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Herbal Approach to the
Treatment of Lyme Disease
Dr. Emily Maiella
432 Greenfield Rd
Montague, MA
413.367.9350
The treatment of
Lyme has changed
• In 2006 I began going to ILADS conferences.
The attendance was not big, usually in just an
auditorium. There was never any
presentations regarding natural medicines
and the treatment of Lyme.
• This year, I attending my 7th ILADS
conference. Not only was the conference
enormous, reaching maximum capacity in at
least 4 big conference rooms, but there was
an entire “track” dedicated alternative
medicine. The treatment of Lyme has shifted.
Listen
Lyme disease is a highly variable and adaptive
organism. There is no one treatment that will work for
all patients. Every incidence is unique and the
practitioner must see the person in front of them.
Patients need individual attention so they can tell their
entire story from the beginning. There is information
in these stories that helps us to step outside the
medical model and approach each person as unique.
These conversations will help us to understand which
healing approach is right for the patient.
Evolution with Peaceful
Intentions
Treatment should always keep in mind that our
immune-system is in a never- ending training and
adaptation program. We are evolving. The same is
true for the microbes.
I truly believe that you can’t heal when fearful. I’m
here to help counter the dooms-day reports
My hope is that we can seek a peaceful inner state in which microbes are welcome as long as they
contribute to the greater whole. It is difficult to
understand Lyme disease in this way, but my hope
is that our unconscious and our immune-system
does/can.
Plant adaptogens have a great potential in helping us
in this necessary process of evolution.
We are Super Organisms!
• The evolutionary process has made become
a symbiote which contains over 3.3 pounds of
microbial mass in our gut, with over 10 trillion
cells that continuously interact with and
modify our genetic phenotype.
• The number of bacteria living within the body
of the average healthy adult human are
estimated to outnumber human cells, 10 to1.
We live in their world….
• 90% of us is bacterial DNA
• 10% of us is our own DNA
Layered Treatment model
The treatment of Lyme and co-infections is a layered process,
because as a patient moves through treatment, it is not
uncommon for the symptom picture and pathology to change.
•
•
•
•
Outer layer: What the immune system is currently challenged with.
Second Layer: The next dominant pathogen/pathology that will
manifest in a change in the symptomatic pattern
Third Layer: Weaker pathogen which will come forward next with a set
on milder symptoms.
Innermost Layer: Deepest layer that is probably related to your
genetic susceptibility.
Foundation Health
There are some foundational aspects of health that I
make sure that are addressed during (or even before)
treatment.
~sleep
~inflammation
~hormones (thyroid, adrenal and sex hormones)
~toxic exposure, including emotional/spiritual (ongoing and
past)
~diet
~immune system imbalance
INFLAMMATION
• Borellia uses specific mechanisms, primarily
inflammation, to breakdown the collagen tissues.
• It is where this breakdown occurs that determines where
the symptoms emerge. If it is in the joints, arthritis
presents. In the meninges, neurological Lyme is seen. In
the heart, Lyme carditis presents.
• Let’s talk cytokines. Cytokines are inflammation
chemicals made by the immune system in chronic
diseases. They cause most of the symptoms. At the
beginning of treatment when killing lyme spirochetes with
antimicrobials (or yeast with antifungals), cytokines are
made in even greater amounts, causing a person to feel
much worse. Curcumin/tumeric, bromelain, boswellia,
ginger and querectin are some great anti-inflammatories.
SLEEP
• 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 (melatonin) to the sleep
centers of the brain. Sleep in the few hours
before midnight is most restorative. There are
many options here.
Hormones
Low hormones occur often in chronic Lyme disease. Again,
cytokines, decrease the effective functioning of the
hypothalamus and pituitary (in your brain). This part of
the brain produces chemicals that induce sleep and that
regulate hormonal systems.
Normally this part of the brain releases messengers such
as thyroid stimulating hormone (TSH),
adrenocorticotropin hormone (ACTH), and follicle
stimulating hormone (FSH) to stimulate the thyroid,
adrenal glands, and sex hormone organs, respectively.
Hypothalamus, Pineal and
Pituitary
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Hormones Cont.
• A better way to check hormone status is to measure the actual
hormone levels like T4/T3 (thyroid), or cortisol/dhea (adrenals),
or estrogen/progesterone/testosterone (sex hormones).
• However, these tests give a broad range of normal, therefore 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.
Adrenals and Thyroid
~Adrenal Insufficiency: rule this out if you have 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. Natural
medicines include: Ashwagandha, schizandra, licorice,
rhodiola
~Low Thyroid: fatigue, achiness, low body temperatures,
cold intolerance, weight gain, constipation, changes in
menstrual periods. Can be confused with adrenal
insufficiency. Natural medicines: Lots of different options
here, just be aware of iodine content as too much can
make thyroid conditions worse.
