General diet modifications for ILD patients

• Eat 5-6 small meals instead of 3 large meals.
• Last meal no later than 7 pm or 3 hours before bedtime.
• Sit up after meals.
• Avoid high-fat foods.
• Limit other foods that increase reflux.

Achieve and maintain a healthy body mass index (BMI). Aim for a BMI of around 20 to 30. Maintaining a healthy weight is important for people with lung disease. Excess weight can increase shortness of breath and puts a strain on your heart, while being underweight can decrease your energy level and make you more susceptible to infection.

Eat a balanced diet with plenty of protein, fresh fruits and vegetables. Protein is the body's building block. You need protein to aid healing and to reduce muscle loss. See our list of high-protein foods and tips for increasing protein in your diet. Carbohydrates should come from fresh fruits and vegetables, rather than processed, high-sugar or starchy foods, which contain more calories and fewer nutrients.

Eat several small meals of high nutritional value. Eating a large meal can leave you feeling too full and can restrict your lungs from fully inflating, making it more difficult to breathe. Eating three smaller meals and three snacks a day makes the stomach less full, leaving more room for your lungs to expand. Make every calorie you eat beneficial to your body.

Eat your main meal early in the day so you'll have more energy throughout the day.

If you wear oxygen, be sure to use it during meals. The body requires lots of oxygen for eating and digestion.

Limit sodium intake. Sodium can cause fluid retention, which may interfere with breathing. You should especially watch your sodium consumption if you're taking prednisone or if you have high blood pressure or heart problems. Try to get no more than 2,400 mg of sodium per day.

Foods especially high in sodium include:

Table salt, the most common source of sodium in our diets. One teaspoon of table salt contains 2,000 mg of sodium.

Processed foods such as:

• Anchovies and sardines
• Chips, crackers, pretzels and nuts
• Frozen dinners
• Ketchup
• Luncheon meats, ham, hot dogs, bacon, sausage and salt pork
• Many breads and bakery goods
• Many canned foods such as soups, vegetables, pork and beans and tomato products
• Many cereals
• Monosodium glutamate (MSG)
• Mustard
• Soy sauce
• Steak sauce

Sodium also occurs naturally in foods. Unsalted, unprocessed foods such as fresh fruits, vegetables, meats and rice often have small amounts of sodium. Most foods in your diet should be unsalted and unprocessed.

Include fiber in your diet. Fiber aids the digestion process and bowel function and should be incorporated into your daily meals. Fiber is found in whole wheat, oat and bran products, fruits and vegetables and beans. The only problem with some high-fiber foods is the excess gas they may produce, which could increase shortness of breath.

Fiber supplements that contain soluble fiber:

• Citrucel

• Nutrisource fiber

Avoid foods that cause gas and bloating. If the foods on this list bother you, eat less of them:

• Apples (raw)
• Asparagus
• Beans (pinto, kidney, black, navy)
• Broccoli
• Brussel sprouts
• Cabbage
• Carbonated drinks
• Cauliflower
• Corn
• Cucumbers
• Melons
• Onions (raw)
• Peas (split, black-eyed)
• Peppers
• Pimentos
• Radishes
• Rutabagas
• Turnips

Limit caffeinated drinks. Caffeine can interfere with some medications and can cause restlessness or nervousness.

Limit alcohol. Alcohol interferes with a good night's rest.

If you have acid reflux, limit foods that increase acidity in the stomach. Spicy foods, caffeine and alcohol can increase stomach acidity and should be limited if you have acid reflux. Avoid lying down for two hours after eating.

For some ways to structure your meal plans, here are some additional resources:

Maintaining a healthy weight is important for people with lung disease. Excess weight can increase shortness of breath and puts a strain on your heart. It can also lead to serious health problems such as type 2 diabetes, heart disease, high blood pressure and sleep apnea. Being underweight can decrease your energy level and make you more susceptible to infection.

A good way to assess your weight is to calculate your body mass index (BMI). BMI is a measure of body fat based on height and weight, and it applies to both adult men and women. You can calculate your BMI with this printable table from the National Institutes of Health, or use UCSF's online BMI calculator.

You should aim for a BMI of around 20 to 30. Certain groups may need to keep the following in mind when calculating their BMI:

• Body builders — Because muscle weighs more than fat, people who are unusually muscular may have a higher BMI.
• Elderly — It's often healthier for the elderly to have a BMI between 25 and 27, rather than lower than 25. If you're older than 65, for example, a slightly higher BMI may help protect you from osteoporosis.
• Children — This BMI information and table applies to adults only. Talk to your child's doctor about what's an appropriate weight for your child's age.

Ways to Add Protein to Your Diet

Milk:

• Drink a glass of milk with a snack.
• Add powdered milk to regular milk to drink or add to any recipe calling for milk, such as pudding, macaroni and cheese, mashed potatoes, custard or casserole.

