Maintaining Body Weight

[Thomas3.20.2010]

We get messages especially this time of year about losing weight and staying in shape but for those with COPD the goals of body size are even more important and don't follow the stereotypes. 

With moderate and severe COPD there is a condition called cachexia that we must keep in mind. Cachexia is commonly known as peripheral muscle wasting but research finds it's not only folks with severe COPD that have this. Estimates  speculate that up to 32% of the entire COPD population suffer from some degree of skeletal muscle wasting.

Of greatest concern are skeletal muscles in the legs, which are less likely to be used due to sedentary living.  Weakness, or loss of strength, in this muscle was the main determining factor of diminished tolerance for exercise in 40-45% of COPD patients, at least according to one study.

In order to prevent cachexia, muscles must stay active.  However, when you’re having a hard time breathing, especially when you exert yourself, staying active can become a major challenge or even seem impossible.

This is why it’s so important to get an early diagnosis, and to work with your doctor to develop a COPD treatment program to help you breathe easier. A key part of this treatment program may involve staying as active as possible. You may want to consult the doctor about pulmonary rehabilitation. Don't wait until you're sick! If you have COPD no matter how mild exercise is imperative!

In my case I have so much more chronic bronchitis symptoms I hardly noticed the shortness of breath, I would just push right through it and ignore the discomfort. One sign to look for is if you find yourself breathing through your mouth when you climb stairs or walk for a long time. 

Disuse, hypoxemia or lack of enough oxygen, malnutrition, and systemic inflammation may all cause muscle wasting. Again and again I'll say it exercise, proper nutrition, taking your medications and following your treatment plan will determine your quality and quantity of Life! The time to start is immediately upon diagnosis! There's no catching up later - if you don't follow through consistently use it or lose it - it's that simple!

So what about being overweight? Well, here's the paradox. Being overweight, even obese, is associated with longer survival in COPD patients!

Does that mean you should try to become obese? Well, it's not quite so straightforward.

While overweight/obese patients tend to have better preserved lung function, muscle mass and exercise capacity, all important predictors of mortality in this disease, obesity is a leading cause of heart disease  and is rapidly approaching as the leading cause of cancer. People with COPD who are overweight or obese are also at risk of obstructive sleep apnea, diabetes and rheumatoid arthritis.

So the conclusion of all this is that it;s extra important to find that happy, healthy medium. Speaking only for myself, I choose to be on the high end of normal weight bordering on overweight but not exceeding it. I achieve this goal with exercise and nutrition. But I am not recommending my plan for anybody but me! 

Please discuss the proper weight management for your COPD and always remember that the term COPD is as broad as the term cancer - each and every one of us has our own combination of obstructive respiratory diseases and need our own treatment plan based on our personal disease specifics.

Here's an explanation that was sent to me by Mark W. Mangus, Sr., BSRC, RRT, RPFT, FAARC for cachexia:

"Yours is a common problem among those with COPD of the severity you seem to have.   The cause is burning up more calories than you are taking in ALL revolving around the work of breathing AND the effects of chronic hypoxemia on metabolism.

What we most often recommend is to add a nutritional supplement to one's intake - a supplement that is high in calories, but, with calories packed dense enough to reduce 'volume' of intake.  Years ago I worked with a nutritionist/licensed dietician who had a particular interest and study in nutritional requirements for COPD.  As well, the EAL, a consortium of nutritional experts recently completed an extensive study of the literature to devise guidelines for nutrition for those with COPD. 

Basic to all guidelines has been the addition of 'high-fat' components to the diet, whether in the form of recommended standard dietary components that are high in healthy fats (mono- and poly-unsaturated fats along with healthier saturated fats) as well as supplemental fats through nutritional drinks.  So, with regard to food components, things like peanut butter and avocados, for two examples, are highly recommended.  I have had a nutritional supplemental drink published for many years that consists of Instant Breakfast with added components of ice Cream and based in whole milk for the higher-fat content of the milk.  

One other recommendation that accompanies the guidelines is the reduction in carbohydrate consumption.  Carbs break down into CO2 and water as waster components, the CO2 'adding' to respiratory workload and actually fostering a higher rate of muscle wasting owing to 'catabolic' activity seen in advanced COPD, where the muscles actually 'eat themselves' into a condition of lower mass.  The objective is not so much to "cut" carbs, rather to reduce their proportion within a food component - in this case - the nutritional supplement.  Raising fat component to 40 or 45 % is the objective, resultantly lowering carb proportion to or below 50 %."

