Lyme disease, also known as Lyme borreliosis, is an infectious disease caused by Borrelia type. There are at least 38 species Borrelia sp. To date, 14 Borrelia species have been recognised to cause Lyme disease.
Epidemiology of Lyme disease (LD)
LD has emerged as the most common vector-borne ( illnesses caused by parasites, viruses and bacteria that are transmitted by mosquitoes, ticks, sandflies, blackflies, tsetse flies, mites, snails and lice) disease in the United States and Europe . There are 300,000 cases per year of LD in the United States and 500,000 in Europe, and an unknown number of unreported cases. The highest incidence in Europe is reported from Austria, the Czech Republic, Germany and Slovenia, as well as from the northern countries bordering the Baltic Sea. LD disease has been acknowledged as a significant health concern. (1, 2)
Climate change and increasing incidence of Lyme in Europe
Since the 1980s, tick vectors have increased in density and spread into higher latitudes and altitudes in Europe. Future climate change in Europe will facilitate a spread of LB into higher latitudes and altitudes, and contribute to increased disease occurrence in endemic areas. In some locations, where climate conditions will become too hot and dry for tick survival, LB will disappear. (3)
Lyme disease in Ireland
The HSE website states that there are between 50-100 cases of so-called early Lyme disease cases annually in Ireland. The most extreme form Lyme neuroborreliosis, is a notifiable disease in Ireland. (4) Lyme neuroborreliosis (LNB) is the most dangerous manifestation of Lyme disease, occurring in 10–15% of infected individuals. (5)
Early Symptoms of Lyme Disease
Stage 1 Early localised infection
Early-localised disease, may appear in the first few days after the tick bite, and up to a month later. In 50-70% of cases it is characterised by Erythema Migrans rash (EM). EM rash is pathognomonic (characteristic for a particular disease) for Lyme disease. It appears as a red ring in a “bulls-eye” pattern, with a central area of lighter erythema or clearing. The rash blanches when light pressure is applied; it can be pruritic (itchy), and warm to the touch. It is usually concentric with the site of the tick’s bite and attachment to the host, but it can also appear at unrelated bodily sites distant to the site of attachment or as multiple intersecting and non-intersecting ring-like rashes. EM can be accompanied by other early symptoms including fever, headache, fatigue, malaise, lethargy, headache, myalgias, arthralgias and regional generalised lymphadenopathy. Approximately 25–50% of infected people do not develop a rash. If rash is not present, then the symptoms at this stage may be indistinguishable from an upper respiratory infection.
Stage 2 Early disseminated infection
Within days to weeks after the onset of local infection, the Borrelia bacteria may begin to spread through the bloodstream. Over 50% of cases develop skin rashes at this stage, with multiple ring-like lesions. Despite treatment using antibiotics 10 to 20% of people develop joint pains, memory problems, and feel tired for at least six months. Occasionally, people develop shooting pains or tingling in their arms and legs.
50% of untreated patients develop moderate to severe musculoskeletal symptoms including migratory polyarthritis (wandering joint pain) and fibromyalgia-like symptoms. 10% of cases develop neurologic manifestations, including meningitis, encephalitis, cranial neuropathy, peripheral neuropathy, myelitis and most commonly, Bell’s palsy. 8-10% of cases present with symptoms of carditis, including conduction defects with bradycardia and mild cardiomyopathy. Less frequent symptoms include lymphadenopathy, conjunctivitis, liver enzyme abnormalities, hepatitis, kidney abnormalities and proteinuria.
Stage 3 Late disseminated infection (late chronic disease)
“Post-treatment Lyme Disease Syndrome” (PTLDS)
PTLDS may occur months or years after the tick bite. 50% of untreated patients develop musculoskeletal manifestations including migratory polyarthritis (wandering joint pains). An additional 10% develop chronic monoarthritis, most commonly in the knee. Less than 10% develop fibromyalgia. Neurologic manifestations of the late chronic stage can include peripheral neuropathies, encephalopathies, meningoencephalitis, Bells palsey, ataxia, dementia, and sleep disorders. Skin problems are also frequently occurrences. While the stages share many overlapping symptoms, they are distinguished by time of occurrence, extent and severity of symptoms and increasing resistance to treatment.
