Archive for the ‘Inflammation’ Category

FREE Webinar: Impact of Gut Microbiome on Immunity & Inflammation

Impact of the Gut Microbiome on Immunity and Inflammation


The gut microbiome consists of a complex set of microbial communities that shape human physiology in multiple ways, both subtle and profound. Two-thirds of the body’s lymphocytes reside in gut-associated lymphoid tissue (GALT) or traverse GALT and return home to other organs. Interaction between gut microbes and GALT creates a basal state of immune activation that starts at the mucosal surface and impacts the entire body. The composition and metabolic activity of intestinal microbes yields effects that promote inflammation and that help resolve inflammation. These effects result from the impact of structural components of microbial cells (e.g., lipopolysaccharides) and metabolites of microbial enzyme activity (e.g., butyrate, hydrogen sulfide).

Recent studies have shown that T-lymphocyte function is especially sensitive to the bacterial composition of the microbiome. The structure and function of the gut microbiome is molded by personal genetics, diet, co-habitation, environmental toxins, hygiene, personal care products, psychosocial stress, intercurrent infections, vitamin D, tryptophan metabolites, nutritional status, medications, herbs, probiotics, and prebiotics. Disturbances in the ecology of the microbiome/host relationship create a condition called dysbiosis, which influences the development and the outcome of many different diseases. The ability to recognize and correct dysbiosis is a skill that can help clinicians improve the outcomes of infectious, allergic, and autoimmune disorders and may aid the immunotherapy of malignancy.

We hope you can join us live on May 18th at 4 PM MT. If not, don’t worry, signing up will still grant you access to the webinar recording.


2022-05-18 16:00:00 MT
Leo Galland, M.D., is recognized as a world leader in functional and integrative medicine and a pioneer in the study of intestinal permeability and the gut microbiome as they impact immune function and systemic health. Educated at Harvard University and the NYU School of Medicine, he completed a residency in internal medicine at the N.Y.U.-Bellevue Medical Center and held faculty positions at the Albert Einstein College of Medicine, Stony Brook University and the University of Connecticut, where he also completed a fellowship in Behavioral Medicine. He subsequently served as Director of Clinical Research at the Gesell Institute of Human Development in New Haven, Connecticut. Since 1985, he has maintained a private consulting practice in New York City where he evaluates and treats patients with complex medical disorders, who visit him from all over the world. Board certified in internal medicine, he is a Fellow of the American College of Physicians and the American College of Nutrition. Dr. Galland has received the Albert Norris Marquis Lifetime Achievement Award from Marquis Who’s Who for his contributions to medical innovation and the Linus Pauling Award from the Institute of Functional Medicine for developing basic principles of functional medicine. He is recognized in The Leading Physicians of the Worldand America’s Top Doctors. Dr. Galland has contributed to world medical literature with several dozen articles in scientific journals and chapters in medical textbooks. He created the section on Functional Foods for the Encyclopedia of Human Nutrition. An international best-selling author, Dr. Galland has appeared in The New York Times, The Washington Post, The Wall Street Journal, on the Dr. Oz Show, The Today Show, and Good Morning America, PBS, CNN, MSNBC, and Fox. His PBS Special, The Allergy Solution, aired over a thousand times. Since January 2020, he has studied the COVID-19 pandemic in depth, compiling his findings in an online, extensively referenced and free Coronavirus Guidebook, and has created educational videos on the long COVID syndrome.
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Lyme & Headaches: Natural Relief for the 5 Most Common Causes

by Jenny Menzel, H.C.
Posted 3/17/22

Take a look at just about every ailment in medical literature, and there’s a good chance you’ll see “headache” listed as a possible symptom, but not all headaches are a result of underlying illness. Most people who get occasional headaches will pop an over-the-counter pain reliever and carry on, but it’s not always that simple for those battling chronic Lyme disease.

Lyme-induced headaches can be constant and debilitating, disrupting everyday tasks that can often be taken for granted — like walking the dog, making breakfast for the kids, or going to work. These symptoms can be so severe that getting out of bed to shower might be the day’s largest accomplishment, with modern headache medicine often unable to supply relief.

old age, health problem, vision and people concept - close up of Asian senior woman  sitting on sofa and having headache at home.She may had Headache Symptoms.She looks pain  and sick

Approximately 80% of children and 50% of adults get Lyme-related headaches, with roughly 17% experiencing at least moderate migraines. Many continue suffering through the pain for months to years with little reprieve. Plus, added to the emotional stress of managing chronic headache pain is the maze of trying to figure out what triggered it in the first place.

So why does Lyme disease cause headaches? And what can you do to find lasting relief? If you’ve been struggling for a while with Lyme and the headaches that often accompany this complex illness, consider whether the following might be contributing factors for you. Although some people might stumble upon a quick fix, that’s probably not the norm for most, so you may have to be persistent in your healing efforts before noticing changes.

5 Lyme Headache Causes and Solutions

various microbes icons

Cause 1: Untreated Microbes

A common misperception about microbes is that they’re generally bad and should be killed. However, our bodies house trillions of helpful microorganisms, which outnumber our own cells by about 10 to 1 and account for up to 3% of our body weight. They’re essential to maintaining homeostasis and balancing our body’s microbiome.

But this balance can be upset when Borrelia burgdorferi, the bacteria that causes Lyme, and coinfections, including bartonella, babesia, and mycoplasma, among others, proliferate throughout the body. The result? They may entrench themselves into places like the brain, kicking up a storm of headache-causing neuroinflammation as the body tries its best to corral the stealth pathogens.

herbal supplement bottle and capsule icon

Solution: Suppress Microbes with Antimicrobial Herbs

To make some progress, you may need to focus on long-term ways to suppress harmful microbes. Herbal antimicrobials may not be as potent outright as traditional antibiotics, but they can combat bacteria over an extended period of time without disrupting the microbiome or the toxicity that can come with aggressive drug therapies. Herbs also boost immunity and tame inflammation — typically not something antibiotics have a flair for. Top herbal choices include:

  • Andrographis: Andrographis has a longstanding history of medicinal use in India, and it contains antibacterial, antiviral, and antiparasitic properties. It also has immune-enhancing, cardioprotective, and liver-protective qualities.
  • Cat’s claw: Native to the Amazon region, cat’s claw contains antimicrobial properties and is a foundational herb in most Lyme disease protocols. Additionally, it has immune-modulating and anti-inflammatory qualities.
  • Japanese knotweed: Japanese knotweed with resveratrol has been used for centuries in traditional Asian medicine, and it’s a potent antioxidant with antimicrobial and anti-inflammatory properties. The herb may also assist in combating bartonella.
  • Chinese skullcap: As a multi-purpose herb, Chinese skullcap has antimicrobial properties, decreases cytokines, and supports immunity. It works well with other herbal remedies to enhance their effectiveness.
  • Sarsaparilla: The root of sarsaparilla has been used throughout the tropics for inflammatory conditions of the skin, connective tissues, and the bowel. It binds to and helps dispose of endotoxins that are released from microbes during die-off.

image split between andrographis, cats claw, japanese knotweed, chinese skullcap, and sarsaparilla

Exciting research published in Frontiers adds credence to the use of plant extracts to combat persistent infections. Japanese knotweed, in particular, offered superior protection against a wide range of microbes by busting biofilms and crossing the blood-brain barrier, where Lyme can impact different regions in the brain and potentially produce headaches. Other herbs that showed antimicrobial properties were black walnut, sweet wormwood, Mediterranean rockrose, and cryptolepis, and they were capable of outperforming common Lyme-fighting antibiotics like doxycycline.

If you’re new to herbal therapy, working with a well-trained, Lyme-literate practitioner or doctor can help you find the right blend of antimicrobial herbs to reduce the frequency and intensity of your Lyme headaches.

flame or inflammation icon

Cause 2: Herxheimer Reactions

Herxheimer reactions (usually referred to as a herx or herxing) can occur within days of starting or increasing dosages in your Lyme protocol. And while plant-based antimicrobials are gentler on the body than antibiotics, they still effectively kill bacteria, which means they’re not exempt from causing herx reactions, including headaches, due to pathogenic die-off.

When these microscopic bugs are attacked and killed, pieces of dead bacteria called endotoxins can create an inflammatory autoimmune-like response. If you find your headaches increase after introducing any form of antimicrobial agents to your system, it may be a sign that you’re not expelling endotoxins fast enough.

icon of water drop with circling arrow

Solution: Detoxify Your Body

Getting your organs of elimination (colon, skin, liver, kidneys, lymph, and lungs) opened up and operating optimally is at the core of minimizing herx reactions, and there are many ways to detox and expel inflammatory endotoxins to improve head pain:

Clean Your Pipes

Constipation is a sign of hampered digestion, keeping toxins stuck in your body and recirculating when they need to get out. Eating a whole-food diet full of fibrous fruits and veggies supports a healthy gut microbiome and increases your ability to export toxins. If diet alone isn’t doing the trick, natural remedies like castor oil packs on the belly, professional colonics, or supplementing with magnesium may keep things flowing.

Sweat It Out

Sweating through your body’s largest elimination organ, the skin, is imperative to ejecting toxins. Exercise is a great way to induce sweat but not necessarily when you’re in the throes of a Lyme headache or migraine. If you’re feeling too depleted for exercise, far-infrared (FIR) saunas, red light therapy, or heating pads can raise your body temperature and spark a toxin-removing sweat session while honoring your need for rest.

Support Your Liver

Your liver works hard to filter toxic waste from the blood and breakdown harmful substances in the body — support it with N-acetyl cysteine (NAC), a valuable antioxidant and glutathione precursor which helps reduce inflammatory cytokines, protect nerve tissues, and combat the toxins that may trigger migraines. One study found that NAC helps reduce the frequency of monthly headaches when combined with vitamins C and E as a preventative measure.

Manage Your Lymph Fluid

Much like the circulatory system carries nutrient-rich blood into our cells for nourishment, the lymphatic system has a similar network of vessels that carries waste away from those same cells, helping us stay healthy by fighting infection. However, there’s one major difference: Our hearts automatically pump blood, whereas our lymphatic system has no such pump and requires the action of your muscles and respiratory system to keep it moving. Manage your lymph fluid by exercising, dry brushing your skin, and adequately hydrating to help your body remove toxic waste.

Be Mindful of Your Breath

Deep breathing has displayed a number of detoxifying effects on the body by reducing stress and circulating lymph. Evidence also shows deep breathing can alter the perception of pain by modulating the sympathetic nervous system through relaxation. A breathing technique that can help your body’s ability to rest and digest is the down-regulated breath, which involves slowing your breathing down to four breaths (or less) per minute.

How to practice down-regulated breathing: In a seated or resting position, slowly inhale through your nose for a count of eight, raising your belly and then your lungs. Hold for a bit at the top of the breath. Then, exhale through your nose while deflating your belly and lungs for a count of eight.

Practice this for a few rounds until you feel yourself relaxing. Because of the strong parasympathetic response, this breath is best done after a meal, before bed, or any time you feel anxious (never while driving). It may take time to reach a full eight counts on each inhale and exhale, but with practice, you’ll find your rhythm.

icon of fork and knife

Cause 3: Food Sensitivities

True food allergies and intolerances are hard to miss and can even be life-threatening in some cases. But for many with Lyme, subtle food sensitivities form slowly and go undetected as a result of leaky gut syndrome — an inflammatory condition caused by intestinal permeability, usually due to long-lived gut imbalances from infections, prolonged antibiotic use, poor diet, and stress. Indeed, many people can pinpoint specific foods that bring on headaches and migraines, but what can be done about it?

stomach icon

Solution: Work on Gut Health

While nixing the offending foods should be at the top of the to-do list to minimize headaches, healing your gut is also a priority so that you don’t have to avoid these foods forever. Demulcent herbs like slippery elm can rebuild the mucosa in your gut lining, while digestive enzymes aid in breaking down the food you eat. The abundant amino acid L-glutamine shows ample ability to increase the tight junction proteins needed for a strong intestinal wall. Additionally, bitter herbs like dandelion and burdock will also take a load off the liver to assist digestion.

icon of two different pills

Cause 4: Medications

Headaches are a side effect of some antibiotics. Those with chronic Lyme disease have often tried a range of antibiotic interventions, making it difficult to tell if the headaches stem from medication use or the illness itself. What’s more, in an effort to cope with head pain or migraines, the overuse of certain pain-relieving medications often end up doing the opposite of their intended design: Instead of alleviating headaches, they wind up causing them.

herbal supplement bottle icon

Solution: Seek Natural Pain Relief


Research suggests that different forms of magnesium, the crucial mineral responsible for over 300 biochemical reactions in the body, has promising potential for migraine relief, with intravenous (IV) magnesium sulphate offering the most impressive results. But if IV magnesium isn’t realistic every time you have a Lyme-related headache, supplementing it may be beneficial for you. However, not all magnesium is created equal. For example, inexpensive magnesium oxide isn’t readily absorbed by the body and may cause loose stools and stomach upset. Instead, opt for such bioavailable forms as magnesium glycinate or liposomal magnesium, the form of the mineral most able to cross the blood-brain barrier.


