Section 2: Lyme Disease Treatment
ASPIRE talks with Tom Moorcroft, DO about some of the most frequently asked questions on Lyme disease and tick-borne illness including Bartonella and Babesia. This article is divided into 4 separate sections.
- Section 2: Treatment for Lyme Disease
Basic Lyme Disease Treatments
Basic Lyme Disease Treatments
- Solid clinical diagnosis of infections
- Treatments must be individualized
- Generally, antibiotics combined with natural products, including different antimicrobial herbs and different tinctures
- Treatment choice is dependent on length of illness
- Early, acute stages – may start with antibiotics
- Late stages – may start with herbals
- Babesia microti and Babesia duncani do not react the same way to the same treatments
- Babesia duncani – I start with herbal treatments and maybe add antibiotics at the end
- Babesia microti – I start with antibiotics and maybe add herbal treatments at the end
- Lyme disease – 200mg of doxycycline may prevent the rash but won’t cure Lyme disease and may cause a false negative on testing. The study that says 200mg of doxycycline prevents Lyme is flawed.
- Prophylactic Antibiotics – doxycycline is the best choice based on currently available evidence, treat for at least 20 days
- Lifestyle changes – Not optional –
- Heal the gut with a plant-focused diet (doesn’t have to be vegetarian), remove sugars & processed foods
- Get sleep – improving the gut increases melatonin and immune function
- Get morning sunlight & turn down lights at night – improves circadian rhythm
- Relax – parasympathetic calm state needed
Obviously, with everybody, I use an individualized treatment approach.To start, I get a solid diagnosis. This includes history and what they were bitten by. It is crucial to know which tick-borne infections you have, because if you’ve got Lyme disease and Babesiosis, but treat only Lyme, it’s unlikely you’ll get all the way better.
I often combine antibiotics with natural products, including different antimicrobial herbs and different tinctures. I look at the evidence we have; we’re in an evidence-based medical culture, yet we keep using these old school treatments. We know Babesia duncani does not respond to typical Babesia treatments the same way that Babesia microti does. So, all of our typical anti-parasitic and antibiotic treatments we might use for the Babesia microti don’t really work on Babesia duncani. For Babesia duncani, I tend to use more herbal treatments and maybe add on antibiotics in the back end. But for Babesia microti, I tend to do it the opposite way.
Treatment also depends on how long someone has been sick. If someone’s been sick for weeks to a couple of months, we might start with antibiotics. If someone’s been sick for a longer time, then we can probably start with herbals, and then put in the antibiotics.
One of the most critical factors in my treatment approach is to not just treat Lyme disease or Babesiosis but to treat you as a human being. I look at what are all the other factors in life. We have to optimize how your immune system is functioning and how well you can heal. This includes adults getting eight to nine hours of sleep a night, and more for kids. This includes eating a plant-based, whole food diet; I’m not saying, be a vegan or vegetarian, but eat plants first and add our proteins. Cut out sugars; cut out processed foods. This is unequivocally mandatory in order to optimize human health and to get better from any other tick-borne infection. We need to get fresh air; getting sunlight in the morning is going to help boost up our natural production of melatonin, allowing for deeper sleep, rejuvenation, and healing. We need our brain and memory to be working well to function and behave better. One may want to prevent dementia or lift brain fog, well then you need to work on sleeping and your gut because gut health and melatonin production are linked. So two ways to optimize melatonin at night are by improving our diet to heal our gut and get natural sunlight in the morning.
At night, we have to turn down the lights to release the melatonin, to foster a nice circadian rhythm and cycle. Brains detoxify primarily at nighttime while you are sleeping. You have to sleep well for your brain to work well, so you have better behavior, memory, and long-term mental health.
We need to chill out. We must take time to de-stress, whether this is prayer, meditation, drawing, expressive dance, or whatever it is for you, you need to do something that brings you into a parasympathetic calm state. This state will allow your gut to heal better; it will allow your gut to feedback “The Happy Neurotransmitters” up into your brain. A healthier gut and improved gut-brain communication will allow more melatonin to be produced.
