Treating Lyme Disease Takes More Than Antibiotics – The Hidden Factors That Determine Recovery with Veronica Porterfield | Lyme Disease | E151

If you screen people for environmental toxins, they'll have about 13 different toxins on average. This is in Haynes' data show up on the testing. Well, that number 10 years ago was 8 to 7 and 20 years before that it was 2 to 3. Welcome back once again, everybody. We are going to continue our series on Lyme disease and treatment today, talking about beyond the basics, beyond just using antibiotics. Probably also talk about some nuances, why antibiotics don't always work, why sometimes you have to use herbs, talk about biofilms, cytokines, all kinds of interesting things that I didn't learn in medical school. Cause I literally wasn't taught about Lyme in medical school. And even when I go to my medical conference, they only talk about like the super basic treatments. So I think the gist of this episode will be at the end of it to understand why treating Lyme disease can be, and this is just Borrelia burgdorferi. This is not all the other tick-borne illnesses. So it can get a little. Convoluted.

Yeah, definitely complex.

So how has our understanding of Lyme disease evolved? Like from it being an unknown, probably arthropod-borne illness in the New England area to first discovering, you know, Lyme disease in Lyme, Connecticut to now we know there's like hundreds of species of Lyme disease. Can you walk us really briefly through the evolution of that, which also plays into our treatment, evolution of treatment?

Maybe you can tell me exactly what you're asking.

Like how would the— would— okay. So initially they were having these fevers in kids in the New England area.

In Lyme, Connecticut.

Yeah. Yeah. And they're like, it looks like it's an arthropod-borne. It's always in the spring. It was like a seasonal juvenile rheumatism, fancy way of saying kids get a rheumatologic-like thing for 6 weeks in the spring and it goes away. No harm, no foul. So there's something going on that we knew was there, but we couldn't see it. Eventually got the test in late, I think late '70s. And they used a Borrelia strain, that one strain, which is still what we use today in our testing, which is one of the reasons why it's also not super accurate. And evolving from that to now, we realize that there's hundreds of strains and it's, there's European strains and there's Miyamoto, and oh, by the way, there's also different tests. Like, can you walk us through the history of the evolution of, from that to today?

I feel like there, well, No, I don't know that I can actually, in terms of like the sort of evolution of thought around Lyme disease. Okay. There are a lot of theories about what happened and why Lyme started. And, um, so I'm not even sure if it's really helpful to talk about like where it came from and why it started and what might've initiated it. Okay.

Well, why don't we talk about some of those theories? Cuz those have popped up recently as far as whether it's related to glyphosate exposure. Going along with the surge of tick-borne illness or even some recent stuff. Was it actually, you know, a bioweapon, which I would've laughed at, which I would've laughed at, you know, 7 or 8 years ago. And now you kind of hear that story and you're like, maybe, maybe.

Yeah. Do we want to talk about that or do we want to focus more on—

Yeah, probably let's not talk about that. But yeah, that's probably, it's a good point. Probably bad to get off the beaten path, but the gist is that it's mutated, it's changed. It's interesting how this has been around forever since about 5,000 BC, cuz we have found individuals with that were frozen in the ice with the spirochetes. So we know this is not new. It's been around for a long time, but the aggressiveness 100% is changing. And is that partially due to nutrition that we're all nutrient deficient? Is it related to the fact that all these kids have high levels of trans fats in our blood, which affect our immune system? We have lipid rafts, which make it easy for viruses and other things to skip from cells to cells. Is it related to our other exposures, our toxins, our immune system being— Yeah. One, when I just finished doing a certification through University of South Florida and personalized medicine, and one of the things they talked about was currently today, if you screen people for environmental toxins, they'll have about 13 different toxins on average. This is NHANES data show up on the testing. Well, that number 10 years ago was 8 to 7, and 20 years before that it was 2 to 3.

Wow.

So we are definitely accumulating more and more chemicals in our body. So why is it Worse now, you know, pick your poison, who knows. But back to the antibiotic thing, you know, I can just use amoxicillin, right? Someone has a tick bite and I can use amoxicillin for 2 weeks. Well, actually a day, right? Like, let's talk about that a little bit. Like where our current standard of care is. Yep. For the Lyme that we recognize, which is only acute Lyme, not chronic Lyme.

Mm-hmm. So standard of care prophylaxis, if you're bitten by a tick, is 200 milligrams of doxycycline once. And we could get into, and, and maybe we put the articles, I don't know if there's a way to link articles to our—

when we do the blog, we can link, that's the easiest thing to do is link articles to them.

