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From the Townsend Letter
July 2015

Multifactorial Approaches to Lyme Infection
by Dan Kenner, PhD, LAc
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The term Lyme-literate is used to describe physicians and health-care providers who regard Lyme disease as a complex multifactorial and hydra-headed clinical syndrome. There are numerous challenges to understanding the complex nature of its clinical manifestations and developing an effective approach to treatment. The 19th-century reductionist model of a pathogenic microbe as the sole cause of a disease and the corollary notion of curing the disease by killing the "bad germ" is obsolete for treating persistent chronic infections.
This reductionist viewpoint limits thinking. A treatment goal of killing the pathogen microbe is the traditional formula for failure. The clinical strategy of a systems biology viewpoint is not to attempt to kill the microbe by direct contact with a poisoning drug, but to change its habitat. A healthy condition of the gut and tissues will not support the overgrowth of toxic microbes. This is the traditional view of German biological medicine and the French concept of the terrain.
In German biological medicine, the model proposed by Dr. Hans-Heinrich Reckeweg in his seminal work Homotoxicology classifies all pathological phenomena in a system of nosological units based on each tissue of the body according to its stage of deterioration. Reckeweg developed a flow chart to be used as a fundamental model. His chart had a vertical line listing all of the body's tissues, grouped according to their embryonic origin. In the horizontal aspect, he listed 6 stages of pathological development, three "Humoral" phases and three "Cellular" phases. Phase One is the "Excretion Phase," followed by the "Reaction Phase," which is acute inflammation; and the Deposition, Impregnation, Degeneration, and Neoplasm Phases represent a nosology of disease vectors. Movement from Phase One toward Phase Six maps the decline of the body's structural and functional integrity. This model is called "The Health-Disease Continuum." In the early "humoral" phases of pathology, the principle of regulation is excretion of pathogens and all harmful elements. In the cellular phases, the principle is precipitation of nocive substances and a resulting congestion of the extracellular matrix, which is referred to by its older term, the mesenchyme. This congestion results in a loss of functionality and a chronic inflammatory condition or degeneration of proximate tissues as cells are deprived of nutrients and bathed in their waste products. One of the main characteristics of chronic disease in this model is the congestion and subsequent erosion of the matrix tissues and the ground substance, the intercellular material in which the cells and fibers of the connective tissue are embedded.
One of the important treatment strategies to relieve congestion is drainage, which is the process of removing obstruction and restoring what Reckeweg called "the dynamic flow" of the tissue fluids at this level of anatomical structure.
The term used to describe a model of the condition of the whole system is the terrain, a term in use since the late 19th century in France in the era of Louis Pasteur and Claude Bernard. The terrain concept was originally a description of the body's fluids and the system of metabolism in its entirety. The most prominent proponent of the terrain philosophy was the famous physiologist Claude Bernard. Bernard proposed that the factors regulating the cellular environment play a primary role in the functioning of the organism as opposed to external factors. Bernard was famously at odds with the equally prominent and internationally famous Louis Pasteur when he said, "The germ is nothing; the terrain is everything." Pasteur's discoveries led to the "germ theory" of disease, in which toxic microbes are considered to be responsible for their related infectious diseases. In the terrain theory, treating an infection requires changing the microbial habitat; that is, the body's global condition, rather than simply attempting to kill a single type of microbe. Bernard also referred to the terrain as the internal medium (milieu intérieur). 
Of course external factors such as toxic microbes can also play an important role in pathogenesis, but Bernard and the terrain-model advocates claimed that disease germs were a trigger and a marker for infectious disease, but the actual cause was the internal predisposition or weakness in the body's internal environment. This emphasis on a person's biological individuality means that a terrain model is much more complex than a simple cataloging of diseases and the germs that supposedly cause them. In chronic infections, the terrain concept may be superior "software" for dealing with its inherent complexity.
Lyme disease in its chronic form is sometimes called "tick-borne illness" because of coinfections by other microbes including Babesia, Bartonella, Ehrlichia, Mycoplasma, and others. In addition, opportunistic infections with the yeast Candida albicans, the bacterium Brucella, and a host of viruses including herpes 1 and 2, HHV-6, Epstein-Barr, Coxsackie, and cytomegalovirus have been reported.

