Diet plays an important role in managing CF. From improving gut health to helping your body fight infection, what you eat can contribute to your overall wellbeing. But just how can a dietitian support you?
Lauren is a senior dietitian with an adult cystic fibrosis unit. Lauren has a decade of experience, and specialises in clinical dietetic areas, both in cystic fibrosis and gastrointestinal surgery. Lauren says the key to building great relationship with your dietitian is honesty.
“If someone is struggling with a dietetic intervention but implies everything is ok, then no one wins.”
“I aim to always involve individuals in developing a plan and acknowledge they have been living with CF for most of their life and understand their body better than anyone.”
We caught up with Lauren to learn more about the role of the dietitian in the CF Clinic Team and how to make the most of their support.
What does a dietitian do?
A dietitian is an expert in food and nutrition, providing personalised advice based on scientific evidence for acute and chronic health conditions. They conduct comprehensive assessments and provide nutrition counselling by addressing diet-disease relationships.
What support can a dietitian offer someone living with CF?
Cystic Fibrosis is a multi-system condition with many nutritional implications and considerations. The overall goal for a dietitian is to ensure nutritional adequacy.
In CF, a dietitian can assist in managing gastrointestinal issues such as pancreatic insufficiency and titrating enzyme dosing. They can focus on diet quality to ensure targets are met for vitamins and minerals. They can assist with carbohydrate distribution and awareness for impaired glucose tolerance or diabetes. Dietitians also provide oral and enteral nutrition support for people who are unable to meet their nutritional needs.
What do dietitians bring to CF Clinic Teams?
Dietitians provide expertise in food and nutrition related issues. This can manifest in managing vitamin and mineral deficiencies and monitoring bone mineral density scans or educating the team about approaches to managing gastrointestinal issues and providing nutrition support during hospital stays.
The dietitian will also liaise with other multi-disciplinary team members to assist in achieving outcomes. For example, working with the physiotherapist to ensure adequate nutrient provision with a changing exercise regime.
What are the key goals when it comes to diet for people with CF?
Historically, typical CF diet recommendations were focused on high energy (sometimes requiring 110-200% more energy than a person without CF), high fat and high salt diets.
However, with emerging treatments such as CFTR modulator therapies, nutritional requirements are changing. We are seeing patients with less inflammation, decreased energy expenditure due to improved lung function and potentially improved nutrient absorption. Despite this, the key objectives remain the same, to strive for adequate nutrition and manage any comorbidities with nutritional implications.
How can diet help people manage their CF?
A diet adequate in energy and protein will assist during exacerbations by ensuring sufficient body stores to fight infection. Promoting diet quality with diverse sources of wholegrains, vegetables and fruits may assist in improving gut health. Carbohydrate awareness can help individuals manage their CF-related diabetes. Focusing on certain nutrients like calcium and vitamin D may prevent the development of bone-related issues.
”However, with emerging treatments such as CFTR modulator therapies, nutritional requirements are changing. We are seeing patients with less inflammation, decreased energy expenditure due to improved lung function and potentially improved nutrient absorption. Despite this, the key objectives remain the same, to strive for adequate nutrition and manage any comorbidities with nutritional implications.
What are some of the reoccurring themes that come up around diet and CF?
We have a diverse cohort and one clinic I may be assisting someone prepare for a marathon and the next managing nausea and vomiting during pregnancy. But I would say the most common issues are gastrointestinal issues.
Gut inflammation and motility issues are recurrent themes in CF, extending beyond just pancreatic insufficiency. Gastrointestinal issues are multi-faceted and often impact heavily on quality of life. Taking comprehensive diet recalls and detailed symptom diaries can assist in determining issues and then referring on to gastroenterologists if necessary.
How can someone with CF get the most out of working with a dietitian?
The best way to achieve outcomes is to be honest. If the dietitian and the individual with CF are working towards different agendas, then no progress will be made. If someone is struggling with a dietetic intervention but implies everything is ok, then no one wins. I aim to always involve individuals in developing a plan and acknowledge they have been living with CF for most of their life and understand their body better than anyone.
What advice would you give someone who has previously had a negative experience with a dietitian?
I would advise that whilst dietitians have the same foundational training, different dietitians have individual approaches. I would encourage the individual to be open with what they found negative about the previous interaction and hope that we could focus on building a relationship to move forward together. When I moved into CF, building relationships with individuals was my first priority before making any recommendations.
What would you like someone with CF to know about your work?
I like to get to know individuals, including their previous dietetic intervention and experiences with clinics or hospital admissions. I would also convey that they are a crucial part of the team, and as such their input is incredibly valuable. I am also a very passionate person and enjoy extending my learning through professional development and challenging usual thinking.
Top diet tips for people with CF?
Firstly, every person is different, so it’s difficult to generalise advice. However, I would encourage diet diversity. By eating a variety of different foods, including fruits, vegetables and wholegrains, you are getting a broader range of nutritional benefits through exposure to nutrients. Secondly, I suggest focusing on quality, not quantity. Rather than aiming to consume as much as you possibly can, consider if the foods and drinks are nutrient-rich rather than energy-dense and nutrient poor such as fast foods or sugar drinks. These will provide sufficient energy; however, they often lack adequate fibre, protein, vitamins and minerals. Lastly, when aiming to increase energy in foods to ensure nutritional adequacy, I suggest focusing on adding fats such as olive oil, canola oil, sunflower oil, avocado and nuts.