If it feels relevant. I mean, we can talk about why, like what research that prophylactic recommendation was based on. It was faulty research. So, and there are a whole slew of things that can happen with that 200mg one-time dose of doxycycline. You can, cause a person to not convert. So they would be like a non-zero converter to Lyme. So if you give them the 200mg doxycycline dose, they may never show up with Lyme antibodies. They may never have positive bands. So you can cause problems by doing that and you actually haven't helped anything. So you could ask if it's probably worse doing it than not. So that's the standard of care for prophylaxis. And then standard of care for treatment is doxycycline twice daily for 3 weeks, or 100mg of doxycycline twice daily for 3 weeks. That would be standard of care. For acute Lyme.

Okay. But what should we do? What should we really do?

Well, I think we should really always, regardless of, you know, what model you ascribe to, regardless of whether you wanna call yourself an IDSA subscriber or an ILADS subscriber, you should always be treating the patient in front of you. So according to ILADS, which is a little bit of a different approach, prophylaxis would be 100mg of doxycycline twice daily for 3 weeks. That's prophylaxis. So you get bitten by a tick regardless of how, how long it's on you, you get 3 weeks of doxycycline, period. Prophylaxis. If you develop any, and that needs to start as soon as possible, ideally within 48 hours of the tick bite. So doesn't, it's not great to start it a week later. For treatment of acute Lyme, um, it would be a minimum of 6 weeks of doxycycline, just twice daily. And then dot, dot, dot depends on how the person's doing. So if they're not feeling better at the end of 6 weeks, you keep going.

So for acute Lyme, do you ever use cefalexin or azithromycin, like macrolides, like azithromycin or cephalosporins like cefalexin for acute?

I don't typically use a macrolide for acute. I might use a cephalosporin, so there wouldn't be anything wrong with that. And there would be no, nothing wrong with doing amoxicillin acutely either.

Okay. Which, cuz you know, with the, the penicillin-based antibiotics are the beta-lactams.

Yeah.

Yeah. Are bactericidal, meaning they kill the bacteria versus doxy and macrolides are bacteriostatic, which means they slow the growth down so your immune system can kill it. So if you had a suppressed immune system for any various reasons, those, those ones might not be quite as good.

Right.

Versus like, um, a cephalosporin. I'm, I'm also hesitant with cephalosporins cuz I've actually seen people get C. diff colitis, which is a horrible thing to get. And I've never seen that with a macrolide or with doxy, but I've seen it. Multiple times with cephalosporins or penicillin, like the old school penicillin type antibiotics.

So, yeah, well, I think it's a good point too about how the different medications work. And doxycycline can be super effective for somebody with chronic Lyme, but sometimes people respond better with amoxicillin or with a cephalosporin for that reason. That's bactericidal versus just being bacteriostatic.

So that's the acute Lyme. Chronic Lyme, you know, what's the current standard of care for chronic Lyme? And then what's the IDSA recommendation? And I'll probably—

so you're laughing because you already know that you're asking a funny question.

I'm asking a funny question. Give me the truth.

There is no standard of care. There's no such thing as chronic Lyme according to IDSA.

So, okay. Well, that's a bummer. I thought we were gonna have some controversial discussion about the fact that, you know, I still, I've talked about this a lot of times, but I moved back to Virginia from the military. It was 2008, 2009. I saw my first Lyme patient ever. I just, I wasn't sure what to do with it. So I called the local infectious disease doctor and they refused to take the consult. And they said two things. One, I don't, we don't take consults for Lyme disease and there's no Lyme disease in Central Virginia. So then I called the Medical College of Virginia where I went to school, my alma mater, figuring I can get infectious disease person there to see the patient. And they didn't return any of my, my phone calls. What? And so I had to learn early on how to take care of this, but it's real, like chronic Lyme disease is not, still is not recognized. So if you think you have chronic Lyme disease, you have to work with a provider that actually thinks it might actually exist.

Would it make sense to talk about pleomorphism in that context?

Sure, absolutely. There we go.

Pleomorphism.

What does pleomorphism, what does that mean?

So it just means that Lyme can change shape, form, metabolic activity based on several factors. And one of the most significant ones is if the spirochete feels stressed, right? So if it feels a threat from the immune system or if it feels a threat from an antibiotic, it can change shape to survive, to survive that threat.

And it can become these little cysts that don't replicate, that don't divide, that amoxicillin or doxycycline or azithromycin won't kill and just sit there for—

They're metabolically less active.

Yeah. Or it can be a cellular, acellular form and be more active and different antibiotics work against that. And so that's one of the ways it can be, you know, the great imitator. And look like a lot of different things. So talk, walk us briefly through some of the different, like in someone who comes with a chronic Lyme disease, what are some of the different antibiotics that are used typically?

