Aaron Hartman, MD presents a clinician-focused overview of chronic Lyme disease, explaining diagnostic difficulties (limited CDC two-tier testing, focus on Borrelia B31, false negatives), common comorbid contributors (mold exposure, mast cell activation, hypermobility/Ehlers–Danlos, autoimmune disorders), and a multimodal treatment mindset beyond prolonged antibiotics. He emphasizes immune evaluation (IgG subclasses, NK cells), biofilm disruption (enzymes like nattokinase, serrapeptidase, lumbrokinase), lipid and herbal adjuncts (phosphatidylcholine, artemisia, Japanese knotweed), and the need to personalize care.
Chapters
Foreign let's talk about Lyme disease, especially chronic Lyme. Not acute Lyme, but chronic Lyme disease. Why this is something I've been avoiding for years, diving into and why I'm choosing to dive into it now. When I first did my functional medicine training about I started back in 2012, chronic Lyme disease wasn't really talked about. We had maybe one lecture through the Institute for Functional Medicine on it. When I did my board Certification through the A4M through George Washington University to get my board certification in integrative, functional and metabolic medicine, we had maybe a half a day on Lyme disease. What I've realized is this is one of the many stealth infections. Whether it's Epstein Barr virus, herpes, hpv, cmv, there's a whole host of infections and actually the average person at any point in time has 10 active infections, viral infections in their body. This is a normal part of living, it's a normal part of life. Our immune systems are supposed to ignore these things. But what's unique about the borrelia the Lyme is it can stay in a low grade smoldering state and tickle your immune system, activate your immune system and bleed into a whole bunch of other issues. If you have mold, for example chronic inflammatory spot syndrome sears, you're more prone to get chronic Lyme. It's hard to treat with antibiotics and one of the results of this has been as many practitioners who are Lyme specialists focus only on the antibiotics of Lyme, resulting in giving people antibiotics for years. This put a really bad taste in my mouth so I really avoided that for years thinking that this is how people treat it with an antibiotic for a year. What I come to find out is it's more complicated and nuanced than that. You have to look at a person's whole entire environment history, a whole host of things to really appreciate if their Lyme is a part of their health issues they're going on with. The other thing is that many other chronic illnesses, mast cell activation hypermobility is one. The hypermobile connective tissues makes someone more prone to a chronic tick borne illness and make it harder for the body to clear it because the connective tissues they have are stretched here, have even less blood and less oxygen than a non hypermobile individual. So sometimes Ehlers Danlos patients for example will pick up a chronic low grade Lyme resulting in their chronic pain and other dysautonomia type stuff. So this made me just want to hedge away from this. What's happened in the last Several years I've been getting stuck with certain patients, certain patients with mold, autoimmune issues, even one patient with Parkinson's who just couldn't figure out what's going on with her, come to find out she had Lyme. And so it's one of those things where I've come back around to realize this is more nuanced than more antibiotics, different antibiotics, changing antibiotics, but you also have to be aware of and treat it. So that's what I'll talk about. And it's one of these things that just, it's part of the mystery illness thing. Being a medical detective, you know, connecting the dots. You really have to have this as one of the things on your radar. The other thing to think about is that there's more cases of acute Lyme in our country every year, or Lyme diagnoses per the CDC criteria, which misses, by the way, about 30 to 40% of all Lyme disease. There are more than there are cases of breast cancer in our country. So this is actually really quite common. There's actually an epidemic of it in China right now, in Asia. So let's take a little deeper, dive into some things that make the diagnosis difficult. One is our current testing only looks at the Borrelia B31, which is one string that was isolated back in the late 70s and early 80s. What happens in the lab when you have a bacteria or a spirochete in this case, and you culture it and reculture it and reculture it, it changes over years and it's not quite what's in wild. And also what's in wild mutates and changes. Now we have over 80 different strains of Borrelia which cause Lyme in our country. We're not looking for any of those. We're only looking for the strain from 50 years ago. Basically that makes it difficult as well. The current testing model we use the antibody, a two tier test just misses half of all people who are later found to be to have Lyme disease. Their first antibody test was actually negative. So our testing we have currently our current standard of care testing just isn't quite up to par. That also makes the diagnosis quite tricky. The second thing is just a legal