Idiopathic pulmonary fibrosis (IPF), a chronic disease that can cause scarring (fibrosis) in the lungs and limit how well they function, can make eating challenging.
Chewing can interfere with the shallow breathing that many people with IPF experience, and a full stomach may limit how well the diaphragm (the main muscle used for breathing) moves, says John Watson, MD, a board-certified pulmonologist with Sentara Health, based in Charlottesville, Virginia. Coughing can also interrupt meals, and some IPF medications can cause nausea or loss of appetite.
All of this can make it difficult for people with IPF to get consistent nutrition and maintain a healthy weight.
However, there are effective ways to manage IPF symptoms while eating. Talk to your healthcare provider about which of the following strategies are best for you.
1. Choose Smaller, More Frequent Meals
Rather than eating three large meals a day, you may find that smaller, more frequent meals work best when you have IPF.
Ideally, this means eating five or six small meals a day, says Dr. Watson.
Keeping portions small helps prevent your stomach from becoming overly full, which gives your diaphragm more room to move and can make breathing feel easier during and after meals, Watson explains.
2. Take Small, Slow Bites
Rodeo Abrencillo, MD, a board-certified pulmonologist at UTHealth Houston and an associate professor of medicine at McGovern Medical School at UTHealth Houston in Texas, suggests taking small, well-chewed bites.
“Smaller bites are easier to swallow to prevent aspiration — which is when food or liquid goes into the airway instead of the stomach — and choking events,” he says.
For people with IPF, eating can be considered similar to exercising, says Watson, meaning your body needs extra oxygen during meals. He encourages eating slowly and pausing between bites to help you stay comfortable and manage shortness of breath.
3. Soften Your Foods to Save Energy
For someone with IPF, the physical effort required to chew food can lead to fatigue and shortness of breath.
“The chewing process can interfere with the rapid, shallow breathing pattern seen in people with more advanced lung disease,” says Watson. “Shortening the chewing process can help control shortness of breath during mealtime.”
Choose soft and moist foods to help reduce that strain, since they take less effort to chew, says Dr. Abrencillo.
Examples include these foods:
- Yogurt
- Scrambled eggs
- Oatmeal
- Soups and stews
If you’re eating meat, leaner, thinner slices and tender cuts are often easier to handle, Abrencillo says.
It can also help to take small sips of water as you eat. This can help moisten food so it’s easier to swallow, says Abrencillo. Try to slow down and pay attention to each bite and swallow. Taking a moment to clear your throat before your next breath can reduce coughing and make eating feel less stressful.
4. Prioritize Nutrient-Dense, High-Calorie Foods
Since you’re eating smaller meals throughout the day, making each one as nutritious as possible becomes important.
“Maintaining a healthy weight and preventing loss of muscle mass helps prevent further progression of shortness of breath and prolongs life,” says Watson.
This means including nutrient-dense foods like fruits, vegetables, and whole grains, as well as lean sources of protein while limiting added sugars and processed fats.
Watson suggests the following ways to add calories and nutrients to your meals without increasing the amount of food you have to eat:
- Drizzle olive oil over vegetables, pasta, and salads to add healthy fat.
- Use nut butters like peanut, almond, and cashew butter on toast and in smoothies.
- Add a few slices of avocado (smash it up if needed).
- Use coconut oil to add calories without changing flavor too much.
- Sip on a nutritional supplement drink or shake as one of your meals for a calorie boost.
If cost is a concern, swaps like beans, frozen vegetables, and store-brand staples can help you eat well on a budget.
Because everyone’s nutritional needs are different, working with a dietitian who understands lung disease is worth considering.
Your healthcare team can help you connect with one.
5. Manage Acid Reflux and Coughing
Many people with IPF also have gastroesophageal reflux disease (GERD), or acid reflux.
Reflux can irritate the lungs and may worsen coughing, so managing it around mealtimes can be helpful, says Watson.
Consider these strategies:
- Track and avoid foods that may worsen GERD symptoms, such as tomatoes, coffee, and chocolate.
- Ask your doctor if taking an antacid medication can help control your reflux.
Medications such as omeprazole (Prilosec) and Famotidine (Pepcid) may be used by some people, Watson says. They either block acid production in the stomach or reduce how much acid is released.
Talk to your healthcare team about whether these make sense for you.
6. Use Supplemental Oxygen During Meals if Prescribed
If you’ve been prescribed supplemental oxygen, wear it while eating to help relieve shortness of breath, says Abrencillo.
Oxygen levels can drop during meals, especially in advanced IPF, he says.
It’s also helpful to keep your oxygen on after you finish eating. Watson suggests using it during the rest period after meals, since your body may still need extra oxygen for a short time as it recovers.
7. Plan Meals Around Your Energy Levels
Watson advises eating when your energy is highest, which for most people is midmorning or early afternoon, he says.
It’s best to avoid eating when you’re already tired or immediately after physical activity, Watson says. Allow time to rest before meals so your body is not already low on oxygen when you sit down to eat.
And plan for 20 to 30 minutes of rest after eating to give yourself time to recover and replenish your oxygen levels, he says.
Cooking itself can be tiring, so consider prepping meals on days when you have more energy.
8. Ask for Support
Managing eating challenges when you have IPF is not something you have to handle on your own. A pulmonologist can help coordinate support, says Abrencillo, and that often involves other specialists:
- A dietitian to help you meet your nutrition needs
- A speech therapist if swallowing is a concern
- A mental health provider if you’re experiencing anxiety or depression
Joining a pulmonary fibrosis support group can help you connect with others facing similar challenges, share tips around living with the condition, and find emotional support, Abrencillo says. Ask your care team about local support groups. You can also find virtual and in-person support groups through the Pulmonary Fibrosis Foundation using its online search tool.
The Takeaway
- Eating slowly and having small, frequent meals that include soft foods such as yogurt and scrambled eggs can help make mealtimes more comfortable when you have IPF.
- To help maintain a healthy weight, consider high-calorie, nutrient-dense choices, including healthy fats and nutritional supplement drinks.
- Use prescribed supplemental oxygen during and after meals, plan to eat when your energy is highest, and avoid common acid reflux triggers such as tomatoes, coffee, and chocolate.
- Nutrition issues, unintentional weight loss, and increased shortness of breath during meals should be discussed with your healthcare team so you can get the support you need.
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