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Fat-Soluble Vitamins
Vitamin levels are often low in Cystic Fibrosis (CF) mainly due to pancreatic insufficiency, which prevents the body from properly breaking down and absorbing fats and fat-soluble vitamins (A, D, E, and K). Thick, sticky mucus blocks pancreatic enzymes from reaching the intestines, causing vitamin deficiencies.
Even with a good diet, food alone often isn’t enough to keep these vitamin levels in the healthy range, so most people with CF need to take vitamin supplements to prevent deficiencies.
Your vitamin levels should be checked at least once a year, and more often if needed. Your CF team will let you know if your supplement dose needs to change. It is important not to take extra vitamins without advice, as too much can be harmful. Always speak to your CF dietitian or pharmacist before starting any new vitamins or supplements.
Because these vitamins are absorbed with fat, it is best to take them with a food or drink that contains some fat, and with pancreatic enzyme capsules if you have pancreatic insufficiency.
This leaflet describes each of the fat soluble vitamins, what they do in the body, and where they are found in food.
Vitamin A
Listed on supplements such as:
- Retinol
- Retinyl palmitate, Retinyl acetate
- Carotenoids
- Beta-Carotene
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Supports good eyesight and healthy skin. Helps the immune system work properly. Important role in keeping the lining of the nose, lungs and intestines healthy. Supports bone and tooth formation. It has a role as an antioxidant that defends the body’s cells from damage. A lack of vitamin A can lead to: -night blindness (when your eyes cannot adjust when moving from light to dark) -dry eyes -reduced ability to fight infections Too much can cause bone or liver problems and can be dangerous in pregnancy. |
Milk, cheese, yoghurt, fortified spreads, egg yolk, oily fish (e.g. salmon, sardines, mackerel, trout) and cod liver oil. Yellow and orange-coloured fruits and vegetables (e.g. carrots, peppers, sweet potatoes, squash, apricots, peaches). Dark green, leafy vegetables (e.g. kale, spinach, green cabbage and broccoli). Liver, liver pate, foggots are all rich sources of vitamin A. You may be at risk of having too much if eaten more than once a week. Cod liver oil is another rich source. Try to store foods away from daylight as this can reduce the amount of vitamin A.
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Vitamin D
Listed on supplements such as:
- Colecalciferol
- Cholecalciferol
- Ergocalciferol
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SOURCES |
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Helps the body absorb calcium from the diet, which is important for strong bones and teeth. Linked to improved lung function and muscle function. Has a role in maintaining a healthy immune system and protecting against infection. A lack of vitamin D can cause bone pain and muscle weakness. Over time, bones will become thin and brittle, increasing the chance of breaking. Too much vitamin D can cause calcium to build up in the body |
The major source of vitamin D is exposure to sunlight during the months of April to September in the UK. The body creates vitamin D from direct sunlight on the skin when outdoors and not wearing sunscreen. Take care not to burn your skin as this increases your risk of skin cancer. People with dark skin may not get enough vitamin D from sunlight. In the winter months of October to March, all adults in the UK are advised to take a vitamin D supplement. Your CF team can advise you on a suitable dose. Small amounts come from foods such as fortified cereals, fortified dairy products and non-dairy alternatives (check the label to be sure), oily fish (e.g. salmon, mackerel, sardines), red meat, egg yolk, liver and mushrooms grown in UV light. Cod liver oil is a rich source. |
Vitamin E
Appears on supplements such as:
- Alpha-tocophero
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ROLE IN HEALTH |
SOURCES |
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Vitamin E is important for keeping your nerves and muscles working properly. It also helps to keep your skin, eyes, red blood cells, lungs and intestines healthy by protecting the outer layer of your body’s cells. Vitamin E works as an antioxidant, which means it helps protect your cells from damage caused by harmful substances called free radicals. Not getting enough vitamin E can cause muscle and nerve problems. Very low levels can lead to more serious issues, such as memory problems, vision loss or heart problems. Vitamin E overdose is uncommon, but very high levels can sometimes increase the risk of bleeding. |
Plant oils like rapeseed, sunflower and olive oil. Wheat germ oil is a very rich source. Avocados, nuts and seeds Wholegrain cereals and cereal products. Green leafy vegetables such as spinach and broccoli. Eggs (small amounts) Try to store foods away from daylight as this can reduce the amount of vitamin E.
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Vitamin K
Also known as:
- Phytomenadione/ Phylloquinone/Phytonadione (K1) – plant source, used in supplements
- Menadiol – manmade source used in supplements
- Menaquinones (K2, MK-4, MK-7) – found in animal products and fermented foods, produced by bacterial conversion of K1
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Important for blood clotting and wound healing. Essential role in keeping bones strong and healthy. If your vitamin K level is low, your blood may not clot as well as it should. This means you could bleed for longer if you are injured, which can sometimes be serious. Low vitamin K levels have also been linked to weaker bones, which can increase the risk of fractures.
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Green leafy vegetables like kale, spinach, green cabbage, broccoli, lettuce, brussels sprouts Soya beans (fermented soybeans or natto is a very rich source) Vegetable oils (soybean, canola, olive oils) Liver Blueberries, grapes, figs Smaller amounts in meat and dairy foods Good bacteria in the intestines also make some vitamin K but antibiotics can destroy these bacteria. |
Calcium
Calcium is a mineral that cannot be made in the body and therefore must be taken from food or supplements.
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Helps build strong bones and teeth Needed for muscles to move (including your heart muscles) Needed for nerves to carry messages between the brain and the rest of the body Helps your blood clot normally If the body does not receive enough calcium from diet or supplements, it will take it from the bones to keep blood levels normal. Over time, this can make bones weaker and more likely to break. Too much calcium, especially from supplements can:
This is why we ask questions about your calcium intake at each annual review. |
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Calcium
Commonly listed in ingredients as:
- Calcium Carbonate
- Calcium Citrate
- Calcium Phosphate
Recommended Daily Amount of Calcium According to Age (CF Trust Guidelines):
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10 – 18 years 1300 mg |
19 – 50 years 1000 mg |
Over 50 years 1200 mg |
Tips to Help You Absorb Calcium from Food and Supplements
- Spinach, dried fruits, nuts, beans and seeds do contain calcium, but they also have natural plant substances (called oxalates and phytates) that attach to calcium and reduce how much your body can absorb. You should not rely on them as your main source of calcium.
- Tea also contains oxalic acid and can interfere with calcium absorption.
- Absorption of calcium from supplements will be reduced if taken with food and drinks containing oxalates and phytates.
- Low-fat dairy products have the same amount of calcium as the full-fat versions.
- Large amounts of alcohol, caffeine and salt can cause the body to lose calcium.
- It is best to spread out calcium sources throughout the day because the body cannot absorb large quantities (more than 600 mg) at one time. This is why you may be advised to split calcium supplements into 2 doses, morning and evening, rather than all at the same time.
My results:
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Date |
Vitamin A |
Vitamin D |
Vitamin E
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Target range: |
0.99-3.35 umol/L |
76-250 nmol/L |
9.5-41.5 umol/L |
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Contact Us:
We would be happy to hear from you and answer any further questions you may have:
Address: Cystic Fibrosis Unit, Frimley Park Hospital, Portsmouth Road, Frimley, GU16 7UJ
Telephone: 0300 613 6665 - 0300 613 4597
Email: Fhft.
Contact us
If you have any queries relating to this information, please contact the Dietetics service.
About this information
Service:
Dietetics
Reference:
DT/016
Approval date:
1 April 2026
Review date:
1 April 2029
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.