Archive for the ‘Treatment’ Category

IV Ozone – What it is and What Are the Benefits

IV OZONE – What it is and What Are the Benefits

By Holtdorf Medical Group



Ozone Therapy is a unique and integrative treatment that is used to increase the amount of oxygen in the body through the introduction of ozone. Ozone Therapy can provide many powerful and healing benefits with little or no side effects. Ozone suppresses infections by killing viruses, bacteria, and yeast, especially those hard-to-treat, resistant pathogens that can be found in chronic conditions, such as Lyme disease. Ozone therapy is also helpful in preventative healthcare. In preventative care, ozone may help strengthen the body’s natural defenses. Lastly, it improves circulation by enhancing the flow of blood.

Below are some of the benefits that can be obtained through Ozone therapy treatment:

  • Effective treatment of resistant pathogens found in chronic conditions
  • Improvement of circulation by enhancing blood flow
  • Stimulation of mitochondria to give your cells’ “powerhouse” energy
  • Improvement of immune function as Ozone IV therapy is a potent immune booster
  • Increasing antioxidant protection and capabilities by stimulating enzyme system
  • Decreasing the immune “overtime” response in autoimmune disease
  • Detoxification by neutralizing toxins processed in liver and kidneys

Who Can Benefit?

IV Ozone therapy is a very effective treatment modality yet should not be thought of as a magic bullet. The treatment can be an indispensable addition to any protocol’s success and is most effective when it is used as part of an integrative treatment plan. The number of treatments needed for therapeutic results are unique to each individual and should be discussed with your practitioner. Individuals experiencing success using Ozone IV therapy treatments:

  • Chronic Fatigue Syndrome
  • Fibromyalgia
  • Cardiovascular disease
  • Diabetes
  • Chronic hepatitis
  • Herpes
  • Chemical sensitivities
  • Macular Degeneration
  • Chronic bladder conditions Colitis
  • Crohn’s disease

Ozone therapy has been studied and used in treating patients for centuries. It is extremely safe when performed properly and under the proper care. Talk with your doctor regarding this treatment to see if it is a good fit for you.

Holtorf Medical GroupThe Holtorf Medical Group specializes in optimizing quality of life and being medical detectives to uncover the underlying cause of symptoms, rather than just prescribing medications to cover-up the symptoms. We are experts in natural, prescription bioidentical hormone replacement and optimization, complex endocrine dysfunction, fibromyalgia, chronic fatigue syndrome and Lyme disease. We’ve dedicated our practice to providing you the best in evidenced-based, integrative medicine that’s not only safe and effective, but provides measurable results.



Ozone is a powerful oxidant and something you should learn about and consider, either as a primary treatment or an adjunctive therapy.  

That said, in my experience it has NOT proven to be curative for Lyme/MSIDS.  While people have improved, they need “tune-ups” or further treatments.

Both my husband and I used blood IV ozone for 2.5 months done weekly under UV light.  I must say neither of us noticed anything.  We were probably at our sickest and desperate to get help.  That’s not to say it wouldn’t make a noticeable difference in someone else OR that it did something positive in us we didn’t feel.

Like any other treatment, one must consider cost – both in time and in money.  Blood ozone requires you to use a practitioner which means travel to and fro and time for treatment.  It is also recommended to be done weekly or even biweekly.  Costs vary, but are approximately $150-$200 per treatment.  Another variable is the machine being used as well as the dosage (type of ozone and amount).  Ozonating a single pint of blood is called “Single pass” vs 10 pints of blood being called “10-pass” or even the “dialysis” type of ozone which makes a complete circuit and allowing blood to ozonated for an hour (strongest form).  We used the single-pass.  After talking with others, I believe the “dialysis” type to be the most effective for Lyme/MSIDS, but obviously costs more ($900-$1,000 per treatment) and takes longer.

One patient’s experience:  This patient also received Prolo-ozone – an injection with ozone & dextrose– typically for pain.  My husband has had this in numerous joints with success.  Not only does it help pain, but it puts the ozone in hard to reach areas where antibiotics have difficulty getting into.  Please also see:

For more on 10-pass:  Patient stories of ozone on all kinds of conditions.

Ozone research:

Landmark Publication on Vitamin C for COVID-19

Landmark Publication on Vitamin C for COVID-19

Analysis by Dr. Joseph MercolaFact Checked


  • While health authorities and mainstream media have ignored, if not outright opposed, the use of vitamin C and other supplements in the treatment of COVID-19, citing lack of clinical evidence, a landmark review recommends the use of vitamin C as an adjunctive therapy for respiratory infections, sepsis and COVID-19
  • According to the authors, “Vitamin C’s antioxidant, anti-inflammatory and immunomodulating effects make it a potential therapeutic candidate, both for the prevention and amelioration of COVID-19 infection, and as an adjunctive therapy in the critical care of COVID-19”
  • Oral vitamin C at doses of 2 to 8 grams a day have been shown to reduce the incidence and duration of respiratory infections
  • Intravenous vitamin C at 6 to 24 grams a day has been shown to reduce mortality, ICU admission rates, hospital stays and time on mechanical ventilation in patients with severe respiratory infections
  • An international vitamin C campaign has been launched in response to the landmark review

Regardless of what the mainstream media want you to think, many are starting to realize the truth, which is that both vitamin C (ascorbic acid) and vitamin D have an enormous amount of research showing they provide important immune function enhancements, and that your immune function is your frontline defense against all illness, including COVID-19.

As reported in the paper “Optimal Nutritional Status for a Well-Functioning Immune System Is an Important Factor to Protect Against Viral Infections,” published April 23, 2020:1

“The role nutrition plays in supporting the immune system is well-established. A wealth of mechanistic and clinical data show that vitamins, including vitamins A, B6, B12, C, D, E, and folate; trace elements, including zinc, iron, selenium, magnesium, and copper; and the omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid play important and complementary roles in supporting the immune system.

Inadequate intake and status of these nutrients are widespread, leading to a decrease in resistance to infections and as a consequence an increase in disease burden.”

High-Dose Vitamin C Acts as an Antiviral Drug

As explained in the video above by Dr. Andrew Saul, editor-in-chief of the Orthomolecular Medicine News Service, at extremely high doses, vitamin C actually acts as an antiviral drug, effectively inactivating viruses.

His Tokyo presentation, “Orthomolecular Medicine and Coronavirus Disease: Historical Basis for Nutritional Treatment,” highlights the fact that when used as a treatment, high doses of vitamin C — often 1,000 times more than the U.S. Recommended Dietary Allowance (RDA) — are needed.

It’s a cornerstone of medical science that dose affects treatment outcome, but this premise isn’t accepted when it comes to vitamin therapy the way it is with drug therapy. Most vitamin C research has used inadequate, low doses, which don’t lead to clinical results.

“The medical literature has ignored over 80 years of laboratory and clinical studies on high-dose ascorbate therapy,” Saul notes, adding that while it’s widely accepted that vitamin C is beneficial in fighting illness, controversy exists over to what extent. “Moderate quantities provide effective prevention,” he says, while “large quantities are therapeutic.”

