My Lyme Markers Are Positive. What Now?

Someone comes to us, they've been told, I've got PANDAS, I've got PANS, I've got Lyme, I've got EBV, I have CMV, I have all these things, right? If you go back in the literature, what you'll find is that when patients have problems with toxins and malnutrition, their bodies cannot clear infections. And when I looked at these cases of patients who were not clearing these infections, what I found was that they tended to have lots and lots of modern exposures to toxins and stress. Good morning, everyone. Dr. Stillman here, back for another Q&A episode. Today's episode title, My Lyme Markers Are Positive, What Now? So this question came to us from a woman who I'm going to call Diane. I'm calling her that because this is a pretty personal question. And while obviously my responses are educational, not medical advice or treatment, I still decided that instead of naming her by name, we would just give you kind of a general overview or snapshot of who she is, what she's dealing with, and what her question is. So we're going to call her Diane. She's a homeschooling mom working part-time in the Midwest. Feels like she's tried everything, is worried she'll crumble under the fatigue and doesn't know what to believe anymore. And everything is so pricey too. Totally get this. Hear it all the time. A lot of people are in your shoes, Diane. So I hope this is helpful. Her core question to me, my labs show a lot of tick-borne illness markers. Where do I even start and how do I know if an approach is actually working versus just throwing things at the wall? Okay. By the way, drop your questions in the comments live. I will answer them to the best of my ability as we go. This is our second episode of this, so I'm still piloting it. If you have feedback, thoughts, questions, people pointed out last time that I didn't, I was mirroring my video. I didn't even know that was a setting I could make. And so the title of my book was backwards and now it's correctly, now it looks right. You can read it. It's not backwards. So I appreciate your guys' feedback and your questions in the comments below. There's also a link to ask your question for me to answer it on a Q&A and book an evaluation with a member of my team. Okay. Let's jump into these questions. So, and by the way, these questions, I start with a big question, but inside this question, there are a lot of implied questions, questions that we actually have to answer if we're going to get to what do we do about the question that was actually asked. So question number 1, why can a tick-borne illness panel come back with a lot of markers and still not tell you clearly what's actually driving your symptoms? So I see this all the time. Someone comes to us, they've been told, I've got PANDAS, I've got PANS, I've got Lyme, I've got EBV, I have CMV, I have all these things, right? Well, I got very curious about this because I noticed that everyone was coming back with these diagnoses, particularly from other practitioners. And they were often coming to me for a 3rd, 4th, 5th, 6th, 20th opinion, whatever. And I was sort of thinking, well, gosh, you know, you did 6 months of IV antibiotics with this guy over here and you did 3 3 months of doxycycline over there, and you did all these antibiotics. Why did they not work? If you go back in the literature, what you'll find is that when patients have problems with toxins and malnutrition, their bodies cannot clear infections. And when I looked at these cases of patients who were not clearing these infections, what I found was that they tended to have lots and lots of modern exposures to toxins and stress. I'm not going to give you guys the whole list because guess what? It's in chapter 4 of my book, now available for preorder. On Amazon. It drops September 15th. Go pick up a copy because I give you all the, all the secrets, all the information, all the best material, all of the clarity that I possibly can in the book. What I found with these patients was when we fixed the environment, the diet, the lifestyle, then we typically didn't need to use any kind of anti-infectives. Now I say that I've still, and still routinely do prescribe antifungals, antibacterials, anti-parasitics because they have a place. And if you want to learn more about that, ask me a question. I'm going to point to a specific case in the book. I had a case that I share in chapter 4 of a gentleman who was told, you've got Lyme, and the Lyme was driving his hyperthyroidism, autoimmune hyperthyroidism. Turns out on further testing, we found that what he really had was a mercury problem, which was due to an overenthusiasm, let's call it, for very high mercury fish, sea bass, tuna, et cetera. We very quickly were able to, with the right medications and supplements, get him into remission. And he therefore avoided having to have his thyroid out, which I was really excited about. And he's still a patient at the practice today. So that's just one example. And so I hope that's helpful background on why you can have a lot of markers positive and yet they don't have necessarily a direct relation to your symptoms. And so I want people to know these markers can be positive, but correlation is not causation is what comes to mind. They're not necessarily the cause. of the problems you're dealing with in your symptoms. Question number 2, why is chasing individual markers one at a time? Why does it tend to leave people feeling like they're playing whack-a-mole? Great question. So I see this a lot. People have multiple lab abnormalities. They try to fix one of them at a time. And they, they often make the mistake of not retesting. That's the number one mistake I see them making. Why is this a mistake? If you trend labs over time, In people who you're taking close care of, you get to know who they