Auto-immune imbalances
T cells and B cells from some patients with
chronic Lyme disease are reactive not only
against Borrelia burgdorferi-specific antigens
but also against various host (self) antigens.
This mimicry might generate autoimmune
inflammatory reactions that could be
responsible for arthritic as well as some
neurological symptoms associated with chronic
Lyme disease.
This happens with people that have specific HLA
genotypes (HLA-DR4 and 2)
Diet and Lifestyle choices
• This is going to be one of the most challenging journey that you
will embark on. There is a lot to be done on your part while the
medicines do their job. My regimen includes dietary changes
with emphasis on nutrient dense foods such as seeds, nuts,
free range eggs, balanced 4:1 omega 6 to omega 3 oil, organic
protein foods, and green leafy vegetables. I usually recommend
all grain/flour, sugar, processed foods, and hydrogenated fats to
be removed. Building a strong nutritional foundation is
paramount and is accomplished by raising the mineral base,
stabilizing the electrolytes, increasing and balancing the
essential fatty acid status.
• Minimizing aggravating factors: This is my toxic 50 gallon
barrel analogy. What have you put into your barrel over your
life? Time to get rid of it. Think toxic homes, toxic
relationships, heavy metal overload, gut dysbiosis, yeast over
growth and food allergies (to think of a few). A food allergy test
and a stool microbiology test is recommended prior to starting
treatment
Herbal protocol
Many options and protocols available. I tend to use Uncaria,
Andrographis, Smilax, Polygonum, Teasel, Stephania and
Guacucium. Dosage is highly variable. Some patients require a
few drops while others require tablespoons to achieve the full
effect. It is difficult for the spirochetes to develop immunity to
this type of an herbal regimen due to the complex constituents
of the herbs.
Herbs have the ability to address many aspects of dysfunction:
~They are anti-inflammatory which help to stop the breaking down
of collagen.
~They support the formation and strength of collagen in the body.
~They allow the doctor to design specific treatment interventions
for the unique symptom picture of the patient.
~Immune system modulators to correct immune dysfunction.
~ Anti-spirochetals to control infection. The use of antispirochetals continues to get lower and lower on the list as time
has gone on.
Polygonum cuspidatum
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Japanese Knotweed
The core herb for Lyme. An invasive botanical
in almost every place where Lyme has
emerged. Nature has a way of helping us but
we stopped listening a long time ago.
Japanese Knotweed shuts down the
inflammatory pathways initiated by the
spirochetes. It inhibits lipoxygenase,
prostaglandin E and NF kB, which are all upregulated in Lyme disease.
Japanese knotweed
• Knotweed crosses the blood brain barrier. It is
specific for inflammation in the meninges (stiff neck
and headaches)
• It is a potent antioxidant and has protective effects on
the brain. It calms the central nervous system and
helps with arthritis symptoms in Lyme disease.
• Knotweed is an herb and drug synergist meaning that
when it is used with antibiotics, it makes them
powerfully effective even in cases where they
previously failed. Take Japanese Knotweed along
with antibiotic therapy.
Japanese knotweed
• It modulates the immune system by either raising or lowering
immune function as required in each unique person (immune
modulating), thereby reducing the dynamics involved in
autoimmunity.
• It is an angiogenesis modulator and controls the healthy
generation of blood vessels. It stimulates microcirculation to the
eyes (due to it’s High content of resveratrol) and joints thus
helping to facilitate the movement of drugs or herbs to those
locations.
• It is cardioprotective and helps to remove endotoxins, which is a
benefit to those with Herxheimer reactions during treatment.
Other published functions of
knotweed
• Peer review literature (pubMed) Many gram neg and
gram pos bacteria, Anti-viral, Hepatitis B and C, many
types of cancer (esp hepatocelluar cancer),
cardiovascular disease, anti-inflammatory.
• Other published positive effects: antimicrobial, protects
against microbial endotoxins, Lowers cholesterol and
lipids, Increases wound healing, Ischemic heart
disease, Leukemia, Stimulates fibroblasts
(proliferative effect), Rheumatoid arthritis, Psoriasis,
Increases bone mass, Anti-aging, Reduces autoimmunity, Strongly neuroprotective (ALS, Alzheimer,
Parkinson’s, MS, cerebral ischemia).
Dosage for knotweed:
• Whole herb (Aka the root) (Hu Zhang) standardized to
8% total resveratrol and 10 mg resveratrol. Source
Naturals 500 mg tablet.
