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A Nutritional Approach A Nutritional Approach

to Lyme Diseaseto Lyme Disease

Ben Briggs, Ben Briggs, RPhRPh, CNC, IACP, CNC, IACP

February 17, 2010February 17, 2010

IntroductionIntroduction

�� Most commonly reported vectorMost commonly reported vector--borne illness in USborne illness in US

�� Most common of all tickMost common of all tick--borne diseasesborne diseases

�� Highly focused geographic distributionHighly focused geographic distribution

�� Primarily focused in the NortheastPrimarily focused in the Northeast

�� Geographic expansion of reservoir mammals &Geographic expansion of reservoir mammals &

human development into rural/suburban areas main human development into rural/suburban areas main

reasons for increasing casesreasons for increasing cases

�� Dubbed Dubbed ““The Great ImitatorThe Great Imitator”” due to mimicking due to mimicking

symptomatolgysymptomatolgy of many diseasesof many diseases

�� RA, MS, Lupus, Bipolar & major depressionRA, MS, Lupus, Bipolar & major depression

StatisticsStatistics

�� 321,128 cases in US from 1990321,128 cases in US from 1990--2008200811

�� 3818 cases in PA in 2008 (30.7% incidence)3818 cases in PA in 2008 (30.7% incidence)11

�� 250% 250% ↑↑ in Lyme disease from 1993in Lyme disease from 1993--2008200811

�� 46% of households in Pocopson twp had at 46% of households in Pocopson twp had at

least 1 family member afflicted with Lyme least 1 family member afflicted with Lyme

diseasedisease22

1 CDC statistics1 CDC statistics 2 2 Lymediseaseassociation.orgLymediseaseassociation.org

Lyme disease distribution in USLyme disease distribution in US

Function of Nutritional ApproachFunction of Nutritional Approach

�� ““The purpose of using a nutritional The purpose of using a nutritional

approach is to provide an adjunct to approach is to provide an adjunct to

traditional therapies as well as to address traditional therapies as well as to address

the multiple nutrient deficiencies that result the multiple nutrient deficiencies that result

with Lyme and associated diseaseswith Lyme and associated diseases””

-- Michael Briggs, Pharm.D. (2010)Michael Briggs, Pharm.D. (2010)

OutlineOutline

�� Gastrointestinal SupportGastrointestinal Support

�� ProbioticsProbiotics

�� LL--glutamineglutamine

�� Foundational SupportFoundational Support

�� MultivitaminMultivitamin

�� BB--complexcomplex

�� MagnesiumMagnesium

�� Vitamin DVitamin D

�� Antioxidant SupportAntioxidant Support

�� AlphaAlpha--lipoiclipoic acidacid

�� CoQ10CoQ10

�� Immune SupportImmune Support

�� CatCat’’s Claws Claw

�� ArtemisininArtemisinin

�� AntiAnti--inflammatory supportinflammatory support

�� Essential fatty acidsEssential fatty acids

�� Combination productsCombination products

�� Hepatic SupportHepatic Support

�� Milk ThistleMilk Thistle

�� NAC & GlutathioneNAC & Glutathione

�� Energy SupportEnergy Support

�� RhodiolaRhodiola

�� Joint SupportJoint Support

�� Glucosamine & Glucosamine & ChondroitinChondroitin

�� Lifestyle SupportLifestyle Support

�� Intestinal Intestinal CandidiasisCandidiasis

�� SleepSleep

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Gastrointestinal SupportGastrointestinal SupportProbioticsProbiotics

�� Friendly flora that Friendly flora that normally inhabit normally inhabit gastrointestinal tractgastrointestinal tract�� Lactobacillus AcidophilusLactobacillus Acidophilus

�� BifidobacteriumBifidobacterium LactisLactis

�� Improve nutrient Improve nutrient absorption & immune absorption & immune functionfunction

�� Discourage pathogen & Discourage pathogen & biofilmbiofilm growthgrowth�� LactoperoxidaseLactoperoxidase