are, what they like to do for fun, what their lifestyle's like, what their diet is like, all of the details we gather on our patients. What you'll find is that there's a, a lot of noise in their lab markers. So for example, if you're looking at Lyme titers, you might find that the titer is X today and Y tomorrow. And there's so much variability that frankly, these tests are of limited utility, limited value. When I'm covering labs with a patient, I'm always explaining to them, this lab varies this much day to day. And I know that because I run it in patients who I've really gotten to know. That isn't published by LabCorp or Quest, or let alone the other functional medicine diagnostic lab companies we, we order specialty testing from. They don't have that data. And most practitioners do not test patients repeatedly to get this background. They just see people 1 or 2 times and that's it. And there's often no repeating of labs, which I think is a colossal mistake. I care very deeply about getting pre and post labs in everyone. Because if you don't get that feedback, I don't think you grow and mature and become better as a clinician. You know, you just kind of keep doing the same thing the same way over and over again. And anyway, I find that boring. I want to get better. You got to get feedback in order to get better. Feedback is, did your intervention move the needle on the lab marker that you were trending? And this is one reason why I don't tend to trend Or even order Lyme serologies. I haven't found them to be useful. And I'll give you another example. Recent case came in, young man told that he had PANDAS or PANS, and I didn't give him any antibiotics. I just did our usual standard operating procedure. And in like 6 weeks to 2 months, he's something like 80% better. Now it's possible he could relapse. It's possible that things weren't really as bad as they made out. I don't know. I care more about the fact that he's basically At or very near his goal that he set when he came in to work with us. And again, just one example of that and not a guarantee by any means. All right. So why does chasing the individual markers leave people like they're playing whack-a-mole? Because that's what it is. You have to look at all these markers in combination. You have to take a really detailed history to understand the context behind each one of them. That's why AI-assisted interpretation of labs is just not where it needs to be for it to be helpful. For the record, we have a Dr. Stillman AI that patients keep telling me they really enjoy and find helpful by booking an evaluation with a member of my team. They can tell you how to get access to it, but they feel like they're playing whack-a-mole because there is no coherent, cohesive plan for dealing with their diet and their lifestyle. It's just take this for that. You know, you take a statin for your Lp, not that I'm endorsing that for the record. You take ashwagandha for your fatigue. You take, you know, astragalus for your Lyme or whatever. And sometimes that's all you can do. And that's another story for another day. But if you really want great results. My experience has been you gotta treat the whole person and not just one or two lab abnormalities. What's the difference between treating a number and treating a person? This is a very important distinction. One of my favorite quotes I quoted in the book in chapter 5 is, listen to the patient, they are telling you the diagnosis. William Osler, founder of Johns Hopkins School of Medicine, said that, and I think it's really true. So when we look at numbers, you cannot interpret a number without the context of the person behind it. So I'll routinely see numbers in lab testing and I'll see, okay, this number indicates that this, this, or this may be going on with the patient, but I need the patient to be in front of me so that I can ask them, hey, is this, this, or this going on? Let me give you a very real example. When I see a low IGF-1 level, this usually coincides or correlates with poor sleep, lack of protein, sometimes lack of calories overall, or extreme unrelenting stress. And I've already gotten to know them a little bit, but I'll also ask them outright, hey, this is low. It usually means one of these 3 things is off. Which of these things do you think it is? Now we don't just take their word for it because we take a dietary history and we determine how much protein are they getting each day on average. So I can tell right there, is that the problem? We take a sleep history. How is your sleep? How fast do you go to sleep? How soundly do you sleep? How rested do you feel when you wake up? So I can tell if their sleep is off. Stress, very subjective. So that's a conversation we have, but that's just one example of one marker. That has a huge impact because IGF-1 is our best surrogate for growth hormone levels. Growth hormone is really what governs our body's ability to rest, regenerate, and repair. And so, you know, you give me somebody with a diagnosis or a label of chronic Lyme disease and you say, well, they've got a low IGF-1 level. You know, what are we going to do? What antibiotic are we going to use? I'm going to ask, no, first, before you even think about antibiotics, how are you going to get their growth hormone levels to a point Where the body can actually engage in repair. Because until you've fixed their sleep and given them adequate protein, let alone calories, and given them a reasonably low stress lifestyle, I've seen this happen. You can throw everything in the kitchen sink at these cases and they will not get better. So that's the difference between treating a number and treating a person. You have to get to know the person behind the number to understand why the number is what the number is. And so many times it is not a cookie cutter question. Sometimes