Category: Articles

Pulmonary Function in CF Improves with HFCWO

Pulmonary Function in CF Improves with HFCWO

Pulmonary Function in CF Improves with HFCWO (High Frequency Chest Wall Oscillation)

 Maureen Newman by Maureen Newman
Ever since High Frequency Chest Wall Oscillation (HFCWO) devices were developed to help patients with cystic fibrosis breathe easier, clinical researchers required appropriate parameters to assess the efficacy of HFCWO-based therapies. It is common practice to look at three main indicators of pulmonary and overall health: mucus clearance, clinical measurements, and pulmonary function tests.

Mucus clearance, which is especially important for cystic fibrosis patients, determines how much mucus (by volume, wet weight, or dry weight)  is coughed up by a patient in a span of time. Clinical measurements include weight, blood oxygen saturation, and blood cell counts. These give a picture of the patient’s general health. However, pulmonary function tests are especially telling of how well the lungs of a cystic fibrosis patient work.

According to the National Library of Medicine, pulmonary function tests evaluate how well the lungs operate while breathing. The series of tests are conducted by breathing in and out normally and/or forcibly through a spirometer (spirometry), breathing normally inside an enclosed box (plethysmography), and breathing a tracer gas. From these tests, clinicians are able to determine a variety of parameters related to lung function, including: tidal volume (VT), diffusion capacity to carbon monoxide (DLCO), expiratory reserve volume (ERV), forced vital capacity (FVC), forced expiratory volume (FEV), forced expiratory flow 25% to 75%, functional residual capacity (FRC), maximum voluntary ventilation (MVV), residual volume (RV), peak expiratory flow (PEF), slow vital capacity (SVC), and total lung capacity (TLC).

Interestingly, two of these seemingly distinct measures — mucus clearance and pulmonary function — are related. When mucus is cleared from the lungs, the lungs seem to be more effective in normal function, as demonstrated by a handful of studies investigating HFCWO-mediated or High Frequency Chest Compression (HFCC)-mediated mucus clearance in patients with cystic fibrosis. These devices apply cyclical pressure to the chest to help move, break up, and clear mucus from the lungs.

Stable CF Patients Show Benefits in Pulmonary Function with HFCC

An early study from 1991 identified the benefits of self-administered HFCC on FVC and FEV in one second (FEV1) in a small group of 16 cystic fibrosis patients who were previously receiving conventional chest physiotherapy (CPT). The patients underwent approximately 22 months of HFCC therapy using “a variable air pulse delivery system and a non-stretch inflatable vest,” according to the journal article published in Pediatric Pulmonology entitled “The Long-term Effect of High-frequency Chest Compression Therapy on Pulmonary Complications of Cystic Fibrosis.” While the patients were on different HFCC therapy regimens involving between 30 and 240 minutes of HFCC a day, each patient underwent at least one 30-minute session per day split into five-minute periods of HFCC. The six total periods were each conducted at a different frequency ranging from 5 and 22 Hz. Following the therapy period, patients experienced a positive change in both FVC and FEV1 compared to conventional CPT.

Another study with 14 stable cystic fibrosis patients in a pediatric pulmonary division of a tertiary care center compared self-administered HFCWO to high-frequency oral airway oscillation and conventional CPT. As described in the study, two modes of HFCWO, two modes of oral airway oscillation, or CPT were applied to a patient once a day in the afternoon, with two days between treatments. The two different HFCWO regimens — 3 Hz or oscillations alternating between 3 and 16 Hz — performed similarly to the other three CPT regimens and allowed patients to expectorate more sputum than they were able to when entering the study. However, there was no change from baseline in pulmonary function tests (FVC, FEV1, or oxygen saturation), possibly because the patients were already in a stable condition and did not have deficient pulmonary function.

HFCC Improves Pulmonary Function Following an Exacerbation

When observing cystic fibrosis patients in a hospital setting, HFCC is just as safe and effective as conventional CPT and may serve as an alternative to help patients enhance their pulmonary function following an acute exacerbation. The study, “Comparison of High Frequency Chest Compression and Conventional Chest Physiotherapy in Hospitalized Patients with Cystic Fibrosis,” which was published in American Journal of Respiratory and Critical Care Medicine, analyzed pulmonary function in 50 cystic fibrosis patients who were admitted to the hospital for an acute exacerbation. Similar to the previous study, patients were treated in six, five-minute periods of HFCC at 6 to 19 Hz. When compared to patients receiving conventional CPT, patients receiving HFCC demonstrated equally significant improvements in pulmonary function tests. All patients were required to receive treatment for at least 14 days, and the hospital discharge rates were similar between the two groups.

These results were replicated in a more short-term setting from a research group at the Cystic Fibrosis Center in Italy. The team conducted a two-day study with 16 cystic fibrosis patients receiving three different CPT regimens, and one form was HFCC. As described in “Short-term Effects of Three Chest Physiotherapy Regimens in Patients Hospitalized for Pulmonary Exacerbations of Cystic Fibrosis: A Cross-over Randomized Study,” which was published in Pediatric Pulmonology, the patients were treated twice a day with each type of CPT for a total of 50 minutes in each session. Following treatment, patients were monitored for wet and dry weight of mucus clearance and lung function. Throughout the two treatment days, the patients experienced no difference in effects as a result of the three different CPT treatment programs, but there was a significant difference in the amount of mucus cleared when looking at any of the three CPT treatments versus a control treatment.

