Biofilms: Gated Communities

     Biofilms are protective communities where various forms of the Lyme bacteria can hide from prescriptive antibiotics, herbal antimicrobials, and the immune system. In chronic Lyme and associated diseases they can cause:

• treatment resistance and
• relapse once antibiotics or herbal antimicrobials are stopped.

     Biofilms are not unique to borrelia, the Lyme disease bacteria. They are known to occur based on scientific studies in various infections such as staph infections of the skin. In Lyme disease, Alan MacDonald MD, has shown biofilms to exist based on his microscopic exams of brain tissues.

Composition      

     In biofilms bacteria produce and cover themselves in a layer of slime composed of mucopolysaccharides. To add structure, the bacteria recruit a protein found in blood called fibrinogen which they then convert to the protein fibrin. Because the fibrin gives structure, the bacteria in biofilms can rid themselves of their outer protein coverings making it harder for the immune system to react against them. In addition the slime layer covers the germs so the immune system cannot see them and antibiotics or antimicrobial supplements cannot reach the germs. Within the biofilms the germs establish highly organized structures and functions where they communicate using various chemical messengers, excrete waste through channels and perform other complex activities to promote the longevity of the community. Biofilms require calcium and magnesium and contain other minerals and heavy metals.

Biofims and Treatment

     In my practice I intentionally treat biofilms

• at the end of treatment to prevent relapse or
• when a treatment is not progressing well due to treatment resistance.

     Some physicians address biofilms at the very beginning or throughout the entire course of a treatment. In my practice I do not do this because my observation is that 90% or more of my patients get well without specific biofilm treatments. Even though we know based on the work of Alan MacDonald MD that biofilms exist in brain tissues of people with Lyme, there is no scientific evidence that they occur in every individual who has Lyme and associated diseases. Furthermore, even if they do exist in all that have borrelia infection, there is no scientific evidence that they universally block treatments. 

How to Treat Biofilms

     Based on my review of biofilm treatments there are two scientifically supported approaches to eliminate biofims in Lyme Disease and many theoretical treatment approaches.

     Research-based Treatments

     Eva Sapi PhD and her colleagues are performing groundbreaking Lyme Disease research.  In the past 2 years she has published two articles based on petri dish experiments in her lab. The first published over a year ago shows that the herbs Banderol and Samento used together completely eliminate biofilm communities and eradicate nearly every germ living in them. Her more recent study of 5 different antibiotics shows that prescription tinidazole decreases the size of biofilm communities and eliminates the germs living in them by over 90 percent. Based on my review of her research, I believe the best antimicrobial approach that eliminates biofilms and the germs that live in them are the herbs Banderol and Samento. Prescriptive tinidazole is a very close second though.

       Theoretical Treatments

     As I noted above biofilms require magnesium and calcium, have various minerals and heavy metals, and contain fibrin protien structures and mucopolysaccharides substances. Theoretical treatments address these various components. Some physicians treat biofilms by

• starving the germs by eliminating or limiting calcium and magnesium,
• removing minerals and heavy metals with the chelating agent EDTA, and
• breaking up the protien fibrin matrix with enzymes like Lumbrokinase or nattokinase.

     In theory, I understand these approaches. However, I think such approaches are overkill. Now I admit that I am a minimalist when it comes to treating Lyme and associated diseases. I believe that physicians should treat using as few supplements or prescriptions as possible to gain the maximum benefit. Even though I work with supplements for instance, I do not think it is useful or appropriate for most patients to leave a medical office or a store with bags full of supplements. Regarding eliminating calcium and magnesium or limiting them, I do not support this. Biofilms exist in us, so of course they require the same minerals that we do to survive. I do not think we should starve the host (a person with Lyme) to kill the germ.

     The only theoretical approach I use in my practice is the supplement Lumbrokinase. It breaks down the fibrin protien skeleton that holds the biofilm together. This alone is enough to break up the biofims. Using Lumbrokinase alone I have seen great improvements in my patients with treatment resistant Lyme and decreased episodes of relapse. An alternative to the Lumbrokinase is nattokinase, but it is a much weaker fibrin dissolving enzyme and I do not find it effective.