I'm just inspired to ask a question. Who knows where that comes from? And it Helps me really understand then what we should do next. All right. Why do so many people with complex tick-borne panels say they've tried everything and still don't feel better? So I, here's the bottom line here. These symptoms are often not arising from the tick-borne infection or whatever is being labeled as the root cause of the problem. And so they are not actually dealing with a tick-borne illness. They're dealing with something else. Again, I covered this in spades in chapter I also cover it in chapter 5, and arguably every chapter has something to do with this. All pieces of our 5-part framework that I cover in the book will explain pieces of why you'll see this phenomenon. Now, the other thing I'll tell you about tried everything is that there's so many things to try. I have been at this for over 20 years now. When you count, if you count from the time that I first determined to go into natural and integrative medicine, I have not tried everything. We're still finding new things that sometimes have been lost to history and not properly publicized, or they've had a smear campaign leveled against them. And basically it's disappeared from the public consciousness. And we're still sorting out how do we integrate these things? And I have to tell you, when you sit down in rooms full of doctors like me who are doing this kind of work, we've always got questions for each other. How are you using this? How are you using that? What have you found with this or that? And everyone's got a different experience and there's so much uncertainty, but What's reassuring is that so long as we do the things that I write about in this book, results tend to come out quite well. Patients are quite happy. They're satisfied with what they see, right? Not a guarantee, just a trend. All right. How should someone think about the order of priorities in terms of their treatment? What usually needs attention first versus later without needing a specific protocol? Okay. So I organize this in a 5-part framework that I explain in the book. Chapter 2 is principles. Chapter 3 is essentials. Chapter 4 is Hazards. Chapter 5 is diagnostics and chapter 6 is therapeutics. And I arranged them in that order. Why? Because my observation was that when patients came in and they didn't have the right principles, mindset, beliefs, ideas about the world and themselves, little things actually matter to me more and more. Do you honor your word? Do you show up on time? I'll be the first to admit that I am not always on time. In my defense, it's because patients ask loaded questions at the end of consultations and I don't feel I can in good conscience just quit the room, but that's another story. Little things like that matter to me because I've observed that the patients who get the best results are not just principled in the way that they follow their wellness routine. They're principled in every aspect of their life. They're genuinely virtuous people. Essentials. There's some things you just have to do to be healthy. You cannot put people in an unhealthy, sick environment with a dysfunctional lifestyle and expect them to get well. It would be like taking a tree, uprooting it from the ground, throwing it in a closet and closing the door and expecting it to thrive. It needs water. It needs sunlight. It needs soil. Guess what's on the COVID of my book? Sunlight, water, and soil. Why? Because these are the 3 magic ingredients that make all life on planet Earth possible. Fun. Okay. Hazards. You have to eliminate the hazards from someone's life that are making them sick. Sometimes this is stuff that's in their body already. I talk about detoxification in the book. It's a very catchy, trendy buzzword, but there's a lot there that I cover in the book. Then you get into diagnostics. So notice I already covered 3 chapters, principles, essentials, hazards, and only then do we bother with lab testing. Why? Because if you don't get those first 3 things right, you can spend all the money in the world on lab testing that you want. And sometimes you will just still come up empty. Frustrates patients all day, frustrates us as providers. That's part of why I wrote the book. I wanted people to get that if you don't get those first 3 things right, or at least reasonably under control, it doesn't matter what you do with diagnostics and therapeutics. You're just gonna temporize illness or not see progress, but then you get into diagnostics. Once you've run your diagnostics, that's when you can rationally pick your therapeutics. And to be fair, diagnostics is not just about lab testing. It's about taking a good history. It's about using forms to gather information. We do all that in the practice. Okay. Next question. Why does the body's terrain matter as much as the bug or infectious thing itself? Right? This is a really important concept. So I want you to imagine that illnesses do not come upon us out of the blue. They are the consequence of small daily sins against nature. When enough of accumulated illnesses will suddenly appear. That's my favorite quote from one of my favorite quotes from Hippocrates, the father of medicine in ancient Greece. What is, what does the body's terrain mean? The more I do this, the more I practice, the more I conceive of the body as this complex ecosystem. It's not a bunch of hoses and tubes and struts and pulleys and levers and filters and whatever, like reductionistic and often modern conventional medical beliefs posit. Truly, the body is like an ecosystem. And when you view it through that lens, you know why, for example, do Do gardens develop weeds? Why do they develop pests? Why do they support them? Well, usually there's something out of balance. And so if you look at organic agriculture as really