vol. 8, issue 1 investigating lyme disease & chronic illnesses in … · 2013. 9. 3. ·...

Vol. 8, Issue 1 Investigating Lyme Disease & Chronic Illnesses in the USA January 2013

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Leading Experts Gather to Decode the Mystery of Chronic Illness

by Scott Forsgren

Healthy MedicineAcademy, in conjunctionwith ResearchedNutritionals, recently hosted"Decoding the Mystery ofChronic Illness" in Phoenix,Arizona. The primary focusof the event was to reviewapproaches for treating per-sisting infectious inflamma-tion. The event featuredmany of the top experts inthe chronic illness landscapeincluding Joseph BurrascanoJr. MD, Norton FishmanMD, Stephen Fry MD, CarolAnn Ryser MD, and otherleaders in the field.

The sessions wereattended by practitionersfrom North America,Europe, and Australia. Itwas a weekend filled withthe very latest research, casestudies, and treatmentapproaches aimed at thoserecovering from chronicLyme disease and otherdebilitating conditions.

The intent behind thisarticle is to cover the high-lights of this highly informa-tive event. For additionaldetails, DVDs are availablefrom ResearchedNutritionals.

Dr. Joseph Burrascano,Jr. MD - "Clinical Updateon Tick-Borne Diseases"

The evening prior tothe formal event, Dr.Burrascano spoke at a gath-ering hosted by the ArizonaLyme Disease Associationand shared a "ClinicalUpdate on Tick-BorneDiseases". While Dr.Burrascano covered the his-tory and the nuts and boltsof Lyme, he also shared anumber of new items whichwere quite informative as heis always on the leading edgeof Lyme disease diagnosisand treatment.

Dr. Burrascano notedthat indirect tests such asthe ELISA, the IFA, and theWestern Blot are notoriouslyunreliable as they are look-ing for a "shadow of expo-sure to a germ". One of themost exciting aspects of histalk was a discussion of therelatively new Borrelia cul-

ture test from AdvancedLaboratory Services.

The early pioneer inculturing Borrelia organismswas Alan B. MacDonald MD.Dr. MacDonald developedthe original Borrelia cultureover twenty years ago. Afterpatient treatment, he wasable to see the persistence ofLyme spirochetes in the cul-ture. Dr. Burrascano askedthe audience, "How can youcall it Post-Lyme Syndromeif Lyme organisms are stillthere?" Ongoing symptomsmay represent ongoing andpersistent infection.

Even though Dr.MacDonald's culture testwas validated three times,his opponents took the posi-tion that his work was fraud-ulent. As a resultMacDonald was forced toleave the Lyme field for overtwo decades. Fortunately forus, he has since returned.

More recently, Dr.MacDonald and Dr. Eva SapiPhD worked as consultantswith Advanced LaboratoryServices to create the mod-ern Borrelia culture test.The test is revolutionary interms of both its sensitivityand specificity. The sensitiv-ity of the test increases thelonger that the culture isobserved from 47% after 1week to 94% after 16 weeks.When confirmed viaDNA/PCR testing, the speci-ficity is 100%. Existing indi-rect methods of testing mayhave sensitivity as low as 50-70% and in some cases mayreport false positives; whichare not possible with the cul-ture as it is looking for theactual bacterium and not anantibody response that relieson a healthy immune sys-tem. Some have even beenable to use a positive culturetest in order to get insurancecoverage for their treatment.The culture test is generallythe most sensitive if theblood is drawn in the lateafternoon.

Coinfection testing,such as for Bartonella orBabesia, may be even lessreliable than testing forBorrelia as commerciallyavailable tests can only testfor a small number of thetotal known strains.

Another importantpoint that Dr. Burrascanohas made repeatedly overthe years is the importanceof testing blood levels forantibiotics. For example, atlow doses, Doxycycline isbacteriostatic and not bacte-ricidal. If someone is notproperly absorbing theantibiotic or the dosing istoo low, the therapy is ulti-mately ineffective and mayeven promote resistantorganisms. Ensuring that

therapeutic doses of antibi-otics are reaching the blood-stream is a critical part ofoptimizing treatment out-come.

Dr. Burrascano notedthat the goal of treatment isto decrease Lyme germswhile simultaneously build-ing up the immune system.It is about balance and notabout eradicating every sin-gle germ. The most impor-tant things one can do insupport of building up theimmune system is to getproper sleep and to exerciseaccording to a programdevised to improve T cellfunction.

The exercise programrecommended by Dr.Burrascano includes wholebody workouts with weightsor resistance machines. Theweight should be light withmany repetitions. It shouldlast for 45-60 minutes, but ifone cannot tolerate that levelof exercise, it is still impor-tant to start with whatevercan be done. There is a pro-gressive warm-up beforeexercise and stretching ofthe entire body after theworkout. There should beno aerobic exercise. Thisprogram is done only every3-4 days and never on con-secutive days. This style ofexercise supports improvedhealth and function of the Tcells which is critical forrecovery.

Intravenousimmunoglobulin, or IVIG,therapy is an underutilizedtreatment option that canrepair nerve damage oftenpresent in long-term Lymedisease. Furthermore, IVIGcan help to reduce cytokinestorms thus reducing inflam-mation without negativelyimpacting the immune sys-

tem. Dr. Burrascano recom-mends testing for damage tosmall nerve fibers as seen onskin biopsy, and also meas-uring total IgG and IgG sub-types and, if nerve damage isfound or if immunoglobulinlevels are low, consideringIVIG therapy.

A low glycemic, lowfat diet is suggested. Alcoholis not allowed as it makesthe overall condition worse.When Borrelia is incubatedwith alcohol, it induces heatshock proteins and makesthe infection far more toxic.Alcohol makes spirochetesmore aggressive and dam-ages the immune system.

Steroids should not beused unless on aggressiveantibiotic therapy. Exercisemust be performed regular-ly. Rest is mandated, andsleep must be sound.Several key nutritional sup-plements are also recom-mended.

