Published in Perspective—JANA (Journal of the American Nutraceutical Association) 2002
By Prof. Garth Nicolson, Paul Berns and Dr. Richard Ngwenya,
JANA (Journal of the American Nutraceutical Association) 2001.
1The Institute for Molecular Medicine, Huntington Beach, California
2Molecular Hyperbaric Medicine, Huntington Beach, California
3James Mobb Immune Enhancement, Harare, Zimbabwe
We have found that chronic illness patients undergoing therapy, including those with chronic fatigue syndrome, fibromyalgia syndrome, rheumatoid arthritis, hepatitis, diabetes, coronary diseases, inflammatory bowel diseases, autoimmune diseases, Gulf War illness, HIV/AIDS, among other chronic illnesses,(1) usually have poor diets that hamper effective treatment. Furthermore, we have found that most of these patients have multiple chronic infections that contribute to their morbidity.(2) If such patients refuse to change their dietary habits, they generally do not recover from their conditions, irrespective of the treatments used for their illnesses.
Thus we consider that diet is extremely important in the treatment of chronic illnesses, and patients must follow some simple procedures to correct their dysfunctional immune systems and gastrointestinal tracts and restore proper nutrition to their bodies.(3)
Chronic illness patients are often immunosuppressed or have dysfunctional immune systems and are therefore susceptible to opportunistic infections.(4) Simple or refined sugars can suppress the immune system, and simple sugars can also stimulate disease-causing microorganisms that require sugars for their growth.
For example, most pathogenic microorganisms require simple sugars so high sugar diets can actually stimulate their proliferation. 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 their bodies, in their blood and in body secretions.(5)
Chronic illness patients with excessive levels of yeasts and other fungi can have their immune system overwhelmed, resulting in fatigue and other signs and symptoms. Certain sugar substitutes can be used to reduce the intake of simple sugars, but we recommend natural sugar substitutes, such as Stevia made from Stevia rebaudiana.
Other foods and food products can potentially stimulate the growth of pathogenic microorganisms. For example, 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.(3) In addition, excess caffeine can affect the immune system. Milk and milk products can stimulate the growth of yeast and fungi as they contain high amounts of sugar and fat, two dietary components that should be reduced in chronic illness patients.(1)
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 gut yeast and fungi. Although the types of yeast in most food products are not pathogenic, they can contribute to an overburdened immune system and must be limited in any chronic illness diet.
We find it especially important that chronic illness patients increase their intake of fresh vegetables. Green vegetables are especially useful because they contain important vitamins, minerals and fiber, and they contain important phytonutrients. 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 cleans the bowel by increasing the movement of pathogenic bacteria and fungi through the gut. Eating vegetables also increases bowel movements, and this can be beneficial to restoring the gut and removing toxins from the body. To help remove pathogenic bacteria from the bowel and bladder some have recommend a non-dietary sugar, D-mannose. This natural sugar inhibits binding of bacteria to biological membranes and does not contribute to bacterial sugar fermentation in the gut.
As a general rule we suggest the following approximate ratios of basic foods for chronic illness patients: 2/3 vegetables, such as fresh uncooked (in moderation) or cooked (most) in-season green, orange and yellow vegetables 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 desired, because these will be broken down slowly to sugars but they should not be a large part of the diet. 1/6 protein, such as chicken, fish and well-cooked, lean meat. Beans are also a good source of protein.
High protein foods are useful, but they must be balanced with vegetables so that they do not cause constipation. 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. Therefore, we recommend eating every 1-1/2 or 2 hours per day.
Many have recommend fruit juices for chronic illness patients, but these are often high in sugars so we feel that 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 are recommended but should not be counted as substantial sources of any of the foods listed above.
VITAMINS, MINERALS AND DIETARY SUPPLEMENTS FOR CHRONIC ILLNESS PATIENTS
Chronic illness patients are often depleted in vitamins (especially B complex, C, E, CoQ-10) and certain minerals.7 One reason for this is that chronic illnesses often result in poor gut absorption.
Therefore, high doses of some vitamins are useful but only in some patients. Most chronic illness patients are depleted in certain vitamins, such as vitamin B complex, possibly because they are not easily absorbed by the gut. We usually recommend supplementation with sublingual natural B-complex vitamins in capsules or liquids (also injectable). We have found that B complex vitamins are especially important in Chlamydia- and Mycoplasma-infected patients.(3)
Even with a general vitamin capsule, most patients may have to supplement with extra vitamin B complex and vitamins C and E, CoQ-10, beta-carotene and bioflavonoids. The best multivitamins come with extra antioxidants and all of the vitamins and minerals mentioned here. 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.(1,3) Also, it is useful to supplement with oils, such as fish oils and flaxseed oils that contain high amounts of omega-3 and omega-6 fatty acids.
Certain minerals are depleted in chronic illness patients, such as zinc, magnesium, chromium and selenium. Some recommend up to 300 mcg/day sodium selenite, followed by lower doses. If the patient is under therapy, vitamins and minerals should not be taken at the same time of day as antibiotics (they should be taken 3 hours after antibiotics), because they can affect drug absorption.
In patients undergoing oxygen therapy, it is recommend that antioxidant vitamins be taken at least 4 hours before or after oxygen therapy.(3) Many chronic illness patients have excess heavy metals in their system, such as mercury, lead, cadmium and other heavy metals, and it is recommended that these be gradually removed by oral or intravenous chelation therapy.
