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The COPD Advocate    An SOB In The Kitchen   Appendix

A. The 'BMI' Calculation

An example of a statistical tool available to dieters is the new Body Mass Index (BMI), attributed to the federal government, who is encouraging its use to determine the degree of a personís obesity. I provide it for your information and amusement, assuming it will tell you nothing you havenít already learned from your mirror. However you look at it, it does allow you to objectively quantify your weight problem.

1) multiply the subjectís weight, in pounds, by 703
2) square the subjectís height, in inches
3) divide the result of step 1 by the result of step 2.

If the result obtained in step 3 is between 25 and 29.9, the subject is "overweight;" if it is above 30, the subject is considered to be "obese." From these values, it seems logical to believe that one scoring 18 or less should be considered "underweight."

B. Re-educating The Taste Buds

Iím not going to tell you to eat all the foods you think you hate, but you may have to change your eating habits, if you are to properly manage your COPD.

Before you argue, remember how you developed your tastes, in the first placeÖ on your motherís lap, taking a taste of this, a taste of that. If she happened to be a Georgia belle, you probably like country ham, beans, cornbread, and smothered fried chicken; if you were raised in Louisiana, you will forever crave Cajun boil, red beans and rice, and oysters on the half-shell. But it took years for you to develop that palate to its present state, and it may take a while to retrain it. You may or may not like it, but it isnít going to hurt you.

The dishes and menus Iím going to suggest will emphasize natural taste, varied textures, attractive colors, blends of flavors, varieties of temperatures, and the highest nutritive quality possible. I will try to make each as simple as possible to prepare but, at the same time, interesting and tempting.

If your palate, or taste buds, or appetite, or whatever you prefer to call it, is hindering the successful management of your COPD, you darn-well better take control of the situation. I hope that this booklet introduces you to a new world of eating. Youíll meet lots of raw vegetables and some fruits that are new to you. There will be strange one-dish combinations, delightful salads, easy sandwiches, and new condiments.

Keep your mind open and weíll have fun with this project.

C. Reading Food Labels

Food manufacturers and packagers are required, by federal law, to provide certain information on their labels.

The first is the list of ingredients, identifying everything used to make the product. It is not a recipe, because it doesnít reveal quantities, but it does list them in descending order of their amounts used. If it says, "flour, water, salt, wheat bran, calcium propionate, food color," you can be pretty sure itís mostly flour and has precious little wheat bran. This information is invaluable to those with food allergies but of limited use to those seeking nutritional data.

Thatís where the "Nutrition Facts" label comes in. The format of this label is pretty standard, but you must understand that some data is stated in a confusing manner. "Serving Size" is one of these, and itís the first item listed. The manufacturer does not have to match his serving size to the USDAís recommendations, so his cold cereal (because it is so dense, or has raisins and nuts in it) may have a serving size of Ĺ cup, while another brand (because itís so puffed up) suggests 1 Ĺ cups. Each varies 50% from the USDA guidelines.

The next item is "servings per container." If you use this for price comparison, beware of differences in serving size.

The next line tells you the total caloric value per serving, and the Calories that come from fat (or oil). This can help you plan and calculate your caloric intake.

You then find a table that lists TOTAL FAT (followed by Saturated, Polyunsaturated, and Monounsaturated); CHOLESTEROL; SODIUM; TOTAL CARBOHYDRATES (followed by Dietary Fiber, and Sugars), and; PROTEIN. For each of the nutrients they show the amount contained in a "serving," in grams, and the percentage of "Recommended Daily Requirement" this "serving" represents. The amounts of fats (and types of fats) and or salt and sugars are critical to those who must limit their intake of these nutrients; the rest of the information will be of interest to those unfamiliar with nutritional guidelines but, in time, will be ignored. The "% Daily Value" is based upon a diet of 2000 calories per day; if your diet varies from this arbitrary standard, the numbers must be adjusted. Unless your doctor advises differently, I suggest you ignore this column.

D. About "Standards" and "Calculations" For Nutrition

The folks who research food values for animals have "laboratories" where the "subject" dogs, cats, cows, or pigs, are individually caged, and fed various diets that are meticulously concocted and weighed (as is the water they drink), while all the feces and urine they excrete is carefully collected, weighed, and analyzed.

