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CFF Logo to come © 2003 Solvay Pharmaceuticals, Inc. All rights reserved. Printed in USA CRN00097 5K July 2003 VITAMINS and cystic fibrosis (CF) Vitamins keep us strong and healthy. People with CF need extra vitamins for good health. This guide has useful facts about vitamins, and makes a great learning tool for people with CF. Not only will you find out what vitamins do, you’ll also see where to find them in the foods you eat. Vitamins are organic compounds that work together to help our bodies grow, give our cells energy, and help fight illness. We get vitamins from the foods we eat, and in some cases, our bodies even make their own. There are 13 different vitamins in all. Each belongs to one of the two main vitamin groups—fat-soluble or water-soluble.1 TWOGROUPS of vitamins Fat-soluble vitamins The fat-soluble group has vitamins A, D, E, and K, which are found in fatty foods and oils. After we digest them, these vitamins are stored in fatty tissue inside our bodies, ready for future use. Because people with CF have trouble digesting fatty foods, they also have trouble getting the right amount of fat-soluble vitamins.1 Water-soluble vitamins The water-soluble group contains vitamin C and the B-complex vitamins, including folic acid, biotin, and pantothenic acid. They are called water-soluble because they are easily absorbed by water inside the body and washed out of the body with sweat and urine. Because they can leave our bodies so easily, we must find ways to get them every day.1 Let’s take a closer look at what each of the 13 vitamins does and where we can find them. 3 VITAMIN A VITAMIN D (carotenes) (calciferol) What a find. Vitamin A was the very first vitamin to be discovered. It was found in 1913, when researchers saw that animals who didn’t get enough vitamin A were not healthy.2 Since then, we’ve learned that vitamin A helps mucous linings in the body stay strong enough to ward off bacteria. It prevents night blindness and makes bones and teeth strong.1,3 Besides night blindness, low levels of vitamin A can also cause dry, scaly skin and raise your risk of infections.1 Vitamin A can be found in lots of foods. Here’s a list of some foods that are good sources3: Beyond the milk. Vitamin D has many health benefits. It keeps normal levels of calcium in the blood, and this helps bones grow strong and stay healthy. It also helps keep the immune and nervous systems working well.1,4,5 If you don’t get enough vitamin D, you may stunt your growth and even get rickets.4,5 How can you get vitamin D? When sunlight touches your skin, it mixes with good cholesterol that’s found just beneath the skin and turns the cholesterol into vitamin D. A little sunlight can help make a lot of vitamin D.4 Vitamin supplements and foods that have vitamin D are also good sources. Here are a few to get you started1,5: ■ Carrots ■ Cantaloupes ■ Sweet ■ Apricots ■ Salmon ■ Cereal ■ Cheese ■ Tuna ■ Eggs ■ Milk ■ Pudding potatoes ■ Vegetable soup pizza 5 VITAMIN K VITAMIN E (phytonadione) (d--tocopheryl acetate) The radical police. Vitamin E is like a police officer who patrols the body to keep bad things from happening. When cells in the body burn energy, they make toxins called free radicals. If these free radicals mix with oxygen, they may cause chronic diseases such as cancer and heart disease. Vitamin E stops free radicals from mixing with oxygen, helping prevent many of these problems.6 Vitamin E also helps red blood cells, muscles, and tissues form properly.1 It’s hard to get all the vitamin E you need from food alone. Some fruits and vegetables have only small amounts. Most meat products don’t have it at all. But vitamin supplements and the following foods can be good sources of vitamin E1,6: ■ Almonds ■ Broccoli ■ Peanuts ■ Margarine ■ Mayonnaise ■ Bread The ouch factor. Every time you cut yourself, your body forms clots to stop the bleeding. There are many factors that aid in this process, and vitamin K is a big one.4 Vitamin K works in the liver to help make many of the substances needed