SUPPLEMENTS and ADVANCED TREATMENTS for LYME and ASSOCIATED DISEASES Marty Ross, MD & Tara Brooke, ND
SUPPLEMENTS and ADVANCED TREATMENTS for LYME and ASSOCIATED DISEASES Marty Ross, MD & Tara Brooke, ND Version 2.0: Blessings 1 © 2013 The Healing Arts Partnership. All rights reserved. Published 2013. Printed in the United States of America. Information: Treat Lyme and Associated Diseases www.treatlyme.net Store: Lyme Disease Supplements and More www.treatlyme.com Practice: The Healing Arts Partnership, Seattle WA www.thehealingartspartnership.net 2 Preface to Version 2.0: Blessings Updates This is the first update since we published Version 1.0: Abundance in 2011. Over this time we have had many interactions with our patients and those attending our educational live webinars and media events (www.treatlyme.net/liveevents). We also continue to educate ourselves attending numerous medical conferences and studying the latest science. Version 2.0: Blessings includes numbers of our sciencebased improvements and new cuttingedge treatment approaches influenced by our collaborative interactions with many of you. The Successful Treatment Recipe Essential Steps to Health The most significant addition to Version 2.0: Blessings is a treatment plan you can implement on your own or in collaboration with your medical provider. ● If you are just starting out or in the middle of a chronic Lyme disease treatment that you are managing on your own it provides the essential steps to manage your care. ● If you are working with a medical provider who uses prescriptions only, you will do better taking these additional steps to improve your care. ● Finally, if you are working with an integrative medicine physician who uses many of these approaches, it may provide additional ideas that they can use to assist you on your road to recovery and taking back your life. From Version 1.0: Abundance Take charge of your health, and start the road to recovery. This Lyme disease treatment manual for supplements and holistic approaches is easy to use. It provides practical information and steps you can take to build or improve your own treatment. The best treatments for chronic Lyme disease include supplements to treat problems that prescription medicines alone do not address. Supplements and Advanced Treatments for Lyme and Associated Diseases includes pages of practical information. Our treatment manual explains Lyme disease medical conditions and provides real treatment solutions. The guidelines in our manual include the same timeproven solutions that we, Marty Ross MD and Tara Brooke ND, provide at The Healing Arts Partnership in Seattle. At The Healing Arts Partnership we treat 3 people from across the globe. Realworld treatment experience matters, and collectively we have 21 years treating those with chronic Lyme disease. You can purchase all of the supplements identified in the treatment manual at Lyme Disease Supplements and More (www.treatlyme.com). When using supplements to treat an illness quality matters. Lyme Disease Supplements and More carries pharmaceutical grade supplements that we handpick for their effectiveness, quality, standardization, and purity. In Health, Marty Ross MD and Tara Brooke ND 4 Disclaimer These guidelines are provided for informational purposes only. Consult a licensed physician or health care practitioner to discuss these guidelines if you have any health problems and you require a medical diagnosis, medical advice, or treatment. A physician mostqualified to treat chronic Lyme disease and and to provide advice regarding these guidelines is one that practices integrative medicine. An integrative medicine physician is either a licensed naturopathic physician (ND or NMD) who has prescriptive authority or an MD or DO who uses prescriptive medicines, supplements, and holistic approaches. If you are unable to find such a physician to guide your care then the next best option is to have a licensed ND or NMD and a prescribing DO or MD as a team. Statements regarding various supplements and products have not been evaluated by the Food and Drug Administration. Specific products are not intended to diagnose, treat, cure or prevent any disease. 5 Table of Contents 3. Preface 5. Disclaimer 7. Overview 8. The Successful Treatment Recipe Essential Steps to Health 17. One: Treatment Essentials 18. Two: Required Supplements 20. Three: Biofilms 21. Four: Bladder 23. Five: Brain and Nerves 29. Six: Detoxification 33. Seven: Energy 36. Eight: Gastrointestinal 40. Nine: Herxheimer Dieoff Reaction and Cytokines 43. Ten: Hormones 46. Eleven: Immune System 50. Twelve: Infection 54. Thirteen: Mental Health 57. Fourteen: Pain 60. Fifteen: Sleep 62. Sixteen: Yeast 6 Overview Treating Lyme disease and associated illnesses requires supplements or prescription medications that address specific symptoms or a medical as they arise. Each medical issue treatment guideline includes a background discussion about an issue with specific supplements and advanced holistic treatment approaches Marty Ross MD and Tara Brooke ND recommend in their practice. The Successful Treatment Recipe; Essential Steps to Health that follows presents an integrative medicine approach to treating Lyme disease which blends prescription and natural medicine approaches. As an editorial decision all other chapters focus on supplements and natural treatment approaches only even when prescription medicine approaches exist. The authors made this decision because prescription medicine approaches for many of the problems are well documented in other sources. Our purpose in presenting this treatment manual is to help you regain your health. If your medical provider works with prescription medicines alone, you may do better adding our recommended supplements and advanced holistic treatment approaches to your care. If your medical provider works with prescription medicines and supplements, review our recommendations to see additional ways to improve your health. The focus of these guidelines is on supplements and advanced holistic medical approaches to treat chronic Lyme disease. Marty Ross MD and Tara Brooke ND also work with a full range of prescriptive medications as necessary to meet the needs of their patients. Drs. Ross and Brooke provide leadingedge care pulling from a broad range of healing traditions: ● Conventional medicine and prescriptions, ● Naturopathic medicine and herbs, vitamins, intravenous therapy, nutrition, homeopathy, detoxification, and physical medicine, ● Chinese medicine and acupuncture, ● Intuitive medicine, ● Shamanic healing practices, and ● Ancient healing breathwork. 7 The Successful Treatment Recipe Essential Steps to Health Here is a treatment plan for anyone with chronic Lyme and associated diseases. It is based on the Treatment Essentials described in Chapter One. It includes essential treatment steps that you should address at the beginning and throughout a treatment. It is designed to: ● kill the infections and ● support the body against the effects of the infections and the herbal antimicrobials or prescription antibiotics. For a discussion of how the herbal medicines work see other sections of this manual. For an explanation of how the prescription medicines work, refer to a drug manual like the Physicians Desk Reference or Drug Facts and Comparisons, or articles at Treat Lyme and Associated Diseases (www.treatlyme.net). While the following treatment approach focuses on a limited number of areas, it is designed to correct all of the Lyme Disease problems like: ● low energy, ● pain, ● insomnia, ● brain, neurologic, and cognitive dysfunction, and ● immune compromise and suppression. Herxheimer dieoff reactions. Note: when a person starts a Lyme Disease treatment or changes herbal and prescription antibiotics it is common to have some worsening. This is usually due to a Herxheimer dieoff reaction. You can read more in Chapter Seven about this reaction and steps you can take to treat it. Treatment Length. Treatment should be continued until you are well. For some this may mean complete recovery and for others not. It is hard to predict, at the beginning of a treatment for someone with chronic Lyme, the degree of recovery. Generally antibiotics should be rotated to prevent resistance to any one antibiotic. We generally try to use an antibiotic for no more than six months. Herbal antibiotics like cat’s claw and otoba bark extract mentioned below can be used longer if you are still improving. We use various combinations of antibiotics during a treatment. We stop a full treatment when someone is either symptom free for 2 months or the improvements are at a plateau for 4 months with no improvements seen after adjustments in the regimen. On average it can take 2 years to recover for someone with chronic Lyme. This is an average. Some people are on the 6 8 month program while others may require years of treatment. Some may even require lifelong maintenance treatment. Persistence is the Key. You will likely feel worse with treatment before you improve due to the Herxheimer Dieoff Reaction. Based on our experience by 3 months of treatment 30% of people have notable improvement, by 6 months 60%, and by 9 months 90%. Generally, we recommend you stay on each of the natural medicines recommended below for a minimum of 6 months to see if they are helping. Natural medicines do help but take time. Once you have marked improvement then you can likely stop many of these natural medicines except for probiotics, curcumin, ashwagandha, and the multivitamin mentioned below. Part 1. Sleep (Use either a natural medicine or prescription medicine. Do not mix natural medicines and prescription medicines together as a first treatment but you can do so later.) Natural medicines: (You can mix these two together or use in combination with the prescriptions medicines if needed.) LTheanine/GABA. 200 mg of Zen (Allergy Research) 1 to 3 pills a night 1 hour before bed. Do not exceed 1200 mg a day if using for nerve pain or anxiety during the day too. Excessive amounts in the day are very sedating, AND/OR Herbal Combination Product. End Fatigue Revitalizing Sleep Formula (Integrative Therapeutics) 1 to 4 pills 1 hour before bed. Prescription medicines: Zolpidem (Ambien) 10 mg 1 pill 30 min before bed (Use if your primary problem is getting to sleep. It is short acting.) AND/OR Clonazepam (Klonopin) 1 mg .5 to 2 pills 30min to 1 hour before bed. (Use if your primary problem is staying asleep. If you have both a falling and staying asleep problem try Ambien first.) Rationale: Sleep is often disturbed in chronic Lyme disease. 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 79 hours of sleep a night. Sleep in the few hours before midnight is most restorative. 9 Part 2. Cytokine Control Natural medicine: Curcumin. Meriva 500 (Thorne) 1 pill 3 times a day. Prescription medicine: (There are no effective and safe options.) Rationale: Cytokines are inflammatory chemicals made by the immune system in chronic Lyme Disease. Lowering them with curcumin and antioxidants found in our recommended multivitamin (Part 5.) will help correct many problems and limit Herxheimer dieoff reactions. On the one hand cytokines are good because they turn on the immune system. They perform a number of functions that include: ● making antibodies work more effectively, ● increasing active white blood cells to fight infections, ● recruiting white blood cells to the location of an infection, ● turning on white blood cells to fight infections, and ● decreasing viral and bacterial replication. On the other hand in chronic Lyme disease the immune system makes too many cytokines which is bad. Too many cytokines: ● suppress the immune system, ● cause pain, ● decrease hormone production from organs like the thyroid and the adrenal glands, ● disturb sleep, ● decrease brain function, ● increase fatigue and tiredness, ● waste muscles, ● cause depression, and ● decrease the function of various organs throughout the body resulting in many other symptoms and medical problems. At the beginning of treatment or when antibiotics are changed the cytokines are made in even greater amounts causing a person to feel much worse. This is called a Herxheimer dieoff reaction. Part 3. Adaptogen Natural medicine: Ashwagandha. Ashwagandha (Ayush) 12 pills in am and 12 pills between 12 pm or Ashwagandha 1:1 Standardized Extract (Medi Herb) 1/2 to 1 tsp in am and 1/2 to 1 tsp between 12 pm. Taking late in the day may disturb sleep. Rationale: An adaptogen is a substance that helps the body deal with the harmful medical and emotional stress of being ill. They have been used for centuries in Ayurvedic and Chinese medicine with great observed benefit. Based on animal experiments ashwagandha improves energy, immune function, and 10 adrenal and thyroid function. It likely has additional beneficial effects that have not been researched. Part 4. Hormones A. Adrenal Insufficiency (Start with the natural medicine or prescription medicine. Do not use both together in the first treatment, but you can do so later if the symptoms of low adrenals persist.) Natural medicine: Ashwagandha. Ashwagandha (Ayush) 12 pills in am and 12 pills between 12 pm or Ashwagandha 1:1 Standardized Extract (Medi Herb) 1/2 to 1 tsp in am and 1/2 to 1 tsp between 12 pm. Taking late in the day may disturb sleep. Prescription medicine: (We rarely use this because there is a very small risk of immune suppression using prescription hydrocortisone. However, the doses we recommend are the normal amounts the adrenal glands should make. On the other hand, ashwagandha is a supportive herb that does not suppress the immune system but helps the adrenals work better.) Cortef 5 mg 1 to 2 pills in am and 12 pills between 12 pm. Taking late in the day may disturb sleep. B. Low Thyroid Natural medicines: (Some recommend iodine but too much can make thyroid conditions worse. Rather than taking iodine use the multivitamin recommended in Part 5 to provide the essential micronutrients the thyroid requires.) Prescription medicine: Dessicated Thyroid ½ grain or Armour Thyroid ½ grain 1 pill in the morning 30 min before anything else and on an empty stomach with water only. Increase every 34 weeks by ½ grain if low thyroid symptoms persist. Rationale: Low hormones occur often in chronic Lyme disease. Inflammatory cytokines made by white blood cells to fight Lyme decrease the effective functioning of an area of the brain called the hypothalamus and pituitary. This part of the brain produces chemicals that induce sleep and that regulate hormonal systems. Normally this part of the brain releases messengers such as thyroid stimulating hormone (TSH), adrenocorticotropin hormone (ACTH), and follicle stimulating hormone (FSH) to stimulate the thyroid, 11 adrenal glands, and sex hormone organs respectively. Because of the dysfunction caused by the cytokines, these regulatory messengers are released based on an incorrect interpretation by the brain of the hormone environment. Thus measurements of these messengers is an unreliable way to determine the hormone status. Another way to check hormone status is to measure the actual hormone levels like T4/T3 (thyroid), or cortisol/dhea (adrenals), or estrogen/progesterone/testosterone (sex hormones). These tests give a broad range of normal however. 