Useful supplementsinclude probiotics, kefir, andsoil-based organisms.Probiotics should be rotatedamongst several types. Amultivitamin with mineralsis suggested. CoQ10 is indi-cated unless Mepron orMalarone are being used.NT-Factor often helps withfatigue. Vitamin D supportsthe immune system and isanti-inflammatory.Essential fatty acids such askrill oil, borage oil, orcoconut oil are necessary.Magnesium can be startedonly after one is on anantimicrobial program; thisis done to avoid the potentialof adding to the biofilm bur-den. Lyme-specific transferfactors assist the immunesystem in recovering fromthe disease. Methyl-B12, B-Complex and methylation

cycle block treatments areoften highly beneficial.

Finally, Dr.Burrascano stressed theimportance of a healthy atti-tude. He suggested cherish-ing the good things in lifeand minimizing or ignoringthe bad. Losing anger andnot feeling sorry for yourselfpromotes an attitude forrecovery. He noted thatbecoming "Lyme-obsessed"is not healthy. One shouldpursue other interests andfind distractions from theircurrent situation. Throughthe journey, we should notlose the person that we are.

Dr. Norton Fishman MD- "Multiple Symptoms,Multiple Systems,Multiple Doctors" and"What is PersistingInfectiousInflammation?"

Dr. Norton Fishmanfinds that inflammation is acommon denominator inchronic illness. Often times,microbes are the initiator ofthe inflammation. He notedthat "inflammation is theimmune systems encounterand response to microbialstimuli in the context of tis-sue injury." Inflammationpresents when the immunesystem is attempting to getrid of an unwelcomed invad-er. The inflammation itselfmay be the cause of many ofthe ongoing symptoms of ill-ness and can be the ongoingtrigger that keeps the illnesschronic.

According to Dr.Fishman, our microbialdefense systems can bedivided into three levels.These are: 1) anatomic andphysiological barriers such

“Experts” ...cont’d pg 2

Dr. Joseph Burrascano

Public HealthAlert

The PHA is committed to research-ing and investigating Lyme Diseaseand other chronic illnesses in theUnited States. We have joined ourforces with local and nationwidesupport group leaders. These groupsinclude the chronic illnesses ofMultiple Sclerosis, Lou Gehrig’sDisease (ALS), Lupus, ChronicFatigue, Fibromyalgia, HeartDisease, Cancer and various otherillnesses of unknown origins.

PHA seeks to bring informationand awareness about these illnessesto the public’s attention. We seek tomake sure that anyone strugglingwith these diseases has proper sup-port emotionally, physically, spiritu-ally and medically.

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FEATURE

as the skin, proper stomachpH, and mucous clearancesystems, 2) innate immunitywhich detects invaders andquickly mounts a protectiveinflammatory response whileactivating the adaptiveimmune system, and 3)adaptive immunity whichconsists of T cells and B cellsand is responsible for creat-ing long-lived immunity tospecific pathogens.

The ABCs of theinflammatory response toinfection include the Antigen(microbes or foreign parti-cles), the Barrier (antigenattack), and the Cytokinecascade. The antigen is theinvasion, the barrier isinvolved in recognition, andthe cytokine cascade is theresponse.

Microbes contain vari-ous pathogenic antigenswhich the immune systemrecognizes. These includelipopolysaccharides con-tained in gram-negative bac-teria, lipoproteins found inspirochetes, proteoglycansassociated with gram-posi-tive bacteria, flagella, DNAand RNA of viruses, andzymosan from the cell-wall ofvarious fungi.

Pattern recognitionreceptors (PRRs) areexpressed by the innateimmune system and areinvolved in recognition ofpathogen-associated molecu-lar patterns (PAMPs) dis-cussed in the previous para-graph. PRRs tell the bodythat there are foreign pro-teins present. Macrophagesare a component ofthe innate immunesystem and areknown as the "bigeaters". They,along with the den-dritic cells, are fur-ther involved in theinitiation of defens-es that make upadaptive immunity.

Next followsthe cytokine cas-cade. NF-κB is akey protein in the immunesystem and tells our DNA tomake proteins to fight micro-bial invasion. It is involvedin the expression of severalhundred genes that encodevarious cytokines,chemokines, and enzymesthat regulate both the innateand adaptive immuneresponse.

Cytokines can be pro-inflammatory such as IL-1,IL-6, IL-12, IFN-y, and TNF−α or anti-inflammatory suchas IL-4, IL-5, and IL-10.Pro-inflammatory cytokinesare part of the body'simmune response topathogens and signal thebody to send in defensessuch as macrophages and Tcells to areas of infection.

The immune systemconsists of several types of T-helper cells: namely Th1,Th2, and Th17. Th1 lympho-cytes are pro-inflammatoryand are involved in theresponse to intracellularorganisms. Th1 immunity isinfluenced by IL-12 whichleads to the production ofIFN-y and blocking of Th2response.

Th2 lymphocytesquiet the cytokines that leadto inflammation and areinvolved in immunity related

to allergic response andextracellular parasites.

Dr. Fishman made theanalogy to the movie "TheGood, The Bad, and TheUgly" with Clint Eastwoodand suggested that IL-10 is"the good", IL-6 is "the bad",and TNF−α is "the ugly".IL-10 is an anti-inflammato-ry cytokine and downregu-lates the expression of Th1immunity. IL-6 can be bothpro-inflammatory and anti-inflammatory and is pro-duced by both the Th1 andTh2 arms of innate immuni-ty. It can promote inflam-mation, lead to muscle wast-ing, and cause endothelialdysfunction. Further, IL-6antagonizes insulin and as aresult can lead to weight gainand insulin resistance. TNF−α is a pro-inflammatorycytokine produced by Th1macrophages. It is a masterregulator of the entirecytokine cascade, is involvedin systemic inflammation,and can result in musclebreakdown and high choles-terol.

Th17 is involved in theimmune response to extra-cellular pathogens and is alikely contributor to autoim-mune diseases. Th17 cellsproduce IL-17. It is highlypro-inflammatory and isinduced by Borrelia.Continuing with the analogyabove, Th17 is like "TheTerminator" with ArnoldSchwarzenegger.

In chronic infections,inflammation is an ongoingpresence. It is thought that

statin drugs may have anti-inflammatory properties andthat cholesterol often riseswhen inflammation is pres-ent.

A Herxheimer reac-tion is an exaggeratedinflammatory response inactive Lyme disease. It is inexcess of what the body canhandle. The effects of exag-gerated inflammation areprolonged sickness, cognitiveimpairment, malaise, pain,depression, and neurologicaldisease.

