Understanding Chronic Infections and Symptoms

If you've been struggling with chronic symptoms, it's possible that a infection could be underlying where these non-responsive symptoms are coming from. In fact, over the past couple years, I've really honed in on certain types of infections that seem to be the root cause for a decent subset of people. And interestingly, these are not gastrointestinal infections, so we're not talking some sort of intestinal parasite or something of that sort. nor do they seem to be some sort of chronic virus like reactivation of Epstein-Barr, which can be problematic perhaps for some people. So what I'd like to do today is cover what these organisms are, give you a checklist of the symptoms so that if you see a number of these symptoms in yourself, you can be prompted to take action. Now regarding action, that could involve testing and I'll share the testing options. But in addition to this, I'm really excited about a questionnaire. the msids38 as it's called which has been validated to be correlating or predictive of if one of these infections is present so it takes one potential financial hurdle of having to go and perform a blood test in order to quantify if you have one of these infections and then finally close with some treatment options now knowing that so many in our audience you care about their gut health, which is just awesome. It's so important. It's such a foundational aspect. I did want to lead with a very, in my view, pivotal study by Dr. Michael Erdman. And here is what he found. Quoting, our data suggests that one should consider an underlying microbial or infection etiology for chronic and unexplained digestive conditions that do not resolve. So even though... The symptoms of a chronic infection could be the systemic inflammatory symptoms. I'll come more to those in a moment. They could also be non-responsive digestive symptoms. So continuing a little further from the same paper from Erdman, which I found to be very insightful, the presence of three or more of any chronic symptom, according to his study, should raise concern that a chronic infection is present. Now, this is not an exhaustive list, but here's some that he highlights in his study. Food intolerances. Well, that sounds pretty familiar. Indigestion, heartburn, nausea and vomiting, constipation, extremity or joint pain, chest pain, shortness of breath, anxiety, and night sweats. So, We'll go into a little more detail about the symptoms, but I wanted to start with this framework to show, to illustrate that there is some data, namely from Erdmann, that looked at a population of people with chronic symptoms. And oftentimes the symptoms are a smattering of digestive and non-digestive symptoms like we just covered. Remember, three or more of those should be piquing your curiosity here. Now, what are these organisms? I mentioned a moment ago. that they're not intestinal parasites. They are, perhaps you could say, parasites. Well, let me just give you the long and short here. So they're a combination of either bacteria or protozoa that tend to infect or at least travel through the blood. The, I think, antiquated way of labeling this would be Lyme disease. The reason why I don't like this moniker is for two reasons. One, I think Lyme carries a lot of sort of wastebasket diagnosis. We're not sure what else to do. We're going to call it Lyme. We're going to call it mold. So I try to be really careful about not letting people think a condition or a diagnosis is worse than it is just because a cohort of people end up being labeled that when a clinician isn't sure what else could be causing their symptoms. That's one. Two, Lyme is actually a specific bacteria. Borrelia. However, there's a different organism that tends to hang out in the same cluster that's more common than Borrelia. This is Babesia. Babesia is actually a protozoa, so it's a slightly more advanced form of a bacteria, and this is truly parasitic. But here's the data point here I wanted to share. This is from a 2018 survey. of a little over 10,000 samples of people who were screened for any one of this family of infection. Again, the antiquated label would be Lyme. But look at this. More common than the Lyme bacteria was Babesia. 37% of people had Babesia, 32% had Lyme or Borrelia, and 19% had Bartonella. And these are the three that I feel are the most relevant to screen for. There are others, as you can see from this visual, but I think the big three, Babesia most common, Borrelia second most common, and Bartonella third. Now, remembering that these do not necessarily infect the gastrointestinal tract, but they can cause digestive symptoms. And by the way, if this has been helpful, please comment and subscribe. I really do appreciate hearing what people think, so I'll look forward to reviewing your comments. So let's discuss in more detail the symptoms. And the way I break this down, it's not necessarily the most perfect or academic parsing, but a general heuristic would be Babesia symptoms, because that's a protozoa, a little bit different, and then bacterial symptoms, and that's where you have the Borrelia and the Bartonella. Let's go through the symptoms because this is where I'm hoping you'll either resonate and then be prompted to take action or hopefully say, no, none of this sounds like me, but let's go through. So again, Babesia is a protozoa. So it's a more advanced bacteria essentially, and it tends to infect the red blood cells. It's known as an intra-arithrocytic. So inside the erythrocytes, red blood cells, parasite. It can cause damage to the mitochondria. And it can also, through infecting the red blood cell and consuming nutrients in the red blood cell, lead to anemias. This is why we can see the key symptoms of fatigue, especially if it's marked fatigue, and this feeling of air hunger. Like you can't get a full breath. These are some hallmarks of Babesia. Babesia can also increase the viscosity or the thickness of the blood. And this allows it to sort of impair circulation to multiple parts of the body, including the brain. Now, this can lead to things like brain fog, potentially fatigue, but it can also lead to this feeling of a lack of coordination. You're a little bit tippy or off balance or you just don't feel steady. Because Babesia can either infect the brain through the red blood cells or cause a reduction of circulation to the brain. by making blood more thick, more viscous, it can cause autonomic dysregulation. So the autonomic nervous system, you have your sympathetic fight or flight, you have your parasympathetic rest and digest. When the ANS is dysregulated, you can have any one of a number of