The Ross Lyme Support Protocol 

A Chronic Lyme Disease Treatment Guideline

Updated 7/1/2019

 

 

 

 

For Chronic Lyme Disease Treatment

"The Ross Lyme Support Protocol is a chronic Lyme disease treatment guideline. It is more comprehensive than the ILADS, IDSA, and CDC treatment guidelines. Discuss these approaches with your healthcare provider to see if they are right for you."  

 – Marty Ross MD LLMD

Introduction
1. Sleep
2. Diet
3. Cytokine Control
4. Adaptogen
5. Hormones
6. Essential Micronutrients
7. Detoxification
8. Exercise
9. Immune System Boosters
10. Yeast
11. Lyme Infection Treatment
12. Coinfection Treatments
13. Additional Natural Medicines
14. Special Considerations
15. Health Decline after Doing Better

About The Ross Lyme Support Protocol

These are Lyme disease treatment guidelines to treat chronic Lyme and associated diseases. This protocol addresses most problems that keep a person from getting well. It is more comprehensive than the antibiotic focused Infectious Disease Society of America (IDSA), International Lyme and Associated Disease Society (ILADS), and United States Centers for Disease Control and Prevention guidelines. While herbal and prescription antibiotics may decrease the germ load in chronic Lyme, they often do not correct the underlying problems that cause ongoing symptoms. 

The Ross Lyme Support Protocol includes essential treatment steps for the beginning and throughout a chronic Lyme disease treatment. It is designed to:

  • boost the immune system,
  • improve detoxification,
  • speed recovery,
  • kill the infections, and
  • protect and repair from the harmful effects of the infections and the herbal or prescription antibiotics.

While the following Lyme disease treatment approach focuses on a limited number of areas, it may correct most of the problems like:

  • low energy,
  • pain,
  • insomnia,
  • brain, neurologic, and thinking problems (brain fog), and
  • immune compromise and suppression.

HERXHEIMER DIE-OFF REACTIONS. When a person starts a Lyme disease treatment or changes herbal and prescription antibiotics, it is common to experience some worsening in symptoms. See Herxheimer Die-off Reaction: Inflammation Run Amok for more information about this and the steps you can take to treat it.

TREATMENT LENGTH AND PERSISTENCE. Generally, it takes a minimum of six months to see if these treatments will help. Natural medicines can speed recovery, but treating Lyme still takes time. Once you have marked improvement, then you can likely stop many of these natural medicines except for probiotics, curcumin, ashwagandha, and a good multivitamin. See Getting Healthy: Will I? When? How Do I? for more information about Lyme disease treatment length and persistence.

ABOUT NATURAL MEDICINES.  The natural medicines I include throughout this protocol are used as nutritional supports based on their known functions. Basic research and my clinical experience shows they may help improve the various problems identified below in Lyme disease.

Disclaimer

These guidelines are based on the best available research, and what I found clinically useful in my Seattle practice. The ideas and recommendations on this website and in this guideline are for informational purposes only. For more information about this, see the sitewide Terms & Conditions.

Downloads

Diagnosis, Tests, and Relapse Prevention.

The Ross Lyme Support Protocol is a set of Lyme disease treatment guidelines. Read or watch the following articles found on Treat Lyme for information about diagnosis, tests, and relapse prevention.

Diagnosis

Tests

Relapse Prevention

Before Treating Lyme Disease

Make Sure It Is Not Mold Toxin Illness.

Mold toxin illness can look just like Lyme disease. Both trigger a reaction in the immune system that produces too many inflammation chemicals called cytokines, and cytokines cause most of the problems seen in both of these illnesses.

If your illness began while you were living or working in a building with obvious mold, I suggest treating for mold toxin illness first. I find correcting this issue may prevent the need to treat for Lyme disease. Once the mold toxins are removed, the immune system can keep Lyme under control. For more information, read Mold and Lyme Toxin Illness and Positive Lyme Test, No Symptoms, Don't Treat.

Very Allergic? Treat Mast Cell Activation Syndrome.

Chronic infections can trigger excessive allergic reactions to food, prescription and natural medicines, and to the environment. If this is your problem, consider using supplements, diet, and medicines for Mast Cell Activation Syndrome. For more information, read Mast Cell Activation Syndrome & Lyme.

Part 1. Sleep

Use either natural medicines that support sleep or prescription medicines. Do not mix natural medicines and prescription medicines together as a first treatment, though you can do so later.

Treatments

Natural medicines:

(You can take these two herbal medicines together or use in combination with the prescription medicines, if needed.)

  • L-Theanine 100 mg 1 to 6 pills a night 1 hour before bed. Do not exceed 1,200 mg a day if using for nerve pain or anxiety during the day, as well. Excessive amounts in the day are very sedating. and/or
  • Herbal Combination 1 to 4 pills 1 hour before bed. (Common herbs in sleep combination pills include valerian root, hops, yams, wild lettuce, L-Theanine, and others. For instance, these herbs are found in a product by Enzymatic Therapy called the Revitalizing Sleep Formula.)

Prescription medicines:

  • Zolpidem (Ambien) 10 mg 1 pill 30 minutes before bed. (Use if your primary problem is getting to sleep. It is short-acting.) and/or
  • Trazodone 50 mg 1/2 to 2 pills 30 minutes before bedtime. (Use this if your primary problem is staying asleep.)

For more information about these items or for additional options about sleep hygiene, see Sleep in Lyme Disease: The Basic Steps. For information about sleep herbs and supplements, see Sleep: The Natural Medicines.  For more information and sleep prescriptions options, see Sleep: The Prescription Medicines.

Why These Treatments May Help

Sleep is often disturbed in chronic Lyme disease. Lack of adequate sleep worsens pain, increases fatigue, and suppresses the immune system. It appears that in response to infection, the excess inflammatory cytokines produced by the immune system decrease the output of sleep inducing hormones to the sleep centers of the brain. And lack of sleep increases cytokines. A restorative amount of sleep is seven to nine hours of sleep per night. Sleep in the few hours before midnight is most restorative.