I often will start with a cephalosporin. So I hear you and I'm not pushing back with the possibility of C. diff infection, but I will start with a cephalosporin for a lot of reasons. But I think the main one is because it is bacteriocidal. If somebody's gonna respond, we'll see pretty quickly, like if we suspect that Lyme disease is an issue for somebody, like let's say they have a few bands that are positive, maybe one of them is Lyme-specific. So we have a suspicion for Lyme, but it's not 100% clear. We haven't proven active infection. And with that suspicion, we're like, okay, let's treat you and see if you feel better, or let's treat you and see if you have a Herxheimer reaction. So I'll start usually with acetylcysteine, so cefdin. And if the person's like, Wow, I feel much different, either because they had a Herxheimer reaction or because they're feeling better, then that's usually my clue. Like the infection is part of what's going on.

And how do you layer on, how do you determine layer on other antibiotics, whether they're, we'll talk about this a little later, things that help with biofilms or things that help with the other, like the cystic form, for example, when you determine to start laying on those additional antibiotics?

So theoretically it's not a bad idea to lay, to layer on at least in a pulsed way, an antibiotic that'll deal with the cystic form, but often I'll give a person a few weeks to see how they respond. If they feel amazing on doxycycline or if they feel amazing on Ceftin, I don't necessarily feel the need to add in metronidazole, tinidazole right outta the gate. Sometimes that gets layered in a few months down the road to make sure that we're covering cystic forms. And often what'll happen is we try to transition somebody off of antibiotics and potentially just onto herbal treatments. Then we start to see things kind of kick back up. At that point, we're adding some cystic medications or antibiotics to treat the cystic form.

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And what kind of additional lab testing do you do to see how someone's responding? Do you do any cytokine panels or natural killer cell counts or CD57s or complement testing if the person's— to track them with labs or using it, do you mainly feel like— so I think it's an important point because there's Horowitz, he, the guy, the godfather of all this stuff actually has done The, I guess he's like the most researched guy. No one's even close. Actually has a validated questionnaire. Correct. That you can score and you can literally, if your score's low, you have a low chance of having what's called multiple systemic infectious disease syndrome, which is all infections. If your score's above a certain level, you're more likely to have it. And you can actually track symptomatic progression, which correlates with your response to treatment. So it's, it's actually some, the point, that's a long-winded way of saying that we're not tracking labs, we're tracking people's symptoms, but specifically using a validated score that's been researched and looked at to— that correlates with the stage by tens of thousands of patient responses. So when you start herbal, you know, I have patients come to see me and they're like, okay, okay, I tried Ambroxan, it didn't work, or I feel horrible. Or they come in with some weird thing and they've done horrible on Doxy, they've done horrible on rifampin, makes 'em feel terrible. They get horrible diarrhea with cefuroxime or whatever. How do you start adding in herbals and what's the rationale behind using herbals?

Herbals are actually really interesting because they can impact, so they have antimicrobial properties, so they can hit different stages or different forms of Lyme. Some of 'em have greater potency for certain forms, but I mean, that's getting into the weeds for our purposes. But they also help to modulate the immune system. Many of them have multiple roles. So people sometimes tolerate herbs better because the herbs are also like reducing inflammation, like modulating cytokine response. Like, so the herbs actually have a lot of different left functions, if you will. Yeah.

And I was just really interested. It was interesting to me to learn that herbs almost universally do have multiple mechanism of action. They might be mainly a biofilm cleaner, or it might be mainly an anti-inflammatory or mainly something that helps block cytokine response, but they typically do multiple things. And because of the way they work, you tend to layer them. So you'll do 3, 4, 5 herbs at a time. But if someone's having Herx reactions and you kind of change perspective a little bit and you do things that help calm down that cytokine response, can you talk about that a little bit? Because I, a lot of our patients will come in, we'll start treating, they do horrible, horrible, horrible. And we have to almost like pull back and be like, wait a second. Let's change direction. Let's start working on inflammation first, calming that down so you don't have these things called Herx reactions. Can you talk about that a little bit?

Sure. So do you want to focus on what a Herx reaction is? Do you want to talk about like why people become toxic?

What it is, why that, and then how we address that in someone who you're giving anirolox to or whatever, and they're feeling horrible.

Okay. So a Herx reaction, I think sort of historically or characteristically occurs when somebody's treating an infection and you have you know, lipopolysaccharide and protein fragments and stuff floating around from the stuff that you're killing and the immune system is seeing it all and reacting. So it's immunogenic. And so sort of based on that immune system response to all of those fragments and pieces that are kind of floating around, you have a worsening of symptoms. Often it feels like flu-like symptoms, but I tell patients like any symptom that feels familiar as part of your infection, if that worsens, that could be a Herxheimer reaction. And Dr. Shore would say people were toxic. And part of that was, you know, you've got the Herx response or you have the Herx reaction. And then on top of that, you've gotta be able to like clear that stuff. You've gotta clear those particles. You've gotta clear that stuff. That stuff is also highly inflammatory. They're reactive oxygen species that are causing oxidation. I mean, there's like a lot of stuff going on as a result of that whole reaction. So like clearing those particles from your body, getting rid of them in your, like through your liver, through your stool, dealing with reactive oxygen species. There are a bunch of layers of addressing that kind of response.