From these tests, they can report that the average mature dog requires about this much of that, and that much of this, just to maintain its body weight, while resting, or that the average pig requires given amounts of protein, carbohydrates, and fats, to grow from twenty pounds to 220 pounds in five months.

But, if you were to see the raw data, you would be quite likely to find that, of the 100 dogs in the test (all of the same breed, because we want to remove every variable possible), some used only 85% as much food, while one used as much as 125% of average. The differences may be only plus/minus 5% for 80% of the animals, but individual differences in disposition, thyroid activity, and other genetic traits can make for significant variances. (In the modern farm enterprise, only the "thrifty" producers are used for breeding purposes; the beasts that eat too much are culled from the herd.)

Those of you with a serious weight problem should, with your doctors help, consider all variables when setting up a nutrition program for you, and this certainly should include investigation into over- or under-production of certain hormones. If you have a nervous disposition, or tend to be obsessive-compulsive, or are a chronic worrier, youíre wasting valuable calories. If, on the other hand, you are sedentary or tend to be psychologically depressed, you may not be burning off enough energy.

We should also mention the importance of fluid intake. Your diet must include enough "liquids" to meet you needs and to keep mucous production more manageable. The "standard" medical advice is, "drink eight glasses of water daily." Some Iíve heard even suggest that it must be water; that other drinks "donít count."

The facts are that eight glasses is an average and that it is far too much for a seventy-year old couch potato who stands five-four and weighs 120 pounds, and far too little for the young bricklayer, toiling in the August sun, standing six-five and weighing 220. You get water from virtually every liquid you drink (liquors being the exception, because the high alcohol content offsets the waterís benefits) and from some foods: coffee or tea are 100% water; milk is 87 to 90%, fruit juices are at least 80%, and raw vegetables may be from 40% to 80% water. Also see Fluids & Water.

MORAL: Average values for diets are excellent for average people; for everyone else, they must be "taken with a grain of salt." (A bit of common sense wouldnít hurt, either.)

E. Sodium-Free Diets, Lactose Intolerance, Etc.

For those who are diabetic, have a problem with cholesterol, must watch your sodium intake, of have other dietary limitations, please study these guidelines I have established for my menus and recipes, and consult with your physician for advice on adapting them to your use:

  • the recipes suggest minimal use of sugar and salt in food preparation; add it at the table, as you are able and inclined.
  • most recipes use olive oil, canola oil, or peanut oil for cooking and baking; the use of butter (as a source of energy) is optional; to keep oil consumption at a minimum, use "pan sprays" for frying and prepare meat, poultry, and fish by broiling or baking.
  • lactose intolerance (that resists treatment with rennin products) will simply mean you must limit your menus to dishes that contain no dairy products.
  • watch for food allergies; you can often substitute ingredients without significantly altering the nutritional values.
  • I make use of lots of beans and raw (or al dente) vegetables, considered by many to be sources of stomach and abdominal gas; if you encounter the problem, try using a product like "Beano" before abandoning the menu.
  • if you follow the "food pyramid" guidelines for balance in your diet, and my suggestions for variety and preparation, you will probably get an adequate supply of vitamins and most minerals; still, when I consider our chronic illness, and with generic brands so inexpensive, I suggest you take one "complete" vitamin (with iron) daily.
  • regular exercise is an aid to good digestion, provided it is started at least an hour after a meal; it stimulated the action of both the small and large intestine.
F. CO2 Production/Retention

Many texts and diet guidelines have, historically, urged COPD patients (especially those with severe emphysema) to follow a "low carbohydrate-high fat" diet, stating that fats and oils provided energy but produced less carbon dioxide than equivalent carbohydrates. These suggestions were based on experiments with laboratory animals and the application to human diet was extrapolated from these data.

