Fw: Dietary considerations in Illness

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Another good one to repost.

Dietary Considerations for Patients with Chronic Illnesses and Multiple

Chronic Infections

by Prof. Garth L. Nicolson, Dr. Ngwenya

ImmuneSupport.com

11-28-2001

There are a number of considerations when undergoing therapy for chronic

illnesses, including whether to use allopathic or traditional Western

medical approaches as well as integrative nutraceutical supplements and an

appropriate diet. Paramount in these considerations is a patient's diet,

irrespective of the type of therapy that is being used to control chronic

illness. We have found that most chronic illness patients, including those

with Chronic Fatigue Syndrome, Fibromyalgia Syndrome, Gulf War Illness,

Rheumatoid Arthritis, Hepatitis, Diabetes, Coronary Diseases, Inflammatory

Bowel Diseases, Autoimmune Diseases, HIV/AIDS, among other chronic

illnesses, usually have poor diets that contribute significantly to their

illnesses.

Furthermore, we have found that patients that refuse to change their dietary

habits usually do not recover from their illnesses. Thus diet is extremely

important, and chronic illness patients must follow some simple procedures

to correct their dysfunctional gastrointestinal tracts and restore proper

nutrition to their bodies.

General Nutritional Considerations for Chronic Illness Patients Chronic

illness patients are often immuno-suppressed or have dysfunctional immune

systems and are susceptible to opportunistic infections, so proper nutrition

is extremely important. Patients should not smoke or drink alcohol or

caffeinated products, and should drink as much fresh fluids as possible,

such as vegetable juices and pure water.

High sugar and high fat foods, such as military (MRE) or other fast foods

and acid forming, allergen-prone and system-stressing foods and especially

high sugar/fat junk foods should be avoided. Increased intake of fresh

vegetables, some low-sugar fruits and grains, and decrease intake of

saturated fats are useful. Note that simple or refined sugars can suppress

the immune system. To build the immune system cruciferous vegetables,

soluble fiber foods, such as prunes and bran, wheat germ, fish and whole

grains are useful. Meat and fish can be consumed for protein, but it should

be lean and well-cooked. In some patients exclusive use of 'organic' foods

has been beneficial, as these do not contain the levels of pesticides and

chemicals as the usual commercial sources of foods.

The important points for chronic illness patients to remember are:

1. Do not eat sugar or high-sugar-containing foods. This is the number one

problem in the diets of most chronic illness patients. Simple processed

sugars can stimulate disease-causing microorganisms that require sugars for

their growth. Pathogenic or disease-causing microorganisms usually require

simple sugars for their growth and are found in the overwhelming majority of

chronic illness patients, so high sugar diets can actually stimulate their

proliferation. For example, high sugar diets stimulate bacteria, yeast and

fungal forms and even parasites, and patients eating processed sugars often

show signs of thrush or yeast and bacteria on their tongue and at other

places in and on their bodies, in their blood and in body secretions.

Since most untreated chronic illness patients have excessive levels of

yeasts and other fungi, these can overwhelm the immune system and produce

fatigue and other signs and symptoms. In addition to stimulating the

over-growth of yeasts and other fungi, simple sugars can also directly

suppress the immune system. Examples foods that are particularly stressing

to chronic illness patients are carbonated drinks, cookies, biscuits, dried

fruits, and any food that contains added sugar. Certain sugar substitutes

can be used, but we recommend natural sugar substitutes, such as Stevia made

from Stevia rebaudiana.

2. Do not consume caffeine. Caffeine can stimulate the growth of certain

microorganisms and can change blood properties and stimulate certain

biochemical pathways that are not helpful for chronic illness patients. In

addition, excess caffeine can modify a patient's immune system and its

ability to fight disease.

