Lyme Disease and Herbal Treatments

Herbal Treatments for Lyme Disease and Tick-Borne Infections

We are so pleased to have Lindsey Wells, ND, join our series of Q&As on Lyme Disease and Tick-Borne Infections. Her focus will be on Herbals.

Dr. Lindsey Wells is a naturopathic physician. Dr. Wells has focused her practice on pediatric primary care and consultative care for Autism Spectrum Disorder (ASD), PANS/PANDAS, other neurodevelopmental disorders, and various chronic illnesses. She uses therapies, including homeopathy, botanical medicine, nutraceuticals, nutrition, counseling, and water therapy. This model of care addresses the biochemical, nutritional, and energetic needs of each patient to improve overall health. For her complete bio and more information, please see her website.

In our office, we combine conventional therapies like antibiotics with integrative therapies such as herbals; we find herbals to be extremely effective. They’re broad spectrum. Our kids have multiple infections, not just one, so they’re a little bit complicated, but with those herbals, we’re able to address multiple infections with one agent. In addition, they’re safer for long-term use, so we feel very comfortable using it for longer periods of time. Longer-term use could be months or years, depending on the severity of the illness.

The CDC estimates there are about 300,000 new cases of Lyme disease discovered each year in the United States. It’s also estimated that 20% of the population will have a tick-borne disease, and up to 35% in some areas. The East Coast, including Connecticut, is endemic for tick-borne illness, so this area falls under the 35% statistic.

  • Antibiotics are the standard of care for Lyme Disease
  • It is reported that 10-20% of people continue to suffer from Lyme Disease symptoms after antibiotic treatment
  • Antibiotics are most effective against the dividing spirochete form of B. burgdorferi
  • However, B. burgdorferi can change its form depending on the conditions for survival
  • These additional forms contain stationary persister forms and biofilms

Antibiotics are the standard of care for Lyme disease treatment. However, it is reported that 10 to 20% of people continue to suffer from Lyme disease after being diagnosed and given a standard antibiotic treatment right away at the start of their illness. I think this number is probably pretty low, and the rates are actually higher. Antibiotics are most effective on the dividing spirochete form of Borrelia burgdorferi when there is an active infection. This bacteria is very smart. They’re much smarter than us, and they will evolve in ways that allow them to be protected. When the spirochete is in its active form, it can divide and reproduce; this is when antibiotics are the most effective in killing them off.

Borrelia burgdorferi Spirochetes can adapt and change their forms, including persister forms, L bacteria, round bodies, biofilm, and additional forms that protect themselves. Since Borrelia adapts for self-protection and two-weeks of antibiotics is often not sufficient, exploring herbals provides some additional ways to treat Lyme disease. This may be the reason there is so much chronic Lyme disease.

Herbals may provide relief to those in which antibiotics didn’t help completely. There are some articles and good research is done on herbals, Lyme and Tick-borne infections.

Study 1: Cooperation of Doxycycline with Phytochemicals and Micronutrients Against Active and Persistent Forms of Borrelia

  • Lyme Disease can be challenging to treat due to its ability to change forms as a protective mechanism
  • Doxycycline is the standard of care for treatment of Lyme Disease
  • Doxycycline is effective against the active form of Borrelia but less effective against biofilms and latent rounded forms
  • Doxycycline combined with Baicalein exhibits additional antimicrobial benefits against the latent rounded form of Borrelia
  • Baicalein is the active constituent found in the herb Chinese Skullcap Doxycycline in combination with iodine demonstrated benefits against spirochetes and biofilms
  • Food sources of iodine include iodized salt, seaweed, seafood
  • Therefore, it is worth considering the addition of these natural substances with the use of doxycycline for a more comprehensive and effective antimicrobial action.