Landmark Paper Puts Vitamin C on the COVID-19 Treatment Map

While health authorities and mainstream media have ignored, if not outright opposed, the use of vitamin C and other supplements in the treatment of COVID-19, citing lack of clinical evidence, we now have a landmark review2 recommending the use of vitamin C as an adjunctive therapy for respiratory infections, sepsis and COVID-19.

The review,3 published December 7, 2020, in the journal Nutrients, was co-written by Dr. Paul Marik who, in 2017, developed a groundbreaking vitamin C-based treatment for sepsis. Marik is now heading up the Front Line COVID-19 Critical Care Alliance,4 which has developed a highly successful treatment for COVID-19.

The COVID-19 protocol was initially dubbed MATH+ (an acronym based on the key components of the treatment), but after several tweaks and updates, the prophylaxis and early outpatient treatment protocol is now known as I-MASK+5 while the hospital treatment has been renamed I-MATH+,6 due to the addition of the drug Ivermectin. Vitamin C remains a central component of this treatment, though.

(The two protocols7,8 are available for download on the FLCCC Alliance website in multiple languages. The clinical and scientific rationale for the I-MATH+ hospital protocol has also been peer-reviewed and was published in the Journal of Intensive Care Medicine9 in mid-December 2020.) As explained in the Nutrients review abstract:10

“There are limited proven therapies for COVID-19. Vitamin C’s antioxidant, anti-inflammatory and immunomodulating effects make it a potential therapeutic candidate, both for the prevention and amelioration of COVID-19 infection, and as an adjunctive therapy in the critical care of COVID-19.

This literature review focuses on vitamin C deficiency in respiratory infections, including COVID-19, and the mechanisms of action in infectious disease, including support of the stress response, its role in preventing and treating colds and pneumonia, and its role in treating sepsis and COVID-19.

The evidence to date indicates that oral vitamin C (2-8 g/day) may reduce the incidence and duration of respiratory infections and intravenous vitamin C (6-24 g/day) has been shown to reduce mortality, intensive care unit (ICU) and hospital stays, and time on mechanical ventilation for severe respiratory infections …

Given the favorable safety profile and low cost of vitamin C, and the frequency of vitamin C deficiency in respiratory infections, it may be worthwhile testing patients’ vitamin C status and treating them accordingly with intravenous administration within ICUs and oral administration in hospitalized persons with COVID-19.”

International Vitamin C Campaign Launched

In a December 16, 2020, action alert,11 Rob Verkerk, Ph.D., founder and scientific director of the Alliance for Natural Health, announced the launch of an international vitamin C campaign12 in response to the landmark review, which “puts all the arguments and science in one, neat place.”

As noted by Verkerk, there are several reasons to take supplemental vitamin C. First, your body cannot make it. Second, most people do not get sufficient amounts from their diet and, third, your body’s requirement for vitamin C can increase 10-fold whenever your immune system is challenged by an infection, disease or physical trauma.

In fact, the Nutrients review13 points out that it’s common for hospitalized patients to have overt vitamin C deficiency, defined as a blood level at or below 11 µmol/L. This is particularly true for older patients and those hospitalized for respiratory infections.

According to the authors, “Vitamin C concentrations are three to 10 times higher in the adrenal glands than in any other organ. It is released from the adrenal cortex under conditions of physiological stress (ACTH stimulation), including viral exposure, raising plasma levels fivefold.” In his action alert, Verkerk notes:14

Taking vitamin C as a preventative and then, upping your intake if you’re infected, is a no brainer.So is using vitamin C intravenously for those with acute respiratory infections, or sepsis, in critical care.

So much so, that we argue — given the now available evidence — that doctors and other health professionals who avoid recommendations on vitamin C in relation to COVID disease prevention and treatment, should be considered medically negligent

There is ample evidence to show that supplements like zinc, vitamin C, and vitamin D can help prevent and treat COVID-19, but we’re prevented from learning about these benefits by the federal government.

Because supplements are not, and can never become, FDA-approved, they cannot claim to have an impact on disease, even when we know they can. This nonsense has to stop.”

How Vitamin C Works

As mentioned, the Nutrients review15 details vitamin C’s mechanisms of action and how it helps in cases of infectious disease, including the common cold, pneumonia, sepsis and COVID-19. For starters, vitamin C has the following basic properties:

  • Anti-inflammatory
  • Immunomodulatory
  • Antioxidant
  • Antithrombotic
  • Antiviral

Beneficial antiviral effects apply to both the innate and adaptive immune systems. When you have an infection, vitamin C improves your immune function in part by promoting the development and maturation of T-lymphocytes, a type of white blood cell that is an essential part of your immune system.

Phagocytes, immune cells that kill pathogenic microbes, are also able to take in oxidized vitamin C and regenerate it to ascorbic acid. With regard to COVID-19 specifically, vitamin C:16

Helps downregulate inflammatory cytokines, thereby reducing the risk of a cytokine storm. It also reduces inflammation through the activation of NF-κB and by increasing superoxide dismutase, catalase and glutathione. Epigenetically, vitamin C regulates genes involved in the upregulation of antioxidant proteins and downregulation of proinflammatory cytokines
Protects your endothelium from oxidant injury
Helps repair damaged tissues
Upregulates expression of Type-1 interferons, your primary antiviral defense mechanism, which SARS-CoV-2 downregulates
Eliminates ACE2 upregulation induced by IL-7. This is particularly noteworthy, as the ACE2 receptor is the entry point for SARS-CoV-2 (the virus’ spike protein binds to ACE2)
Appears to be a powerful inhibitor of Mpro, a key protease (enzyme) in SARS-CoV-2 that activates viral nonstructural proteins
Regulates neutrophil extracellular trap formation (NETosis), a maladaptive response that results in tissue damage and organ failure
Enhances lung epithelial barrier function in an animal model of sepsis by promoting epigenetic and transcriptional expression of protein-channels at the alveolar capillary membrane that regulate alveolar fluid clearance
Mediates the adrenocortical stress response, particularly in sepsis

The graph below, from the Nutrients review, illustrates the key ways in which vitamin C ameliorates the pathology seen in COVID-19.

vitamin C ameliorates the pathology seen in COVID-19

Nebulized Peroxide May Be Even Better

The beautiful graphic above makes it really clear that one of the primary ways that vitamin C works is through the generation of reactive oxygen species. Guess what the primary one is? If you guessed hydrogen peroxide give yourself a high five!

It is highly likely that the peroxide forms a very powerful signaling function that stimulates the immune system to defeat whatever viral threat it is exposed to. This is one of the reasons why nebulized peroxide is my absolute favorite intervention for acute viral illnesses. It is highly effective, inexpensive and has no side effects when used at the very low doses recommended (0.1%, which is 30 times less concentrated than regular drugstore 3% peroxide).

My video below discusses the details of how you can use this therapy. The key is to have your nebulizer already purchased and ready to go so that it is locked and loaded and you don’t have to go out and purchase anything if you or a loved one gets sick. You can still use vitamin C with the peroxide, as they likely have a powerful synergy and use different complimentary mechanisms.

