Biofilms: Lyme Disease Gated Communities

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"I updated this article on 3/1/19 to include new information about how biofilms work, stevia, a product called BioDisrupt, and information about volatile oils like oregano." Marty Ross MD

The Problem with Lyme Biofilms

Lyme disease biofilms are protective communities for Lyme germs. In these, various forms of the Lyme bacteria evade the immune system and hide from herbal and prescription antibiotics. In chronic Lyme and associated diseases they can cause:

  • treatment resistance,
  • antibiotic resistance, and
  • relapse once antibiotics or herbal antimicrobials are stopped.

In addition, biofilms provide an environment where Lyme persister cells can hibernate. For more information about persisters see How to Treat Persister Lyme. What Works?

Biofilms are not unique to borrelia, the Lyme disease bacteria. They are known to occur based on scientific studies in various infections such as staph infections of the skin and in Candida yeast infections. In Lyme disease, Alan MacDonald, MD has shown biofilms to exist in people with Lyme based on his microscopic exams of brain tissues. In the laboratory, Eva Sapi PhD showed that Lyme biofilms have the typical components and same behavior as biofilms found in other infections.

How Lyme Disease Biofilms Work

In Lyme disease biofilms bacteria produce and cover themselves in a layer of sugar slime called mucopolysaccharides. To add structure, the bacteria recruit a protein found in blood called fibrinogen which they use to create a fibrin protein skeleton. Because the fibrin gives structure, the bacteria in biofilms can rid themselves of their outer protein coverings. This makes it harder for the immune system to react against them. In addition, the slime layer covers the germs so the immune system cannot see them. Antibiotics or antimicrobial supplements may have difficulty reaching the germs. In biofilms germs use efflux pumps to remove antibiotics creating antibiotic resistance.

Within the Lyme disease biofilms the germs establish highly organized structures and functions. For instance they have tubes they use to take in nutrients. They also communicate using various chemical messengers, excrete waste through channels and perform other complex activities to promote the longevity of the community. Biofilms require calcium and magnesium and contain other minerals and heavy metals.

Biofilms grow and thrive through a number of steps. First biofilms have to stick to surfaces; this is called adherence. Then germs in biofilms talk to each other through quorum sensing making the germs and biofilm stronger. Germs in biofilms use efflux pumps that flush antibiotics out. Biofilms also grow through germ swarming motility where some bacteria develop tails to rapidly spread.

Biofilms also contain various types of bacteria, in addition to borrelia (the Lyme germ). These bacteria, the fibrin-based proteins, and the mucopolysaccharide sugar slime provide the architectural structure which holds the biofilm together.

Lyme Disease Biofilms and Treatment

When I practiced, I intentionally treated Lyme disease biofilms

  • at the end of treatment to prevent relapse or
  • when a treatment was not progressing well due to treatment resistance usually between six to nine months.

Some physicians address Lyme disease biofilms at the very beginning or throughout the entire course of a treatment. In my practice I did not do this. My observation was that 90 percent or more of my patients got well without specific biofilm treatments. We know based on the work of Alan MacDonald MD that biofilms exist in brain tissues of people with Lyme. However, there is no scientific evidence that they occur in every individual who has Lyme and associated diseases. Furthermore, even if they do exist in all that have borrelia infection, there is no scientific evidence that they universally block treatments.

One reason people can get better without specifically treating for Lyme disease biofilm is all antibiotics can decrease biofilm size. Research by Eva Sapi PhD shows that the antibiotics doxycycline, metronidazole, tinidazole, and amoxicillin can reduce biofilm size by various degrees. The best of these is the drug tinidazole which reduces biofilm by 50 to 55 percent. While doxycycline reduced biofilm by 40 percent, metronidazole by 30 percent and amoxicillin by 30 percent. Note she did not study the whole list of antibiotics I often used to treat Lyme disease described in A Lyme Disease Antibiotic Guide.

How to Treat Lyme Disease Biofilms

Based on my review of biofilm treatments in Lyme disease, there are a handful of scientifically supported approaches to eliminate Lyme biofilms and many theoretical treatment approaches. I call some "theoretical treatment approaches" because specific research supporting their use has not been done on Lyme germs either in the lab or in humans.

