Understanding Vitamins

Cystic fibrosis patients who are pancreatic insufficient and have to rely on enzyme supplements in order to have adequate nutrition, tend to have low vitamin levels. Vitamins A, B, D, E and K are the ones of primary concern. Routine blood work can determine how much of a particular vitamin is being absorbed. In cases where a person is vitamin deficient, vitamin supplements are recommended. Products like ADEKS, AquADEKs and SourceCF ABDEKS are three of the most commonly recognized vitamin supplements for patients with cystic fibrosis.

In order to understand the importance of each vitamin, we must look at how they function in the body. Vitamins are divided into two main categories: fat-soluble and water-soluble. Cystic fibrosis patients, due to their low body fat, have trouble absorbing fat-soluble vitamins.

Fat Soluble

A: divided into retinols and beta carotenes, vitamin A is needed for growth and cell development. It helps the body maintain healthy skin, hair and nails, not to mention gums, bones and teeth. Some studies have even linked it to being a likely way to prevent lung cancer.

When the body doesn’t get enough vitamin A, nightblindness is the most noticeable symptom. In children, insufficient levels of vitamin A can cause stunted growth or small stature. Cystic fibrosis patients without enough vitamin A are more prone to infection of any type. Dry skin is also a symptom of lack of vitamin A in the body.

D: also called calciterol, vitamin D is a precursor to calcium absorption. It helps the body maintain bone density. This is one vitamin that the body is able to generate on its own. Exposure to direct sunlight in reasonable amounts is what triggers the body to produce this vitamin.

Food sources of Vitamin D include milk, butter, egg yolks, and fatty fish. These are excellent food choices for people with cystic fibrosis since they provide high calories, good and some protein. The body doesn’t need much vitamin D—only 5 micrograms.

Vitamin D deficiency commonly presents itself as diarrhea, loss of appetite and headaches. Determining whether these symptoms are caused by lack of vitamin D or are signs of some other complication of cystic fibrosis can be difficult, especially in children.

E: tocopherol is the technical term for vitamin E. An important antioxidant, this vitamin helps the body maintain muscle structure and red blood cells. Healthy red blood cells are important for people with cystic fibrosis, since adequate oxygen saturation is needed to maintain good health.

There are no physical symptoms that are associated with low levels of vitamin E, but inadequate concentrations of it in can interfere with a woman’s ability to carry a pregnancy to term. Food sources of vitamin E are those high in “good cholesterol,” for example, eggs, vegetable oils, margarine and mayonnaise and nuts. Dark green leafy vegetables, particularly spinach and asparagus are high in vitamin E.

K: Without vitamin K, the body cannot clot blood properly. In people with cystic fibrosis, deficiency in vitamin K can lead to challenging bouts of hemoptysis (coughing up blood) even to the point of requiring an embolization to stop the bleeding. Excess bleeding, especially for women, can also result in iron deficiency. This impairs the body’s ability to heal from infection. People who bruise easily may be deficient in vitamin K.

One amusing way to tell if a person is deficient in vitamin K is to take a piece of real gold (14k or better) and press it to the person’s cheek and “draw” a line with it. If the person’s cheek develops a dark gray line where the gold was, the person is vitamin deficient.

Water-Soluble Vitamins

Biotin: This vitamin sets the pace of a person’s metabolism and is a source of energy for the body. Egg yolks, soybeans, cereal and yeast products (excluding beer) are foods that contain biotin. Lack of biotin can lead to depression, dry, scaly skin and hair loss. Although uncommon in people with cystic fibrosis, high blood cholesterol is a sign of biotin deficiency.

Folate: Also known as folic acid and folacin, this vitamin is needed to make DNA, RNA and the ever-essential red blood cells. It also helps the body synthesize amino acids. Without it, weight loss, anemia and digestive issues can occur. Women who are pregnant and have insufficient folic acid levels are at a greater risk for having a baby with birth defects. Folate also helps liver function—which is useful for cystic fibrosis patients with liver damage.

Sources of folate in food include: liver, avocados, raw vegetables, and crunchy vegetables like broccoli and celery.

Niacin: B3 is the form of niacin needed to metabolize energy. It’s important as it promotes normal growth of the body, especially early in life. Sources of niacin include: lean meat, chicken and turkey, seafood, eggs, legumes and fortified cereal.

Lack of niacin can lead to diarrhea and particularly watery (as opposed to fatty) stool. It can also cause mouth sores.

B: along with niacin (B₃) B₅, B₂, B₁ and B₆ are required for energy. In patients with cystic fibrosis, a lot of energy is used in fighting lung infections, carrying out airway clearance, and remaining as active as possible. One particularly useful role of vitamin B1, also called thiamine, is that it promotes normal digestion, and appetite. The other B vitamins are essential in helping the body convert carbohydrates (sugars and starches) into usable energy. They also contribute to healthy growth and synthesis of oxygen-carrying red blood cells.

Insufficient levels of vitamin B have been linked to depression and mood swings. Along with depression is a lack of appetite and weight loss. In people with cystic fibrosis it is important to properly assess whether any mood changes are the result of vitamin insufficiency, or if there is something else going on. Weakness and anemia are other symptoms of low vitamin B.

Patients with cystic fibrosis related diabetes should also be sure they are getting adequate amounts of vitamin B₅ (pantothenic acid) in the diet since one symptom of deficiency is low blood sugar. This, combined with a decreased ability to fight infection can cause instable blood sugar levels.

Studies have shown that the leading cause of vitamin B₁₂ deficiency is caused by an inability to properly absorb the vitamin in the intestinal tract. This is largely the case in patients with cystic fibrosis. The thick, sticky mucus in the digestive tract is what keeps the small intestine from absorbing B vitamins.

C: ascorbic acid, found mostly in citrus fruits, melons and other brightly colored fruits and vegetables, was once considered a panacea for the common cold. Though its cure-all reputation has been debunked, there’s no denying the benefits of vitamin C. The body uses this vitamin to strengthen the walls of blood vessels and prevent atherosclerosis or hardening of the veins—good news for patients who need PICC lines or midlines.

Signs of vitamin C deficiency include: loose teeth, bleeding gums, poor or decreased appetite and the inability to heal from a simple infection. Since vitamin C increases iron absorption, extremely low levels of vitamin C can lead to internal bleeding or massive hemoptysis.