• Use 3-4 caps 3-4 times/day. Work up slowly to this dose
• Contraindications: Pregnancy, Consider carefully when
giving with blood thinners (synergistic effect), may cause
a metallic or odd taste in the mouth.
andrographis paniculata
• King of Bitters
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Andrographis paniculata
a simple pubmed search….
1.
2.
3.
4.
5.
6.
kidney protective (rapid excretion via kidneys)
anti-spirochetal
crosses blood brain barrier
protects heart muscle, anti-inflammatory
Calming
potent modulating effect on mast cell and neutrophil
activity: turns off inappropriate mast-cell allergic
reactions in tissue
7. enhances liver function
8. protective effects against inflammation-mediated
neurodegeneration of brain, spinal chord and CSF
Andrographis paniculata
8.
9.
10.
11.
12.
13.
Filarial diseases
leptospirosis
malaria (suggesting strong effect against Babesia)
periodontal bacteria (gum disease)
AIDS
cancers: prostate, breast, colon, anal, stomach ,skin
melanoma, leukemia
14. TB
15. Tonsilitis, pheumonia, herpes, E. coli, snake bites
Andrographis paniculata
• Dosage: 400 mg capsules standardized to 10%
andrographolides. Start with 1 cap 4 times/day. Slowly
increase to 3 caps 4 times/day. Stay on this dose till
Lyme sx significantly decreased, then slowly decrease
dose.
• It needs to be taken at least three times a day as it
moves out of the body rapidly.
• Stop during severe Herxheimer reactions. 1 year
• Contraindications: andrographis lowers progesterone
(natural contraceptive), pregnancy, and acute gallbladder
disease. The main side effect of andrographis is that 1%
of the people that take it will get severe hives that takes
as long as two months to resolve. Start with a lower dose
to watch for s/e’s
Smilax glabra
• Roots: 6-8 feet long
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Smilax glabra, spp.
• Sarsaparilla root has been used for
centuries by the indigenous peoples of
Central and South America for sexual
impotence, rheumatism, skin ailments,
and as a general tonic for physical
weakness.
Smilax
• Amazonian medicine men use sarsaparilla
root internally and externally for leprosy and
other skin problems (such as psoriasis and
dermatitis.) Leprosy can be common in areas
where the disease is carried by armadillos
(and in the Amazon, armadillos are "on the
menu" in indigenous diets).
Smilax and Syphilis
• European physicians from as early back as
1536, considered sarsaparilla root a tonic,
blood purifier, diuretic, and sweat promoter,
BUT mostly as an syphilis cure. Since this
time, Smilax roots have had a long history of
use for syphilis and other sexually-transmitted
diseases throughout the world.
• It was registered as an official herb in the
U.S. Pharmacopoeia as a syphilis treatment
from 1820 to 1910.
More uses of Smilax
• A U.S. patent was awarded in 2003
describing these flavonoids to be effective in
treating autoimmune diseases and
inflammatory reactions through their
immunomodulating effects. Sarsasapogenin
and smilagenin were subjects of a 2001 U.S.
patent which reported that these Smilax
steroids had the ability to treat senile
dementia, cognitive dysfunction, and
Alzheimer's disease.
What is an endotoxin anyway?
• Clinical research has validated the traditional
use of sarsaparilla for skin conditions such as
psoriasis, eczema, acne, and leprosy.
(NEJM).
• One of the possible mechanisms of action in
psoriasis is sarsaparilla's blood cleansing
properties. Individuals with psoriasis have
been found to have high levels of endotoxins
circulating in the bloodstream (endotoxins are
cell wall fragments of bacteria). Sarsaponin,
one of sarsaparilla's main steroids, was found
to bind to these endotoxins and remove them,
Smilax glabra (Sarsaparilla)
(another pubmed search)
1.
2.
3.
4.
5.
6.
7.
Leptospirosis
Treponema pallidum (syphilis)
liver flukes (clonorchis sinensis)
shigella and salmonella
Leprosy
TB
fungal skin infections
Smilax glabra
other published/clinical
evidence
• Lyme endotoxin binding
• Lessens Herxheimer reactions
• Improvement in mental and psychological parameters in
chronic lyme and syphilis
• Modulates immune responses esp w/ autoimmune
dysregulation
• Arthritis (anti-inflammatory and pain relieving)
• Psoriasis and eczema, Reduces skin breakdown
• Neuroprotective (crosses blood brain barrier)
• Improves liver function, including Hepatitis C
• Lessens fatigue
• Increases libido
• Asthma, hay fever, rhinitis
Smilax Glabra
• Dosage: 425-500 mg caps 1-3 caps 3-4 times/day.
