Section 4: Lyme Treatment – Overview of Literature Review
Nancy O’Hara, MD, MPH, FAAP, a member of the ASPIRE Professional Advisory Board, presented on Lyme Disease, Tick-Borne Illness and Co-infections as part of the NECH Educational Series. This presentation is divided into 5 separate posts.
- Literature Review of Tick-borne Diseases Literature (1500-2018)
- Lyme Treatment Overview from Literature Review
- Adverse Reactions to Antibiotics
- Nutritional Approaches when Treating Lyme
- Treatment Recap
- Lyme Disease Fundamentals – Section Links
Nancy O’Hara, MD, provides an overview of Lyme disease and treatment recommendations culled from the research literature (1500-2018).
- 20% of the population will have tick-borne diseases and up to 35% in some areas (like CT and other endemic areas)
- Many new species of tick-borne diseases discovered in disease states (especially neuroborreliosis)
- Alternatives to one tier testing (ELISA and Western/immunoblots) (Alasel & Keusgen et al 2018, Cabezas-Cruz et al 2018)
- CXCL 13 and 9 as a marker for Lyme disease, improving PCF methods
- Biofilm busters to better target Lyme (Lacout et all 2018)
- Polyvagal Theory by Stephen Porges – Vagal Nerve “ablated” by Lyme – Vagal sensory ablation causes memory loss especially spatial memory
- Clinical application to improve vagal tone (look left and right, put hands on the occiput (bones sticking out of the back of your head) and look right with your eyes for 30-60 seconds or until you feel the saliva in your mouth or need to take a big breath, then repeat on the left and continue to repeat 4 times – this is known to help memory and brain fog.
- Pulse dosing – scant evidence and widely varied approaches (Sharma B. Antimcrob Agents Ther. 2015)
- Antibiotics for pediatrics
- Adverse reactions to Antibiotics (all not included)
- Photosensitivity –Tetracyclines, Fluoroquinolones, Sulfonamides
- EKG needed for some Antibiotics
- Liver and Kidney function
- Peripheral neuropathy
- Gallbladder disease
- Herbal Protocols – Must be followed strictly (review talk by Dr. Lindsey Wells)
- Beyond Balance
- Byron White
- Herbs – not in a set protocol
- Diet – protein, high fiber, low carbs, low glycemic index, organic
- Probiotics & Prebiotics
- B vitamins and other vitamins and minerals as warranted
- EFAs and other anti-inflammatories
So 20% of the population, and in areas like this, up to 35% of the population will have Lyme disease. There are many, many new tick-borne diseases. We need to look at a lot of new testing. There’s a urine test now that’s a DNA test that may be a good test for Lyme disease. Also, biofilm busters are important because Lyme likes to hide in cells. The Polyvagal tone treatment is a very good treatment for some of the memory loss. See bullets above. Pulse dosing is something that is used by some clinicians, but it has widely varied approaches and very poor evidence supporting it.
Adverse Reactions to Antibiotics
There can be a lot of adverse reactions to antibiotics. I talked about the photosensitivity. You always have to watch liver and kidney function. With some of the antibiotics, we need to get an EKG to make sure that a child does not have an abnormal EKG. We also need to look at neuropathy caused by antibiotics or certainly gallbladder disease, as we’ve seen in some kids with using some antibiotics. So again, in our practice, we do use these antibiotics, but we often use them together with herbs to try to decrease some of these complications.
If you did not listen to Dr. Well’s talk on Lyme & Herbals, I highly recommend you look at the transcripts of that because in this practice, we may see start with antibiotics, but we very quickly try to get to herbal protocols. And in a lot of kids, we start with herbal protocols. The main reason is it is much more comprehensive. We don’t like to put any child on three, four, or more antibiotics. And often, that’s what we have to do if they have Borrelia burgdorferi as well as one, two, or three co-infections.
There are many other important lifestyle choices and supplements that imperative to think about when treating Lyme. Sleep is crucial; the immune system regenerates when you’re sleeping. The detoxification system works when you’re sleeping. We decrease our brain cell size by 70% every night. That natural detoxification that happens when you are asleep is very important, draining through the lymphatics. Exercise is very important, sweating to get out those toxins out of our body.
And then most important is Food. Food is medicine. A diet that is anti-inflammatory, high in proteins, fibers, organic foods (as much as possible), low carbs, low glycemic index is supportive of healing. Provide probiotics and prebiotics in foods as well as orally. Then look into COQ10, magnesium, B vitamins, minerals, and essential fatty acids. Those are also very helpful for Lyme and very individualized to the patient being treated. Often mitochondrial support is also necessary.
Nutritional Approaches when Treating Lyme
- Treat inflammation and kill microbes with diet
- Remove sugars, synthetics, gluten, casein
- Add bone broth, fermented food, organics
- Stevia as anti-microbial and as a sweetener
- Oregano, cinnamon, clove as essential oils in vitro as effective as antibiotics. Anecdotally use as aromatherapy, topically and in foods
- Antibiotics cause germs to go into protected, hidden areas such as biofilm. Use natural and supplemental enzymes and herbs to counteract biofilm.
These are some specifics you’ll hear about this with regard to all the diet talks we give. Any way you can help your child to eat more healthfully is really important. And herbs and spices are really important too: oregano, cinnamon, clove, garlic, ginger.
- Treat multisystem disease (deficiencies, diet, metabolism, immunotherapy)
- Steroids – may further suppress immune system
- Chronic Lyme – combination antibiotics and/or herbs, treat intracellular, cell wall and persistor forms
- Symptoms flare in cycles every 4 weeks – keep records
- Binders – binds neurotoxins (taken two hours away from other medications)
- Treatment pitfalls – not addressing Multisystem nature of problem, immunotherapy, yeast, underlying mitochondrial and metabolic issues
So most importantly, treat multi-system diseases. Steroids and IVIG may be counter indicated initially because of the immune system effects. We may add later, but we start treating Lyme first. Remember that symptoms flare in cycles of four weeks. We may need to use binders to bind up the neurotoxins with Lyme or with mold. Binders need to be taken at least two hours, sometimes four hours away from any other medications. The biggest pitfalls are not treating underlying problems like metabolic problems, mitochondrial problems, not treating yeast, not providing immunotherapy, and not addressing this as a multicenter multiphase disease. Recovering from Lyme is hard; it is not something that happens easily. And Lyme and co-infections are something that we see in so many of our kids.
- Section 1: Lyme Disease Basics
- Section 2: ILADS Lyme Disease Guidance
- Section 3: MSIDS & Chronic Lyme
- Section 5: Co-Infections Overview