We all are becoming more aware of Lyme disease, as the incidence of this tick-borne infection is persistently high, and for many states such as the endemic regions of the upper Midwest and Northeastern United States, it continues to increase.[i] Confirmed cases continue to show up far outside these regions as well, with documented cases in almost all the continental US states yearly.
Lyme disease, for some, can become a complex and chronic debilitating condition due to the ability of the causative pathogenic bacteria Borrelia burgdorferi to persist by switching to a cystic form or existing within a biofilm-like colony, as well as by differentially expressing proteins and genes that enable survival in the host.[ii,iii,iv] Coinfections such as Bartonella, Ehrlichia, Anaplasma and Babesia are commonly transmitted with B. burgdorferi, [v,vi]and not only lead to symptoms associated with their presence, but also can increase Lyme disease severity.[vii]
Because of these many factors, we not only see resistance to treatment with antibiotics, but also to botanicals, necessitating a multifactorial approach of rotating various botanicals and other natural substances through a long course of treatment. Symptoms also can often worsen through the course of treatment, due to a reaction referred to as “die-off” that is caused by the by-products associated with bacterial lysis increasing the inflammatory response in the body. These products of bacterial die-off not only stimulate a further immune response and inflammation, they also can adversely affect organ and systemic function, sometimes critically, in patients with Lyme disease.[viii,ix]
Given these many factors, it is important to consider options for treatment which can address each of these challenges distinctly when supporting a patient with Lyme disease. Additionally, support for symptom palliation also is often necessary to help alleviate the chronic symptoms which can include fatigue, difficulty thinking, and pain that often come with this disease.
Systemic Support to Address the Cause and the Symptoms
Artemisia annua, also known as sweet wormwood, or Qinghao, has a long history of use as an antimicrobial agent, and broadly acts as an antiparasitic, antibacterial, antifungal, and antiviral agent.[x,xi] Artemisinin, the primary active moiety found in A. annua, has been shown to be active against Babesia, as well as common chronic additional infections which burden the immune system including cytomegalovirus, herpes simplex virus, Epstein-Barr virus, and Toxoplasmosis gondii.[xii,xiii,xiv,xv] A. annua and its derivatives also may impact the levels of microbes such as Candida spp. which may be out of balance in the gut,[xvi] and it has been shown to affect biofilms which make some of these pathogens resistant to treatment.[xvii,xviii] In a recent study of patients experiencing short-term memory deficits associated with Lyme disease, oral treatment with artesunate, a water-soluble artemisinin derivative, was shown to significantly reduce the short-term memory difficulties which may occur with both Borrelia spp. and Babesia infections.[xix]
Cat’s claw (Uncaria tomentosa), also known in Spanish as uña de gato, is ideally suited in the Lyme setting, as in addition to its immune-supportive actions, it has been shown to have anti-inflammatory, anti-arthritic, and antioxidant effects, and supports cognitive function as well.[xx] Cat’s claw has been shown to enhance proliferation of both T helper and B lymphocytes,[xxi,xxii] also increasing lymphocyte viability and survival. Cat’s claw has been shown in both rheumatoid and osteoarthritis to significantly improve symptoms of joint swelling and pain, which many patients also may experience with Lyme disease.[xxiii,xxiv] Cat’s claw also is a potent inhibitor of tumor necrosis factor (TNF)-α, a primary pro-inflammatory cytokine associated with the acute immune system response.[xxv] In multiple animal studies, cat’s claw has been demonstrated to have a neuroprotective effect and improve memory as well.[xxvi,xxvii]
Lactoferrin, a glycoprotein found in milk and at much higher concentrations in colostrum, has broad antimicrobial action against parasites, bacteria, fungi, and viruses.[xxviii] It has been shown to inhibit the growth of Babesia spp.,[xxix] one of the common co-infections, and has an inhibitory effect on bacterial biofilms,[xxx]including that of B. burgdorferi.[xxxi] Lactoferrin has been shown to neutralize lipopolysaccharide (LPS),[xxxii] a primary contributor to the “die-off” reaction, also directly inhibiting the LPS-induced immune system response.[xxxiii,xxxiv] Similar to cat’s claw, lactoferrin has been shown in several studies to decrease levels of TNF-α as well.[xxxv]
Chitosan, a biopolymer derived from the shell of crustaceans, acts as a chelator and supports the removal of a wide array of toxins from the body including mycotoxins, metals, and LPS.[xxxvi, xxxvii,xxxviii] It has the ability to chelate and remove the heavy metals manganese and zinc,[xxxix,xl] which are two essential minerals for the lifecycle and metabolic needs of B. burgdorferi, and serve as central regulators of many of its virulence genes.[xli,xlii] Chitosan has been shown to act as a biofilm-disrupting agent, particularly when the chitosan is of low molecular weight.[xliii,xliv] Low molecular weight chitosan has been shown specifically, in the setting of Lyme, to reduce symptoms attributed to the die-off reaction.[xlv] In the gut, the larger chitosan particles have a prebiotic effect, promoting the growth of Bifidobacterium spp. and Lactobacillus spp., which are predominant healthy flora that also support the reduction of inflammation and a normal immune response.[xlvi,xlvii,xlviii]
Finally, support for cellular function and repair also may help to reduce symptoms associated with Lyme disease, improving the fatigue which many experience. Lipid replacement therapy, the supplementation of glycerophospholipids that are the main component of cellular membranes, in combination with additional antioxidants such as coenzyme Q10 (CoQ10)supports cellular function and repair, in particular that of the mitochondria, the energy-generating units found in all of the cells. Multiple studies utilizing glycerophospholipids as a monotherapy or in combination with additional nutrients have shown positive outcomes in similar settings of chronic fatigue, including that specifically attributable to Lyme disease, also leading to improvements in mitochondrial function. [xlix,l,li]
Although the challenges associated with supporting patients whose health has been compromised by a tick-borne infection do have many complexities, therapies such as these, or a combination thereof, are an excellent evidence-based starting point which can help to notably improve the disease course for patients who experience tick-borne infections.
Written by Carrie Decker, ND
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