Ways to minimizeHerxheimer responsesinclude:

Pulling back the throttleon the treatment inducingthe reaction Salicylates and NSAIDs

Omega-3 oilsZincAnti-inflammatory herbsEnzymesStatins Thiazolidinediones (such

as Actos)ProbioticsVitamin D3

When Vitamin D 1,25is high and D, 25 is low, thisis a sign of an inflammatory

response in activatedmacrophages often seen inactive Lyme disease. Thiscan also be seen in sarcoido-sis, a much less common dis-ease. An ideal D, 25 levelwould be around 60. Thedesired form of Vitamin Dfor supplementation is D3.

Through several keymechanisms, bacteria evadebeing killed by antibiotics.These include the formationof biofilms, phenotypic varia-tion (persister cells which areslow growing and insensitiveto treatment and the abilityto change form into granules,blebs, and cysts), and geneticmutation which makes theorganisms less susceptible totherapy. It is primarily theability to produce biofilmsand to change forms thatmakes treating chronic bac-terial infections such asBorrelia quite difficult.

Due to these chal-lenges, several differentantibiotic strategies are oftenemployed. These includepulsing, combination thera-py, cyst busters, selective tar-geting antimicrobial pep-tides, antibiotic-generatedhydroxyl radicals, andaddressing biofilms.

Jeremy Ellis PhD -"Clinical LaboratoryTechnology -Microscopic, Serologic,and Molecular Markersof Disease"

Dr. Jeremy Ellis is thelaboratory manager of FryLaboratories in Scottsdale,

Arizona. He presented onthe various technologiesavailable in testing for vec-tor-borne diseases.

The main technologiesthat are used in laboratorytesting today includemicroscopy, serology, andmolecular diagnostics. Eachof these technologies haspluses and minuses. Dr.Ellis articulated the testparameters of each of theprimary technologies avail-able. These parametersincluded the type of test,detection, specificity, andsensitivity. The type of testcan be either direct or indi-rect (meaning it is lookingfor the actual organism orother indirect evidence of theorganism, such as host anti-bodies). The detection capa-bilities of a test could bebroad spectrum or narrow.The specificity of a given testis how specific is the identifi-cation of a given sample andwas described as eithermixed or accurate. The sen-sitivity of a test may be mod-erate, complicated, or excep-tional depending on howmany organisms must bepresent for detection.

Microscopy is an olderstandard. Under the micro-scope, one can see organisms

such as Plasmodium,Babesia, spirochetes, filaria,and other organisms. It canbe diagnostic and "seeing isbelieving". However, theinformation obtained is oftenvery general, the organismmust be present in the sam-ple being observed, andmicroscopy is very skill andtechnology dependent.

Serology tests general-ly look at blood or other flu-ids for antibodies to a givenantigen and are thus indirecttests. One advantage is thatserologies do not require thatthe organism itself is presentin the blood sample beingtested. It can be diagnostic,and in some cases, can beused to determine whetherthe condition is acute orchronic. The downside ofserological testing is that itrequires a competentimmune system that is capa-ble of creating antibodiesand there can be cross-reac-tivity with other organisms.

Molecular diagnosticslook for specific states ofhealth or disease by studyingmolecules such as DNA andRNA. These are exceptional-ly sensitive and specific.They can not only be diag-nostic but can be quantita-tive. It is a direct test andthus also requires the organ-ism to be present in the sam-ple.

An ideal testingmethod would be direct,broad spectrum, accurate,and have exceptional sensi-tivity. DNA sequencing hasall of these attributes and is

the upcominggold standard forvector-borne andinfectious diseasetesting.

Dr. Ellis cov-ered various vec-tor-borne coinfec-tions such asBabesia,Bartonella,Anaplasma,Ehrlichia,

Rickettsia, Toxoplasma, andCoxiella.

Babesia is an apicom-plexan or protozoan organ-ism which can lead tomalaise, fever, chills, arthral-gia, fatigue, headache, weak-ness, enlargement of the liverand spleen, and anemia.Clinical manifestation oftentakes 1 to 4 weeks after anexposure. Species that infecthumans include Babesiamicroti, Babesia duncani,Babesia divergens, andBabesia bovis.

Bartonella is analphaproteobacteria and canlive both inside and outsideof red blood cells. There areat least 50 different specieswith 8-10 of them known toinfect humans. Any of thesethat can infect dogs can alsoinfect humans. Bartonella isknown to attack the lining ofthe vascular system. It canresult in fever, malaise,swollen lymph nodes,enlargement of the spleen,arthralgia, and mylagia. Thecommon species infectinghumans include Bartonellahenselae, Bartonella quin-tana, Bartonella bacilli-formis, and Bartonella eliza-bethae.

Anaplasma and “Experts” ...cont’d pg 3

TestTechnology Type of Test Detection Specificity Sensitivity

Microscopy Direct Broad Spectrum Mixed Moderate

Serology Indirect Narrow Mixed Complicated

MolecularDiagnostics Direct Moderate Accurate Exceptional

“Experts” ...cont’d from pg 1

MEDICAL PERSPECTIVES


Ehrlichia are alphapro-teobacteria that can lead tofever, myalgia, headache,chills, rash, and gastroin-testinal issues. Ehrlichiamuris is an emerging speciesin Florida. The most com-mon species includeAnaplasma phagocy-tophilum, Anaplasma mar-ginale, Ehrlichia chaffeensis,Ehrlichia canis, Ehrlichiaewingii, and Ehrlichiamuris. These are intracellu-lar organisms.

Rickettsia is analphaproteobacteria that canresult in fever, rash, and flu-like symptoms. It acts verysimilarly to a virus. It is tick,lice, mite, and flea-borne.Toxoplasma gondii isbelieved to be an issue in10.8% of the population ofthe United States. It formscysts within the tissues andeven in the brain and gener-ally does not go away. It canlead to retinal damage,organ damage, andencephalitis. Cats are one ofthe primary reservoirs ofToxoplasma, which is thereason pregnant women arewarned not to change litterboxes while pregnant.Coxiella causes the diseasecommonly known as Q-Fever and leads toheadaches, chills, and respi-ratory symptoms. It isextremely contagious andcan be transmitted via ticksor in milk and is a knownbiowarfare agent.

