Friday, May 30, 2008

What do you think about supplements and alternative and complentary treatments for Lyme

It is very hard to find doctors who treat chronic Lyme disease. Many physicians use a lot of supplements, herbs and experimental therapies. There is not a lot of science which supports these treatments. Many of them have no benefits and some may be harmful. I have treated many patients who have spent years taking all sorts of alternative remedies, having spent many thousands of dollars who have not improved. I have found that Lyme itself is so controversial. So I try to stick to therapies for which there is some scientific evidence or at least rational mechanisms of action which seem very reasonable. It is my job to make sure I cause no harm to my patients. Patients have been treated with intravenous hydrogen peroxide, vitamin C and colloidal silver. These treatments are extreme, unproven and may be very harmful. Dr. Burrascano, for whom I have the utmost respect, considered the father of the chronic Lyme discipline recommends a host of vitamins and supplements. He does not back up these recommendations with any studies which prove that these things make a difference. My patients get better without a plethora of supplements. The cost of these things is not insignificant. I will address some of the supplements and give comments about them. Multivitamins: no evidence that they help. Alpha-lipoic acid: No evidence that it helps. Co-enzyme Q 10: There is evidence that this drug, supplement helps patients with congestive heart failure; there is no evidence that it helps Lyme patients. L-carnitine: Serum levels may be low. This can be documented with a blood test. It may help with muscle pain. In my experience this supplement has not been helpful and I do not recommend it generally. Magnesium: This is an important mineral for muscle and nerve function. Serum levels do not correlate with tissue levels. The red blood cell level of magnesium may be a better surrogate marker for deficiency in tissues. Certainly patients who take diuretics are magnesium depleted. Magnesium has been clearly shown to help patients with muscle cramps. With all this said, I have not found that Lyme patients with muscle pain benefit from this supplement. But it is benign, inexpensive and worth trying. Be aware it also acts as a laxative. Omega-3 supplements, like fish oil and flax seed oil: These supplements may have many benefits, particularly with regard to cardiovascular protection. Some psychiatrist report improvement in a variety of psychiatric symptoms with these supplements. They are reported to have inti-inflammatory and anti-0xident properties. My experience: Not helpful. Take them if you have a cholesterol or cardiovascular issue. Vitamin B12: Many Lyme patients have low levels of this vitamin which is critical to nerve functions. When levels are below 350 the assay may not be accurate. I do recommend treatment for patients with B12 levels under 300. I have not seen that it makes a difference clinically, but it seems a prudent preventive measure. Usually 1000ugm orally per day is sufficient. Methyl-Cobalamin, a special injectable form of B12 is also recommended by Dr. Burrascano. It is expensive and I see no reason to recommend it. Folic acid: This vitamin can also be low in Lyme disease. I prescribe it when lab test show deficiency. It also essential to the nervous system. Vitamin C: Of no clear value, I do not recommend it. I will talk about mega C with NaCl later. Many patients are on Plaquenil to cause alkalinization of tissues. Vitamin C may cause acidification and counteract this medicine. Also, because vitamin C exists in both a reduced and oxidized state it may promote oxidation in tissues rather than acting as an anti-oxidant as advertised. Zinc: May help to prevent colds when used topically as "Cold-eze" , it has been shown to enhance wound healing. There is the notion that short courses of zinc may boost immune function in certain scenarios. However, long term use of zinc has not been shown to beneficial and I do not recommend it. Vitamin D: I do not recommend this at all. It may be harmful and have deleterious effects on the immune response to Lyme. There are many other vitamins and supplements taken by many patients. I have no evidence to support any of them. Herbal medicines are a different matter.

I have a lot of respect for Herbal medicines. They have been around for thousands of years. Indian Aruvdedic therapies are supported by a long tradition. The same can be said for Chinese and native American herbal therapies. Herbs are real medicines which cause a real pharmacological response in patients. The truth is that there is very little scientific research to support the use of these therapies. Most medical research is sponsored by pharmaceutical companies who are able to patent their inventions. There are no financial incentives to fund research on natural medicines. Still, there is good evidence that many herbs work. In Germany, St. John's wort is more likely to prescribed for depression than Prozac, because it works. Many patients with Lyme have been treated extensively with herbs. I am concerned. These preparations are unregulated and of unknown effectiveness and safety. Perhaps my patient sample is biased, but I have treated many patients who have failed expensive alternative herbal therapies. The most touted herbal remedy is Cat's claw. Some patients report that it has been a little helpful, but it has not altered the amount or duration of antibiotics necessary to get patients into remission. My patients have been kind enough to give me some books. The book "Healing Lyme" by Buhner has a brilliant summary of basic science surrounding the Lyme issue. He offers a host of complex herbal protocols which he claims can used in various ways. There are no studies or scientific verification of any kind to validate these recommendations. I am opened minded, but somewhat skeptical about these therapies. There are non vitamin or mineral based, non herbal supplements which I think are useful. They will be described below.

Bile acid binders for neurotoxins appears to be very effective; this was discussed elsewhere. In the book "The Top 10 Lyme Disease Treatments" I was introduced to the concept of systemic enzyme supplementation. The concept is that much inflammation seen in Lyme and other disorders causing joint and muscle pain is due to circulating immune complexes. These are antigen and antibody bound complexes which stay in circulation for some time and provoke immune responses characterized by inflammation. Enzymes which "digest" unwanted proteins can be taken which speed up the removal of these unwanted protein complexes. The enzymes are primarily digestive enzymes but also include Bromelain, a component from pineapple which may reduce inflammation. Whether or not this purported mechanism of action is real I cannot say, but these therapies do seem to work. They are used extensively in Germany and other European countries, and there is a body of research which supports their efficacy. The primary preparation which has been studied is called Wobenzym-N. It is enterically coated to avoid uptake in the gastrointestinal tract and promote adsorption into the bloodstream. It is taken twice daily between meals. I cannot say the effects of this preparation are overwhelming, but many patients do seem to have modest therapeutic benefits. It is particularly helpful with pain. It is not an anti-Lyme therapy, but an adjunct which may safely provide symptomatic relief.

There are many herbs and supplements which I know very little about. Perhaps over time I will feel more positive about recommending others.

Salt and vitamin C seems to be strange therapy for Lyme. It is talked about on a website called Lymephotos.com and in Rosner's book, "The Top 10....". I have patients who have tried it. It has not been very successful. I do think it has seem de-worming properties. If patients are infected with parasitic worms such things may be expressed in the stool when this treatment is used. Some Lyme patients think there is a relationship between Lyme and micro-fillarial infections of the intestines. I am open to the notion that there may some parasitic infections about which medical science currently has no knowledge. It may be possible that there is a tie in with Lyme. Although this is highly speculative some interesting ideas will be discussed in a section dealing with a disturbing and thankfully rare illness, called Morgellons disease. Morgellons patients appear to all be infected with Lyme as well as a mysterious parasite.

4 comments:

dave said...

What about the use of artemisia for treating lyme or coinfections? Is there evidence to suggest it is useful therapy?

Lyme report: Montgomery County, MD said...

Artemesia is a potent antimalaria Chinese herb. Its use is supported in standard textbooks. Artemesia is a supplement which is recommended by many authorities for suspected Babesia infections including, Burrascano and Jemsek. It is no used alone. It is usually combined with Mepron and a macrolide antibiotic. It is not used for Lyme or any other co-infections. The recommended dose is 500mg three times daily. Artemesin is similar and may used as well. This a potent herb with clinically proven anti parasitic properties.

luccy said...
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akash said...

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