Why 2 Weeks of Antibiotics Fails Chronic Lyme Patients

We are going to end up our three part conversation on Lyme disease and tick related illnesses talking about beyond antibiotics. So what else can you do besides antibiotics? What's a functional medicine approach? This includes naturopathic medicine, includes herbals, it includes anti inflammatories, a whole bunch of things. But why? I guess the first thing is why would we need, why would we need anything else besides antibiotics? I thought they worked for Lyme. Don't you just do two weeks and it goes away? Like isn't that all you need?

Oh gosh, that's. I mean we can certainly talk about treatment if you want with antibiotics and the different approaches from IDSA and iads, but if we don't want to talk about that, we can talk about what we can use to make antibiotics more effective.

Well, I think the first thing is like why, like why isn't just two weeks good enough? Because that's the current mantra from the ids Infectious Disease Society of America is that and if it's neurolyme, you need a month of IV and that's it. So you got, you know, two options basically.

Right. So the tests and the studies that that information is based on were actually flawed. The mouse model that they used for determining that the doxycycline 200 milligram one time dose for prophylaxis and that a couple weeks of doxycycline for like an erythema migrans rash so known Lyme infection and is sufficient is flawed. And we know that actually you would need for prophylaxis it's really three weeks. And we can go into the weeds on this if you want to. Do you think that'd be helpful?

Sure.

Okay. We can cut it out if it's not helpful. So the common thought is if a tick is not attached for at least 48, but generally people say 72 hours. So if it's not embedded for at least that long, that you don't need any sort of prophylaxis and any treatment, anything. We do know that it takes some time for borrelia to migrate from a tick's stomach into their saliva. What we don't know is when a tick attaches to you, if it's been previously attached to a deer, a rabbit, a mouse. So has that process of priming already begun? So we can't say with any sort of certainty that just because the tick has only been attached to you for two hours that the saliva wasn't primed, that you don't have borrelia. So there's A disagreement or a difference of opinion, even at that level between I lads and idsa. So from sort of the more aggressive or the more like, let's call it the ILADS perspective, somebody who's had an embedded tick needs prophylaxis regardless of how long it's been embedded. And, and that prophylaxis is not a one time dose of 200 milligrams of doxycycline. That prophylaxis is three weeks of doxycycline.

Three weeks.

And ideally, so, you know, this is like a public service announcement. Ideally that would start within the first 48 hours. Ideally you're not finding an embedded tick, going on vacation, coming back and saying, oh yeah, I had that tick. Ideally you're starting that course within 48 hours. Because the way that doxycycline works, as you know, but maybe not everybody knows, is it prevents the spirochete from replicating with the thought that your immune system can come in and deal with it. So if you let that replication process happen for a period of time and then you stop it, by then you already have a lot of kind of limes swimming around, if that makes sense.

Yeah.

So anyway, and then the appropriate treatment according to ilads for a Lyme infection. What is a Lyme infection? So a Lyme infection is certainly an erythema migrans. Rash is diagnostic of lyme, but about 50% of people who have Lyme won't develop a rash. So if somebody's like, well, you know, I had an embedded tick and then a couple weeks later I developed flu like symptoms, but I never had a rash so I probably don't have Lyme. That's not true. That's not the case. So if somebody's developing flu like symptoms in the middle of summer after a tick bite, then we're like, that's Lyme. For our purposes we're understanding like, okay, this person is suspicious for Lyme. And we recognize that in the first couple weeks we may not have a positive antibody test. So we're treating for six weeks with doxycycline twice a day, 100 milligrams. And then at the end of that time we're observing to see what's happening. Now let's back it up. You know, that was kind of like high level difference between IDSA and ilads. But in terms of making that treatment more effective, we're adding a few things to make sure that the antibiotics can have the best chance of dealing with what we've, we've got going on so the first thing is biofilms. And I know you and I have talked about biofilms before and I had a funny, I guess, metaphor for biofilms that you were like, oh, is that really. So let's hear your metaphor for biofilms or let's hear how you understand biofilms.

