Author
Presentation by Ms. Hilal Ersöz, summarized by Sabine Habicht | As published in Alpha1 Journal 1/2025.
Nutrition – a complex topic. This article focuses primarily on the various components that should be included in the daily diet to optimally nourish the body. A balanced diet, tailored to individual needs, is crucial for supporting individuals with a chronic condition like alpha-1 antitrypsin deficiency! Conversely, malnutrition and nutritional deficiencies can exacerbate the condition, weaken the immune system, and trigger acute exacerbations.
Nutrients
Nutrients are essential substances that the body needs for cell growth, development, and also for providing energy.
Nutrients are divided into macronutrients and micronutrients.
Macronutrients: The three macronutrients are protein, carbohydrates, and fats.
protein It is required for cell and tissue building, as well as for repairs – e.g., in wound healing, etc. – for enzymes and hormones, in which protein acts as a catalyst, i.e., enabling or influencing chemical reactions in the body.
Proteins are classified into essential and non-essential amino acids. Amino acids are organic molecules and thus essentially the building blocks of proteins. Essential means that our bodies need amino acids but cannot produce them themselves; therefore, we must obtain them through our diet.
Protein is found primarily in meat, fish, eggs, but also in legumes, nuts and dairy products.
carbohydrates Carbohydrates are a source of energy—energy we need to live. They are divided into simple and complex forms, which differ in their chemical structure and how they are processed by the body. Simple carbohydrates, also called sugars, consist of short sugar chains and are digested quickly, leading to a rapid rise in blood sugar levels. Complex carbohydrates, such as starch and fiber, have longer sugar chains and are digested more slowly, resulting in a more gradual release of energy. We commonly refer to simple carbohydrates as "bad" and complex carbohydrates as "good." Carbohydrates are found primarily in whole grains, fruits, vegetables, rice, and potatoes.
Fat Fats are important for energy storage, organ protection, and cell growth. They are also essential for the absorption of fat-soluble vitamins (A, D, E, and K). A distinction is made between saturated, unsaturated, and trans fats. Fats are found in vegetable oils, as well as in nuts, seeds, avocados, and fatty fish.
Micronutrients:
Micronutrients These are vital substances that the body needs in small amounts but cannot produce itself. They include vitamins and minerals (including trace elements and macroelements), as well as, depending on the definition, proteinogenic amino acids and essential omega fatty acids. Unlike macronutrients, they do not provide energy, but are essential for metabolic processes and strengthen the immune system.
Vitamins They are important for metabolic processes, strengthen the immune system, and promote and protect cell growth. A deficiency should be avoided, especially with all of the following vitamins.
- Vitamin A
- Vitamin C
- Vitamin E
- Vitamin B12
- Vitamin D
mineralsThere are two types of minerals: macrominerals and trace elements. Macrominerals are minerals that occur in larger quantities in the body (more than 50 milligrams per kilogram of body weight).
Quantity elementsThe major minerals include calcium, phosphorus, magnesium, sodium, and potassium. Calcium is mentioned here because it performs a variety of functions (building block of bones and teeth, important for the nervous system, muscles, blood clotting, and cell wall stability), but it is also necessary for vitamin D to be absorbed from the gastrointestinal tract into the bloodstream.
However, an overdose/overconcentration of calcium can lead to kidney stones and impaired kidney function.
Trace elements:
Trace elements Trace elements are essential minerals that the body requires only in very small amounts (usually less than 50 mg per kilogram of body weight), but are nevertheless indispensable for a multitude of metabolic processes and functions. They are often components of enzymes and hormones and play an important role in oxygen supply, energy metabolism, and immune responses. Among the most important trace elements are iron, iodine, zinc, and selenium.
iron Iron is important, for example, for the transport and temporary storage of oxygen. It is a component of enzymes whose functions are incredibly diverse: energy production, DNA synthesis, the metabolism of vitamins A, D, and K, amino acids, fatty acids, and cholesterol, the detoxification of substances such as medications, protection against reactive oxygen species, and a role in inflammatory responses.
In addition to iron deficiency, an oversupply with harmful effects is also possible here, such as accumulation in various organs, cell damage and functional disorders.
It's good to know: Calcium and iron levels illustrate how important it is to consult a doctor or nutritionist and have your levels checked before taking any supplements. In most cases, a balanced, individually tailored diet is sufficient.
