ILADS 2015: From Bench to Bedside: Translating Research Into Clinical Practice

This blog entry shares my notes from some of the sessions I attended at the 2015 ILADS conference in Fort Lauderdale, FL.  As my interest is in more integrative and alternative treatment options, this may not be an accurate representation of the overall content of the event as there are several concurrent sessions, and thus, I was unable to attend many of the lectures at the event.  Recordings of the sessions may be found from the ILADS web site at http://www.ilads.org.  

I started going to ILADS in 2006 and this was my TENTH YEAR! to attend the event.  I haven't missed a single annual conference since 2006.  I am grateful to ILADS for all they have done to help those of us that have dealt with Lyme and for all that they continue to do.  I'm excited to see how many people come to this event every year.  It should be even larger, but it has grown notably in the past decade.  

Disclaimer: Nothing in this text is intended to serve as medical advice. All medical decisions should be made only with the guidance of your own personal licensed medical authority.

Disclaimer: This information was taken as notes during the conference and may not represent the exact statements of the speakers. Errors and/or omissions may be present.

Note: As this information may be updated as any errors are found, I kindly request that you link to this single source of information rather than copying the content below. If any updates or corrections are made, this will help to ensure that anyone reading this is getting the most current and accurate information. 

Kerry Clark MPH, PhD started off with "Lyme Disease in the Southern United States" and shared:

• Borrelia organisms have been found in reptiles; there may be many reservoirs.
• There are 20 species of Lyme Borrelia worldwide with 7 in the United States; not just Borrelia burgdorferi.
• 4 of these can infect people in the US and cause disease; Borrelia burgdorferi, Borrelia andersonii, Borrelia americana, and Borrelia bissettii.
• Most testing is aimed at one B31 strain of one species - Borrelia burgdorferi sensu stricto.
• There is a high infection rate in Ixodes scapularis ticks throughout Canada. 
• Lizards can become infected with Borrelia.
• In patients in the south, almost none test positive based on the CDC 2-tiered testing criteria even when Lyme has been proven through other means.
• Several rodents in the United States have tested positive for Borrelia garinii.
• Lyme Borrelia DNA has been found in Lonestar ticks. There are high levels of spotted fever in Lonestar ticks; Rickettsia amblyommii.
• He has seen multiple spirochetes come together under one cell membrane.

Neil Spector MD talked on "How Lessons from Personalized Cancer Care Can Inform Management of Lyme Disease" and shared:

• He personally had Lyme and it resulted in the need for a heart transplant.
• He has written about his story in a book called "Gone in a Heartbeat: A Physician's Search for True Healing".
• He compared cancer and Lyme and showed that there were numerous commonalities such as inflammation, treating early resulting in the best outcomes, resistance mechanisms, and more.
• Cancers have a sweet tooth and are addicted to sugar; Borrelia is the same.
• Borrelia requires a lot of sugar intake to metabolize, survive, and proliferate.
• Efflux pumps spit out antibiotics just like cancer cells spit out chemotherapy.
• 1 in 2 men and 1 in 3 women will developer cancer in their lifetime.
• The human body has 100 trillion cells. The gut has 10 times as many microbes with 100 times as many genes as the human.
• Lyme disease is the infectious disease equivalent of cancer - some are responsive to treatment while others are highly "metastatic".

Tom Moorcroft DO spoke on "Borrelia Miyamotoi" and shared:

• Borrelia miyamotoi is in the relapsing fever group of Borrelias with Borrelia hermsii.
• It comes from Ixodes scapularis with an infection prevalence as high as 15% or more.
• It is the first Borrelia to be known to be transmitted transovarially.
• More than 25% of cases of Lyme are in children 5-9 years old.
• Borrelia miyamotoi prevalence was 1-7.5% in a California study and 2% in a New York study.
• Any tick bite is a high risk tick bite.
• Two-tier testing misses 44% of truly positive cases of Lyme.
• Doxycycline, Amoxicillin, Cefotaxime, and Penicillin may be helpful; possibly macrolides.
• For central nervous system disease, ceftriaxone, cefotaxime, or penicillin by IV or high dose orals may be used.
• Combination treatment may be needed for 4-6 weeks with cell wall and intracellular antibiotics and herbals. It is now known whether or not biofilms or cysts occur with Borrelia miyamotoi. He continues treating for 6-8 weeks beyond the point of being symptom free.
• Borrelia miyamotoi comes from the black-legged tick which is year round and children are at high risk.