Importance of Pulmonary Function in Cystic Fibrosis Patients

Researchers and clinicians have continued to design and develop HFCWO therapy vests with the goal of breaking up mucus secretions and allowing cystic fibrosis patient to improve pulmonary function. From a clinician’s point of view, each patient is born with normal lungs and airways but defective chloride channels. Early inflammation, infection, and scarring contribute to loss of lung function, especially following exacerbations. Therefore, it is important to frequently and regularly measure pulmonary function to ensure patients have adequate function relative to reference values. With abundant evidence establishing the ability of HFCWO-based vests to improve pulmonary and overall health, clinicians have begun to incorporate these vests into normal treatment plans for cystic fibrosis.

Salty Girls the Beauty of Women with CF

Salty Girls the Beauty of Women with CF

New Photography Book Captures the Beauty of Women with CF

Salty Girls the Beauty of Women with CF – Patients model their bodies and scars to raise awareness and empower others

Salty Girls the Beauty of Women with CF – The burden of cystic fibrosis (CF) is both physical and psychological for those with the disease — a struggle that many people are unaware of. Photographer Ian Pettigrew recently published the book Salty Girls to capture CF patients’ everyday reality and to celebrate the women who suffer from the disease and persevere despite their daily struggles with CF.

Salty Girls portrays women diagnosed with cystic fibrosis — who struggle with symptoms that can range from persistent coughing and thick mucus, wheezing, shortness of breath, lung infections, and inflamed nasal passages to poor weight gain and growth, intestinal blockage, and severe constipation — in all their beauty, however much it differs from society’s standards.

“Imagine what it is like growing up as a woman in today’s society, where the media demands perfection, and where body-shaming has become all too prevalent,” Pettigrew said to Cystic Fibrosis News Today. “It’s a constant struggle to maintain this concept of ‘beauty’. Now imagine you have double lung transplant scars, meconium ileus scar, liver and pancreas transplant scars, or PICC line and mediport scars.”

“Because CF affects the digestive system, the appearance of being underweight is prevalent, leading to Salty Girlssnarky observations of ‘anorexic.’ This is the reality for many women with cystic fibrosis,” he added.

Salty Girls aims to challenge the norm and help end body-shaming through photographs of female CF patients embracing their bodies and willing to reveal  their CF-related scars.

“NO MORE feeling embarrassed or ashamed of their bodies, The Salty Girls have now inspired other women with CF, from literally all around the world,” wrote Pettigrew. The women photographed for the book hope to bring others to likewise embrace their strength, resilience, and innate beauty. Salty Girls grew out of another project by the photographer meant to raise awareness for CF, as well as to call all women to stand together, be bold, and know that they are beautiful.

That other project is Pettigrew’s  first book of adult CF patient portraits, Just Breathe. Around the time he was working that book, he came across a photo of the model Bethany Townsend, who suffers from Crohn’s disease, and an interview of another model who suffers from the skin disease vitiligo. Their publicity made him realize there was no public face — no model — with CF, and he decide it was high time for one. “I know what these women go through on a daily basis; everyday is a struggle,” the photographer said, made worse because, “to the uninformed, it’s an invisible fatal disease. With this book it’s invisible no more.”

Salty Girls includes photos of 77 women, taken with their own clothing and posing in more than 25 cities. The project was initiated in August 2014, published over a year and 10,000 kilometers’ worth of traveling later, and is now available online.

The books Salty Girls and Just Breathe were also recently featured in Stephen Shannon’s CF weekly column, where he selects articles that capture interesting events for the CF community. Shannon, who is a CF patient himself and a molecular biology specialist, wrote about the considerable media attention being given to Pettigrew’s exclusive work for Cystic Fibrosis News Today.

Healthy Eating

Healthy Eating

Healthy Eating

Healthy Eating – Published in CFF web site.

The mucus your body produces makes it hard to absorb fat and nutrients, which is why a good CF diet is one that is high in calories and high in fat. Maintaining a healthy weight — and sometimes increasing it — is key to fighting infection and keeping your lungs and body strong. By making small changes in your daily routine, you can make a big difference in your weight.

Tips for Planning and Preparing Meals

Successfully managing a “CF belly” really depends upon three things: input, processing and output. It’s that simple — but it means planning ahead.

Prepare to eat (input), have what you need to digest (process) what you’ve consumed and anticipate the results (output).

Whether you are feeling great or when you’re ill and don’t feel hungry, give yourself time to plan. Before you go to sleep, think about the busy day ahead. Where will you be spending your time? Where can you easily stash food? Is there a refrigerator nearby? Microwave? How about a place to eat?

Think about “packability.” Plan meals or snacks that you can carry in your backpack, purse or briefcase and store in your desk drawer, locker or a cooler in your car. Buy a variety of foods so you don’t get tired of eating the same foods every day.

Cook once to eat three times. When cooking, make enough to pack a meal for tomorrow’s lunch or use plastic containers to freeze meals that you can easily “grab ‘n go.”

Even if you are only cooking for one or two people, look for magazines and recipe books designed for smaller portions so food doesn’t go to waste. Or make a full portion and freeze part of it for when you’re not feeling up to cooking.