These are all things that are critical for healing from anything. So, be it Lyme disease, acute or chronic, COVID-19, influenza B, or any other health problems. These are not optional; these are mandatory things for your health and the health of your family. These lifestyle changes will allow Lyme and treatments for anything else to work better.
What Are My Thoughts on Prophylactic Antibiotic Use for Lyme Disease?
What I know is there’s really no solid studies on Lyme disease and prophylactic antibiotics out there.
We know the study on using a double dose of doxycycline is flawed; you can read the paper. It’s just not as scientifically sound as we need it to be. One study in mice shows that giving long-acting doxycycline works for the equivalent of 19 days is 100% effective against Lyme disease. Then if we give the mouse Lyme and Anaplasmosis again, it is also 100% effective.
So for people with confirmed deer tick bites, I assess them, find out the risk factors, and I offer a prophylactic or preventive treatment of doxycycline as it is the best antibiotic option based on the literature. There are other studies looking at amoxicillin, but they’re not strong enough to draw any real conclusions to be used in clinical practice. We will use doxycycline for three or four weeks, sometimes a little longer.
There have been herbal protocols that clinically have been shown to be very effective. But we don’t have larger studies to support their use. So, I do use those with really close follow up.
The bottom line on prophylaxis is we need better studies. Until we have them, we use the best available evidence combined with our clinical experience.
If you get bitten by another non-deer tick, we do not have much literature on prophylaxis. You essentially have to think about short term treatment. For example, one dose for a dog tick might be problematic because we could blunt the onset of the rash that comes with Rocky Mountain Spotted Fever, which could lead to more harm, so we would probably not want to do that. Typical treatments for Rocky Mountain Spotted Fever might be 10 or 14 days. If you and your provider want to look at a 21-day treatment, then that might be a different story but that’s really an individualized decision.
I think that prophylaxis has a place, but you have to work closely with your treating provider to know what’s going on and potential risks and benefits.
We give people antibiotics for acne all the time. If you meet the right criteria for potential benefit from a prophylactic treatment, then I think it’s reasonable to have that conversation with your provider and potentially do it. If I had acne, nobody would question anything. If I want to prevent myself from having persistent Lyme disease, all of a sudden, it becomes a problem and we’re said to be overusing antibiotics. I’m not saying everybody should use long term antibiotics; you have to think about the risk involved in that tick bite, how long the tick was potentially attached, and dive deep into it with your provider.
What are the Dormant Forms of Lyme?
Forms of Lyme Disease
- Active – Spirochete – causes most symptoms
- Dormant (most known forms) – protects itself until host’s environment is hospitable for reproduction
- Cyst/Round Form – rolls into a protective ball
- Biofilm Form – forms and sits under a protective coating
The active form of Lyme is the spirochete form. This is the form causing most of the symptoms, at least that’s what we believe at the moment. It is the most metabolically active. When we try to kill the spirochete through our immune system, with antibiotics and antimicrobial herbs, the spirochetes go into a dormant form, a protected form. There are many dormant forms; the two we know about are the cyst/round body form and biofilm form. The cyst is, essentially, when the spirochete rolls up in insides itself into a ball and remains dormant until the environment around it within your body becomes more hospitable for it to reproduce. The biofilm form is when a bunch of organisms hang out together. These organisms sequester fat, fibrin, polysaccharides and other substances to protect themselves. Biofilm is a protective coating almost like a slime mold and can be quite strong. They are various estimates on what antibiotic dose would penetrate them, but the estimates range between 200-500 times a normal antibiotic dose.
Thoughts on Steroid Use in PANS with Lyme
- You can use steroids with an acute PANS flare to help with neuro-inflammation even if you have Lyme.
- One paper on Lyme and steroid use has been misinterpreted.
- Long-term steroid use is not desirable.
- Many PANS patients do well on short-term steroids although there is a risk of increased neuropsychiatric issues for anyone using steroids.
