Using Food as Medicine to Manage CF: A Nutritionist’s View

As a clinician, I have consulted with many patients over the years and have had the opportunity to be inspired and impacted by many. Most recently I had the pleasure of connecting with Brad, who shared with me his hero-like journey with cystic fibrosis. What struck me the most, besides his unbelievably positive outlook on life, was the direct connection between the gut microbiome, lungs, liver, pancreas, kidneys, and nutritional status.

The range of reasons why someone would come to see an RD (Registered Dietitian) vary, but the common denominator is that food and lifestyle can be adapted and modified to create impactful and long-lasting change physiologically, psychologically, and spiritually.

Although the lungs are the primary organ we think of when discussing CF, the reality is that this disease affects the epithelial cells of both the lungs and the stomach/lumen (the latter the inner space or cavity of tubular organs like the intestines). CF causes an excess of phlegm and mucus to accumulate in both of these organs and effects functionality.

The production of phlegm in the lungs inhibits oxygen uptake into the bloodstream, and in the stomach/lumen affects their proficiency to digest and absorb all the nutrients from food. For this reason, individuals with CF find it hard to maintain weight, keep energy up, and stay properly hydrated. Immunity decreases as well, creating an opportunity for bacteria to enter the system.

Interested in Cystic Fibrosis research? Sign up for our forums and join the conversation!

From a Chinese medicine perspective, we are comprised of two different types of chi (i.e., life energy) to function. One is the chi we are born with and it is stored in the kidney. The other is the “postnatal chi,” and this is the energy we continually make as our lives progress. It is made from air taken though the lungs and food taken through the stomach.

The combination of air and food is how we literally live. Since CF affects the lungs and the stomach, there is a deficiency in the amount of postnatal chi produced. Because of this, more of the “limited supply chi” from the kidneys that we are born with is used up earlier than normal. One of the symptoms of depleting kidney chi is fluid deficiency.

Since fluid is cooling for the body, when there is lack of it, heat accumulates to create a salt imbalance and essential electrolytes are lost through extracellular tissues and fluids like sweat and phlegm. This presents as problematic as other manifestations can arise. These include life-threatening lung infections, and obstructions of the pancreas that can stop natural enzymes from helping the body break down and absorb food, leading to fat and nutrient malabsorption. These malfunctions inhibit the liver’s functionality, causing a CF-related form of diabetes and insulin resistance.

Antibiotics and anti-inflammatory medications are typically prescribed to help clear mucus from the lungs; however, these medications can have potential effects on the overall balance of the gastrointestinal (GI) microbiome. This is supported by the 2016 Pediatric Pulmonology article “The CF Gastrointestinal Microbiome: Structure and Clinical Impact” that notes: “ A growing body of evidence suggests that GI microbiome in people with CF is altered, and that these dysbiosis contribute to disease manifestations in many organs, both within and beyond the GI tract.”  As the article continues: “The GI microbiome is shaped by host diet, immunity, and other physicochemical characteristics of the GI tract, and perturbations such as antibiotics treatments can lead to persistent changes in microbial constituency and function. These GI microbes also play a critical roles in hosts nutrition and health.”

If there is no other choice but to take antibiotics, make sure that you consume probiotics as well, either before or after taking the medications, to maintain an optimal ratio of gut bacteria.

So, how can we use food as medicine?

Food combining for gut health

1. 1. The basic rule is to eat protein alone or with green/non–starchy vegetables.
   2. Fats can be eaten with green or non–starchy vegetables and/or starches
   3. Starches can be eaten with green vegetables and/or fats

Eat small, frequent meals using this food combining guide. Meals should be either fat-based or protein-based but not combined together. This is an excellent method for glucose control as well.

Bitters

Take bitters before meals. Bitters help trigger the release of digestive and pancreatic enzymes, specifically bile, which are essential for digesting fats that have essential metabolic functions for health and wellness.

According to an article published in 2014 in the Journal of Pediatric Gastroenterology and Nutrition, “About 90 percent of patients with CF in the US have pancreatic insufficiency and are at risk for fat malabsorption and fat soluble vitamin deficiency.”

Improving these secretions are crucial in weight management because, even if the calories are increased, if the ability to absorb the nutrients aren’t available than desired outcomes won’t be achieved.  Bitters are also lung and kidney strengtheners, and are especially good at clearing infections with a lot of phlegm and inflammation as well as chronic infection.

Some of the best options are alfalfa, dark leafy greens, asparagus, celery, peel of citrus fruits, radishes, scallions, apple cider vinegar. Bitter herbs are especially good, and include dandelion leaf and root, chamomile, echinacea.

