Thursday, October 31, 2013

Lyme disease, Alzheimer's disease, Glutathione

Nothing short of amazing. This 62 year old female walked into my office beaming. She drove more than an hour to my office, something she had been incapable of doing for many years.

This patient had been dealing with 2 sick family members over the past years and had neglected herself. Over the last 2 years her family had become progressively concerned. She was loosing the ability to function. She could hear something repeated ten times over only to forget it moments later. She was experiencing a rapid, global decline in cognitive functioning and the ability to manage activities of daily living.

She had a long history of Lyme disease but had been non-compliant with therapy. She complained that every medicine gave her side effects: a moot point since she never remembered to take them.

We skipped the SPECT scan and went right to a PET scan.  These are both nuclear medicine scans which make observations regarding brain function. A SPECT images blood flow: areas of the brain which are not functioning have decreased/abnormal blood flow and therefore oxygen utilization patterns.  The PET images tagged glucose and actually images areas of the brain that are specifically not metabolizing sugar, not working/nonfunctional.  The PET is approved for an adjunct in making the diagnosis of Alzheimer's disease.

Her PET showed classic signs of Alzheimer's disease.  With these results the patient was now worried and agreed to attempt to treat Lyme disease in earnest.  And as one of her astute neurologist astutely: Alzheimer's doesn't get better. She has.

On my recent exam I could find nothing significantly wrong with her memory. Doctors frequently assess mental capacity with a mini-mental examination. She did great. She could count backwards from 100 by serial 7s; she could recall three items after 5 and 10 minutes and she could spell WORLD backwards. Her affect showed clarity I have seen in 5 years.

So what happened?  IV antibiotic therapy. I started treating her with Rocephin. Chronic pain melted away which was a great relief but her mental status was not quick to change. I then added Flagyl, a drug which fights the strange pleomorphic (cyst-like) forms of Borrelia in the brain.  After 3 months her brain was not significantly better.  Now after 4 1/2 months there is a real change. My patient did something else as well,  with my approval under my radar. We ordered IV glutathione which she has been receiving every other day for the last month. I don't know yet, but this could be a game changer.

Glutathione is the master antioxidant on a cellular level and it is critical for detoxification on a cellular level. Chronically ill patients are generally deficient. Many patients have reported that intermittent doses of IV glutathione in their doctor's office have been very helpful. Having a PICC provided convenient access.

I am hearing a lot about methylation. The induction of methylation pathways promotes glutathione and this can be achieved with a number of supplements, primarily various forms of B12 and folate.  Active forms of B12 including methylcobalamine and hydroxycobalamine are taken under the tongue with special forms of folic acid such as Folinic acid. The recommended protocols are a bit more complex.

It makes me wonder if this might be why patients frequently have a lot of energy after receiving B12 shots. Maybe not a placebo effect after all.

The simultaneous use of hyperbaric oxygen therapy also augments the effectiveness of antibiotics for brain recovery.  Hyperbaric by itself, results published (for what its worth), at low pressures, about 1.5 ATA is associated with significant cognitive improvements.

As I ramble on.... the snarky (for what its worth) comment has to do with how doctors like me look at medical studies with our distrust of "evidence based medicine."  Perhaps it is a little hypocritical for us to throw out the studies that deny chronic Lyme but keep studies that prove things we believe in/agree with. Well lets not go overboard and throw out the baby with the bath water. Some studies are useful. Anyway, the "denialist" studies never proved their point: they were poorly designed with built in biases and them misinterpreted.  In my blogs there is a recurring theme:  medicine is a healing art, not a science. But studies and science have a great deal of value. The help us understand mechanisms and at times point us in a direction.

12 comments:

Summer Lyme said...

Glutathione has been probably the only thing to reliably improve my symptoms (temporarily). Methylcobalamin is the only other thing that helps me tremendously for psychological symptoms (depression and anxiety). Both are "coincidentally" injected.

I met with a cardiologist the other day who looked at me like I had two heads when I mentioned how helpful glutathione IV's are for me. He had never heard of using it and was clearly extremely skeptical.

I have an extremely persistent case that is unresponsive to standard antibiotics and herbs. Glutathione and B12 are what keep me sane so that I can continue to research and try every treatment option that is accessible to me.

Jeff Sutton said...

This is a fantastic story. So many people I know have had similar success with glutathione. Such a powerful antioxidant, so glad to hear she has had such benefits from glutathione and b12.

Tiggerkat said...

what do you think about PO N-Acetyl Cysteine?

Jeera said...

Dear doctor, you said it well, it is an art not a science only.
What makes me wonder is that all these combination of treatments provide relief but what is the long term impact?
How far it helps to get remission inpatients?, few months? Or few years?, from your experience can you share what is the longest remission time you have seen...
And what a patient can hope for in the long run when these combination therapy used?
As always thanks for your effort and the invaluble meaning your work instils on us.

Tanya said...

Have you had any luck with high dose Vitamin C. I had several rounds of this via IV when I was feeling terrible and it helped pain and fatigue for a few days.

MuonGlue said...

