Episode #165: Bartonella with Dr. Brian Plante, ND

Why You Should Listen

In this episode, you will learn about the vector-borne infection Bartonella.

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About My Guest

My guest for this episode is Dr. Brian Plante. Brian Plante, ND is a licensed naturopathic doctor with extensive training in integrative healthcare approaches. He specializes in working with patients suffering from complex immune dysfunction such as Lyme disease, chronic viral infections, environmental toxicity (such as from mold and heavy metals), autoimmune disease, Mast Cell Activation Syndrome, and Chronic Fatigue Syndrome/Myalgic Encephalomyelitis. Additionally, Dr. Plante helps patients recover from functional gastrointestinal conditions, adrenal and thyroid disorders, and neuropsychiatric disorders. With each patient Dr. Plante meets, he conducts a comprehensive evaluation in order to get a complete picture and then creates individualized treatment plans to address that patient’s specific concerns. Dr. Plante is a graduate of the National University of Natural Medicine in Portland, OR, as well as a member of the International Lyme and Associated Diseases Society (ILADS). He believes that one integral step in helping patients heal from complex chronic illness is by empowering them with knowledge and understanding. He facilitates this by patiently taking however much time is needed to investigate a patient’s symptoms and concerns thoroughly. Through compassionate listening, thoughtful instruction, and a steadfast commitment to helping patients experience lasting, positive change, Dr. Plante can combat the frustration patients often experience in their struggle to find answers. His goal with every patient with whom he interacts is to provide support and guidance in their journey toward achieving optimal health.

Key Takeaways

• What symptoms provide clues for the potential of Bartonella?
• Could Bartonella be an explanation for many neuropsychiatric conditions?
• Might Bartonella play a role in SIBO?
• What are the vectors through which Bartonella may be acquired?
• What labs are useful for exploring the potential presence of Bartonella?
• How often does mold exposure play a role in Bartonella patients?
• Can Bartonella be a trigger for MCAS?
• Can Bartonella be a driver of autoimmunity and immune dysregulation?
• Might Bartonella play a role in hypermobility syndromes and Ehlers-Danlos Syndrome?
• What role does Bartonella play in Morgellons?
• What is the foundation for treating Bartonella?
• What modalities can be helpful for terrain optimization?
• What role do nutritional IVs play in Bartonella treatment?
• Are antibiotics necessary in treating Bartonella?
• What herbs may be helpful for addressing Bartonella?
• How might oxidative therapies such as ozone, EBOO, and ozone plasmapheresis be used?
• How often do biofilms need to be addressed?
• What antimicrobial and immune-modulating peptides have a role?
• Can Bartonella be fully eradicated?
• Once a patient has recovered, can treatment be stopped? Or is there a maintenance strategy for longer-term support?

Connect With My Guest

http://BioResetMedical.com 

Interview Date

May 3, 2022

Transcript

Transcript Disclaimer: Transcripts are intended to provide optimized access to information contained in the podcast.  They are not a full replacement for the discussion.  Timestamps are provided to facilitate finding portions of the conversation.  Errors and omissions may be present as the transcript is not created by someone familiar with the topics being discussed.  Please Contact Me with any corrections.  

 [INTRODUCTION]

[00:00:01] ANNOUNCER: Welcome to BetterHealthGuy Blogcasts, empowering your better health. And now, here's Scott, your Better Health Guy.

The content of this show is for informational purposes only, and is not intended to diagnose, treat or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health related decisions with your own personal medical authority.

[00:00:35] SCOTT: Hello, everyone and welcome to episode number 165 of the BetterHealthGuy Blogcasts series. Today's guest is Dr. Brian Plante, and the topic of the show is Bartonella. Dr. Brian Plante is a licensed naturopathic doctor with extensive training and integrative healthcare approaches. He specializes in working with patients suffering from complex immune dysfunction such as Lyme disease, chronic viral infections, environmental toxicity, such as mold and heavy metals, autoimmune disease, Mast Cell Activation Syndrome, and Chronic Fatigue Syndrome or Myalgic Encephalomyelitis.

Additionally, Dr. Plante helps patients recover from functional gastrointestinal conditions, adrenal and thyroid disorders and neuropsychiatric disorders. With each patient Dr. Plante meets, he conducts a comprehensive evaluation in order to get a complete picture and then creates individualized treatment plans to address that patient's specific concerns.

Dr. Plante is a graduate of the National University of Natural Medicine in Portland, Oregon, as well as a member of the International Lyme and Associated Diseases Society. He believes that one integral step in helping patients heal from complex chronic illness is empowering them with knowledge and understanding. He facilitates this by patiently taking however much time is needed to investigate a patient's symptoms and concerns thoroughly.

Through compassionate listening, thoughtful instruction, and a steadfast commitment to helping patients experience lasting positive change, Dr. Plante can combat the frustration patients often experience in their struggle to find answers. His goal with every patient with whom he interacts is to provide support and guidance in their journey toward achieving optimal health.

And now, my interview with Dr. Brian Plante.

[INTERVIEW]

[00:02:30] SCOTT: Bartonella is arguably the most challenging issue in the treatment of Lyme and coinfections, or in Bartonella and coinfections, as we'll talk about. I'm super excited today to have Dr. Brian Plante on the podcast to share his experience with us. Thanks for being here, Dr. Plante.

[00:02:47] DR. PLANTE: Thanks so much for having me. Super excited.

[00:02:49] SCOTT: Talk to us about the life path or journey that led you to doing the work that you do today. Did you have a personal health journey that drew you to working with these complex chronic conditions?

[00:03:01] DR. PLANTE: Yeah. So as a naturopathic doctor, I've always been interested in how there are many determinants of health; physically, psychologically, spiritually, environmentally. And so that was always kind of in the background. But when I was at school, there wasn't a lot of training that we got in Lyme disease, and complex immune disorders, and mold toxicity.

I got Mono in my second year of med school, and it really threw a wrench in things. I had a doctor at the time say, “You might want to think about taking a leave of absence.” I did not do that. It may have been a good idea to do that. But I was battling EBV for years. And still, to some extent have to keep a leg up on it with some of the tools that we'll talk about today. I also think that I had mold exposure that wasn't identified at the time. I was seeing a lot of acupuncturists, and they were like, “Oh, there's something in your diet. There's some kind of toxin.” But I was living in the Pacific Northwest where it was damp for most of the year, and I had an apartment backed up to a forest. And I kept the windows open a lot. So I think I had mold exposure in that.

And so part of it was just kind of trying to be my own detective and make sense of why is this virus so difficult to kind of get a leg up on. And then also trying to make sense of some of my brain quirks. I'm a highly sensitive person. Definitely not neurotypical. And so more sensitive to stimuli and social interactions and stuff.

And so, what I found when I was in residency and started working, being exposed to a lot of folks who take for an illness and chronic illnesses that I felt like I understood what it felt like. Even though I didn't have Lyme, it was like, “Okay, I understand that fatigue thing.” And I also understand the brain component of like, “Oh, these lights are super bright.” Even in my clinic now, I'll be like, “Hey, are you okay with this lighting? Or like should we dim this lighting?” And they're like, “Yeah, how do you know? Like, that's perfect.” Like, “Well, I got my blue blockers right here.” So I think I feel kind of a bit of an affinity neurologically to folks who are struggling with these inflammatory conditions.

[00:05:06] SCOTT: I like the term brain quirks. Definitely can relate to some of those myself. So let's start off by talking about some of the key symptoms that you observe in your patients that kind of clue you into the potential for Bartonella. We know there's never one thing in chronic illness that's really kind of the one driver. But how does a patient where Bartonella is maybe dominant or a primary issue? How do they present in your office? And what are some of the distinguishing characteristics that you see?

[00:05:35] DR. PLANTE: Yeah. There is so much overlap between Bartonella symptoms and the symptoms of other tick-borne infections. And so things like fatigue, muscle pain, joint pain, headaches, GI dysregulation doesn't always point us in the clear direction of which infection may be dominant or even persistent. Although, certainly, all of those could be present. Any or all of those could be present in Bartonella.

When I'm really saying we need to evaluate for Bartonella here is when there is neuropsychiatric manifestations, particularly with no other clear cause. If someone tells me they had anxiety or depression their entire life, I'm not as interested as if they say, “Ever since whatever, a particular point in time, maybe there was a known insect or animal bite, maybe not, I feel really anxious for no reason, or I'm so irritable, or having episodes of where I just feel like I can't control my anger.”

Schizophrenia has been associated with Bartonella. I see a lot of mast cell activation syndrome, which we're going to talk about a little later. And dysautonomia, which is kind of an umbrella term for dysregulation of the autonomic nervous system. And that often shows up as Postural Orthostatic Tachycardia Syndrome. It can show up as temperature dysregulation. A lot of times we'll see people with hypermobility issues. And some of that can be genetic. But Bartonella does, in fact, the extracellular matrix and can affect collagen remodeling among other tissues that can also infect/affect.

But a lot of times, it's like you pick up on these subtle patterns, you're like, “Okay, there's some foot pain from vascular inflammation. There's anxiety and irritability.” They seem very sensitive to antimicrobials. Like they're having significant die-off. And a lot of it looks like neuropsych. And there's some dysautonomia. That's when I'm really thinking, “We need to look for Bartonella if we haven't already.” And then I'm asking all our relevant kind of vector exposure questions.

[00:07:29] SCOTT: It's interesting that Bartonella creates so many neuropsychiatric symptoms in addition to the physical symptoms. And I'm wondering, do you think that Bartonella could be an explanation for many conditions that conventional medicine considers psychiatric in nature?

[00:07:45] DR. PLANTE: Absolutely. So I think that the future of psychiatry might be a bold statement. But I think the future of psychiatry is understanding the immune system. We know that the GI – The gut-brain microbiome axis is huge when it comes to neuropsych conditions and how severely they present. I remember reading just this anecdotal article when I was in medical school about a patient who had failed multiple antidepressants, and was given a probiotic, and their depression went away.

And so we see – And that's one example, that the inflammation at the gut barrier is a huge factor. And there's a lot of infectious organisms, particularly these low-abundance vector-borne infections that can infect the nervous system. Or by infecting other tissues cause more of a systemic inflammatory reaction that can affect the brain.

We do have some – Associated some data that shows associations with schizophrenia. And then it's particularly anxiety and depression as well. And neurodegenerative diseases have also been implicated. They found Borrelia Lyme in the brains of folks with dementia. And so, I think it's only a matter of time until we have a clear mapping of the role of low-abundance vector-borne infections in psychiatric disease. But I do suspect we're going to see more and more of that. And we do see a lot of people get better when we treat that.

[00:09:06] SCOTT: Yeah, I would totally agree. I've collaborated with a few people over the years that were in the mental health field that then had their own vector-borne condition journey, and then really struggled to kind of go back to the way that they thought about the work they were doing previously, because they had a totally different perspective on what could be driving a lot of these conditions. So I agree with you. I think it's an area that really needs a lot more exploration.

One of the other symptoms that some people will talk about is what looks like stretch marks. Some people call them Bartonella tracks. Some people call them striae or striae. Do you see those resolving with treatment? Or is it something that even after the infection has been largely treated, no longer producing other symptoms that those signs may still persist?