Biofeedback is a non-invasive way to gain greater awareness and control over certain body functions, and it’s proven itself as a useful tool to reduce migraines as well. As a matter of fact, a study published in Behavioral and Brain Functions found migraine frequency and symptom severity were cut in half for up to 70% in the study participants.

The average sustained results lasted around 14.5 months after therapies were discontinued — and one of three biofeedback therapies used in the trial, hemoencephalography (HEG), was considered to be a superior migraine management tool compared to other biofeedback options. Plus, when administered by a trained professional (like a healthcare provider), most insurance carriers often cover biofeedback sessions.


This primary anti-inflammatory compound found in the spice turmeric has been attributed to providing potent pain relief, according to one study in the International Journal of Preventive Medicine. Curcumin has proven its power to reduce the severity, frequency, and duration of headache and migraine symptoms by targeting the same NF-kB and COX pathways as aspirin and ibuprofen, thereby regulating pain and inflammation known to cause migraine headaches.

lightning bolts for stress icon

Cause 5: Chronic Stress

It’s a safe bet that if we were to dig to the root of all illness, some form of physical, mental, or emotional stress could be found. In fact, according to a study published in The Journal of Headache and Pain, perceived stress is the most common trigger of chronic migraines. There are proven ways to modulate our body’s stress response, but finding the methods that work best for you is what matters most — as it should be something you can maintain long enough to experience the benefits.

calming waves icon

Solution: Calm Your Nervous System

Learning to self-soothe in stressful situations can go a long way toward curbing headaches. However, if you feel like you’ve tried everything to get rid of them, get back to the basics with a stress-reducing, mind-body practice, where you can be in control. But don’t let this be one more thing on your to-do list that stresses you out, too. Keep it simple by choosing one practice you feel curious about, start slow, and be consistent. Some mind-body options to consider include:

Managing these five causes can go a long way toward warding off future headaches and migraines caused by Lyme (and life). And while it may seem overwhelming to keep up with it all, investing time and effort into just a few of these solutions will eventually pay off. Keep at it, even if relief isn’t felt overnight. It can and often does get better.

Dr. Rawls is a physician who overcame Lyme disease through natural herbal therapy. You can learn more about Lyme disease in Dr. Rawls’ new best selling book, Unlocking Lyme.

You can also learn about Dr. Rawls’ personal journey in overcoming Lyme disease and fibromyalgia in his popular blog post, My Chronic Lyme Journey.

1. Busch V, Magerl W, Kern U, Haas J, Hajak G, Eichhammer P. The effect of deep and slow breathing on pain perception, autonomic activity, and mood processing–an experimental study. Pain Med. 2012;13(2):215-228. doi: 10.1111/j.1526-4637.2011.01243.x
2. Donta ST. Issues in the diagnosis and treatment of lyme disease. Open Neurol J. 2012;6:140-145. doi: 10.2174/1874205X01206010140
3. Feng J, Leone J, Schweig S, Zhang Y. Evaluation of natural and botanical medicines for activity against growing and non-growing forms of B. Burgdorferi. Frontiers in Medicine. 2020;7. doi: 10.3389/fmed.2020.00006
4. Logigian EL, Kaplan RF, Steere AC. Chronic neurologic manifestations of lyme disease. New England Journal of Medicine. 1990;323(21):1438-1444. doi: 10.1056/nejm199011223232102
5. Moon HJ, Seo JG, Park SP. Perceived stress in patients with migraine: a case-control study. J Headache Pain. 2017;18(1):73. doi: 10.1186/s10194-017-0780-8
6. Naik GS, Gaur GS, Pal GK. Effect of Modified Slow Breathing Exercise on Perceived Stress and Basal Cardiovascular Parameters. Int J Yoga. 2018;11(1):53-58. doi: 10.4103/ijoy.IJOY_41_16
7. Rao R, Samak G. Role of Glutamine in Protection of Intestinal Epithelial Tight Junctions. J Epithel Biol Pharmacol. 2012;5(Suppl 1-M7):47-54. doi: 10.2174/1875044301205010047
8. Rebman AW, Bechtold KT, Yang T, et al. The clinical, symptom, and quality-of-life characterization of a well-defined group of patients with Posttreatment Lyme disease syndrome. Frontiers in Medicine. 2017;4. doi: 10.3389/fmed.2017.00224
9. Visser EJ, Drummond PD, Lee-Visser JLA. Reduction in Migraine and Headache Frequency and Intensity With Combined Antioxidant Prophylaxis (N-acetylcysteine, Vitamin E, and Vitamin C): A Randomized Sham-Controlled Pilot Study. Pain Pract. 2020;20(7):737-747. doi: 10.1111/papr.12902
10. Yablon LA, Mauskop A. Magnesium in headache. In: Vink R, Nechifor M, editors. Magnesium in the Central Nervous System [Internet]. Adelaide (AU): University of Adelaide Press; 2011. Available from:

Neem – Everything You Need to Know

By Dr. Bill Rawls


Common name: Neem
Scientific Name: Azadirachta indica
Other names: Neem tree, nim, nimtree, Indian lilac, margosa, nimba
Family: Meliaceae
Location: Mainly cultivated in the Indian subcontinent
Known for: Bitter taste and antimicrobial properties
Part Used: Stem bark, leaves, and seeds
Fun fact: In addition to being used medicinally, neem sprays make eco-friendly and very effective insecticides and fungicides for use in organic gardens and on house plants.
Good for: Microbial infections, inflammatory conditions of the skin and gut, gut dysbiosis, stomach hyperacidity, detoxification, lung health, and metabolic health
Key Properties & Actions: anti-inflammatory, hypoglycemic, antipyretic (lowers fevers), antimalarial, antifungal, antiviral, antioxidant, antiamoebic, and a bitter digestive tonic


Neem is a fast-growing and long-living tree that has earned the title of “village pharmacy” in its native home of India.2 Fully stocked with medicinal value, neem supports healing of a wide variety of acute and chronic ailments but is most well-known for its broad-spectrum and potent antimicrobial properties. Additionally, it is often used for helping relieve gut microbiome imbalances, supporting skin and hair health, and supporting normal blood sugar levels.

What is Neem?

close up view of neem leaves

Bitter neem leaves are the most widely used part of the neem tree, a fast-growing medicinal plant belonging to the mahogany family.

Dubbed the Tree of the 21st Century by the United Nations, the neem tree has become one of the most heavily researched plants in the past few decades due to its potent and wide-ranging medicinal value. It has established itself over centuries as an affordable remedy of choice, especially in developing countries, where up to 80% of people rely on plant medicine as their main source of healthcare.3

This fast-growing evergreen erects a straight trunk as high as 100 feet with a canopy as wide as 65 feet, making it an excellent shade tree in the sunny climates where it prefers to grow.

View of rows of neem trees, with many green leaves growing on mounds in rural Thai agriculture.

A neem tree can grow 100 feet tall and 65 feet wide, making it an excellent shade tree in the hot climates where it grows. Plants in hotter climates often have broad antimicrobial medicinal activity since they must produce more phytochemicals to defend themselves against microbes that flourish in warmer climates.

Green leaves and stem bark are the most commonly used medicinal parts of the neem tree, but it also has blooming white flower clusters that produce a sweet lilac scent that carries for miles. Although not exactly tasty, neem trees also produce edible olive-shaped fruits that turn from green to yellow when ripe, holding one to three seeds inside.

Neem can grow almost anywhere, withstanding temperatures ranging between 40ºF to 120ºF. They routinely grow as old as 200 years and can be found throughout much of Asia, Africa, South America, and even in the warmer regions of Australia and the United States.8

A butterfly enjoying a sweet honey-scented neem flower

A butterfly enjoying a sweet honey-scented neem flower.

Benefits of Neem and How It Works

Broad-Spectrum Antimicrobial Properties

When it comes to fighting viruses, bacteria, parasites, and fungi, neem has been used for acute topical and internal infections as well as for combatting longer-lasting, insect-borne infections such as chronic Lyme disease, West Nile virus, chikungunya, and dengue fever.13 Numerous studies have isolated over 400 active chemical compounds found in neem, which helps explain its protective activity against the infections mentioned above as well as candida, salmonella, chlamydia, herpesviruses, methicillin-resistant Staphylococcus aureus (MRSA), and more.1

Although a group of active compounds in neem called limonoids have been shown to combat malaria-infected cells in mice in one particular study, the overall conclusions are mixed. Other studies found that neem failed to eliminate malaria symptoms. However, new research on a limonoid compound called gedunin is providing hope that different preparations and dosing methods of neem may create more consistent results in combating aspects of this particular disease.14

Balances the Gut Microbiome and Supports Digestion

Neem’s championed antimicrobial properties also help to stabilize gut flora, and it has been used for fighting against gut dysbiosis issues, including small intestine bacterial overgrowth (SIBO), intestinal parasites, and candida. Not only does neem support a healthy microbiome by eliminating inflammatory toxins and pathogens, but it also has been studied for its ability to break up intestinal biofilms and reduce hyperacidity, which can help heal and prevent gastric and intestinal ulcers.6 All of these gut health benefits can have positive impacts on the nervous system due to an intimate connection via the gut-brain axis.

Metabolic Support

Neem extract has been used to help lower blood sugar levels in people with metabolic syndrome and Type 2 diabetes. In several human studies, neem, given as an adjunct to diabetic medications such as metformin, showed enhanced results compared to using the medications alone. Not only did the combination lower blood sugar levels, but it also reduced hemoglobin A1C levels (a better measure of average long-term blood sugar levels) as well as improved the blood triglyceride and cholesterol profile.15,16,17

Detoxifies the Body

Ayurveda, one of the primary traditional medical systems of India, suggests that ama (natural toxins that accumulate in the body as a result of environmental, dietary, and lifestyle choices) is the main source of most disease-causing imbalances outside of infection — and neem is at the top of the list of ama-detoxifying plants.

Modern science agrees with labeling neem a toxin-purifying herb, and one of its phytochemical compounds called nimbin leads the way in providing antiseptic and antifungal effects.4 Neem clears toxicity from the body, specifically by dilating blood vessels (which promotes the removal of waste), regulating bile production, and reducing inflammation associated with chronic and acute infections. Eliminating toxins from the body can create a host of benefits, including boosted immunity and energy.

Supports Skin Health

Neem’s claim to fame in the modern world has been due, in large part, to its beauty-enhancing effects on the skin. Inflammation, poor detoxification, and microbiome imbalances in the body can manifest through the skin in the form of acne, redness, irritation, rashes, and decreased wound healing. Neem’s antimicrobial and anti-inflammatory properties, used both topically and internally, have been found to help clear and heal wounds and other skin irritations.7

Promotes Hair Health

Along with our skin, hair also reflects our identity and health, and if you have problems with either, neem oil (pressed from neem seeds) doesn’t disappoint. One important compound in neem called azadirachtin12 has insecticidal properties powerful enough to thwart parasites like lice13 and antifungal actions that prevent the buildup of fungi on the scalp that often causes dandruff.11

In Ayurveda, where neem has been used for hair health for centuries, hair loss is considered to be caused by what is referred to as “excess heat trapped in the head,” which can lead to thinning, flaking, itchiness, and drying of the scalp. Neem’s cooling property quells and reduces “trapped heat,” while neem oil lubricates follicles, boosts blood flow to the head, and nourishes the scalp with essential nutrients needed for lively locks.