Organize Your Kitchen

Organize your kitchen so that everything you need for “grab ‘n go” snacks and meals are within arm’s length. Keep in stock things like paper bags, plastic bags, napkins and food containers.

Create a shelf in your kitchen or refrigerator just for your “grab ‘n go” favorites.

Keep plastic containers on hand to store meal-sized portions in the refrigerator or freezer. In the morning, just grab a filled container to take to work or school or wherever you go.

Organize Your Shopping

Avoid wandering aimlessly around the grocery store by planning ahead. Plan out your menu for the week so you have what you need on hand and don’t have to play the “What’s for dinner?” game.

Many cooking websites provide creative ideas for menu planning, such as theme meals (Taco Night or No-Meat Mondays). Thinking ahead ensures more nutritious and satisfying options.

Buy in bulk to save. You can save money by buying in bulk at discount stores and individually wrapping foods yourself in plastic wrap, plastic bags or foil.

Read food labels. Food labels will help you learn to choose foods that meet your goals.

Keep an eye out for new ideas. Just look around you. “Grab ‘n go” options are everywhere. Check out the selection in convenience stores, vending machines, corner markets, food stands.

Grab ‘n Go Meals and Snacks

Eating should be enjoyable. Planning your meals and snacks ahead of time can help you avoid added stress or going hungry during any part of the day. The following ideas can inspire you and even boost your appetite.


  • Scramble an egg or two with cheese, wrap it in a tortilla and off you go.
  • Microwave a breakfast sandwich while you are dressing.
  • Keep canned shakes, yogurt drinks and other high-calorie beverages in your book bag or briefcase.
  • Buy giant muffins in bulk and wrap and freeze each in its own bag.
  • Before you go to bed, fill a water bottle with your favorite beverage or shake each night. Grab it before you head out in the morning.
  • Make a batch of French toast or pancakes, wrap individual servings and freeze. In the morning, pop a serving in the microwave.
  • Keep single-serving oatmeal (in a packet or a prepackaged insulated bowl) in your pantry or cupboard. Just add hot milk and take it with you.
  • Buy cold cereal in individual containers (bowls or boxes) or pour your favorite cereal into a plastic container. Take along single servings of boxed liquid milk (the kind that does not need to be refrigerated).
  • Keep a bowl of fruit by your house or car keys. Grab a banana, orange or apple on your way out the door.


  • Top bagel halves with spaghetti sauce and shredded cheese for a pizza bagel.
  • Make sandwiches (ham, turkey) at the beginning of the week and freeze them. Toss one in your bag and let it thaw during the day. You can also look for frozen sandwiches in the grocery store.
  • Think about refrigerated wraps or burritos. Buy microwavable burritos, so you can wrap one in a paper towel, heat it and run.
  • Pack microwavable instant soup, instant noodles, fun-size containers of spaghetti and meatballs or macaroni and cheese
  • Try a tuna kit (tuna fish, crackers and mayo).


You never know when you’re going to be held up or stuck somewhere — carry a snack with you. Easy-access snacks are particularly important.

Keep these snacks cool with an ice pack in an insulated lunch bag or cooler:

  • High-fat deli meat and cheese “roll-ups”
  • Cheese sticks and single servings (peel-and-eat varieties such as Gouda, cheddar and string cheeses)
  • Single servings of whole-milk cottage cheese
  • Whole-milk yogurt and yogurt drinks
  • Hummus in a small container and pita bread cut into triangles
  • Single-serving canned pears, peaches or fruit cocktail

Keep these anywhere:

  • Trail mix
  • Granola, protein and snack bars
  • Fig bars
  • Cheese and cracker packs
  • Shakes, canned or bottled
  • Individual peanut butter packets
  • Muffins
  • Graham crackers, vanilla wafers, gingersnap cookies, animal crackers
  • Nuts (peanuts, cashews, almonds, walnuts, macadamia nuts)
  • Sunflower seeds
  • Raisin bread
  • Pretzels or chips
  • Cereal
  • Single-serving juice or milk boxes
  • Dried fruit
  • Bottled coffee drinks
  • Pudding snacks (some brands do not have to be refrigerated)
  • Hot cocoa mix
  • Fresh fruit

Take Bathroom Precautions

Before you leave the house, go to the bathroom. Don’t hold it! Inevitably, if you decide to wait, you’ll get caught in traffic or stuck on a subway or worse.

If you are having a particularly “bad belly” day, think about your route ahead of time. If you are driving, prepare to stop at rest stops you know are clean. If you are in a big city, head for the public restrooms in hotel lobbies or upscale department stores.

For privacy, find the family or handicap facilities.

If you are having more stomachaches or gas while at school or work, you may want to spend some extra time in the bathroom. Some people like to keep a small can of air freshener with them to minimize the smell.

If you are having more stomach pain or gas than usual, call your CF care team for advice. You should never feel ill at ease or embarrassed about taking care of yourself.

Gain healthy amounts of weight to protect your lung function

Gain healthy amounts of weight to protect your lung function

Gain healthy amounts of weight to protect your lung function

In both adolescents and adults, nutritional status can play a major role in the rate of disease progression. Individuals with poor nutritional status and low weight retention are at a higher risk for worsening lung function and increased mortality. However, in light of a new study from Hospital Universitario Ramón y Cajal in Spain, it seems that patients can reverse these risk factors by gaining a healthy amount of weight.