[00:09:53] DR. PLANTE: Yeah. That's a great one. I've only seen that in a fraction of the folks that I work with that have Bartonella. And when you see it, it's very distinct. That kind of looks like tongues of fire or like a comet, where there's like a red tip and then it kind of fades. And you'll often see them in a series. In the majority of cases that I've treated, I do see those resolve usually fairly early on.

In many cases, they're considered to be diagnostic. Like you see them in the context of symptoms and you're like, “Okay, we should still run labs. But let's get treatment started right away.” I've even seen that go away with Azithromycin within a couple of weeks. And so, most of the cases that I work with that's resolved, there are many instances where we don't even see the tracks show up.

[00:10:39] SCOTT: I want to talk a little bit about SIBO. And so one of my observations over the years is that, in SIBO, Rifaximin is one of the commonly used medications. Xifaxan is another name for it. Rifampin, commonly used in the treatment of Bartonella. So I'm wondering if you think that Bartonella could be a contributor to SIBO. And wondering if Bartonella may have some gut or GI manifestations as well. Could that be impacting, let's say, the vagus nerve? Impacting the migrating motor complex? Increasing the potential for SIBO? Any thoughts on a potential correlation between Bartonella and SIBO?

[00:11:17] DR. PLANTE: Yes. So I've seen it a number of times. What's interesting is I've seen it a number of times where we're treating SIBO as the tip of the iceberg. But we don't know that fully. Like we're doing Rifaximin. We're doing herbs. We're doing motility agents. They're getting some improvement, and then we stop Rifaximin, and they relapse. And there's been a number of instances where I found mycotoxins in cases like that. And I've also found vector-borne infections, including Bartonella.

And there does appear to be a dysmotility component, likely through the vagus nerve. Bartonella and other vector-borne infections can infect the gut as well. And primarily, the vasculature. And so if we think, “Okay, if the blood vessel cells, particularly the endothelial cells, are being infected, and there's an inflammatory reaction happening there, that's going to affect blood flow to potentially everywhere in the body.”

And so if you add that to neuropsychiatric distress, that's kind of a recipe for reduced blood flow to the gut. Or put another way, instead of the rest and digest branch of the nervous system, you have more of the fight or flight. And so blood is going away from the gut. So you have less digestion. You have dysmotility. And then of course, there's the immune dysregulation component, which we'll talk a little bit more about. That Bartonella will actually secrete anti-inflammatory cytokines to try to suppress, which seems paradoxical, right? You would think inflammatory. But actually, anti-inflammatory, because it wants to remain undetected.

And so we're dysregulating the gut immune system. We're dysregulating blood flow to the gut. And we're dysregulating the nerve function that regulates the gut. A lot of times we're going to see that show up as small intestinal bacterial overgrowth, or small intestinal fungal overgrowth. A lot of times, both.

And so if I'm treating a SIBO case, or a SIFO case, and we're just not getting anywhere, and we start treating tick-borne infections, I do often see that get better. And it's kind of cool, because they're like, “Oh, wow! The Azithromycin, which you wouldn't have thought of as being a SIBO drug, or methylene blue, even sometimes Doxy,” which, although, tetracyclines are sometimes used for SIBO, we can see some improvement.

[00:13:23] SCOTT: And it's interesting, too, that you brought in the mold and mycotoxin piece. I know Ann Corson of course and talks about this all the time. Neil Nathan does as well. Dr. Corson will say that mycotoxins, in terms of their impact to the gut, are like throwing sparks on a silk scarf. And so, I think it's really important, as you pointed out, to think about that as well. That environmental exposure externally might actually be part of why we have this internal microbiome imbalance as well.

We know that there are many vectors for Bartonella. Tick bite is not necessarily required. So what are some of the vectors that you see in your patients? And do you think that Bartonella could be transmitted in pregnancy, potentially via breastfeeding or even sexual transmission?

[00:14:05] DR. PLANTE: Yeah. Great question. That’s not answer yes. That’s a multistep question. So, vector. This is what's so fascinating about zoonotic or vector-borne infections, is like we're just at the beginning as a medical community, and as a research community, in terms of identifying all of the different species of organisms that can be transmitted. And then what are their vectors? And so, Bartonella kind of came on the scene as a tick-borne coinfection of Lyme. Because a lot of times we were saying, “Well, why are some of these Lyme cases not responding to anti-Borrelia antibiotics? “Oh, well, there's Babesia, or Bartonella, or potentially others as well.”

But the reality is ticks are still kind of considered debatable in terms of whether or not they're actually a vector of Bartonella. Now, clinically, we see that, that it appears to be there's been sampling of ticks in the Bay Area and testing their microbiomes for Bartonella. And they've found it in a large percentage. I suspect that it is a tick-borne infection. But fleas are actually the most common vector.

And what's interesting is actually how they transmit it. You would think when the fleas are biting you that it would go through their saliva, but they actually have – They will defecate on to the skin. And it's in the feces. And then that will burrow into the skin, get into the blood vessels, infect the red blood cells on the endothelium. And then it's kind of off to the races at that point.

And so, fleabites, most commonly from cats or even dogs as well, will harbor different species. There're at least 20 species that we know can infect humans, potentially more. But current diagnostic testing is really only looking at a few of them. And so we're still in the process of figuring out just how relatively abundant are these infections in our environment. But fleabites, also lice. The research, more body lice than head lice. Although, I don't think it's out of the question that head lice could be a potential route of transmission. Biting flies. People ask me all the time about mosquitoes? I'm just not sure. I think it's really hard to identify that for sure. I think the Babesia, there's a little bit more stock in that because it's like malaria, and often present similar.

I'm always asking about pets. So it's like, “Do you have a cat? Did you ever have a cat? Do you have dogs? Do they sleep in your bed with you? How much did it like your face? Any bites or scratches that you remember?” And sometimes people will say, “Well, I never had pets, but I got a major dog bite when I was four-years-old. And I’ve been struggling with chronic issues since then.” Or something like that.

And so, animal – And then farm animals, too, sometimes. Like people – I've seen it in folks who work with horses a lot, and ride horses. And that may have been through a tick bite, or a fly bite, or a flea bite. But it may have been through direct contact with the animal as well.

In terms of pregnancy, I think the jury is still out on this one. My suspicion and what I see clinically is a lot of families that have tick-borne infection. We know, for sure, that Lyme can be transmitted transplacentally, from mother to fetus. I've seen it with the Babesia a number of times. And there have been instances where I suspect that's been the case with Bartonella, as well. And we will have lab testing for both the parent and the child, the mother and the child. And we often will find – I'd say, I've seen it a few times.

In terms of through breast milk or sexually, that's where I think it's a lot harder to say definitively, because we don't have solid research data on this in the literature right now. But it's one of the things that I'm always considering. How far along is mom in treatment when she's lactating? Are we doing maintenance support that's going to be safe during lactation?

In terms of sexual transmission, I've seen so many spouses both with Lyme. With Bartonella, I've seen it a little bit less. So it may be occurring. I don't know if we're able to say definitively that this is a sexually-transmitted infection.

[00:17:56] SCOTT: Many people think of Bartonella as a coinfection of Lyme or Borrelia. It seems that Bartonella is probably far more challenging to address than Borrelia. So I'm wondering if you see Bartonella as a coinfection of Lyme. Or do you see Borrelia as a co infection of Bartonella? Which one do you think is really the kingpin in this situation?

[00:18:18] DR. PLANTE: Yeah. So I think there can be variation in this from person to person. But the effects of Bartonella and Babesia on the immune system, and I'll talk about that in just a second, seem to be so dysregulated, that it's a lot harder to treat Lyme than it would be in somebody who only has Lyme.

So I've been saying this for a year or so now that I really think that Bartonella and Babesia are the primary players. And that Borrelia is kind of the tip of the iceberg. And it's one of the easier ones to detect. And one of the relatively more straightforward ones to treat just because people have been treating it for a lot longer, like doctors. So we have more knowledge about what's helpful for that.

So what do we mean about why is Bartonella potentially the main player? It's that it both passively evades the immune system by hiding out in tissues that are hard for immune cells to get to. It's a notorious biofilm former. Biofilm is this kind of protective matrix that bacteria create to shield themselves off from the immune system and create a more hospitable environment for them and for other microbes. And then also is involved in these fibrin nests, which are these networks of basically clotting proteins that form intravascularly. And they form these like – They almost look like encampments when you're looking at it under a microscope. Babesia does this as well.

There's some research, early research, that’s suggesting that Babesia and Bartonella are synergistically involved in this nest formation. So there's more of a resistance factor in terms of being able to get at it from an immune and antimicrobial standpoint. You got to break through those nests, you got to break through that biofilm.

Borrelia, Lyme, can be a biofilm former as well, and there can be persister forms, but not to the same extent. At least not that we're seeing clinically. There's some relatively newer data that does suggest that Bartonella can also be in a persister form, which basically means it's less susceptible to antibiotics, and you need to use slightly different tools or different antibiotics. So there's that component of it. It's harder for the immune system and for anti-microbials to get to. And then there's a kind of active immune evasion, where it secretes anti-inflammatory cytokines that turn down a Th1 or antimicrobial immune response. And we'll talk a little bit more about that when it comes to Th2, and Th17, and Treg. But there's often kind of a pseudo-immune tolerance type dynamic where the infection is trying to remain undetected. We think about this in animals, and how this would be adaptive for the organism to remain undetected by the host’s immune system so that they can survive long enough for their offspring to get picked up by the next biting insect and carry it on.

And so, when we, the accidental host, get exposed, there's all this immune signaling that starts going on. And that's part of why we see it as a precursor to Bartonella as a precursor to autoimmunity, or allergy syndromes as well. I think we're going to find that it's a much bigger player than we previously thought.

[00:21:22] SCOTT: Yeah. I think Bartonella and Babesia are far more symptom-producing and far more challenging to treat than Borrelia. So I share your observations there. Like Borrelia, like the Babesia, Bartonella can be really difficult to confirm with lab testing. So I'm wondering if you can walk us through some of the key labs that you find useful in diagnosing Bartonella? And are there some cases where you look at symptoms and you can't get that lab confirmation? So you decide that you just empirically proceed with treatment to see what type of a response that person may have?

[00:21:56] DR. PLANTE: Yes, so both of those. At this stage in my practice, although this is an ever-evolving process, I'm using primarily IGeneX and Galaxy Diagnostics. From a cost standpoint, I found IGeneX ImmunoBlot, the Bartonella IgM and IgG ImmunoBlot, which is essentially just a refined Western Blot, to be reliable, in addition to getting a symptom questionnaire and thorough analysis of kind of vector exposure history. I will also run Galaxy Diagnostics. I really liked their IFA, because it quantifies their IgG immunoassay, immunofluorescent assay, because it quantifies the amount of antibodies. And so it's a serial dilution.

And so if you're like, “Okay, IgG is positive, but IgM is not positive on IGeneX, is this still an active infection? Or is this just antibody production related to past exposure?” If you run the Galaxy IFA, you're going to see – If that titer is really high, and it's correlating with symptoms, I'm expecting that we're going to see that that organism is still active.

Of course, Galaxy is also doing some really exciting cutting-edge work with culture enrichment, PCR, and the droplet digital PCR. I haven't done a ton of it mostly just from a cost standpoint. But it's certainly exciting. And that is what's being used. My understanding is that's what they're using when they're involved in research studies that Galaxy is partnering with. I don't want to speak on behalf of them. But I know that that's one of those things that we're using more and more as a community, as the vector-borne infection community is trying to really pinpoint what treatments are effective. And how do we track changes in active infection?