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 as long as treatment does not increase hormone levels above the upper end of normal. Hormones provide many functions in the body. Proper levels improve energy and help the immune system to work more effectively. Symptoms: Adrenal Insufficiency: fatigue, recurrent infections, poor recovery from infections, low blood sugar with shakiness and irritability relieved by eating, low blood pressure and dizziness on standing, afternoon crashing, and sugar cravings. Low thyroid: fatigue, achiness, low body temperatures, cold intolerance, weight gain, constipation, changes in menstrual periods. Part 5. Essential Micronutrients Natural medicine: Multivitamin. End Fatigue Daily Energy Enfusion (Integrative Therapeutics). Take one scoop daily. If sensitive then Mediclear (Thorne) is an alternative. Take one scoop 2 times a day. Rationale: To heal and feel better requires a multivitamin with an essential set of vitamins, minerals, amino acids, and antioxidants. A good multivitamin improves functioning of the immune system, muscles, brain and nerves, hormones, organs including the kidney and liver, detoxification, and decreases inflammation. It also protects the body from the toxic effect of prescriptive antibiotics. Part 6. Yeast Prevention and Treatment ● For yeast overgrowth prevention use probiotics and antifungals in A & B. ● For current intestinal yeast overgrowth treatment use probiotics and antifungals in A & C. A. Probiotics: Required for Yeast Prevention and Treatment Natural medicine: Probiotic. HMF (Seroyal/Genestra) is one of the few probiotics on the market shown to repopulate the intestines in scientific studies. Take at least 2 pills daily 12 at least 1 hour away from antibiotics. During an active yeast infection consider increasing to 4 pills daily either one time a day or divided in to two doses. B. Antifungals for Prevention: (Use either the natural medicine or prescription medicine. You do not need to use both together.) Natural medicine: Herbal Combination Product. Phytostan (Integrative Therapeutics) 2 pills 2 times a day. Prescription medicine: Nystatin 500,000IU 2 pills 2 times a day. C. Antifungals for Treatment: (Do this if you have a yeast screening score of 140 or higher (see below). When you complete treatment, then start yeast prevention antifungals as above. Use the natural medicine or prescription medicine option but not both together.) Natural medicine: Herbal Combination Product. Phytostan (Integrative Therapeutics) 2 pills 2 times a day. This will take 34 months to get yeast overgrowth under control. Prescription medicine: Nystatin 500,000IU 2 pills 2 times a day, and Fluconazole (Diflucan) 200mg 1 time daily for 30 days. Use in combination with nystatin to prevent drug resistance. This combination will take 30 days to get yeast under control.) Rationale: Too many yeast in the intestines (yeast overgrowth) is a common problem that occurs in those with chronic Lyme disease either during treatment or prior to beginning treatment. Antibiotics used to treat Lyme can lead to too many yeast. Immune suppression prior to starting antibiotics can also cause yeast overgrowth. Yeast overgrowth can result in an ongoing systemic allergic reaction to the yeast that can suppress the immune system. It may also lead to inflammatory cytokine and oxidizing agent excess that lead to many of the Lyme disease symptoms and pain. Food allergies and sensitivities can be the result of yeast overgrowth too. 13 There is not a useful diagnostic blood test or stool test for yeast overgrowth. While some may test for antibodies in the blood to intestinal yeast, antibodies are common even when yeast are in balance. In addition it is normal to have stool cultures grow yeast; so a culture does not indicate if yeast are in excess. For this reason, yeast are diagnosed using a screening questionnaire (see http://www.treatlyme.net/storage/documents/yeast.pdf ). This questionnaire evaluates for the possibility of yeast overgrowth based on yeast overgrowth risk factors and intensity of symptoms. In general we find people benefit from treatment if the score is 140 or higher. At the beginning of a Lyme disease treatment, often before antibiotics are started it is essential to treat yeast. Doing so can limit the severity of dieoff reactions from treating Lyme because removing yeast removes one source of inflammatory cytokine excess. Part 7. Lyme Infection Treatment (Take either the natural medicines or the prescription medicines. Do not take both together at the beginning, although you can do so later.) A. The First Month Natural medicines: Otoba Bark Extract and Cat’s Claw. Banderol and Samento (Nutramedix) 5 drops 2 times a day of each herb and increase the dosing every 2 days by 1 drop per dose till taking 20 drops 2 times a day. Based on the manufacturers recommendations, take the herbs at least 15 minutes from each other. Take on an empty stomach. Do not take 30 minutes before through 2 hours after having food, medicines, or supplements. If you get a Herxheimer dieoff reaction do not advance the dose till it decreases. Prescription medicines: (We generally start with oral antibiotics. For considerations about IV antibiotics see Kills Lyme Germs: A Brief Antibiotic Guide (www.treatlyme.net/treatslymegerms). Doxycycline 100 mg 2pills 2 times a day or 4 pills 1 time a day. Take with food to prevent nausea. Do not take with calcium supplements or calcium fortified dairy products like milk or cheese or milk substitutes like rice milk OR Clarithromycin (Biaxin) 500mg 1 pill 2 times a day. B. After the First Month If you are on otoba bark extract and cats claw advance to 30 drops 2 times a day by increasing by 1 drop per dose every other day. See above for timing of taking the medications. If you are on prescription medicines see Kills Lyme Germs: A Brief 14 Antibiotic Guide (http://www.treatlyme.net/killslymegerms). You will need to work with your physician to add an additional antibiotic(s) to treat all 3 forms of the lyme germ. Rationale: Lyme exist in three different forms. These are the spirochete, the lform (lives in cells), and the microscopic cyst form. A treatment should treat all three forms at the same time. However at the first treatment take care to avoid an intense dieoff reaction by starting one prescription antibiotic only. Otoba bark extract and cat’s claw treat all three forms of the germ. Because these herbs are dosed using drops, they can be more easily regulated to manage a die off reaction by not increasing the dose until the reaction lessens if present. In our experience any oral antibiotic combination works as well as the Otoba bark extract and cat’s claw combination which is 85% to 90% of the time. Doxycycline or Clarithromycin treat the spirochete and the lform, after the first month if a Herxheimer dieoff reaction is not too bad, an anticyst agent should be added. This is not done at the first visit because the Herxheimer dieoff reaction could be too intense. Part 8. Detoxification Reduce the total load of negative environmental influences on your health: ● eat organic foods, ● avoid gluten, scents, alcohol and tobacco, and ● decrease emotional stress. Support Liver detoxification by taking the multivitamin recommended in Part 5. Drink water regularly to support kidney detoxification. Part 9. Coinfection Treatments for Bartonella and/or Babesia If you have one of them do not start treatments for the coinfections at the initial visit. Wait one month or longer to adjust to the Herxheimer dieoff reaction from treating the Lyme infection and to stabilize on the supportive supplements. If you have both of these coinfections you should treat one first before adding a treatment for the other. See Kills Bartonella: A Brief Antibiotic Guide (http://www.treatlyme.net/killsbartonella) and/or Kills Babesia: A Brief Antibiotic Guide (http://www.treatlyme.net/killsbabesia) for natural and prescription antibiotic approaches you can take to treat these infections. Part 10. Additional Natural Medicines and Prescription Medicines Many other natural medicines to manage symptoms and problems exist. Wait one month after beginning a treatment to start these. If significant problems remain then add the recommended supplements found in the other chapters of this manual based on your problems. 15 Part 11. Exercise This improves blood flow to all tissues and releases various chemicals that produce healing effects. If exercise makes a person worse, it should be done only to a tolerable level. Usually at the beginning of treatment exercise at any level should not be done due to tolerance issues. Overexercise which makes a person feel worse may suppress the immune system and impair healing. Part 12. Special Considerations for Six Months and Beyond There are additional steps you should consider by 6 to 9 months of treatment if you are not having adequate improvement. Consider adding ● detoxification treatments for MTHFR methylation defect, biotoxins, and heavy metals described in Chapter Three: Detoxification, ● biofilm treatments in described in Chapter Six: Biofilms, ● chronic viral infection treatments described in Chapter Twelve: Infection, ● mitochondrial dysfunction treatments described in Chapter Seven: Energy, ● coinfection treatments described in Chapter Twelve: Infection, Kills Bartonella: A Brief Antibiotic Guide (http://www.treatlyme.net/killsbartonella), or Kills Babesia: A Brief Antibiotic Guide ( http://www.treatlyme.net/killsbabesia) if symptoms of these recur or continue, or ● yeast treatments described in Chapter Sixteen: Yeast if you have a number of these symptoms: increased sugar cravings, intestinal gassiness or bloating, recent vaginal yeast infection, oral yeast, and/or vaginal or rectal itching. Part 13. Health Decline after Doing Better It is common to have ups and downs during the course of a treatment. In some cases there can be a significant decline after a person is doing better. In these cases consider yeast overgrowth of the intestines or relapse of a bartonella or babesia coinfection. Excessive yeast in the intestines lead to increased levels of cytokines. Because excess cytokines cause many of the chronic Lyme disease symptoms, it could seem like your Lyme disease is getting worse. Yeast could be the cause of your decline if you have a number of these symptoms: increased sugar cravings, intestinal gassiness or bloating, recent vaginal yeast infection, oral yeast, and/or vaginal or rectal itching. For yeast treatment see Part 6. Yeast Prevention and Treatment above. 16 One: Treatment Essentials Plans to heal fatiguing illnesses including Lyme disease, fibromyalgia, and chronic fatigue syndrome should address these Treatment Essentials. Sleep: Seven to nine hours of sleep a night is essential to restore the immune system, improve pain, and restore energy. Hormones: In these illnesses, hormonal systems such as the thyroid and adrenals often do not receive signals from the brain to work properly. Correcting imbalances will restore energy and support an active immune system. Infections: These can include yeast overgrowth in the intestines, bacteria including the Lyme disease bacteria and coinfections, various viruses, and parasites. Diet and Basic Healing Micronutrients: To heal and feel better requires an essential set of vitamins, minerals, amino acids, and antioxidants. It is necessary to identify and remove allergic and sensitive foods. Exercise: This improves blood flow to all tissues and releases various chemicals that produce healing effects. If exercise makes a person worse, it should be done only to a tolerable level. Overexercise which makes a person feel worse may suppress the immune system and impair healing. Environmental Toxins: Removing the negative influence of heavy metals like lead and mercury, electromagnetic pollution, and mold and chemical toxins is helpful. Organic foods are best. The foundation of The Successful Treatment Recipe includes these Treatment Essentials. In the Recipe we weave these essential components in a successful treatment approach. 