Archive for the ‘Inflammation’ Category

The Hidden Immune Pandemic

http://  Approx. 14 min.

March 18, 2021

The Hidden Immune Pandemic

Well known Lyme literate doctor Stephen Phillips on the Dr. Oz Show.

Dr. Phillips understands the issues surrounding autoimmune disease personally as he was diagnosed with two.  He wants to give people hope in that there are many things that can be done to give you a full life.  While Lyme is mentioned the conversation is much more broad.  I appreciate the fact Dr. Phillips states that getting to the root cause is the key.  In the case of Lyme/MSIDS, it’s the infections.

Fantastic, informative video.  Please share.

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Telling patients “it’s all in their heads” is basically telling them that doctors are too lazy to determine what’s causing their illness.

3 Lyme Arthritis Studies & How Our Immune System Can Fail to Shut Off When There’s An Infection

https://globallymealliance.org/lyme-arthritis-and-inflammation-shut-it-off/

A SUMMARY OF 3 LYME ARTHRITIS STUDIES AND HOW OUR IMMUNE SYSTEM CAN FAIL TO SHUT OFF WHEN THERE’S AN INFECTION.

by Mayla Hsu, Ph.D., Director of Research and Science, GLA

Arthritis is one of the most common symptoms of Lyme disease, commonly presenting as swelling and pain in the joints. Borrelia burgdorferi bacteria, which cause Lyme disease, migrate to the joints and create the arthritic symptoms. However, growing evidence implicates not only the bacteria, but the immune system itself as playing a key role in the disease. It’s an example of how something that should protect us can also be harmful.

Our immune system has evolved to help us get rid of pathogens like B. burgdorferi. But if it’s working like a finely tuned machine, the immune system should turn off when the job is done. Instead, research has shown multiple ways that the immune system may be failing to stop the inflammatory response after infection, thus prolonging symptoms that can be very debilitating. To study this in Lyme arthritis, synovial fluid surrounding the joints can be collected from patients. It is then analyzed for the presence of immune cells and cytokines, the chemical messengers produced by cells to help kill pathogens.

Some Lyme arthritis patients have symptoms that do not improve after antibiotic therapy, known as antibiotic-refractory Lyme arthritis. Synovial fluid from these patients has been previously studied for the presence of regulatory T cells (Tregs). These immune cells, which are a subset of specialized T cells, were counted because they act as an “off switch” for inflammation. It was suspected that one pathway to long-term Lyme arthritis may be through insufficient or malfunctioning Tregs.

In the synovial fluid of antibiotic-refractory arthritis patients, an average of 5% of activated T cells were Tregs, as compared to antibiotic-responsive arthritis patients, who had 12%. Those with fewer Tregs were less responsive to anti-rheumatic medications, their arthritis took longer to resolve, and a number of them required synovectomies, or surgical removal of inflamed joint tissues, to resolve their symptoms.

A limitation of this early study was that the amount of Tregs found in the patients before and during early B. burgdorferi infection could not be analyzed, since the patients were only identified after Lyme arthritis was well underway. Might higher pre-existing Tregs be associated with quicker recovery from arthritis? If so, the number of these cells could be used as a possible prognostic marker to help with treatment decisions.

One way to determine this would be to assess Treg cells before and after experimentally infecting animals with B. burgdorferi, since such an experiment could not be done in humans. A new study in mice used an engineered mouse strain called C57BL/6 DEREG to address this question. In these mice, Treg cells can be depleted when animals are administered minute, nontoxic doses of diphtheria toxin. This was done either before or after infecting mice, and results were compared to nondepleted mice.

The researchers found that depletion of Tregs before infection with B. burgdorferi caused earlier tibiotarsal joint swelling (day 10 after infection) than in non-depleted mice (day 16 after infection). Additionally, the Treg-depleted mice had significantly more joint swelling than control mice, and in fact, had a second wave of swelling that peaked at day 22 after infection.

The contribution of Tregs after B. burgdorferi infection was studied by depleting mice one to three weeks post-infection, and then comparing joint swelling with nondepleted mice. Although these Treg-depleted mice did have increased joint swelling compared to non-depleted animals, the difference in swelling did not achieve statistical significance and was less than in mice depleted before infection.