Cheese:

• Add cheese to sandwiches, toast, tortillas and crackers. Melt cheese on vegetables, pasta and meat.
• Have a bowl of chili with melted cheddar cheese.
• Make a pasta dish with ricotta cheese and sauce, melt mozzarella on top and sprinkle with parmesan cheese.
• Mix cottage cheese with fresh or canned fruit.

Yogurt:

• Have yogurt as a snack; add some nuts or seeds for extra protein.

Poultry and Fish:

• Chop chicken or turkey into small pieces and add two to three ounces to each serving of soup.
• Eat chicken salad as an entree, in a sandwich or on crackers.
• Add ground turkey or beef to spaghetti sauce of chili.
• Have a tuna fish sandwich or just a can of tuna fish as part of your lunch.

Eggs:

• Eat hard-boiled eggs as snacks.
• Eat deviled eggs.
• Make an omelet with whole eggs or egg whites and add shredded cheese, chopped meats and vegetables. You will get less saturated fat with egg whites but you need two egg whites to equal the amount of protein in one whole egg.

Nuts and Nut Butters:

• Have a peanut butter and jelly sandwich or eat peanut butter mixed with a banana.
• Add chopped or ground nuts to muffins, pancakes, milkshakes, stir-fry or other meals and snacks.

Tofu:

• Make a milkshake or pudding pie with silken tofu.

Beans and Legumes:

• Make a bean dip: Layer refried beans, cheese, sour cream, guacamole and other desired ingredients, and eat as is or with chips.
• Eat hummus with pita bread, vegetable sticks or crackers.

Supplemental Drinks:

• Consume supplemental drinks such as Ensure or Boost Plus. The "plus" versions have about 6 to 8 more grams of protein than the regular kind.

All of these ideas can be adjusted to decrease saturated fat content. For instance, use low- or non-fat dairy products such as milk, cheese, yogurt, ricotta and cottage cheese; use egg whites instead of whole eggs; and use low- or non-fat mayonnaise and sour cream.

High-Protein Foods

The amount of protein in common foods is listed below. A good shortcut is that one ounce of meat or fish has about 7 grams of protein.

Beef

• Hamburger patty, 4 ounces — 28 grams
• Steak, 6 ounces — 42 grams
• Most cuts of beef — 7 grams of protein per ounce

Chicken

• Chicken breast, 3.5 ounces — 30 grams
• Chicken thigh, average size — 10 grams
• Drumstick — 11 grams
• Wing — 6 grams
• Chicken meat, 4 ounces cooked — 35 grams

Pork

• Pork chop, average size — 22 grams
• Pork loin or tenderloin, 4 ounces — 29 grams
• Ham, 3 ounces — 19 grams
• Ground pork, 3 ounces cooked — 22 grams
• Bacon, 1 slice — 3 grams
• Canadian-style bacon (back bacon), slice — 5 to 6 grams

Eggs and Dairy

• Egg, large — 6 grams
• Milk, 1 cup — 8 grams
• Cottage cheese, 1/2 cup — 15 grams
• Yogurt, 1 cup — usually 8 to 12 grams
• Soft cheeses (Mozzarella, Brie, Camembert) — 6 grams per ounce
• Medium cheeses (Cheddar, Swiss) — 7 or 8 grams per ounce
• Hard cheeses (Parmesan) — 10 grams per ounce

Beans (including soy)

• Tofu, 1/2 cup — 20 grams
• Tofu, 1 ounce — 2.3 grams
• Soy milk, 1 cup — 6 to 10 grams
• Most beans (black, pinto, lentils, etc) — about 7 to 10 grams protein per half cup of cooked beans
• Soy beans, 1/2 cup cooked — 14 grams
• Split peas, 1/2 cup cooked — 8 grams

Nuts and Seeds

• Peanut butter, 2 tablespoons — 8 grams
• Almonds, 1/4 cup — 8 grams
• Peanuts, 1/4 cup — 9 grams
• Cashews, 1/4 cup — 5 grams
• Pecans, 1/4 cup — 2.5 grams
• Sunflower seeds, 1/4 cup — 6 grams
• Pumpkin seeds, 1/4 cup — 19 grams
• Flax seeds, 1/4 cup — 8 grams

Fish

• Most fish filets or steaks — about 6 grams per ounce
• Tuna, 6-ounce can — 40 grams

People with chronic lung disease use lots of energy to breathe — they can burn 10 times more calories just breathing than someone without chronic lung disease. To prevent unwanted weight loss, follow the guidelines below, as well as those in the General Guidelines for Eating Healthy with Chronic Lung Disease. In addition to preventing weight loss, proper nutrition helps prevent infection, facilitate breathing and maintain a healthy respiratory system.

• Eat a high-calorie, high-protein diet. Concentrate on foods that are calorie-dense but healthy. See our sample week's high-calorie, high-protein meal plan for ideas.
• Add an extra 250 to 500 calories per day. This is how much people losing weight need. See our recipes for high-calorie, healthy snacks to get ideas for how to add these additional calories to your diet.
• Avoid drinking lots of fluids with meals. Fluids may make you feel full and prevent you from consuming the calories you need.
• Consume a high-calorie nutritional drink. Nutritional beverages such as Ensure or Boost can help add healthy calories to your diet.

