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Tests in lyme and related conditions

Coinfection Bartonella updates

In some cases, patients prefer chronic lyme treatment without prescription antibiotics. In others, herbal and immune system options may be the best options in my opinion. What is generally referred to as chronic lyme, actually should include patients who fall into the subset of those with still active, persistent infections, as well as those who most likely have had the infection in the past, for which there are persisting symptoms possibly due to immunological and neurological changes. There is much debate as to which makes up the majority of cases of patients with persistent symptoms, but for a practitioner with one patient in front of them, the debate does not matter as much as a rationale approach that takes into account risk vs possible benefit. The likelihood of benefit can be estimated by labs that might indicate active infection, or other issues such as neurological changes, hormone changes, etc - it is very patient specific.

Treatment of lyme disease without antibiotics (not acute lyme)

Many of my chronic lyme patients have come to me after they have been on repeated courses of antibiotics, with only temporary improvement. In these cases, one option for treatment is a more holistic, naturopathic approach to chronic lyme disease which involves nutritional support to regulate physiology, detoxification, more broad spectrum antimicrobials (herbs ozone / ultraviolet blood irradiation therapy, other naturopathic treatments), and immune system modulation.

Regulate imbalances in hormones, neurological function

Methyl B12 is often given for neurological support and methylation support. In my experience, B12 in very high doses can help with some of the fatigue and brain fog experienced by chronic lyme patients. The methyl form of B12 also may help with the methylation process in the body, which is intricately involved with detoxification and glutathione production in the cell (glutathione is the intracellular antioxidant and how cells detoxify).  Care must be taken, as rarely some may aggravate with methyl donors, such as methyl B12, methyl folate, SAMe. Often, we can get hints from methylation by assessing 24 hour levels of hormones and their metabolites as well.

Fish oil (high in EPA) and systemic enzymes are then often used for cellular membranes and blood fluidity. Nutrient delivery is key in my experience, and is the main thing that improves the symptoms of brain fog and fatigue in the chronic lyme patient. 

 Assessment of hormones, especially thyroid and adrenal insufficiencies, is profoundly useful. There is some information on this page on bioidentical hormones, but in essence, we look often for cases of borderline or suboptimal adrenal hormones. This usually contributes to fatigue, for which supportive measures on stress, optimizing nutrition (diet as well as cellular nutrition, and helping to ensure that factors for hormone balance are in place can be useful.

Detoxification of the toxins produced by lyme infection

This is the arm of treatment that is as important as the antimicrobial arm. In my opinion, the majority of the symptoms of chronic lyme come from the accumulation of toxins that are produced by the germ. Toxins are somewhat of a generic term, the can be thought of metabolic products that stimulate aberrant inflammation. This is from my own experience, as well of that of many other clinicians, that finds that patients often get better when a focus on detoxification is made. If the underlying infection is not treated, and the immune dysregulation not treated, then patients may relapse of course, as the toxin burden starts to creep up again.  It is a catch 22 situation though, as the toxins do need to be dealt with otherwise it is also hard for the patient to clear the infection.

Treatments are very varied depending on the evaluation for which toxins may be present. It is very difficult to assess directly for infection related toxins, however we can get indirect information on what toxin may be affecting the patient by assessing other pathways. For example, we may assess for mycotoxins from mold, heavy metals, organic toxins, all of which may not be of course directly from Lyme and a related infection. However, the patient's ability to excrete above such toxins may be compromised as they are ill and improving this may help the overall homeostatic function of the patient. Treatment can be a combination of the oral supplement protocol as well as an office treatments.

Emotional toxins and other psychological issues can be roadblocks to healing as well. If this is the case, I refer out for EMDR and cognitive behavioral therapy.

Lowering of microbial (lyme) burden

Antibiotics may be recommended for this arm of treatment. If a patient has failed or not responded to antibiotic therapy for chronic lyme in the past, in my experience they still may respond if the other three arms of treatment (nutrition, detoxification, immune modulation) are added in. Herbal options, and especially ozone therapy, are excellent first choices if not an acute case.

When using these options, risks such as allergy and upper gut irritation with the herbs is a discussion. With antibiotics, the risk of resistance, lower GI issues including serious cases of diarrhea, allergy, are concerns to be discussed. Because of such risks, and the fact that my own experiences been that herbal options are often just as effective although somewhat slower to have clear changes, herbal options are often considered first.

The herbal options that I prefer include much of the newer research that has been published on especially japanese knotweed, cryptolepsis, as well as various essential oils. The classic formulas such as cats claw, Buhner herbs are useful. I do find favorable results with the formulas from Beyond balance as well.

Many patients on any antimicrobial therapy, be it antibiotic drugs, herbal medications, or ozone therapy, report a ‘healing crisis’ or ‘herxheimer reaction’ around the time when infections are thought to be killed. This may very well be the case, but there is a theory that the symptoms are actually manifested by an increase in toxin secretion by the microbes when they are threatened with antimicrobial treatment.  In my experience, making sure that arm 2 (detoxification) of this protocol is in full effect minimizes the reaction, while still allowing a reduction in microbial burden.

