Control Cytokines: A Guide to Fix Lyme Symptoms & The Immune System

Your source for quality supplements

Shop Now

Cytokines in a Lyme disease treatment image from Marty Ross MD

Updated: 6/27/23

About Cytokines in Lyme Disease and Related Conditions

Lowering inflammatory cytokines made by the immune system is essential for Lyme disease and related conditions recovery. In this article, I discuss why this is so and lay out a nutritional support plan using supplements to lower cytokines.

Cytokines are proteins made by various types of white blood cells to turn on the immune system to attack invaders like:

  • bacteria (for example, Lyme germs and the co-infections),
  • intestinal yeast,
  • parasites,
  • viruses,
  • Lyme and mold toxins,
  • environmental toxins, and
  • heavy metals toxins, like lead and mercury.

Marty Ross MD Discusses Cytokines


Cytokines are Good, Right? Well, Yes and No.

In the right amount, cytokines promote healing. In excess, they cause all of the major Lyme disease symptoms and dysregulate the immune system. The problem in chronic Lyme and associated diseases is that they are usually made in excess. Fortunately, there are some great steps you can take to lower cytokines.

Good: The Right Amount of Cytokines:

  • make antibodies work more effectively,
  • increase active white blood cells,
  • recruit white blood cells to where they are needed,
  • turn on white blood cells, and
  • decrease viral and bacterial replication.

Bad: Too Many Cytokines:

  • dysregulate the immune system,
  • cause pain,
  • decrease hormone production from organs, like the thyroid and the adrenal glands,
  • disturb sleep,
  • decrease brain function,
  • increase fatigue and tiredness,
  • waste muscles,
  • cause depression, and
  • decrease the function of various organs throughout the body, resulting in many other symptoms and medical problems.

Let’s Be Clear: Lyme Symptoms are Excess Cytokine Symptoms

Most Lyme symptoms are really excess cytokine symptoms. Moreover, other conditions that increase cytokines add to your cytokine pool.

That is why some people with Lyme disease must also address other cytokine producing problems like mold detox issues, yeast overgrowth in the intestines, SIBO, parasites, and viral infections.

Herxheimer Die-Off Reactions

A cytokine flare that occurs when a person starts killing germs is called a Herxheimer die-off reaction. This occurs when the immune system sees dead bug parts from killing germs and toxins that get released from the inside of the germs. In this situation, the immune system makes more cytokines, causing a person to feel much worse.

Cytokines: How They are Made and Regulated

Cytokines are made when immune cells are stimulated by germs, toxins, oxidizing agents, other cytokines, other agents, and insomnia.

NF-kB Signals for Cytokine Production

Once the immune cells are stimulated, an intracellular messenger called NF-kB (nuclear factor kappa beta) causes genetic programming for the production of cytokines and the turning on of white blood cells. Antioxidants like glutathione, quercetin, and curcumin lower oxidation triggers for NF-kB. Supplements, like curcumin, also block the function of NF-kB.

Kinase Enzymes

Within the white blood cells, the production of cytokines requires enzymes called kinases. Herbs that block kinase enzymes, like quercetin, can help lower cytokines.

Nrf2 Signals Production of Antioxidants.

Cells also have a genetic messenger that increases cell production of antioxidants like glutathione. This messenger is called Nrf2 (nuclear factor 2). Some supplements, like resveratrol and curcumin, turn on Nrf2. Antioxidants decrease oxidizing agents that trigger cytokine production. Therefore, turning on Nrf2 creates antioxidants, which decreases cytokine production.

Sleep Lowers Cytokine Inflammation in Lyme Disease

Sleep also has a big impact on cytokines. Lack of sleep triggers more cytokines and high cytokines can cause insomnia.

How to Lower Cytokines

Get Sleep

First, it is important to get 7-9 hours of sleep a night. Sleep lowers cytokines.

Use Supplements

To lower cytokines, there are a number of interventions to:

  • increase antioxidants,
  • decrease NF-kB genetic programming of cells,
  • increase Nrf2,
  • block kinase enzymes, and
  • detox.


Based on the work of Martin Pall PhD, it is critical to lower oxidizing agents that trigger cytokine production. Glutathione, which is made in every cell, and its building blocks, alpha-lipoic acid (ALA) and N-acetyl cysteine (NAC), are helpful. Curcumin, which is a component of turmeric, and quercetin are also good antioxidants.


Glutathione and its precursor building blocks, ALA and NAC, also help remove toxins.


Curcumin, quercetin, and resveratrol decrease NF-kB induced genetic signals to produce cytokines.