Well, every chronic infection is a biofilm issue. Okay, 100%. I actually did a course at the University of Denmark on chronic infections and it was basically all about biofilms is kind of interesting. Biofilms are stuff that bacteria, fungus will secrete that actually helps them survive. And typically, you know, if you have a group of bacteria, they're going to make biofilms because they live in colonies, they live in groups, they don't live by themselves. So the analogy I give people, it's kind of that dish rag. You live on your, your countertop, your sink for like a week and gets kind of slimy. That's what biofilms are. And those are dish rags. When they get like that, you can't just rinse them off. You have to like stick them in the washing machine and hot water and soap to break it down. You can't just rinse them off. And people get that analogy, that slimy.

Stuff on your teeth when you drink.

It in the morning, it's tartar. It's a tartar on your teeth. And thing is, any chronic infection is a biofilm issue. So Lyme, yes, we're talking about Lyme. But if you have any other chronic infection, someone has chronic lung infections, bronchiectasis, someone has Mac, which are traditional pulmonary infections, tuberculosis, these all are biofilm issues. And all of a sudden, the thing we're talking about here with this one unique thing of Lyme spans all medicine totally.

So I give an example often. I don't know why I pick on H. Pylori. I think it's because.

Which causes stomach ulcers, right?

That's a particular infection in the stomach or a bacteria in the stomach that can cause stomach ulcers. And I've had enough patients who have been treated for H. Pylori with a few different antibiotics for a number of weeks. On the other side of their treatment, maybe a few months later, test positive again for H. Pylori and have been told you have antibiotic resistant H. Pylori. And in reality, it's probably more likely, or at least possible that it's not that it's antibiotic resident H. Pylori, it's just that H. Pylori does create a biofilm which my metaphor was having like a force field. Right. Like it's a bacterial or a microbial force field. So if the antibiotics that you're taking to treat an infection can't actually come into contact with the target, then it's not going to work. And it's not because this is antibiotic resistant, it's just because it's got a force field that you haven't disrupted to actually let the antibiotics come into contact with the bacteria. Okay. So this is appropriate or relevant for Lyme and other tick borne infections too. So if you're giving somebody antibiotics, even multiple antibiotics for a Lyme infection, and Lyme are living inside that kind of protected space that they've created the biofilm, the antibiotics can't actually come into contact with Lyme and really be as effective as we would want them to be. So one of the things that we add is a biofilm disruptor. Usually we're careful about the timing of that because if we disrupt a bunch of biofilm and release a bunch of Lyme, you know, a person can feel much sicker unnecessarily. So it's good to have some antimicrobial treatment on board and have a little bit of coverage before you start breaking up the biofilm.

Yeah. So biofilms are part of the issue with crocodile, Lyme or any chronic infection. Next issue is immune suppression. People's immune systems are just dysregulated, suppressed, overreactive, or under reactive. And so it just gets hard to clear these things.

We talked about that in the first session, but I'll bring it up here because it's been probably a couple weeks since people have heard it, even though it's been a couple minutes since you and I talked about it. So Lyme or Borrelia will interfere with the function of the innate immune system. One of the things that it impacts is the complement cascade. So if you think about what is that? What is a complement cascade? Complement cascade, I guess I'm big on metaphors, is kind of like the alarm system or like the, you know, like this is the immune system's way of communicating that there's an issue. It's kind of like it's the immune system's way to sound an alarm. So if Lyme is able to disrupt that or stop that process from happening, then the rest of the immune system is not alerted to the fact that there's a problem. And so you can't have a typical immune response when that is kind of being hamstrung. Does that make sense?

Yeah.

So, I mean, that's just one thing that Lyme does. Lyme does a bunch of other things too. One tricky thing that Lyme does is it works. Will assume different forms. So there's an active phase of Lyme and then there's a persister phase of Lyme. So Lyme is smart. If you take antibiotics and Lyme is in the active phase, it'll go basically into kind of like a Lyme hibernation. Right. It takes on a different form so that it can wait out the treatment and what's threatening it. And then when that's done, it can kind of come back and into its active form. So there are a lot of ways that Lyme can evade treatment and also the immune system and kind of shut things down from. From that perspective.

