Cystic Fibrosis. Inflammation. Nutrition.
Cystic fibrosis (CF) is a degenerative disease characterization by it's chronic inflammatory process.
The abnormal CFTR protein results in abnormally thick mucous in the airways. This thickened mucous further results in obstruction in the airway allowing pathogenic bacteria to growth and thrive. The respiratory become infected and inflamed.
This progress continues on throughout the life of the person with cystic fibrosis.
Mucolytics, such as pulmozymes, helps to loosen the mucous. Antibiotics, such as tobi, helps to fight the bacterial infection. Anti-inflammatory drugs are used to help reduce inflammation.
Cystic Fibrosis and Inflammation.
Because of the chronic inflammation associated with CF, patients tend to have low levels of glutathione (GSH), which is an important modulator of the immune and inflammatory process.
GSH bathes the extracellular space of sensitive tissues that come in contact with the oxygen in the air, and this includes the eye, the lungs, and the gastro-intestinal system, among others. The epithelial cells in these systems releases GSH into the extracellular space to protect them from oxidant damage. Unfortunately, in most of the systems just described, the epithelial channel used to release GSH is the CFTR. This means that those with CFTR mutations releases much less GSH.
CFTR defect is also associated with defective fatty acid metabolism resulting in low levels of anti-inflammatory fatty acids, such as linoleic acid and docosahexaenoic acid (DHA), and high levels of pro-inflammatory fatty acid, such as arachidonic acid.
Nutrition and Inflammation
Saturated and trans fat intake is associated with increase risk of cardiovascular disease and chronic inflammation, which is likely an important component in the pathophysiology of many chronic diseases, such as type 2 diabetes, Alzheimer’s disease, and many types of cancers.
As the longevity of CF population extends, we’re dealing with adult CF patients with adult chronic medical problems, such as hypertension, CVD, etc.
As we know, many chronic adult medical problems are diet- and lifestyle-related, and are the results on chronic inflammation.
How does the current CF diet measure?
Smith et al analyzed 136 food diaries in 27 children and found a high proportion of calories from fat (38% - recommendation for CF is 40%), high proportion of fat from saturated fat (134% of recommended intake), and a mean polyunsaturated fat intake was 92%.
Can Nutrition influence inflammation?
Food can activate the inflammatory response.
Food can inhibit the inflammatory response by correcting a nutrient deficit that causes inflammation.
Food can also inhibit an inflammatory response by restricting pro-inflammatory agents, such as saturated and trans fat.
Inflammation Causing Food
Unhealthy Saturated Fats (including trans fat): processed/convenience foods, fried foods, dairy products, animal protein
Refined Carbohydrates: processed/convenience foods, bread, pasta, crackers, baked goods, most breakfast cereals, sweets/desserts, soft drinks, juices…
Inflammation Fighting Food
Omega-3 Fatty Acids (DHA & EPA): fatty fish (salmon, tuna, trout, herring, mackerel), chia seeds, flaxseed, walnuts, grass-fed beef & butter
Polyphenols: fresh fruits/ vegetables, whole grains and green tea
Can we create a diet that maximizes health and still meet nutritional needs of people with CF?
The Mediterranean diet or anti-inflammatory diet is rich in omega-3 fatty acids, antioxidants and restricted in red meat, processed food, saturated fats and trans fats.
The anti-inflammatory diet has an increased mono-unsaturated fatty acids to saturated fatty acids ratio, and ω-3 to ω-6 fatty acids ratio. It has been shown to have anti-inflammatory effects when compared with a typical North American and Northern European diet.
Rich in omega-3 fatty acid: cold water fish, flax seeds, chia seeds, walnuts, fish oil supplement 4-6g daily.
Rich in antioxidants & fiber: fresh fruits/vegetables, nuts, seeds, beans, whole gains, dark chocolate (no fiber).
Rich in herbs and spices: garlic (allicin), turmeric (curcumin), hot peppers (capsaicin), ginger (gingerois), cinnamon, onions, cilantro, parlsey, basil, rosemary…
Limit red meat, processed/convenient foods, sweets, baked goods, butter/margarine, trans fat…
Anti-inflammatory Diet for Cystic Fibrosis
Nutritional goals are still to achieve appropriate weight gain, meet nutritional needs and prevent malnutrition or deficits.
This diet still needs to be high calorie and high fat (40% of total calories).
Studies show DHA and EPA supplement can reverse the CF-related fatty abnormalities in CFTR.
Current CF Diet vs Anti-Inflammatory diet for Cystic Fibrosis
Both diets provides about 4,200 calories per day and more than 40% of dietary fat, the current recommendation.
The anti-inflammatory diet has a much lower ω-3 to ω-6 fatty acids ratio of 1:4. Ideal ratio is 1:4.
And this is not including additional supplementation with fish oil.
Which diet for cystic fibrosis would you be eating?
Anti-Inflammatory Calorie Boosters for Cystic Fibrosis
Flaxseed oil or extra virgin olive oil or coconut oil (45kcal/tsp) drizzle on everything.
Coconut cream (50kcal/tbsp) use in recipes or beverages, smoothies
Nuts (170kcal/oz) tossed in salads, blended in smoothies, added to baked goods, granola/trail mix.
Beans in stew/casserole, soup, brownies
Chia seed or flaxseed (omega-3 & fiber) add to smoothies, breakfast cereals, baked goods, stews and casserole
Nut butter (190kcal/2 tbsp) spread on toast, crackers, pancakes, chips, crackers, eat with fruits/vegetables.
Bean dip (hummus 25kcal/tbsp) or avocado dip (guacamole 25kcal/tbsp) with vegetables, chips, salads, etc
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