Eating well with COPD

The information in this booklet is not intended to replace your doctor’s advice. If he or she feels you need help in planning the right diet, you may be referred to a registered dietitian. COPD is a serious condition. Be sure to consult your health care team with any questions you have about your condition.

COPD
Understanding COPD is easier when you know how the lungs normally work. When you breathe in, or inhale, oxygen enters the lungs. When you breathe out, or exhale, carbon dioxide leaves the lungs and the body. This complete cycle is called respiration. When a person with COPD inhales, less oxygen than normal enters the lungs and when he or she exhales, not all of the carbon dioxide leaves the lungs.

COPD is the term used to describe a group of respiratory diseases. These diseases include emphysema and chronic bronchitis. Both of these conditions are characterized by difficulty getting air into and out of the body. Few people have pure chronic bronchitis or pure emphysema. Usually, both conditions are present at the same time. COPD does not include other conditions such as asthma.

Chronic bronchitis is an inflammation and eventual scarring of the lining of the bronchial tubes of the lungs. Approximately 8.9 million Americans have chronic bronchitis with symptoms such as chronic cough, increased mucus, and shortness of breath.

Classic emphysema develops after many years of damage to the lung tissues. The walls between the tiny air sacs in the lungs break down, forming larger spaces. The ability of the lungs to expand and contract is lessened. Emphysema is more often seen in older Americans. Symptoms of emphysema may include cough, shortness of breath, and a limited tolerance for exercise.

Causes and Prevention of COPD
The primary cause of both chronic bronchitis and emphysema is cigarette smoking. A person who smokes is 10 times more likely to die from COPD than a person who does not smoke. Environmental pollutants found inside and outside may damage the lungs and contribute to COPD. Genetic factors may also play a role in which people are at higher risk for developing COPD.

There are some things you can do to reduce the risk of developing COPD or to help keep it from becoming worse. The first of these is to stop smoking. Lung tissue destroyed by smoking cannot be replaced, but stopping smoking prevents further destruction of cells and reduces the inflammation of chronic bronchitis.

Managing COPD
To reduce and control the symptoms of COPD, people should adopt a healthy lifestyle. This lifestyle includes stopping smoking, avoiding secondary cigarette smoke and other air pollutants, exercising, and eating well. The proper diet, along with the physical activity recommended by your health care team, will keep your arm, chest, and leg muscles strong and your heart and lungs well supplied with oxygen.

Medicine
You may have to take several different types of medicines, including bronchodilators and antibiotics. Bronchodilators help open up air passages in the lungs. These medicines may be pills or liquids that are inhaled. Bronchodilators may be used for relief of symptoms (rescue medicines) or on a regular basis to reduce or prevent symptoms (maintenance medicines). Be sure that you understand why and when to take each of the medicines your doctor prescribes for you. Albuterol and combination inhalers are two of the more commonly prescribed bronchodilators. When using an inhaler, be sure to rinse your mouth with water or mouthwash after each use. Antibiotics help prevent infections.

It is very important to take your medicines as they are prescribed. NEVER change the amount of medicine you take without talking with your doctor and NEVER use anyone else’s medicine. Always ask your doctor for more information about a medicine you don’t understand. Make sure that you know when to take your medications. It is also important to know which foods to avoid when taking certain medications. Always consult with your doctor before taking any herbal remedies. Also, keep a diary of your medicines and any side effects you may have. Note if the medicine doesn’t seem to be working. Talk over the diary with your doctor. Communicating with your doctor and health care team is extremely important to your health.

Respiratory therapy and oxygen
If you need to take breathing treatments at home, be sure to keep all of your equipment in one convenient location. If you take the treatment during the night, have the equipment near your bed. A small bedside table with a drawer to hold tubes, medicine cups, and mouthpieces is a good choice. Clean and sterilize all equipment according to the instructions. Instructions vary, so don’t worry if you know people who clean their equipment differently than you do.