Kristine Gedroic, MD
An increasing number of doctors are developing new strategies to accommodate the needs of patients with the range of symptoms attributed to chronic Lyme disease. Kristine Gedroic, MD, is the founder of the Gedroic Center for Integrative Medicine in Morristown, New Jersey. Her approach to Lyme disease reflects this view of a complex pathological syndrome, not as a specific entity with a microbial etiology (i.e., Koch's postulates), but an intricate set of interactions between the host and microbe populations. She uses various botanical, biological, and homeopathic medications in an integrative approach that involves detoxification of environmental toxins and heavy metals, correcting gut dysbiosis, draining and unburdening the extracellular matrix, and assisting the patient in cultivating lifestyle habits that support positive treatment outcomes.
Relieving congestion in the extracellular matrix is of primary importance in her treatment approach. For cellular detoxification to occur and to facilitate the clearance of microbes, the matrix must be detoxified in order to accommodate the flow of microbial debris. The body possesses an innate flow system that represents the natural inertia of healing. In the ideal scenario, the practitioner is able to harness this mechanism to facilitate the healing process naturally. Gedroic also believes that the cell membrane disruption is at the root of chronic Borrelia infection. She uses several diagnostic tests from Stony Brook University, Fry Labs, IgeneX Labs, Advanced Labs, Doctor's Data and Vitamin Diagnostics, BodyBio, as well as national labs – Quest, LabCorp, and BioReference, in order to run a comprehensive panel that assesses global balance of the immune system, as well as nutritional deficiencies that may be confounding the treatment paradigm. Testing can identify the presence of various toxins, as well as the presence of coinfections from Bartonella, Babesia, Ehrlichia, Mycoplasmas, Chlamydias, viruses, and Protomyxzoa.
For a qualitative assessment of the patient's condition, she emphasizes the importance of using the Stained Blood Film Test (epierythrocytic bacteria) from Fry Labs to evaluate the presence of biofilms. Gedroic says, "If I could only do one test, it would be this. It gives a visual read on the degree of polymicrobial infection and congestion of the matrix."
Biofilms are multicellular communities held together by a self-produced extracellular matrix. The CDC estimates that 65% of infection today involves biofilms. Estimates suggest that biofilms are up to 1000 times more resistant to antibiotics than planktonic forms.
Constitutional assessment is another important factor to determine if the patient can withstand stimulation or a challenge to the immune resources; that is, if a patient is "stable" or "depleted." The depleted patient may require additional nutrient and herbal support.
does not necessarily make someone symptomatic. It is opportunistic and takes advantage of a compromised host. Sometimes the Lyme microbes are simply there and don't play as important a role in the chronic nature of the problem. These are cases that need to be approached differently. This is described as membrane instability: when a patient's cellular membranes are impaired to the extent that they are not capable of maintaining immune regulation. In these cases, Borrelia is often only a small part of the problem. Once cellular membrane integrity is restored, symptoms abate. Antibiotics are rarely needed for longer than 2 or 3 months. If the patient continues to be symptomatic, it means that a different pathogen is dominant or cellular integrity needs to be restored.
The PEKANA medications play an important role for regulation and drainage of the matrix. Biological medicines from Syntrion and SanPharma are considered immunomodulatory or "cellular reprogramming therapy" and are vital to immune support for treatment of infections. SyImmune is important for latent infections and to nudge the immune system out of anergy, SyCircue for inflammation and matrix congestion, SyResp and SyGest for gut dysbiosis, SyRegule for fungal infections, and SyInfect as a broad-spectrum agent for infections. SanPharma medications have similar effects for infections, inflammation, and dysbiosis. Herbal tinctures from Beyond Balance are also used for disinfection, detoxification, and inflammation. Gedroic likes the traditional Ayurvedic herb guggul (Commiphora wightii) for treatment of biofilms.
Treatment of gut dysbiosis often requires a combination of the paleo diet with probiotics and GI Repair Nutrients (from Vital Nutrients).
Her favorite protocol is:
SyGest or SyFungin (Syntrion): ½ tab to 1 tab t.i.d.
Apo-STOM +/− SyDetox (PEKANA/Syntrion): 5 drops b.i.d. to ½ tsp b.i.d.
Opsonat (PEKANA): 3 drops daily to 15 drops b.i.d.
Core Pau D'Arco (Energetix): 5 drops daily to 30 drops b.i.d.
Core Berberine Blend (Energetix): 5 drops daily to 30 drops b.i.d.