17 Two: Required Supplements To heal and feel better requires a multivitamin with an essential set of vitamins, minerals, amino acids, and antioxidants. A good multivitamin improves functioning of the immune system, muscles, brain and nerves, hormones, organs including the kidney and liver, detoxification, and decreases inflammation. It also protects the body from the toxic effect of prescriptive antibiotics. Probiotics like acidophilus are healthy intestinal bacteria. They improve digestion so vitamins and nutrients are absorbed. Intestinal bacteria detox harmful foods and chemicals, protect agains food allergies, and aid in digestion. Probiotics also help prevent and treat yeast overgrowth in the intestines. Due to infection caused immune suppression and the use of antimicrobials like prescriptive antibiotics, yeast can grow excessively in the intestines. Excessive yeast trigger allergic reactions and inflammation chemicals that worsen Lyme disease symptoms. Curcumin decreases quinolinic acid and lowers inflammatory cytokines. It is a component of the seasoning turmeric. Quinolinic acid is a brain and nerve toxin made during infection. It causes brain fog and cognitive dysfunction. Cytokines are inflammation chemicals made by the immune system. In proper balance they improve immune function and germ killing. In excess cytokines ● cause most of the Lyme disease symptoms, ● suppress the immune system, and ● decrease hormones. At the beginning of treatment when killing lyme germs with antimicrobials or yeast with antifungals, cytokines are made in even greater amounts causing a person to feel much worse. This is called a Herxheimer dieoff reaction. Our Recommendations Multivitamin. End Fatigue Daily Energy Enfusion (Integrative Therapeutics). Take one scoop daily. If sensitive than Mediclear (Thorne) is an alternative. Take one scoop 2 times a day. Probiotic. HMF (Seroyal/Genestra) is one of the few probiotics on the market shown in scientific studies to repopulate the intestines. Take at least 2 pills daily at least 1 hour away from antibiotics. 18 Curcumin. Meriva 500 (Thorne) 1 pill 3 times a day. 19 Three: Biofilms Biofilms are mucopolysaccharide layers of slime held together by a protein skeleton that can cover communities of Lyme germs. They do occur in Lyme disease as described by Alan MacDonald, MD and Eva Sapi PhD. Biofilms may limit the ability of the immune system to see Lyme disease germs and may also block antibiotics from bacteria. According to the work of Dr. Sapi, in a laboratory experiment otoba extract and cat’s claw used together removed nearly all of the Lyme biofilms. In theory lumbrokinase should remove biofilms too. (WARNING: Treating biofilms may result in more effective killing of germs by antibiotics. This can sometimes trigger a Herxheimer dieoff reactio. See Chapter Nine: Herxheimer Dieoff Reaction for more information). Our Recommendations If you are using otoba bark extract and cat’s claw to treat Lyme (See A Successful Treatment Recipe and Chapter Twelve: Infections) then you do not need to add another supplement to remove biofilms. If you are on a prescription antibiotic regimen ● use lumbrokinase and ● do not add otoba bark extract and cat’s claw to remove biofilms unless your physician advises you to do so. Lumbrokinase. Lumbrokinase (Allergy Research) 1 pill 2 times a day on an empty stomach, except water, for 1 hour before and after taking. Otoba Bark Extract and Cat’s Claw. Banderol and Samento (Nutramedix) 5 drops 2 times a day of each herb and increase the dosing every 2 days by 1 drop per dose till taking 30 drops 2 times a day. Based on the manufacturers recommendations, take the herbs at least 15 minutes from each other. Take on an empty stomach. Do not take for 30 minutes before through 2 hours after having food, medicines, or supplements. If you get a Herxheimer dieoff reaction do not advance the dose till it decreases. 20 Four: Bladder Some patients with Lyme disease and bartonella infection have bladder symptoms similar to those seen in bladder infections. These symptoms include increased urge to urinate, bladder pain and pain on urination, bladder cramping, and increased frequency of urination. When these symptoms occur, a bladder infection should be ruled out. When it is ruled out, these symptoms are often the result of a condition called Interstitial Cystitis. Depending on your age and other risk factors, a urologist may need to evaluate your bladder with a fiberoptic scope to assure that cancer is not present and to confirm a diagnosis of Interstitial Cystitis. There are many possible causes of Interstitial Cystitis. Bartonella is a common cause when these symptoms are seen in Lyme disease, but the Lyme germ borrellia may also be a cause. The end result of these infections is inflammation of the lining of the bladder. Treatment is directed at rebuilding the healthy lining of the bladder and decreasing inflammation. Glycosaminoglycans for the bladder lining protect the lining of the bladder. These are supplied by Glucosamine Sulfate. Also the sulfur from Glucosamine Sulfate has an analgesic and antiinflammatory effect on the damaged bladder lining. Larginine helps to increase nitric oxide production. Nitric oxide leads to decreased production of inflammatory prostaglandins. Quercetin also helps by decreasing histamine release from allergies and through its antiinflammatory effects by decreasing both the production of inflammatory cytokines from infections like borrelia and bartonella and inflammatory prostaglandins. (Quercetin is helpful in dieoff reaction and pain.) An herbal combination product includes all of these substances in addition to others that help the bladder. Ultimately treating the borrelia or bartonella infections with antimicrobials will decrease inflammation cytokines and can cure the Interstitial Cystitis. Diet modification can help by removing inflammatory and allergic foods. Eliminating the following foods is helpful for some: aged cheeses; alcohol; artificial sweeteners; chocolate; citrus juices; coffee; cranberry juice; fava and lima beans; meats that are cured, processed, smoked, canned, aged, or that contain nitrites; most fruits except blueberries, honeydew melon, and pears; nuts except almonds, cashews, and pine nuts; onions; rye bread; seasonings and anything else that contain MSG; sour cream; sourdough bread; soy; tea; tofu; tomatoes; and yogurt. Our Recommendations If present treat borrelia and bartonella with antimicrobials. Use the herbal combination 21 product and stop any other quercetin or glucosamine sulfate you may be on. Herbal Combination. Bladder Ease (Vitanica) 3 pills 3 times a day. Or use quercetin and glucosamine sulfate but do not use the herbal combination. Quercetin. Quercetone (Thorne) 2 pills 3 times a day. Glucosamine Sulfate. Glucosamine Sulfate (Thorne) 1 pill 3 times a day. Stop alcohol, caffeine and foods containing nitrites or MSG. In 4 to 6 months of treating your infections and using these supplements, if symptoms persist, then remove the remaining foods noted in the background section above. In 34 weeks, if diet elimination works, then try adding foods back in 1 at a time every four days to see which foods are a problem. 22 Five: Brain and Nerves Many people with Lyme disease and coinfections have: ● central nervous system (the brain and spinal cord) involvement with cognitive thinking dysfunction, seizures, dizziness, tremors, paralysis or agitation, and/or ● peripheral neuropathies (nerve dysfunction and injury outside of the brain and spinal cord). In more extreme central nervous system involvement Lyme and coinfections can cause, mimic, or exacerbate Multiple Sclerosis, Parkinson’s Disease, Alzheimer’s Disease, and Amyotrophic Lateral Sclerosis (ALS) also called Lou Gehrig’s Disease in addition to other conditions. For these conditions Lyme is not the only cause. Individuals can have these conditions without having Lyme disease. 1. Central Nervous System Cognitive dysfunction is a very common problem that often resolves once the Lyme germ and coinfections are under control. Cognitive impairments occur with memory and information processing. Severe cognitive dysfunction and other central nervous system problems are often a sign of a bartonella coinfection in addition to the Lyme germ infection. Central nervous system problems are due to a number of factors. These include: ● toxin injury from quinolinic acid produced in the brain during infection, biotoxins from mold and the Lyme germ, coinfections and/or the environment, ● inflammation from cytokines and prostaglandins produced by the immune system in response to the infections, and ● oxidation agent damage or destruction. In Parkinson’s Disease caused or exacerbated by Lyme disease an area of the brain called the substantia nigra is injured. This area of the brain produces dopamine. In Parkinson’s the brain stops producing sufficient levels of dopamine resulting in tremors, decreased facial expressiveness, cognitive impairment, and stiffness of arm and leg movements. In addition, glutathione is also low. Multiple Sclerosis caused or exacerbated by Lyme disease results in a loss of nerve coverings in areas of the brain and spinal cord. The nerve covering is a fatty layer called myelin. Demyelination causes a loss of proper nerve function with numbness, 23 temperature dysregulation, paralysis of limbs, and bowel and bladder dysfunction. In Alzheimer’s Disease there is dementia. Dr. Alan MacDonald has shown that Lyme germs exist in brain biopsy tissues of those with this condition. The infection causes the changes seen in Alzheimer’s disease of plaques and neurofibrillary tangles. In ALS (Lou Gehrig's Disease) there is degeneration of upper and lower motor neurons of the central nervous system. These are the nerves that make muscles work. The symptoms are varied and can include muscle twitches and tremors, loss of limb function, difficulty with swallowing, and weakness. 2. Peripheral Nervous System As a result of toxins, inflammation, and oxidative damage the peripheral nerves can have injury. Symptoms include numbness, partial loss of limb function, severe constipation from intestine palsy, or nerve pain. The intestinal palsy and constipation occur when the nerves that cause intestinal muscle contraction stop working due to injury. Nerve pain has qualities that include touch hypersensitivity and burning, electric, sharp, and stabbing sensations. Supplements for Central and/or Peripheral Nervous System Repair and reversal of nerve injury in and out of the brain is directed at removing toxins, decreasing inflammation, lowering oxidative agents and repairing structural damage. Curcumin, a component of the seasoning turmeric, decreases the neurotoxin quinolinic acid made in the brain during infection. It also decreases the production of inflammatory cytokines by the immune system. Coenzyme Q10 (CoQ10) restores energy generation in injured nerve cells. In Parkinson’s disease it is often very helpful as individuals are found to have very low CoQ10 brain levels. Lithium orotate improves nerve signaling and thus thinking. It is also helpful in Alzheimer’s disease and is shown to clear the neurofibrillary tangles. It promotes dopamine and serotonin neurotransmitter activity which can calm an agitated nervous system. For these conditions it is useful at supportive doses of 15 to 30mg a day. This compares with doses used to medicinally treat the psychiatric condition of bipolar illness at 600 to 900 mg a day. Glutathione is a very useful antioxidant that repairs nerve damage. It is not well 24 absorbed orally and works best in intravenous form. It can help all neurologic conditions but is particularly helpful in Parkinson’s Disease and ALS. Another way to raise glutathione levels in nerve cells is to take alpha lipoic acid and/or nacetylcysteine. Omega3 fatty acids decrease inflammation by limiting inflammatory prostaglandin production. This is particularly helpful in MS and Alzheimer's. Omega3 fatty acids also help repair the nerve walls. Phosphatidylserine is a phospholipid fat found in the cell walls of nerves. It also helps repair nerve cell wall damage. Gingko Biloba is shown to improve memory by lowering oxidative agents, relaxing blood vessel walls to improve blood flow to the brain, and decreasing blood clotting. Vitamin B12 helps energy and nerve function. In MS it can help rebuild the myelin covering of the nerves. Ltheanine is an aminoacid like compound that raises levels of the neurotransmitter gaba in the brain which calms nervous system hyperexcitability. Finally a good multivitamin rich in a variety of vitamin Bs, antioxidants, vitamin E, and vitamin D can improve nerve function and helps with detoxification. See Chapter Six: Detoxification for information and help with toxins. For intestinal palsy and nonnerve treatments for constipation see Chapter Eight: Gastrointestinal. For cell energy generation principles see Chapter Seven: Energy. Our Recommendations 1. Central Nervous System General. For anyone with problems in these areas curcumin and a good multivitamin are a must. If there is significant impairment at the beginning also use CoQ10 and omega3 fatty acids. In 2 months of treating Lyme and coinfections with antimicrobials, if significant central nervous symptoms remain then add lithium orotate and consider alpha lipoic acid, and phosphatidyl serine. As an alternative to Alpha Lipoic Acid use NAcetyl Cysteine or combination of both. 25 Curcumin. Meriva 500 (Thorne)1 pill 3 times a day. Multivitamin. End Fatigue Daily Energy Enfusion (Integrative Therapeutics). Take one scoop daily. If sensitive than Mediclear (Thorne) is an alternative. Take one scoop 2 times a day. Coenzyme Q10. QBest 100 (Thorne) 1 pill daily. Be sure to stop this if you are on Malarone or Mepron. Omega3 fatty acids. Eskimo3 (Integrative Therapeutics) 3 pills 1 time a day. This is a mercury free source. Alpha Lipoic Acid. Super Lipoic Acid (Seroyal/Genestra) 1 pill 2 times a day. Acetyl LCarnitine. Carnityl (Thorne) 1 pills 2 times a day for 1 month, then 1 pill daily. Benefit usually occurs by 2 months. Lithium Orotate. Lithium Orotate (Pure Encapsulations) 12 pills 3 times a day. Phosphatidylserine. IsoPhos (Thorne) 1 pill daily. NAcetyl Cysteine. Cysteplus (Thorne) 1 pill 3 times a day. Alpha Lipoic Acid and NAcetyl Cysteine. Glutathione Precursors (Pharmax) 1 pill 3 times a day. Cognition and Thinking. For cognitive impairment not resolved with 2 months of antimicrobials, curcumin, and a good multivitamin add lithium orotate and/or gingko biloba for a minimum of 2 months. Lithium Orotate. Lithium Orotate (Pure Encapsulations) 12 pills 3 times a day. Gingko Biloba. Gingko Biloba Plus (Integrative Therapeutics) 1 pill 2 times a day. Multiple Sclerosis, Parkinson’s Disease, and ALS. For Multiple Sclerosis use vitamin b12 orally or as intramuscular injections to rebuild the myelin from the beginning of treatment. For Parkinson’s Disease use high dose CoQ10 from the beginning of treatment and IV glutathione at least 3 times a week. For ALS consider IV Glutathione 26 too. Vitamin B12. Methylguard (Thorne) 3 pills daily. This is taken in addition to the Vitamin b12 in the multivitamin. Coenzyme Q10. QBest 100 (Thorne) 3 pills 3 times a day. Be sure to stop this if you are on Malarone or Mepron. Irritable Nervous System. For an irritable central nervous system with agitation, anxiety, tremors, shakes, or seizures try lithium orotate or Ltheanine from the beginning of treatment. You can take these together too. Consider stopping the Ltheanine once on antimicrobials for 24 months. Lithium Orotate. Lithium Orotate (Pure Encapsulations) 12 pills 3 times a day. LTheanine. LTheanine (Integrative Therapeutics) 1 to 3 pills 3 times a day (do not exceed 12 pills in 24 hour period). Adjust amount based on pain response and sleepiness. 