Biofilm Treatment Approach

     Treat biofilms in the last four months of treatment to prevent relapse or anytime in treatment when resistance to antibiotics or herbal antimicrobials is blocking progress.

     So how do I design a treatment for biofilms? My favorite and most effective approach is to use Banderol and Samento.  When using these two herbs, I stop all prescritpive antibiotics. Dr. Sapi's work suggest this is the most effective approach, and this is what I observe in my practice as well. Another approach is to use prescritipive tinidazole in an antibiotic approach. I use Lumbrokinase, if an antibiotic approach is working fairly well, or if Banderol and Samento do not work, or if a person cannot tolerate the nausea or abdominal cramping that can occur with tinidazole. It is safe to add Lumbrokinase to any antibiotic regimen. To read how to use Banderol and Samento or Lumbrokinase or to purchase these supplements click on the Links in this section.

     One word of caution, when treating biofilms, sometimes die-off Herxheimer reactions can occur. In a die off reaction the immune system makes more inflammatory chemicals that can temporarily make the Lyme and associated diseases symptoms worse. To read about these reactions and the treatment approach I use for them see the Treatment Manual: Supplements and Advanced Treatments in Lyme and Associated Diseases.

Final Word

     As Dr Brooke and I note on this site, often supplements offer better approaches to treat this illness than prescription-only treatment approaches. The examples laid out above regarding treating biofilms with Banderol and Samento or Lumbrokinase provide perfect examples of our claim. See Treat Lyme and Associated Diseases to see other examples of how you can improve your prescription-based approach.  

Finished?

It was a good week here at The Healing Arts Partnership.  One of my patients with chronic Lyme disease graduated from treatment while another group of patients seen this week are nearing that point.  While I enjoy many aspects of my practice, seeing patients complete treatment and celebrating that with them is what I enjoy most.  So what does it mean to finish treatment?

For patient confidentiality I cannot identify the graduating patient by name, but I can by how he occurs to me.  He is Mr. Canadian Sweet Spirit Big Heart (MCSSBH).  MCSSBH came to my practice nearly 2 years ago.  Because of his illness, he had to stop his job as a carpenter and was no longer able to participate actively in his family life.  Three days ago as we talked he noted very good energy and that his life was once more under his command.  He spoke of fully working as a carpenter and participating actively and lovingly in his family life.  During our visit, we talked about what it means to be finished with treatment.  We then created together his plan of action to maintain his health inorder to live his life fully.  As we said goodbye, MCSSBH blessed me and thanked me for the return of his life.  I thanked him for his kind and touching words and sent him on his way...and I blessed him back.

The conversation I had with MCSSBH, is similar in medical content to those I have with others in his situation.  The concern I have in finishing treatment is to prevent relapse.  So there it is....the reality I do not like to share, and what my patients do not like to hear.  It is not clear if treating Lyme completely eliminates the germ from one's body.  Relapses are actually quite common for those with chronic Lyme disease.  It might be fair to say that for those who have had the illness more than a year before beginning treatment at the end their dis-ease is in remission.  This is not the case for those with acute Lyme treated within a month of infection.  Treatment for the majority of this group truly seems to eradicate the germ.  For those treated within 1 month to a year after the infection, it is a mixed bag based on my experience.  Some do not relapse while others do.

As I prepare patients for remission I am focusing on preventing relapse.  One reason patients may relapse is that Lyme germs convert to prescriptive antibiotic resistant forms.  These resistant forms are germ cysts and biofilm communities.  Biofilms are layers of slime that cover germs hiding them from the immune system and preventing antibiotics from getting in.  So in the months leading up to the end of treatment I work to treat the Lyme borellia cysts with anti-microbials like metronidazole, tinidazole, fluconazole, or grape fruit seed extract.  I also work to remove biofilms with an enzyme derived from earthworms called Lumbrokinase.  To read more about biofilms and Lumbrokinase see the biofilms page at Lyme Disease Supplements and More.  Another option to the anti-microbials and Lumbrokinase is to use Samento and Banderol in the final months.  These treat all three forms of the germ and appear to diminish biofilms.  Please see the previous posting on this blog for detailed information about these two herbs.