TLabs is also doing some really exciting stuff for TLab in terms of microscopy and fluorescence. I haven't started using them yet. But they're still kind of research purposes only. But I know that there are clinicians that are using that just to inform the process of evaluation. And that's if you see it under a microscope, you know it's there, because you're seeing it. But the absence of it doesn't necessarily rule out active infection.

So there is always kind of – and ILADS still defines these as clinical, not laboratory diagnoses. So I always disclose that to patients, because they're going to be spending a lot of money on testing. They’re going to be spending money on treatment. I want them to know that we're assembling – I call it the landscape puzzle. It's a puzzle. Maybe it's the Grand Canyon, or a rainforest. And some of those puzzle pieces are going to come from your symptoms. Some of those puzzle pieces are going to come from your history. And some of those pieces are going to come from labs. And some of them are going to come from your response to treatment.

And so we are working together over a couple of months, at least initially, just to gather all those pieces and make sense of what are these obstacles to your health? What are the infections present? What are their toxins present? Where do we need to really kind of dial things? And so that's really my approach to Bartonella as well.

[00:24:50] SCOTT: When we have these chronic infections like Borrelia, like Bartonella, like the Babesia, why is it that some people become ill or have a disease process but other people are completely symptom-free? What are the factors that differentiate the group that never noticed they have an infection from those that develop years, or decades, or lifelong health challenges in some cases?

[00:25:13] DR. PLANTE: Yeah. So I think this is the million-dollar question in chronic disease and in the future of medicine, integrative medicine, but just medicine in general, which is the return to more of a terrain theory, rather than the germ is what's causing the illness in everybody. Instead, there's a dysregulation in the terrain or the ecology of our physiology.

One of the things I love about being a naturopathic doctor is we were kind of taught that very early on. The more I do medicine, the more I get exposed to different conventional and more targeted approaches. And then I keep finding, though, clinically, that I'm coming back to that pattern of, “Wait a minute. You and your husband both have Lyme and are both living in this moldy apartment. He's totally fine. You're sick. What's going on?”

And so there's genetic factors, there's lifetime exposure factors. Maybe she grew up on a farm that had chemical runoff, or maybe was exposed to tick bites earlier in life that he wasn't exposed to. So there's that exposure history difference. There is the stress component to it. So, trauma, PTSD, limbic activation, all those things can affect the way that our brain and our immune system communicate with each other. And that can affect how somebody responds to treatment.

I think the folks that are the sickest right now with chronic inflammatory illness are the canaries in the coal mine and are going to bring our attention both medically and as a society to the fact that we're not really living in a harmonious relationship with the natural world. We've got to deal with microplastics. We've got to deal with hundreds of foreign molecules to our physiology that were developed over the course of the last 100 or so years.

And at least in the West, our microbiome diversity is lower than it's ever been. And diversity of microbes is associated with the robustness of our immune system in terms of being able to buffer against outside stressors and promote immune tolerance to things like foods and airborne potential allergens, things like that.

And so our immune systems, like, they evolved to be dealing with a lot of ongoing outside stressors that we would experience, say, if we’re like living in the woods our whole life. And so now that we're in these kind of hyper-hygienic environments, and then are also exposed to all these xenobiotics, or foreign molecules, coupled with the things I've mentioned, there's a lot of stuff stressing our immune system.

So I think the sign of the times is different immune stress than we've ever had to deal with in our evolutionary history. And so some people that are genetically susceptible, that had in utero inflammatory exposures, and then all the other things I just mentioned, seem to be more inclined to be showing the signs and symptoms of the chronic inflammatory illnesses that I think many of us are going to ultimately end up with if we continue to have the exposures that were exposed to.

So I know that's kind of a heavy thing to think about. But I think this is a wake-up call. And the more doctors and the more patients to talk about these conditions, the more attention I think we're going to put to why are some folks more sick than others? And ultimately, what can we control in our environment to promote health across the board? COVID is another thing that's bringing our attention to that as well.

[00:28:31] SCOTT: Talk to us about the idea that Bartonella may produce a toxin. What is the purpose of that toxin? And can it be removed independently of antimicrobial strategies? How do we deal with this toxin? Or how does it shift some of the treatment approaches, if at all?

[00:28:48] DR. PLANTE: So I love this question, because I went down the research rabbit hole with this one. I wasn't able to find anything in the literature suggesting an exotoxin, or a secreted Shiga toxin or something like that that some of these other organisms make that produce a severe acute inflammatory response.

It is a gram-negative bacterium. So it does produce lipopolysaccharide, which is also known as endotoxin, which is a part of the cell membrane that in most infections does stimulate an inflammatory response. And when it gets into the bloodstream can stimulate a significant inflammatory response.

What's very interesting about Bartonella, and kind of dovetails on what we talked about before with immune dysregulation, particularly Bartonella Quintana, their LPS actually stimulates the production of IL-10, which is an anti-inflammatory cytokine, that was shown in the research to actually block out LPS induction of inflammation by E. Coli. And so it does have an endotoxin. But it has a bit of an immune dysregulating or anti-inflammatory endotoxin. At least what I was able to find with Quintana. Not sure about some of the other species. And be very curious to hear if you've heard from others that are seeing more, either endotoxin or exotoxin reactions. But I found that interesting, because a lot of times we are seeing Bartonella show up in more of a dysregulated immune type activity than over inflammatory type activity, at least early on.

[00:30:16] SCOTT: Is there anything unique that you do then to help the body deal with lipopolysaccharides? Like, that's an issue even beyond Bartonella. But does that change anything?

[00:30:27] DR. PLANTE: Well, a lot of times folks with leaky gut or gut permeability have issues with LPS antibody production, because there's a lot of LPS in the E. coli which are part of our normal flora. A lot of gram-negative bacteria in our gut. And so when you have a lot of extra LPS floating around in the bloodstream, it can be inflammatory.

And so Bartonella LPS, not so much. But just thinking about LPS in general, supporting gut barrier function. I use a lot of anti-inflammatory supplements, because, honestly, I think two things cause chronic illness; stress and inflammation. And there's all sorts of different kinds of stress and all sorts of kinds of inflammation. But a lot of anti-inflammatories that aren't immune suppressive are usually helpful. So there's that.

And then if there was mentioned in the past from me about Bartonella toxins, I may have been referring to some of the metabolic waste materials that microbes dump when you start killing them and disrupting their cell walls and their cell membranes, also known as facilitating a Herxheimer reaction, or die off symptoms. And there's a lot of things that we do to kind of help manage that.

[00:31:29] SCOTT: So digging in a bit more to the contributor of mold and mycotoxins to immune dysregulation, to chronic infections, how often do you see someone with Bartonella and Lyme-related issues that does not have some degree of mold exposure or mycotoxin burden as part of the puzzle? And if someone is dealing with environmental mold and Bartonella, in what order would you then approach treatment?

[00:31:54] DR. PLANTE: Yeah, so in the vast majority of cases, I do see at least some mycotoxin component. So I'm working with a few patients now who are in the process of moving out of their home to a newer home that, hopefully, fingers crossed, has less mold. And that we did find mold than the previous home. We did see elevated urine mycotoxins being excreted. And then we also found a lot of – One or more vector-borne infections and even opportunistic viral infections.

The traditional, or I should say the dominant, I should say, school of thought, is to treat the mold first. Because mold dysregulates the immune system. Mycotoxins tend to dis regulate the immune system by blunting the Th1 one blunting the productive antimicrobial activity of the immune system, and over expressing the Th17 or less productive inflammatory cycle pipe, as well as allergy type components of the immune system as well. If there's mast cell activation, then that's a whole another story, and we will talk about that.

But generally speaking, we want to get the mycotoxins to a more manageable level before we start treating infections. What I found is that this isn't always black and white. I wouldn't say we won't do anything for Lyme and Bartonella until we've gotten all the mold out. Not everybody may agree with me. But in a lot of cases, I found starting the antibiotics, as long as you have some degree of antifungal protection, if you're suspecting colonization with mold, whether that's an in statin, pulsing, one of the Azole antifungals, or just herbs. I use a lot of herbs, because they have antibacterial and antifungal – Many herbs will have both antibacterial and antifungal activities. So you get some coverage there. But the main idea is if micro toxicity is really dominating the picture, we want to get that to a more manageable degree. They'll be able to tolerate Bartonella treatment a lot better with less die-off symptoms, and it'll be more effective

[00:33:45] SCOTT: With what we've seen in the past couple of years with COVID, I'm wondering how that's impacted the landscape of the people you're treating? Are you seeing more Bartonella, more Borrelia, or maybe activation of chronic viruses like EBV? So is the immune dysregulation from COVID leading to activation of some of these things that may have been dormant in the body or controlled by the immune system prior to having COVID, for example?

[00:34:10] DR. PLANTE: Yeah. So it was interesting, because I joined the BioReset Medical team probably about 9, 10 months ago. And so, there were, of course, changes in the COVID landscape since my last clinic and where I am now. And so at my previous clinic, a lot of the folks that I was working with vector-borne infections knew that they had them, or we diagnose them, but they hadn't yet gotten COVID. And so, a lot of our conversations were around how do we prevent outside of the box of what the CDC is recommending? How do we prevent COVID? How do we mitigate long haul COVID in the couple of instances that we're seeing? And we did tend to see it a little bit more in folks with previous infections and toxins.

At BioReset, we see a lot of people who previously thought they were healthy. They're like, “I was fine until I got COVID. And now I have long haul symptoms. And the threat of my immune system is kind of coming undone.” We also saw a lot of folks have reactions to the COVID vaccine, which is quite interesting. Because, previously, the last clinic I was working with folks who were being treated for infections, we were really working on their immune system. A lot of them got vaccinated and were totally fine.

So I think whether it was the vaccine, or the or the virus, or both, it was the straw – In many folks, it was the straw that broke the camel's back. Or I use the analogy a lot of the supersaturated solution, because I was a chemistry major and I'm kind of a chemistry nerd. That's where you have all this crystallized solute dissolved in liquid. And it's to the point where you can't add any more solute to that liquid. Or it's going to come out of solution. But you look at the solution, it looks totally clear. You add that extra speck of solute, and all of a sudden everything crystallizes out. And it doesn't really matter how much more liquid you add to it. It won't go back into solution.

We're finding a lot of vector-borne infections, and a lot of mycotoxicity, and a lot of chronic viral infections in folks with long haul COVID that never knew they had them. So there was something about the additional insult, whether that's the immune dysregulation caused by COVID, the persistence of the virus, or the persistence of viral fragments that are continuing to activate the immune system. We're still flushing that out. Although there does seem to be some emerging evidence that suggests that it may be at least a chronic infection, if not some of those other pieces as well, COVID, which is quite interesting. So the short answer is yes.

And what we're finding right now is that the best approach to treatment – And I’m very open to this being incorrect in the future. But our best approach to treatment is to identify and treat those underlying immune stressors. There are a lot of talks on, “Okay, what's the miracle thing that can treat long haul COVID? How would we use antivirals that have targeted effectiveness against COVID, or seem to be having effectiveness against COVID, to then treat long haul COVID?” But in many cases, it's treating the mold and the other infections and regulating the inflammatory milieu that we're seeing the best improvement in terms of long haul COVID.