Yeah, you have your cellular, your acellular form and then your cystic or persister. And different antibiotics work against those as well as different herbals. So let's talk about, you know, clinically approach, you know, because people's immune system, because it's kind of hard to know sometimes, which is a bigger issue. Is a biofilm issue. Is it a suppression issue? So let's talk about briefly. You know, when you're starting to treat someone and most of the people we see have a chronic Lyme. I mean, it's not the acute Lyme. I mean, if you sign up to see us, you know, it takes, you know, a week or two to fill your paperwork out. You come see us in eight or 12 weeks. And if it's acute and you're feeling horrible, you're probably going to urgent care and not getting treated. But the thing about it is that most people you see have chronic Lyme. So let's keep in that realm. So you got Ambox and someone. What else are we going to do? So how do we kind of help someone not hurt, not have this inflammatory response? What are some things that can be done for that?

For that? Yeah. So some useful detox support. There are a few things that you can do. I think glutathione is probably the biggest one. You can do it orally or iv. I'm in it. I think we've had enough Lyme patients who've done so well on Glutathione IVs. They feel amazing. It's hard to afford that much glutathione, and it's hard to get it kind.

Of.

Into your system in the same way that an IV would do it. So whether it's glutathione IV or whether it's oral glutathione is very helpful for detox and you can increase the dose as needed. Usually when we're starting antibiotics, we're doing it gradually. So a titrated approach so that we're not causing this massive hercs like right up front. So we're starting somebody kind of ramping that up while we're starting the detox to kind of mitigate or even eliminate a Herxheimer reaction. Other things that can help with detox or, you know, kind of that process. Berber pinella is an herb that's really useful for that, especially for neurological symptoms or neurological HERC symptoms. Berber pinella is really good. Epsom salt baths and not with just like a tablespoon of Epsom salt sprinkled in like a cup or two of Epsom salt in every bath can be very helpful for detox. I will say that a caveat for that is for mast cell patients. So people who have Lyme disease and mast cell activation, a hot bath can be activating in a bad way. But usually Epsom salt baths will help. Alka Seltzer Gold, they used to sell. Now there's a company that has. I don't know if you've heard of Healthgevity.

Yes.

They have a product that's the equivalent of Alka Seltzer Gold. So using that on a limited basis is also useful for detox. So those would be kind of the big. The big ones.

Yeah. And also you can also use herbs for treatment.

Yeah.

Well, also anti inflammatory. Some of the herbs like resveratrol or Japanese knotweed or both anti inflammatory blocking cytokines. They also help with biofilms. They also help with actually direct. So which is one of the reasons like herbs are so amazing. Yeah. Because they depending on the herbs, you know, they can actually cover all of those basis and they, they tend to need to combine combinations like with cinnamon, oregano, doing liposomal versions of that.

What are your favorites for detoxing?

For detoxing? Well, I like resveratrol. It's kind of a really easy go to. That's relatively easy to get a hold of. I tend to like for detox using lipids and because part of the issue with chronic infections is biofilms and the most prominent phospholipid in biofilms is actually phosphorylcholine.

Okay.

And how many of our patients have issues with their lipid membranes? The answer is a lot. So I'll use phosphylcholine. It also helps calm your nervous system down. So, and that's something that I haven't heard a lot of, like Lyme lecturers talk about, but in. But in the lipid world, it's like the go to kind of thing can be really helpful. You can also do some biofilm work with tudka, which is something that helps ramp up the peroxisomes to burn off. A lot of these infections when they're traveling from cell to cell. Are using lipid rafts and lipid membranes to travel. And so you can use things like torso deoxycholic acid to speed up your cell's natural process of bringing those things out. Also can help with digestive kind of issues. Omega 3s, high dose Omega 3s. When people have these cytokine responses, it's not direct detox help, I think, which might be your point, but it's blocking that pathway. The pathway that flare and then.

And SPMs, yes.

Using Pro resolving mediators is amazing. It's kind of like nature steroid and that bites. So if someone's hurting, I will stop what I'm doing and then give them Omega 3s, SPMs, throw in some other lipids, wait a month, and then kind of try to keep some kind of antimicrobial, herbal something on board that they can tolerate and then come back and revisit it. Because a lot of these Herx reactions are just, you're releasing, you're killing the bugs. You're releasing cell walls, cell membranes, particles like microtoxins, cytokine, but your immune system is like freaking releasing cytokines. And so which is exactly which, where I got this approach from was actually from our service patients, because in that world we started detoxifying people with binders, which just seems kind of the opposite. What's the word I was saying? Parentical. It's not parentical, but I haven't eaten today yet, so my brain's not working quite as good as it should be. But like, when you'll detox them with a basic binder, they flare. And so it's interesting, like in the, in the. And this is a little nuance in the Lyme world, people say, oh, it's the bacteria thing, let's do these things. And the mold world, we realize it's a detox response. And the answer, it's kind of sort of a little bit of both. Yeah.