2. Peripheral Nervous System At the beginning of treatment start CoQ10, alpha lipoic acid, and take the multivitamin. As an alternative to alpha lipoic acid use nacetyl cysteine or combination of both. For nerve pain use Ltheanine. Coenzyme Q10. QBest 100 (Thorne) 1 pill daily. Be sure to stop this if you are on Malarone or Mepron. Alpha Lipoic Acid. Super Lipoic Acid (Seroyal/Genestra) 1 pill 2 times a day. NAcetyl Cysteine. Cysteplus (Thorne) 1 pill 3 times a day. Alpha Lipoic Acid and NAcetyl Cysteine. Glutathione Precursors (Pharmax) 1 pill 3 times a day. Multivitamin. End Fatigue Daily Energy Enfusion (Integrative Therapeutics). Take one scoop daily. If sensitive than Mediclear (Thorne) is an alternative. Take one scoop 2 times a day. LTheanine. LTheanine (Integrative Therapeutics) 1 to 3 pills 3 times a day (do 27 not exceed 12 pills in 24 hour period). Adjust amount based on pain response and sleepiness. 28 Six: Detoxification Biochemical Toxins Detoxification is the process of removing toxins from our bodies. In modern life, we are exposed to many toxins in our environment. For people with Lyme and associated diseases there are added toxins from germs and/or the medications. The sum of all of the toxins is sometimes called the "toxic load." The toxins produce inflammation, and it is the inflammation imbalance from excess inflammatory cytokines that produces the disease. The world we live in is more toxic than ever with increasing levels of environmental, chemical, mold, and heavy metal toxins. Due to soil depletion and poor eating styles/habits, many people do not have the vital nutrients they need to support the detoxification organs of the body. Thus eating well is not enough to overcome the toxic load. Illness, chronic and acute infections, and the use of pharmaceuticals all further stress detoxification or directly lead to greater toxin production. For instance, the Lyme germ produces a biotoxin. To end the disease of Lyme and associated diseases requires detoxification. In particular, detoxification support is needed in cases of: ● ● ● ● ● ● ● ● ● ● ● micronutrient deficiency/ Improper nutrition, constipation, dehydration, chronic infection or illness, pharmaceutical medication use, overthecounter medication use, lack of regular exercise, heavy metal toxicity, solvent burden, genetic mutations in the detox process, and other environmental toxic burden. 1. Lifestyle Practices A person with chronic Lyme should limit exposures to toxins. To do this eat organic foods, avoid alcohol, cigarettes, perfumes and colognes. Avoid exposures to chemical toxins in the home and in the environment. Limit tracking toxins into your home by removing shoes on entering. 29 The foundation of healthy detoxification is adequate hydration, proper nutrition, daily bowel movements, urination every 12 hours while awake, regular sweating (infrared sauna, hot baths, exercise, or medically supervised hyperthermia baths), and mild to moderate exercise 3 4 times each week. Regarding hydration, it is important to drink 68 glasses a water a day. For information on how to treat constipation see Chapter Eight: Gastrointestinal if you are having less than 1 bowel movement a day. 2. Supplements Liver Detoxification. Liver detoxification requires adequate micronutrients and glutathione, the master detoxification agent found in all of our cells. The building blocks. Proper nutrition alone is not enough to provide the essential nutrients necessary to support the organs responsible for detox. A well balanced multivitamin with mixed amino acids taken daily is the foundation of detoxification. Active glutathione is made in cells with Alpha Lipoic Acid and NAcetyl Cysteine (NAC). Glutathione is a very powerful antioxidant generated in all cells and used in the liver to detox fat soluble toxins. Unfortunately, oral glutathione is poorly absorbed. The best way to increase cellular glutathione levels is through intravenous administration or to give alpha lipoic acid and/or NAC. MTHFR and Methylation. If a person has a MTHFR genetic defect they are unable to produce adequate levels of glutathione. MTHFR is an enzyme that converts inactive folate into the active form called 5methyltetrahydrofolate (5MTHF). 5MTHF and methylcobalamin (a methylated form of vitamin B12) are used in a process called methylation. Methylation is required to produce glutathione. A MTHFR dna mutation analysis blood test shows if a person has this problem. Another clue is having sensitivities to many different prescriptions or supplements. Biotoxins. Based on the work of Ritchie Shoemaker, MD about 25% of individuals have a genetic predisposition which does not allow the removal of Lyme and/or mold biotoxins. In these individuals toxins are incorrectly processed and then passed into the intestines where they are reabsorbed into the bloodstream. Soluble fiber binds biotoxins in the intestine so that they are passed out of the body in the stool and not reabsorbed. To see if you could have this problem, do a visual contrast study (VCS). You can do this online at www.survivingmold.com. If you fail the VCS, there is a high probability you have biotoxin illness. There is also a genetic test called HLA. However it is expensive and often considered experimental by health insurance companies. 30 Quinolinic Acid. Quinolinic acid is a brain nerve toxin made in the brain during infection. It causes brain fog and cognitive dysfunction. Curcumin decreases quinolinic acid and lowers inflammatory cytokines. It is a component of the seasoning turmeric. Heavy Metals. Finally, if you have had a heavy metal exposure or your treatment has stopped progressing consider the possibility of heavy metal toxicity. Heavy metals like lead and mercury are very strong and irreversible enzyme inhibitors. At the cell membrane or in the liver, heavy metals can stop the activities of many protective enzymes systems. In addition, they impair the function of the energy factories in our cells called mitochondria (Chapter Seven: Energy). If needed your healthcare provider can test you for heavy metals. Your doctor will likely add a chelator, such as DMSA, which is a substance that grabs on to all metals in the body to help eliminate them. Emotional Toxins Lifestyle practices to remove emotional toxins. One of the strongest suppressors of the immune system is emotional turmoil and stress. For some, to get well requires healing old traumas like abuse and improving or ending stressful roelationships with others. For some working with a counselor can be very helpful. In addition to talk therapy, shamanic healing practices are also very helpful (see www.thehealingartspartnership.net/shamanichealingpractices.html. For some, regular spiritual practices like going to church and meditation are beneficial. Other ways to lower emotional toxicity are light to moderate exercise which releases calming chemicals and expressive arts like music or dance that provide joy. Some use the lessons of the illness to see if what they do in life is fulfilling at the soul or spirit level. Sometimes career changes are helpful. Isolation is not good for health. It is important to have supportive individuals, families, and communities. Lyme disease support groups are helpful for some. Our Recommendations Follow the lifestyle recommendations in 1. Biotoxins and 2. Emotional Toxins above. Take the multivitamin and curcumin. Multivitamin. End Fatigue Daily Energy Enfusion (Integrative Therapeutics). Take one scoop daily. If sensitive then Mediclear (Thorne) is an alternative. Take one scoop 2 times a day. Curcumin. Meriva 500 (Thorne) 1 pill 3 times a day. 31 If blood testing shows liver inflammation then add Alpha Lipoic Acid. If liver inflammation remains with this then add Nacetylcysteine or stop the Alpha Lipoic Acid and start the glutathione precursors. Alpha Lipoic Acid. Super Lipoic Acid (Seroyal/Genestra) 1 pill 2 times a day. NAcetyl Cysteine. Cysteplus (Thorne) 1 pill 3 times a day. Alpha Lipoic Acid and NAcetyl Cysteine. Glutathione Precursors (Pharmax) 1 pill 3 times a day. If you fail the VCS test add soluble fiber. If you have an MTHFR DNA mutation or are extremely sensitive to supplements and prescriptions use 5MTHF and methylcobalamin found in Methylguard. Once on a full dose of this add 5MTHF. Based on testing remove heavy metals with DMSA. Soluble Fiber. Fractionated Citrus Pectin (Thorne) 1 scoop 2 to 4 times a day. 5MTHF and Methylcobalamin. Methylguard (Thorne) 13 pills 1 time a day. Start at 1 pill and increase every 7 days as tolerated up to 3 pills. Go slowly because opening up blocked detoxification with this supplement could cause more fatigue, body pain, and cognitive dysfunction. 5MTHF. 5MTHF 1 mg or 5MTHF 5 mg (Thorne) 1 pill daily. Add the 1 mg dose after your are stable on Methylguard. Only add the 5mg dose if advised by your physician. DMSA. Captomer (Thorne) as directed by your physician. 32 Seven: Energy An effect of Lyme disease is fatigue. This has multiple components and is due to increased oxidation agents and inflammatory cytokines produced by the immune system in response to the infection. Inflammatory cytokines decrease the effective functioning of an area of the brain called the hypothalamus and pituitary. This part of the brain produces chemicals that induce sleep and that regulate the bodies hormonal systems. Poor sleep and hormonal imbalances lead to fatigue. For a discussion of sleep and hormones see Chapter Ten: Hormones and Chapter Fifteen: Sleep respectively. Under stress, the body and its systems have a great need for essential micronutrients. Depletion of these are a component of fatigue as well. Mitochondrial Dysfunction The energy factories of the cells are mitochondria. Often in Lyme disease the functioning of these are greatly impaired. Inside mitochondria, parts of fatty acids are burned into a type of cell fuel called ATP. Because of the increased oxidative agents in Lyme the phospholipid covering of the mitochondria may stop working effectively resulting in poor uptake of the fatty acid parts and creating disruptions in the energy burning reactions. The covering of the mitochondria can heal with the addition of healthy phospholipids. The transport of fatty acid parts into the mitochondria is helped when there are sufficient levels of acetyl lcarnitine. Optimal functioning of energy creating reactions also requires essential minerals and B complexes found in a good multivitamin. An essential antioxidant for these reactions is coenzyme Q10. Another cause of mitochondrial dysfunction is heavy metal toxicity from metals like lead and mercury. When these metals build up in the cells of the body they attach themselves to sulfur. The mitochondria contain many enzymes that drive energy burning reactions. These enzymes contain sulfur. So when heavy metals are in excess, many of the enzymes in mitochondria do not work effectively. Random blood testing for these metals is not effective. It generally will only demonstrate recent exposures. To test for heavy metals requires the use of a chelation agent that draws the heavy metals out of the cells. Generally, Naturopathic Doctors and Integrative Medicine physicians are trained to evaluate and treat heavy metal toxicity. For a discussion on treatment of heavy metal toxicity see Chapter Six: Detoxification. Magnesium is needed for energy production in the mitochondria too. Testing is usually not necesary since magnesium is the number one nutrient deficiency in humans. However to do testing red blood cell levels of magnesium should be measured. The best 33 forms of magnesium are Magnesium citrate, malate or glutamate. Adaptogen An adaptogen is a substance that helps the body deal with the harmful medical and emotional stress of being ill. They have been used for centuries in Ayurvedic and Chinese medicine with great observed benefit. Based on animal experiments ashwagandha improves energy, immune function, and adrenal and thyroid function. It likely has additional beneficial effects that have not been researched. Our Recommendations Use the multivitamin and ashwagandha. Consider adding Coenzyme Q10 and magnesium. Multivitamin. End Fatigue Energy Enfusion (Integrative Therapeutics) 1 scoop daily or if not tolerated Mediclear (Thorne) 1 scoop 2 times a day. Ashwagandha. Ashwagandha (Ayush) 12 pills in am and 12 pills between 12pm or Ashwagandha 1:1 Standardized Extract (Medi Herb) 1/2 to 1 tsp in am and 1/2 to 1 tsp between 12 pm. Taking late in the day may disturb sleep. Coenzyme Q10. QBest 100 (Thorne) 1 pill daily. Be sure to stop this if you are on Malarone or Mepron. Magnesium Malate. Magnesium Citramate (Thorne) 1 pill before bed then increase to 1 in the morning and 2 before bed (max dose 2 pill 3 times per day). If more magnesium is needed consider IV therapy. After a few months of treating Lyme disease with antimicrobials, if energy is not lifting or remains proportionally worse than the other Lyme disease symptoms, then consider adding phospholipids. Phospholipids. NT Factor (Researched Nutritionals) 2 pills 3 times a day for 2 months then 1 pill 3 times a day. Benefit is usually noted within the first 2 months. After 2 more months if this does not help, then add Acetyl LCarnitine and proceed with heavy metal testing. 