When the joints were examined for evidence of pathology, all of the mice whose Tregs were depleted prior to infection had lymphocyte infiltration into the joints and surrounding soft tissues, indicating the presence of immune cells homing to a site of inflammation. However, only a single mouse in the nondepleted group had a mild degree of immune cell infiltration on the surface of the joint. For mice whose Tregs were depleted one to three weeks after infection, there were no inflammatory pathological changes observed in the joint tissues.

Together, the mouse studies suggest that joint swelling and pathology were more dependent on the amount of Tregs before, rather than after infection by B. burgdorferi. But Treg function, not just abundance, may also be important. In other words, what do Tregs actually do to reduce arthritis?

Experiments that assess Treg function often focus on their ability to regulate, or suppress the proliferation of other immune cells. Tregs are also studied for their inhibition of inflammatory cytokine production. In one study of a limited number of Lyme patients, T cells, of which Tregs were a subset, were collectively cultured from the synovial fluid of either antibiotic-responsive or antibiotic-refractory arthritis patients. Tregs from the refractory patients were less able to suppress the production of inflammatory cytokines like interferon gamma (IFNγ) and tumor necrosis factor alpha (TNFα) than those from the antibiotic-responsive patients.

These findings suggest that both the lower amount of Tregs, and the loss of their suppressive functions, may be why some patients have antibiotic-refractory arthritis. The study of Treg depletion in mice showed this tendency too. More studies are needed to explain how other cytokines may be involved in promoting an infection environment that ultimately, resolves or continues inflammation.

And, why some people have lower Tregs to begin with is also not yet understood – whether it is genetically determined or occurs in response to infection. But what is obvious is that the interplay between B. burgdorferi and the host immune response is complicated, depending on switches to turn inflammation on and off. More research will help us understand this regulation, and how host protection can possibly turn into harm.

RELATED BLOGS:

Lyme Arthritis: The Antibody Connection
Research POV: Lyme Arthritis and Peptidoglycan
Possible Clue to Lyme Arthritis Found in People’s Inflamed Joints

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25-Year-Old With Transverse Myelitis & Lyme

https://danielcameronmd.com/lyme-podcast-transverse-myelitis-lyme-disease/

LYME PODCAST: A 25-YEAR-OLD MAN WITH TRANSVERSE MYELITIS AND LYME DISEASE

A 25-year-old man with transverse myelitis and Lyme disease

I will be discussing a 25-year-old man with transverse myelitis and Lyme disease. “He showed gradual improvement in gait, motor and sensory functions of his lower extremities along with a resolution of neurogenic bowel.” wrote the authors. The authors added. “He continues to need intermittent self-catheterization for neurogenic bladder.”

 
 
Podcast:  https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5idXp6c3Byb3V0LmNvbS83NzIxNjAucnNz/episode/QnV6enNwcm91dC0zMDE1NDE4?sa=X&ved=0CAUQkfYCahcKEwjgy6vH3KPvAhUAAAAAHQAAAAAQAg

Dumic and colleague first discussed this case in the journal IDCases  in 2019.

“A previously healthy 25-year-old man presented with inability to urinate and frequent falls associated with bilateral lower extremity weakness and numbness.” wrote the authors.

Two weeks earlier, he described a red circumferential rash. His rash was approximately 10 cm in diameter, which is about 4 inch in diameter. The CDC only requires a 5 cm rash to diagnose Lyme disease criteria, which is about 2 inches.

He lived in Wisconsin, USA, with extensive exposure to ticks. He lived next to the woods, hiked, camped, and fished, and has two dogs. He had no recent history of a tick bite.

He also developed a mild, intermittent headache, mild neck stiffness, and thought he had a fever. Flu-like symptoms have commonly been reported in Lyme disease.

Did he get treated for Lyme disease? No.

The rash disappeared within a week without treatment. The erythema migrans rash of Lyme disease often clears without treatment.