Since you are not using full strength 3% peroxide and diluting it by 30 to 50 times, it is unlikely the stabilizers will present a problem, but to be safe, it is best to use FOOD-GRADE peroxide. Also, do not dilute it with plain water as the lack of electrolytes in the water can damage your lungs if you nebulize it. Instead, use saline or add a small amount of salt to the water to eliminate this risk.

peroxide dilution charts

Clinical Evidence

The Nutrients review17 also includes clinical evidence for the role of vitamin C in COVID-19, noting that early oral supplementation might help prevent a mild case from developing into something more serious. In patients with critical symptoms, intravenous administration of vitamin C has been shown to speed up recovery, reducing both ICU stays and mortality.

Interestingly, vitamin C deficiency and COVID-19 share many of the same risk factors, including male gender, darker skin, older age and comorbidities such as diabetes, high blood pressure and COPD. All of these subgroups are at increased risk for severe COVID-19 and, according to the authors, all “have also been shown to have lower serum vitamin C levels.”

Commenting on the clinical evidence supporting the use of vitamin C in the treatment of COVID-19, the authors write:18

“There are currently 45 trials registered on investigating vitamin C with or without other treatments for COVID-19. In the first RCT to test the value of vitamin C in critically ill COVID-19 patients, 54 ventilated patients in Wuhan, China, were treated with a placebo (sterile water) or intravenous vitamin C at a dose of 24 g/day for 7 days …

The more severely ill patients with SOFA [sequential organ failure assessment] scores ≥ 3 in the vitamin C group exhibited a reduction in 28-day mortality: 18% versus 50% in univariate survival analysis (Figure 2). No study-related adverse events were reported.”

Figure 2 below, from version 1 of the study,19 “High-Dose Vitamin C Infusion for the Treatment of Critically Ill COVID-19,” posted on the preprint server Research Square August 10, 2020 (updated September 23, at which point it was renamed20), shows the 28-day mortality rates between critically ill COVID-19 patients given high-dose IV vitamin C (HDIVC) compared to those given a placebo.

28 day mortality rates

The Nutrient review also summarizes findings from other COVID-19 trials using vitamin C, as well as a few case reports:21

“In the UK, the Chelsea and Westminster hospital ICU, where adult ICU patients were administered 1 g of intravenous vitamin C every 12 h together with anticoagulants, has reported 29% mortality, compared to the average 41% reported by the Intensive Care National Audit and Research Centre (ICNARC) for all UK ICUs …

The Frontline COVID-19 Critical Care Expert Group (FLCCC), a group of emergency medicine experts, have reported that, with the combined use of 6 g/day intravenous vitamin C (1.5 g every 6 h), plus steroids and anticoagulants, mortality was 5% in two ICUs in the US (United Memorial Hospital in Houston, Texas, and Norfolk General Hospital in Norfolk, Virginia), the lowest mortality rates in their respective counties.

A case report of 17 COVID-19 patients who were given 1 g of intravenous vitamin C every 8 h for 3 days reported a mortality rate of 12% with 18% rates of intubation and mechanical ventilation and a significant decrease in inflammatory markers, including ferritin and D-dimer, and a trend towards decreasing FiO2 requirements.

Another case of unexpected recovery following high-dose intravenous vitamin C has also been reported. While these case reports are subject to confounding and are not prima facie evidence of effects, they do illustrate the feasibility of using vitamin C for COVID-19 with no adverse effects reported.”

How Much Vitamin C Do You Need?

As detailed in the introduction of the Nutrients review,22 primates and humans are dependent on an adequate supply of vitamin C from fruits and vegetables. Gorillas need 4.5 grams a day, while smaller primates weighing around 7.5 kilos need about 600 mg per day. This gives us a clue as to what the human requirement might be, and it’s quite a bit higher than the daily recommended intake. According to the authors:23

“The EU Average Requirement of 90 mg/day for men and 80 mg/day for women is to maintain a normal plasma level of 50 µmol/L, which is the mean plasma level in UK adults. This is sufficient to prevent scurvy but may be inadequate when a person is under viral exposure and physiological stress.

An expert panel in cooperation with the Swiss Society of Nutrition recommended that everyone supplement with 200 mg ‘to fill the nutrient gap for the general population and especially for the adults age 65 and older. This supplement is targeted to strengthen the immune system.’ The Linus Pauling Institute recommends 400 mg for older adults (>50 years old).

Pharmacokinetic studies in healthy volunteers support a 200-mg daily dose to produce a plasma level of circa 70 to 90 µmol/L. Complete plasma saturation occurs between 1 g daily and 3 g every four hours, being the highest tolerated oral dose, giving a predicted peak plasma concentration of circa 220 µmol/L.

The same dose given intravenously raises plasma vitamin C levels approximately tenfold. Higher intakes of vitamin C are likely to be needed during viral infections with 2–3 g/day required to maintain normal plasma levels between 60 and 80 µmol/L. Whether higher plasma levels have additional benefit is yet to be determined, but would be consistent with the results of the clinical trials discussed in this review.”

While high-dose vitamin C regimens typically call for intravenous administration, if treating a viral infection at home (be it COVID-19 or something else), you could use oral liposomal vitamin C, as this allows you to take far higher doses without causing loose stools.

You can take up to 100 grams of liposomal vitamin C without problems and get really high blood levels, equivalent to or higher than intravenous vitamin C. I view that as an acute treatment, however. I discourage people from taking mega doses of vitamin C on a regular basis if they’re not actually sick, because it is essentially a drug — or at least it works like one.

Saul, who has worked with and recommended vitamin C for most of his professional life suggests taking “enough vitamin C to be symptom-free,” whatever dosage that might be. When you’re well, you typically don’t need more than the 200 mg to 400 mg recommended in the quote above.

+ Sources and References



This science won’t matter to our public health ‘authorities’ any more than the Danish Mask study showing masks don’t work.  Both defy their narrative so they are shouted down or flatly ignored.  So much for “following the science.”  The Lyme/MSIDS world has lived in this “twilight zone” for over 40 years.

Other COVID treatments showing success:  

Alpha-gal Syndrome – Symptoms, Diagnosis, & Treatment

There is growing evidence that certain types of tick bites can trigger alpha-gal syndrome (AGS) a life-threatening allergy to red meat and meat-related products.

In some individuals, it appears tick bites can result in the sensitization to a carbohydrate known as galactose-alpha-1,3-galactose, or “alpha-gal” for short. This sugar molecule is found in most mammals you might be likely to eat, but not in fish or fowl.

Most recognized food allergies, such as to peanuts or shellfish, will prompt an immediate reaction after being consumed. That’s not the case with AGS, however, which can take up to eight hours (or even more) after exposure to produce a reaction.

Note: exposure to alpha-gal via inhalation, injected drugs or vaccines can cause an immediate reaction.

Alpha-gal syndrome - meats that contain alpha-gal

Examples of commonly consumed mammalian meats that contain alpha-gal include beef, pork, lamb, goat, venison and buffalo. Common foods that are derived from mammals include lard, milk, cream, ice cream, and cheese—although the majority of AGS patients do tolerate dairy products.

Personal products that use ingredients containing “hydrolyzed protein” (gelatin), lanolin, glycerin, collagen, or tallow are particularly problematic.

