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

Inflammed StomachInflammed Stomach

NodularityNodularity GastritisGastritis

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

Inflammation causes Inflammation causes

permeable gutpermeable gut

Foreign proteins to Foreign proteins to

immune systemimmune system

Crohn’s, Colitis, Celiac Crohn’s, Colitis, Celiac

PsoriasisPsoriasis

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

Immune Activation Neovascular Rash

SNAKE LIKE = INFECTION

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

Nutritional GoalsNutritional Goals

• Minimize nutritional risk by providing:

adequate calories, protein, carbohydrates

healthy fats, vitamins and minerals

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)

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)

Immune ActivationImmune ActivationScalp Psoriasis to…….. Crohn’s Disease

Canker SoreCanker Sore

Inflammatory UlcersInflammatory Ulcers

Colon UlcersColon Ulcers

ColitisColitis

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

Celiac Disease

Enzymes lost in disease malabsorption affected:

Lactase milk sugar

Sucrase table sugar

Maltase Simple starch

Glucoamylase Complex starch as rice

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

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

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

Pseudomembranous Colitis

• 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

ProbioticsProbiotics• > 90% killed by stomach acid> 90% killed by stomach acid

• LactobacillusLactobacillus• BifidobacterBifidobacter

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

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

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

Immune SupressionImmune SupressionACNE progresses to….. THIRD DEGREE BURN

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

Obesity

• Inactivity, joint pains, malaise, fatigue

• High caloric foods… leads to………….

Gallstones

Insulin Resistance

Fatty Liver

Sleep Apnea

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

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