Confirming Lyme disease diagnosis
Confirming the diagnosis of active Lyme disease requires a history of one of the above clinical stages along with supportive findings of positive Lyme antibody serology (ELISA). Lyme seroconversion usually takes place three to six weeks after inoculation by tick bite. ELISA testing is 89% sensitive and 72% specific. Positive and borderline positive ELISA tests require confirmation with Western Blot analysis. (6, 7)
Western medical treatment of LD
The first line treatment of LD is based on antibiotics such as doxycycline used for adults and amoxicillin or cefuroxime axetil for adults and children. These antibiotics have been found to be quite effective when administrated at the early stages of LD, but not at its late stages.
Side effects of antibiotic therapy
20% of patients diagnosed with LD that are treated with antibiotics experience side effects such as symptoms of fatigue and aches and pain in the joints and/or muscles lasting up to 6 months.
Post-Treatment Lyme Disease Syndrome (PTLDS)
Patients treated for Lyme disease with a recommended 2 to 4 week course of antibiotics commonly have lingering symptoms of fatigue, pain, or joint and muscle aches at the time they finish treatment. In a small percentage of cases, these symptoms can last for more than 6 months. Although sometimes called “chronic Lyme disease,” this condition is properly known as “Post-treatment Lyme Disease Syndrome” (PTLDS). (8)
Long term antibiotic therapy does not work
Regardless of the cause of PTLDS, studies indicate that patients who received prolonged courses of antibiotics do no better in the long run than patients treated with placebo. Furthermore, long-term antibiotic treatment for LD has been associated with serious complications and Antibiotic Resistance is suspected in Lyme disease. (9)
Erythromycin resistance in Borrelia burgdorferi
Reading establishing drug resistance Borrelia burgdorferi, there is a difficulty in establishing the extent of drug resistance due to the difficulty in isolating Borrelia burgdorferi from patients in the later stages of the disease. This makes it hard to determine whether drug-resistant strains are a major cause of poor clinical outcomes.(10)
Latent forms of Borrelia sp are resistant to standard antibiotic treatment. The fact is western medicine has little options in the treatment of latent Borrelia. Herbal medicine and nutritional supplements however have been shown to be very effective in the treatment of latent forms of Borrelia sp. (10)
Mechanism of resistance
NB, Many other mechanism such as horizontal gene transfer (11) exist that I will not discuss here although my herbal tonic is formulated to specifically address.
It has been observed the reoccurrence of Lyme disease due to antibiotic resistance is associated with biofilm-like aggregates in Borrelia burgdorferi, Borrelia afzelii and Borrelia garinii. (5) Biofilms are surface-attached groups of microbial cells encased in an extracellular matrix that are significantly less susceptible to antibiotics. (12) Biofilms have evolved to allow cells to survive in hostile environments. Biofilms are difficult to eradicate and contribute to untreatable infections (13) and antimicrobial resistance. (14, 15) Biofilm-based infections are extremely difficult to cure. The increased tolerance to antibiotics described in the persisting forms of Borrelia spp., is one reason behind the development of Lyme neuroborreliosis (LNB), the most dangerous manifestation of LD. (5)
A Lyme disease vaccine was introduced in 1998, but was withdrawn due to controversies over side effects. (4) These side effects include inducing autoimmunity. (16)
See below Natural Medicine Treatment of Lyme disease
Pathophysiology of Lyme disease
Lyme bacteria is pro-inflammatory and immunosuppressive
The pathogenesis of the disease in its early stages is associated with the presence of bacteria at the site of inflammation, whereas in the later stages of disease, autoimmune features contribute significantly. It has been suggested that chronic persistence of Borrelia burgdorferi in affected tissues is of pathogenic relevance. Long-term exposure of the host immune system to spirochaetes and/or borrelial compounds may induce chronic autoimmune disease. The study of bacterium-host interactions has revealed a variety of pro-inflammatory and also immunomodulatory-immunosuppressive features caused by the pathogen. Chronic disease may require immunosuppressive treatment. (16)
