Lyme Disease in Australia

1. Lyme Disease in Australia Nicola McFadzean, N.D. Naturopathic Doctor

2. What is Lyme Disease? • by definition, Lyme disease refers to an illness caused by the bacteria Borreliaburgdorferi (and expanded to include other strains of Borrelia such as afzelii, andersonii, garinii) • traditionally thought of as a tick-borne illness but various modes of transmission are possible (fleas, mites, lice, mosquitoes etc). • research limited by suspicion of Lyme being passed sexually and mother to baby in utero. • Lyme disease also involves multiple infectious agents (co-infections) • Traditionally thought of as not being in Australia but that is incorrect. This raises major problem with getting adequate medical care.

3. Identifying Lyme disease The Great Imitator – can mimic MS, ALS, Parkinson’s, fibromyalgia, chronic fatigue syndrome, rheumatoid arthritis, autistic-spectrum disorders (kids) etc. • General – debilitating fatigue, insomnia, malaise, headaches, dizziness/ lightheadedness • Neurological – numbness, tingling, paralysis, Bells palsy, burning/ shooting pain, motor neuron impairment, optic neuritis, facial numbness

4. Cognitive – short-term memory loss, difficulty concentrating, lack of focus • Psycho-emotional – anxiety, depression, OCD, irritability • Musculoskeletal – joint/ muscle pain – migrating joint pain typical; muscle weakness, restless legs, stiff neck • Digestive – nausea, irritable bowel, abdominal pain • EENT – ringing in the ears, visual changes (blurriness etc), hearing loss • Cardiac – palpitations, arrhythmias • Genitourinary – pelvic pain, irritable bladder

5. Co-infections & Lyme Disease • While Borrelia might be the underlying infectious agent in Lyme disease, there are other co-infections that may co-exist with Borrelia. • Most commonly - Babesia, Bartonella, Erlichia, Rickettsia. • Mycoplasma, Chlamydia and Candida are other microbes commonly present or out of balance in Lyme disease patients.

6. At least 80% of my patients in the U.S. carry at least one co-infection (based on labs and clinical picture); many Australian patients are co-infected also. • Babesia is a parasite, not a bacteria, so requires different treatment options.

7. Some hallmark symptoms of co-infections Babesia – • night sweats, low grade fevers, temperature regulation problems, shortness of breath/ air hunger, capillary angiomas, ear ringing, blurry vision, anxiety, nausea, vivid or violent dreams, hormone imbalance, vasculitis (red skin with white splotches). Jaw/ head/ neck symptoms.

8. Bartonella – • severe joint pain, ice pick headaches, bowel problems, pain/ burning in the soles of feet, rib pain, abdominal pain, CNS symptoms out of proportion to skeletal, OCD behavior/ severe anxiety, straie on skin, subcutaneous nodules, scratches.

9. Erlichia/ Rickettsia - • knife-like headaches, severe muscle pain, low WBC, rapid onset, neuro symptoms (seizures, shooting pains), tendon pain, right upper quadrant pain.

10. Diagnosing Lyme Disease • Textbook presentation – tick bite, EM rash, flu-like illness. • Acute Lyme disease very different to chronic Lyme. • Chronic Lyme disease is predominantly a clinical diagnosis. • Labs are used to back up the clinical impression. • Australian labs may not be highly sensitive. • U.S. lab – IgeneX - specialty Lyme lab in California. • Tests for Lyme and co-infections. • Can have blood drawn in Australian and Fedex’d over.

11. Types of tests • ELISA – first test done as screening test. ELISA is measuring an immune reaction but is not highly sensitive – most cases missed. A negative ELISA test does not rule out Lyme disease. Not a sensitive test. • PCR – looks for DNA of bacteria in blood. Can do for borrelia and all coinfections. Specific but not highly sensitive.

12. Western blot – looks at IgM (active, current infection) and IgG (longer term, more chronic infection or past exposure). • Certain bands are significant – IgeneX recognizes certain bands that the CDC does not. • Need a certain number of bands to be present to make a positive result – but even one Lyme-specific band may indicate infection (hence need clinical picture)

13. FISH tests – babesia and bartonella. These are smear tests where they stain the sample and see the bugs glowing in the dark! • Antibody tests for babesia, bartonella, rickettsia, erlichia. IgG and IgM. • CD-57 – immune marker that is suppressed in Lyme disease. Can be used to track progress of treatment over time, but not a perfect science. Available in Australia/ do not run through IGeneX. * Running multiple tests increases the likelihood of making an accurate diagnosis.

14. Treating Lyme Disease Three key points to be aware of when talking about treatment – (1) Borrelia exists in three different forms – can morph from one to another – 1. Spirochete 2. L-form (cell wall deficient) 3. Cyst form

15. (2) Need to address co-infections – babesia, bartonella, rickettsia, erlichia. (3) Herxheimer reaction – when bugs are killed they release neurotoxins which can cause a temporary worsening of symptoms. Things can get worse before they get better. This can influence greatly how gently or aggressively we can treat.

16. Allopathic Treatment of Lyme Disease Acute Lyme disease – • 6-8 weeks, if high enough doses and treatment started early enough can eradicate infection. • IDSA guidelines say 21 days is sufficient for all Lyme.

17. Chronic Lyme disease – • Need long term antibiotics – several months up to 2 years and beyond. • Need to combine antibiotics for different forms of Borrelia. • May need IM or IV antibiotics, and/or various combinations of orals. • Meds chosen depends on patient sensitivity levels, allergies, co-infections, side effects • Often higher doses needed than used for other conditions.

