Eating More Fruits and Tomatoes May Improve Lung Function

Eating More Fruits and Tomatoes Associated With Slower Decline in Lung Function, Particularly in Ex-smokers

Background: In healthy adults after 30 years of age, there is a gradual worsening (decline) in lung function. This is considered a normal part of aging.

However, in someone who has COPD and continues to smoke, lung function worsens (declines) at a rate 2 – 3 times faster than a normal healthy person. Stopping smoking is important for those with COPD because it slows down the worsening in lung function.

Eating more fruits and tomatoes is healthy.

Fruits and vegetables

Whether diet affects changes in lung function over time is unclear. It has been suggested that eating foods rich in antioxidants (fruits and vegetables) may also help to slow down worsening.

Dr. Vanessa Garcia Larsen

Vanessa Garcia Larsen, Ph.D., is Assistant Professor of Human Nutrition at the Johns Hopkins Bloomberg School of Public Health

Study: Dr. Garcia Larsen and colleagues from the John Hopkins Bloomberg School of Public Health studied adults from three different countries (Germany, Norway, and the United Kingdom) 10 years apart. In 2002, subjects answered questions about the types of foods that they ate and how often (called a food frequency questionnaire) and also performed breathing tests. Ten years later, these same subjects were invited to return for repeat breathing tests. The study was published on-line on December 21, 2017, in the European Respiratory Journal.

Two breathing test results were evaluated: 1. the amount of air exhaled in one second called FEV1; and 2. the total amount of air exhaled called FVC.


FEV1 is used to grade COPD severity and assess COPD prognosis

Diagram of spirometry to diagnose COPD. FEV1 is the amount of air exhaled in one second.


Results: A total of 680 individuals were evaluated at the two time periods as part of the European Community Respiratory Health Survey. Average age was 44 years. Over 40% smoked cigarettes at some point during the ten years, and 16% were current smokers at the time of the 2nd breathing tests. On average, subjects in the study ate four fruits each day.

Eating fruits and tomatoes including tomaotes slows decline in lung function

Jar of tomatoes

The major findings were: 1. in all subjects, eating tomatoes was associated with a slower decline in both FEV1 and FVC – this was particularly evident in ex-smokers; 2. a higher intake of fruits in middle-aged individuals was associated with a slower decline in FEV1; and 3. a higher intake of apples, bananas, tomatoes, herbal tea, and Vitamin C was associated with a slower decline in FVC.

Conclusions: The authors concluded that eating more fruits and tomatoes is associated with a slower decline in lung function, particularly in ex-smokers.

My Comments: Although this study was performed in the general population, the results appear to be relevant to those with COPD. Many fruits contain various antioxidants that reduce inflammation in the body including the lungs. Tomatoes are rich in lycopene – a carotenoid – which also has antioxidant activity.

I encourage those with COPD to try – eating more fruits and tomatoes – as part of your daily diet. These are natural foods that are not only heart healthy, but may also help to slow worsening of lung function.



How Can I Boost My Immune System to Prevent Chest Infections?

Foods to Boost the Immune System

Dear Dr. Mahler:

I want to know what I can do to prevent chest infections this coming winter. Each winter season I seem to get 1 or 2 flare-ups of my COPD which are due to bronchitis. Each time I am treated with an antibiotic and prednisone, and it can take up to a month for me to recover completely. I have had COPD for about 8 years, and take Symbicort inhaler in morning and evening along with ProAir for breathing problems. I get a flu shot every fall and have received both pneumonia shots. I am willing to try new things. Many thanks.

Ralph from Morris, IL

Dear Ralph:

Your question is important for everyone who has COPD. Avoiding chest infections is “key” for feeling well and keeping active throughout the winter months. Some people who have a flare-up (called an exacerbation) find that recovery from an episode may take weeks to months, and that prednisone may need to prescribed for longer than the usual 5 – 10 days.

You didn’t mention whether you smoke or not. Remember, cigarette smoking and inhaling irritants in air damage the lining of the breathing tubes (airways) that make it easier for viruses and bacteria to infect the chest. So, it is important that you do not smoke and avoid inhaling smoke, dust, fumes, etc.

Here are some foods to consider which can boost the immune system:

Button mushrooms can boost the immune system

Button mushrooms

  1. Button mushrooms – contain selenium, riboflavin, and niacin
  2. Blueberries, elderberries, and acai berries – have antioxidants
  3. Oysters – contain zinc
  4. Watermelon – has glutathione, an antioxidant
  5. Low fat yogurt – contains probiotics, or good bacteria, which may ease the severity of colds.
  6. Spinach can boost the immune system


    Spinach – has folate and vitamin C

  7. Tea – contain polyphenols and flavonoids
  8. Sweet potato – contains beta carotene
  9. Broccoli – has vitamins A and C as well as glutathione
  10. Garlic – contains allicin, a sulfur compound responsible for health benefits
  11. Miso – has probiotics
  12. Chicken soup – contains carnosine
  13. Pomegranate juice – contains punicalagins, an antioxidant, and folate
  14. Ginger – has antioxidants

I encourage you to try 1 or 2 of these different choices every day in order to boost your immune system. Also, stay active and avoid touching your face with your hands.


