Dr. Ingels is the author of The Lyme Solution: A 5-Part Plan To Fight The Inflammatory Autoimmune Response And Beat Lyme Disease (get your copy here!), and a respected leader in natural medicine with numerous publications, international lectures and 30 years experience in the healthcare field. Dr. Ingels is a licensed naturopathic physician in the State of Connecticut and a licensed Doctor of Naturopathic Medicine in the State of California. He maintains practices in both states.
Dr. Ingels' practice focuses on environmental medicine with special emphasis on Lyme disease, autism, Pediatric Acute-onset Neuropsychiatric Syndrome (PANS and PANDAS) and chronic immune dysfunction, including allergies, asthma, recurrent or persistent infections and other genetic or acquired immune problems.
- Antibiotics are still considered the standard treatment for Lyme; even Lyme-literate MDs still use them in high, long-term doses and sometimes via IV. Can you discuss what you've seen clinically with the patients who use this approach, versus those who go for herbs right off the bat? Dr Ingels had Lyme himself, and did the standard course of treatment: 21 days of doxycycline. He got sick just before starting his own practice and was working 10-12 hr days. After 8 mo got symptoms again. He figured it probably wasn't a new tick bite. Changed to other antibiotics. Over 8-9 mo, changed the protocol. He lost 25 lbs. He saw Dr Zhong and began his herbal protocol, and within weeks, pt was 85% better. That was his wake-up call. In acute Lyme, Abx can be very effective. But chronic or persistent state, they seems to do more harm than good. Antibiotics damage the mitochondria, compounding the problems that occur from antibiotics themselves. They have clinical improvement while they're on it, but within weeks to months, they're back to square one. Herbal therapy encompasses a broader scope of what Lyme does to the body, and is not totally focused on the organism. They are also anti-inflammatory, improve circulation, and help brain fog. There is good evidence in the literature ? eventually Lyme becomes autoimmune.
- Have you seen that prior antibiotic use prolongs the length of time that patients will require herbal treatment? Long-term ABx: have to undo the damage that has occurred. Have to do all the right things to improve gut function: probiotics, glutamine, digestive enzymes, etc. With animal studies: can take up to 6 mo to repopulate after a single round of antibiotics. It's hard to know when we get the gut back to a normal healthy level. He does see MCAS on people who have been on long-term ABx. It's part of the damage to the gut.
- Your top herbal protocols are Zhang and a modified Cowden, followed by Byron White and Stephen Buhner. These latter two are the ones I have most experience with, largely for price and ease of use. Can you briefly discuss the differences between the four herbal protocols for our listeners? He went through the Zhang protocol himself, and out of all those out there, it's the one that casts the widest net, addressing all the issues that Lyme addresses. It is a complicated medical condition. Chinese herbal medicine as a whole: it's not one herb for one condition. They help balance each other. There's more of an intention behind it. Dr. Zhang started looking at the pharmacology of what the herbs are doing. It addresses the broadest scope of what Lyme does, and there's a lot less herxing. The nature of how the herbs are formulated minimizes this. The biggest down side is cost. He did meet with the company out of CA: makes sure they are free of heavy metals and etc and they are highly concentrated, but this process makes them pricey. A month's supply: $450-500. Dr Cowden herbs: the whole protocol was complicated and hard to follow: 8-12 herbs. But some of the herbs work better than doxycycline, and there are just four of them that are really necessary. He has people go on just those four. People like them bc they're liquids: drops in water, easy to take, don't taste horrible (so it's reasonable for kids) and the cost: $125-130 for 6 weeks. It's more cost-effective for people. Dr Zhang: 80% get clinical improvement, or Cowden: 70%. He's had people who start on one protocol and change to another and feel better. At the end of the day, the protocols all do the same kind of thing. He hasn't used Byron White and Beyond Balance as much: lots of herxing. But these are drop doses, so it's easy for people to do them.
- For herxing, I generally recommend slowing down herbal treatments, and/or infrared sauna or deep tissue Swedish massage (per Buhner's recommendations). I haven't tried the herbs you list (AI#3 or burbur)?can you speak to their mechanism of action? The AI #3 is anti-inflammatory. Burbur is more about detox: improving these pathways which helps to reduce inflammation. Some people will take burbur every 10-15 minutes. Alkalinizing the body also helps with herxing: reducing allergies and sensitivities. TriSalts: a sodium, potassium, and bicarb formula seems to help. Bicarb alkalinizes the body, and this seems to reduce allergies, autoimmunity, inflammation, etc.
- You recommend an alkaline diet for your Lyme patients. Why this one? Our bodies function well at an alkaline pH. The rest of the body is very alkaline. All the things in the environment tend to make us very acidic. The down-stream effect is that this creates more inflammation in the body. Dr Ingels found that an alkaline diet clinically is beneficial, but it's something people can follow long-term. The ketogenic diet is hard to sustain long-term. Paleo: tend to eat a lot of meat. With alkaline diet, trying to keep animal protein to 20%. You can eat too much meat! It's hard on the kidneys: too much of this can be an issue.
- He had a little boy with classic PANS and had sky-high strep Abs. Started treating for strep and he got a little better but the symptoms were still there. He had been treated for Lyme and thought he was fine. Gave Lyme LDI and he reacted. What he thinks happened in his case: Lyme was still there but strep was the catalyst. The Lyme triggered the autoimmune reaction.
