Pulmonary Rehabilitation Dietary Advice

1. Pulmonary Rehabilitation Dietary Advice By Stephanie Lee-Barrett Dietitian Colchester General Hospital

2. Facts About COPD & Diet • Diet and Nutrition should be an important part of treatment • Breathing requires more energy with COPD • Muscles involved may require 10x more calories than those without COPD • Good nutrition will help reduce hospitalisation from chest infection

3. Bread, rice, potatoes, pasta Fruit and vegetables The eatwell plate Milk and dairy foods Meat, fish, eggs, beans Foods and drinks high in fat and/or sugar

4. General Dietary Advice • Enjoy variety of foods • Limit salt intake • Drink plenty of fluids 6-8 glasses/day • Include high fibre foods e.g. veg, fruit, wholegrain foods, cereal, pasta, rice • Eat several small meals per day

5. Body Mass Index (BMI) • Used to measure if an individual is a healthy weight, underweight or overweight BMI= Weight (kg) Height (m²) • Fit into certain categories 16-19 = Underweight 20-25 = Normal weight 26-30 = Overweight 31-40 = Obese

6. Dietary Advice if you are Underweight

7. Underweight Weight loss Loss of respiratory muscle strength More energy required to breathe Increased difficulty breathing and increased risk of infection

8. Poor appetite • Have regular meals & snacks • Eat anything fancied • Eat from a smaller plate • Avoid filling up on veg, salads, fizzy drinks • Sip nourishing high energy fluids e.g. milk, hot choc, malt drink, milkshake • A short walk before meals may increase appetite • A small amount of alcohol can stimulate appetite

9. Slow Eater • Try eating small amounts little & often • Consider a plate warmer & insulated mug • Do not hurry over meals, eat slowly and chew foods well

10. Short of Breath While Eating/ After Meals • Eat more slowly • Choose foods that are easy to chew - softer foods • Try eating 5-6 small meals/day • Try drinking liquids at the end of your meals. • Eat while sitting up to ease pressure on the lungs

11. Too Tired to Eat Later in Day • Choose foods that are easier to prepare • If possible ask family members to help with meal preparation • Freeze extra portions • Rest before eating • Try eating main meal early in the day

12. Feeling of fullness quickly • Eat smaller meals more frequently, rather than one or two big meals • Try not to fill up on fluid whilst eating.

13. Food Fortification • Fortified milk - add 4tbsp skimmed milk powder to 1pint full cream milk • Add butter/margarine/ghee/cream/cheese to mash potatoes, vegetables and sauces • Add cream/ice cream/custard to puddings and fruit • Use sugary foods (unless diabetic) - jam/sugar/syrup/honey added to cereals and puddings

14. Sandwiches - cheese/egg/meat with pickles/sauces Toast- cheese/beans/ egg/fish Toasted crumpets with cheese Convenience meals Jacket potato with cheese/beans/tuna mayo Crackers or digestive biscuits with butter and cheese Mousse/yoghurt/jelly/ trifle/fromage frais Fruit loaf/malt loaf with butter Quick Snack Ideas

15. Nutritional Supplements • If the discussed ideas do not help to improve your intake, nutritional supplements may be used • Complan® and Build-up® are available to buy “over the counter”. • Others are available on prescription from your GP. • Variety of flavours (sweet and savoury). • Often preferred chilled • Can be incorporated into recipes e.g. milk pudding, ice cream, custard, milkshakes, mousses.

16. Dietary Advice if you are Overweight

17. Overweight • Consequence of : • high energy intake from food • reduced exercise tolerance • steroid use • Extra weight increases workload of heart and lungs to supply oxygen around body • Excess fat in abdominal area makes it difficult for the lungs to expand fully

18. Starchy Foods • Include at each meal • Main source of energy • Starchy foods are filling • Choose wholemeal + wholewheat varieties • Myth that starchy foods are ‘fattening’

19. Fruit and Vegetables • Rich in vitamins and minerals • Help protect against infection • Aim for 5 portions per day • Fresh, frozen, canned or dried

20. Meat, Fish and Alternatives • Provides protein, vitamins + minerals • Recommend 2 servings/day • Avoid roasting or frying in large amounts of oil/fat • Try healthier cooking methods • Choose lean meat • Remove visible fat & skins from meatand poultry.

21. Milk and Dairy Products • Provides protein and calcium • Recommend 3 servings/day • Use semi-skimmed milk instead of full cream milk • Use low fat cheeses e.g. Cottage cheese, edam, half fat cheddar • Try low fat yoghurts • If on long term steroids - it is important you have enough calcium.

22. Fatty and sugary foods • Try using sweeteners • Choose lower calorie sugar free/no added sugar drinks • Keep sweets, puddings, cakes, chocolate, take-aways, pies and pastries as a treat • Try tinned fruit in natural juice rather than syrup.

23. Hints for weight control • Think of the benefits of weight loss • Make healthier changes to your diet • Fill up on fruit and veg • Have regular meals • Avoid foods which are high in fat and sugar. Aim for: • <3g total fat /100g product • <5g added sugar/100g product • Set realistic, achievable target lose (1-2lbs/week). • Do not crash diet. Consider keeping a food diary

24. Alcohol • high in calories and should be kept within sensible limits. • Women ≤14 units per week • Men ≤ 21 units per week • Aim for 2-3 alcohol free days. • A unit of alcohol is: • Half a pint of beer, cider or larger (medium strength) • 1 small glass of wine (125ml) • 1 small glass of sherry • 1 measure of spirits

25. Summary…. • Good nutrition helps reduce infections • Need energy to help you breathe • If underweight - choose high protein/calorie foods - important have enough energy • If overweight - choose low fat/low sugar foods, eat more fruit/veg • Refer to relevant diet sheets - examples of menu plans and snack ideas