Source: Goc, Anna & Niedzwiecki, Aleksandra & Rath, Matthias. Cooperation of Doxycycline with Phytochemicals and Micronutrients Against Active and Persistent Forms of Borrelia sp. Int J Biol Sci. 2016 Jul 22. doi: 10.7150/ijbs.16060

This article looked at doxycycline as it is the standard of care for the treatment of Lyme disease. They found it was effective against that active dividing form of Borrelia, but it was less effective on biofilms and latent rounded body forms. Next, they looked at doxycycline combined with Baicalein, which is the active constituent in Chinese Skullcap. More detail on Chinese Skullcap is included further on in this article. It is one of my favorite herbs to use. They found the combination of doxycycline and Baicalein provided the additional benefit of being able to attack the latent, rounded form, not just the active dividing spirochete form of Borrelia. They also found that doxycycline, in combination with iodine demonstrated benefits against the spirochetes, as well as biofilms. I will not be talking further about iodine since the focus of this article is on herbs specifically. It is a nutrient found in iodized salt, seafood, or seaweed. I prefer the pink Himalayan sea salt because there can be some traces of iodine in there. This is another example of how natural substances can be helpful for Lyme, even when in combination with antibiotics.

So again, in our practice, in addition to antibiotics, we often add in herbals with the hopes to wean patients off of the antibiotics, eventually, so they are not on them long-term.

Study 2: Natural and Botanical Medicines for Activity Against Growing and Non-growing Forms of B. burgdorferi

  • Fortunately, there are multiple herbals that are safe and have potent antimicrobial properties making them effective agents against the persister forms of B. burgdorferi. These include:
    • Japanese Knotweed
    • Cats Claw
    • Cryptolepis
    • Artemisia
    • Black Walnut
    • Chinese Skullcap

Source: Feng Jie, Leone Jacob, Schweig Sunjya, Zhang Ying Evaluation of Natural and Botanical Medicines for Activity Against Growing and Non-growing Forms of B. burgdorferi. Front. Med., 21 February 2020. DOI=10.3389/fmed.2020.00006

This new study came out in February 2020. It found multiple herbals that are safe and have potential potent antimicrobial benefits against the persister form of Borrelia burgdorferi. It reviews the literature on different herbals, including Cryptolepis, black walnut, Chinese Skullcap, Japanese Knotweed, grapefruit seed extract, Monolaurin, and many more. They then reviewed which studies showed those herbs having benefits against Borrelia burgdorferi. From there, they studied the herbs to see which are most effective against the persister form of Borrelia. I will go over the most beneficial herbs in more detail, including their beneficial properties, as well as why I like to use them.

Japanese Knotweed

  • Polygonum cuspidatum (Japanese Knotweed) is one of my favorite herbals for Lyme and Bartonella infections
  • A natural occurring constituent of Japanese Knotweed is
  • Resveratrol is a potent antioxidant that contributes to the anti-inflammatory, neuroprotective, and cardioprotective benefits of Japanese Knotweed
  • This herbal has documented activity against the log phase spirochetes and stationary phase of Borrelia burgdoferi

Source: Evaluation of Natural and Botanical Medicines for Activity Against Growing and Non-growing Forms of B. burgdorferi 

Japanese Knotweed is very popular for treating Lyme. It’s also one that’s used very often for Bartonella infections, and it has a naturally occurring constituent known as resveratrol. Resveratrol is the antioxidant in red wine that got a lot of good press. Essentially resveratrol is a potent antioxidant, has anti-inflammatory, neuroprotective, and cardioprotective properties. All of these are important for Lyme because there’s a lot of inflammation in the body when you have a chronic infection. With Lyme, one could have brain fog; resveratrol could help with the neuroprotective piece of the healing puzzle. Resveratrol could help with the cardiovascular impact of Lyme. It also has documented activity against the log phase spirochetes, as well as the stationary phase of borrelia burgdorferi. vAgain, you want treatments that are helpful not just for that active dividing spirochete form but also other forms that antibiotics are not as effective against.

