Vitamins

Your body needs vitamins to help it grow, function, and fight off infection. Try to incorporate foods rich in these vitamins and take a vitamin supplement, if necessary.

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Summary
  • People with cystic fibrosis have trouble absorbing fats, which means they have trouble absorbing vitamins that need fat to be absorbed -- A, D, E, and K. These fat-soluble vitamins are critical to normal growth and good nutrition.

  • People with CF also need to get water-soluble vitamins, which include vitamin C and the B-complex vitamins, folic acid, biotin, and pantothenic acid. They are called water-soluble because they are easily absorbed with water in the body.

  • Besides eating a nutritious diet, you may have to take a CF-specific multivitamin supplement. Multivitamin supplements for people who have CF come in pills, softgel capsules, chewable tablets, or liquid drops. They contain fat-soluble and water-soluble vitamins to meet the needs of people with CF who take pancreatic enzymes.

Sometimes a member of your CF care team will ask you to take a single nutrient vitamin supplement, such as vitamin D. Most single nutrient vitamin supplements are available over the counter, although some require a prescription.

If you have questions about affording vitamin supplements, contact CF Foundation Compass by calling 844-COMPASS, Monday through Friday, 9 a.m. until 7 p.m. ET, or emailing compass@cff.org.

To get the most from your vitamin supplements, always take them with a meal or snack that contains fat and your enzymes. As with all products, always follow the directions you and your CF care team  developed.

Vitamin A

Vitamin A has many roles in health. It helps the immune system fight infections. It is needed for healthy skin, normal vision, and healthy intestines. Low levels of vitamin A can cause night blindness and skin disorders and raise your risk of infections. Low vitamin A also can be associated with zinc deficiency, which can impair growth. 

Vitamin A can be found in animal foods such as liver, eggs, and milk, as well as in darkly colored fruits and vegetables including these:

  • Carrots
  • Sweet potatoes
  • Cantaloupes
  • Apricots
  • Peaches
  • Spinach
  • Broccoli

Vitamin D

Vitamin D helps build and maintain strong bones and teeth by maintaining the right amount of the minerals calcium and phosphorus in your blood. Without enough vitamin D, bones can become thin and brittle. People with CF are at risk for osteoporosis and osteopenia. Vitamin D also helps keep the immune and nervous systems working well.

Exposure to sunlight provides you with some, but often not enough, of the vitamin D you need. Many people with CF need to take extra vitamin D in addition to the amount provided in CF-specific multivitamins. Other good food sources of vitamin D include these foods:

  • Salmon
  • Mackerel
  • Canned sardines
  • Tuna
  • Milk
  • Cereal
  • Eggs

Vitamin E

Vitamin E is an antioxidant, which means that it protects compounds in the body from combining with oxygen. When compounds become oxidized, they become harmful to the body. Vitamin E also helps make red blood cells and keeps the nervous and immune systems healthy.

It is hard to get all the vitamin E you need from food alone. Some fruits and vegetables have small amounts. Most meat products do not have it at all. Vitamin supplements and the following foods can be good sources of vitamin E: 

  • Almonds
  • Peanuts
  • Mayonnaise
  • Broccoli
  • Margarine
  • Bread (whole grain) and wheat germ

Vitamin K

Vitamin K is best known for its role in helping blood clot. Without it, a cut could bleed for a long time and a small bruise could turn into a big one. Vitamin K also helps keep bones healthy. Some of the vitamin K you need is made in the intestines, but the amount can be reduced in people who take antibiotics.

All forms of multivitamin supplements designed for people with CF include vitamin K, but not all over-the-counter multivitamins do. If you are not using multivitamin supplements designed specifically for people with CF, be sure to check the ingredient label and choose one that contains vitamin K.

To make sure you get vitamin K in your diet, eat lots of dark green, leafy vegetables. Here are some good sources of vitamin K:

  • Broccoli
  • Spinach
  • Leaf lettuce
  • Peas
  • Brussels sprouts
  • Coleslaw
  • Kale

B-Vitamins

Vitamin B1 helps change carbohydrates into energy that the body needs every day. It is also necessary for the maintenance of healthy skin, the heart, and the nervous system. 