So the conclusion of all this is that it's extra important to find that happy, healthy medium. Speaking only for myself, I choose to be on the high end of normal weight bordering on overweight but not exceeding it. I achieve this goal with exercise and nutrition. But I am not recommending my plan for anybody but me! 

Please discuss the proper weight management for your COPD and always remember that the term COPD is as broad as the term cancer - each and every one of us has our own combination of obstructive respiratory diseases and need our own treatment plan based on our personal disease specifics.

We can't change the fact that we have COPD but we do have the power to make the best of what we have!

[MarilynH]

Thank you Thomas....

[elvan]

Thank you very much, Thomas.  It is not a discussion I have had with my pulmonologist...I am on the lower weight scale but I work out on a stationary bike five days a week and I also do upper body work outs.  I don't see evidence of muscle wasting...I work hard so I won't.  I can't carry too much extra weight because of my back and my scoliosis.  

[anaussiemom]

Thank you

[Barb102]

Thank u Thomas   I did not know this.   I had a bone density test and was told my arm and leg bones are thinning. I thought it was age I’m 66 now. But after reading what you explained, and having COPD , I’m wondering if it’s more than just age. I will look into this. Thank you again 

Barb

[constanceclum]

Good info Thomas, thanks.

[Barbscloud]

Quite informative.  Thank you.

[Giulia]

Thank you for the information, Thomas.  

[Wisteria]

Thank you.  That explains a lot.  Last year I went through cancer treatment.  Chemo &  radiation.  I lost weight, but prior to my diagnosis I had also lost weight.  I didn't know I had COPD.  I don't have a morning cough, I don't get bronchitis. I do have extreme shortness of breath which started pretty suddenly and at first was only noticible when I was going upstairs and it has quickly escalated.  I'm only 57 and on O2 at night.  I have no energy.

I also have Addison's disease and hypothyroidism.  The meds I take for that should put the weight on me but they aren't. (steroids)  I'm currently using Cannabis sublingual drops to help increase my appetite.  Since I've just recently started, I haven't seen a change yet.  I'm 80 lbs. Being constantly fatigued, I don't know where to begin to start getting muscle back. Just getting out of bed in the morning gets my heart racing and my breathing labored.  My mom died at 83 of COPD.  I thought I had so much more time.

If you have any suggestions, I'd appreciate hearing them.  I'm on Chantix and my quit date is 11/1.  I've been smoking about 4 per day for the last 3 days...and honestly not truly enjoying them, but I am craving that bit of nicotine.

~Wis

[elvan]

Wisteria‌ I was MUCH thinner before I quit and I didn't watch my diet at all, in fact, I probably "smoked" more than one meal.  I have a stationary bike that I use and it really helps to build leg muscle AND it also actually GIVES me energy.  I do upper body workouts with very small free weights and I use stretchy bands.  I pretty much always worked out.  During the summer, being able to use a pool REALLY helped immensely.  I can't tolerate an indoor pool because the chlorine makes it really hard for me to breathe.  You could try starting with some leg lifts while you are still in bed...you can't go from not doing any exercise to jumping into full blown work outs.  Slowly work your way up.  It really sounds like you would benefit from pulmonary rehabilitation perhaps at a later date.  I have been on steroids for over 26 years and they did not cause my weight to go up.  I am also on O2 at night but I am 69, not 57.  You really are young to have these symptoms but the hypothyroidism is a huge factor.  Stick with it...once you quit completely, I think it will help.  Also, ask your doctor about recommendations.  Are you using any inhalers?  I have two that I use regularly and I have a rescue inhaler handy when I need it.  Doing breathing exercises helps with my rapid pulse and the feeling that I can't breath...deep breath IN, hold and exhale slowly through purse lips.  It helps with relaxing and it helps to get your oxygen saturations up and your pulse down.  My respiratory therapist in pulmonary rehabilitation recommended that I use bubbles to help remind myself how to breathe.  I take a breath in and if I exhale too quickly...I don't get any bubbles.  If I exhale slowly and control my breathing, I get all kinds of bubbles and that's amusing as well as therapeutic.  COPD is not easy to deal with and people who do not have it or have no experience with it don't seem to be able to understand that.  Start slow and with the advice of your doctor.  I did not have a lot of patience with people I cared for who had COPD when I was working as an RN, I had NO idea how terrifying it could be.  The only panic attacks I have experienced in my life have been related to breathing or not being ABLE to breathe.  The more you know about this insidious disease, the better you will be able to deal with it.  I am really glad that you read Thomas's blog....seriously, I have learned more from that man than I EVER learned from my medical education.  That's pretty sad but true.  

Ellen