5 Nutrition Tips for Lung Health

It's been about 6 weeks since I lost my dad from complications of a chronic genetic lung condition called Alpha-1 Antitrypsin Deficiency. This condition is an autosomal co-dominant condition that is relatively rare, with an occurrence rate of 1 in 1500-3500 people with European ancestry (1,2, 3). This condition causes low levels of alpha-1 antitryspin protein. The body naturally produces an enzyme called neutrophil elastase during infections but when not neutralized with the help of antitrypsin protein, the neutrophil elastase can attack normal tissues (like the lungs). This causes lung damage over time and results in emphysema. My dad described his ability to breathe similar to that of breathing through a small straw.

My dad was a big reason why I became a dietitian; I wanted to do my best personally to take care of the healthy and strong body I was given because not everyone is so fortunate to have that. I also wanted to be able to share that with others, so I made it my career. I have been fortunate enough to work with multiple pulmonary populations throughout my career and have helped to support those with the following diagnosis: cystic fibrosis, bronchiectasis, respiratory failure, sarcoidosis, pulmonary hypertension, ARDS (acute respiratory distress syndrome), COVID-19, chronic lung disease and bronchopulmonary dysplasia (in infants). I have cared for patients with lung function within normal range and with severe respiratory failure, those receiving oxygen support through a nasal cannula, those on non-invasive positive pressure airway support (CPAP/BiPAP), and those who are intubated with a breathing tube or have a tracheostomy. Nutrition is important, although looks different, in all of these situations.

I decided to put together some nutrition tips for supporting general lung health. Please note that these may look different depending on each individual's situation. This is not meant to serve as medical advice. Please reach out to your healthcare team for more information on your particular situation.

PROTEIN: consume enough of it.

• Lungs are an organ made up of smooth muscle tissue. When the body does not get enough protein, it is unable to maintain essential functions like supporting the structure of healthy lung tissue.

• During illness, the body uses more protein to make immune components to fight off infection. It is important to get enough protein during these times to support those increased needs.

• If the body is not getting enough energy or it is in a hypermetabolic state (burning more energy than usual), it will break down muscle for protein (amino acids) to make energy through a process called gluconeogenesis (4). It is important to consume enough protein during these times to maintain lean body tissue and organ integrity.

CARBOHYDRATES: consume nutritious options in appropriate portions.

• Carbohydrates are the body's preferred source of energy. Consuming a balanced amount of carbohydrates can support adequate energy for the lungs to complete essential functions. Believe it or not, breathing requires a lot of energy, even in a healthy individual. For those with increased work of breathing, this can increase energy demands significantly. For most adults, an energy intake comprised of 45-65% carbohydrates is appropriate.

• Excess carbohydrate intake can result in excess CO2 production in the body due to the digestion, metabolism, and breakdown of glucose. This amount of CO2 produced is referred to as the respiratory quotient (5). Most people with healthy lungs are able to have adequate gas exchange in the alveoli of the lungs and exhale this CO2. For people with compromised respiratory function, this may be more difficult. Again, balance is key. My recommendation is to combine carbohydrates with fiber-rich foods and protein/fat to help slow digestion and absorption of carbohydrates.

• For those with impaired glucose utilization (insulin resistance and diabetes), elevated blood sugars can increase risk of infection (6). This can impact lung health with regard to respiratory viruses and bacterial or fungal infections. Elevated glucose levels slow blood flow in the body, limiting perfusion of tissues with blood and essential nutrients and oxygen (7). This impacts the health of all organs, including the lungs. Maintaining healthy blood sugar levels is important.

• Carbohydrates are sources of prebiotics (think fiber), which are important to establishing a healthy gut microbiota. Prebiotics serve as a nutrient source for probiotics. The gut microbiota is a complex community of bacteria in the gut that are responsible for supporting many physiological processes like digestion, immunity, inflammatory modulation, and serotonin production (8). A new area of research is focusing on the gut-lung axis, with studies showing some impact on respiratory health for cystic fibrosis, COPD, and asthma (9). Eating fiber rich carbohydrates help to support a healthy guy microbiome (whole grains, fruits, vegetables, legumes).

FAT: aim for choosing anti-inflammatory sources.

• Nutritious fats in the form of omega 3s and poly/monounsaturated fatty acids are helpful in promoting healthy lungs. Omega 3 fatty acids are anti-inflammatory and are associated with lower chronic disease risk, including slower decline in lung function (10).