If you need to use supplemental oxygen, have the supplier visit you and explain how the equipment works. Keep the supplier’s emergency number close to your telephone. Oxygen is a prescribed drug, so you will need to ask your doctor any questions you have about amount and usage.

Exercising for GOOD HEALTH
Not being able to “do” things is one of the most distressing aspects of COPD. Endurance exercise such as walking or riding a bicycle and weight lifting, as prescribed by your doctor, may help improve your symptoms, your appetite, your sleep patterns, and your feeling about living. Doctors aren’t sure why exercise helps in these areas, but they think it’s related to the conditioning of the muscles. Well-conditioned muscles use less energy.

You and your doctor should work together to establish realistic exercise goals. The first goal may be to increase the number of steps you can climb or increase the distance you can walk before you have any symptoms. You should not become fatigued during exercise; that may put a strain on your heart.

Keeping a diary of your exercise is one way to see the progress you make. Include your specific exercise goals, how you did, how you felt during each exercise session, and any difficulties you had during each session. Take the diary with you to follow-up doctor visits and discuss your progress.

Some communities have rehabilitation programs that teach endurance, strength and mobility exercises, ways to help bronchial drainage and removal of secretions, effective cough procedures, and ways to relax and conserve energy. People who have participated in such programs find that they can exercise more and generally feel better. Check with your hospital or the local chapter of the American Lung Association to locate the program nearest you.

Eating RIGHT
Most people are surprised to learn that the food they eat may affect their breathing. Your body uses food as fuel for all of its activities. The process of changing food to fuel in the body is called metabolism. Oxygen and food are the raw materials of the process, and energy and carbon dioxide are the finished products. Carbon dioxide is a waste product and is exhaled. Your body uses the energy to function. The right mix of nutrients in your diet can help you breathe easier. No single food will supply all the nutrients you need. A healthy diet has lots of variety. You and your health care team will work out a meal plan just for you. Be sure to tell your team:

• what foods you like
• what foods you don’t like and won’t eat
• your daily schedule, including your exercise
• any other health problems or special dietary needs you have

Food Plan
Foods contain three major sources of energy: carbohydrates, protein, and fat. The metabolism of each requires a different amount of oxygen and produces a different amount of carbon dioxide. Metabolism of carbohydrates produces the most carbon dioxide for the amount of oxygen used; metabolism of fat produces the least. For some people with COPD, eating a diet with less carbohydrates and more fat helps them to breathe easier.

You should talk with a registered dietitian (RD) who specializes in COPD. An RD can work with you to develop a food plan you can live with; provide tips on reading food labels, grocery shopping, cooking and baking, and eating away from home; and recommend cookbooks and other materials. An RD can also review your medications and discuss any possible drug-food interactions with you.

You can find an RD who specializes in COPD by asking your doctor, or by visiting the American Dietetic Association National Center for Nutrition and Dietetics, at www.eatright.org.

An RD will consider these factors when designing your food plan:

Calorie intake to meet energy needs
A diet with the amount of calories your body needs will give you energy to help you do the things you want to do. Your body may be using more calories than you think. A person with COPD can burn 10 times as many calories breathing as a healthy person does. Some people with COPD find that they lose weight without trying. Others find they become overweight easily.

Carbohydrate intake
Carbohydrates are the major sources of fuel for the body. Simple carbohydrates, also called sugar, are a main component of foods such as table sugar, candy, cake, and regular soft drinks. Complex carbohydrates, such as those in breads, pastas, and vegetables, are a good source of vitamins, minerals, and fiber. Dietary fiber, which comes mainly from foods high in complex carbohydrates, is an important part of the diet, especially for older people. Health care experts recommend 20 to 35 grams of fiber a day to help maintain bowel function.

Protein intake
Muscle and other body tissues are composed of protein. Experts believe the need for protein may increase as we age. It is important that people with COPD eat good source of protein at least twice a day to help maintain strong respiratory muscles. The best sources of protein are milk, eggs, cheese, meat, fish, poultry, nuts, and dried beans or peas.