Enhances Oral Hygiene

Neem’s antibacterial properties make it a perfect herb to combat unhealthy bacteria in the mouth. One study shows that neem’s antiseptic action protects teeth and gums against plaque-induced gingivitis, proving to be equally as effective as oral disinfectants like chlorhexidine, a germicidal drug often used in medicated mouthwashes for gingivitis.9 Indeed, in many countries where neem plants flourish, the twigs themselves are used as a sort of rudimentary toothbrush to keep teeth and gums healthy and mouth microbes in check.7

Supports the Respiratory Tract

A study published by the International Journal of Molecular Medicine found neem leaf extract significantly reduced inflammation caused by cigarette smoke in the lungs of mice, suggesting the potential for neem to assist with symptoms of chronic obstructive pulmonary disease (COPD).10

Medicinal neem leaves with fruits close up

Ripened neem fruits hold one to three seeds, which have reportedly been used historically as a natural birth control method. This is one reason that use of neem is not advised for pregnant women or women planning to become pregnant.
History & Traditional Use

While neem is best known for its use as an Ayurvedic herb, the revered tree has even deeper roots in the oldest of the three main Indian medical systems known as Siddha medicine, dating as far back as 10,000 B.C. to 4,000 B.C in South Indian Tamil culture.

In some of its earliest usage, neem flowers were used to prevent bile disorders, and the neem leaf was used to relieve symptomatic ulcers. Neem bark, on the other hand, was used in central nervous system-related disorders.

Many of these ancient claims are supported by today’s science, too. For example, anxiety has been shown to be improved by neem without causing impaired motor function — a common side effect often experienced while taking some anti-anxiety medications.11

wooden bowl of neem leaf powder with pile of leaves behind

Neem leaf powder is most often used topically for skin, hair, and dental health.

How to Use and Dosing

Just as there are multiple ways neem benefits the body, there are a variety of forms of delivery using different parts of the neem tree.

For Internal Use

As a Supplement: Neem is often taken as a whole-herb powder, powdered extract, or tincture. Dosing always depends on the product quality, preparation method, and the individual using it, but here are some generally recommended serving sizes for reference. For products made from the powder of the whole leaf, general dosage recommendations are typically in the range of 500 to 1000 mg, 1-2 times daily. For powdered leaf extracts, 150 to 250 mg, 1-2 times daily. For a neem leaf tincture, 0.5 to 1 mL, 1-3 times daily.

Neem works well with other antimicrobial herbs such as houttuynia, cryptolepis, Chinese salvia, prickly ash, andrographis, cat’s claw, and Japanese knotweed.

As Herbal Tea: Drinking neem tea isn’t typically the most preferred method of consuming neem due to its bitter nature. The bitterness is due to many of its antimicrobial compounds, but thankfully there are ways to dress it up for your enjoyment if you want to take it as a tea.

Adding citrus, ginger, mint, berries, cinnamon, or a pinch of a sweetener of your choice to your neem tea can help offset its astringency. Keep it simple, and start light by combining a small amount of whole neem leaves or neem powder with one or two of the above options until you find the winning combo.

For External Use

As a Powder: Calm red and inflamed skin by adding neem powder to a hot bath for a medicinal soak.

Neem Ayurvedic Oil with Mortar and Pestle

Neem oil is pressed from the seeds of neem fruits and can tame acne and inflammation in the skin and also decrease dandruff.

Neem Oil for Smooth Skin: A few drops of neem oil applied to the face (and larger amounts as needed for the body) 20-30 minutes before showering can improve skin moisture and reduce acne.

Neem Oil for Healthy Hair: To relieve dandruff or simply nourish your hair, rub neem oil into the scalp using the pads of your fingertips to avoid scraping your skin with your nails. Let the oil soak in for up to an hour before washing it out with shampoo.


Because neem has been shown to reduce blood glucose, people with diabetes or anyone on blood sugar-lowering medications should work with their healthcare provider before taking neem internally.12

Always check with your healthcare practitioner before use if you are taking medications. For more general education on potential interactions between herbs and medications, check out Dr. Bill Rawls’ article: Is it Safe to Take Herbs with My Medications?

Precautions & Side Effects

Do not use neem internally if you are pregnant or trying to conceive. As neem is such a potent herb, it’s typically best used at lower doses in combination with other balancing herbs. Traditional use suggests it’s best to avoid taking large doses of neem for an extended time, especially for those with a tendency toward having cold, dry constitutions.


This information is intended only as general education and should not be substituted for professional medical advice. Any mentioned general dosage options, safety notices, or possible interactions with prescription drugs are for educational purposes only and must be considered in the context of each individual’s health situation. Use this information only as a reference in conjunction with the guidance of a qualified healthcare practitioner.

Want to See the Science? Check Out Our References Below.

1. Kharwar RN, Sharma VK, Mishra A, et al. Harnessing the phytotherapeutic treasure troves of the ancient medicinal plant azadirachta indica (neem) and associated endophytic microorganisms. Planta Medica. 2020;86(13/14):906-940. doi: 10.1055/a-1107-9370
2. Gupta SC, Prasad S, Tyagi AK, Kunnumakkara AB, Aggarwal BB. Neem (azadirachta indica): An Indian traditional panacea with modern molecular basis. Phytomedicine. 2017;34:14-20. doi: 10.1016/j.phymed.2017.07.001
3. Kumar VS, Navaratnam V. Neem (Azadirachta indica): Prehistory to Contemporary Medicinal Uses to Humankind. Asian Pac J Trop Biomed. 2013;3(7):505-514. doi: 10.1016/S2221-1691(13)60105-7
4. Islas JF, Acosta E, G-Buentello Z, et al. An overview of neem (Azadirachta indica) and its potential impact on health. Journal of Functional Foods. 2020;74:104171. doi: 10.1016/j.jff.2020.104171
5. Sarkar L, Oko L, Gupta S, et al. Azadirachta indica A. Juss bark extract and its nimbin isomers restrict β-coronaviral infection and replication. Virology. 2022;569:13-28. doi: 10.1016/j.virol.2022.01.002
6. Harjai K, Bala A, Gupta RK, Sharma R. Leaf extract of Azadirachta indica (neem): a potential antibiofilm agent for Pseudomonas aeruginosa. Pathog Dis. 2013;69(1):62-65. doi: 10.1111/2049-632X.12050
7. Alzohairy MA. Therapeutics Role of Azadirachta indica (Neem) and Their Active Constituents in Diseases Prevention and Treatment. Evid Based Complement Alternat Med. 2016;2016:7382506. doi: 10.1155/2016/7382506
8. Abdel-Ghaffar F, Al-Quraishy S, Al-Rasheid KA, Mehlhorn H. Efficacy of a Single Treatment of Head Lice with a Neem Seed Extract: An In Vivo and In Vitro Study on Nits and Motile Stages. Parasitol Res. 2012;110(1):277-280. doi: 10.1007/s00436-011-2484-3
9. Chatterjee A, Saluja M, Singh N, Kandwal A. To Evaluate the Antigingivitis and Antiplaque Effect of an Azadirachta indica (Neem) Mouthrinse on Plaque Induced Gingivitis: A double-blind, randomized, controlled trial. J Indian Soc Periodontol. 2011;15(4):398-401. doi: 10.4103/0972-124X.9257
10. Lee JW, Ryu HW, Park SY, et al. Protective effects of neem (Azadirachta indica A. Juss.) leaf extract against cigarette smoke- and lipopolysaccharide-induced pulmonary inflammation. Int J Mol Med. 2017;40(6):1932-1940. doi: 10.3892/ijmm.2017.3178
11. Thaxter KA, Young LE, Young RE, Parshad O, Addae J. An extract of neem leaves reduces anxiety without causing motor side effects in an experimental model. West Indian Med J. 2010;59(3):245-248.
12. Pingali U, Ali MA, Gundagani S, Nutalapati C. Evaluation of the Effect of an Aqueous Extract of Azadirachta indica (Neem) Leaves and Twigs on Glycemic Control, Endothelial Dysfunction and Systemic Inflammation in Subjects with Type 2 Diabetes Mellitus – A Randomized, Double-Blind, Placebo-Controlled Clinical Study. Diabetes Metab Syndr Obes. 2020;13:4401-4412. Published 2020 Nov 17. doi: 10.2147/DMSO.S274378
13. Parida MM, Upadhyay C, Pandya G, Jana AM. Inhibitory potential of neem (Azadirachta indica Juss) leaves on dengue virus type-2 replication. J Ethnopharmacol. 2002;79(2):273-278. doi: 10.1016/s0378-8741(01)00395-
14. ​​MacKinnon S, Durst T, Arnason JT, et al. Antimalarial activity of tropical Meliaceae extracts and gedunin derivatives. J Nat Prod. 1997;60(4):336-341. doi: 10.1021/np9605394
15. Waheed A, Miana GA, Ahmad SI. Clinical investigation of hypoglycemic effect of seeds of Azadirachta-inidca in type-2 (NIDDM) diabetes mellitus. Pak J Pharm Sci. 2006;19(4):322-325.
16. Patil SM, Shirahatti PS, Ramu R. Azadirachta indica A. Juss (neem) against diabetes mellitus: a critical review on its phytochemistry, pharmacology, and toxicology [published online ahead of print, 2021 Sep 25]. J Pharm Pharmacol. 2021;rgab098. doi: 10.1093/jpp/rgab098
17. Pingali U, Ali MA, Gundagani S, Nutalapati C. Evaluation of the Effect of an Aqueous Extract of Azadirachta indica (Neem) Leaves and Twigs on Glycemic Control, Endothelial Dysfunction and Systemic Inflammation in Subjects with Type 2 Diabetes Mellitus – A Randomized, Double-Blind, Placebo-Controlled Clinical Study. Diabetes Metab Syndr Obes. 2020;13:4401-4412. Published 2020 Nov 17. doi: 10.2147/DMSO.S274378

*This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Always consult your qualified healthcare provider before beginning any diet or program.

Does Lyme Impair Memory? 6 Restorative Solutions to Help Get Your Brain Back on Track

Does Lyme Impair Memory? 6 Restorative Solutions to Help Get Your Brain Back on Track

by Jenny Menzel
Updated 3/3/22

Have you ever walked into a room and forgotten the very reason you went there in the first place? Or, how about searching high and low for your missing glasses, only to discover they’ve been on top of your head the whole time? We’ve all experienced brief moments of forgetfulness once in a while, and mostly, they can be humorous. But if you’re struggling with neurological manifestations of Lyme disease, memory issues may be a daily, discouraging occurrence — and that’s no laughing matter.

So why do memory issues and chronic Lyme disease go hand in hand? And more importantly, what does this mean for the health of your brain and its capacity to store and recall information over time? Let’s take a closer look at the reasons why your memory may not be operating optimally, plus natural solutions to restore its function.

Neurological Lyme: A Recap

Neurological Lyme is a different flavor of Lyme disease that occurs when infection with the bacteria Borrelia burgdorferi affects the cranial or peripheral nerves or the central nervous system (CNS), reports the Centers for Disease Control and Prevention (CDC).

In other words, when a Lyme infection triggers an immune response, the immune system rallies white blood cells (WBCs) to act in defense, and inflammatory cytokine activity increases in the brain and spinal cord. When these immune cells infiltrate the CNS in response to a chronic infection, a range of noticeable neurological symptoms may result, such as:

  • Memory loss
  • Cognitive issues
  • Learning disabilities
  • Headaches
  • Bell’s palsy (facial paralysis)
  • Meningitis
  • Numbness and tingling in the extremities
  • Visual impairment
  • Brain fog
  • Depression, anxiety, and other mental health conditions
    Sensation changes on the skin

Not everyone with Lyme disease will experience neurological symptoms, though. When it comes to newly-diagnosed, acute infections, approximately 15% of patients reportedly experience one or more neurological effects like Bell’s palsy, meningitis, or numbness and tingling in the arms or legs, according to research published by Frontiers in Neurology. But this figure may be just the tip of the iceberg.

For a host of reasons, getting an accurate diagnosis and obtaining treatment for Lyme is often delayed (sometimes for months to years) due to a lack of physician understanding and public awareness, an unseen tick bite, the absence of the hallmark erythema migrans (bull’s-eye rash), and insensitive testing methods that produce false negatives.

This delay in diagnosis and adequate treatment allows the bacteria to flourish unchecked, embedding itself deeper into hard-to-reach areas of the body, like the brain — increasing the likelihood of developing difficult-to-eradicate chronic neurological symptoms.

