Herbal Approach to the Treatment of Lyme Disease

1. Herbal Approach to theTreatment of Lyme Disease Dr. Emily Maiella 432 Greenfield Rd Montague, MA 413.367.9350

2. The treatment ofLyme has changed • In 2006 I began going to ILADS conferences. The attendance was not big, usually in just an auditorium. There was never any presentations regarding natural medicines and the treatment of Lyme. • This year, I attending my 7th ILADS conference. Not only was the conference enormous, reaching maximum capacity in at least 4 big conference rooms, but there was an entire “track” dedicated alternative medicine. The treatment of Lyme has shifted.

3. Alternative treatments are more cumbersome, but it is more joyful when you get there and more congruent in keeping with the needs of the earth.

4. Listen Lyme disease is a highly variable and adaptive organism. There is no one treatment that will work for all patients. Every incidence is unique and the practitioner must see the person in front of them. Patients need individual attention so they can tell their entire story from the beginning. There is information in these stories that help to guide where the treatment begin. What was your life like before this illness? “The response of the host makes the disease”. It is often not the bugs that create the symptoms, but our immune systems response to them is far more relevant.

5. Evolution with Peaceful Intentions Treatment should always keep in mind that our immune-system is in a never- ending training and adaptation program. We are evolving. The same is true for the microbes. I truly believe that you can’t heal when fearful. I’m here to help counter the dooms-day reports My hope is that we can seek a peaceful inner state - in which microbes are welcome as long as they contribute to the greater whole. It is difficult to understand Lyme disease in this way, but my hope is that our unconscious and our immune-system does/can. Plant adaptogens have a great potential in helping us in this necessary process of evolution.

6. We are Super Organisms! • The evolutionary process has made become a symbiote which contains over 3.3 pounds of microbial mass in our gut, with over 10 trillion cells that continuously interact with and modify our genetic phenotype. • The number of bacteria living within the body of the average healthy adult human are estimated to outnumber human cells, 10 to1.

7. We live in their world…. • 90% of us is bacterial DNA • 10% of us is our own DNA Parasite elimination prior to Lyme treatment is important. (ie lung worm for chronic fatigue patients)

8. Layered Treatment model The treatment of Lyme and co-infections is a layered process, because as a patient moves through treatment, it is not uncommon for the symptom picture and pathology to change. • Outer layer: What the immune system is currently challenged with. • Second Layer: The next dominant pathogen/pathology that will manifest in a change in the symptomatic pattern • Third Layer: Weaker pathogen which will come forward next with a set on milder symptoms. • Innermost Layer: Deepest layer that is probably related to your genetic susceptibility.

9. Foundation Health There are some foundational aspects of health that I make sure that are addressed during (or even before) treatment. ~sleep ~inflammation ~hormones (thyroid, adrenal, insulin and sex hormones) ~toxic exposures (metals, EMF’s, mold), including emotional/spiritual (ongoing and past) ~diet ~immune system imbalance

10. Hierarchy of Treatment • 1) Correct basic physiological parameters (pH, electrolytes, HPU/KPU, constipation, hormones) • 2) Immune Modulation (which accounts for most of the symptoms) • 3) Detox of biotoxins and exogenic toxins • 4) Decreasing microbial and parasitic burden. Note that the last step is killing the microbes.

11. INFLAMMATION • Borellia uses specific mechanisms, primarily inflammation, to breakdown the collagen tissues. • It is where this breakdown occurs that determines where the symptoms emerge. If it is in the joints, arthritis presents. In the meningies, neurological Lyme is seen. In the heart, Lyme carditis presents.  • Cytokines are inflammation chemicals made by the immune system in chronic diseases. They cause most of the symptoms. At the beginning of treatment when killing lyme spirochetes with antimicrobials (or yeast with antifungals), cytokines are made in even greater amounts, causing a person to feel much worse. Curcumin/tumeric, bromelain, boswellia, ginger and querectin are some great anti-inflammatories.

