Thursday, December 18, 2008

Diet for COPD

The best insights into diets that help COPD (chronic obstructive pulmonary disease) come from studies of mountain climbers. Any diet that helps a mountain climber climb with less oxygen can also help a COPD sufferer get through the day better. The difference is, mountain climbers eventually come back to normal oxygen atmosphere, while people with COPD have to make comprehensive dietary changes.

Medical researchers first recognized in the 1960s that low body weight and, in particular, loss of muscle mass, did not bode well for people with COPD. Due to the increased effort required to breathe and constant inflammation, people with emphysema and other chronic obstructive pulmonary diseases can lose weight even when they eat normally.

In a phenomenon known in the medical literature as meal-related dyspnea, sufferers of COPD get out of breath when they eat, because efficient use of nutrients required added oxygen. When they have to breathe hard, they eat less, even though their bodies require more food. When even eating requires effort, it is very important to pay close attention to the right mix of carbohydrates, proteins, and fat to minimize need for extra oxygen but maximize nutrition to the skeletal muscles. And because the muscles across the chest are already stressed, it is also important to ensure the stomach empties quickly to avoid bloating.

Researchers have found that the best combination of macronutrients for people with COPD is high-carb, high-protein, but low fat. High fat meals move through the digestive tract more slowly than low-fat meals. They are more likely to cause bloating and abdominal tension, weakening the muscles of the diaphragm. Gram for gram and ounce of ounce, fat requires the most oxygen of all the macronutrients to be converted into energy. Eating a high-fat meal requires deeper breathing that can cause respiratory distress.

Researchers have also found that smaller and more frequent meals are better than larger and less frequent meals in COPD. In one study, exercise endurance was strikingly reduced when participants consumed a 2092 kJ supplement (roughly equivalent to 500 calories), but not reduced at all when the consumed half as much carbohydrate (about 250 calories).

The lower calorie meal also passed through the stomach more quickly with less strain to the lungs and heart. Higher calorie supplements interfere with appetite and make it harder to get a full range of nutrients from natural food. Lower calorie supplements do not interfere with appetite and allow normal eating patterns.

It’s also important to avoid certain kinds of fat. The biochemical process that makes the lungs sensitive to allergens is fueled by the chemical thromboxane. Your body’s production of thromboxane is greater when you eat egg yolks, beef tallow (still used in cooking fast food French fries by some fast food chains), and fried foods.

Your body’s production of thromboxane decreases when your diet includes fish. A study of 8,006 male smokers in Hawaii found that those who ate two or more servings of fish per week lost lung capacity at less than half the rate of those who did not. The protective effect of fish oils was greatest for the smokers who smoked the most. Another study published in the prestigious New England Journal of Medicine suggests that smokers are protected from the development of bronchitis, emphysema, and pneumonia when their diets include polyunsaturated fatty acids from any source. EPA, DHA, and flaxseed oil are good sources of polyunsaturated fatty acids in treating COPD, as are any recipe that helps relieve asthma.

4 comments:

  1. As the COPD Guide for About.com, would love to know your sources for this article. I would like to do an article about this for my site www.copd.about.com.

    Thanks.
    Deborah, RN

    ReplyDelete
  2. I developed this article in part from conversations with a friend, who happens to be an RN, who climbed Mt. Everest, and with Jim Duke, a family friend, about emphysema. But there are references in the literature. Here you go (a partial list). Let me know when you finish your article. I'd love to read it.

    Robert

    Evidence against redox regulation of energy homoeostasis in humans at high altitude.

    Bailey DM, Ainslie PN, Jackson SK, Richardson RS, Ghatei M.

    Clin Sci (Lond). 2004 Dec;107(6):589-600.
    Effect of exercise, body composition, and nutritional intake on bone parameters in male elite rock climbers.

    Kemmler W, Roloff I, Baumann H, Schöffl V, Weineck J, Kalender W, Engelke K.

    Int J Sports Med. 2006 Aug;27(8):653-9. Epub 2006 Feb 1.

    The effect of drinking tea at high altitude on hydration status and mood.

    Scott D, Rycroft JA, Aspen J, Chapman C, Brown B.

    Eur J Appl Physiol. 2004 Apr;91(4):493-8. Epub 2004 Feb 11.
    Symptoms of infection and acute mountain sickness; associated metabolic sequelae and problems in differential diagnosis.

    Bailey DM, Davies B, Castell LM, Collier DJ, Milledge JS, Hullin DA, Seddon PS, Young IS.

    High Alt Med Biol. 2003 Fall;4(3):319-31.

    Energy metabolism increases and regional body fat decreases while regional muscle mass is spared in humans climbing Mt. Everest.

    Reynolds RD, Lickteig JA, Deuster PA, Howard MP, Conway JM, Pietersma A, deStoppelaar J, Deurenberg P.

    J Nutr. 1999 Jul;129(7):1307-14.

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  3. The logic you employ doesn't work. You assume that the problem in COPD is oxigen when infact it is CO2 removal. High Fat Low Carb is the way to achieve low CO2. See http://www.drhoffman.com/page.cfm/639

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  4. Here's the thing about high-fat diets that work for COPD. They tend to be liquid, passing throught the gut with ease. I accept your point that these diets may be better than the traditional high-carb diet, but the issue is whether the fat can be absorbed. A liquid high-fat diet may work well, but a Kentucky fried chicken diet would be a disaster.

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