[00:37:05] SCOTT: Let's talk a bit about mast cell activation syndrome, about the cell danger response, about dysautonomias. Do you think that Bartonella could be the sole trigger or primary trigger for mast cell activation, Cell Danger Response, dysautonomias, like POTS. Do you see mast cell activation when it's just Lyme? Do you see it with just mold? Or is it fairly common that Bartonella needs to be part of that picture?

[00:37:31] DR. PLANTE: So, earlier in my career, I started to notice some – Or in my career in treating these infections, I started to notice some patterns, which were I very rarely saw mast cell activation syndrome in Lyme disease alone. I did see it in mold toxicity alone. And I did see it in Bartonella Alone. Very commonly, it would be some kind of combination of that. So mold and Lyme, Lyme and Bart, Bart and mold.

But I remember being very surprised at how many times I saw it in what seemed like Bartonella alone. Now, we didn't always go down the rabbit hole, at least initially, in terms of toxic metal testing. And there's the possibility that they were slow excreters in terms of urinary mycotoxins. Not to mention some of the controversy around lab methodologies in terms of testing mycotoxins. And so could they have had mold and Bartonella and that's why they developed MCAS and we just didn't find the mold? Yeah, it's possible. So is purely anecdotal.

But I have seen what has seemed like Bartonella being the primary driver of the overactive mast cell or Th2 type response. And a lot of times those are folks who also have dysautonomia. Many folks have said that dysautonomia and mast cell activation syndrome are two sides of the same coin. There are a lot of factors that can contribute to dysautonomia. But the mast cell degranulation of histamine and other inflammatory mediators, on the ends of autonomic neurons, can dysregulate their signaling and often shows up as POTS, or dysautonomia, attempt dysregulation, that kind of things. And so, sometimes mast cell – A lot of times mast cell stabilizers will help with dysautonomia symptoms. When there's dysautonomia, there can also be hypermobility.

[00:39:19] SCOTT: Digging in a bit more to Cell Danger Response, Dr. Naviaux’s work, do you commonly observe that people that are kind of stuck in that protective CDR1 state can move on to CDR2, and CDR3, and ultimately out of that cell danger response with treatment of Bartonella?

[00:39:37] DR. PLANTE: In my experience, yes. But if you go slow, I think folks that are really in that cell danger – And I'm still getting to be familiar with Dr. Naviaux work and kind of the nuances of the different stages of the cell danger response and how best to manage that. What it seems like is if they're stuck in that, at least initially, we don't want to do too much to stir the pot, because the body is working really hard to maintain homeostasis.

And so the art of antimicrobial treatment and detox treatment is going slow and tracking the responsiveness of the body. And a lot of times there's a limbic activation component as well. So I'm usually getting folks on either the DNRS or the Gupta program to help reset the limbic system. There may need to be mast cell stabilization support. Although I don't suspect the CDR is always due to MCAS. But it's something that I'm thinking about. And then it's just like, “Okay, we're drop dosing herbs. I'm just getting into the beyond balanced formulas now. And I'm liking them because they're tolerable, but still helpful. And so I'm not going to be giving somebody high doses of Rifampin or Cryptolepis right out of the gate if I suspect that there's an overactive Cell Danger Response.

[00:40:50] SCOTT: We know that mast cell activation is an indication of Th2 dominance. Same arena where we see auto immunity, allergy, asthma, those types of things. So With digging further into this T cell polarization arena where Th1 is blunted, Th2 is often heightened, what are some of the contributors to Th2 dominance that can then lead to autoimmunity? Th1 being diminished, can lead to the persistence of these chronic infections? Where do you think Bartonella fits in terms of being a driver for autoimmunity? And then more broadly, how much of the symptom picture is the bug, versus the immune response, or host response to the bug?

[00:41:28] DR. PLANTE: So what's really interesting is some of the newer research around autoimmunity is showing more and more Th17 activity, which is a distinct branch of the immune system that's involved in perpetuating inflammation. And we might think, “Well, that's got to always be bad, right?” Not always. We think about calling in reinforcements. For some reason, I’m just keeping this Lord of the Rings image in my mind of like the Th1 is leading the attack. And then that scene in The Two Towers when – It's been a few years since I've seen it. But when the reinforcements come right at the end, right? When all hope is lost. That's kind of the Th17.

So under a healthy environment, that Th17 will just be an extra bump for the immune system to do what it needs to do, and then it's time to go home. Treg or Th2 kicks in and is anti-inflammatory and says, “Okay, we can pack up our bags and we can kind of calm down.”

With autoimmunity, we see an overexpression of Th17. An under expression over time in a lot of autoimmune diseases, although, not all of them, of Th1. And a loss of immune tolerance, or a loss of that T-regulatory anti-inflammatory T cell component. And so there's a lot of dynamics and there's a lot of folks that are really kind of on the frontier of how these immune system things play out. We need more of a Th1 response, in a lot of these cases. We also need more of a Th3, or T-regulatory, anti-inflammatory. So it's like how do we both treat the infections with Th1 that are causing the dysregulation of Th2 and Th17, while at the same time promoting self-tolerance through that Treg so that your immune system doesn't keep attacking itself.

There's a variety of ways in which Bartonella does is primarily through the cytokine production, both that the organism itself makes and that the immune system makes in response to the organism. And a lot of these are Th2 cytokines, which tend to facilitate mast cell activation. Not as a syndrome, but just as a process. And then just the dysregulation of the immune system that can happen with other insults tends to prime those mast cells to be more and more responsive to less and less of an actual threat. It's kind of like folks have referred to it as PTSD of the immune system is what mast cell activation syndrome is.

And I love that analogy, because a lot of times there's significant anxiety and significant nervous system hypervigilance, sensory sensitivity, all that that goes along with it. And so when I say it like that, they're like, “Oh, that's so validating. My immune system and my brain are in this relationship that everything is a threat.”

And so, circling back to kind of those components of the question, there are mechanisms that directly facilitated Th2 two response. The fact that Th1 is actively blunted I think is part of why Th17 says, “We need to pick up the slack.” And by trying to perpetuate a relatively weak antimicrobial attack, there's a loss of self-tolerance. And there's also a molecular mimicry. There's a variety of mechanisms involved in autoimmunity. Collateral damage, like when you disrupt a cell, especially when there's an intracellular infection, you have T cells that break, that lyse that cell. You're going to have self-proteins get disseminated. And those are going to be picked up by antigen presenting cells and prime others T cells. And so that kind of is what initiates the autoimmune cascade.

But in most cases, the best approach to treatment is going to be to calm down that autoimmune process and then kind of go back and identify and treat what are those underlying triggers that cause the immune disruption and cause this perpetual offensive move to be going in the first place.

[00:45:10] SCOTT: More and more I see people struggling with hypermobility syndromes, Ehlers-Danlos Syndrome, even things like Cranial Cervical Instability, or CCI. I'm wondering what you think the role of Bartonella is in those conditions? And how do you un-layer the factors that are stressing a person's collagen, their structural integrity? What can you do to support structural integrity in people with these conditions?

[00:45:35] DR. PLANTE: I think that it plays a role. Bartonella does cause collagen remodeling. I don't think that in the majority of – And this is fairly anecdotal. But I don't think that the majority of cases of Ehlers-Danlos are caused by Bartonella. There is definitely a hereditary component. I just had a great consult with somebody earlier this week who we did a very thorough infectious disease, environmental exposure screen, and there wasn't anything clear. Now we're still going to do some testing. But it was like, “Hmm. What's going on here?” Because there's symptoms of mast cell activation syndrome, and EDS, and fibromyalgia and all that kind of stuff. Turns out, many folks in that person's family have EDS, and many of them have the atopic triad of asthma, allergies and eczema, or some variant of that.

And so for this particular individual, it may not be an infectious cause. Although we're certainly going to look for infectious aggravators. But there seems to be more of a hereditary component here. Although I'm still suspicious that maybe there's early life exposure of something that we're not recalling, or injured, or exposure of that. And so, I think there are many mechanisms at play here.

The biggest thing, especially from kind of a naturopathic standpoint, is identifying and treating anything that could potentially be aggravating a predisposed system. And so, sure, okay, somebody has hypermobility. They may always have hypermobility. What can we do to manage that? Regenerative injection therapies might be helpful in terms of strengthening connective tissue, collagen, supportive nutrients. So I'm a big fan of Designs for Health Arthroben, which is collagen that has Scutellaria. It has baicalin in it, from Chinese skullcap, which is antiviral and anti-inflammatory.

I haven't seen that in and of itself be like a miracle. But in the context of kind of everything, nutrient cofactors, minerals, lysine, we use a lot of peptides. GHK is connective tissue supporting. There's a lot we can do that can kind of support connective tissue in and of itself as well as trying to treat these underlying inflammatory triggers that are involved in collagen remodeling.

[00:47:43] SCOTT: And the Chinese skullcap is interesting, too. I think that's one of maybe two herbs that are thought to have some potential role in the Cell Danger Response, in that while they don't address all of the receptors, like Suramin might, that they do have some anti- purinergic properties as well. So it seems like Chinese skullcap is getting a lot more attention in recent years in this realm.

Many people have made a connection between Bartonella and Morgellons, or maybe better said some people, because there probably aren't many people that really actually acknowledged that condition. But what I've heard over the years from people like Dr. Ginger Savely, is that things that work for Morgellons are often those things that are treating Bartonella. And so I'm wondering if you've worked with many Morgellons patients? And if so, do you find that treating Bartonella or using things that might support Bartonella can improve the quality of life in the Morgellons population?

[00:47:28] DR. PLANTE: Yes, I suspect so. I've worked with a few with Morgellons. And I've found Bartonella present in all of those cases. And I did see improvement with macrolide antibiotics, like Azithromycin or Clarithromycin. There often is a parasitic component. So I see Ivermectin being very helpful. There's some evidence to suggest Ivermectin can be helpful for Bartonella as well. And so there's this question of, “Okay, well, what are we actually treating?” And I almost always see a mold component in Morgellons.

The way I think about Morgellons is – And I love what Dr. Savely is doing, and others in this field as well. But the way I think about it is this like mold, severe, severe untreated mold, and vector-borne infection that's been present for quite some time and hasn’t probably been treated. And oftentimes, I'll see hepatitis.

I know, Dr. Savely has mentioned this as well. I've seen Hep C a couple of times in a patient either knew they had or didn't know they had. And so there appears to be this poly microbial component, coupled with just not being treated. And so I remember this one patient I had a few years ago, and I was like, “Tell me about –” Like, he was in his 60s. And I was like, “Tell me about your early life exposure to mold.” He was like, “Oh, it was so bad that nobody should have been living in that house.”

And I've done consults with folks on the phone that they're like, “I'm seeing things coming out of my skin.” And I'm like, “Tell me about if you're living in mold.” And they're like, “Actually, I was just evicted from my place because how bad the mold was.” Or maybe evicted isn't the right word. But like, so bad. And so, there's almost always that that I've seen. And then there is that responsiveness to Bartonella treatment.

[00:50:16] SCOTT: Let's talk a little bit then about treatment strategy. So do you start with antimicrobials? Or are there some foundational things that you do first to set the stage for treatment?

[00:50:26] DR. PLANTE: Yeah. So the immune dysregulation piece is so critical. I put a lot of attention to that, as well as initial detox. And so if there is toxicity present, that kind of goes without saying. But we want to address that. I put a lot of emphasis on what I call anti-inflammatory buffering. Those are going to be things that support the Treg response.