�� LactoferrinsLactoferrins

�� Synthesize Vitamin K & Synthesize Vitamin K & certain Bcertain B--vitaminsvitamins

�� May be in capsule or May be in capsule or powder formpowder form�� Most are DairyMost are Dairy--freefree

�� Refrigerated or shelfRefrigerated or shelf--stable productsstable products

�� Rotate or mix brands to Rotate or mix brands to confuse pathogensconfuse pathogens

�� Kefir is only yogurtKefir is only yogurt--like like product that is approvedproduct that is approved

�� Note: Throughout this slide show, there will Note: Throughout this slide show, there will

be slides showing pictures of be slides showing pictures of ““recommended recommended

productsproducts””. These products should not be . These products should not be

considered an endorsement of these specific considered an endorsement of these specific

branded items but representative of the branded items but representative of the

products that are recommended to assist in products that are recommended to assist in

well being. The LDASEPA, by showing well being. The LDASEPA, by showing

these slides does not specifically endorse these slides does not specifically endorse

any of these products.any of these products.

Recommended ProductsRecommended Products

Recommended ProductsRecommended Products Gastrointestinal SupportGastrointestinal SupportLL--glutamineglutamine

�� Most abundant amino acid in bodyMost abundant amino acid in body

�� Used for repair of inflamed mucosa & Used for repair of inflamed mucosa &

immune supportimmune support

�� Stomach, intestinesStomach, intestines

�� Promotes formation of glutathione w/NACPromotes formation of glutathione w/NAC

�� Involved in more metabolic processes than Involved in more metabolic processes than

any other amino acidany other amino acid

�� 33--4g in powder form up to 4 times daily4g in powder form up to 4 times daily

Recommended ProductsRecommended ProductsFoundational SupportFoundational Support

MultivitaminsMultivitamins

�� Provide a convenient way to take a variety of Provide a convenient way to take a variety of

nutrients to prevent deficienciesnutrients to prevent deficiencies

�� Come in tablet, capsule, powder or liquid formCome in tablet, capsule, powder or liquid form

�� Pick product that allows best compliancePick product that allows best compliance

�� I.e. Once a day productI.e. Once a day product

�� Should not take the place of a healthy dietShould not take the place of a healthy diet

�� Should contain at least 100% of US RDAShould contain at least 100% of US RDA

�� RDAs developed when soils were not depleted & are RDAs developed when soils were not depleted & are

usually inadequate amountsusually inadequate amounts

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Recommended ProductsRecommended ProductsFoundational SupportFoundational Support

BB--complexcomplex

�� Contains Vitamins B1, B2, B3, B5, B6, BContains Vitamins B1, B2, B3, B5, B6, B--12, & folic acid12, & folic acid

�� Some people cannot activateSome people cannot activate

•• Use metabolically active formsUse metabolically active forms

�� I.e. P5P, 5I.e. P5P, 5--MTHF, MTHF, methylcobalaminmethylcobalamin

�� Necessary for healthy nerve, adrenal, muscle, Necessary for healthy nerve, adrenal, muscle,

skin, liver cell function & skin, liver cell function & ↓↓ homocysteinehomocysteine levelslevels

�� 50mg once to twice daily with meals50mg once to twice daily with meals

�� WaterWater--soluble soluble →→ excess excreted in urineexcess excreted in urine

�� No accumulationNo accumulation

Recommended ProductsRecommended ProductsFoundational SupportFoundational Support

MagnesiumMagnesium

�� 44thth most abundant most abundant mineral in bodymineral in body

�� Involved in over 300 Involved in over 300 reactions in bodyreactions in body

�� Commonly overlooked Commonly overlooked deficiencydeficiency

�� Helpful for tremors, Helpful for tremors, twitches, weakness, twitches, weakness, muscle soreness & muscle soreness & crampscramps

�� Chelated forms provides Chelated forms provides highest absorptionhighest absorption