Yeah.

What else do you wanna add about that?

You know, it also, one of the things I've learned is that your body makes its own toxins and the biggest toxin factor in your body is actually the bacteria in your gut. And so all of a sudden, and it's called endotoxin or lipopolysaccharide, which By itself can cause autoimmune diseases by itself. A lot of the sepsis responses people have when they're septic is actually from those, particularly E. coli, but gram-negative bacteria releasing endotoxins into your environment. And anytime you take an antibiotic or a mild antimicrobial, you're actually releasing those. And so just the herbal, depending on how sick the person is and how inflamed they are, you know, in the mold world, we see this all the time when we start to detoxify people, we'll start doing, using binders. We'll use, you know, cholestyramine or Welcol or whatever. And people will flare because of having this, as they get detoxified, they have that big cytokine response. And so one of the things I've realized is some, some, in some of these patients looking at the toxins in your gut, particularly lipopolysaccharide, and one of the best binders for that is actually activated charcoal. Charcoal. Yeah. And using these old school binders to like, okay, you're doing horrible. Let's put this on board to bind those inner toxins so that when we're killing stuff, they're not gonna be released. Because real ultimately what you're doing is not just acting against the Lyme or whatever infection you're treating. It's, it's acting against any bacteria in and on your body and your colon contains 99.9% of all those bacteria and release of those can flare all your symptoms and make you feel miserable and make you feel like you're going backwards, not forwards. And so a lot of times you have to stop whatever you're doing, add on some more cytokine stuff, whether it's things that block cytokine release, whether it's things that inactivate cytokines, whether it's things that actually block the bacteria that release the toxins that activate. So there's nuance, a lot of different nuances to that. But the idea is that if these patients' symptoms are worsening, just pushing forward with more antibiotics, more antibiotics, more antibiotics, more herbs, more herbs, more herbs actually can make them worse, not better.

Yeah. So we would usually, like, if we started any kind of treatment, herbal or antibiotic, if somebody had a Herxheimer reaction, we would immediately back off of whatever we were doing. And I mean, I still do this today, so. Let's say we start, and honestly, and you've seen this too, like when I start somebody on any sort of antimicrobial treatment for a tick-borne illness, I'm starting at a fraction of the sort of standard dose, seeing how somebody responds, because it's a lot easier for so many reasons, but particularly in terms of like patient adherence to the protocol, if they feel well while they're doing it. So start like maybe at a fraction of the dose of Ceftin and then gradually increase. And meanwhile, ramp up like the detox support and ramp up all of the other stuff so that the person feels well through the course of treatment if possible. But sure, if you start somebody on 500 of sephthan twice a day and they have a Herxheimer reaction, you would back it off, you would support detox, and then you would kind of go from there.

Yeah. So we talked about some of the herbal things. Now I don't wanna get into like the Buhner versus the Cowden versus the Zhang. There's a bunch of different herbal protocols that, that practitioners have spent years kind of fine-tuning. Maybe at a 10,000-foot view, how would you look at those? Because what I've kind of done is I've not done my training. I learned, oh yeah, resveratrol and garlic and cinnamon and clove and all these, you know, liposomal this. And it, there's data behind all of it. Like how would you approach, like, do you have to use the Buhner protocol or the Cowden protocol? Or can you, like, how would you navigate that or recommend people navigating that for a patient with Lyme disease?

That's a really good question. So each protocol has its different focus, if you will. Like, and I honestly am not so familiar with them that I could speak to them super intelligently, but I think Cowden is a much more kind of regimented protocol versus the Buhner protocol, which is a little bit more flexible. And Cowden, I want to say, focuses more on like detoxing and biofilm, where Buhner maybe talks a little bit more about balancing the immune system and cytokine. I mean, each of them has their element, but I think if you know what the action of the herbs is, and I also honestly, and obviously I trained with Dr. Shore, but he has a paper where he's looked at the activity of each herb and it's like a meta-analysis of like what particular tick-borne illness it'll affect and what stage, like, like an active or more of a persister stage. So I use that as my guideline, like where are we right now in treatment and what do we need?

Yeah. I mean, I, and my protocol for every person looks different.

A hundred percent.