And then more recently, I've been doing a little bit more to also support the Th1 response. That comes from the work of Dr. Yanuck, talking about how there's often a blunted Th1 response when we have an overactive Th17 response. So I love that.

And so there are a lot of things that both support Th1 and are anti-inflammatory. The bioflavonoids, luteolin, baicalin, those kinds of things. And so, anti-inflammatory support until things are a little bit more manageable. So I use a lot of fish oil. I use a lot of high potency. I use a lot of D and K in combination. I use a lot of curcumin. I use a lot of bioflavonoids. I've been excited about aronia lately, which is a berry. You can add it to a smoothie. You can add it to an oatmeal. I put it in my oatmeal every day. It's really high in bioflavonoids, which are those dark-colored proanthocyanidins, and polyphenols, and things that are basically scavengers and free radicals. Those are going to be vascularly protective, which is important in Bartonella. They're going to be neurologically protective, and can also sometimes facilitate, at least quercetin can, gut barrier integrity.

And so working on the gut, kind of normalizing the inflammatory response. Supporting the antimicrobial branch of the inflammatory response, then adding the anti-microbials, whether those are herbs, antibiotics, or both. And we're tailoring that to the individual. I'm happy to talk more about those nitty-gritty pieces. But I think setting that stage makes treatment a lot more tolerable, and ultimately a lot more effective.

[00:52:10] SCOTT: So what are some of those things that you're finding them that are supporting the Treg, the Th3 side of that immune modulation?

[00:52:18] DR. PLANTE: Yeah. So many of the things that I had just mentioned, like fish oil, vitamin D, curcumin, a lot of times I'll find adrenal dysregulation on lab testing, as well as vitamin D deficiency. And so I consider those to be in the realm of the complexity of what we're talking about, like super, super easy, low-hanging fruit. Like, “Oh, your cortisol is low. You have HPA axis dysregulation.” Colloquially referred to as adrenal fatigue. And your vitamin D is like 16. So we get that up.

And I’ll often do like vitamin D injection, 50,000 IU once a week for like four to eight weeks depending on their levels, in addition to D3 and K2 orally every day. And I find that gets things up quick. I know there's a lot of different ways to do vitamin D dosing. But getting vitamin D regulated, the adrenal regulation piece is critical. I'll use a combination of adrenal glandulars or HPA Axis regulating herbs, including licorice, and a lot of times low dose hydrocortisone, or Cortef.

Interestingly enough, in autoimmunity, sometimes people will have high cortisol on testing. But when you give them Cortef to reduce the inflammation, their cortisol will actually normalize. So there appears to be a bit of a regulating effect there. I’ll also use low dose naltrexone. I have found that to not be the most effective when we're primarily dealing with infections, and inflammation due to multiple systemic infectious disease syndrome. Where I see it being the most helpful is when somebody has obvious autoimmune disease. They've been diagnosed with RA. They've been diagnosed with Crohn's, Sjogren’s. In all those cases, I'll try to get them started on LDN. That's a compounded medication. I'll titrate that up as tolerated while we're working on these other pieces. We do a lot of IV nutritional therapy. I'll talk about that as well.

[00:54:07] SCOTT: What are some of the tools that you find are helpful in the terrain optimization or detoxification drainage? Are there specific things that you like to do in that realm for opening the channels of elimination? The emunctories?  Do you use binders? What are your thoughts?

[00:54:23] DR. PLANTE: Yeah. So if anybody heard the Mold and Mycotoxins Summit just of – What was it? Last week, or the week before? I did a talk on constipation and the importance of having regular bowel movements when it comes to eliminating detoxification. So one, I tend to see a lot of constipation in folks with either micro toxicity or Bartonella infection because of the things that we had talked about earlier today.

In Natural Medicine, we call them the emunctories.  So that's going to be the liver, gallbladder, colon system. We eliminate things that way. The urinary system. The skin. The lymphatics, and the respiratory system, because we actually breathe out with toxic waste, including carbon dioxide. And so supporting those is going to be foundational. There are a lot of herbs that support kidney function, that support liver function, milk thistle, Oregon grape, parsley, and like other diuretic herbs. There are many formulas, including beyond balanced formulas, that can be helpful for that. Stimulating sweating is huge. So whether that's sauna, exercise, if they can tolerate it. Epsom salt baths are probably the cheapest that I'll have folks do, assuming that they can tolerate some of the vasodilation that occurs with the heat and with the magnesium. But even just starting small, like I want you to just barely break a sweat, and then that's all you're going to do today. And you're going to do that just a couple of times a week until we get you to a point where you can sweat more. Hydration is critical. So oral hydration – You'll see here, I'm drinking Ultima Replenisher.

[00:55:52] SCOTT: Hey, that’s what I got in my glass, too.

[00:55:54] DR. PLANTE: That's the best one. Yeah. There's a lot of great electrolytes out there. BioPure has one, too, that's low additives. But I like this one because it doesn't have sugar. It's low sodium. Just staying hydrated is going to keep lymphatic and circulatory – Blood circulation higher. We do a lot IV hydration and a lot of IV nutritional therapy.

And so, yes, making sure people are having regular bowel movements. Getting binders on board, especially when we're doing antimicrobials. There's going to be a lot of debris that's generated and a lot of inflammatory waste. And so I find Alka-Seltzer Gold. I find binders helpful.

Bitters, digestive bitters, are probably my favorite thing to do for constipation. I've had people on opiates, because of surgery or whatever, who took ginger, 5-HTP, stool softeners, fiber, all that stuff. And it was the bitters that did it. So I can't say enough good things about those. And it's super naturopathic.

[00:56:45] SCOTT: And I'm guessing it's because the bitters are having an effect on the bile that then is helping with the constipation, right? The whole gallbladder bile piece of it, which actually then is also nice, because the bitters, at least the way I think about it, can make the binders more effective because you're then getting the bile into the small intestine and colon where the binders hopefully then are going to meet up with some of those things. So yeah, I'm a big fan of those bitters as well.

[00:57:08] DR. PLANTE: Dry skin brushing is great from a lymphatic standpoint, lymphatic herbs. Basically, anything that's going to – We call them lymphagogues. But anything that's going to support either the circulation of lymph through counter irritant type properties. And the return of lymph into the bloodstream is going to allow – Because a lot of metabolic waste materials do accumulate in this extracellular matrix.

And unless there's flow of that fluid – In Chinese medicine, we refer to it as stagnant chi. As long as there's stagnation in some kind of circulation, whether that's electromagnetic or fluid circulation, we're going to have a buildup of toxins. And so any kind of movement, muscle contraction, sweating, circulatory work, even just contrast, hydrotherapy, can be helpful for that. And then the herbs that I mentioned.

[00:57:55] SCOTT: Do you find that your patients benefit from IV nutritional support during the treatment process? And what are some of the nutritional IVs that they potentially find helpful?

[00:58:04] DR. PLANTE: Very much so. And so, there can be impaired intestinal absorption related to vagus dysfunction, related to lack of circulation to the gut. There can also just be hard to, yeah, break down foods fully. A lot of times, folks with Mast Cell Activation Syndrome also aren't able to really tolerate a nutrient-diverse diet, because foods might be either high FODMAPs or cause more of a mast cell type response. And so we kind of have to take those barriers to nutrition into account.

But even with oral vitamin supplements, we're not necessarily saturating and getting to those Supra physiologic doses that are needed to really exert lasting change. And so I haven't seen – I say this in a positive way. But I haven't seen IV nutritional therapy by itself the be all end all of treating Bartonella. But I've seen it be very helpful in terms of improving resilience, supporting cognitive function, increasing energy and supporting detox reactions.

I've been playing around for the last few months with higher doses of sodium bicarbonate in saline, like 15 to 20 CCs and a 500-mil bag of normal saline. It's kind of like Alka-Seltzer Gold in a bag. And that helps so much. So I've had people that are either Herxing come in and they’re like, “I don't want to do – I don't tolerate B vitamins. I don't tolerate glutathione. I don't want to do NAD. What can I do that can just kind of mitigate this a little bit?” And we’ll give them that. And then maybe give them like a little bit of minerals and a little bit of vitamin C, like more of an antioxidant dose. And that's helpful.

So that's kind of on one end of the spectrum. And then on the other end of the spectrum, you can do high-dose vitamin C. We do a lot of ozone therapy, which is its own thing that we can talk about. IV methylene blue, IV artemisinin. These are all antimicrobials. But just the vitamins and mineral cofactors are really helpful in terms of regulating our biochemistry. A lot of times there's genetic snips and an issue in terms of converting certain things to other things. And so when we're giving those vitamins and minerals directly into the bloodstream, they get where they need to go.

[01:00:07] SCOTT: Yeah. It’s amazing how much of a difference Alka-Seltzer Gold, which seems so simple, can have. And thus, I also think when people are doing Epsom salt baths, that baking soda added to the bath can also be quite helpful in some of these Herxheimer reactions, or muscle soreness, stiffness, those types of things.

You talked a bit about the concept of anti-inflammatory buffering. I think you've touched on some of those tools earlier. But are there any other tools that are kind of your go-tos for this anti-inflammatory buffering to assist or prepare the person for the treatment of Bartonella?

[01:00:41] DR. PLANTE: Yeah. So I think I talked in different places about different ones. But there's Th3 regulating supplements. Getting their vitamin D and their adrenal levels into the appropriate range. Addressing nutritional status. So if they're anemic – I mean, iron can be inflammatory. So that's its own kind of controversy. But getting them out of the state of where their severely iron deficient and able to oxygenate better is going to help things regulate, even though oxygen itself can be a little bit oxidative. Just basically treating the low-hanging fruit on the medical side of things is a top priority.

And it sounds so simple, but I can't even tell you how many times I've seen that not given attention to, where docs will only run an IGeneX, or a tick-borne infection panel, or a urine mycotoxin test and not do a comprehensive quest or lab core analysis for what the immune system is doing. So if immunoglobulins are dysregulated, we're going to need some support there. If hormones are dysregulated, we're going to need support there.

So I'm a big fan of the neurosteroids, DHEA, progesterone, pregnenolone, especially in folks that need them. And so I'll run those levels. And it's very common in reproductive age women that there's hormone dysregulation. And so if they've got a lot of neuro inflammatory symptoms, anxiety, insomnia, a lot of times they're going to benefit from a little bit of progesterone, bioidentical progesterone sublingual, either in a troche or liquid, because it'll absorb better and get into the circulation more, so than in cream would.

In addition to hormone-modulating herbs, to kind of buffer the nervous system against that. And then also some of the drainage support, like Burbur Pinella. I'm a big fan of Jernigan Neuro-Antitox II. These are things that help with lymphatic flow in the brain. Getting adequate sleep. I mean, sleep exercise. Again, exercise is kind of a loaded one because of the mitochondrial dysfunction and the adrenal fatigue. And sometimes people feel worse with that. But I always have a conversation, say, “How much can you move? I don't want you to push yourself too much. But a little bit of movement is going to be helpful as we go throughout this process.” And so lifestyle, those supplements, and then some of that IV stuff.

[01:02:43] SCOTT: Yeah, I'm a big fan of the Burbur Pinella, as well. And I found that Pinella specifically seems to be helpful in Bartonella for a lot of the nervous system type things that people have. So it's more like a nervous system drainage tool. Sounds like you’ve found it helpful in Bartonella specifically as well.

