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NUTRITION IN LYME andNUTRITION IN LYME andTICK INFECTIONSTICK INFECTIONS
Martin D. Fried, MD, FAAP, ABPNSMartin D. Fried, MD, FAAP, ABPNS
Physician Nutrition SpecialistPhysician Nutrition Specialist
3200 Sunset Ave Suite 1003200 Sunset Ave Suite 100
Ocean, NJ 07712Ocean, NJ 07712
www.healthydays.infowww.healthydays.info
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Inflammed StomachInflammed Stomach
NodularityNodularity GastritisGastritis
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Leaky Gut from InfectionLeaky Gut from Infection
• Gastritis with foreign protein Gastritis with foreign protein leaking into the blood streamleaking into the blood stream
• Examples of immune activation Examples of immune activation psoriasis,psoriasis,
IBD, CeliacIBD, Celiac
Neovascular rashesNeovascular rashes
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Inflammation causes Inflammation causes
permeable gutpermeable gut
Foreign proteins to Foreign proteins to
immune systemimmune system
Crohn’s, Colitis, Celiac Crohn’s, Colitis, Celiac
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PsoriasisPsoriasis
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Immune/AutoimmuneImmune/Autoimmune• Crohn’s, Celiac, Ulcerative ColitisCrohn’s, Celiac, Ulcerative Colitis
• Lyme, Bartonella, MycoplasmaLyme, Bartonella, Mycoplasma
• Inflammatory mediators include:Inflammatory mediators include:Tumor necrosis factorTumor necrosis factor
interleukins 2, 6, 10interleukins 2, 6, 10
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Immune Activation Neovascular Rash
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SNAKE LIKE = INFECTION
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Nutritional GoalsNutritional Goals
• Minimize Nutritional Risk• Provide Nutrition• enhance absorption and tolerance• Maintain intestinal integrity• Favorably alter intestinal flora• Regulate immune system favorably• Address fatigue and obesity
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Nutritional GoalsNutritional Goals
• Minimize nutritional risk by providing:
adequate calories, protein, carbohydrates
healthy fats, vitamins and minerals
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Provide Nutrition to Enhance Provide Nutrition to Enhance Absorption and ToleranceAbsorption and Tolerance
• Whey verses Casein properties of milk• Whey empties faster (reference 1)
• Casein delays gastric emptying
• In cases of Neurologic conditions affecting gut motility, whey protein is preferred
• Mixture of protein sizes of varying length helps absorption due to dual transport of Proteins (reference 2)
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Lyme can cause IBD, CeliacLyme can cause IBD, Celiac
• Genetic predisposition
• Environmental trigger (infection)
• albumin, protein absorption, folate• Calcium and fat Consider Zinc and
Iron deficiencies (references 3-6)
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Immune ActivationImmune ActivationScalp Psoriasis to…….. Crohn’s Disease
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Canker SoreCanker Sore
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Inflammatory UlcersInflammatory Ulcers
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Colon UlcersColon Ulcers
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ColitisColitis
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Celiac vs Food IntoleranceCeliac vs Food Intolerance
• Celiac is Autoimmune to wheat, rye, barleyCeliac is Autoimmune to wheat, rye, barley
• Gluten, Genetics and EnvironmentGluten, Genetics and Environment
• Allergy is IgE mediatedAllergy is IgE mediated
• Celiac is non IgE mediated Celiac is non IgE mediated
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Celiac Disease
Enzymes lost in disease malabsorption affected:
Lactase milk sugar
Sucrase table sugar
Maltase Simple starch
Glucoamylase Complex starch as rice
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Maintain Intestinal IntegrityMaintain Intestinal Integrity
• Iron, Zinc, AlbuminIron, Zinc, Albumin• Fat soluble vitamins A,D,E,K Fat soluble vitamins A,D,E,K (refer 4-7)(refer 4-7)
• B12 malabsorption in ileumB12 malabsorption in ileum
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Alter GI Flora FavorablyAlter GI Flora Favorably