34 Acetyl LCarnitine. Carnityl (Thorne) 1 pills 2 times a day for 1 month , then 1 pill daily. Benefit usually occurs by 2 months. 35 Eight: Gastrointestinal As a result of Lyme disease, side effects of medications or supplements, and disruption of the normal healthy bacterial/yeast balance in the intestines, some patients have gastrointestinal issues. Gastrointestinal symptoms include: ● nausea, ● pain or burning in the chest, area below the chest bone, or the abdomen, ● loose stools or diarrhea, ● intestinal gassiness and bloating, and/or ● abdominal cramping. Because there are a variety of causes to these symptoms, it is helpful to have a physician or other licensed health care practitioner evaluate any of these issues. Nausea Nausea can be an effect of the illness or a sideeffect of medications, especially tetracyclines like doxycycline and minocycline. It may often be alleviated with ginger, peppermint, or spearmint tea or with chewed deghlyzerated licorice (DGL). It is not clear how ginger, peppermint, or spearmint work. DGL works best when chewed. Saliva and licorice work together to form a gelatinous mucus layer that protects the stomach lining from irritating medicines, and this allows inflamed tissue to heal. Esophagitis or Gastritis Esophagitis and Gastritis are due to inflammation of the lining of the food pipe and the lining of the stomach respectively. Symptoms of these include a burning or gnawing pain under the chest bone for esophagitis and in the area below the chest bone for gastritis. Both of these conditions are also helped with chewed DGL. Diarrhea/Abdominal Pain or Cramps Diarrhea with or without abdominal pain or cramps can be due to leaky gut syndrome from yeast overgrowth, C. difficile infection, or a direct side effect of antibiotics. Healthy functioning intestines are populated with a balance of good bacteria and yeast. The yeast and bacteria compete with each other for intestinal territory. Good bacteria decline due to the use of antibiotics, environmental stresses, immune suppression from chronic illness, the use of steroids, and/or other factors. When this happens, yeast can grow to take over the territory vacated by the good bacteria. The imbalance of yeast and bacteria 36 is called dysbiosis. Dysbiosis from too few healthy bacteria and/or too many yeast leads to leaky gut syndrome and poor digestion. In this situation there is a breakdown of the protective gelatinous covering of the intestinal lining and damage to the cells that line the intestines. In leaky gut syndrome toxins and allergic agents are absorbed into the bloodstream creating toxin excess, inflammation, and allergic reactions. Indigestion can also occur because there is poor breakdown and absorption of nutrients in the intestines. Overgrowth of C. difficile bacteria in the intestines can be a cause of ongoing watery diarrhea with or without crampy abdominal pain. It is caused by being on antibiotics. C. difficile normally lives in the intestines in balance with the other intestinal organisms. However some antibiotics result in the germ becoming excessive. In excess it releases a toxin that leads to severe diarrhea and abdominal cramping. There is a stool test that physicians and healthcare practitioners use to determine if a person has this infection. When it is present, antibiotics must be stopped and an effective one for C. difficile started. Saccharomyces Boulardi is a beneficial yeast that lives in the intestines that can help treat and prevent C. difficile. To treat crampy abdominal pain and diarrhea that is not a direct side effect of a medication or the result of C. difficile, there are a number of things to do. Replenishing the healthy bacteria of the intestines with a good probiotic is helpful. At times adding Saccharomyces Boulardi, a healthy yeast that lives in the intestines, is helpful too. Carob powder found at grocery stores helps to constipate. See if there is yeast overgrowth of the intestines and treat it (see Chapter Sixteen: Yeast). If yeast are not the problem then Lglutamine can help. It helps rebuild the gelatinous intestinal mucous lining and is a cell fuel for intestinal cells that helps them heal. The gelatinous layer can also be helped with an herbal combination product that supports the mucous layer. Such products can include DGL, plantains, slippery elm, and marsh mallow. Digestive enzymes can help break food down when healthy bacteria are not able to do so. Constipation Some people with Lyme also develop constipation with infrequent bowel movements and cramping. One cause of this is a palsy of the nerves that make the intestines work due to nerve injury from the Lyme infection. See Chapter Five: Brain and Nerves for help with this situation. Constipation is also a side effect of medications such as narcotics for pain or antidepression medications. Constipation is alleviated when water is held within the intestines. This is accomplished by increasing fluid intake and taking foods or nutrients that attract water. Foods rich in fiber attract water. In addition high dose Vitamin C and magnesium salts attract water too. Foods rich in fiber also stimulate the lining of the intestines which cause the muscles within the intestinal lining to squeeze the intestinal contents forward. 37 Our Recommendations Nausea: Try ginger, spearmint, and peppermint alone or in combination first. If these do not work then try the deghlyzerated licorice first alone then in combination with the teas. Ginger. Drink or sip as often as needed throughout the day. Create a tea using tea in bags from the grocery store (use organic when possible to avoid toxins). You can also make ginger tea from scratch by slicing or grating peeled or unpeeled ginger into small pieces and placing a handful into boiling water for 10 minutes. Note: unpeeled ginger can have mold on its covering. Strain the liquid before drinking. Spearmint and/or Peppermint. Drink or sip as often as needed throughout the day. Create a tea using tea in bags from the grocery store (use organic when possible to avoid toxins.) Deghlyzerated Licorice. Rhizinate or Rhizinate 3X (Integrative Therapeutics) chew 2 pills of each 20 minutes before eating 3 times a day. (Chewing is required for saliva to mix with the licorice to fully activate its beneficial effects.) Esophagitis or Gastritis: Deghlyzerated Licorice. Rhizinate or Rhizinate 3X (Integrative Therapeutics) chew 2 pills 20 minutes before eating 3 times a day. (Chewing is required for saliva to mix with the licorice to activate its effects.) Diarrhea with/without Abdominal Pain or Cramps: When diarrhea comes on with the addition of a new herbal or prescriptive antimicrobial it is often due to a side effect of the medicine. Increasing your probiotic as a first step is often helpful or adding Saccharomyces Boulardi. Sometimes it is necessary to use both a probiotic and Saccharomyces Boulardi. Add Carob powder if necessary too. Probiotic. HMF (Genestra) start at 2 pills 1 time a day. For diarrhea double the dose to 2 pills 2 times a day. Be sure to take it as far away from antibiotics as possible. 38 Saccharomyces Boulardi. SacroB (Thorne) start at 2 pills 1 time a day. For diarrhea double the dose to 2 pills 2 times a day. Be sure to take it as far away from antiyeast medications as possible. Carob powder. Find at your grocery store as an organic source. Take 1 tablespoon 1 to 3 times a day added to food. Organic apple sauce is a good option. See the background section above for recommendations regarding yeast. Treat yeast if present first as recommended in Chapter Sixteen: Yeast. Also if having severe diarrhea, your physician should test for C. difficile. If you have C. difficile, in addition to the antibiotic prescribed for this take Saccharomyces Boulardi during the treatment and in an ongoing basis to prevent return of C. difficile. When probiotics, Saccharomyces Boulardi, or treating yeast (if present) do not entirely work, then add LGlutamine or digestive enzymes or do both. For ongoing burning abdominal pain around the belly button or below the belly button, sometimes working with an herbal combination product to rebuild the gelatinous coating of the small intestines can be helpful too. LGlutamine. LGlutamine Powder (Thorne) use 1 to 2 scoops by mouth 3 times a day. Digestive Enzymes. Similase (Integrative Therapeutics) 1 to 3 pills 20 minutes before meals 3 times a day. Adjust based on beneficial effect. Herbal Combination Product. GIEncap (Thorne) 1 pill 3 times a day. Constipation: Increase fluid intake to 48 to 64 oz of water daily. Have a diet rich in fiber by increasing the intake of fruits, vegetables, whole grains, and legumes or beans. If this does not work then add Vitamin C or magnesium or a combination of both. See Chapter Five: Brain and Nerves for help with palsy of the gut if these measures are required on an ongoing basis and do not appear to be medicine side effects. Vitamin C. Start at 2000mg a day and increase up to 10,000mg a day by adding 1,000mg a day. Adjust until you have desired stool frequency and consistency. Magnesium Malate. Magnesium Citramate (Thorne) 1 to 2 pills 3 times a day. Adjust to desired stool frequency and consistency. 39 Nine: Herxheimer Dieoff Reaction and Cytokines A dieoff reaction, also called a Herxheimer reaction, can occur when treating the Lyme germ, some coinfections, and yeast. It causes a worsening of most Lyme disease symptoms like pain, fatigue, and poor thinking. It occurs as bacteria or yeast die during antibiotic treatment. In dieoff reaction, there is a release of toxins which results in the immune system producing too many inflammatory cytokines such as tumor necrosis factor alpha, interleukin6, and interleukin8 to name a few. On the one hand cytokines are good because they turn on the immune system. They perform a number of functions that include: ● ● ● ● ● making antibodies work more effectively, increasing active white blood cells to fight infections, recruiting white blood cells to the location of an infection, turning on white blood cells to fight infections, and decreasing viral and bacterial replication. On the other hand in chronic Lyme disease the immune system makes too many cytokines which is bad. Too many cytokines: ● suppress the immune system, ● cause pain, ● decrease hormone production from organs like the thyroid and the adrenal glands, ● disturb sleep, ● decrease brain function, ● increase fatigue and tiredness, ● waste muscles, ● cause depression, and ● decrease the function of various organs throughout the body resulting in many other symptoms and medical problems. To decrease the severity of dieoff reaction removing toxins and decreasing inflammatory cytokines is helpful. Based on the work of Martin Pall, PhD, antioxidants lower oxidizing agents that trigger cytokine production. Ecklonia cava extract derived from seaweed is a potent oral antioxidant which seems to have a greater effect than other ones. In addition to this, alpha lipoic acid (ALA), nacetyl cysteine (NAC), and glutathione are helpful. Oral glutathione is poorly absorbed, so this is best taken in an IV form through a physicians office. Glutathione, and its precursor building blocks of ALA 40 and NAC, also support liver removal of toxins. In addition to working with these antioxidants, quercetin, an antioxidant bioflavanoid is also an inflammatory kinase inhibitor. Kinases are enzymes required in the production of cytokines. Blocking kinases with quercetin interferes with the cytokine production line. Curcumin is another antioxidant that lowers cytokine production. It also lowers prostaglandin pain chemicals that are triggered by inflammatory cytokines. Ume plum concentrate helps remove toxins and changes acid levels (alkaline) in a way that improves dieoff reaction symptoms. Our Recommendations Start with curcumin first. If this is not helpful then add ecklonia cava extract with or without quercetin. For severe cases do a combination of ecklonia cava, curcumin, quercetin and ume plum concentrate. This combination works to block the cytokine production line and decreases oxidizing agents that trigger additional production. These treatments can take 12 weeks for maximum effect to be felt or seen. For severe dieoff reactions use IV glutathione as a potent antioxidant and to support liver detoxification. Curcumin. Meriva 500 (Thorne) 1 to 2 pills 3 times a day. Ecklonia Cava. Fibroboost (Allergy Research) 2 pills 2 to 3 times a day. Quercetin. Quercetone (Thorne) 2 pills 3 times a day. Ume Plum Concentrate. Ume Plum Balls (Eden) suck on 23 balls 3 to 5 times a day. Glutathione Intravenous (IV). 