Part 2. Diet

Treatments

Eat a Paleo-based diet rich in organic foods, healthy fats, proteins, and vitamin rich vegetables. For more detailed information about the diet, see The Best Brain, Inflammation, Pain, Energy & Detox Diet Ever.

An elimination diet is another diet to consider starting. For detailed information, see Elimination Diet to Find Food Problems.

Why These Treatments May Help

A Paleo diet is low in simple sugars, which decreases the chances of developing intestinal yeast. It also promotes brain health and supports the energy factories—called mitochondria—found in every cell. Because it is low in sugar, it may decrease inflammation.

An elimination diet helps a person find which foods that trigger allergies or inflammation reactions. If you are reacting to foods, consider trying an elimination diet first. Removing allergic and inflammatory foods from your diet leads to decreased pain and improved energy.

Part 3. Cytokine Control

Treatments

Natural medicines:

  • Curcumin 500 mg 1 pill 3 times a day. Choose a liposomal product. In such a product, the curcumin is microscopically wrapped in oil like sunflower oil to increase its absorption. or
  • Anti-Cytokine Combination 1-2 pills 3 times a day.  Anti-cytokine combinations include curcumin, resveratrol, black tea extract, and N-Acetyl Cysteine (NAC). One product that contains these items is CytoQuel by Researched Nutritionals.

Prescription medicines:

There are no effective and safe options.

Why These Treatments May Help

Cytokines are inflammatory chemicals made by the immune system in chronic Lyme disease. Nutritional supports like curcumin, resveratrol, black tea extract, NAC, and antioxidants found in a good multivitamin (see Part 6.) may lower cytokines. This can

  • correct many Lyme symptoms,
  • boost the immune system, and
  • limit Herxheimer die-off reactions.

On the one hand, cytokines are good because they turn on the immune system. They perform a number of functions that include:

  • making antibodies work more effectively,
  • increasing active white blood cells to fight infections,
  • recruiting white blood cells to the location of an infection,
  • turning on white blood cells to fight infections, and
  • decreasing viral and bacterial replication.

On the other hand, in chronic Lyme disease the immune system makes too many cytokines, which is bad. Too many cytokines

  • suppress 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.

At the beginning of treatment or when antibiotics are changed, the cytokines are made in even greater amounts, which causes a person to feel much worse. This is called a Herxheimer dieoff reaction.

See Control Cytokines: A Guide to Fix Lyme Symptoms & The Immune System for more information and additional herbal medicine options to use in a Lyme disease treatment.

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Part 4. Adaptogen

Treatment

Natural medicine:

  • Ashwagandha 400 mg 1 to 2 pills in the morning and 1 to 2 pills between 12 pm. Taking ashwagandha late in the day may disturb sleep.

Why This Treatment May Help

An adaptogen is a substance that helps the body deal with the harmful medical and emotional stress of being ill. Adaptogens have been used for centuries in Ayurvedic and Chinese medicine with greatly observed benefits. Based on animal experiments, ashwagandha may improve energy, immune function, and adrenal and thyroid function. It likely has additional beneficial effects that have not been researched.

Part 5. Hormones

Read the "Why These Treatments May Help" section below to determine, based on symptoms alone, if you could have low hormones.

Treatments

Adrenal Insufficiency

Start with the natural medicine or prescription medicine. It is possible to use both together if the symptoms of low adrenals persist.

Natural medicine:

  • Ashwagandha 400 mg 1-2 pills in the morning and 1 to 2 pills between 1-2 pm. Taking late in the day may disturb sleep.

Prescription medicine:

In my practice, I rarely used this because there is a very small risk of immune suppression using prescription hydrocortisone. However, the doses I recommend are the normal amounts the adrenal glands should make. I prefer ashwagandha because it is a supportive herb that does not suppress the immune system.

  • Cortef 5 mg 1 to 2 pills in the morning and 1 to 2 pills between 12 pm. Taking late in the day may disturb sleep.

Low Thyroid

Natural medicines:

  • Ashwagandha 400 mg 1 to 2 pills in the morning and 1 to 2 pills between 1-2 pm. Taking late in the day may disturb sleep. Also use with
  • Zinc 20 mg, Selenium 100 to 200 mcg, and Iodine 200 to 300 mcg 1 time a day. (These are often found in multivitamins or you can supplement them individually.)

Use these natural medicines first for one to two months before adding or trying the prescription medicine option below. Often, working with these supplements corrects the thyroid so you do not need to take thyroid prescription medicines.

Prescription medicines:

  • Desiccated Thyroid 1⁄2 grain or Armour Thyroid 1⁄2 grain 1 pill in the morning 30 minutes before anything else and on an empty stomach with water only. Increase every 3 to 4 weeks by 1⁄2 grain if low thyroid symptoms persist.

For more information about how to manage thyroid, even if your tests are normal, read my comprehensive article: Hypothyroidism. The Best Tests, Meds, & Vitamins.

Why These Treatments May Help

Fixing low adrenals and/or low thyroid can help the immune system work better and possibly improves energy. A person could have normal range testing for each of the hormones, but still have clinically low hormones. Because of the unreliability of testing, treatment for low hormones should occur if there are clinical symptoms of low hormones as long as treatment does not increase hormone levels above the upper end of normal.

Diagnose Based on Symptoms

If you have a number of these symptoms, consider using the natural medicine approaches for each respective problem.

Adrenal Insufficiency: fatigue, recurrent infections, poor recovery from infections, low blood sugar with shakiness and irritability relieved by eating, low blood pressure and dizziness on standing, afternoon crashing, and sugar cravings.

Low thyroid: fatigue, achiness, dry skin, cold intolerance, weight gain, constipation, and changes in menstrual periods.

