Nutrition for Your Chronic Lung Disease

Nutrition is the balance between the nutrients and energy that comes from the food we eat and the body’s demand from them to ensure growth, health maintenance and specific functions.

The Canada Food Guide supports a healthy balance of lean protein, fruits and vegetables, and whole grains.

Important things to know to manage your health with your diet: 

Nutritional Imbalance: whether overnutrition or undernutrition, imbalance can cause increased fatigue, low mood, increased risk of hospitalization and slow your recovery from illness or flare-up (exacerbation) of your lung disease.

Why weight matters

• Overnutrition - calorie intake in greater than the body's needs - can cause overweight and making it harder for your heart and lungs to supply oxygen to your muscles and organs
• Undernutrition - calorie intake does not meet your body's demands - can lead to unwanted weight loss, putting you at greater risk of illness
• In either case, losing muscle mass weakens the muscles that help with breathing

According to Health Canda, a healthy BMI for adults 20 years and older is between 18.5 and 24.9, while a BMI of 25 to 29.9 is considered overweight.

A low BMI can be unhealthy, especially for older adults. This has led some experts to suggest that the healthiest weight for seniors is one that falls between BMIs 25 and 27, and that should be maintained with a healthy diet and regular exercise.

There are certain risks associated with having a high BMI at any age. These include heart disease, high blood pressure, diabetes, and stroke.

Extra calories may be needed because you use more energy to breathe, cough, and fight infection.  

• Choosing the nutrient rich foods to increase calories makes a difference
• Preventing weight loss as your disease progresses is an important discussion to have with your healthcare team or a registered dietitian. Supplements may be necessary to improve your nutritional wellness.

Diet and Nutrition Concerns with COPD

Undernutrition: is seen in about 30% of persons with advanced lung disease. 

Overnutrition: is seen in 65% of persons with mild to moderate COPD. If you carry extra weight around the midline, this limits your diaphragm from moving effectively.  

Intervention: Nutritional Therapy Combined with Exercise. Working with a registered dietician can help to determine a plan that is right for you. They may prescribe an appetite stimulant or a high caloric supplement to preserve weight and energy balance.

General Tips

• Drink water regularly
• Use honey or maple syrup as sweeteners
• Reduce sodium (salt)
• Eat smaller meals more often OR small meals and healthy snacks
• Eat more fruits and vegetables, lean protein (chicken, fish, venison, beans and tofu), plant fats (olive, peanut, canola, sesame oils), nuts (pecans, almonds, hazelnuts, walnuts), avocado, seeds (flax, sesame, unsalted sunflower seeds)
• Limit carbohydrates to whole grain options
• Limit dairy to small low-fat options
• Avoid high carbohydrate diets – They increase your body’s production of carbon dioxide
• Avoid simple carbohydrates like sugar, cakes, cookies, white bread and pasta, sugary drinks
• Avoid high fat meats and dairy

To Decrease Shortness of Breath 

• Eat foods that are easy to chew
• Do not be in a rush to eat 
• Sit upright at the table, it is OK to rest your elbows on the table because it helps to expand your chest
• Use your oxygen during meal times

To Decrease Fatigue

• Rest upright for 30 – 60 minutes before eating
• Eat your largest meal earlier in the day
• Prepare ingredients for easy to cook meals while seated
• Prepare for meals well in advance
• Freeze leftovers for another day
• Get help from family, friends, or organizations like Meals-on-Wheels

To Decrease Bloating and Reflux

• Eat slowly to avoid swallowing air which can cause bloating that leads to shortness of breath
• Eat several small meals
• Drink fluids one hour before and one hour after meals, rather than during the meal
• Choose cooked vegetables over raw vegetables
• Choose lean protein, and low fat/fat free dairy (or alternatives)
• Avoid gassy foods: cabbage, broccoli, Brussels sprouts, onions, carbonated drinks
• Avoid foods that are highly acidic: tomatoes, citrus, vinegar or pickled vegetables
• Avoid spicy foods that can increase reflux which triggers a reaction in your esophagus and lungs 

Following healthy nutrition requirements of Canada’s Food Guide supports the maintenance of healthy weight in persons with asthma. 

Foods rich in antioxidants can decrease inflammation in the body including the lungs. This can help to support the effectiveness of asthma medications making it easier to control your asthma. 

• Berries
• Beans
• Pecans
• Broccoli, beets and red cabbage
• Leafy greens (spinach, kale) 
• Dark chocolate 

People with asthma are 3 times more likely to have Gastro Esophageal Reflux Disease (GERD). GERD can irritate lung tissue causing inflammation, constriction, and obstruction in the airways. Talk with your healthcare team or a registered dietician about diet changes or medications to decrease GERD.