I wish there was a "finished" test in Lyme, but there is not.   When I first started treating this illness, Joe Burrascano, MD and others promoted an idea that a person would not relapse at the end of treatment if two conditions were met.   First, a person had to be symptom free for 2 months.  Second, the CD-57 test had to be in a normal range of at least 150 or higher.  So the CD-57 looked like it could be the "finished" test. 

The CD-57 is a type of white blood cell that is often suppressed in those with immune suppression caused by Lyme disease.  If it is normal at the end of treatment it indicates that there is not immune suppression.  What I learned through my own observations over the years is that even with normal CD-57 counts and having no symptoms at the end of treatment, many will eventually relapse years down the road.  My observation was eventually confirmed by many of my International Lyme and Associated Diseases Society (ILADS) colleagues at the annual meeting two years ago in Washington, DC.

I now consider treatment "finished" in two separate situations.  A person's treatment is complete when they are symptom free of Lyme disease for two months or if they are at a plateau for 4 or more months and no changes in her treatment protocol moves the treatment forward.  I no longer test the CD-57 because I do not think it accurately predicts anything. 

When a person's treatment is "finished" I suggest one of three different courses.  The foundation of all three choices is to support the immune system vigorously.  More on this later.  The three choices are:

1. wait and see,
2. use preventive herbal anit-microbials, and
3. use preventive prescriptive anti-microbials.

In the wait and see approach I advise a quick return visit if any Lyme disease symptoms return.  My experience for those that choose this option, is that if Lyme disease does become active a course of anti-biotics or herbal anti-microbials quickly turns things around.  People usually do not go back into the "hole" of the disease but rather have a return to health within weeks to a few months.

In the preventive anti-microbial approaches, I use herbs or prescriptive anti-microbials in a more limited way than while under full treatment to police the body and to keep the remaining Lyme germs under control.  In using anti-microbials this way, I treat Lyme disease as I would other chronic infectious conditions like HIV disease where people do quite well as long as they take anti-virus drugs to keep the germ-load down. 

It is too early to see if the use of preventive anti-microbials will actually prevent relapse for most.  It is an approach that I have only used for the last 2 years or so, but my initial observations of its usefulness look promising. 

You may wonder how I decide which of the three approaches I recommend to each patient.  How do I decide?  I don't.  I have my patient's decide based on the above information and what feels right.  I strongly believe in the power of intuition.  In letting my patient's choose what feels right to them, I am tapping into the deep knowing "intuition" that we all innately have.  In my practice, I observe that people do best when I give them the choice to tap into their own sense of what is right, their own intuitive sense.

Although the to do or not to do anti-microbials discussion is important, what is most important at the end of treatment is to support the immune system.  So I recommend:

1. regular sleep of seven or more hours a night. 
2. regular exercise as long as it does not make a person worse. 
3. whole and organic foods to limit toxins that can suppress the immune system. 
4. a good multi-vitamin that provides all of the essential nutrients the immune system requires, and
5. continuing emotional detoxification.

For much more information about immune support, please read the Immune System page and about emotional detoxification on the Detoxification page from Lyme Disease Supplements and More found at www.treatlyme.com. 

So back to my patient, MCSSBH.  We discussed his options.  He was not certain if he would choose a wait and see approach or to use an herbal anti-microbial preventive approach.  I was not disturbed by this, because I knew he would figure out what is best for him based on his own innate intelligence.  I look forward to hearing how he is doing in his reinvigorated life.