Lyme is an autoimmune disease due to molecular mimicry
It is thought that exposure to the Borrelia bacterium during Lyme disease causes a long-lived and damaging inflammatory response, making LD a form of pathogen-induced autoimmune disease. The production of this reaction might be due to a form of molecular mimicry (where your body’s immune system can’t recognise its own cells from foreign cells), where Borrelia avoids being killed by the immune system by resembling normal parts of the body's tissues. Chronic symptoms from an autoimmune reaction could explain why some symptoms persist even after the spirochetes have been eliminated from the body. This hypothesis may explain why chronic arthritis persists after antibiotic therapy. (17) Studies have also revealed that Borrelia burgdorferi shares common epitopes which mimic self-proteins and this .immunological cross-reactivity is also involved in the pathogenesis of not only lyme arthritis but also the potentially fatal Lyme carditis. (18)
Heavy metals and chelation
Heavy metal toxicity, particularly mercury, is often copathogenic to LD. Specifically, LD was said to predispose to symptomatic mercury toxicity; consequently, mercury (and heavy metal) chelation is recommended adjunct to other treatments for Lyme disease. It is thought that a T helper cell type 1 -like response is required for optimal eradication of Borrelia. Mercury exposure in experimental Lyme arthritis decreases Th1-like responses and arthritis severity and delays eradication of Borrelia burgdorferi. (19)
The potential problem with Lyme disease diagnosis
Over the past few decades, patients with chronic unexplained fatigue, often accompanied by other unexplained symptoms, have been incorrectly identified as having chronic brucellosis (1930s–1950s), chronic Epstein-Barr virus infection (1960s–1980s), chronic candidiasis (1970s–1990s), toxic mould exposure (1980s-present), chronic xenotropic murine leukemia virus-related virus infection (2009–2011), and chronic Borrelia burgdorferi infection (Lyme disease) (1980s-present). The term chronic Lyme disease has been applied to patients with a great diversity of symptoms that go well beyond fatigue and has been the most resistant to change because it is supported by a sizable and vocal constituency of patient as well as by healthcare practitioners who hold similar viewpoints. Regardless a proper diagnosis by a GP needs to be ascertained as discussed above in Confirming Lyme disease diagnosis.
Prognosis in LD
It is said that antibiotic therapy treatment is curative if applied correctly although considering the prevalence of PTLDS and evidence of antibiotic resistance, I would not only beg to differ but go so far as to say that the emergence of LD is because of antimicrobial resistance. The severity and treatment of LD is often complicated due to late diagnosis, failure of antibiotic treatment, simultaneous infection with other tick-borne diseases and in immune-suppressed patients.
Despite treatment using antibiotics 10 to 20% of people develop joint pains, memory problems, and feel tired for at least six months. A meta-analysis published in 2005 found some patients with LD have fatigue, joint or muscle pain, and neuro-cognitive symptoms persisting for years, despite antibiotic treatment. (22)
Natural Medicine Approaches to Prevent and Treat Lyme Disease
Several natural compounds have shown potent anti-borreliae activity indicating their potential in enhancing the efficacy of current treatments for Lyme disease, and offering new options in cases of antibiotic resistance. There are at least 38 species Borrelia sp. To date, 14 of them have been recognised to cause LD. From a natural medicine perspective the distinct type of species is irrelevant. If phytochemical and micronutrients are anti-borreliae they will work to eradicate the bacteria and treat LD. With antibiotic resistance to Borrelia sp emerging, natural alternatives to standard western medical treatments are paramount.
Phytochemicals with anti-borreliae efficacy
Polyphenols like apigenin, malvidin, quercetin, resveratrol and viniferin, ellagic acid, Oleuropein, amydalin, fucoidan, berberine, nordihydrogualaretic acid, the compounds baicalein and monolaurin expressed bacteriostatic and/or bactericidal anti-spirochetal effects.
