Dr. Galland’s Integrated Approach to Lyme Disease

by Dr. Leo Galland

Today I look at an integrated approach to fighting back against Lyme disease.

 

Lyme disease presents many challenges, from prevention and diagnosis to treatment. Given the scope of the problem, more research, education and prevention should be done to fight Lyme disease. Read Why Lyme is the Mystery Disease

 

This season, many people will receive antibiotic treatment for tick bites or suspected infection.

 

Some studies have shown that different strains of Borrelia, the bacteria that cause Lyme disease, differ in the way they respond to antibiotics.

 

In my experience, there is no single “best” treatment.

 

People vary greatly in their response to antibiotic therapy and their tolerance for different antibiotics. The “Advanced Topics in Lyme Disease” published by Dr. Joseph Burrascano, a pioneering physician specializing in Lyme disease, are a good place to start in terms of getting up to speed on this difficult to treat infection.

 

Antibiotics are the standard therapy for Lyme disease. Like other drugs, the way they are taken can strongly influence the outcome of treatment.

 

Interactions between antibiotics and food or supplements are very important, and have been described in the medical journals. To help educate people about this research, I created a database of interactions that is accessible as a free online tool here at Pill Advised.

 

Information on drug/food interactions is also available from your pharmacist and often included in the patient-package insert when you buy medication. This should be checked for each individual drug being taken, because the dosage form (sustained-release vs. regular, for example) may influence the effect of food on drug absorption.

 

Read Risk of Lyme Disease Expands

 

Here are highlighted interactions between some common antibiotics and food or supplements:

 

Food or Supplements May Affect Antibiotic Absorption

 

Doxycyline, the most commonly prescribed antibiotic for Lyme disease, forms complexes with minerals like calcium, magnesium and iron, that impair antibiotic absorption. Because of their high calcium content, dairy products should not be taken within several hours of doxycycline. A glass of milk reduces doxycycline absorption by almost 30%.

 

Doxycycline should also be taken several hours apart from nutritional supplements containing minerals (calcium, magnesium, iron, zinc). Some herbal dietary supplements, like fennel and dandelion, are rich enough in mineral content that their consumption may negatively affect doxycycline absorption. The food and drug interactions that affect doxycycline are shared by other antibiotics in its class, like minocycline and tetracycline.

 

Read Lyme Disease Hides in Lymph Nodes

 

Penicillins are another class of antibiotics used to treat Lyme disease. They may also have their absorption impaired when taken with food, but by a different mechanism. Food causes most drugs to be retained in the stomach, where the presence of acid can cause penicillin to decompose. This effect is more likely to occur with penicillin V and ampicillin than with amoxicillin, which is more stable. Extended-release amoxicillin, however, may actually be more bioavailable when taken with food. Psyllium fiber, used to treat constipation, has been shown to bind penicillin, decreasing its absorption.

 

Two other classes of antibiotics often used to treat Lyme disease are also affected by food. These are cephalosporins, which include cefuroxime (Ceftin or Omnicef), and macrolides, which include claithromycin (Biaxin) and azithromycin (Zithromax). Food enhances absorption of cefuroxime and of the extended-release form of clarithromycin. Food impairs absorption of Zithromax capsules, but appears to not impact absorption of Zithromax tablets Azithromycin can be irritating to the stomach. If you need to take it with food, request the tablet form.

 

More: Lyme Disease: the Perfect Storm

 

Always check with your pharmacist on the best way to take the specific prescription you’re been given. The difference can affect the success of treatment.

 

Clarithromycin is subject to an additional type of interaction. It may interact with herbal supplements. Clarithromycin is changed to an inactive metabolite by an enzyme called CYP3A4, which acts on it in the intestinal lining. The herb Echinacea, used as an immune stimulant, inhibits intestinal CYP3A4, and might increase absorption of active clarithromycin. St. John’s wort, used to relieve depression, in contrast, increases CYP3A4 activity, and may potentially decrease clarithromycin absorption.

 

Antibiotics May Deplete Beneficial Bacteria and Nutrients

 

The human body is home to about a hundred trillion bacteria. For every cell, your body harbors about ten bacteria. Taking antibiotics can have a massive impact on your normal bacterial population, depleting sensitive organisms and allowing resistant ones to overgrow.

 

The most common effect is antibiotic-induced diarrhea, which may be prevented by the use of probiotics. The best studied probiotics are Saccharomyces boulardii, a yeast, dubbed “yeast against yeast” in France, Lactobacillus rhamnosis GG, Lactobacillus plantarum and Lactobacillus sporogenes.