Additional products that can bring on an alpha-gal reaction are jello, gelatin capsules, certain medications, pig or cow heart valves, surgical mesh, certain vaccines and unlabeled “natural flavorings” in foods.

Some people with AGS also react to carrageenan, a common food additive made from red algae, which also contains alpha-gal. (So even being strictly vegan won’t necessarily protect you from AGS reactions.)

How are ticks involved in alpha-gal syndrome?

Alpha-gal meat allergy has been reported all over the world including Asia, Australia, Central America, Europe, Germany, Japan, South Korea, and the United States.

The tick species most often associated with Alpha-gal syndrome is the lone star tick

In the U.S., the tick species most often associated with AGS is the lone star tick (Amblyomma americanum) found throughout the South, East and parts of the Midwest. Recent research suggests that the blacklegged tick (Ixodes scapularis and Ixodes pacificus) may also be implicated in alpha-gal syndrome.

The Asian longhorned tick (Haemaphysalis longicornis), the primary trigger of AGS in Asia, has shown up in the US recently, but has yet to be implicated in AGS here. The Cayenne tick (Amblyomma cajennese) found in southern Texas and Florida has also been linked to AGS in Central America, but not yet in the U.S.

While no known pathogen has been linked to triggering AGS, more research is needed to understand the mechanism and the role that ticks play. Currently the thought is that the tick saliva plays a role in activating the allergy to alpha-gal.

Who’s at risk for AGS?

Alpha-gal syndrome is a much more common allergy in the U.S. today than it was a decade ago, with the number of laboratory-confirmed cases growing from 12 in 2009 to over 34,000 in 2019. Unfortunately, AGS has no insurance billing code (ICD code), nor is it a reportable illness to the CDC.

Experts agree alpha-gal syndrome is under-reported in geographic areas where tick bites are common.

Alpha-gal syndrome Lone Star Tick in the United States

Surveillance for IgE to alpha-gal. Percent positive rates are presented for IgE to alpha-gal within each of six regions in the United States, 2012-2013 (7300 samples). Diagonal white lines on the map represent the known geographic distribution of the lone star tick (Data and map, Viracor-IBT Laboratories; Tick Distribution, CDC).

For now, the biggest risk factor for AGS appears to be repeated bites by ticks that contain alpha-gal in their saliva and salivary glands. It is not understood why, but not everyone who is bitten by a tick containing alpha-gal will develop AGS.

While both children and adults can acquire AGS, most cases have been reported in adults.

Certainly, if a patient with recent tick exposure presents with sudden onset anaphylaxis and recurrent gastrointestinal symptoms, AGS should be considered.

Alpha-gal syndrome is a much more common allergy in the U.S. today than it was a decade ago, with the number of laboratory-confirmed cases growing from 12 in 2009 to over 34,000 in 2019.

What are the symptoms of alpha-gal syndrome?

The symptoms of alpha-gal syndrome are often delayed, making it much harder to pinpoint the trigger. Someone may wake up at 3 o’clock in the morning in the throes of serious allergic reaction, and have no idea it was brought on by a hamburger they ate the night before.

Symptoms can range from itching and stomach upset to breathing difficulty and full anaphylaxis. AGS reactions often start with itching of the palms of hands and soles of feet.

Common symptoms of AGS include:

  • 90% have skin symptoms: itching “pruritus,” flushing “erythema,” hives “urticaria” (swollen, pale red bumps or “wheals” on the skin), angioedema (swelling in deep layers below the skin)
  • 60% develop anaphylaxis (a potentially deadly reaction that can restrict breathing)
  • 60% have gastrointestinal symptoms (abdominal pain, diarrhea, acid reflux, cramping, vomiting)
  • 30-40% experience cardiac symptoms: rapid decrease in blood pressure (hypotension, POTS); palpitations (atypical chest symptoms)
  • 30-40% experience respiratory symptoms (wheezing, coughing, shortness of breath)
  • 20% of patients will have GI symptoms alone (may present like irritable bowel syndrome)
  • 3-5% develop mast cell activation syndrome
  • arthritis (rare)
  • mouth swelling, sores (rare)

How is AGS diagnosed?

If you experience symptoms after eating mammalian meat products, immediately notify your primary care physician or allergist. Unlike most tick-borne pathogens, the onset of AGS usually takes at least 4-6 weeks from the time of the tick bite. Complicating things further, about a third of patients do not recall a tick bite.

Your doctor should be able to determine if you have AGS based upon your clinical symptoms and a positive blood test: immunoglobulin E (IgE) to the oligosaccharide glactose-alpha-1,3 galactose (alpha-gal.)

In the U.S., Viracor is the main laboratory for AGS testing. The Viracor “specific IgE galactose-alpha-1,3-galactose” test can be taken at most commercial laboratories like Labcorp and Quest and shipped to Viracor.

Warning: The test for alpha-gal is often mistaken for “alpha-galactosidase” or “a-galactosidase A deficiency”—note these are the wrong tests! Because the test is so new, it is recommended to take the proper testing codes with you to the doctor and the laboratory. Click here to download and print a PDF on the proper testing codes for alpha-gal syndrome.

How is Alpha-gal syndrome treated?

There are currently no U.S. FDA-approved medications for the treatment of AGS. As with most allergies, the mainstay of management is avoidance of the allergen. Therefore, the best practice is to avoid exposure to:

  1. Mammalian meats
  2. Personal products containing mammalian derivatives
  3. Medical products containing mammalian proteins, derivatives or parts
  4. Medications containing mammalian proteins or derivatives

Knowing you must avoid mammalian products is only half the battle, as these products have worked their way into nearly every level of our modern life.

For instance, gelatin is the main ingredient of jellybeans, candy corn, marshmallows, puddings and the capsules of many medications. Chicken and turkey sausages may be stuffed in pork casings, lard (rendered pork fat) is found in many pre-made gravies, sauces, soups, candies, chips, fries, and more.

As with all serious allergies, it is important to have the proper diagnosis and be prepared with how to respond in the event of an emergency. Most allergists will recommend wearing a medical alert bracelet and carrying an EpiPen and an antihistamine with you at all times.

Avoiding alpha-gal hidden components

Mammalian proteins and parts can be found in many medications and medical products. . Because the source of many ingredients is not listed on product labels, your pharmacist may need to contact the manufacturer. Have your pharmacist ask specifically if it contains galactose-alpha-1,3-galactose, alpha-gal, mammalian meat, or any animal by-products.

Common sources of alpha-gal include:

  1. heart valve replacement derived from pig or cow,
  2. monoclonal antibodies (cetuximab)
  3. vaccines (zostavax, MMR and some flu),
  4. pancreatic enzyme replacement therapy,
  5. thyroid hormone replacement,
  6. fillers in medications (magnesium stearate, stearic acid, lactic acid, glycerin, gelatin, lactose)
  7. antivenom,
  8. protein powders,
  9. vaginal capsules
  10. heparin

Alpha-gal & co-infections

Ticks that carry alpha-gal are known to carry many other pathogens that can be simultaneously transmitted to humans. It is possible to acquire any of these other tick transmitted diseases and also have alpha-gal syndrome. It is also possible to have AGS alone.