symptoms, including an elevated heart rate at night. And this accounts for why some people will say, I'm lying in bed. I've had my brain. pre-bed routine, haven't had caffeine late in the day, all the things are being done correctly, yet I'm still lying in bed feeling like I'm wired and wide awake, or maybe even like my heart is going a little bit fast. This is because you're in fight or flight when you shouldn't be, which is downstream to the autonomic regulation. So from that follows, logically, insomnia can be caused by Babesia. Another very hallmark of Babesia would be unexplained Fever, night sweats, chills, or hot flashes. And these are all secondary to dysregulation of the autonomic nervous system. Something that I wanted to thank Dr. Brandeis over at ILADS for pointing out to me is panic attacks that last longer than one hour. And panic attacks and anxiety, it's a little bit blurred in terms of how we distinguish one from the other. But nevertheless, if you're having a panic attack or a very, very, very anxious state for longer than an hour, this might be Babesia. And of course, again, Babesia can cause digestive symptoms. So this is the one organism, the protozoa. Now, the other camp would be the bacteria. Taking a step back, the reason why I separate these as such is the treatments tend to be a little bit different for a protozoa as compared to a bacteria. Yes, there's some overlap, but this is why I frame them as such. With Borrelia, Lyme, and with Bartonella, here are some of the key symptoms. Remembering these are bacteria, and especially, but not limited to the Bartonella, it can infect the lining of the blood vessels, and this can impair circulation for different reasons. So while Babesia will make blood thicker and harder to get into microvasculature, brain, and genitals just as to example maybe the end of the hands and feet bartonella can infect the lining of the blood vessels and cause damage there and therefore impair circulation in a different way Now, interestingly, Bartonella can infect the bone marrow and also, again, infect the red blood cells. It's possible for these bacteria to directly infect the immune cells, so the microglia in the brain and the macrophages. This is akin to if you have warring countries attacking their military bases, right? So this is one of the things that I find most potentially problematic about these bacteria is that they... actively target your immune cells. Whereas the Babesia will slow down circulation, these organisms can form biofilms, which can be part of the reason, part of the reason why there's chronicity, meaning that they don't fully go away with treatment, is because they can hide behind these biofilms. Now, this is all able to be treated, but just want to make you aware. So the other thing here to key in on with these two bacteria is when you see a predominance. of neurological symptoms, you're thinking these bacteria, as compared to the protozoa, could be present. So when I say predominance, it means that if someone has six symptoms, four of those six are brain-related. Brain fog, depression, anxiety, maybe neuropathy, okay? So brain fog, cognitive impairment, anxiety, depression. cramping, which is oftentimes neurologically mediated, muscle twitching, and neuropathies. So this is something really to cue in on is when you see someone who has a lot of cognitive or neurological symptoms and there's no other good reason why, you may want to be thinking about Bartonella or Borrelia. Also, a couple other hallmarks, especially of Bartonella, are pain. shin pain, tooth or gum pain, pain on the soles of the feet when waking up. So the first few steps kind of hurts. That's because of impaired circulation clearing from the bottom of the feet. And so the paths of the feet feel swollen and tender for the first few steps in the morning. And again, because there is this impairment of the endothelium in there for circulation, you can have red eyes, you can have spider veins or broken blood vessels. And additionally, especially with Bartonella, there's something known as Bartonella-associated skin lesions. And this could include, and I'll share a few visuals for those of you who are watching this, stretch marks known as striae, or what look like funny pimples known as bacillary angiomatosis, or even something different known as petechia, which are these small circular bruise-like dots, essentially. So it's not a one big round bruise like you hit your thigh on a coffee table. It's a number of small sort of pea-sized or maybe a little bit smaller circular bruises that can come and go. And again, this is due to the fact that circulation in the endothelium can be damaged. And again, there can be chronic digestive symptoms from either the Bartonella or the Borrelia bacteria. So that's your rundown. It covers a lot of symptoms. So then how can we go a step further to try to quantify what seems like a large list of symptoms into a score? This comes back to that questionnaire I mentioned earlier, validated by Dr. Richard Horowitz, called the MSIDS38. M-S-I-D-S 38. It's 38 questions that Horowitz validated can be predictive of if an infection is present. Now, you can very easily search this online and go to the test on your own. You'll see the scoring, and usually when you pull up the questionnaire, the scoring is barred at the bottom. If your score is less than 21, that's considered normal. If your score is between 21 and 45, that indicates an infection is possible. And if your score is above 46, that indicates an infection is possible. probable. I really appreciate this because it simplifies the next step, which would be take the questionnaire, and if you score probable or possible, then perhaps do some testing. Usually, the preferred method of testing is pairing an indirect measure, like your conventional doctor would do via a Western blot, that tells you, is the immune system responding? to the Lyme bacteria, to the Bartonella bacteria, or to the Babesia protozoa. And you can also look at other... Ways of testing, there's a marker known as IFA or immunoblots or T-cell assays. These are all indirect measures that are looking at antibody or immune system responses to these potential infections. That gives you a partial window. That should be paired with what's known as a direct measure, where you're actually finding evidence of the microbe specifically in the blood. And this is usually done with either a DNA test. known as PCR, or an RNA test, which is known as FISH. So what we've been doing is a combination of both the direct and the indirect using labs such as T-Labs, Igenix, or Vibrant Wellness. Now the caveat here, the downside, is that to do