Fat intake
Fat is a rich source of energy. It also produces the least carbon dioxide when it is metabolized. More fat can be eaten if gaining weight is important. Less fat can be included in the diet if your goal is to lose weight.

Saturated fats often are solid at room temperature and come mainly from animal sources – butter, lard, fat, and skin fat of meat and poultry – and from palm, coconut, and hydrogenated vegetable oils. Limit sources of animal fats and try to cut down on the amount of visibly fatty meats that you eat.

There are several different types of fats. Generally, saturated fat and trans fat are bad for your health. Mono- and polyunsaturated fats are better for your health.
Mono- and polyunsaturated fats do not contain cholesterol. These fats are often liquid at room temperature and come from plant sources – canola, safflower, and corn oils. If your RD tells you to increase the fat in your diet, make it the polyunsaturated kind. Use liquid vegetable oils, soft margarines, and mayonnaise made from plant oils. The need to follow a diet low in cholesterol and saturated fat varies from person to person. Be sure to discuss the role of fat in your diet with your doctor and RD.

Trans fat is made when vegetable oils are hardened into shortening and margarine. It is also found in fried foods such as fried chicken and french fries. Many cookies, crackers, doughnuts, and pastries contain trans fat. Read the label on food packages and limit foods that contain trans fat.

Vitamin and mineral intake
Many people find taking a general purpose multivitamin helpful. Often, people with COPD take steroids. Long-term use of steroids may increase your need for calcium. Consider taking calcium supplements. Look for one that includes vitamin D. Calcium carbonate or calcium citrate are good sources of calcium. Before adding any vitamins to your daily routine, be sure to discuss with your doctor.

Sodium intake
Too much sodium may cause edema (swelling) that may increase blood pressure. If edema or high blood pressure are health problems for you, talk with your doctor about how much sodium you should be eating each day. Ask your RD about the use of spices and herbs in seasoning your food and other ways you can decrease your sodium intake.

Fluid intake
Fluid is important because two thirds of our body is water. A good intake of water is important to help keep mucus thin for easier removal. Talk with your doctor about your water intake. A good goal for many people is 6 to 8 glasses (8 fluid ounces each) daily. Don’t try to drink this much fluid at once; spread it out over the entire day. Some people find it helpful to fill a water pitcher every morning with all the water they are supposed to drink in one day. They then refill their glass from that pitcher and keep track of their progress during the course of the day. Remember, any fluid counts toward your fluid goal, and most foods contribute a substantial amount of fluid, as well.

Timing of meals
Eating several small meals a day instead of two or three large ones can help you eat well and not feel uncomfortable. Here’s why: Your organs aren’t packed tightly inside your body. A muscular membrane, the diaphragm, is in the space between the lungs and the stomach. The diaphragm moves down and up as you breathe in and out. A full stomach presses up into the space below the diaphragm.

This keeps the diaphragm from moving as far down as it should when you breathe in and your lungs don’t fill completely (see diagram on page 15).

Try dividing your day’s food into 4 to 6 small meals. You can eat a small breakfast, lunch, and dinner. Then get the rest of your nutritional needs for the day by eating two or three between-meal snacks.

Another idea to help you feel more comfortable after eating is to limit foods that may produce gas. For some people, these foods include broccoli, cauliflower, beans, and carbonated beverages. You may want to try using Beano®, if you would still like to eat some of those vegetables.

In addition, try not to rush through your meal. Eat slowly in a relaxed manner. Sometimes if you try to eat very quickly, you may accidentally swallow air. This results in more air in your stomach and greater discomfort.

Checking your weight
Get in the habit of weighing yourself regularly. The scale will alert you to weight loss or gain. You should see your doctor or dietitian if you continue to lose weight or see a weight gain while following the recommended diet. You can be too thin! A well-nourished body is better able to handle infections. When people with COPD get an infection, it can become serious quickly and result in hospitalization. Good nutrition can help prevent that from happening. If illness does occur, a well-nourished body can respond better to treatment.