[01:02:59] DR. PLANTE: Yeah. I haven't done a whole lot of side by side comparison of Burbur by itself, and Pinella by itself, versus the – I'm just using them both. But I agree with you, that it does seem to be helpful.

[01:03:11] SCOTT: So with Bartonella treatment then, do you find that antibiotics are a necessary tool? Is there a good foundational kind of place to start in the pharmaceutical realm for Bartonella treatment? And do you think that IV antibiotics are a requirement for Bartonella treatment?

[01:03:28] DR. PLANTE: I do find that antibiotics in some way, shape or form are necessary in the majority of cases. I almost always start with Azithromycin, probably because a lot of the folks that I work with are more on the sensitive end of the spectrum and have been sick for quite some time. And so it's like, “Well, Clarithro is going to be stronger.” They’re the same class of antibiotic as Azithromycin. But it has a shorter half-life and a bit of a stronger action. So it's kind of like a quicker, but stronger jab. And in the long term, I find that, in addition to other antibiotics that we’ll I'll talk about in a minute, to be more helpful.

But I like Azithromycin, because it's fairly gentle when it comes to Lyme. And it's pretty good, at least initially, when it comes to Bartonella without being super Herxy. if I'm having somebody really Herxing him with that, then I'm looking at mold, and I'm looking at these other things, and I'm making sure drainage is appropriate.

But I'll start with a macrolide. I'll graduate them from Azithro to Clarithro. I use a lot of methylene blue. It doesn't work for everybody. But I like it because it is mitochondrially supportive. It increases oxygen utilization in the mitochondria. It's cognitively supportive as a reversible monoamine oxidase inhibitor. So it's going to support serotonin, norepinephrine and dopamine. A lot of folks with Bartonella have attention issues, brain fog, low-motivation, and could really benefit from that.

In the majority of cases, it's safe with lower doses of psychotropic medications that are affecting those neurotransmitters. But I do always ask about that, because you don't want to give really high doses of methylene blue, particularly IV, if someone is on a serotonin medication. And then it's also broad-spectrum antimicrobial against Borrelia, Bartonella, and Babesia. And it may even have some antiviral effects as well.

And so I'll compound that, usually 50 milligrams twice a day. And then I'll round that out with herbs, but we'll sometimes use Doxy as well, Bactrim, cephalosporins and Rifampin in cases where – The interesting thing about Rifampin is it can be pulsed. You don't have to take it every day. And there's a lot of drug-drug interactions that Rifampin has. And so I'm always kind of paying attention to that if the patient is on something that they need to be taking for another condition.

[01:05:35] SCOTT: I think a lot of times when people start getting into the antibiotic realm, they think, “Let's find the biggest hammer and kill the bug.” One of the things I liked that you said in a prior conversation was that Azithromycin that you found that people generally seem to tolerate it. And that it's a tool that you use to marginalize the infection. So it's not necessarily that you're coming in that that's the big hammer. But just kind of, I would almost say, just taking the edge off of the microbial contribution to whatever's overflowing their bucket. Am I thinking about that the right way?

[01:06:06] DR. PLANTE: Absolutely, absolutely. So I've worked with so many folks who – And I intend no disrespect to folks that have had this approach to be very helpful. But I see a lot of folks that have not had success with heroic, aggressive antibiotic therapy. And so that's when it's like we're building that landscape puzzle. And I want to know just how sensitive this person is. If we're two months in and they're like, “I'm not Herxing. I'm not Herxing. I'm not Herxing,” then we're going to start going for the bigger guns. And we're going to talk about IV antibiotics.

I did a lot of IV antibiotics in my last clinic, less here because we do so much ozone. But oftentimes, they are helpful. I’ll do ceftriaxone, Metronidazole and Azithromycin, usually in a series. But we'll start with just the Ceftriaxone. Antibiotics, they have their place. They can be very helpful. But I'm having a conversation with a person's body. And if they can tolerate it, we turn the volume up.

I say treating your illness is like you may have a row of 10 dials with different volumes. How much detox? How much anti-inflammatory? How much antimicrobials? And then we can change that, really, at any time, based on the feedback that we're getting. And so I don't think any path is necessarily set. And that the individualization has allowed us to help people that haven't been able to get the results they were looking for before.

[01:07:22] SCOTT: I know Clotrimazole is another one that some practitioners use in the treatment of Bartonella. Rifabutin as well, which I think is a cousin of Rifampin, if I'm not mistaken, right? So any experience with either of those two medications?

[01:07:36] DR. PLANTE: I haven't used Rifabutin as much. But I'm interested in it, especially after listening to Henry Lindner talk about Babesia, and it's used in Babesia, because it targets a particular vacuole or some kind of organelle in Babesia. And so a lot of people with Babesia and Bartonella can benefit from that. I haven't used it that much.

Clotrimazole, I was getting excited about using, and have used it with a couple of people. And then to be honest, I just kind of forgot about it, because I was like I'm using all these other tools, and we're getting good results. But if there's a fungal component – Clotrimazole, to my knowledge, needs to be compounded for oral use. It’s primarily available over the counter as for like Athlete's Foot, like Lotrimin. It's like a topical antifungal.

And so in folks with mold and Bartonella, I've found that it's not super Herxy, especially if you start low. And so it seems to be helpful in cases where you're like, “I really want to not have there be fungal overgrowth that occurs while we're doing this.”

[01:08:29] SCOTT: I think, back when I was going through my treatment for Bartonella, that was back in the day when people were using lots of fluoroquinolones, things like Avelox, and Levaquin, and tools of that nature that not uncommonly could lead to what people call floxing or fluoroquinolone toxicity. Wondering if there's still a place for fluoroquinolones in the treatment of Bartonella. Or is there risk not worth it most of the time?

[01:08:54] DR. PLANTE: Yeah, it's a great question. I know that there are doctors that are still using it and are comfortable with that and comfortable with that risk assessment. I am not. I've only been doing this a few years. And so, for me just, I've seen too many cases of fluoroquinolones toxicity, especially in the context of mold or untreated mold. And so when I'm seeing Bartonella, and there's any suspicion of mold, I would not do fluoroquinolones unless there wasn't any other option. That's me personally. If there's a doctor that's like, “I've been using them for years, and I really think this is appropriate for you, and relatively safe,” then fine. But I would not be afraid to ask your doctor, “What do you think about this?” if they are recommending that. Because the mitochondrial dysfunction that occurs from fluoroquinolone toxicity can be kind of a nightmare, honestly. Not to mention the avoidance of fluoride containing molecules that needs to happen, I think, for long term recovery to really proceed.

[01:09:45] SCOTT: With some of these antibiotics, do you find that there's any additional advantage to having liposomal compounds made of some of these antibiotic tools?

[01:09:55] DR. PLANTE: In some cases. So I've just explored this with a few individuals who have exhibited gastrointestinal distress with antibiotics because of usually years of previous antibiotic treatment. I'm always giving gut barrier support with antibiotics. And I'm always getting high doses of adequate – The appropriate types of probiotics. But if even that's not doing it, I'm curious. Let me just say that, because I haven't done it a ton. But I'm curious if liposomal antibiotics, which tend to pass the gut barrier and absorb more systemically are kind of a way to work around that. The two to folks I tried that with, that didn't work. That doesn't mean that it can't. Just that wasn't the reason.

I think another reason that's valuable for thinking about liposomal antibiotics is if they can't get IV antibiotics, and they want something that's a little bit more intracellular penetration, particularly the cephalosporin. So I use Hopkinton drug a lot. I hope it's okay that I'm mentioning specific ones. But I use Hopkinton drug in Massachusetts a lot. I think they're phenomenal. They're great when it comes to asking questions. They make a liposomal ceftriaxone. That's not, to my knowledge, available elsewhere. And so that's kind of cool if you really need to use Rocephin, which is the – For Ceftriaxone, it’s a generic for that. You don’t want to give yourself gluteal injections of it because they're painful and they can cause scarring, and you're not able to get or afford IV antibiotics. That's another option.

And then I think there's also liposomal Rifampin. There's a lot of them that can be made, maybe reach out to – They're not paying me for this, but reach out to Hopkinton.

[01:11:24] SCOTT: Talk to Michael. Yeah.

[01:11:24] DR. PLANTE: Yeah, exactly. Or Dennis. Yeah.

[01:11:27] SCOTT: Yeah. And it's definitely interesting, too, because I think some of these liposomal type preparations, if we can avoid having that PIC lines, or ports, or some of those other things, which I had a PIC line for a while many years ago. And it was something that I ideally would have liked to avoid. I mean, it doesn't come without risk and some complication. Let's maybe dig into some of the other antimicrobial tools, any herbal interventions that really stand out for you? Any supplements. What are your favorite herbs in the Bartonella arena?

[01:11:53] DR. PLANTE: Yeah. If I could do – I call it the desert island, tick-borne infection herb, just because if I could only do one herb, that would be it. Although now that I said that, maybe not. But Cryptolepis, I love. I find it to be highly effective. It's just very Herxy. And so I don't usually start with that. I often start with Biocidin, honestly. Biocidin, LSF, which is liposomal biocide. And it's a very readily available formula. It has essential oils in it. It's relatively broad spectrum. And it's biofilm disrupting just to an extent, but in a way that's gentle.

And so I find that it walks the line that I'm trying to walk with the patients that I work with, which is sensitive, but also needing treatment. And so I'll do that to start. If they're Herxing significantly with Biocidin, then we need to go slow with things. We're talking dropped doses of individual herbs later, like Houttuynia, or Japanese knotweed, eventually Crypto.

But if they're like, “Yeah, I'm up to two pumps, three times a day. No problem.” Then it's like, “Great. Let's bring in the Crypto. You can work up gradually to five mils, or one teaspoon three times a day of that. Houttuynia, which also has antiviral activity against the Herpes viruses, particularly Herpes simplex 1 and 2, as well as activity against Borrelia. It's a Chinese herb. It can be a little bit cooling. So in folks that I work with that are a little bit more on deficient type constitution, I might not use that one long term. But that one can be like a half a teaspoon up to six times a day.

I use a lot of Japanese knotweed. It's neuroprotective. It's a source of resveratrol. It's antiviral. And it targets Lyme and Bartonella. It may even target Babesia. I have to review that paper from Leone and Zhang and some of those other guys. I like artemisinin. It's also antiviral. I like herbs that have – I mean, it's funny, because my last name is Plante. I never really intended to go into natural medicine until college. But what I find is herbs are just – They're so versatile. They've been fighting the war against microbes longer than we've been around. And they tend to be more modulating. And so a lot of times, they're going to have flavonoids and anti-inflammatory components in them that folks with these infections need to support their physiology, as well as being antimicrobial against bacteria, fungi and viruses, sometimes even protozoa.

And so I like herbs that do a lot of things, because that kind of covers our behinds a little bit when it comes to the limitations of diagnostic testing. Okay, we don't know if – We don't definitively know if this infection is present or not. It's kind of funny. I had a doctor, when I was in med school, who was treating me for EBV at the end of my time there. And she was like, “Hey, I really recommend Lyme testing.” You hike. And I couldn’t afford it. And to be honest, I was a little bit in denial. And so I was like, “I don't want to do it. I decline it,” whatever. I strongly recommend, for anyone listening, that you don't do that. That you do do the testing.

