Lyme disease

Introduction

Lyme disease is a bacterial infection caused by various species of Borrelia. These are all spirochetes (spiral shaped bacteria), that can in certain circumstances change into a cyst like form that is very hard to detect.

The disease is in most cases caught when a juvenile tick about the size of a sesame seed latches onto your skin with its legs and pushes its chelicerae (cutting tools) and feeding tube through your skin. It also secretes a numbing agent to help it avoid detection. It stays attached for up to 2 days as it drinks a huge amount of blood in comparison to its body size. The longer it stays attached, the greater your chances of getting Lyme disease, assuming of course that the tick is one that has Lyme disease itself. Most ticks do not. So if you are bitten by a tick the chance of getting Lyme could be anywhere between 1-30%, but in the UK the percentage chance of getting Lyme is normally on the lower end of this range.

Ticks that carry Lyme disease are found in most regions of the UK, especially Scotland and the south of England. Those that intend to infect you are found at the top of long grasses from where they can attach to your clothing or bare legs. They like wet temperate conditions and will be more prevalent after wet weather. In hot dry conditions they are more likely to be found on logs or in leaf litter.

How can Lyme disease affect your body?

Lyme disease is able to affect your immune system in a number of ways causing three major effects:

  1. Lowered immunity – this puts you at risk of further different types of infection that may have been transmitted with the original tick bite. These include babesiosis, bartonella, ehrlichiosis, rickettsia, mycoplasma and chlamydia. Many of these display flu like symptoms and it is often difficult to tell these infections apart. A number of these diseases also have the potential to cause long term complications.
  2. Auto immunity – is where your immune system starts attacking your own tissues. Examples include multiple sclerosis and rheumatoid arthritis, which are associated with Lyme disease.
  3. Inflammation – plays a role in virtually all diseases that affect us. More specifically with Lyme there are associations with Parkinson’s, Alzheimer’s and Motor Neuron disease, reflecting the extent to which Lyme disease attacks the central nervous system.

Symptoms

After an infected tick has detached from your skin and the bacteria have entered your bloodstream it may take up to a month to develop any symptoms. These can include in somewhere between 30-70% of cases a distinctive bull’s eye rash which is known as “erythema migrans” meaning a rash that can move about the body. Other acute symptoms can include:

  • Sweats and chills
  • Headaches and neck pain
  • Muscle and joint aches
  • Insomnia.

If the infection is left untreated or antibiotic treatment fails then it is possible to get longer term chronic symptoms which include:

  • Fatigue
  • Depression, anxiety and cognitive defects
  • Persistent muscle and joint aches
  • Tingling extremities
  • Cardiac problems such as heart block and arrhythmias.

Because Lyme disease causes big changes to your immune system persistent chronic Lyme infection can increase your chances of contracting Multiple Sclerosis, Rheumatoid Arthritis and certain dementias.

How many people have Lyme?

UK Government statistics accept up to 1000 cases being reported each year (1), which represents roughly a prevalence of little more than 1 in 67,500. However the true number of cases is thought to be much higher than this due to the lack of understanding that the average GP and the guideline forming committees in the UK (and USA) have about the disease.

In the US the official figures from the CDC – Centres for Disease Control, accept a much larger 300,000 cases per year representing an incidence rate of 1 in 1,100. This however is also thought to be an underestimate, and other studies from the US suggest that Lyme disease incidence could be as much as 1 million cases per year or 1 in 330 (2). For the UK the figure is accepted to be lower with an incidence rate of 1 in 8,500 representing around 8,000 new cases per year (3). This could however still be an underestimate as Britain is behind the US in its Lyme disease experience level, and as a result different strains of bacteria could have evaded detection in the study. Also there are known problems that exist with the current testing methods for Lyme making it likely that incidence rates are higher in both the US and UK.

Is there a controversy about Lyme disease?

If you consult the internet it is easy to get the impression that there are two warring factions when it comes to the understanding of Lyme disease. It is stated that the health authorities believe that Lyme is only an acute illness that can be successfully treated with just one course of antibiotics. The alternative health community on the other hand are seen as believing that Lyme disease has chronic manifestations that last for many years and that are often very debilitating.

There are references to the “Lyme wars” in the US where treatment guidelines issued by the Infectious Diseases Society of America (IDSA) have limited the scope of treatment for people who claim to be suffering from chronic Lyme disease. That is Lyme disease that persists for longer than a few months. If the national guidelines say some treatments are not necessary, then the insurance companies in the US stop paying for them and patients are effectively prevented from pursuing a number of alternative treatment options (4).

