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BREATHLESS WEBSITE: This site was founded by John Kirtley. Sadly he died in 2008 |
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DIET
This is a boring subject now for many. We are constantly being bombarded with TV and radio programmes on the subject, stories in the press and magazines. Being overweight, being underweight, eat five portions of fruit and vegetables, take vitamins, don't take vitamins, wine and choclate are bad and a week later, wine and chocolate are good. Do we need to go on?
However, for people with COPD, this is a vital subject and can affect our breathing and our life span. If we are over-weight then our breathing worsens and our chances of developing heart disease or diabetes, for example, also increase. If we are underweight, we could be killed off by the next next bus or next exacerbation because our immunity system will be reduced and our fat reserves limited.
How can we define being over-weight, under weight or just normal? Well the most common way of measuring this is called the Body Mass Index or BMI. There are other ways such as measuring body fat and so forth, but the BMI is perhaps easily understood and calculated. You can even buy weighing machines that will calculate it for you. Since many COPD patients still work in feet and inches and stones and pounds. Here is a rough guide to an ideal weight for our height, without shoes in ft and ins and stones and lbs. This results in a BMI of 20 - 25.
Height Weight Range (Stones.pounds) 4 ft 10 ins 6.12 to 8.8 4 ft 11 ins 7.1 to 8.12 5 ft 0 in 7.4 to 9.2 5 ft 1 in 7.8 to. 9.7 5 ft 2 ins 7.11 to 9.11 5 ft 3 ins 8.1 to 10.1 5 ft 4 ins 8.5 to 10.6 5 ft 5 ins 8.8 to 10.10 5 ft 6 ins 8.12 to 11.1 5 ft 7 ins 9.2 to 11.6 5 ft 8 ins 9.6 to 11.10 5 ft 9 ins 9.9 to 12.1 5 ft 10 ins 9.13 to 12.6 5 ft 11 ins 10.3 to 12.11 6 ft 0 in 10.7 to 13.2 6 ft 1 in 10.12 to 13.7 6 ft 2 ins 11.2 to 13.13
Now in our opinion COPD sufferers should aim for the higher of the two weights i.e. a Body Mass Index of 25. If you are much heavier than that for your height, you might find you get more breathless than is normal, even with COPD, and if you are much, much heavier then you must try losing weight. As important is that if you are underweight with a BMI less than 20, you must try to put on weight. Your GP may suggest that you take some food supplements, like Complan or Ensure Plus, in addition to your normal meals. If you are underweight and have a severe infection you may not be able or want to eat and you will have no fat reserves to fall back on. For people who are over-weight we suggest they see their GP and/or go to http://www.weightwatchers.co.uk/health/asm/calc_bmi.aspx where you can calculate your BMI (this also allows you to use metres and kilogrammes if you are happier with that!) and use the rest of the weightwatchers site to find out tips on how to lose weight. On this page we want to concentrate on the difficulties patients with COPD experience with eating and preparing food.
Why is weight loss so common in COPD, and especially emphysema?
The answers are complex but sometimes poorly understood. From our own perspectives, it is not a problem since our partners do the shopping and cooking and each of us has developed our own strategy for eating which we will explain later. Both of us have been on our own many times however and can offer some answers. Because one can becme breathless walking to the shops, buying food in any quantity can become a nightmare. The problem can be approached in three ways.
(a) Purchase a computer so that one can order food on the internet (but if you are living on a small pension this is not perhaps a solution for you). (b Buy a mobile scooter (It helps if you qualify for a mobility allowance) and in fine and warmish weather you can use that. Many people have a car of course. (c) Use ambulatory oxygen so you can help your partner and exercise - at least when the weather is suitable!
Becoming breathless in the kitchen makes the idea of making food an effort and disincentive. The problem can be dealt with in the following ways :
(a) By placing a high stool by the preparation surfaces - sitting down makes everything that much easier. If you still need oxygen you should be supplied with a concentrator that has a tube that will stretch all around your home. (b) By making meals as simple as possible. If you are underweight it really doesn't matter what you eat as long as you eat, so dont worry too much about fats and sugar, unless you are over-weight! (c) Buy or borrow a microwave. When you are feeling down, slip a prepared meal from the supermarket into it and you will have food in minutes! (d) Use a food blender, not a juicer (you will lose a lot of fibre if you use a juicer). Wash some vegetables - don't bother to peel them - then chop them up and put them straight into the blender with a little milk/water/yoghurt. No need to cook them. These are called Smoothies and you can drink some of your five portions of vegetables and fruit throughout the day. (e) If you can't be bothered to cook chicken – buy some cooked from the supermarket. Eat pieces with your Smoothies! Tuna comes in cans and is good for you. Buy them with an easy opening tab and spread on cut bread. Grab a tomato. And that's a nice little meal. Even beans can be eaten straight out of the can if you're really short of breath. And soup just needs heating up in the microwave. These are just a few tips but we will add more as we think of them!