Cat’s Claw

  • Unicaria tomentosa (Cat’s Claw)
  • Shown to have anti-borrelial effects in vitro
  • Properties:
    • Neuroprotective
    • Anti-inflammatory
    • DNA repair
    • Antiviral

Source: In Vitro Effectiveness of Samento and Banderol Herbal Extracts on the Different Morphological Forms of Borrelia Burgdorferi

Some studies show that Cat’s Claw has anti-borrelia effects in vitro against Lyme disease. Its properties include it is neuroprotective, anti-inflammatory, and DNA repair. I usually put Cat’s Claw in my protocols for Lyme, specifically Borrelia. But I also include in protocols for PANS patients in which viruses are at play. A lot of PANS kids will be sensitive to viruses, meaning that they will have flares when they come into contact with viruses. Cat’s claw has antiviral properties. It’s also great for people who have Epstein Barr virus or mono. This is one that you might want to consider.

Cryptolepis

  • Cryptolepis sanguinolenta has been used in traditional medicine for treatment of malaria, TB, hepatitis, and septicemia
  • It has been shown to have strong activity against the stationary form of Borrelia burgdorferi
  • This is one of my go-to herbals for Babesia (a common Co-Infection)
  • I often include this herbal to treatment plans of children with PANS when their history includes strep, Lyme, and Babesia with great success
  • Cryptolepis has the following properties:
    • Anti-inflammatory
    • Antifungal
    • Anti-amoebic
    • Antibacterial

Sources: Evaluation of Natural and Botanical Medicines for Activity Against Growing and Non-growing Forms of B. burgdorferi

Phytochemical and Pharmacological Review of Cryptolepis sanguinolenta (Lindl.) Schlechter

Next is Cryptolepis is definitely becoming one of my favorite herbals to be used for my PANS kids. It has been used in traditional medicine for the treatment of malaria, TB, hepatitis, and septicemia. Cryptolepis has many different properties, including being anti-inflammatory, and it has some anti-parasitic and antibacterial properties, as well as antifungal so, it can help with yeast overgrowth. It is a really broad-spectrum herb. It has been shown in studies to have strong activity against the stationary form of borrelia burgdorferi. It is one of my go-to herbals for Babesia, a common co-infection. Because of its antibacterial properties, it’s actually pretty good for strep too. So, I consider using it for my PANS kids if strep is present in conjunction with Babesia or Lyme.

Artemisia

  • Artemisia annua (Sweet Wormwood) has been used medically for >2000 year
  • Its active constituent ARTEMISININ is famous – Was recognized in 2015 with a Nobel Prize from its role in treating malaria!
  • Artemisinin has documented activity against stationary phase of Borrelia burgdorferi
  • It has been shown to reduce short term memory impairment when combined with IV ceftriaxone in patients with Lyme Disease
  • This herbal is also a potent anti-parasitic

Source: Evaluation of Natural and Botanical Medicines for Activity Against Growing and Non-growing Forms of B. burgdorferi

Youyou Tu: Significance of winning the 2015 Nobel Prize in Physiology or Medicine

Artemisia, also known as sweet wormwood, has been used medicinally for over 2000 years. Its active constituent is Artemisia. It was recognized in 2015 with a Nobel Prize for its role in treating malaria. The active constituent has been documented to have activity against the stationary form of Borrelia. It’s been shown to reduce short-term memory impairment when it’s combined with IV ceftriaxone in patients with Lyme disease. This is another example of using herbals with traditional antibiotic treatment.

This herbal is a potent anti-parasitic. Again, I use a lot for my PANS kids if they have parasites. Lyme can be carried inside of parasites. Parasites are most active around during the full so, if your child has an increase in symptoms that correlate with the moon cycles, you might want to consider Artemisia.

Houttuynia

Houttuynia is a broad-spectrum antibacterial and antiviral. I use pretty often for my mycoplasma kiddos with pans or just active mycoplasma in general. Houttuynia has a pretty good activity against Bartonella. I use it in my Bartonella protocols because it can decrease the cytokine cast cascade. Cytokines are the part of the immune system that lead to the inflammation seen in Bartonella infections.