Ticks that carry alpha-gal are known to carry many other pathogens

The lone star tick, the primary source of AGS in the U.S., is known to transmit the following diseases:

  • human monocytotropic ehrlichiosis (HME)
  • ehrlichiosis (Ehrlichia chaffeensis, Ehrlichia ewingii, and Panola Mountain ehrlichia)
  • Rocky Mountain spotted fever (RMSF)
  • tularemia (Francisella tularensis)
  • Heartland virus
  • Bourbon virus
  • Q fever
  • tick paralysis
  • STARI, an illness similar to Lyme disease, caused Borrelia lonestari
With alpha-gal recently discovered in blacklegged ticks, we may also begin to see an increase in AGS in patients with Lyme disease, anaplasmosis, babesiosis, ehrlichiosis, relapsing fever borreliosis, Powassan virus disease, and other diseases transmitted by these ticks.

How to prevent alpha-gal syndrome

For now, the best way to avoid getting AGS is to avoid tick bites. This means wearing tick repellent when working, hiking or playing in grassy or wooded areas where ticks are found. Protecting your pets and doing thorough tick checks after being outdoors is helpful.

If you are bitten by a tick, we suggest following these eight steps.

What to do if you have alpha-gal syndrome?

Learning you have an allergy to all mammalian products can be overwhelming. Because this is such a newly discovered condition there are few resources available.

When it comes to making medical decisions, it’s important to have a knowledgeable provider who understands the risks versus benefits of certain medications and procedures. Vaccines that contain gelatin are one of the riskier products, but if you need a rabies shot, for instance, your doctor may determine the benefits outweigh the risks and take the necessary steps to mitigate the adverse effects.

To learn more about the history, symptoms and how to diagnose alpha-gal syndrome listen to this interview with Dr. Scott Commins, of the University of North Carolina.

Additional help can be found at:


  1. CDC | Alpha-gal allergy
  2. HHS | Alpha-Gal Syndrome Subcommittee Report to the Tick-Borne Disease Working Group
  3. Commins SP, Satinover SM, Hosen J, Mozena J, Borish L, Lewis BD, Woodfolk JA, Platts-Mills TA. (2009) Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-alpha-1,3-galactose. J. Allergy and Clin Immunol 123(2):426-33. doi: 10.1016/j.jaci.2008.10.052.
  4. Commins, S. P., James, H. R., Kelly, L. A., Pochan, S. L., Workman, L. J., Perzanowski, M. S., Kocan, K. M., Fahy, J. V., Nganga, L. W., Ronmark, E., Cooper, P. J., & Platts-Mills, T. A. (2011). The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-α-1,3-galactose. J. Allergy and Clin Immunol, 127(5), 1286–93.e6. DOI:
  5. Commins SP (2020) Diagnosis & management of alpha-gal syndrome: lessons from 2,500 patients, Expert Review of Clinical Immunology, 16:7, 667-677, DOI: 10.1080/1744666X.2020.1782745
  6. Fiocchi A, Restani P, Riva E, Qualizza R, Bruni P, Restelli AR, Galli CL. (1995)  Meat allergy: I–Specific IgE to BSA and OSA in atopic, beef sensitive children. J Am Coll Nutr. 14(3):239-44. doi: 10.1080/07315724.1995.10718502. PMID: 8586772.
  7. Hamsten C, Tran TAT, Starkhammar M, Brauner A, Commins SP, Platts-Mills TAE, van Hage M. (2013) Red meat allergy in Sweden: association with tick sensitization and B-negative blood groups. J. Allergy and Clin Immunol. 132(6):1431-1434. doi: 10.1016/j.jaci.2013.07.050. Epub 2013 Oct 4. PMID: 24094548; PMCID: PMC4036066.
  8. Kuehn BM. (2018) Tick Bite Linked to Red Meat Allergy. JAMA. 23;319(4):332. doi: 10.1001/jama.2017.20802. PMID: 29362779.
  9. Mullins RJ, James H, Platts-Mills TA, Commins S.(2012) Relationship between red meat allergy and sensitization to gelatin and galactose-α-1,3-galactose. J. Allergy and Clin Immunol. 129(5):1334-1342.e1. doi: 10.1016/j.jaci.2012.02.038. Epub 2012 Apr 3. PMID: 22480538; PMCID: PMC3340561.
  10. Platts-Mills, TAE, Schuyler, AJ,Commins,SP, et. al ( 2018) Characterizing the Geographic Distribution of the Alpha-gal Syndrome: Relevance to Lone Star Ticks (Amblyomma americanum) and Rickettsia. J. Allergy and Clinical Immun 141;2. DOI:
  11. Wilson JM, Schuyler AJ, Workman L, Gupta M, James HR, Posthumus J, McGowan EC, Commins SP, Platts-Mills TAE.  (2019) Investigation into the α-Gal Syndrome: Characteristics of 261 Children and Adults Reporting Red Meat Allergy. J. Allergy and Clin Immunol Pract. 7(7):2348-2358.e4. doi: 10.1016/j.jaip.2019.03.031.

How to Overcome a Lyme Treatment Plateau: 4 Steps to Jumpstart Your Recovery

How to Overcome a Lyme Treatment Plateau: 4 Steps to Jumpstart Your Recovery

How to Overcome a Lyme Treatment Plateau: 4 Steps to Jumpstart Your Recovery

by Jenny Lelwica Buttaccio
Posted 1/5/2021

Regardless of whether you’ve been treating chronic Lyme disease for a few months or several years, you’ve probably gone through tough times where you feel like nothing has moved the needle on your symptoms. It can raise all sorts of questions, the big one being, is any of this really helping me, or is it time to give up and move on? Lack of tangible progress is frustrating, but it doesn’t mean all hope for improvement is lost.

Treatment plateaus happen to everyone, and they may look a little bit different from person to person. One person may struggle with pain; for another, it may be lingering neurological symptoms. Whatever the symptoms are that leave you feeling stuck, the question at the forefront of your mind becomes, “Is there any way to move past this?”

By understanding some of the factors that contribute to plateaus, there’s a good chance you can get to the bottom of it, decide on a course of action, and start making progress again. Let’s take a look at four key ways to overcome a frustrating treatment plateau.

#1 Reassess the Five System Disruptors.

Revisiting your current protocol can clue you into areas that might be hindering progress. But if you’ve been treating for months or years, how do you even know where to begin?

First, take a look at the five system disruptors, says Bill Rawls, MD, Medical Director of RawlsMD and Vital Plan. “When you’ve lost momentum, that’s the time to systemically go through the five biggest variables that wreak havoc on the immune system and could affect recovery.”