Using Medical Nutritional PRODUCTS
You may find it difficult to meet your nutritional needs with regular foods, especially if you need a lot of calories every day. Also, if your RD has suggested that you get more of your calories from fat – the polyunsaturated, monounsaturated, and low-cholesterol variety – you may not be able to meet this goal easily with ordinary foods. So, your RD or doctor may suggest you drink a liquid called a medical nutritional product. Many people who need extra calories and nutrients add a medical nutritional product to their diet. Some of these products can be used as a complete diet by people who can’t eat ordinary foods, or they can be added to regular meals by people who can’t eat enough food.

Pulmocare® Therapeutic Nutrition for People With COPD is a low-carbohydrate, high-fat formula specifically designed to reduce carbon dioxide production. Pulmocare is a nutritionally complete liquid food. It is low in saturated fats and cholesterol. Pulmocare is a good source of calories, protein, vitamins, and minerals – nutrients that are important for your lung health. Using Pulmocare can help you get all the nutrients and calories you need.

Pulmocare® can be used as a beverage with meals, as a between-meal snack, or as an occasional meal. It can also be used in recipes to add variety to your diet. Pulmocare is available at most drugstores. For convenient home delivery, you can order Pulmocare by calling Home Delivery, toll-free at 1-800-986-8502.

Diet Hints
Here are some ways you can help yourself eat meals that provide your body with the nutrients it needs. If you have certain favorite foods you’re not sure about, ask your dietitian if they are high in carbohydrates. Your dietitian may suggest ways that other foods can be used to balance the carbohydrates in those foods you most enjoy.

• Choose foods that are easy to prepare. If you use all your energy to cook, you won’t have enough left to eat.
• Ask a family member or friend to help with grocery shopping or cooking if you are too short of breath to do these tasks. 
• Rest just before eating.
• Eat more food early in the morning if you’re usually too tired to eat later in the day.
• Avoid foods that cause gas or bloating. They tend to make breathing more difficult.
• Eat 4 to 6 small meals a day. This enables your diaphragm to move freely and lets your lungs fill with air and empty out more easily (see page 15).
• Use water-packed fruit, or fruit with no added sugar. Fresh fruit is also a good choice.
• Add margarine or other sources of fat to breads and vegetables. If high cholesterol levels are a problem for you, use mono- or polyunsaturated fats, oils, and margarines.
• If drinking liquids with meals makes you feel too full to eat, limit liquids with meals; drink an hour after meals.
• Use artificially sweetened jams, jellies, and hard candies.

Pulmocare® Recipes
Eating well with COPD often includes increasing the amount of fat in your diet. But eating higher-fat foods can be a problem because you need to limit saturated fats and cholesterol. The Pulmocare recipes that follow have been designed to be low in cholesterol and saturated fats, so relax and enjoy.

Banana Pulmoshake       Yield: 2 servings
8 fl oz (1 can) Vanilla Pulmocare®, well chilled
1/2 cup vanilla nonfat frozen dessert
1/2 medium banana, sliced
1 tablespoon canola oil

1. 1.      Combine all ingredients in a blender or food processor.
2. 2.      Blend for 10 to 15 seconds. Serve immediately.
3. 3.      Per Serving: Calories 310, Protein 10 g, Carbohydrates 29 g, Fat 18 g, Sodium 190 mg.

