Helpful Nutritional Information Related to NTM/Bronchiectasis Patients

Posted on March 24, 2017   |   
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This blog post was written by Katie Keating, RN, MS, and patient advocate

As a client of a respiratory specialty care facility, many of us have spoken with a nutritionist. Often, we were not feeling up to par and perhaps were overwhelmed with information that was provided to us. It is difficult to learn and retain newly acquired information under these circumstances. Hiring a private or personal nutritionist can be financially challenging and not feasible for most of us. Proper nutrition is an important factor to remaining healthy and to minimize the risks associated with poor dietary intake. Below is some nutritional information that you may find useful.

Nutrition is so important for patients with NTM/Bronchiectasis because:

  • The respiratory system and the gastrointestinal systems are all interconnected; gastric reflux is greatly affected by the foods we ingest and may result in worsening of our respiratory symptoms.
  • Good nutrition assists us in the healing process, whether it is pneumonia, the flu or common cold.
  • Serotonin is produced in the gut; our moods and mental focus are affected by the foods we ingest.

Again, what we eat affects our health, similar to the old expression on computers, JIJO, junk in, junk out. Some poor food selections are not only creating a venue for bacteria, but acidic foods such as sugar, tea, coffee, alcohol and non-grass fed meats are worsening the issue by depleting the good bacteria in the gut and harming our esophagus.

Keeping an ideal weight supports your lungs as they work. Good nutrition gives your body the energy it needs do the work of breathing and staying active. Our bodies require water and a source of food/energy regularly. Calories are the fuel that helps our bodies work. Calories come from the grains, vegetables, fruits, proteins and fats that we eat. We also need vitamins and minerals that cannot be created within our bodies; we find these in the plants, fruits and vegetables and animal foods that we eat.

It is important to minimize processed foods in your diet and focus on ingesting the most nutritionally dense foods possible. Nutritionally dense foods and beverages are rich in minerals, vitamins, and other elements that provide adequate nutritional intake. These foods are also lower in salt, sugars, starches and fat and contribute to greater health. The United States Department of Agriculture (USDA) says a healthy diet is one that focuses on fruits, vegetables, whole grains, and fat -free or low -fat milk and milk foods. A healthy diet includes lean meats, poultry – (chicken and turkey), fish, beans, eggs and nuts, low in saturated fats, trans fats, cholesterol, salt and added sugars. Grains, vegetables and fruits should make up most of our diet.

We need the combination of nutrients to keep our metabolism working normally. The combination of foods is like an “uber” that transports the food into the cell, providing us with the energy we so desperately crave. Good nutrition will improve digestive health, optimize treatment and lessen other complications.

Intestinal microbiota, or gut flora and the gut barrier determine gut health. Inside the gut are about 100 trillion live organisms that promote GI function, protect the body from infection, and regulate metabolism and the mucosal immune system. In fact, they compromise more than 75% of the immune system. * (1)

The following is a list of the different food groups and their importance:

  • Carbohydrates: there are three types of carbohydrates, starch, sugar and fiber. Starches and sugars provide your body with the main source of energy. Simple carbohydrates consist of table sugar (sucrose), glucose, fructose and galactose. Sucrose occurs naturally and can be found in fruits, grains and vegetables. These sugars can be absorbed directly and do not require breakdown from enzymes. Lactose is a natural sugar, found in milk. American Heart Association guidelines for daily sugar intake are 6teaspoons or 24 grams for non-diabetic women and 9 teaspoons or 36 grams for non-diabetic men.

    Other examples of simple carbohydrates include candy, cake, and white flour, which give you short lasting energy or a quick fix. Some breads, cereal, rice and pasta give you long-lasting energy. Refined products are not recommended, such as white bread, only unrefined products. Complex carbohydrates consist of foods such as spinach, broccoli and asparagus.

  • Fiber: needed to lower cholesterol and slows down the digestion of carbs which is why your blood sugar does not spike as much after fiber -filled fruit compared to eating a candy bar. Fiber slows absorption and fat conversion. It is important not to eat quickly since it increases cortisol and insulin levels. Avoid being constipated by adding lots of fiber and fluid to your diet.
  • Protein is important for respiratory patients. It is a major component of muscles, enzymes, hormones and antibodies that fight infection. Lack of protein can reduce the lungs' ability to fight infections in people with NTM/Bronchiectasis.

    When proteins are consumed and digested, proteins are broken down into various organic compounds known as amino acids. These 20 amino acids are then rebuilt within the body to create various structures including cells, muscles, and organs.

    A protein that provides all nine essential amino acids is considered complete protein. Essential amino acids cannot be made within the body and must be provided by the diet. Protein sources that provide all essential amino acids are considered complete. The nine essential amino acids include histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine. An incomplete protein is low in one or more essential amino acids and must be combined with other protein sources to be utilized properly.

    All animal proteins are complete, including chicken, turkey, red meat, fish, dairy and eggs. The main sources of protein are meat, fish, eggs, poultry, legumes and dairy products. You can also get complete proteins through foods such as tofu, buckwheat and quinoa.

  • Incomplete Protein: Legumes, fruit and veggies are all lacking the same amino acids, while nuts, grains and seeds are missing the other essential amino acids. Combining one food from each incomplete group—like beans and brown rice or almonds and asparagus will make a complete protein. The goal is to have protein at every meal, portion size of a palm.