Banderol and Samento

I am having quite a bit of success using the herbs Banderol and Samento (toa free cats claw from Nutramedix) even when prescriptive antibiotics are no longer working.  I added these two herbs into my treatments in August of 2010 based on a research paper published in the July 2010 Townsend Letter.  Eva Sapi, PhD and her research group showed that Banderol and Samento treat the various forms of the Lyme germ even in biofilm colonies.  Her work also suggested that Samento and Banderol have a synergistic effect where the sum of the killing is greater than the individual effects of each herb.

When I first started to work with Banderol and Samento, I introduced them into the treatments of my patients that had plateaued on prescriptive antibiotics at a good level of health.  During these plateaus I had tried various prescriptive regimens targeted at all three forms of the lyme germs and treated for biofilms with lumbrokinase to move the treatments forward without success.  Many of these patients had energy levels of 80% of normal with minimal body pain and good cognition.  For these patients I offered Banderol and Samento as a means of preventing recurrence off of prescriptive antibiotics and to possibly move the treatments forward.  I started the Banderol and Samento at 10 drop 2 times a day and added 1 drop per dose per day till each patient was at 20 drops 2 times a day.

To my surprise, I observed that nearly 90 percent of patients I placed on this protocol had marked improvements in fatigue by the follow up appointments at 2 months.  Some reported significant die-off reactions.  Eventually based on my patients’ observed and reported successes, I started to work with Banderol and Samento in the middle of treatment courses and now more recently at the initiation of treatments.

I am pleased for my patients because across the board I am observing good benefits.  In the beginning and middle of treatments, I am finding success with Banderol and Samento that compare with those of prescriptive antibiotic regimens.  At the end of treatments or when a patient has plateaued, I am finding that these two herbs also move treatments forward.  

Working with these two herbs, I have changed my opinion of the benefit of herbal anti-microbials.  In the past I recommended teasel, cumanda, andrographis, and cats claw in various combinations and in rotations similar to those found in the Cowden Protocol.  In my practice I found success with herbal anti-microbials about 60% of the time.  This compares with the 90% chance of improvement that I have observed with prescriptive antibiotic protocols.  Naturally, when given a choice between the herbs and prescriptive anti-microbials with these observed success rates, most of my patients elected prescriptive regimens.  That is changing now and I believe that the Samento/Banderal combination provides a very effective option that may approach the effectiveness of the prescriptive regimens.

So what is going on here?  Based on the work of Sapi et al, I think this combination effectively kills the various forms of Lyme borrellia while it limits biofilm formation.  My success in moving plateaued treatments forward even suggest that these herbs can kill germs in dormant phases where prescriptive antibiotics do not work.  I am not clear from Dr. Sapi’s work if these two herbs break up biofilms or if they kill the germs in the biofilms which results in the biofilm decline.   In the end it does not really matter, because for my patients, this combination works.

Over time, because of die-off reactions, I have changed how I start the regimen.  Now I start treatments at 5 drops 2 times a day of each herb and increase the dosing every 2 days by 1 drop per dose till a patient is taking 15 drops 2 times a day.  With this approach I am finding limited die-off reactions.  One more thing, based on the manufacturers recommendations, I advise that the herbs are taken at least 15 minutes from each other and that they are taken on an empty stomach.  

(Please be aware that none of these statements of effectiveness of Banderol and Samento are verified by the FDA and that my findings do not substitute for the care of a qualified integrative medicine practitioner like a naturopathic physician or a medical doctor that works with herbs and prescriptive medicines.)

Success, Eureka, It Works!

Chronic Lyme and associated diseases are very difficult to treat.  So what works?  The truth is that a limited science exists regarding effective or ineffective treatments.  And for some patients the answer is elusive. While the Infectious Disease Society of America (IDSA) believes that the science is cut and dry regarding Lyme disease treatment, it is not.  Because of the limited science around this illness, I often feel that I am practicing frontier medicine.  To heal my patients I must pioneer treatments with a direction from science and research even when there is not a large body of research evidence.  My treatments are often in front of science.  I hope some day the research will catch up.

