Seven top takeaways from the Integrative Practitioner Summit on environmental medicine

By Avery St. Onge

Integrative Practitioner hosted its third Digital Summit of 2022 on September 20. The event focused on environmental medicine and included live sessions covering subjects such as chronic Lyme disease, botanical medicine, and detoxification.

If you were unable to attend the event, we’ve compiled a round-up of highlights from the live presentations. You can also watch the content on-demand here.

1. Chronic Lyme disease is a complex illness, commonly coupled with other infections.

According to Daniel Kinderlehrer, MD, an integrative physician in Denver, Colorado, who specializes in diagnosis and treatment of tick-born illnesses, there are two categories chronic Lyme disease. The first category, he said, consists of patients who have been treated for acute Lyme disease.

“That is, they had a tick bite that they may or may not have noticed, but then they developed a rash, and maybe even a bullseye rash, and then they were treated for acute Lyme disease with a relatively short course of antibiotics,” said Kinderlehrer.

Lyme disease is considered chronic when despite being treated, patients experience symptoms for weeks, months, or years after their original treatment. This is called Post-Treatment Lyme Disease Syndrome (PTLDS). To Kinderlehrer, this name suggests that for these patients there’s no longer a line of therapy to follow to treat their Lyme disease symptoms, which is inaccurate.

“It’s a nomenclature I really don’t like because it suggests that the line isn’t there anymore,” he said.” “The line is there, but there’s more than just one line.”

The second category includes those who have developed chronic symptoms despite never getting a tick-borne infection diagnosis, Kinderlehrer said. No matter the category someone fits into, virtually all patients with chronic Lyme disease have additional infections, often caused by other tick-borne microbes. These co-infections commonly come in the form of babesia, bartonella, anaplasma, and mycoplasma. According to Kinderlehrer, co-infections cause a range of different symptoms, making Lyme disease more difficult to treat. This condition is known as Lyme disease complex.

2. Lyme disease is often accompanied by a psychiatric illness, mood disorders, and physical symptoms.

According to Kinderlehrer, research has shown that Lyme disease is prevalent within psychiatric populations. In one psychiatric hospital alone, 33 percent of patients were serologically positive for Lyme disease according to a study published in The American Journal of Psychiatry.

In his presentation, Kinderlehrer said Lyme disease may play a role in the onset of mental illness. The microbes of tick-borne illnesses are not killed by a local inflammatory response, rather they attack software which causes systemic inflation.

“It’s like too many soldiers on the field, but they’re shooting,” he said. “They’re disorganized. They’re shooting at each other. They’re certainly not a coherent attack on the enemy.”

As the body overreacts to the invasion of tick-borne illnesses, chaos ensues in the regulatory system resulting in a plethora of health concerns including neuroinflammation, a central contributor to psychiatric illness. In his review of literature on the subject, Kinderlehrer said he found Lyme disease was associated with many psychiatric disorders, such as depression, anxiety disorders, and bipolar disorder.

Bartonella, bacteria than can be spread through ticks, has also been linked to several psychiatric disorders like obsessive-compulsive disorder (OCD), psychosis, and personality disorders, Kinderlehrer said.

In addition, Kinderlehrer said psychiatric disorders caused by tick-borne illnesses are often accompanied by physical symptoms, commonly overlooked by doctors. For instance, patients with a tick-borne infection and a psychiatric disorder sometimes present bartonella striae, skin lesions that resemble stretch marks. These can be a tell-tale sign of a mental disorder caused by a tick-borne illness.

“As soon as a patient says, ‘I have anxiety and depression’, that’s it, they’re given a DSM-5 [Diagnostic and Statistical Manual of Mental Disorders] diagnosis,” said Kinderlehrer. “No one’s paying attention to the physical symptoms, which are considered secondary.”

3. Practitioners must be aware of patterns associated with Lyme disease, and have prepared screening tools, diagnostic tests, and referral networks.

Pattern recognition is essential in the diagnosis process, Kinderlehrer said. Psychiatric patients with poor or paradoxical responses to medications, an absence of family history of psychiatric illnesses, or an onset of neuropsychological symptoms without psychological precipitants should be considered for Lyme disease. Additionally, Kinderlehrer said psychiatric patients diagnosed with chronic fatigue syndrome, fibromyalgia, autoimmune illnesses with mood disorders, chronic viral infection, and malingerer, should be considered for Lyme disease complex.

To screen for Lyme disease, Kinderlehrer suggested using a multi-system questionnaire that asks about common symptoms of Lyme disease such as fatigue, cognitive dysfunction, muscle and joint pain, and mood disorders.

Most commercial laboratories do inadequate testing when it comes to Lyme disease complex, according to Kinderlehrer. Finding a lab that does thorough testing for Lyme disease is essential, which can require some research. Babesia and bartonella, two common co-infections in Lyme disease complex that should also be tested for, are more easily detectable and can be tested with more mainstream devices.

Finally, Kinderlehrer recommended practitioners unfamiliar with Lyme disease get assistance from a Lyme disease-literate physician who can properly interpret their patient’s test results and help with the referral process. Even with a diagnosis,  Kinderlehrer said, practitioners must be aware that some conventional medicine providers might not fully acknowledge Lyme disease.

“Testing for Lyme disease is not straightforward, and the diagnosis is still not generally accepted by mainstream medicine despite the overwhelming evidence,” said Kinderlehrer. “And the evidence is indeed overwhelming.”

4. Botanicals can be used effectively to treat health problems, but when used incorrectly, they can have harmful effects.

There are hundreds of different molecules in plants able to exert specific actions on the human body, said Darin Ingels, ND, FAAEM, FMAPS, author, international speaker, and expert on Lyme disease in Fairfield, Connecticut. Just as these molecules can he used to heal, they can be harmful. In turn, practitioners must understand the chemical nature of plants to help provide patients with the best prescriptions and avoid dangerous interactions with other medications.

“If you’re new to botanical medicine, you have to understand that some plants have different strains, different species,” said Ingels. “When you’re selecting the plant that you want to use, you want to make sure that you’re advising your patient or client on the right species.”

Different species of plants have different chemical properties. For example, according to Ingels, the plant artemisia has several different species that are used in botanical medicine to accomplish different goals. Artemisia absinthium, or wormwood, and Artemisia vulgaris, or mugwort, are used primarily in traditional Chinese medicine. However, in western medicine, Artemisia annua, also known as sweet wormwood, is commonly used for Lyme disease and other tick-borne illnesses.

In addition, Ingels stressed practitioners use the right part of a plant to treat a patient. For instance, the root of blue flag iris (Iris versicolor) must be used when trying to simulate the liver, gallbladder, pancreas, and colon.

Understanding which plants have the greatest potential for toxicity is crucial when practicing safe plant medicine, Ingels said. Berberine alkaloids, for instance, are uterine stimulants and should not be used during pregnancy. High doses of the alkaloids, that are found in barberry (berberis vulgaris) and Oregon grape (berberis aquifolium), can suppress heart rate, myocardial contradictions, and bronchial constriction. Practitioners must understand the toxicity in plants such as these, and use them with caution, said Ingels. However, most herbs are generally considered safe and when used correctly, have little to no side effects, he said.

5. Herbs can help facilitate detoxification through the liver, gallbladder, kidneys, and skin.

According to Ingels, plants such as peppermint (Mentha piperita), cayenne (Capsicum frutescens), and dandelion (Taraxacum officinalis), are known as “mild liver botanicals.” When used correctly, these plants can help promote better digestion and better peristalsis while having a mild impact on the liver itself.

In addition, there are stronger liver botanicals. These, Ingels explained have a more stimulating effect on the liver itself. Plants considered strong liver botanicals include plants such as blue flag iris, greater celadine (cheidonium majus), and milk thistle (Silybum marianum). These plants can help stimulate secretion of pancreatic enzymes, improve circulation in the liver, and protect the liver against oxidative damage.

As for using botanicals as laxatives for detoxification, getting the right dose is essential. Plants like cascara (Rhamnus purshiana), senna (Cassia angustifolia), and black walnut (Juglans nigra), are all going to cause diarrhea, Ingels said.

“But again, it’s about dose,” he said. “Find the right dose that gets them moving but not so much that they’re getting chronic watery diarrhea.”

Topicals can also assist in detoxification. Castor bean (Ricinus communis) has been used as a purgative and anti-inflammatory both internally and externally. When used internally, he said, castor bean should only be used in the short-term, as it can irritate the intestinal lining. For external use, Ingels recommended applying a thin layer of the oil over the upper right quadrant (RUQ) of the abdomen, then apply a hot water bottle or heating pad for 15 to 60 minutes, separated from the skin by a sheet of wax or parchment paper.

Essential oils like lemongrass (Cymbopogon citratus), rosemary (Salvia Rosmarinus), and grapefruit (Citrus racemose), can induce detoxication enzymes and have a calming effect on the nervous system. Ingels said he instructs patients to dilute essential oils in a carrier oil such as coconut or avocado oil and use a few drops topically. However, he said he only recommends essential oils be used externally as they can irritate the inside of the body when ingested.  

In addition, specific herbs like dandelion leaf (Taraxacum officinalis), and kava kava (Piper methysticum) can help increase urinary output and improve kidney function. No matter what botanical is being used, Ingels said, detoxification is an ongoing process.

“Lowering the body burden of toxins is still the most important factor,” said Ingels. “We use these plants as a way to help promote you know getting rid of the junk that’s already there, but we want to try to curtail the influx of toxins in the first place.”

6. Practitioners should test their patients regularly for arsenic levels, and avoid the substance to help prevent disease.

Arsenic is a metalloid, which means it has properties of both metals and nonmetals, said Joseph Pizzorno, ND, founding president of Bastyr University and editor and chief of Integrative Medicine: A Clinicians Journal. It’s naturally distributed in soil and water, however, it is also used industrially, commercially, residentially, and in food, leading to significant environmental contamination.

According to Pizzorno, arsenic is associated with a higher risk for several health conditions such as fungal infections, diabetes, hypertension, and cancer. In recent years, molecules that protect the body from arsenic have been removed from food due to chemical farming techniques, impairing detoxification and increasing the arsenic body load.

The main sources of arsenic are water, most commonly groundwater, food, including rice, chicken, and fish, as well as smoking and old forms of treated wood. According to Pizzorno, it can be avoided through limiting consumption of poultry, drinking clean water, and choosing low-arsenic fish. When eating rice, Pizzorno suggested boiling it for five minutes, then discarding the water, and cooking it again.

Arsenic levels can be assessed through urine and toenails. If arsenic measures are above 12 micrograms of arsenic per gram (ug As/g) creatinine during a random or first morning urine test, there is a higher risk of cardiovascular disease, diabetes, respiratory problems, cancers, and neurological dysfunction indicated, Pizzorno said. A first morning urine test that is lower than 7.0 ug As/g creatine indicates a normal environment. For a toenail test, historic arsenic exposure is seen in test results lower than 0.5 ug/g. According to Pizzorno, testing for arsenic and lead are leading methods to help predict disease.

“There are more predictive of disease than any of the standard blood measures that we’re currently testing people for things like CBC [complete blood count] cholesterol and sed rate [Erythrocyte sedimentation rate],” he said.

7. Standardizing lead testing in primary care could prevent serious illness and death.

According to Pizzorno, lead is the second most common cause of chronic disease in the world. He said a blood lead level of five to nine microgram per deciliter (ug / dL) has been associated with an increased risk of death from all causes, cardiovascular disease, and cancer. In addition, lead levels have been associated with brain cancer, infertility, amyotrophic lateral sclerosis (ALS), attention deficient/hyperactivity disorder (ADHD), and juvenile intelligence quotient (IQ).

Lead in blood has a half-life of around 30 days, and only indicates recent exposure. For a test that measures cumulative exposure, Pizzorno suggested bone lead tests because most lead is stored in bone. He recommended bone lead tests over blood tests when trying to predict hypertension, electrocardiogram (ECG) disturbances, pulse pressure, renal function, cognition, and cataracts.

Blood lead levels for children should be below 3.0 ug/dL, said Pizzorno. For adults, blood lead levels should not surpass 5.0 ug/dL. However, he said he encouraged practitioners to challenge these results with further tests like bone tests and provoked urine tests.

To prevent increased lead levels, Pizzorno said patients should maintain their bone health and test their water at home, especially if their home was built, or the water supply to the home was installed, before 1987.

For lead intervention, Pizzorno suggested supplements including, 500 milligrams (mg) of calcium bidaily (bid), 500 mg bid of vitamin C, and 500 mg bid of N-Acetyl Cysteine (NAC). In a patient has a high blood lead level and symptoms, Pizzorno suggested using ethylenediaminetetraacetic acid (EDTA) orally or intravenously and dimercaptosuccinic acid (DMSA), 250 mg, three times a day, orally.

“Lead affects at least one quarter of people in North America,” said Pizzorno. “And lead to the worst diseases, the things that kill people, like heart disease, cancer, and stroke. So, I believe that makes the case that regular screening of blood for lead should be a part of the standard of care in primary medicine.”