Pungent and sour foods

These foods help to disperse mucus and stimulate digestion. Examples are garlic and cayenne. But its important to remember that spices can have both a warming and a cooling effect. When there is inflammation, cooling spices like peppermint and radishes are beneficial; whereas when there is a pathogen or a cold that needs to be burned out, warming spices like cinnamon, ginger, black pepper, anise, horseradish, mustard greens, hot peppers, and fennel can be helpful.

Garlic and onions are considered medicinal for their antimicrobial properties and antioxidants. Be sure to crush garlic and let it sit for 10 minutes before consuming it to optimize its healing potential by releasing the oil that contains allicin.  

Sour foods stimulate digestion and make fats and proteins easier to digest. Drinking a glass of warm water with lemon or starting a meal with a fermented food like a pickle or sauerkraut can be beneficial. Other sour foods include; limes, olives, sour apples, leeks, blackberries, raspberries, olives and tomatoes.

Increase fiber, favor low glycemic index foods

Fiber helps to slow down the release of glucose into the bloodstream, directly supporting a reduction in blood sugar, and offers protection against the insulin resistance and osteoporosis that can occur due to dysbiosis, electrolyte imbalance, and de-mineralization.

A low carbohydrate diet is not indicated, but reduce simple concentrated sugars like high-fructose corn syrup, agave, brown rice syrup, cane sugar and artificial sweeteners. Raw honey can be used as a replacement for sweeteners, but should be eaten with other foods or in very small quantities to decrease the incidence of a spike in blood sugar. Eating whole foods that contain sugars, such as fruits and grains, do not contribute to de-mineralization because of the beneficial dietary properties of fiber, vitamins, minerals, fats, and proteins.

Good choices include 100% stone-ground whole wheat or pumpernickel bread, oatmeal (rolled or steel-cut), oat bran, muesli, pasta, converted rice, barley, bulgar, sweet potato, corn, yams, lima/butter beans, peas, legumes and lentils, most fruits, non-starchy vegetables, carrots, and avocados.

Beneficial fatty acids

High quality fish oil, either from seafood or a supplement, contains the anti-inflammatory omega-3’s EPA & DHA to combat oxidative stress. Examples of supplements are krill oil and cod liver oil. These oils are very high in fat soluble vitamins A, D, E, and K and must be consumed with a fatty meal and enzymes for proper absorption.

Omega-6 fatty acids from vegetable and seed oils (safflower, sunflower, corn, grapeseed, peanut, etc.) that are found in the standard American diet are inflammatory and must be reduced.  Attempt to achieve a balanced ratio of omega-3:omega-6 fatty acid in the diet of 1:2–1:4

Probiotics

As mentioned earlier, antibiotics can disturb the microbial balance by killing off both bad and good bacteria. It is the good bacteria that helps to digest food and protect us from food–borne pathogens and toxins. A lack of beneficial gut bacteria can cause diarrhea, gas, reflux, poor digestion and bloating, and may also lead to increased lung infections.

Food–based probiotics are found in fermented foods. Examples are cultured dairy (yogurt and kefir), sauerkraut, kimchi, kombucha, fermented grains and meats. They should be packaged as “live,” “raw” or “probiotic.”

If supplementation is indicated, be sure to purchase a probiotic that has at least 10 different strains of bacteria, with at least 20 CFU’s per pill. The bottle should indicate its potency is guaranteed until the expiration date. Some probiotics contain prebiotics in them. Prebiotics are fibers from complex carbohydrates and are excellent for the probiotics to feed on.

As a whole, ensuring proper digestion and absorption of nutrition is essential for individuals with cystic fibrosis. A high-calorie, high-protein diet from good quality sources is key. Special attention to hydration, salt balance, fat, and extra vitamins — including chelated zinc, magnesium and D3 — are indicated to support overall health and continued vibrancy.

***

Alana Kessler, MS, RD, CDN, E-RYT, is a registered dietitian, nutritionist, weight management expert, and an accredited member of the CDR (Commission on Dietetic Registration) and the American Dietetic Association. She is also a yoga and meditation teacher, Ayurveda specialist, and the founder of the New York City-based fully integrated mind, body, and spirit urban sanctuary, BE WELL. Alana’s BE WELL ARC System and Method Mapping technique is a holistic multidisciplinary approach to health and wellness that blends Eastern and clinical Western diet and lifestyle support to effect long-lasting behavior change.

A graduate of NYU with a BA and MS in clinical nutrition, Alana is dedicated to helping others learn how to nourish themselves, create balance, and understand their true nature through nutrition, yoga, and inner wellness. She leads Yin Yoga workshops and trainings as well as wellness retreats at international locations. Her health, fitness, and lifestyle expertise has been featured in Aaptiv.com, Droz.com, EatThis.com, RD.com, Redbook, WomensHealthmag.com, and Vogue. For more information, visit her website at bewellbyak.com.