Multi-factorial contributors to what we label Lyme spectrum disease

1. Multi-factorial contributors to what we label Lyme spectrum disease Dr. Kenneth F. Kochler, D.O. Functional Medicine VA Beach, VA. www.longevitymedical.org

2. Total Bacterial & Viral Body Burden • Lyme Species and co-infections • Lyme (not Lymes) Lyme Connecticut • Borellia (burgdorferi) a spirochete-classic Lyme • Bartonella-henselea • Babesia-Babesiosis-Babesiamicroti • Erlichia-Erlichiosis-chaffeensis & ewingii • Mycoplasma & Clostridia • Brucella • Fanciscella-tularensis (Tularemia) • Rickettsia-rickettsii (Rocky Mt Spotted Fever)

3. Lyme • Borreliaburgdorferi-spirocete • Bannwarth Syndrome? • Lyme, CT-1975 as “juvenile rheumatoid arthritis” by local Mothers • Called Lyme in 1982 • Organisms harbored in the tick’s stomach

4. Babesia • Malaria-like protozoan species • Intra-erythrocytic-in RBC’s • Destroys RBC’s-anemia-jaundice-malaise • Asymptomatic in otherwise healthy hosts • Tick-transfusion & transplacental transmission • Victor Babes-1888-in cattle with febrile hemoglobinuria • Texas cattle fever-1893 (now cats & mice) • 1st human case-1957-Yugoslavian cattle farmer • 1st US case-1969-Nantuket Mass.

5. Ehrlichiosis All livestock • WBC Intracytoplasmic gram negative orgasm resembling Rickettsia • Human granulocytic anaplasmosis (HGA), granulocytes • formerly known as HGE (ehlichiosis)-moncytes • Type depends on infecting species & leukocyte type infected

6. Bartonella • A.L. Barton-1909-described organisms that adhered to RBC’s-Bartonia • Later- Bartonellabacilliformis-gram negative • Initially thought to be rickettsiae • B. henselea-catscratch disease

7. VIRUSES & VACCINATIONS • Hepatitis • H1N1 • HIV • XMRV (newly researched retro virus) Xenotropic murine leukemia retro-virus An RNA > DNA virus discovered 2006 in human prostate cancer tissue 67%Assoc with Chronic fatigue Syndrome (2009-Whitmore Peterson Institute, NV) • Vaccination residuals due to vaccine viral contaminants (herpes type 6 & 7)

8. Heavy Metal Toxicity Body Burden • Mercury, Lead, Cadmium, Antimony, Arsenic, Aluminum, Nickel (include fluoride) • Heavy Metal toxicity masquerades as AUTO-IMMUNE DISEASE “neuro-endocrine disruptors” • Impaired enzyme& receptor function with yeast overgrowth (candida as an adaptation) • Assayed via NutrEval by Genova Diagnostics or Doctor’s Data RBC Elements

9. Mercury: Sources • Thimersol(50% Hg by volume) was the preservative in most vaccines until approx2001. (current shift to aluminum) • Cumulative dose in vaccines from birth to age 5 years exceeded the EPA guidelines for safety. • Large population of older children and young adults have had significant exposure (Hg thermometers as a child) • Study on NYC adult population revealed 24.8% had bloodlevels at or exceeding 5ug/l, the NY State reportable level. • McKelveyW. Environ Health Perspect. 2007 Oct;115(10):1435-41 • Seafood, dental amalgams, and industrial output account for the major sources of exposure today. (Coal-fired power plants) • WHO. Methyl Mercury. Environmental Health Criteria, vol. 101. Geneva: World Health Organization, 1990 SallstenG, et.al., J Dent Res 1996; 75: 594–8

10. Mercury Toxicity: • Low level chronic exposure can lead to nervous system • damage resulting in depression, anxiety & cognitive loss • Weiss B, Clarkson TW, Simon W. Environ Health Perspect 2002; 110 (Suppl 5): 851–4 • Autoimmunity Issues • Paresthesias, insommnia, cognitive difficulties, • neuromuscular changes, headaches and anxiety, third cranial nerve palsy. • http://www.epa.gov/iris/subst/0692.htm