Dr. Stephen E. Fry MD -"Vector-Borne Diseases,Biofilm Communities,ProtomyxzoaRheumatica:Mechanisms ofPersistent Infections"

Biofilms, also referredto as "slime", are "a struc-tured community of bacterialcells enclosed in a self-pro-duced polymeric matrix andadherent to an inert or livingsurface". The most powerfulglues known to man aremade by bacteria.

Biofilms impact teeth,drinking water, pipes used inoil recovery, cooling water,food processing, ship hulls,and medical implants. Mosturinary catheters are coatedwith silver as silver is aknown anti-biofilm agent.

Dr. Fry and his lab,Fry Laboratories, have beeninvestigating the role of aprotozoan organism knownas Protomyxzoa rheumatica(formerly FL1953) andbiofilms in many differentchronic health conditions.They postulate that proto-zoan organisms may beinvolved in chronic rhinosi-nusitis. In Cystic Fibrosis,several organisms may beinvolved, but once the bacte-ria Burkholderia cepacia ispresent and begins to pro-duce biofilms, life expectan-cy is generally two years orless. Kidney stones may bethe result of biofilm-formingnanobacteria. Very simpleorganisms can createbiofilms; it is possible thateven viruses create biofilms.

Chronic, non-healingwounds are often associatedwith biofilms. Biofilm podscolonize the bladder inchronic urinary tract infec-tions. Biofilms are often afactor in osteonecrosis of thejaw, and in these cases, 2-15different types of organismsthat are not considered nor-mal periodontal flora may bepresent.

Culturing for routineinfections is often very use-ful. However, biofilm organ-isms are difficult to culture.Biofilm infections are chron-ic in nature and very difficultto eradicate. Pathogens areprotected from antimicrobialtherapies by the biofilm, andthe immune system is unableto eradicate these protectedpathogens. It has been sug-gested that inflammationnourishes biofilm communi-ties. Biofilms are the rule innature, not the exception.

Biofilms consist ofnumerous microorganisms,extracellular polymeric sub-stances, proteins, DNA, cal-cium, magnesium, and iron.Biofilms play a role in manychronic diseases. They likeflow environments and,along with Protomyxzoarheumatica, may play a rolein CCSVI (chronic cere-brospinal venous insufficien-cy).

Protomyxzoarheumatica appears to be anemerging infection in thosewith Lyme disease and manyother chronic conditionssuch as Chronic Fatigue

Syndrome, RheumatoidArthritis, Scleroderma,Parkinson's, MS, and ALS.Protomyxzoa is an inflam-matory trigger and vascularpathogen. It is similar inmany ways toToxoplasmosis, Malaria,and Babesia, but is also aprofound biofilm former. Itmay ultimately be the causeof most neurological dis-eases.

ALS may be the resultof the combination ofProtomyxzoa and the bacte-ria Ralstonia; both of whichare profound biofilm form-ers that ultimately affect thesubstantia nigra, an area ofthe brain that producesdopamine.

Protomyxzoa doeshave a flagella and thus maybe one explanation for a pos-itive 41 kDa band onWestern Blots for Borrelia.

Plaquenil,Methotrexate (folic acidantagonist; Protomyxzoauses folic acid), herbals,enzymes, mechanicalremoval of biofilm, antipro-tozoals, and antimalarialsare currently used for treat-ment. Some antimalarialtreatments such asClindamycin, Minocycline,and Biaxin have shown to behelpful in treatingProtomyxzoa. Magnesiumand arginine are contraindi-cated in Dr. Fry's treatmentapproach as these benefit theProtomyxzoa. Fats arerestricted using theMcDougall diet as fats areused by the organism forreplication and as a compo-nent of the biofilm; theamount of Protomyxzoaobserved via laboratory test-ing directly correlates to theamount of fat in the diet.

David Berg MS -"UnderlyingPathophysiology:Hypercoagulation"

One of the very com-mon issues in chronic ill-nesses which have chronicinfections as an underlyingfactor is thick blood orhypercoagulation. When theblood is too thick, treatmenthas not been optimized andoutcomes are often disap-pointing.

Inflammation and

lack of blood flow are hall-marks of many chronic dis-ease states. When theimmune system is activated,this leads to inflammationwhich activates the clottingcascade. Inflammation com-bined with coagulationdefects and pathogens leadsto fibrin build-up in the cap-illaries and chronic illness.

There are many dif-ferent types of coagulationdefects and when each isconsidered separately, theseimpact only a small portionof the population, but whenlooking at the sum total ofthe possible defects, at least1 in 4 people are impacted.

Activation of thecoagulation system can betriggered by many differentfactors such as viruses(HHV-6, CMV, EBV, HSV-1,HSV-2, Parvovirus, HerpesZoster), bacteria(Mycoplasma, Chlamydia,Borrelia, Brucella, Staph,Strep, Ehrlichia,Bartonella), yeast(Candida), parasites(Babesia, Protomyxzoarheumatica), vaccinations,heavy metals, chemicals, andtrauma.

The ISAC (ImmuneSystem ActivatedCoagulation) panel fromEsoterix Labs is a group ofblood tests that demonstratehow activated the coagula-

tion system is. With expertinterpretation of the results,one can determine appropri-ate therapies. These mayinclude fibrinolytics such asBromelain, Wobenzym,Serrapeptidase, Endozyme,Nattokinase, Lumbrokinaseand anticoagulants such asHeparin. Berg suggests thatin his experience, Boluoke (aspecific Lumbrokinase prod-uct) is the best option formany people.Lumbrokinase is approxi-mately 50-100 times moreeffective than Nattokinaseand is capable of dissolvingdebris both inside and out-side of the blood vessels.Boluoke seems to help bothwith fibrin accumulation andreduction of biofilms.Boluoke can be taken with orwithout food.

As fibrin is depositedin the capillaries, tissues donot get necessary oxygen.Nutrients and hormonescannot enter tissues, andwaste products cannot beremoved.

Coagulation is alsotriggered by an increase infat cells. The more fat wecarry, the more cytokinesour body will have whichplays a role in inflammation.Losing weight improves bothinflammation and coagula-tion.