Much Like Our Brains, Neurological Lyme is Complicated

The widespread idea that Lyme disease is easily cured with a 10- to 14-day course of antibiotics persists within most corners of mainstream medicine today. But there is a growing body of evidence to suggest the contrary: For example, in 2013, the International Journal of General Medicine published findings that the Lyme spirochete Borrelia is stealthy enough to evade immune detection and even survive attacks from antibiotics.

split image between borrelia and piles of drug capsules

Anyone experienced with this illness knows, too, that Lyme disease is so much more than a single microbe. With multiple strains of Borrelia in the mix and other common tick-borne coinfections like Bartonella, Babesia, Ehrlichia, and Mycoplasma, understanding the full effects of neurological Lyme is truly complex. However, thanks to the ongoing work of independent researchers and scientists, our understanding continues to unfold and offer helpful clues to the challenging neurological symptoms that so many people deal with.

The Impact of Neurological Lyme on Memory

On average, your brain has 86 billion neurons, each sending out numerous signals from head to toe at breakneck speed to process and store information, control movement and balance, and utilize your five senses, among other crucial tasks. Neurological Lyme can directly impact those functions, including memory, and here’s how.

How Memories are Formed

The study of human memory stretches as far back as 2,000 years to the times of Aristotle, with the first scientific approach introduced in the mid-1880’s by German philosopher Herman Ebbinghaus — the man responsible for classifying the memory types still relevant today. He discovered we actually have three different memory types, giving valuable insight into how the brain works:

  1. Sensory Memory (SM): Formed by how we see, hear, touch, smell, and taste things, SM allows you to remember by stimulating your five senses. After the stimulation, the sensing is assigned to short-term or long-term memory. Smelling your favorite food cooking, hearing a dog bark in the distance, or feeling the texture of wet grass beneath your feet after a spring rain are examples of sensory stimulation we attach to our short-term and long-term memory.
  2. Short-Term Memory (STM): Less fleeting than sensory memory and less permanent than long-term memory, STM helps you recall specific information about anything for just a brief period. Where you park your car at a shopping center is considered a STM due to the “short-term” need to retain the information. STM will get you to your car after you exit the store, but if there is no need to save the information to long-term memory, the memory quickly fades.
  3. Long Term Memory (LTM): There are two types of LTM: explicit and implicit. Explicit LTM is when we consciously and deliberately try to memorize something, like someone’s birthday, phone number, or lyrics to a new song. Implicit LTM is what we remember unconsciously by repetition without even trying, like riding a bike or taking a specific route to work. Any memory we can recall after 30 seconds is considered “long-term,” which is a majority of our memories.

Our memories form in three distinct stages— encoding, storage, and recall. Encoding is how the information gets into your brain, usually through one or more of the five senses. Storage is when that incoming information is briefly stored into STM, or more permanently, into LTM. The final stage is recall, how we retrieve the information after it’s stored.

When stealth microbes like Borrelia make their way to the CNS, they become savage disruptors, creating a breakdown of communication across multiple body systems by damaging nerve cells, kicking up inflammation, and disorganizing neurotransmitters and hormones, thereby instigating memory problems over time. Here are some of the top known ways neurological Lyme impedes your memory.

Neuroinflammation in the Brain

A recent study probing the brains of Lyme patients with chronic symptoms showed the presence of high levels of a substance called inflammatory translocator protein (TSPO), an inflammatory chemical released by two specific types of brain immune cells.

What does this mean for your memory? High levels of neuroinflammatory chemicals may decrease brain function, manifesting in such problems as brain fog and memory loss. Though the study was small-scale, it demonstrates a physiological basis for cognitive problems and validates the experience of countless people living with Lyme.

graphic of brain producing static electricity

Demyelination of Nerves

Much like electrical wires require insulation to keep the electrical current contained, the nerves in our brains are protected with an outer sheath called myelin, which protects nerves for other electrical impulses. Because microbes like Borrelia and Mycoplasma consider myelin a high-value resource to snack on, people with neurological Lyme are vulnerable to demyelination — deterioration of the nerve coating. When this happens, raw nerves are eventually exposed, and signaling between the nerves diminishes, resulting in communication breakdown. Demyelination caused by Lyme disease has been documented as early as 1989, suggesting the probability of CNS involvement, even after the initial infection appeared to be resolved.

Possible Dementia Connection

Although some studies have suggested dementia-like syndromes may exist as rare manifestations of neurological Lyme, recent research points to a more direct connection. Findings in Frontiers in Neurology support the possibility that neurological Lyme might be linked to Lewy body dementia, a condition where abnormal protein deposits to the nerve cells in the brain cause severely impaired reasoning, mood changes, and memory loss.

While there’s still a lot to learn about this manifestation, this is the first time a persistent neurological Lyme infection has been directly linked to the presence of dementia-inducing antibodies.

6 Effective Solutions to Restore Your Memory

Unfortunately, the current CDC treatment guidelines for neurological Lyme are antibiotics that are often ineffective in later stages of the illness, but all hope is not lost. If you’re experiencing Lyme-related memory problems, there are lifestyle habits and natural remedies like herbs that can help normalize disrupted communications in the brain and nervous system and enhance your memory. Here’s how.

icon of fish, chicken, and eggs

1. Eat Brain Food.

Nourishing your body with a balanced, anti-inflammatory diet rich in vegetables, healthy omega-3 fats, and choline-dense protein like poultry, fish, and eggs is one of the best ways to begin nourishing a vibrant memory and curb unwanted inflammation. As for brain fruit, blueberries full of flavonoids top the list. Furthermore, adding anti-inflammatory spices to your food is another way to benefit the brain. Turmeric and saffron win by supporting the vascular system and boosting blood flow to the brain. Fun tip: Have fun trying out new recipes by focusing on one new brain food per week to find your favorites.

icon of puzzle on phone

2. Get Creative with Brain Games.

While cognitive exercise apps such as Elevate or Lumosity are great options to get your brain in shape, don’t discount the power of your mind to make up your own activities. For example, make a game out of everyday events like shopping for groceries. Tally up the prices in your head as you shop, starting with just a few items and working your way up to see if you can calculate the amount you’ll pay at the register. Over time, you’ll sense improvements, and the process will get easier. However, if you prefer a break from the digital realm, classic crossword puzzles are another great (and inexpensive) option to challenge your memory.

icon of headphones

3. Try Interactive Metronome Therapy (IMT).

Take brain games to the next level with Interactive Metronome (IM), a therapy that is used to enhance memory, attention, focus, speech, and sensory skills in those struggling with cognitive impairment from various forms of brain injuries — even those associated with Lyme disease. By resetting your internal brain clock and retraining neural pathways, the therapy improves communication and desensitizes hyperactive areas of the brain while activating the sluggish areas. The brain-balancing exercises are often covered by insurance and can be performed under the supervision of a variety of professional therapists to increase the brain’s ability to record, store, and recall memories.

icon of herbal supplement bottle and capsules

4. Use Brain Supportive Herbs.

Balancing the brain with herbs will naturally boost your memory by creating healthy stress responses and sleep-wake cycles and reducing the microbial load. Some top herbs to suppress infectious microbes, reduce neuroinflammation, and increase needed blood circulation to the brain include:

Need a boost of clean energy in the morning to feel awake and alert? Herbs can help there, too. Try rhodiola or licorice root in the morning to get your day going without caffeine. And for a nightcap to gently unwind, try herbs with balancing and soothing properties like ashwagandha and l-theanine to regulate the HPA-axis and calm the nervous system for better quality sleep.

icon of moon and stars

5. Reduce Excess Brain Stimulation.

We live in a noisy world and are probably the most overloaded with stimuli than ever before in human history, but there are steps you can take to reduce the noise and help you focus. Try setting a specific time to digitally unplug every night, and consider setting your smartphone outside of your bedroom on the charger.

Need your phone for an alarm clock? Set it on airplane mode to avoid distracting notifications — or go minimalist with a simple alarm clock. Additionally, infuse your nightly routine with calming scents like rosemary, frankincense, and lavender. When delivered through the olfactory system, these essential oils can cool an inflamed nervous system, creating a clearer mind able to retain and recall information.

icon of human doing tai chi

6. Cultivate a Mind-Body Connection.

Mind-body practices like hypnosis, yoga, tai-chi, and meditation combine mental and physical focus with breathing and body movements, and scientific evidence supporting their positive effects on the nervous system is growing:

Research published by the Journal of Alzheimer’s found that after only 8 weeks of daily meditation, a small group of participants ages 52 to 77 experienced a significant increase in cerebral blood flow to the frontal and parietal lobes of the brain — two areas responsible for retrieving stored memories. If beginning a mind-body practice has been on your Lyme recovery to-do list for a while, the health of your brain and better memory are two great reasons to get started!

Healing Takes Time

If you’ve been struggling with memory problems from Lyme, you’ve likely come to find that healing is a marathon, not a sprint. Because our brain cells take the longest to repair, improving Lyme-related memory issues isn’t easy, but it’s possible — and worth it.

To sharpen your memory, combine these tips with the essentials, like a comprehensive natural protocol to suppress microbes, a reparative sleep schedule, and exercise as tolerated. If you remember nothing else, remember to keep it simple, pace yourself, and (gently) keep going.

1. Berndtson K. Review of evidence for immune evasion and persistent infection in lyme disease. International Journal of General Medicine. 2013:291. doi: 10.2147/ijgm.s44114
2. Blanc F, Philippi N, Cretin B, et al. Lyme neuroborreliosis and dementia. J Alzheimers Dis. 2014;41(4):1087-1093. doi: 10.3233/JAD-130446
3. Bloomfield MA, Green SF, Hindocha C, et al. The effects of acute cannabidiol on cerebral blood flow and its relationship to memory: An arterial spin labeling magnetic resonance imaging study. Journal of Psychopharmacology. 2020;34(9):981-989. doi: 10.1177/0269881120936419
4. Chianese R, Coccurello R, Viggiano A, et al. Impact of Dietary Fats on Brain Functions. Curr Neuropharmacol. 2018;16(7):1059-1085. doi: 10.2174/1570159X15666171017102547
5. Ebbinghaus H. Memory: a contribution to experimental psychology. Ann Neurosci. 2013;20(4):155-156. doi: 10.5214/ans.0972.7531.200408
6. Gadila SKG, Rosoklija G, Dwork AJ, Fallon BA, Embers ME. Detecting Borrelia Spirochetes: A Case Study With Validation Among Autopsy Specimens. Front Neurol. 2021 May 10;12:628045. doi: 10.3389/fneur.2021.628045
7. Hein S, Whyte AR, Wood E, Rodriguez-Mateos A, Williams CM. Systematic Review of the Effects of Blueberry on Cognitive Performance as We Age. J Gerontol A Biol Sci Med Sci. 2019;74(7):984-995. doi: 10.1093/gerona/glz082
8. Herculano-Houzel S. The human brain in numbers: a linearly scaled-up primate brain. Front Hum Neurosci. 2009 Nov 9;3:31. doi: 10.3389/neuro.09.031.2009
9. Khalsa DS. Stress, Meditation, and Alzheimer’s Disease Prevention: Where The Evidence Stands. J Alzheimers Dis. 2015;48(1):1-12. doi: 10.3233/JAD-142766
10. Kristoferitsch W, Aboulenein-Djamshidian F, Jecel J, et al. Secondary dementia due to lyme neuroborreliosis. Wiener klinische Wochenschrift. 2018;130(15-16):468-478. doi: 10.1007/s00508-018-1361-9
11. Neurologic Lyme Disease. Centers for Disease Control and Prevention. Website. Published August 11, 2021. Accessed February 27, 2022.
12. New Scan Technique reveals brain inflammation associated with post-treatment lyme disease syndrome. Johns Hopkins Medicine Newsroom. Website. Published February 5, 2019. Accessed February 27, 2022.
13. Pachner AR, Duray P, Steere AC. Central nervous system manifestations of lyme disease. Archives of Neurology. 1989;46(7):790-795. doi: 10.1001/archneur.1989.00520430086023
14. Pragya SU, Mehta ND, Abomoelak B, et al. Effects of Combining Meditation Techniques on Short-Term Memory, Attention, and Affect in Healthy College Students. Front Psychol. 2021;12:607573. Published 2021 Mar 5. doi: 10.3389/fpsyg.2021.607573
15. The science behind IM. Interactive Metronome. Website. Published July 21, 2020. Accessed February 27, 2022.

