Naturally High Fiber Foods

Nutritionists recommend consuming 20-30 grams per day of dietary fiber. Time to get out the Metamucil? Think you need to add a fiber pill supplement to your daily meal?Not necessarily. Eating enough fiber can happen simply by selecting the right foods as part of the diet.

Dietary fiber is fiber that comes from plant sources. It is usually referred to as roughage and is useful to prevent constipation, relieve diverticulosis, reduce the risk of colon cancer and helps lower blood cholesterol levels. It can also be used as an effective way to help control weight.

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Natural High Fiber Foods

Failure to Thrive (FTT)

The first few years in a child's life are critical period during which the most dramatic changes in growth and mental development take place. When a baby or toddler doesn't gain weight and grow at the predicted rate, a doctor may say that the child is failing to thrive. In many cases, failure to thrive and its accompanying symptoms can be the key to effectively diagnosing cystic fibrosis as early as possible.

Failure to Thrive (FTT) is detected when a child falls below the 80th percentile for height and weight at a given age. Failure to thrive is a somewhat ambiguous term, is not a formal diagnosis. However, it serves as a starting point for exploring the underlying cause of the condition.

Symptoms or behaviors that may indicate failure to thrive include:

-Frequent diarrhea or vomiting

-Irritability and colic

-Unfocused eyes, inability to concentrate

-Developmental benchmarks such as sitting up, talking, etc. are not reached when expected

-Refusing food

-Repeated infections

In many cases, failure to thrive is connected to a baby's inability to eat or utilize calories and nutrients properly. The causes can be either physical, as in the case of a child with a cleft palate who cannot suckle for breast or bottle feeding. Failure to thrive may also be the result of a chronic condition like cystic fibrosis, in which the pancreas cannot secrete the enzymes required to help the body absorb food. Food allergies, celiac disease, and inability to tolerate milk protein are just a few of the underlying causes of failure to thrive in infants.

A child who is failing to thrive may also be the product of a poor socio-economic environment. Living in poverty without access to health care, or an inability to buy the appropriate foods for an infant, can cause failure to thrive. Sadly, failure to thrive is sometimes caused by child abuse.

Doctors rely on growth charts to determine whether an infant is growing normally. Specifically, a baby's birth weight should double by the age of 4 months, and should grow almost 10 inches in the first year. Although birth weight may drop initially, when an infant does not recover that lost weight in a suitable amount of time (2 weeks), the doctor will look into the reasons as to why. Even babies who are born prematurely are expected to progress according to an adjusted growth chart.

Correctly diagnosing the cause of FTT as early as possible is essential to prescribing the most appropriate and effective treatment plan.

Nasogastric (NG) Tube Feeding

Cystic fibrosis patients are encouraged to follow a diet that is high in calories. Doctors recommend that the calories come from high energy foods such as animal proteins and fats. Patients who are pancreatic insufficient have a difficult time gaining and maintaining a healthy weight. As a result, these patients are malnourished. Research has demonstrated that up to 30% of young adult patients with cystic fibrosis (CF) are malnourished.

Failure to maintain a healthy body mass index (BMI) can lead to lower pulmonary function, since the body is not absorbing the nutrients needed to build up strong respiratory muscles. This is just one of the reasons why weight loss is often a precursor or indicator of a respiratory infection. When patients are severely malnourished they may become candidates for what is called "nutritional rehabilitation." This means that the patient is given additional calories and energy via tube feeding.

When Is It Used?

The most popular way of tube feeding is called nasogastric (NG) feeding. Nasogastric feeding involved inserting a thick, flexible tube through the nose, back down the esophagus and into the stomach. From there liquids can either be added to or removed from the stomach. There are different scenarios in which NG feeding is used. These may include instances when a patient is experiencing a bowel blockage and must not eat solid food by mouth; post-operational use to prevent the acidic contents of the stomach from being aspirated (inhaled.) Perhaps the most familiar use of NG tubes is when a person has to have their "stomach pumped" in order to remove poison, or an overdose of oral medication.

NG-tubes are intended for infrequent, short-term use. For general purposes such as post-operative emptying of the stomach, they are only in place for two or three days. However, in the case of cystic fibrosis patients who require tube-feeding, this may be longer. Some cystic fibrosis patients have a new NG-tube inserted on a nightly basis, so they can receive nutrition while they sleep.

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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.