My research, which includes conversations and correspondence with qualified nutritionists, indicates this theory to be unsubstantiated. In effect, my sources agree that, calorie for calorie, the metabolism of a calorie of food produces the same amount of CO2, water, and energy, regardless or whether it came from ingested carbohydrate, protein, or fats/oils. (This is supported by Drs. Thomas L. Petty and Brian Tiep, in the booklet "Essentials of Pulmonary Rehabilitation," co-authored by Mary Burns, RN, and published by The Pulmonary Education and Rehabilitation Foundation.)

The subject is pretty much moot, however, in my suggested menus and recipes, because, by stressing the use of nuts, seeds, whole-milk dairy products, butter, and vegetable oils, I stress (except for those who are significantly overweight) a diet that is relatively high in healthy fats and oils.

G. Herbs and Spices

Allspice pot roasts, meatballs, mild fish, chicken, barbecue sauce, cabbage
Basil beef, pork, mild fish, chicken, omelets, tomato/sauces, asparagus, beans
Chili powder meat loaf Welsh rarebit, beef stew, chili, cauliflower, onions, peas
Cilantro salads, stews, soups
Cinnamon ham, pork, stewed chicken, fruits, carrots, onions, sweet potatoes
Cloves ham, corned beef, baked beans, bean or onion soup, squash
Cumin beef, pork, Mexican dishes
Dill weed beef, lamb, rice dishes, salmon, deviled eggs, cabbage, cream dressings
Ginger baked beans, rice dishes, baked chicken, bean or onion soup, carrots
Mace meat loaf, Welsh rarebit, baked mild fish, vegetable soup, cabbage
Marjoram beef, pork, scrambled eggs, salmon cakes, chicken or potato soup
Nutmeg meat loaf, fried chicken, salad dressings, carrots, cauliflower, corn
Oregano any Italian dish with tomatoes, beef soup or stew, cabbage, onions
Rosemary soups, beef, fish, poultry, soups
Sage pork, chicken, omelets, chicken or tomato soup, lima beans, squash
Thyme roasted beef, pork, chicken, or turkey; omelets, tomato, carrots, peas

H. Glossary

Acids/bases Terms used to describe an ingredientís acidity, or pH level. Of importance in chemical reactions required for baking, marinating, and maserating, and critical to the flavors imparted . Common acidic ingredients are vinegar, citrus juices, and wines. Baking soda is a common basic ingredient.
Carbohydrates A group of nutrients formed as compounds of carbon and hydrogen, comprised primarily of two groups: sugars and starches. They are generally easy to digest and some are completely soluble in water. They are primarily found in fruits, grains and nuts. Sugars may appear on a food label as glucose, dextrose, fructose, or lactose, for example, while carbohydrates may be called flours or glutens.
Enzymes Complex secretions of the several glands in our bodies that cause or facilitate chemical processes in our digestive tracts, muscles, and bones.
Minerals Those materials, including calcium, phosphorus, potassium, iron, and zinc, required for building and maintaining bones, teeth, blood, nerves, etc. Those required in only minute amounts are called "trace minerals."
Oils and Fats Important nutritional ingredients that are most frequently found in butter, lard, oleomargarine, "cooking oil," and suet. The difference between an oil and a fat is that, usually, oils are liquid at room temperature and fats are not. Important sources of energy, for those with a cholesterol problem, they should be clearly understood to be either "saturated," "polyunsaturated," or "monounsaturated."
Proteins This is a family of complex foodstuffs consisting of any of a mind-boggling array of "building blocks" called amino acids. The human body can manufacture some amino acids (and, therefore, some proteins) but a number of the "minor" proteins must be obtained from the foods we eat. This necessitates a significant diversity in the "balanced" diet.
Salts There are many "salts" in nature, including magnesium hydrate or, calcium carbonate, but the one of primary interest in nutrition is NaCl (sodium chloride), or "table salt. It is significant because, being such an excellent flavor enhancer, it is used extensively and, for those who have high blood pressure, or edema, it is to be kept at the lowest level possible.
Vitamins A family of compounds required to aid the chemical processes in our bodies. Some are manufactured by our various organs (when we are healthy and eat well) and others must be obtained in our diets.

I. How To Boil Water

If you are a stranger to the kitchen, the following explanations may make it easier to follow recipes you read here (and elsewhere).

