- AquADEKs™ contains increased amounts of the antioxidant beta-carotene which has been shown to correlate with improved lung function in CF and other lung diseases.
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Lung disease in cystic fibrosis is characterized by chronic endobronchial infection and a chronic neutrophilic inflammatory response which releases large amounts of free radicals and proteolytic enzymes which overwhelm the existing protective systems of both antioxidants and antiproteases. CF patients frequently have decreased plasma concentrations of beta-carotene, an important antioxidant. This oxidant-antioxidant imbalance can lead to tissue injury from an attack on unsaturated fatty acids of lipid structures and proteins, especially enzymes and DNA. Recent clinical data show that patients with CF who are sufficiently supplemented with vitamin E but with an uncorrected b-carotene deficiency still exhibit increased lipid peroxidation. Several studies show that beta-carotene supplementation is necessary to normalize MDA (a marker of lipid peroxidation), and this translates into a significantly decreased number of days of antibiotic treatment for acute pulmonary exacerbations.
Supporting studies
- Cobanoglu, N, Ozcelik, U, Gocmen, A, Kiper, N, Dogru, D. Antioxidant effect of beta-carotene in cystic fibrosis and bronchiectasis: clinical and laboratory parameters of a pilot study. Acta Paediatr 2002; 91 (7): 793-798.
This study showed that high levels of MDA decreased after 6 months of beta-carotene therapy There was an inverse correlation between decreasing pulmonary function and increasing plasma MDA concentrations. Beta-carotene decreases the inflammation in the lungs by decreasing the oxidant events which contribute to lung damage.
- Renner, S, Rath, R, Lehr, S. Effects of beta-carotene supplementation for six months on clinical and laboratory parameters in patients with cystic fibrosis. Thorax 2001; 56: 48-52.
This study showed that antioxidant supplementation may improve clinical outcomes such as required length of antibiotic treatment in a randomized, placebo-controlled clinical trial. In this trial of 24 CF patients, antibiotic treatment days in the group receiving high levels of supplementation were significantly shorter (9.8 days) than in the control group (14.5 days).
- AquADEKs™ contains less preformed vitamin A than competitive products. High vitamin A intake may result in hypervitaminosis A.
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Supporting studies
- Graham-Maar, RC, Schall, JI, Stettler, N, Zemel, BS, Stallings, VA. Elevated vitamin A intake and serum retinol in preadolescent children with cystic fibrosis. Am J Clin Nutr 2006; 84 (1):174-182.
Results suggest that children with CF may be ingesting more supplemental vitamin A than necessary, leading to concerns about chronic hypervitaminosis A, which adversely affects liver and bone health. Attention must be given to the content of preformed vitamin A in supplements, since 78% of patients studied had preformed retinol intakes exceeding the upper limit set by the Institute of Medicine, and 18% had preformed retinol intake exceeding CF recommendations.
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CF Softgel/Tablet Product
(per softgel/tablet)
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AquADEKs™
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ADEKs®
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Vitamax®
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Source CF®
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Beta-carotene
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10 mg
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3.2 mg
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1.5 mg
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3.2 mg
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Pre-formed
Vitamin A
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1,500 IU
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3,600 IU
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2,500 IU
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3,600 IU
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CF Liquid Product
per ml
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AquADEKs™
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ADEKs®
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Vitamax®
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Source CF®
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Beta-carotene
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3 mg
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1 mg
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0 mg
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1 mg
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Pre-formed Vitamin A
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750 IU
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1,585 IU
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3,170 IU
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1,490 IU
|
- Compared to ADEKs® tablets and SourceCF Softgels, AquADEKs™ contains increased amounts of vitamins D & K for improved bone health.
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Bone health & osteoporosis are increasingly important issues in CF as lifespans increase. Malnutrition, decreased absorption of vitamin D, decreased sun exposure, and medications such as steroids contribute to the higher rates of osteoporosis.
Supporting studies
- Conway, SP, Wolfe, SP, Brownlee, KG, White, H. Vitamin K Status Among Children with Cystic Fibrosis and its Relationship to Bone Mineral Density and Bone Turnover. Pediatrics 2005; 115:1325-1331.
Vitamin K deficiency is common in CF children, and vitamin K and bone health are related. This study suggested that vitamin K has a role in maintaining the balance between bone formation and bone resorption.
- Boyle, MP, Noschese, ML, Watts, SL. Failure of High-Dose Ergocalciferol to Correct Vitamin D Deficiency in Adults with Cystic Fibrosis. Am J Respir Crit Care Med. 2005;172 (2):212-217.
Most CF patients are deficient in vitamin D even at current levels of supplementation, and should consider supplementing vitamin D at a higher level.
- AquADEKs™ contains vitamin E as natural mixed tocopherols as found in our food for greater antioxidant and anti-inflammatory benefits. Supplementing with only alpha-tocopherol can lead to an imbalance of tocopherols with high alpha-tocopherol and very low levels of the other tocopherols.
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CF patients need the right form of vitamin E to optimize their antioxidant status. Most supplements contain only alpha-tocopherol. AquADEKs contains mixed tocopherols (alpha-, beta-, gamma-, and delta-tocopherol) for increased antioxidant effect.