Nutrition, Exercise and Well Being

Lungs aren’t the only organs affected by the thick, sticky mucus that cystic fibrosis produces. The pancreas, an exocrine gland that normally secretes digestive enzymes necessary to absorb nutrients from food, can be coated with mucus as well. In fact, nearly 85% of CF patients demonstrate pancreatic insufficiency before age 10. This can lead to issues of malabsorption and malnutrition due to the body’s inability to break down fats, carbohydrates and protein before they pass into the intestinal system.

Nutrition and Calories

In order to remedy this problem, many CF patients are prescribed digestive enzyme supplements to help the body better absorb the vitamins and minerals that are present in the diet. However, digestive enzymes are only part of the solution. A person with CF needs to incorporate more calories into their diet than other healthy people the same age. Important ways that you can help your child with CF grow healthy and strong include providing good overall nutrition along with extra fat and calories as well as prescribed enzymes.

Table 1. Caloric Intake Ranges Based on Age Group and Activity

It is important for everyone with CF to combine good nutrition with appropriate exercise. One of the challenges that await school-aged children upon returning to the classroom is that eating habits may need to change. For example, a child who has been able to “graze” frequently during the day may have trouble adjusting to the pre-determined eating schedule set by the school or classroom.

Another problem that may indirectly affect CF students is the obesity epidemic. Many schools are adopting low-calorie, low-fat meal programs in an attempt to address the alarming rise in the number of overweight and obese children. If your child is participating in a school lunch program, be sure that the meal offers the appropriate amount of calories for your child’s age and activity level.

On school days, offer your child or young adult a large, balanced breakfast. Meals that include complex carbohydrates (e.g. whole grain toast) take longer for the body to break down and provide energy for a longer period of time. You the school nurse, who in turn may speak with your child’s teacher or the school administration, to permit additional snack breaks as necessary.

Correlating Nutrition and Lung Health

The need for adequate nutrition cannot be stressed enough. The Cystic Fibrosis Foundation (CFF) has identified a correlation between nutritional health and lung health. Studies have shown that patients with better Body Mass Index (BMI) values for their age, height, and weight, typically perform better on pulmonary function tests. Many CF physicians stress the importance of patients reaching healthy weight and BMI goals before age 6 in order to reduce the likelihood of hospitalizations due to pulmonary exacerbations.

Certain sports related activities, such as running and jumping, generate vibrations in the chest cavity which may stimulate coughing. Coughing should never be suppressed, because it is how the body rids itself of infection-prone mucus in the lungs. Getting the body moving acts as a natural form of chest physiotherapy.

Exercise is also an effective way to prevent infection and inflammation of the lungs. Scientific studies have demonstrated that physical exercise is just as important as chest physiotherapy. Any sort of activity that forces the respiration rate to increase will naturally strengthen the muscles used to cough. Strong back, chest, and abdominal muscles that are well toned from exercise can make coughing easier and less exhausting. Aerobic (oxygen using) and cardio-pulmonary exercise is particularly important for people with CF. As the heart rate increases, the rate of blood flow increases, thereby delivering vital oxygen throughout the body.

Although it may be tempting for parents of students with CF to want their child to opt-out of physical education class, this is not a good idea. The school nurse should speak with coaches and PE teachers about the importance of exercise and its benefit to the student with CF. Students with CF should be encouraged to participate as much as they are able in sports or other fitness activities. If outdoor activity aggravates allergy symptoms, look for other ways to encourage rigorous cardio-pulmonary activity.

Community classes in martial arts, dance, or gymnastics may be an alternative. Another option is to have your student enroll in the school’s band or orchestra. Wind instruments such as the clarinet, trombone, trumpet or French horn are excellent for improving and maintaining lung function. This can also open the doors to scholarship opportunities when your student is ready to apply for college.

The combination of nutrition and exercise can lead to lasting benefits for all ages of those with cystic fibrosis. Many CF Team Clinics have nutritionists and/or dietitians on staff to help determine the best way to incorporate adequate nutrition and exercise into the busy lives of CF patients and their care givers.

Understanding Zinc

Zinc is one of the essential nutrients that the body needs in order to function properly. Found mostly in red meats and other high protein foods, zinc is required in small amounts for the body to not only carry out vital chemical reactions, but also to promote a healthy immune system.

-Zinc in the Diet-

As a dietary supplement, the benefits of zinc are very closely tied to the body's requirement and use of vitamin A. For example, both zinc and vitamin A are useful to promote good eyesight, particularly night vision. Also, zinc and vitamin A are required by red blood cells in order for the body to heal itself from wounds or infections. Scientists and medical professionals estimate that there are no fewer than 3,000 proteins in the body that rely on zinc to carry out their normal functions. Zinc works in the body by activating a type of protein called enzymes. When the human body has adequate amounts of zinc, certain types of the body's cells will secrete a small amount of a zinc ion that works as a signal to stimulate a specific biological process.

Oysters are considered one of the best sources of zinc. However, for people with allergies to shellfish this is impractical. Other foods that promote good zinc absorption include:

Lean beef
Fortified breakfast cereal
Chicken (dark meat)
Yogurt
Nuts and legumes

-Zinc Deficiency-

If the body is deficient in zinc any of the following symptoms may occur:

Diarrhea
Hair loss
Diminished eyesight
Poor memory
Organ malfunction (particularly the liver)
Poor appetite
Bleeding disorders
Congenital defects (caused by pregnant women who are zinc deficient)

-Who Needs Zinc?-

Preventing zinc deficiency is easy done by ensuring that the diet is rich in foods that are known to have adequate levels of zinc. Other risk factors for developing zinc deficiency include alcoholism (which impairs the liver) and conditions like Chron's disease, Cystic Fibrosis or Colitis which may lead to frequent bouts of diarrhea. The recommended daily intake of zinc for adults is actually quite small. Males and females respectively only need 11mg and 8mg per day.

-Zinc and Colds-

There is some anecdotal evidence suggesting that zinc can help the body fend off the common cold. However, since colds are caused by a virus (specifically a rhinovirus), the best course of treatment for a cold is to try to alleviate the symptoms and just wait for it to run its course. Products such as Cold-Eeze lozenges, may help some people, particularly those who are harder hit by the cold due to being immunocompromised and already zinc deficient; however, such products cannot truly be relied upon as a means to speed up the healing process from a cold.

Understanding Vitamin A

Everyone knows that vitamins are important for good health. Of the 13 essential vitamins, the human body can only manufacture a small portion of these. The rest must come from the diet or, in some cases, supplementation. But what exactly are the benefits of these vitamins and how much of it do we need to be healthy? In particular, what are the benefits of Vitamin A, and what are its sources?

As an antioxidant, vitamin A prevents cell damage caused by free radials and may be helpful in preventing some types of cancer. It is believed that vitamin A may help protect against lung cancer. Vitamin A has also played a part in helping heal and prevent acne. The potent acne medication, Accutane (isotretinoin), is a derivative of vitamin A.

Good sources of the retinol form of vitamin A in the diet include the following:

Cheeses
Egg yolks
Fortified whole milk
Liver
Salmon

Retinol plays many important roles in the body. It prevents night blindness and is essential for good eye health. Without retinol, cell division and cell growth cannot proceed normally. Bones and teeth need the proper amounts of vitamin A in order to develop properly. Other parts of the body, such as the tissue that lines intestines and airways also require retinol.

Vitamin A is a fat soluble vitamin that exists in multiple forms. Retinol, retinoic acid, and retinyl esters are stand-alone forms. This means that they are readily available in foods in their current form, and do not need to be combined with other minerals in order to be effective. The two types of vitamin a are retinols and beta carotene. Most of the time Vitamin A is referred to interchangeably with either of these terms. Vitamin A in the diet comes from two main sources: animal products and plants. Retinols are obtained from animal products, whereas the form beta carotene comes from plants such as yellow and orange vegetables.

Beta carotene is abundant in the following plant sources:

Broccoli
Carrots
Cantaloupe
Pumpkins
Spinach
Yellow squash
Yams

Healthy adults only need 800-1000 micrograms of vitamin A on a daily basis. Too much vitamin A can cause headaches and vision problems, joint aches, loss of appetite, and skin problems. Women who are pregnant should not take vitamin A supplements, since excessive amounts of retinol have been linked to birth defects.

Cautions about GSH Supplementation

Glutathione (GSH, L-gamma-glutamyl-L-cysteinylglycine) is the predominant anti-oxidant in the aqueous cytoplasm of cells. Virtually all cells require glutathione for viability and function. Glutathione is synthesized from three amino acids in a two-step process, beginning with the combination of glutamic acid & cysteine and ending with the addition of glycine. The liver & lungs are the primary sites of glutathione synthesis. Glycine & glutamic acid are plentiful in cells, so it is the availability of cysteine that controls the reaction rate. Neuronal overexpression of the rate-limiting enzyme for glutathione synthesis in transgenic fruit flies has been shown to increase mean and maximum lifespan by up to 50% [JOURNAL OF BIOLOGICAL CHEMISTRY; Orr,WC; 280(45):37331-37338 (2005)].

