Registered Dietitian and CF Nutrition Specialist Suzanne Michel, MPH, RD, LDN

Expert Q&A

When I’m not feeling well I often lose my appetite and have a hard time maintaining my weight. What can I do to help avoid losing weight?

It is so hard to chew and breathe when someone is sick, either with a bad cold, or sick with a flare-up of their CF lung disease. Eating foods that are soft and don’t require a great deal of chewing will help get in enough calories. Instead of eating bagels, steak, or hoagies try softer foods such as macaroni and cheese, mashed potatoes, ground beef and puddings. Think about drinking fluids that are higher in calories. Some examples are: cream soups, milkshakes, instant breakfast powder added to whole milk, and canned formulas.

Body Mass Index (BMI) is supposed to be a good tool to determine a person’s recommended weight for height. How do I calculate my own BMI?

Body Mass Index is a calculation used to determine how healthy an individual’s weight is relative to their height. To calculate your personal BMI, refer to the calculators on the Centers for Disease Control and Prevention website , which offers separate BMI calculators for both adults and children/teens. To learn more about other indicators of healthy weight, visit the Centers for Disease Control and Prevention website.

My child is a picky eater and it is difficult to get him to finish his meals. What strategies can I use to encourage him to eat appropriately while considering his CF?

For a picky eater, have a routine for meals and snacks. Offer food at about the same time and the same place so your child learns what to expect. If your child is a mealtime talker and forgets to eat, set a rule that he or she has to take two bites before they can finish the story they are telling. Once your child learns that two bites are necessary before you will listen, increase the bites to three then four bites. When planning meals try to include one food you know your child will eat on the menu. Make your child’s plate look as pretty as possible, using different colors. Talk with your CF Center dietitian for other ideas that will help your child become a better eater.

Can infants with CF receive all of the calories they need from just breast milk?

Yes, infants who have CF and are breast feeding can thrive. A baby who has CF should be taken to see their CF Center team or pediatrician on a monthly basis. The baby’s growth will be checked at each visit. If for some reason your baby is not gaining enough weight, work with your CF Center team to figure out the right balance for your infant.

When you are cooking for an individual with CF, how can you make sure other family members maintain a healthy weight?

People who have CF need to eat a diet that is higher in calories and salt. Other family members do not need the same number of calories or amount of salt. Instead of adding extra salt to an entire recipe, ask the person who has CF to salt their food when they are served. Keep a salt shaker at their place at the table. Also, add extra butter or margarine to foods when served. Someone who does not have CF does not need the same size portion and should take smaller portions. While whole milk is important in a high calorie diet, nonfat milk is best if you do not have CF. Someone who does not have CF may fill their plate with fruits and vegetables and the person who has CF may take smaller portions of low calorie fruits and vegetables and add butter or margarine to hot vegetables.

How do I make sure I am getting enough nutrients?

Eating foods from all of the food groups: dairy, protein, fruits, vegetables, whole grains and fats will assure that your diet is packed with nutrition. Even so, you may need to take supplemental vitamins and perhaps minerals such as iron, calcium and zinc. Your CF Center dietitian can review your food intake to be sure it contains a variety of foods and nutrients. The Center will also check your blood levels each year to see if you need supplemental vitamins or minerals.

Do I need to count the fat, calories, or something else?

Counting calories or grams of fat can be a big job. If you are gaining weight and growing, there is no need to take it on. If weight gain is a challenge, your CF Center dietitian will work with you on ways to add more calories to what you usually eat without counting calories. Ask your CF Center dietitian to calculate your daily calorie goal.

Some parents like to be given a calorie goal. If you would like a calorie goal ask your CF Center dietitian to figure out what a good goal would be for your child. A good way to track nutritional intake is by using an online food tracker such as Super Tracker, recommended by the United States Department of Agriculture.

How does CF affect the rest of my body?

Thick mucus can affect many organs in the body of someone who has CF. In addition to making it harder to breathe, it blocks the pancreas and gallbladder, making it hard to digest and absorb the nutrients in food. Mucus can also block the lungs, liver, intestines and reproductive organs making it hard for these organs to function.

People who have CF have important nutrition needs. To be sure that your bones stay healthy, it is important to get enough calcium and vitamins D and K. Zinc plays an important role in growth and someone who has CF may need extra zinc if the diet does not supply enough. Without sufficient salt, a person who has CF may become dehydrated; they also may not grow as expected. If you do not get enough vitamin A you may develop “night blindness.” Working with your CF Center team will help you meet all of the nutrition challenges.

What foods can I keep in my backpack, purse, desk, or car

There are so many different foods that you can take with you to school or on outings. Examples are: trail mix, granola bars, shakes that are canned or bottled, or peanut butter crackers. Look at "Grab and Go" at the CF Services website for lists of foods that you can take with you anywhere you go.

To be sure that my toddler eats enough to gain weight, I feed him whenever I can, rather than at set mealtimes, yet he is not gaining weight. What can I do?

It is understandable that you are concerned about your child’s weight and want to feed him all day long. But it is actually better to have set times for meals and snacks so that your child knows when to expect to eat. Having regular meals and snacks makes giving the correct dose of enzymes easier. Think about creating a meal and snack time routine. For example, have your child wash up, sit in the same place when eating and stay seated until finished. While they eat, limit distractions, and most importantly, sit and eat with your child. Make sure to praise good eating.

Your child’s dietitian may ask you to keep a food record of everything your child eats and drinks for several days. With this information, you can work with your CF Center dietitian to develop a nutrition plan.

How can I include fruits and vegetables in a high calorie diet?

This is an important question and can be a real challenge, but with some creativity you can do it. Add cheese to vegetables. Dip cooked or raw vegetables into salad dressing or dips. Grate vegetables into spaghetti sauce. Add vegetables to pizza. Spread cream cheese or peanut butter on fresh fruit. Dip fruit into whole milk yogurt. Make a fruit smoothie with whole milk and whole milk yogurt. See "Color Your Calories" at the CF Services website for more ideas.

CF Resources

External Resources:

The CFChef CF Nutrition Guide was developed with input from Registered Dietitian and CF Nutrition Specialist Suzanne Michel, MPH, RD, LDN, based on information and guidelines from the Cystic Fibrosis Foundation. The Cystic Fibrosis Foundation is not affiliated with, and has not endorsed, the AbbVie CFChef program. The content on is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment.