Tailored integrative approaches for Lyme disease

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By Wendy Pecoraro, MSN, APRN, DipACLM

As we enter the summer months, tick season is upon us, especially for those in the endemic areas of New England, mid-Atlantic, or northern and central Midwestern states.

Ixodes, black-legged deer ticks, transmit the Lyme virus to humans through a bite. The course of Lyme disease occurs in stages, which include early Lyme disease, late or Disseminated Lyme disease, and persistent Lyme disease.

It is imperative that clinicians maintain a high degree of suspicion for early Lyme disease in the coming months and that disseminated and persistent Lyme disease is on the differential diagnosis list for many of the chronic neuropsychiatric symptoms integrative practitioners treat.

There are at least five subspecies of Borrelia burgdorferi, over 100 strains in the United States and 300 strains worldwide. This diversity is thought to contribute to the antigenic variability of the spirochete to evade being picked up on Lyme testing, evade the immune system and antibiotic therapy, leading to chronic infection. Furthermore, a person with Lyme disease may be co-infected with other organisms, such as babesia, which often require different antibiotic therapy.

There are well-established treatment guidelines for early stage Lyme disease through the International Lyme and Associated Diseases Educational Foundation. This article will provide an overview of the causative organism and symptoms of Lyme disease as well as options for testing. The bulk of it will cover treatment of persistent Lyme disease as well as supportive care.

Lyme disease is caused by Borrelia burgdorferi, a type of bacteria known as a spirochete. After the initial transfer of the bacteria from the Ixodes tick to the affected individual, the spirochetes spread locally at the site of the bite. An expanding rash called Erythma migrans (EM) develops around the tick bite in 35-59 percent of patients who contract Lyme disease. This rash usually becomes evident two to 30 days after the bite. Roughly 80 percent of EMs are solid red ovals. The “bulls-eye” or target like rash is the easiest EM to recognize, but it’s not commonly seen. On dark skin, the EM can look like a bruise. Some people have multiple EMs and some patients never notice a rash.

Depending on the circumstances, blood tests are not always appropriate. In cases of a known tick bite or when an EM rash is present, testing is not helpful. The most common Lyme disease tests look for human antibodies to the bacteria. It can take several weeks for the antibodies to appear. If symptoms have been present for a few weeks, IgM and IgG Western Blot tests can be done. If negative, a new blood sample can be tested by a lab specializing in testing for tick-borne infections, such as, IgeneX, though these tests are very expensive which can be a barrier for patients. Lyme disease is primarily a clinical diagnosis because after an initial bacteremic phase, that may last for up to 90 days, but usually for a few weeks, the organisms can no longer be reliably cultured or otherwise detected in blood, urine, spinal fluid, or other body fluids.

The symptoms of Lyme disease can become more severe over time and include neurological symptoms as well as impacts on many different body systems and organs. Lyme disease is virulent, evasive, and able to cause many different problems. Symptoms of Lyme can include lack of energy to crushing fatigue, joint pain, muscle pain, fibromyalgia, sleep problems. Lyme neurological problems can include brain fog, vision disturbances, headaches, memory loss.

An individualized approach is particularly significant when dealing with complex and poorly understood multisystem diseases. In opposition to this conservative and traditional approach, some have attempted to oversimplify the diagnosis of Lyme disease by reducing the diagnosis to reliance upon the United States Centers for Disease Control and Prevention (CDC) surveillance definition. However, the surveillance definition has never been intended to be a sole diagnostic criterion, particularly in late-stage disease. Although meeting the surveillance definition for Lyme disease may confirm the diagnosis, not meeting the surveillance definition does not rule out the diagnosis of the disease.

The evaluation of persistent Lyme disease must include screening for other biotoxin exposures, such as mold, can mimic Lyme disease and therefore increase the difficulty of obtaining an accurate diagnosis. The body’s reaction to a Lyme infection is a genetically mediated, Neuro-inflammatory response that can persist in about 20 percent of patients, even long after the infection has been treated. The consequences of chronic inflammation due to Lyme disease can be devastating, including organ injury, especially to the brain and nervous system more broadly, and even induce persistent, aberrant gene expression, leading to loss of normal cell functioning.

I not only tailor the treatment to the individual but use a stepwise approach. The initial conversation with the patient must set the expectation that this is a long process. They should not expect to feel better in the first few weeks. In fact, they may feel worse due to Herxheimer reaction which manifests as the abrupt onset of fever, chills, myalgia, headache, tachycardia, hyperventilation, flushing, and mild hypotension.

It’s difficult to start treatment with recommendations to enhance sleep because problems with sleep are often multifactorial. Lack of adequate sleep worsens pain, increases fatigue, and suppresses the immune system. It appears that in response to infection, the excess inflammatory cytokines produced by the immune system decrease the output of sleep inducing hormones to the sleep centers of the brain. A restorative amount of sleep is seven to nine hours of sleep per night. 

Dietary changes include an anti-inflammatory diet. As it is low in sugar, it may decrease inflammation. An elimination diet helps a person find which foods that trigger allergies or inflammation reactions. If you are reacting to foods, practitioners should consider trying an elimination diet first with patients. Removing allergic and inflammatory foods from the diet often leads to decreased pain and improved energy.

Cytokines are inflammatory chemicals made by the immune system in chronic Lyme disease. Nutritional supports like curcumin, resveratrol, black tea extract, and antioxidants can be found in a good multivitamin and may lower cytokines. This can correct many Lyme symptoms, support the immune system, and limit Herxheimer die-off reactions.

Next, I concentrate on detoxification with liposomal glutathione, 400 to 500 milligrams, one tablet once per day. Glutathione is the master detox chemical used by the liver to remove toxins. It also helps remove neurotoxins and repair brain tissue.

Assessing adrenal and thyroid function can help. Treating underlying abnormalities can support the immune system and possibly improve energy. A person could have normal range testing for each of the hormones, but still have clinically low hormones. Because of the unreliability of testing, treatment for low hormones should occur if there are clinical symptoms of low hormones if treatment does not increase hormone levels above the upper end of normal.

An adaptogen, like ashwagandha, 400 milligrams, one to two pills in the morning and afternoon, can help the body deal with the harmful medical and emotional stress of being ill. Adaptogens have been used for centuries in Ayurvedic and Chinese medicine with greatly observed benefits. Based on animal experiments, ashwagandha may improve energy, immune function, and adrenal and thyroid function. 

I typically wait a month or so for patients to find a level of exercise they can do that does not make them feel worse the next day. This may mean they can only walk half a block or do gentle restorative yoga. In addition to making people feel worse, strenuous exercise may suppress the immune system and impair healing.

Lyme disease itself is treated with a pharmaceutical regimen, which I advise patients to take with food to prevent nausea. Additionally, I suggest patients not take with calcium supplements or calcium-fortified dairy products like milk, cheese, or milk substitutes like rice milk. Antibiotic regimens can cause or worsen candida infection. To treat this, I prescribe a combination of antifungal medications, which take about 30 days to control the infection.

It is common for to have Bartonella and Babesia coinfections. If these infections are present, I will wait one month or longer to adjust to the Herxheimer die-off reaction from treating the Lyme infection and to stabilize on the supportive supplements.

If a patient has both coinfections, treat one first before adding a treatment for the other. When both are present, my preference is to treat for Bartonella first for two to three months and then add treatment for Babesia.

We are now learning that chronic infections are at the root of many auto-immune disorders and diseases, and there is a hypothesis that we will look back 30 to 50 years from now and have a lot more answers about this connection. Lyme disease and its related co-infections are big triggers for autoimmune disease due to the inflammation and immune disruption they cause, and it is imperative that integrative practitioners learn as much as they can to better serve their patients.

References

Cameron, D, Johnson, L & Maloney, E. (2014). Evidence Assessments and Guideline Recommendations in Lyme Disease: The Clinical Management of Known Tick Bites, Erythema Migrans Rashes and Persistent Disease. International Lyme and Associated Diseases Society. Retrieved from: https://www.ilads.org/patient-care/ilads-treatment-guidelines/

Klinghardt, D. (2020). Biological Lyme Protocol. The Klinghardt Institute of Healing. Retrieved from: https://klinghardtinstitute.com/klinghardtprotocols/biological-lyme-protocol/

Ross, M. (2019). The Ross Lyme Support Protocol: A Chronic Lyme Disease Treatment Guideline. Retrieved from: https://www.treatlyme.net/lyme-disease-treatment-guidelines

U.S. Centers for Disease Control and Prevention (2017). Case Definitions and Report Forms. Retrieved from: https://www.cdc.gov/lyme/stats/forms.html