Best of: Is It Really Fibromyalgia, MS, or Chronic Fatigue? – What Doctors Overlook with Dr. Richard Horowitz | E174

This week, we're going to review our podcast with Dr. Horowitz, probably the best-known Lyme expert in the world. He's actually the premier researcher on Lyme disease complications and why it's so difficult right now. In this conversation, we review his research, his life's work. Why is Lyme disease so complicated? Why is it a mystery illness? Why does it look like chronic fatigue, fibro? Why did it pop up during the pandemic? Why did COVID reactivate it? So many great questions we dive into during this conversation. For all you out there who've had a loved one with Lyme disease or just wondering about it, here today you can hear from the world's top expert on it. Hope you enjoy today's episode.

So in medical school, of course, they always teach you to get to the sources of a problem. Don't just name a disease and throw a drug at it. Figure out why people are sick. So ultimately, when I started seeing these people with bullseye rashes and I went to the literature to figure out what to do, we gave them a month of doxycycline, a month of amoxicillin, Maybe 75% of the people got better, but 25, 30% didn't. And that's when I had to go on a journey to figure out, well, why are these people staying ill?

I am super excited to be here with the world-renowned Dr. Richard Horowitz, probably one of the top Lyme experts in the world, definitely one of the top in the United States, to talk about all things Lyme and Lyme-related with chronic health issues, which is what we specialize here at Richmond Integrative Functional Medicine. So super excited to have you. Here with us today, Dr. Horowitz.

No, it's my pleasure. Thank you for inviting me.

Yeah. So I'm going to real quick, just for some people who don't know who you are, go through your intro really quick and have you tell a little bit about yourself. Because I'm assuming most people know who you are, but at this stage of the game, but you know, there's always some who might not. So it's always good to get a little intro. Dr. Horowitz is a double board certified internist and he's medical director of the Hudson Valley Healing Arts Center and an integrated medical center, which combines both classical and complementary approaches. to treatment of Lyme disease and other tick-borne disorders. He's treated over 13,000 Lyme patients and tick-borne disease patients in the last 35 years, which I don't think anybody else can probably say that, with patients coming from all around the United States, Canada, Europe to his clinic. He was former assistant director of medicine for the Ambassador and Brothers Hospital. I was trying to say this in Poughkeepsie, New York. Poughkeepsie. Oh, Poughkeepsie. That's how you spell Poughkeepsie. Oh, okay. All right. And he's one of the founding members for ILADS, as well as being a member for the International Lyme and Associated Disease Educational Foundation. Lots of things in your past. You've written many books. One is Lyme Disease: Why Can't I Get Better? How Can I Get Better? And you've actually done some science fiction, one of which was The Awakening, which is talking about climate change. And you have another one coming out soon that actually deals with Crohn's disease in 2025. So maybe we'll actually talk about that a little bit towards the end, but I'm super excited to have you here today, Dr. Orwitz, with us.

Yeah, it's my pleasure. So for everybody listening out there, just want to let you know that we'll, we'll go through some of the basics today of Lyme and tick-borne and why people stay sick, but The most important thing you should know from right from the get-go is that there's a lot of controversies out there about why people are sick and why they don't get better. You should know that there are answers. Those of us who've been in the trenches for a long time, we've been working at this. As, you know, as Aaron told you, it's been about 35 years I've been working at this. I've been in medicine for 40. And I'll talk to you today a little bit about some of the breakthroughs we've made with Dapsone combination therapy, why the MSIDS model, the 16-point model, is so important, especially for doctors who don't know anything about functional medicine. It really explains why many people, not just by the way with Lyme, but many people suffering with chronic fatigue syndrome, myalgic encephalomyelitis, fibromyalgia, autoimmune illness, MS, even dementia, why a lot of these people have overlapping factors. And this new book, which we can touch on later, I did get a contract from Simon and Schuster for a 3rd science book.

Sure.

And what it's essentially gonna do is take a lot of these chronic illnesses that are now affecting people across the world. And show how the 16-point MSITS model could be applied. And when I started kind of doing this just to see like, does it apply? We found for long COVID, all 16 points replicable. For Alzheimer's, all 16 points. I'm just finishing up now one on ADD, ADHD. It looks like all 16 points, maybe pain might not, and deconditioning might not be the only ones that are applicable, but at least 14 outta 16 points. So most of these chronic diseases have an inflammatory component, but it's really just a question of getting to the sources of where the inflammation's coming from. And what the downstream effects are.

That's really intriguing, the 16-point, because it's really— we'll talk about that in a second. But as far as your history, you've been in this for a long time, from back in the beginnings when we weren't quite sure what this was, through even the double dapson therapy, which is something I just literally learned about last year at the International Lyme Meeting. Could you just give us like a whirlwind tour of like the history of Lyme from back in the Stone Age, when we thought it was some infectious inflammatory thing in kids, to like today? Because I think a lot of people need to appreciate the history of where we've come from to really understand, one, how much science is behind what you're talking about, and two, why even though there's so much science that the mainstream conventional model is still so much in the dark as far as this chronic infectious disease.

Yeah, it's a great question. So back in the 1970s when I was still in med school, Alan Steere had initially discovered Lyme disease when they were going to Lyme, Connecticut. In fact, we just passed through I missed Connecticut on the way home from Rhode Island and had a pass line. And I always love stopping my car and taking a picture when I get out, which says, had Lyme. And then the next one says, Chester had Lyme. And it's like, what are you going to do? You're going to name all your towns in Connecticut with people who've had Lyme disease. But so in the 1970s, when we discovered it was a bacteria that was making people sick, initially even Alan Steere thought, oh, this was a chronic persistent bacterial infection.

And that— Kind of as time went on, it got to be like, well, maybe it's more of an autoimmune problem.

We're not really sure if the bacteria persists. So if you look at the last 40, 50 years of what's happened in this disease, and I, I got into it back in the late 1980s, early '90s when I moved up to the Poughkeepsie-Hyde Park area in upstate New York, about 2 hours north of New York City. I didn't realize when I was getting out of internal medicine training at Mount Sinai, I was walking into the largest Lyme endemic area in the United States at the time, which was Dutchess County. So in medical school, of course, they always teach you to get to the sources of a problem. And because I did my training in Europe, and maybe this was part of it, it was really like, just don't just name a disease and throw a drug at it, figure out why people are sick. And so ultimately when I started seeing these people with bullseye rashes and I went to the literature to figure out what to do, you know, we gave 'em a month of doxycycline, a month of amoxicillin, maybe 75% of the people got better, but 25, 30% didn't. And that's when I had to go on a journey to figure out, well, why are these people staying ill? And it made me think back to my spiritual teacher, Lama Gendun Rinpoche, when I was in Europe doing my training for 7 years at the Free University of Brussels. I'd met the Tibetan lamas when I was there back in 1981, and I studied with them learning meditation. I was always interested in the functioning of the mind and the power of the mind. And of course, being stressed in medical school, meditation was a great thing. And I went to Lama Gyendun right before I became a doctor, and I said to him, I'm going out in the world. I'm going to be a physician. What do you want me to know? What's the most important thing I should— you want to tell me to get patients better? And he said, Richard, the most important thing is put yourself in people's shoes and do for them whatever you would want to get done for yourself. It's called exchanging yourself with others. And it's funny because when those patients were sick, I did what an internist usually does. I first sent them to a neurologist. infectious disease doctors, rheumatologists. Not one person could figure out why these people were sick. So I started going to the Lyme Disease Foundation trainings at that point by Karen Forstner. Joe Boriscana was there. Ken Liebner was there. Sam Donta was there. And I learned from them. They were the giants on whose shoulders I was standing. And basically, I started using more antibiotics, learned it worked, but it was always the problem of why do these people keep relapsing every time We stopped the treatment and fast forward over the last 25, 30 years, we discovered it was Babesia. I had a patient in my practice in a wheelchair, sick with Lyme for 5 years, couldn't walk with drenching sweats in her 30s. I just got back from the Lyme conference hearing about Babesia, and I was, I wondered whether it wasn't supposed to be in Dutchess County, but we tested her and we tested the ticks, found it, gave her 10 days of mepronazithromax, and for the first time in 5 years, she walked out of a wheelchair. Took months, but she ended up walking. Now she's skiing. And then a couple of years later, we discovered Bartonella, which is really a big factor in keeping people ill. Now we'll talk about that. And it's like every year I just kept digging and digging to figure it out. And then one year it was heavy metals. A dentist friend of mine tested positive for mercury and lead, and I tested myself. I was positive. I tested my patients. They were positive.