Donald A. Mahler, M.D.



Sweet potato

Sweet potato

New Inhaler with Ectoin® Protects Against Effects of Air Pollution

Inhaled Ectoin® Provides Natural Barrier in Airways

Dear Dr. Mahler:

I live in London where there we have air pollution. My COPD is fairly stable, but I have breathing problems when I go outside and walk my dog. I check the air quality index each day, and try to limit activities to early AM and late afternoon. However, both my dog and I have to get out of the apartment several times a day or else we go crazy. Is there anything else that I can do?

Willie of London, UK

Dear Willie,

As you know, outdoor air pollution is a global health issue that kills over 3 million people a year. Research is showing new impacts on health in addition to lung and heart disease, such as Alzheimer’s, mental illness, and diabetes.

A new inhaler has been developed by a German medical device company called bitop AG. The inhaler has a molecule called Ectoin® which was discovered in the 1980s in a desert bacteria. According to Dr. Andreas Bilstein at bitop, “It is quite an inert molecule that does one main thing, which is bind water, which stablizes cell membrane tissues against physical or chemical damage.”

Ectoin may help to reduce damage to airways from air pollution

Particulate matter coming out of smokestacks in city

When inhaled, Ectoin® provides a natural barrier to help prevent damage caused by air pollution particles that can lead to inflammation of the breathing tubes (airways).  Dr. Bilstein stated that the perfect situation is that the person inhales it in the morning and evening at home.

So far, the inhaler has been tested in small groups of patients with asthma, COPD, and bronchitis considered to be at risk from air pollution.

Ectoin® does not interact with cell receptors so it is classified as a medical device rather than a drug. This means that large clinical studies are not required for official approval and the inhaler could be on sale soon. The estimated cost will be 17 pounds ($22) per month.

Bitop AG is the worldwide producer of Ectoin®. The company has about 35 employees with headquarters in Witten, Germany.

I suggest that you keep an eye out for when Ectoin® will be available. In the meantime, considering eating a lot of fruits and vegetables. These foods contain antioxidants which can provide some protection from inhaling air pollutants.


Donald A. Mahler, M.D.

Lifestyle Options to Reduce Inflammation in COPD

How to Reduce Inflammation in COPD

Dear Dr. Mahler:

I read in your book that inflammation is part of COPD.  What does that actually mean?  I am 67 years old and was diagnosed with chronic bronchitis form of COPD about 3 years ago.  I quit smoking at the time, and still work selling real estate.  If inflammation is bad, what can I do to get rid of it? Thanks.

Bill from Pensacola, FL

Dear Bill,

In Latin, inflammation means “set afire.”  It is an important part of the body’s immune system to heal an injury or fight an infection. However, if this persists and is chronic, inflammation plays a key role in various diseases – like asthma, diabetes, heart disease, bowel disease – in addition to COPD.

woman holding candle

Smoking cigarettes and inhaling irritants causes injury to the breathing tubes and air sacs.  In response, the body calls in, or recruits, white blood cells to the area of injury.  This results in redness and swelling of the area – the features of inflammation.  See the figure on the right below.

Right photo shows acute bronchitis with inflammation

Photo on right shows acute bronchitis with yellow mucus inside the airway along with redness and swelling of the wall.

If someone continues to smoke, the inflammation persists and becomes chronic. This causes swelling in the lining of the breathing tubes that narrows the opening and reduces the ability to exhale air. In addition, inflammation makes it more likely that the muscle that wraps around the breathing tubes will constrict or tighten. This is called bronchoconstriction and further reduces the flow of air out of the lungs.

Here is what you can do to try to reduce inflammatory changes in your lungs:

  1. Don’t smoke.  It is great that you already quit.
  2. Avoid inhaling irritants in the air like smog, dust, smoke, fumes, fibers, soot, etc.
  3. Eat healthy foods that includes lots of fruits, vegetables, whole grains,


    beans, nuts, olive oil, and fish especially salmon –  that have anti-inflammatory effects.  Blueberries are the BEST.

  4. Consider spices – such as ginger root, cinnamon, clove, black pepper, and tumeric – which may provide anti-inflammatory benefits. More research is needed to know whether these and other spices help with inflammation in COPD.
  5. Get enough sleep. Studies show that when healthy individuals are sleep deprived, there is an increase of inflammation in the body. How this happens is unclear.
  6. Try to exercise at least 3 – 4 times a week.k13084522
  7. For a treat, eat dark chocolate which is loaded with organic compounds that are biologically active and function as antioxidants. These include polyphenols, flavanols, and catechins.


I hope that this information answers your question.

Best wishes,

Donald A. Mahler, M.D.