“Nutritional status is a prognostic factor in cystic fibrosis,” wrote lead author of the study, Dr. M. Cano Megías. “Prevention of nutritional impairment and weight loss are major clinical objectives because they are associated with worsening of lung function and increased mortality.”

As explained in the article, “Association of the Relative Change in Weight and Body Mass Index with Lung Function in Teenagers and Adults with Cystic Fibrosis: Influence of Gender and Diabetes,” which was published in the Spanish journal Endocrinología y Nutrición, the research team wanted to determine if there was a relationship between changes in clinical nutrition parameters and changes in lung function. They evaluated weight, height, body mass index (BMI), and oral glucose tolerance for clinical nutrition parameters and forced expiratory volume in one second percent predicted (FEV1%) for lung function.

When the researchers created correlation model comparing changes in weight and changes in FEV1%, they saw a positive relationship. When patients experienced a greater than 6% change in weight, there was an associated change in FEV1% of 9.31%. Conversely, when patients saw a weight loss of at least 2%, they saw a 12.09% decrease in FEV1%.

An additional parameter that the researchers found to impact changes in lung function was diabetic status. Individuals with cystic fibrosis who had impaired fasting glucose tolerance were more likely to experience poorer lung function following a negative change in weight relative to individuals with cystic fibrosis who had normal glucose tolerance.

“In patients with cystic fibrosis, a relative weight gain is positively associated to FEV1%, while a relative weight loss of at least 2% has a significant negative impact on lung function,” concluded the authors. Patients with cystic fibrosis may therefore be encouraged to gain healthy amounts of weight to protect their lung function.

maureennewman  by Maureen Newman

Maureen Newman is a senior Science and Research writer for Cystic Fibrosis News Today. Maureen is currently a PhD student studying biomedical engineering at University of Rochester, working towards a career of research in biomaterials for drug delivery and regenerative medicine. She is an integral part of Dr. Danielle Benoit’s laboratory, where she is investigating bone-homing therapeutics for osteoporosis treatment.

Nutrition for adults with Cystic Fibrosis

Nutrition for adults with Cystic Fibrosis

Nutrition for adults with Cystic Fibrosis

* published in CF Trust (UK) website.

A suitable diet is essential for adults with cystic fibrosis. A healthy, well-nourished body can deal more effectively with chest infections or weight loss caused by illness.

Some aspects of adult life may affect your diet, such as starting work, living away from home, or pregnancy. Additional complications in older people with cystic fibrosis, such as diabetes or bone disease, can also affect nutritional requirements.

Because adults with cystic fibrosis have higher energy needs, it is important that you have a high energy and protein intake. This is especially true if you have frequent chest infections or are losing a lot of fat in your stools.

Protein intake should be as much as twice the regular recommended adult amount; your dietitian will advise you.

It is also important to have a balance between sugary or fatty, energy rich foods and foods that contain protein, vitamins and minerals.

While you don’t need to avoid any particular foods, people with cystic fibrosis should eat plenty of:

  • Fatty foods – butter, ice cream, chocolate
  • Sugary foods – jam, puddings, sweets
  • Milk and dairy products – cheese, yoghurts
  • Starchy foods – pasta, rice, bread
  • Protein foods – fish, eggs, meat
  • Vitamin/mineral-rich foods – fruit, vegetables

Fatty foods
Fat is one of the most concentrated forms of energy, so fatty foods are the best way to increase your energy intake. If you have problems tolerating fat or certain foods that upset you, changing your pancreatic enzymes could be the solution.

If you don’t like the taste of foods like butter, chocolate and fried foods, you can use alternatives that are high in energy but taste less fatty, such as nuts, biscuits, cakes and oily fish, which. This is particularly relevant if you have spent years on a low fat diet, like the people old enough to remember a fat-free diet in the 1970s and ’80s.

Pancreatic enzymes
Around 85% or more of people with cystic fibrosis have insufficient pancreatic function and need to take pancreatic enzymes to help their digestion. Different enzymes suit different people, so if you have any questions about type or dosage you should consult your doctor. You should only stop taking enzymes on the advice of your doctor; otherwise you run the risk of bowel blockage, which would require hospital treatment.

Vegetarian or vegan diet
While both vegetarian and vegan diets can contain the essential nutrients, they are restrictive in what they allow which can make it difficult to sustain a high energy intake.

Strict vegan diets are not advisable for adults with cystic fibrosis because they are particularly low in energy and can be bulky or filling.

A high-energy vegetarian diet is possible with expert help. You should consult your doctor or dietitian if you are or feel strongly about becoming vegetarian.

Vitamin supplements
Vitamin A, D, E and K supplements must be taken regularly, and are available in the form of a prescribed multivitamin supplement. Without supplements, the levels of vitamins in your blood can fall and there is a risk of deficiency. Your supplement may change when you first attend an adult clinic because supplements differ for children and adults.