�� I.e. aspartate, citrateI.e. aspartate, citrate

�� Chronic stress & alcohol Chronic stress & alcohol consumption depletes consumption depletes magnesium storesmagnesium stores→→ ↓↓ REMREM sleep, muscle sleep, muscle

spasms, constipation, spasms, constipation, hormone imbalances, low hormone imbalances, low energy, calcification of energy, calcification of organsorgans

�� Dose: As much as the Dose: As much as the body can toleratebody can tolerate�� Too Too muchmuch→→looseloose stoolsstools

�� 300300--600mg daily600mg daily

Recommended ProductsRecommended ProductsFoundational SupportFoundational Support

Vitamin DVitamin D--33

�� Active form of Vitamin DActive form of Vitamin D

�� 60% deficiency in NE60% deficiency in NE

�� Has >200 mechanismsHas >200 mechanisms

�� 25(OH)D levels>40mg/dl25(OH)D levels>40mg/dl�� 6060--80mg/dl80mg/dl→→ idealideal

�� >100mg/dl is harmful>100mg/dl is harmful

�� 40004000--5000IU daily w/food5000IU daily w/food�� Liquid or Liquid or softgelsoftgel onlyonly

�� 10K10K--25K daily x 5 days for 25K daily x 5 days for viral infectionsviral infections

�� Up to 200K daily safe in Up to 200K daily safe in studiesstudies

�� Most researched nutrient Most researched nutrient in industry currentlyin industry currently

�� Deficiency associated Deficiency associated with cancer, CVD, HTN, with cancer, CVD, HTN, stroke, MS, RA, IBD, stroke, MS, RA, IBD, osteoporosis, chronic osteoporosis, chronic pain, falls, viral infections, pain, falls, viral infections, depression, autism, depression, autism, periodontal diseaseperiodontal disease

�� Antimicrobial peptides Antimicrobial peptides combat a variety of combat a variety of viruses viruses

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Recommended ProductsRecommended ProductsAntioxidant SupportAntioxidant Support

CoEnzymeCoEnzyme Q10Q10

�� Intracellular antioxidant Intracellular antioxidant

essential for energy essential for energy

productionproduction

�� ↑↑ ATP production in ATP production in

mitochondria of cellsmitochondria of cells

�� Affects most active Affects most active

metabolic cellsmetabolic cells

�� Heart, immune, GI mucosaHeart, immune, GI mucosa

�� Contraindicated during Contraindicated during

atavaquone useatavaquone use

�� Mepron, Mepron, MalaroneMalarone

�� Depleted by Depleted by StatinStatin drugsdrugs

�� 200200--400mg daily with 400mg daily with

meals in oil soluble formmeals in oil soluble form

�� Use Use ubiquinolubiquinol in elderly in elderly

due to due to ↓↓ ability to activate ability to activate

ubiquinoneubiquinone

Recommended ProductsRecommended ProductsAntioxidant SupportAntioxidant Support

AlphaAlpha--LipoicLipoic AcidAcid

�� Antioxidant that neutralizes free radicals in water Antioxidant that neutralizes free radicals in water

& fat soluble regions of cells& fat soluble regions of cells

�� Facilitates transport of CoQ10 into mitochondriaFacilitates transport of CoQ10 into mitochondria

�� Helps recycle Helps recycle edogenousedogenous antioxidants antioxidants

�� I.e. glutathioneI.e. glutathione

�� Provides support for liver detoxificationProvides support for liver detoxification

�� RR--isomer is more biologically activeisomer is more biologically active

�� 300mg twice daily with meals300mg twice daily with meals

Recommended ProductsRecommended ProductsImmune SupportImmune Support

TOATOA--free Catfree Cat’’s Claw (s Claw (UnaUna de de GatoGato))

�� TOATOA--free Catfree Cat’’s Claw has toxic alkaloids s Claw has toxic alkaloids

removed to prevent liver damageremoved to prevent liver damage

�� Immune enhancing & antimicrobial propertiesImmune enhancing & antimicrobial properties