Research-based Treatments

Eva Sapi PhD and her colleagues are performing groundbreaking Lyme Disease research. In 2010 and 2011 she published two articles based on petri dish experiments in her lab. The first shows that the herbs otoba bark extract and cat's claw tinctures used together completely eliminate biofilm communities. They also eradicate nearly every germ living in them. Another study of five different antibiotics shows that prescription tinidazole decreases the size of biofilm communities by 50 to 55 percent. It also eliminates the germs living in them by over 90 percent. Based on my review of her research, I believe the best antimicrobial approach that eliminates biofilms and the germs that live in them are the herbs otoba bark extract and cat's claw tinctures. Prescriptive tinidazole is a very close second though.

In late 2015 Dr. Sapi published another petri dish study showing that stevia extract from Nutramedix decreases biofilm size by nearly 40 percent while eliminating most Lyme germs in the biofilm. She also showed stevia can kill persister cells of Lyme. For more information about stevia see Stevia for Lyme Disease. However, my clinical experience working with stevia, prior to stopping clinical practice in 2018, suggests that in living people, stevia does not work.

More recent studies show that Biocidin, which is a mix of various herbs, could be an effective product to support biofilm treatment. Petri dish experiments show it eliminates nearly 100 percent of biofilm. It is proposed that Biocidin works in a number of different ways. One way is by preventing germs from sticking to surfaces called adherence; another is to block quorum sensing where germs in biofilms talk to each other making the germs and biofilm stronger. Germs in biofilms use efflux pumps that flush antibiotics out. And Biocidin appears to block these pumps. Finally it limits germ swarming motility where some bacteria develop tails to rapidly spread. Read more in Biocidin: A Potent Antimicrobial and Biofilm Breaker.

The latest research from Ying Zhang, MD at Johns Hopkins University shows that various volatile oils can break down biofilms. His work does not indicate how these oils work. The three oils that breakdown Lyme biofilms in his lab experiments also kill persister cells. The oils are oregano, cinnamon, and clove. This research is promising. However, a few years ago there was a treatment fad to use various types of essential oils to treat Lyme. My observation is that most did not benefit from this treatment. So it is possible that the petri dish findings of Ying Zhang, MD will not necessarily work in living people. 

Theoretical Treatments

As I noted above biofilms require magnesium and calcium, have various minerals and heavy metals, have numerous types of bacteria living in them, and contain fibrin protein structures and mucopolysaccharides substances. Theoretical treatments address these various components. Some physicians treat biofilms by

  • starving the germs by eliminating or limiting calcium and magnesium,
  • removing minerals and heavy metals with the chelating agent EDTA, 
  • breaking up the protein fibrin matrix with enzymes like lumbrokinase, protease, or nattokinase,
  • breaking up the sugar matrix with enzymes like serratiopeptidase, beta-glucanase, lipase, cellulase, and hemicellulase, 
  • using herbs like cranberry fruit extract, berberine, rosemary extract, peppermint oil, and N-acetyl cysteine which individually or collectively may alter germ swarming motility, adherence, quorum sensing, or even kill biofilm bacteria.

Regarding eliminating calcium and magnesium or limiting them, I do not support this. Biofilms exist in us, so of course they require the same minerals that we do to survive. I do not think we should starve the host (a person with Lyme) to kill the germ.

The theoretical approach I used in my practice was Lumbrokinase. It may break down the fibrin protein skeleton that holds the biofilm together. This alone is enough to break up the biofilms. Using Lumbrokinase alone I have seen great improvements in my patients with treatment resistant Lyme and decreased episodes of relapse. An alternative to the Lumbrokinase is nattokinase, but it is a much weaker fibrin dissolving enzyme and I did not find it effective. 

And if I was still in practice, I would try a newer supplement product called BioDisrupt by Research Nutritionals. This product may support the treatment of biofilms because its components may attack the biofilm in numerous ways. It contains various enzymes that could break down the mucopolysaccharide sugar and proteins in Lyme biofilms. It also contains numerous herbs that may limit quorum sensing, adhesion, and germ swarming motility to help destabilize the biofilms. Finally, some of its herbal components may kill the various germs in biofilms. 