Dr. Stephen E. Fry




Berg is an expert at inter-preting traditional CBCs aswell. For example, a lowwhite blood cell (WBC)count with elevated neu-trophils and depressed lym-phocytes is commonly seenin Borrelia infections. Hesuggests that wheneosinophils are elevated evenat 4-6, one should check forparasites. When 3 times thehemoglobin value is 1% ormore below the value ofhematocrit, this may suggestor be an indicator of Babesiaor Protomyxzoa infections,both of which leach ironfrom RBCs to live.

Author Note:Evaluating for hypercoagu-lation with an ISAC panel isa key part of a well-plannedtreatment approach. I havepersonally done it morethan once over the yearsand am in the process ofdoing it again. Once theresults are received, yourdoctor can schedule a con-sultation with David Berg tobetter understand what thefindings mean and whattreatment options may beappropriate.

Ruth Kriz APRN -"UnderlyingPathophysiology:Diagnosis andTreatment ofCoagulation andResultant CascadingIssues"

Approximately 20% ofthe population is geneticallypredisposed to coagulationproblems. However, in peo-ple with chronic illness, thisnumber doubles to at least40% having a genetic predis-position resulting in a coagu-lation issue. Inflammationand infections trigger athickening of the blood, orhypercoagulation, and ulti-mately biofilm formation.Inflammation is the triggerfor the cytokine cascade aswell as the production of fib-rin which is a component ofbiofilm.

While some peoplemay feel better as a result ofbiofilms walling off variousinfections, biofilms must beaddressed over time in orderto optimize clinical out-comes. Biofilms consist ofmany different types ofmicrobes. The microbes liv-ing within a biofilm are1,000 times more resistantto antibiotic therapy. Genetransfer is facilitated withina biofilm community suchthat the biofilm communitybecomes more stable andmore resistant to treatment.

Kriz uses the ISACpanel (discussed previouslyin this article) as a way toevaluate the state of thecoagulation system. Whenindicated, Boluoke is oftenhelpful for breaking downbiofilms and releasing theinfections within the biofilmcommunity.

Within the ISACpanel, CD62P can be used asa marker of viral load.Viruses can trigger anincrease in fibrinogen.Antivirals such as andro-graphis and transfer factorsmay be helpful in normaliz-ing CD62P.

Coagulation issues are

often addressed by reducingthe infectious triggers,decreasing inflammationthrough modulation ofHerxheimer reactions andreduction in toxic burden,breaking down fibrin withenzymes and other thera-pies, preventing clotting riskwith Heparin or Lovenox,and addressing genetic pre-dispositions.

Carol Ann Ryser MD -"Central Nervous SystemInflammation Secondaryto PersistingInflammation"

Dr. Ryser's journey into thetreatment of chronic illness-es such as Lyme diseasecame in the early 1980'swhen she had a Lymepatient that had previouslybeen diagnosed as schizo-phrenic.

PET and SPECT scansare ordered to look atinflammation in the brainwhich she calls "The FireWithin". Various microbescan be the cause if ongoinginflammation. Enterococcusis a "nasty bug" which canlead to interstitial cystitisand diarrhea. The virusCoxsackie is a huge problemwhich can lead toFibromyalgia, gastrointesti-nal problems, and inflamma-tion of the heart. HSV-1 cancause inflammation of thebrain.

Stressors that stimu-late inflammation includeinfections, surgery, emotion-al trauma, gastrointestinaldisease, heavy metals, tox-ins, vector-borne diseases,child birth, autoimmunity,cancer, obesity, ChronicFatigue Syndrome,Fibromyalgia, and diabetes.

5 million Americanshave Alzheimer's disease,and people over age 85 havea 50% chance of developingthe condition. By 2050, over100 million people world-wide will have the conditionwith 15 million of those inthe United States.Alzheimer's is related toinflammation of the brainand accounts for 50-80% ofcases of dementia. 200,000people have Alzheimer's dis-ease before the age of 40.

The pancreas andbrain need glucose to sur-vive. New research showsthe brain makes insulin.Insulin is produced in thebrain independent of its pro-duction in the pancreas.Aerobic metabolism usesglucose and insulin; whereasanaerobic metabolism usesketones.

There are severalways to increase ketonesincluding a high fat (long-chain carbon fats such asC8-C12, MCT, and Coconutoil), low glucose, low proteindiet. Foods that containmedium chain fatty acids areeasily absorbed and convert-ed into ketones by the liver.These ketones can cross theblood-brain barrier andserve as fuel for the brain.They have an ability to acti-vate neurons independentfrom glucose and insulin. Insome cases, seizures can bedue to insulin/glucose mal-function, and a ketogenicdiet may be helpful in con-

trolling the condition.Some of the items

which negatively impact thebrain include: obesity, smok-ing, hypertension, lack ofexercise, sleep apnea, dia-betes, hypercoagulation, oxy-gen deprivation, inflamma-tion, infections, drugs, alco-hol, and some medicationssuch as statins.

Hypoglycemia of thebrain combined with inflam-mation leads to many cogni-tive symptoms; which leadsto eating more and eventualweight gain. Insulin is need-ed to allow glucose into a celland is converted into ATPwhich provides energy need-ed for life. Neurons in thebrain, however, can utilizeketones as energy; entirelybypassing theglucose/insulin system. TheAtkins and South Beachdiets are mild ketogenicdiets.

Ketones are madefrom medium-chain triglyc-erides (MCT/coconut oils).Ketones produce twice asmuch ATP as glucose andcan cross the blood-brainbarrier. ConsumingMCT/coconut oil coverts toketones but does not reachthe level of ketoacidosis seenin diabetes.

Diabetes is a condi-tion that 26 millionAmericans struggle with;while 79 million have predia-betes. Diabetes leads to riskof increased blood pressure,heart disease, stroke, prob-lems in the nervous system,pain in the extremities, andultimately poor wound heal-ing and dementia.Hypoglycemia results whenthere is too much insulin forthe amount of carbohydratesthat have been consumed.Symptoms include twitching,seizures, confusion, cognitiveissues, fatigue, muscle weak-ness, memory loss, insom-nia, and tremors.

Alzheimer's disease isnow termed "Type 3Diabetes" given that there isreduced insulin in the brain,an abnormal signaling path-way for the use of energy,and abnormal mitochondrialfunction. There are overlapsbetween Alzheimer's diseaseand Type 1 and Type 2 dia-betes.