3. Reduce or eliminate milk products. Milk and milk products stimulate the

growth of yeast and fungi. Milk also contains high amounts of sugar and fat,

two dietary components that should be reduced in the diet of chronic illness

patients. Sour milk or its products, such as yogurt, can be troublesome for

some patients. We usually suggest that patients use supplementation with

Lactobacillus acidophillus and other friendly bacteria (from 3-6 billion

live organisms twice per day) to restore gastrointestinal balance. The gut

contains approximately 2 kilograms of bacteria, and these bacteria are

important in digestion and maintenance of a healthy gastrointestinal system.

The use of friendly bacteria supplements is discussed in more detail below.

4. Reduce starch intake. Starches are broken down to simple sugars, and

simple sugars as discussed above are not useful for chronic illness

patients. Since starches are complex carbohydrates, they are broken down

gradually to simple sugars, so some starch is not bad for chronic illness

patients, but an attempt should be made to limit the amount of starches in

any diet. Diets rich in pastas and breads should be avoided.

5. Increase intake of vegetables. Vegetables, especially green vegetables,

are especially useful in helping to restore the food balance in chronic

illness patients, because they contain important vitamins, minerals and

fiber. They also tend to decrease the amounts of pathogenic bacteria and

fungi in the gut because these mainly use simple sugars and lipids to grow.

Vegetables also help cleanse the bowel by moving pathogenic bacteria and

fungi through the gut. Eating lots of vegetables also increases bowel

movements, and this can be beneficial to restoring the gut and removing

toxins from the body.

6. Reduce intake of yeast-containing foods. High yeast breads, cheeses, and

other milk products that contain yeast are not particularly useful for

chronic illness patients because they add to the overall burden of yeast and

fungi in the gut. Although the types of yeast in such food products are not

pathogenic or disease causing, they can under certain circumstances

overburden a fully taxed immune system and must be limited in any diet for

chronic illness patients.

7. Increase intake of dietary fiber. Dietary fiber increases bowel movements

and helps to remove harmful bacteria from the gastrointestinal system.

Increasing the number of bowel movements per day is important in helping to

remove partially digested food and bacteria from the gut. Most chronic

illness patients have problems with constipation (producing small, hard

stools), and increasing the number of bowel movements and their volumes are

important. To help remove pathogenic bacteria from the bowel and bladder

some recommend a non-dietary sugar, D-mannose (Biotech Co., 800-345-1199).

This natural sugar inhibits binding of bacteria to biological membranes and

does not contribute to bacterial sugar fermentation in the gut.

8. Eat small amounts every one and one-half to two-hours. Eating small

amounts of food often, as much as every 1-1/2 hours is necessary to keep the

stomach partially full so that stomach acid and bile will not be

overproduced and irritate the gastrointestinal system. Eating small amounts

of natural foods also aids in digestion and movement of digested food. The

strategy is to never be hungry and have lots of fresh vegetables and other

foods available all of the time.

9. Reduce the intake of cured or over-refined canned foods. These foods

contain preservatives, nitrites and high levels of salt and curing

substances. These can cause problems by irritating the gastrointestinal

lining, and nitrites can contribute to carcinogenesis. High salt levels are

detrimental to maintaining normal blood pressure and homeostasis.

10. Eliminate alcohol and tobacco. Alcohol is converted to sugars and most

alcoholic beverages contain high levels of sugar, such as beer, wine and

other spirits. In addition to the problems with sugar discussed above,

alcohol damages the nervous tissue (brain and peripheral nerves) and

irritates the gastrointestinal lining. Some have recommended small amounts

of alcohol, but we are against the use of alcohol in any form by chronic

illness patients. Overuse of tobacco use can result in emphysema, lung and

thoracic cancers, high blood pressure, heart disease and other problems, so

chronic illness patients should not use tobacco products in any form.

11. Increase water and juice intake. Purified water is a natural cleanser,

and chronic illness patients usually do not drink enough water. They should

be drinking the equivalent of 8 full glasses of water each day. Juices,

especially vegetable juices are especially good sources of vitamins and

minerals and other phytonutrients. Increased water intake is also good for

bladder and urinary tract infections. Some have used dried cranberry

(without the usual high levels of sugars) powder dissolved in water with

natural sweeteners to cleanse the urinary tract of pathogenic bacteria.