Lyme Disease Biofilms Treatment Approach

When to Treat Biofilms

Based on my clinical experience when I was in practice, I found it helpful to treat biofilms in the last four months of treatment to prevent relapse or anytime in treatment when resistance to antibiotics or herbal antimicrobials was blocking progress. As I noted above, most antibiotics can reduce Lyme disease biofilm size, so it is possible there is no need for the targeted treatments I discuss below.

Approaches that Seem to Help

I find Biocidin very useful to target biofilms based on the clinical response of my patients.  Biocidin can be used with both herbal antibiotics and prescription antibiotics. My other favorite approach is to use otoba bark extract and cat's claw tinctures. When using these two herbs, I would stop all prescriptive antibiotics. Dr. Sapi's work suggest this is the most effective approach, and this is what I observed in my practice as well. Another approach is to use prescriptive tinidazole in an antibiotic approach. I like lumbrokinase, if an antibiotic approach is working fairly well, or if otoba bark extract and cat's claw tinctures do not work, or if a person cannot tolerate the nausea or abdominal cramping that can occur with tinidazole. It is safe to add lumbrokinase to any antibiotic regimen. 

One newer approach that may help is to use BioDisrupt by Researched Nutritionals. As I said above based on the laboratory effect of its individual enzymes and herbs, this may be an effective approach to add to existing antibiotic regimens. I am interested in hearing back from people who try this product to see if it actually helps.

For information about dosing see the following separate articles I have on this site. For information about tinidazole see A Lyme Disease Antibiotic Guide. See also Otoba Bark Extract and Cat's Claw Tinctures, and Lumbrokinase. For information about Biocidin see Biocidin: A Potent Antimicrobial & Biofilm Breaker. For information about BioDisrupt refer to the dosing recommendation on the bottle.

One word of caution, when treating biofilms, sometimes Herxheimer die-off reactions can occur. In a die-off reaction the immune system makes more inflammatory chemicals that can temporarily make the Lyme and associated diseases symptoms worse.

References:

  1. Sapi, E. et. al. Evaluation of in-vitro antibiotic susceptibility of different morphological forms of Borrelia burgdorferi. Infection and Drug Resistance 2011:4 97–113.
  2. Sapi, E. et al. Effectiveness of Stevia Rebaudiana whole leaf extract against the various morphological forms of Borrelia Burgdorferi in Vitro. European Journal of Microbiology and Immunology 5 (2015) 4. pp. 268 -280. DOI 10.1556/1886.2015.00031
  3. Sapi E, Bastian SL, Mpoy CM, et al. Characterization of biofilm formation by Borrelia burgdorferi in vitro. PLoS One. 2012;7(10):e48277.
  4. Humphreys, Corene. (2015) “Biocidin Research Update – The Science Behind the Success.” USA White Paper Webinar Series June 18, 2015. Retrieved from https://www.youtube.com/watch?time_continue=32&v=j3s_vf2p4dI
  5. Fresco, Rachel. (2014) “Biocidin: Clinical Protocols for Dysbiosis and Biofilms.” Retrieved from  https://www.youtube.com/watch?v=OY_1F7bx9AA
  6. Gilbert, Leona. (2016) “Analysis of the Activity of Biocidin Compounds against Borrelia.” Unpublished presentation of research  conducted by Dr. Gilbert’s lab in Finland provided through personal communication from Rachel Fresco LAc PhD.
  7. Marques, C. “Activity of Biocidin against biofilms microbial biofilms.” Unpublished manuscript of research conducted by Dr. Marques provided through personal communication with Rachel Fresco LAc PhD.
  8. Feng J, Zhang S, Shi W, Zubcevik N, Miklossy J, Zhang Y. Selective Essential Oils from Spice or Culinary Herbs Have High Activity against Stationary Phase and Biofilm Borrelia burgdorferi. Front Med (Lausanne). 2017;4:169. Published 2017 Oct 11. doi:10.3389/fmed.2017.00169

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