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• Antioxidants are low and there is increased oxidative damage in CF. The chronic, recurrent infections in CF lead to inflammation which in turn leads to increased free radical damage. Antioxidants can prevent free radical damage, reduce inflammation and prevent or delay progression of CF. Examples of antioxidants that have been found to be low in CF include vitamin A, vitamin E and beta carotene. Beta carotene seems to reduce lung inflammation. Vitamin C is also associated with reduced lung inflammation. The amounts of antioxidants provided in a high dose daily multivitamin are reasonable.
• Digestive enzymes are mostly destroyed by the acid produced in the stomach. For this reason the use of fungal enzymes that are acid resistant has been advocated. Unfortunately the acid resistant fungal enzymes are very vulnerable to destruction by enzymes that break down proteins. Studies comparing the acid resistant enzymes to standard (pancreatic) digestive enzymes shows that the fungal enzymes are slightly less effective in aiding digestion. In the future digestive enzymes that are resistant to both acid and protein degradation may offer more effective choices . Excessively high doses of digestive enzymes should be avoided as they may cause scarring and fibrosis of the colon.
• Essential fatty acids (EFA) are often low or deficient in CF due to the fat malabsorption. Low levels of EFA seem to be associated with greater risk of lung infections in CF. Taking two to three grams twice daily of a blend of essential fatty acids is reasonable. Flax oil or fish oil are commonly used as they are rich sources of EFA or their derivatives.
• Glutathione is an antioxidant. When used in aerosol form, glutathione suppresses oxidation and reduces inflammation in the lungs of CF patients.
• Iron levels tend to be elevated in the lung secretions of CF patients. This may contribute to oxidative injury of the lung. In light of this iron supplements should not be used unless absolutely necessary.
• N-acetyl cysteine (NAC) thins secretions, perhaps by enhancing the transport of chloride ions. NAC is also an antioxidant that reduces the free radical damage thought to play a role in the progression of CF. Optimal dosing has not been determined.
• Quercetin, like NAC, enhances the flow of chloride ions  and may be beneficial in CF. Research is needed to determine possible benefits and appropriate dosing.
• Selenium is a trace mineral that is important for antioxidant enzymes in the body . Supplementation with selenium may therefore be reasonable to reduce the excessive free radical damage known to occur in CF (. Many multivitamins provide 200 micrograms of selenium daily. This should be more than adequate.
• Taurine may be useful in CF since it enhances absorption of fats . A dose of 1 - 2 grams with meals may be helpful.
• Vitamin K deficiency is common in CF . Routine supplementation with vitamin K may be beneficial but optimal doses have not been determined .
• Zinc deficiency seems to be common in CF . Zinc deficiency in CF patients may manifest itself as chronic skin problems . Taking 30 milligrams of zinc daily in a multivitamin may be helpful. More zinc may be needed if the blood levels are very low.