Curcumin, resveratrol, and black tea extracts containing the polyphenol EGCG increase Nrf2, which increases cell-level production of glutathione and other antioxidants.

Kinase Enzymes

Quercetin also blocks kinase enzymes required in the production of cytokines. Blocking kinases with quercetin interferes with the cytokine production line.

Treatment Approach

Step 1: Lower or Remove the Cause of Cytokine Excess

As I note above, various infections and mold toxicity trigger the immune system to make excess cytokines. The most important step to lowering cytokines is to remove or lower the cause like Lyme, Bartonella, Babesia, intestinal yeast overgrowth, mold toxicity, or other chronic infections. 

For information about treating Lyme and related infections see The Ross Lyme Support Protocol. For more specific information for each infection see the Infections Treatment Plans section. For information about treating mold toxicity see Lyme and Mold Toxin Illness.

Step 2: Throughout Treatment

Use a good multivitamin that includes alpha-lipoic acid, N-acetyl cysteine, antioxidants, and other micronutrients that decrease oxidizing agents and support liver detoxification. I prefer multivitamin products in powder form made by Thorne or in a pill form by Researched Nutritionals.

  • Sleep 7-9 Hours a Night. See the Sleep section to learn techniques to aid sleep and sleep prescription and supplement options.
  • Curcumin 500 mg 1-2 pills 3 times a day OR Anti-Cytokine Combination. (Find a combination product that contains curcumin, resveratrol, black tea extract, and NAC. Cytoquel by Researched Nutritionals is one product that contains these herbs.) 1-2 pills 3 times a day.
  • Multivitamin. Use multivitamin powders by Thorne or a pill by Researched Nutritionals. Use as directed on the product label.

Step 3: Add More Antioxidants and Detox Agents

For more severe cases, add oral glutathione while continuing the multivitamin and curcumin or anti-cytokine combination. Glutathione is also a great choice if there is nerve pain or numbness. If the addition of glutathione is not effective, then consider adding quercetin. This combination works to block the cytokine production line and decreases oxidizing agents that trigger production. These treatments can take 1-2 weeks for maximum effect.

  • Liposomal Glutathione 400-500 mg 1 or 2 times a day.
  • Quercetin 250 mg 2 pills 3 times a day.

If glutathione is not tolerated, then work with one or a combination of the following antioxidants that are used to make glutathione:

  • Alpha-Lipoic Acid 350 mg 1 pill 2 times a day.
  • N-Acetyl Cysteine 500 mg 1 pill 3 times a day.

Step 4: Severe Situations like Herxheimer Die-off Reactions.

For severe situations and bad Herxheimer die-off reactions that are not improving with Steps 1 and 2, use IV glutathione as a potent antioxidant and to support liver detoxification. This is administered in an integrative medicine physician’s office. Another option is to use glutathione in a nebulizer. Glutathione IV is stronger than glutathione by nebulizer in my experience. Using a nebulizer, you breathe in a fine mist of the glutathione which is absorbed into the blood through the blood vessels in the lungs. Sometimes start a person with four IV glutathione treatments and then change to glutathione by nebulizer to continue the treatment.

  • Glutathione IV 1200 mg to 2500 mg 2 times a week for a minimum of four treatments. If it helps but there are still improvements with the last treatment, consider weekly treatments until improvements plateau. You will likely feel more tired after the first treatment.
  • Glutathione by Nebulizer 200mg/ml 2ml 2 times a day for adults. Children can take 100mg/ml 1ml to 2ml 2 times a day.


The ideas and recommendations on this website and in this article are for informational purposes only. For more information about this, see the sitewide Terms & Conditions.