From a genetic per-spective, ApoE4 types oftenhave recurrent fever blistersand are up to 15 times morelikely to developerAlzheimer's than the averageperson. This gene can beturned on and off by variousenvironmental factorsthrough what is termed "epi-genetics". Environmentalinfluences may include airpollution, pesticides, nutri-tional deficiencies, heavymetals, chemicals, smoking,alcohol, depletion of choles-terol, and other factors.Cholesterol-lowering med-ications that lower choles-terol below 150 should beavoided.

Beta-amyloid plaquesare observed in Alzheimer'sbrains. Recent thoughtssuggest that these may bethe immune system'sresponse to infection and notthe cause of the disease.HSV-1, or Herpes Simplex 1,causes cold sores and is a

potential contributor inAlzheimer's as it is found inelderly brains. It is found in90% of beta-amyloidplaques, and the virusincreases a protein thatcauses tangles to form in thebrain.

Fatty acids found incoconut oil dissolve the lipidcapsule around the viruswhich can kill it. Valtrex hasa similar effect. Viruses maybe a factor in many chronicillnesses; even diabetes.

Alzheimer's diseaseinvolves mitochondrial dys-function, and ketones can bebeneficial in addressing this.Ketones are efficient produc-ers of ATP, or energy in themitochondria. They alsoimprove the function of theheart by up to 30%.

Nitrosamines arechemical compounds foundin many foods includingbeer, fish, meat, and cheeseand any products preservedwith nitrites. These com-pounds form toxic ceramidesin the liver which can crossinto the brain destroyinginsulin-producing cells andleading to insulin resistance.This leads to a decrease inthe uptake of glucose and tocell death resulting in tan-gles in the brain and theexplosion of virus replicatingfactories.

Much of the researchinto coconut oil andAlzheimer's disease evolvedfrom the work of Dr. MaryNewport MD as she attempt-ed to slow the progression ofher husband's ownAlzheimer's disease.

Except for pregnantwomen which concentrateMCTs in breast milk, humanbeings do not make ketones;thus they must be sourcedprimarily from coconut oiland palm kernel oil.Coconut oil and MCT oil candelay the onset ofAlzheimer's disease and evenreverse the condition insome people.

For dementia orAlzheimer's disease, Ryserconsiders things likeHeparin, Boluoke, orHydralyte (anelectrolyte/glucose formula-tion) to address oxygen dep-rivation; CoQ10, magne-

sium, D-Ribose, NADH, NTFactor, amino acids, growthhormone, essentially fattyacids, and vitamins toaddress mitochondrialimpairments; an alkalinediet combined with phos-phatidylcholine; and MCT oiland coconut oil. For olderpeople with Alzheimer's, aprescription medical foodcalled Axona may be used toincrease ketones.

In patients withchronic illnesses, working onthe brain often helps toresolve many aspects of thecondition. Thus, ketonesmay be an ideal brain food.Ryser recommends a mix-ture of 12 ounces of coconutoil with 16 ounces of MCT oilstored at room temperature.The oils only stay in thebody for about eight hoursand can be taken with orwithout food. Dosing startsat 1 teaspoon per day andworks up to 2 tablespoonsthree times per day. The lastdose should be at bedtime toavoid becoming hypo-glycemic and sleep deprived.Some report significantimprovement in sleep withthe oils. The oils can evenbe frozen in ice cube trayswith chocolate to make atasty popsicle.

Coconut oil is anantiviral and can be quiteuseful in downregulatingviral activity. Many childrenrespond very well to theketone protocol in anattempt to control seizures.Ryser puts many of herpatients with diabetes,chronic inflammation, infec-tions, memory problems,and chronic illness on analkaline diet and onMCT/coconut oil.

Another useful optionis the YES Ultimate EFAParent Essential Oils (PEOs)product. These oils heal thevascular system and reduceinflammation while improv-ing circulation. The bodyconverts these plant oils intoOmega 3, 6, 9, and DHA.

Ryser often usesBenadryl to support propersleep and finds that it can behelpful for Herxheimer reac-tions. Lumbrokinase canalso be helpful when experi


Dr. Carol Ann Ryser



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encing Herxheimer symp-toms. Curcumin is used toboth reduce fibrinogen andquell inflammation.

Much of the researchthat has come out of theAlzheimer's world aroundinsulin and the brain com-bined with inflammationmay explain many of thesymptoms commonlyobserved in chronic illnessessuch as Lyme disease.Addressing insulin deficien-cies, infections, inflamma-tion, and hypercoagulation iskey to both the treatment ofAlzheimer's disease and thetreatment of vector-borneillness and other inflamma-tory processes or toxic expo-sures.

Dr. Joseph Burrascano,Jr. MD - "The Paradigmfor Persisting InfectiousInflammation"

Over time, more andmore people are presentingwith complex and difficult totreat chronic illnesses. Someof these such as ChronicFatigue Syndrome,Fibromyalgia, Autism, MS,ALS, and others have noclear etiology. One commondenominator is that theseconditions seem to followgeographic distributionswhich would lead one toconsider these to be infec-tious conditions. Maps ofthe spread of autism over

decades appear consistentwith what would be observedwith the spread of infectiousdisease over the same timeperiod. All of these condi-tions involve the immunesystem, cytokine cascades,and resulting activation ofinflammation.

Borrelia inhibits Bcells, T cells, and NK cellsand reduces their popula-tions. B cells remain perpet-ually activated in Lyme dis-ease. There is an upregula-tion of pro-inflammatorycytokines with a concurrentdownregulation of anti-inflammatory cytokines.

Borrelia has manyunique characteristics. Itcan survive in ticks, mam-mals, reptiles, and birds. Itchanges form between spiral,cystic, and granular forms asa protective mechanism inresponse to environmentalstressors. It grows veryslowly; much likeTuberculosis. Given that itsreplication cycle is so long,longer term treatment isrequired. Borrelia producesits own biotoxin known as"Bb Tox 1". It may haveperiods where it is dormantand does not continue todivide, but it continues toproduce toxic productswhich promote ongoinginflammation. If the organ-ism is not in an activegrowth phase, antibioticswill not kill it.