But anyway, she kind of snuck in the back door and gave me Cistus incanus, which is a really, really broad-spectrum antimicrobial herb. BioPure makes it. You can also get it from a few other places. It's antiviral. It's like she was treating my EBV. But she was also like, “I’m not going to take any chances. I'm going to give you –” I think Klinghardt has casually referred to it as like the one herb that you need to treat Lyme. And I'm quoting that. I've heard that through a third party. So I don't mean –

[01:15:15] SCOTT: It's definitely one of his bigger ones for early retroviruses, selective biofilm inhibitor. I mean, there's a lot of good things about it from his perspective, for sure.

[01:15:24] DR. PLANTE: Yeah. It's great. And when I first started taking it, it was kind of Herxy. So it's definitely biofilm disrupting. People traditionally in the Mediterranean drink it as a tea, because it's really good for your oral health. So I'll use it as a mouthwash and people with dental infections, in addition to other things. And so I like Cistus a lot as well. But herbs that cover multiple bases.

[01:15:43] SCOTT: And interestingly enough, BioPure now has a cistus mouthwash that they just came out with as well. So it's arriving today, because I need to try it as well.

[01:15:49] DR. PLANTE: Oh, cool. Oh, let me know what you think. Yeah.

[01:15:55] SCOTT: I know, there are some things that we wouldn't do. Like let's say high-dose manganese in Borrelia. Some people think that could be a concern. I know Dr. Klinghardt has talked about not using too many B vitamins in the treatment of parasites. And so are there any supplements or materials that you maybe wouldn't use or you would avoid in Bartonella treatment?

[01:16:16] DR. PLANTE: Yeah. That's a great question. I'm not familiar off the top of my head of any one or two nutrients that you wouldn't want to do too much of. But I would think, just in general, anytime we're trying to really force our physiology to do one thing, you're putting yourself at an increased risk. So there's going to be some kind of side effect to that, whether that's more of an enhanced detox reaction, a blunted immune response or a mis-directed immune response. Of course, there is the concern that certain micronutrients can feed microorganisms. And I'm guessing that's probably one of the considerations with manganese and beryllium. And I'm a little less familiar with that.

[01:16:51] SCOTT: Let's talk a little about your experience then with ozone, which I know is something you have deep experience and use a lot. So ozone and Bartonella, is that something that you find helpful? Does it lead patients to higher ground? And if so, how do you like to introduce ozone into the body for Bartonella support?

[01:17:08] DR. PLANTE: Yeah. So I do see it being helpful. I don't think that it's the only thing. I mean, I think that there are some places that are really prioritizing that and saying ozone is like the one thing that we're going to use to get rid of this. I find that it pairs really nicely with the anti-microbials, both prescription and herbal, and all the foundations of naturopathic and integrative medicine that we previously discussed. It's when you put it all together, I find ozone can really help take it to the next level.

And so we do a lot of IV ozone here. I've done IV ozone at my last clinic, Major Auto Hemotherapy. Here, we use the Hermann Multipass Machine. And so what that is, is it's an automated machine that is going to pull a little bit of blood from one arm. It's going to ozonate it. And then it's going to return that blood to your arm. And then that'll circulate. And we may do that multiple times. And each time you do it, it's called a pass. And so if you've heard of the 10 pass ozone, that's what that is.

We also do something called ozone dialysis, which is a higher potency continuous ozonation, where it's also referred to as EBO2, or extracorporeal blood oxygenation and ozonation, where we have two IVs, one in each arm. One is pulling blood out. It's running it through an elaborate filtration system, where we're also ozonating the blood. That filtration systems going to remove micro globulins and other proteins and some of the inflammatory debris that gets generated from die-off.

And so, what I found is that there are some cases of folks that I've worked with that Herx hurts with the 10 pass, but don't Herx with those on dialysis, which is very interesting. Because those in dialysis is technically – It's like instead of taking a cup of water out of the river and cleaning it and putting it back in the river, you're like putting a hose of cleaning product or whatever, healthy cleaning product, into the river, and continuously ozonating. We've run it for about 45 minutes.

And I found that folks tend to – A lot of times get a pretty significant reduction in their chronic viral or chronic vector-borne infection symptoms just by doing that every couple of weeks. We do have folks come from around the country and stay a week or so and do days of treatment. What I found to be the most helpful is when folks are doing it on a regular basis. So it's not just like you come for a week. We do see people improve significantly. But we're not really necessarily saying that like, “Okay, you're done now.” It's more like the folks that are local that are coming in every two weeks or every three weeks for ozone dialysis, and IV nutrients, plus all that other stuff that we're doing, they're getting the best results. We also do something called ozone plasmapheresis, which is a little bit more detoxifying, and a little less antimicrobial. But you do get a little bit of both.

[01:19:44] SCOTT: So Dr. Klinghardt kind of popularized this concept of Apheresis. And people in Germany were doing this. I believe there's some people now in the US that do it as well. Dr. Isaac Eliaz, for example. So is the ozone dialysis or ozone plasmapheresis that you talked about, is that similar to apheresis? Do we know what type of environmental toxicants might be getting removed? Is it pulling out metals or mycotoxins? Does it have some role in the biofilm arena, for example?

[01:20:13] DR. PLANTE: Yeah, it's a great question. So my understanding is that they're similar, but it's a different filtration device. And I know this is a plug for the Peptide Summit. But Dr. Cook did talk, I think, with Dr. Eliaz about that, and the differences there. So there's definitely more about that. The idea with plasmapheresis, that's going to be the most similar to the apheresis. And I'm talking about ozone plasmapheresis, which is a little bit different than conventional plasmapheresis that you would get at a hospital, which removes essentially all of your plasma. So plasma is that liquid portion of the blood. And that's going to have carrier proteins, which are often bound to toxins. It's going to have free-floating toxins. It's going to remove antibodies, which is the idea for using it for autoimmune disease. You're removing auto antibodies. And so when we do ozone plasmapheresis, we're removing about 20% to 30% of your blood plasma, which is significantly less, and so better tolerated.

I'm a little bit skeptical. And again, I could be wrong. But I'm a little bit skeptical pulling metals, just because a lot of times these metals are in soft tissue. And so I get really curious – Or hard tissue, connective tissue, bone. So I get curious, if it's not actively in blood circulation, how are we getting it out without the use of chelators. And again, there may be some ways that we're doing that that I'm not aware of.

So we don't claim with our device that we're removing metals. But we do suspect that we're removing anything that's bound to carrier proteins. We're reducing the overall antibody load, and then anything that's free floating. And so I've had folks provoke with glutathione, if they can tolerate it. Like I had somebody come out. This is a few months ago. They were going to just come out for one day. All they had was one day. And they were just diagnosed with mold toxicity by a functional medicine practitioner that they're working with. And previously had come to our office only for ozone dialysis, which is more antimicrobial, less detoxifying.

And so that doc had put her on a ton of glutathione. And I said, “Oh, you're already taking a lot of good violence. So you're circulating stuff. Why don't you do ozone plasmapheresis?” And it was perfect. Because basically, we were like skimming off, siphoning off from the top, all those mobilized toxins. And it was great. She just needed that one day.

Now, that didn't mean that we cured the mold toxicity and there weren't other things. But like getting her back into functional range was affected with that. And so there are probably a few things that are happening that we don't fully understand. We've tried to send samples to pathologists, and it's been hard to get them to run exactly what is in the sample.

[01:22:42] SCOTT: In this patient population, how important do you think biofilms are? How often do you need to do something specific to address them? It seems to me that a lot of people get well without really doing something super aggressive for breaking down biofilms. So I'm interested in your thoughts. How important is that? Where does it fit in?

[01:23:00] DR. PLANTE: Yeah, so I do find it often to be important. Not always, but often. The question is, how much? And how aggressive? And when? So I never start with aggressive biofilm disruption. At most, I'll use Biocidin liposomal, which in my opinion and my experience is fairly mild on the biofilm disrupting front. Or NAC. Glutathione to some extent as well. But I won't use the chelator biofilm disruptors early on. I won't use high doses of Lumbrokinase, or Serrapeptase early on. And I won't use the Bismuth containing. I really liked the Bismuth thiol complexes that form. Like there's a product called Biofilm Phase-2 Advanced that has Bismuth, ALA, and black cumin seed. And the ALA and the Bismuth will form Bismuth thiol complex, which is a pretty potent phase-2 biofilm disruptor. And I find that helpful in folks that are more resistant.

Hey, every time I get off antibiotics, I relapse. Oh, hey, I switched our herbal regimen up. But we're still using research-based herbs that should have effectiveness. And it's not helping as much as when I was taking the full dose of crypto. Oh, okay, we probably need some stronger biofilm support.

So I kind of have this flow chart that I made of like gentle to more extreme. And so it's kind of like NAC, Biocidin, Serrapeptase, Lumbrokinase, and then the Bismuth thiols. And you can even get a compounded Bismuth thiol from – There's a few pharmacies that make it. It’s called BioSolve. And it's DMSA with the Bismuth subnitrate and the ALA. And so you form an even more robust di-thiol Bismuth complex, which can be very disruptive. And I find that to be helpful in persistent parasitic infection with the Babesia nest formation when you combine it with lumbrokinase. And so with Babesia, I think the lumbrokinase is pretty critical if it's chronic and you're not getting – And there's hypercoagulability and all that. And so I think that the million-dollar question is kind of like it's one of those 10 dials. It’s how much biofilm disruption? If they're just not getting better, you probably need more biofilm agents.

[01:25:04] SCOTT: Yeah. And I think the Cistus that you just mentioned can be really helpful in this biofilm arena as well. It sounds like that's another tool that you use. I know you work a lot with various peptides. So wondering if you can talk a little bit about the peptides. And I know it's a long conversation. But just curious about does LL-37, for example, have a place in Bartonella patients? How about the immunomodulatory peptides? And with the peptides, do you find that people benefit more from the antimicrobial peptides or more from the immune modulating peptides?

[01:25:32] DR. PLANTE: Yeah, great question. So, I always will start with the immune modulating peptides, as you may, the thymic peptides. I find BPC-157 immune modulatory and a little bit mass cell stabilizing, particularly the oral form of that. There're the Russian bio regulator peptides, which has its own conversation there around that. But there are some immune modulating ones there.

I like the immune modulating ones because, again, with Bartonella, I think the primary issue is the immune dysregulation. And so that's the overactivity of the inflammatory response and an under activity of the antimicrobial response. The thymic peptides tend to be very regulating there. So Thymulin and Thymosin alpha 1, support B cell, T cell and natural killer cell function, and support Treg simultaneously.

And so, what's so cool about that is you are modulating the body's ability to respond to these infections. And then if you add LL-37 Later – The way I describe it as Ta1 is your shield and your sword, and LL-37 is that dagger you have in your boot. And so it's that added edge that can be a little bit cytotoxic. It's antibacterial, probably antifungal and antiviral as well. But without a little bit of modulating padding, it can be a little bit more aggressive.

But I have seen patients with Bartonella say, “Yeah, Ta1 and the other thymine peptides are helpful. But what I really noticed is when I started the LL-37. Wow, that did something.” And so I won't usually do that for more than one to three months at a time, but 100 micrograms a day can be an added edge.

[01:27:02] SCOTT: So continuing on them with immunomodulatory tools potentially helpful for Bartonella, you mentioned LDI, or low-dose immunotherapy. So is that a tool that you're using for treatment of Bartonella? And what about transfer factors? Do they have a place here as well?