I was just going to say, like, as you're talking, I'm thinking, you know, your patients are really lucky that you can pull from all those worlds because you have the benefit of just a broader Awareness. And so the options that are available to you in your toolkit to help them are much greater.

And I've not had patients, some of my super sensitive patients that react with everything. They react with, like, fluid, like the tap water. Right. They don't react with lipids, typically. The thing. They just don't like it. It's icky, it's nasty, it's thick. I don't like it. It's usually a patient preference thing. It's not. I took PC and hurt felt worse. Yeah, It's. I took it and. Yeah. Which it still means people don't take it. But in my mind it's. No, I took it and I felt horrible for three days, you know.

Well, that's the reason we're bringing phosphatidylcholine IVs. Right. So that maybe we can do some of that in a different way.

Exactly. We're doing lots of things like that. Whether it's PMF to calm your nervous system down using local hyperbaric. There's lots of ways to like, like to treat this when people have reactions. Yeah. But herbals, anti inflammatories and then other. And we haven't talked about the general stuff like trauma.

Oh, wait. Can I just say one more thing about herbals? Because I was talking about herb, biofilm and then detox. One other thing that is really, really important if you're gonna be on antibiotics for any period of time. So we talked about adding a biofilm disruptor. We talked about.

Let me. This. I'll let you finish. For people listening, we're not talking about everything we do.

Yeah, yeah. No.

So it's like, this is meant to be an educational kind of thing. So, like, we could literally talk about this for hours. We go to lectures for, like, weeks on this stuff. So there's always gonna be something. And Veronica here is getting ready to fill in one of the many, many, many, many things we've left out in our short conversation. Go ahead.

Oh, I just. I wanted to talk briefly about herbals for treatment. For antimicrobial treatment.

Yes, please. Yeah.

But the other thing that I was going to just mention is kind of like foundational. And just because people are going to be taking antibiotics, always remember to take a high potency probiotic.

Yes.

So don't forget that. That's really key.

I've seen early in my career, I saw so much C. Diff.

Oh, gosh.

I got really good at treating resistant C. Diff. And that was before we had stool transplants. Your option was basically an oral bank. And then it was like, they don't get better. So they got colectomy, they got surgery. They got really. And I actually understood super minimally, but enough for the biofilm and the pulsing issues. Pulsing. Treatment of C. Diff we talk about all the time in the Lyme world, right? And people are like, that's weird. Who. It's like, we do this in the C. Diff world because this whole spore phenomenon, and we realize that maybe two weeks is enough. So once you do the two weeks, they're better, but you stop, it comes back. Then you have to pulse it and use. Use colostiamine to bind the toxins of C. Diff that cause the colitis. It actually helps you clear the C. Diff better. And so all of a sudden, like, some of these. These things that I. I learned that from reading up to date, which is the. The go to. But it's interesting how this is a little side thing here, rabbit trail, like something that a really good clinician would do with a C. Diff patient is standard in the Lyme world, but yet one world says the other world is hooey. Right. I feel like just if we talked more, we'd all do a lot better in the practice of medicine.

Agreed. Agreed.

Herbs.

So usually rather than doing a finite course of treatment and then saying, we're done with antibiotics at a minimum, so, you know, we could decide whether we would continue antibiotics for a period of time as needed, but at a minimum, we would transition people onto herbs. So we don't just say, okay, you've been on antibiotics for 6 weeks or 12 weeks or however many weeks, and now we're done, and then we hope you do okay. Usually we're transitioning to an herbal antimicrobial to see if a person can sustain the benefit that they've gotten from the antibiotics. So we want to try to make and improvement durable. We want somebody to feel better long term. So it's kind of like a tapering process. The most common herb that we were seeing, just because it has effect against Borrelia, but also against bartonella mibesia. And it's pretty potent, actually is a combination of cinnamon, clove, oregano, like you were saying. And we do like a liposomal form. The particular dose is patient dependent, but it's something that often will start as we're tapering off of an antibiotic. So we don't usually just say, okay, you were taking 100 milligrams of doxycycline twice a day for this long and now we're done. We might drop it to 100 milligrams a day while we're adding an herb in and seeing if the person continues to feel well. And then over time, over a few weeks or months, we would then taper the herb as well. But herbs are often a transition. Some patients will stay on herbs for a long time. Some. Some patients will do well with a taper of herbs. But herbs actually are a pretty important part of my approach. I mean, it's pretty foundational.