Complete Guide to Lyme Disease & Coinfection Tests

Dr. Rawls’ Complete Guide to Lyme Disease and Coinfection Tests

This is a newly updated excerpt taken from Dr. Rawls’ best-selling book Unlocking Lyme. This installment focuses on how reliable diagnostic testing is for Lyme disease and Lyme coinfections.

by Dr. Bill Rawls
Updated 3/1/21

An Introduction to Lab Testing

Lyme disease tests can serve as valuable resources for the diagnosis and treatment of tick-borne disease. But it’s important not to get too hung up on the results.

The problem of chronic Lyme disease, can’t be solved exclusively by looking at lab results, which is something I know from personal experience. In fact, becoming overly obsessed with lab results can hinder the recovery process.

Lab work provides a snapshot of what’s going on inside your body. But multiple other factors — including your symptoms, the length of time you’ve had them, and clinical presentation, as well as the environments in which you live, work, and travel — all factor into making an accurate diagnosis.

Furthermore, the human body is an immensely complex biological machine, with millions of different biochemical functions happening simultaneously. Lab tests provide an ever-so-small glimpse at certain key functions of different systems in the body. From those indicators, determinations can be made about how well the body is functioning and whether illness is present.

Laboratory assessment, however, is far from absolute. Because the human body is so complex, the ability of lab testing to predict a specific chronic illness, such as one from a tick-borne disease, is often limited. All labs are subject to variability and different interpretations.

There are literally thousands of different lab tests that can be performed, but only a fraction of them are well understood. Many should be left for research purposes only. Problems arise when doctors order obscure tests that are still poorly understood. Before you have labs drawn, ask your doctor to explain the purpose of each test and why they would be helpful in addressing your health situation.

The information provided by labs is only valuable if it is put to good use. Millions of dollars are wasted every year on labs, with the resulting information never used. Before you have labs drawn, ask yourself and your doctor: “Will the information from this lab — or any other diagnostic test — influence my approach to getting well?” If the answer is no, then you may want to reconsider having that particular test performed.

For chronic illnesses like chronic Lyme disease, fibromyalgia, and chronic fatigue syndrome, general lab evaluations are usually unremarkable. In these cases, the greatest value of labs is ruling out the possibility of a more threatening condition. Mildly abnormal labs generally return to normal as your health improves.

The following is a guide to the labs that I’ve found to be most valuable in evaluating chronic illnesses like chronic Lyme and fibromyalgia. It is, by no means, an absolute or exclusive list.

Basic Lab Tests Everyone Needs

side view of scientist writing down test results while working in laboratory

There are certain basic tests and a few specialized ones that have great value. These are the tests that everyone who suspects they have Lyme should consider getting. In addition to taking a detailed medical history, the following list of labs can be ordered by any healthcare provider. Typically, these tests are covered by health insurance.

Complete Blood Count (CBC with Differential)

This test measures cellular components of blood:

  • White Blood Cell count (WBC): Low WBC (< 4,000) can indicate chronic infection with a virus or low-virulence bacteria such as mycoplasma, but it can also occur in healthy people. Elevated WBC (>11,500) can indicate an active infection.
  • Differential (diff): This measures different types and ratios of white blood cells present. Sometimes, it can be helpful for defining a particular type of infection (bacteria vs. viral vs. parasite), but it is not always absolute.
  • Hemoglobin (Hb): Anemia is indicated by Hb < 12.0. Anemia can be caused by blood loss due to factors like heavy periods, inadequate production of red blood cells (RBCs), and increased destruction of RBCs from malaria, babesia, bartonella, or other infections. Hb levels > 16.0 can be associated with smoking, living at altitude, and excessive iron stores in the body (hemochromatosis).

Blood Chemistries

These are a measure of common chemical components of the body, including:

  • Electrolytes: Sodium, potassium, chloride, CO2; these are generally normal, unless you are really sick.
  • Liver function: Abnormal values suggest an elevated rate of liver compromise, possibly from toxins or viruses such as hepatitis. Elevated bilirubin suggests increased breakdown and turnover of red blood cells (babesia, bartonella). Certain low-virulence microbes (bartonella) destroy red blood cells.
  • Kidney function: BUN (blood urea nitrogen) and creatinine screen for kidney disease.

Glucose Metabolism

Excessive carbohydrate consumption is a major system disrupter that must be controlled before recovery is possible. Three primary tests — fasting blood glucose, hemoglobin A1c, and fasting insulin — define insulin resistance and abnormal glucose metabolism:

  • Fasting blood glucose: Levels >100 mg/dl suggest pre-diabetes. Levels >126 mg/dl suggest overt diabetes.
  • Fasting insulin: Levels defined as elevated suggest insulin resistance (normal range varies depending on the lab). Insulin resistance is a factor contributing to immune dysfunction and hormone imbalances.
  • Hemoglobin A1c (HbA1c): HbA1c measures the cumulative damage done by excessive carbohydrate consumption. Ideal is 4.8-5.2%. Levels > 5.6% indicate pre-diabetes. Levels > 6.4% indicate overt diabetes.


Magnesium and calcium are the primary minerals measured:

  • Magnesium: Magnesium levels are often low during chronic illness. Aggressive magnesium supplements, however, can often worsen Lyme symptoms. Generally, magnesium levels will return to normal as health improves.
  • Calcium: Persistently elevated calcium levels can indicate the presence of a small benign tumor producing excessive parathyroid hormone (PTH). Symptoms can mimic fibromyalgia and chronic Lyme. Follow-up testing should include PTH levels.

Thyroid Function

Complete thyroid function should include thyroid stimulating hormone (TSH), free T4, free T3, and thyroid antibodies. Illnesses associated with chronic immune dysfunction are commonly associated with abnormal thyroid function. Correcting abnormal thyroid function can accelerate recovery. Testing for thyroid antibodies (TPO and thyroglobulin) is important to identify Hashimoto’s disease, a form of autoimmune thyroid dysfunction.

Lipid Panel

This is a basic evaluation for cardiovascular risk. Cholesterol commonly increases with age and/or a decline in liver function. Cholesterol can be lowered by following specific nutritional guidelines. Significantly elevated cholesterol, however, should be addressed by your healthcare provider and may require medication.

Autoimmune Testing

Chronic immune dysfunction and stealth microbes like borrelia play a major role in autoimmunity. The type of autoimmune illness that occurs is related to the factors that disrupt immune function, the person’s genetics, and the spectrum of stealth microbes.

Though diagnosis of specific autoimmune illnesses is complex and requires extensive testing, basic screening for autoimmunity can be done with two tests:

  • Rheumatoid factor: A standard test, it reveals if severe arthritis is present
  • ANA titer: Positive in many types of autoimmune disease

C-Reactive Protein (CRP)

CRP is a measure of inflammation. It is probably more valuable for monitoring health habits than anything else. High levels (>10) correlate with poor health habits and increased risk of disease.

Normal CRP levels, however, are often present in individuals who follow good dietary habits and yet still suffer from a chronic illness.

Vitamin D

Vitamin D is not only important for healthy bones, but also very important for normal immune function. There are several forms of vitamin D; calcidiol (25 OH vitamin D) is the most commonly measured form in blood tests.

Both normal ranges for blood levels of vitamin D and indications for supplementation are controversial, and various medical organizations and nonprofit groups don’t seem close to reaching a consensus just yet. For example, the Institute of Medicine (IOM) considers up to 4,000 IU of vitamin D3 a safe dosage for most adults. But the Endocrine Society suggests a safe dose for most adults can go all the way up to 10,000 IU.

With the differing viewpoints, how do you know what to do? For starters, know that levels of >40 ng/ml have been associated with reduced risk for many cancers and for chronic disease in general. And achieving consistent vitamin D levels of >40 ng/ml is also important for Lyme disease, chronic fatigue syndrome, and fibromyalgia recovery.

Ultimately, the best way to stay on top of your vitamin D levels is to work with your healthcare provider to determine which dose is right for you. Ideally, have your levels checked every six months.

Vitamin B12

Low B12 levels (normal ranges vary between labs) can be a sign of low intake (sometimes seen in vegetarians), but more commonly it’s a sign of inadequate absorption and gastric dysfunction. Vitamin B12 generally increases spontaneously with improved health habits, but in the short term, B12 injections or sublingual (under the tongue) supplements can improve energy levels. Activated forms like methylcobalamin or hydroxocobalamin of B12 are better absorbed orally than the more common inactive form, cyanocobalamin, used in most multivitamin products.


Ferritin measures iron stores. Low ferritin levels can indicate low stores of iron in the body, which can be associated with fatigue. High ferritin levels indicate abnormal retention of iron in the body (called hemochromatosis), which can be associated with liver damage and nonspecific symptoms. High levels can also be associated with autoimmunity and chronic infection.


Test strips for urine testing can be obtained online without a prescription. Here’s what they measure for:

  • pH: Urine pH should be consistently alkaline, reflecting high consumption of vegetables and fruit. A normal range is 4.5 to 7.8.
  • WBCs, nitrites: These tests show evidence of a urinary tract infection.
  • Protein: Elevated levels can indicate kidney disease.
  • Bilirubin: Elevated levels show increased turnover or destruction of red blood cells.

Mold and Mycotoxins

Evaluation for mold is indicated anytime there is any suspicion of mold. It is possibly the most important evaluation you can do. Mycotoxins (mold toxins) are potent immune disruptors and cause a wide spectrum of nonspecific symptoms, including a chronic inflammatory response, neurological symptoms, and persistent insomnia. If mold sensitivity is an issue, the only option for complete relief is eradicating mold from your environment.

The first step in evaluating for mold is using your nose and eyes to search for it. Moisture is necessary for mold to grow. Mold, however, can be hidden in walls, crawl spaces, attics, and more. It is possible to test for mold with simple kits that can be ordered online. It is also possible to test for mycotoxins in urine or the potential for mold exposure through blood tests. Ones that could potentially be useful include:

  • HLA-DR: This genetic blood test determines whether a person has the genes that trigger the immune system to properly recognize and excrete mycotoxins from the body.
  • C4a: C4a is a complement protein known as an anaphylatoxin, a substance that creates a response similar to an allergic reaction. It also executes tasks related to the immune system and inflammation. An elevated C4a may be present in individuals who have been exposed to mycotoxins. Note that C4a levels may also be elevated in patients with Lyme disease and lupus.
  • MSH (Melanocyte-Stimulating Hormone): The hormone MSH is produced in the hypothalamus and the pituitary gland. It regulates neuroimmune pathways, including melatonin, cortisol, cytokines, sex hormones, and the integrity of mucous membranes. Among mold patients who developed Chronic Inflammatory Response Syndrome (CIRS), 95% have decreased MSH functioning.
  • VCS (Visual Contrast Sensitivity): A VCS test measures your ability to detect changes in visual contrast, a function that may be impaired in individuals who have been exposed to biotoxins. The test is available online or can be completed in a doctor’s office.

However, with or without testing, the solution to a mold problem is completely avoiding mold. Testing may only be needed if you’re not getting better within weeks or months after complete elimination of the mold problem.

Advanced Laboratory Testing

Laboratory tests in glass flasks closeup. Chemical reagents in medical lab

The following tests are discussed because they are often recommended, but they seldom influence the status of recovery. These tests should be reserved for special circumstances or when recovery is not progressing, but not performed routinely.

Omega-3/Omega-6 Ratio

The ratio of omega-3 fatty acids to omega-6 fatty acids is a marker for balance of inflammatory factors in the body. Proper diet and supplementation generally result in satisfactory omega fatty acid ratios.

Cytokine Testing (Th1/Th2)

Cytokines are the messengers of the immune system. Cells of the immune system use cytokines to signal to each other and pass directions. Stealth microbes manipulate cytokines to generate inflammation and redirect immune functions in favor of the microbe.

Though the immune system and its interactions with different microbes is extremely complex (still beyond our complete understanding), effort has been made to simplify immune functions into two pathways important for chronic illnesses associated with stealth microbes. Below, “Th” stands for T helper cells:

  • Th1 pathway: Associated with cell-mediated immunity and intracellular pathogens. When the Th1 pathway is overactive, it’s associated with inflammation and autoimmunity.
  • Th2 pathway: Associated with antibody-mediated immunity and extracellular parasites. When overactive, the Th2 pathway is associated with asthma and allergies.