Clam Chowder       Yield: 4 servings
1/4 cup chopped onion
1/4 cup chopped celery
2 slices turkey bacon, chopped
2 tablespoons canola oil
2 small potatoes, diced
13 oz (2 cans) minced clams, reserve juice
1/4 teaspoon thyme
1/4 teaspoon garlic powder
16 fl oz (2 cans) Vanilla Pulmocare®
Black pepper to taste

1. 1.      Fry onions, celery, and bacon in oil until tender.
2. 2.      Add clam juice and potatoes and cook over medium heat until potatoes are tender.
3. 3.      Add garlic powder, thyme, and Pulmocare and heat gently. Do not boil.
4. 4.      Add clams and heat just until clams are warm. Do not overheat or clams will become rubbery.
5. 5.      Add pepper to taste. Serve immediately.
6. 6.      Per Serving: Calories 370, Protein 22 g, Carbohydrate 25 g, Fat 20 g, Sodium 400 mg.

Cheesy Tuna Casserole*       Yield: 4 servings
7 1/4 oz (1 box) Tuna Helper® Cheesy Noodles
2 tablespoons canola oil
6 1/2 oz (1 can) tuna in canola or vegetable oil, undrained
1 teaspoon dehydrated minced onions
1/2 teaspoon black pepper
2 tablespoons pimento peppers
16 fl oz (2 cans) Vanilla Pulmocare®
2 cups hot water

1. 1.      Stir all ingredients together in a 10-inch skillet.
2. 2.      Heat to boiling, stirring occasionally.
3. 3.      Reduce heat; cover and simmer 10 minutes, stirring occasionally.
4. 4.      Uncover and cook to desired consistency.
5. 5.      *If you are on a sodium-restricted diet, ask your health care professional if you should use this recipe.
6. 6.      Per Serving: Calories 557, Protein 27 g, Carbohydrate 52 g, Fat 27 g, Sodium 1260 mg.

Choco-Nut Shake       Yield: 2 servings
8 fl oz (1 can) Vanilla Pulmocare®, well chilled
2 tablespoons smooth, natural-style peanut butter
1/2 cup vanilla nonfat frozen yogurt
2 tablespoons chocolate syrup
1 tablespoon canola oil

1. 1.      Place all ingredients in a blender or food processor.
2. 2.      Blend for 15 seconds until thick and frothy. Serve immediately or chill in freezer until ready to serve.
3. 3.      Per Serving: Calories 420, Protein 14 g, Carbohydrate 36 g, Fat 26 g, Sodium 240 mg.

Peanut Butter Pie  Yield: 8 servings (9-inch pie)
1 prepared chocolate-cookie crust for 9-inch pie
3.4 oz (1 pkg) vanilla instant pudding
3 tablespoons natural-style, smooth peanut butter
1 tablespoon canola oil
16 fl oz (2 cans) Vanilla Pulmocare®

1. 1.      Combine pudding, peanut butter, oil, and Pulmocare in a medium bowl.
2. 2.      Beat with a mixer at low speed for 1 minute.
3. 3.      Pour into chocolate-cookie crust.
4. 4.      Freeze until set.
5. 5.      Per Serving: Calories 330, Protein 7 g, Carbohydrate 34 g, Fat 19 g, Sodium 460 mg.

Bran Muffins       Yield: 12 muffins
1 1/2 cups bran cereal (such as All-Bran®)
1 1/2 cups all-purpose flour
1/2 cup sugar
1 tablespoon baking powder
1 teaspoon cinnamon
1/4 teaspoon nutmeg
1/4 teaspoon salt
8 fl oz (1 can) Vanilla or Strawberry Pulmocare®
1/4 cup Egg Beaters®
1/2 cup canola oil
1/2 cup raisins (optional)

1. 1.      Preheat oven to 400°F.
2. 2.      Combine dry ingredients (and raisins, if using).
3. 3.      In a separate bowl, whisk together Pulmocare, Egg Beaters, and oil.
4. 4.      Add liquid mixture to dry ingredients, mixing only until the batter is evenly moist. Do not overmix.
5. 5.      Divide the batter into 12 muffin tins.
6. 6.      Bake 15 minutes, or until a toothpick inserted into the center of a muffin comes out clean.
7. 7.      Per Serving: Calories 250, Protein 5 g, Carbohydrate 36 g, Fat 11 g, Sodium 330 mg.