It was almost like every year I would discover a new factor.

And what it came to after all these years was discovering 16 factors that were keeping people ill. 6 of them were driving inflammation. 10 of them were downstream effects. So it was just really a stepwise fashion of constantly looking because every time I found something that worked, it was like, well, a whole layer of my patients would get better, but there was a whole, again, a whole set of them that wouldn't get better or would keep relapsing. And it was only until probably about 8 or 9 years ago when Johns Hopkins researchers, along with Eva Schoppe from University of New Haven, Kim Lewis from Northeastern, Stanford University researchers, they all started talking about Lyme being a biofilm persister infection.

And what that meant is not that it persisted.

I had done studies on metronidazole Flagyl back over 20 years ago with Dr. Mark Natkinson-Barn. We found that it worked.

And about 6 months later, Dr.

Borsen from Norway published that Flagyl hits the cystic forms or S-forms, L-forms, cell wall deficient forms of Borrelia. And we said, okay, That's probably why people have persistent infections. It turned out that it might have been part of it, but the real story was these are biofilm infections, just like you got to go to the dentist to take the plaque off your teeth or you get gingivitis. It's the same thing. So once we started using biofilm agents and persister drugs, like used for tuberculosis and leprosy, and that's how I came to Dapsone, we started seeing honestly miraculous results where we did not have to leave people on antibiotics forever. So it took about 3 decades for me constantly being in the trenches, just digging to figure out what was keeping these people ill. And, you know, now I'm going to be applying for NIH grants myself this coming year, and hopefully we'll get a randomized controlled double-blind placebo trial on dapsone so I can prove to the world that actually we do have answers.

Every fall, the schedule tightens and most of our attention goes to getting the kids ready. Almost none of it goes to the person holding the whole thing together. So I put together these 3 things just for that: a daily multivitamin in the active forms your body can actually use, quercetin and nettles to support your immune and respiratory health without the drowsiness, and NAC and acetylcysteine to help your body rebuild its own antioxidant reserve. This is what I take every fall. That's aaronhartmanmd.com/backtoschool.

That's a really interesting journey. One of the things I think is really cool about that is your whole 16-point way. It's almost like your practice of medicine as you were doing things, you created this model. And it's really funny how much of that actually correlates with the IFM, different models, A4M. But you kind of created this like Lyme-centric out and realized, hey, for people with chronic infections, you need to work on gut health, you need to work on sleep, you need to work on your mental health. Like so many things. I think it's really cool how you Figure that out through your practice of medicine. One question off that, in my talk with different people who've been doing this for a long, long time, have you noticed, like, are the patients you're seeing, do you feel like they're getting sicker over time? Like, your difficult patients are more difficult? Because when I talk with other practitioners who've been doing this for decades, they talk to me about how their chronically ill patients seem sicker now than they were 20 years ago. Have you experienced that in your world as well?

Absolutely. Not even a question. And actually, what's made it worse from my perspective, is mycotoxins, mold toxin illness. That's definitely gotten worse in the last decade from what I've seen. I don't think we were checking for it probably as much as we should have decades ago, but now it's showing up in over 90% of my patients. And I used to, I used to joke with Neil Nathan, who's a good friend of mine in California, because he would say that all the symptoms you see with chronic Lyme can be seen in mycotoxin illness, which is true. But the difference, of course, with Lyme is the symptoms come and go. have good and bad days. The joint pain, the muscle pain, and the nerve pain, tingling, numbness, burning, stabbing migrates. Migratory pain is the hallmark of active chronic Lyme. But otherwise, you do see fatigue and aches and pains and brain fog with mold illness. But the other thing that has made people sicker in the last 4 or 5 years is COVID. And now we're finding a lot of our patients have COVID long hauler. They're reactivating their viruses. I'm seeing way more Epstein-Barr reactivation herpesvirus 6 reactivation that I'd ever seen before in years past. We used to look for it. We would find it on occasion.

We're finding it pretty frequently at this point. So I think what's happening is between Lyme disease can affect your B cells.

We find that Lyme and Bartonella can cause immune deficiency with CVID, with chronic variable immune deficiency. And I published this in the literature. We get low immunoglobulin Gs, we get low subclasses. So your B cells basically become deficient. And it's because when Borrelia burgdorferi invades your body, and this was proven in the mouse model, it was probably about, I don't know, 15 years ago in University of California Davis, where Nicole Baumgardt proved that when Borrelia invades the lymph nodes, it gets rid of the parts of the lymph nodes that make IgG antibodies. You're left with IgM. So when all these patients get positive CDC IgM Western blots or immunoblots with a 2341 or a 3941, 23andMe, it's because you've knocked out the B-cells. Well, now COVID comes along and now you're getting B-cell and T-cell exhaustion. So essentially what's happening is people's immune systems are getting overwhelmed, and then you've got mold toxins like gliotoxins that are making the whole thing worse on top of all the heavy metals and other toxins where people's detox pathways aren't working.

Hmm.

So now, whereas I'd say probably 6 years ago, we were finding Dapsone, of course, was working quite well and we, we we've kept tweaking it year after year. It's now become very clear that it is all these different Bartonella species that the people that fail double dose and even high dose Dapsone combination therapy, it's because they have active Bartonella. If they have day sweats, night sweats, chills, flushing, air hunger, and unexplained cough, they usually have active Babesia. So with active Babesia barred, the Dapsone protocol will not be as effective.

Right.

You'll still get help, but it's not gonna completely clear all your symptoms. And now we're finding it's these COVID long haulers with either pieces of the virus or active virus in the body stimulating the macrophages and monocytes to put out these inflammatory cytokines and chemokines that are driving the inflammatory response apart from the immune system being affected. And again, all these toxins getting in. So there's not a doubt in, in the last decade I have seen patients getting sicker. And now we've had to integrate kind of long COVID protocols and mold protocols and more advanced Bartonella protocols or new treatments for Babesia. Those are the things we've had to do in the last 5, 6, 7 years so that when these sicker patients were coming in, we could get them better.

Actually, that was one of my questions toward the end. But since you mentioned that, I'll just hop into this. One of the things you've done is actually kind of dove into the association with what the model, the way you look at stuff in another virus, COVID, SARS-CoV-19. What are some of the parts of that protocol where there's overlap with Lyme? What are some parts of that where you're finding out that they're being activated? Or what are some similarities or differences in what the COVID stuff you're doing? Because I think a lot of people don't realize some of the literature that actually, actually you've all been publishing about reactivation of infections because of COVID and how that kind of interplays with people's illness and them not getting better.

Yeah. So, I was very lucky in April 2020, my researcher and I, Dr.