This is, of course, an oversimplification of a very complex process. In general, chronic Lyme and other illnesses associated with chronic immune dysfunction and stealth microbes are Th1 dominant.

Many herbs help balance this dysfunction by reducing overactive cytokines associated with inflammation and enhancing antibody and functional cell mediated immunity. A few herbs that stimulate Th1 functions (astragalus, echinacea) should be avoided during the early stages of recovery. Generally, measuring cytokines is unnecessary for recovery.

Adrenal Hormone Testing

Adrenal dysfunction or adrenal fatigue is a given in any chronic illness. Elevated cortisol levels, associated with increased physical and emotional stress, contribute to sleeplessness, stress intolerance, agitation, and anxiety. Prolonged adrenal stress can deplete cortisol, with resulting symptoms of extreme fatigue, total stress intolerance, and excessive sleeping (but sleep is dysfunctional and not restful).

Because adrenal dysfunction is always present in chronic illness and generally normalizes with proper therapy, measurement of adrenal hormone levels is generally not necessary. On rare occasions when a patient is not improving, measurement of cortisol can be beneficial.

  • Salivary cortisol: Measured four times over 24 hours, it’s the best measure of adrenal function, but symptoms are often a better guide.
  • Dehydroepiandrosterone sulphate (DHEAS): DHEAS measures adrenal function; high levels indicate excessive function, and low levels indicate inadequate function. This test is often performed, but it is not as reliable as cortisol measurement (which is also usually unnecessary, as symptoms are generally adequate to evaluate adrenal function). It is useful in only select circumstances.

Reproductive Hormones

Menopause can exacerbate the symptoms of any chronic illness. Though usually obvious (with the absence of periods), menopause can be confirmed by an elevated pituitary hormone called FSH: levels >25 indicate menopause. Other hormone levels, including estrogen and progesterone, are generally not necessary to measure, but may be recommended by your healthcare provider. In men with fatigue, total and free testosterone are sometimes indicated.

  • Female: Salivary or blood E1, E2, E3, free testosterone, progesterone, FSH (screening FSH, Estradiol levels)
  • Male: Free testosterone, total testosterone

Testing for Toxins

Build-up of heavy metals and other toxins can be a hidden factor in chronic illness. However, every person living on the planet today is carrying some heavy metals, and no one really knows how much is enough to cause disease. The biggest source of concern is amalgam dental fillings (though recent opinions are suggesting that amalgam fillings do not shed as much mercury as once thought).

A healthful diet and lifestyle along with key supplements will generally reduce heavy metals in the body. Save heavy metal testing for last on the list; if you are still not getting better, ask your doctor about testing.

  • Hair samples: This is the least reliable method of testing for heavy metals.
  • Blood test: It’s valuable only for testing acute exposure.
  • 24-hour urine after DMSA: This is the most accurate assessment. Urine is collected for 24 hours after use of 100 mg of DMSA (Dimercaptosuccinic acid, a chelation medication) to pull heavy metals out of tissues.

The presence of organic toxins (pesticides, plastic residues) is almost a given and can be addressed with dietary and lifestyle modifications. Chlorella is excellent for pulling organic toxins out of the body.

Food Sensitivities

Chronic gastrointestinal dysfunction is often associated with sensitivities to commonly consumed foods (which is not the same as food allergies, like a peanut allergy). Symptoms associated with food sensitivities are commonly delayed for 1-2 days after the food is consumed. Typical symptoms include fatigue, joint pain, muscle pain, and general achiness — in fact, food sensitivities alone can be the root of many symptoms.

  • Food sensitivities are best determined by an elimination diet — a diet designed to selectively eliminate and identify problem foods.
  • Problem foods can also be delineated with specific IgG and IgA testing. Currently, there are several food sensitivity tests on the market, and many of them can be customized to test a range of foods, preservatives, medications, and more, and some can be delivered to your home. Depending on the company used and number of items tested, prices vary from just under $200 to several hundreds of dollars.

Comprehensive Stool Analysis

Stool analysis is valuable for defining gastrointestinal dysfunction and diagnosing parasites and yeast overgrowth. This expensive test is generally reserved for extreme cases when dietary modifications and supplements are not enough to overcome gastrointestinal problems. It is rarely necessary.

Folate and Methylation

There are about 40 different genetic mutations that can affect MTHFR, a gene that plays an important role in the body’s ability to use folate or folic acid. About 40% of the population has one abnormal gene and are moderately affected. About 12% of the population has two abnormal genes and is more significantly affected.

Problems associated with MTHFR mutations include elevated risk of stroke and heart attack, increased cancer risk, defects in embryo development (spinal tube defects), and neurological symptoms including insomnia, irritability, depression, brain fog, neuropathy (burning tingling feet and hands), and restless legs syndrome. It also can be a factor in recovery from fibromyalgia and Lyme disease.

For folks who want the technical details:

MTHFR is a gene that codes for an enzyme called methylenetetrahydrofolate reductase. This enzyme is vital for creating 5-methyltetrahydrofolate, an essential substance for converting the amino acid homocysteine into the amino acid methionine.

Methionine is essential for amino acid synthesis, formation of glutathione (an important intracellular antioxidant), formation of DNA, and detoxification. Methionine is also important for formation of SAMe, which plays a key role in metabolism of dopamine, serotonin, and melatonin. Without this important enzyme, all these pathways are blocked.

Testing for MTHFR mutations involves a simple blood test or DNA cheek swab that costs about $100 to $200; the blood test may be covered by insurance. Checking for elevations of homocysteine and RBC folate in the blood is an indirect way to check for the problem.

The best solution for elevated levels is getting plenty of natural 5-methyltetrahydrofolate (methylfolate for short). Leafy greens are a great source, but if you have a mutation, supplementing is a good idea. Folic acid, found in most multivitamin products, will not work because it must be converted by the deficient enzyme.

You must supplement with 5-methyltetrahydrofolate; 400-800 micrograms daily is generally adequate for anyone with a single mutation (especially if you eat plenty of leafy greens). If you have a double mutation, it is a good idea to take an extra 400-800 micrograms. For additional benefit, you can add 400-800 mg of SAMe daily, in the evening. SAMe supports detoxification and can improve sleep.

Chemical components called “methyl groups” that are essential for proper detoxification can also be supplied by vitamins B6 and B12. It is, however, important to get the activated forms of these important vitamins. The activated form of vitamin B6 is pyridoxal 5-phosphate, and the active form of vitamin B12 is methylcobalamin.

Healthful diet and adequate supplementation of methyl donors is generally adequate for recovery. MTHFR testing is only necessary if recovery is not progressing.

In my medical practice, I had the fortune of working with a lab that measured MTHFR for no charge. For the five years it was available, I tested all my patients. Surprisingly, I found it played a more minor role in recovery than I expected. I had chronic Lyme sufferers who were severely symptomatic who had no mutations, and perfectly healthy people who had double mutations.

Testing Beyond the Lab

Doctor checking brain scan for Lyme euro symptoms

Certain types of symptoms require evaluation by diagnostic procedures conducted by specialists in their respective fields. These symptoms include:

  • Neurological symptoms: Severe neurological symptoms are evaluated with a nerve conduction test and MRI of the brain to assess the nervous system. The purpose is ruling out multiple sclerosis.
  • Cardiac symptoms: Heart symptoms like chest pain and irregular heartbeat are evaluated by EKG and Holter monitor (a wearable device for tracking your heart rhythm). Findings may lead to cardiac catheterization.
  • GI symptoms: Stomach pain and symptoms are often evaluated by an upper endoscopy. Lower intestinal and colon symptoms are evaluated by colonoscopy. Routine colon cancer screening with colonoscopy is recommended every 10 years for everyone over 50.

Testing for Microbes

bacterias and microbes under microscope. Viral disease. 3d illustration

Testing for microbes in chronic illness is often like opening up a can of worms. Detection of a microbe in the body is only as good as the technology, and right now, the technology for diagnosing borrelia and other low-virulence stealth microbes is fair at best (they’re called “stealth” microbes for a reason).

And that’s for the species of microbes we know about. Research continues to press on in the search for stealth microbes that play a role in Lyme disease, including new forms of borrelia.

The long and the short of it is, all ticks carry potentially pathogenic microbes. If you have ever been bitten by a tick, you have been exposed to microbes, and you likely harbor one or more stealth microbes in your body. If you have all the signs and symptoms of chronic Lyme disease, then the chances that you are carrying some species of borrelia is high — no matter what the testing shows.

When you consider that borrelia has been prevalent in ticks worldwide for thousands of years, and that asymptomatic carriers are extremely common, borrelia is probably much more prevalent than is widely accepted.

The other side of the story is that as testing gets better and better, it will likely reveal that many healthy people have borrelia, and that everyone harbors some stealth microbes — Lyme coinfections like mycoplasma, bartonella, chlamydia, and many others are remarkably common.

The key to being healthy is robust immune function.

When you start seeing chronic Lyme disease for what it is — chronic immune dysfunction, with a pot of stealth microbes boiling over — the compulsion to test for specific microbes becomes less relevant. There are always possibilities that can’t be accounted for.

When I evaluate a person with possible chronic Lyme disease, it’s easier to just assume that borrelia and other stealth microbes are present. This allows me to have less reliance on unreliable lab results.

To Test or Not To Test

Sick man wrapped into blanket sitting on sofa in front of table with papers while staying at home

Our ability to test for microbes species is limited to a small piece of a much larger pie of unknowns. The total microbiome of the body consists of many thousands of microbe species; who knows how many of them are stealth microbes or opportunistic pathogens. A comprehensive herbal protocol covers for most possibilities, both known and unknown.

Which brings up the question: “Why test at all?”

Frankly, the most pressing reason to test is academic — that “need to know” quality that we all share as humans.

If you choose a conventional route of therapy, however, testing will likely be necessary. In fact, many doctors will not consider writing a prescription until testing is done and results are available. Considering the extreme limitations of the present state of testing for stealth microbes, it is one of the major drawbacks to pursuing a conventional route of therapy.

If you choose a natural route of therapy, testing is much less necessary. A comprehensive herbal protocol covers for borrelia and most other possibilities (without the toxicity associated with drugs and synthetic antibiotics). Many people have gotten well without doing any testing at all.

The biggest reason to test is if you are not improving. Sometimes testing can uncover the presence of other vector-borne diseases (babesia, ehrlichia, rickettsia, anaplasma), or viral reactivation of a herpes-type virus for which a prescription antimicrobial may provide benefit.

That nagging need to know, however, is a fundamental characteristic of human nature. “Could there be something present that could be easily treated?” is a question that often lingers in the back of everyone’s mind. Before proceeding any further, however, know that testing for microbes can unnecessarily complicate your recovery.

There are no absolutes when it comes to stealth microbes. A negative test does not rule out the possibility of a certain microbe being present or the possibility of other microbes being present. Diagnosis should not rely on labs alone. It’s a matter of adding up all the clues, including the symptom profile, prevalence of possible microbes in the geographic area, and any other factors that may be helpful in making the diagnosis.

If you decide to do lab testing, the place to start is with labs covered by your medical insurance. Insurance policies are highly variable, however, and it is up to you (not your doctor) to find out what is and isn’t covered.

Most healthcare insurance policies will cover testing for borrelia and possible coinfections with in-network labs. Most in-network labs, however, only do basic-level testing, which often carries a low probability of actually diagnosing an offending microbe.

Specialty labs do more advanced and sophisticated lab testing, but are generally not covered by insurance, and they can be pricey. Expense is the primary reason these tests are not covered by insurance. Testing for borrelia alone is not sufficient; if you are going to do testing, you really need to test for all the known possibilities. This can run $1,000 or substantially more.

Because of demand, there is a proliferation of specialty labs doing testing. The oldest and possibly best-known is IGeneX, but there are many new and innovative testing labs coming on the scene. Blood can be drawn at the doctor’s office and sent to a specialty lab, but you will probably be responsible for the bill.