18. Borrelia – need to address all three phases Spirochetes • Penicillins – amoxicillin, Bicillin (IM) • Cephalosporins – ceftriaxone (IV), cefuroxime L-forms • Macrolides – azithromycin, clarithromycin • Tetracyclines – minocycline, doxycycline Cysts • Metronidazole, tinidazole • Plaquinil (hydroxychloroquine) • Alinia

19. So may layer one medication from each group; start one at a time, monitor effects and side effects; be aware of interactions. • Example regimen – doxycycline, clarithromycin, Bicillin, tinidazole pulse. • Prioritize treating Borrelia first or coinfections first ?

20. Babesia • Mepron (atovaquone) • Malarone (atovaquone plus proguanil) • Larium • Coartum • Alinia • Septra/ Bactrim

21. Bartonella • Doxycycline • Rifampin • Ciprofloxacin/ levaquin • Septra/ Bactrim • Zithromax (weak)

22. Erlichia/ Rickettsia • Doxycycline • Rifampin Mycoplasma • Doxycycline/ minocycline • Levaquin

23. Role of Naturopathy in the Treatment of Lyme Disease

24. Holistic approach is important - simply hitting bugs over the head with a hammer is not enough. 1. Boost immune function 2. Mediate inflammation 3. Antimicrobial – bug killing; synergism with antibiotics or alternative for those who cannot tolerate (or access) antibiotics 4. Supportive Herxheimer reactions

25. 5. Offsetting side effects of antibiotics 6. Adrenal support and hormone balancing 7. Provide symptom relief (pain, muscle spasms, sleep issues, depression, energy etc) 8. Other issues – heavy metals, candida, GI infections, mold toxicity, chronic viral infections (herpes, EBV, CMV, HHV-6)

26. 1. Immune Function • Want the body to be able to fight the infection itself. • Avoid nutritional factors that suppress immune function such as sugar. • Transfer Factors – researched to boost NK cell activity. (general and Lyme specific) • Beta-glucans • Colostrum • Astragalus • Mushroom extracts – reishi, shitake, maitake, etc.

27. 2. Mediate Inflammation • Herbs – curcumin, white willow, holy basil • Proteolytic enzymes – protease, bromelain, papain, serrazimes. • Essential fatty acids – often need 4-6 grams daily. Fish or flax.

28. 3. Antimicrobials • Lyme – teasel, samento (cats claw), guaiacum, grapefruit seed extract • Babesia – artemisinin, cryptolepis • Bartonella – Houttuynia (HH2 by Zhang) • Parasites – black walnut, wormwood, clove, ginger, gentian • Yeast – oil of oregano, pau d’arco, garlic, cinnamon, caprylic acid. • Others – olive leaf extract, colloidal silver

29. 4. Supporting Herxheimer reactions/ detoxification • Glutathione • Smilax glabrae (Chinese sarsaparilla) • Liver/ kidney herbs • Lemon juice in water • Epsom salts baths • FIR sauna (with caution) • Lymphatic drainage massage (with caution)

30. 5. Offsetting side effects of antibiotics • Candida overgrowth – prevention with probiotics – 100 billion live organisms daily, give before bed, at least 2 hours after last dose of antibiotics or antimicrobial herbs. • Saccromyces boulardi can be used in conjunction. • Liver and kidney function – monthly labwork. Herbs such as dandelion, milk thistle, burdock, schisandra. Do not give milk thistle to a patient taking Mepron or Malarone (reduces efficacy)

31. 6. Adrenal support and hormone balancing • Adrenals under major stress – assess using salivary testing throughout the day. • Herbs – rhodiola, ginseng, ashwaghanda. Balancing better than stimulating. • Hormone precursors – DHEA, pregnenolone • Reproductive hormone support – maca, black cohosh (good for bladder irritability also), progesterone, testosterone. • Hormones often get out of whack especially in Babesiosis.

32. 7. Symptom relief • Pain – herbal anti-inflammatories and proteolytic enzymes • Nerve pain relief – St John’s wort, lemon balm, Jamaica dogwood • Energy – • Adrenal support, thyroid support (iodine and tyrosine) • Mitochondrial support – CoQ10 (not with Mepron or Malarone), NADH, NT factor, carnitine, keto-glutaric acid. • Ribose

33. Sleep – 5-HTP, melatonin, valerian, lemon balm, passion flower, chamomile, L-theanine • Muscle spasms – magnesium, malic acid, potassium • Depression – amino acid therapy can be helpful – • Tyrosine – energizing for the brain, also support thyroid • 5-HTP – supports serotonin, calming, helps depression • GABA/ L-theanine – good for anxiety/ OCD

34. 8. Other issues • Heavy metals • GI infections • Mold toxicity • Chronic viral infections (herpes, EBV, CMV, HHV-6)

35. Nutrition and Lifestyle Factors • Drink 2L daily of clean, filtered water – helps to flush out waste material • Reduce foods that cause inflammation – gluten, dairy, any foods with IgGintolerance • Diet should comprise mostly of lean, organic proteins, fruits and vegetables, healthy fats such as olives, avocado, coconut, flax oil • Ensure adequate fiber to sweep/ detox bowels – flax seed, psyllium

36. Minimize sugars, caffeine and saturated fats • Sleep – maximize sleep before midnight • Exercise – some gentle exercise is good, but not so much that it wears the person out or increases pain/ fatigue in following days. Stretching, pilates, swimming, walking.

37. CONCLUSION • Lyme disease does exist in Australia. • Lyme disease is complex and multi-factorial. • Co-infections are important – missing those can hamper recovery. • Effective treatment involves so much more than hitting bugs over the head. • Natural medicine and a holistic viewpoint very valuable. • Recovery is slow and steady, but much improvement is possible!!