to clot blood.4 Without vitamin K, a cut could bleed for a long time, and a small bruise could turn into a big one.4 Vitamin K can be found in many foods. To make sure you get vitamin K in your diet, eat lots of dark-green, leafy vegetables. Here are some good food sources of vitamin K1,4: ■ Broccoli ■ Peas ■ Spinach ■ Potatoes ■ Leaf ■ Olive lettuce oil (whole grain) 7 VITAMIN B 2 VITAMIN B1 (thiamine) Head of the B team. Vitamin B1 has a big job. As part of the B-complex team, it joins with the other B vitamins to help the body work right. Vitamin B1 helps change carbohydrates and fats into energy that the body needs every day.4 Cells in your muscles and glands rely on this energy to work, and so do your nervous system and the heart.4 It’s easy to get all the vitamin B1 you need for good health because it’s found in lots of foods and in vitamin supplements. The foods in the following list can help you make vitamin B1 a part of your daily diet.1,4 ■ Pork ■ Ham ■ Pecans ■ Chickpeas ■ Lima ■ Beef beans (riboflavin) Inside the cell. For you to stay active and healthy, every cell in your body must work hard to change food into energy. Vitamin B2 goes inside your cells and makes enzymes that release the energy stored in food. It also helps your body make healthy red blood cells. Low levels of vitamin B2 can lead to bad skin and itchy eyes.4 Foods that have vitamin B2, such as the ones on the list below, are a common part of a good diet. But since people with CF may have trouble digesting some of them, they may need vitamin supplements as well.1,4 ■ Milk ■ Cereal ■ Yogurt ■ Pasta ■ Cheese ■ Peas 9 VITAMIN B 6 VITAMIN B3 (niacin) The sugar supervisor. Just like B1 and B2, vitamin B3 helps cells turn food into energy. Vitamin B3 also helps control your glucose (sugar) level, so you have all the energy you need when you need it most, during exercise and other physical activities. As part of the B team, B3 works with the other vitamins to keep your skin healthy and your nervous and digestive systems working right.4 While vitamin B3 is found in lots of foods we eat, it’s really common in poultry and dairy products. Here are some foods you can eat to get vitamin B34: (pyridoxine) The protein machine. Vitamin B6 helps make more than 100 enzymes that turn the protein you eat into the protein your body uses to keep healthy and strong. This vitamin also makes hemoglobin, the part of red blood cells that carries oxygen through the body. Vitamin B6 even unlocks energy from carbohydrates stored in your body to keep you active all day.7 ■ Tuna ■ Lamb If you don’t like vegetables, don’t worry. A good way to get vitamin B6 is by eating chicken, pork, beef, and fish. You can find vitamin B6 in these foods as well7: ■ Peanuts ■ Beef ■ Cereal ■ Garbanzo ■ Chicken ■ Pork ■ Baked ■ Oatmeal potatoes ■ Bananas ■ Roast beans beef 11 VITAMIN B12 VITAMIN B 9 (folic acid) (cobalamin) Out with the old and in with the new. Vitamin B9, also called folic acid, helps your body make millions of fresh new cells every day to replace the old tired ones.4 New cells help you grow and keep you healthy. If you don’t get enough B9, you may get diarrhea, have a sore tongue, or feel like you’re going to throw up.4 A tiny vitamin with a big job. You need only a small amount of vitamin B12 in your diet, but that small amount protects your nerve cells.4,8 It also makes healthy red blood cells that take oxygen and nutrients to different parts of your body. If you don’t get enough B12 every day, your body won’t make enough red blood cells, and the ones you do have will not be strong enough to keep you healthy.4 Folic acid is found in many vegetables and beans. But if these foods are cooked too long, they lose a lot of B9. That’s why you may need a vitamin supplement plus a healthy diet with the following foods4: If you like beef and seafood, you’re in luck. These foods have high levels of B12. But if you don’t eat animal products, you may not get enough B12 and should take vitamin supplements. Here are some good food sources of B12.8 ■ Lentils ■ Black-eyed ■ Spinach ■ Navy peas