Jyotsna Shah PhD from IGeneX spoke on "Looks Like Lyme, Acts Like Lyme, But It's Not Lyme" and shared:

• Borrelia miyamotoi may be higher prevalence in the blood than Borrelia burgdorferi.
• There may be far more relapsing fever Borrelias that we don't know about yet.
• The same ticks that transmit Lyme can transmit relapsing fever Borrelias.
• There are more unknowns than knowns about tick-borne diseases.
• 98% of Borrelia miyamotoi patients have fatigue and fever; also a high incidence of headache.
• Borrelia IFA has cross reactivity with relapsing fever Borrelias.
• q-PCR looks for Borrelia burgdorferi and relapsing fever Borrelias.
• IGeneX developed a Relapsing Fever Borrelia Western Blot. Band 75 is important; as is 45, 37, and 23.
• They mostly see IgM positive and very few IgG positives with Borrelia miyamotoi.
• In 111 patients, 14.4% had Borrelia, 11.7% had Relapsing Fever Borrelias, 5% Borrelia burgdorferi, 5% Borrelia burgdorferi and Borrelia miyamotoi. In the same study, Relapsing Fever Borrelia Western Blot showed a 41% positive outcome. With PCR and Western Blot, positive rate for Relapsing Fever Borrelia was 45%.

Garth Ehrlich PhD spoke on "Towards the Development of Definitive Diagnostics for Borrelia Burgdorferi" and shared:

• He compared otitis media, sinusitus, and post tick-bite disease.
• There can be acute and chronic forms. You can culture acute forms.
• Acute forms are viewed as infection; chronic forms not viewed as infection.
• Acute grow planktonically vs. chronic which are a biofilm (not single cells but become a multicellular organism).
• Most damage with biofilm infections comes from the host response trying to get rid of the infection.
• Acute is monoclonal; chronic is polycolonal.
• Different strains of the same species have different genes and share them to stay one step ahead.
• Biofilms are taking a bath in their neighbors DNA.
• Magnetic Particle Imaging is like an MRI but looks for infections in the body. Could potentially track stem cells, cancer diagnosis, inflammation imaging, and biofilms.
• They are working on ways to image Borrelia.

Farshid Sam Rahbar MD lectured on "GI Manifestations and Treatment Options in Lyme and Common Co-Infections" and shared:

• He works the Los Angeles Integrative Gastroenterology and Nutrition.
• When it comes to ticks, we live in their world; they don't live on our world.
• Lyme and coinfections can present as GI manifestations.
• 99% of their patients did not come to them with a Lyme diagnosis.
• In 2013-2014, there were over 100 cases of Lyme in their practice.
• 53% were Borrelia culture positive, 59% were Western Blot (non-CDC criteria included) positive, and 49% were Elispot positive.
• Of 39 negative Western Blot patients, 22 of 39 were positive with the culture or Elispot.
• Top 10 symptoms they see are bloating (76%), tire easily/weak (65%), anxiety (50%), abdominal pain (48%), sleepiness (44%), constipation (42%), food intolerances (42%), irregular bowel movements (37%), weight loss/weight gain (36%), and joint pain (34%).
• If a patient is using cannabinoids for any other reason than recreation, they need to test for Lyme.
• SIBO is characterized by high hydrogen, high methane. With high methane, think of Lyme and tick-borne diseases.
• Methanobrevibacter brevii or Methanobrevibacter smithii can be causes of high methane and can be related to immune disorders associated with tick-borne diseases.
• 65% had SIBO in their practice but only 15% if they had been previously treated for Lyme.
• Candida and parasites must be explored.
• Every patient they see has increased intestinal permeability.
• Gastroperesis is often related to tick-borne diseases.
• For SIBO, treatment consists of a low fermentation diet, no food 2 hours before bed, eat slow and chew adequately, support the immune system, reduce stress, hydrochloric acid, pancreatic and vegetarian enzymes.
• Zinc carnosine improves the GI systems ability to right infections.
• Rifaximin blocks plasmid formation and prevents resistance from another antibiotic from forming.
• Linaclotide increases fluid and GI motility; safe for constipation.
• May use oral immunoglobulins such as colostrum or Enteragam.
• For SIBO, may use ox bile, zinc carnosine, herbs (berberine, grapefruit seed extract, oregano oil, Candibactin AR/BR, Dysbiocide, FC Cidal, and allicin), antibiotics (Rifaximin, Neomycin, Flagyl, Paromomycin).
• For leaky gut, may improve eating habits, address infections, correct nutritional deficiencies, use pure amino acids, glutamine, zinc carnosine, berberine, and omega 3 oils, EnteraGam, Lubriprosotone.
• Lubiprostone may help with leaky gut / tight junctions.
• For constipation, Prucalopride, Lubiprostone, and Linaclotide.
• L-Theanine can be helpful for GERD. Baclofen may be used.
• Those with Lyme may present with primary GI symptoms that are complex and persistent.
• Lyme patients commonly have SIBO, GERD, Gastritis, and IBD.

