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Here's a pop quiz: What kinds of food can kids with cystic fibrosis (say: sis -tik fy- bro -sus) eat?

1. mac 'n cheese
2. hot dogs
3. broccoli
4. caramel apples
5. all of the above

If you picked "5," you're right! Kids with cystic fibrosis (CF) can eat all of these foods - and they usually need to eat more of them than most kids do. We'll explain why in a minute, but first let's look at what CF is.

CF Basics

CF is a disease that affects epithelial cells (say: eh-puh- thee -lee-ul sells), which are found in lots of places in the body, like the lungs and the digestive system . Problems in these cells can upset the balance of salt and water in the body. This causes the body to make abnormally thick mucus (like the kind in your nose when you have a really bad cold), which can clog up the lungs and make if hard for kids with CF to breathe.

This problem can also affect the digestive system and block the body from getting the good stuff from food it needs, like fats and vitamins . This means kids with CF may be short for their age and not weigh enough. Kids with CF may get sick a lot more often than other kids because of these lung and digestive problems.

CF is a genetic (say: juh- neh -tik) disease. This means that you can't catch CF. Kids with CF are born with it because a gene for the disease is passed on to them by both of their parents, who each carry a CF gene in their bodies, but don't have CF themselves.

The good news is that when kids with CF eat well and take their medicines , they can keep themselves healthier.

Food Fitness

All kids need to eat well to grow up healthy and strong. But kids with CF need to eat more than most other kids, so they and their parents often work with a CF dietitian (say: dy-uh- tih -shun) to plan what they should eat. A dietitian is someone who knows all about food and nutrition.

Each kid is different, but most kids with CF will eat three meals a day plus snacks to make sure that they get all of the calories they need. This isn't all that different from other kids, but the meals and snacks that a kid with CF eats should have more calories and fat in them. It's also very important that a kid with CF not miss meals.

So what do kids with CF use these extra calories for? Like everyone else, kids with CF need calories to grow, to gain weight, and to have energy to play. But kids with CF need extra calories because their bodies have a hard time absorbing fat and nutrients (say: noo -tree-entz) in food. Instead of absorbing the fat and nutrients from food, some of these important things can go right out of the person's body in their bowel movements. Kids with CF also may need more calories to help their bodies fight the lung infections they tend to get.

Let's take a closer look at some important nutrients and where to find them.

It's All in the Nutrients

Nutrients are the things in food that help keep our bodies running well. Kids with CF have some nutrients that they need to make sure they eat each day. These include:

Iron . Iron is essential for carrying oxygen to all the body's cells. You can find iron in some cereals, meats, dried fruits, and dark green vegetables.

Zinc . Zinc is important for growth, healing, and staying healthy. You'll find zinc in meats, liver, eggs, and seafood.

Calcium . Calcium helps build strong bones. Milk, yogurt, cheese, and calcium-fortified juices are rich in calcium.

Salt . Kids with CF lose a lot of salt in their sweat, especially during hot weather and when they exercise. A good way to replace this salt is by adding salt to food and eating salty snacks. During hot weather and when kids play sports, they may need sports drinks during and after practice or gym class.

Yummy, Healthy, and Full of Calories

All kids need to eat a balanced diet of regular meals and snacks that include plenty of fruits, veggies, grains, dairy products, and protein. But kids with CF need to work with their CF dietitian and their parents to create meal plans. Meal plans are important to ensure that kids with CF get all the calories and nutrients they need.

This might sound hard, but here are some simple tips. Click on the links for some great recipes that a grown-up can help you make:

• Drink whole milk and milkshakes .
• Add extra butter or margarine to foods like potatoes or pasta.
• Eat burgers with bacon and cheese.
• Eat pizza with extra cheese.
• Add cheese to sandwiches.
• At breakfast, eat omelets with extra cheese, ham, or bacon.
• Top salads and sandwiches with avocados or guacamole.
• Eat ice cream, pudding , and cheesecake for dessert.
• Top hot chocolate, pudding, and other desserts with whipped cream.
• Keep trail mix , nuts, packets of cheese, or peanut butter crackers handy for snacks.

More Than Just Food

For some kids with CF, eating lots of great meals isn't enough - they may need a little extra help.

Some kids with CF need to take vitamins, especially for vitamins A, D, E, and K. These vitamins help kids stay healthy. But to do their work, they have to be absorbed by the body and dissolved in fat. Because most kids with CF have trouble absorbing fat into their bodies, they often have low levels of these vitamins and need to take larger amounts of them as pills.

Most kids with CF need to take pills that contain enzymes (say: en -zimes). Someone takes enzymes because his or her pancreas (say: pan -kree-us) doesn't work properly. The pancreas is a gland that's connected to the small intestine (say: in- tes -tun). It makes juices containing enzymes that help the small intestine digest fat, starch, and protein. If the pancreas can't make these juices normally, the problem is called pancreatic insufficiency (say: pan-kree- ah -tik in-suh- fih -shun-see).

Most kids with CF will have pancreatic insufficiency by the time they are 8 or 9 years old. It's important for these kids to take enzymes before they eat most foods. The enzymes will help these kids digest their food better.

Food Frustration

Many people want to eat less and lose weight. Kids with CF have the opposite problem: They have to eat when they aren't hungry, don't feel like eating, or none of their friends are eating. If you are a kid with CF, remember that eating well and taking your enzymes and vitamins will help you have the energy to do all the great things you want to do with your friends, from playing soccer to going to sleepovers.

And if you have a friend with CF, now you know why he or she digs in every day at lunch. Maybe you can dig into a healthy lunch, too - and help other kids understand why eating right helps someone with CF stay healthy and strong.

Reviewed by: Allison Brinkley, RD, LD/N, CNSD
Date reviewed: February 2007