What Lyme Disease Is

Lyme disease was is a tick-borne bacterial illness most commonly associated with outdoor activities in New England.  It was first reported in Connecticut in 1975, but unfortunately, it didn’t stay where it came from—although there is still a higher prevalence of Lyme in the New England states than in, say, Arizona, it is far from unheard of here (and many of my patients appear to have gotten Lyme in more endemic areas, and it remains dormant for years until a trigger event occurs to cause it to become active.) 

Part of the reason Lyme is rarely discussed is because it can look like so many other conditions, and because it is very difficult to diagnose. 

How You Get Lyme, and its Progression

Because Lyme is transmitted via tick bite, the infection is localized at first. Classically Lyme presents with a “bullseye” rash (also known as erythema migrans) near the bite location, though many patients later confirmed to carry the bacteria responsible for Lyme (various organisms in the Borrelia family—including but not limited to the originally discovered Borrelia burgdorferi) recall neither a tick nor a rash.  Other early symptoms are very non-specific, and can be mistaken for a flu-like illness.  These symptoms may include chills, fever, malaise, headache, muscle pain, stiff neck, and sometimes lightheadedness and itching.  If the illness is caught at this stage, four weeks of antibiotic therapy should be sufficient for treatment. 

Unfortunately, if Lyme is not caught at this early stage, it can become disseminated throughout the body weeks to months later, affecting the joints and the nervous system especially.  Unexplained neurological symptoms, including tingling and numbness, vision changes, light and sound sensitivity, speech disturbances, and nerve pain are big red flags for Lyme.  Other symptoms include cognitive deficits, palpitations, and joint pain, as well as anxiety, depression, and insomnia in some people.

Testing for Lyme

Lab testing proves difficult for several reasons.  The first is that the Borrelia organisms will not trigger a rise in even the body’s initial antibodies (IgM) until 4-6 weeks after infection.  The IgM antibodies which recognize Borrelia later convert to IgG  (the more lasting type of antibodies) several months down the line.  Therefore, each of these markers must be tested for at the proper time in order to indicate infection. 

Furthermore, Borrelia IgG fades over time, because Borrelia has adapted mechanisms to evade the immune system; if a patient has been infected for three or more years, the Western Blot (a lab test which identifies proteins in a tissue sample by molecular weight) is unlikely to be positive.  For this reason, ILADS recommends that doctors run panels including a few other proteins which are not specific to Lyme but are known to fluctuate when Lyme is present (called complement c4a, which rises with inflammatory conditions, and CD57, which is depressed in chronic Lyme).  I’ve found complement c3a can also be helpful, as can TGFb1, though it is biotoxin-specific rather than Lyme-specific. Since none of these testing methods are fool-proof, I also use the Horowitz Lyme Questionnaire, as an additional piece of data for both diagnosis and also monitoring of treatment.

Coinfections of Lyme

The picture is further complicated by the fact that ticks infected with Lyme are often infected with a number of other organisms as well.  Coinfections may include:

  • Babesia: presents with a number of symptoms, but most classically day and night sweats, shortness of breath and air hunger, chronic cough, and worsened Lyme symptoms
  • Bartonella: presents with neurological twitches, burning soles of the feet, rashes, and a wide range of other symptoms
  • Ehrlichia: presents with muscle pain, severe headache, and low white blood cell and platelet count. 

Additionally, when the immune system is depressed, certain viruses which were already present and kept at bay may flare, including Epstein Barr, Human Herpes Virus 6, and Cytomegalovirus, among others. 

A few bacteria may also take advantage of the immune system’s sluggishness, including mycoplasma and Chlamydia pneumonia.  As if that weren’t enough, fungal organisms tend to overgrow in the gut and sometimes the sinuses, as well. 

If these coinfections and opportunistic infections are present, you have to address the whole picture. Treating Lyme alone won’t be enough.

Treatment Therapeutic Order

Because the case is so complicated, treatment has to be strategic.  If the patient has been ill for some time, it is first necessary to support the whole person and address any complications, such as yeast overgrowth, nutritional, or hormonal deficiencies.  This will ensure that the patient is at his or her strongest going into the treatment protocol.   

Depending on the person, I may at this point address chronic viral or bacterial infections next, or go straight for either Lyme or the coinfections. One organism is usually dominant, and while sometimes specialty testing can distinguish which organism we need to deal with next, sometimes it’s more a matter of assessing symptoms.

Sometimes coinfections form biofilm communities, which are aggregates of cells that adhere to each other and to a body surface, and cover themselves with a layer of extracellular DNA, proteins, sugars, and fats in order to protect themselves from the immune system.  Biofilms can be identified using laser scanning microscopy—but it’s challenging to find labs that will test for this. We can generally just assume the presence of biofilms, as this is what organisms naturally do within the body. Everyone has biofilms; the question is whether or not they are contributing to illness.

Borrelia can hide from the immune system using multiple configurations (including the L-form, which hides inside cells, the more traditional spiral form, and the cystic form)—therefore, treatment usually requires at least months, if not longer. While gold standard Lyme treatment is still antibiotics, I’ve found that some of the sickest Lyme patients I’ve encountered are those who have undergone long-term antibiotic treatment, as it weakens the immune system. Herbal protocols are equally effective and do not confer the collateral damage that antibiotics tend to do, so this is my treatment of choice. I also integrate Low Dose Immunotherapy in some cases, and in other cases may choose Low Dose Immunotherapy alone for patients who are unable to tolerate even herbal treatment.

Throughout the treatment protocol, it is important to support the patient’s detoxification pathways as well.  As the organisms die off, fragments spill into the bloodstream and may trigger immune responses which can make the patient feel very ill (called a “herxheimer” reaction).  Supporting detoxification will enable these bacterial remnants to move through the body quickly, rather than remain in circulation. 

The Upshot

Lyme Disease is a complex illness, and some cases of it are substantially trickier than others depending on complicating factors. But it is possible to get your life back.