Nutrition - CF Buzz

Diet and Nutrition

The usual message about food and diet is “eat fewer calories, avoid fatty food and don’t eat too much sugar and salt.”

For people with cystic fibrosis, the opposite is true. That’s because people with CF have trouble absorbing enough nutrients, minerals and energy from the food they eat. Their pancreas becomes clogged with mucus stopping digestive enzymes reaching the stomach, which means food is not properly digested and the nutrients not absorbed. Click here to read more about enzymes and their importance.

When the body doesn’t have the right nutrients and minerals, it doesn’t function properly, and can’t fight off infections effectively. This is why diet and nutrition is really important for people with cystic fibrosis, but it can also be a challenge.

As a general rule of thumb, people with CF should eat about 20 to 50 per cent more calories each day than people without CF. During times of illness, especially when fighting off infections, calorie intake needs to increase further as the body needs extra energy.


Weight gain plan

Having CF can make it a challenge to keep weight on and sometimes it can feel like a hard slog to gain weight. But don’t despair. Just like people who are trying to lose weight, there are some simple ways to help add the kilos (rather than shed them).

Track your weight with the CF Buzz App or on a calendar. It’s a great way of monitoring how your diet is working, and help you make adjustments where necessary.

Keep a check on enzymes – without the right amount, no matter how much food is eaten, it won’t help weight gain. Check out the Enzymes section for more information.

Enlist help from family and friends. Give them ideas on the type of foods you need to eat. This way they can make sure the next time you head for dinner, you’ll be eating properly.

Stock the pantry and fridge with high calorie foods and lots of snacks. If it’s already there and ready to go, you’re more likely to eat it. Make this even easier by creating a high calorie online shopping list with your supermarket of choice and have it delivered to your door. See the Calorie Boosters ideas below for great pantry staples.

Swap low calorie food for high calorie food e.g. white bread (700Kj) for bagels (1400Kj); sugar doughnuts (1100Kj) for iced walnut scrolls (2700Kj); low fat yoghurt (280Kj) for full fat yoghurt (1900Kj).

Eat often – eat three large meals and three snacks every day, or even better, eat something every hour

Eat breakfast  – it kick starts the metabolism and increases appetite. If typical breakfast foods aren’t palatable, eat anything that is. And if eating breakfast is a new thing, start small and light e.g. yoghurt and fruit. It won’t be long before you start waking up hungry.

Eat larger portions especially of meat, sauces, dressings, butter, margarine, oil, cheese, pasta, rice and potato

Add lots of ‘extras’ to food – things like butter, dressings, cheese or nuts. Check out the Calorie Boosters below for ideas

Trick the brain into eating more without noticing by using larger plates and bowls

Make drinks count  – everyone needs at least two litres of fluid each day, but people with CF should include high energy drinks like milk shakes, iced coffees and chocolates, fruit juices, fruit smoothies and whole milk. Add one to three teaspoons of vegetable oil to milkshakes and smoothies. It adds calories without affecting the taste.

When you don’t feel like eating – distract yourself by eating while watching TV, working on the computer, reading a magazine or sitting on the train or bus.

Have a bed-time snack – people that have a late night snack tend to eat more calories in a day, and it won’t affect your appetite for the next meal since you’ll have slept for 8 hours – try an extra bit of dessert, a Milo or cheese sandwich


Calorie Boosters

Add lots of “calorie boosters” to foods!


Did you know that one tablespoon of margarine is worth 600kJ of energy?

That’s equal to two extra slices of bread, and won’t make you feel as full.


Some calorie boosters to add to your food:

• Margarine / butter
• Oil
• Double/pure cream
• Whole egg mayonnaise
• Sour cream
• Salad dressing, especially creamy ones
• Nuts
• Dried fruit
• Grated cheese
• Cream cheese spread
• Peanut butter
• Sweetened condensed milk
• Caramel sauce
• Pesto dressing
• Hollandaise sauce

Get creative with them and create some new recipes, e.g. blend some peanut butter into a chocolate milkshake.

Snacking throughout the day should be part of your CF diet plan.

Add some of these to your shopping list:

• Almond custard scrolls, Danish pastries, croissants
• Premium ice-cream or yoghurt – choose the brands with a high fat content
• Cheese and crackers (some crackers have higher calories than others)
• Nuts, seeds, dried fruit and nut bars
• Potato or soy crisps, Piranha or Bhuja snack mix
• Savoury snacks e.g. salami, cans of tuna and salmon in oil
• Hot chocolates, flavoured milk or smoothies
• Desserts e.g. crème caramel, creamy rice, mousse, custard, cheesecake
• Mud cake, lamingtons, muffins, apple pie, jumbo cookies


Daily meal/snack idea


Large bowl of toasted muesli and milk
High calorie yoghurt 300mL

Morning snack:

Full fat cheese and crackers (5 crackers + 5 cheese slices)
Flavoured milk 300mL


Bread rolls / Turkish bread with extra slices of meat + cheese + mayo + avocado + butter + any salads (higher calorie meat like salami, tuna in oil, chicken schnitzel, sausages, salmon)


Butter Chicken + 1 Ensure Plus

Afternoon snack:

Almond Custard Scroll (wrap a few in cling wrap & freeze)
Flavoured milk 300mL


Any meat (fried in oil) + 2 cups mashed / rice /pasta (add cream/butter) + vegetables drizzled in lashings of butter/oil and grated cheese + 2 slices garlic bread + 500ml flavoured milk

After dinner snack:

Canned fruit and 2 scoops of premium ice-cream

Before bed snack:

Macadamia nut bar

Try some of the recipe ideas on the CF Chef page. 


Eating plan when unwell

A poor appetite and weight loss are often the first signs of a chest infection. It is important to continue your high energy diet when you are sick to make sure your body has the energy to fight the infection, especially if you have a fever.
When you’re sick and don’t feel like eating try some of these ideas:

• Liquid energy is often easier, drink more flavoured milk, fruit juice and nutritional supplements such as Sustagen and Ensure Plus
• Make the most of any times you do feel hungry
• If the smell of food stops you from eating, eat food cold or at room temperature
• Try to eat with other people rather than alone
• Aim for more regular snacks than main meals
• Split main meals if you become full too quickly e.g. have half your sandwich at lunch time and the other half 30 minutes later
• Drink liquids after the meal, rather than during, to leave more room for food
• Distract yourself while eating, eat while reading, surfing the web, on social media, watching movies/TV
• Eat whatever you feel like, it is okay to have breakfast cereal at dinner time and pizza at breakfast


Nutritional food supplements

Nutritional supplement drinks and products contain the kilojoules, protein, vitamins and minerals that your body needs. They are easy to drink and digest quickly, leaving plenty of room for the next meal.

They can be a great way of “eating” when you don’t feel like food.

Click here for more information about vitamin supplements.


Salt replacement

The Cystic Fibrosis Transmembrane Conductance Regulator gene is responsible for getting salt and water into the cells. Cystic fibrosis is caused by a mutation of this gene, which stops that process happening.

So, people with cystic fibrosis need extra salt in their diet to prevent salt deficiency and dehydration. Just as too much salt is unhealthy for people without CF, too little salt is unhealthy for people with CF.

Eating more salt is important, but salt depletes calcium levels, so it’s important to increase calcium intake as well. See below for more information about calcium.

People with CF lose more salt in their sweat – often 5 times more than people without CF. Rapid depletion of salt can occur with exercise, fevers, infection or exposure to high temperatures and humid climates.

Thirst isn’t a good indicator of fluid requirements because lower levels of sodium in the blood may decrease your natural thirst drive.

Watch out for these signs and symptoms of salt and fluid deficiency:

• Fatigue, dizziness
• Decreased or dark urine
• Decreased appetite
• Muscle cramps
• Headaches
• Nausea & vomiting
• Poor concentration
• Salt crystals forming on the skin

Adding extra salt to meals and snacks is a great way to keep levels up, but if a quick replacement is needed, try some of these:

  • Toppin salt tablets: 600mg sodium/tablet
  • Gatorade Prime Liquid: 233mg sodium/250mL
  • Powerade Zero Liquid: 128mg sodium/250mL
  • Powerade Isotonic Liquid: 70mg sodium/250mL
  • High5 Zero electrolyte tablet: 260mg sodium/tablet
  • Nunn Active Hydration: 360mg sodium/tablet in water
  • Gastrolyte tablets: 138mg sodium/tablet
  • Gastrolyte sachets – 1 sachet in water has 278mg sodium
  • Gastroyte liquid: 268mg sodium/250mL
  • Hydralyte tablet: 87.5mg sodium/tablet
  • Hydralyte ice block: 156mg sodium/ice block


Bones and calcium

Calcium plays a major role in keeping bones strong. It’s recommended that adults with CF have around 900 – 1500mg of calcium in their diet per day.
Milk and other dairy products are good sources of calcium, some come fortified with calcium.

Other foods high in calcium include:

  • Leafy green vegetables like kale, spinach, broccoli
  • Oranges
  • Sardines
  • Salmon
  • Baked and other canned beans
  • For extra calcium add 2 – 4 tablespoons of milk powder to recipes, cereal, milk, puddings, casseroles, soups etc. This will add 52mg of calcium per tablespoon.

The best form of calcium is real food, but your CF team might also suggest calcium supplements in the form of carbonate (such as Caltrate). These need gastric acids to be absorbed so should be taken with meals and at a different time than anti-reflux medications. Calcium in other forms such as citrate don’t require gastric acidity.

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