If you're still not getting enough calories, take a multivitamin and mineral supplement.

High-Calorie and High-Protein Meals

Each meal below has between 400 to 600 calories.

Snacks and Desserts

To get 2,000 calories daily, add two choices from the list below to the sample menu. For 2,500 calories daily, eat three choices from the list below.

People with chronic lung disease may gain weight for many reasons, such as poor diet, medications and lack of exercise because of shortness of breath. This weight gain can be stopped by following the guidelines below, in addition to those in the General Guidelines for Healthy Eating.

Eat a high-protein, low-carbohydrate diet. There is some evidence that this kind of diet may decrease appetite.

Eat carbohydrates in the form of fresh fruits and vegetables, not "simple" carbs. Simple carbohydrates and concentrated sweets, such as cakes, pies, cookies, jams, honey, chips, breads, candy and other highly processed foods are full of empty calories. Fresh fruits and vegetables are full of important nutrients that your body needs.

Limit saturated fat and cholesterol. Choose lean meats, poultry and fish; avoid fried foods and foods with oil, butter, margarine and mayonnaise.

Eat small, frequent meals. This will help satisfy your appetite and make breathing easier than if you eat large meals.

Watch portion size. This  website from the National Heart, Lung and Blood Institute has helpful information, especially the BMI calculator, menu planner and "portion distortion" sections.

You can also print and cut out this Serving Size Card from the National Institutes of Health, as a guide for healthy portion sizes.

Use the plate method to plan healthy meals. It can be modified to fit a high-protein, low-carbohydrate diet.

Exercise regularly as advised. Daily walking, working out at a gym and participating in pulmonary rehabilitation burn calories and help you maintain function, strength and endurance. They also improve your sense of well-being and help prevent muscle and bone loss.

Seek support. You can find support at your local hospital's weight management program, or through organizations such as Weight Watchers.

Medications prescribed for ILD are sometimes associated with gastrointestinal side effects. Below are some tips on how to manage some of these side effects.

Diarrhea 

• Eat smaller meals frequently throughout the day.
• Include sources of soluble fiber to absorb excess water in stools.
• Avoid greasy, fatty, and fried foods.
• Avoid concentrated sweets such as candy, cakes, cookies, and muffins.
• Avoid sweet or sugary drinks such as fruit juices, soft drinks and sodas.
• Avoid foods that cause you gas and cramping.
• Drink fluids between meals. Diarrhea can cause dehydration. Drink liquids such as water, broth, sports beverages, Gatorade, and popsicles.
• Avoid foods and drinks that can have a laxative effect. Examples include prunes, prune juice and apple juice.
• Drink milk if it is a regular part of your diet. Some individuals will experience temporary lactose intolerance during a phase of acute diarrhea.
• Avoid the use of straws, as they can introduce unnecessary gas and cramping.

Nausea

• Eat regular meals 5-6 per day. Having some food in your stomach may help you feel better.
• Try dry Saltine-style crackers, toast, natural potato chips, and pretzels.
• Keep crackers at your bedside if nausea is a problem in the morning or after a nap.
• Try foods that are easy on your stomach, such as oatmeal, rice, or cream of wheat, boiled potatoes or noodle
• Low-fat protein sources such as skinned chicken or tofu that is baked or broiled, not fried
• Peaches or other soft, mild-tasting fruits and vegetables
• Clear liquids such as apple and cranberry juice, low-salt broth, and carbonated drinks without caffeine
• Teas such as ginger and peppermint, served lukewarm or cold.
• Slowly drink or sip liquids throughout the day.
• Stay away from odors. Have someone else cook if possible. Eat in the dining room or in a room other than the kitchen.
• Try colder foods and main-dish salads. Avoid hot foods and hot liquids.
• Track your nausea by taking note of any particular food or events that trigger it. See if there is a pattern, and if so, try to change that pattern.
• Stay quiet after meals. Try to rest while sitting up for about an hour – you can watch TV, read a magazine, talk with a loved one, or enjoy the company of your pet.
• Avoid fried, greasy, and rich foods.
• Don't force yourself to eat your favorite foods when you feel nauseated, as you may develop a dislike for these foods.

Loss of appetite and weight loss

• Eat by the clock rather than by your hunger mechanism.
• Snack between meals.
• Make every bite count.
• Plan for special circumstances.
• Plan your daily menu in advance.
• Request help in preparing your meals.
• Fix several portions of your favorite foods and freeze them.
• Make food visually appealing.
• Appeal to your sense of smell.
• Make your mealtimes pleasant.
• High calorie shakes between meals: some examples include those made by Ensure, Boost, Carnation Instant Breakfast, Orgain, Kate Farm, or your own home-made shakes!