11. Cadmium: Sources: Color pigment (dyes & paints) Cigarette smoke Ni-Cd batteries Phosphate fertilizers Jarup L et al. Health effects of cadmium exposure—a review of the literature and a risk estimate. Scand J Work Environ Health 1998; 24 (Suppl 1): 1–51 WHO. Cadmium. Environmental Health Criteria, vol. 134. Geneva: World Health Organization, 1992 Toxicity: Kidney damage Osteoporosis Cancer-thyroid & Prostate Jarup, L. Br. Med. Bull. 68:167-182 (2003)

12. Lead: Sources: Gasoline (Worldwide major source but not in US) Lead in drinking water primarily dueto the presence of lead in certain pipes, solder, and fixtures. In kids toys and lead based paints in old homes (and especially in paint that is not interstate transported) Toxicity: Decreased IQ Memory deterioration Cancer Anemia Peripheral nerve symptoms Hypertension especially in menopausal women WHO. Lead. Environmental Health Criteria, vol. 165. Geneva: World Health Organization, 1995 Steenland K, Boffetta P. Am J Ind Med 2000; 38: 295–9

13. Arsenic: Sources: Wood preservative Fish Pesticides/food Industrial exposure Toxicity: Cancer-lung, bladder, & kidney Peripheral neuropathy Anemia GI Effects WHO. Arsenic and Arsenic Compounds. Environmental Health Criteria, vol. 224. Geneva: World Health Organization, 2001 ChilversDC, Peterson PJ. Global cycling of arsenic. In: Hutchinson TC, Meema KM (eds) lead, Mercury, Cadmium and Arsenic in the Environment. Chichester: John Wiley & Sons, 1987; 279–303 www.epa.gov/ttn/atw/hlthef/arsenic.html

14. Testing for heavy metals: (Redistribution to the RBC’s) • Blood levels useful for acute exposure, but an unreliable tool for chronic low level exposures. • Mercury has affinity for fatty tissueand is rarely found in serum. • The half-life of lead in blood is about one month whereas the • half-life in bone is 20-30 years. (35) • WHO. Lead. Environmental Health Criteria, vol. 165. Geneva: World Health Organization, 1995 • Difficult to accurately assess total body burden. Urinary porphyrins have some utility – currently probably the best clinical test available. • Hair Mineral Analysis may be helpful, but show false negative in • individuals with compromised detoxification pathways • Provocative challenge-involves administering a test dose of a chelator • (DMPS, DMSA, or EDTA) and measuring pre- and post- fecal &/or • urine for heavy metals.

15. Heavy Metals (con’t) • Treatment: • Nutritional support during chelation essential • I. Gut binding agents-Bentonite, Charcoal, Zeolite, chlorella, garlic • Cholestyramine-low dose, pulsed, with caution • II. Mineral replacement-depending on the chelator used, replace • minerals aggressively with special attention to Ca & Mg • with EDTA (Suppositories) and Cu & Zn with DMPS/DMSA • III. Antioxidant support-necessary to quench free radicals generated • during heavy metal removal. Supplement with A, C, E, Zn, • selenium, and reduced glutathione. • IV. Hepatic support

16. GLUTATHIONE ADEQUACY • Genomics to determine GST enzyme pathway adequacy (glutathione-S-transferase) • Serum Glutathione levels-baseline determination is a must (but largely unknown or forgotten by most physicians) Lab Corp offers this testing and is included in the Genova NutrEval • The MASTER ANTIOXIDANT of the body! • Excellent for natural metal chelation (which impacts Lyme disease)

17. METHYLATION • Methyl group (-CH3) donator • Needed for phase II liver detox via COMT • Defects = elevated Estrogen & catecholamines • Role in: NEUROTRANSMITTER chemistry, cardiovascular disease, cancer, metal detox, and B-12 & Folate metabolism • SAMe, TMG, methyl B-12 & THF • SNP on COMT, MTHFR C677T (47% incidence in caucasians) • Cystathione-beta-syntase enzyme: B-6/P-5-P & GSH

18. Mg P5P P5P Zn B12 Methylation Cycle 5,10 MTHF Methionine SAM MSR Methionine Synthase MTHR SAH 5 MTHF Homocysteine Homocysteine CBS Cystathione Cysteine Glutathione Taurine