Part 6. Essential Micronutrients

Treatment

Natural medicine:

  • Multivitamin. Use a vitamin that has numerous amino acids, antioxidants, minerals, and various vitamin Bs, including B12 and folate. I prefer powders by Thorne and Integrative Therapeutics and capsules by Researched Nutritionals.

Why This Treatment May Help

In my opinion, to heal and feel better requires a multivitamin with an essential set of vitamins, minerals, amino acids, and antioxidants. A good multivitamin can improve functioning of the immune system, muscles, brain and nerves, hormones, organs including the kidney and liver, and detoxification, in addition to decreasing inflammation. It also may protect the body from the toxic effect of prescriptive antibiotics.

Part 7. Detoxification

Treatments

Reduce the total load of negative environmental influences on your health by

  • eating organic foods,
  • avoiding gluten, scents, alcohol, and tobacco, and
  • decreasing emotional stress.

Natural Medicine:

Support Liver detoxification.

  • Liposomal Glutathione 400 to 500 mg 1 pill 1 time a day. Glutathione is the master detox chemical used by the liver to remove toxins. It also helps remove neurotoxins and repair brain tissue. It works better than other herbal options like Pinella or Burbur. Read more in Glutathione: The Great Fixer.
  • Detox Diet: Drink water regularly to support kidney detoxification. A general rule of thumb is to drink half of your ideal body weight (measured in pounds) as ounces of non-caffeinated liquids a day. For example, a person with a 150-pound ideal body weight should drink 75 ounces a day of non-caffeinated liquid. Eat healthy vegetables and a limited number of fruits a day for vitamins and for fiber. Fiber binds toxins in the intestines and promotes their removal from the body through regular bowel movements.

See Lyme Detoxification 101: The Basics for more detailed information.

Why These Treatments May Help

Lyme produces toxins that lead to inflammation from cytokines. This suppresses the immune system and gives many of the Lyme symptoms. In addition, many of the natural and prescription medicines can have toxic effects. These detoxification steps may protect against and fix toxin issues.

Part 8. Exercise

Treatment

Exercise to tolerance. Find a level you can do that does not make you worse the next day. This may mean you can only walk half a block at the beginning. Furthermore, over exercise—an amount that makes a person feel worse—may suppress the immune system and impair healing. Be careful. At the beginning of treatment, you may have to wait to begin exercise until you have some improvements.

Why This Treatment May Help

Exercise improves blood flow to all tissues. This improves the penetration of antibiotics and helps with detox. Exercise also releases various chemicals like endorphins and enkephalins that produce healing effects and improve immune function.

Part 9. Immune System Boosters

The entire Ross Lyme Support Protocol is designed to support and boost your immune system. Because of this, most people do not need to take specific immune system boosters. The Ross Lyme Support Protocol supports the immune system through:

  • sleeping
  • lowering cytokines
  • detoxing
  • using an adaptogen
  • fixing hormonal problems
  • killing Lyme, yeast, and coinfections
  • exercising as tolerated and
  • eating a Paleo or elimination diet to fix immune system dysfunction.

In addition to these steps, there are additional supplements you can take. To read more about these options, see How to Boost the Immune System in Lyme. I do not recommend these additional supplements at first. Consider adding them six to nine months into treatment or during antibiotic holiday periods.

Part 10. Yeast

Read “Why These Treatments May Help” below to determine if you may have a current intestinal yeast overgrowth problem requiring treatment.

Treatments

Prevention or Treatment

  • For yeast overgrowth prevention, use probiotics and antifungals in A & B.
  • For current intestinal yeast overgrowth treatment use probiotics and antifungals in A & C.

A. PROBIOTICS: REQUIRED FOR YEAST PREVENTION OR TREATMENT

Natural medicine:

  • Probiotic. Use a product shown to repopulate the intestines in scientific studies. Take at least 5-10 billion live cultures one hour away from antibiotics. During an active yeast infection, consider increasing to 20 billion cultures one time a day or divided into two doses.

B. ANTIFUNGALS FOR PREVENTION:

Use either the natural medicine or prescription medicine. You do not need to use both together.

Natural medicine:

  • Herbal Combination 2 pills 2 times a day. Common herbs found individually or mixed together include: Pau D'arco, caprylic acid, rosemary oil, thyme oil, garlic, and grapefruit seed extract. You can find these herbs in products like Phytostan by Integrative Therapeutics and CapriPlus by Karuna.

Prescription medicine:

  • Nystatin 500,000 IU 2 pills 2 times a day.

C. ANTIFUNGALS FOR TREATMENT:

Do this if you have a yeast screening score of 140 or higher (see below). When you complete treatment, then start yeast prevention antifungals as above. Use the natural medicine or prescription medicine option, but not both together.

Natural medicine:

  • Herbal Combination. 2 pills 2 times a day. Common herbs found individually or mixed together include: Pau D'arco, caprylic acid, rosemary oil, thyme oil, garlic, and grapefruit seed extract. You can find these herbs in products like Phytostan by Integrative Therapeutics and CapriPlus by Karuna. This will take 3 to 4 months to get yeast overgrowth under control.

Prescription medicine:

Use both of the following together.

  • Nystatin 500,000 IU 2 pills 2 times a day, and
  • Fluconazole (Diflucan) 200 mg 1 time daily for 30 days. Use in combination with nystatin to prevent drug resistance. This combination will take 30 days to get yeast under control.

Additional Options:

Some have great difficulty getting rid of intestinal yeast overgrowth. See Kills Yeast: A Brief Guide for more herbal and prescription medicine options.

Why These Treatments May Help

Too many yeasts in the intestines (yeast overgrowth) is a common problem that occurs in those with chronic Lyme disease either during or prior to beginning Lyme disease treatment.