Phyllis Freeman, good friend of mine for, I don't know, 35 years, Phyllis and I and James Bursace, who's at this point president of our 501, we published the first article in the world literature on glutathione for COVID. And when COVID was coming out, December, January, February, when we were starting to really see those really bad cases, I looked at the cytokines and the chemokines that were coming out from COVID And I noticed it was kind of strange. It was like, here's TNF-alpha, here's IL-1, IL-2, IL-6, IL-8, IL-10. It's like, that looks very familiar. Those are like the same cytokines I've seen with Lyme disease during Herxheimer reactions. So I remembered that in my Babesia patients, when they came in with shortness of breath, one of the things I used to do, because the cytokine storm would affect their lungs, is I would give them a shot of IV glutathione, 2,000 milligrams, and literally within minutes, they would tell me their shortness of breath was better. So when we had a couple of cases come into our office with long— with COVID and extremely ill with COVID pneumonitis, I decided to try glutathione. Giving N-acetylcysteine, which regenerates glutathione, giving alpha-lipoic acid, which also regenerates glutathione intracellular, and giving very high-dose glutathione up to 2,000 milligrams 3 times per day. And these 3 supplements, NAC, alpha-lipoic acid, and glutathione, block a switch inside the nucleus called NF-kappaB. Well, it turned out that was one of the major switches that COVID was turning on with these cytokine storms to get people sick. We've not had one person die from COVID ever in our practice since 2020 when this virus came out. And we developed the protocol of blocking NF-kappaB, stimulating Nrf2, which is another anti-inflammatory pathway using turmeric, broccoli seed extract, sulforaphane glucosinolate, resveratrol, green tea. Those are the 4 supplements or dietary factors that you need to stimulate Nrf2. We were blocking NLRP3 inflammasomes with LDN, low-dose naltrexone, and low-dose melatonin. And then addressing other cytokines like what was happening with prostaglandins, et cetera. But the beauty of this is with COVID and we just published this in April of this year in Microorganisms. All when people say, gee, what is long COVID? Why are people staying sick? When we did a PubMed search, we found that all 16 factors on the MSIDS model that I've been using for chronic Lyme are now published in the medical literature for long COVID. Every one of them. The only difference, of course, is one is stimulated by a virus, the other is caused by bacterial infections.

Other than that, the inflammatory cytokines and chemokines, they're actually, they're fairly similar.

Now, Bruce Patterson has run through Radiance Diagnostics. He has a long hauler panel. And for those of you listening who may have long hauler and you're not sure, you can get the studies done. The website to go to is www.covidlonghaulers.com. and you ordered the 14-cytokine panel from Radiance Diagnostics. What he found is that if you have high levels of interferon gamma, IL-4, VGF, he found certain markers were very, very significantly associated with this ongoing monocyte macrophage activation that was happening in long COVID. Whereas in Lyme, these cytokines and chemokines were a little different. But I will tell you, and the problem is many of the patients that you're seeing with long COVID actually have Lyme. They have Babesia, they have Bartonella, they have mold. So the problem is when you're even looking at these inflammatory chemokines and cytokines, the number of factors that's driving inflammation is overlapping in the MSIDS model. And we've tried maraviroc and pravastatin, which has been published.

I'm not sure I'm seeing results yet like I would hope. I'm mostly seeing the results when we're able to knock down these reactivated viruses.

But I'm really finding it's getting rid of the mold, getting rid of the toxins, opening up the detox pathways, taking care of the mast cell, addressing the POTS dysautonomia. And using persister drug regimens like dapsone combination therapy for Lyme and bart, newer Babesia therapies like tafenoquine atovaquone—that's what's making the biggest difference in these people. But it is interesting that when we're dealing with long COVID or chronic Lyme, it's the same factors that are keeping people ill. So doctors and patients shouldn't be that mystified that in a chronic disease—and you know they're now calling it infection-associated chronic illness. Well, that's great. It's true, except it's not really giving you a model to tell you what to do for these people. And, and that's the only reason I keep saying it's either Lyme MCID or it's non-Lyme MCID. COVID, long COVID would be non-Lyme MCID, but they've shown that many of these COVID patients in fact have Lyme.

So we're gonna find as years go on to try and like put these diseases in boxes, like, yeah, you have pure chronic Lyme. It's like, that's not true. Nobody that comes to me has just Lyme.

They pretty much always have co-infections and activated viruses and mold toxins and POTS.

You just gotta get used to the idea that the one disease, one cause, one disease model from the 1800s, from Koch's postulate or Pasteur's postulate, it doesn't work in 21st century medicine, especially when we've got all these viruses and toxins that are getting into people's bodies.

Yeah, I think we throw on top of that chemicals, petroleum distillates, just so much stuff in our environment that suppresses our immune system, that affects our immune response. That's like, it's a toxic mess. One question I want to put to you that I struggled with initially, I think a lot of practitioners out there, when you talk about reactivation of viruses, could you explain how you're making that diagnosis? Because when I talk to my infectious disease colleagues and I'm ordering an Epstein-Barr panel or, or a herpes panel or zoster panel, we debate on whether this is a marker for reactivation or not. So could you actually help for more for the practitioners out there? How are you diagnosing like a viral reactivation with the— what are your criteria? What are you looking at?

Most of the time I'm actually looking at PCRs. So I'm looking at an Epstein-Barr PCR that's positive in the blood where Quest or LabCorp will come back with a logarithmic number like 2.3 logarithmic. It's like they'll tell you the number of copies of the virus in the blood. So when I'm talking about reactivation, I'm usually looking at PCRs for HHV-6, Epstein-Barr. You can look for a fourfold increase in titers, but the problem with a lot of these Epstein-Barr patients, they already have very high titers to begin with. Sometimes even the early antigens are positive. So I'm really looking for PCR to prove that it's activated. And there's only so many things you can give, but a clue I will give to the practitioners, you know, I think a lot of us tend to use famciclovir or valacyclovir for these patients apart from natural things that support immunity like glutathione, interestingly enough, does have antiviral effects. There's a new supplement I've been looking at, which is called PDC Activate. Which affects the Peyer's patches in the gut, and it's increasing alpha interferon, which has a broad effect against these different viral infections. Now that we're looking at things like monkeypox, bird flu, just today I posted on, I have a Substack, by the way, called Medical Detective. You Can Get Better. It's free to sign up for anyone who wants it. We're doing weekly blogs at this point. Today's blog, it just came out, was on oropouche virus. That's another new spreading virus that's happening with the climate. So when, you know, in this day and age when we're exposed to COVID and RSV and influenza and bird flu is starting to come out, monkeypox just got out of Africa. It showed up in Thailand and in some of the Scandinavian countries like Sweden. We're going to be looking at new pandemics. Unfortunately, I believe in the near future, people are going to have to get their immune system, their B cells, their T cells, the CD4, CD8, Their natural killer cells, immunoglobulin subclasses. I'm telling my patients to get these checked because we need our immune system in tip-top shape at this point in time. So if you go on Medical Detective, you can't get better Substack, you'll read all of these. And we're finding that we are now giving our patients a lot more antiviral support. Obviously, that's support of the microbiome. I've been on 3,6-beta-glucan probably for 20 years to increase my natural killer cells. You know, we use transfer factors, but I, I like his postbiotic that's in PDC Activate because it's something I can give to my patients to say, look, no matter what viruses are happening, this is something that may help. But interesting with EBV, there's a study that I came across by accident on pursantine dipyridamole showing that it stops EBV reactivation.

Okay.

Because we know that it can cause Burkitt's lymphoma and, and a whole host of different problems in people if it stays active. So just today, my nurse practitioner, John, called me about someone who keeps reactivating, and we talked about putting them on dipyridamole. So I think doctors need to be aware that they're going to have to start doing some PubMed searches unless you're going to IFM and ILADS conferences where we'll hopefully give you these tricks and clues. But I'm doing PubMed searches all the time and read about an hour of scientific literature every morning just to try and keep up with what's going on. I mean, it's an information overload. You probably know this yourself.

Yeah. Yeah. I get up every morning and read between 6 and 7 in the morning. And unfortunately, the kids wake up early. It really just really frustrates me because I'm like, I'm trying to read right now. You're messing up my reading time. Now you keep on referring to research. I think that's something else that a lot of people don't realize. Like what kind of research are you involved with? How many articles have you published? How have you integrated with your personal learning, this idea of creating research that then can go out to the wider community? Like tell us a little bit about that.