His condition took a turn for the worse. “Five days prior to admission, he developed urinary retention as well as progressive numbness and weakness in his lower extremities.” wrote the authors. He was also not able to move his bowels.

His sensory deficit progressed from “left foot numbness to the upper thorax right below the nipple line anteriorly and below the shoulder blades posteriorly.” write the authors.

He began to fall due to the weakness of both legs and problems with his gait.

His physical examination revealed several findings. He had weakness of both legs, mild spasticity in both knees, increased reflexes in his legs, a diminished sensation in his legs, and a Babinski sign of the left foot.

A positive Babinski sign occurs when a doctor stimulates the bottom of the foot. The big toe bends up and back to the top of the foot, and the other toes fan out. This can mean there is some problem with the nervous system.

He had evidence suggestive of myelitis on an MRI “MRI of the cervical and thoracic spine revealed T2 signal hyperintensity in the central spinal cord gray matter at C5, C6 and T3 to T9 levels suggestive of myelitis.” write the authors. They use the term suggestive as a T2 signal hyperintensity can be from other causes. Myelitis refers to inflammation of the spinal cord.

He had strong evidence of an inflammatory process in his spinal fluid as measured by a pleocytosis in his spinal fluid. These are white cells in his spinal fluid. His antibody test for Lyme disease was negative.

His PCR for Lyme disease was positive. They were able to confirm PCR tests were positive for Lyme disease using a molecular detection test at the Mayo Medical Laboratories.

He was diagnosed and treated for acute transverse myelitis.

TRANSVERSE MYELITIS AND LYME DISEASE

The man’s motor, sensory, and autonomic dysfunction were typical of acute transverse myelitis. Autonomic dysfunction is a part of the nervous system that regulates internal organs such as the heart, stomach and intestines. The autonomic nervous system is composed of the Sympathetic and Parasympathetic system. It has also been called the fight-or-flight response. The man was unable to control his bowels and bladder.

OUTCOME

He was treated for Lyme disease with IV ceftriaxone. He also was treated with an intravenous antiviral medicine, Acyclovir, for two days until the spinal tap PCR was positive. Finally, he was treated with the steroid methylprednisolone 1 g IV daily for three days.

“He showed gradual improvement in gait, motor and sensory functions of his lower extremities along with a resolution of neurogenic bowel.” wrote the authors.

The authors added, “he continues to need intermittent self-catheterization for neurogenic bladder.”

This is not the first case of transverse myelitis and Lyme disease patients according to the authors. Their search revealed six other cases of neurologic Lyme disease associated with acute transverse myelitis.

What can we learn from this cases?

  1. Acute transverse myelitis can occur in Lyme disease.
  2. The spinal tap in Lyme disease can present with a high white count, also called pleocytosis, and still have a negative antibody test.
  3. A positive PCR test was able to confirm Lyme disease in this patient.
  4. The man’s acute transverse myelitis and Lyme disease improved with antibiotic treatment.

What questions does these cases raise?

  1. How often does transverse myelitis occur in Lyme disease?
  2. Would the man have been treated for Lyme disease if the PCR test at the Mayo had been negative?
  3. Would the man no longer need intermittent self-catheterization for neurogenic bladder if he were treated with more than a single one-month course of intravenous ceftriaxone?</li
  4. Were there other autonomic issues not described by the authors?</li
TREATING TICK-BORNE DISEASE IN MY PRACTICE

In my practice, each individual requires a careful assessment. That is why I order a broad range of blood tests for other illnesses in addition to tick-borne infections. I also arrange consultations with specialists as needed.

Many patients are complex, as highlighted in this Inside Lyme Podcast series.

We need more doctors with skills recognizing a tick-borne illness in an individual with acute transverse myelitis and Lyme disease. We hope that professionals evaluating individuals with acute transverse myelitis can use this case to remind them to look for tick-borne illnesses and treat accordingly.

Inside Lyme Podcast Series

This Inside Lyme case series will be discussed on my Facebook and made available on podcast and YouTube.  As always, it is your likes, comments, and shares that help spread the word about this series and our work. If you can, please leave a review on iTunes or wherever else you get your podcasts.  Sign up for our newsletter to keep up with our cases.