an analogy for natural and integrative medical care, you know, you'll see that. Do they maybe spray some things on the, on the crops? Yeah, hopefully. And usually they're benign things. Like, for example, I've heard of people using like extracts of spicy peppers, like jalapeños, in order to treat pests, right? Harmless, totally natural, degrades over time, right? I've heard of them bringing in ducks in order to eat pests like slugs, insects, snails, et cetera. If we view the body the same way, if we give the body what it needs, if we treat the soil of the body, if you will, as a complex system that needs certain ingredients in order to be well, that's when you'll get the best results and you'll get the greatest resiliency and endurance in the human being. And so I look at the body as having this terrain. I think about it no different as a field. And I look primarily at the body's mineral status as the best marker of where is the terrain, because you will see these remarkable things in the hair. So long as you do enough testing and you know how to treat the test results that you get back, you'll see huge quantities of heavy metals in patients. You'll see them come out of people as you treat them. You'll see nutritional deficiencies that would not otherwise have been apparent. You'll see imbalances in nutrients that wouldn't have escaped your notice if you only did blood or urine testing. I cover this again in chapter 5, right? In detail, the testing that we run. So I hope people understand this concept, the body, the diseases you develop are going to emerge from the complex system that is your body. And you really should start by asking the question, what can I do to change my body so that it does not support this illness? And that's not as simple as just take this, take that. Here's a pill. Here's a potion. Here's a powder. Here's a lotion. It's a complex question that has to do with your sleep quality and your diet and your nutritional load and your stress levels and all these other things that we get into in the book and that we get into in practice. All right. What role does time play in healing and why do quick fixes often backfire with complex cases that may or may not have infections like this? What a great question. Hippocrates, another one of my favorite quotes of his is healing is sometimes not just a matter of time. It is a matter of opportunity. So you do need to keep in mind that healing is sometimes a matter of time, but it is also a matter of taking the right action. Right. He also said sometimes to do nothing is a good remedy. I think that's a fascinating idea. It can be difficult to be patient with a process when you're suffering and you just want relief. I totally understand that. But patience is one of the most important things to bring to the table when you're trying to overcome a complex chronic illness of any kind. Now, I'm not saying you should be patient to the, to the point of, I'm going to continue to do things that are obviously not working. You have to think through, well, what's a reasonable timeframe for me to expect my plan to bear fruit or yield improvement. I'm usually looking for significant improvements within weeks, but sometimes you have to be more patient than that. When it comes to quick fixes, I find that they're routinely a disaster because at the end of the day, I find that the root causes of someone's illness are almost always fairly apparent if we just have enough time to take a diligent, detailed history. I packed everything that I find most important to our cases into our 30-Day Immune Wellness Roadmap. Which starts with our 14-day reset and then our 14-day detox, and then goes through a bunch of other key things we share with patients in the first 30 days of our process. That is actually how our AI is supposed to start. So if you sign up for one of our programs or memberships and you log into the AI, it should take you through that process. If you want to see what this really looks like in great detail, again, to get access to that, you book an evaluation with a member of my team to understand what your options are for accessing it. But my point is quick fixes often lead people to not deal with the root cause of the problem. And so they just end up back at square one. I'm going to pick on one of my least favorite therapeutics right now, which is the GLP-1s. Everyone is going crazy for retatrutide, tirzepatide, Ozempic, and I can see the trial lawyers circling. They can see where this is headed. There's going to be lots of people who use the GLP-1s. They lose muscle mass. They don't control their diet and their lifestyle. They lose weight, but they lose bone mass and they lose muscle mass. And so they fall, they break a hip and they die young. People are abusing these drugs. I'm not saying there's not a time and a reasonable way to use them. The way I look at it, it's like jamming on the gas pedal when you have your parking brake on. Let's talk through why does the car smell funny? Why is it making that weird noise? Why is it beeping at you? You forgot to release the parking brake. I'm not kidding. Some of the stuff we find in consults with patients is so simple and so easy to fix. And to us, so obvious. But patients don't get this. They don't get taught it in school. They don't hear it from other doctors or practitioners. People don't take the time to take detailed histories and really get to know their patients. We're different anyway. So I cover this in chapter 2. So more on it there. All right. That's all the time we have for today. Ask me anything for my next livestream. The link is below. If you're tired, foggy, or inflamed and would like to reclaim your health, we would love to help you book an evaluation with a member of my team at stillmanmd.link/eval. Thanks for listening. Take care. Have a great day.