1. NUTRITION IN LYME and TICK INFECTIONS Martin D. Fried, MD, FAAP, ABPNS Physician Nutrition Specialist 3200 Sunset Ave Suite 100 Ocean, NJ 07712 www.healthydays.info

2. Inflammed Stomach NodularityGastritis NodularityGastritis

3. Leaky Gut from Infection Gastritis with foreign protein leaking into the blood stream Gastritis with foreign protein leaking into the blood stream Examples of immune activation psoriasis,Examples of immune activation psoriasis, IBD, Celiac IBD, Celiac Neovascular rashes

4. Inflammation causes permeable gut Foreign proteins to immune system Crohn’s, Colitis, Celiac

6. Psoriasis

7. Immune/Autoimmune Crohn’s, Celiac, Ulcerative ColitisCrohn’s, Celiac, Ulcerative Colitis Lyme, Bartonella, MycoplasmaLyme, Bartonella, Mycoplasma Inflammatory mediators include: Tumor necrosis factor interleukins 2, 6, 10Inflammatory mediators include: Tumor necrosis factor interleukins 2, 6, 10

8. Immune Activation Neovascular Rash

9. SNAKE LIKE = INFECTION

10. Nutritional 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

11. Nutritional Goals Minimize nutritional risk by providing: adequate calories, protein, carbohydrates healthy fats, vitamins and minerals

12. Provide Nutrition to Enhance Absorption 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)

13. Lyme can cause IBD, Celiac Genetic predisposition Environmental trigger (infection) albumin, protein absorption, folate Calcium and fat Consider Zinc and Iron deficiencies (references 3-6)

14. Immune Activation Scalp Psoriasis to…….. Crohn’s Disease

15. Canker Sore

16. Inflammatory Ulcers

17. Colon Ulcers

18. Colitis

19. Celiac vs Food Intolerance Celiac is Autoimmune to wheat, rye, barley Celiac is Autoimmune to wheat, rye, barley Gluten, Genetics and Environment Gluten, Genetics and Environment Allergy is IgE mediated Allergy is IgE mediated Celiac is non IgE mediated Celiac is non IgE mediated

20. Celiac Disease Enzymes lost in disease malabsorption affected: Lactasemilk sugar Sucrasetable sugar MaltaseSimple starch GlucoamylaseComplex starch as rice

21. Maintain Intestinal Integrity Iron, Zinc, AlbuminIron, Zinc, Albumin Fat soluble vitamins A,D,E,K (refer 4-7)Fat soluble vitamins A,D,E,K (refer 4-7) B12 malabsorption in ileumB12 malabsorption in ileum

22. Alter 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

23. Clostridium difficile C. difficile is normal bacterial flora C. difficile is normal bacterial flora Antibiotics kill lactobacilli, bifidobacter Antibiotics kill lactobacilli, bifidobacter C. difficile overgrowth occurs C. difficile overgrowth occurs C. difficile elicits – Toxin A and Toxin B C. difficile elicits – Toxin A and Toxin B Pseudomembranous colits Pseudomembranous colits Treat with Metronidazole and pre/probiotics Treat with Metronidazole and pre/probiotics

24. Pseudomembranous Colitis

25. Normal Flora Yeast Normal Flora Yeast Antibiotics kills Normal Flora Antibiotics kills Normal Flora Yeast overgrowth occurs Yeast overgrowth occurs Diet to produce lactobacillus, bifidobacteria Diet to produce lactobacillus, bifidobacteria Short chained fructooligosaccharides (FOS) Short chained fructooligosaccharides (FOS) Candida Albicans

26. Probiotics > 90% killed by stomach acid> 90% killed by stomach acid LactobacillusLactobacillus BifidobacterBifidobacter

27. Prebiotics Natural Carbohydrates not digested by : amylase, sucrase and maltaseNatural Carbohydrates not digested by : amylase, sucrase and maltase scFOSscFOS Sources include banana, garlic, onion, leeks, whole wheat, asparagus and tomato productsSources include banana, garlic, onion, leeks, whole wheat, asparagus and tomato products

28. Keeps yeast and C difficile in check Lowers the pH in the colon Acidic environment is bifidogenic

29. Foods with sc FOS Soluble Fiber in Fruits and Vegetables Soluble Fiber in Fruits and Vegetables Fermented in colon to short chain Fatty acids by normal colonic flora (refer 8,9) Fermented in colon to short chain Fatty acids by normal colonic flora (refer 8,9) banana onions banana onions garlic asparagus garlic asparagus Barley wheat Barley wheat Tomatoes leeks Tomatoes leeks

30. Immune Supression ACNE progresses to…..THIRD DEGREE BURN

31. Down 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

32. Obesity Inactivity, joint pains, malaise, fatigue High caloric foods… leads to………….

33. Gallstones

34. Insulin Resistance

35. Fatty Liver

36. Sleep Apnea

37. Conclusions Lyme, Bartonella, Mycoplasma cause inflammation and changes in the GI tract Lyme, Bartonella, Mycoplasma cause inflammation and changes in the GI tract Prevent yeast, c. difficile overgrowth with prebiotics and probiotics Prevent yeast, c. difficile overgrowth with prebiotics and probiotics Address specific nutritional deficiencies Address specific nutritional deficiencies Consider omega three foods to down regulate autoimmune activation Consider omega three foods to down regulate autoimmune activation

38. 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