So Joe Boriscano actually is the one who got me to start even thinking about publishing years ago when I was going to the LDF conferences. And this is back in the early 1990s. I was the first doctor to diagnose babesiosis in the Hudson Valley, and I did it as abstract forms, right? I would, I would publish on it. We, we sent like 30 ticks out to Hygienics in Rhode Island, showed that Babesia was in the ticks. I started doing abstracts and I'd probably put out 15 or 20 abstracts from everything from We were finding Bartonella 20-plus years ago, putting out abstracts on heavy metals, on pregnancy, on Lyme getting into pregnant women. Whenever I found something that I thought was clinically relevant for patients and doctors, I was starting to put in an abstract. And then I started actually going to the literature and publishing, and I've encouraged my colleagues to do the same. So right now, I think I've got somewhere between, I don't know, maybe 25 or 30 articles I've published, most of them with my, my good friend, Dr. Phyllis Freeman, over the last 20, 30 years. And every article I've published, we've generally done 1 or 2 a year, is always focused on how can I improve the learning both for patients and doctors to get people better. So one of them was a validated symptom questionnaire that's on our website, cangetbetter.com. You just go under symptoms and you can download the HMQ, the Horowitz MCITS questionnaire. It was validated in 1,600 people through the State University of New Paltz. And it's a validated symptom questionnaire because we know the Lyme testing is not all that reliable.

So we use this questionnaire as a screen.

Any doctor can use it. Any patient can take it. If you score over 63, it's greater than 2 standard deviations above the mean. You have a pretty high likelihood of having Lyme. And then we just look at the bands on an immunoblot, and I play what I call Lyme bingo with patients. If you have the 23 OspC, 31 OspA, 34 OspB, 39, or 83-93 band on an immunoblot, which is recombinant DNA. Any one of those bands with a high score on the HMQ with migratory pain, hallmark of Lyme, you've got Lyme disease or some form of borreliosis. It doesn't have to be Borrelia burgdorferi sensu stricto. It could be European strains with abscessi, garinii. There's up to like 18 different strains at this point we could be looking at. But the point being, there are easy ways, really, honestly, it's not a mystery on how to diagnose people, but you have to know the tools. So all the publishing I've done is like, oh, they just discovered Lyme's a persistor bacteria.

Let's go to the literature. TB and leprosy are persistor bacterias.

Let's look at those drugs. And I looked at dapsone and I went, oh my God, it checks all the boxes. Good oral penetration into the brain. I don't need rocephin.

Anti-inflammatory, every manifestation of Lyme or chronic disease due to inflammation. It is a persister drug. It hits autoimmune illness. It hits Babesia and malaria-like parasites. Like it was checking all the boxes. So all I did was say, all right, rifampin dapsone cures leprosy.

Let me add doxycycline to it and see what happens. And it was a home run from day one. But what's taken me years to figure out is what was the ideal dose of dapsone?

The length of time you need to be on it, and then especially when you have Bartonella, how many pulses do you need to get rid of Bartonella?

Because Bartonella is also a biofilm persister bacteria. There's many different strains of it. You'll see that if you run a Igenix immunoblot or use Galaxy Labs or even T-Labs that will do Bartonella fish testing. You'll see that most of these patients that are sick at this point have Bartonella. So we learned over time through trial and error. I need 2-week pulses, at least 4 of them in patients with high-dose dapsone, just 6 days of high-dose dapsone for Bartonella. But it only works, right, fully if you've gotten rid of the mold toxins, if you don't have low adrenals, if your POTS dysautonomia has been taken care of, if you're getting to sleep.

In other words, you've got to still look at all these inflammatory factors and downstream effects that are making people sick. There's not one person that's ever going to be the same that goes to a Lyme practice They all have different factors keeping them ill, but there's common denominators.

So, everything we've published really has just been from a practical standpoint, how do we get patients better? Let's get it in the literature and see if we can help other physicians and patients to use that information, hopefully stimulate more research in that area.

I think that's a really important point there where you're like, just talking about every patient's different and you might try an antibiotic on someone. If they don't work, you combine. But then ultimately, if people aren't getting better, there's something else under the hood, whether it's mold, Dysautonomia, POTS. Do you see a lot of hypermobility? I don't know what your thoughts are on hypermobility as far as the connective tissue stuff, because that's where something I feel like there's a connection with hypermobility because of people's fascia and decreased blood flow to fascia. Is that something you've noticed with some of these Lyme patients?

Oh, absolutely. Absolutely. In fact, the ones who have the worst POTS dysautonomia, they all have EDS. They are a very difficult group. Normally with POTS dysautonomia, I I'll give them salt and fluids to raise their blood pressure. And for those listening, there's 2 types of dysautonomia. The average one, which I'd say is like 99%, is people stand up, they get dizzy, they get palpitations, they're tired, they have brain fog, they have anxiety. In other words, same symptoms you see with chronic Lyme and even burns. But the difference is, is that it's low blood pressure, and then they stand up, the blood pressure starts to drop, and the autonomic kicks in, the pulse rate goes up. So, if The pulse rate goes up over 30. That's what you get if you went to a hospital with a head-up tilt table test. We do this in the office. We just do sitting and standing blood pressures. So I can give people salt and fluids, a little bit of licorice to raise their pressure, midodrine to constrict the vessels, bring it up. I don't use Florinef, fludrocortisone, so much. Rarely droxidopa if they're bad. But to get rid of POTS dysautonomia, because it's part of long COVID, people who get inflammation from long COVID get POTS. People who get inflammation from Lyme and Bartke POTS, you really got to do vagal retraining. Whether it's the Annie Hopper dynamic neural retraining, it's the Gupta AIR amygdala insula retraining, primal trust. There's a lot of different vagal retraining out there, including like vagal stimulators like the Apollo Neurostim. People have to do their work to retrain their autonomic nervous system. But you're correct; it's the EDS patients, of course, that are the worst. And they are the most difficult ones to treat over time, just like the ones that have chemical sensitivity. You know, the people that walk into rooms and say, I can smell the perfumes, I get sick as a dog. Their detox pathways are affected. They're loaded with mold. They're also very, very challenging patients to be dealing with. You've got to unload their bodies before you really can go after a lot of—

I was on a call with you and Dr. Nathan back, I think this was past March, and you'd mentioned Primal Trust that you were starting to use it. And I just That was the first time I heard about it. With those brain retraining things, is there one that you think is a more favorite one in certain situations, or is it more trial and error? What resonates with the patient? What do they think they're more likely to do? Do you have a— because I feel like so many of my patients, they get to a sticking point and their issue is brain retraining.

The one that I generally prefer these days is the Gupta AIR. And the reason I prefer it is that it has scientific validation. They published a study in the past year, showing that they did see statistical differences with fatigue and chronic fatigue in those who had long COVID who did their technique. What I also like about it is it's meditation-based. My wife, who is completely well, she's 6 years in remission from doing Dapsone combination therapy. But my wife still has some symptoms of dysautonomia and still needs a little bit of Midodrine. Now, I got her the Annie Hopper, but my wife's a little bit stubborn. She would start doing the technique, And she'd listen to Annie Hopper on the screen and she starts screaming at her. It's like, you bimbo, all the symptoms you're complaining about are chronic Lyme.

Why are you telling people? It's like, honey, stop yelling at the television screen. She can't hear you. So she, she never got past Annie Hopper.

And then I gave her the Gupta technique and she liked it.

Yep.

And I, I have a bias because I've been meditating and studying with these Tibetan teachers for over 40 years.

And from my perspective, I think meditation is a really, really important thing. It goes beyond religion, it goes beyond spiritual beliefs. It's really just working with the mind and learning how to train the mind. And I think in this day and age of all the stresses we're dealing with, to learn simple meditation techniques that are effective, I mean, some people do it with apps, but I learned from literally enlightened lamas. I've got that, and someday, by the way, my 3rd science book will be coming out, and actually it'll probably be early 2026. I have volumes of notes. This will likely be my 4th book. I have, I don't know, maybe 20 volumes of notes of having studied with these teachers for 40 years. I'm like a really good note taker.

I probably got a several volume set of like the collected works of the enlightened lamas of the Kagyu.