Do Eat:

• Whole grains
• Low fat dairy
• Lean protein
• Colourful fruits and vegetables
• Foods rich in Vitamins E and C, carotene and selenium

Limit/Avoid

• Processed high sodium foods
• High nitrate and high sulfate foods: lunch meats, canned fish and meat, bacon and ham

Some of the nutritional recommendations for people with pulmonary fibrosis are based on an increased demand on respiratory muscles, low blood oxygen levels, increased inflammation, increased acid reflux and diarrhea. These symptoms often lead to low physical activity.  

People who suffer from overnutrition or undernutrition are encouraged to meet with a registered dietician to make dietary changes that support having an ideal body weight for an extended quality of life.

Nutritional recommendations for pulmonary fibrosis

Do Eat

• Whole grains
• Lean proteins
• Low sodium
• Low fat/fat-free dairy products
• Variety of fruits and vegetables
• Plant based fats like olive oil

Steps to Manage GERD

• Achieve and maintain a healthy weight
• Stay sitting upright during meals and for 45-60 minutes after eating 
• Raise the head of your bed when sleeping. “Bed blocks” and/or foam wedges are more effective than pillows at keeping the head and esophagus higher than the stomach while sleeping
• Avoid or Limit:
  – Large amounts of food at one time
  – Eating close to bedtime (2-3hrs)
  – Restrictive clothing around the waist
  – Foods that trigger reflux – chocolate, peppermint, onions, garlic, tomatoes and citrus
  – Smoking, alcohol, and caffeine especially around bedtime

The body’s ability to absorb nutrients is affected by how the pancreas functions in people with cystic fibrosis (CF). According to the Canadian Food Guide, a well balanced, healthy, normal diet, with a few extras, is important. Maintaining a healthy body weight, with nutrient rich foods, is linked to preserving good lung function. 

The dietary goal for people living with CF is to prevent nutritional deficiencies. A registered dietitian is an important member of your healthcare team who can help to manage and monitor adequate nutrition, pancreatic enzymes, vitamin and caloric supplementation, as well as lactose and glucose intolerance.  

Do Eat

• Foods higher in sodium, especially when the temperature and perspiration increase
• Drink more fluid especially when the temperatures and perspiration increase
• Increase protein intake because of malabsorption
• Increase fat intake to 35-40% - provides required energy, essential fatty acids and fat soluble
• Vitamins D, A, K and E

For more on nutritional support with Cystic Fibrosis, visit: www.cysticfibrosis.ca/uploads/resources/CF%20Health/English/CF-Healthy-Nutrition.pdf
 

Unintentional weight loss is a common symptom in the diagnosis of lung cancer. It can impact the effectiveness of lung cancer treatment. Weight loss is also a consequence of cancer treatment, a result of medications that cause loss of appetite, taste alterations, nausea, vomiting, pain in the mouth and inflammation in the esophagus. 

The nutritional goal for people with lung cancer is to support the healing process. Adequate nutrition makes cancer treatments more beneficial, helps maintain your functional status and helps to prevent loss of weight and muscle mass.

Do Eat

• B-vitamins, iron, protein, and anti-oxidant rich foods (Berries, beans, nuts, broccoli, leafy greens)
• Small meals and snacks that are high in calories and protein every 2-3 hours while awake, instead of three regular sized meals. (Egg, fish, meat, cheese, dairy)
• Soft, moist foods that are easy to eat and swallow and take little energy to prepare (yogurt and oats, pudding and berries, peanut butter and banana, soup and crackers, egg salad sandwich)
• Bland foods that are low in odor are easier to stomach when nauseated
• Eight-10 cups of fluids per day (water, clear juice, broth, herbal tea) Try using a large straw

Avoid or limit:

• Hot or cold foods
• Alcohol and smoking
• Refined or processed foods

Lung Cancer Canada recommends proteins to help maintain your muscle mass and strength to support healing especially during treatment. See the table in the link below for protein options.

For more on nutritional support with lung cancer, visit: www.lungcancercanada.ca/LungCancerCanada/media/Documents/Infosheets/Healthy-Diet-Choices.pdf
 

Caloric and Protein Requirements during healing in Patients Treated for Lung Cancer

Source: Caring Ambassadors – Lung Cancer 

Have a discussion with your healthcare team or a registered dietician if you have diabetes, kidney or liver disease as your requirements may be different than those listed in the section associated to your lung disease. 