The most effective antimicrobial compounds against all forms of the two tested Borrelia sp. were baicalein and monolaurin. (23)
Herbal medicine sources of Phytochemicals with anti-borreliae efficacy
Other herbs showing anti-borreliae efficacy include Common teasel Dipsacus fullonum /sylvestris, Cat’s Claw Uncaria tomentosa and Otoba bark Otoba parvifolia. Extracts from Cat’s Claw and Otoba bark demonstrate significant effects on active and dormant forms of Borrelia burgdorferi sensu stricto especially when used in combination. Common teasel has been studied and shows efficacy against Borrelia afzeli. (24)
• Apigenin is abundant in the flowers of Chamomile Matricaria chamomilla and Passionflower Passiflora incarnata
• Passiflora and Chamomile also both contain quercetin.
• Gotu cola Centella asiatica contains quercetin.
• Scutt Baic Scutellaria baicalensis root contains baicalein.
• Barberry Berberis vulgaris contains berberine.
• Ashwagandha Withania Somnivera contains quercetin.
• Bladderwrack Fucus vesiculosus contains fucoidan.
• Black walnut green hull Juglans nigra and Anise Illicium verum have bacteriostatic effect.
• Extracts from Wild cherry Prunus serotina have bacteriostatic effect. (24)
Other plant extracts showing bacteriostatic effects against Lyme
25 different agents have been examined including enzymes, amino acids, fatty acids, heavy metal chelators and vitamins.
Supplements with bacteriostatic effects against Lyme
Vitamins including D3 and C and iodine exhibit inhibitory effect against spirochetes of Borrelia burgdorferi sensu stricto and Borrelia garinii. Vitamin B-complex has bacteriostatic effect. Serrapeptase (enzyme isolated from bacteria found in silkworms) has bacteriostatic effects. (23, 24)
Additional natural medicine approaches: Biofilm inhibition
The majority of herbs are polyphenol rich. Polyphenols interact with bacterial cell wall synthesis and interfere with protein regulation. (25)
Other Biofilm inhibitors potential for use against Borrelia sp;
• Ginger Zingiber Officinalis is described as a broad spectrum biofilm inhibitor. (26)
• Garlic Allium sativum extract inhibits Candida albicans biofilms. (27)
• Cranberry Vaccinium macrocarpon inhibits biofilms and treats drug resistant uropathogens. (28)
• The constituents berberine, carvacrol, cinnamaldehyde, eugenol and thymol worked synergistically in combination with streptomycin on Salmonella Typhimurium and Listeria monocytogenes. (29)
• Oregano constituents carvacrol and thymol, inhibited biofilms of Staphylococcus aureus and Staphylococcus epidermidis. (30)
• N-acetylcysteine (NAC) a cysteine supplement and glutathione precursor inhibits biofilms and is recommended as an adjuvant therapy for microbial infection. (31)
Carahealth Anti Lyme Disease Tonic
This tonic is a formulation of herbal medicine sources of the phytochemicals described with anti-borreliae efficacy.
Not all herbs are created equal
Common teasel Dipsacus sylvestris
Cat’s Claw Uncaria tomentosa
Otoba Bark Extract Otoba parvifolia
Chamomile Matricaria chamomilla
Passionflower Passiflora incarnata
Gotu cola Centella asiatica
Scutt Baic Scutellaria baicalensis
Barberry Berberis vulgaris
Withania Withania Somnivera
Bladderwrack Fucus vesiculosus
Black walnut green hull Juglans nigra
Wild cherry bark Prunus serotina
Diet sources of phytochemicals with anti-borreliae efficacy
Monolaurin is a molecule that comes from lauric acid, a constituent of coconuts.
Malvidin is responsible for the blue colour found in petals of the Primula polyanthus plants. It is primarily responsible for the colour of red wine, Vitis vinifera being one of its sources.
Fucoidan a dietary fibre found in brown seaweed including wakame, hijiki, kombu, and Bladderwrack seaweed and kelp (iodine), exhibits inhibitory effect against spirochetes of B. burgdorferi sensu stricto and B. garinii. (23)
Ellagic acid is in Green Tea.
Oleuropein is in Olive oil.
Amygdalin is also known as laetrile (or vitamin B17) and derived from apricot kernels. It is also found in plants like lima beans, clover and sorghum.