It's not, I think that's the gist for me is that it's like, you know, cuz you'll hear people, I went to this and this, this was the protocol. I'm like, wow, for how, for all hundreds of patients they've seen or just for like one person? Everybody's different. And I have people now who are still on, you know, resveratrol and a little bit of garlic and the, that kind of liposomal combined. Clove, cinnamon, oregano, oregano product. Because once I stop that, I feel worse. The symptoms start coming back. And so, like, and that's their maintenance, you know? And so, and that's not any of the official protocols. It's their personal, what works for them. So I think my point of that is there are protocols out there and sometimes you have to try things because you don't have access to a practitioner and whatnot. And actually the first, very first thing I read was actually I read Junior's, a couple of his books and he was, He's brilliant. I'm brilliant. Master herbalist, like just crazy. You know, it was a little overwhelming to be honest with you and have my notes. But the point is like everybody, everybody's protocol is gonna look different. And I don't like the word protocol. I like their personalized treatment plan's gonna look different because it's personalized for them based on how they do. And some people have, some patients you do AMBOX once for 4 weeks and you're done. Well, 6 or 8 weeks, but. You know, in some people it's like they're on Ambrox for 3 or 6 months, but if you're on Ambrox for longer than that, I, my thing is I'm starting to care. What are we really missing here? What are you missing? Like I had one young, one patient who was working at a clinic in DC and had been on Ambrox for a year. This, I should have made, I should have made this story at the beginning. For Ambrox for a year, no better, no better, no better. And finally they're like, okay, we're going to put a PICC line in you so we can do Rucephin after a year of trying. Triple oral antibiotics and her mom was like, you know what? I think we'll go back to Richmond, see Hartman, figure things out. You know, come to find out she had mold issues and so she wasn't responding. So the point of that is every person, you have to treat them as an individual. And if they're not getting better, the question is why? And usually you find there's, unfortunately it's usually not just a Lyme patient. It's a Lyme, mold, SIBO, dysbiosis, post-concussive syndrome, you know. MCAS. Yeah. Hypermobile POTS patient, you know, that we see.

But I would say generally for me, like my goal for patients, if possible, and obviously everybody, like you said, is different, but I don't love being on antibiotics or having my patients on antibiotics for, if possible, like no more than 6 months. So at that point I'm asking myself like, and like everybody's different. I certainly, I'm, I'm sure that if any of my patients are listening, they're like, wait, I've been on antibiotics for 9 months. Like what? So depending on the need and depending on what's going on, depending on whether they have multiple tick-borne infections, I mean, there are a lot of factors. A hundred percent.

Yeah. And also depending how they went on it, cuz if someone is on doxy and you try to take that off and all of a sudden they do horrible, like, well, you know, my, cutting my teeth in primary care, we would give doxycycline to young high school kids to take for acne for years. I wouldn't blink twice at. So if it's like this person's functional on. And they use doxy, there's lower prescription branded versions of doxycycline for rosacea, you know? And so it's, the point is that you have to individualize it for the person. Hard and fast rules, um, are not the way it works. That's great when you're learning, but when you're actually practicing, you have to treat the patient.

And if it's possible to transition somebody to herbs from antibiotics, then I'm always trying to do that.

100%. I've had really good results. This is in the sci— I guess we're, we're gonna talk about treatment. I don't think we talked specifically, but heavy methylene blue.

Oh yeah.

As a biofilm buster as well as an antimicrobial helping actually get more. Yeah. So let's talk about the biofilms. Actually, I need to turn the page over. 'Cause that's something we've mentioned a couple times. Talk about biofilms. 'Cause I first became really aware, they actually took a course from, it was the University of Denmark and they had, it was actually an orthopedic surgery course, but it was all about biofilms. And the gist of it was every chronic infection is a biofilm issue. Orthopedic surgery, dental infection, heart valve, it doesn't matter. They're all biofilm issues. And when I started hearing about that initially in the Lyme world, I'm like, biofilms? Like, what are biofilms? That's the, you know, and then you realize it's actually a thing. So speak to that briefly.

Well, I've given on this podcast, I've given my kind of like little metaphor or analogy for biofilms. So I talked about how I see it as a force field, and that's what I explain to patients, but I'd love to hear. What your analogy or metaphor is and how you explain it to patients.