- Options other than steroids: Low-Dose Naltrexone, CBD, diet ibuprofen.
I get questions quite often about using steroids in PANS cases with an acute neuroinflammatory response. Sometimes we might need to put the proverbial lid on a PANS flare in patients who also have Lyme disease. In Lyme disease, there’s really no reason to fear steroids. The idea that one cannot use steroids in a Lyme patient came from one paper that showed if you had untreated Lyme and were given steroids for the swollen knee, then you would statistically do worse with your knee. However, if you had been diagnoses and treated for Lyme disease, and then gotten steroids for a swollen knee, your outcomes were not worse.
No one wants to go on steroids. Long-term steroid use leads to things like immuno-suppression, suppression of the adrenal gland, and even osteoporosis. The only people who absolutely need long-term steroids should be using them.
But there are short-term uses of steroids that are necessary, such as for a PANS flare, really bad poison oak, or an asthma flare. If we need an acute dose for a short period of time, upwards of three weeks, we can do that; this should not make Lyme worse. I’ve actually seen people do better after their steroids. I am not saying everybody with Lyme or PANS should get steroids. I’m saying the evidence does not support being concerned because of Lyme if it has already been treated, even for only for three or four weeks. You will do just as fine as anybody else. Now, do we have enough evidence to make a blanket statement that steroids will be fine for all people with Lyme? No, definitely not. But what we do know is that most people will do okay. Many kids with Lyme, Bartonella, mold, and strep induced PANS generally do really well on steroids during a flare.
We also know that steroids may not work for PANS, and they can actually exacerbate symptoms, but this is less commonly seen. They don’t get worse because of the Lyme; we know that some percentage of people who are on steroids will have neuropsychiatric symptoms, even if they don’t have pre-existing PANS. We need to look at this information, determine the patient’s needs, and use the steroids if we need them.
We try other ways to immune modulate like Low-Dose Naltrexone, CBD, diet, or even ibuprofen. There are so many different ways to modulate the immune system, but if we need steroids, don’t be afraid of them.
Can One Be Cured of Lyme Disease? Or, Is Managed Recovery More Accurate?
Cure or Managed Recovery for Lyme Disease
- Yes, being cured of Lyme disease is possible
- Early diagnosis and treatment leads to better outcomes more quickly
- Long term symptoms and pre-existing conditions can lengthen treatment course
- Having a positive mindset about healing helps
I think most people have the ability to be cured. With that said, there are certainly people who have a really difficult road. They’ve been sick for a long time, or they have other pre-existing conditions so, they may need to manage themselves over a long period of time. However, for the most part, people can get better. The sooner we diagnose and treat the Lyme disease, the more the patient makes all the lifestyle modifications (improve sleep, improve diet, get fresh air, does parasympathetic work to relax), the better they do. For some, we can completely reverse the symptoms and others we can’t. But my assumption is always, always optimistic; we can get this done until proven otherwise.
I think a cure is achievable for the vast majority of people. This is contrary to what you see most often from people on the internet. A lot of it has to do with mindset. I talk about focusing on what we want our future to look like, why do we want it to look like that, getting into the emotions, and what does it feel like when we’re well. It’s not just about getting well; it’s about why do we want to be well and then getting ourselves into a place to make that happen. A lot of people don’t really buy into that stuff. Well, if you think you’re going to be sick with chronic Lyme disease for the rest of your life, chances are you’re right. If you think there’s a cure and you can heal enough, so your life is amazing again, then you give yourself at least half a chance to get there. Start thinking about it and start living today like we can get somewhere and that in another year, we are going to be cured. So again, I can’t guarantee it for everybody but I think we should give the full-court press because most people do have the possibility of getting to the place we call cure.
Section Links to Overview of Lyme & Tick-Borne Illness – Dr. Moorcroft
- Section 1: Lyme Disease and Tick-Borne Illness Overview
- Section 2: Treatment for Lyme Disease
- Section 3: PANS & Lyme Disease
- Section 4: Bartonella & Babesia Co-Infections