Stabilization of the nervous system: PsyStabil (PEKANA):
    Viscum (PEKANA)
    SyDetox (Syntrion)
    SyCircue (Syntrion)
Dalektro N (PEKANA), E-Lyte (BodyBio)
SR3 Balance Oil
Phosphatidylcholine (BodyBio or Nutrasal)
The triad of apo-STOM, SyDetox, and Viscum is particularly effective as a starting point.

Intravenous treatment can be a decisive element in intractable cases. Gedroic has discovered that intravenous phosphatidyl choline can break up the congestive membranes of biofilms. This is sometimes followed up with IV glutathione. Additional detoxification measures may also be taken intravenously.

Countermeasures for Herxheimer reactions:
Increase drainage of the extracellular matrix
Parsley/burbur/Pinella from NutraMedix
Options for alkalinization:
    Alka-Seltzer Gold
    Magnesium carbonate
      (BodyBio or BioTech)
    Potassium bicarb (BioTech)
    Lemon water
Gedroic notes that since the introduction of matrix drainage and German biological medicine therapies, there has been a 75% reduction in Herxheimer reactions in her practice.
Gedroic's research projects are under the umbrella of the Gedroic Research Initiative (GRI), associated with the Institute for Infectious and Inflammatory Disease (I3D) at Rutgers University, a project with more than 2000 contributing scientists. One proposed study is designed to assess the impact of helminthic infections in the gut microbiome and host susceptibility, another is to evaluate the influence of biofilms and molds on the intractability of chronic infection. A third research project involves examination of the effect of occult viral infection on ADHD.

Ann Corson, MD
Another physician who specializes in treatment of chronic infections in all their complexity is Ann Corson, MD, of Cochranville, Pennsylvania. To explain the complexities of how she treats a chronic infection, Corson uses a very vivid depiction of the terrain: "I'm not just going into battle. I need to get the lay of the land and get the situation to my advantage. I have to destroy the enemy and carry the dead bodies away and then break down the debris. Then, the battlefield needs to be cleaned up and restored. This can take time." This metaphor also describes the strategy of drainage of the extracellular matrix. This is how Corson has adapted the principles of German biological medicine to serve the needs of her patients.
Corson explains that German biological medicine provides a framework for restoration of overall vitality, gastrointestinal function, and endothelial integrity; for drainage of the extracellular matrix, restoration of GALT, MALT, spleen and bone marrow function, and assistance in the regulation of neuroimmune, neuroendocrine, and neurovascular control mechanisms. It is necessary to have a complex model because there are multiple challenges in treating patients with tick-borne disease: polymicrobial infections with all classes of organisms, gut dysbiosis, liver/gallbladder dysfunction, hormonal and metabolic dysfunction, systemic inflammation – unregulated and stuck in the "on" position, vasculitis and hypercoagulability, a toxin-encumbered extracellular matrix, metabolic faults in detoxification, mitochondrial dysfunction, and immune-system/bone marrow dysfunction.
For stable improvement, it's necessary to address all of these issues and take countermeasures as required. These include the control or elimination of dominant pathogenic microbes, elimination of environmental toxins, reduction of inflammation and neuroexcitotoxins, restoration of gut and respiratory mucosal integrity, the buffering and elimination of hypercoagulation, the support of genetic and epigenetic weaknesses and restoration of neuroendocrine system function. It requires identifying allergies to food or environmental factors, lifestyle changes, stress reduction to address emotional and spiritual needs, and, often, structural work. Throughout treatment it is to helpful to mitigate the effects of treatment such as Herxheimer reactions as progress is monitored.
Evaluation of each patient's needs requires a thorough history, physical examination, and strategic laboratory testing. A full history includes details from conception to the present, trauma history, both physical and emotional, surgical and dental history, and family history. A social history includes details of home, work, and school as well as environmental issues such as mold exposure, EMFs in home or work environment, and any arthropod insect exposure risk factors. History and physical exam include a history of symptoms and their time of onset, a complete review of systems, vital signs, and physical and neurological examination.
Laboratory evaluation necessarily includes tests for many classes of infection, a full medical workup with CBC with differential, CMP, UA, HLA typing for biotoxin illness, methylation genetic profiling, hypercoagulability evaluation, inflammatory cytokines, and autoimmune makers. Other important tests include hormonal evaluation, stool testing, food allergy assessment, urinary kryptopyrroles (KPU), heavy metal challenge test, and nagalase testing.

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