Healthy snack options for diabetics with lung disease:

• Whole grain products: Oats, barley, brown rice, whole wheat, whole rye, quinoa, buckwheat
• Legumes: Hummus, chickpeas, bean salad
• Fruits: Medium apple, orange, pear, blueberries, strawberries
• Non-starchy vegetables (low glycemic index): Carrots, cucumbers, broccoli, cauliflower, bean sprouts
• Dairy: Low-fat cheese, sugar-free yogurt
• Homemade trail mix
• Bigger snacks: Hummus with pita, yogurt with fruit, cereal with skim milk, low-fat cheese with four rye crackers
• Stick to water and sugar-free drinks
• Always add a protein to every snack: Legumes, nuts, nut butter, dairy
• Choose high-fibre foods

Making lifestyle changes is important when you have chronic lung disease and diabetes. 

• Eat healthy foods: more fruits, vegetables, lean protein and whole grains. Eat nutrient rich foods that are low in fat and calories
• Exercise: exercise uses more muscles at greater intensity, using up more energy. This helps your body to need less insulin which helps to control your blood sugar
• Lose weight if needed: if overweight, losing even a few pounds cam improve your blood sugar. 

Check your blood sugar before and after exercise. For more information, visit: www.diabetes.ca/nutrition---fitness/exercise---activity
 

Eating patterns quickly become eating habits. It is easy to fall into patterns of selecting healthy food choices.

Below are healthy options for protein, nutrient rich vegetables and fruit, and single serving sized of whole grain foods to consider when planning for and preparing meals

Healthy Protein Options (Source: Lung Cancer Canada)  

Animal Protein

• Beef
• Chicken, Turkey
• Eggs, Fish
• Lamb
• Pork

Dairy Protein

• Milk
• Cheese
• Milk-based Soup
• Custard
• Pudding
• Yogurt

Vegetable Protein

• Legumes (Black Beans, Chickpeas, Kidney Beans, Lentils, Navy Beans)
• Nuts, Seeds, Nut Butters
• Soy Milk
• Tofu

Fruit and Vegetables (Source: 811 Nova Scotia Canada)

• Broccoli, cauliflower and Brussels sprouts
• Leafy greens, such as chard, cabbage and bok choy
• Dark, leafy greens, such as spinach and kale
• Squash, carrots, sweet potatoes, pumpkin and turnip
• Snap peas, green beans, peppers and asparagus
• Apples, plums, mangos, papaya, pineapple and bananas
• Blueberries, strawberries, cherries, pomegranate and grapes
• Citrus fruits, such as grapefruit and oranges
• Peaches, pears and melon
• Tomatoes and avocados

Whole Grain Products (Source: Q & Anna Wordpress - touring Canada's food guide)

• Bagel, whole grain: ½ bagel, 45 g
• Barley: 125 ml, ½ cup, cooked
• Bread, pumpernickel or rye: 1 slice, 35 g
• Bread, whole grain: 1 slice, 35 g
• Bulgur: 125 mL, ½ cup, cooked
• Cereal, cold, whole grain: 30g
• Cereal, hot, whole grain (ex: oatmeal): 150 g, 175 mL, 3/4 cup, cooked
• Couscous, whole wheat: 125 mL, ½ cup, cooked
• Crackers, rye: 30g
• Crackers, whole grain: 30g
• English muffin, whole grain: ½ muffin, 35 g
• Muffin, whole grain ½ muffin, 35 g
• Pasta/noodles, whole grain: 125mL, ½ cup, cooked
• Pita, whole grain: 35 g, ½ pita
• Popcorn, plain: 500 mL, 2 cups
• Quinoa: 125 mL, ½ cup, cooked
• Rice, brown 125 mL, ½ cup - cooked
• Rice, wild: 125 mL, ½ cup - cooked
• Roll, whole wheat 1 roll, 35 g
• Tortilla, whole wheat: ½ piece, 35 g
• Waffle, whole wheat: 1 small, 35 g

Water and clear fluids (low sodium/low sugar) – if you do not have fluid restrictions

• Six to eight - 250 ml (8fl oz) glasses per day thins mucus secretion
• Regulates body temperature
• Hydration promotes clear mindedness, healthy kidney, and bowel function, decrease muscle and joint pain
• Hydrating foods include watermelon, strawberries, cucumber, and celery

Vitamin D

• Supports bone density by helping calcium absorption
• Maintains immune health
• Reduces inflammation
• Vitamin D rich foods (mushrooms, tuna, salmon, sardines, cod liver oil)
• Foods fortified with Vitamin D (Orange juices, Milk and dairy products, plant-milks, cereals)