Weight gain
Keeping your weight at a reasonable level can be hard, especially if you suffer from chest infections, but there are a few things that may help:

  • Only actively try to gain weight when you are well – chest infections use extra energy, so concentrate on maintaining your weight during illness
  • Eat regularly – an erratic diet can reduce your average energy intake
  • Try to have a high energy drink before bed
  • Avoid replacing food with high energy drinks
  • Increase the energy content of your food
  • Don’t rely on prescribable supplements like high energy drinks and glucose polymers to increase your weight
  • Consult your doctor or dietician if you are having trouble maintaining your weight

Weight loss
Poor appetite and weight loss are often the first signs of a chest infection. Appetite may be slow to return, but you should try to keep up a high energy diet regardless. We have a few suggestions that may help:

  • Abandon large meals if they are too filling – snacks can contain just as much energy
  • Try to have a snack or high energy drink every two hours
  • Consume energy in liquid form when you are unwell – high energy drinks may be more palatable than food
  • If you can’t make your own drinks, you may want to try prescribable supplements like glucose powder, liquid glucose or high energy drinks

Tube feeding
In the case of extreme weight loss, tube feeding may be an option to ensure you keep up a high energy intake. There are two types of tube feeding:

  • Nasogastric (a tube inserted into the nose)
  • Gastrostomy (a tube directly into the stomach)

The type of tube will depend on your personal choice and needs and the policy of your treatment centre. If the treatment is going to last for more than a few weeks a gastrostomy tube is probably the best option; it is hidden from view and can’t be dislodged or coughed out during physiotherapy.

Consult your doctor or dietitian to find out more.

Four Important Fat-Soluble Vitamins

Four Important Fat-Soluble Vitamins

Four Important Fat-Soluble Vitamins

By Dr. Mercola

Dietary fats are an important nutritional component not only because your body needs them for building healthy cells and producing hormones—fat is also required for the absorption of fat-soluble vitamins.

This includes vitamins A, D, E, and K, all of which perform a variety of important functions in your body. Vitamins A, D, and K cooperate synergistically, not only with each other but also with essential minerals like magnesium, calcium, and zinc.

This level of synergy is a reminder that your best bet is to cooperate with the wisdom of nature by eating a wide variety of nutrient-dense foods, and in the case of vitamin D, by getting appropriate sun exposure.

Optimizing your vitamin D levels could cut your risk for cancer in half. One study shows it may also slash your risk of heart attacks by 50% – and sunshine is free.

It can be rather tricky to fine-tune all the ratios of individual vitamins, minerals, and fats if you primarily rely on dietary supplements. That said, in some cases supplementation may be a wise choice, and I’ll review some of the basics to consider if you think you need more than your diet can provide you.


The Synergy Between Vitamins A, D, and K

Both vitamins A and D contribute to immune function by binding to their respective receptors, thereby directing cellular processes that promote healthy immune responses.

However, studies in isolated cells suggest that vitamin D may only be able to activate its receptor with the direct cooperation of vitamin A and other studies have raised questions about vitamin A’s ability to negate vitamin D’s benefits if the ratio between them favors vitamin A too much…

One of the simplest ways to ensure an appropriate and beneficial ratio between these two vitamins is to make sure you’re getting your vitamin D from sensible sun exposure, and your vitamin A or beta-carotene from your diet, in the form of colorful vegetables.

The reason this works is it’s the retinoic acid (retinol) form of vitamin A that is problematic. Not beta carotene. Beta carotene is not a concern because it is PRE-vitamin A. Your body will simply not over-convert beta carotene to excessive levels of vitamin A.

Taking beta carotene supplements also will not interfere with your vitamin D, so that’s another option if for some reason you cannot get enough veggies in your diet. Chlorella is also loaded with natural beta carotene and can be very useful for optimizing your vitamin A levels. Vitamins A and D also cooperate to regulate the production of certain vitamin K-dependent proteins.

Once vitamin K2 activates these proteins, they help mineralize bones and teeth, protect arteries and other soft tissues from abnormal calcification, and protect against cell death. Magnesium, calcium, vitamin D3, or vitamin K2 also work in tandem, so if you’re considering taking one, you need to take all the others into consideration as well.

Study Predicts Vitamin A Supplements for Kids Could Save 600,000 Lives a Year

While vitamin D has received plenty of attention over the past decade, other vitamins, such as A, have receded into the background. But that doesn’t make them any less important.

Vitamin A is important for healthy vision, immune function, and proper cell growth, and according to previous research, preventing vitamin A deficiency in children could save an estimated 600,000 lives each year. As reported by Science Daily:

“[A] team of researchers… analyzed the results of 43 trials of vitamin A supplementation involving over 200,000 children aged 6 months to 5 years…

They found vitamin A supplements reduced child mortality by 24 percent in low and middle income countries. It may also reduce mortality and disability by preventing measles, diarrhea and vision problems, including night blindness.

The authors say that, if the risk of death for 190 million vitamin A deficient children were reduced by 24 percent, over 600,000 lives would be saved each year and 20 million disability-adjusted life years (a measure of quantity and quality of life) would be gained.”

Vitamin D—One of the Simplest Solutions to Wide-Ranging Health Problems

Researchers have now realized that vitamin D is involved in the biochemical cellular machinery of all the cells and tissues in your body. When you are deficient, your entire body will end up struggling to operate optimally.

Unfortunately, vitamin D deficiency is still rampant around the world, even in sun-drenched areas, as many shun the sun for fear of skin cancer, or simply spend most of their daylight hours working indoors.