a good profile screening for these three organisms and looking at both direct and indirect methodologies, You're looking at probably $1,600 to $3,000. To have the confirmation, that would be worth it and will be worth it for a lot of people. However, some people are on more of a budget. So what do we do in these cases? What can we do in these cases? Well, there is a test known as Acudart. Acudart is a finger stick blood draw. The challenge is it's only going to give you the indirect measure of the immune system. And it's not as robust as these other tests. However, for a little under $500, I like it at least as an initial phase screening. If it's positive, okay, that's helpful. If it's negative, we can't confidently conclude that there's none of these organisms present, but at least we can do a cheaper screening. And in other cases, we may solely go based upon their history. their symptoms as assessed by the MSIDS-38, and then empirically and cautiously try some treatments, especially with the herbal treatments, and see what sort of response we get. So there's a number of options here. It would be incorrect to say you have to test. I do think because these organisms can lead to some die-off, so a few days, maybe even a couple weeks, of feeling worse before you feel better, I see the case, especially due to this, to have some sort of lab confirmation so that when you're not feeling well, when some of your symptoms are actively flaring, you can have the confidence that this is part of treatment response and sort of push through that die-off. period or the Jerish-Herxamer's reaction where you can feel a little bit worse before you feel better. Okay, so coming to treatment, there's two components to this. Treating the terrain of the individual, this would be sort of the Bacomp theory or philosophy of the individual is what matters and their health, the host health. And then on the other side would be directly targeting the microbe, more of the Pasteur argument, which is you need to treat the pathogen. Together seems to be where one achieves the best outcomes. And we've seen this principle most namely with fungal or candida overgrowth. When combining diet along with antimicrobial therapy, the results may approximately double when adding diet to some sort of killing agent. So it makes sense that we'd see the same thing here. So foundationally, sleep exercise, stress. Now, looking at a couple of these, some people may not be able to sleep well. They're doing all the things, like I mentioned earlier, but they still can't sleep. So this could mean that one of these organisms is present. Or stress. What if you have a lot of anxiety and you say, gosh, I'm taking walks, I'm spending time in nature, I'm meditating, but I still feel anxious. Okay. Do your best realizing that part of the limitations here might be resolved when treating one of these organisms. Diet. Especially thinking about what is the best diet for your gut type, because the gut has such a substantial impact on the immune system. And then gut health supports. Again, because the gut is so important for systemic immune function, we want to make sure the gut's in good working order first. And also, because we may have improved tolerance to whatever the therapeutics are. if someone has improved gut health. So that's foundation. And for most people, I think it's important to start there and build up some resiliency and also simultaneously reduce some reactivity before then going into the antimicrobial therapy. And that's important because, and I'll see this in the clinic where people are so gung ho to go blasting after the organism. And I totally get it when you're not feeling well, but we want to set you up for success. And this is something that years and years ago I had discussed with SIBO and why Some people seem to improve when treating small intestinal bacterial overgrowth short term and then relapse because they haven't laid the appropriate foundation first. So then whatever antimicrobial or antibiotic therapy they do, the results are short-lived. So same principle applies here. Okay, regarding the targeted antimicrobials. Coming back to the heuristic I laid out before, I look at these as treating a protozoa versus treating bacteria. So Babesia versus Babesia. Bartonella and Borrelia. So for the bacteria, again, remembering that especially with the herbals and the natural agents, they oftentimes will hit multiple mechanisms or both protozoa and bacteria at the same time, but there are some skewings that we can use. And I've shared before the table we've been developing and a huge credit to Dr. Zhang on this, who's done a lot of the research showing the... activity of different botanicals or herbals against different organisms and even the types of organisms, meaning are they growing? Are they in biofilm? So we can really be fairly precise. Bacteria. Four bacteria, so Borrelia and Bartonella. Garlic, oregano, clove, and cinnamon may be some of the best. Additionally, especially for Bartonella, methylene blue, which is actually a medical dye, can be quite helpful with one very important caveat. You cannot do high dose methylene blue if you have a deficiency of what's known as G6PD. It's a blood test that you can run at LabCorp or at Quest. Very important before you go on to higher dose methylene blue, because methylene blue is often used in higher doses, 5 milligrams, 10, maybe 15, maybe even up to as high as perhaps 50 for mitochondria and cognitive function. It's going to have some low-level antimicrobial activity at those doses, but you can go as high as 300 milligrams twice per day to treat Bartonella. Again, do not do so until you have confirmed. You do not have a deficiency of G6PD because if you do, it can cause damage to your red blood cells, which can be quite serious. It's not very common. but it's just a smart screening to undergo. The protozoa, the babesia, this is where different herbals can be used, like artemisia, cryptopolis, or seda. Now, medications like antibiotics for the Borrelia and Bartonella, being bacteria, and then anti-protozoal drugs, usually these are just taking from anti-malarial drugs, like atovaquone or tefeniquin, can be used to treat babesia. But I wanted to come to some of the wonderful research from Dr. Zhang, quoting his 2017 study. We were able to identify 23 essential oils at 1% concentration, so not super high doses, that are more active than the control persister drug daptomycin. So he compared herbs against a control antibiotic and here's what they found. That oregano, clove, cinnamon highlighted themselves as having a remarkable activity even at very low concentrations. Why the Zhang research