So how do I work?  I read medical, science, and research journals for new ideas.  I attend conferences and learn from the best and brightest. I dialogue about approaches with my colleagues.  I develop and implement new and cutting-edge treatments based on the real-time experiences of my patients here on the front-lines of Lyme care.  Ultimately what works is not based on some other person’s opinion or on laboratory and university science.  How I determine what works is based on the improvements patients report here in my left-coast Seattle office.  

What I am writing is heresy to many in the medical community.  The current trend is for physicians and health care practitioners to practice evidence-based medicine based on research.  The problem with the so called “evidence-based” medicine is that much of the research is bought by the pharmaceuticals or influenced by the medical insurance industry.  Some “independent” researchers for Lyme disease receive payments from the insurance industry as consultants which compromises their body of research work.  A bigger problem is that for much of what we do in medicine and in particular with Lyme disease, the science truly does not exist. Treating without solid research backing and adjusting clinical approaches based on clinical evidence of what works best is not novel to Lyme treatment.  In fact, research shows that only 50% of conventional medicine treatments have a solid research evidence base.  

To help advance Lyme disease treatments from time to time I will write about the successful approaches I am having with my patients.  So IDSA and evidence-based physicians beware, these writings are about my practice-based scientifically rooted treatments and real-world experiences that are not proven by evidence-based research.  I hope my writings will shape the care of others.  

So later this week I will present Banderol and Samento. 

Haunted

I awoke this morning haunted by the e-mail from my patient.  I live by the oath. I have a true mission to alleviate suffering and try do no harm, but here I had.  I want to make excuses, to explain the complexities, for her to understand that I truly did not know.  But in the end the medicine and supplement I recommended made her worse.  But in the end I feel guilty for not knowing better and the harm I caused her.  But in the end I feel humbled and made small by all the complexities of treating this dis-ease.  But in the end, I worry that she and every patient I treat gets better....and, I remain haunted.  

She wrote:

I have made some interesting discoveries, which should help you improve the treatment of your patients on Thyroid medication.

1.  Ciprofloxacin reduces the absorption of thyroid medication.  To prevent that, they should be taken 6 hours apart.

2.  Alpha Lipoic Acid also reduces the absorption of thyroid medication.  They cannot be taken together, period. 

I have enough health challenges without adding thyroid problems, as I am sure you understand.  So I am disappointed that you were not aware of these issues and could not advise me better.  I could have felt a bit better since November, hadn't my thyroid absorption been reduced due to drug interaction.  To be fair, I am also disappointed that my MD here didn't know either about cipro.

So, once again I am taught by one of my patients and this illness.  I am grateful that she shared her disappointment and discoveries As I process the letter, I juxtapose it against all the exciting discoveries, and new treatment options I learned this weekend at “The Challenge of Emerging Infections in the 21st Century: Terrain, Tolerance, and Susceptibility.”  This was a conference presented by the Institute for Functional Medicine.  

Before receiving my patient’s e-mail, I was racing in my head from one new idea to the next of how I would revolutionize each of my patient’s treatments with all of the new discoveries of the weekend...and there were many.  This morning, in addition to feeling haunted, guilty, and worry, I also can touch that excitement of new discovery and new healing options for my patients.  

So I will live today with the dichotomy of yesterday.  While working with the latest discoveries I must remain vigilant to the details of something as simple and complex as the correct timing of when to take thyroid medication in relationship to alpha lipoic acid and ciprofloxacin.  As I deliver what at times are cutting-edge treatments to my patients, I must also focus on the basics.

I also realize that my greatest teachers are my patients. The discoveries that they often bring to me I am able to incorporate into their own treatments or those of others.  Yes, I learned a lot of exciting and new information this weekend at the conference from the best and the brightest of integrative and functional medicine.  But this illness, this Lyme dis-ease, is far too complex for just the experts and the physicians that treat the illness to figure out.  It requires a truly collaborative approach between myself and my patients. And I am blessed by many patients who are willing to walk this complicated partnership with me.  So to my patient who wrote me about her thyroid medication, I am sorry for the harm I caused you, and I thank you for teaching me a lesson that will benefit many.