Manufactured L-glutathione (GSH) is one of the experimental and unregulated supplement that some CF patients are using to treat inflammation. The human body makes a certain amount of glutathione on its own. It is speculated that by using glutathione supplements, inflammation that occurs in response to infection, can be decreased. It is important to keep in mind that because GSH is used as a supplement, it cannot be approved as a viable treatment option for people with CF. For this reason, people who elect to use GSH supplements do so at their own risk. Click here to read about how GSH is used by cystic fibrosis patients.

Here's some of what I learned:


1. The Cystic Fibrosis Foundation forbids its accredited Care Centers from telling patients about the supplement.

2. This quote was attached to a guide that describes how GSH should be used. This warning alone makes me not want to touch the stuff with a 10-foot pole.

Warning: Before inhaling GSH, consult with your doctor and obtain their permission. This therapy treatment is experimental, clinically unproven, and has caused serious side effects, including bronchial constriction and increased congestion in some users. Before taking any GSH, see Reported Detrimental Effects. People choosing to use this therapy must do so AT THEIR OWN RISK. The authors cannot be responsible for any direct or indirect damage caused by using GSH. The authors do not endorse the use of GSH, nor do they guarantee beneficial results. Detrimental side effects in addition to those listed in this guide might occur. The authors do not testify that the statements in this paper are accurate; many statements will be revised as more reports come in. This guide was not written to endorse the use of GSH; it was written so that the experiences of people who have inhaled GSH can be shared. Last update: 1/11/99.

3. GSH is a yeast product. Yeast is a fungus, so it stands to reason that inhaling GSH could cause some bad allergic reactions, perhaps even anaphlactic shock. It's quite possible that people with allergic bronchopulmonary aspergilliosis would exhibit a similar allergic reaction to GSH.

4. I found a highly suspect "testimonial" about someone whose daughter has been on the stuff. They boast weight gain, improved growth. The reason I say this is suspect is because just about EVERY child will naturally gain weight and grow taller as he or she gets older.

5. GSH is not regulated by the FDA, and therefore its makers have no accountability when it comes to the safety of the supplement. This also means that they aren't subject to "truth in advertising," so basically they can say whatever they want to to promote it.

6. People who are allergic to MSG (monosodium glutamate) should not use GSH.

7. Unpleasant and detrimental side effects may include:

• Bronchial constriction
• Coughing
• Headache
• Feeling of congestion an hour or more after inhalation
• Abdominal discomfort
• Shakiness
• Flu-like feelings
• Nausea
• Diarrhea
  
• Dizziness

Trust your doctor's recommendations about which preventive medications you or your child should be taking to treat inflammation. GSH supplementation may not be a safe or reasonable choice.

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More information:

Rethinking CF Pathology

MSG usage is Unnecessary and Unscientific

Glutathione Response to Pseudomonas Infection

Blood Work: Understanding BUN and Creatinine

In order to determine kidney function, a blood test called the BUN Creatinine is performed. BUN stands for blood urine nitrogen. It measures how much urea is present in the bloodstream. High levels of urea indicate that the kidneys are having trouble filtering it out. The most noticeable effect of impaired kidney function is a marked decrease in the output of urine. This is a sign of dehydration.

Cystic fibrosis (CF) patients are prone to dehydration due to the abnormal function of the cystic fibrosis trans-membrane regulator (CFTR) protein. This is primarily what causes the characteristically salty sweat in people with CF. Dehydration and the loss of electrolytes during sweating can wreak havoc on the kidneys. When this happens, the imbalance of electrolytes can result in a buildup of nitrogen in the blood that is caused by a buildup of urea in the body.

Urea is a molecule comprised of carbon, oxygen, nitrogen and hydrogen in the formula CH₄N₂O. This chemical is released into the bloodstream by the liver as the body breaks down proteins. In healthy kidneys, urea is removed from the blood, and passes easily into the urine. When kidney function is impaired, a buildup of urea occurs.

A normal BUN level is usually in the range of 10 to 20 milligrams per deciliter (mg/dL). It is just as important to prevent the BUN from being too high as it is from it falling below the normal range.