�� Contains Contains quinovicquinovic acid glycosidesacid glycosides

�� Similar in structure to Similar in structure to fluoroquinolonesfluoroquinolones ((i.e.Ciproi.e.Cipro))

�� Used as an adjunct to Antibiotic therapyUsed as an adjunct to Antibiotic therapy

�� Herxheimer reactions possible so titrate dosage Herxheimer reactions possible so titrate dosage

to 1 capsule 3 times daily with meals for 6to 1 capsule 3 times daily with meals for 6--8 8

months (3months (3--4 life cycles)4 life cycles)

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Recommended ProductsRecommended ProductsImmune SupportImmune Support

ArtemisininArtemisinin

�� Active component of Sweet WormwoodActive component of Sweet Wormwood

�� Shown to be beneficial for balancing Shown to be beneficial for balancing

microbiology of the GI tractmicrobiology of the GI tract

�� Used primarily as an adjunct for coUsed primarily as an adjunct for co--infectionsinfections

�� Contraindicated in pregnant/nursing womenContraindicated in pregnant/nursing women

�� Herxheimer reactions possible so titrate dosage Herxheimer reactions possible so titrate dosage

to 1 to 1 softgelsoftgel twice daily with mealstwice daily with meals

�� Used in globally for malaria treatmentUsed in globally for malaria treatment

Recommended ProductsRecommended ProductsAntiAnti--inflammatory Supportinflammatory SupportEssential Fatty Acids (Essential Fatty Acids (EFAsEFAs))

�� Must be consumed in diet as body does Must be consumed in diet as body does

not manufacturenot manufacture

�� Improve memory, mood, & cognitionImprove memory, mood, & cognition

�� AntiAnti--inflammatory propertiesinflammatory properties

�� Manufacturing process is critical for qualityManufacturing process is critical for quality

�� ColdCold--pressed or molecularly distilledpressed or molecularly distilled

�� 10001000--6000mg daily with meals6000mg daily with meals

�� Examples include fish, flax, or borage oilExamples include fish, flax, or borage oil

Recommended ProductsRecommended ProductsAntiAnti--inflammatory Supportinflammatory Support

Combination ProductsCombination Products

�� Combine herbs like turmeric, ginger, Combine herbs like turmeric, ginger,

rosemary, Baikal skullcap, green tearosemary, Baikal skullcap, green tea

�� Work on multiple inflammatory pathways Work on multiple inflammatory pathways

compared to COXcompared to COX--1 or COX1 or COX--2 only in 2 only in RxsRxs

�� Shown to decrease CShown to decrease C--reactive proteinreactive protein

�� Used primarily for pain & swelling reliefUsed primarily for pain & swelling relief

�� 11--2 2 softgelssoftgels/capsules up to 4 times daily /capsules up to 4 times daily

with mealswith meals

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Recommended ProductsRecommended Products Hepatic SupportHepatic SupportMilk ThistleMilk Thistle

�� Promotes regeneration of liver cellsPromotes regeneration of liver cells

�� Blocks entry of toxins into liver cellsBlocks entry of toxins into liver cells

�� Helps maintain glutathione & SOD levelsHelps maintain glutathione & SOD levels

�� ↓↓ AST, ALT, & AST, ALT, & AlkAlk PhosPhos levelslevels

�� Promotes healthy bile flowPromotes healthy bile flow

�� 100100--250mg up to 3 times daily with meals250mg up to 3 times daily with meals

Recommended ProductsRecommended Products Hepatic SupportHepatic SupportNN--acetyl acetyl cysteinecysteine & Glutathione& Glutathione

