By Darin Ingels, ND, FAAEM

Lyme disease has become the fastest growing insect-borne infectious disease in the United States, Europe, and Asia. More than 476,000 people each year in the United States¹ and 65,000 people in Europe² are affected by this epidemic—and this number seems to climb every year.

Lyme disease is named after its origins in Lyme, Connecticut, where an unusually high number of children experienced unexplained arthritis in the late 1970s. After several years of research, Dr. Willy Burgdorfer identified the underlying cause of these children’s illness as a newly identified spirochete, so was named Borrelia burgdorferi.

There are over 100 different species of Borrelia in the United States and more than 300 worldwide. The most common, Borrelia burgdorferi, with 15 subspecies, causes most of the cases of Lyme disease in the United States.³ Othercommon species responsible for Lyme in the United States and Europe are Borrelia garinii, Borrelia afzelii, and Borrelia miyamotoi.⁴ Most Borrelia infections are acquired through a deer tick bite (Ixodes scapularis on the west coast of the USA and Ixodes pacificus on the east coast). However, there is some evidence that other biting insects may also carry and spread Lyme disease.⁵

The conventional medical understanding of Lyme disease is somewhat limited to those who have acute infection, whereas “chronic” Lyme disease or post-Lyme syndrome has become more controversial and has poor consensus among physicians about the best way to diagnose it and treat it.⁶

An acute case of Lyme disease consists of symptoms that develop within days or weeks of a tick bite and may be treated relatively easily at the outset. Newer research suggests that Lyme disease may become persistent or chronic, and that some of the Borrelia bacteria are resistant to antibiotic therapies. These “persister cells” become persistent, leading to ongoing symptoms in patients, despite having undergone treatment.⁷ However, in this author’s opinion, both types of Lyme are misunderstood.

The early acute phase of Lyme disease generally occurs from three to thirty days after a tick bite. Symptoms may include the following⁸:

• Fever
• Chills
• Throbbing headaches or migraines
• Profound fatigue
• Neuropathy
• Muscle and joint pain, especially migratory joint pain
• Swollen lymph nodes
• Bell’s palsy
• Erythema migrans (EM) rash (“bull’s eye rash”)

The most well-known and characteristic symptom of the acute phase is the EM or bull’s eye rash. It begins at the site of a tick bite, expanding until it reaches up to 12 inches or more in diameter. Rarely itchy or painful, this rash sometimes clears as it enlarges, so that it resembles a target or “bull’s eye.” The presence of the EM rash and migratory joint pain are both pathognomonic for Lyme disease.

It is important to note that many people experience few of these symptoms and often go misdiagnosed or underdiagnosed.⁹ Lyme disease is called “The Great Imitator,” since it looks like numerous other illnesses, so it is not uncommon for physicians to overlook Lyme disease as a cause and believe the symptoms are due to other etiologies. Lyme disease has been found in people who have been diagnosed with chronic fatigue syndrome, fibromyalgia, multiple sclerosis, mononucleosis, Parkinson’s disease, Alzheimer’s disease and many other illnesses.^10-12

People suffering from chronic Lyme disease can look clinically different and may present with any of the symptoms seen with acute Lyme disease, plus the following¹³:

• Abdominal pain and bowel changes,
• Memory loss or cognitive impairment,
• Light or sound sensitivity,
• Dizziness or vertigo,
• Sleep disturbances,
• Cardiac problems (mitral valve prolapse/MVP, heart block, palpitations, chest pain),
• Balance or coordination deficits,
• Endocrine disruption: hypothyroidism, irregular menses, etc.

The CDC states that some people with acute Lyme disease will go on to develop chronic Lyme disease or post-Lyme syndrome,¹⁴ but many Lyme-literate physicians feel this is more common than believed.

Lyme and Autoimmunity

Many symptoms seen with chronic or persistent Lyme can be attributed to autoimmunity. Some research found that outer-surface protein A (OspA), a protein integral in the outer surface of the Borrelia bacterium, is structurally similar to human lymphocyte function associated antigen-1 or hLFA-1.¹⁵ Since hLFA-1 is found on the surface of T cells, immune stimulation against OspA can cross-react through molecular mimicry and cause T-cell activation within the joints. This is what causes Lyme patients to develop chronic joint pain, even if they have been treated with antibiotics.