I mean, the way, well, the way I think about biofilms are you have your wash rag and maybe people are different at their homes, but we have wash rags that'll sit on the countertop for a week or two. You pick it up and slimy. That's a biofilm. And anytime you have your, your water bottle, you haven't washed in 2 or 3 weeks and you kind of, it's got that funny smell, it's slimy, it's a biofilm. And so biofilms are everywhere. You have them on your skin, your sinuses. And they're as unique as the bacteria that are in them. So the biofilm on your eyelids is gonna be different than the biofilm on your axilla, which is different than the biofilm in your vagina. And if you have good biofilms, you don't get chronic vaginal infections, chronic UTIs, chronic colitis. The mucus in your colon is like the, you hear of the world's biggest biofilm. It's like, it's millimeters thick, right? It's small, but it's bigger. And so what happens is you have these, this environment that's a mixture of stuff that actually helps protect your body. But it uses bacteria and their byproducts as part of the protection. If you get the wrong bacteria in there, then they take advantage of that protection.

They weaponize it.

Yeah. They weaponize it against you. And so when you have, you know, a chronic, you know, I learned this with MRSA early on. You just, these boils would keep on coming up. You slice them, they open up, they come back, antibiotics, they come back. You get, you have to deal with biofilms. So I learned that early on in 2004, 2005 when I was in the military, cuz we, we had lots of MRSA in Florida.

Which is interesting cuz probably at that time before there was a whole lot of awareness about biofilms, people just thought that it was antibiotic resistant. Yes. And the question is like, is it actually antibiotic resistant or do we just have to address the biofilm?

Yeah, I think that's a great point that we haven't talked about before, is that a lot of this with these things is a biofilm issue, not a resistance issue.

Well, with Lyme in particular, because of the many forms that we were just talking about, the pleomorphism of Lyme, if it resists treatment or if it seems to resist treatment, if it keeps popping back up, the biofilm issue is one and the different forms of Lyme. Is another.

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So what kind of, um, things do you like to use for biofilms and why?

Yeah, so there are different types of things. Like herbs can be great for biofilms. Cinnamon, clove, oregano, in addition to being antimicrobial, have some biofilm disrupting properties, especially oregano oil. I mean, there's so many herbs that can work for biofilm and Cryptolepis has some biofilm disrupting properties. Many of the herbs that we use in Lyme or other tick-borne treatment. Have some biofilm disrupting properties. Grapefruit seed extract. I mean, there are a bunch, but if there's a thought that there's fibrin in the biofilms, then we use enzymes like serrapeptidase or lympo— lympokinase was our go-to. I mean, that's what I historically use.

So use enzymes to break down the films. And it's really interesting. This is why I love connecting the dots. Your body naturally, your pancreas naturally releases small amounts of pancreatic enzymes, even when you're not eating, that go into your, your gut and actually get absorbed. Through your mucosa and go out through your body and they actually break down these protein things. So you can actually use high doses of oral pancreatic enzymes between meals. Meals. As systemic anti-inflammatories.

And that just— And this, this is the mechanism.

So this is how it works. You take it not with a meal, between a meal, it gets absorbed. Not all of it, some of it goes through your blood. And when you have these protein fatty conglomerations in your joint, in your vasculature, wherever, It actually breaks those down. And so, and your body naturally does it just like the bile. You know, your body, you, you make bile, it goes to your gallbladder, stores it. You make pancreatic enzymes that stored in your center, you know, your center cells and they dump it when you eat a meal. But what happens between meals, they don't stop making it. It fills up your, your gallbladder, then it spills slowly. And so all of a sudden bile salts, which are, help dissolve fat and certain things actually are part of the way you maintain your gut. Microbiome and biofilm stuff, and you can use high doses of it to actually treat some of these things as well. So it's really interesting. These concepts may initially sound weird, but it's your body already kind of does this.

Yeah.

To a certain extent, we're just taking this information and 20x-ing and 30x-ing it to use it for our sick people. So that's the stuff I kind of geek out on. I'm like, it's so cool. Like your body's already super smart.

Definitely. So, um, and I'm sure that our listeners will want to know what your favorite biofilm disruptors are.

Depends on my mood. You know, I like Interphase Plus a lot, mainly because it uses EDTA as an inert ingredient and at about 1,000 milligrams, which is great for biofilms, but it also binds heavy metals. Yeah. And so how many people have lead and other cadmium and aluminum in their systems? The answer is a lot. And so I like that one for, um, as a biofilm enzyme kind of thing. I do like, I like pancreatic enzymes. I like Inflamatone as a product made by, uh, but specifically made for between meals.

That's true.