 

The normal gastrointestinal bacterial flora synthesizes B vitamins, biotin and vitamin K, which are absorbed and utilized by humans. Depletion of normal bacteria by prolonged antibiotic therapy may produce vitamin deficits. Bleeding caused by vitamin K deficiency has occurred as a result of cephalosporin antibiotics.

 

High dose penicillin therapy causes increased excretion of potassium by the kidneys. When combined with antibiotic-induced diarrhea or poor appetite, this effect may cause potassium deficiency, with fatigue and muscle weakness as primary symptoms.

 

When taking antibiotics for several weeks, it may be worthwhile to take probiotics and a multivitamin.

 

More: Probiotics or Friendly Bacteria

 

As I have highlighted here, research has revealed how antibiotic treatment can be impacted by foods, such as dairy, and supplements, such as calcium, and herbs. Antibiotics may also lead to nutritional deficiencies, and beneficial bacteria can be reduced.

 

Read Lyme Disease Ticks Spreading in Canada

 

Now I’d like to hear from you:

 

Have you been tested for Lyme or other tick-borne diseases?

 

Have you received treatment for Lyme, and has it helped?

 

Let me know your thoughts by posting a comment below.

 

Best Health,

 

Leo Galland, MD

 

References and Further Reading

 

Preac Mursic V, Marget W, Busch U, Pleterski Rigler D, Hagl S, “Kill kinetics of Borrelia burgdorferi and bacterial findings in relation to the treatment of Lyme borreliosis.” Infection. 1996 Jan-Feb;24(1):9-16. Max v. Pettenkofer Institut, Ludwig-Maximilians-Universität München, Germany.

 

Agwuh KN, MacGowan A. “Pharmacokinetics and pharmacodynamics of the tetracyclines including glycylcyclines.” J Antimicrob Chemother. 2006 Aug;58(2):256-65 Department of Medical Microbiology, Old Medical School, Leeds General Infirmary Great George Street, Leeds LS1 2EX, UK.

 

Kshirsagar NA, Ankalesaria PS. “Effect of food on doxycycline absorption.” J Postgrad Med. 1987 Jul;33(3):117-9.

 

“Comparative effect of different types of food on the bioavailability of cefaclor extended release tablet.” Khan BA, Ahmed T, Karim S, Monif T, Saha N, Sharma PL. Eur J Drug Metab Pharmacokinet. 2004 Apr-Jun;29(2):125-32

 

Karim S, Ahmed T, Monif T, Saha N, Sharma PL. “The effect of four different types of food on the bioavailability of cefaclor.” Eur J Drug Metab Pharmacokinet. 2003 Jul-Sep;28(3):185-90

 

Guay DR, Gustavson LE, Devcich KJ, Zhang J, Cao G, Olson CA. “Pharmacokinetics and tolerability of extended-release clarithromycin.” Clin Ther. 2001 Apr;23(4):566-77. Institute for the Study of Geriatric Pharmacotherapy, College of Pharmacy, University of Minnesota, Minneapolis 55455, USA.

 

“Mechanistic study of the azithromycin dosage-form-dependent food effect.” Curatolo W, Foulds G, Labadie R. Pharm Res. 2010 Jul;27(7):1361-6

 

Gorski JC, Huang SM, Pinto A, Hamman MA, Hilligoss JK, Zaheer NA, Desai M, Miller M, Hall SD. “The effect of echinacea (Echinacea purpurea root) on cytochrome P450 activity in vivo.” Clin Pharmacol Ther.2004 Jan;75(1):89-100. Department of Medicine, Indiana University School of Medicine, Indianapolis, 46202-2879, USA

 

Alitalo et al. “Hypoprothrombinaemia and bleeding during administration of cefamandole and cefoperazone.” Ann Clin res 1985; 17: 116-9.

 

Shimada et al. “Bleeding secondary to vitamin K deficiency in patients receiving parenteral cephem antibiotics.” J Antimicob Chemother 1984; 14 (Suppl B): 325-330

 

Gill et al, “Hypokalemic metabolic alkalosis induced by high-dose ampicillin sodium.” Am J Hosp Pharm 1977; 34: 528-31

 

Surawicz et al, “Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: A prospective study.” Gastroenterol 1989; 96: 981-88

 

Vanderhoof et al, “Lactobacillus GG in the prevention of antibiotic-associated diarrhea in children.” J Pediatr 1999; 135: 564-48.

 

Armuzzi et al, “The effect of oral administration of Lactobacillus GG on antibiotic-associated gastrointestinal side effects during helicobacter pylori eradication therapy.” Aliment Pharmacol Ther 2001; 15: 163-69.

 

LaRosa et al, “Prevention of antibiotic-associated diarrhea with Lactobacillus sporogens and fructo-oligosaccharides in children. A multicentre double-blind vs placebo study.” Minerva Pediatr 2003; 55: 447-52.

