Ras Kahai is a cardiorespiratory dietitian at the Royal Brompton & Harefield hospitals. Ras works with patients with all respiratory conditions including pulmonary fibrosis.
Nutrition is an essential part of our life, culture and society. It can be really challenging to not have an appetite and no desire to eat. I know it’s especially tough for family and friends to watch their loved ones struggling.
Nutrition is not a one box fits all. Patients may find their lung condition makes them put on weight, as it may become more difficult to exercise with increased breathlessness whilst others struggle to maintain or gain weight.
Many people with pulmonary fibrosis have challenges with nutrition for a variety of reasons which can include breathlessness, fatigue, side effects of medications, anxiety, nausea or gastrointestinal disturbances.
We know that nutrition gives you the energy and strength to do what matters to you. The energy and protein from food supports maintaining muscle and micronutrients to keep your body functioning.
There is increasing evidence pointing to maintenance muscle mass being a key factor in pulmonary fibrosis. Reduced muscle mass around your lungs and diaphragm may affect breathing. Additionally, if muscle is reduced around your arms and legs, it can make you less mobile and unable to do the things you want to.
What can you do to maintain or increase muscle mass?
• Have a protein source with every meal such as meat, fish, beans or tofu.
• Link in with your physiotherapist/pulmonary rehab team and discuss what strengthening/muscle building exercises may help
How can I lose weight?
• Eat mindfully, really concentrate on the taste and savour your food.
• Keep an eye on portion sizes (but not for vegetables) and try using a smaller plate
• Plan your meals ahead of time to ensure you have healthier foods in reach. Try to have three balanced meals a day.
• Before snacking, try to have a glass of water to check your thirst is quenched. Consider having a protein or fibre rich snack.
What if I can’t manage my main meal?
• Try to eat small, frequent meals, aiming for 6 to 7 small meals per day as large portions can be overwhelming.
• Include a high calorie/protein nourishing snack or drink if you can’t finish your main meal
• Establish regular mealtimes and eat at the same time each day, aiming to eat 2-3 hours apart.
• Make the most of meal times when your appetite is good during the day and try to eat more.
What are your tips for both patients and carers?
• Encourage your loved one to eat in a kind and compassionate way, whilst giving space. It can be difficult for patients who struggle with appetite to be constantly nagged and this can impact on your relationship.
• If appetite is poor, check with your GP as to whether a ‘healthy’ diet is still relevant. They may give permission to eat a wider variety of foods outside public health guidance.
• When you are having blood tests, request your vitamin D to be checked alongside.
What are the danger signs to look out for – when do you need urgent help?
• Significant weight loss is the biggest one. As little as 5% loss of your body weight has been likened to worsened outcomes in pulmonary fibrosis. Consider weighing yourself every now and again or look out for changes in clothes size or jewellery not fitting.
• You can calculate your body mass index (BMI) via the NHS website – www.nhs.uk/live-well/healthy-weight/bmi-calculator
• Also watch out for a reduction in strength.
• Poor appetite and eating less than a quarter of your normal intake for consecutive days.
• If you’re feeling increasingly concerned I recommend requesting a dietetic referral from your GP, consultant or specialist nurse.
To find out more head to APF’s nutrition page – https://www.actionpf.org/information-support/eating-well-with-pulmonary-fibrosis
This article was sourced from our APF Insider magazine, packed with free information to help you live well, stories from others living with pulmonary fibrosis, research news and updates from our community. Sign up to receive your own copy.