Increase slowly to full dosage, stay on it for 2 months,
then slowly reduce to maintenance dose of 1 caps 3
times/day. At least 1 year
• Contraindications: Increases digitalis, digoxin (CHF and
dysrhythmias ) and Bismuth absorption, increased
elimination of hypnotic drugs.
Uncaria tomentosa
• Cat’s Claw; Amazonian vine.
Make sure that only the bark is
harvested, as some companies harvest the root, and is therefore in
danger of over harvesting.
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Uncaria tomentosa
In lyme, it acts as a immune potentiator, which
helps to raise CD57 white blood cell counts.
Anti-inflammatory and analgesic, so useful for
joint and muscle pain associated with Lyme.
Especially good for neuroborreliosis, chronic
fatigue and cognitive decline.
Cat’s Claw
TOA’s (Tetracyclic oxindole
alkaloids)
or
not?
In some cases, people have experienced that they cannot
tolerate full-spectrum Cat's Claw, however, they can
tolerate TOA-free. I have not found the studies on TOAfree to be very convincing. It is actually the TOA’s that
help the central and peripheral nervous system. The
POA’s (Pentacyclic oxindole alkaloids) which is another
type of alkaloid in Cat’s Claw, helps with the immune
modulation, so both are important. I generally suggest
using full-spectrum Cat's Claw.
For a great discussion on the differences: http://www.raintree.com/toa-poa-article.htm#.UYf5-StATms
Teasel: Pinyin name in is Xu Duan,
“restore what is broken”
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Teasel-from an eclectic
perspective
• When a plant has a prickly doctrine of
signature (like eluethero, nettle and
raspberry) they will help you to break
something down and weave something new.
Used to tease cloth, wool in particular
(tapestry).
• Eclectic herbalist say that is will mend things
that are broken, esp in energetic field.
Adrenal pulses will change when using it.
Teasel: Traditional Chinese
Medicine
• Yang tonifying herb, Dipsacus fortifies the
lower back, knees and bones.
• It has a positive effect on the sinews and
joints as well and is used for pain and
stiffness from decreased Kidney energy or
from traumatic injury.
• It is also used to promote the movement of
blood and to repair damaged tissues.
Teasel
• Side of the road medicine, just like Lyme is a side of
the road disease
• Only small amounts necessary
• Can be taken internally as a tincture or decoction,
applied topically in a salve or liniment, or one could
address all aspects of the disharmony and choose
internal and external treatment simultaneously.
Stephania
(Mountain Turtle)
• Parts used: rootlet or vine. The root which
looks like a boulder and grows on top of the
ground, which a vine grows from
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Stephania
S. tetrandra and S. cepharantha)
Lyme specific functions:
~Decreases inflammation in the CNS
(Bell’s palsy, uveitis, eyes)
~Decreased inflammation in the joints
~decreased fluid build up in tissues and
joints
~helps to heal endothelium
~Immunomodulation
Stephania S. tetrandra and S. cepharantha)
Peer review literature/Science: effective against:
1. Potent anti-inflammatory:
~Reduces the pro-inflammatory cytokines: IL-1 beta, ILalpha, TNF-a, IL-6, IL-8 and COX-2 (especially in CNS
and joints)
~Reduces NF-kappa B and IL-6 during
neuroborreliosis, ~Modulates HLA-DR expression
2. Treatment of silicosis (also breast implant immune
complications)
3. Protects endothelium from endotoxin damage
4. Reduces vascular permeability
5. Bell’s palsy (decreased edema and vascular
extravasation AND by decreasing IL-6, IL-8 and TNF-a)
6. Free radical scavenger: Inhibits h202-induced neuronal
cell death)
Stephania
7. Inhibits toxic glutamate levels in brain
8. Ca-channel blocker: 50 more potent than verapmil for
the tx heart disease/hypertension)
9. Retinopathy (modulates formation of new blood vessels
and improvement of vision, specifically for diabetic
retinopathy)
10. Malaria (and Babesia)
11. Inhibits cancer cell proliferation and multi-drug
resistance in cancer
12. Anti-fibrotic/anti-scar formation
13. Blocks abnormal histamine release/stabilizes mast
cells
•
Dosage: 1:5 tincture of both forms of Stephania, 1 tsp
Stephania
• In Japan, there is a proprietary herbal formula
called cepharnatha, which consists of the five
main alkaloids in Stephania c.
• It’s widely available there, and is used for the
tx of chronic inflammatory disease, radiation
induced leukopenia, asthma and alopecia
areata (all peer reviewed).
• Dosage: 1 tsp, 3 times per day. Do not use
with AV block or severely hypotensive, or if
taking Ca channel blocker, beta blocker or
digoxin