is so pivotal is when it comes to the area of what's known as vector-borne infections or Lyme, the more antiquated label, there's certainly a bias in the research toward pharmaceuticals, toward antibiotics. And it's not because the herbals have been studied and demonstrated to be ineffective. It's just due to a paucity of research. So this is why the Zhang research, even though it is in vitro, is still very interesting. And you'll see, and you do see, many clinicians in the field, myself included, who are seeing clear responsiveness with the herbals. People have die-off, then they feel better. You start them on a second treatment that's herbal in nature, a little more die-off. and then they feel even better you can use the antibacterial antibiotics or the antimalarials. I do have concern with the antibiotics for obvious reasons, because oftentimes the treatment here is not a month. It's usually three, four, five, six months, maybe even longer. And so using antibiotics for that long, and also if someone has a underlying predisposition to fungal overgrowth would make me much more apprehensive about using antibiotics. A couple other things on treatment. As we discussed, these organisms can create biofilms or more viscous blood. So things that treat biofilms and or make the blood less viscous can be helpful. Modulation of inflammation can also be helpful. And this is where things like ginseng, ashwagandha that are adaptogenic also have a time and a place. And then finally... Hyperbaric oxygen therapy, also known as HPOT, can improve mitochondrial function, can improve circulation, can disrupt biofilms, can improve immune function, both being anti-inflammatory, helping the immune system function more effectively, and can even have an anti-aging effect by stimulating stem cells. Stumbling blocks. I think the die-off is something that, especially if you are an individual... who's had a history of food reactivity, supplement reactivity, maybe environmental reactivity, and you're fairly attentive to how you feel, you go into some die-off and you back off and say, oh, it was a reaction. I'm going to stop. So this is where I do think this is an area wherein having a clinician who can monitor you and help orient you to big picture and are you on the right track will prevent what seems to happen in some of these situations, which is I do a little bit of treatment. I pull back. I'm not sure what to do. I go off. I read on a blog about all these things that can treat the symptoms, like natural ways of quelling anxiety or depression. I spin my wheels. And then when I report back to my health care provider, I haven't followed through with the original recommendations. And then I've tried a few different things. And so you don't really have any good data in terms of, OK, we're going to change just one variable. See how you do. Keep our perspective macro, meaning looking at. a time span of two to four weeks rather than two to four days because there can be micro fluctuations. Like I said, you can get a little worse before you get better. So having the confidence and the experience to be guided through that, I feel can be quite helpful. And then another stumbling block, depending on your history here, if you've done more conventional treatment with antibiotics and you felt like I just didn't get better, or maybe even I got worse. that might be due to exacerbating a pre-existing fungal overgrowth in the gut. And we do have good tools here, namely another questionnaire by Sandelman, the FRDQ-7, which is a questionnaire that will give you a risk quantification for fungal overgrowth. Okay, and just in brief here, how do you pick these things up? Obviously, Lyme disease, everyone knows, is vectored by ticks. But there's... more to the story. Fleas, mosquitoes, biting flies, and even reservoir hosts like cats and dogs can pass these things. The other point I would make is this is not to mean you can't have a cat or a dog or go outside. This comes back to the Bacomp argument of the importance of host health. And I think what happens here is there's probably a decent degree of these microbes in circulation in both healthy and ill populations. But it's the ill populations that have had some sort of antecedent that has weakened their immune system. And now we have to help strengthen the immune system and push down the load of these microbes. Think about Epstein Barr virus or even chickenpox. Especially chickenpox can reactivate and come back later in life. So you never fully clear, in this case, the virus. But if your immune system becomes suppressed, now it can become problematic. I think that same thing applies here. Again, I just mentioned that because when you learn that the outdoors and flies and fleas and lice and cats and dogs may pass these, people could make the mistake, in my view, mistake to avoid going in nature. And I do think that's not the right way to frame this. Now, sure, if there's a... area where there's known to be a heavy infestation of ticks, then take precautions. I was having a conversation with a colleague of mine who's in the Boston area, obviously the Northeast is fairly endemic. And he said he stopped running on a trail because so many people were picking ticks off of them at the end of his run. So I would say in that case, either get long sleeves and pants or find maybe a different route to run on. But just be careful not to go to a neurotic, fearful place because time in nature is very, very... therapeutic. That is what I wanted to go through in terms of some hallmark symptoms that a vector borne infection, a chronic infection might be present. Remembering these are not gastrointestinal, but they can cause gastrointestinal symptoms as well as other systemic symptoms, especially for those who are having chronic neurological symptoms that are non-responsive. I think this is an area that needs to be better researched and brought more to the forefront of clinicians who are looking at the full picture of patients and helping them to pick this out. And again, that MSIDS 38 questionnaire is something you can fill out on your own in less than five minutes and get a quantification of your potential risk. And the final point, I just want to reiterate, these things are very well able to be treated. Be careful if you go to LIME message boards and things like that. You tend to see the worst case scenario, and people who are wanting to vent. So I would really be careful and know that with the right treatment, like so many other things, there is a very clear path to improving your health and putting these symptoms in the rear view mirror. Okay. Well, I hope that helps guys. And until next time.