Grapefruit seed extract is anti-borreliae
In vitro evaluation showed that grapefruit seed extract (GSE) can be a powerful agent against spirochetes and the cysts of Borrelia afzelii. (24)
Stevia rebaudiana is anti-borreliae
The same research team reported about significant efficacy of extracts from leaves of Stevia rebaudiana against all forms of Borrelia burgdorferi sensu strict. Interestingly, Stevia leaf extract is commonly used as a sugar substitute and toxicological studies have shown that it does not have mutagenic, teratogenic, or carcinogenic effects.
Ledum palustre is the primary remedy for acute LD especially when there is a purplish area at the bite site. If a rash is present, the individual needing Ledum would typically report that it is better for cold compresses. Ledum can be used preventatively I areas where the risk of Lyme infection is prevalent.
Arnica montana would be considered after a tick bite where there is considerable soreness of either the bite site or the muscles in general. Marked tenderness and a bruised sensation of the body are the hallmark of this remedy.
Prevention is the best cure
Wearing long-sleeved tops and long trousers tucked into socks is the best way to avoid being bitten. Walking in the middle of the path and avoiding sitting on logs are other ways of avoiding ticks. Removing the tick from your body within 12 hours of being bitten means an infected tick won’t have had enough time to spread the bacteria into your body. However, here in Ireland the lack of awareness of Lyme disease and other bacterial infections carried by ticks means most people don’t check themselves. “We need warning signs of possible infections by ticks in public parks and we would like to see all stages of Lyme disease become notifiable, not just neuroborreliosis,” says Ann Maher from Tick Talk Ireland, the support group for those with Lyme disease. The National Parks and Wildlife Service said it might consider placing warning signs in its nature reserves, following a call from Kerry County Council.
Carina Harkin BHSc.Nat.BHSc.Hom.BHSc.Acu.
Cert IV TAE. MPH (pending)
1. Semenza JC, Suk JE. Vector-borne diseases and climate change: a European perspective. FEMS Microbiol Lett. 2018;365(2):fnx244.
2. Stone BL, Tourand Y, Brissette CA. Brave New Worlds: The Expanding Universe of Lyme Disease. Vector Borne Zoonotic Dis. 2017;17(9):619-29.
3. Lindgren E, Jaenson T. Lyme Borreliosis in Europe: Influences of Climate and Climate Change, Epidemiology, Ecology and Adaptation Measures. 2006.
4. HSE. Lyme disease 2019 [Available from: https://www.hse.ie/eng/health/az/l/lyme-disease/.
5. Di Domenico EG, Cavallo I, Bordignon V, D'Agosto G, Pontone M, Trento E, et al. The Emerging Role of Microbial Biofilm in Lyme Neuroborreliosis. Front Neurol. 2018;9:1048-.
6. Healthline. Lyme Disease 2019 [Available from: https://www.healthline.com/health/lyme-disease#symptoms.
7. HPSC. Laboratory testing for Lyme disease: FAQs for general public 2019 [Available from: https://www.hpsc.ie/a-z/vectorborne/lymedisease/factsheet/lymetesting/.
8. CDC. Post-Treatment Lyme Disease Syndrome (PTLDS) 2019 [Available from: https://www.cdc.gov/lyme/postlds/index.html.
9. Lantos PM. Chronic Lyme disease. Infectious disease clinics of North America. 2015;29(2):325-40.
10. Jackson CR, Boylan JA, Frye JG, Gherardini FC. Evidence of a conjugal erythromycin resistance element in the Lyme disease spirochete Borrelia burgdorferi. International journal of antimicrobial agents. 2007;30(6):496-504.
11. Jackson CR, Boylan JA, Frye JG, Gherardini FC. Evidence of a conjugal erythromycin resistance element in the Lyme disease spirochete Borrelia burgdorferi. International journal of antimicrobial agents. 2007;30(6):496-504.
12. Hall CW, Mah T-F. Molecular mechanisms of biofilm-based antibiotic resistance and tolerance in pathogenic bacteria. FEMS Microbiology Reviews. 2017;41(3):276-301.