• Minimize Clostridium difficile - colitisMinimize Clostridium difficile - colitis• Reduce Candida albicans – yeast overgrowthReduce Candida albicans – yeast overgrowth• Short chained Fructoligosaccharides (scFOS)Short chained Fructoligosaccharides (scFOS)• Promote growth of BifidobacteriaPromote growth of Bifidobacteria• Lactobacillus acidophillusLactobacillus acidophillus
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Clostridium difficileClostridium difficile
• C. difficile is normal bacterial floraC. difficile is normal bacterial flora
• Antibiotics kill lactobacilli, bifidobacterAntibiotics kill lactobacilli, bifidobacter
• C. difficile overgrowth occursC. difficile overgrowth occurs
• C. difficile elicits – Toxin A and Toxin BC. difficile elicits – Toxin A and Toxin B
• Pseudomembranous colitsPseudomembranous colits
• Treat with Metronidazole and pre/probioticsTreat with Metronidazole and pre/probiotics
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Pseudomembranous Colitis
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• Normal Flora YeastNormal Flora Yeast
• Antibiotics kills Normal FloraAntibiotics kills Normal Flora
• Yeast overgrowth occursYeast overgrowth occurs
• Diet to produce lactobacillus, bifidobacteriaDiet to produce lactobacillus, bifidobacteria
• Short chained fructooligosaccharides (FOS)Short chained fructooligosaccharides (FOS)
Candida Albicans
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ProbioticsProbiotics• > 90% killed by stomach acid> 90% killed by stomach acid
• LactobacillusLactobacillus• BifidobacterBifidobacter
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PrebioticsPrebiotics
• Natural Carbohydrates not digested Natural Carbohydrates not digested by : amylase, sucrase and maltaseby : amylase, sucrase and maltase
• scFOSscFOS
• Sources include banana, garlic, Sources include banana, garlic, onion, leeks, whole wheat, asparagus onion, leeks, whole wheat, asparagus and tomato productsand tomato products
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Keeps yeast and C difficile in checkKeeps yeast and C difficile in check
Lowers the pH in the colonLowers the pH in the colon
Acidic environment is bifidogenicAcidic environment is bifidogenic
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Foods with sc FOSFoods with sc FOS
• Soluble Fiber in Fruits and VegetablesSoluble Fiber in Fruits and Vegetables
• Fermented in colon to short chain Fatty Fermented in colon to short chain Fatty
acids by normal colonic flora acids by normal colonic flora (refer 8,9) (refer 8,9)
• banana banana onions onions
• garlic garlic asparagusasparagus
• Barley Barley wheat wheat
• TomatoesTomatoes leeks leeks
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Immune SupressionImmune SupressionACNE progresses to….. THIRD DEGREE BURN
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Down regulate InflammationDown regulate Inflammation
• Omega three oils are anti-inflammatoryOmega three oils are anti-inflammatory• Salmon, tuna, herring, walnuts, almondsSalmon, tuna, herring, walnuts, almonds
• Omega six oils are inflammatoryOmega six oils are inflammatory
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Obesity
• Inactivity, joint pains, malaise, fatigue
• High caloric foods… leads to………….
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Gallstones
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Insulin Resistance
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Fatty Liver
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Sleep Apnea
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ConclusionsConclusions
• Lyme, Bartonella, Mycoplasma cause Lyme, Bartonella, Mycoplasma cause
inflammation and changes in the GI tractinflammation and changes in the GI tract
• Prevent yeast, c. difficile overgrowth Prevent yeast, c. difficile overgrowth
with prebiotics and probioticswith prebiotics and probiotics
• Address specific nutritional deficiencies Address specific nutritional deficiencies
• Consider omega three foods to down Consider omega three foods to down
regulate autoimmune activationregulate autoimmune activation
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References• 1) J Pediatr 1992;120:569-572
• 2)Ann Rev Physiol 2004; 66:361-384
• 3) J Ped Gastroenterol Nutr 1985;4:45-51
• 4) Am J Physiol 1995;268
• 5) Am J Physiol 1999;277
• 6) Ann Surg 1996; 223:316-333
• 7) J Nutr 2001; 131:2157-2163
• 8) Lancet 1993; 342:1266-1268
• 9) Am J Gastroenterol 1990;85:1307-1312