Nutrition, especially macronutrients (e.g. protein, fat, carbohydrates) and micronutrients (e.g. vitamins, minerals), plays an important and fundamental role in immune function. Nutritional status can play a critically important role in the health and overall well-being of people living with immune-system disorders. Not only as a contributor to proper immune function and response, but because immune disorders themselves, and the conditions related to them, can negatively affect many nutrients. These negative consequences can lead to other complications and ultimately to debilitating malnutrition, a disease in and of itself.

Malnutrition can be the consequence of inadequate caloric or protein intake, malabsorption, metabolic changes, and/or changes in organ system function. Single or multiple nutrient deficiencies can significantly impair immunity, increase mortality, and influence susceptibility to infections. Research also supports the hypothesis that vitamin and mineral needs of people with immune disorders may differ from those of healthy individuals, or those with other medical conditions. As such, a Registered Dietitian (RD) with specialized training in nutrition and the immune system is critically important to the proper care of people living with immune system disorders.

The Center for Special Immunology (CSI) provides a holistic comprehensive treatment program for its patients, including state-of-the-art nutritional evaluations and therapies. As part of the initial evaluation for all CSI patients, an in-depth nutritional assessment is performed. This evaluation includes:

• A computerized nutrient intake analysis
• Body composition measurements (the amount of muscle and fat in the body)
• An evaluation of the micronutrient levels in the blood
• A meeting with the Registered Dietitian (RD) in order to develop an individualized nutrition treatment program.

It is CSI’s philosophy to incorporate advanced nutritional care as an integral part of the overall medical management of our patients. The RD is a vital part of the CSI healthcare team.

What You Will Be Asked To Do

1. Complete a three-day food diary and mail back to CSI as soon as possible. Write down everything and exactly how much you eat and drink for three days. This information will be computer analyzed. You will be provided with a detailed print out of the amount and breakdown of things you are putting inside your body.
2. Complete a three-day activity log and mail back to CSI as soon as possible. Write down everything you do for three days. If you are exercising, jot down your workout program. The Registered Dietitian (RD) will analyze this information. She will calculate your basic energy and protein needs accounting for how much activity you perform. She will make recommendations on the types and amounts of exercises you should be doing.
3. Return to CSI in a fasting state (nothing to eat for at least 8 – 12 hours; black coffee, water and medications are OK). During this visit fasting laboratory assessments will be obtained and your body composition measured. The lab will measure the amounts of the micronutrients in your blood stream. The RD and physician will review the micronutrient lab results with you at a later office meeting. Very specific recommendations will be made for nutritional supplements based upon your lab results. Your body composition will also be assessed by Bioelectric Impedance Analysis (BIA). This is a rapid and painless method for determining how much muscle, fat and water your body is made of. A report will be generated and reviewed with you at the first meeting with the RD.
4. Meet with the RD. The first meeting with the dietitian is approximately one hour in length. The dietitian will have already spent time analyzing and reviewing all of your information and results before your first appointment. During this visit she will teach you about food and water safety. She will review your nutrient intake analysis of calories, protein, fat and other nutrients. She will make specific diet recommendations, meal plans and set goals for your protein and calorie intake. She will assess your exercise and activity regime. She will make specific recommendations for exercise.
5. Finally, she will explore any potential side effects from medications, food allergies or food access problems. She will also deal with any of your specific issues such as weight loss or weight gain, diabetes, hypoglycemia, high cholesterol or body composition changes. The RD will present all of the analyses and recommendations to your physician and the rest of the CSI treatment team. The RD will schedule follow up visits separate from the doctor to monitor your progress and address any new or ongoing issues. She is also available for any urgent nutrition problem.

Nutritional support is an essential part of the CSI experience. It is the backbone for overall health and well-being. Feel free to contact the dietician as needed.

• Nutrition Problems Addressed at CSI
  Weight gain
• Weight loss
• High cholesterol or triglycerides
• Lipodystrophy or body composition changes
• Swallowing problems
• Nausea, vomiting or diarrhea
• Bloating or Gas
• Diabetes
• Muscle-mass loss (wasting)

NUTRITIONAL TID BITS
Your nutritional health chiefly depends on eating correctly. Some quick tips:

• Eat small frequent meals through out the day. Do not skip a meal.
• Watch the extra fat and sugar in your meals
• Eat at least 2-3 fruits and 2-3 vegetables everyday
• Include fiber in your diet from whole grains, beans, etc.
• Drink plenty of non-caffeine fluids such as water
• Snack on low fat choices such as string cheese, fruit and nuts in moderation.

Are you trying to lose some extra pounds? Some helpful tips:

• Eat small frequent meals, low in fat and sugar.
• Get plenty of fiber in meals to keep you satisfied
• Drink plenty of non-caffeine fluids such as water
• Get regular exercise such as walking. Get out and walk daily for about 10-15 minutes
• Watch portion sizes

Are you trying to gain a few extra pounds? Here are a few simple tips:

• Eat small frequent meals. Add healthy fats such as olive oil and canola oil to foods. Try adding nuts to dishes to give extra protein and calories.
• Remember to eat snacks that are high quality such as fruit but try a bit of peanut butter smeared on it.
• Do not skip meals
• Try to eat in a stress free environment to help keep your stomach from being upset.
• Ask for something to help stimulate your appetite if necessary from your healthcare provider

Is diarrhea giving you the run around? Try some helpful tips:

• Watch the amount of fatty foods you are eating
• See if milk or dairy products are causing the problem
• Add fiber to the diet by using commercial products such as Fiber-Con, Citrucel, Metamucil or Psyllium fiber
• Drink only bottled water and do not eat any undercooked foods.

NUTRICEUTICALS

CSI physicians and dietitians have specialized in nutrition for immune disorders for over 15 years. During that time, we have had the opportunity to evaluate, recommend and use numerous different nutritional products. Over the past 5 – 10 years, many excellent nutritional products have been developed by so called nutriceutical companies. Many of these companies use multi-level marketing (MLM) to distribute their products. The only way to access these products is through their MLM channels. The products cannot be bought in stores or outlets. Since we have evaluated and believe in several products produced by MLM companies, we want to make you aware of our participation in some of these programs. We believe that full disclosure is important for you to make an informed decision. We have carefully screened these companies and believe in the scientific claims behind their select products we recommend.

Neither CSI nor the MLM company will encourage you to sign up in one of these programs. However, in order to obtain certain products we may recommend, you will need to go through the MLM channel. We will try to make this as easy as possible by providing Internet access links. Should you not wish to use this MLM channel, please discuss this with the Registered Dietitian or doctor who can suggest alternative products or make other arrangements for you to acquire the recommended product.

ANTIVIRAL MEDICATION SUPPLEMENT "PROPHYLAXIS"

• Multi Vitamin* use as directed: one with breakfast and dinner
• B-Complex 100 mg: one with breakfast
• Carnitor (L-Carnitine) 330mg: three with breakfast and dinner
  (Carnitor must be obtained by prescription from your physician)
• Alpha Lipoic Acid (ALA) 100mg: one with breakfast and dinner
• CoEnzyme Q 100mg: one with breakfast and dinner
• N-Acetyl Cysteine 500mg: one with breakfast and dinner
• Vitamin C 500mg (optional): one with breakfast, lunch, dinner and bedtime

For further information you may contact the CSI registered dietician:
Ellyn Silverman, RD at 714.751.5800 ext.28