We suggest the following approximate ratios of basic foods for chronic

illness patients: 2/3 vegetables, such as fresh uncooked (in moderation) or

cooked (mostly) in-season green, orange and yellow vegetables, such as

salads, squash, beans, etc. in vegetable oils (olive or sunflower are best),

and juices made from vegetables. A wide variety of juices can be made with

mixtures of various vegetables, and we recommend that these be taken as

often as possible. Some fruit can be added, but most fruit contains sugars

and acids, and so they must be used in moderation.

1/6 starch, such as whole grains, rice, non-yeast or low-yeast breads, oats,

and other natural sources. Some intake of complex carbohydrates is not bad,

because these will be broken down slowly to sugars in your body but they

should not be a large part of any diet for chronic illness patients.

1/6 protein, such as chicken, fish and well-cooked lean meat. Beans are also

a good source of protein. High protein foods are good, but they must be

balanced with vegetables so that they do not remain for excessive times in

the gut and cause constipation.

Of course, it is not always possible to follow completely the above

suggestions, so moderation should be the rule. Since vegetables do not

contain the calories that are present in most diets, most patients will

gradually lose weight unless the quantities eaten are increased. This is why

we recommend eating every 1-1/2 or 2 hours per day. Many professionals have

recommend fruit juices for chronic illness patients, but these are often

high in simple sugars so they must be used in moderation. For patients who

are under-weight, we recommend that they eat substantial meals as often as

possible and increase the amounts of protein. Teas (especially herbal),

vegetable juices, water and soups should not be counted as substantial

sources of any of the foods listed above and can be eaten at any time.

Vitamins and Minerals for Chronic Illness Patients: Chronic illness patients

are often depleted in vitamins (especially B complex, C, E, CoQ-10) and

certain minerals. The reason for this is that chronic illnesses often result

in poor absorption. Therefore, high oral doses of some vitamins are useful;

others, such as vitamin B complex, cannot be easily absorbed by the gut

(oral dose). Sublingual (under the tongue) natural B-complex vitamins in

capsules or liquids (also injectable) should be used instead of swallowed

capsules. B complex vitamins are especially important in Chlamydia and

Mycoplasma infected patients. Patients should take a daily General Vitamin

capsule, but they may have to supplement with extra vitamin B complex and

vitamins C and E, CoQ-10, beta-carotene, folic acid and bioflavanoids.

Some amino acids, such as L-cysteine, L-tyrosine and L-glutamine have been

recommended for chronic illness patients, and L-carnitine and malic acid are

reported to be useful. Also, it is useful to supplement with oils that

contain high amounts of 'omega' fatty acids, such as fish oils and flaxseed

oils. Certain minerals are depleted in chronic illness patients, such as

zinc, magnesium, chromium and selenium.

Some recommend up to 200 mcg/day sodium selenite, followed by lower doses.

The best multivitamins come with extra antioxidants. If patients are on

antibiotics for treatment of chronic infections, vitamins and minerals

should not be taken at the same time of day as antibiotics. Vitamins and

minerals should be taken 3 hours after antibiotics, because they can affect

antibiotic absorption. Some recommend that antioxidant vitamins be taken at

least 4 hours before or after oxygen therapy.

The suggested doses of vitamins can vary dramatically among patients;

consult with your physician or nutritionist for appropriate dosage. Many

chronic illness patients have excess heavy metals in their system, such as

mercury, lead, cadmium and other heavy metals. .For heavy metal removal,

chelation therapy or certain oral products, such garlic supplements and oral

chelation products have been shown to useful in many patients.

12. Add at least a multi-vitamin, sublingual vitamin B complex and CoQ-10 to

the diet. As described above, most chronic illness patients are depleted in

certain vitamins, and a multi-vitamin and B complex vitamins and CoQ-10 will

help restore this imbalance. Other supplements should be considered as well,

such as certain amino acids, fish oils, etc. These are often low in chronic

illness patients and must be increased by supplementation.