Now regarding action, that could involve testing and I'll share the testing options. But in addition to this, I'm really excited about a questionnaire. the msids38 as it's called which has been validated to be correlating or predictive of if one of these infections is present so it takes one potential financial hurdle of having to go and perform a blood test in order to quantify if you have one of these infections and then finally close with some treatment options now knowing that so many in our audience you care about their gut health, which is just awesome. It's so important.

It's such a foundational aspect. I did want to lead with a very, in my view, pivotal study by Dr. Michael Erdman. And here is what he found. Quoting, our data suggests that one should consider an underlying microbial or infection etiology for chronic and unexplained digestive conditions that do not resolve. So even though...

The symptoms of a chronic infection could be the systemic inflammatory symptoms. I'll come more to those in a moment. They could also be non-responsive digestive symptoms.

So continuing a little further from the same paper from Erdman, which I found to be very insightful, the presence of three or more of any chronic symptom, according to his study, should raise concern that a chronic infection is present. Now, this is not an exhaustive list, but here's some that he highlights in his study. Food intolerances.

Well, that sounds pretty familiar. Indigestion, heartburn, nausea and vomiting, constipation, extremity or joint pain, chest pain, shortness of breath, anxiety, and night sweats. So, We'll go into a little more detail about the symptoms, but I wanted to start with this framework to show, to illustrate that there is some data, namely from Erdmann, that looked at a population of people with chronic symptoms. And oftentimes the symptoms are a smattering of digestive and non-digestive symptoms like we just covered.

Remember, three or more of those should be piquing your curiosity here. Now, what are these organisms? I mentioned a moment ago.

that they're not intestinal parasites. They are, perhaps you could say, parasites. Well, let me just give you the long and short here.

So they're a combination of either bacteria or protozoa that tend to infect or at least travel through the blood. The, I think, antiquated way of labeling this would be Lyme disease. The reason why I don't like this moniker is for two reasons. One, I think Lyme carries a lot of sort of wastebasket diagnosis.

We're not sure what else to do. We're going to call it Lyme. We're going to call it mold. So I try to be really careful about not letting people think a condition or a diagnosis is worse than it is just because a cohort of people end up being labeled that when a clinician isn't sure what else could be causing their symptoms. That's one.

Two, Lyme is actually a specific bacteria. Borrelia. However, there's a different organism that tends to hang out in the same cluster that's more common than Borrelia. This is Babesia. Babesia is actually a protozoa, so it's a slightly more advanced form of a bacteria, and this is truly parasitic.

But here's the data point here I wanted to share. This is from a 2018 survey. of a little over 10,000 samples of people who were screened for any one of this family of infection.

Again, the antiquated label would be Lyme. But look at this. More common than the Lyme bacteria was Babesia.

37% of people had Babesia, 32% had Lyme or Borrelia, and 19% had Bartonella. And these are the three that I feel are the most relevant to screen for. There are others, as you can see from this visual, but I think the big three, Babesia most common, Borrelia second most common, and Bartonella third. Now, remembering that these do not necessarily infect the gastrointestinal tract, but they can cause digestive symptoms. And by the way, if this has been helpful, please comment and subscribe.

I really do appreciate hearing what people think, so I'll look forward to reviewing your comments. So let's discuss in more detail the symptoms. And the way I break this down, it's not necessarily the most perfect or academic parsing, but a general heuristic would be Babesia symptoms, because that's a protozoa, a little bit different, and then bacterial symptoms, and that's where you have the Borrelia and the Bartonella. Let's go through the symptoms because this is where I'm hoping you'll either resonate and then be prompted to take action or hopefully say, no, none of this sounds like me, but let's go through.

So again, Babesia is a protozoa. So it's a more advanced bacteria essentially, and it tends to infect the red blood cells. It's known as an intra-arithrocytic. So inside the erythrocytes, red blood cells, parasite. It can cause damage to the mitochondria.

And it can also, through infecting the red blood cell and consuming nutrients in the red blood cell, lead to anemias. This is why we can see the key symptoms of fatigue, especially if it's marked fatigue, and this feeling of air hunger. Like you can't get a full breath.

These are some hallmarks of Babesia. Babesia can also increase the viscosity or the thickness of the blood. And this allows it to sort of impair circulation to multiple parts of the body, including the brain.

Now, this can lead to things like brain fog, potentially fatigue, but it can also lead to this feeling of a lack of coordination. You're a little bit tippy or off balance or you just don't feel steady. Because Babesia can either infect the brain through the red blood cells or cause a reduction of circulation to the brain. by making blood more thick, more viscous, it can cause autonomic dysregulation. So the autonomic nervous system, you have your sympathetic fight or flight, you have your parasympathetic rest and digest.

When the ANS is dysregulated, you can have any one of a number of symptoms, including an elevated heart rate at night. And this accounts for why some people will say, I'm lying in bed. I've had my brain. pre-bed routine, haven't had caffeine late in the day, all the things are being done correctly, yet I'm still lying in bed feeling like I'm wired and wide awake, or maybe even like my heart is going a little bit fast. This is because you're in fight or flight when you shouldn't be, which is downstream to the autonomic regulation.