Dietary fiber
Another component of our diet is dietary fiber. Dietary fiber consists of indigestible, fibrous substances, primarily found in plant-based foods (e.g., fiber in beans, zucchini, and legumes), which pass through the gastrointestinal tract undigested. In the large intestine, they absorb water and swell. The importance of dietary fiber is often underestimated – the name "ballast" may contribute to this. However, dietary fiber has a positive effect on digestion, promotes satiety, and has a prebiotic effect.
Today we know that dietary fiber can even reduce risks such as obesity, high blood pressure, coronary heart disease, diabetes and also colon cancer.
Incidentally, whole grain products with a high proportion of whole grains (e.g., whole rye bread) have a lower glycemic index than products made from milled grains, as do whole grain products made from oats or barley, in contrast to comparable whole wheat products. The low glycemic index means that blood sugar levels rise only slowly.
While there's no such thing as too much fiber in the strictest sense, it can sometimes (especially whole grains) cause gastrointestinal symptoms such as bloating or stomach pain – particularly when you first start increasing your fiber intake. Usually, the body adjusts to the increased fiber intake after a while.
Water Water is essential for the body, as it performs a multitude of functions. It is a key component of all body cells and fluids and serves as a transport medium and solvent for nutrients, hormones, and other vital substances. Water also regulates body temperature, supports metabolic processes, and aids in the elimination of metabolic waste products.
You should consume about 2–3 liters of water per day, depending on age, gender, and activity level. This recommended amount includes all liquids as well as water-rich foods like fruits and vegetables. One-third of your daily water intake is usually obtained through solid food, and more than half through beverages. Mineral water, tap water, and (unsweetened) herbal and fruit teas are preferable. Coffee and black tea are only recommended in moderation (3–4 cups).
Nutrition at AATM
body weight
Generally, body weight should be monitored during AATM (Advanced Adiposity Syndrome). Both being overweight and underweight should be avoided. Body weight is measured using the so-called BMI (Body Mass Index), which indicates the ratio of body weight to height. The BMI is calculated by dividing weight in kilograms by the square of height in meters (kg/m²).
For an AATM, the BMI value should not be below 18.5/19 and likewise should not exceed 25.
Being overweight is particularly bad for liver diseases, but it also puts additional strain on breathing and thus lung function.
Being underweight and malnutrition weaken the immune system and promote acute exacerbations. However, be aware: Malnutrition, including deficiencies in essential nutrients, can also occur in overweight individuals!
composition
An optimal nutritional composition for AATM includes:
20 % Protein
- Milk and dairy products daily
- Fish 1-2 times per week
- Meat/sausage products (45 g per week) and eggs (3 per week) in moderation
30 % Carbohydrates
- Variety of nutritional components according to recommendations of the German Nutrition Society
- Fruit and vegetables 5 times a day
- Sugar and salt in moderation
40 % Fats
- Rapeseed, soybean, linseed, hemp and walnut oils are suitable because they contain plenty of omega-3 fatty acids.
- as well as nuts such as walnuts, macadamia nuts and cashews
The intake of protein and fats is slightly higher compared to people with healthy lungs.
Helpful tips about food
Meal prep, or in other words: Prepare your meals for several days, portion them, and freeze some of them if necessary. This saves time and effort.
Hygiene in the kitchen
- Replace kitchen sponges every 5-7 days – this reduces the bacterial load.
- Avoid using harsh cleaning agents that irritate the respiratory tract.
- Turn on the extractor fan or ventilate if necessary.
Five to six smaller meals a day are recommended. The sitting position makes eating easier.
Food and liver
To avoid putting additional strain on the liver, the following measures are helpful:
- no alcohol
- Consume a healthy amount of fruit, as some fruits (e.g., apples, pears, grapes, cherries, figs, mangoes) contain a lot of fructose.
- Do not consume foods sweetened with fructose.
- adequate protein intake
Insufficient supply of necessary nutrients
If your daily diet does not provide the necessary nutrients, you should definitely talk to your doctor about it.
The following possible measures can then be considered:
- Nutritional counseling/nutritional therapy (may be prescribed by a doctor)
- Possibly supplemental high-calorie food, especially in cases of underweight.
- Vitamin and mineral supplementation should only be done in consultation with a doctor and with appropriate laboratory diagnostics to determine whether a deficiency actually exists.
