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Lyme disease

• Signs and Symptoms
• What Causes It?
• Who's Most At Risk?
• What to Expect at Your Provider's Office
• Treatment Options
• Prognosis and Possible Complications
• Following Up
• Supporting Research

Lyme disease is the most common tick-borne disease in the United States, with approximately 16,000 new cases reported each year. The disorder was first identified in 1975 when a group of children in Lyme, Connecticut, experienced mysterious arthritis-like symptoms. The deer tick carrying the bacterium B. burgdorferi is responsible for the spread of the disease in the United States. Cases have been reported in nearly all states, and the disease is also on the rise in large areas of Asia and Europe.

Signs and Symptoms

Lyme disease may be accompanied by the following signs and symptoms:

• Red rash that appears within a few weeks of a tick bite, initially as a small red spot at the site of the bite. The spot expands over time, forming a circle or oval and sometimes resembling a bull's eye. The rash can range in size from that of a dime to the entire width of a person's back. As the infection spreads, rashes can appear at different places on the body.
• Flu-like symptoms -- fever, headache, stiff neck, body aches, and fatigue.
• Arthritis -- 60% of people not treated with antibiotics develop recurring attacks of arthritis, most commonly in the knees, that last a few days to a few months. About 10 - 20% of untreated individuals will develop ongoing arthritis.
• Neurological symptoms -- stiff neck and severe headache (may indicate meningitis), temporary paralysis of muscles in the face (Bell's palsy), numbness, pain or weakness in the limbs, or poor motor coordination. Symptoms can develop weeks, months, or even years following an untreated infection, and can last for weeks or months. Symptoms usually resolve completely, but they may recur.
• Heart problems -- heart abnormalities such as palpitations, lightheadedness, fainting, chest pain, and shortness of breath are uncommon. Symptoms may appear several weeks after infection and last a few days or weeks.

What Causes It?

Ixodes ticks carrying the bacterium B. burgdorferi bite people. The bacteria enter the skin at the site of the bite, after the infected tick has been in place 36 - 48 hours. Symptoms are primarily due to the body's response to this invasion.

Who's Most At Risk?

The following factors may increase the risk for developing Lyme disease.

• Environment -- exposure to heavily wooded areas.
• Season -- infection is most likely during the summer and fall.
• Age -- most common in children and young adults.
• Location -- 90% of cases occur in the coastal northeast, as well as in Wisconsin, Minnesota, California, and Oregon.

What to Expect at Your Provider's Office

Lyme disease can be difficult to diagnose because many of its symptoms mimic those of other disorders. About one quarter of people with Lyme disease do not develop a rash. Your health care provider will consider your risk factors and will check your blood for antibodies against B. burgdorferi to confirm the presence of the bacterium. A spinal tap may be performed to detect brain and spinal cord inflammation and to examine antibodies or genetic material of B. burgdorferi in the spinal fluid.

Treatment Options

Prevention

The best defense against Lyme disease is to guard against tick bites. Avoid heavily wooded areas, wear protective clothing, and apply tick repellant. Wear light-colored clothing (which makes ticks easier to detect), do a careful inspection of your body after outdoor activities in wooded or grassy areas, and, if ticks are found, remove them with tweezers. New evidence suggests that it may even be possible to prevent Lyme disease if antibiotics are administered within 3 days of a tick bite.

A vaccine against Lyme disease was approved by the FDA in December 1998. The vaccine is recommended for those who live, travel, or work in areas where Lyme disease is prevalent. Studies indicate that the vaccine is about 80% effective.

Drug Therapies

Your health care provider may prescribe the following medications:

• Antibiotics, such as amoxicillin, doxycycline, cefuroxime axetil, or erythromycin are used. In the case of neurological symptoms, ceftriaxone or penicillin is used.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) for relief of symptoms.

Complementary and Alternative Therapies

Lyme disease affects many body systems, so treatment that includes complementary therapies, such as homeopathy and stress management, may have benefits. Chiropractic therapy may help relieve pain, make you more mobile, and improve range of motion.

Always tell your health care provider about the herbs and supplements you are using or considering using.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

• Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
• Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
• Avoid refined foods such as white breads, pastas, and especially sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), and beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

You may be able to address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-vitamins, and trace minerals, such as magnesium, calcium, folic acid, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil one to three times daily, to help decrease inflammation and improve immunity. Cold-water fish, such as salmon or halibut, are good sources, but do not replace dietary supplementation.
• Probiotic supplement (containing Lactobacillus acidophilus ), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
• Grapefruit seed extract ( Citrus paradisi ), 100 mg capsule or 5 - 10 drops (in favorite beverage) three times daily, for antibacterial or antifungal activity and immunity.
• Vitamin C, 500 - 1000 mg one to three times daily, as an antioxidant, and for immune support.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and muscular support.
• Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
• SAMe (s-adenosyl-L-methionine), 100 - 200 mg before breakfast daily, for mood improvement.
• L-theanine, 200 mg one to three times daily, for stress and nervous system support.
• Melatonin, 2 - 5 mg before bed, when needed for sleep, and to improve immunity.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Green tea ( Camellia sinensis ) standardized extract, 250 - 500 mg daily, for antioxidant, anti-inflammatory and heart health effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Ginkgo ( Ginkgo biloba ) standardized extract, 40 - 80 mg three times daily, for antioxidant and heart health support.
• Cat's claw ( Uncaria tomentosa ) standardized extract, 20 mg three times a day, for inflammation and antibacterial or antifungal activity.
• Reishi mushroom ( Ganoderma lucidum ), 150 - 300 mg two to three times daily, for inflammation and for immunity. You may also take a tincture of this mushroom extract, 30 - 60 drops two to three times a day.
• Olive leaf ( Olea europaea ) standardized extract, 250 - 500 mg one to three times daily, for antibacterial or antifungal activity and immunity. You may also prepare teas from the leaf of this herb.
• Garlic (Allium sativum) , standardized extract, 400 mg two to three times daily, for antibacterial or antifungal and immune activity.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend treatments for Lyme disease based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person’s constitutional type -- your physical, emotional, and intellectual makeup. In some cases, such as Lyme disease, a professional homeopath may prescribe specific remedies without considering the individual's constitutional state. Such remedies for Lyme disease include:

• Arsenicum album
• Borrelia burgdorferi nosode
• Carcinosin
• Lac canimum
• Ledum
• Mercurius
• Syphilinum
• Thuja

Acupuncture

Acupuncture may help relieve pain, increase mobility, and reduce fatigue. Chinese herbal formulas, used by many acupuncturists, may help resolve joint, muscular, and neurological symptoms from B. burgdorferi infection after many courses of antibiotics.

Massage

Massage therapy may help relieve muscle pain and increase mobility as part of a physical therapy program.

Prognosis and Possible Complications

The long-term prognosis for most patients treated with antibiotics is excellent. Delay in treatment can result in complications.

Following Up

If you have a severe and advanced case of Lyme disease with varied symptoms, your health care provider may want to see you regularly.

Supporting Research

Ahlemeyer B, Krieglstein J. Neuroprotective effects of Ginkgo biloba extract. Cell Mol Life Sci . 2003;60(9):1779-92.

American College of Physicians. Guidelines for Laboratory Evaluation in the Diagnosis of Lyme Disease. Ann Intern Med. 1997;126:1106-1123.

Beers MH, Berkow R, eds. The Merck Manual of Diagnosis and Therapy . Whitehouse Station, NJ: Merck & Co.; 1999:1189-1191.

Bell DR, Gochenaur K. Direct vasoactive and vasoprotective properties of anthocyanin-rich extracts. J Appl Physiol . 2006;100(4):1164-70.

Bock SJ. Integrative treatment of Lyme disease. Int J Integrative Med. 1999;1(3):19-23.

Brier SR. Lyme disease. J Manipulative Physiol Ther. 1990;13(6):337-339.

Burrascano JJ Jr. Advanced Topics in Lyme Disease: Diagnostic Hints and Treatment Guidelines for Tick Borne Illnesses. 13th ed. Accesssed August 8, 2000.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea--a review. J Am Coll Nutr . 2006;25(2):79-99.

Cantorna MT, Hayes CE, DeLuca HF. 1,25-Dihydroxycholecalciferol inhibits the progression of arthritis in murine models of human arthritis. J Nutr. 1998;128(1):68-72.

Cantorna MT, Hayes CE. Vitamin A deficiency exacerbates murine Lyme arthritis. J Infect Dis . 1996. 174(4):747-751.

Fontani G, Corradeschi F, Felici A, et al. Cognitive and physiological effects of Omega-3 polyunsaturated fatty acid supplementation in healthy subjects. Eur J Clin Invest . 2005;35(11):691-9.

Gaby AR. The role of coenzyme Q10 in clinical medicine: Part 1. Alt Med Rev . 1996; 1(1):11-17.

Heggers JP, Cottingham J, Gussman J, et al. The effectiveness of processed grapefruit-seed extract as an antibacterial agent: II. Mechanism of action and in vitro toxicity. J Altern Complement Med . 2002;8(3):333-40.

Heitzman ME, Neto CC, Winiarz E, Vaisberg AJ, Hammond GB. Ethnobotany, phytochemistry and pharmacology of Uncaria (Rubiaceae). Phytochemistry . 2005;66(1):5-29.

Jonas WB. Do homeopathic nosodes protect against infection? An experimental test. Altern Ther Health Med. 1999;5(5):36-40.

Kacherski SE. The diagnosis and treatment of Lyme related TMJ utilizing the Bi-Digital O-Ring test, homeopathic dilutions of reference controlled substances and nutritional support. Acupunct Electrother Res. 1997;22(1):76.

Kimura K, Ozeki M, Juneja LR, Ohira H. l-Theanine reduces psychological and physiological stress responses. Biol Psychol . 2006 Aug 21.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide . Hudson, OH:LexiComp; 2000: 452-454.

Mischoulon D, Fava M. Role of S-adenosyl-L-methionine in the treatment of depression: a review of the evidence. Am J Clin Nutr . 2002;76(5):1158S-61S.

Ramachandran U, Divekar HM, Grover SK, Srivastava KK. New experimental model for the evaluation of adaptogenic products . J Ethnopharmacol . 1990 Jul;29(3):275-81.

Rotsein OD. Oxidants and antioxidant therapy. Crit Care Clin . 2001;17(1):239-47.

Seltzer EG, et al. Long-term outcomes of persons with Lyme disease. JAMA . 2000;283:609-616.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr . 2002;21(6):495-505.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Tarcher/Putnam; 1995.

Van Benschoten MM. Treatment of Lyme disease via Omura's test of acupoints and Chinese herbal formulas. Am J Acupunct. 1992;20(4):363-367.

Wang HK. The therapeutic potential of flavonoids. Expert Opin Investig Drugs . 2000;9(9):2103-19.

Whitmont RD. Homeopathy and Lyme disease . J Am Inst Homeopath. Winter 1997-98;90(4):186-198.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J . 2005;46(5):585-96.

• Review Date: 9/5/2006
• Reviewed By: Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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