Possible Causes of high BUN

• High protein diets
• Certain medications such as tobramycin
• Dehydration
• Heart failure
• Presence of Addison’s disease
• Blockage of urinary tract due to kidney stones
• Intestinal bleeding

Possible Causes of low BUN

• Liver disease
• Malnutrition
• Low protein diet (common in vegetarians and vegans)
• Severe muscle injury
• Pregnancy

Typically, a BUN level is measured at the same time as a creatinine measurement. Creatine (note spelling) is a protein that generally remains at a consistent level in the bloodstream. It’s made in the liver, then serves as the energy source when muscles are used. As the breakdown of muscles takes place, the waste product creatinine is formed and is then filtered through the kidneys. By comparing the amount of BUN and creatinine, the doctor can determine whether kidney function is normal or impaired. A normal ratio of BUN:creatinine is anywhere in the range of 10:1 to 20:1.

Patients with CF, particularly those who have pancreatic insufficiency, tend to be malnourished. This can result in lower BUN/Creatinine ratios. As mentioned before about the levels of urea, the BUN/Creatinine ratio can be elevated due to dehydration. In general men have higher BUN than women. The BUN level also increases naturally with age.

Blood work for the purpose of monitoring BUN/Creatinine is done every other day throughout the course of intravenous antibiotics. This is to ensure that the concentration of the prescribed medication is not so high that it compromises the patient’s kidney function. It is important for patients undergoing IV therapy to remain adequately hydrated in order to maintain normal and healthy kidney function.

Vitamin B and Depression

Mental health experts have studied the connection between chronic illness and depression. Correctly diagnosing and treating a particular condition means understanding its definition. The definitions of different psychological disorders are in a state of constant change.

Currently there are 3 generally recognized types of clinical depression:

1. Major Depression
2. Dysthemia
3. Bipolar Disorder

In its broadest definition, depression is the result of overwhelming thoughts such as anxiety, fear, pessimism, or helplessness being turned inward on oneself. The specific causes of a depressive disorder or event may not be clearly pinpointed, but in all cases of clinical depression, there is an underlying problem with the brain's chemistry. When depression is concurrent with chronic illness, determining whether one causes the other can be difficult.

There is evidence that illness triggers depression. There is also evidence that shows depression leads to illness. Elissa Sonnenberg's article, "Depression and Chronic Illness: Which Comes First" explains how the body and mind interact.

Many patients with CF experience depression, but what causes the depression? Based on what the medical community knows about the links between vitamin deficiencies and depression, one can reasonably assume that vitamin deficiency may play a role in the mental health of cystic fibrosis patients.

Proper diet and nutrition is essential for people with CF; not only because it enables the body to fight of infection more easily, but because the brain needs to be in good health. Health care professionals agree that complex carbohydrates are necessary for optimal brain function. Things such as whole-grain breads, cereals and pasta serve as an excellent source of B vitamins, which deliver a supply of amino acids to the brain.

The brain is responsible for our moods, muscle function, thoughts and emotions. A healthy brain is essential for a healthy body. Although the details of how diet and mental health are connected are not fully known, there is an undeniable link between the two. For example, foods like soy beans and liver have the potential to improve brain function in people with mood disorders. Unfortunately, much of what we know on this subject is more along the lines of what not to do, rather than what to do.

The vitamin of greatest concern in the treatment and understanding of depression, is vitamin B12. Commonly known as folate, vitamin B12 is responsible for the production of neurostransmitters. It also regulates mood. The Mayo Clinic reports that poor nutrition is the leading cause of vitamin B12 deficiency. The inability of the body to properly break down food to obtain nutrients complicates this potential solution. In other words, the answer for cystic fibrosis patients may not be found in just adding a B12 vitamin to the diet.


For more information, please read the article "A Shot in Time Saves Mind" by Syd Baumel

Additional resources:

Is Depression a Vitamin Deficiency?

How Do Vitamin Supplements Help Cystic fibrosis

Effective Diets Must Consider the Mind Along with the Body

Why Vitamin Supplements are Essential for Health

Vitamin Deficiency, Folate, and Depression

Vitamin for Depression?

DEXA Scans

Over the last decade, CF researchers and physicians have observed that as patients with CF age, their metabolic rate (i.e. how much energy the body uses) changes are disease severity increases. Malabsorption issues are closely linked with poor performance on pulmonary function tests. It is of utmost importance that CF patients and their clinics work hard to maintain adequate nutritional status.