 

Leipner et al, “Therapy with proteolytic enzymes in rheumatic disorders.” BioDrugs. 2001;15(12):779-89.

 

Luerti & Vignali, “Influence of bromelain on penetration of antibiotics in uterus, salpinx and ovary.” Drugs Exp Clin Res 1978, 4: 45-48.

 

4 thoughts on “Dr. Galland’s Integrated Approach to Lyme Disease

  1. hannah zucker

    hi Dr. Galland, 6/11 to adirondacks in n.y. thought spider bite, then maybe ringworm because of odd ring that developed a couple of inches from bite area lasting a few weeks then began to fade and on top of that caught a terrible cold? flu? real bad for a few weeks but never really letting up. constant headache developed worse at night , ringing in right ear and inside base of head , intermittant blurred vision, very swollen upper eyelid, so bad i can see the fluid through the skin, eye dr x’s 3 1st exam normal, 2nd pressures unequal and up in left eye which actually was more blurry but dr. could see no reason for it 3rd appt. normal again but did note ther were a lot of floaters? the eyes where very swollen and bloodshot and gave me eyedrops and sent me on my way. ENT, cat scan of sinus, hearing test (hearing great, He was sure there would be a deficit in ringing right ear. swallow test normal but throat looked very red? no treatment. Nuero exam, mri head, mra of neck all normal? Nuero thought tia or ms? went to rhuematologist, all rhuem factors normal. she asked me if i was recently bit by anything, and then i remembered n.y. she did a lyme titer and also a western blot which came back with 2 abormalcies band 23, 45, possitive. she said she could not treat but made a consult to an infect disease specialist, refusing to see me, stating she does not treat lyme disease when no-one said i had lyme but that i am real sick and need to get to the bottom of this problem which is interfering with my abitily to function. 2nd infect disease consult came back with the same response so here i am deserted. i actually called both offices myself not believing a dr. would refuse a consult? I even called the cdc and was told by the representative that answered to phone that the cdc’s stance on the matter is that lyme disease should be a clinical dx. since the tests are so untrustworthy, but if there was any question better to treat then not too. but dr’s here in florida act like its a made up disease and don’t seem to take it seriously so i’m almost ashamed to bring it up. i’ved tried just about everything i’ve found on the web samento banderol edta monolaurin and the list goes on even ordered bee venum pills from new zealand’ i had seen an article on pub med re: melitin in bee venum but it was oral like homeopathic and i don’t know if this is the same as injections. i even checked to see if any local dr’s or apitherpist in my area with no luck. since then have developed pain in shoulders, pins and needles down arms mostly left, a unbelievable bout of knee pain lasting about 6 or seven weeks i’ mean so bad it was a challenged to get on and off the toilet? that’s actually what got me to order the bee venum i’m not sure if thats what made the difference in the knee pain from hell but thank god it let up i’m only afraid it might happen again i guess maybe if i didn’t wash my face for a while a broke out real bad a dermatologist would have no problem writing script for long term antibiotic? well i found you on the web and thought i’d take advantage of the invite to write,good thing i can think behind all this pain and pressure, but now can understand why a lot of the crazy things that people are doing just might be associated with this type of illness because the pain and pressure in the head is relentless and could make someone very angry. thank god i don’t have that king of personality. but sure wish i could get out of this nightmare of a mess, sincerely, hannah

  2. Jason

    Hannah ~

    I see you wrote this a while back in October. Hopefully, you have located a LLMD since then, a Lyme Literate Medical Doctor.

    You really need someone with experience treating the disease, otherwise it will be very difficult to get over Lyme.

    I am speaking from experience, unfortunately.

    Depending what area you are in, go to Google and typle LLMD in CT (for example).

    You should be able to quickly register on forums where you can locate a good LLMD.

    GOOD LUCK!

    Jason

  3. Jon Sterngold MD

    Many of us who failed antibiotic treatment for late Lyme got our lives back using Rife machines. It saved my life - after the failure of 7 years of antibiotics guided by the top guys in the realm. There’s an exponentially expanding underground of desperate sufferers who get well within a year or two of committed use. Someday….

  4. Ginny

    Thank you for any help you may be able to give me. I was dx with Lyme approx. 18 years ago. I was treated by an LLMD in NJ with 3 solid years of rotating antibiotics with one month of IV Rocephin. Then I was told I was done…no more antibiotics. I have lived a seminormal life sice then except for the chronic pain and fatigue. I hold down a full time job (demanding job). The past year and a half have been a down hill slide with pain moving into upper extremities and hands…severe on many days…lots of opiates, nnsri,etc. Where can I get help? I live in north NJ and will drive distance PRN.

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