2500 mg IV over 10 to 15 min 2 times a week for 4 treatments. You may get worse with the first treatment. Do 4 treatments to see if it will work. If helpful consider weekly administration after the first 4 treatments till improvements are at a plateau. If Fibroboost is not tolerated, or if Lyme disease and dieoff symptoms include nerve pain or numbness, then work with one or a combination of the following antioxidants. Alpha Lipoic Acid. Super Lipoic Acid (Seroyal/Genestra) 1 pill 2 times a day. NAcetyl Cysteine. Cysteplus (Thorne) 1 pill 3 times a day. Alpha Lipoic Acid and NAcetyl Cysteine. Glutathione Precursors (Pharmax) 41 1 pill 3 times a day. For more about nerve pain see Chapter Fourteen: Pain. For detoxification ideas see Chapter Six: Detoxification. Also see Required Supplements and take the End Fatigue Energy Enfusion (Integrative Therapeutics) or Mediclear (Thorne). Both of these multivitamins are packed full of essential antioxidants and nutrients that work to lower cytokines by decreasing the production of oxidizing agents and removing them. 42 Ten: Hormones Low hormones occur often in chronic Lyme disease. Inflammatory cytokines made by white blood cells to fight Lyme decrease the effective functioning of an area of the brain called the hypothalamus and pituitary. This part of the brain produces chemicals that induce sleep and that regulate hormonal systems. Normally this part of the brain releases messengers such as thyroid stimulating hormone (TSH), adrenocorticotropin hormone (ACTH), and follicle stimulating hormone (FSH) to stimulate the thyroid, adrenal glands, and sex hormone organs respectively. Because of the dysfunction caused by the cytokines, these regulatory messengers are released based on an incorrect interpretation by the brain of the hormone environment. Thus measurements of these messengers are an unreliable way to determine the hormone status. Another way to check hormone status is to measure the actual hormone levels like T4/T3 (thyroid), or cortisol/dhea (adrenals), or estrogen/progesterone/testosterone (sex hormones). These tests give a broad range of normal however. 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 as long as treatment does not increase hormone levels above the upper end of normal. Hormones provide many functions in the body. Proper levels improve energy and help the immune system to work more effectively. Symptoms Low thyroid: fatigue, achiness, low body temperatures, cold intolerance, weight gain, constipation, changes in menstrual periods. Adrenal Insufficiency: fatigue, recurrent infections, poor recovery from infections, low blood sugar with shakiness and irritability relieved by eating, low blood pressure and dizziness on standing, afternoon crashing, and sugar cravings. Testosterone: low sex drive, fatigue, poor stamina and muscle wasting. Estrogen and Progesterone: low sex drive, hot flashes and night sweats, fatigue, changes in menstrual blood flow. Treatments The hormonal systems require essential micronutrients found in a high quality multivitamin to work best. Thyroid glandulars like desiccated thyroid and armour 43 thyroid are available by prescription. Based on experience, these often work better than synthetic thyroid products like synthroid. The adrenals can be supported to work better. Ashwagandha, an Ayurvedic and Chinese medicinal herb, is an adaptogen that supports adrenal function and can improve cortisol and dhea levels. It also lowers inflammatory cytokines that cause many Lyme symptoms. As a neutral herb it tends not to cause the caffeinelike jitteriness that can occur with other herbs that support the adrenals like ginseng or rhodiola. Adrenal glandulars are the cortex of the adrenal gland and thus contain cortisol and dhea. Testosterone, estrogen and progesterone, are available through compounding pharmacies from organic plantbased sources, but do require prescriptions. Phytoestrogens are plantbased estrogen analogs that produce many of the healthy benefits of estrogens without the risks associated with prescriptive formulations. These include herbs such as don quai, black cohosh, and red clover. Our Recommendations Each patient should take a multivitamin that supports all the the hormonal systems. (Warning: Before beginning any glandular treatment have blood testing done with your healthcare practitioner to ensure that your hormone levels do not exceed the top end of normal range. Only use glandulars at a level that remove the low hormone symptoms and do not exceed the upper limit of normal on laboratory testing.) Multivitamin. End Fatigue Daily Energy Enfusion (Integrative Therapeutics). Take one scoop daily. If sensitive than Mediclear (Thorne) is an alternative. Take one scoop 2 times a day. Adrenal Insufficiency Start with Ashwagandha first and if you still continue to have symptoms of low adrenals proceed to taking adrenal glandulars. If you have low libido after working with ashwagandha or the glandulars, then consider adding DHEA. Ashwagandha. Ashwagandha (Ayush) 12 pills in am and 12 pills between 12 pm or Ashwagandha 1:1 Standardized Extract (Medi Herb) 1/2 to 1 tsp in am and 1/2 to 1 tsp between 12 pm. Taking late in the day may disturb sleep. Adrenal Glandulars. Isocort (Bezwecken) should only be taken under the direction of a health care practitioner. DHEA. DHEA5 (Integrative Therapeutics) take 1 to 5 pills 1 time a day based on 44 DHEASO4 blood levels. Treat to reach a blood level of 150180 mcg/dL for women and 350350 mcg/dL for men. Low Thyroid Be sure to correct adrenal insufficiency for at least 2 weeks before beginning treatment. Sometimes supporting the adrenals will lead to better function of the thyroid. Thyroid Glandulars. Desiccated thyroid or armour thyroid 30mg (1/2 grain) 1 to 5 pills in the am on an empty stomach 30 minutes before any food or medications. See your healthcare provider for these to obtain a prescription. Increase doses to remove low thyroid symptoms every 3 weeks. Do not exceed the upper limits of normal T4 thyroid testing because this could lead to osteoporosis. Low Sex Hormones If phytoestrogens do not remove low estrogen symptoms or if you have symptoms of low testosterone or progesterone, then see your healthcare practitioner for prescriptive medicine options. These can include compounded medications. Phytoestrogens. Herbal Symmetry (Vitanica) 1 to 2 capsules 2 times a day. Start at 1 pill 2 times a day and in 2 weeks if still having symptoms, then increase. 45 Eleven: Immune System Acute or chronic Lyme disease and associated coinfections directly suppress the immune system through a variety of mechanisms. Other factors like: ● allergies (seasonal and food), ● stress, ● environmental and Lyme infection toxins, ● trauma (surgery, accidents or excess exercising), ● opportunistic infections (yeast, parasites,common colds, the flu, HHV6, etc....), and ● diets lacking essential micronutrients compromise the immune system further. Finally, inflammatory cytokines made by the immune system in excess can suppress the immune system. See Chapter Nine: Herxheimer Dieoff Reaction and Cytokines for more information.) One of the best ways to optimize your immune system is through regular immune boosting practices. These include light to moderate exercise, meditation, quality sleep, and a healthy diet. Although exercise is generally good, if done in excess it too can suppress the immune system. So exercise to tolerance only. Experiment to see what amount and intensity of exercise does not leave you more tired or in pain the next day. For some in the beginning of treatment, any amount of exercise is too much. Support for the immune system starts by providing the building blocks it needs which are free of environmental toxins. A diet rich in whole (nonprocessed) organic foods provides essential micronutrients for immune function and optimal liver and kidney detoxification. However, a healthy diet alone does not provide adequate levels of essential micronutrients for those with chronic Lyme disease. Compared to the past, the earth is less micronutrient dense. For this reason a well balanced multivitamin with minerals plus amino acids is essential. Curcumin, a component of turmeric, is an antioxidant that works at the cellular level through a variety of mechanisms to block cytokine production. Thymic protein A boosts cellmediated immunity. This is a refined thymus gland protein that turns on T4 white blood cells and increases the immune system's ability to fight acute and chronic infection. Astragalus complex or olive leaf extract stimulate and modulate the immune system for those with chronic infections and long term immune dysfunction. Both are antioxidants. Olive leaf extract also has direct antimicrobial properties. Anthocyannins are molecules found in plant based foods. They have strong 46 antioxidant properties that protect lymphocytes, which are a type of white blood cells, from oxidative damage. Anthocyannins are also antiinflammatory. Transfer Factors turn on components of cell mediatedimmunity. General transfer factors turn on a group of cellmediated immunity cells called natural killer cells. When turned on these cells help fight a variety of bacterial and virus infections. Targeted transfer factors for chronic Lyme and associated diseases turn on the cellmediated immune response for specific infections that can occur in chronic Lyme and associated diseases. These infections are borrelia (the Lyme disease germ), bartonella, and babesia. In addition targeted transfer factors effect the cellmediated immune response against HHV6, EBV, and CMV virus infections. These are viruses found in most healthy people that are kept under control by the cellmediated part of the immune system. In individuals with chronic Lyme disease these viruses can become more active. Medicinal Mushrooms also turn on cell mediatedimmunity against viruses and bacteria. a multivariety mushroom mix works effectively against bacteria and viral infections. Reishi mushrooms turn on the immune system against bacteria and viruses and work better than a multivariety mushroom mix against viruses. Many things in the environment suppress the immune system. These include pesticides, insecticides, heavy metals, and poor quality air and water. Emotional and biologic toxins also suppress the immune system. See Chapter Six: Detoxification for more information on how to help deal with these complications. For information on treating opportunistic infections listed above see Chapter Twelve: Infection. Our Recommendations Follow advice about sleep, diet, exercise, meditation, stress, opportunistic infections, detoxification, and environmental health discussed above. Take the multivitamin and curcumin. Multivitamin. End Fatigue Daily Energy Enfusion (Integrative Therapeutics). Take one scoop daily. If sensitive than Mediclear (Thorne) is an alternative. Take one scoop 2 times a day. Curcumin. Meriva 500 (Thorne) 1 to 2 pills 3 times a day. Beginning of Treatment 47 Start either general transfer factors or the multivariety mushroom mix. Consider doing this especially if there is a history of repeat colds and other viral infections prior to beginning treatment. General Transfer Factors. Transfer Factor MultiImmune (Researched Nutritionals) 2 pills 1 time a day without food (do not take beginning 30 min before eating through 2 hours after eating.) Multivariety Mushroom Mix. 5 Mushroom Formula (JHS Natural Products) 1 to 2 pills 3 times a day. Chronic Viral Infections (HHV6, EBV, or CMV) For information about these infections and a full treatment approach see Chapter Twelve: Infection. For immune support during the chronic viral infection treatment use both reishi mushrooms and thymic protein A. Reishi Mushrooms. Reishi Gano Mushrooms (JHS Naturals) 1 to 3 pills 3 times a day. Thymic Protien A. Proboost (Genicel) 1 package under tongue away from food 3 times each day for 2 days at the onset of any acute viral infection then 1 packet daily. Borrelia, Bartonella, Babesia, HHV6, EBV, and CMV When treatment for borrelia, bartonella or babesia is going poorly after 6 months of treatment add targeted transfer factors. If babesia, bartonella, or borrelia relapse, then add targeted transfer factors and remain on them once the antimicrobials are stopped. Targeted Transfer Factors. Transfer Factor LymPlus (Researched Nutritionals) 1 pill daily for 7 days, then 1 pill 2 times a day without food (do not take beginning 30 min before eating through 2 hours after eating.) Repeat Viral Infections If you keep getting repeated viral infections like colds and the flu, then add Thymic Protein A and Astragulus Complex. If this does not help then add olive leaf extract. Also consider adding Anthocyannins. Thymic Protein A. Proboost (Genicel) 1 package under tongue away from food 48 3 times each day for 2 days at the onset of any acute viral infection then 1 packet daily. Astragalus complex. Astragalus Complex (MediHerb) 2 pills in morning and 2 pills in the afternoon. Olive leaf extract. Olive Leaf Extract (Thorne) 1 pill 2 times each day with food. Anthocyannins. Fruit Anthocyanins (Natural health) 1 tsp 36 times each day in 8 oz water. 