Yeah. So you don't take it with a meal. So it's, it's, it's curcumin and it does a little bit of romaine, a little bit of rutine, I believe, curcumin, boswellia, and then some, um, plant enzymes that you absorb and go and it helps affect you systemically. I have a, patient taking it right now who has some C-like antibodies. And I have him do it between meals to help with biofilms and also help with, because it's also strong anti-inflammatory. Those are my current go-tos as far as enzymes. As far as biofilm breaking things down, I like lots of binders, particularly charcoal, clay, alginate. I'm usually on empty stomach and that's more to help with the endotoxin part. 'Cause I'm finding out, I've been doing a lot of research on environmental medicine and endotoxins in the environment. And it's really interesting how much in the regular environmental medicine world, how much data there is on endotoxins in the air from industry as well as just organic material rotting that actually can be measured in the air that the government measures and can affect people's health. And so it's like, if that's the case in the environment, I mean, your gut has way, way, way more. And certain things like bile acids can help with the fatty acid and those things to get out of system, putting in PC and— oh, by the way, PC, you know, I love PC. So I'm glad you— PC is amazing for biofilms. Oh my gosh. PC, phosphatidylcholine is the primary phospholipid in all your biofilms. So all of a sudden taking a healthy fat can have a massive impact on your biofilms. Oh, by the way, it also helps stabilize cell membranes to minimize Herx reactions. Oh, by the way, it actually helps your liver detox. 'Cause it's the first organ after the gut that gets hit with when you dose that. And so something that is not traditionally followed in the Lyme world and other worlds, PC is a great, great thing that I plug. And you know, I use it all the time for all your service patients. And how many patients have, you know, by the way, PC also activates your parasympathetic nervous system, pushes acetylcholine production. So how many of our patients have vagal nerve disruptions and don't have enough acetylcholine? The answer is Maybe all of 'em. Yeah. So all of a sudden that's something that's super basic and simple and easy that I've had many patients that have taken it and been like, wow, I'm thinking clearer. Inflammation management. So people, you know, we talked about cytokine stuff, we talked about some biofilm things. People have also inflammation. So what do you typically give people when they're having these cytokine, these Herx reactions, which is an inflammatory thing, not just dealing with the biofilm, but also dealing with inflammation?

I would say foundationally, and this is interesting because it's definitely more focused on one aspect of kind of toxic reaction or detoxing. Foundationally, what we're using for like HERC support or toxin kind of like detoxing is glutathione. So if we're thinking like, what are the different mechanisms or like what's happening in a Herxheimer reaction when we talk about reactive oxygen species and like oxidant load or whatever, like glutathione is certainly helping with that. But I mean, there's several others that we can talk about, but glutathione I would say is kind of the cornerstone of kind of supporting people through a Herx or like preventing a Herx if we can. Yeah.

I also like SPM using pro-resolving mediators. They are the thing that downregulates your inflammatory, like your body makes inflammation and it ramps it down. So if you get infection, you want your omega-6 things to go down the prostaglandins, glycosinoids is a fancy term. I think we're using that term now more versus prostaglandins, but it's the same. Different term, same concept. And you want to be pro-inflammatory when you get infected, but then you wanna be anti-inflammatory when you're clearing things up. And so a lot of people don't have the ability to, to do that, that phase shift. And so taking pro-resolving mediators can actually push that. And I use them for acute pain patients as well, cuz they kind of sort of act like steroids, which is really cool. And then also, if someone's hurting, like maybe stopping the protocol and putting on board actually omega-3s, which again, recognizing we're gonna help calm down that response. And sometimes activate charcoal and buffered vitamin C or 2-way vitamin C is another great endotoxin antidote, but it also helps produce glutathione. And so those are a couple things that can be helpful.

Glycine.

Glycine.

So can you talk about SPMs? 'Cause patients will say, well, I looked at the back of my SPM bottle and it says it's from fish oil. Like I'm already taking a fish oil, like what's the difference? Or.

Yeah, so this is a little controversial depending on which expert you talk to, but pro-resolving mediators are these, they're in fish oil and basically you have to take, like, you know, people can say you take a lot of fish oil and you purify it and you get a little bit of SPM out. So there are some of these pro-resolving mediators, marisins, syringans, resolvans, that are in fish oil, but the amount is very, very small. Okay. And most of them in your body, your body makes. And so if you want to get like that quantity, you have to take something that super, super concentrates it down. The controversy is that these protozoal mediators have a very short half-life. They're not very stable. And so where is it coming from? How's it being sourced? Because if it's just like fish oil, you know, most fi— I would not recommend people taking a non-vetted fish oil 'cause most of it's rancid, most of it's oxidized, and now it's not helpful, it's harmful. And so SPMs are a similar kind of thing where the protozoal mediators, where, where is it coming from? SPM's a product name. I keep on saying, sorry, but not supposed to say product names or whatever, but So you wanna make sure where's it coming from. And there's like two or three, I know of two manufacturers in the world and they're both Norwegian, Scandinavian, like North Sea area. That source of stuff is sent back. Some people will be like, well, I'll just eat caviar, which is fine. That's a great source of pro-resolving mediators. It's just a very expensive way of, a way of doing it. But you wanna make sure you're getting a clean product, a good product, and it's not old cuz these things are kind of sensitive.