12. SLEEP • Often disturbed in chronic Lyme disease. Lack of adequate sleep worsens pain, increases fatigue, and suppresses the immune system. • It appears that in response to infection, the excess inflammatory cytokines produced by the immune system decrease the output of sleep inducing hormones (melatonin) to the sleep centers of the brain. Sleep in the few hours before midnight is most restorative. There are many options here. • Melatonin very useful due to it’s wide range of therapuetic benefits http://www.lef.org/magazine/mag2008/aug2008_Beyond-Sleep-New-Medical-Applications-for-Melatonin_01.htm

13. Hormones Low hormones occur often in chronic Lyme disease. Again, cytokines, decrease the effective functioning of the hypothalamus, pineal and pituitary glands (in your brain). These parts of the brain produce chemicals that induce sleep and that regulate hormonal systems. Normally this part of the brain releases messengers such as thyroid stimulating hormone (TSH), adrenocorticotropin hormone (ACTH), and follicle stimulating hormone (FSH) to stimulate the thyroid, adrenal glands, and sex hormone organs, respectively.

14. Hormones Cont. • A better way to check hormone status is to measure the actual hormone levels like T4/T3 (thyroid), or cortisol/dhea (adrenals), or estrogen/progesterone/testosterone (sex hormones). • However, these tests give a broad range of normal, therefore a person could have normal range testing for each of the hormones but still have clinically low hormones. Because of the unreliability of testing, treatment for low hormones should occur if there are clinical symptoms of low hormones as long as treatment does not increase hormone levels above the upper end of normal.

15. Adrenals and Thyroid Adrenal Insufficiency: rule this out if you have fatigue, recurrent infections, poor recovery from infections, low blood sugar with shakiness and irritability relieved by eating, low blood pressure and dizziness on standing, afternoon crashing, and sugar cravings. Natural medicines include: Ashwagandha, schizandra, licorice, rhodiola Prolonged antibiotic therapy will deplete the adrenals. Low Thyroid: fatigue, achiness, low body temperatures, cold intolerance, weight gain, constipation, changes in menstrual periods. Can be confused with adrenal insufficiency. Natural medicines: Lots of different options here, just be aware of iodine content as too much can make thyroid conditions worse.  

16. Auto-immune imbalances T cells and B cells from some patients with chronic Lyme disease are reactive not only against Borrelia burgdorferi-specific antigens but also against various host (self) antigens. This mimicry might generate autoimmune inflammatory reactions that could be responsible for arthritic as well as some neurological symptoms associated with chronic Lyme disease. This happens with people that have specific HLA genotypes (HLA-DR4 and 2)

17. Diet and Lifestyle choices • This is going to be one of the most challenging journey that you will embark on. There is a lot to be done on your part while the medicines do their job. My treatment plan includes dietary changes with emphasis on nutrient dense foods such as seeds, nuts, free range eggs, balanced 4:1 omega 6 to omega 3 oil, organic protein foods, and green leafy vegetables. I usually recommend all grain/flour, sugar, processed foods, and hydrogenated fats to be removed. Building a strong nutritional foundation is paramount and is accomplished by raising the mineral base, stabilizing the electrolytes, increasing and balancing essential fatty acids. • Minimizing aggravating factors: This is my toxic 50 gallon barrel analogy. What have you put into your barrel over your life? Time to get rid of it. Think toxic homes, toxic relationships, heavy metal overload, gut dysbiosis, yeast over growth and food allergies (to think of a few). A food allergy test and a stool microbiology test is recommended prior to starting treatment

18. Herbal protocol Many options and protocols available. I tend to use Uncaria, Andrographis, Smilax, Polygonum, Teasel, Stephania garlic and Guacucium. Dosage is highly variable. Some patients need a few drops while others require tablespoons. It is difficult for the spirochetes to develop immunity to this type of an herbal regimen due to the complex phytochemicals of the herbs. Herbs have the ability to address many aspects of dysfunction: ~They are anti-inflammatory which help to stop the breaking down of collagen. ~They support the formation and strength of collagen in the body. ~They allow the doctor to design specific treatment interventions for the unique symptom picture of the patient. ~Immune system modulators to correct immune dysfunction. ~ Anti-spirochetals to control infection. The use of anti-spirochetals continues to get lower and lower on the list as time has gone on. 