19. BIOFILMS • A community of bacteria, parasites, etc imbedded in an extracellular polymeric substance (EPS) aka slime • Composed of DNA, protein & polysaccharides • NEG CHARGED, and attracts Ca/Mg/Fe to strengthen its matrix • Organisms communicate and exchange genetic material (QUORUM SENSING) • EPS creates antibiotic resistance requiring 100-1000X concentration of the drug & prevents phagocytosis (WBC organism eradication)

20. BIOFILMS • NIH states that 80% of all chronic infections are biofilm mediated (ie: chronic sinusitis) • This jello-like shield created by bacteria protects against environmental stress and promotes propagation (it’s everywhere: teeth to ship hulls) (Imagine the water-mold issue) • Chemical signals serve as intelligent communication (Quorum Sensing) • Unless biofilms are managed, hosts are subject to unending recurring symptoms from infection

21. BIOFILM & LYME • Once bacteria have joined into biofilm communities, they can no longer be effectively targeted by the immune system. They persist as a chronic infection and inflammatory process. High dose antibiotics and steroids may offer temporary relief, yet the infection never is totally eradicated. Initial organisms are commonly Staph and parasites.

22. BIOFILM & LYME • Borrelia may undergo genome-wide genetic exchange, including plasmid transfers. Virulence can rapidly be enhanced. • Conjugal plasmid transfer ability from Escherichia coli to Bartonella has been established and documented to transfer antibiotic resistance genes.

23. ENDOCRINOPATHIES • Hormone decline & Imbalance = aging • Insulin Resistance = aging • Hypoadrenalism w/ decr cortisol = fatigue • Hypothyroidism w/ decr Free T3 & incr rT3 • Hormone imbalances: male and female hypogonadism (declines in DHEA and testosterone = aging) • Growth Hormone (IgF-1) decline = aging • Melatonin & Melanocyte Stimulating Hormone (decline as markers for immune deficiency)

24. NUTRITION MINERALS-especially magnesium & selenium Trace MINERALS: rhubidium, indium, cesium VITAMINS-especially C, mixed fractions of E (gamma), D3 (25-hydroxy) storage pool & 1,25 di-hydroxy (active w/ receptor) (Marshall Protocol) AMINO ACIDS-especially cysteine, glycine, glutamine (GSH) , methionine & taurine

25. GENOMICS • DNA MUTATIONS • POLYMORPHISMS • SNP(S) single nucleotide polymorphisms • Defective or incomplete GENE expression • Inadequate enzyme & receptor function • Impaired biochemistry and cellular respiration • Fatigue & degenerative disorders • Assayed via Genovations (Genomic testing) • by Genova Diagnostics www.gdx.net

26. SO WHAT CAN WE DO? • Nutritional Assessment-NutrEval (Genova) • Heavy Metal Assessment-NutrEval • Essential Fatty Acid Assessment for cell membrane integrity and function-NutrEval • Hormone Assessment-NeuroScience • Neurotransmitter Assessment-NeuroScience • Proper mineral and vitamin supplements after assessment-NutrEval • Glutathione assessment-NutrEval • www.gdx.net (search NutrEval)

27. What else? • Yeast management • Metal detox via chelation • Biofilm management- EDTA, Proteolytic Enzymes ( Natto or Lumbrokinase), Inter-Face Plus by Prothera • Chinese Herbs that penetrate biofilm: Berberine extract from Coptidis Rhizome (Goldenseal) • Herbs that interfere with Quorum Sensing: Red & blue berries, kale, oregano, basil, rosemary, turmeric, ginger, garlic. • Probiotics

28. MORE HERBS • Allicin/Garlic (Allicillin) • Aloe, Artemisia absinthium • Echinacea, Grapefruit Seed Extract • Mushrooms, Astragalus, Andrographis • Ashwaganda, Boswellia, Neem • Manuka Honey?