References:
  1. Dumic I, Vitorovic D, Spritzer S, Sviggum E, Patel J, Ramanan P. Acute transverse myelitis – A rare clinical manifestation of Lyme neuroborreliosis. IDCases. 2019;15:e00479.
  2. Kenney MJ, Ganta CK. Autonomic Nervous System and Immune System Interactions. Compr Physiol. 2014 July ; 4(3): 1177–1200.

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What is a Herxheimer Reaction and What Can I Do About It?

https://holtorfmed.com/articles/lyme-disease/what-is-a-herxheimer-reaction-and-what-can-i-do-about-it

What is a Herxheimer Reaction and What Can I Do About It?

9/21/20

By Holtdorf Medical Group

This natural bodily response is known as the Herxheimer reaction. Being familiar with this occurrence and methods of reducing its intensity can be beneficial for those being treated for chronic conditions, gastrointestinal disease, or toxicity.

An Introduction to The Herxheimer Reaction

The Herxheimer response is a natural bodily process triggered by a greater prevalence of endotoxins. These substances are released when harmful microorganisms and bacteria are destroyed or die off. As damaging bacteria are destroyed, they release previously contained endotoxins into the bloodstream. This allows the toxins to be transported to the appropriate system and subsequently expelled from the body. However, rapid destruction of bacteria can cause an influx of endotoxins resulting in greater toxicity. When this occurs, the immune system responds by triggering an acute immune response resulting in inflammation that may be experienced throughout the body. This can cause worsening of current symptoms and the development of new symptoms.

The Herxheimer reaction is frequently seen during antibiotic treatments because antibiotics destroy numerous microorganisms and bacteria. Although the Herxheimer reaction is typically non-lethal, it does frequently cause temporary pain, discomfort, and worsening of symptoms. Symptom severity is often indicative of the level of inflammation triggered by the immune system.

Common symptoms that develop or worsen due to a Herxheimer response include:

  • Bloating
  • Brain Fog
  • Chills
  • Cold Sweats
  • Constipation
  • Cramps
  • Diarrhea
  • Fatigue
  • Fever
  • Headaches
  • Irritability
  • Joint Pain
  • Lethargy
  • Muscle Pain
  • Nausea
  • Skin Irritation
  • Sore Throat

Typically, symptoms develop within a couple of hours to several days after treatment. However, depending on the location of the bacteria, symptoms may develop later.

Because of the sudden worsening of symptoms, it is common for patients to feel that the severity of their condition has increased due to the treatment. However, even though treatment causes a temporary increase in symptom intensity due to greater release of toxins the condition ultimately improves. The body responding in this way usually means that the treatment is actually working effectively.

A Herxheimer reaction can last for a week or upwards of multiple months. The duration of the reaction is dependent on individual patient factors. Perhaps the greatest determinant of reaction length is what condition is being treated and its status. For example, Lyme disease is more likely to cause longer Herxheimer reactions. Other factors include the body’s ability to transport toxins and other debris, and the patient’s overall health. Therefore, each patient experiences Herxheimer reactions at a different level of severity and varying duration.

As long as the Herxheimer reaction is not too severe, treatment should continue. It is common for patients to be alarmed or concerned about the development of new symptoms and stop treatment. However, if the symptoms are caused by a Herxheimer reaction, it is best to continue treatment as long as symptoms are bearable.

Reducing the Impact of a Herxheimer Reaction

Even though a Herxheimer reaction indicates that treatment is working effectively, it doesn’t make the patient’s condition any more comfortable in the immediate. Fortunately, there are many ways of limiting the symptomatic impact of a Herxheimer reaction without inhibiting treatment efficacy. The following suggestions can and should be used when detoxing, using antibiotics, or being treated for infections and other forms of chronic disease to limit Herxheimer intensity.

Drink Plenty of Liquids

Distilled water, herbal teas, and most other non-sugary fluids, aid in the removal of toxins and cleansing of the gastrointestinal tract. Maintaining a high level of hydration also supports liver and kidney function which further improves detoxification. Keeping these systems working at their best can help the body better eliminate toxins released into the bloodstream thereby reducing Herxheimer symptoms.

