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COPD and micronutrients

What exactly is COPD?

COPD stands for "Chronic Obstructive Lung Disease" and is a chronic obstructive pulmonary disease that currently affects around 384 million people worldwide and around 10.6 million in Germany.

It is an insidiously developing chronic lung disease with persistent coughing, phlegm, phlegm, shortness of breath (especially under stress) and a feeling of tightness in the chest. The airways are persistently narrow and inflamed.

The starting point is usually chronic obstructive bronchitis.

As a result of COPD, there are frequent infections and the development of pulmonary emphysema ("bloated lungs") with overinflation and destruction of the lung tissue, especially the alveoli and possibly also cor pulmonale (right-sided heart failure) .

In COPD, inflammation, oxidative stress and mucus hypersecretion are responsible for the symptoms.

What are the possible causes of COPD?

  • Mainly pollutant particles (e.g. from smoking, fine dust) or gases
  • Genetic alpha-1-antitrypsin deficiency (AAT breaks down tissue destroyed by inflammation)

What is the classic therapy for COPD?

Classic therapy knows the following measures in particular:

  • Lifestyle change and smoking cessation
  • Breathing training and physiotherapy
  • Bronchodilators, corticoids, mucolytics, oxygen
  • Surgery (e.g. removal of destroyed alveoli, lung transplantation)

What can micronutrients do for COPD?

One in five patients with chronic obstructive pulmonary disease is malnourished, with severe COPD it is almost half . The causes are increased energy consumption due to the disease (more energy is required for breathing due to the narrowing of the airways), insufficient food intake due to a lack of appetite and lower energy production in the mitochondria, since less oxygen is available for "combustion" than in healthy people .

It has also been shown (cf. ESPEN 2006) that in COPD patients a muscle breakdown takes place. This can be due to lack of exercise due to breathing problems, lack of nutrients (see above) and/or chronic inflammatory processes caused by COPD. Therefore, magnesium, which is directly involved in the function of the muscles, is a standard component in micronutrient therapy for COPD. In addition, the protein intake should be slightly increased: to build muscle 2.5 g protein per kilogram of body weight, to maintain 1.9 g/kg (cf. Bargon J, Müller U; nutrition at COPD; Nutrition Review 2012; 2: 96).

After all, about 1/3 of all COPD patients have osteoporosis (cf. ). The cause has not yet been finally clarified, but a connection with therapy with inhalable cortisone (ICS) is suspected (cf. COPD guideline 2018). A sensible supplementation with accompanying osteoporosis is calcium and vitamin D3 & K2 , which is central to the regulation of calcium balance.

Because COPD leads to chronic inflammation in the airways and lung tissue, two components play a central role in micronutrient therapy:

  • Omega 3 fatty acids with a high EPA content (therefore no algae oil should be used, since there is usually only a relevant DHA and not EPA content) (cf. Wey S; Orthomolecular therapy in obstructive airway diseases; EHK 2018; 67(05): 291-300)
  • Antioxidants (e.g. an antioxidant complex such as ANTI-OX) as free radical scavengers, because chronic inflammation leads to free radicals which in turn lead to chain reactions and damage to tissue

In addition to the studies on omega 3 and antioxidants already cited in the Academy article on chronic inflammation (, there are also studies , which have a clear focus on respiratory diseases, such as:

  • "Omega-3 fatty acids increase resistance to pneumonia (due to Klebsiella) in mice through anti-inflammatory effects and upregulation of the unspecific and specific immune system" (cf. Sharma S et l.; Dietary Supplementation With omega-3 Polyunsaturated Fatty Acids Ameliorates Acute Pneumonia Induced by Klebsiella Pneumoniae in BALB/c Mice. Can J Microbiol 2013, 59 (7), 503-10)
  • “Omega 3 fatty acids improve survival, bacterial invasion and inflammation in the lungs in mice. The data can be transferred to humans and improve patient outcome and risk of pneumonia" (cf. Hinojosa CA et al.; Omega-3 Fatty Acids in Contrast to omega-6 Protect Against Pneumococcal Pneumonia. Microb Pathog 2020, 141, 103979)

The amino acid L-cysteine, which will be included as a central component in the new edition of CLEAN , also plays an important role in the context of micronutrient supply in COPD. Here, too, there is a good study situation, such as:

  • “Cysteine ​​1500 mg significantly reduces the exacerbation rate in COPD by 25% compared to placebo, but only after at least 3 months of therapy. In addition, quality of life and activity improved significantly” (cf. Zheng JP et al.; Effect of carbocisteine ​​on acute exacerbation of chronic obstructive pulmonary disease (PEACE Study): a randomized placebo-controlled study; Lancet 2008; 371, 2013-2018)

Flavonoids such as Quercetin are also known to have an immunomodulating effect. And there are already significant studies with regard to diseases of the respiratory tract, such as: Flavonoids (0.2-1.2 g/dg) reduce the incidence of infections of the upper respiratory tract by 33%. The number of sick days decreased by 40% (cf. Sommerville VS et al.; Effect of flavonoids on upper respiratory tract infections and immune function; Adv Nutr 2016).

The two medicinal mushrooms Hericium & Reishi are also an exciting combination. We have written our own Academy article on their importance for the microbiome in the intestine: . And like the lungs, the gut also has a barrier function and microbiota, albeit less than the gut:

The more than 100 known microbiota species (bacteria, viruses, bacteriophages, fungi) "sit" on the epithelium of the lungs. They mainly come from the throat (main germs there are Neisseria, Prevotella and Veillonella) and more rarely from the nose or from the intestine (e.g. through microaspiration).

The composition differs from the microbiota in the throat/nose and intestines (e.g. there are no digestive bacteria, but germs of the upper respiratory tract).But the same applies to the lungs as in the intestines: The higher the germ diversity and the better the balance of the germs, the better protection and lung function

Dysbioses can occur with a decrease in the variety of germs (e.g. in the case of COPD only 28% of a healthy person!) and an increase in potentially pathogenic germs (e.g. Pseudomonas), e.g. as a result of

  • cystic fibrosis, COPD, asthma, allergies, infections
  • Use of medication (e.g. antibiotics, corticoids)
  • Exposure to pollutants (e.g. smoking, particulate matter)

Dysbioses affect barrier function and immunity. They trigger inflammation, increase the risk of disease, worsen disease stage and lung function. See also Engel M et al.; Influence of lung CT changes in chronic obstructive pulmonary disease (COPD) on the human lung microbiome; Plos One 2017; doi: 10.1371/journal.pone.0180859): In chronic obstructive pulmonary disease (COPD), structural changes in the lungs and dysbiosis can occur over time, which favors the colonization of potentially pathogenic bacteria.


And a healthy microbiome in the intestine is also of great importance for the microbiome in the lungs, because lungs and intestines are linked via the so-called "gut-lung axis". The lungs develop in the 4th week of embryonic development as a fold of the foregut and, as with the intestinal microbiome, the development of the lung microbiome also takes place at an early age ("neonatal window of opportunity"). Measures similar to those for the intestinal microbiome are effective here, i.e. primarily breastfeeding and a healthy diet.

The intestinal flora and oral probiotics influence the microbiota of the lungs, e.g. via "cross talk" (exchange of information) and protect e.g. against allergies:

  • Direct effects, e.g. through microaspiration in the lungs
  • Indirect effects, including via short-chain fatty acids (SCFA), which improve the reactivity of the lung immune system

Therefore, measures in the intestine (such as medicinal mushrooms) are also relevant for the lungs.


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