Like, it's really interesting stuff of like how they see the world, their view of reality. What we're doing down here, how we work with our situations. I've really enjoyed working with them. So I, I do have a bias towards meditation, which is probably why I like the Gupta, but it has at least been scientifically validated and published. So I would say for people, it's a good place to start. Primal Trust, by the way, is excellent. It's a bit more expensive, but I do find these vagal stimulators to do it at home very useful for people. Many people, they don't always want to sit and learn to meditate, but if you do these vagal techniques, you gotta give it a half hour a day minimum, even up to an hour a day, but it's worth it. People do get better using these techniques.

Gotcha. Gotcha. Now, some of the medications you mentioned before, kind of evolution of those. And one of the things I started doing a couple of years ago, because it's, I don't want to say it's reading my Braille, but sometimes I feel like you get 1 or 2 bands. Is this Lyme or whatever? The patient, their symptom score is like 32 or whatever. And doing the antibiotic trials. And early on in my career, like 2008, 2010, I started seeing some people like getting really better on these trials. You know, what are your thoughts to practitioners out there who has a patient who's not quite, doesn't fit all the categories doing a therapeutic trial of azithromycin, doxycycline, an ABOC to see how the patient responds?

So, I mean, I think the first key is you obviously have to establish a differential diagnosis. And so when patients come to me, and by the way, I'm not sure I should be saying this on a podcast, but I am starting very shortly a consultation model for physicians so that the doctors across the world, the US and the rest, if they need my help with their patients, they will be working with me. They'll be prescribing, they'll be helping me with the differential. But I just did this yesterday with a doctor who had a very sick 16-year-old with Bartonella, stretch marks all over her body. And I had to explain like how to use the 16-point model, what testing to do. Absolutely. So I'm kind of in there now in the trenches. I just started doing it a month or 2 ago. And It's actually quite satisfying for me to, to do it. But, but the point being, when you're dealing with somebody early on who, like, you're not really sure, you've gotta really check all, you gotta check all the boxes. Like, did you check for Lyme, Babesia, Bartonella? So immunoblots from IGEnX for me is a first step. You can do an ELISA Western blot from Questrolab, LabCorp, but the problem is they only check for one strain of Borrelia.

Mm-hmm.

So if I do a Lyme immunoblot, and it's not expensive, it's covered completely for Medicare. But if that's all you did, it's somewhere over $300. And usually the IgMs are going to be positive more than the IgGs. I only really need one Borrelia-specific band because if you've got an OspC23kDa in your blood, there's no other way apart from lying you're getting this in your blood if you don't have it. Especially, by the way, if you've got good and bad days, symptoms come and go, a chronic fatiguing musculoskeletal neuropsychiatric illness. I'm not falling asleep and it's migratory pain. So I will even treat people with one band, but— Yeah. I want to know if they have Babesia duncani in my crudi. I may want to get a Babesia immunoblot. I definitely want a Babesia FISH, especially if they have day sweats, night sweats, chills. The point in medicine is, is you know this, you've got to do a differential diagnosis.

So I want to get Bartonella immunoblots.

I want Bartonella FISH testing.

I need to see if they have mast cell disorder.

I'll occasionally do a CDSA, a comprehensive digestive stool analysis, if they have gut issues. A lot of these patients have SIBO. They have Candida. They have the wrong types of microbiomes with the wrong bacteria in their gut driving inflammation and autoimmunity. They don't sleep at night. So I really do go through the MSIDS model the first time that someone comes to me, because if they have low adrenals and if they have POTS and if they have Lyme and if they're not sleeping, all those things make you tired.

Yeah.

But each one of them may be contributing in a different way to the fatigue.

So when I do an antibiotic trial, I need to know really what are the inflammatory factors and the downstream effects, but I would at least expect, and I'll give you an example.

If you gave somebody doxycycline and a course of dapsone, right? You suspected they have Lyme. Most patients who do doxy and dapsone with or without rifampin, they will at some point get a Herxheimer reaction, right? And I've even done it with herbs where you take the Byron White herbs like Byron White AL or 8-BART, which are very powerful. And you just give people a bunch of drops of this, a lot of these people will hurt. Basically, they're getting a cytokine release. You're killing the bugs. But I do find that in most of these patients, you will get a classic response. They'll either feel better or they will feel worse. It is very unusual if you have chronic Lyme disease and you give people persister drugs, rifampin, dapsone, pyrazinamide, methylene blue. Those are the 4 main persister drugs. If you give it to people, They're going to usually shift. They're going to get better or worse, but it's very unusual they're going to say, I don't feel any difference at all. Unless, and this would be unusual, there's so much mold toxins in their body or their adrenals are so low or they've got overlapping factors that they just can't feel the effects. But normally still, they're going to get a Herxheimer reaction or something's going to shift to tell the clinician, yes, it's really there.

Yeah. One thing I want to clarify with what you said, because I think this is an important point, because in my training, They obviously have to do the standard test, which is raw rabbit serum, and then you do the Western blot. But what you're saying is like, if they have just the IgG band 23 positive, that is specific enough in a person with symptoms to say they probably have got Lyme. They don't still need 4 other additional bands. And even with the IGeneX, where it's like 3, if they're having this 23, these more specific bands in your world with positive symptoms and undulating or changing symptoms with the Horowitz scale, In your world, that is a Lyme patient.

Absolutely. Not even a question. But you have to put, for the medical legal reasons in medical records, you have to write in your chart that the 23 OspC is a significant positive band. And there's no other way that someone's going to have this, especially by the way, the immunoblots, because they're recombinant DNA, you can't get false positives, including the 31. If you do a Western blot and you do a 31 band, that OspA can be driven by Epstein-Barr reactivation or autoimmune illness. It's not specific. So you really do need an immunoblot, but that's the 31. If you're talking 39, 39 is like the most specific band you're going to have for Lyme. And there's others like 58 that I would put as number 6 for my bands that still actually have statistical significance. But the key always, and you know this, is you have to do a differential diagnosis. Have you ruled out other illnesses?

Mm-hmm.

If somebody has sweats and let's say they're a man in their 30s, my joke for men is, are you in menopause? You know, they look at me and go, huh? And it's like, come on, it's a bad joke, but you're not in menopause. So, you know, you run the thyroids. Okay. They don't have hyperthyroidism. They're not in menopause. They didn't go to India. They don't have malaria. They don't have a cough. You do a chest x-ray. They don't have non-Hodgkin's lymphoma or TB that cause drenching night sweats. So in my last book, How Can I Get Better? I think it's something like pages 50 to 66. I have differential diagnoses that for every symptom, Then someone has— as a clinician, you should always be doing a differential diagnosis. And medical boards will always leave you alone if they see you use your brain and you've done a differential diagnosis and you've ruled out other diseases, and then you give a treatment and the patient says, I'm better, and this happened. Nothing's going to happen, folks. That is good medicine. That's the way medicine is supposed to be practiced. And I, I can tell you this from being in medicine for over 40 years. It works. So, but you do have to do a differential diagnosis.

Yeah. And you said a phrase I think, feel like, is one of the many dreaded phrases for practicing physicians, which is medical legal concerns. And so, yes. Yeah. And so I want you to speak to that briefly. A little aside, when I first moved back, I was in the military for a while. I moved back to Virginia in 2007, saw a patient, did a Western blot. They had Lyme. And I'm like, well, This is serious. I actually called the local infectious disease doctor and they were like, well, there's no Lyme in Central Virginia and we don't take consults for it. And I was like, well, okay, that's interesting. Then I called the Medical College of Virginia and they refused to call me back. And in hindsight, this is probably because of the concern for medical legal aspect of dealing with this mystery illness that doesn't exist or doesn't exist. Or could you speak to how that fear of medical legal concerns in our system is actually probably preventing a lot of people from actually being more aggressive. Because I feel like a lot of doctors don't go down this route because they're scared, this fear of losing their license. Could you give your, your sage words of sort of thoughts or wisdom on that?