Chinese Skullcap

  • Scutellaria Baicalensis (Chinese Skullcap)
  • Chinese Skullcap has neuroprotective, antioxidant, and anti-excitatory activity
  • Its active constituent Baicalein is responsible for these benefits
  • Baicalein has been shown to have activity against the various forms of Borrelia burgdoferi including log phase, latent round bodies, and biofilm formation
  • Calming due to its activity on GABA receptor

Source: Evaluation of Natural and Botanical Medicines for Activity Against Growing and Non-growing Forms of B. burgdorferi

Interaction of Flavones From the Roots of Scutellaria Baicalensis With the Benzodiazepine Site

The next is a Chinese Skullcap, Scutellaria baicalensis, one of my favorite herbs.

It is important not to mistake this for its cousin Skullcap lateriflora, which is popular for its sleep support. Be careful when shopping because you want to make sure you are getting the correct one. Chinese Skullcap is usually in my starting lineup for treatments for Lyme disease because of its anti-inflammatory and antimicrobial activity, but it also has neuroprotective, antioxidant, and anti-excitatory properties. Its active constituent is Baicalein. This is the herb discussed in the first study on the combination of doxycycline with different phytonutrients that showed antimicrobial benefits against the rounded forms of Lyme. Since it has anti-excitatory, it can be calming because it works specifically on the GABA receptor sites. I do use with people with neurological symptoms, including brain fog from Lyme disease due to its ability to decrease the neuro-inflammation. So, again, one of my favorite herbals.

Motherwort

  • Supportive herb and provides protection for mitochondria
  • Neuroprotective
    • Decreases ROS in brain
    • Decreased BCL-2 and increased BAX in brain
    • Reduced ischemia/reperfusion damage in brain
  • Helpful for heart
  • Great for anxiety, aggression/rages, sleeplessness and neurological symptoms from Lyme and Lyme Co-Infections

Motherwort is a supportive herb; it provides protection for the mitochondria. I encourage everyone to look into the cell danger response that Bob Navieux has been working, which essentially shows that the mitochondria are important for the immune system. We always thought the immune system was the one trying to fight off infection. But in reality, the mitochondria are part of what is working to fight off the infection. If your mitochondria are not functioning well, then they are not able to help fight off infection well.

Motherwort is neuroprotective; it decreases reactive oxygen species in the brain. It decreases B-cell lymphoma 2, known as BCL-2. There is an increase in BCL-2 levels seen in certain cancer in psychiatric disorders in the central nervous system and some autoimmune properties. So, from Lyme, we see patients with psychiatric symptoms from the central nervous system, as well as autoimmune properties, and Motherwort can be helpful to decrease the BCL-2 levels. Motherwort can also increase BAX, which needs to be in a modulated balance with the BCL-2.

Motherwort reduces ischemia and damage in the brain. It is also great for the heart. Clinically, I find it to be great for anxiety for aggression and for or those who have sleep disruptions and neurological symptoms from Lyme and co-infections.

Recap of Herbals for Lyme Disease

I usually start with Japanese Knotweed and my Cat’s Claw. Depending on the person, I might consider some others like Artemisia and possibly Andrographis as it helps with modulating the immune system. Andrographis is not for everyone; it can be hit or miss for my PANS patients. Teasel can be used for Lyme and I have had great success with. If your child is able to handle combination products, Biocidin might be helpful because it’s a broad spectrum. A-L complex, Byron White formula, is another helpful combination product (see below)


Lyme Co-Infections/Tick-Borne Diseases

Lyme Disease

  • Japanese Knotweed
  • Cats Claw
  • Cryptolepis
  • Artemisia
  • Black Walnut
  • Chinese Skullcap