[01:27:17] DR. PLANTE: Yeah. So I really like Researched Nutritionals products and the different transfer factors, formulas, but I use their Transfer Factor  Multi-Immune formula a lot. And these are essentially immune signaling molecules that can be modulating. I like that formula in particular, because it's got the anti-inflammatory, like pomegranate and stuff, as well as like necessary vitamins and minerals, and the immune modulating mushrooms and Astragalus.

And so, I love peptides. Don't get me wrong. I love peptides. I love ozone. I love some of this advanced stuff. But I find sometimes the simple – Like, Astragalus has been around for thousands of years. Immune modulating mushrooms are not new, although people are certainly talking about them more. And those formulas, I found them to be helpful, especially when there's a lot of autoimmunity. Because it's a matter of like how do we decrease inflammation without compromising our antimicrobial activity that we need so much?

Lotus immunotherapy, I use a lot more in my last office. And Dr. Jamie Conkel, who I trained under, use it a lot. I tried it personally for some of my stuff, and I didn't see it as a game changer. So it's amazing how are – Just full disclosure, how our personal biases factor into kind of what tools we stick with. Same with homeopathy. I've seen it work miracles for other people. Didn't do much for me. I don't use it that much. It doesn't mean it's not a valuable tool. And I actually would like to get back into using LDI, because I think that it's helpful. It kind of has this cross between the idea of what a vaccine does. I’m not saying that it is a vaccine, and homeopathic in the sense that it's telling the immune system, “There's a little bit of this product here. There’s a little bit of this antigen.” And your immune system sees it and says, “Hey, it's okay. I don't have to mount an inflammatory response to that.” And you do that while you're doing all that other stuff. And it seems to be balancing.

[01:29:00] SCOTT: Yeah, personally, I found LDI to be just magical. I had some pretty significant pain, burning, numbness and whatnot in one leg that turned out to be related to Herpes zoster. And after having had it for quite a while before we figured out exactly what it was, one dose of low dose immunotherapy, I had that sensation for almost two years, and the next morning, it was gone. Now I had to continue doing the low dose immunotherapy every couple months. But that was probably in my whole journey now of over 20 years of recovering from these things, that was probably one of the few experiences that I've had where you could really say, “Oh, my goodness. That one thing did something that was super, super obvious.” So yeah, I'm glad that you're excited about exploring those as well.

Big question, do you think that Bartonella can be fully eradicated from the body? Or is it more likely to case that it remains at some low level that it becomes part of our microbiome? That we've created more tolerance to it? And we're really just focused on getting the immune system to be less burdened, less dysregulated, so that it can manage this over time, like those people that have this infection, but have zero symptoms at all.

[01:30:09] DR. PLANTE: I think you nailed it. I wish that I could record exactly what – I mean, I'm going to cut that out and just send that to my patients and be like, “This is our goal, I think.” And so I think the jury's still out from an evidence standpoint, because our diagnostics need to be refined enough that we can confidently say that a negative test result indicates that the infection is not present in any degree. And I don't think we're anywhere near that point.

My theory is that we get to a place of ecological normalization. And so I think that's a perfect dovetail question after talking about Lotus immunotherapy, because the whole idea there is that we're telling the immune system, “This isn't as much of a threat anymore.” And that's the same idea with allergies, allergy shots. We want to reduce the burden of these, even though they are considered to be low abundance infections relative to some of the infections that we see that cause more acute illness. We want to reduce the load so that the immune system is able to do what it needs to do.

And so, there's the antimicrobials that help that. And then there's supporting and modulating host immunity so that the immune system not only can take over when you withdraw the antimicrobials, but be in a more harmonious relationship and say, “We don't need a mountain of significant inflammatory response.” Or, “Hey, this organism might be secreting some Th2 supporting cytokines. But we don't really care, because the rest of our mast cell milieu is relatively chill.” And like we can buffer against that. Just like some people can stay in a moldy condo for a weekend on a vacation and not get sick.

And so, we really want to promote resilience, physiology and resilience of the immune system. And identifying and treating all of these diverse things that can affect our immune system can help put us in a place where even if Bartonella, or Borrelia, or these other I hang out in our ecology, it's not a problem anymore.

[01:32:01] SCOTT: So then building on that, once you've worked with somebody in their past that symptomatic stage of their illness, longer term, do you stop treatment? Or is there some aspect of a few maintenance therapy, maintenance interventions, that can keep them from having a recurrence of some of their Bartonella symptoms?

[01:32:18] DR. PLANTE: Yeah. So I'm a huge fan of maintenance herbs, at the very least. And the reason for that is they tend to be less aggressive, unless they're like isolate standardized extracts. They tend to be gentler on our normal flora. I'll also have focus on more immune modulating probiotics, like the MegaSporeBiotic and the soil-based probiotics, because they tend to keep the not so friendly guys there. But it's not like you're over-pushing Lactobacillus or over-pushing Bifidobacteria.

And then maintenance, nutrients support, and some kind of host immune support, whether that's Astragalus, mushrooms pulsing peptides every couple of weeks or months. That stuff can be very helpful to do for a year or more after resolution of symptoms. And so whether that's Biocidin, or Cryptolepis, or Houttuynia, or some of the other ones I mentioned. Even just a few days a week can be better than none.

I'm at the point now with my EBV where I'm just kind of like, “Oh, I'm in a high stress situation. I'm not sleeping great. I'm traveling.” It flares. I take extra thyroid support. I run the Valtrex right now. And I feel so much better, in addition to herbs and other things. And it's just like you get to this point where you become so familiar with how your body is responding to this that you're in charge of the dials now. Your doctor can be kind of more of a consultant.

And then it's just like, “Oh, I need to up my support on that department. Maybe I need to do antibiotics for a month or a couple of weeks.” But I don't believe in doing persistent antibiotics for years after, unless there's clinical evidence, not just lab evidence, but clinical evidence of persistent infection. Because even if you're seeing it in the labs, but they're feeling perfect, do we need to treat it? I think that's a question. I don't think so.

[01:33:58] SCOTT: We know that for many patients, this can be a difficult path. And so I'm wondering, what can you say to provide listeners with some hope that they can get past it and can improve the quality of their lives?

[01:34:09] DR. PLANTE: Yeah. So I always tell folks that a doctor, including me, should never tell you that there's nothing more we can do. There are just so many tools in the toolkit when it comes to nutrient support, when it comes to hydration support. I had a patient who came who had been treated for years with IV antibiotics and was just feeling super discouraged. Started developing new neurologic symptoms in her 30s and was like, “Okay. Well, we need a different approach.” And then we even tried like oral Clarithromycin. Couldn't even tolerate one dose without severe GI upset. And so it was like, “Well, we just can't do that right now.”

And so we've been relying on herbs. We've been doing a ton of IV nutrient support. She's feeling better than she's ever felt. We're really optimistic that even just doing that. And like now she's able to do methylene blue, and we're titrating up on Cryptolepis. And so you may be at a point in your juncture, in your healing journey, where what you've been doing or what you have tried isn't working. There's something else you could try. And maybe what you were doing before could eventually be very helpful medicine and much better tolerated, but just isn't right now. Or maybe not.

But, I mean, there's so many things we didn't even talk about that are on the horizon that I would love to learn more about that can be tools and supporting these conditions. And so I'm just working with the best tools that I have been exposed to up to now in terms of pharmaceutical lifestyle, and naturopathic, and regenerative and saying, “This is what we're working with now.” But even with that, it's hard to try everything. It's hard to get to a point where you're like, “I don't have anything else.” I don't think I've ever said that actually. And this is just a relatively newer doctor.

So hang in there. It sucks. Let's be honest about that. It's a long road, and it's frustrating, and it's expensive, and it's painful. And make space to be able to process those emotions. But there are tools, and there are evolving tools, including narrow spectrum therapeutic in terms of antibiotics that are going to be less more likely to target these specific organisms. And so, I am optimistic about the future of chronic disease care.

[01:36:17] SCOTT: For people that are interested in working with you, are you taking new patients? Do you do telemedicine? Are there certain states that you can work with?

[01:36:24] DR. PLANTE: Yes. So I am licensed in California right now. And we do do telemedicine often. We do have folks who come visit us from around the country. Some of our other doctors are licensed in other states. I'm currently waiting on licensure in Oregon, Washington, Idaho and Montana. But that will likely take a little while. So we'd be happy to support you at BioReset Medical. We have a website, bioresetmedical.com. All one word. No dashes, or underscores, or anything. And we're here to support you with the best of what integrative and regenerative medicine has to offer for these conditions.

[01:37:00] SCOTT: So my last question is the same for every guest, and that is what are some of the key things that you do on a daily basis in support of your own health?

[01:37:06] DR. PLANTE: Yeah. So I mentioned a couple of them like the Ultima. I’ll do IVs once a week or so. I'm working a lot. I'm going to be transparent about that. And so, you do what you can from a nutrition standpoint. I do try to minimize the processed food. And the snacks that I do eat are like healthy snacks. I'm gluten-free and dairy-free. Unfortunately, the coolest thing to do when you're in naturopathic school was to figure out what your food sensitivities were. I'm still trying to figure out if it was worth it, because I ate gluten and dairy my whole life. And now when I do, they're so delicious, but I do not do well. And so I avoid those.

Sleep and stress management is really important to me. And my showers are cold. And I take a lot of supplements. And that stuff all helps. And it’s like I said, with the dials, it's like, I don't take 20 supplements every day. It's like, “Oh, I need more adrenal support this week.” So I take more adrenal support. “Oh, my gut is kind of weird. I’ll up the Biocidin, the Lauricidin, the biofilm.” Like, I had sushi the other day, and I decided to do chelation, because I had some DMSA and EDTA the next day, and I felt so good on Monday. And I was like, “Wow! I needed that,” even though my metals haven't been historically that high.

And so anyway, it's just you'll learn so much about how to treat other folks just by, one, trying things. I'm not saying I recommend this. I'm a doctor. So I can do this. But try things on myself or like learning new things and being like, “This is what I think I need right now.” And that has informed a lot of my clinical insight in terms of working with other people.

[01:38:32] SCOTT: Beautiful. Such an excellent conversation. Bartonella, obviously, is one of the bigger players in this realm in chronic Lyme disease, mold illness in some cases as well. Just really appreciate you sharing a lot of your toolbox with us. Super exciting to see a lot of the tools that you're using, and just really appreciate you being so generous with your time today. So thanks for being here, Dr. Plante.

[01:38:52] DR. PLANTE: Thanks so much for having me.

[OUTRO]

[01:38:53] SCOTT: To learn more about today's guest, visit BioResetMedical.com. That's BioResetMedical.com. BioResetMedical.com.

Thanks for listening to today's episode. If you're enjoying the show, please leave a positive rating or review, as doing so we'll help the show reach a broader audience. To follow me on Facebook, Instagram, Twitter or MeWe, you can find me there as Better Health Guy. To support the show, please visit BetterHealthGuy.com/donate. To be added to my newsletter please visit BetterHealthGuy.com/newsletters. This, and other shows, can be found on YouTube, Apple Podcasts, Google Podcasts, Stitcher and Spotify.

[01:39:39] ANNOUNCER: Thanks for listening to this BetterHealthGuy Blogcast with Scott, your better health guy. To check out additional shows and learn more about Scott's personal journey to better health, please visit BetterHealthGuy.com.

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Disclaimer

The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.