The chief offenders most likely to impact progress include:

system disruptor-chronic stress

1. Chronic Stress

Constant stress is a biggie when it comes to roadblocks that hinder progress. Unmitigated stress takes its toll on the immune system’s ability to ward off infections. Although you can’t outrun stress, if you’ve recently been experiencing an uptick of it, that’s an area where you can begin to take steps to address it. Activities like vagus nerve stimulation, acupuncture, and deep breathing exercises can help bring on the calm, recalibrate an overworked nervous system, and get some balance back in your life.

system disruptor-poor diet

2. Poor Diet and Food Sensitivities

If you notice gastrointestinal (GI) symptoms like bloating, gas, or inflammation, your diet is the first place to look. The typical modern American diet is full of processed foods, refined carbohydrates, and artificial ingredients that our gastrointestinal systems aren’t built to process, which can cause all sorts of digestive distress. Not to mention, this way of eating is often deficient in the vitamins, minerals, and nutrients your body needs to promote healing.

Food sensitivities linked to the things we eat day in and day out are another factor that may be playing a role in stopping your progress, notes Dr. Rawls. Foods that tend to be the most problematic for people include:

  • Gluten: Found in wheat, rye, barley, and many pre-packaged foods, gluten is a plant protein with the ability to irritate the lining of the gut and cause inflammation.
  • Soy: Soy is a common allergen, and it shows up in a wide range of foods. Edamame, soybean oil, soy lecithin, and soy protein are a few of the soy variations to watch out for.
  • Lectin: Lectins are another type of plant protein found in grains, beans, legumes, tree nuts, and nightshade vegetables like peppers, tomatoes, and eggplant. Lectins may act as an irritant to the gut when they bind to molecules in the cell membranes, leading to irritation, inflammation, and leaky gut syndrome.
  • Mycotoxins: Mycotoxins are mold toxins that, in addition to being found in the environment, are also often found in foods like peanuts, processed meats, mushrooms, and most dairy products. Mycotoxins can induce a host of allergy symptoms and systemic symptoms like fatigue, brain fog, digestive issues, and pain.

Many people experience delayed reactions to the foods they’re sensitive to, so it’s not always easy to pinpoint the cause. If you think your health plateau may be due to food sensitivities, your best bet is to leave those foods out of your diet for a while and see if it yields improvements.

system disruptor-toxins

3. Your Environment

There are all sorts of toxins in the environment that can impair the function of the immune system and all systems of the body, one of the most common ones being mold. For people who have developed sensitivity to mold, mold mycotoxins can cause a barrage of multi-systemic symptoms.

Your body absorbs mycotoxins through the airways as well as the intestinal lining, says Dr. Rawls. “Once mycotoxins are inside of the body, they trigger inflammation and oxidative stress, which further leads to a disruption in immune system functions.”

Like food sensitivities, the effects of mold exposure might not appear for several days. Think back to when your treatment plateau began. Is it possible you’ve come in contact with mold or are dealing with hidden sources of it? If so, take action to try to lower the toxic load as best as you can.

In addition to mold, consider whether there are significant concentrations of other unnatural toxins in your environment and aim to minimize your exposure to those as well. Urban dwellers often have to deal with polluted air, but people living in rural areas can be exposed to high levels of toxic pesticides and herbicides from agriculture.

system disruptor-sedentary

4. Too Little Movement

When you’re feeling ill, exercise is probably the last thing on your mind. However, movement is critical to improve circulation, enhance detoxification, and boost endorphins — all much-needed functions to help you feel better. But don’t feel disheartened if you’re not up to aggressive exercise. Restorative activities like qigong, Pilates, or walking can get the blood flowing while minimizing the risks of a setback or flare-up.

When regular physical activity isn’t practical because of inflamed tissues, infrared sauna can be an adequate substitute. Infrared sauna (or any sauna, for that matter) stimulates blood flow, dilates blood vessels, and flushes debris from tissues. This enhances detoxification and reduces inflammation.

system disruptor-microbes

5. New Microbes

With chronic Lyme disease, there’s always the possibility that coinfections like bartonella, babesia, or mycoplasma may be factoring into the equation and causing symptoms. There’s also the potential for exposure to a new microbe like a virus, or perhaps you’ve had another tick bite. The presence of other stealth pathogens can further hinder the immune system’s ability to ward off infections and might be the hurdle that caused you to stall out on your recovery.

#2 See a Doctor If New Symptoms Pop Up.

medicine, technology and healthcare concept - african american young woman or patient having video chat with doctor on tablet pc computer at home

It’s not uncommon for people with Lyme disease to tough out the day-to-day symptoms. Patients become accustomed to the inability to predict how they’ll feel from one day to the next. But there are times, especially if you’ve undertaken self-treatment, where seeing a doctor is an appropriate step.

“Anytime you have unusual symptoms that are out of the ordinary — you haven’t had them before — you should see a doctor,” says Dr. Rawls. “If you’re having symptoms that are getting worse, you should see a doctor. It could be something other than Lyme, and sometimes, you need to be evaluated.”

Symptoms that should not be ignored include:

  • Chest pain
  • Heart palpitations
  • Shortness of breath
  • Severe or recurring pain somewhere in your body (for example, headaches, abdominal pain, pain with urination)
  • Sudden weight changes
  • Fainting
  • Persistent fevers or one that reaches 103℉ or higher
  • Confusion

These symptoms serve as a guideline; other concerns might arise that aren’t on the list. The bottom line? If something doesn’t feel right, it’s better to have it checked out and get some peace of mind rather than to brush it off.

#3 Change Up Your Herbal Protocol.

three wooden spoons with different colored herb capsules on each

Have you been using herbal therapy for a while and feel like your progress has halted? If so, it might be time to switch things up a little.

“When you’ve used something for a long time, even herbs, I do feel some people build up a tolerance to them,” says Dr. Rawls. “It might not happen to everyone, but it does happen to some people, and we’re not exactly sure why.”

To combat a potential tolerance to herbs, try the following steps to get back on the path to feeling better.

1. Increase Your Current Herbs.

Most herbs have a wide dosing range associated with taking them, meaning some people may need higher doses than others to be effective. If you’re stuck in a rut, but you’ve noticed some gains with your current herbal protocol, try bumping up the dosages — one herb or blend at a time — to see if you experience improvements. Since herbs have a low potential for toxicity, raising the dose is generally considered safe, with the most common side effect being mild GI discomfort.

Additionally, many herbs are warming herbs, which can generate heat in the body and may leave you feeling stimulated. When raising your dosages, Dr. Rawls advises making sure you’re supplementing with immune-modulating herbs like reishi mushroom, sarsaparilla, and ashwagandha as well. These herbs balance the immune system and keep it from kicking into overdrive.

2. Add Different Herbs to The Rotation.

Another question to consider: Could there be other microbes at play contributing to my symptoms? Though the foundational herbs in many protocols have some coverage against coinfections like bartonella, babesia, and mycoplasma, sometimes you need a more targeted approach to suppressing those microbes. To strengthen your defenses against stealth pathogens, Dr. Rawls recommends slowly adding in one new herb at a time. His herbs of choice include:

group of white bidens flowers growing on stems


Bidens, specifically Bidens pilosa, is the species that has the most powerful action against malaria and malaria-like microorganisms like babesia. In addition to its antimalarial properties, Bidens pilosa is antibacterial, anti-inflammatory, and neuroprotective.

Suggested dosage: Bidens pilosa is most potent when prepared as an alcohol tincture. The dose may vary depending on the company you buy it from, but tinctures are an excellent way to begin at a low dose of the herb and increase drops as tolerated.