Well, first of all, you're absolutely correct. This is a medical-political disease. It's not just a medical illness. And unfortunately, our government has done an extremely poor job. They have taken sides early on in a scientific debate. With the IDSA, the Infectious Disease Society of America, who early on with their guidelines said chronic Lyme doesn't exist. It's not a chronic persistent infection. The blood tests are reliable, even though the science said the exact opposite, which is what the ILADS guidelines were publishing. But people took sides, as oftentimes, unfortunately, in medicine they do. And know this from the history of medicine: this kind of action has been the fact like you look. At OB-GYN with Dr. Semmelweis from the 1800s. He said, hey, I'm washing my hands and women don't die as often and babies do well. And they basically, he committed suicide. They, they threw him outta medicine going, you're crazy.

Why would you wash your hands?

Or Dr. Marshall from Australia.

Um, we don't need to take people's stomachs out when they have ulcers.

It's a bacteria. It's like, oh, you have gotta be kidding me. It's like, all right, I'll drink the stuff myself with H. pylori.

I mean, look at the history of medicine. This is absolutely no different.

The fact is, I was railing a little bit on my Facebook page, and again, if people want up-to-date information on what goes on, just follow me at Dr. D.R. Richard Horowitz at Facebook. Right just today, you know, Tufts University got a $20+ million grant. Why are people sick with chronic Lyme? Well, Linden Hu, who got this, he never called me up and said, hey Rich, you were on the first round of the HHS Tick-Borne Working Group.

You've been in the trenches for 40 years with patients.

Tell me exactly, I know you published, what are you seeing?

I'd like to integrate that. I never got a call. It's almost like there's a complete disconnect between the universities and those of us in the trenches, which is why, by the way, I've been publishing my results so people cannot say this is anecdotal. It's published in peer-reviewed science, but it is still an ongoing political debate.

And most universities have gag orders for these people who work there You cannot say that it is a chronic persistent illness.

I don't care if it's Hopkins, I don't care if it's top Stanford.

You will not hear this from a university, which is why I am now forced to go to the NIH and get my grants myself and do a double-blind placebo-controlled randomized trial on Dapsone combination therapy because this type of political idiocy that is hurting patients.

And by the way, speaking of how bad it is, when I started years ago, let's say 10 years ago, And I was looking at the figures. CDC said, oh, it's 30,000 people a year. Then about, I don't know, 5, 6 years ago, well, actually the numbers are 10 times worse.

It's 300,000 people a year.

Then a couple of years ago, it's like, well, actually we're up to 476,000 people. And then the year before they went, you know, we just checked the figures. It's 1.7 times higher than we suspected. So you're telling us now that over 3 million Americans per year Almost 1% of the US population is exposed to Lyme disease. And in The Lancet Global Health, about 3 years ago, they published that 1 out of 7 people on the planet, 14.5% of the global population, has been exposed to Borrelia burgdorferi. But you will not get any world leader or any medical department in any country to say this is what causes chronic Lyme. Why? Because they're following our CDC and our government. Yeah.

And when I worked at HHS and I served for 2 years for free, right, to help my country, just as you did in the military, I could not convince people no matter how much I was publishing.

They did 6 years of this HHS Tick-Borne Disease Working Group.

I'm sorry, I just don't see that anything majorly political has changed, even though we've now shown it's a persister bacteria under biofilms, not just by me, but by other researchers.

Oh, boy.

So, docs, as far as how to treat patients, You took the Hippocratic Oath.

The way you do this, your job is to help patients, but of course you must protect yourself at the same point in time. How do you protect yourself?

Put my questionnaire in your medical records because it is basically showing above 2 standard deviations if you score high and migratory pain.

Do a differential diagnosis. Make sure you're saying in your chart which Lyme-specific bands the patient has and if they're migratory pain. Put all the Dapsone articles in your medical literature if you're using it to say that there's published research. All you have to do really to protect yourself is do a differential diagnosis, take a good clinical history, and put all the literature that's out there right now in your medical records backing up what you're doing, and nothing will happen to you.

At least not from my experience.

Virginia can be a tricky state. I know a doctor there that had a problem a couple of years ago. In Virginia with her license for Lyme, and it's happened in other states also, which is unfortunate because you're right, doctors are scared to treat in the middle of an epidemic.

And that is the fault of our governmental agencies who have not been able to get past their own egos when they said, we believe the IDSA. The IDSA and their guidelines, they have nothing to say about chronic Lyme.

Shame on you in the middle of an epidemic that you've allowed politics to hurt patients. Shame on you. And And that's because we don't have enough medical ethics that has gotten into all of our organizations, or we would not be having the problem that we're having right now.

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Yeah. I know when I first started kind of getting into this, my heart and my resource was my family, my daughter. One of the things I was like, I'm not— okay, I'm not going to deal with chronic Lyme disease because I don't want to deal with it. I'm not going to deal with mold. I'm not going to deal with POTS. I literally said that to myself. And about a year into it, I'm like, I don't know if I can. So I started doing some mold stuff. I'm like, and then I'm like doing the Schumacher training and Dr. Heyman. I'm like, can this many people really have mold? There's no way that every third person I'm seeing has a mold issue. Then I started looking for Lyme. I'm like, there's no way. And so then it's almost like this, I don't want to get in this complex type of care. And then you get there, you realize, oh my gosh, this is absolutely everywhere. If you want to deal with a thyroid patient, I have to deal with Lyme and mold. If I'm going to deal with a chronic fatigue patient, I have to deal with mold and Lyme and tick-borne illnesses. And you just realize if you really want to take care of these people, you have to take a deep dive. And if you don't, you're just going to always be on the surface. You're never going to get into people's root causes and really help people's bodies to heal.

No, absolutely. You're absolutely right. I mean, and that's ultimately what it comes down to. No matter what we tell ourselves we're going to do when we start medicine, patients change your mind. And ultimately, it's compassion, right? You You have to put yourself in the patient's shoes and say, they're sick. What would I want done if I was in their position? And what ultimately you're forced to do is exactly that. You must get to the root causes of illness. And unfortunately, in our society, in the way the medical system works, and this is partially from Big Pharma that funds— I think they fund like 75% of all the medical schools and training comes from Big Pharma. Now, I use Big Pharma. I love pharmaceutical drugs. Please don't get me wrong, but there's a place for them. This still, the essence of medicine has to be the root causes of chronic illness. It's not one cause anymore, it's root causes. And environmental toxins and infections are driving a whole bunch of this. And a lot of us who went through medical school, we were not taught this. We have to learn this when we get out into the field because our patients who require it, we learn it.

Yeah. Now, one thing that I was really intrigued by when I went to my very first ILADS meeting, probably a year and a half ago, I started studying this years ago, but eventually, I'm like, I got to get the little certification. And, Do all kinds of stuff. I was really interested about some practitioners only did herbs. Like, I was going to some of the breakout conferences. So, could you— and that was different parts of the country. Could you speak to the use of herbs with chronic Lyme disease? Is it an issue of severity? Like, some people with Lyme disease can be treated with herbs alone, or can, in the right hands, herbs be an equivalent to some of the stuff you're doing? How do you look at that difference of treatment styles or whatnot in this world of chronic tick-borne illnesses?

There are definitely a lot of herbs that are helpful for chronic tick-borne illness. And years ago, before I knew about biofilm persister bugs and drugs like dapsone combination therapy, I was using the Cowden protocol with Samento, Banderol, quinoa, et cetera. I was using traditional Chinese herbs from Dr. Zhong, Coptis HH Circulation P, AI3. I was using Beyond Balance. I was using a lot of these herbs and they do help. There's not even a doubt. They will help patients. The problem from my perspective is that because these are biofilm persister infections, even though there is some literature that Cryptolepis has some persister properties and it's good for persisters and it has some effect on Babesia, it's not necessarily going to be strong enough in your sickest patients. So a lot of the naturopathic doctors in states where they can only do herbs, they can still get patients better. Like I work with Dr. Mariah Hinchey, And for those of you who've not, didn't know we did this, we'll be doing another Doctors Talk Healing from Lyme Summit 2.0 this coming year. I think it's coming out in April of 2025. Stay tuned 'cause there'll be over 40 world experts that Dr. Mariah Hinchie and I will be interviewing. And if you look at the Doctors Talk we did from last year, Dr. Hinchie did an amazing job about talking about all the natural herbal therapies that are available. There are definitely a lot of ways to skin a cat. So yes, herbs are useful, but in my world, because I can use antibiotics, I'm always looking for the fact that because we're always talking about antibiotic resistance and we don't want to use long-term antibiotics, and there are some ILADS docs or other docs who do use long-term because they don't realize that you don't have to. That the whole point of learning about biofilm persister bacteria is that once I get people through an 8 to 9 week double dose, last week high dose Dapsone protocol, which is 9 weeks, of an oral generic antibiotic protocol.