Why this should be the case is a mystery to me as chronic manifestations for Lyme disease are well recognized in the scientific literature including in my very own microbiology textbook. As my textbook is by Indian authors it may reflect a greater understanding of parasitic illnesses in the third world than in the affluent West. Also even the latest mainstream scientific studies seem to recognise that up to 20% of Lyme disease cases lead to chronic Lyme. However for a number of reasons this figure is likely to be an underestimate (5).

There is however no excuse for this degree of ignorance however, and if you have confirmed Lyme disease and encounter a doctor who questions the possibility of chronic Lyme disease then you are best off changing doctors.

Is Lyme disease spreading?

The number of reports and articles about Lyme disease has grown quickly in the past two decades. Is this due to more awareness and greater publicity or is the disease actually spreading, as many people claim?

Tick numbers have been correlated quite well with cases of Lyme disease and there is good evidence that tick numbers have increased recently as a result of climate change which has led to increased tick lifespans, increased migration of tick carrying animals and human development of wild areas where the ticks reside.

How do I get Lyme disease?

Lyme disease affects children more than other age groups with one study showing that 41% of cases were found in 0-9 year olds. Any ten year age group in the UK under the age of 60 should consist of around12-13%, and so in children prevalence of Lyme infection is around 3 times what it would be if we were all equally affected. This is probably due to increased exposure to the habitats of the ticks that carry the disease, including long grasses, logs and leaf litter in the outdoor environment.

Infectious tick prevalence is most during the late spring and mid-summer. A long hard frosty period reduces numbers dramatically for a month or two. They can be found as much in urban parks and gardens as in the countryside. Many old people get infected in care homes, which show that ticks can enter the living quarters of humans as well as their natural habitats.

Diagnosis

The CDC recommend a two tier approach to testing with an ELISA test (checking for antibodies to the Lyme infections) followed by a Western Blot test which may also look for a number of surface proteins that can be found on the Borrelia bacterium.

The problem with this approach is that it currently misses around 50% of cases (false negative tests) and so many people go undiagnosed. This could be for a number of reasons including

  1. Their antibody response has faded away due to a weakened immune system.
  2. There has been too long a duration between infection and diagnostic testing.
  3. Their Lyme was caused by a strain of Borrelia bacteria that elicits a different immune response by virtue of having different surface proteins.

Other means of diagnosis are being developed, such as the CD57 test and blood culture test.

  1. The CD57 test looks for a sugary patch on the outer surface of our white blood cells. In people with Lyme there is evidence that they have low levels of this sugary CD57 marker.
  2. Blood culture is perhaps the most promising development as antibody tests such as ELISA and Western Blot do not always show up positive results when a person appears to have Lyme disease symptoms. Also, because it actually detects the bacteria rather than a marker that the bacteria may cause, it is the most definitive test that is possible. Borrelia bacteria, unlike most bacteria, are very slow to replicate, dividing perhaps once per month. By culturing the bacteria in blood for 2-4 months a greater chance of seeing the bacteria is achieved. One concern with this test is that there could be false positive tests. This would be the case if it was normal for people to carry very low amounts of the Borrelia bacteria without symptoms. However, currently it is thought that our blood should be completely free of these bacteria meaning that the test should indicate accurately the presence of Lyme infection whether latent or causing symptoms.

Treatments

Standard antibiotics

A single round of antibiotics is rarely sufficient to completely clear Lyme disease from the system. As such some clinicians have suggested a multi antibiotic approach. In some but not all cases this has proved relatively successful.

Doxycycline, amoxicillin and cefuroxime are some of the antibiotics that have shown efficacy in treating Lyme disease. The treatment course is normally between 2-4 weeks. However many people do not recover fully and this has led to further research efforts to try to find a “cure”.

There is laboratory evidence that cinnamon bark, clove buds and oregano oils all have the ability to kill Borrelia (5). These essential oils all have the ability to remove biofilm, the protective coat that Borrelia bacteria use to evade antibiotics. Along with some others, these essential oils are likely to be tested in animal models for their effectiveness before entering a standard drug development phase.

Herbal antibiotics

Some herbal formulas taken for a set period of time in combination with others in what is termed an “herbal protocol” have also shown promise in treating Lyme.

In particular some essential oils have been tested and given rise to ongoing early stage drug development projects. However another more natural approach is to use the test-tube findings of various studies to concoct an herbal anti-Lyme protocol.