Breathlessness can make just eating difficult and tiring. Also if you eat a big meal your stomach fills up and makes it more difficult for you to breathe. Ever felt that after bolting your food?
We found the following helpful. (a) Instead of eating three meals a day make it five or six small portions.
(b) Fish is often more easily eaten and digested than meat so have that at least twice a week. For patients who are underweight, fish and chip take-a-ways are fine but not every night!! We mentioned tuna earlier on, but you can add tinned salmon, mackerel and sardines on brown bread or toast, or just on their own. You could follow that with a blender smoothie and you have a small meal. If someone cooks for you let them make you a full evening meal, but if you eat half of it early on in the evening, have a rest and then nibble away at the rest! Try not to eat for at least 2 hours before going to bed,
(c) For breakfast one can tend to pick at things because that is the worst part of the day for many of us - the time when we feel most breathless (apart from the late evening when we are tired!). Have some pate and toast with plenty of fluid - tea of coffee. Sometimes have a boiled egg or some scrambled egg (you can make that easily in the microwave) and then a bit later have a smoothie (you can prepare enough of this in advance to last 2 days).
(d) If your teeth are fine and you can pick at nuts do so if you can, do. Even chocolate is quite good for you if you wish to put on weight. Try ice cream. Some tinned fruit slips down the throat quite well every now and then if you haven't got any fresh vegetables in the house. At night have a glass of milk and some chocolate biscuits to eat if you feel thirsty or hungry during the night.
(e) If you live on your own try making a stew with meat or chicken in a large stew pan. All you need to do is cut up the vegetables and pop them in - make enough for 2 or 3 days. Add water & gravy granules & some herbs and cook until the meat is tender. Some people don't add salt. Store in a refrigerator but don't reheat the lot the next time you want some - just spoon what you need into a pan. OK, we know that sounds like a lot of work (at least an hour) but afterwards bliss - no more cooking for a while. This might apply more to the winter!
But don't leave it in the fridge for much longer please.
Chew your food well and eat slowly. Use your oxygen at the same time if it is necessary. Drink plenty of fluids - milk, water, fruit juices, tea, chocolate and coffee but avoid the last three in the evening. They might keep you awake. Try using honey instead of sugar - if you can afford it!! And preferably do not use table salt.
There is a book on Smoothies that I recommend. See BOOKs . But BLEND not JUICE.
SHOULD I TAKE VITAMINS? Well if you ask your GP he'll probably say that if you have a balanced diet you'll be wasting your money. John asked one of his a few years back about potassium (because he took inhaled steroids) but he said "No, a banana a day should do it." At the time he was living on his own and a journey to the shops was a mammoth task. Adding bananas to his already heavy bag was often too much for him! So people have different ideas on vitamins but at the very least John would recommend taking a multi-vitamin tablet. He also took extra vitamin C,D,Potassium, L Carnitine, and Selenium, but it is a matter of personal choice. He said "They haven't done me any harm that I know of but I have no idea if they have helped! I just believe they have. A recent study has shown that certain vitamins, such as E, are not very effective and others may be harmful. So I guess I should recommend a multi-vitamin only. [Certainly none should be taken to excess]. On of my fads was SUPERFOODS and in particular WOLFBERRIES ( otherwise known as GOJI BERRIES) which contains vast amounts of anitioxidants and so forth, and are apparently gulped down by the Chinese, and who of course live forever". If you are interested read about them at http://www.creative-nature.co.uk/catalog/product_info.php?cPath=42&products_id=204
Summary
Always sit on a stool or wheelchair or similar while making a meal. If you use a blender don't bother to peel your fruit (except for oranges or similar). Just wash them and chop them up - add water/milk/yoghurt and drink them if you are having a bad day. We are not concerned about the long term effects of insecticides! Try to keep your meals small and frequent. In the winter we often prepare a stew which can be kept in the refrigerator for up to three days. Don't re-heat the whole thing. Just take out of the stew pot enough for a meal. Use a microwave to cook things quickly - they are simple and easy to use. We don't normally recommend ready made meals but let's be honest, if you are infirm and breathless it is important to keep eating - anything! It is very important to keep your weight within the BMI (BODY MASS INDEX) 20-25. If you lose weight either eat more even in liquid form (Complan, Ensure etc) or if that does not work consult your GP immediately. Remember you need more energy because of the extra work you have use for just breathing. If you are losing weight contact your GP immediately.
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