beans ■ Peanuts ■ Tuna ■ Pork ■ Lima ■ Salmon ■ Eggs ■ Beef ■ Chicken beans 13 VITAMIN C PANTOTHENIC ACID (ascorbic acid) Keeping things together. Vitamin C does hundreds of jobs in the body. It works hard to fight free radicals that can hurt your cells.4 Vitamin C also helps make collagen, a sticky substance that keeps your bones and muscles together, and helps blood vessels stay strong.1,4 It also can help lower blood pressure, heal a wound, and shorten the length of a cold.4 Our bodies need a diet rich in vitamin C foods to stay healthy.4 The good news is that vitamin C is found in many fruits and vegetables like the ones listed below.4 ■ Red peppers ■ Papaya ■ Oranges (d-cal pantothenate) The enzyme maker. Pantothenic acid helps change fat and carbohydrates into energy.1 It also helps make red blood cells and control the body’s hormones.1,4 Low levels of pantothenic acid can lead to stomach cramps, vomiting, and tingling in the hands and feet.1 It’s easy to get the right amounts of pantothenic acid because it’s found in many foods that are a part of a daily diet. Here are some ideas4: ■ Avocados ■ Lentils ■ Strawberries ■ Mushrooms ■ Potatoes ■ Cantaloupes ■ Chicken ■ Eggs ■ Mangoes 15 EXTRASUPPORT BIOTIN for vitamins Made from good bacteria? Some bacteria that live inside the body help you stay healthy. In fact, these good bacteria make a vitamin called biotin.4 Biotin helps the body turn foods into fatty acids, and it helps change carbohydrates into energy.1 You need biotin to keep your hair healthy, but it does not help restore hair lost in natural balding.4 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, and there are many common foods that have it as well.4 ■ Peanuts ■ Peas ■ Chocolate ■ Bacon ■ Eggs ■ Bananas All 13 fat-soluble and water-soluble vitamins play a role in your health. They all work together to help your body work well. Besides eating a good diet, you may have to take vitamin supplements to get the extra nutrients needed to best manage CF. Vitamin supplements with one or more of the fat-soluble or water-soluble vitamins can come in pills, capsules, tablets, or liquid drops. Many types of vitamin supplements are available today. Over-the-counter vitamins can be found on the shelves of most local grocery stores and pharmacies. Other vitamins are available by prescription only. Because people with CF have trouble digesting certain vitamins, a prescription supplement may be used to meet their extra nutritional needs. 17 EXTRASUPPORT REFERENCES for vitamins (cont’d) To get the most from your vitamin supplements, always take them with meals and your pancreatic enzyme therapy. As with all prescription products, always follow the orders of your healthcare provider. Remember, vitamins are a big part of living a happy and healthy life. If you have any questions or concerns about vitamins and vitamin supplements, talk to your healthcare provider. He or she knows CF and can tell you what is best for you. References: 1. Brody J. Vitamins: micronutrients or miracle drugs? In: Brody J, ed. Jane Brody’s Nutrition Book. New York, NY: Bantam Books; 1987:155-181. 2. Underwood BA. Prevention of vitamin A deficiency.In: Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers. Available at: www.nap.edu/openbook/030906029X/html/103.html. Accessed May 22, 2003. 3. Facts About Dietary Supplements. Vitamin A and Carotenoids. Clinical Nutrition Service. National Institutes of Health. November 26, 2002. 4. Reavley N. Vitamins. In: The New Encyclopedia of Vitamins, Minerals, Supplements, and Herbs. New York, NY: M. Evans and Co., Inc. 1998:33-179. 5. Facts About Dietary Supplements. Vitamin D. Clinical Nutrition Service. National Institutes of Health. March 2001. 6. Facts About Dietary Supplements. Vitamin E. Clinical Nutrition Service. National Institutes of Health. February 6, 2002. 7. Facts About Dietary Supplements. Vitamin B6. Clinical Nutrition Service. National Institutes of Health. January 2001. 8. Facts About Dietary Supplements. Vitamin B12. Clinical Nutrition Service. National Institutes of Health. January 2001.