So from that follows, logically, insomnia can be caused by Babesia. Another very hallmark of Babesia would be unexplained Fever, night sweats, chills, or hot flashes. And these are all secondary to dysregulation of the autonomic nervous system. Something that I wanted to thank Dr. Brandeis over at ILADS for pointing out to me is panic attacks that last longer than one hour.

And panic attacks and anxiety, it's a little bit blurred in terms of how we distinguish one from the other. But nevertheless, if you're having a panic attack or a very, very, very anxious state for longer than an hour, this might be Babesia. And of course, again, Babesia can cause digestive symptoms. So this is the one organism, the protozoa. Now, the other camp would be the bacteria.

Taking a step back, the reason why I separate these as such is the treatments tend to be a little bit different for a protozoa as compared to a bacteria. Yes, there's some overlap, but this is why I frame them as such. With Borrelia, Lyme, and with Bartonella, here are some of the key symptoms. Remembering these are bacteria, and especially, but not limited to the Bartonella, it can infect the lining of the blood vessels, and this can impair circulation for different reasons.

So while Babesia will make blood thicker and harder to get into microvasculature, brain, and genitals just as to example maybe the end of the hands and feet bartonella can infect the lining of the blood vessels and cause damage there and therefore impair circulation in a different way Now, interestingly, Bartonella can infect the bone marrow and also, again, infect the red blood cells. It's possible for these bacteria to directly infect the immune cells, so the microglia in the brain and the macrophages. This is akin to if you have warring countries attacking their military bases, right?

So this is one of the things that I find most potentially problematic about these bacteria is that they... actively target your immune cells. Whereas the Babesia will slow down circulation, these organisms can form biofilms, which can be part of the reason, part of the reason why there's chronicity, meaning that they don't fully go away with treatment, is because they can hide behind these biofilms. Now, this is all able to be treated, but just want to make you aware. So the other thing here to key in on with these two bacteria is when you see a predominance.

of neurological symptoms, you're thinking these bacteria, as compared to the protozoa, could be present. So when I say predominance, it means that if someone has six symptoms, four of those six are brain-related. Brain fog, depression, anxiety, maybe neuropathy, okay? So brain fog, cognitive impairment, anxiety, depression.

cramping, which is oftentimes neurologically mediated, muscle twitching, and neuropathies. So this is something really to cue in on is when you see someone who has a lot of cognitive or neurological symptoms and there's no other good reason why, you may want to be thinking about Bartonella or Borrelia. Also, a couple other hallmarks, especially of Bartonella, are pain. shin pain, tooth or gum pain, pain on the soles of the feet when waking up.

So the first few steps kind of hurts. That's because of impaired circulation clearing from the bottom of the feet. And so the paths of the feet feel swollen and tender for the first few steps in the morning. And again, because there is this impairment of the endothelium in there for circulation, you can have red eyes, you can have spider veins or broken blood vessels. And additionally, especially with Bartonella, there's something known as Bartonella-associated skin lesions.

And this could include, and I'll share a few visuals for those of you who are watching this, stretch marks known as striae, or what look like funny pimples known as bacillary angiomatosis, or even something different known as petechia, which are these small circular bruise-like dots, essentially. So it's not a one big round bruise like you hit your thigh on a coffee table. It's a number of small sort of pea-sized or maybe a little bit smaller circular bruises that can come and go. And again, this is due to the fact that circulation in the endothelium can be damaged.

And again, there can be chronic digestive symptoms from either the Bartonella or the Borrelia bacteria. So that's your rundown. It covers a lot of symptoms. So then how can we go a step further to try to quantify what seems like a large list of symptoms into a score? This comes back to that questionnaire I mentioned earlier, validated by Dr. Richard Horowitz, called the MSIDS38.

M-S-I-D-S 38. It's 38 questions that Horowitz validated can be predictive of if an infection is present. Now, you can very easily search this online and go to the test on your own. You'll see the scoring, and usually when you pull up the questionnaire, the scoring is barred at the bottom. If your score is less than 21, that's considered normal.

If your score is between 21 and 45, that indicates an infection is possible. And if your score is above 46, that indicates an infection is possible. probable. I really appreciate this because it simplifies the next step, which would be take the questionnaire, and if you score probable or possible, then perhaps do some testing. Usually, the preferred method of testing is pairing an indirect measure, like your conventional doctor would do via a Western blot, that tells you, is the immune system responding?

to the Lyme bacteria, to the Bartonella bacteria, or to the Babesia protozoa. And you can also look at other... Ways of testing, there's a marker known as IFA or immunoblots or T-cell assays.

These are all indirect measures that are looking at antibody or immune system responses to these potential infections. That gives you a partial window. That should be paired with what's known as a direct measure, where you're actually finding evidence of the microbe specifically in the blood. And this is usually done with either a DNA test.

known as PCR, or an RNA test, which is known as FISH. So what we've been doing is a combination of both the direct and the indirect using labs such as T-Labs, Igenix, or Vibrant Wellness. Now the caveat here, the downside, is that to do a good profile screening for these three organisms and looking at both direct and indirect methodologies, You're looking at probably $1,600 to $3,000.