Reasons to Test

Here are some of the more compelling arguments in favor of testing:

  • Needing to know
  • Some stealth microbes are more virulent than others and respond better to antibiotic therapy; a positive test can help direct therapy.
  • Obtaining lab tests for microbes supports research and increases the knowledge base of stealth microbes.
  • Financial support for labs and institutions doing testing.
  • Testing for a specific microbe is primarily valuable for acute symptoms after a tick bite.
  • Testing for Epstein-Barr virus (EBV), cytomegalovirus (CMV), and other herpes-type viruses (there are eight that commonly infect humans) can be valuable because high titers associated with reactivation of these viruses may respond to antiviral therapy.

Limitations of Testing

Current testing options are indeed limited, and results often don’t contribute to faster or more successful recovery. Here’s a summary of testing limitations:

  • Multiple microbes are always present; a positive test for one does not rule out the presence of others.
  • During chronic infection, stealth microbes occur in very low concentrations in isolated areas of the body, making diagnosis by any means very challenging.
  • Stealth microbes commonly live inside cells, and some can exist in cyst forms (especially when they are under pressure). Both are factors that make diagnosis a real challenge.
  • Stealth microbes readily manipulate the immune system — detection depends on antibody production.
  • Cross-reactivity with other bacteria is common, including normal flora.
  • Most testing is species specific; many species of each type (genera) of microbe are possible, for which there is no available testing.
  • Symptoms of chronic Lyme can occur without the presence of borrelia and can be caused by other stealth microbes (though borrelia may be present with a false negative test).
  • Everyone harbors stealth microbes; the microbiome is extremely complex.
  • The concept of testing for chronic infections with stealth microbes is relatively new; most testing is focused on acute illness.
  • False negative rates are high for all forms of testing; false positives are also possible.
  • Testing for the many possibilities can run several thousands of dollars, often not covered by insurance.
  • A positive test for a specific microbe can provide false peace of mind.
  • A negative test does not exclude the presence of a microbe (especially during chronic illness).

Common Types of Testing for Microbes

Close up of unrecognizable scientist dropping blood samples in test tubes while working on research in laboratory, copy space

Testing is getting better, and there are a variety of different ways to test, but none of them are anywhere near 100% accurate. Testing is mostly useful for diagnosing acute illness. This is especially true when symptoms of illness suggest infection with a higher virulence microbe that might respond to acute treatment with antibiotics. New innovations may gradually improve testing for chronic illness associated with stealth microbes.

Direct Testing

Direct testing includes visualizing the microbe directly in tissue or blood samples, or growing the microbe out of tissue or blood samples in a media that is specific for that microbe. Direct testing is not species specific, so any species of the microbe can be diagnosed. Polymerase chain reaction (PCR) tests look directly for the microbe’s DNA and are species specific (uncommon species may be present but will not be diagnosed).

These forms of testing are most useful for diagnosing acute infections. Direct methods are not reliable for chronic infections because stealth microbes occur in such low concentrations in the body during chronic infection, are not present in the blood in high numbers, can occur in dormant or cyst forms, live inside cells, and gravitate toward isolated recesses of the body.

Examples of direct testing:

  • Tissue/Blood: Direct visualization
  • Tissue/Blood Culture: Uses culture media specific for the microbe to grow the microbe in culture
  • Polymerase Chain Reaction (PCR): Direct detection of microbe DNA in tissues, blood, and urine

Indirect Testing (Serology)

Indirect testing relies on antibody production to the microbe (serology). Evidence of acute infection is best evaluated with IgM antibodies and late acute or chronic infection with IgG antibodies. Some testing regimens require serial titers (testing at different time intervals) to distinguish between acute and chronic infections.

Different types of serology are available for different microbes. Accuracy for testing chronic illness associated with stealth microbes is greatly limited by low concentrations of the microbe in the body with reduced or inadequate antibody response for testing.

Examples of indirect testing include:

  • Enzyme-Linked Immunoassay (ELISA test, EIA): It measures antibodies in the patient’s serum that are specific to microbial antigens (part of the microbe) by using labeled enzymes to bind the antibodies for measurement.
  • Immunofluorescence Assay (IFA): This test utilizes fluorescent dyes to identify the presence of microbe-specific antibodies in the patient’s serum.
  • Western Blot: Detects antibodies to multiple different microbial antigens by measuring different protein bands. Collectively, the presence of multiple bands allows diagnosis of infection with a specific microbe. A Western Blot is more sensitive than ELISA for borrelia.

Diagnosing Borrelia

The stealth nature of Borrelia burgdorferi makes it very difficult to diagnose. Developing tests to detect it is a real challenge because it:

  • Stays deep in tissues
  • Has the ability to live inside cells (intracellular)
  • Has elaborate ways of tricking the immune system
  • Changes its genetic signature readily
  • Doesn’t require high concentrations of microbes to cause illness

In the United States, mainstream Lyme testing is specific for Borrelia burgdorferi, but there are presently 21 other species of Borrelia that can cause Lyme disease. In Europe, two other species of borrelia — Borrelia afzelii and Borrelia garinii — are more common than Borrelia burgdorferi as a cause of Lyme disease.

Because of the mobility of people, different borrelia species are circulating around the world. This contributes to another layer of difficulty in diagnosis. It is becoming evidence that other species are much more common than once thought.

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Bull’s-Eye Rash (Erythema Migrans)

The classic bull’s-eye rash is signified by redness extending outward from the tick bite site with an outer, more prominent red ring. Symptoms of Lyme disease associated with a history of tick bite and bull’s-eye rash are the most reliable way to diagnose infection with borrelia, but even that is far from absolute.

There are likely other types of microbes that can cause a bull’s-eye rash. Only ⅓ of people with Lyme disease will have bull’s-eye rash, and only 10% of bull’s-eye rashes are associated with the presence of borrelia in the blood.

Blood/Tissue Culture

The most definitive test for proving the presence of a microbe is growing it in a lab from a tissue or blood sample. Because borrelia exists in such low concentrations in blood and tissues, and because borrelia is so difficult to grow under artificial conditions, cultures are generally not useful for diagnosing Lyme disease.

EIA tests (ELISA and ELFA)

This tests the host for antibodies produced against borrelia. It is recommended as a screening test for Lyme disease. The Centers for Disease Control (CDC) defines this test as an important screening test for Lyme disease. But in clinical practice, most healthcare providers who treat Lyme disease find that this Lyme disease test has poor predictive value and limited usefulness. It has no value for diagnosing chronic Lyme.

PCR for B. burgdorferi

Short for Polymerase Chain Reaction, a PCR tests directly for borrelia DNA in the host’s blood, tissues, or urine. Historically, PCR has had limited accuracy, but improvements in technique are allowing PCR for microbial DNA to be the future of testing. At some point, it may be possible to define a person’s entire microbiome.

For now, testing is available for the most common species of borrelia and many common species of coinfections with other stealth microbes. Testing is most accurate during acute infection, and much less accurate during chronic infection.

Again, the bottom line is that if you have many or most symptoms of chronic Lyme disease, then you are likely harboring at least one species of borrelia and several other species of stealth microbes — no matter what the testing shows.

Many companies are offering microbial DNA testing, but a few are taking the lead. DNA Connexions tests DNA in either blood or urine specimens for three species of borrelia and several of the most common coinfections. Testing kits are available online.

Western Blot

The Western Blot for Borrelia burgdorferi relies on production of antibodies by the host’s immune system for different parts (antigens) of the bacteria. Antibody production does not occur until the body’s secondary defense kicks in, and it’s dependent on the host’s ability to mount an immune response.

The Western Blot test may provide a more accurate diagnosis of Lyme disease than most of the other available tests, but testing is more valuable for the late acute than chronic illness. In addition, the test is oriented toward diagnosis of Borrelia burgdorferi, and not other species of borrelia that may cause Lyme disease.

Because borrelia shares antigens with other bacteria, multiple positive antibodies (called bands) are required for a true positive test. Western blot is performed for both IgM and IgG antibodies in an effort to separate acute from chronic illness.

IgM antibodies show acute Lyme disease. IgM testing can be positive as early as one week after infection, and remains positive for six to eight weeks after initial exposure. CDC guidelines require two positive bands out of three (23-25, 39, 41). IGeneX labs add three extra bands (31, 38, 83-93), the first two of which were removed from the CDC criteria during the development of an unsuccessful vaccine and were never replaced.

The IgG antibody is typically present a few months following initial infection. IgG antibodies are more indicative of chronic disease. CDC guidelines require five positive bands out of 10 (18, 23-25, 28, 30, 39, 41, 45, 58, 66, 83-93). The IGeneX criteria is two bands out of six (18, 23-25, 28, 30, 39, 41, 45, 58, 66, 83-93). Band 41 is specific for the flagella (tail) of spirochetes (corkscrew bacteria), but is not absolutely specific for borrelia.

Acute viral infections can cause false positive results. Data reported from IGeneX supports that some Lyme patients may have only restricted IgM response to Borrelia burgdorferi. Because Lyme patients have different immune systems, only approximately 70% of those with Lyme disease will generate a positive Western Blot. Patients who test positive for rheumatoid factor or Epstein-Barr virus may have false negative tests.

IGeneX Western Blot is around $125. IGeneX is now offering PCR testing for Borrelia miyamotoi (associated with relapsing fever) for $265, as well as immunofluorescence testing (FISH) for babesia, anaplasma, ehrlichia, and rickettsia.


Aperiomics testing uses metagenomic sequencing with blood samples, tissue swabs, urine specimens, or fecal samples to identify every known bacteria, virus, fungus, and parasite — their database alone contains more than 37,000 microorganisms.

This test helps target which pathogens may be causing your symptoms. For example, if you have an ongoing gastrointestinal problem, and treatments haven’t brought you relief, you might benefit from the fecal testing kit, which could identify one or more pathogens responsible for making you ill.

Also, Aperiomics tests for Lyme disease and coinfections, but it will likely come with a hefty price tag. Since stealth microbes often hide in various tissues throughout the body, the company recommends testing kits that collect blood, swab, urine, and fecal samples, which can cost upwards of $2700. However, if your symptoms are more specific, you may be able to do less testing, and ultimately, save some money.

Although it’s tempting to gain as much information as you can about what’s making you feel ill, remember that no test is completely definitive, and the results might not change the trajectory of your treatment. Before you splurge on costly testing, talk with your healthcare provider about how new information can be used to advance your recovery.

Direct Tick Testing

If you actually kept the tick that bit you, it is possible to have the tick checked for certain microbes. The testing, however, does not check for all possibilities. Tic-Kit will check the tick for borrelia, bartonella, babesia, and ehrlichia.

Also, IGenex has a tick-test kit, which looks for pathogens like borrelia, tick-borne relapsing fever (TBRF), babesia, anaplasma, ehrlichia, bartonella, and rickettsia.

Finally, local or state agencies, such as universities, may offer tick testing at little to no cost as part of research and data collection projects.


The bite of the Lone Star tick is associated with a Lyme-like illness named STARI (southern tick-associated rash illness). STARI can be associated with a bull’s-eye rash and all the symptoms of Lyme disease, but tests for borrelia are always negative. The cause of STARI is presently unknown, but another form of borrelia is suspected.

Testing and Diagnosing Coinfections and Related Microbes

Blood test tubes in woman hands, modern laboratory background

There are quite a few microbes spread by blood-sucking insects (ticks, mosquitoes, fleas, lice, chiggers, biting flies, scabies) that have stealth characteristics similar to those of Borrelia burgdorferi; some we know about, and others still waiting to be discovered.

They all have stealth characteristics and the ability to infect and thrive inside cells. They are masters of evading the immune system, and can be even harder to diagnose than borrelia. Symptoms profiles are similar to borrelia and related mostly to stimulation of cytokine cascades, not concentrations of microbes. Though they each have slightly different strategies, their motive is the same: complete a lifecycle stage within the host and move on.

The primary known players in chronic Lyme include mycoplasma, bartonella, and chlamydia species. The most well-known species of babesia, anaplasma, ehrlichia, and rickettsia are more apt to cause acute illness and less apt to be associated with chronic illness, but research is discovering lesser known and lesser virulent species of these microbes that are associated with chronic Lyme. Reactivation of herpes-type viruses is common in chronic Lyme.

Though testing is possible for some species of these microbes, when a natural route of recovery is chosen, extensive testing is not necessary and can actually be very misleading.


