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Wednesday, February 26, 2014

An inconvenient truth

The CDC has replaced the term post Lyme disease with post treatment Lyme disease syndrome and admit on its website that the cause of the syndrome is not known. The CDC says the cause of the syndrome is unknown but acknowledges research shows persistence in animals. The CDC claims that studies show no benefit from prolonged antibiotic therapy and that patients with this syndrome eventually get better without further care; both of these statements are wrong. Substantial, contemporary literature disputes the first claim and nothing supports the latter claim. The piece (CDC web page) dredges up the notion that patients who do not get better with 2-4 weeks of therapy have an "autoimmune" disease comparable to three other bacteria which cause the same sort of thing. Strep throat - rheumatic fever; chlamydia - the STD variety- Reiter's syndrome; and Campylobacter, a gut bug- Guillain-Barre syndrome. None of these other germs is anything like Lyme disease: the analogies are poorly drawn. These other bacteria cause localized infection: throat, genitals, colon: Lyme is a widely disseminating multisystem bacteria. Reiter's syndrome is an obsolete term now replaced with reactive arthritis.(at least use the correct mainstream terminology). I do not dispute that a variety of microorganisms cause autoimmune disease. But the existence of an autoimmune phenomenon does not preclude the role of chronic, persisting infection. Chlamydias are small intracellular organisms which do not clear easily. Latest research, 2010:

Controversial Treatment Approach Could Lead to a Cure
   Keywords for this press release: reactive arthritis, Chlamydia-induced reactive arthritis, Reiter's syndrome, chronic ReA, Chlamydia trachomatis bacterium, antibiotic treatment, chlamydial gene transcription, heat-shock proteins, chlamydial protein synthesis, antibiotic combinations, doxycycline, azithromycin, rifampin
Researchers from University of South Florida College of Medicine found a combination of antibiotics to be an effective treatment for Chlamydia-induced reactive arthritis, a major step forward in the management, and possibly cure, of this disease. Results of this study are published in the May issue of Arthritis & Rheumatism, a journal of the American College of Rheumatology.

Strep throat. An aerobic gram positive cocci which replicates every 20 minutes and infects superficial throat structures and tonsils is very different from an anerobic, pleomorphic, blood-brain crossing spirochete. Thankfully we rarely see rheumatic fever anymore, but patients with recurring disease were frequently treated with long term penicillin therapy including Bicillin injections. A significant percent of the population is permanently colonized with strep and remain so no matter how many courses of amoxicillin they take.  PANDAS is a more contemporary issue in this same vein. 

Guillain-Barre. An awful syndrome. Can be caused by flu vaccines, Lyme disease and many other infections. This is apples and oranges.

Patients with post-treatment Lyme have a disease so complex and varied that it can make your brain stop working or cause your heart to stop.

Nothing else is like this.  Lyme spirochetes disseminate widely, easily cross into the brain and infect a host of tissues. These other syndromes are not comparable. The CDC piece is dismissive, essentially saying: autoimmune disorders occur in the aftermath of other infections so there is nothing special about this post-treatment Lyme syndrome which is relatively rare and gets better by itself anyhow.

Assertions that a few weeks of doxycycline kill all Lyme spirochetes have no basis in fact or science.

Antibiotics are not that effective. If they were we would die every time we took them. It is impossible to eradicate all the flora in our gut with any course of antibiotics, thankfully. Otherwise our immune systems would be fatally wounded.  I do not believe we ever eradicate all dental spirochetes protected by biofilms with courses of antibiotics. How then are we going to eradicate Borrelia spirochetes, demonstrating the best survival skills of any organism on the planet.  Spirochetes persist in mice, dogs, monkeys and people. It is an inconvenient truth.

Friday, February 14, 2014

Bile acid sequestrants, mold, toxins and Lyme

My patient after 5 years of antibiotic treatment had been in a fairly remitted state. And then she was exposed to toxic mold and the entire Lyme syndrome became activated.  She experienced recurrent fatigue, pains, cognitive dysfunction, mood swings with emotional ups and downs, along with night sweats and other symptoms had taken multiple naturopathic therapies for detoxification which had not helped much.  We started Welchol, which had been helpful in the past and which was very effective right away. A urine test sent to Realtime laboratories showed the presence of mycotoxins. The concept is that even though the home mold issue had been remediated, mold persisted in her sinuses elaborating toxins. The treatment for this was intranasal antifungal therapy, intraconazole, combined with BEG, to treat bacteria and also break down biofilms. Topically EDTA works here to degrade biofilms mucopolysaccharide strands held together by calcium which is in turn chelated by this agent. Other aspects of her illness, including:   neuro-Lyme, Babesia and Bartonella were also addressed independently.  The addition of glutathione and methy b12 and methylfolate may promote detoxification and seem to be helpful.