Antibiotics used to treat Lyme can lead to too many yeasts. Immune suppression prior to starting antibiotics can also cause yeast overgrowth. Yeast overgrowth can result in an ongoing systemic allergic reaction to the yeast that can suppress the immune system. Yeast overgrowth also leads to inflammatory cytokine excess that causes many of the Lyme disease symptoms and pain. Food allergies and sensitivities can be the result of yeast overgrowth, too.

A useful diagnostic blood test or stool test for yeast overgrowth does not exist. While some physicians may test for antibodies to intestinal yeast in the blood, antibodies are common even when yeasts are in balance. In addition, it is normal to have stool cultures grow yeast; so, a culture does not indicate if yeasts are in excess. For this reason, yeast is diagnosed using my yeast screening questionnaire. This questionnaire evaluates for the possibility of yeast overgrowth based on yeast overgrowth risk factors and intensity of symptoms. In general, I find people benefit from treatment if the score is 140 or higher.

At the beginning of a Lyme disease treatment, often before antibiotics are started, it is essential to treat yeast. Doing so can limit the severity of Herxheimer die-off reactions from treating Lyme because removing yeast removes one source of inflammatory cytokine excess.

Part 11. Lyme Infection Treatment

“Based on my experience, these natural medicine and prescription medicine options have equal chances of helping a person. The chance they will help is 85 to 90 percent over a six-month period of time.” Marty Ross, MD

Treatments

Natural medicines:

  • Otoba Bark Extract and Cat’s Claw. 5 drops 2 times a day of each herb, increasing the dosing every 2 days by 1 drop per dose until taking 30 drops 2 times a day. Take on an empty stomach. Do not take 30 minutes before through 2 hours after having food, medicines, or supplements. If you get a Herxheimer die-off reaction do not advance the dose until it decreases.

OR

Prescription medicines (and Grapefruit Seed Extract herbal medicine):

I generally start with oral antibiotics. For considerations about IV antibiotics, see A Lyme Disease Antibiotic Guide.

  • Doxycycline 100 mg 2 pills 2 times a day or 4 pills 1 time a day. Take with food to prevent nausea. Do not take with calcium supplements or calcium-fortified dairy products like milk, cheese, or milk substitutes like rice milk. OR
  • Clarithromycin (Biaxin) 500 mg 1 pill 2 times a day. Use doxycycline if you have an Anaplasma or Ehrlichia coinfection.

TAKE WITH

  • Rifampin 300 mg 2 pills 1 time a day OR
  • Tinidazole 500 mg 2 or 3 times a day OR
  • Grapefruit Seed Extract 250 mg 1 pill 2 times a day.

For many more Lyme herbal and prescription antibiotic options, see A Lyme Disease Antibiotic Guide.

Why These Treatments May Help

Lyme exists in different forms (spirochete and microscopic cyst) and lives in and out of cells. A Lyme disease treatment should treat all forms and places where the germ lives at the same time.

Otoba Bark Extract and Cat’s Claw are nutritional supports that seem to treat all forms and locations. Because these herbs are dosed using drops, they can be more easily regulated to manage a die-off reaction by not increasing the dose until the reaction lessens. In my experience, any oral antibiotic combination works as well as the Otoba Bark Extract and Cat’s Claw combination, which is 85 to 90 percent of the time.

Doxycycline or clarithromycin treat the spirochete. They also treat Lyme in and out of cells. Rifampin, tinidazole, and grapefruit seed extract treat the cyst form.

Part 12. Coinfection Treatments

Treatments

Do not start treatments for the Bartonella or Babesia coinfections at the initial visit. Wait one month or longer to adjust to the Herxheimer die-off reaction from treating the Lyme infection and to stabilize on the supportive supplements.

If you have both of these coinfections, treat one first before adding a treatment for the other. When both are present, my preference is to treat for Bartonella first for two to three months and then add treatment for Babesia. Treat these coinfections at the same time you treat the Lyme infection.

Natural Medicines:

Bartonella

In my experience, these nutritional supports work 70 to 75 percent of the time and take four to six months. If you do not have improvement in Bartonella symptoms by two months, then change to prescription medicines. Any of my recommended prescription medicine options work about 80 to 85 percent of the time.

  • Houttuynia 5 drops 2 times a day of each herb and increase the dosing every 2 days by 1 drop per dose until taking 30 drops 2 times a day. Take on an empty stomach. Do not take 30 minutes before through 2 hours after having food, medicines, or supplements. AND
  • Sida Acuta 1/4 tsp 3 times a day for 1 week, then increase to 1/2 tsp 3 times a day. It is best to take this without food. It can be taken at the same time as the Houttuynia.

Babesia

In my experience, these nutritional supports work 75 to 80 percent of the time and take four to five months. If you do not have improvement in Babesia symptoms by two months, then change to prescription medicines. Any of my recommended prescription options works about 80 to 85 percent of the time.

  • Cryptolepis 5 ml 3 times a day. AND/OR
  • Artemisinin 100 mg 2 or 3 pills 2 times a day for 3 days on the medication then take 11 days off. Continue this 14-day cycle. The goal is to reach 5 pills 3 times a day on the 3 days the medication is taken. I use artemisinin this way because the intestines develop an enzyme that destroys this herbal medicine if it is used longer than three days. Be aware the dose on the 3 days is quite strong. Often it causes a worsening of the Babesia symptoms beginning on the second day and sometimes lasting until six days later. If a person is very medicine sensitive I start at 1 or 2 pills 3 times a day. Artemisinin often does not work well for Babesia from tick bites on the East Coast of the U.S.

Prescription Medicines:

See Kills Bartonella: A Brief Guide and/or Kills Babesia: A Brief Guide for prescription approaches you can take to treat these infections.

Why These Treatments May Help

Based on my experience, a person will not recover from Lyme if these two Lyme coinfections are not treated when they are present. It is as though they protect Lyme. Conversely, Lyme seems to protect them, as well, which is why it takes months to get rid of these infections.