49 Twelve: Infection In chronic Lyme and associated diseases there are a variety of infectious agents responsible for symptoms. The ticks that transmit the Lyme disease germ, borrelia, can also transmit other coinfections. The coinfections are bartonella, babesia, ehrlichia, and anaplasma. If a person has coinfections, it is more difficult to treat chronic Lyme disease. To heal, the coinfections require treatment too. It is best to treat these infections at the beginning of the borrelia treatment. If they are not treated, often people do not recover. In addition to the coinfections, some people have other common chronic infections (CCI) which are found in most people. These germs are kept under control in healthy people and do not usually cause any ongoing health problems. However, in chronic Lyme disease they can become active due to immune suppression and can lead to ongoing fatigue, body pain, and many other Lyme disease symptoms. The CCI are 3 viruses: human herpes virus 6 (HHV6), the mono Epstein Barr virus (EBV), and cytomegalovirus (CMV). There are also 2 bacteria: mycoplasma pneumoniae and chlamydia pneumoniae. The best way to treat EBV, HHV6, CMV, mycoplasma or chlamydia is to first treat chronic Lyme disease and its coinfections by addressing all of the steps in The Successful Treatment Recipe. Often the immune system will work more effectively and control the CCI when Lyme disease and the coinfections are under control. However, after treating borrelia and the coinfections for 9 months or more without major improvements, then the CCI should be treated because they may also be an ongoing source of health problems and immune suppression. Yeast is another common infection that occurs in those with chronic Lyme disease. For a discussion of this problem and treatment options see Chapter Sixteen: Yeast. To decide which infections a person has, there is effective testing for the CCI. The best approach is to see if there are marked elevations in the IGG family of antibodies. Marked elevations of these antibodies indicate that the CCIs are active. For borrelia, the most useful test is a western blot performed by an independent lab which reports the antibody pattern against 14 kinds of proteins found on the covering. There is also a blood culture that can be done for borrelia, but it takes 2 months to get a final result and is much more expensive than the western blot. Testing for borrelia is not perfect and at best is positive 80% of the time when a person has chronic Lyme disease. Some studies indicate it is less accurate that 80%. As the US Centers for Disease Control and Prevention notes, Lyme disease is always a clinical diagnosis. One can have Lyme disease with negative testing. Babesia testing is not perfect either. Some estimate that there are 15 or more strains, but current testing can only detect antibodies against 2 strains. Bartonella testing 50 is also not perfect. By some estimates there are 30 or more strains of bartonella or bartonellalikeorganisms while antibody testing exists for two strains only. For both Babesia and Bartonella, there are additional tests that can be performed, but these other tests have many flaws as well and have high false negative rates. This means a person can have these infections even when these other tests are negative. For ehrlichia and anaplasma, there is effective antibody testing available. Because of the flaws in testing, Lyme literate medical doctors will often treat for borrelia, bartonella, or babesia based on symptoms alone. For lists of common borrelia, babesia, and bartonella symptoms refer to related articles at Treat Lyme and Associated Diseases (www.treatlyme.net). A person should see a Lyme literate medical doctor (MD, ND, NMD, or DO) to determine if they have coinfections based on symptoms even when testing is negative. There are natural medicine treatment options for HHV6, EBV, CMV, borrelia, babesia, and bartonella. However, based on our experience the prescriptive antibiotics are the most effective treatment for bartonella, and the only effective treatments for mycoplasma pneumoniae and chlamydia pneumoniae. While they are not presented here there are also effective prescriptive antibiotic and antiviral treatments for all of the CCIs, borrelia and the coinfections. For borrelia, some holistic doctors rely on the Cowden protocol and the Buehner herbal protocol. These treatments are found elsewhere on the internet. However, in our experience these herbal protocols have limited success in getting a person optimally well. They can however keep Lyme disease in remission and prevent relapse once a full treatment is completed. There are a variety of herbs that treat borrelia. These include, but are note limited to, cat's claw, Otoba bark extract, andrographis, teasel, cumanda, and grapefruit seed extract. Of these, the best option is a combination of Otoba bark extract and cat's claw. According to the work of Eva Sapi, Phd, Otoba bark extract and cat's claw used together treat the various borrelia forms including the spirochetes and cysts. This combination also eradicates biofilms. Based on our clinical experience it works 85% to 90% of the time as both a frontline treatment and for dormant borrelia. For a frontline treatment it appears to have as great a chance of helping as any oral prescription antibiotic combination. In dormant borrelia, the germ exists primarily in cyst forms and biofilm communities. Biofilms are layers of slime that cover germs. They block antibiotics and prevent the immune system from reaching the germs. Grapefruit seed extract effectively treats borrelia cysts. It should be used in combination with prescriptive antibiotics that treat the other forms of borrelia. Antimicrobials that treat malaria also treat babesia. Effective herbal treatment for these infections are artemisinin and cryptolepis. The World Health Organization 51 recommends artemisinin as a frontline treatment for malaria. Because the intestines develop enzymes that deactivate artemisinin with prolonged use, it is best to use it with pulsedosing. Typically the intestines develop the deactivating enzyme after three days of use. Cryptolepis is an herb from Ghana used to treat malaria with great success. Over the past year we have used it with good success, although it appears to have less effectiveness than artemisinin. Olive leaf extract and monolaurin are antiviral herbs that treat EBV, CMV, and HHV6. When treating these viruses it is also helpful to turn on the antiviral components of the immune system with reishi mushrooms and thymic protein A. For more information about how reishi mushrooms and thymic protein A work, see the Chapter Eleven: Immune System. Our Recommendations Borrelia Take Otoba bark extract and cat’s claw in combination. Do not take these herbs in the time period that begins 30 minutes before through 2 hours after taking food, medicines or supplements. Otoba Bark Extract. Banderol (Nutramedix) 5 drops in water 2 times a day and increase by 1 drop per dose every other day till at 30 drops 2 times a day. If a Herxheimer Dieoff reaction develops, do not advance the dose until the reaction decreases. Cat’s Claw. Samento (Nutramedix) 5 drops in water 2 times a day and increase by 1 drop per dose every other day till at 15 drops 2 times a day. If dieoff reaction develops, do not advance the dose till the reaction decreases. Grapefruit Seed Extract. Grapefruit Seed Extract (Pure Encapsulations) 1 pill 2 times a day. Babesia Start with artemisinin. It seems to work more often than cryptolepis. A usual length of treatment for babesia is 45 months. It may take 12 months to see improvement in babesia symptoms. If no improvement then change to cryptolepis. 52 Artemisinin. Artemisinin (Allergy Research) 3 to 5 pills 3 times a day for 3 days in a row of a 14 day cycle. Continue to cycle by taking for 3 days followed by 11 days off. Treat for a minimum of 5 months. Start at 3 pills and increase after the first 3 day period to 4 pills per dose if there is no worsening of symptoms. If tolerating at 4 pills per dose, then increase to 5 pills per dose at the next 3 day period. Cryptolepis. Cryptolepis (Woodland Essence) 5 ml 3 times a day. Bartonella Always start with prescriptive medicine options first which have a greater chance of success. But if these are not tolerated or ineffective then try the herbal combination product. Herbal Combination. ABart (Byron White Formulas) use as directed by your physician. Byron White Formulas are only available through registered practitioners. EBV, CMV, HHV6 Use either monolaurin or olive leaf extract in combination with both the thymic protein A and reishi mushrooms. Olive leaf extract is best, but if it is not tolerated, then switch to monolaurin. Monolaurin. Monolaurin (Ecological Formulas) 1 pill 3 times a day. Increase up to 3 pills 3 times a day as tolerated. Do not advance the dosing till any dieoffreaction or worsening of symptoms decline. Olive Leaf Extract. Olive Leaf Extract (Thorne) 1 pill 3 times a day. Increase up to 3 pills 3 times a day as tolerated. Do not advance the dosing until any dieoffreaction or worsening of symptoms decline. Thymic Protein A. Proboost (Proboost) 1 packet under the tongue 2 or 3 times a day. Three times a day is best. Reishi Mushrooms. Reishi Gano 161 (JHS Natural Products) 1 pill 3 times a day. 53 Thirteen: Mental Health It is common for people who have Lyme disease and associated diseases to have mental health issues. These issues are either ● reactive: a normal and understandable reaction to feeling ill, or ● organic: caused by the the Lyme germ or the Lyme disease coinfections. Depression and anxiety are the most common issues but mental health problems can also include manic depression (bipolar illness), obsession and compulsion, attention deficit and hyperactivity, and other mental health problems. (To be clear, the mental health issues as part of Lyme disease are correctly diagnosed as mental health problems. By comparison some are also told all of the symptoms they experience with Lyme disease are somatic or in their heads and that essentially they are crazy. These diagnosis and opinions are incorrect. Wrongly, doctors who do not understand or who deny chronic Lyme disease say that problems with the illness are solvable with a good counselor and psychiatric medications.) Symptoms of depression can include: ● a feeling of hopelessness, ● difficulty falling or staying asleep, ● decreased interest in the things a person normally likes to do, ● guilty feelings, ● poor concentration, ● decreased energy, ● increased or decreased appetite, ● suicide or escape thinking, and ● thinking over a problem again and again. Anxiety is also common and can be generalized and ongoing with some hills and valleys or can occur in extreme waves from out of nowhere as panic attacks. As noted above there are also other mental health problems. However, supplements are mainly useful for depression and anxiety so this guideline addresses these mental health issues only. Ultimately, treating the mental health problems seen in Lyme and associated disease requires treating the underlying infections. The Lyme germ itself can cause the full range of mental health issues described here. Bartonella, one of the coinfections, is known to cause the full range of mental health disorders too, and is commonly the cause of ongoing anxiety and restlessness as well as depression. Babesia is known for causing 54 anxiety panic attacks. To sort out the germs causing mental health problems and to receive correct germ treatment with antimicrobials, see a Lyme literate medical doctor. In some cases treating with supplements is not enough. In these situations people may benefit from seeing a mental health professional for prescription or psychotherapy management. Hypericum perforatum (St. John’s wort) is a commonly used herb for depression. It is not entirely clear how it works. 5 hydroxytryptophan is a building block that raises the neurotransmitter serotonin in the brain. Increased serotonin can alleviate depression and anxiety. (By comparison common antidepressants from the SSRI family like prozac, zoloft, paxil, and celexa decrease the brain's removal of serotonin leading to higher brain levels.) LTheanine is an amino acid prologue that decreases nerve hyperexcitability and can raise the neurotransmitter gaba that calms nerves. Lithium orotate at supportive dosing changes neurotransmitters so there is calming. Dosing used to calm is 15 to 30 mg a day compared to prescriptive dosing of 600 mg to 900 mg a day used to treat manic depression. An herbal combination product can contain a variety of calming herbs for the treatment of anxiety. Our Recommendations Depression Start with either hypericum perforatum or 5 hydroxytryptophan. In 3 weeks if no benefit is seen then change to the other. (Note that neither one of these herbs should be taken with prescriptive antidepression medicines because they may cause serotonin syndrome that could lead to death.) Hypericum Perforatum. St. John’s Wort Plus (Genestra) 1 pill 3 times a day. 5 Hydroxytryptophan. 5 hydroxytryptophan (Thorne) 2 pills 3 times a day. Anxiety Start with Ltheanine for anxiety alone. For depression with anxiety start with 5 hydroxyryptophan. Try the lithium orotate and the herbal combination product alone or in combination with Ltheanine or the 5 hydroxytryptophan. LTheanine. LTheanine (Integrative Therapeutics) 1 to 3 pills 3 times a day (do not exceed 12 pills in 24 hour period). Adjust amount based on pain response and sleepiness. 55 5 Hydroxytryptophan. 