Bile acid sequestrants, (BAS) primarily cholestyramine and Welchol have become popularized for their putative role in the removal of toxins. In the past, I implied, or stated that these agents remove neurotoxins. This statement cannot be supported. I do not believe they remove quinolinic acid.

QUIN, quinolinic acid is the major neurotoxin associated with Lyme neuroborreliosis and possibly many other neuro-inflammatory diseases: HIV dementia, Parkinson’s disease, motor neuron diseases, Huntinington’s disease, MS and psychiatric disorders.  It is produced and released by infiltrating macrophages and activated by glial cells. The concentration of QUIN in cerebrospinal fluid may correlate with the severity of these illnesses. QUIN serum concentration was recently shown to be associated with increased hepatic encephalopathy seen in patients with cirrhosis of the liver.  QUIN, an NMDA agonist, acts as a neurotoxin, gliotoxin,, proinflammatory mediator, prooxidant molecule and may alter the integrity of the BBB.

Many exogenous toxins have negative effects on the brain and central nervous system.
BAS have been shown to help removal of toxins from mold and some bacteria. There is no narrative to support the contention that Lyme is a biotoxin disease or that BAS removes these unsubstantiated toxins. 

BASs remove stuff. 

Bile acids are produced by the liver and circulated through the small bowel to assist in the digestion of fat, emulsification. BAS remove these substances – and other things. For example, thyroid hormone. Recent studies point to the usefulness of these agents for thyrotoxicosis. BAS also remove toxins associated with C. diff colitis. BAS have other effects which are not well understood. Their primary purpose is to lower cholesterol. Bile acids are derived from cholesterol; when they are taken away -  the liver makes new bile acids from circulating serum cholesterol therefore lowering serum cholesterol levels.  For reasons not understood, BAS also lower blood sugar. The BAS, as previously stated, has been shown to lower CRP levels, an indicator of lowered inflammation by way of complement activation. 

BAS may cause decreased adsorption of some drugs, (not most). Penicillin and tetracycline are on the list. There is a concern about fat soluble vitamins, not proved. 

Activated charcoal is also reported to remove mycotoxins. Charcoal is known as the universal antidote for poisoning; I am afraid it also indiscreetly removes drugs you want to keep on board.

As more adverse information about statin drugs comes out:  raise blood sugar, cause cognitive difficulties, cause muscle inflammation and liver inflammation --  in general, I would argue that BAS should be considered in lieu of the more toxic agents. Pharmaceutical representatives quickly point out that “data” only supports the use of statins to prevent cardiovascular disease. Older studies with cholestyramine showed similar results: new studies will never be done with these drugs because of economics. But I digress.

Wednesday, February 12, 2014


I must confess, there truly is a problem with anti-science in this country. But the IDSA has it backwards. Truths are easily ignored/denied when politically convenient.

Scientist, such as those who deny the reality of global climate change, readily discard science when it suits their politics.

Persistence of Lyme? recent literature:

1) Persistence of Borrelia burgdorferi in Rhesus Macaques,  Jan 2012, Embers et al. Tulane University.
 2) Two previous studies in mice and one in dogs prove persistence of the organism.  See Columbia University Lyme Research Center, Editorial Fallon.

OK that's animals, People?

1) Brian Fallon, A Reappraisal of the US Clinical Trials of Post-Treatment Lyme Disease Syndrome. Conclusion: Repeat use of antibiotics helps: i.e. Lyme persists in humans.
2) Bio-statistical review of the 4 studies NIH sponsored studies: Delong, Brown University, Nov 2012: Re-treatment can be beneficial: i.e. Lyme persists in humans.

The basis of the entirety of the IDSA arguments is being called into question by heavy hitters in the world of academic scientific research.

Politics? Study 2010, Johnson, Stricker, in Philosophy, Ethics and Humanities in Medicine, The IDSA panel:

a) 40% of panel members had financial conflicts of interest
b) Since the level of evidence was poor many guidelines based on subjective expert opinion, 38/71.
c) IDSA guidelines published in IDSA journal, calls into question bias of "peer review process."
d) Failure to acknowledge legitimate controversy
e) Guidelines restrict the use of clinical judgement and fail to offer alternative treatments.
f) IDSA panel comprised of academic researchers, not practitioners with clinical experience.

Science is a systemic process which seeks out truths about the world and universe around us. Here are examples of truth uncovered by the very process held sacrosanct by the IDSA. Does science matter to those whose opinions are cast in stone and predicated on politics?  Those who deny global climate change will not change their views until a glacier from a new ice age lands on their house. What will it take to change the mind of those who truly believe that 3 weeks of doxycycline cures patients with long-term Lyme disease? 

There is absolutely a problem with anti-science in America.