Limit Exposure to Toxins

Our modern environment contains many toxins that can promote toxicity thereby contributing to the intensity of Herxheimer symptoms. Avoiding alcohol, smoke, BPAs, pesticides, and processed products can reduce the strain on the immune system and support detoxification.

Sleep More

The body conducts many restorative processes while at rest that it cannot accomplish when it is awake. When experiencing a Herxheimer reaction due to greater toxicity, it is best to allow more time for quality sleep. If you believe that you are suffering from toxin exposure, schedule an additional hour or two of sleep per night. It is likely that the body will benefit greatly from getting between nine to ten hours of sleep while detoxing.

Use a Probiotic

Probiotics are collections of good bacteria that support gastrointestinal function including the colon. By supporting the colon with a high-quality probiotic, it can remain clean and efficient thereby improving the detox process and reducing the intensity of a Herxheimer reaction. Probiotics can also help reverse the destruction of good gut bacteria caused by antibiotics. This can help restore gut health and limit Herxheimer symptoms.

Finishing Out Strong

The Herxheimer reaction is a natural response to the destruction of harmful bacteria and other threatening microorganisms. If the reaction is exceedingly uncomfortable or severe, cessation or reduction of treatment may be warranted. A heightened reaction may result in the shutting down of certain bodily systems. However, if possible, it is best to fight through the symptoms and continue treatment because Herxheimer reactions typically indicate that treatment is working as intended. Utilizing the methods discussed above can help limit the impact of a Herxheimer reaction to better support the treatment process, reduce symptoms, and promote greater wellness.


Resources

How Underlying Conditions Affect Your Immune System

https://holtorfmed.com/articles/immune-health/how-underlying-conditions-affect-your-immune-system

How Underlying Conditions Affect Your Immune System

By Holtdorf Medical Group

12/15/20

The immune system plays the crucial role of protecting the body and defending against pathogens, illness, and disease. As such, a decline in immune function often results in greater occurrence and increased severity of sickness. Unfortunately, chronic health conditions impact 6 out of every 10 American adults and these conditions often impair their underlying immune system and function.

Below are some of the most common chronic conditions and the ways in which they compromise the immune system.

Heart Disease

Heart disease affects 121.5 million adults in the United States. The term heart disease describes a range of conditions such as coronary artery disease, congenital heart defects, and issues that affect the heart’s muscle, valves, and rhythm. All of these conditions have the ability to negatively affect the immune system as the body perceives the cholesterol-containing plaque inside coronary blood vessels as a foreign invader and works to eliminate it, which results in inflammation. If the body continues to attack the coronary blockages, the prolonged state of inflammation strains the immune system as it is forced to continually stay in an active state and fight the plaque rather than potential foreign invaders.

Heart disease can also impact your lung function. Because a compromised heart struggles to effectively pump blood from the lungs to the rest of the body, blood can build up and raise the pressure in the pulmonary veins. This results in fluid being pushed into the lungs, making it harder to breathe. It is important to note this connection between the heart and lungs and the strain that results between the two with heart disease patients, as it makes them more vulnerable to respiratory infection when their lungs are weakened.

Chronic Lung Disease

The lungs are not only weakened by heart disease but also conditions such as severe asthma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, and chronic pneumonia. All of these diseases block airflow to the lungs, making it difficult to breathe and resulting in irritated lung cells and inflammation.

These inflamed lung cells also strain the immune system as they fuel an immune system cycle in which the body sends additional inflammatory immune cells to the lungs in an attempt to fight the chronic conditions. Long-term lung inflammation leads to both extensive lung damage and an impaired immune response to respiratory infections.

Diabetes and High Blood Sugar

With more than 100 million U.S. adults now estimated to have either diabetes or pre-diabetes and 47 million estimated to have metabolic syndrome, it is important to understand how this affects the body’s capacity to fight off illness.