Part 13. Additional Natural Medicines

Many other natural medicines help manage symptoms and problems existing in Lyme disease. Wait one month after beginning a Lyme disease treatment to start these. For additional treatment ideas based on your specific medical problems, see articles in the following medical problem chapters. For instance, if you have severe brain fog or numbness, find helpful articles in the Brain & Nerves chapter.

Part 14. Special Considerations

Persister Lyme Infection Regimen

New research shows that Lyme can develop persisters. These are germ forms that go into hibernation and can ignore antibiotics. This condition can occur after someone is on antibiotics for some time. If you have tried antibiotics before and not gotten better, or if you are a year or more into treatment and not seeing good improvements, consider a persister Lyme regimen. For more information, read How to Treat Persister Lyme. What Works?  

If You Are Becoming More Allergic With Treatment

Chronic infections can trigger excessive allergic reactions to food, prescription and natural medicines, and to the environment. If this is your problem, consider using supplements, diet, and medicines for Mast Cell Activation Syndrome. For more information, read Mast Cell Activation Syndrome & Lyme.

Three Months

My experience in chronic Lyme disease treatment shows that by three months of treatment, 30 percent of people have improvement. Generally, these people have an easier chance recovering from Lyme disease with traditional herbal and prescription antibiotic combinations. For those that are not having significant changes by three months, then adding Biocidin could help. Based on lab experiments, various herbs in Biocidin may break down biofilms and decrease antibiotic resistance by blocking efflux pumps that remove antibiotics from germs. Read more in Biocidin: A Potent Antimicrobial & Biofilm Breaker.

Biocidin LSF. Start at 1 pump under the tongue 1 time a day. Every 2 days increase by 1 pump first as 1 pump 2 times a day, then 1 pump 3 times a day, and eventually to 2 pumps 3 times a day. If you develop a Herxheimer die-off reaction, do not increase until it passes. For sensitive people, place 1 pump in 5 ounces of water. Start with 1 ounce 1 time a day. Increase by 1 ounce a day increasing gradually at first to 1 ounce 3 times a day. Eventually, as tolerated, work up to 10 ounces (2 pumps) 3 times a day.

Six Months and Beyond

There are additional treatment steps to consider by six to nine months of Lyme disease treatment if you are not having adequate improvement. Read these articles online at Treat Lyme (treatlyme.net) for more information.

Detoxification

Biofilms

Chronic viral infections

Boost energy, fix mitochondria cell energy factories

Co-infections

Continually review your symptoms to see if you have a coinfection that was missed. Treating Lyme is like peeling the layers of an onion. As you treat, it sometimes becomes more apparent which coinfections are present. In addition, it is possible to have coinfection relapses.

Autoimmune illness and chronic Inflammation

Yeast

If you have a number of these symptoms—such as increased sugar cravings, intestinal gassiness or bloating, recent vaginal yeast infection, oral yeast, and/or vaginal or rectal itching—consider treating for yeast overgrowth in the intestines.

Part 15. Health Decline after Doing Better

It is common to have ups and downs during a Lyme disease treatment. In some cases, there can be a significant decline after a person is doing better. In these cases, consider yeast overgrowth of the intestines or relapse of a Bartonella or Babesia coinfection. In my experience, most major health declines are due to yeast overgrowth in the intestines. This is true even if significant symptoms of yeast do not exist.

Excessive yeast in the intestines lead to increased levels of cytokines. Because excess cytokines cause many of the chronic Lyme disease symptoms, it could seem like your Lyme disease is getting worse.

Yeast could be the cause of your decline if you have a number of these symptoms: increased sugar cravings, intestinal gassiness or bloating, recent vaginal yeast infection, oral yeast, and/or vaginal or rectal itching. For information on diagnosing yeast, see A Silent Problem: Do You Have Yeast? For yeast treatment information, see Kills Yeast: A Brief Guide.

References

View Citations

Mold Toxin Illness:

  1. Brewer JH et al., Detection of Mycotoxins in Patients with Chronic Fatigue Syndrome. Toxins 2013, 5, 605-617; doi:10.3390/toxins5040605.
  2. Nathan, Neil (2016). Mold and Mycotoxins: Current Evaluation and Treatment 2016. Pennsauken, NJ: BookBaby.
  3. Shoemaker, Ritchie (2005). Mold Warriors. Baltimore MD: Gateway Press.
  4. Shoemaker, Ritchie (2010). Surviving Mold. Baltimore, MD: Otter Bay Books.
  5. Shoemaker, Ritchie. Mold Illness & the Surviving Mold Official Book. http://www.survivingmold.com/

Mast Cell Activation Syndrome:

  1. Theoharides, T. (2016). Mast Cell Activation. Lecture presented at ILADS annual meeting, Philadelphia.
  2. Theoharides, T., Valent, P., Akin, C., Mast Cells, Mastocytosis, and Related Disorders. N Engl J Med,373;2, 163-172.
  3. Talkington, J., & Nickell, S. P. (1999). Borrelia burgdorferi Spirochetes Induce Mast Cell  Activation and Cytokine Release. Infection and Immunity, 67(3), 1107–1115.

