A few of my patients suffer with chronic obstructive pulmonary disease (COPD). Often, they do not want to eat much as it can put pressure on their lungs and make it harder to breathe comfortably. There are also other reasons why their relationship with food becomes difficult which I’ll explain below. The end result, however, can be an unhealthy weight loss that further undermines their health. If you have COPD, you’ll want to know about the connection between your appetite, certain foods, and digestion.
Anorexia and COPD
The word “anorexia” is associated most always with women, or young girls, starving themselves to become unreasonably thin. However, in the larger sense of the word, anorexia actually refers to any situation in which the appetite is seriously decreased. It is used in relation to COPD patients because they often have problems with eating, digestion and breathing. As a result, ongoing, unintentional weight loss can occur. Here are some reasons why:
1. Shortness of breath and fatigue: Often times, my patients tell me they just feel too tired to eat very much. Shortness of breath and oxygen decrease can cause ongoing fatigue which serves to decrease appetite. Plus, you often just don’t feel like preparing, or eating, food when tired.
2. Diaphragm pressure: In COPD, the diaphragm (breathing muscle) often flattens and can cause a false feeling of fullness in the stomach. As well, it can cause pressure and inability to breathe comfortably when more food is consumed. It can also lead to indigestion as well.
3. Altered taste of food: Medications taken for COPD, like inhalers, can alter taste buds on the tongue and cause food to lose its taste or taste “funny”. Both can decrease the desire to eat and/or the pleasure derived from eating anything. In addition, COPD patients often produce a lot of phlegm which can change the taste of food and/or just make it uncomfortable to breathe while eating.
4. Medications: COPD medications can sometimes cause nausea and indigestion for some people and these conditions also hamper appetite and eating healthy. Ask your doctor if there is some adjustment in dosage, or brand, or way of taking that can alleviate these symptoms.
5. Depression: Many COPD patients can be depressed. Not only does the condition decrease oxygen, which can affect the brain, just the ongoing difficulty breathing can cause depression.
Keep A Healthy Weight and Breathe Easier
Any one of the reasons listed above can cause COPD patients to develop a low nutritional status and resultant unhealthy weight loss. However, a good nutritional status helps keep the immune system strong to better handle COPD treatment and decrease symptoms. Here are some things I recommend to my COPD patients to both keep a healthier weight and breathe easier at the same time:
1. Smaller, more frequent meals. Eating a smaller amount of food several times a day is much easier on your digestion and your breathing. It will also help boost energy levels during the day. Eating breakfast is important though you may not feel like it. A very light breakfast like a cup of Greek yogurt (higher protein) with ¼ cup of blackberries has a lot of nutritional value and shouldn’t cause discomfort from pressure or indigestion. Forego large amounts of soft drinks (more than ½ liter a day) that will fill you up, likely cause pressure, and certainly won’t boost nutritional status. In fact, a recent study out of the University of Adelaide in Australia revealed that soft drink consumption is associated with the development of asthma and COPD.
2. Focus on antioxidants. Focus on a few servings of high antioxidant fruits and cruciferous vegetables (broccoli, Brussels sprouts, cauliflower) a day. A recent study out of Johns Hopkins showed that the sulforophanes in cruciferous vegetables can help COPD significantly by fighting inflammation as well as, or better, than corticosteroids.
3. Nutritional supplements. In any chronic disease where nutrition is compromised, supplements are crucial. Use liquid-form supplements that have high ORAC (antioxidant) values. One good one is ORAC-7, a liquid taken in 2 Tbsp daily.
4. Get enough protein. If you’re not eating enough and cannot maintain a good weight, you’re likely also losing muscle mass. Add at least 2 ounces of high quality protein to each small meal you eat a day. Also, liquid protein shakes in small volumes, with 1 tsp glutamine added, between regular meals can help maintain muscle mass.
5. Nutritious snacks. Higher calorie, but healthy snacks, like ¼ cup of mixed nuts, 1-2 ounces of cheese, a few crackers with peanut butter, can help keep your weight from falling too low.
6. Drink water. Staying well-hydrated is very important in COPD. It helps thin phlegm in lungs and keeps energy levels up. However, drink smaller 6-8 ounce servings several times a day between your meals to prevent feeling full too fast.
7. Dairy and Phlegm. Some of my COPD patients feel that eating dairy causes them to develop more phlegm which then worsens their breathing. Although there is no real proven evidence that dairy does cause phlegm, I heed my patients anecdotal evidence. If dairy seems to have this effect on you, find other sources of calcium like light almond milk.
COPD can be challenging to live with. However, I tell my patients that with the proper medication adjustments, creating an eating schedule and amount of food that works to keep their weight healthy and breathing more comfortable, it is a condition that can be successfully managed. Find a good pulmonary doctor who keeps abreast of the new findings in managing COPD to help you enjoy eating again and create a brighter outlook for your life.
Mark Rosenberg, M.D.