Research suggests that increasing levels of vitamin D3 among the general population could potentially prevent chronic diseases that claim nearly one million lives throughout the world each year. Incidence of several types of cancer and heart disease could also be slashed in half.

Vitamin D also helps fight infections of all kinds, including colds and the flu, as it regulates the expression of genes that influence your immune system to attack and destroy bacteria and viruses.

Optimizing your vitamin D levels should be at the top of the list for virtually everyone, regardless of your age, sex, color, or health status, as vitamin D deficiency has been linked to an astonishingly diverse array of common chronic diseases, including:

Cancer Hypertension Heart disease
Autism Obesity Rheumatoid arthritis
Diabetes 1 and 2 Multiple Sclerosis Crohn’s disease
Cold & Flu Inflammatory Bowel Disease Tuberculosis
Septicemia Signs of aging Dementia
Eczema & Psoriasis Insomnia Hearing loss
Muscle pain Cavities Periodontal disease
Osteoporosis Macular degeneration Reduced C-section risk
Pre eclampsia Seizures Infertility
Asthma Cystic fibrosis Migraines
Depression Alzheimer’s disease Schizophrenia

General Vitamin D Guidelines

To maximally benefit from vitamin D, you need a vitamin D level of at least 40 ng/ml, and to get there, you may need around 5,000-6,000 IUs of vitamin D3 per day or more, from all sources, and that includes appropriate sun exposure, food, and/or a vitamin D3 supplement. Research suggests the ideal range for optimal health is between 50-70 ng/ml, and if you have cancer or heart disease, the ideal may be even higher.

Ideally, test your vitamin D level at least twice a year to ensure you maintain a clinically relevant level year-round. Keep in mind that if you take a vitamin D supplement, you also increase your body’s need for vitamin K2. Vitamin K2 deficiency is actually what produces the symptoms of vitamin D toxicity, which includes inappropriate calcification that can lead to hardening of your arteries.


Both Vitamin D and A Need Magnesium and Zinc to Work Properly

Vitamins A and D carry out most of their functions by regulating gene expression, but to do this, they also need magnesium, both directly and indirectly. For starters, your cells can only produce vitamin A and D receptors with the assistance of magnesium. Even fully activated vitamin D (calcitriol) is useless in the absence of magnesium. Magnesium also helps digest the fat needed for their absorption.

As noted by Christopher Masterjohn in a previous article on my site, magnesium contributes to more than 300 chemical reactions, including every reaction that depends on ATP, the universal energy currency of your cells. It also activates the enzyme that makes copies of DNA, as well as the enzyme that makes RNA, which is responsible for translating the codes contained within your genes into the production of every protein within your body. This process of translating the DNA code in order to produce proteins is called “gene expression.”

Unfortunately, industrial agriculture has massively depleted most soils of beneficial minerals like magnesium, so many are not getting sufficient amounts from their diet. An exception might be if you eat organic foods (grown in soil treated with mineral fertilizers), in which case you may still be able to get a lot of your magnesium from your food.

Seaweed and green leafy vegetables like spinach and Swiss chard are excellent sources of magnesium, as are some beans, nuts and seeds, like pumpkin, sunflower, and sesame seeds. Avocados also contain magnesium. Juicing your vegetables is a great way to ensure you’re getting enough of them in your diet.

Zinc is another mineral that plays an important role in the function of fat-soluble vitamins. There are well-documented interactions between vitamin A and zinc. Vitamin A supports the intestinal absorption of zinc, and zinc, in turn, supports the formation of vesicles involved in transporting vitamin A and the other the fat-soluble vitamins across your intestinal wall. If you have low zinc, supplementing will support vitamin A’s role in eye health. Zinc also interacts with vitamin D, and it appears they promote each other’s intestinal absorption.

Vitamin E Is Important for Vision and Cancer Prevention

Vitamin E is a potent antioxidant and immune-system booster that—like vitamin D—has been shown to have a number of cancer-fighting properties. It may also be helpful in the treatment of obesity-related fatty liver disease and Alzheimer’s. Vitamin E is also important for eye health, and can help lower your risk of age-related macular degeneration (AMD), a leading cause of vision loss in the elderly.

“Vitamin E” actually refers to a family of at least eight fat-soluble antioxidant compounds and, ideally, vitamin E should be consumed in the broader family of mixed natural tocopherols and tocotrienols, (also referred to as full-spectrum vitamin E) to get the maximum benefits. Avoid synthetic vitamin E (tocopheryl), as it will not provide your body with the benefits that natural full-spectrum vitamin E will. According to Dr. Evan Shute, a physician who has worked with vitamin E for over three decades, healthy women need around 400 IUs of vitamin E per day, while men need around 600 IUs daily.

The best way to ensure you’re getting the full spectrum of vitamin E in a form your body can use is to make smart dietary choices. Tocopherol and its subgroups are found in certain nuts and green leafy vegetables, for instance. Sources of tocotrienols include palm oil, rice bran, and barley oils.

However, since there are relatively few healthy dietary sources of vitamin E, a natural supplement may be necessary for some. If you’re interested in increasing your dietary sources of vitamin E, try eating more raw organic nuts, such as hazelnuts, almonds, walnuts, and pecans, legumes, and green vegetables, such as spinach and broccoli.

