6 Best Food Choices for COPD

Many people with COPD find it hard to eat, which can lead to unintentional weight loss, muscle loss, and malnutrition, says Jorge Mercado, MD, director of pulmonary medicine at NYU Langone Hospital in Brooklyn.

Indeed, a study published in the January 2019 issue of the International Journal of Chronic Obstructive Pulmonary Disease found that most people with COPD do not meet their energy and protein requirements.

When you skimp on calories and protein, the muscles used in breathing — which need to work extra hard when you have COPD — become smaller and weaker, worsening breathing problems. “So, protein [the building block of muscle] is one of the things we encourage patients to try to increase in their diets,” Dr. Mercado adds.

To help maintain strong respiratory muscles, the American Lung Association (ALA) recommends that people with COPD reach for protein-rich foods at least twice a day.

Good protein sources include:

• Milk
• Eggs
• Cheese
• Meat
• Fish
• Poultry
• Nuts
• Dried beans

If you need to gain weight, the ALA advises choosing protein sources with a higher fat content, such as whole milk and whole-milk cheese and yogurt.

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More than half of COPD and emphysema patients develop a vitamin D deficiency at some point, notes the National Emphysema Foundation (NEA).

One reason is that steroids, often prescribed to people with COPD, can interfere with vitamin D absorption. Another is that COPD symptoms like breathlessness can lead to spending less time outdoors in the sun, a natural source of vitamin D.

Vitamin D is essential for bone health, and getting too little can lead to osteoporosis (brittle bones), a disease that is common in people with COPD.

The vitamin is also emerging as a key nutrient for lung health. Some research suggests that for people with COPD, a deficiency of D may contribute to a decline in lung function over time, along with an increased risk of a sudden worsening (or exacerbation) of COPD symptoms, says the NEA.

“There have also been studies that show supplementing patients with vitamin D may decrease the number of flare-ups,” says Mercado. For example, a trial published in January 2019 in the journal Thorax found that vitamin D supplementation was associated with a 45 percent reduction in moderate to severe exacerbations among COPD patients who were deficient in vitamin D.

But before you start popping supplements, talk to your doctor about whether taking D makes sense for you. In the meantime, you can increase your D intake just by reaching for certain foods.

Good sources of vitamin D include:

• Egg yolks
• Almond milk
• Vitamin D–fortified orange juice
• Salmon
• Flounder
• Tilapia
• Uncooked mushrooms
• Milk, yogurt, and other dairy products fortified with vitamin D
• Canned sardines
• Canned light tuna

Fiber is another important ingredient in a healthy diet for COPD, says MeiLan Han, MD, a pulmonologist at University of Michigan Hospital in Ann Arbor and author of Breathing Lessons: A Doctor’s Guide to Lung Health.

Fiber is the indigestible part of plant food that helps move food along the digestive tract. Dr. Han encourages her COPD patients to get enough fiber in their diets to “keep things moving” and avoid constipation and bloating, which can make it more difficult for people with COPD to breathe.

A fiber-rich diet can also help you lower cholesterol levels, reducing your risk of heart disease, a condition that often coexists with COPD.

The ALA recommends that people with COPD eat 20 to 30 grams of fiber each day. Fiber-rich foods include:

• Whole wheat bread
• Whole grain cereals
• Oats
• Quinoa
• Brown rice
• Whole grain pastas
• Legumes like beans, peas, and lentils
• Fruits
• Vegetables

Eating smaller, more frequent meals, rather than the usual three per day, can be a good strategy for managing COPD because it can assist breathing, says Han.

“The thoracic [chest] and abdominal cavity have a fixed amount of space,” she explains. “The more [room] that one of those compartments takes up, the less room there is for the other compartment.”

Over time, COPD can cause the lungs to trap gas, become enlarged, and start to push down on the diaphragm (the muscle that helps you breathe). Having a full stomach can further restrict breathing by pushing up on the diaphragm and lungs, Han explains.

The ALA recommends people with COPD eat four to six small meals (or large, healthy snacks) a day to allow the diaphragm to move freely and the lungs to fill with air and empty out more easily.

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Studies suggest that eating foods rich in omega-3 fatty acids, found in cold-water fish and some plant foods, may help ease lung inflammation and reduce COPD symptoms.

In a meta-analysis published in August 2019 in COPD: Journal of Chronic Obstructive Pulmonary Disease, researchers found a link between eating a Mediterranean diet — traditionally high in omega-3-rich seafood and plants — and reduced incidence of COPD. This may, in part, be due to the anti-inflammatory properties of omega-3 fatty acids, the investigators wrote.

Another study, published in May 2019 in the journal BMC Pulmonary Medicine, found that a subset of COPD patients with higher intake of the omega-3 fatty acid alpha-linolenic acid (ALA) were less likely to experience chronic cough and wheezing.

Omega-3 fats are also rich in calories, so they can help people with COPD who find it difficult to eat enough to meet their daily energy needs, says Alicia Romano, RD, a registered dietitian at the Frances Stern Nutrition Center at Tufts Medical Center in Boston.

“Calorie-rich foods at meals are very helpful,” she says. “Omega-3 fatty acids can add an extra layer of value with a potential anti-inflammatory effect.”

Omega-3s are considered “essential” fats because they’re not made by the body, so we need to get them from food. Omega-3-rich choices include:

• Salmon
• Sardines
• Atlantic mackerel
• Cod
• Canned light tuna
• Flaxseed and flaxseed oil
• Walnuts
• Canola oil
• Green leafy vegetables
• Eggs and other food products fortified with omega-3 fatty acids

Staying hydrated is crucial to overall good health. “Water is essential in a lot of different body processes, so being hydrated helps our organs function properly,” says Romano. “In patients with COPD, this is especially important because they have organs that are under more stress.”

COPD patients also tend to produce a lot of phlegm and other secretions. Good hydration will help thin the mucus in your airways and make it easier to clear your lungs, Romano adds.

The ALA recommends people with COPD drink six to eight glasses of water per day, ideally spread throughout the day to avoid overfilling the stomach.

Not a fan of plain old H20? You can also get your fill of fluids by drinking any healthy, caffeine-free fluid (such as milk, herbal teas, and juices) and eating fruits and vegetables, which offer a substantial amount of water, says Romano.

Cucumbers, celery, and watermelon are among the most hydrating foods.

But keep in mind that some people with COPD who also have heart problems might need to limit their fluid intake. If you are not sure whether you have fluid restrictions, check with your doctor.