Several other proteins can be immune targets and induce autoimmunity, including endothelial cell growth factor (ECGF), apolipoprotein B-100, and annexin A2—which are commonly found in people with other autoimmune diseases, such as rheumatoid arthritis and lupus.¹⁶ One study found that auto-antibodies may be directed against the flagellar protein of Borrelia, cross-reacting with a peripheral nerve protein, causing numbness, tingling, and pain.¹⁷ There is also evidence that Lyme-reactive antibodies form against proteins in the brain, giving rise to neurological symptoms.¹⁸

Many of us in the Lyme community believe that chronic Lyme disease may be as much of an autoimmune disease as it is an infection. This is significant as treatment strategies may be altered so that treatment is not solely geared toward eradication of the infection, but a whole-body approach designed to help support the immune system, along with other affected systems (cardiovascular, neurological, etc.).

Lyme Testing:  Major Pitfalls of the Two-Tiered System

According to the CDC, Lyme disease is a clinical diagnosis,¹⁹ which means it is based on signs, symptoms, and history, not solely on a lab test alone. Lab testing for Lyme disease has been woefully inadequate for decades, due to the poor sensitivity and specificity of the testing itself. Currently, the CDC recommends a two-tier testing system starting with a Lyme screen test.

One study found that in 55 people with known Lyme disease, less than 46 percent of them had either IgG or IgM antibodies when first tested.²⁰ Another study found the Lyme screen test may only pick up about 56% of people who have Lyme disease.²¹ To make matters worse, the CDC guidelines do not recommend doing a Western blot if the Lyme screen is negative. However, the Western blot is a more sensitive and specific test. Research shows that the Western Blot is more accurate in diagnosing Lyme disease because it looks for very specific antibodies often seen in Lyme disease patients but not found in healthy controls.²²

With such poor sensitivity in standard conventional testing, it is no wonder so many people do not get a proper diagnosis. So the bottom line is a negative test does not exclude the possibility of having Lyme disease, but a positive test confirms exposure to the organism causing Lyme disease (albeit, there is some degree of false positivity²³). It is important to evaluate lab testing in conjunction with a patient’s clinical presentation. Someone could have been exposed to Borrelia and never got Lyme disease, but may still have antibodies in their blood. This is why it is necessary to always consider your patient’s symptoms before starting any treatment.

Conventional Treatment of Lyme Disease

The conventional medical treatment for Lyme disease is to take antibiotics for up to three weeks after diagnosis. Since Lyme disease was first discovered in 1982, this has been the recommendation of most government, medical, and public health organizations in the United States. While mainstream infectious disease doctors do not generally deviate from the CDC recommendations, others feel that the standard 21 days of antibiotic therapy are not enough to defeat Lyme disease. Many doctors who are members of the International Lyme and Associated Diseases Society (ILADS) will use longer courses of antibiotics, both oral and intravenous, for weeks, months, or even years. Using up to three or four antibiotics at once is now common.²⁴

Most bacteria replicate every 20 minutes, but Borrelia species replicate much slower, every 1 to 16 days. Since many antibiotics commonly used to treat Lyme disease only work when the organism is replicating (bacteriostatic), they are not effective when the organism is in a dormant state and therefore would take longer to eradicate the infection. Current guidelines from the CDC only address acute Lyme disease and do not address chronic Lyme disease at all.

Long-term antibiotic use kills off a large portion of your normal, healthy gut bacteria, which are necessary for maintaining the health of your immune system and fighting infection. The destruction of friendly bacteria creates a disrupted microbiome, making your immune system less efficient in getting rid of infections.²⁵ Long-term antibiotics can also lead to kidney and liver damage, as well as many other harmful side effects.^26,27

Although there is evidence that antibiotics can be effective in acute Lyme disease, studies on long-term antibiotic use either show no effectiveness at all, or limited benefits that stop when antibiotics are discontinued.^28-30

Herbal Treatment of Lyme Disease

In line with the tenets of naturopathic medicine, treating Lyme disease should encompass the whole person, including diet, lifestyle, comorbid conditions, immune status and environmental exposure, in addition to treating active infection. By taking a whole-body approach, it addresses many of the underlying factors that keep people with Lyme disease ill. The focus of this article is on the therapeutic use of herbal medicines in the treatment of Lyme disease and mitigating factors.

Herbal therapy has been used to treat various infections for thousands of years around the world. Many herbs found in our materia medica have antimicrobial, anti-inflammatory, demulcent, hepatoprotective, and immune-boosting properties. This gives the clinician the opportunity to find herbs that have the medicinal properties desired for each patient to custom-tailor each treatment regimen.