5 hydroxytryptophan (Thorne) 1 2 pills 3 times a day. Try 1 pill 3 times daily intially for 2 weeks and if not effective enough then increase to 2 pills 3 times a day. Lithium Orotate. Lithium Orotate (Pure Encapsulations) 12 pills 3 times a day. Herbal Combination. Herbal Calm (Genestra) 1 to 2 pills 3 times a day. 56 Fourteen: Pain Pain is the result of inflammation and direct injury of certain tissues. In Lyme, white blood cells that attack germs produce inflammatory cytokines like interleukin6 and tissue necrosis factor alpha. These cytokines have many effects that ultimately produce inflammatory prostaglandins and hypercoagulability (easy clotting) of the blood. Hypercoagulability can lead to poor blood flow into tissues fed by small blood vessels because the blood becomes more "sticky". This can lead to poor oxygenation of all tissues including the muscles. When muscles do not receive sufficient oxygen they ache and can develop spasms. Common overthecounter treatments for pain like ibuprofen and aspirin lower prostaglandins by blocking COX enzymes that are used to produce them. One way that cytokines increase pain is to increase the production of COX enzymes. Treatment approaches to reduce pain in Lyme work to lower inflammatory cytokines, decrease prostaglandins, improve blood flow to the tissues, and decrease muscle spasms. Limit inflammatory cytokines. Based on the work of Martin Pall, PhD, antioxidants lower oxidizing agents that trigger cytokine production. Ecklonia cava extract derived from seaweed is a potent oral antioxidant which seems to have greater effect than other ones. Quercetin, an antioxidant bioflavonoid, is also an inflammatory kinase inhibitor. Kinases are enzymes required in the production of cytokines. Blocking kinases with quercetin interferes with the cytokine production line. Curcumin decreases inflammatory cytokine production too through a variety of intracellular mechanisms. Omega3 fatty acids also decrease cytokine production. Limit inflammatory prostaglandins. Curcumin and quercetin interfere with COX enzymes. Omega3 fatty acids found in fishoil also limit the production of prostaglandins through a variety of mechanisms. Note: curcumin found in food does not have these clinical effects because it is too poorly absorbed. Improve tissue blood flow. Warm baths and infrared saunas are helpful because they lead to dilation of the small blood vessels which increases tissue oxygenation. Lumbrokinase, an enzyme from earthworms, can decrease the stickiness of the blood. Decrease Muscle Spasm. Magnesium helps reduce muscle spasm. Of the various forms of magnesium, magnesium malate (malic acid) works best. Neurological Pain This is a unique type of pain due to nerve inflammation and injury. It has a variety of 57 qualities including burning, stabbing, sharp, fire, and electric. Alpha lipoic acid, an antioxidant that is used to produce intracellular glutathione, repairs injured nerves and can help nerve pain. LTheanine is an amino acid derivative that raises the neurotransmitter GABA. Increased GABA can decrease agitation, insomnia, and neurologic pain. Our Recommendations Basic approach: Take curcumin and omega3 oil for pain. If this is not effective then add ecklonia cava with or without quercetin. When starting a treatment or when making a change, give 23 weeks to see the benefit. Curcumin. Meriva 500 (Thorne) 12 pills 3 times a day. This is a special phytosome formulation that increases absorption and duration of the curcumin. Ecklonia cava. Fibroboost (Allergy Research) 2 pills 2 or 3 times a day. Omega3 fatty acids. Eskimo3 (Integrative Therapeutics) 3 pills 1 time a day. This is a mercury free source. Quercetin. Quercetone (Thorne) 2 pills 3 times a day. The inclusion of chalone increases the absorption. Muscle pain: Heat the body through warm baths or far infrared sauna. Start slow at about 10 to 15 min for each because the increase blood flow may trigger die off reactions. Build up to 30 min at a time daily if tolerated. Also use magnesium malate. If this is not effective then do a trial of lumbrokinase for 12 months. Be aware that this too could trigger a dieoff reaction from increase blood flow and the removal of biofilms. Magnesium malate. Magnesium Citramate (Thorne) 1 pill 3 times a day. Take away from certain antibiotics including Biaxin and Zithromax. Lumbrokinase. Lumbrokinase (Allergy Research) 20mg 1 pill 2 times a day on an empty stomach except water by 1 hour either side of taking it. Neurological pain: Take this in addition to the basic approach. Start with Ltheanine first only if there is insomnia and anxiousness or agitation too. You can take both of these together. Alpha Lipoic Acid. Super Lipoic Acid (Seroyal/Genestra) 1 pill 2 times a day. 58 May take a number of months to see the benefit. LTheanine. LTheanine (Integrative Therapeutics) 1 to 3 pills 3 times a day (do not exceed 12 pills in 24 hour period). Adjust amount based on pain response and sleepiness. Also see Chapter Two: Required Supplements and take End Fatigue Energy Enfusion (Integrative Therapeutics) or Mediclear (Thorne). Both of these multivitamins are packed full of essential antioxidants and nutrients that work to lower cytokines by decreasing the production of oxidizing agents and removing them. 59 Fifteen: Sleep Sleep is often disturbed in chronic Lyme disease. 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 79 hours of sleep a night. Sleep during the few hours before midnight is most restorative. The best way to get sleep is through good sleep hygiene. This includes: ● having the same designated sleep time each night no later than 10:00 PM, ● initiating sleep no more than 30 minutes from the designated sleep time nightly, ● if using sleep medicines or supplements, take them one hour before the designated sleep time, ● no alcohol before bed, ● avoiding caffeine later in the day, ● not performing work in bed, ● eating a small protein snack before bed time to avoid low blood sugar wakening in the middle of the night, and ● keeping your room cool and dark. A variety of herbs can help with sleep as can prescriptive medicines. Often given the severity of the sleep disturbances seen in chronic Lyme disease, prescriptive options are necessary. It is common to layer supplements and prescriptive medicines together. Herbs that induce sleep do so through a variety of mechanisms. Some like Ltheanine, GABA, and 5hydroxytryptophan raise neurotransmitters that induce sleep. Others like valerian root interact with GABA brain receptors on nerves that induce sleep. Some sleep herbal combination products include a variety of sleep herbs like valerian, wild lettuce, ltheanine, and hops. The hormone melatonin is produced by the brain in relation to light exposure. Daytime light suppresses its production. Before sleep time there is a natural surge in production which induces sleep. Melatonin seems to work best in those with sleep cycle disturbances. It helps restore a natural sleep cycle if it is taken 1 hour before the designated sleep time. To correct sleep cycle disturbances move the designated sleep time back slowly in 15 minute increments every 3 to 7 days. Our Recommendations Try any of the following herbs alone or in combination. Be careful when mixing the Ltheanine products of Zen and the End Fatigue Revitalizing Sleep formula because 60 both contain ltheanine. Try to limit the total ltheanine a night to no more than 600 mg. Each product should help within 1 to 2 nights. If one helps partially, but not all the way consider taking in combination with another. If the herbs do not work, then see your healthcare practitioner for prescription sleep medications to obtain 79 hours of sleep a night. Melatonin. Melatonin 1 mg (Physiologics) or Melaton3 (Thorne) 1 or 3 mg 1 hour before the designated sleep time. Find the dose that works best. Do not exceed 9mg a night. Do not take during the day due to cancer risk. 5Hydroxytryptophan. 5Hydroxytryptophan (Thorne) 4 to 8 pills 1 hour before bed. Start at 4 pills and increase nightly by 1 pill till to a maximum of 8 pills if needed. (Warning: Do not take if using antidepressant prescriptive medications because this could result in very high serotonin levels in the brain which could result in death.) LTheanine/GABA. 200mg of Zen (Allergy Research) 1 to 3 pills a night 1 hour before bed. Do not exceed 1200 mg a day if using for nerve pain or anxiety during the day too. Excessive amounts in the day are very sedating. Herbal Combination Product. End Fatigue Revitalizing Sleep Formula (Integrative Therapeutics) 1 to 4 pills 1 hour before bed. 61 Sixteen: Yeast Too many yeast in the intestines (yeast overgrowth) is a common problem that occurs in those with chronic Lyme disease either during treatment or prior to beginning treatment. Yeast overgrowth can result in an ongoing systemic allergic reaction to the yeast that can suppress the immune system. It may also lead to inflammatory cytokine and oxidizing agent excess that lead to many of the Lyme disease symptoms and pain. Food allergies and sensitivities can be the result of yeast overgrowth too. Healthy functioning intestines are populated with a balance of good bacteria and yeast. The yeast and bacteria compete with each other for intestinal territory. Good bacteria decline due to the use of antibiotics, environmental stresses, immune suppression from chronic illness, the use of steroids, and/or other factors. When this happens, yeast grow to take over the territory vacated by the good bacteria. The imbalance of yeast and bacteria is called dysbiosis. Dysbiosis leads to leaky gut syndrome and poor digestion. In leaky gut syndrome toxins and allergic agents are absorbed into the bloodstream creating toxin excess, inflammation, and allergic reactions. Indigestion can also occur because there is poor breakdown and absorption of nutrients in the intestines. Diagnosing and Deciding to Treat Yeast Overgrowth There is not a useful diagnostic blood test or stool test for yeast overgrowth. While some may test for antibodies in the blood to intestinal yeast, antibodies are common even when yeast are in balance. In addition it is normal to have stool cultures grow yeast; so a culture does not indicate if yeast are in excess. For that reason, yeast are diagnosed using a screening questionnaire (see http://www.treatlyme.net/storage/documents/yeast.pdf). This questionnaire evaluates for the possibility of yeast overgrowth based on yeast overgrowth risk factors and intensity of symptoms. In general, people benefit from treatment if the score is 140 or higher. At the beginning of a Lyme disease treatment, often before antibiotics are started it is essential to treat yeast. Doing so can limit the severity of dieoff reactions from treating Lyme because removing yeast, removes one source of inflammatory cytokine excess. Typically dieoff reactions trigger cytokine excess which result in the dieoff reaction symptoms. Another time to consider diagnosing and treating yeast overgrowth during treatment is whenever there is an unexplainable worsening of symptoms with or without clear signs of yeast overgrowth. Excessive yeast lead to more inflammatory cytokines. Excess cytokines are what produce many of the symptoms of Lyme disease. During a decline of health, in addition to the possibility of an increase in Lyme germ or coinfection activity 62 producing cytokine excess, yeast overgrowth should be considered. Preventing and Treating Yeast Overgrowth While on bacterial antimicrobials during treatment it is essential to replace healthy bacteria with an intestinal probiotic. At times herbal antiyeast treatments are needed too and include herbal antiyeast combination products with volatile oils like rosemary and thyme, peau d'arco, caprylic acid, and grapefruit seed extract. Garlic or grapefruit seed extract alone at the proper dose can remove excessive yeast too. If herbal options do not work, then prevention or even full treatment with prescriptive medications is necessary. Our Recommendations Active yeast overgrowth treatment: (Warning: Treating yeast can trigger a Herxherimer dieoff reaction. If this occurs, see Chapter Nine: Herxheimer Dieoff Reaction and Cytokines.) At the beginning of treatment either prior to starting bacterial antimicrobials or as they are initiated most people with a yeast screening score over 140 benefit from treating yeast. Anyone with a rapid decline in symptoms may have yeast overgrowth too (see discussion above). Probiotic. HMF (Seroyal/Genestra) is one of the few probiotics on the market shown to repopulate the intestines in scientific studies. Take at least 2 pills daily at least 1 hour away from antibiotics. During an active yeast infection consider increasing to 4 pills daily either one time a day or divided in to two doses. (Excessive amounts of probiotics have lead to blood infections so do not exceed 4 pills daily unless directed to do so by your healthcare practitioner.) Herbal AntiYeast Combination. Phytostan (Integrative therapeutics) 2 to 3 capsules 2 to 3 times a day. This will likely take 34 months to get yeast fully under control. (See your physician for a prescription combination of diflucan and nystatin that can work within a month to have yeast control if time is an issue.) Yeast prevention: Always take the probiotic. If there has been an active yeast infection in the past or one that develops during treatment then use either the herbal antiyeast combination, garlic, 63 or grapefruit seed extract. Probiotic. HMF (Seroyal/Genestra) is one of the few probiotics on the market shown to repopulate the intestines in scientific studies. Take at least 2 pills daily at least 1 hour away from antibiotics. During an active yeast infection consider increasing to 4 pills daily either one time a day or divided in two doses. Herbal AntiYeast Combination. Phytostan (Integrative therapeutics) 2 capsules 2 times a day. Garlic. Garlic (Allergy Research) 23 pills 3 times a day. Start at 1 pill 3 times a day and add 1 pill per day till you have a dieoff reaction or until at the maximum dose. Grapefruit Seed Extract. Grapefruit Seed Extract (Pure Encapsulations) 1 pill 2 times a day. 64
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