19. Polygonum cuspidatum

20. Japanese Knotweed An invasive botanical in almost every place where Lyme has emerged. Nature has a way of helping. Japanese Knotweed shuts down the inflammatory pathways initiated by the spirochetes. It inhibits lipoxygenase, prostaglandin E and NF kB, which are all up-regulated in Lyme disease.

21. Japanese knotweed • Knotweed crosses the blood brain barrier. It is specific for inflammation in the meninges (stiff neck and headaches) • It is a potent antioxidant and has protective effects on the brain. It calms the central nervous system and helps with arthritis symptoms in Lyme disease. • Knotweed is an herb and drug synergist meaning that when it is used with antibiotics, it makes them powerfully effective even in cases where they previously failed. Take Japanese Knotweed along with antibiotic therapy.

22. Japanese knotweed • It modulates the immune system by either raising or lowering immune function as required in each unique person (immune modulating), thereby reducing the dynamics involved in autoimmunity. • It is an angiogenesis modulator and controls the healthy generation of blood vessels. It stimulates microcirculation to the eyes (due to it’s High content of resveratrol) and joints thus helping to facilitate the movement of drugs or herbs to those locations. • It is cardioprotective and helps to remove endotoxins, which is a benefit to those with Herxheimer reactions during treatment. 

23. Japanese knotweed • Traditional Chinese Medicine has used it as a blood-moving herb, to resolve inflammation, stagnation, and poor circulation, but also as a supportive herb, to counter debility and immune fatigue. Because it is considered to be an herb that slows down the aging process (together with its relative Polygonum multiflorum, also known as Fo Ti and Shou Wu), millions of Chinese use Japanese knotweed to prolong youth.

24. Japanese knotweed • Similar to astragalus, it has an adaptogenic or immune-balancing quality, which makes this an effective ally in balancing the body’s immune responses; it can stimulate immune cells, as in Lyme disease, or modulate them, as in an autoimmune disease. By supporting the blood flow to difficult-to-reach regions of the body, Japanese knotweedʼs antimicrobial and anti-inflammatory actions can reach the eyes, joints, and brain.

25. Other published functions of knotweed • Peer review literature (pubMed): Many gram neg and gram pos bacteria, Anti-viral, Hepatitis B and C, many types of cancer (esp hepatocelluar cancer), cardiovascular disease, anti-inflammatory. • Other published positive effects: antimicrobial, protects against microbial endotoxins, Lowers cholesterol and lipids, Increases wound healing, Ischemic heart disease, Leukemia, Stimulates fibroblasts (proliferative effect), Rheumatoid arthritis, Psoriasis, Increases bone mass, Reduces auto-immunity, Strongly neuroprotective (ALS, Alzheimer, Parkinson’s, MS, cerebral ischemia).

26. Dosage for knotweed: • Whole herb (Aka the root) (Hu Zhang) standardized to 8% total resveratrol and 10 mg resveratrol. 500 mg tablet. • Use 3-4 caps 3-4 times/day. Work up slowly to this dose • Contraindications: Pregnancy, Consider carefully when giving with blood thinners (synergistic effect), may cause a metallic or odd taste in the mouth. 

27. andrographis paniculata • King of Bitters

28. Andrographis paniculata • Andrographis has been used traditionally in China to treat all manners of febrile diseases and infections. It is used throughout China and India for its apparent anti-parasitic and antimicrobial actions to treat syphilis, malaria, and worms; and for swollen lymph glands with fever, abscesses, and lung and sinus infections. It was used in many cultures to treat syphilis until antibiotic drugs became more available.

