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2 Eat as if what you choose makes a difference. It does.

3 Overview: Nutrition and NTM What should I eat with my lung disease? What can I eat with reflux? I have no appetite. What can I do? How do I gain weight?

4 What should I eat with my lung disease? First, understand the setting.

5 The Setting - The Cycle of Infection & Malnutrition Unintentional weight loss Muscle & fat loss Micronutrient deficiency Lowered immunity INFECTION Each worsens the other Infection nutritional status Appetite loss, Fever Muscle & fat breakdown Nutrient loss Malabsorption Malnutrition immunity MALNUTRITION

6 What should I eat?.. HIGH-CALORIE, HIGH-PROTEIN, NUTRIENT-DENSE FOODS to AVOID weight loss, MINIMIZE muscle and fat losses, REPLETE nutrients, STENGTHEN THE IMMUNE SYSTEM and SPEED RECOVERY

7 Nutritional supplementation Daily multivitamin (MVI) is reasonable choose age-appropriate MVI choose third-party certified supplement avoid megadoses of minerals and vitamins High-dose and/or daily vitamin D may be required Aiming for vitamin D level of 50 Ergocalciferol (5000 IU weekly D2) to treat deficiency IU D3 thereafter as daily maintenance dose

8 What can I eat with reflux?

9 Recommended Beverages: caffeine-free coffee substitutes herbal teas low-fat milk almond, cow, soy and other plant-based milks non-citrus juices apple, blueberry, cherry, grape, pomegranate, etc. water plain, flavored (non-citrus), infused with berries/cucumbers, etc.

10 Beverages to Avoid/Limit: alcohol caffeinated & decaffeinated coffee and tea carbonation chocolate and mint flavors citrus fruits & juice cranberry, grapefruit, lemon, lime, orange, pineapple, tomato energy drinks soda vinegar

11 Recommended Foods: lean proteins beans, chicken, eggs, fish, meat, nuts, seafood, soy, turkey dairy: cheese, milk, yogurt grains barley, oatmeal, quinoa, rice, whole-wheat non-citrus fruits apple, banana, berries, melon, peaches, etc. vegetables bell pepper, broccoli, carrot, cucumber, onion, etc. herbs and spices basil, cilantro, oregano, rosemary, thyme, etc.

12 Foods to Avoid/Limit: chocolate fatty meats bacon, bologna, hot dots, pepperoni, sausage, etc. full-fat dairy cheese, milk, yogurt fried foods chips, French fries, deep-fried chicken/seafood, etc. high-fat sweets brownies, cakes, cookies, donuts, etc. hot peppers black, cayenne, jalapeno, etc. ketchup & mustard mint candy, gum, etc. spicy foods tomatoes and tomato sauce vinegar

13 Other Diet Recommendations with Reflux: Avoid overeating: enjoy small, frequent meals. Avoid drinking fluids and eating food 3 hours before bedtime. Limit fluids to 6 fl oz per hour during the day.

14 I have no appetite. What can I do?

15 You may lose your appetite due to: excessive coughing and/or fatigue being sick (acute and chronic) medication side effects Recognize appetite loss as a warning sign of: sickness risk of weight loss, including beneficial fat and muscle Don t accept appetite loss; manage it to stay strong.

16 Treat food like medicine; food is a drug. take it by the clock, on a schedule, do not miss a dose. don t wait until you are hungry to eat: nibble often. eat with a purpose: if you don t eat, you waste away. Choose favorite foods any time of day. enjoy breakfast foods for lunch, snack or dinner. Eat when you have more energy. Keep snacks handy.

17 Focus on easy to prepare and take-out foods: boiled eggs canned chicken, soup, tuna cheese, cottage cheese, yogurt convenience foods dry or instant cereal frozen fruits, vegetables prepared and restaurant foods protein bars and shakes roast chicken

18 Avoid difficult to digest foods: excessive raw vegetables or whole-grains tough meats Avoid gas-producing foods: will vary by individual beans broccoli, cauliflower Brussels sprouts cabbage onions Avoid diet foods and sugar substitutes.

19 Consider and speak to your doctor about appetite stimulants with severe appetite loss: Dronabinol Megestrol Mirtazapine

20 How do I gain weight?

21 You may lose weight unintentionally due to: appetite loss increased work of breathing due to coughing, shortness of breath medication side effects reduced intake due to coughing, illness wasting due to acute and chronic inflammation affects fat and lean muscle

22 Underweight and weight loss increase risk of: fat and muscle losses that may be hard to recover lower immunity mental and physical weakness

23 Add and concentrate calories in daily diet: intake by calories a day to gain ½-1 lb a week 30 grams protein at each meal may muscle mass Rely on regular eating pattern: 3 meals, 2 snacks add mid-morning and mid-afternoon snacks stop skipping meals

24 Avoid drinking excessive non-calorie beverages: plain coffee, tea, water diet drinks Drink calories: milk: almond, cow, soy and other plant-based milks juice (non-citrus with reflux) homemade high-calorie smoothies with added oils and/or protein powder nutrition supplements

25 Choose big portions protein foods at meals: 2+ eggs 120 calories, 12 g protein 1 cup full-fat cottage cheese 100 calories, 24 g protein 1 cup full-fat greek yogurt 220 calories, 8 g protein 2+ oz cheese 220 calories, 12 g protein 4+ oz chicken, fish, meat 300 calories g protein 1/3+ cup nuts or seeds 150 calories, 5-10 g protein 2+ Tbsp. nut butters 180 calories, 8 g protein

26 Add fats & oils to foods: avocado butter cheese extra-virgin olive oil gravy mayo pesto salad dressing tapenade

27 Supplement as needed: Naked/Odwalla fruit smoothies, protein shakes Ensure Plus or Boost Plus (360 calories per 8 oz) Boost Very High Calorie (530 calories per 8 oz) Orgain Energy or protein bars Clif, KIND, Larabar, thinkthin Protein powders in homemade shakes MRM, SPIRU-TEIN, Tera s whey, etc.

28 Eat well and experience well Michelle MacDonald, MS, RDN, CDE