Side effects: There are no known side effects associated with Bidens pilosa, however, some plants can become contaminated with heavy metals. Make sure you purchase the product from a reputable company that takes steps to minimize exposure to heavy metals. Additionally, you should not take this plant if you have diabetes, as it can cause fluctuations in blood glucose or insulin levels.

white Houttuynia flower on green leaves


Native to India and Nepal, houttuynia is a potent antiviral with activity also against mycoplasma.

Suggested dosage: The dose may vary depending on a company’s preparation.

Side effects: The herb can have a fishy smell but is otherwise well tolerated.

green Crytopleptis leaves and flower


Traditionally used to treat malaria in Africa, cryptolepis demonstrates systemic antibacterial properties and antiprotozoal properties. The herb is anti-inflammatory and provides antimicrobial activity against babesia.

Suggested dosage: Cryptolepis is available as a powder, tea, capsule, or tincture, so the dose varies depending on the preparation.

Side effects: It tends to be well-tolerated in most people.

green neem leaves on stem


Neem is native to India and offers potent antibacterial, antiviral, antifungal, anti-inflammatory, and antioxidant properties. It may contain antimalarial properties against babesia. Also, it has a protective effect on the liver and kidneys.

Suggested dosage: Dosing varies by preparation, so follow the recommendations provided by whatever product use.

Side effects: Most people tolerate the leaf and bark extracts well.

black cumin seeds in wooden spoon

Black Cumin Seed Oil

Native to the Middle East, Europe, and parts of Asia, black cumin seed oil contains antimicrobial, immune-balancing, and anti-inflammatory properties. The herb may be particularly potent against bartonella.

Suggested dosage: The dosing will vary depending on the preparation, so follow the recommendations on the product you choose.

Side effects: The herb is generally well-tolerated, but some mild GI upset has been reported in some people.

Oregano Essential Oil in bliss bottle and dropper

Oregano Essential Oil

As a potent antimicrobial, oregano essential oil has been shown to defend against persistent borrelia infections in patients with chronic Lyme disease symptoms. Oregano oil contains anti-inflammatory and antioxidant qualities as well.

Suggested dosage: Oregano is available as a capsule, liquid, and in liposomal form, and the dose varies depending on the preparation.

Side effects: Oregano oil can cause some GI discomfort, so it’s best to take the herb with food.

3. Know When to Scale Back.

Sometimes, hitting treatment hard for a while can lead to an intensification of symptoms, in which case it might be time to hit the pause button for a bit. Treatment with herbal therapy or other protocols is about finding the “sweet spot,” says Dr. Rawls. It’s a point at which the herbs are potent enough to be effective but not so strong that they cause a harsh Herxheimer reaction and make you miserable.

inside of heat sauna with a bucket of brushed and towels

Detox strategies like infrared sauna, yoga, and rebounding can support your body’s efforts to eliminate debris and toxic substances, so your cells can get the water, nutrients, and oxygen they need for optimal functioning. Plus, there’s no shame in backing off of treatment for a few days or even a couple of weeks until you begin to feel better. Once the intense symptoms subside, slowly ease back into your treatment protocol at lower doses.

#4 Consider Additional Testing.

If you’ve followed the above steps and find you’re still at a standstill, you might benefit from further testing for chronic infections or other lab tests your doctor may deem beneficial. “The more we test, the more we know, so there’s value in it,” says Dr. Rawls. “Testing may help use tailor herbs or other treatments a bit better.”

But testing for chronic infections has its drawbacks due to a lack of sensitivity and reliability. “If you do additional testing and find something, great! We can treat it,” explains Dr. Rawls. “But if you do testing, and it’s negative, you can’t assume other chronic infections aren’t there. So remember, testing is fair at best.”

Ultimately, the choice to test is a decision best made in partnership with you and your healthcare provider. If more information alters the course of treatment and helps you get over this bump in the road, it might be a good idea to pursue it.

The Bottom Line

When it comes to Lyme disease, a plateau can certainly be discouraging. But as you work through the different variables that might be interrupting your healing, you’ll likely discover an area or two in need of attention. As you address those concerns, you’ll begin to experience progress again. Soon, your recovery plateau will become a thing of the past.

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. Clancy JA, Deuchars SA, Deuchars J. The wonders of the Wanderer. Exp Physiol. 2013;98(1):38-45. doi: 10.1113/expphysiol.2012.064543
2. Feng J, Shi W, Miklossy J, Tauxe GM, McMeniman CJ, Zhang Y. Identification of Essential Oils with Strong Activity against Stationary Phase Borrelia burgdorferi. Antibiotics (Basel). 2018 Oct 16;7(4):89. doi: 10.3390/antibiotics7040089
3. Prevalence of Building Dampness. Indoor Air Quality Scientific Findings Resource Bank website.
Hopefully you are under the supervision of a Lyme literate doctor.  Two heads are better than one and the first place to start is to discuss this plateau with your practitioner.  LLMD’s treat many people and have experience and often know just what to use or try to take you to the next step.  For more on LLMDs:
Another recommendation is to keep a monthly calendar with plenty of space to write down daily symptoms in the box.  Then, from this make a monthly  “executive summary” for your practitioner.  That way you can focus on exact symptoms (and the evolution of them) at your appointment.
I also realize many patients live in places where there aren’t any LLMDs.  This often necessitates a self-directed approach with herbs as the only option available.  There are also others where LLMD’s just aren’t affordable and cases where patients haven’t seen improvement on antibiotics – however, there can be many reasons for this:
  • wrong antibiotics are being used
  • wrong dosage is being used
  • patient is blaming the antibiotics when it’s often herxheimer reactions causing the horrible symptoms and they just need to push through or take steps to manage these
  • pathogens are causing the symptoms (Bartonella is known to cause GI symptoms)

Since this is unlike anything you’ve ever treated for in the past, it’s hard to understand that you typically feel a whole lot worse before you start feeling better.  It’s also imperative you go on a low or no sugar diet, take plenty of good quality refrigerators pre and probiotics.  

Then there’s the issue of all the other issues that can crop up that have nothing to do with antimicrobial treatment at all such as MCAS, mold, food sensitivities, etc.  These other issues are becoming more common now due to our toxic environment – including electromagnetic radiation.  Some patients have to avoid WiFi altogether.
Another point not mentioned in the article is that this really is best described as peeling an onion layer by layer.  You start out with a certain set of symptoms that changes over time.  For instance, when both my husband and I began treatment for Lyme disease, we didn’t notice any Babesia symptoms, but as time wore on and we knocked back a portion of the germ load, all of a sudden we were having air-hunger and chest pressure – common symptoms of Babesia.
In my experience few patients have just Lyme disease anymore – particularly if they are chronically/persistently infected.  These complex cases require time and many different antimicrobials in a layered fashion, and most of all – an open mind.