NACNAC

�� SulfurSulfur--containing amino containing amino

acid precursor to Lacid precursor to L--

cysteinecysteine & glutathione& glutathione

�� Antioxidant & liver Antioxidant & liver

protectantprotectant actionsactions

�� Immune enhancing Immune enhancing

capabilitiescapabilities

�� 600600--900mg 2900mg 2--4 times daily 4 times daily

with mealswith meals

GlutathioneGlutathione

�� One of most important One of most important

antioxidants in bodyantioxidants in body

•• Must be in reduced formMust be in reduced form

�� Essential for Phase I & II Essential for Phase I & II

liver detoxificationliver detoxification

�� Involved in liver, lung, Involved in liver, lung,

immune, bowel, heart, immune, bowel, heart,

brain, pancreatic, & eye brain, pancreatic, & eye

healthhealth

�� 100100--300mg up to 3 times 300mg up to 3 times

daily with mealsdaily with meals

Recommended ProductsRecommended ProductsEnergy SupportEnergy Support

Rhodiola & GinsengRhodiola & Ginseng

�� AdaptogensAdaptogens that help with fatigue, stress & that help with fatigue, stress &

immune functionimmune function

�� Raise ATP in muscle cellsRaise ATP in muscle cells

�� NonNon--stimulants safe for use in pts with stimulants safe for use in pts with

high blood pressurehigh blood pressure

�� May be used longMay be used long--term without breaksterm without breaks

�� 1 capsule 21 capsule 2--3 times daily with meals3 times daily with meals

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Recommended ProductsRecommended ProductsJoint SupportJoint Support

Glucosamine & Glucosamine & ChodroitinChodroitin SulfateSulfate

�� Provide building blocks of cartilage to Provide building blocks of cartilage to

rebuild cushioning between jointsrebuild cushioning between joints

�� Sulfate forms more active than Sulfate forms more active than HClHCl formsforms

�� Sulfates facilitate old cartilage removalSulfates facilitate old cartilage removal

�� Safe for patients with a sulfa drug allergySafe for patients with a sulfa drug allergy

�� ShellfishShellfish--free forms now available for free forms now available for

patients with hypersensitivitiespatients with hypersensitivities

�� 1500mg/1200mg daily in divided doses1500mg/1200mg daily in divided doses

Recommended ProductsRecommended ProductsLifestyle SupportLifestyle Support

Intestinal Intestinal CandidiasisCandidiasis

�� Intestinal Intestinal candidiasiscandidiasis is very common in Lyme is very common in Lyme

patients due to extensive antibiotic usagepatients due to extensive antibiotic usage

�� Affects GI, immune, nervous, urinary, & hormonal Affects GI, immune, nervous, urinary, & hormonal

systemssystems

�� Restricted diet a MUST Restricted diet a MUST plusplus cidalcidal RxsRxs or herbalsor herbals

�� NO sugars, HFCS, artificial sweetenersNO sugars, HFCS, artificial sweeteners

•• SteviaStevia, Agave, or Raw honey if tolerable, Agave, or Raw honey if tolerable

�� NO fruit juices, sodas, alcoholNO fruit juices, sodas, alcohol

�� NO dairy, grains, peanuts, vinegarsNO dairy, grains, peanuts, vinegars

�� NO mushrooms or fermented foodsNO mushrooms or fermented foods

Recommended ProductsRecommended Products SleepSleep

�� Chronic sleep deprivation linked to Chronic sleep deprivation linked to immune dysfunction, memory loss, immune dysfunction, memory loss, hypertension, diabetes, & cancerhypertension, diabetes, & cancer

�� <6hrs/night <6hrs/night ↓↓ melatonin, immune functionmelatonin, immune function

�� Recommended 8Recommended 8--9hrs sleep per night9hrs sleep per night

�� Avoid stimulants & anxiety provoking Avoid stimulants & anxiety provoking activities before bedtimeactivities before bedtime

�� Room should be as dark as possible to Room should be as dark as possible to maximize melatonin productionmaximize melatonin production

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ConclusionConclusion

�� The best approach to Lyme & associated The best approach to Lyme & associated

diseases is to work with knowledgeable diseases is to work with knowledgeable

healthcare professionals along with the healthcare professionals along with the

integration of traditional & alternative therapiesintegration of traditional & alternative therapies