Food Preparation

Chop: cut into pieces, size is usually stated; if not, try Ĺ inch square
Dice: chop into pieces ľ" square
Mince: chop into pieces 1/8" square or smaller
Slice: self explanatory; the thickness should be uniform, as specified
Cube: (usually applied to meats) means to slice or chop into bite sizes
Julienne: slice and cross-slice, form long, uniform shapes, like French fries
Chiffonade: make thin strips of leafy foods by rolling them, then slicing
Grind: produce a fine-to-coarse powder, using a mill or similar device
Grate: produce a coarse "grind" or fine "mince," using a "grater"
Puree: produce a thick liquid, usually in a blender or food processor
Peel, pare: to remove the skin or peeling from a fruit or vegetable
Essence: the thin outer peel of a citrus fruit containing the essential oils
Mix: to combine ingredients
Blend: to mix ingredients (such as sugar and butter) to a smooth texture
Beat: to mix vigorously
Whip: to mix vigorously at high speed, so as to incorporate air
Whisk: similar to "whipping," by hand, often to emulsify a mixture
Stir: a synonym of "mix" usually applied to a cooking technique
Fold: careful mixing of beaten egg whites into a batter
Marinate: soaking a cut of meat in a liquid or paste to flavor or tenderize
Macerate: "marinating" of vegetables
Fillet: to produce a boneless cut of meat or fish (a filet)
Tenderize: to pound a cut of meat and break-down coarse fibers
Dredge: coat with flour, usually seasoned, prior to frying
Bread: coat with a flour batter, or eggs and flour, prior to cooking

Cooking

Boil: cook rapidly in a pot or kettle, the liquid surface bubbling actively
Simmer: to boil gently, the surface showing only small bubbles
Blanch: to emerse a vegetable in boiling liquid only briefly, then cool
Steam: cook over boiling liquid in a covered pan or pot
Poach: similar to "steam" and usually applied to eggs, meats, fish
Steep: to place item in boiling water, remove from heat, allow to stand
Fricassee: to simmer meat with aromatic vegetables, covered with liquid
Braise: similar to fricassee, with liquid only partially covering meat, lid on
Bake or roast: cook in the oven (may be covered or open)
Fry: cook in a skillet, with an oil or fat
Deep-fry: cook quickly in a kettle or saucepan, in a large quantity of oil
Saute: to fry gently and briefly
Stir-fry: to fry in a small quantity of oil at high temperature
Broil or grill: cook at high heat on a grilled surface without fats or oils
Barbecue: to cook at low heat on a grill, using a spicy marinade/sauce
Sear: heat each face of a cut of meat to seal in the juices before roasting
Brown: similar to searing, the meat is more thoroughly cooked
Deglaze:loosen bits of meat and juices adhering to a pan, to use in sauces
Al dente: cooked only to the "firm to the bite" stage
Fork tender: the stage of cooking when a fork will pierce the food easily
Garnish: add color or interest to a plate or dish (e.g., parsley, orange peel)

J. Helpful Web Resources

The Internet has many sites that offer information on nutrition and diet. The ones I have selected list seem to be reasonably easy for the lay-person to understand and to offer some depth and complexity to those who wish (or must) make their diet more of a science project. I have examined each site and deem them reliable, but I specifically disclaim responsibility for their content, and for any financial interest in the websites or any products mentioned.

You Are What You Eat: A Guide to Good Nutrition is quite comprehensive (though difficult to navigate). I especially recommend the sections which offer The Food Guide Pyramid, Food Labels, and Food Counter. Bookmark Eating Right with CyberDiet. It contains listings of every food you can imagine.

Johns Hopkins offers Dietitian - Healthy Body Calculator, Medical Nutrition Therapy, Fluids & Water, and Food Fallacies & Quackery

Living With COPD: Your Nutritional Status is from the Cheshire Medical Center.

On a low-fat diet? Read Cholesterol & Saturated Fat

The University of Illinois offers personalized caloric-need calculator at Nutrition Analysis Tool.

I've included a site on Natural Nutrition.


Rejoin An SOB In The Kitchen.

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