29. Andrographis paniculata • Recent scientific research, has indicated that it has antimicrobial effects, it supports immune function, increases interleukin-2 production, and has some cancer-targeting actions. (Singha PK, Roy S, Dey S. Antimicrobial activity of Andrographis paniculata. Fitoterapia. 2003;74:692-694; Kumar RA, Sridevi K, Kumar NV, Nanduri S, Rajagopal S. Anticancer and immunostimulatory compounds from Andrographis paniculata. J Ethnopharmacol. 2004;92:291-295; Rajagopal S, Kumar RA, Deevi DS, Satyanarayana C, Rajagopalan R. Andrographolide, a potential cancer therapeutic agent isolated from Andrographis paniculata. J Exp Ther Oncol. 2003;3:147-158.)

30. Andrographis paniculataa simple pubmed search…. • kidney protective (rapid excretion via kidneys) • anti-spirochetal • crosses blood brain barrier • protects heart muscle, anti-inflammatory • potent modulating effect on mast cell and neutrophil activity: turns off inappropriate mast-cell allergic reactions in tissue • enhances liver function • protective effects against inflammation-mediated neurodegeneration of brain, spinal cord and CSF

31. Andrographis paniculata • Filarial diseases • leptospirosis • malaria (suggesting strong effect against Babesia) • periodontal bacteria (gum disease) • AIDS • cancers: prostate, breast, colon, anal, stomach ,skin melanoma, leukemia • TB • Tonsilitis, pheumonia, herpes, E. coli, snake bites

32. Andrographis paniculata • Dosage: 400 mg capsules standardized to 10% andrographolides. Start with 1 cap 4 times/day. Slowly increase to 3 caps 4 times/day. Stay on this dose till Lyme sx significantly decreased, then slowly decrease dose. • It needs to be taken at least three times a day as it moves out of the body rapidly. • Stop during severe Herxheimer reactions. 1 year • Contraindications: andrographis lowers progesterone (natural contraceptive), pregnancy, and acute gallbladder disease. The main side effect of andrographis is that 1% of the people that take it will get severe hives that takes as long as two months to resolve. Start with a lower dose to watch for s/e’s

33. Smilax glabra • Roots: 6-8 feet long

34. Smilax glabra, spp. • Sarsaparilla root has been used for centuries by the indigenous peoples of Central and South America for sexual impotence, rheumatism, skin ailments, and as a general tonic for physical weakness.

35. Smilax • Amazonian medicine folk use sarsaparilla root internally and externally for leprosy and other skin problems (such as psoriasis and dermatitis.) • Just FYI: Leprosy can be common in areas where the disease is carried by armadillos (and in the Amazon, armadillos are "on the menu" in indigenous diets).

36. Smilax and Syphilis • European physicians from as early back as 1536, considered sarsaparilla root a tonic, blood purifier, diuretic, and sweat promoter, BUT mostly as an syphilis cure. Since this time, Smilax roots have had a long history of use for syphilis and other sexually-transmitted diseases throughout the world. • It was registered as an official herb in the U.S. Pharmacopoeia as a syphilis treatment from 1820 to 1910.

37. More uses of Smilax • A U.S. patent was awarded in 2003 describing these flavonoids to be effective in treating autoimmune diseases and inflammatory reactions through their immunomodulating effects. Sarsasapogenin and smilagenin were subjects of a 2001 U.S. patent which reported that these Smilax steroids had the ability to treat senile dementia, cognitive dysfunction, and Alzheimer's disease.

38. What is an endotoxin anyway? • Clinical research has validated the traditional use of sarsaparilla for skin conditions such as psoriasis, eczema, acne, and leprosy. (NEJM). • One of the possible mechanisms of action in psoriasis is sarsaparilla's blood cleansing properties. Pts. with psoriasis have been found to have high levels of endotoxins circulating in the bloodstream (endotoxins are cell wall fragments of bacteria). Sarsaponin, one of sarsaparilla's main steroids, was found to bind to these endotoxins and remove them, thus improving psoriasis.