Occasionally though, in my experience, even though the chronic lyme patient is getting full detoxification support, Herxheimer like reactions still occur. In these cases there are many in the office treatments that can help to calm the inflammation based on the individual assessment. 

Immunomodulation

The final arm of treatment is vitally important. Most chronic lyme patients have a subset of their immune system severely compromised, the CD57 group of NK cells (natural killer white blood cells). The NK cells are important in fighting off infection, including chronic lyme and coinfections, in my experience.

A patient can often get well with Arm 1 and 2 of treatment, and less recurrence will happen with Arm 3 of treatment, but Arm 4 is vital in order to make sure infections do not recur. Again, often ozone therapy is most important of the stage.

Summary

4 arms of treatment for chronic lyme patients, can be used with or without antibiotic treatment. Chronic lyme patients are some of the most self-educated patients I have dealt with, and most are well aware of antibiotic approaches to the illness. Remember that any antimicrobial treatment can be very effective in my experience, but in my mind is only one arm of treatment.  Follow up care would involve assessing to immune system functioning, lab response, and most importantly, looking for a clinical response that persists. Relapses can occur, and when this happens treatment is started again

Recent posts and references:

This is not an exhaustive list, and is not meant to equally represent the data as publications have been conflicting and controversial. A patient-centered, risk based discussion vs possible benefit should be taken with any practitioner, and second opinions sought as well.

The Long-Term Persistence of Borrelia burgdorferi Antigens and DNA in the Tissues of a Patient with Lyme Disease. Sapi E, Kasliwala RS, Ismail H, Torres JP, Oldakowski M, Markland S, Gaur G, Melillo A, Eisendle K, Liegner KB, Libien J, Goldman JE. Antibiotics (Basel). 2019 Oct 11;8(4):183. doi: 10.3390/antibiotics8040183.

Stationary phase persister/biofilm microcolony of Borrelia burgdorferi causes more severe disease in a mouse model of Lyme arthritis: implications for understanding persistence, Post-treatment Lyme Disease Syndrome (PTLDS), and treatment failure. Feng J, Li T, Yee R, Yuan Y, Bai C, Cai M, Shi W, Embers M, Brayton C, Saeki H, Gabrielson K, Zhang Y. Discov Med. 2019 Mar;27(148):125-138. ---------

Update of the Swiss guidelines on post-treatment Lyme disease syndrome. Nemeth J, Bernasconi E, Heininger U, Abbas M, Nadal D, Strahm C, Erb S, Zimmerli S, Furrer H, Delaloye J, Kuntzer T, Altpeter E, Sturzenegger M, Weber R, For The Swiss Society For Infectious Diseases And The Swiss Society For Neurology. Swiss Med Wkly. 2016 Dec 5;146:w14353. doi: 10.4414/smw.2016.14353. eCollection 2016. (a good summary of the viewpoint of not a persistent infection) -----------

Ozone: A Multifaceted Molecule with Unexpected Therapeutic Activity. Zanardi I, Borrelli E, Valacchi G, Travagli V, Bocci V. Curr Med Chem. 2016;23(4):304-14. doi: 10.2174/0929867323666151221150420. ------------

Subtle vitamin-B12 deficiency and psychiatry: a largely unnoticed but devastating relationship? Dommisse J. Med Hypotheses. 1991 Feb;34(2):131-40. doi: 10.1016/0306-9877(91)90181-w. -----------

Evaluation of Natural and Botanical Medicines for Activity Against Growing and Non-growing Forms of B. burgdorferi. Feng J, Leone J, Schweig S, Zhang Y. Front Med (Lausanne). 2020 Feb 21;7:6. doi: 10.3389/fmed.2020.00006. eCollection 2020. -----------

Novel Diagnosis of Lyme Disease: Potential for CAM Intervention. Vojdani A, Hebroni F, Raphael Y, Erde J, Raxlen B. Evid Based Complement Alternat Med. 2009 Sep;6(3):283-95. doi: 10.1093/ecam/nem138. Epub 2007 Oct 15. ---------

Decreased Expression of the CD57 Molecule in T Lymphocytes of Patients with Chronic Fatigue Syndrome. Espinosa P, Urra JM. Mol Neurobiol. 2019 Sep;56(9):6581-6585. doi: 10.1007/s12035-019-1549-7. Epub 2019 Mar 21. ---------------

Decreased CD57 lymphocyte subset in patients with chronic Lyme disease. Stricker RB, Winger EE. Immunol Lett. 2001 Feb 1;76(1):43-8. doi: 10.1016/s0165-2478(00)00316-3. ----------

Longterm decrease in the CD57 lymphocyte subset in a patient with chronic Lyme disease. Stricker RB, Burrascano J, Winger E. Ann Agric Environ Med. 2002;9(1):111-3.