Healthy Eating Tips for Severe COPD
Eating well can literally help you breathe easier when you have COPD. Here are some strategies you can start trying today.
If you live with chronic obstructive pulmonary disease (COPD), you spend a lot of time focusing on your breath. In fact, you probably have a whole set of respiratory exercises to practice every day. But there's a good chance you're missing out on another important tool that can also help you breathe easier: having a healthy diet. “Food is the fuel the body needs to perform all activities, including breathing,” says Jane Martin, assistant director of education for the COPD Foundation and a licensed respiratory therapist based in Washington, D.C. “Good nutrition helps the body fight infections, including the very ones that can settle in the lungs and lead to pneumonia.”
The reality though? Twenty-five percent of people with COPD are malnourished and among this group 50% have been hospitalized because of it, according to research published in Tanaffos. “Multiple factors can lead to malnourishment in individuals with COPD,” says Kiah Connolly, M.D., a board-certified emergency medicine physician at Kaiser Permanente in Sacramento, CA, and health director of Trifecta Nutrition, a health-focused meal-delivery service. “The increased work of breathing leads to burning more calories throughout the day. But other factors, including medications, age, decreased oxygen delivery to the tissues in the body, and a state of inflammation, can also contribute to an abnormal metabolism.” The clinical term for this is called pulmonary cachexia syndrome, adds Dr. Connolly, and it can increase the risk of mortality in those with COPD.
With such a strong link between nutrition and lung health for COPD patients, it’s important to make smart food choices. Here are some healthy food swaps you can make throughout the day. As with any diet advice, make sure to talk to your healthcare provider before adding or removing foods to make sure it’s a safe option for you.
All Day Long
Graze instead of gorge: In fact, grazing is a crucial strategy to managing COPD. To make sure you’re getting all the micronutrients you need throughout the day, eat more frequently and focus on portion sizes. Martin suggests having six smaller meals instead of three larger ones. This will help you avoid having a full stomach push up on the diaphragm (the muscle that helps you breathe) and lungs. You can also talk to your doctor to see if you should be taking a daily multivitamin to ensure your nutritional needs are being met.
Instead of French toast, scramble some eggs: “A diet low in carbs results in lower carbon-dioxide production,” says Carol Aguirre, R.D., a dietician and nutritionist at Nutrition Connections in Boca Raton, FL. And that’s important because people dealing with COPD often struggle with exhalation, which can lead to hypercapnia, or excessive carbon dioxide in the bloodstream.
“Carbon dioxide is a waste product that we exhale. The metabolism of carbohydrates produces the most carbon dioxide while metabolism of fat produces the least, so eating a diet lower in
carbs may help people with COPD better manage the condition.” Add some avocado to your eggs for an extra dose of healthy fats, which will also keep carbon dioxide production down.
Pour yourself a bowl of bran cereal instead of a sugary option: “The goal is to get enough fiber in the day, around 25 to 30 grams total,” says Aguirre. “Bran cereal will set you off to a great start.” And while it’s sometimes hard to resist a sugar craving in the morning, sweet cereals will only exacerbate COPD symptoms. “Foods high in calories and low in nutritional value [like sugar] should be avoided in people with COPD,” says Dr. Connolly. “This can contribute to a dysfunctional metabolism, cause high blood sugar, and will not help a malnourished state as these foods contain so little nutritional value.”
Go for grilled chicken over fried: Fried food (especially fried-in-vegetable-oil food) can often cause gas and bloating, which can make breathing even more uncomfortable for those who have COPD, says Aguirre. “Over-inflated lungs found often in COPD can push down on the diaphragm and the stomach,” adds Martin. “But a stomach that’s too full can push up on the diaphragm and the lungs, which can cause even more difficulty breathing.” To recap: Small meals, not fried, will keep your belly and your lungs in a more comfortable place.
Have a handful of unsalted nuts instead of a side of chips: Nuts have more protein and more healthy fats than carb-heavy snacks like potato chips. Those nutrients will reduce the amount of carbon dioxide produced in the body and help make exhaling less taxing.
Another reason to skip chips: They're salty. “Too much sodium can cause swelling that may increase blood pressure,” says Aguirre. High blood pressure (especially in the lungs' arteries) can contribute to the shortness of breath or breathlessness that comes with COPD.
Swap steak for salmon: “Salmon is nutrient dense, rich with omega-3 healthy fats and other essential amino acids as well as vitamin D, which may contribute to improving respiratory muscle strength,” says Dr. Connolly. The anti-inflammatory effects of omega-3 on top of the antioxidants found in fish has been associated with a decrease of COPD symptoms in both smokers and non-smokers and has been shown to produce higher levels of FEV1, a measurement that shows the amount of air you can push from your lungs in one second.
Pile on the veggies in place of rice: “Fresh fruits and vegetables contain essential vitamins, minerals, antioxidants, phytochemicals, and fiber you need to stay healthy,” says Aguirre. And while we all should be eating more vegetables it’s especially important for COPD patients to fill up their plate with greens. Research published in Nutrients found that fruits and vegetables are among the major dietary tools for improving lung function in those with COPD due to the anti-inflammatory and antioxidant properties they come with. Skip the rice in order to reduce that carb-induced carbon dioxide production. More kale, please!
Replace low-fat yogurt and ice cream for full-fat options: Those on a calorie-restricted diet are usually told by their healthcare provider to choose skim or low-fat dairy options, but for COPD patients fat may be key. “One result of COPD that occurs in some people is excessive thinness and muscle wasting,” says Martin. “People diagnosed with COPD who are at or below ideal body weight are more likely to lose weight to the point of being too thin, putting them at risk for loss of muscle tone and strength.” Healthy foods that are higher in calories (and won’t cause bloating) may be best to maintain muscle mass and help your lungs work more efficiently.
COPD and Malnutrition: Tanaffos. (2016). “Effect of Dietary Supplementation on Body Composition, Pulmonary Function and Health-Related Quality of Life in Patients with Stable COPD.” ncbi.nlm.nih.gov/pmc/articles/PMC5410119
COPD and Hypercapnia: StatPearls. (2019). “Chronic Obstructive Pulmonary Disease (COPD) Compensatory Measure.” ncbi.nlm.nih.gov/books/NBK525962/
Pulmonary Cachexia Syndrome and COPD Mortality: Respiratory Research. (2019). “It’s more than low BMI: prevalence of cachexia and associated mortality in COPD.” respiratory-research.biomedcentral.com/articles/10.1186/s12931-019-1073-3
Vegetables and COPD: Nutrients. (2019). “Role of Diet in Chronic Obstructive Pulmonary Disease Prevention and Treatment.” ncbi.nlm.nih.gov/pmc/articles/PMC6627281/
COPD Nutritional Guidelines: Cleveland Clinic. “Nutritional Guidelines for People with COPD.” my.clevelandclinic.org/health/articles/9451-nutritional-guidelines-for-people-with-copd
COPD and Metabolism: Journal of Thoracic Disease. (2018). “Can muscle protein metabolism be specifically targeted by nutritional support and exercise training in chronic obstructive pulmonary disease?” ncbi.nlm.nih.gov/pmc/articles/PMC5989103/