Then we take a break for 6 to 8 weeks because the counts—

dapsum causes anemia. It takes about 6 to 8 weeks for the counts to come back to normal. We want to make sure their methemoglobin levels are fine. They have to be G6PD positive. There's a whole set of criteria. But once they've done that, if they have Bartonella, which now we're finding over 90% do, if you give 2-week antibiotic pulses roughly every 2 months, I will put a lot of these patients into long-term remission.

without having to be on chronic herbs for the rest of their life.

So my goal was always to find the shortest, quickest, most effective treatment regimen for a worldwide epidemic. So getting back to herbs, herbs are helpful, but you're gonna have to stay on these herbs for long-term because once you stop them, a lot of the symptoms will come back. And what I was doing years ago when I was using antibiotics and then stopping, we would put people on these other herbal protocols for maybe 6 months or a year, and it would hold a lot of these people. They would not be too bad. They would hold and stay pretty good. And then all of a sudden, they would start to break through with symptoms, and we'd have to put them back on antibiotics. That has not happened after we started to use persister drugs, mostly dapsone combination therapy, rarely disulfiram, because those are the only drugs that have been put out there that hit these biofilm persister bacteria.

Okay.

So herbs are useful. There's not a doubt. But from my perspective, I want quick, I want fast, and I don't want long-term antibiotics because of antibiotic resistance in the world, although most of the resistance is not coming from people giving antibiotics for otitis media. It's in the feed. It's in the animal feed. It's not coming from ILADS doctors giving long-term antibiotics. Whole separate issue.

Yeah, I think something like 80% of all antibiotics used in our country are used in the animal agribusiness. So it's compared to what they use in animal feed and cows, it makes what we do look pretty small. I did hear you talk about Double Dam. So it was last year at the ILADS conference up in Boston. And I got super excited. I got the article, I read it, and I started going through it. And I'm— I started getting scared when you, when you started going through there about the anemia, basically hemolytic anemia. What advice— and I, I feel like I'm a pretty well-seasoned physician. I worked in the hospital for 15 years in the ICU. And so, but I got kind of scared where I'm like inducing hemolytic anemia. And, you know, what, what advice would you give someone like me who has yet to use Dapsone, but used all kinds of other antibiotics, or someone else who's going to be listening to, potentially could be listening to this? If they want to start putting their toes into this world of Dapsone, how would you recommend someone who wants to ease into this, ease into it? And you might want to mention your article as well. We'll talk about that.

Yeah. So, first of all, for the people who want the most updated treatment protocol, if you look up in the journal Microorganisms, September 2023, Dr. Freeman and I published something like a 53-page article on these updated protocols. In fact, Every little bit of the protocol of how to do it is in there with an overview of all the side effects. So the side effects of Dapsone are do no harm. H stands for Herxheimer reactions. A stands for anemia. It's a folic acid-induced anemia. R stands for rashes for people that are highly sulfur sensitive. Although most people, even with Bactrim sensitivities, can take it. We'll use an H1/H2 blocker if we have to, if there's any question. And M stands for methemoglobinemia. Because Dapsone causes oxidative stress and you don't carry oxygen in your blood as well. So how do we reverse those side effects and get people through? The example I'll give you is somebody that has lung cancer. If you knew that you had, or let's say lymphoma, which is actually a better one for non-Hodgkin's. We know that certain forms of cancer like non-Hodgkin's lymphoma are well treatable with chemotherapy and sometimes with radiotherapy, but you are going to get side effects from chemo and radiotherapy. Your counts may drop. You're going to have side effects. But if you knew that after you did all of these sessions, you would be in full remission and have your life going forward, you would say to yourself, well, it's certainly worth it to go through the protocol. There's absolutely no difference here.

There's not one person that has ever died from Dapsone combination therapy.

But, but here's what happens with the anemia. You have to make sure, number one, that people are not G6PD deficient.

Glucose-6-phosphate dehydrogenase.

I've only found 2 people in all of the 13,000+ people I've ever treated That are G6PD deficient. So first of all, most people will be able to take Dapsone, but you have to make sure they're not iron deficient. The the woman that I did the consultation for yesterday, this young woman, she had a low ferritin, low iron CBC. She you have to replace the iron and get the counts back up. She was 11.3, and I said to this doctor, "You can't do Dapsone yet." She was 13.7 last year, hemoglobin. I said, "Listen, get her iron levels in there. Get her." hemoglobin to go back up. And in the meantime, what I want you to do is 2-week pulses without dapsone. The girl was already on doxy, rifampin, Zithromax. I said because she had Bartonella with all these stretch marks, add methylene blue because methylene blue with rifampin and Zithromax will hit bart persisters. Add on 4 biofilm agents with biocidin, stevia, cinnamon, clove, oregano oil, and peppermint oil.

And I want you to go up on the methylene blue dose the first week, working up to 200 BID.

The last week, you can go to 300 BID, which is the top dose and the most effective for BART. Double your rifampin to 600 BID, and just do that for 2 weeks, and then stop all your antibiotics.

Now, with high-dose methylene blue without dapso, you will sometimes see a hemolytic anemia of up to about 2 grams.

But if somebody even has a hemoglobin of 11.3 and they go to 9.3, the minute the methylene blue's off and not on board, they're going to go right back to normal. As long as their B12, folic acid, and iron, right, are on board.

Yes.

So you don't really worry about it because this is a woman that I was dealing with that had horrible neuropsych reactions, that was trying to commit suicide, cut herself because her Bartonella was so bad. What I said to this doctor is, once the counts are up, we're then going to do Dapsone. But in the meantime, I want you to pulse these antibiotics. Now, the way to get your foot in the water with Dapsone is just start with low doses. You know, how did I learn how to use high-dose dapsone? Well, I only started with 25 of dapsone, and then I watched what happened. There's hardly any anemia when you use 25 with doxyrefampin, but I always use high-dose leucovorin and Zaequilexar, which is Follify, 15 milligrams of L-methylfolate. So I give, if you read the articles, efficacy of high-dose dapsone combination therapy for the treatment of chronic Lyme-Barton microorganisms, 2023. You'll see that what ultimately happens is the anemia on the average will be about a 4-gram drop.

Some of it is hemolysis, and some of it is based on the fact that it's just interfering with folic acid metabolism.

But we're giving up to 300 milligrams of folic acid now with people who do this protocol. I'm using 100 milligrams of leucovorin twice a day, 60 milligrams of L-methylfolate twice a day with B12, with iron. While they're doing these protocols.

So if you look at the study we did, you'll see on the average it's about a 4-gram drop. So if you're like 13 hemoglobin and you drop to 9, the minute you stop the Dapsone, 6 to 8 weeks later, as long as you keep them on high-dose folic acid, B12, iron, they're back at 13. It's no big deal. The highest amount that I see the hemoglobin drop will be up to about 6 grams. And the worst I've seen is in somebody with thalassemia minor.

You know, where they have a low MCV, they start with like a 10.5 hemoglobin. I've seen it go down to like 6.5, but these are young women, 22 years old. And the minute you stop it, by the way, the hemoglobin goes up by 1.5 grams every several days when you leave them on high-dose folic acid.

It takes a while to get used to this. But the point being, having done this in like 1,000 people over 10 years, you don't need to blood transfuse these people. The counts come back to normal. You just have to get used to the side effects. And I tell people it's like cancer chemotherapy. You are going to get side effects, but they're reversible.