Bartonella

  • Japanese Knotweed
  • Houttuynia
  • Cordyceps
  • EGCG with quercetin
  • A-Bart
  • Sida Acuta
  • L-arginine
  • Red Root

Babesia

  • Cryptolepis
  • Chinese Skullcap
  • Bidens pilosa
  • Artemisinin
  • Red Sage
  • Sida Acuta
  • A-BAB (Barton White Formula)

Ehrlichia

  • Cordyceps
  • Red sage
  • Houttuynia
  • Chinese Skullcap
  • Astragalus
  • Kudzu
  • Quercetin

These are the herbs I use most in my practice for the three most common Lyme co-infections.

Bartonella

Japanese Knotweed, I always use that one. I tend to use a lot of Cordyceps, a medicinal mushroom, which helps support the immune system. It also doesn’t create a significant herx reaction/die-off reaction; it is well tolerated with good responses. EGCG with quercetin is another good choice. EGCG is the active constituent in green tea, a potent antioxidant. Quercetin is another anti-inflammatory and anti-histamine that is helpful for Bartonella. I use a lot of A- Bart, a Byron white formula. Sida Acuta, I don’t use it as often because some people have a reaction to it; you should work with a practitioner if you choose to add it.

Essential Oils

So here was an article that looked at essential oils and herbs against the stationary forms, specifically the biofilms of Borrelia. They found that essential oils could help with treating persister forms of Lyme bacteria. They looked at about 18 different essential oils; the most effective were oregano, cinnamon bark, clove, citronella, and wintergreen. So, one thing I caution is that I don’t recommend ingesting essential oils without talking to your physician. Essential oils are very powerful; think about how much plant material is necessary to produce one ounce of essential oil. I do recommend diffusing essential oils in the air or apply a dropper or two topically. Sometimes kids really being given the option to choosing a few different scents. Have your child choose which one they want that day and apply it to their wrist. It allows them to feel like they’re in control of something, and it can be a fun activity. I do not use essential oils as the only treatment for Lyme but it might be a nice adjunct to therapy to herbals.

Source: Feng Jie, Zhang Shuo, Shi Wanliang, Zubcevik Nevena, Miklossy Judith, Zhang Ying. Selective Essential Oils from Spice or Culinary Herbs Have High Activity against Stationary Phase and Biofilm Borrelia burgdorferi. Front. Med., 11 October 2017 | https://doi.org/10.3389/fmed.2017.00169


Lyme Protocols

There are four protocols for Lyme that I have had good success with.

Buhner Protocol

  • Single herbals
  • Anti-inflammatory and immunomodulatory benefits

I use this protocol often. He has a great book, Healing Lyme. The reason I like Buhner is that it uses single herbals, meaning that there’s not a combination of a tincture. I tend to start that way with a lot of our kids, especially with PANS/PANDAS or autism, as they tend to be very sensitive. If your child didn’t respond well to a combination product, we wouldn’t know which herb was an issue. They all have anti-inflammatory benefits as well as immunomodulatory benefits. I always try to find treatments with multiple benefits so we can hit multiple issues with one product, rather than adding so many products. Plus, Buhner protocol tends to be well tolerated.

Byron White Protocol

  • Multiple herbal extract
  • Extremely potent
  • Energetic component
  • Start with DETOX 2 – Then introduce tincture starting low (1 DROP) and slowly increase

Byron White is a combination product with multiple formulations using many herbs and extracts. It is extremely potent. What I like about Byron White’s formulations is that they have an energetic component and that energetic component works against the specific germ you are trying to target. Byron White recommends starting is using Detox-2, which is a binder. You start by using it for about two weeks to help get the detoxification pathways going before you implement the specific tincture. When you introduce the tincture, you start very low with one drop, and then I usually recommend increasing by one-drop increments every week to a specific dosage based on your child’s weight.

Beyond Balance

  • Combination formulas
  • Provide antimicrobial and detoxification support
  • All in glycerite form so taste is better tolerated
  • Start low (1 DROP) and increase up as tolerated

Beyond Balance has Lyme protocols, which are combination tinctures providing antimicrobial and detoxification support. They are all in glycerin form, so they taste better are more tolerated by children. I also start this one with a low dose, meaning one drop and increase as tolerated based on they’re weight. Tox-ease-GL, I sometimes use for herx reactions. This is a really nice formula that can be supportive when you start to add in different herbs.

Cowden Protocol

  • Broad-spectrum herbals
  • Monthly protocol that utilizes 14 NutraMedix products on a rotational basis
  • Products are taken daily according to a set schedule
  • . All products are prepackaged into individual monthly sets
  • 9-month

Cowden Protocol is another set of broad-spectrum herbals. It’s a monthly protocol that utilizes about 14 different Nutramedix products on a rotational basis; it’s a very specific protocol. The products are going to be taken daily with the set schedule that you work on with the practitioner. All products, to help with compliance, are prepackaged into individual monthly sets; it’s a nine-month program. This is a very intense protocol. If you are interested in that protocol Vicki Kobliner, who is our dietician in the office, works with the Cowden Protocol.


Herxheimer Reaction or Die-Off Reaction

  • Herxheimer reaction ~20% of patients
    • First described with PCN treatment of syphilis
    • Intensification of baseline symptoms
    • Variable duration, onset often within hours
  • Herx Support
    • Epsom salt baths
    • GI DETOX
    • Activated Charcoal
    • Burbur pinella
    • Tox-ease
    • Alkalization – Alka Seltzer Gold
    • Other binders

It is important to understand what a Herxheimer or Die Off reaction is and how to mitigate it.

Herbs that are antimicrobial will likely set off a herxheimer reaction. About 20% of patients will experience this. It was first described with the use of penicillin treatment for syphilis. Essentially what happens is that the baseline symptoms intensify. There’s a variable duration of a herx reaction and onset can often happen within hours. What happens is these germs living in the body are really loving life in their nice home, and they want to stay there. When you start to kill them off using different herbs or antibiotics, these germs release biotoxins that alert their friends that something is going to kill them. Then the body responds to those biotoxins by increasing inflammatory cytokines, IL-6, IL-8, and TNF-a, and that increased inflammation causes us to have an increase in symptoms.

Symptoms could present as an increase in neuropsychiatric symptoms or physical symptoms such as fatigue, brain fog, pains, fever, chills headaches, anxiety, etc. A herxheimer reaction is actually a good thing. It let us know that we are actively addressing the underlying infections, but my goal is never to make children or families uncomfortable. There are things we can do to make a herxheimer reaction/die-off more manageable. Daily Epsom salt baths need to be paired with baking soda to help the alkalization of the body. To aid with alkalization, you can consider Alka Seltzer gold. Some people don’t like the taste, but it’s worth considering, and you can do it up to three times a day. The thought is that those who are more alkaline, so less acidic, tend to have less extreme herxheimer reactions or die-off reactions.

In combination with Epsom salts with baking soda or Alka Seltzer gold, you can add binders independently. My favorite binder is GI Detox by Biobotanical research. It is a combination product with aloe, pectin, zeolite clay, and activated charcoal that helps to bind biotoxins to get them out of the body to decrease inflammation and other die-off symptoms. With this binder, you want to give it two hours away from any other medications or supplements as it will bind to them and draw them out of the body.

I tend to use GI Detox more than activated charcoal because it’s non-constipating. The last thing I want to do is kill off bugs and have them just sit in the body to be reabsorbed, increasing inflammation by reabsorbing toxins. Activated charcoal is a great binder, but it can be constipating. The next is Burber Panella, part of the Cowden Protocol. You can dose this frequently (up to every 10 minutes) if need be. Tox-Ease from Beyond Balance is another one that I use often that is gentle and effective for managing die-off symptoms.

 

 

 

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