13. Bjarnsholt T. The role of bacterial biofilms in chronic infections. APMIS Supplementum. 2013(136):1-51.
14. Hall-Stoodley L, Costerton JW, Stoodley P. Bacterial biofilms: from the Natural environment to infectious diseases. Nature Reviews Microbiology. 2004;2:95.
15. Gupta PD, Birdi TJ. Development of botanicals to combat antibiotic resistance. Journal of Ayurveda and integrative medicine. 2017;8(4):266-75.
16. Singh SK, Girschick HJ. Lyme borreliosis: from infection to autoimmunity. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 2004;10(7):598-614.
17. Oldstone MB. Molecular mimicry and immune-mediated diseases. Faseb j. 1998;12(13):1255-65.
18. Raveche ES, Schutzer SE, Fernandes H, Bateman H, McCarthy BA, Nickell SP, et al. Evidence of Borrelia autoimmunity-induced component of Lyme carditis and arthritis. Journal of clinical microbiology. 2005;43(2):850-6.
19. Ekerfelt C, Andersson M, Olausson A, Bergstrom S, Hultman P. Mercury exposure as a model for deviation of cytokine responses in experimental Lyme arthritis: HgCl2 treatment decreases T helper cell type 1-like responses and arthritis severity but delays eradication of Borrelia burgdorferi in C3H/HeN mice. Clin Exp Immunol. 2007;150(1):189-97.
20. Brennecke D, Duarte B, Paiva F, Caçador I, Canning-Clode J. Microplastics as vector for heavy metal contamination from the marine environment. Estuarine, Coastal and Shelf Science. 2016;178:189-95.
21. Munier B, Bendell LI. Macro and micro plastics sorb and desorb metals and act as a point source of trace metals to coastal ecosystems. PloS one. 2018;13(2):e0191759-e.
22. Cairns V, Godwin J. Post-Lyme borreliosis syndrome: a meta-analysis of reported symptoms. International Journal of Epidemiology. 2005;34(6):1340-5.
23. Goc A, Niedzwiecki A, Rath M. In vitro evaluation of antibacterial activity of phytochemicals and micronutrients against Borrelia burgdorferi and Borrelia garinii. Journal of applied microbiology. 2015;119(6):1561-72.
24. Goc A, Rath M. The anti-borreliae efficacy of phytochemicals and micronutrients: an update. Ther Adv Infect Dis. 2016;3(3-4):75-82.
25. Papuc C, Goran GV, Predescu CN, Nicorescu V, Stefan G. Plant Polyphenols as Antioxidant and Antibacterial Agents for Shelf-Life Extension of Meat and Meat Products: Classification, Structures, Sources, and Action Mechanisms. 2017;16(6):1243-68.
26. Kim HS, Park HD. Ginger extract inhibits biofilm formation by Pseudomonas aeruginosa PA14. PLoS One. 2013;8(9):e76106.
27. Shuford JA, Steckelberg JM, Patel R. Effects of fresh garlic extract on Candida albicans biofilms. Antimicrob Agents Chemother. 2005;49(1):473.
28. Reid G, Hsiehl J, Potter P, Mighton J, Lam D, Warren D, et al. Cranberry juice consumption may reduce biofilms on uroepithelial cells: pilot study in spinal cord injured patients. Spinal cord. 2001;39(1):26-30.
29. Liu Q, Niu H, Zhang W, Mu H, Sun C, Duan J. Synergy among thymol, eugenol, berberine, cinnamaldehyde and streptomycin against planktonic and biofilm-associated food-borne pathogens. Letters in applied microbiology. 2015;60(5):421-30.
30. Nostro A, Sudano Roccaro A, Bisignano G, Marino A, Cannatelli MA, Pizzimenti FC, et al. Effects of oregano, carvacrol and thymol on Staphylococcus aureus and Staphylococcus epidermidis biofilms. Journal of medical microbiology. 2007;56(Pt 4):519-23.
31. Dinicola S, De Grazia S, Carlomagno G, Pintucci JP. N-acetylcysteine as powerful molecule to destroy bacterial biofilms. A systematic review. European review for medical and pharmacological sciences. 2014;18(19):2942-8.