Lyme Disease – The Great Imitator

Lyme disease is a great imitator and should be considered in the differential diagnosis for diseases with nebulous symptoms of multiple etiologies. It affects multiple systems in the body including neurological, cardiovascular, musculoskeletal, hormones and immune system. Lyme disease is caused by the spirochete Borrelia burgdorferi and transmitted by the deer tick. The Centers for Disease Control and Prevention estimate that 300,000 people are diagnosed with Lyme disease in the US every year. However due to the current poor testing system, many people who actual have Lyme may be misdiagnosed and under treated. Lyme disease is found on every continent except Antarctica. Rates have increased significantly over time.

The classic sign for Lyme disease is a rash called erythema migrans which may occur at the site of the bite 3 to 30 days after the bite. The International Association and Diseases Society states that less than 50% of patient’s recall having a tick bite or a rash (1) Some of the early symptoms may present with flu like illness, Bell’s palsy (facial droop), fever, malaise, soreness or headache among other symptoms. Some of the chronic symptoms can include mental status changes, numbness, tingling, dizziness, severe fatigue, confusion, mood instability, hormonal changes and chronic pain.

The management of Lyme disease is controversial. Two medical societies hold widely divergent views on the best approach to diagnosis and treating Lyme Disease. This is one of the challenges that make it difficult for patients to be properly treated. (2)

The Infectious Diseases Society of America (IDSA), regards Lyme disease as easy to cure with a short course of antibiotics. This group denies the existence of chronic Lyme disease.

I am a member of the International Lyme and Associated Diseases Society (ILADS). The most recently published ILADS guidelines recommend individualized treatment based on the severity of symptoms, the presence of tick borne co infections and the patient’s response to treatment (3). We recommend that treatment be based on clinical judgment. Clinical judgment is a central element of the medical profession, essential for the performance of the doctor, and potentially generating information also for other clinicians and for scientists and health care managers. (4). Treatment can include formal antibiotics as well as herbal holistic strategies for healing.

It has been shown that 10-50% of patients treated for Lyme Disease persist with symptoms or relapse (5). I have learned by experience that in some of my more chronic cases, formal antibiotics may be warranted. However, the goal of treatment is to transition to a more holistic treatment approach as soon as the patient is clinically stable. Current laboratory tests are unable to confirm or deny persistent infection on a routine basis. Several studies have demonstrated persistent infections by PCR and culture post antibiotic treatment.

The treatment of Lyme Disease and its Co -Infections requires an evidence based comprehensive approach which incorporates functional medicine as well as traditional strategies of healing. Due to the fact that Lyme disease encompasses multiple systems, an all-encompassing treatment approach is imperative for long term relief and stability. In this practice, functional medicine provides the context within which to fully address the needs of my complex patient population. I have found it to be important to place emphasis on how areas of functional medicine influence the personalized treatment of a Lyme patient.

Institute for Functional Medicine Clinical Matrix for Core Imbalance. From the Institute for Functional Medicine: Textbook of Functional Medicine. Gig Harbor, Wash: The Institute for Functional Medicine, 2005, p 100. © 2005 The Institute of Functional Medicine.

Environmental Inputs

This refers to a good nutritional status and exercise regimen. It is imperative to remove toxins from the diet during the treatment of any illness. We perform nutritional test that evaluate your baseline imbalances in an effort to develop a plan to treat your deficiencies and any absorption issues based on the results. Diet and lifestyle changes are a critical component of the treatment paradigm for Lyme disease. Removing environmental causes of disease, like mold and heavy metal can be critical in the treatment of this disease complex.

Energy production and oxidative stress

There has been a published correlation with Chronic Lyme disease and Chronic Fatigue. Fatigue is the most noticeable symptom of low energy production and high levels of oxidative stress. It is important that we address each of these individual problems as a part of the Lyme disease treatment paradigm.

Detoxification and Biotransformation

Detoxification is the metabolic process of the body, facilitated by enzymes that change toxins into less toxic or more readily removable substances. Detoxification is greatly dependent on how we manage our internal environment.

Hormonal and neurotransmitter imbalances

Neuroendocrine support is essential for healthy maintenance. It has been shown that Lyme disease can potentially contribute to endocrine dysfunction. It is imperative that sleep is restored and relaxation techniques are implemented. A balanced endocrine system and decreased stress response is essential in the treatment of Lyme disease.

Gastrointestinal Imbalances

I am a firm believer that the gut is the key to health. Some patients with severe symptoms may warrant the utilization of antibiotics as a component of their treatment program. Antibiotic therapy can lead to the disruption of the GI microbiome. About 70% of our immune cells are located in the gastrointestinal tract. There are publications of the association between the gut and immune response. Restoring GI imbalances is essential and can improve immune function and nutritional status, decrease inflammation and improve detoxification imbalances.

Structural imbalances

Lyme disease can cause destruction of the musculoskeletal system and chronic pain.  Increasing joint and muscle pain can lead to improper use of muscle groups which contributes to further structural destabilization and possible injury. The functional medicine approach addresses the reduction of systemic inflammation which potentially leads to greater pain control.

The immune and inflammatory imbalance

Chronic Lyme disease is characterized by persistent arthritic and neurological features occurring as a result of the tissue damages induced by the infection. The onset of chronic symptoms thereafter is misattributed to other autoimmune diseases, and likewise, the autoimmune diseases may be a direct result of the Lyme infection itself.

Mind and Spirit

This is a vital role in physical health. The functions of the mind influence the health of the body and the sickness in the body can affect our moods and emotions through molecules and nervous system pathways (6). Our mind and spirit affects our emotions, directly impacting stress mediators of functional health.

In conclusion, Lyme disease is very complex and affects numerous interconnected systems. It is imperative that a comprehensive treatment approach is taken in order to treat not only the underlying infectious process, but the numerous systemic imbalances created during the process.

For more information, please refer to www.ilads.org

-Dr. Eboni Cornish

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