- You discuss immunotherapy, as well. Can you discuss briefly what it is for the audience? Who makes a good candidate for immunotherapy? When do you add this in? Low-Dose Immunotherapy is a type of therapy designed to modulate the way the immune system reacts to an organism. At a certain point, Lyme becomes autoimmune and this tries to turn that off. Dr Ty Vincent, the founder, had done another therapy called LDA (low dose allergy therapy). He realized that the mechanism by which the immune system reacts to an allergen is similar. LDI has been a game-changer for a lot of patients. Will start people on an herbal protocol first, bc he's not sure we ever 100% get rid of Lyme. We never really know if it's gone. He likes to use herbs to reduce the load in the body first. If there are 1000 bacteria aggravating the body, you can get it down to 100 or 10 and people do feel an improvement. LDI can be applied to any microbe. In can be a game-changer, but in some cases it can be a trainwreck too ? might cause flares. This tells us that the organism for which they are being treated is probably why they feel the way they feel. If you give a dose and they don't flare, it may not be a huge trigger. Once you find out what the right dose is, they have another one every 7-8 weeks. 1.5-2 yrs is normal for treatment. Usually it's not just Lyme: there are other microbes that play a role. Dr Vincent has had 150 docs in N America who have trained with him on how to do it. But this is one of the few therapies that really helps to turn off the autoimmunity.
- What is your preferred testing for coinfections ? or do you typically go by symptoms? Lyme is a clinical diagnosis. Even the CDC website says that. He used to do this test for a living as a microbiologist. This test was developed 40 yrs ago, and based on a group of people who had known Lyme Disease: they drew their blood and saw what was there and assumed those were typical. Some of the Abs turned out to be specific and some not. Lyme-specific Abs suggests that you've been exposed but not necessarily that the organism is causing your current issues. There is value in testing: does it through labs that are more specific: Global Lyme Diagnostics, IgeneX, Medical Diagnostic Lab in New Jersey. False positives are non-existent. For coinfection testing: same labs for this as well. Thinks it's a good idea to know what you're dealing with.
- Can you talk about a few key symptoms that will lead you to think of specific coinfections? Bullseye rash or migratory joint pain is Lyme. Nothing else does that. Bartonella: purple/reddish streaks on the skin that look like stretch marks. Most stretch marks with weight loss tend to be clear to opaque. Also tends to have a lot of neuropathy, though that can also be Lyme. Babesia: cyclical fever, hot flushing. Temp doesn't always go up but they'll feel feverish. Air hunger also: don't feel like you're getting a deep breath. Anaplasma, RMSF: unless you get the rash, nothing unique to these.
- Along those lines: you say CD57 is not Lyme-specific, and while I've certainly heard this too (and have seen exceptions in practice), I have never seen any studies to indicate what other conditions can cause low CD57. Do you know of any in particular? Mold can do this and it can mimic Lyme more than anything else. If people are on Lyme treatment and not responding well, mold would be something they'd look at next. A lot of viruses can cause this as well, and there are some who inherently have low CD57. Most people don't have this tested until they get sick. Viruses can invade the white cells and cause them to go low. He's never found that it correlates with much and doesn't think it's a reliable marker on how they're doing. He stopped doing that a long time ago.
- Lyme Testing: the questionnaire in Dr Ingels' book is one of the better markers for whether or not you have Lyme. Every lab test can have a false negative. Trying to assess whether you've had exposure: 23, 34, 39, 93. A lot of these are called negative bc they're measuring quantity of Abs, measuring you against a control. The threshold for yes/no is too high. The Lyme screening test is only 43% sensitive.
- You mention that there is little evidence that Lyme can transmit in utero. I'm surprised by this, as I'd always heard the opposite, and have seen Lyme show up in moms and kids (or at least Lyme specific bands show up on WB in kids and also in spouses of Lyme patients). Can you elaborate on this a bit? This is controversial. In the research, with maternal transmission, kids have higher risks of birth defects. He has worked with families where he's seen children born to mothers with Lyme and seen developmental delays that make him believe they may have acquired Lyme from mom. With Ab testing, if you'll test a child, only IgG passes the placenta so you won't know if that's Mom's or the child's. If you see IgM in the child, that's the child, not mom. There is some maternal transmission: that's his opinion. We all go through the decision of do we treat during pregnancy? He's surprised in some ways that docs may give Abx during pregnancy but won't give herbs. He tends to use the modified Cowden in pregnant women bc there's no evidence of toxicity in the individual herbs. Does recommend pregnant moms get treated if they know they have Lyme disease. In the first 6 mo, you can also see it come over from Mom. Sexual transmission: the research says no. He hasn't seen good evidence of this. It's possible, but unclear. If there's a blood exchange it's possible but unlikely.
- Do you have any recommended way to test for biofilms internally, or do you just assume they're there with chronic infections and always include them in a Lyme protocol? There's not a great way to test for this. There are some companies that say Dark Field Microscopy. But it's based on our knowledge of Lyme. Presence of biofilms are not abnormal, but Lyme is incredibly good at making biofilms. We do this to give the immune system the best chance.
- Anything I have not asked: self-care: it's easy to let this slide if you're chronically sick. Get good quality sleep: this is when the body repairs and restores itself. Moving your body: exercise is critical. You can do gentle things like stretching, yoga, etc. He likes this bc it's adaptable to any fitness level. Mental health: if you're chronically ill, this is mentally and emotionally taxing. At some point your friends and family get tired of hearing about it. It's important to establish a support system outside of friends and family: a Lyme support group, a therapist. Make yourself a priority.