Diagnosis of mycoplasma is challenging, especially if it’s a chronic infection. Most commonly, amplified Polymerase Chain Reaction (PCR) tests are used for diagnosis, which look at a blood sample for DNA that is specific to the microbe.

PCR is species specific and focused on diagnosing acute respiratory or genital mycoplasma infections. When testing for mycoplasma, ask to be tested for all the possible species (M. fermentans, M. genitalium, M. penetrans, M. hominis, M. pneumoniae, M. synoviae, Ureaplasma urealyticum). Note that 75% of acute infections show cold agglutinins (clumping of red blood cells).

Serial titers testing for antibodies with enzyme-linked immunosorbent assays can be used to test for acute infection. Persistent elevated titer may indicate a chronic infection or an asymptomatic carrier, but in general, chronic infection with mycoplasma is difficult to diagnose. A low WBC count is found in 25% of chronic infections.


The best test for bartonella is an amplified version of PCR called ePCR by Galaxy Diagnostics. The company, located in Research Triangle, North Carolina, offers both ePCR and serology testing for bartonella. Standard PCR for bartonella costs $260; ePCR costs $650 or more.

Testing is species specific; the most common species are included in the testing protocol. The company also offers standard PCR for anaplasma, babesia, ehrlichia, and rickettsia (the most common species) for $230 each (or $615 for a total tick panel).

Note that if you have private insurance, you will be asked to pre-pay for the test, which you may submit to your insurance carrier for reimbursement. Galaxy Diagnostics is a Medicare provider, so you will not need to pay upfront. However, if Medicare denies the claim, you’ll be responsible to pick up the cost of the test.


An Indirect Immunofluorescent Assay (IFA) tests for IgG and IgM antibodies produced by the body against babesia. Diagnosis relies on a four-fold rise in antibody titer over several weeks. The first sample should be taken as early in the disease process as possible, and the second sample taken two to four weeks later.

A PCR (Polymerase Chain Reaction) detects microbial DNA in a blood sample. IGeneX uses an amplified version of PCR and FISH together for improved accuracy of testing for B. microti and B. ducani.

Ehrlichia, Anaplasma, and Rickettsia

These microbes have the potential to cause severe illness; therapy should not await laboratory diagnosis if acute infection with any of these microbes is suspected. Blood can be drawn when therapy is initiated to confirm the infection.

The most accurate test is serial serology using Indirect Immunofluorescent Assay (IFA). Diagnosis relies on a four-fold rise in antibody titer over several weeks. The first sample should be taken as early in the disease process as possible, and the second sample taken two to four weeks later.

PCR is 60-85% effective for diagnosing ehrlichia and 70-90% effective for diagnosing anaplasma, but it’s less valuable for diagnosing Rocky Mountain spotted fever (RMSF). Accuracy for diagnosing chronic infection is unknown. There are many new species of these microbes being discovered for which routine testing is not yet available.


Pelvic infection associated with C. trachomatis is diagnosed by vaginal swab in females (either patient or clinician collected) and urine sample in males. Nucleic acid amplification tests (NAATs) are the most sensitive. Yearly screening for females under age 25 is recommended by the CDC.

Testing for C. pneumoniae (respiratory infection) is performed with PCR specific for C. pneumoniae DNA from a blood sample. Present testing includes only the two most common species out of nine known species.


The list of viruses that can cause chronic infection with chronic reactions in the human body is long. A partial list includes Epstein-Barr virus (EBV), cytomegalovirus (CMV), HSV-1, HSV-2, herpes zoster virus, HHV-6a, HHV-6b, HHV-7, parvovirus B-19, adenoviruses, and hepatitis B and C.

Reactivation of dormant viruses is commonly associated with immune dysfunction that occurs with fibromyalgia, Lyme disease, and similar chronic illnesses. Testing for specific viral reactivation is generally not necessary, but if you are interested, the best source of information about testing is Lab Tests Online.

The two most common reactivated viruses associated with chronic flu-like symptoms include Epstein-Barr virus and cytomegalovirus.

Epstein-Barr Virus (EBV)

To evaluate acute and chronic infection for EBV, four antibodies are commonly tested including viral capsid antigen (VCA) IgG, VCA IgM, D early antigen (EA-D), and Epstein-Barr nuclear antigen (EBNA). Here’s how to interpret results:

    • The presence of VCA IgG antibodies indicates recent or past EBV infection.
    • The presence of VCA IgM antibodies and the absence of antibodies to EBNA indicates recent infection.
    • The presence of antibodies to EBNA indicates infection sometime in the past.

Antibodies to EBNA develop six to eight weeks after the time of infection and are present for life.

  • The presence of VCA-IgG, EA-D, and EBNA may indicate reactivation of the virus.

Cytomegalovirus (CMV)

To evaluate acute and chronic CMV infection, a blood sample is tested for IgG and IgM antibodies to CMV. Here’s how to interpret findings:

  • The presence of CMV IgM indicates a recent active infection.
  • The presence of both CMV IgM and CMV IgG can indicate active primary infection or reactivation of dormant virus.
  • The presence of CMV IgG only indicates past exposure.

Intestinal Parasites

Intestinal parasites are common in third world countries where sanitation and waste disposal systems are poor, but much less common in developed countries. Parasite eggs are consumed with contaminated food, hatch inside the body, go through a lifecycle, lay eggs, and then die. The eggs do not hatch inside the body, but are shed in feces. Chronic parasite re-infestation requires continual consumption of contaminated food.

People in developed countries do occasionally consume parasite eggs from eating raw foods and can occasionally harbor very low levels of parasites, but rarely enough to cause symptoms of infestation. Infections are always self-limited unless contaminated food is again consumed.

Testing is rarely indicated. Testing stool for eggs and parasites is not very sensitive and is almost always negative unless infestation is large.

Transmission of Vector-Borne Diseases: How Stealth Microbes Make Their Way

Deer Tick on fingertip, zoomed in

Different stealth microbes have different transmission routes. Knowing the mode of transmission can sometimes be helpful in diagnosis. Many of them can be transmitted by ticks. For borrelia, STARI, babesia, ehrlichia, and anaplasma, this is a major route of transmission.

If the type of tick is known, sometimes it can be helpful in defining types of microbes present. This is not absolute, however. Most tick-borne microbes can be spread by a variety of ticks.

In addition, many stealth microbes are also spread by other biting insects (mosquitoes, fleas, lice, biting flies, chiggers), sexual contact, blood transfusions, and some by air droplets. Mycoplasma and bartonella are more commonly spread by other means and can already be present but silent at the time of infection with a different tick-borne microbe. Mycoplasma and bartonella are probably more common in individuals diagnosed with fibromyalgia and chronic fatigue (along with other stealth microbes).

Here are some common microbe-tick connections:

  • Borrelia: The black-legged deer tick (Ixodes scapularis), most common in the Northeastern, Mid-Atlantic, and North-Central U.S., and the western black-legged tick (Ixodes pacificus) on the Pacific U.S. coast
  • STARI: The Lone Star tick (Amblyomma americanum), most common in the Southern U.S. extending out to Oklahoma and Texas, and in the Mid-Atlantic extending up into Northeastern U.S.
  • Mycoplasma: Mostly passed via respiratory and sexual transmission, but mycoplasma can be spread by biting insects, including ticks (probably numerous species). Numerous species of mycoplasma are widely distributed worldwide. Mycoplasma may be a primary factor in fibromyalgia, chronic fatigue syndrome, and autoimmune disease.
  • Bartonella: Most commonly associated with a scratch of an infected animal (cat, dog), bartonella can also be spread by fleas and lice. Ticks are a vector, but specific tick species have not been specified. Bartonella may be a primary factor in fibromyalgia and chronic fatigue.
  • Babesia: Black-legged deer ticks (Ixodes scapularis), most common in New England (Maine, Vermont, New Hampshire, Massachusetts, Connecticut, and Rhode Island), New York, New Jersey, Wisconsin, Minnesota, but spreading southward. Also present in the Southeastern U.S., with Georgia as the epicenter.
  • Ehrlichia: Most common in Northeast and Southeast U.S., it’s most concentrated in a band stretching from North Carolina to Oklahoma (South, South-central, Southeast), which is the distribution of the Lone Star tick (Amblyomma americanum). Ehrlichia is also transmitted by black-legged (Ixodes scapularis) and western black-legged (Ixodes pacificus) ticks, along with other tick species worldwide.
  • Anaplasma: Black-legged tick (Ixodes scapularis) in the Northeast and Upper Midwest and western black-legged tick (Ixodes pacificus) in northern California.
  • Rickettsia (Rocky Mountain spotted fever): American dog tick (Dermacentor variabilis), which has the most common distribution in the mid-states east of the Rockies; Rocky Mountain wood tick (Dermacentor andersoni); and brown dog tick (Rhipicephalus sanguineus), which is commonly found in Arizona. But RMSF is widely distributed across the U.S. and can occur in any state.

Hallmark Signs and Symptoms of Infection

Elderly woman suffering with parkinson's disease symptoms

Chronic infection with any stealth microbe is associated with nonspecific symptoms (it is their very nature). Even the symptoms that are considered classic for a particular microbe do not always occur. There are numerous species and strains of all of the different microbes, each of which have slightly different characteristics. If a classic symptom is present, however, it may help with diagnosis and treatment.

  • Borrelia: Microbes bore into areas of the body with collagen (skin, joints, brain) leading to a bull’s-eye rash (in 1/3 of cases), migrating arthritis, and brain fog
  • STARI: Probably another species of borrelia with the same characteristics as Lyme; symptoms include bull’s-eye rash (in 1/3 of cases) and migrating arthritis
  • Mycoplasma: Infect tissues that line areas in the body leading to initial respiratory or pelvic symptoms (depending on infection site), fatigue, and intestinal issues
  • Bartonella: Infect white blood cells and cells lining blood vessels and scavenge red blood cells for food; can result in bone pain from infection in bone marrow and pain in the soles of feet (from damage to blood vessels when walking)
  • Babesia: Infect red blood cells, liver, spleen; symptoms can include relapsing high fevers with drenching sweats and liver/spleen enlargement
  • Ehrlichia/Anaplasma: Infect specific types of white blood cells; symptoms can include high fever, headache, and muscle pain. It is mostly associated with acute disease; chronic disease is not as common
  • Rickettsia (Rocky Mountain spotted fever): Infect cells that line blood vessels, causing severe vasculitis. Symptoms can include high fever, spotted rash (90% of cases), and severe swelling in the extremities. It is mostly associated with acute disease; chronic disease is not common
  • Chlamydia: Chlamydia trachomatis can be spread by ticks, but is more commonly spread by sexual contact or respiratory infection. It can, however, be present at the time of infection with other microbes by tick bite. It is a common stealth microbe associated with chronic fatigue. It also has possible links to multiple sclerosis. Chlamydia is spread as a sexually transmitted disease and has been associated with chronic pelvic pain in women, infertility, and chronic fatigue. Chlamydia pneumoniae, which is associated with acute respiratory infection, has also been associated with chronic fatigue

Where to Get Lyme Disease Tests

Locating a healthcare provider who’s knowledgeable about Lyme disease to order the appropriate labs and test kits can be very overwhelming. You may find that you need more than one practitioner to help you. For starters, if you have a relationship with a primary care physician (PCP), even one who might not understand Lyme, they can order the routine lab tests so that you’re more likely to get them reimbursed by your health insurance.

The specialized test kits, such as coinfection panels, mycotoxin tests, or food sensitivities, will often be ordered by a Lyme-literate medical doctor (LLMD) or a functional medicine doctor who has some familiarity with Lyme. Ultimately, you’ll want to find a doctor you can trust, so they can identify the cause of your symptoms and how to help you on the road to recovery.

Dr. Rawls’ understanding of the treatment of Lyme disease, coinfections, and the value of diagnostic testing comes from his medical expertise as a doctor, as well as his personal experience as a Lyme sufferer. To learn more about Dr. Rawls, read his post about his chronic Lyme disease journey and his book Unlocking Lyme.

Dr. Rawls is a physician who overcame Lyme disease through natural herbal therapy. You can learn more about Lyme disease in Dr. Rawls’ new best selling book, Unlocking Lyme.  You can also learn about Dr. Rawls’ personal journey in overcoming Lyme disease and fibromyalgia in his popular blog post, My Chronic Lyme Journey.

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