So there's a lot of different herb. I actually was writing down a couple of the ones that came to mind while you were talking. Whether it's the Byron White, the Nutrimetics, which has the cow din, the Zhang protocol, Research Nutritionals has their own protocol. Or are they different sameness. Like, what is your perspective on all this? Because for a while I was just basically making my own cocktails. Because you go to these conferences and people take like five bottles of all stuff like, what, in 10,000 Foot View, is there one better than another? Is it just a different approach?

That's a good question. I think when it comes to protocols, I think I'm gonna refer back to something that you've said, that we don't typically take a protocol approach to medicine. When we're adding herbs in, we're looking at how somebody's responding. So if symptoms are improving with herbs, and that's the herb that works, and we have an array to choose from and we're looking at the particular combination. So let me just back up for a second. Herbs can also have. And you know, so herbs can also have pretty significant side effects for people. Artemisia can cause people to get super depressed. I mean, like suicidal ideation depressed. So if we add an herb, we're also looking, I mean, always looking at the response. So the person's best protocol is really patient specific. So this is really all about personalized medicine.

Have you. I've read a lot about artemisia increasing liver enzymes. I've looked for it. I've not seen it. You've probably used it more than I have. Have you seen artemisia? Because they actually would use artemisin in, in China to treat Lyme disease there. Right.

So oral.

Oral. Have you seen.

I think it's.

Yeah, Artu State's like the name for artemisin, I think, and Artia. It gets kind of complicated. But the. Have you seen the elevate? I'm starting out. Okay. Have you seen it?

Yes. Yeah.

You've seen that. Okay. What doses have you seen It.

So that's variable. Often when we're using artemisia or like, it's often an herbal combination which has variable amounts. But when we start to kind of back it off and see, like, what in combination was the problem, and we start to add the Japanese knotweed back in, or we have Cryptolepis back in or whatever, it's like the enzymes didn't go back up until we added aromation back in.

Fair enough. Yeah. So point is that they can all be helpful. They help with biofilms. Cryptolepsis is really cool because it blocks cytokines and biofilms and has direct antimicrobial activity. Yeah. Which is. Which is. Which is interesting because my understanding, and you can correct me if I'm wrong with this, is that with the resveratrol, which is the source you want to be from is Japanese knotweed, not the grapes. Yeah, exactly. It's the one. Yeah. And so I think that's a little unique nuance that a lot of people, like, take resveratrol, but they're not taking the stuff sourced from Japanese knotweed, which is what you want to be taking.

Absolutely. So I'm going to confirm that, and I'm also going to just reflect right now that I'm wishing that we had done this interview in reverse and that we could have heard from you a little bit more, kind of your thoughts and your approach, because I really appreciate what you're adding.

Yeah. So herbs are helpful. Antibiotics, cytokines, and I think supporting our immune system. Now wrote down the last bit because you have to sort people's immune system. One thing we really didn't talk about a whole bunch was I don't want to spend too much time on, because we've talked about this tons, is like, gut health. If someone's got cb, dysbiosis, if they have parasites, if they got hypochlorhydria, low stomach acid, if they have pancrec insufficiency, like, this is gonna mess all right up. So you really gotta get people's gut a little better. Stress response. I don't wanna say all cause all. I don't say none or all cause all. Both are very absolutist. And I've realized in my life I can't be an absolutist. But I feel like most, like 95 to 99% of people have some kind of trauma. They're coming with croc, Lyme mold, Babesia, Bart, and I mean, Bart can cause neuropsychiatric issues. Right. You know, and so all of A sudden we have to do brain rewiring, brain retraining. Super ridiculously important because that can actually make your healing process get stuck. Sleep. How many of these people have sleep disturbances? A lot.

They will get better for not sleeping.

