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“Nutrition and ILD”—A PFF Disease Education Webinar (Part One)

“Nutrition and ILD”—A PFF Disease Education Webinar (Part One)

What role does diet play in PF? Gain valuable insights from a registered dietician-nutritionist

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As part of its Disease Education Webinar Series, the Pulmonary Fibrosis Foundation presented “Nutrition and ILD” on August 16, 2017.* The webinar was presented by the PFF’s Chief Medical Officer Gregory P. Cosgrove, MD of National Jewish Health (NJH) and featured Michelle MacDonald, MS, RDN, CDE, a clinical dietician supervisor and certified diabetes educator also from NJH.

Roughly one hour in length, below is a detailed overview of the first 30 minutes.

Part of disease therapy

  • Our food choices do make a difference, says MacDonald. Nutritious foods can help patients to not just feel better, but possibly manage PF/ILD better.
  • Nutrition is part of disease therapy, giving energy to breathe, maintain daily activities, and fight infection, for example.
  • The webinar addressed six common ILD/PF patient concerns:

o   Eating with lung disease

o   Eating with acid reflux

o   Dealing with appetite loss

o   Gaining weight, particularly muscle

o   Losing weight

o   Managing drug side effects with diet

Eating with lung disease (3:20)

  • Set a regular eating pattern of three meals and two snacks that are plant-based, well-balanced, and contain lean protein.
  • There is little scientific evidence to support a specific diet for ILD due to lack of research in the area. Further, there is no one-size-fits-all diet. What you eat should be tailored to personal needs: acid reflux, losing or gaining weight, etc.

Eating with acid reflux (6:05)

  • Reflux is food backup from the throat or stomach, which can lead to cough.
  • Risk of aspiration is increased in which food particles are breathed directly into the lungs, raising the potential for lung infection and inflammation.
  • Anti-reflux medications may be prescribed.
  • Besides water, drinks for reflux include coffee substitutes and herbal teas (both caffeine-free); non-citrus juices like cherry and pomegranate; and low-fat milk, which can be plant-based (example, almond).
  • Example foods and drinks to avoid or limit are alcohol; coffee and tea (caffeine is a trigger for reflux); carbonated drinks such as soda; citrus fruits and juices like cranberry, grapefruit and orange; tomatoes and tomato products (juice, sauce, paste); and vinegar.
  • Example foods to enjoy are lean proteins such as beans, poultry, fish, eggs, and non- or low-fat dairy; grains like oatmeal, barley, and brown rice; non-citrus fruits such as (red) apples, bananas, and berries; virtually all vegetables except tomatoes; and herbs/spices.
  • Foods to avoid or limit are chocolate, fatty meats, full-fat dairy, fried and spicy foods, high-fat sweets, hot peppers, ketchup and mustard, and mints.
  • As many of these foods are hard to avoid, MacDonald advises limiting intake to one such food a day (preferably earlier in the day), and avoiding multiple “triggers” at one sitting.
  • Meal timing is also critical, especially with trigger foods. It is best not to eat or drink within three hours of bedtime so the stomach can be emptied before reclining.

Overcoming appetite loss (13:48)

  • Loss of appetite can occur from coughing and tiredness, from inflammation associated with ILD or sickness, and from medication side effects.
  • Appetite loss is a sign of potential sickness.
  •  It should not be accepted and must be managed, as it can lead to loss of beneficial weight such as muscle which is necessary for functionality.
  • Tips for managing appetite loss are viewing food as medicine in which eating is scheduled and “doses” are not missed; eating often in small doses, regardless of hunger, and with purpose (to avoid muscle wasting); enjoying favorite foods at any time of day (example, breakfast foods at dinner); eating when energy is higher; and having snacks at the ready.
  • Easy to prepare and takeout foods are advised: boiled eggs, canned soups and fish, pouched meals, yogurt, dry cereal, instant oatmeal, prepared foods like roast chicken, frozen fruits and vegetables, protein bars and shakes, etc.
  • Avoid hard-to-digest foods such as raw vegetables; gas-producing foods like beans, broccoli, and onions; and diet foods that may not be well tolerated.
  •  A doctor may be able to prescribe appetite stimulants for severe cases. MacDonald has seen these drugs renew the desire to eat.

Gaining weight (22:40)

  • Unintended weight loss can result from, for example, appetite loss, extra work from coughing and labored breathing, drug side effects, and body mass wasting from inflammation.
  • This weight loss can raise risk of not being able to recoup lost body mass, leading to strength loss and weakened immunity.
  • Add 250-500 calories per day to normal intake to potentially gain ½-1 lb per week.
  • 30 grams of protein per meal may support muscle growth to help with breathing and mobility.
  • Stick to a regular eating pattern of three meals and two snacks. Do not skip meals.
  • Avoid filling up on non-caloric drinks such as plain coffee, water, and diet beverages.
  • Consider liquid calories: milk; (non-citrus) juice; and homemade protein smoothies with banana, berries, avocado, and protein powder, for instance. In severe cases, a supplement like Ensure Plus may be prudent.
  • MacDonald emphasizes big portions of protein foods to help reach an extra 250-500 calories per day (example, two or more eggs, a cup of full-fat Greek yogurt, and 4-plus oz of poultry, fish or lean meat).
  • Equally helpful is adding fats and oils to meals, such as avocado, natural peanut butter, cheese, and extra-virgin olive oil.
  • It is important to realize calorie content in each of the major nutrients:

o   1 gram of fat has 9 calories (do not skimp on fat when trying to gain weight)

o   1 gram of carbohydrate has 4 calories

o   1 gram of protein has 4 calories

o   Water has zero calories

  • Example recommended supplements are Naked/Odwalla fruit smoothies and protein shakes, Ensure Plus or Boost Plus, KIND energy bars, and MRM and tera’s whey protein powder brands.

View the full webinar. The webinar can also be found on YouTube where slides can be viewed in full screen mode.

To obtain any slides, additional advice, or referral information, contact the PFF Patient Communication Center at

*Pulmonary Fibrosis Foundation. (2017, August 16). “Nutrition and ILD” [Webinar]. From Disease Education Webinar Series.

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