• Similar to protein, lipids support the structure and function of lung tissue. Pulmonary surfactant that works to keep alveoli (gas exchange sacks in the lungs) open so they can work well is comprised primarily of fat.

• For those with active lung disease, fat is a great source of calories in a small volume. This can be helpful for a couple reasons. People with pulmonary conditions have increased energy expenditure and may struggle to eat enough because it is hard to eat and breathe at the same time. Being able to consume adequate calories in a small volume can reduce work or eating/breathing. Fat metabolism also produces lower levels of CO2 than protein and carbohydrates (5). This makes it a great sources of extra calories for people with obstructive lung conditions that make it difficult to exchange and exhale CO2.

MICRONUTRIENTS: these are important building blocks for health, including the lungs

• Several vitamins and minerals serve as antioxidants which work to reduce the impacts of free radicals that cause inflammation. This is helpful for the lungs as they are directly impacted by inflammation from exposure to environmental pollution and damage from infections. These nutrients include: vitamin A, vitamin C, vitamin E, zinc, and selenium (11). It is ideal to get these nutrients from foods. The best way to optimize micronutrient intake through foods is to eat a large variety of whole foods from each food group.

• Iron is a mineral that helps support oxygen transport throughout the body. Inadequate iron intake and status can make it hard for the body to get the oxygen it needs to vital tissues. Consuming a variety of iron-rich foods from day-to-day is helpful in preventing deficiency. Iron-rich foods include: oysters, beans, lentils, spinach, dark chocolate, and beef (12).

• Emerging studies are showing that appropriate vitamin D status is associated with better lung function (13). This is likely related to vitamin D's function in modulating the immune and inflammatory response. This is a good reason to take some time to get outside and get those lunch walks in. 10-15 minutes of sun exposure to the hands, face, and arms at mid-day during warmer months may be enough to support vitamin D status. This depends on geographic location. The winter months may require supplementation. Talk to your healthcare team about supplementation.

FUNCTIONAL FOODS: probiotics and phytonutrients

• As previously reviewed with prebiotics, the gut-lung axis is an emerging area of study with positive support thus far. Results indicate benefits for overall lung function with a healthy and balanced gut microbiota (8). Probiotics can be found in foods such as yogurt, fermented vegetables (kimchi, sauerkraut, some pickles), kombucha, and kefir. Supplementation, specifically which strain of probiotics, dosing, and timing may vary depending on current microbiome status which requires a stool test to assess.

• Phytonutrients are compounds in plant-based foods that are known for their impact in reducing risk of chronic diseases. They have anti-inflammatory properties. To increase phytonutrient intake, I recommend consuming a variety of fruits, vegetables, legumes, and grains with deep, bright colors. See my handout on phytonutrients for more information.

If this all feels like a lot, my recommendation would be to start small. Think about which foods you can include into your routine to prove more nutrients. For example, if you're having yogurt with breakfast, try adding some berries (phytonutrients) and walnuts (anti-inflammatory fats). If you are used to having meat with dinner every night, swap it out for salmon 1-2x/week. If you are having tacos, add some black beans and rice cauliflower to the taco meat.

There are many lifestyle factors that also go into supporting lung health: environmental exposures, movement, community, and etc. To stay within my scope of practice, I will not be discussing these, but recommend you explore them if you are curious. My biggest take away for mentioning this is, for the love of all things beautiful in life, do NOT smoke (yep, vaping too).

If you have any thoughts, comments, or questions regarding this topic please reach out. I would love to have a conversation about it.

For more information on lung health, see the following links.

American Lung Association: https://www.lung.org/

Alpha-1 Foundation: https://www.alpha1.org/

National Heart, Lung, and Blood Institute: https://www.nhlbi.nih.gov/

Cystic Fibrosis Foundation: https://www.cff.org/

COPD Foundation- Nutrition: https://www.copdfoundation.org/Learn-More/I-am-a-Person-with-COPD/Nutrition-for-Someone-with-COPD.aspx

References:

1. National Heart, Lung, and Blood Institute: Alpha-1 Antitrypsin Deficiency

2. Alpha-1 Foundation: What is Alpha-1?

3. American Lung Association: Alpha-1 Antitrypsin Deficiency

4. Gluconeogenesis

5. Respiratory Quotient

6. Glycemic Control and Infection Risk

7. Impaired Tissue Perfusion

8. Gut Microbiota, Prebiotics, Probiotics

9. Probiotics and Lung Disease

10. Omega 3's and Lung Health

11. Antioxidant Nutrients

12. Iron Health Professional Fact Sheet

13. Vitamin D and Lung Health