by cigarette smoke and poor intake of anti-oxidative nutrients is believed to be a significant contributing factor to the degree of systemic inflammation present in COPD patients and smokers. In turn, systemic inflammation is believed to be a major cause of airway obstruction and the inability to breathe fully.

 

While researchers suggest that boosting antioxidant intake through diet and nutritional supplementation can raise blood levels of antioxidants there is not yet a standard recommendation regarding which foods/supplements to consume, and in what quantities/dosages to consume them. However, it is hard to imagine that a COPD patient or current smoker could consume enough antioxidant rich food to offset the effects of cigarette smoke/lung disease. Therefore, we recommend that COPD patients and smokers consider taking a high potency multi-nutrient in addition to consuming more antioxidant rich foods. It is worth at least discussing a high-potency multi-nutrient with your doctor. No individual ingredient in any supplement is a silver-bullet to prevent or cure lung disease, but a broad range of ingredients that have antioxidant properties may prove helpful in restoring your body’s natural antioxidant defenses.