As a protective mech-anism, Borrelia createsbiofilms which makes treat-ment even more difficult.The lead biofilm researcherin the world of Lyme diseaseis Dr. Eva Sapi PhD.Biofilms "protect the resi-dent individuals from hostenvironments such as hostimmune system attack orantibiotic therapy". Biofilmsconsist of a polysaccharidematrix secreted by Borreliaand other organisms, agummy substance calledalginate, calcium, proteins,lipids, and other substances.Organisms protected withina biofilm community are1,000 times more resistantto antibiotic therapy. Thesebiofilm communities are notstatic; organisms enter andleave this protected spaceregularly.

Biofilms incorporatecalcium, magnesium, andiron, and over time, theyharden and get "crunchy".Dr. Cecile Jardin is an expertin Rickettsial infections andfinds that it is best to avoidtaking iron or magnesiumuntil after a patient is onantibiotic therapy. Inresearch studies, the combi-nation of NutraMedixSamento and Banderol dis-solved biofilms and madeBorrelia more susceptible toantibiotic therapies such asDoxycycline or Tinidazole.

Dr. Dietrich

Klinghardt believes that theendothelium, or lining of theblood vessels, is a reservoirfor microorganisms. Biofilmcommunities protect theseorganisms, and the endresult is ongoing infectionand ongoing generalizedinflammation.

Alan MacDonald MDstudied the brains of thosewith Alzheimer's and foundBorrelia DNA in many of thesamples. Judy Miklossy MD,PhD found Borrelia in thebrain 13 times more fre-quently in those withAlzheimer's (90%) thanwithout. Beta amyloid,which is commonly seen inAlzheimer's, can be inducedby Borrelia in tissue cul-tures. Interestingly,Treponema denticola, a den-tal spirochete, has also beenfound in the brain.

Given the knownimpacts of Borrelia onhealth, early and accuratediagnosis is important. Atest must be available that isbulletproof and eliminatesfalse negative and false posi-tive results.

There are over 300different strains of Borreliaand the existing serologiesare often based on only 1 or2 of these. Existing serologi-cal tests may have sensitivi-ties as low as 29-68%. Themore ill a patient is, the lesssensitive serological testingwill generally be.

PCR sensitivity maybe as low as 30%.Additionally, PCR testingmay detect non-livingBorrelia DNA.Furthermore, PCR tests aregenerally not accepted asproof of infection by insur-ance companies.

A new gold standardhas emerged with the recentBorrelia culture test. A cul-ture can be used to see if aperson is still infected withliving Borrelia. It can iso-late all strains of Borreliaand then narrow them downand precisely identify anycultured organisms.

In the past, culturingBorrelia was very difficult asthe microbe is very slow-growing. Alan MacDonaldMD was a pioneer in theearly days and created atechnique for culturingBorrelia. However, at thattime, it could take up to 10.5months for a positive cultureto be returned. The key tocreating a viable culture testwas to create a culture sys-tem that matches the nutri-ents and environmental con-ditions of a living host.Advanced LaboratoryServices in Pennsylvania hasnow made a Borrelia culturecommercially available. Thetest is approximately 94%sensitive and 100% specific.

A positive cultureresult indicates that an

“Experts”... cont’d pg 6




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active infection was presentat the time the blood wasdrawn. The lab has a twostep process. The first stepis a 7-10 day short-term cul-ture. 43% of positive resultsoccur during this period oftime. If the result is indeter-minate or negative, the cul-ture is then moved to long-term culture for up to fouradditional months. It is bestto have the blood drawnwhen a patient is sympto-matic, and early afternoon isthe best time of day to do thedraw. For maximal test sen-sitivity, it is best to drawblood for the culture afterhaving been off all antimi-crobials, including antibi-otics and herbs, for at leastfour weeks. A positive cul-ture test may be recognizedby insurance companies andhas been successfully used tosupport coverage for IV ther-apy.

Treatment strategyshould include supportivemeasures including therapyfor yeast and detoxificationconsiderations, antibiotictherapy including coveragefor coinfections, biofilmbusters, close follow-up withthe patient including regularoffice visits and lab testing,and several regimens overtime. Antibiotic blood levelsshould be measured toensure that adequate druglevels are obtained; under-dosing kills the weakerorganisms and leaves thestronger ones behind.Antibiotics combinationsmust be utilized that coverextracellular and intracellu-lar compartments, that con-sider body fluids and tissues,and that address the variousforms of the organism.

There is a hierarchy ofefficacy with antibiotics thatstarts with slight benefitfrom oral antibiotics, morebenefit from intramuscularBicillin, and most notablebenefit from IV therapy.Burrascano mentioned thatlooking back, he would usefar more IV therapy if hewere still in active practicethan he did. Some of theconsiderations for IV thera-py include abnormal spinalfluid, inflammation of thelining of the joints combinedwith a high sed rate, illnesslasting longer than one year,being over 60 years old,acute disseminated illness infirst trimester, acute carditis,documented immune defi-ciency, prior use of steroidor other immune suppres-sants, or failure of or intoler-ance to oral therapy.

It takes days to weeksbefore Borrelia can recoverfrom an antibiotic hit. Thus,pulsed therapy is oftenemployed as it is not always

necessary to be on antibi-otics on a daily basis. Somepractitioners use a 3 days onfollowed by 4 days offapproach. With pulsing ofantibiotics and a heparinlock, it is often possible to doIV therapy without a PICCline. A pulsed approach canbe used both with oral andIV medications. The excep-tion to this is that the "azole"drugs such as Metronidazolerequire 14 days of continu-ous use to be maximallyeffective. 14 days on fol-lowed by 14 days off may beconsidered. Zithromax has along half-life and thus ismore difficult to pulse, but itmay not need to be givendaily. Bicillin cannot bepulsed since it is injectedand long-acting.Additionally, this approachis specific to Borrelia anddoes not apply to coinfectiontherapeutics.

It is important to notethat Borrelia very quicklydevelops drug resistance. Itis not a good idea to uselower doses of medications.Doses should be full strengthand pulsed.

Another antibioticapproach is called cycle ther-apy. With cycle therapy, onedoes antibiotics for severalmonths and then stops com-pletely. You then wait for arelapse or return of symp-toms and then start treat-ment again. One generallywaits approximately 4 weeksbefore restarting as it takesthat long for Borrelia torecover and start dividingagain, and for cyst forms tochange back into spirocheteswhere they are more suscep-tible to therapy. Once treat-ment is restarted, it is donefor 4-6 weeks and then thecycle is repeated.