39. Smilax and the Herx reaction • As bacteria break down, they release endotoxins that normally are cleansed from the gut by the lymphatic system and the liver. If the endotoxins are excessive and cannot be eliminated, the body experiences a toxic overload. This toxic overload triggers an inflammatory reaction as the body moves into a fight pattern, causing a flare-up of symptoms of arthritic pain, skin inflammation, and irritability. Sarsaparilla’s binds endotoxins in the intestines before they get into the bloodstream.

40. Smilax glabra (Sarsaparilla)(another pubmed search) 1. Leptospirosis 2. Treponema pallidum (syphilis) • liver flukes (clonorchis sinensis) • shigella and salmonella • Leprosy • TB • fungal skin infections

41. Smilax glabraother published/clinical evidence • Lyme endotoxin binding • Lessens Herxheimer reactions • Improvement in mental and psychological parameters in chronic lyme and syphilis • Modulates immune responses esp w/ autoimmune dysregulation • Arthritis (anti-inflammatory and pain relieving) • Psoriasis and eczema, Reduces skin breakdown • Neuroprotective (crosses blood brain barrier) • Improves liver function, including Hepatitis C • Lessens fatigue • Increases libido • Asthma, hay fever, rhinitis

42. Smilax Glabra • Dosage: 425-500 mg caps 1-3 caps 3-4 times/day. Increase slowly to full dosage, stay on it for 2 months, then slowly reduce to maintenance dose of 1 caps 3 times/day. At least 1 year • Contraindications: Increases digitalis, digoxin (CHF and dysrhythmias ) and Bismuth absorption, increased elimination of hypnotic drugs.

43. Uncaria tomentosa • Cat’s Claw; Amazonian vine. Make sure that only the bark is harvested, as some companies harvest the root, and is therefore in danger of over harvesting.

44. Uncaria tomentosa In lyme, it acts as a immune potentiator, which helps to raise CD57 white blood cell counts. Anti-inflammatory and analgesic, so useful for joint and muscle pain associated with Lyme. Especially good for neuroborreliosis, chronic fatigue and cognitive decline.

45. Cat’s claw • The Asháninka Indian priests in Perú used Catʼs claw to regulate disturbances between a personʼs body and spirit.

46. Cat’s ClawTOA’s (Tetracyclic oxindole alkaloids) or not? In some cases, people have experienced that they cannot tolerate full-spectrum Cat's Claw, however, they can tolerate TOA-free. I have not found the studies on TOA-free to be very convincing. It is actually the TOA’s that help the central and peripheral nervous system. The POA’s (Pentacyclic oxindole alkaloids) which is another type of alkaloid in Cat’s Claw, helps with the immune modulation, so both are important. I generally suggest using full-spectrum Cat's Claw. For a great discussion on the differences: http://www.rain-tree.com/toa-poa-article.htm#.UYf5-StATms

47. Teasel: Pinyin name in is Xu Duan, “restore what is broken”

48. Teasel-from an eclectic perspective • When a plant has a prickly doctrine of signature (like eluethero, nettle and raspberry) they will help you to break something down and weave something new. Used to tease cloth, wool in particular (tapestry). • Eclectic herbalist say that is will mend things that are broken, esp in energetic field. Adrenal pulses will change when using it.

49. Teasel • Lyme disease spirochetes attack and penetrate into collagen tissue, affecting the joints and tendons throughout the body, teasel root seems to fit right in. Rather than killing the bacteria, teasel helps to change the bodyʼs environment, so that the body itself can kill off the Lyme bacteria by bringing the bacteria into the bloodstream, where it can detoxify.

50. Teasel: Traditional Chinese Medicine • Yang tonifying herb, Dipsacus fortifies the lower back, knees and bones. • It has a positive effect on the sinews and joints as well and is used for pain and stiffness from decreased Kidney energy or from traumatic injury. • It is also used to promote the movement of blood and to repair damaged tissues.