REPLACEMENT OF GUT FLORA AND DIGESTIVE ENZYMES
Sour milk or its products, such as yogurt, have been touted as useful for chronic illness patients but they can be troublesome for some patients; therefore, we usually insist that patients supplement with Lactobacillus acidophilus and other probiotic bacteria.(1,3) Also, patients undergoing treatment with antibiotics and other substances risk destruction of normal gut flora that provide important digestive enzymes for processing food in the gut. Antibiotic use that depletes normal gut bacteria and can result in over-growth of less desirable bacteria.
To supplement bacteria in the gastrointestinal system 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 L. acidophilus, L. bifidus, B. bifidum, L. bulgaricus and FOS (fructoologosaccharides) to promote growth of these probiotics in the gut are available from a variety of sources. This is also important to restore gastrointestinal balance.
For irritable bowel, a Chinese nutraceutical mixture has proven to be very effective in clinical trials.(6) 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.(8)
NATURAL IMMUNE MODULATORS AND NATURAL REMEDIES
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A number of natural remedies, such as ginseng root, herbal teas, lemon/olive drink, olive leaf extract with antioxidants fresh or deodorized garlic and oregano oil (in enteric coated capsules), among others, are useful, especially during or after antibiotic therapy.(1,3) Some additional remedies are: olive leaf extract, lactoferrin and the natural plant products or herbal mixtures. Other important examples are immune modulators, such as bioactive whey protein, transfer factors and other colostrum-derived products and plant glucans. Good immune boosters have been isolated from mushroom extracts and are widely available from a number of manufacturers.
These products have been used to maintain or boost immune systems. Although they appear to help many patients, their clinical effectiveness in chronic illness patients has not been carefully evaluated. They appear to be useful during or after antibiotic/antiviral therapy in a maintenance program to prevent relapse and opportunistic secondary infections.
Yeast overgrowth occurs often in chronic illness patients, especially in females and is usually first seen as vaginal infections or thrush (white coating) on the tongue.5 Various antifungals (Nystatin, Amphotericin B, Fluconazole, Diflucan, Sporanox) 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. As mentioned above, L. acidophilus mixtures are used to restore gut flora and suppress fungal growth.
Natural or nutraceutical approaches to controlling yeast infections include supplementation with the following formulations: Pau d’ arco, grapefruit seed extract, olive leaf extract, caprylic acid, garlic extract and enteric-coated oregano oil. 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.
SOME OTHER RECOMMENDATIONS
Chronic illness patients should not smoke or drink alcohol or caffeinated products. Alcohol is converted to sugars and most alcoholic beverages, such as beer, wine and other spirits, also contain high levels of sugars. 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.
Patients should drink as much fresh fluids as they can, such as vegetable juices and pure water. They should avoid high sugar and high fat foods, such as military rations or “fast” foods and acid forming, allergen-prone and system-stressing foods. Increased intake of fresh vegetables, some low-sugar fruits and grains, and decreased intake of saturated fats are useful for chronic illness patients.
Also, dietary fiber increases bowel movements and helps to remove harmful bacteria from the gastrointestinal system. Most chronic illness patients have problems with constipation (producing small, hard stools), and increasing the number of bowel movements and their volumes are important.
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. Patients should also reduce their 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.
If the instructions above are followed, patients should notice a change in their health within a short period of time. However, recovery from chronic illnesses is a long, slow process, and patients should be counseled not to be discouraged if cyclic periods of more and less severity of illness (morbidity) persist for long periods. Diet an important part of recovery, and the recommendations above are only a part of the program of recovery. Finally, 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.
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2. Nicolson GL, Nasralla M, Franco AR, et al. Mycoplasmal infections in fatigue illnesses: Chronic Fatigue and Fibromyalgia Syndromes, Gulf War Illness and Rheumatoid Arthritis. J Chronic Fatigue Syndr. 2000; 6(3/4):23-39. Available at
3. Nicolson GL, Nasralla M, Franco AR, et al. Diagnosis and Integrative Treatment of Intracellular Bacterial Infections in Chronic Fatigue and Fibromyalgia Syndromes, Gulf War Illness, Rheumatoid Arthritis and other Chronic Illnesses. Clin Pract Altern Med. 2000; 1(2):92-102. Available at
4. Patarca R, Mark T, Fletcher MA, Klimas N. Immunology of Chronic Fatigue Syndrome. J Chronic Fatigue Syndr. 2000; 6(3/4): 69-107. Available at
5. Teitelbaum, J. Fighting those persistent infections in Chronic Fatigue Syndrome. From Fatigued to Fantastic Newsletter (part 1) 2000; 3(3):1-9. (part 2) 2001; 4(1):1-14. Available at
6. Bensoussan A, Talley NJ, Hing M, Menzies R, Guo A, Ngu M. Treatment of Irritable Bowel Syndrome with Chinese herbal medicine. A randomized controlled trial. JAMA 1998; 280:1585-1589.
7. Rea WJ, Pan Y, Johnson AR, Ross GH, Suyama H, Fenyves EJ. Reduction of chemical sensitivity by means of heat depuration, physical therapy and nutritional supplementation in a controlled environment. J Nutrit Environ Med. 1996; 6: 141-148.
8. Cichoke AJ. The Complete Book of Enzyme Therapy. Garden City Park, NY: Avery Publishing Group; 1999.
Prof. Garth L. Nicolson
The Institute for Molecular Medicine
15162 Triton Lane
Huntington Beach, CA 92649
Phone: 714-903-2900 Fax: 714-379-2082
Source: www.immed.org. © The Institute for Molecular Medicine. All rights reserved.