            A 2020 study from Johns Hopkins found Artemisia annua (sweet wormwood/sweet annie) and Uncaria tomentosa (cat’s claw)were effective at killing Borrelia in its stationary phase and both more effective than doxycycline and cefuroxime in-vitro.³¹ Artemisia annua has also been widely studied and used in treating malaria.³² Although distinctly different microbes, malaria (Plasmodium species) and Babesia species share similar characteristics in their ability to invade red blood cells and cause infection. Dr. Zhang and colleagues showed that Artemisia annua and other herbs were also effective against Babesia duncani.³³ Fortunately, many herbs that are effective against Lyme are also effective against many tick-borne coinfections. This may help simplify treatment protocols as any one herb may cover multiple infections.

            Uncaria tomentosa has numerous clinical benefits and has significant anti-inflammatory, antioxidant, immune stimulating, adaptogenic, and hepatoprotective benefits.^34,35 Specific oxindole alkaloids inhibit NF-kB, therefore reducing inflammation.³⁶ Dr. Eva Sapi reported in Townsend Letter in July 2010 that Uncaria tomentosa and Otaba species were more effective than doxycycline at eliminating Borrelia burgdorferi in both its spirochetal and round body forms, where doxycycline significantly increased round body forms.³⁷ This has been one of the most effective herbs I have used in the treatment of Lyme disease in targeting the organisms and reducing inflammation.

Houttuynia cordata (chameleon plant) has been used in traditional Chinese medicine to treat various inflammatory and infectious diseases. It has been a common herb used in China to treat another spirochete illness, leptospirosis.³⁸ The flavonoids and alkaloids possess anti-inflammatory and anti-oxidant properties.³⁹ Some of the essential oils found in Houttuynia have direct inhibitory activity against herpes simplex virus-1 (HSV-1), influenza virus and human immunodeficiency virus-1 (HIV-1).⁴⁰ This herb has been useful in modulating inflammation in Lyme patients, as well as helping prevent and treat secondary opportunistic viral illness.

Coptis (Coptis chinensis) is another herb that has been used in traditional Chinese medicine for thousands of years for a broad-spectrum infections. It is rich in coptisine and berberine, which have anti-cancer, anti-inflammatory and anti-bacterial effects.⁴¹ Research suggests Coptis may also help reduce oxidative stress and protect against neuronal damage.⁴² This is clinically important as so many Lyme patients exhibit signs and symptoms of neuroinflammation and may even show elements of demyelination on magnetic resonance imaging (MRI). Herbs that help reduce oxidative stress and are also neuroprotective may help slow or reverse this process.

Lyme disease can suppress humoral immunity, thereby making these patients more susceptible to immune suppression and secondary viral infections.⁴³ Herbs that can help stimulate the immune system may help restore normal immune responses. Cordyceps sinensis (Cordyceps) is a medicinal mushroom that grows in the high altitudes of Tibet on the backs of caterpillars. This unusual fungus has demonstrated efficacy in lowering blood sugar and cholesterol, reducing inflammation, stimulating nonspecific immune responses, improving libido, and helping fight off various viral infections.⁴⁴ Cordyceps also contain beta-glucans, which are well-known to help stimulate the immune system. Like many of its other medicinal mushroom cousins, its immune activation targets mostly T cells and NK cells.⁴³

The psychological and neurological impact Lyme can have, especially with persistent Lyme disease, can be substantial. One of the most effective herbs I have found to combat this is Hericium erinaceus (lion’s mane). This other medicinal mushroom can help reduce depression and improve cognitive function.^45,46 There is additional evidence to suggest lion’s mane may also help promote oligodendrocyte maturation and stimulate myelin basic protein, which in turn may help with remyelination of damaged neurons.⁴⁷ With so many Lyme patients experiencing neurocognitive decline, mood disorders, and/or neuropathy, lion’s mane is an excellent herb to add as part of a treatment protocol for those suffering from these symptoms.

There are now several herbs that have been shown to be effective at treating Borrelia in its different forms and at different stages of its life cycle. Other practitioners such as Dr. Lee Cowden, Stephen Buhner, Dr. Qingcai Zhang, Susan McCammish, Byron White and others have helped shape many of the herbal protocols used today in clinical practice. My personal experience in having treated over 7000 Lyme patients is that herbs are generally well-tolerated and effective in treating Lyme disease and other tick-borne illnesses, with minimal adverse side effects.

Summary

Early detection and treatment of Lyme disease gives your patient the best chance of recovery without future complications. Many naturopathic therapies can be as or more effective than conventional antibiotic therapy, as antibiotic therapy only addresses eradicating the organism and fails to address underlying immune, autoimmune and detoxification dysfunction. Most naturopathic physicians or functional medicine practitioners are likely to see Lyme patients in their practice at some point due to the diverse nature in which Lyme manifests. Following basic naturopathic principles, along with some understanding of Lyme-specific protocols can greatly improve the health of Lyme patients and help them overcome their illness.

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