To have the confirmation, that would be worth it and will be worth it for a lot of people. However, some people are on more of a budget. So what do we do in these cases? What can we do in these cases?

Well, there is a test known as Acudart. Acudart is a finger stick blood draw. The challenge is it's only going to give you the indirect measure of the immune system. And it's not as robust as these other tests. However, for a little under $500, I like it at least as an initial phase screening.

If it's positive, okay, that's helpful. If it's negative, we can't confidently conclude that there's none of these organisms present, but at least we can do a cheaper screening. And in other cases, we may solely go based upon their history.

their symptoms as assessed by the MSIDS-38, and then empirically and cautiously try some treatments, especially with the herbal treatments, and see what sort of response we get. So there's a number of options here. It would be incorrect to say you have to test. I do think because these organisms can lead to some die-off, so a few days, maybe even a couple weeks, of feeling worse before you feel better, I see the case, especially due to this, to have some sort of lab confirmation so that when you're not feeling well, when some of your symptoms are actively flaring, you can have the confidence that this is part of treatment response and sort of push through that die-off.

period or the Jerish-Herxamer's reaction where you can feel a little bit worse before you feel better. Okay, so coming to treatment, there's two components to this. Treating the terrain of the individual, this would be sort of the Bacomp theory or philosophy of the individual is what matters and their health, the host health.

And then on the other side would be directly targeting the microbe, more of the Pasteur argument, which is you need to treat the pathogen. Together seems to be where one achieves the best outcomes. And we've seen this principle most namely with fungal or candida overgrowth.

When combining diet along with antimicrobial therapy, the results may approximately double when adding diet to some sort of killing agent. So it makes sense that we'd see the same thing here. So foundationally, sleep exercise, stress. Now, looking at a couple of these, some people may not be able to sleep well.

They're doing all the things, like I mentioned earlier, but they still can't sleep. So this could mean that one of these organisms is present. Or stress. What if you have a lot of anxiety and you say, gosh, I'm taking walks, I'm spending time in nature, I'm meditating, but I still feel anxious. Okay.

Do your best realizing that part of the limitations here might be resolved when treating one of these organisms. Diet. Especially thinking about what is the best diet for your gut type, because the gut has such a substantial impact on the immune system.

And then gut health supports. Again, because the gut is so important for systemic immune function, we want to make sure the gut's in good working order first. And also, because we may have improved tolerance to whatever the therapeutics are. if someone has improved gut health. So that's foundation.

And for most people, I think it's important to start there and build up some resiliency and also simultaneously reduce some reactivity before then going into the antimicrobial therapy. And that's important because, and I'll see this in the clinic where people are so gung ho to go blasting after the organism. And I totally get it when you're not feeling well, but we want to set you up for success.

And this is something that years and years ago I had discussed with SIBO and why Some people seem to improve when treating small intestinal bacterial overgrowth short term and then relapse because they haven't laid the appropriate foundation first. So then whatever antimicrobial or antibiotic therapy they do, the results are short-lived. So same principle applies here.

Okay, regarding the targeted antimicrobials. Coming back to the heuristic I laid out before, I look at these as treating a protozoa versus treating bacteria. So Babesia versus Babesia. Bartonella and Borrelia.

So for the bacteria, again, remembering that especially with the herbals and the natural agents, they oftentimes will hit multiple mechanisms or both protozoa and bacteria at the same time, but there are some skewings that we can use. And I've shared before the table we've been developing and a huge credit to Dr. Zhang on this, who's done a lot of the research showing the... activity of different botanicals or herbals against different organisms and even the types of organisms, meaning are they growing?

Are they in biofilm? So we can really be fairly precise. Bacteria.

Four bacteria, so Borrelia and Bartonella. Garlic, oregano, clove, and cinnamon may be some of the best. Additionally, especially for Bartonella, methylene blue, which is actually a medical dye, can be quite helpful with one very important caveat.

You cannot do high dose methylene blue if you have a deficiency of what's known as G6PD. It's a blood test that you can run at LabCorp or at Quest. Very important before you go on to higher dose methylene blue, because methylene blue is often used in higher doses, 5 milligrams, 10, maybe 15, maybe even up to as high as perhaps 50 for mitochondria and cognitive function. It's going to have some low-level antimicrobial activity at those doses, but you can go as high as 300 milligrams twice per day to treat Bartonella.

Again, do not do so until you have confirmed. You do not have a deficiency of G6PD because if you do, it can cause damage to your red blood cells, which can be quite serious. It's not very common.

but it's just a smart screening to undergo. The protozoa, the babesia, this is where different herbals can be used, like artemisia, cryptopolis, or seda. Now, medications like antibiotics for the Borrelia and Bartonella, being bacteria, and then anti-protozoal drugs, usually these are just taking from anti-malarial drugs, like atovaquone or tefeniquin, can be used to treat babesia. But I wanted to come to some of the wonderful research from Dr. Zhang, quoting his 2017 study.

We were able to identify 23 essential oils at 1% concentration, so not super high doses, that are more active than the control persister drug daptomycin. So he compared herbs against a control antibiotic and here's what they found. That oregano, clove, cinnamon highlighted themselves as having a remarkable activity even at very low concentrations. Why the Zhang research is so pivotal is when it comes to the area of what's known as vector-borne infections or Lyme, the more antiquated label, there's certainly a bias in the research toward pharmaceuticals, toward antibiotics. And it's not because the herbals have been studied and demonstrated to be ineffective.