13. Add a mineral supplement if certain minerals are not present in a

multi-vitamin. Zinc, magnesium, calcium and especially selenium are often

present in multivitamins, but the amounts may be too low for chronic illness

patients. Some patients live in areas with especially low mineral content in

the drinking water and soil, such as selenium, and they should always

supplement these depleted minerals in the diet. Physicians or nutritionists

need to make sure that patients are receiving the most optimal amounts of

minerals.

14. Make sure that enough helpful lipids are being eaten, such as the lipids

in fish or fish oils. Fish contain useful oils, such as omega-3 and omega-6

fatty acids, among others, and these have been shown to be beneficial for

the heart and other organs. Flaxseed oils and some other oils can substitute

for fish oils. These oils are healthy and should not be considered harmful

or useless fats.

Replacement of Gut Flora and Digestive Enzymes: Patients undergoing

treatment with antibiotics and other substances risk destruction of normal

gut flora or friendly bacteria that provide important digestive enzymes for

processing food in the gut. Antibiotic use depletes normal gut bacteria and

can result in over-growth of less desirable bacteria. To supplement bacteria

in the gastrointestinal system yogurt and especially live cultures of

Lactobacillus acidophilus in capsules or powder are strongly recommended (at

least 3-6 billion live organisms at least two or three times per day).

Mixtures of Lactobacillus acidophilus, L. bifidus, B. bifidum, L. bulgaricus

and FOS (fructoologosaccharides) to promote growth of these probiotics in

the gut are important. L. acidophilus mixtures (above 3 billion live

organisms) should be taken three times per day. For irritable bowel, certain

mixtures of Chinese herbs have proven to be very effective in clinical

trials. Another problem in chronic illness patients is the lack of digestive

enzymes that can process foods to useful metabolites in the gut. We

recommend a combination of natural digestive enzymes (usually from plant

sources) plus antioxidants.

15. Take a probiotic supplement containing at least 3 billion live

Lactobacillus acidophilus plus other 'friendly' bacteria at least twice per

day. These supplements are available at most drug and food stores, but the

best products are available in health food stores. Most recommend the

mixtures of at least three different types of friendly bacteria, and these

products are especially good for the gut.

16. Take a supplement of natural digestive enzymes that aid in digestion.

These natural sources of digestive enzymes help digest food and make it

available in a form that can be readily absorbed. These should be taken at

least twice per day with meals to aid digestion, food uptake and help to

minimize leaky gut problems that can introduce pathogenic bacteria into the

blood.

Natural Immune Modulators and Natural Remedies: A number of natural

remedies, such as ginseng root, herbal teas, lemon/olive drink, olive leaf

extract with antioxidants are sometimes useful, especially during or after

antibiotic therapy. More important examples are immune modulators, such as

bioactive whey protein, oral transfer factors and plant glycans.

Some additional remedies are: olive leaf extract, lactoferrin and some

natural plant products or herbal mixtures. Good immune boosters have been

isolated from certain mushroom extracts. These products have been used to

boost immune systems. Although they appear to help many patients, their

clinical effectiveness in chronic illness patients has not been carefully

evaluated, and in our experience patients show individual differences in

responses to these nutraceutical supplements. They appear to be useful

during therapy to boost the immune system or after antibiotic/antiviral

therapy in a maintenance program to prevent relapse and opportunistic

secondary infections.

17. Add an immune modulator and a natural remedy. Several types of immune

modulators are listed above. Unfortunately, each patient is different and

may respond differently to the many products that are on the market, so

patients will have to decide with the advice of care provider what is best.