View Citations

  1. Ballatori N, Krance SM, Notenboom S, Shi S, Tieu K, Hammond CL. Glutathione dysregulation and the etiology and progression of human diseases. Biol Chem. 2009;390(3):191–214. doi:10.1515/BC.2009.033 (View)
  2. Bocci V, Valacchi G. Nrf2 activation as target to implement therapeutic treatments. Front Chem. 2015;3:4. doi:10.3389/fchem.2015.00004 (View)
  3. Butler T. (2017). The Jarisch-Herxheimer reaction after antibiotic treatment of spirochetal infections: A review of recent cases and our understanding of pathogenesis. Am J Trop Med Hyg. 96(1):46–52. doi:10.4269/ajtmh.16-0434 D’Andrea G. Quercetin: A flavonol with multifaceted therapeutic applications? Fitoterapia. 2015;106:256–271. doi:10.1016/j.fitote.2015.09.018 (View)
  4. D’Andrea G. Quercetin: a flavonol with multifaceted therapeutic applications? Fitoterapia. 2015;106:256–71. (View)
  5. Gulcubuk A, Haktanir D, Cakiris A, et al. Effects of curcumin on proinflammatory cytokines and tissue injury in the early and late phases of experimental acute pancreatitis. Pancreatology. 13(4):347-354. doi:10.1016/j.pan.2013.05.005 (View)
  6. Krysta K, Krzystanek M, Bratek A, Krupka-Matuszczyk I. Sleep and inflammatory markers in different psychiatric disorders. J Neural Transm. 2017;124(Suppl 1):179-186. doi:10.1007/s00702-015-1492-3 (View)
  7. Lee DW, Gardner R, Porter DL, et al. Current concepts in the diagnosis and management of cytokine release syndrome. Blood. 2014;124(2):188-195. doi:10.1182/blood-2014-05-552729 (View)
  8. Linus Pauling Institute. Curcumin. Oregon State University. Updated February 2016. Accessed August 18, 2018.
  9. Lu SC. Glutathione synthesis. Biochim biophys acta. 2013;1830(5):3143-3153. doi:10.1016/j.bbagen.2012.09.008 (View)
  10. Pall ML. Approaches to Curing Chronic Fatigue Syndrome/Myalgic Encephalomyelitis, Fibromyalgia, Multiple Chemical Sensitivity, Gulf War Syndrome, and Possibly Many Others. Townsend Letter. Published February/March 2010. Accessed August 19, 2018.
  11. Peacock BN, Gherezghiher TB, Hilario JD, Kellerman GH. New insights into Lyme disease. Redox Biol. 2015;5:66–70. doi:10.1016/j.redox.2015.03.002 (View)
  12. Pizzorno J. Glutathione! Integr Med (Encinitas). 2014;13(1):8-12. (View)
  13. Pound MW, May DB. Proposed mechanisms and preventative options of Jarisch-Herxheimer reactions. J Clin Pharm Ther. 2005;30(3):291–295. doi:10.1111/j.1365-2710.2005.00631.x (View)
  14. Shachar I, Karin N. The dual roles of inflammatory cytokines and chemokines in the regulation of autoimmune diseases and their clinical implications. J Leukoc Biol. 2013;93(1):51–61. doi:10.1189/jlb.0612293 (View)
  15. Sinha R, Sinha I, Calcagnotto A, et al. Oral supplementation with liposomal glutathione elevates body stores of glutathione and markers of immune function. Eur J Clin Nutr. 2018;72(1):105–111. doi:10.1038/ejcn.2017.132 (View)
  16. Strle K, Drouin EE, Shen S, et al. Borrelia burgdorferi stimulates macrophages to secrete higher levels of cytokines and chemokines than Borrelia afzelii or Borrelia garinii. J Infect Dis. 2009;200(12):1936–1943. doi:10.1086/648091 (View)
  17. Strle K, Sulka KB, Pianta A, et al. T-helper 17 cell cytokine responses in Lyme disease correlate with Borrelia burgdorferi antibodies during early Infection and with autoantibodies late in the illness in patients with antibiotic-refractory Lyme arthritis. Clin Infect Dis. 2017;64(7):930–938. doi:10.1093/cid/cix002 (View)
  18. Zhao F, Gong Y, Hu Y, et al. Curcumin and its major metabolites inhibit the inflammatory response induced by lipopolysaccharide: Translocation of nuclear factor-κB as potential target. Mol Med Rep. 2015;11(4):3087-3093. doi:10.3892/mmr.2014.3079 (View)
Marty Ross MD Image

Follow Marty Ross MD

See full profile: on LinkedIn.
See the latest: on Twitter, YouTube, and Instagram.

About The Author

Marty Ross, MD is a passionate Lyme disease educator and clinical expert. He helps Lyme sufferers and their physicians see what really works based on his review of the science and extensive real-world experience. Dr. Ross is licensed to practice medicine in Washington State (License: MD00033296) where he has treated thousands of Lyme disease patients in his Seattle practice.

Marty Ross, MD is a graduate of Indiana University School of Medicine and Georgetown University Family Medicine Residency. He is a member of the International Lyme and Associated Disease Society (ILADS), The Institute for Functional Medicine, and The American Academy of Anti-Aging Medicine (A4M).

keep up with our LATEST!

Subscribe to receive our FREE pdf download book: How to Successfully Treat Lyme: Key Info before You Treat or Treat Again & The Ross Lyme Support Protocol; health tips; updates; special offers; and more.