Supporting studies
- Huang,SH, Schall,JI, Zemel,BS, Stallings, VA. Vitamin E Status in Children with Cystic Fibrosis and Pancreatic Insufficiency. J Pediatrics 2006;148:556-559.
Eighty-three percent of children with CF using a nutritional supplement had higher serum alpha-tocopherol: cholesterol ratios than their NHANES III counterparts.
- Wolf G. How an increased intake of alpha-tocopherol can suppress the bioavailability of gamma-tocopherol. Nutr Rev. 2006; 64(6):295-299.
- Jiang Q, Ames BN. Gamma-tocopherol, but not alpha-tocopherol, decreases proinflammatory eicosanoids and inflammation damage in rats. FASEB J. 2003;17 (8):816-822.
Members of the vitamin E family have different functions and activities. Gamma-tocopherol, the most abundant form in our diet, is anti-inflammatory. Most supplements contain only alpha-tocopherol which depletes gamma and the other tocopherols. AquADEKs supplies a balanced mixture of natural tocopherols and is rich in gamma-tocopherol.
- AquADEKs™ contains CoQ10, which is often deficient in CF patients, for improved lung function.
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Supporting studies
- Sokol, R, Osberg, I, Sontag, MK, Wagener, JS. Reduced Serum Coenzyme Q10 concentrations in children with cystic fibrosis. North American Meeting on Cystic Fibrosis, Pediatric Pulmonology, 2003; 36, Issue S25, Pages 8-376.
Sokol showed that 78% of patients had plasma coenzyme Q10 levels below the lower limit of normal (<0.4 μg/ml, 88/112 patients) despite the fact that an estimated 70% of these patients take vitamin supplementation.
- Wagener, J, Sontag, M, Pardee, C, Sokol, R, Accurso, F, Papas, G. Impact of an Antioxidant Solution on Airway Inflammation in Patients with Cystic Fibrosis. Abstract accepted at the North American Cystic Fibrosis Conference, 2006.
This pilot study suggests that an increased level of CoQ10 is related to a mild improvement in airway inflammation.
- AquADEKs™ contains selenium, which boosts the effects of natural antioxidants.
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Selenium is a cofactor for our endogenous antioxidant enzymes such as glutathione. There is evidence that glutathione in lungs is low. In addition, selenium functions synergistically with vitamin E.
Supporting studies
- Hudson VM. New insights into the pathogenesis of cystic fibrosis: pivotal role of glutathione system dysfunction and implications for therapy. Treat Respir Med. 2004;3 (6):353-363.
Cystic fibrosis mutations significantly decrease GSH efflux from cells without redundant channels to the CFTR; this leads to deficiency of GSH in the epithelial lining fluid of the lung, as well as in other compartments, including immune system cells and the gastrointestinal tract. This deficiency is exaggerated over time as the higher-than-normal oxidant burden of cystic fibrosis leads to successively larger decrements in GSH without the normal opportunity to fully recover physiologic levels. This GSH system dysfunction may be the trigger for initial depletion of other antioxidants and may also play a role in initiating the over-inflammation characteristic of cystic fibrosis.
- Starosta V, Rietschel E, Paul K, Baumann U, Griese M. Oxidative changes of bronchoalveolar proteins in cystic fibrosis. Chest 2006; 129(2):431-437.
This study supports the hypothesis that oxidative damage of pulmonary proteins during chronic and excessive neutrophilic endobronchial inflammation may contribute to the decline of lung function in CF patients.
- CF patients have decreased antioxidant levels and may benefit from supplementation with an antioxidant enriched formulation.
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Supporting studies
- Back, EI, Frindt, C, Nohr, D. Antioxidant deficiency in cystic fibrosis: when is the right time to take action? Am J Clin Nutr 2004; 80:374-384.
Adult CF patients showed distinct vitamin deficits and elevated indicators of oxidative stress with progression to clinical status. Suggested innovative supplementation strategies need to optimize antioxidant status of patients.
- Wood, LG, Fitzgerald, DA, Gibson, PG. Oxidative Stress in Cystic Fibrosis: Dietary and Metabolic Factors. Journal of the American College of Nutrition, 2001; Vol. 20, No 2, 157-165.
Despite similar dietary intake, lower plasma antioxidant concentrations were observed in the CF group. 8-isi-PGF2α (a marker of oxidative stress which correlates with markers of inflammation) was inversely correlated with plasma levels of vitamins E, C, and beta-carotene. The immune response appears to be a key factor causing oxidative stress. Antioxidant intervention aimed at reducing oxidative stress in CF needs to be assessed.
- Brown, RK, Wyatt, H, Price, JF, Kelly, FJ. Pulmonary dysfunction in cystic fibrosis is associated with oxidative stress. Eur Respir J, 1996; 9: 334-339.
This study provides evidence that cystic fibrosis patients have inadequate antioxidant defenses to cope with the elevated oxidative stress that they regularly experience. Recurring oxidative lung injury contributes to the decline in pulmonary function in these patients.
- Borowitz, D, Baker, R, Stallings, V. Consensus Report on Nutrition for Pediatric Patients with Cystic Fibrosis. Journal of Pediatric Gastroenterology and Nutrition 2002; 35:246-259
These reports document deficiencies of lipophilic antioxidants in cystic fibrosis patients and the need for higher levels for supplementation.
The information provided in this secton is intended for United States Healthcare Professionals only.
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