29. CYTOKINES • This is what you actually causes your demise • Cytokine determination to assess level of inflammation (significant amounts produced in adipose tissues of the body) • NeuroScience has cytokine panel testing • www.neurorelief.com • Cytokines are managed by downregulating inflammation • CRP and EFA adequacy are markers

30. Transfer Factors • Peptides of low molecular weight (approximately 5 kDa) and perhaps RNA • Made by Th1 CD4+ Helper T-cells • Present in colostrum • Three components - Antigen specific region, region that binds to Th1 Helper T-cells, and a connector • Can strengthen cell-mediated immunity against specific pathogens • Can be used to immunize against specific pathogens Aaron White, PhD Using Transfer Factor to Strengthen Cell-Mediated Immunity Integrative Healthcare Symposium 2010

31. Definition of transfer factor • Borkowsky and Lawrence (1979): • “‘Transfer Factor’ was originally coined as a convenient shorthand to describe the material or materials present in leukocyte extracts or dialysates of skin test-positive donors that had the capacity to transfer cutaneous delayed type hypersensitivity responses to skin test-negative human subjects.” • Now commonly used in the plural – “transfer factors” Aaron White, PhD Using Transfer Factor to Strengthen Cell-Mediated Immunity Integrative Healthcare Symposium 2010

32. Potential future uses of transfer factors • List of known pathogens growing and includes a variety of intracellular agents (mycoplasma; cell-wall deficient bacteria; XMRV, HHV6 and other viruses). • Transfer factors can be (and are) custom made for pathogens • Many pathogens suppress Th1 immunity (HIV, Lyme) and require cell-mediated immunity to be beaten. • Transfer factors strengthen cell-mediated immunity. • Could be helpful for autoimmune conditions involving too much Th2 (e.g., lupus) but seem less likely to be effective against those involving too much Th1 (e.g., multiple sclerosis). • Cancer treatment • Could be used to support or even replace many vaccines, which skew the immune system in the Th2 direction. Aaron White, PhD Using Transfer Factor to Strengthen Cell-Mediated Immunity Integrative Healthcare Symposium 2010

33. www.researchednutritionals.com • A small clinical trial study showed a better increase in CD57 counts using both Multi-mmune and LymPlus transfer factors simultaneously. • Patients taking 2 capsules of Multi-immune 2 X daily showed a 600% increase in NK cells

34. STRATEGIES-HOW TO DECIDE • Lyme testing in this country is poor • Many false positives and negatives • Inadequate band assessment • PCR (Polymerase Chain Reaction) via www.frylabs.com w/ special staining • Live Blood Analysis is medically outlawed • James Schaller, MD favors IGeneX western blot (does a single + band constitute Lyme spectrum disease? Not good for the insurance companies) * Zyto Bio-Resonance Scan www.zyto.com Rapidly assessment of stressors and balancers

35. PERUVIAN RAIN FOREST HERBS • Sorted-out via Zyto • Provided by NutraMedix • Excellent response to these broad spectrum anti-microbial, anti-viral, anti-fungal, and anti-inflammatory herbal tinctures • Samento and Banderol were discussed as excellent remedies for Lyme in the July 2010 issue of the Townsend Letter

36. NutraMedix

37. NutraMedix

38. Homeopathy • Deseret Biologics (Des Bio) www.besbio.com • Series Remedies: Borrelia, Brucellosis, Chlamydia, Condyloma, Coxsackie, CMV, Epstein Bar, Giardia, Hepatitis, Herpes Simplex, Zoster, Mycoplasma, Parvovirus, Toxoplasmosis, RMSF, Bartonella, etc. • WOW! • Nothing to loose!... • Detox, Drainage…. • Energique- www.energiqueherbal.com • Single remedies

39. LYME TREATMENT FAILURE http://www.publichealthalert.org/Articles/jamesschaller/18_reasons_lyme_treatments_fail.htm

40. CONCLUSION • Lyme is not the hub of he wheel • It’s a spoke • Lyme spectrum illness management is extremely complex and intricate • Therapy needs to be prioritized and individualized • You cannot get where you want to be with just unending antibiotics…

41. Treatment of gut and systemic biofilms in Lyme Disease can greatly reduce the reservoir of Borrelia and its associated co-infections resulting in a greatly diminished risk of relapse • Heavy metals are ubiquitous. They can compromise immune function, promote overgrowth of candida, as well as dysbioticgut flora. • Judicial heavy metal detoxification, either once the lyme/co-infection load has been reduced, or concurrently, with appropriate methylation support as needed, may improve outcome and potentially reduce the likelihood of relapse