Similarly, there are many natural remedies on the market, and although these

are generally good for chronic illness patients, each patient is different

and may respond disparately to different products. In some cases, foods can

substitute for a portion of the natural remedies. For example, fresh garlic,

olive leaf extract, oregano oil (in enteric coated capsules), among others

have been shown to be useful. Purified milk products, such as bioactive whey

and transfer factors made from colostrum or mother's milk, are also useful

for many patients and contain natural substances that suppress pathogenic

organisms and stimulate the immune system. Mixtures of herbal formulations

are especially useful and very popular as a method to boost immune

responses.

Yeast/Fungal Overgrowth while on Antibiotics: Yeast overgrowth occurs often

in chronic illness patients, especially in females (usually first seen as

vaginal infections or thrush [white coating] on the tongue). Gynecologists

recommend Nizoral, Diflucan, Sporanox, Mycelex, or anti-yeast creams.

Metronidazole [Flagyl, Prostat] has been used to prevent fungal or parasite

overgrowth or other antifungals [Nystatin, Amphotericin B, Fluconazole,

Diflucan, Sporanox or Pau d' arco] have been administered for fungal

infections that can occur while on antibiotics.

Some patients have as their principal problem systemic fungal infections

that can be seen using dark field microscopy of blood smears. For

superficial fungal infections, such as fungal nail, topical antifungals are

effective. As mentioned above, L. acidophillus mixtures are used to restore

gut flora. Bacterial overgrowth can also occur, for example, in between

cycles of antibiotics or after antibiotics/antivirals have been stopped.

Natural or nutraceutical approaches to controlling yeast infections include

supplementation with the following formulations: Pau d' arco, grapefruit

extract, olive leaf extract (most of these require at least 2 capsules 3X

per day), caprylic acid, garlic extract and enteric-coated oregano oil.

These can be found in health food stores, along with instructions on how

they are used to control yeast and fungal infections. Diet is especially

important in controlling yeast overgrowth, and the dietary instructions

above should be followed, such as the elimination of most simple or refined

sugars from the diet and other instructions listed above.

18. When necessary, take a anti-fungal medication or a natural yeast and

fungal controlling remedy. Most chronic illness patients have trouble with

yeast/fungal infections, and these must be controlled to permit recovery of

the immune system. If the yeast or fungi are not excessive, the natural

anti-fungal food supplements (Pau d' arco, grapefruit extract, olive leaf

extract, caprylic acid, garlic extract or enteric-coated oregano oil) should

be used first because they may be less stressing on the body, and they are

certainly less expensive.

If the instructions above are followed, patients will start to notice a

change in health within a short period of time. However, recovery from

chronic illnesses is long, slow process, and patients should not be

discouraged if cyclic periods of more and less severity of illness

(morbidity) persist. Patients must decide to make diet an important part of

their recovery, and the recommendations above are only a part of the program

of recovery. We consider it unlikely that patients will recover from their

chronic illnesses unless they change their diet and eating habits, so diet

is as important as other factors in recovery.

For Further Information: Professor Garth L. Nicolson, Ph.D. The Institute

for Molecular Medicine (http://www.immed.org/) 15162 Triton Lane Huntington

Beach, CA 92649 Tel: (714) 903-2900

Selected References:

Nicolson GL: Considerations when undergoing treatment for chronic infections

found in Chronic Fatigue Syndrome, Fibromyalgia Syndrome and Gulf War

Illnesses. (Part 1). International Journal of Medicine 1998; 1:115-117.

Nicolson GL, Nasralla M, Franco AR, Erwin R, Nicolson NL, Ngwenya R, Berns

P.

Diagnosis and Integrative Treatment of Intracellular Bacterial Infections in

Chronic Fatigue and Fibromyalgia Syndromes, Gulf War Illness, Rheumatoid

Arthritis and other Chronic Illnesses. Clinical Practice of Alternative

Medicine 2000; 1(2):92-102.

Teitelbaum, J. Fighting those persistent infections in Chronic Fatigue

Syndrome. From Fatigued to Fantastic Newsletter 2000 and 2001; 3(3) and

4(1).