Vitamin K2 for Optimal Heart and Bone Health

Vitamin K1 is most well-known for the role it plays in blood clotting. In fact the “K” in “vitamin K” stands for “koagulation”, the German word for blood clotting. From its discovery in the 1930s through the late 1970s, we knew of no other roles for vitamin K. Since researchers throughout the twentieth century saw the two forms of the vitamin as interchangeable, they ignored vitamin K2 as though its scarcity made it irrelevant.

The realization that vitamin K is not just for blood clotting, however, led us to discover that vitamins K1 and K2 are not interchangeable after all: vitamin K1 more effectively supports blood clotting, while vitamin K2 is also essential for building strong bones, preventing heart disease, and it plays a crucial part in other bodily processes as well. In fact, vitamin K2 is sometimes referred to as “the forgotten vitamin” because its major benefits are often overlooked.

Like vitamin A, vitamin K2 is an important adjunct to vitamin D, and if you are deficient in one, neither will work optimally. According to one of the worlds top vitamin K researchers, Dr. Cees Vermeer, most people are deficient in vitamin K. Most of you get enough K from your diet to maintain adequate blood clotting, but NOT enough to protect you from a variety of other health problems, such as:

Arterial calcification, cardiovascular disease, and varicose veins Dementia. Recent research suggests adding vitamin K-rich foods such as spinach, kale, collards, and mustard greens to your diet can slow cognitive decline. Seniors who ate one to two servings of leafy greens per day were found to have the cognitive ability of a person 11 years younger than those who consumed none
Osteoporosis Tooth decay
Prostate cancer, lung cancer, liver cancer, and leukemia Infectious diseases such as pneumonia

There are three types of vitamin K:

  • Vitamin K1 (phylloquinone), found naturally in plants, especially green vegetables; K1 goes directly to your liver and helps you maintain healthy blood clotting
  • Vitamin K2 (menaquinone), made by the bacteria that line your gastrointestinal tract; K2 goes straight to your blood vessel walls, bones, and tissues other than your liver. The biological role of vitamin K2 is to help move calcium into the proper areas in your body, such as your bones and teeth. It also helps remove calcium from areas where it shouldn’t be, such as in your arteries and soft tissues
  • Vitamin K3 (menadione) is a synthetic form I do not recommend; it’s important to note that toxicity has occurred in infants injected with synthetic vitamin K3

Vitamin K2, which is made in your body and also produced by bacteria in fermented foods, and is a superior form of vitamin K2. It’s the one I recommend for supplementation, as it’s natural and non-toxic, even at 500 times the recommended daily allowance (RDA). Increasing your K2 by consuming more fermented foods is the most desirable way to increase your levels. The food highest in natural K2 is natto, which is a form of fermented soybeans.

You can obtain all of the vitamin K2 you need (about 200 micrograms) by eating 15 grams of natto daily, which is half an ounce. By using a specially formulated starter culture you can also dramatically boost the vitamin K2 content of your homemade fermented vegetables.

Vitamins and Cystic Fibrosis

Vitamins and Cystic Fibrosis

Vitamins and Cystic Fibrosis

Published by CF Association Canada

Many people with CF have problems when they eat food, making it hard for their intestines to soak up nutrients, especially fat. To help with this, en­zymes are taken with meals and snacks. Vitamins A, D, E, & K are unique because they need fat in order to be ‘soaked up’ by your body, they are called “fat-soluble” vitamins. Even when someone takes enzymes they can still lose fat in their stool. If they are losing fat then they are probably also losing vitamins. If you don’t take your vitamins, over time, you may develop low levels in your blood. This is known as a “vitamin deficiency”.

You may wonder why it is important for someone with CF to take their vitamins if they don’t have a problem when they eat. To understand why, you must real­ize that vitamins are important to your body when you are healthy, but they even more important when you are sick. People who have CF may find they get sick more often than people who don’t have CF. To help their bodies fight an infection they need more vitamins than someone without CF. We ask people with CF to take a vitamin pill because it is very hard to get enough vitamins from food alone. Our focus is often the fat soluble vitamins, but it is important to remember that all vitamins are needed for a healthy body.


Vitamin A Vitamin A has many important roles in the body. It helps you see at night and lets your eyes adjust when you move from a dark place to a bright place. If you have a vitamin A deficiency then your eyes may not be able to get used to changes in light. There have been peo­ple with CF who have reported having this problem. If you think this is a prob­lem speak to your CF doctor. Vitamin A also helps make skin healthy and helps fight infection when you get sick. During childhood it helps you grow. It is found in eggs, liver, tomatoes, milk, and some fruits & vegetables. For people with CF, food sources are not enough to prevent vitamin A deficiency, therefore a vitamin supplement is usually recommended.


Vitamin D Vitamin D comes from two sources. It is made by the skin when it is exposed to sunlight, and it is found in the foods we eat. It helps your body absorb calcium, and helps move calcium from your blood to your bones. Without enough vitamin D your bones can weaken and the chances of breaking a bone become greater. While foods such as eggs and cereals contain vitamin D, the main source is milk. A vitamin supplement is usually recommended to make sure you get enough every day.


