Nutrition Tips for Pulmonary Fibrosis (ILD Diet) so you can manage the disease related symptoms of weakness, weight loss and resultant shortness of breath. A recent study [1] reveals that “in idiopathic pulmonary fibrosis (IPF), several factors may have a negative impact on the nutritional status, including an increased respiratory muscles load, release of inflammation mediators, the coexistence of hypoxemia, and physical inactivity. Nutritional abnormalities also have an impact on IPF clinical outcomes.” Given the relevance of nutritional status in IPF patients, clinical nutritionist Dt. Pooja Lakhani details the importance of nutrition for lung disease patients. Read till the end to uncover the 5 Nutrition Tips for Pulmonary fibrosis.
Living With Pulmonary Fibrosis – Can Optimal Nutrition Make It Better ?
According to the American Lung Association, an average adult takes approximately twenty thousand breaths per day. If you have been diagnosed with chronic or long-term lung disorder, these breaths which otherwise seem to be a default phenomenon, may become difficult for you. Pulmonary fibrosis is one amongst many such lung disorders. The word “pulmonary” means “lungs” and “fibrosis” stands for scarred tissues, something similar to a scar on skin after an injury or surgery.
Hence, in simple sense Pulmonary Fibrosis is a disease in which there is scarring of lungs. While initially, most patients may not experience any symptom at all, over a period of time as the scarred tissue blocks movement of oxygen from inside of the lungs into the bloodstream. As a result of which, patients may start experiencing symptoms like shortness of breath and decreased capacity to perform routine activities. Unfortunately, most patients do not pay attention to these subtle signs of reduced functional capacity or getting tired easily as something serious until it manifests itself as near irreversible chronic lung disorder (interstitial lung disease).
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Cigarette smoking, environmental irritants, occupational exposure to toxic substances etc are common factors that may increase chances of developing a chronic lung disorder like pulmonary fibrosis but in many cases, the cause may be unknown. Although symptoms do vary from person to person, common symptoms include coughing of significant intensity, fatigue, shortness of breath, achy joints, reduced appetite, decreased food intake, weakness and weight loss.
Importance Of Adequate Nutrition In PF:
Talking about nutritional management and care for people with pulmonary fibrosis, there is no direct pathway. But many research studies have found patients with this disease to be malnourished. Naturally, as it does affect food intake due to low appetite, taste changes, dry mouth and throat due to use of nebulisers and oxygen support and sometimes also due to certain medications. It has been observed that up to 45% patients lose more than 10% of muscle mass within one year of being diagnosed with a chronic lung disease. Lungs play an extremely important role in overall immunity and functioning of body’s cells. When lungs are unable to work properly, body requires more and more energy to maintain basic breathing and oxygen saturation levels in blood, decreased nutritional intake may directly lead to involuntary weight loss.
Medical Research [1] suggests that more attention should be devoted to the assessment of the undernutrition and overnutrition, as well as of muscle strength and physical performance in IPF patients, taking also into account that an adequate clinical management of gastrointestinal complications makes IPF drug treatments more feasible. It is important to recognise the importance of pulmonary rehabilitation program, including nutritional assessment, education, dietary and lifestyle change, while dealing with patients of pulmonary fibrosis.
Self-Assessment Of Nutritional Status:
Before we move on to details of optimal diet to establish and maintain optimal nutritional status in patients with pulmonary fibrosis, it is noteworthy that no two patients are same and that each patient may be facing their own individual problems in terms of dietary intake. Hence, nutritional screening and assessment of nutritional status is a must. It gives a fair idea about individual nutritional status and intensity of nutrition support needed.
It is highly recommended to look for subtle signs of malnutrition like –
- More than 5% of involuntary weight loss
- Decreased food intake – less than 50% than usual
- Change in size of clothing
- Reduced working capacity
- Unexplained fatigue or early tiredness
For a more objective evidence of muscle mass loss, a group of researchers in Japan [2] developed “Yubi-wakka” (finger-ring test) which helps in detecting the risk of sarcopenia (low muscle mass) at an early stage. In this simple self-assessment test, the examinee surrounds his or her non-dominant calf with a finger-ring made by joining index finger and thumb of both hands, in a sitting position to determine whether the calf was “larger”, “just fit” or “smaller” than the finger ring.
For finger-ring test with larger calf circumference, one may be overweight or obese with probable sarcopenia, just fit indicates normal muscle mass and smaller is a sign of muscle mass loss.
Steps To Improve Nutritional Intake In Pulmonary Fibrosis:
How To Gain Weight With Pulmonary Fibrosis?