Other supplemental protein suggestions:

  • Add skim milk powder to hot milk, cereal, eggs, soups, casseroles, gravies and ground meat dishes. This will add extra protein and calcium to your diet.
  • Add chopped, high protein poultry, meats, cheese or legumes to soups and casseroles and vegetables. Nuts also can be added.
  • Blend finely chopped hard-boiled egg or egg substitute into a sauce, gravy or soup.4
  • Include high protein snacks such as instant breakfast, protein bars, cottage cheese and puddings in your diet.
  • Have peanut butter, bean dips, nuts, cottage cheese or other cheese with snacks to add additional protein calorie. Try using double strength milk.
  • Calcium: helps with lung function, muscle contraction and blood clotting. Calcium also plays an important role in making our bones strong, helping the immune system and transporting nerve impulses.
  • Dairy products are the main source of calcium. People who cannot eat dairy must choose their foods carefully to make sure they get enough calcium. Calcium is not easily absorbed. And just because a food has calcium does not mean your body can use the calcium. Vitamin D is important for calcium to be absorbed.
  • Two glasses of milk can satisfy the daily adult need for calcium. Many people believe that drinking cow's milk will create extra mucus in their nose, throat and lungs. This is not true. The fats in milk can leave a soft, filmy coating in your throat and mouth. This may make you feel like you have extra mucus in your throat. Milk is an important part of a good diet. * (2)
  • Sodium: read the sodium content on the labels. Look for products having less than 140 mg sodium per serving or labeled "low sodium”. Please stay away from processed foods with sodium greater than 500 mg. Water retention due to salt only makes it more challenging for our bodies.
  • High sodium foods include: cured smoked and canned meats, bologna, frankfurters, ham and salami - regular canned vegetables, soups and vegetable juices - salted snacks (nuts, pretzels, chips) regular frozen meals, foods in brine (pickles, olives, sauerkraut, feta cheese) regular processed cheeses, seasoned salt, meat tenderizer, MSG, soy sauce and barbeque sauce
  • Magnesium: is the "fuel" that makes muscles work. It is also an important mineral that is involved in blood clotting, muscle contraction and protein production. Magnesium also works with in calcium to help control the activity of the bronchial tubes. A low level of magnesium weakens' the muscles. This is true for the breathing muscles.
  • Magnesium is found in the chlorophyll or green pigment of plants. Dark green vegetables are rich natural sources of magnesium. Magnesium may also be found in whole grains, beans, peas, lentils, tofu and some seafood. Foods made from refined flours (like white bread) have 80 percent less magnesium than whole grain flours.
  • Phosphorus: plays a role in all living cells. It helps in the building and repairing of tissues and it plays a role in the formation of bone. Most people get this amount by eating meat, poultry, eggs and milk products. A lack of enough phosphorus is rare in healthy adults. But people with respiratory issues are at risk for not having enough phosphorus. The low levels are likely caused by drug side effects. Some of the medicines taken by respiratory patients have been linked to low phosphorus levels. The drugs can cause large amounts of phosphorus to be released from the kidneys. A poor diet can also cause low phosphorus levels. Please speak with your doctor about your phosphorous levels. Phosphorous is not measured in routine blood work. Having enough phosphorous is important for lung function.
  • Potassium: is required for muscle contractions. It is very important for the heart muscle. High or low levels of potassium can cause an irregular heartbeat. Some diuretics cause the kidneys to release large amounts of potassium from the body. If you are taking diuretics, your doctor will check your potassium levels. You can keep good potassium level by eating foods high in it. These include: milk, yogurt, winter squash, tomatoes, apricots, cantaloupe, bananas, oranges, prunes, carrots, potatoes, raisins, spinach, and dates, salmon and dairy.
  • Good fats: less than 5 grams per serving, twice a day, am and pm, olive oil or ghee is recommended. Limit trans fats and deep-frying, fatty foods. High fat foods are digested more slowly.

Please use the links below for specific dietary guidelines, for your specific age group.

The Relationship between Drugs and Nutrients: some respiratory medicines can have an effect on your nutritional needs. In addition, the foods you eat can change a drug's effectiveness. For example, calcium can lessen the effectiveness of antibiotics if taken to close to the time of administration. Grapefruit juice can also affect the potency of an antibiotic. For more information about the relationship between drugs, nutrients and food, please speak with your doctor and or pharmacist.

Many of us look fine, not overweight, and not extremely underweight. Many of us have an invisible disorder; we are continuously on off antibiotics throughout the year. I denied the importance of food for many years until I suffered the consequences of doing so. Nutrients work like an orchestra; you must have the right combination for all to work well together. If we are missing one nutrient, some of our body systems slow down or malfunction. Remember, our gut, brains and lungs are all interconnected. Cravings are a sign of a deficiency, we crave sugar when we are low in minerals; we crave salt when low in magnesium.

Many of us do not have the energy to food shop, cook, clean up and do it over and over again when not feeling up to par; it becomes a vicious cycle of eating poorly. Change is very difficult; however, we have to look towards the possible end result of having more energy.

What is your specific goal, your motivation to eat healthier? What inspires you to truly take lasting action? Who will support you in making changes? We can assist each other thru this online community.

I will be posting articles on nutrition over the next month. I would greatly appreciate your suggestions, recipes to assist all of us on this journey. Remember, small, committed steps will become more beneficial rather than diving in full speed and being unable to sustain. Good nutrition can help you to have a better quality of life, which is what we all strive for.

The COPD Foundation advises that before you make any changes to your medications or therapies that you first consult with your doctor.