People with cystic fibrosis, especially those who are diagnosed as having pancreatic insufficiency, have great difficulty absorbing vital minerals and nutrients from food. Doctors regularly prescribe vitamin and mineral supplements for CF patients with the expectation and hope that semi-normal levels of these can be attained in the body.

Without sufficient concentrations of certain vitamins and minerals in the body, a patient with CF may develop bone density problems. As the number of patients exhibiting weak bones has increased, there is an added emphasis being placed on the necessity of what are called DEXA scans.

DEXA (dual energy x-ray absorptiometry) scans should be performed every three years to measure bone mineral density.

The procedure of a DEXA scan is painless and simple. The patient lies on his/her back on an examination table under a scanner arm. The scanner then uses x-ray beams from two different directions to the patient’s body. The energy from the x-rays travels at a particular frequency, and is transmitted to a receiver that determines how quickly it moved through the bone. It does this by counting photons, which are energy particles. In places where the bone is denser, the x-ray beam slows down. By measuring these rates of transmission, overall bone density is calculated.

A computer takes the information about the number of photons and compares it to a normal, expected value. The result is called a “T” score. Different T scores can tell a doctor whether a patient is at risk for developing osteoporosis, or is perhaps exhibiting osteopenia.

The entire DEXA scan procedure only takes 4 minutes to scan the entire body. Since the test is performed annually, the CF team can identify problems with mineral density and work with a patient to take preventive measures to prevent bone loss. Calcium supplements with D vitamins added are commonly prescribed. Vitamin D, which is a fat soluble vitamin, is directly responsible for how much calcium comprises the bones in the body.

Many people have heard of osteoporosis, but osteopenia is not as commonly known. Osteopenia is when a person's bones are less dense than normal. Eventually it could lead to osteoporosis. Typically people who develop this condition are much older and are likely to be post-menopausal women. Bone density losses take place more frequently as people age. However, people with CF are likely to be diagnoses with osteopenia or osteoporosis at younger ages.. Without sufficient vitamin D and calcium to build strong bones, the risk of developing osteoporosis or osteopenia increases.

Other things that can help a patient safeguard his/herself against future problems with bone mineralization includes the following:

• eat a diet rich in calcium and vitamin D
• limit caffeine intake
• limit alcohol consumption
• do weight-bearing exercise like running, walking, or hiking (basically anything that forces my body to work against gravity)
• take care of mental health issues so that they don't adversely affect physical health
• sit in the sun for about 15 minutes per day to give the body the opportunity to make its own vitamin D

For more information please visit the following links:

Nutritional Problems in CF
Post-Transplant Osteoporosis in CF
Prepubertal Bone Mineral Accretion
Study of Benefits of Growth Hormone for CF

How Vitamins Help

People with CF tend to be underweight and malnourished despite ravenous appetites. Furthermore, the mucus causes many gastro-intestinal problems, including malabsorption. Vitamin supplements are often prescribed in order to make up for everything the body is not getting from digested foods. Fat is exceptionally difficult to digest. Vitamins A, D, E and K, all of which are fat soluble, are the most common supplements taken by CF patients. In general, these help the body fight off inevitable infections.

-Retinol (vitamin A) promotes good vision, including night vision. It is an antioxidant, which means it wards off anything that would attempt to consume oxygen in the blood. It also helps prevent osteoporosis.

-Vitamin D is especially important for a person with CF when it comes to maintaining bone density. In the absence of vitamin D, osteoporosis may occur. Without a strong skeletal structure, good posture is compromised making airway clearance more difficult. This in turn leads to increased frequency of lung infections.

-Vitamin E, an antioxidant, is integral in the formation of red blood cells. Blood that is well oxygenated helps maintain good pulmonary function.

-Vitamin K, also known as mephyton, helps maintain bone density as well as promote blood coagulation. Although this vitamin is synthesized naturally in the intestines, the amount is not enough. Like vitamin D, mephyton is useful in preventing osteoporosis.

Each of these vitamins work together, which is why the body requires specific amounts of each. People with cystic fibrosis should have the doctor frequently monitor their vitamin levels to ensure proper nutritional status.

Related Resources:

Personal thoughts on Nutrition

Glyconutrients? None For Me, Thanks

Special Programs from SourceCF: Why Pay for Vitamins if You Don't Have To?

Products and Services from Axcan (the makers of ADEKs)