An herbal protocol would normally involve more than one herb in order to utilise the different antimicrobial properties of each compound found in the various herbs. For instance you would want to degrade the cyst form of Borrelia, break up the biofilm layer that protects Borrelia and also inhibit the growth and spread of Borrelia to maximise the potency of any anti-microbial protocol. Some of the following herbs have shown promise in testing against the Borrelia bacteria:

  1. Oregano contains various compounds. One called carvacrol has been shown to act against the cyst form of Borrelia. Other compounds help to break up biofilm layers that protect the Lyme bacteria.
  2. Monolaurin from coconut oil, like oregano oil can act against the cyst forms and biofilm protected forms of Borrelia. It is also found in human breast milk.
  3. Cinnamon bark has also been shown to break up biofilm.
  4. Chinese skullcap and its active compound baicalein act against biofilm.
  5. Iodine from kelp has been found to be active against the cyst stage of Borrelia.
  6. Garlic oil has been shown to inhibit the growth of Borrelia.
  7. Olive oil and its compound hydroxytyrosol have also been shown to inhibit the growth of Borrelia.

Lyme inflammation diet

This diet is not so much aimed at eliminating the bacteria that cause Lyme disease as making it easier to live with Lyme disease by reducing symptoms. It may also help you respond better to any antibiotics you take.

4 dietary steps to improve symptoms

STEP 1

Remove inflammatory foods including:

  1. All processed foods, which strongly associated with inflammation.
  2. Processed cooking oils which are also responsible for increased inflammation.
  3. Foods high in sugars which trigger inflammatory responses, partially due to changes in your gut flora.
  4. Gluten containing foods may also cause inflammation in some people via increased intestinal permeability, which allows foreign proteins to enter the bloodstream triggering an immune response.

STEP 2

Include anti-inflammatory foods including:

  1. Meat and fish that is well reared or caught, such as those that have organic certification.
  2. Daily portions of vegetables. Vegetables with a higher glycaemic index such as potatoes should be moderated as a high blood sugar level can impair the immune response to Lyme disease. (6).
  3. Healthy oils, nuts and seeds contain fats that are anti-inflammatory as well as important anti-inflammatory vitamins and minerals.  The healthy oils include olive oil, coconut oil, cod liver oil, butter and lard. Nuts and seeds should be in their natural state and not coated with sunflower oil or other processed oils.
  4. Some grains may be OK, but many people with Lyme and an imbalanced gut flora will struggle to eat large portions of lentils, beans or other grain based foods.

STEP 3

Support your Glutathione and Nrf2 detoxification systems by:

  1. Eating foods that contain the nutrients that help build your glutathione system including:
    1. The amino acids that help build the glutathione system. The most important of which is gelatine found in particular in the off cuts of meat that people eschew for muscle meats nowadays. Gelatine is found in particular in connective tissues that connect our skeleton together. Bone broth and brawn are two options that are relatively easy to obtain from your local butchers. For vegans without a strict adherence to veganism jelly and marshmallow are options. For strict vegans, beans, legumes, nuts and seeds offer the best glycine containing possibilities. Pumpkin seeds contain particularly good amounts.
    2. The mineral selenium is a key component of your glutathione system and can be obtained from Brazil nuts, most fish and seafood as well as chicken and eggs.
    3. Many vegetables, especially the leafy greens and onion family contain compounds that help boost the glutathione system.
  2. Eating foods that contain nutrients that boost your Nrf2 anti-oxidant system including:
    1. Berries of all types.
    2. Chocolate, red wine and green tea which all contain compounds that boost the Nrf2 system. Too many of these compounds however have been shown to reverse the benefits to your Nrf2 system, so keep your intake of these foods to regular, but moderate portion sizes.

STEP 4

Keep your immune system generally supported by getting enough vitamin D either through sunshine or vitamin D containing foods such as cod liver oil, liver or butter.

There are two other dietary approaches that may help out if your Lyme disease has neurological (depression, anxiety, cognitive deficits or dementia) or autoimmune complications (Multiple Sclerosis, Rheumatoid Arthritis or other forms of arthritis). These are the Keto diet and AIP – Auto Immune Protocol diet respectively.

References

  1. https://www.nice.org.uk/guidance/ng95/chapter/Context NICE and Public Health England’s perspective on prevalence of Lyme disease.
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3879353/ US study suggesting incidence of up to 1 million per year in the US.
  3. https://www.bmj.com/company/newsroom/uk-tick-borne-lyme-disease-cases-may-be-3-times-higher-than-previous-estimates/ UK study on Lyme disease incidence rate.
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2048873/ The “Lyme wars”.
  5. https://www.frontiersin.org/articles/10.3389/fmed.2017.00169/full Essential oils can kill off Lyme bacteria and mainstream figures for chronic Lyme.
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4920391/ High blood sugar impairs immune responses to Lyme disease.
  7. https://lymediseaseuk.com/lyme-disease/ UK Charity that represents the views of many UK Lyme disease sufferers.