Now, cancer chemotherapy, you get cancer brain fog, you get neuropathy from cisplatin, you get long-term side effects sometimes that don't go away.

There are no long-term side effects from Dapsone combination therapy. It doesn't happen. It just takes a while for the counts to reverse. So doctors that have not used this, It is the most effective protocol. But the way to get used to it is just start with lower doses of Dapsone.

Watch the counts.

Start with men that have a 15 or 16 hemoglobin. If you have a man with a 16 hemoglobin, you could blindfold yourself, throw darts at it, and say, just do the protocol and get back to me 3 months later. And they'll be fine because even if they drop 4 grams, who cares? And the methemoglobin will be 5 or 6% on high-dose methylene blue. They will say to you, oh my God, doc, I've got blue hands. I've got blue lips. The methemoglobin will be 5 or 6%, could be 8 or 9%. That's not dangerous. It's just annoying as hell. Dangerous is 50 to 60% methemoglobin.

Hmm.

And we are using cimetidine 400 BID, glutathione 1,000 twice a day, vitamin C a gram twice a day, vitamin E 300 twice a day, methylene blue 300 BID. These all reverse methemoglobin.

So methemoglobin is not even an issue anymore with the Dapsone protocol.

Your patients just have to know you're going to feel crappy. You may have some blue hands, blue lips. You're going to feel short of breath, but you're going to get your life back in most cases and feel tremendously better because it's the only short-term oral generic protocol that has ever been published. I know of nothing that is nearly as effective as short-term dapsone protocol, but get used to it. You know, you, you gotta grow a pair. Sorry to say it a little bit. When I go to ILADS, by the way, in San Antonio, for those who are coming, I will be doing a stand-up comedy routine, by the way. the ILDF. And part of it may be making fun of some of these doctors who are not using it because they do need to grow a pair. Because listen, your patients need to come first. But if you're not using Dapsone, you really got to get over it. Put your foot in the water and start using low doses and you'll see. Oh, okay. I got up to 50. The counts went down by a gram and a half. I stopped it. The counts went back to normal. Now get used to 75, 100 of Dapsone. You're going to end up at the same conclusion I am at now. After doing this for 10 years, like, okay, you get used to the drops in the hemoglobin, it goes back to normal. You get used to the methemoglobin, it goes back to normal. It's like, but these people get their lives back.

Yeah.

I mean, that's kind of where I'm at at this point. There's nothing long-term that happens from these protocols. And because we're using over 500 billion probiotics twice a day, I mean, I'm using Therac, Orthobiotic, Saccharomyces boulardii, and Probiomax 350 billion from Zymogen. All acid-resistant strains.

I'm using so much good probiotics. I haven't seen a case of C. diff in years on all these people.

If I think they may have a Candida problem in their gut when they're done, I might give 'em a couple of weeks of fluconazole to clear out their—

on nystatin and biofilm agents during the whole protocol, which is getting rid of Candida.

So I am protecting these people from oxidative stress, protecting them from the methemoglobin, high doses of folic acid to stop the anemia. I mean, we're doing Using all the things we talked about earlier, blocking NF-kappaB, stimulating— we're doing everything we can to make this protocol tolerable.

I mean, it's taken me literally 9 to 10 years of tweaking this protocol to get it to where it is now. And that's— I'm ready for an NIH double-blind study because I'm not going to do a study if I don't know the results already. I already know what the results are going to show.

I think just one thing to talk about with your analogy with Like cancer and Lyme. I remember reading, I forget when and where, but I was looking at the quality of life of patients with chronic Lyme disease, and it was the same or worse than people with chronic cancer. So, like your analogy with you carry cancer, I think some people might think, oh my gosh, that's kind of crazy. But people with chronic Lyme disease, in many ways, their life, their quality of life is actually worse than a cancer patient, which is just crazy to think about.

No, it's true. And it also goes back, the way they used to say years ago is that it's as bad as chronic congestive heart failure. Which is, which is pretty much equivalent to what you're saying. No, it is a very debilitating disease. And I don't think our— the people on top— I mean, I've contacted Ben Beard from the CDC who knows me well, and I said, Ben, look at the Dapsone. But by the way, for those of you who are listening, just today, so today's September 18th, I just posted the 10 Dapsone articles that had been published in the medical literature and the 90-minute Dapsone documentary. It's on my Facebook page. Dr. Richard Horowitz. You can watch the 90-minute Dapsone documentary. By the way, most patients who watch it sign up and go, all right, put me on Dapsone.

So it's different. You know, you read the articles and it's like, it's scary.

It's like anemia, methemoglobinemia. And then go look at the patients and hear what they have to say.

It's like they get their lives back. So ultimately, as long as you've got the scientific backup and you start learning about it, doctors will get used to this.

But I really would encourage people, please, please follow me at, on my Facebook at Dr. Richard Horowitz and sign up for the medical Medical Detective Substack, because every week I'm putting out this new information that patients and doctors need to know about, about the risks in the world. We're about to finish up on 6 viral infections. I did 9 or 10 of them on Lyme, by the way, which you'll probably find really useful on how to diagnose Lyme, what are the clinic symptoms, and it goes beyond what I published and even in my books. And it's all free on the Medical Detective Substack. People can sign up for free.

That's great information. I really see forward to To be respectful, respect your time. But you've already said it multiple times. So people, they want to learn more about you. Like, what are your next steps? What are you doing now? Where can they— I know you've said it multiple times, but to put it in one space, where can people find more about you, more about what you're doing, see videos about patients and their experiences? Where can people just find out about more? If they want to follow you, where can they do that?

Yeah. So my website is www.cangetbetter.com and you can sign up for email updates. As I said, the other way to do it, to find out what I'm doing is Just check in with Facebook because multiple times a week I'm posting articles and like every time a new article comes out on Bartonella or Lyme, I'm posting a comment usually about it. And then of course the Medical Detective Substack that I started doing, which is free for subscribers, is like I'm blogging once a week on what I think are pretty much the most important things people need to know about as, you know, climate change is increasing tick-borne infections and mosquito-borne infections. So I'd say that's probably the best way to To kind of stay abreast of what I'm doing.

Cool. Dr. Horowitz, a super thank you for your time. I know you're a busy man doing lots of stuff with research. I really appreciate you sharing your brilliance with our community. And best of wishes. You're doing awesome work. I've been following your stuff for years and it's really changed the way I practice medicine and had a positive impact on my patients. I want to thank you for that as well.

It's my pleasure. And if you ever have any questions, honestly, about the DAPSOM, as I said, I'm— I know I'm going to regret saying this out loud about the consultation model, but Yeah. If you ever get a really complex patient and you're not sure and they're afraid to do Dapsone, I do have a model. I mean, people obviously pay me to do it. They pay you.

Yeah.

Pays me. But for tho— and I just did it with a couple of doctors and I'm finding is if I can do this with a couple of doctors holding their hands, doing these protocols, teaching 'em the mSIDS map, teaching 'em how to do Dapsone, I don't have to do it anymore. You know, I used to do a doctor training once a year, and in fact, on our website, I should probably tell you this also. There's a doctor, there's a doctor training video we did last year with Neil Nathan and other doctors, Dr. Bruscano. I mean, it's a fee. It's only for physicians. It's not for patients, but it's for doctors to learn about what I do so that then if you do the consultation model, you do it a couple of times, it's like you'll become an expert also.

It's like, okay, check the boxes.

I didn't check you met for mold. I didn't check for POTS. It's like, it's, it's not all that complicated after you get used to the fact that you just gotta know where to look and you gotta know what the tools are, right? That you gotta use for each of these. But once you start doing it, it's not as complicated, I think, as as people think. So, there are tools out there for, for people. And, and if you need any help, please, please let me know. I'm around.

Awesome. Thank you for that. Thank you so much for your time.

My pleasure. Okay. Have a good one.

All right. Bye.

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