The following nutritional guidelines or dietary modifications may be helpful in improving nutrient intake for patients with PF:
- Maximize Anti-oxidant Intake: Diet rich in antioxidants helps to free radicals that the body emits. Some of dietary sources rich in anti-oxidants include green leafy vegetables, sweet potatoes, broccoli, and other cruciferous vegetables like carrots, tomatoes, garlic, herbs, spices, citrus fruits, cherries, all types of berries, green tea and cocoa.
- Enhance Lean Protein Intake: Lean protein like fish and poultry not only have a higher protein content but their utilisation in body is also significant, which is called as its biological value. Egg whites can be consumed almost every day with 1-2 meals or as a mid-meal snack while fish and chicken can be consumed up to 3-4 times per week.
- Omega-3 Fatty Acid Intake: Omega-3 fatty acids have been proven to be beneficial in acute lung injury in many researches. Due to its anti-inflammatory function in the body, regular intake of omega-3 fatty acid sources in diet may also prove to be helpful in chronic lung diseases like PF. Including salmon, sardines, walnuts, flaxseeds in diet routinely helps provide enough of this anti-inflammatory nutrient.
- Pre and Probiotic Intake: Role of pre and probiotics has long been studied in maintaining gut health and immunity, however recent researches have also showed favourable outcomes in chronic diseases by including them in diet. Insoluble fiber in diet such as those from whole grains, vegetable and fruit peels, unprocessed cereals and pulses etc remain undigested in the human gut and utilised as sources of energy by the gut bacteria and therefore serve as probiotics. While fermented foods like idli, dosa, appam, curd, yogurt and germinated foods like sprouted moong, usual and missal etc. serve as sources of probiotics in diet.
- Maintain optimal hydration: As mentioned earlier, people with a chronic lung disease spend relatively more amount of energy in maintaining baseline breathing and levels of oxygen in blood. The condition may worsen when coupled with dehydration. Apart from adequate water intake, beverages like lime juice, home made soups, fruit smoothies, coconut water etc can be included at regular intervals to maintain electrolyte balance apart from achieving optimal fluid intake.
- Limit sodium intake: Excessive sodium intake may lead to water retention requiring increased effort in breathing. Primary source of sodium in diet is salt. Hence, it is recommended to consume with lesser added salt. A simple way too achieve this is beading half the salt than usual when cooking food, your taste buds shall adapt this new taste in 2-3 weeks’ time making this less salted food seem absolutely normal. Other sources of sodium intake in diet include preserved and processed foods like jam, ketchup, pickles, farsaans, cakes, cookies, bread, flavoured dips etc. Attempt should be made to reduce their intake to not more than one per week.
5 Nutrition Tips for IPF & Lung Health
Optimal Diet And Lung Rejuvenation:
Here we would like to share 5 basic tips to enhance nutritional intake for people living with pulmonary fibrosis:
- Five A Day: Include minimum 5 servings of fruits and vegetables of different colours per day
- Wholesome Grains: opt for whole grains like unprocessed wheat, unpolished rice or brown rice, jowar, bajra, ragi, whole pulses and lentils
- Dear Dairy: up to 500 ml skim milk and milk products like curd, yogurt, buttermilk, cottage cheese should be consumed daily
- Powerful Protein: consume pulses, legumes, lentils, nuts, oilseeds, lean fish and poultry to incorporate enough protein in diet
- Favorable Fats: good sources of fats like nuts and oilseeds, avocados, olive oil should be included, apart from limiting use of oils and fats during cooking. Up to 500-600 ml of cooking oil intake per person per month is generally recommended.
RespiRehab propagates medically supervised pulmonary rehabilitation to promote healing from within the lungs. A holistic inter-disciplinary approach including clinical dietitian and chest physiotherapist is proven to improve breathing and quality of life. This has a direct impact on reducing the incidence of exacerbations as well as hospitalisation. If you or a loved one has ILD, Pulmonary Fibrosis, COPD, emphysema, chronic bronchitis or another chronic lung disease and would like to learn more about pulmonary rehabilitation, call us at +91 9920991647 or ask for call back by clicking here.
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Scientific References:
[1] Nutrition in Patients with Idiopathic Pulmonary Fibrosis: Critical Issues Analysis and Future Research Directions, Published online 2020 Apr 17. doi: 10.3390/nu12041131, PMCID: PMC7231241, PMID: 32316662
[2] “Yubi-wakka” (finger-ring) test: A practical self-screening method for sarcopenia, and a predictor of disability and mortality among Japanese community-dwelling older adults. Tomoki Tanaka, Kyo Takahashi, Masahiro Akishita, Tetsuo Tsuji, Katsuya Iijima, PMID: 28898523 DOI: 10.1111/ggi.13163.
Note: This article is meant for general informational purpose only and should not be used in place of medical advice. Please ask for appointment with dietitian for a personalised advice as pertinent to your specific condition.