It's just due to a paucity of research. So this is why the Zhang research, even though it is in vitro, is still very interesting. And you'll see, and you do see, many clinicians in the field, myself included, who are seeing clear responsiveness with the herbals.

People have die-off, then they feel better. You start them on a second treatment that's herbal in nature, a little more die-off. and then they feel even better you can use the antibacterial antibiotics or the antimalarials.

I do have concern with the antibiotics for obvious reasons, because oftentimes the treatment here is not a month. It's usually three, four, five, six months, maybe even longer. And so using antibiotics for that long, and also if someone has a underlying predisposition to fungal overgrowth would make me much more apprehensive about using antibiotics.

A couple other things on treatment. As we discussed, these organisms can create biofilms or more viscous blood. So things that treat biofilms and or make the blood less viscous can be helpful. Modulation of inflammation can also be helpful. And this is where things like ginseng, ashwagandha that are adaptogenic also have a time and a place.

And then finally... Hyperbaric oxygen therapy, also known as HPOT, can improve mitochondrial function, can improve circulation, can disrupt biofilms, can improve immune function, both being anti-inflammatory, helping the immune system function more effectively, and can even have an anti-aging effect by stimulating stem cells. Stumbling blocks.

I think the die-off is something that, especially if you are an individual... who's had a history of food reactivity, supplement reactivity, maybe environmental reactivity, and you're fairly attentive to how you feel, you go into some die-off and you back off and say, oh, it was a reaction. I'm going to stop.

So this is where I do think this is an area wherein having a clinician who can monitor you and help orient you to big picture and are you on the right track will prevent what seems to happen in some of these situations, which is I do a little bit of treatment. I pull back. I'm not sure what to do.

I go off. I read on a blog about all these things that can treat the symptoms, like natural ways of quelling anxiety or depression. I spin my wheels. And then when I report back to my health care provider, I haven't followed through with the original recommendations.

And then I've tried a few different things. And so you don't really have any good data in terms of, OK, we're going to change just one variable. See how you do.

Keep our perspective macro, meaning looking at. a time span of two to four weeks rather than two to four days because there can be micro fluctuations. Like I said, you can get a little worse before you get better.

So having the confidence and the experience to be guided through that, I feel can be quite helpful. And then another stumbling block, depending on your history here, if you've done more conventional treatment with antibiotics and you felt like I just didn't get better, or maybe even I got worse. that might be due to exacerbating a pre-existing fungal overgrowth in the gut.

And we do have good tools here, namely another questionnaire by Sandelman, the FRDQ-7, which is a questionnaire that will give you a risk quantification for fungal overgrowth. Okay, and just in brief here, how do you pick these things up? Obviously, Lyme disease, everyone knows, is vectored by ticks. But there's...

more to the story. Fleas, mosquitoes, biting flies, and even reservoir hosts like cats and dogs can pass these things. The other point I would make is this is not to mean you can't have a cat or a dog or go outside.

This comes back to the Bacomp argument of the importance of host health. And I think what happens here is there's probably a decent degree of these microbes in circulation in both healthy and ill populations. But it's the ill populations that have had some sort of antecedent that has weakened their immune system. And now we have to help strengthen the immune system and push down the load of these microbes.

Think about Epstein Barr virus or even chickenpox. Especially chickenpox can reactivate and come back later in life. So you never fully clear, in this case, the virus. But if your immune system becomes suppressed, now it can become problematic. I think that same thing applies here.

Again, I just mentioned that because when you learn that the outdoors and flies and fleas and lice and cats and dogs may pass these, people could make the mistake, in my view, mistake to avoid going in nature. And I do think that's not the right way to frame this. Now, sure, if there's a... area where there's known to be a heavy infestation of ticks, then take precautions. I was having a conversation with a colleague of mine who's in the Boston area, obviously the Northeast is fairly endemic.

And he said he stopped running on a trail because so many people were picking ticks off of them at the end of his run. So I would say in that case, either get long sleeves and pants or find maybe a different route to run on. But just be careful not to go to a neurotic, fearful place because time in nature is very, very...

therapeutic. That is what I wanted to go through in terms of some hallmark symptoms that a vector borne infection, a chronic infection might be present. Remembering these are not gastrointestinal, but they can cause gastrointestinal symptoms as well as other systemic symptoms, especially for those who are having chronic neurological symptoms that are non-responsive. I think this is an area that needs to be better researched and brought more to the forefront of clinicians who are looking at the full picture of patients and helping them to pick this out. And again, that MSIDS 38 questionnaire is something you can fill out on your own in less than five minutes and get a quantification of your potential risk.

And the final point, I just want to reiterate, these things are very well able to be treated. Be careful if you go to LIME message boards and things like that. You tend to see the worst case scenario, and people who are wanting to vent.

So I would really be careful and know that with the right treatment, like so many other things, there is a very clear path to improving your health and putting these symptoms in the rear view mirror. Okay. Well, I hope that helps guys.

And until next time.

Transcript for:Understanding Chronic Infections and Symptoms

Transcript for:
Understanding Chronic Infections and Symptoms