Diabetes is a disease that occurs when the body’s ability to produce or respond to the hormone insulin is impaired resulting in elevated blood sugar levels, a state called hyperglycemia. Chronic hyperglycemia, which can occur in type 1 and type 2 diabetes, can damage the function of white blood cells such as neutrophils and T cells, which help fight off viruses, toxins, and bacteria.

High blood sugar compromises the body’s antioxidant system, which helps fight against free radicals and oxidative stress. Additionally, people with high blood sugar often have reduced blood flow because the sugar creates increased blood viscosity, which makes it more difficult for the blood to reach smaller blood vessels in the eyes, heart, nerves, feet, arms, and kidneys. The reduced internal blood flow makes the body less capable of mobilizing immune cells that are responsible for defending the body against infection.

Immunocompromised Conditions

There are many conditions that can result in someone being immunocompromised, or impaired or unable to fight against pathogens. Cancer, bone marrow or organ transplantation, HIV or AIDS, and prolonged use of certain medications can all lead to someone being immunocompromised.

Regardless of the condition or cause, those who are immunocompromised produce fewer T cells, macrophages, and complement proteins, which are all key parts of the immune system. Therefore, when the immune system lacks these aspects of its defense response, its ability to combat illness is impaired.

Autoimmune Conditions

Unlike those that are immunocompromised and have an underactive immune system, the 24 million Americans with autoimmunity have an overactive immune system. Patients with conditions such as lupus, celiac disease, Hashimoto’s thyroiditis, multiple sclerosis, or rheumatoid arthritis may suffer from their immune system being overactive to the point of attacking its own healthy cells. Therefore, unlike the previously addressed conditions, those with autoimmune conditions do not necessarily have a weakened immune response rather, they are more likely to have complications from illnesses when their body overcompensates and begins to attack itself.

If you do have an underlying condition that puts you at a higher risk of developing a severe illness, the good news is that chronic health issues can be well managed through nutrition, lifestyle, and medications. At Holtorf Medical Group, our expert physicians utilize innovative treatments to strengthen your immune system. Give us a call at 844-844-2981 to learn about our immune-supporting therapies, and see how we can help you!


Resources
  1. Annals of the American Thoracic Society, http://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201503-126AW.
  2. “Autoimmune Diseases.” National Institute of Environmental Health Sciences, U.S. Department of Health and Human Services, http://www.niehs.nih.gov/health/topics/conditions/autoimmune/index.cfm.
  3. Bentley-Lewis, Rhonda, et al. “The Metabolic Syndrome in Women.” Nature Clinical Practice. Endocrinology & Metabolism, U.S. National Library of Medicine, Oct. 2007, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4428566/.
  4. “Cardiovascular Diseases Affect Nearly Half of American Adults, Statistics Show.” http://Www.heart.org, http://www.heart.org/en/news/2019/01/31/cardiovascular-diseases-affect-nearly-half-of-american-adults-statistics-show.
  5. “Chronic Diseases in America.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 24 Sept. 2020, http://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm
  6. Forfia, Paul R, et al. “Pulmonary Heart Disease: The Heart-Lung Interaction and Its Impact on Patient Phenotypes.” Pulmonary Circulation, Medknow Publications & Media Pvt Ltd, Jan. 2013, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3641739/.
  7. Kingwell, Bronwyn A., et al. “Type 2 Diabetic Individuals Have Impaired Leg Blood Flow Responses to Exercise.” Diabetes Care, American Diabetes Association, 1 Mar. 2003, care.diabetesjournals.org/content/26/3/899.
  8. “Metabolic Syndrome.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 14 Mar. 2019, http://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916.
  9. “New CDC Report: More than 100 Million Americans Have Diabetes or Prediabetes.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 18 July 2017, http://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html.
  10. “What Are Congenital Heart Defects?” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 17 Nov. 2020, http://www.cdc.gov/ncbddd/heartdefects/facts.html.
  11. Zhou, Tong, et al. “Role of Adaptive and Innate Immunity in Type 2 Diabetes Mellitus.” Journal of Diabetes Research, Hindawi, 8 Nov. 2018, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6250017/.

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