For nerve healing,intravenous immunoglobulin(IVIG) can be very helpful,and Dr. Burrascano highlyrecommends this therapy tohelp remyelinate and healnerve fibers. Lyme vaccinepatients with documentednerve damage were able toheal the damage with IVIGtherapy. IVIG mediates andcalms cytokine storms whichmakes it anti-inflammatory;while not being suppressiveto the immune system. IVIGis underutilized in the treat-ment of Lyme disease. Manywith Lyme have IgG subclass1 and subclass 3 deficiencies.IgG subclass testing is readi-ly available and often veryinformative.

66% of those withLyme in Long Island wereshown to have Babesiamicroti. Ticks in New Jerseyin one study were shown tohave a higher incidence ofBartonella than Borrelia;

thus Bartonella is a verycommon coinfection as well.In another study inConnecticut, ticks wereshown to have Borrelia,Bartonella, Ehrlichia,Anaplasma, West Nile Virus,and nematodes. Candidaand Flaviviruses have beenidentified in other studies.Those with chronic Lyme areoften coinfected withMycoplasma, Chlamydia,and Q-Fever. They alsooften express reactivation ofviruses such as EBV, CMV,and HHV-6.

Final Thoughts

On the last day of theevent, a panel discussiontook place with the expertsthat had presented over theweekend. Some of the inter-esting discussion items fromthe panel and event atten-dees included:

Protomyxzoarheumatica may be a maincause of hypercoagulability.Protomyxzoa may cause sig-nificant vascular disease.Alinia and Beyond BalanceMC-BAB-2 have been foundby one practitioner to beuseful in treating this proto-zoan. Another practitionerfound Beyond Balance MC-PZ to be beneficial. It wassuggested that herbals mayhave value in the treatmentof Protomyxzoa and be lesstoxic than other options.

Dr. Fry shared thatthere is no downside to aplant-based diet; thoughsome may need to supple-ment B12, D3, iron, and pos-sibly iodine. In a handful ofwomen, BMI can go too low;should target > 22. Relativeto the treatment ofProtomyxzoa, the immunesystem seems to work bestwhen fat is removed fromthe diet. Spinach is 10%Omega-3 and apples containeven more. Only if thepatient cannot tolerate thediet, nuts or avocado may beadded in some cases.

Protomyxzoa is foundin mosquitoes. In one study,81% of mosquitoes in a high-ly endemic area tested posi-tive for the protozoan. It islikely a worldwide pathogen.Treatment may consist of aplant-based diet, tetracy-clines, and Plaquenil.

Pain in the long bonesor sternum is often relatedto Babesia. Babesia shouldbe suspected when anemia ispresent.

When there is no hairon the legs, this could be anindication of a clottingabnormality. Heparin treatsbiofilms as well as hyperco-agulation. Heparin may be amiracle drug and may beanti-inflammatory,

antimetastatic, anti-Babesia,and it may help to knockProtomyxzoa off of the ves-sel walls.

Viral infections oftenraise CD57. Elevation hasbeen observed in beta strepand whooping cough. CD57is often a useful screeningtest, but is not always usefulin tracking progress as itstays low until the very endand then rapidly rises.When CD57 is low, there isoften a correlation with IgGsubclass deficiencies.

When CD57 is below20, this suggests multiplecoinfections. It is suspectedthat all of the tick-borneinfections can be gestational-ly transmitted andProtomyxzoa has beenfound in cord blood.

In one sample, 98% ofpatients with interstitial cys-titis tested positive forProtomyxzoa.

One practitionerobserved that 40% of herinterstitial cystitis patientsstarted having symptomsafter a new sexual partner.It has been observed thatthere is an increase inrheumatoid arthritis in peo-ple that marry someone withthe condition.

Antibiotics may raiseINR, a measure of coagula-tion. Vitamin K2 may be ahelpful consideration.

A probiotic capsulevaginally (except when thecervix is open prior to birth)may help to protect the uri-nary tract.

Probiotics should betaken as far away fromantibiotics as possible.

While there is stillmore to chronic illness thatneeds to be understood,events such as this one moveus much closer to decodingthe mystery once and for all.

ResourcesAdvanced Laboratory

Services (Borrelia culture) -http://www.advanced-lab.com

Arizona Lyme DiseaseAssociation -http://www.azlyme.org

David Berg MS - [email protected]

Jeremy Ellis PhD -http://www.FryLabs.com

Norton Fishman MD -http://www.ohpmd.com

Ruth Kriz APRN -http://ruthkriz.com/

Stephen E. Fry MD -http://www.FryLabs.com

Healthy Medicine

Academy organizedDecoding the Mystery ofChronic Illness. For otherevents hosted by HealthyMedicine Academy, visithttp://www.HealthyMedicineAcademy.com

ResearchedNutritionals - http://www.ResearchedNutritionals.com

Carol Ann Ryser MD -http://www.HealthCentersOfAmerica.com

Special thanks toResearched Nutritionals forputting on such a compellingevent and for continuing todevelop products which havebeen a great benefit to manyof us.

Author Note: At theevent, two practitioners sit-ting behind me both hadtubes of ResearchedNutritionals new liposomalglutathione product andboth gave wildly positive tes-timonials of how it hadcleared their brains. As aresult, I've started using Tri-Fortify Orange LiposomalGlutathione as well and findit to be the first glutathioneI've ever tried that actuallytasted good!

Disclaimer: Thecontent of this article is forinformational purposes only.It is not intended to be asubstitute for professionalmedical advice, diagnosis, ortreatment. Always contactyour trained medical profes-sional when making anyhealth-related decisions. Asthis article was taken fromthe author's event notes,errors or omissions may bepresent. phaaphaa


About the Author

Scott Forsgren is the editorand founder ofBetterHealthGuy.com wherehe shares his almost sixteenyear journey through achronic illness only diag-nosed as Lyme disease aftereight years of searching foranswers.

Scott was honored tobe awarded an "EducationalExcellence Award" from theLIA Foundation for hisefforts in educating the pub-lic on Lyme disease. Scottcan be reached [email protected].


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