Banana Cream Pie       Yield: 8 servings (9 inch pie)
1 prepared graham-cracker crust for 9-inch pie
3.4 oz (1 pkg) banana instant pudding
2 tablespoons canola oil
16 fl oz (2 cans) Vanilla Pulmocare®

1. 1.      Combine pudding, oil, and Pulmocare in a medium bowl.
2. 2.      Beat with a mixer at low speed for 1 minute.
3. 3.      Pour into graham-cracker crust.
4. 4.      Freeze until set.
5. 5.      Per Serving: Calories 310, Protein 5 g, Carbohydrate 37 g, Fat 16 g, Sodium 430 mg.

Carrot Cake       Yield: 9 servings
1 1/4 cups all-purpose flour
1 teaspoon baking soda
1 teaspoon baking powder
1/2 teaspoon salt
1 teaspoon cinnamon
1/2 teaspoon allspice
1 cup grated carrots
1/3 cup raisins
8 fl oz (1 can) Vanilla Pulmocare®
1/4 cup canola oil
1/2 cup Egg Beaters®
3/4 cup sugar

1. 1.      Preheat oven to 350°F; grease and flour an 8-inch-square baking pan.
2. 2.      Combine flour, baking soda, baking powder, salt, cinnamon, and allspice in a large mixing bowl.
3. 3.      Stir carrots and raisins into flour mixture.
4. 4.      Combine Pulmocare, oil, Egg Beaters, and sugar until well mixed.
5. 5.      Add to the carrot and flour mixture. Stir until well mixed.
6. 6.      Pour into prepared pan.
7. 7.      Bake 30 minutes, or until toothpick inserted in the middle of the cake comes out clean. Serve plain or iced.
8. 8.      Per Serving: Calories 250, Protein 5 g, Carbohydrate 39 g, Fat 9 g, Sodium 390 mg.

Pineapple Pudding Cake       Yield: 9 servings
1/4 cup Egg Beaters®
3 tablespoons canola oil
1 yellow cake mix (1-layer size)
3.4 oz (1 pkg) instant lemon pudding
20 fl oz (2 1/2 cans) Vanilla Pulmocare®, well chilled
20 oz (1 can) crushed pineapple

1. 1.      Grease a 2-quart square baking dish.
2. 2.      Prepare the cake mix according to package directions, using the Egg Beaters, oil, and 1/2 cup of Pulmocare.
3. 3.      Pour batter into prepared pan.
4. 4.      Combine the remaining 2 cups of Pulmocare with the lemon pudding. Mix for 1 minute.
5. 5.      Stir together the pudding and undrained crushed pineapple. Pour over cake batter.
6. 6.      Bake at 350°F for 50 minutes, or until a toothpick inserted into the cake portion comes out clean. Serve warm or chilled.
7. 7.      Per Serving: Calories 330, Protein 6 g, Carbohydrate 45 g, Fat 14 g, Sodium 440 mg.

Pumpkin Pie       Yield: 8 servings (9-inch pie)
1/2 cup Egg Beaters®
1 1/2 cups solid-packed, canned pumpkin
1/2 cup sugar
2 teaspoons ground cinnamon
1/2 teaspoon ground ginger
1/4 teaspoon ground cloves
12 fl oz (1 1/2 cans Vanilla Pulmocare®)
1 unbaked, deep-dish frozen pie shell for 9-inch pan

1. 1.      Preheat oven to 375°F.
2. 2.      Combine all ingredients to make filling.
3. 3.      Pour into pie shell.
4. 4.      Bake at 375°F for 15 minutes.
5. 5.      Reduce heat to 350°F and bake an additional 45 minutes, or until a knife inserted in the center of the pie comes out clean. Cool and serve.
6. 6.      Per Serving: Calories 310, Protein 5 g, Carbohydrate 37 g, Fat 16 g, Sodium 430 mg.