Sleep:

  1. Krysta K, Krzystanek M, Bratek A, Krupka-Matuszczyk I. Sleep and inflammatory markers in different psychiatric disorders. J Neural Transm (Vienna). 2017;124(Suppl 1):179–186. doi:10.1007/s00702-015-1492-3
  2. Lu K,  Gray MA,  Oliver C,  Liley DT,  Harrison BJ, Bartholomeus CF, Phan K L,  Nathan PJ. The acute effects of L‐theanine in comparison with alprazolam on anticipatory anxiety in humans. Hum. Psychopharmacol. Clin. Exp. 2004;19:457-465. doi:10.1002/hup.611
  3. Lyon MR, Kapoor MP, Juneja LR. The effects of L-theanine (Suntheanine(R)) on objective sleep quality in boys with attention deficit hyperactivity disorder (ADHD): a randomized, double-blind, placebo-controlled clinical trial. Altern. Med. Rev. 2011;16(4):348–354.
  4. Liu L, Liu C, Wang Y, Wang P, Li Y, Li B. Herbal Medicine for Anxiety, Depression and Insomnia. Curr Neuropharmacol. 2015;13(4):481–493. doi:10.2174/1570159X130415083112273.
  5. Gooneratne NS. Complementary and alternative medicine for sleep disturbances in older adults. Clin Geriatr Med. 2008;24(1):121–viii. doi:10.1016/j.cger.2007.08.002
  6. Romero K, Goparaju B, Russo K, Westover MB, Bianchi MT. Alternative remedies for insomnia: a proposed method for personalized therapeutic trials. Nat Sci Sleep. 2017;9:97–108. Published 2017 Mar 17. doi:10.2147/NSS.S128095
  7. Buysse DJ. Insomnia. JAMA. 2013;309(7):706–716. doi:10.1001/jama.2013.193
  8. Proctor A, Bianchi MT. Clinical pharmacology in sleep medicine. ISRN Pharmacol. ;2012:914168. doi:10.5402/2012/914168

Diet:

See the references sections for The Best Brain, Inflammation, Pain, Energy & Detox Diet Ever and Elimination Diet to Find Food Problems.

Cytokines:

  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;390:191–214. doi:10.1515/BC.2009.033.
  2. Bocci V, Valacchi G. Nrf2 activation as target to implement therapeutic treatments. Frontiers in Chemistry. 2015;3:4. doi:10.3389/fchem.2015.00004.
  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. 96:46–52. 10.4269/ajtmh.16-0434
  4. D’Andrea G. Quercetin: a flavonol with multifaceted therapeutic applications? Fitoterapia. 2015;106:256–71.
  5. Gulcubuk 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.
  6. Krysta K, Krzystanek M, Bratek A, Krupka-Matuszczyk I. Sleep and inflammatory markers in different psychiatric disorders. Journal of Neural Transmission. 2017;124(Suppl 1):179-186. doi:10.1007/s00702-015-1492-3.
  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.
  8. Linus Pauling Institute, Oregon State University. Curcumin. Micronutrient Information Center; Phytochemicals website. lpi.oregonstate.edu/mic/dietary-factors/phytochemicals/curcumin Accessed August 18, 2018.
  9. Lu SC. Glutathione synthesis. Biochimica et biophysica acta. 2013;1830:3143-3153
  10. Pall M. Approaches to curing chronic fatigue syndrome/myalgic encephalomyelitis, fibromyalgia, multiple chemical sensitivity, gulf war syndrom, and possibley many others. Townsend Letter. 2010 (Feb/March) www.townsendletter.com/FebMarch2010/cureNO0210.html Accessed August 19, 2018
  11. Peacock BN, Gherezghiher TB, Hilario JD. et al. New insights into Lyme disease. Redox Biol. 2015;5:66–70. doi.org/10.1016/j.redox.2015.03.002.
  12. Pizzorno J. Glutathione! Integrative Medicine: A Clinician’s Journal. 2014;13(1):8-12.
  13. Pound MW, May DB. Proposed mechanisms and preventative options of Jarisch-Herxheimer reactions. J. Clin. Pharm. Ther. 2005;30:291–295. 10.1111/j.1365-2710.2005.00631.x
  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.
  15. Sinha R, Sinha L, Calcagnotto A, Trushin N, Haley JS, Schell TD, Richie Jr JP. Oral supplementation with liposomal glutathione elevates body stores of glutathione and markers of immune function. European Journal of Clinical Nutrition. 2018;72:105–111.
  16. Strle K , Drouin EE, Shen S, El Khoury J, McHugh G, Ruzic-Sabljic E, Strle F, Steere AC. Borrelia burgdorferi stimulates macrophages to secrete higher levels of cytokines and chemokines than Borrelia afzelii or Borrelia garinii. The Journal of Infectious Diseases. 2009;200(12):1936–1943, doi.org/10.1086/648091
  17. Strle K, Sulka KB, Pianta A, Crowley JT, Arvikar SL, Anselmo A, Sadreyev R, Steere, AC. 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 srthritis, Clinical Infectious Diseases. 2017;64(7):930–938. doi.org/10.1093/cid/cix002
  18. Zhao F, Gong Y, Hu Y, Lu, M, Wang J, Dong J, Qiu F. Curcumin and its major metabolites inhibit the inflammatory response induced by lipopolysaccharide: Translocation of nuclear factor-κB as potential target. Molecular Medicine Reports. 2015;11:3087-3093. doi.org/10.3892/mmr.2014.3079

Adaptogen:

  1. Mishra L, Singh B, Dagenais S. Scientific Basis for the Therapeutic Use of Withania somnifera (Ashwagandha): A Review. Altern Med Rev 2000;5(4) 334-346.
  2. Liao LY, He YF, Li L, et al. A preliminary review of studies on adaptogens: comparison of their bioactivity in TCM with that of ginseng-like herbs used worldwide. Chin Med. 2018;13:57. Published 2018 Nov 16. doi:10.1186/s13020-018-0214-9

Hormones:

  1. Mishra L, Singh B, Dagenais S. Scientific Basis for the Therapeutic Use of Withania somnifera (Ashwagandha): A Review. Altern Med Rev 2000;5(4) 334-346.
  2. Liao LY, He YF, Li L, et al. A preliminary review of studies on adaptogens: comparison of their bioactivity in TCM with that of ginseng-like herbs used worldwide. Chin Med. 2018;13:57. Published 2018 Nov 16. doi:10.1186/s13020-018-0214-9
  3. Jefferies, W. (2004). Safe uses of cortisol. Springfield, Ill.: Charles C. Thomas.
  4. Wiersinga WM, Duntas L, Fadeyev V, Nygaard B, Vanderpump MPJ. 2012 ETA guidelines: the use of l-t4 + l-t3 in the treatment of hypothyroidism. Eur Thyroid J 2012;1:55-71.
  5. Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, Cooper DS, Kim BW, Peeters RP, Rosenthal MS, Sawka AM. Guidelines for the Treatment of Hypothyroidism. Prepared by the American Thyroid Association Taskforce on Thyroid Hormone Replacement. Thyroid 2014;24(12):1670-1751.
  6. Canaris GJ, Steiner J, Ridgway C. Do Traditional Symptoms of Hypothyroidism Correlate with Biochemical Disease? J Gen Intern Med 1997;12:544-550.
  7. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanik JI, Pessah-Pollack R, Singer PA, Woeber KA. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012;18(6):988-1028.
  8. Burch HB, Burman KD, Cooper DS, Hennessey JV. A 2013 survey of clinical practice patterns in the management of primary hypothyroidism. J Clin Endocrinol Metab 99: 2077-2085.
  9. Kelly G. Peripheral metabolism of thyroid hormones: a review. Alt Med Review 2000;5(4):306-333.
  10. Bianco AC, Kim BW: Deiodinase: implications of the local control of thyroid hormone action. J Clin Invest 2006;116:2571-2579.
  11. Shoemaker R. “The Biotoxin Pathway.” The Biotoxin Pathway | Surviving Mold, www.survivingmold.com/diagnosis/the-biotoxin-pathway.
  12. Riedel W, et al. Secretory pattern of GH, TSH, thyroid hormones, ACTH, cortisol, FSH, and LH in patients with fibromyalgia syndrome following systemic injection of the relevant hypothalamic-releasing hormones. Z Rheumatol. 1998;57 Suppl 2:81-7.
  13. Lukaczer D. Advanced assessment and treatment of thyroid dysfunction. Oral presentation at: The Institute for Functional Medicine Hormone Advanced Practice Module; July, 2017; Chicago, IL.
  14. Hoang TD, Olsen CH, Mai VQ, Clyde PW, Shakir MK, Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study. J Clin Endocrinol. 2013 May;98(5):1982-90.
  15. Toulis KA Anastasilakis AD, Tzellos TG, Goulis DG, Kouvelas D. Selenium supplementation in the treatment of Hashimoto’s thyroiditis: a systematic review and a meta-analysis. Thyroid 2010 Oct;20(10):1163-73.
  16. Van Zuuren EJ, Albusta AY, Fedorowicz Z, Carter B, Pijl H. Selenium supplementation for Hashimoto’s thyroiditis: summary of a Cochrane systematic review. Eur Thyroid J 2014;3:25–31.
  17. Roy S, Loh HH, Effects of opioids on the immune system. Neurochem Res 1996;21: 1375-1386.
  18. Risdahl JM, Khanna KV, Peterson PK, Molitor TW, Opiates and infection. J Neuroimmunol 1998;83:4-18.
  19. Younger, Jarred, et al. Low‐dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double‐blind, placebo‐controlled, counterbalanced, crossover trial assessing daily pain levels. Arthritis & Rheumatism 2013 Feb;65(2):529-38.
  20. Smith JP, et al. Low-dose naltrexone therapy improves active Crohn's disease. American Journal of Gastroenterology 2007;102(4):820-828.
  21. Bruce AC, et al. Pilot trial of low dose naltrexone and quality of life in MS. Annals of Neurology 2010 August;68(2):145–150.
  22. Howell JG, Staehling NW, Flanders WD, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2022: 489-499.
  23. Kratzsch J, Fiedler GM, Leichtle A, et al. New reference intervals for thyrotropin and thyroid hormones based on National Academy of Clinical Biochemistry criteria and regular ultrasonography of the thyroid. Clin Chem. 2005 51:1480-1486.
  24. Biondi B. The normal TSH reference range: what has changed in the last decade? J Clin Endocrinol Metab, September 2013, 98(9): 3584-3587.
  25. Flynn, RW, SR Bonellie, RT Jun, et al. Serum thyroid stimulating hormone concentration and morbidity from cardiovascular disease and fractures in patients on long-term thyroxine therapy. J Clin Endocrinol Metab 2010;95:1.
  26. Andersen S, Pedersen KM, Gruun NH, Laurberg P. Narrow individual variations in serum T4 and T3 in normal subjects: a clue to the understanding of subclinical thyroid disease.J Clin Endocrinol Metab. 2002 Mar;87(3):1068-72.
  27. Gaby AR. “Sub-laboratory” hypothyroidism and the empirical use of armour thyroid. Alt Med Review 2004 (9)2:157-179.
  28. Caturegli P, De Remigis A, Chuang K, Dembele M, Iwama S. Hashimoto’s thyroiditis: celebrating the centennial through the lens of the Johns Hopkins hospital surgical pathology records. Thyroid 2013. Feb; 23(2):145-50.
  29. Canaris GJ, Steiner J, Ridgway C. Do Traditional Symptoms of Hypothyroidism Correlate with Biochemical Disease? J Gen Intern Med 1997;12:544-550.

Essential Micronutrients:

  1. Teitelbaum, J. Chapter 6: "N" — Nutritional Support, the Building Blocks of Good Health. In: From Fatigued to Fantastic!. 3rd ed. New York, NY: Penguin; 2007.

Detoxification:

  1. Pizzorno, J. The Toxin Solution: How Hidden Poisons in the Air, Water, Food, and Products We Use Are Destroying Our Health--AND WHAT WE CAN DO TO FIX IT. New York, NY: HarperCollins; 2017.
  2. Pizzorno J. Glutathione! Integrative Medicine: A Clinician’s Journal. 2014;13(1):8-12.
  3. Sinha R, Sinha L, Calcagnotto A, Trushin N, Haley JS, Schell TD, Richie Jr JP. Oral supplementation with liposomal glutathione elevates body stores of glutathione and markers of immune function. European Journal of Clinical Nutrition. 2018;72:105–111.