Yeah. Okay, cool. So people who are taking fish oil could still benefit from SPMs.

100%. Yes. Quick answer. Yes. Other things with the cytokine stuff, I'll actually, we'll also use different kinds of immunoglobulins. IgG, things that we extract from either colostrum or there's actually a proprietary product that's serum-derived IgG, which if you ever heard of IV IgG, it's an oral version of that. That can be super, super helpful for calming this down as well. Cuz it basically is your immune system. Part of what immune system does is bind toxins. So you're actually consuming this. And, um, immunoglobulin shots. I mean, if you get exposed to hepatitis A or other things, it's routine in traditional medicine, get an immunoglobulin shot to prevent you getting that infection. So we're just doing it in a non-invasive way to help people's immune system deal with some of these cytokines.

I think another thing, and kind of going back to the herbs, berber panella is really helpful for neurological detox. Are you familiar with this berber panella?

Oh yeah. Berber, berber.

Yeah. So for people who have like mainly neurological Herx symptoms, if they're tired, if they have like brain fog, if they're, you know, whatever, then berberine can be really helpful for detoxing.

And also how much of it is a mast cell thing? And then do you start using mast cell things like luteolin and a bunch of other things that can be helpful to calm down that aspect? You know, how many people with chronic Lyme disease also have mast cell issues?

Most of them.

Yeah. So all of a sudden that's another world of stuff. Do they need chromelin? Do they need other things to help? Calm down.

Right. So that's actually something that I often, when you're like, what do we do to prepare a patient for Lyme treatment and like setting them up for success with their Lyme treatment? Stabilizing mast cells is one thing because that will sink the ship. If you get to a point where your mast cells are so activated because of treatment, because of the infection or because of the treatment of the infection, that you can't go further with treatment because the person is so reactive, that'll, that'll stop everything.

And sometimes if people have horrible flares, it can be like a microtrauma.

Oh, 100%.

And all of a sudden they're like, I had this reaction, I had that reaction. I have patients that are so paralyzed, they don't wanna do something cuz they're of a fear of a reaction. And ultimately part of the cool thing about mast cells is they're, they're part of your immune system that has a connection with your neurological system. And so you can have stress-induced hives, stress-induced, or stress-induced anaphylaxis. Literally you get stressed and you almost, you die almost. So the thing about it is if someone's having a stress response and they have mast cell issues with Lyme, you know, minimizing that stress response can also, in these more complicated people, it's almost like I have to call me, I'm working with someone right now who literally work, I'm talking about using ketamine. Okay. Because everything with her is just, it's like, okay, we need to like reset your brain cuz you literally are reacting with everything. And which is a little bit of a big gun, but I'm glad we have it. That's, it's a, it's a good gun to have. And for the users, those of you who don't know what ketamine is, it's a drug that's been around for decades. First used it actually in Ecuador in a mission hospital in Ecuador with a kid who snuffed a thing up his nose and he couldn't get it out. So we had to knock him out to pull it out. So it was, it was fun. We don't talk about diet that much. Is, is the diet that people eat that important when they're dealing with Lyme?

Well, you can really undermine your treatment by eating an inflammatory diet. So that's one thing, but particularly for people who are taking antibiotics for a period of time, if you can reduce sugar, you know, like you're setting yourself up for a better outcome if you can manage what you can with your diet.

I think it's just diet. It's so key. It's so important. And it's like, yeah, removing sugar, removing processed foods, removing rancid fats and rancid oils. Like we're literally giving people expensive fats to consume and they blow it, blow it by eating a bunch of French fries, you know, you know, I tell my patients to get a high-quality extra virgin olive oil. They, it's not inexpensive. And it's like, you just, I'm not gonna say names, but you go to a local restaurant and get your favorite fried whatever, and you just blew that whole growler of extra virgin olive oil inside. Jesus Christ. You know, so diet is really, really critical. And you can do like low-amylose diets and anti-inflammatory diets. You just don't want the diet to be its own stressor.

100%.

Yeah. So I think what we'll do is we'll stop there with this. Okay. And next talk about some of the testing stuff. Sounds good. Which is where it gets fun because this is why we do the kind of testing we do.

That sounds good. All right.

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My daughter was never supposed to walk, talk, or crawl. And today at 19, she's thriving. And guess what? We ignored every single thing the specialist told us to do.

Hi, I'm Dr.

Aaron Hartman, MD, and I wrote Incurable: From Hopeless Diagnosis to Defying All Odds so you don't have to navigate this alone. In it, we share the secrets that she and thousands of my patients have used. Grab the book or Audible wherever books are sold, or you can find it in the link below.