I think the ancients knew that the difference between staying ill and recovering is about detoxification (cancer, Lyme, etc.) A methylation protocol has helped me tremendously. I take methyl folate, methylcobalamin injections, and L-selenomethionine, amongst many other products like chlorella, green drinks.. Also, I chelated with CaEDTA suppositories for 3 months, low dose, and will resume with other chelators after retesting for heavy metals (I had extremely high levels of lead and mercury). The most helpful supplement I take is an amino acid complex (Platinum Plus Amino Acids-for ingredient list. I have no affiliation with the company), it literally helped me get out of bed, mostly relieving my fatigue, and muscle and joint pain. I had brain swelling from a virus causing what I thought was hypopituitarism (I made a comment about this in July of 2013), but it wasn't causing all my other symptoms of fatigue and pain, it was my liver detox. pathways, low functioning immune system, and cortisol dysfunction. I have low functioning adrenal glands and a low IGG subclass 1, and most likely the MTHFR gene got activated, or shut down-not sure how that works. I take adrenal glandulars instead of cortisol and I feel relaxed instead of anxious (I also take a little NatureThroid for the T3 effects-wonderful). My point is that methylation support and adrenal support is huge for infection, inflammation and detoxing. I had stopped eating eggs, dairy and wheat (because food allergies/gut issue from Lyme..) for many years and I believe I induced an amino acid deficiency, which in turn I became (even more)low on glutathione. I feel amazing on IV glutathione, but wanted to find a way for my body to make it's own and I believe the amino acids (with extra sulfur &molybdenum) assist in (metallothionein) detoxification, help my digestive system and blood sugar regulation, which has changed my life. I had Lyme for so long before being treated with antibiotics that I now feel like a human with damage that I can accept, but mitigate somewhat with these supplements. It's been a huge change for me. We need functional medicine-thank you LymeMD. (I see an integrative Lyme MD in California, but research a lot-it takes a village to become healthy) It is possible that we are all canaries in the coal mine now. There is nothing wrong with me (even with a defective MTHFR gene), but there is something wrong with asking our body to detoxify the huge amount of unnatural chemicals, toxic halides, etc. that we have put into our food, air, and water..

Lyme report: Montgomery County, MD said...

The longer I do this the more open-minded I become. I would like to get away from the term integrative medicine and instead simply use the word medicine. If your treatment is rationale and explainable by a Western understanding of physiology then it is consistent with the practice of Western, allopathic medicine. (This is different from alternative therapies like acupuncture which cannot be explained by Western science). There may be many approaches to a case like yours and some therapies may be effective for some but not others.

I am now interested in the use of chelation -- something I have avoided. Nasal sprays for chronic sinusitis due to bacteria and fungi include EDTA. Chelating agents are used to break down biofilms. And now I know how. The mucopolysaccharide bands that comprise biofilms are bound together with calcium.

A recent study showed a modest benefit in the treatment of cardiovascular disease (IV EDTA).

I am not convinced that heavy metals are generally an issue. This may be an issue in selected cases. If this was not an issue before Lyme disease I do not know why it becomes one. Although the straw that broke the camel's back concept may be applicable.

Patients who have been chronically ill for years are a different cohort from patients were very healthy until they suddenly or gradually became ill after contracting tick-borne illness. I think the two groups should be approached with a different paradigm.

Don't you think patients who take the latest FDA approved medicines, later taken off the market because of toxicity, are also canaries in the coal mine.

This is the nature of medicine. The state of the art always functions on a shifting line.

Thanks for sharing your experience.

Lyme report: Montgomery County, MD said...

The longer I do this the more open-minded I become. I would like to get away from the term integrative medicine and instead simply use the word medicine. If your treatment is rationale and explainable by a Western understanding of physiology then it is consistent with the practice of Western, allopathic medicine. (This is different from alternative therapies like acupuncture which cannot be explained by Western science). There may be many approaches to a case like yours and some therapies may be effective for some but not others.

I am now interested in the use of chelation -- something I have avoided. Nasal sprays for chronic sinusitis due to bacteria and fungi include EDTA. Chelating agents are used to break down biofilms. And now I know how. The mucopolysaccharide bands that comprise biofilms are bound together with calcium.

A recent study showed a modest benefit in the treatment of cardiovascular disease (IV EDTA).

I am not convinced that heavy metals are generally an issue. This may be an issue in selected cases. If this was not an issue before Lyme disease I do not know why it becomes one. Although the straw that broke the camel's back concept may be applicable.

Patients who have been chronically ill for years are a different cohort from patients were very healthy until they suddenly or gradually became ill after contracting tick-borne illness. I think the two groups should be approached with a different paradigm.

Don't you think patients who take the latest FDA approved medicines, later taken off the market because of toxicity, are also canaries in the coal mine.

This is the nature of medicine. The state of the art always functions on a shifting line.

Thanks for sharing your experience.

endlyme said...

From what I understand, glutathione production is greatly affected by the MTHFR gene. If you have a defective copy your methylation process will be significantly hampered. The C677T mutation reduces glutathione production among other things. LymeMD - have you looked at Dr. Ben Lynch's website: MTHFR.net? (He is a cell biologist studying MTHFR mutation). You will understand his research better than I. Please look.

David Tal said...

Nice post about Alzheimer's Care, really this will increase day by day. But we are responsible for providing the nursing care, health care facilities for senior or disables people. Our communities understand the unique need and provide the special environment to the seniors.

Alzheimer Clinic

Katherine Belson said...

chronic lyme disease for 20 years. Herx reaction eventually wears off, but can rear its ugly head after switching anti-biotics. Left with brain fog after 4 months of treatment. Getting glutathione IV injection tomorrow. Can't wait!!! Sincerely, William Nowlan

jonathan said...

glutathione has never done too much for me. one possible reason is that it doesn't penetrate cells. so patients with bad (toxic) intracellular infections won't be helped at all by it. you'll find it in plasma but not in whole blood. to create glutathione inside cells the cell has to make it on its own, which means supplementing with NAC and ALA.