aspect. Chronic Lyme disease becomes a legal thing, especially when people are in long amounts of antibiotics and it's frowned on by the current Infectious Disease Society of America. So what happens is you have to be willing to step outside the box if you're going to treat this disease or entity. So those are important topics. But Once I kind of realized for my clinic I really need to take hold of this. Just like I need to address mold and mcas and hypermobility on top of all the usual functional stuff like an autoimmune and brain and stuff stress. I just realized I have to take a deep dive and understand it more. And some of the things I've realized have been kind of interesting, have helped illuminate my mind. The one thing is that many times patients I've given antibiotics to for other unrelated illnesses that got better, maybe I was treating their underlying tick disease. So for example, doxycycline was used to treat rheumatoid arthritis back in the 1970s and 80s. Was the undiagnosed Lyme disease or tick borne illness being treated? Because this is a routine treatment for that as well. I've been using many other practitioners use these antibiotics as an anti inflammatory to help with inflammation. Where actually indeed were these undiagnosed infections being treated? Well, one of the newer things that's happening, and this is where I'm coming to with this, one of the newer things is because people's immune system is suppressed, sometimes you have to use a trial, an antibiotic to release some of the spirochetes, the immune system to respond. Then they do the testing. This is a newer understanding about how you actually once have to treat and then see if your immune system responds to it. Then also looking at the immune system proper, many Lyme mold and even especially conventionally trained physicians don't do immunoglobulin checks, especially IgG1, 2, 3 and 4. If those are suppressed or low normal and the natural killer cell count is low, this person will not make antibodies to many infections in their body and they get low grade infections. So this just complicates everything. Okay, that's my basic introductory. So how do you address this? The first thing you have to get a diagnosis which can be hard because the testing isn't super accurate. Some of the newer testing with Igenics actually uses new technology that has a better sensitivity and specificity. Meaning that if the test is positive, you really have disease that's negative, you really don't. Recurrent testing isn't really good with that. So having more advanced testing but also realizing that sometimes patients have to be. You have to use different ways to modulate their immune system. Typical gut stuff, removing mold, nutritional things, lipid therapies, which interesting enough, when people have bad fats in their body, it actually makes it easier for the spirochete to move through their body. So actually using lipids like phosphacylcholine can actually help the person's immune system clear out the toxins from the Lyme as well as boost immune system function. So now we have a more robust treatment algorithm or treatment plan. Then realizing that in China, for example, in Asia they've been using herbs for this for long, long time. And there's great data on artemisia and other herbs that actually can help treat Polygom capsivitum, which is Japanese knotweed, using devil's claw. There's a whole host of other things that actually can help modulate your immune system, help the immune system respond better and then taking even a deeper dive, realizing that biofilms are a big, big factor in chronic Lyme because as well as Bartonella, because these things actually make their own sticky gooey biofilms and can hide from the immune system. All chronic inf, by definition are a biofilm issue. Whether it's a chronic sinus infection, chronic lung infection, chronic skin infection and yes, a chronic tick borne related illness. Biofilms are involved in all chronic infections. And so now realizing using things that help with biofilms like enzymes, nattokinase, serrapeptidase, lumbrokinase, and even using sometimes other non enzyme biofilm busters can be really super helpful for these patients. And finally doing other things to boost the immune system and taking a deep dive with hypermobility, which makes all this more difficult. Autoimmune issues mold Again there's a whole host of people with chronic mold issues that are being diagnosed with chronic Lyme. It's actually they have a mold environment that needs to be addressed. So this gets kind of tricky. So I did a three part series kind of diving into these different aspects that I just want to share with you all on my website through my blog. So if you want to learn more you can hop in there and as usual, if you have questions about things, feel free to reach out to me through social media and ask. Some of these series that I do like this are based on patience and interaction with individuals online saying hey, I got a question about this. Can you take a deep dive into it and help me understand it better? Hopefully this was helpful for you and if so let us know. Also let us know other topics you'd be interested in learning about. Take care, talk to you soon.