Rising Geriatric Babesia Cases May Require Longer Treatment


woman with geriatric babesia receiving medication from nurse

The number of Babesia cases among the elderly in the U.S. appears to be growing. According to a study by Menis and colleagues, published in the journal Open Forum Infectious Diseases, 19,469 Medicare beneficiaries had a Babesia diagnosis recorded between 2006 – 2017, with the highest rates occurring in babesiosis-endemic states. [1]

Overall, the number of individuals contracting Babesia is rising, as well. The annual number of cases per year climbed from 4 per 100,000 to 9 per 100,000 in the U.S. between 2006 and 2017. The annual number of cases of Babesia per year for individuals over the age of 85 was 4 out of 100,000. In comparison, the number of Lyme disease cases among the elderly was 15.98 per 100,000.

Most of the cases of Babesia occurred in the Lyme-endemic states of Massachusetts, Rhode Island, Connecticut, New York, and New Jersey, according to the authors. Other states recording Babesia cases included Florida, Pennsylvania, California, Maryland, and Virginia. Some cases of Babesia were also reported in New Hampshire, Maine, Vermont, Minnesota, Wisconsin, Texas, North Carolina, and Illinois.

The most common test used to diagnose Babesia was a blood smear in the institutional setting, wrote Menis in a related paper. [2] The intracellular parasite in the red blood cell clears after a few days. The most common tests used in a physician’s office involved antibody or PCR testing. [2]

Co-infections can be deadly

A Babesia infection can be serious for patients.

Patients co-infected with Lyme disease experienced more symptoms and a more persistent episode of illness than did those (n=10) experiencing babesial infection alone,” wrote Krause and colleagues [3]. In another paper, the authors explain, “Immunocompromised people who are infected by B. microti are at risk of persistent relapsing illness.” [4]

For some patients, including the elderly, a Babesia infection can be more serious. “Babesiosis can be life threatening, particularly for persons who are asplenic, immunocompromised, or elderly,” wrote Krause et al. [4]

85-year-old dies from Babesia and Ehrlichia

Javed and colleagues describe the case of an 85-year-old man who died of a concurrent Babesiosis and Ehrlichiosis infection. [5]

He was an avid gardener and golfer in good health except for hypertension. He did not have a tick bite or rash. The man was hospitalized with weakness and jaundice. He had mild anemia, a very low platelet count, a mildly elevated bilirubin, and mildly reduced renal function.

The doctors diagnosed Babesia based on a bone marrow biopsy revealing intraerythrocytic inclusions (tetrads), typical of babesiosis. In retrospective, his admitting bloods from admission revealed parasitemia in 8% of the red blood cells. The Babesia antibody IgM and IgG were positive for Babesia.

READ MORE: Elderly Lyme disease patients more likely to have unfavorable treatment outcomes

The elderly man was treated with IV clindamycin and IV quinine. His anemia worsened despite transfusion of two units of blood and he was transferred to a tertiary hospital for possible exchange transfusion. The doctor added azithromycin but not Atovaquone.

His condition worsened. His oxygen saturation dropped to 84% and he subsequently developed bilateral pneumonia, renal failure, hepatic failure, and a coma. He was too ill to tolerate exchange transfusion.

He died within 60 hours of admission to the tertiary care center.

Post-mortem tests were positive for Human Monocytic Ehrlichiosis, the cause of Ehrlichia. He was never treated with doxycycline, the most commonly prescribed medication for Ehrlichia.

Treatment of Babesia

Krause and colleagues reported that a 10-day course of Mepron and Zithromax would be as effective as clindamycin and quinine and have less side effects. [3] The Medicare beneficiaries were far more likely to be prescribed Mepron with Zithromax than clindamycin and quinine. [1]

Some patients with Babesia require longer treatment. Krause and colleagues reported immunocompromised and elderly patients were more likely to need longer term therapy.” [4]

In another paper, the authors point out that,

“Such patients generally require antibabesial treatment for >or=6 weeks to achieve cure, including 2 weeks after parasites are no longer detected on blood smear.” [4]

More than one-third of elderly Babesia patients were not treated with anti-Babesia treatment during their evaluation. The study was not designed to determine if the elderly were subsequently treated.

IDSA position

The 2020 Infectious Diseases Society of America (IDSA) guidelines for Babesia highlighted concerns regarding severe Babesia in the elderly.

“Numerous immunodeficiencies and comorbidities have been associated with severe babesiosis, including asplenia and hyposplenism, cancer, congestive heart failure, HIV infection, immunosuppressive drugs, and advanced age.” [6]

For immunocompromised patients, we suggest monitoring Babesia parasitemia using peripheral blood smears even after they become asymptomatic and until blood smears are negative. PCR testing should be considered if blood smears have become negative but symptoms persist (weak recommendation, moderate-quality evidence).

In addition, the IDSA guidelines advised longer treatment for immunocompromised Babesia patients.

“A subgroup of highly immunocompromised patients reported in a case control study required at least 6 consecutive weeks of antibiotic therapy, including 2 final weeks during which parasites were no longer detected on peripheral blood smear.” [6]

However, some patients can relapse.

“A few cases of relapse despite at least 6 consecutive weeks of atovaquone plus azithromycin demonstrate that resistance to atovaquone and/or azithromycin can emerge in highly immunocompromised patients during an extended course of this antibiotic combination,” wrote Krause et al. [6]

Editor’s note: I share the same concerns regarding Babesia in the elderly, and I base the length of antibiotics on the patient’s response to treatment.

  1. Menis M, Whitaker BI, Wernecke M, et al. Babesiosis Occurrence among the U.S. Medicare Beneficiaries Ages 65 and Older, During 2006-2017: Overall, and by State and County of Residence. Open Forum Infectious Diseases. 2020
  2. Menis M, Forshee RA, Kumar S, McKean S, Warnock R, Izurieta HS, Gondalia R, Johnson C, Mintz PD, Walderhaug MO, Worrall CM, Kelman JA, Anderson SA. Babesiosis Occurrence among the Elderly in the United States, as Recorded in Large Medicare Databases during 2006-2013. PLoS One. 2015 Oct 15;10(10)
  3. Krause PJ, Telford SR, 3rd, Spielman A, et al. Concurrent Lyme disease and babesiosis. Evidence for increased severity and duration of illness. JAMA. Jun 5 1996;275(21):1657-60.
  4. Krause PJ, Gewurz BE, Hill D, et al. Persistent and relapsing babesiosis in immunocompromised patients. Clin Infect Dis. Feb 1 2008;46(3):370-6. doi:10.1086/525852
  5. Javed MZ, Srivastava M, Zhang S, Kandathil M. Concurrent babesiosis and ehrlichiosis in an elderly host. Mayo Clin Proc. May 2001;76(5):563-5. doi:10.4065/76.5.563
  6. Krause PJ, Auwaerter PG, Bannuru RR, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA): 2020 Guideline on Diagnosis and Management of Babesiosis. Clin Infect Dis. Nov 30 2020;doi:10.1093/cid/ciaa1216


For more:

Mainstream medicine still does not believe the seriousness of this complex illness that thousands upon thousands are suffering from.  The interaction of confections make cases extremely difficult to treat.  Do not mess around with this, get to a Lyme literate doctor asap:  These doctors typically layer treatment to reduce any potential of resistance to treatment.  We often took 4 things simultaneously.