Exercise:

  1. Larun L, Brurberg KG, Odgaard-Jensen J, Price JR. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2017;4(4):CD003200. Published 2017 Apr 25. doi:10.1002/14651858.CD003200.pub7
  2. Jones, D. (2010). Textbook of functional medicine. Gig Harbor, WA.: Institute for Functional Medicine.

Immune System Boosters:

  1. Myers, A. The Autoimmune Solution: Prevent and Reverse the Full Spectrum of Inflammatory Symptoms and Diseases. New York, NY. HarpperOne; 2015
  2. Jones, D. (2010). Textbook of functional medicine. Gig Harbor, WA.: Institute for Functional Medicine.

Yeast:

  1. Kumamoto CA, Inflammation and Gastrointestinal Candida Colonization. Curr Opin Microbiol. 2011 August; 14(4): 386-391. Doi: 10.1016/j.mib.2011.07.015
  2. Bowe WP, Logan AC, Acne Vulgaris, Probiotics and The Gut-Brain-Skin Axis - Back to The Future?
  3. Olmstead S. et al. Candida, Fungal-Type Dysbiosis, and Chronic Disease: Exploring the Nature of the Yeast Connection. Townsend Letter, June, 2012 townsendletter.com/June2012/candida0612.html.

Lyme Infection Treatment:

  1. Buhner SH. Healing Lyme: Natural Healing of Lyme Borreliosis and the Coinfections Chlamydia and Spotted Fever Rickettsioses. 2nd ed. Silver City, NM: Raven Press; 2015.
  2. Cameron DJ, Johnson LB, Maloney EL. Evidence assessments and guidelines recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Rev Anti-Infect Ther. 2014;12:1103–1135. doi: 10.1586/14787210.2014.940900.
  3. Datar A, Kaur N, Patel S, Luecke D, Sapi E. In vitro effectiveness of samento and banderol herbal extracts on the different morphological forms of Borrelia burgdorferi. Townsend Lett. 2010;7: 1–4.
  4. Gilbert L. 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. 2016.
  5. Goc A, Rath M. The anti-Borreliae efficacy of phytochemicals and micronutrients: an update. Ther Adv Infect Dis. 2016;3(3-4):75–82. doi:10.1177/2049936116655502.
  6. Miklossy J, Kasas S, Zurn AD, McCall S, Yu S, McGeer PL. Persisting atypical and cystic forms of Borrelia burgdorferi and local inflammation in Lyme neuroborreliosis. J Neuroinflammation. 2008;5:40.
  7. Sapi E, Kaur N, Ananwu S, Luecke DF, Luecke DF, Datar A, Patel S, Rossi M, Stricker RB. Evaluation of in-vitro antibiotic susceptibility of different morphological forms of Borrelia burgdorferi. Infect Drug Resist. 2011;4:97–11.

Coinfections Treatment:

  1. Buhner SH. Healing Lyme Disease Coinfections: Complementary and Holistic Treatments for Bartonella and Mycoplasma. Rochester, VT: Healing Arts Press; 2013.
  2. Biswas S, Rolain J-M. Bartonella infection: treatment and drug resistance. Future Microbiol. 2010;5(11):1719-1731. doi:10.2217/fmb.10.133.
  3. Buhner SH. Natural Treatments for Lyme Coinfections: Anaplasma, Babesia, and Ehrlichia. Rochester, VT: Healing Arts Press; 2015.
  4. Vannier E, Gewurz BE, Krause PJ. Human Babesiosis. Infect Dis Clin North Am. 2008;22(3):469-ix. doi:10.1016/j.idc.2008.03.010.

Special Considerations:

Lyme Persisters

  1. Sharma B, Brown AV, Matluck NE, Hu LT, Lewis K. Borrelia burgdorferi, the causative agent of Lyme disease, forms drug-tolerant persister cells. Antimicrob Agents Chemother. 2016;59:4616–4624. doi:10.1128/AAC.00864-15.
  2. Feng J, Auwaerter PG, Zhang Y. Drug combinations against Borrelia burgdorferi persisters in vitro: eradication achieved by using daptomycin, cefoperazone and doxycycline. PLoS ONE. 10(3): e0117207. doi:10.1371/journal.pone.0117207.

Mast Cell Activation Syndrome

  1. Theoharides, T. (2016). Mast Cell Activation. Lecture presented at ILADS annual meeting, Philadelphia.
  2. Theoharides, T., Valent, P., Akin, C., Mast Cells, Mastocytosis, and Related Disorders. N Engl J Med,373;2, 163-172.
  3. Talkington, J., & Nickell, S. P. (1999). Borrelia burgdorferi Spirochetes Induce Mast Cell  Activation and Cytokine Release. Infection and Immunity, 67(3), 1107–1115.

Biocidin

  1. Gilbert, L. (2016). Preliminary Report on Activity of Biocidin against Borrelia Species (Rep.). University of Jyväskylä, Biological and Environmental Science Dept.
  2. 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.

Health Decline After Doing Better:

  1. Kumamoto CA, Inflammation and Gastrointestinal Candida Colonization. Curr Opin Microbiol. 2011 August; 14(4): 386-391. Doi: 10.1016/j.mib.2011.07.015
  2. Olmstead S. et al. Candida, Fungal-Type Dysbiosis, and Chronic Disease: Exploring the Nature of the Yeast Connection. Townsend Letter, June, 2012 townsendletter.com/June2012/candida0612.html.

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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 where he treated thousands of Lyme disease patients in his Seattle practice through late 2018. Marty is currently on sabbatical in Austin, TX. Dr. Ross plans to reopen his Seattle Lyme practice in early 2020.

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) and The Institute for Functional Medicine.

 

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