They won't get better. They're not sleeping. They won't get better if their diagnosis change. They won't get better if they don't fix their gut. And then lastly, how do we. I think we've already answered this, but the last thing was how do we sequence this? And this could be like one sentence or five sentence. Like because we said a lot and we've Talked, you know, Dr. Jensen have talked about sirs, we've talked about mast cell stuff. I think we talked about other stuff. We talk about format. It's like, how do we even sequence this stuff? Because it gets kind of complicated.

Yeah, I don't. Maybe overly simplistic kind of.

Let's keep it super simple because we could talk hours about all the nuances. So.

Yeah. So just on a very simple level, my approach is to help people to feel better as quickly as possible while we're dealing with things underneath. So if somebody's hormones are off, like we're working to balance those hormones. We're not waiting until we've dealt with the infection because we know that the infection was causing some of the imbalances to deal with that because the person's not going to feel well. So we're helping a person to feel well in the short term while we're dealing with kind of these issues in the long term. So you help people to feel well so that they can live their lives and go to work and, you know, have their families or do their thing, whatever they want to do. And then you're dealing with this in the long term. And then as you're dealing with it, you may hit roadblocks. Like, I have a patient that she was doing really well with Lyme, she got a sibo infection, her Lyme reactivated, and then she got mast cell activation on top of that. So then we had to back it up, get her mast cells to be able to tolerate treatment for Lyme. So the sequencing kind of to your larger point, and I wanted to give that example, the sequencing of events for an individual is based on A, what's bothering them the most, B, what they're able to tolerate and see kind of what makes the most sense. Sense for that particular person. So that's what I would say.

Cool. And, you know, simplified. Yeah. You work on. You gotta master the foundations for meats, gut, stress, sleep, get the nutrition back up. If they got mold issues, clean the environment. Obviously you're gonna start treating the Lyme once you get the diagnosis. But realize those basic things have to happen. Hormones I tend depends on me. I don't see patients with hormones. If the hormones are there, they'll come with a hormone complaint, but it's usually the cortisol's off. It's usually they got a bunch of other things going on. So I will try to manage some things. Sometimes you have to like jump in the hormones. But typically I'll do a bunch of stuff first that's just mine. Dr. Jensen. I had debate with that about that as well. Just because the gut is where most of your estrogen is detoxified. So if your guts are wrecked, it's gonna be hard to balance. If your thyroid's off, its hormones are gonna work. It's just gonna be a little wonky.

So I'm actually thinking more about men in this case than women.

Oh.

Men like really low testosterone.

A little different. That's a little different. Women are more complicated. They have this symphony of stuff. And guys have a hammer. It's like, yeah. If the symphony required for bringing life into the world, the guy's hammer is like, I can like plow through. So I agree with that statement.

Yes.

If it's a guy with low T, gotta get it out. The nuance would be if it's a female's low testosterone and she's got painful end. Of course, chronic UTIs, everything down south is just wrong. People forget that the outer third of the vagina, including your, your labia minora, are androgen sensitive tissues. And if you have below testosterone, those tissues won't work the right way, which can cause a lot. It's interesting how much like in sclerosis is a great example that you can treat that with dhea. You can treat that at the topic of testosterone. Yes, estrogen helps with it, but that's one of those things. I've had such good results with topical testosterone or DHEA down there for that. Which if people don't know what like in sclerosis is, it's when you get these like white thin areas in your paper. Thin. Yeah. And it's, it's like literally. But it's just thinking about it as a male thinking about down there turning the tissue paper just sounds horrible.

Yeah.

You know, and I never experienced it before. But the point is like, like you could. That can be super helpful. So in certain situations, I'm jumping right into it. On that note, this is a great conversation. We could. You know, one thing I want to tell people on us that are watching is, you know, just going to one ILABS course is like 25 hours of lectures just to get your toes wet in this. Right. And so this is not the entirety of what there is out there. It's just give people an idea that there's a lot of other things they can do and if they're not getting better, other options. And I want people to be aware of that because we're all made for health and we need to be the best version of ourself. And if you're not healing something that's either that's blocking your buyer's ability to something or repair or you're lacking something, if you just remove the blocks and feel on much lack, then it's interesting our buyers just kind of do what they're made to do do. That's kind of cool.

Thanks for this conversation.

Dr. Marvin. Thanks a lot for being with us and we'll talk to everybody.