The foods in the following list can help you make vitamin B1 a part of your daily diet:

  • Pork
  • Long-grain rice
  • Peas
  • Pecans
  • Bread
  • Oranges

Vitamin B2 (riboflavin) helps turn food into energy and repairs tissue. It also helps your body make healthy red blood cells. Low levels of vitamin B2 can lead to bad skin and itchy eyes.

Here are some foods that are good sources of vitamin B2:

  • Milk
  • Yogurt
  • Eggs
  • Cereal
  • Pasta
  • Chicken

Vitamin B3 (niacin) plays a role in metabolizing fats and is used to treat high levels of “bad” cholesterol. Vitamin B3 works with the other vitamins to keep your skin healthy and your nervous and digestive systems working right.

Although vitamin B3 is found in many foods, it is really common in poultry and dairy products. Here are some foods you can eat to get this vitamin:

  • Tuna
  • Peanuts
  • Chicken
  • Lamb
  • Beef
  • Pork

Vitamin B6 plays an important role in the metabolism of amino acids (the building blocks of protein). It is also needed for proper functioning of the nervous system and production of hemoglobin, the part of red blood cells that carries oxygen throughout the body. A deficiency of vitamin B6 can cause depression or anemia.

If you don't like to eat vegetables, do not worry. A good way to get vitamin B6 is to eat chicken, pork, beef, and fish. You also can find B6 in these foods:

  • Eggs
  • Baked potatoes
  • Bananas
  • Garbanzo beans (chickpeas)
  • Oatmeal

Vitamin B9 (folic acid) plays a role in the production of genetic material, in tissue growth, and in the proper formation of red blood cells. It is important for healthy cell division and replication, which is essential for growth. A deficiency in vitamin B9 can cause anemia, abnormal tissue growth, and birth defects.

Folic acid is found in many vegetables and fruit juices, but if these foods are cooked too long, they lose a lot of B9. That is why you may need a vitamin supplement plus a healthy diet with the following foods:

  • Lentils
  • Asparagus
  • Spinach
  • Cereal
  • Peanuts
  • Orange juice

You need only a small amount of vitamin B12 in your diet, but that small amount protects your nerve cells. It is also needed to form red blood cells. Vitamin B12 deficiency can cause a type of anemia known as pernicious anemia, which is commonly found in the elderly and in strict vegetarians. 

If you like beef and seafood, you are lucky. These foods are good sources of B12. But if you do not eat animal products, you may not get enough B12 and should take vitamin supplements. Here are some food sources of B12:

  • Salmon
  • Beef
  • Tuna
  • Milk
  • Pork
  • Chicken

Vitamin C

Vitamin C does hundreds of jobs in the body. It works hard to fight free radicals that can hurt your cells. Vitamin C also helps make collagen, a sticky substance that keeps your bones and muscles together, and helps blood vessels stay strong. It also can help heal a wound.

Our bodies need a diet rich in vitamin C foods to stay healthy. The good news is that vitamin C is found in many fruits and vegetables such as the ones listed below:

  • Broccoli
  • Grapefruit
  • Oranges
  • Strawberries
  • Cantaloupes
  • Mangoes

Pantothenic Acid

The enzyme maker, pantothenic acid, helps metabolize fats, carbohydrates, and proteins. It also helps make red blood cells and control the body's hormones. Low levels of pantothenic acid can lead to stomach cramps, vomiting, and tingling in the hands and feet. 

It is easy to get the right amounts of pantothenic acid because it is found in many foods that are a part of a daily diet. Here are some ideas:

  • Avocados
  • Mushrooms
  • Chicken
  • Lentils
  • Potatoes
  • Eggs

Biotin

Some bacteria that live inside the body help you stay healthy. In fact, these “good” bacteria make a vitamin called biotin. Biotin helps metabolize fats, carbohydrates and proteins. You need biotin to keep your hair healthy.

There are lots of ways to get the biotin you need every day. In addition to the biotin that your body makes, vitamin supplements have good amounts. There are many common foods that have it as well, such as these:

  • Milk
  • Chocolate
  • Eggs
  • Cheese
  • Bacon
  • Chicken

Parts of this document were adapted, with permission, from material written by Suzanne Michel, MPH, RD, LDN.

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