Vitamin E Vitamin E has become very popular because of its role as an antioxidant. As you grow your body goes through many changes. As your body changes it produces harmful products that can destroy your healthy cells. Vitamin E helps get rid of these harmful products and this is why it is called an antioxidant. A deficiency of vitamin E can affect your body’s ability to protect itself when you get sick. For people with cystic fibrosis this may affect their lungs and their ability to breath. Foods that contain vitamin E include plant oils, margarines, and some fruits & vegetables. Diet alone cannot prevent a vitamin E deficiency in people with CF, therefore a supplement is usually recommended.


Vitamin K Most of the vitamin K we need comes from our diet. It is found in green vegetables, plant oils, and margarine. We also have healthy bacteria in our intestines that produce vitamin K. Even though the bacteria in your intestine is healthy, it can be destroyed by the anti­biotics you may take for a lung infection. This can affect the amount of vitamin K you get on a daily basis. Vitamin K is very important because it helps your blood clot. When you cut yourself, the time it takes for your cut to stop bleeding is affected by how much vitamin K you have in your body. The longer it takes to ‘clot’ the less vitamin K you may have. Vitamin K is also important for proper bone growth in children. To prevent a deficiency many people with CF take a supplement that contains vitamin K.


People with CF are at a very high risk for getting vitamin deficiencies. These deficiencies are serious and can include symptoms such as night blindness, bone fractures, back pain, and bleeding. They may also affect how quickly you recover from a lung infection. You can prevent these deficiencies just by taking your vitamins recommended by your CF clinic. To make sure get the most from vitamin supplements it is best to take them with food and enzymes.


VITAMIN A sources:

  • liver
  • egg yolk
  • dairy products
  • green leafy or yellow
  • vegetables


VITAMIN D sources:

  • liver
  • fish
  • fortified milk and margarine
  • egg yolk


VITAMIN E sources:

  • vegetable oils
  • nuts
  • eggs
  • wheat germ


VITAMIN K sources:

  • green leafy vegetables
  • liver
  • vegetable oils
  • bacteria in the intestine also make vitamin K
Vitamin “D” Supplements

Vitamin “D” Supplements

Vitamin “D” Supplements

By Suzanne Michel – Registered Dietitian

Are you taking vitamin D pills in addition to your daily CF multivitamin? If the answer is yes, you may want to ask your CF Center about taking MVW Complete Formulation® multivitamins with higher vitamin D. The higher D products are currently available as a softgel and will soon be available as a bubble gum flavored chewable. Whether you take the higher D softgel, or higher D chewable, each product contains all of the recommended vitamins you need, plus 3000IU of vitamin D.

Each MVW Complete Formulation® D3000 Multivitamin Softgel contains the same amount of vitamins as the regular MVW Complete Formulation® Softgel, but has more vitamin D – 3000IU per softgel. The recommended dose for individuals above the age of 10 is two (2) softgels daily, providing 6000IU of vitamin D.

Like the regular MVW Complete Formulation Multivitamin® Chewable, for ages 4 to 8 years, the recommended dose of the MVW Complete Formulation® D3000 Multivitamin Chewable is one (1) chewable daily. For individuals over 9 years of age, two (2) chewables are usually taken per day. This chewable will have a bubble gum flavor.

The amount of vitamin D in the MVW Complete Formulation® higher D multivitamin products meet the recommendations published in the CFF evidence-based paper: An update on the screening, diagnosis, management, and treatment of vitamin D deficiency in individuals with cystic fibrosis, published in 2012. The vitamin D in each product is cholecalciferol, a form recommended for vitamin D supplements.

When taking the MVW Complete Formulation® higher D products, you may be able to stop taking your additional vitamin D pills. Your CF Center Registered Dietitian can help you figure out what is best for you. As with all fat-soluble vitamins (K, E, D, A) it is best to take the multivitamins with a fat-containing food or drink and, and if you take enzymes, with your enzymes. The price of the MVW Complete Formulation D3000 Multivitamin® products is the same as the regular MVW Complete Formulation Multivitamins®.

Why is vitamin D important for everyone, but especially for individuals who have CF? Vitamin D has long been known as important for bone health. Vitamin D along with sufficient calcium keeps our bones in good shape avoiding rickets, kyphosis, or osteopenia. More and more research is revealing other important roles for vitamin D including support of immune function and preventing inflammation (infection). The relationship of vitamin D to lung health was first reported for asthma. Researchers found that vitamin D deficiency results in decreased pulmonary function, worse asthma control, and perhaps decreased response to asthma therapies. The work with asthma led CF researchers to look at vitamin D and CF pulmonary health. The research is still early, but reports are available which describe a significant relationship of serum vitamin D levels to pulmonary function and pulmonary exacerbation. In summary, vitamin D is important for both bone health and pulmonary health. Using the MVW Complete Formulation D3000 multivitamins may help maintain optimal blood levels of vitamin D.

Vitamin D in the MVW Complete Formulation® Multivitamins

MVW Complete Formulation® Liquid Drop: 750IU/0.5ml
MVW Complete Formulation® Multivitamin Chewable: 1500IU/chewable*
MVW Complete Formulation® D3000 Multivitamin Chewable: 3000IU/chewable*
MVW Complete Formulation® Multivitamin Softgel: 1500IU/softgel**
MVW Complete Formulation® D3000 Multivitamin Softgel: 3000IU/softgel**

* Recommended dose for ages 4 to 8 years is one chewable daily
**Recommended dose for ages 10 and up is 2 softgels daily