Henry Childers IV MD spoke on "Integrative Approaches to Tick-Borne Diseases" and shared:

• He does not use antibiotics; with few exceptions.
• When anaerobic respiration increases, we use oxygen less over time, make 2 ATP, and create lactic acid. Inflammation increases. The more lactic acid, the lower the pH, and the more the inflammation.
• Free radicals are bad guys; antioxidants are the cops.
• Free radicals are mutagenic and degrade the mitochondria. Bad guys increase; good guys decrease which leads to aging and degenerative disease.
• The effects of loss of oxygen are infection, arthritis, cancer, diabetes, autoimmune diseases, dementia, impaired immunity, and aging.
• NAD to NADH ratio should be 700 to 1 (predominantly aerobic). It's all about NAD/NADH ratio.
• When we are less aerobic, lactic acid increases 19 times, there is a decrease in apoptosis, increased protein catabolism.
• Ozone forms peroxides. Ozonides increase metabolism up to 40%, improve circulation, increase growth factors, modulate cytokine production, support antioxidant response elements, act as an antimicrobial with no resistance, are anti-neoplastic, stimulate nitric oxide, activate Nrf2, stimulate stem cells, and potentiate the immune system.
• Bacterial cells do not make antioxidants and are subject to oxidation.
• Ozone stimulates the immune system in a balanced way.
• It should be used and should be covered by insurance; but it is not. It is used in Spain, Germany, Cuba, Russia, South America, and Europe.
• Ozone binds with Keap1 and increases transcription of glutathione.
• Antibodies in the immune system produce ozone to eradicate infection.
• Ozone may be used in blood, rectally, sauna, prolozone, IV saline, bladder/ear/vaginal insufflation, ozonated water, ozonated oil, and intra-aerterially.
• Uses Hydrosol silver IV and oral silver; Argentyn 23. Positively charged silver molecules.
• Uses UBI, IV vitamins, PEMF, thyroid support, botanicals, neurotransmitter testing.
• If using antibiotics, they can be potentiated with ozone.
• Tests for heavy metals.
• For Herxheimer reactions, he uses silver and UV light. 

Norton Fishman MD spoke in "Inflammation: Our Best Friend and Worst Enemy" and shared:

• Inflammation is the immune response to infection, injury, or dangerous molecules. It is essential to survival; it is the control of the response that is essential.
• Uncontrolled activation can lead to disease and tissue damage.
• Monocytes become activated and become macrophages. Can also become dendritic cells.
• Microglia serve as the brain's monitoring system.
• There are PRRs (Pattern Recognition Receptors which are evolutionarily endowed), PAMPs (Pathogen Associated Molecular Patterns), and DAMPs (Danger Associated Pattern Molecules).
• IL-1b is the master warrior.
• Inappropriate microglial activation can lead to earlier priming, persisting Lyme infections and coinfections, microbiome alterations, food sensitivities, mold sensitivities, autoimmunity, and genetic predispositions.
• He made the point that if he doesn't get gluten out of the way, he cannot help a patient with Lyme.
• Higher performing people get Lyme the worst.
• Solutions include lowering the ongoing load of PAMP signals by resolving or tolerating persistent infection, using enzymes for biofilms, pulsing for persisters, lowering the ongoing load of DAMP signals through detoxification of molecules of damage, reducing the amplification of newly recruited cytokines through modulation of NF-kb and inflammasome cascades, quelling the production of oxidants by quieting NADPH oxidase system, and reinforcing the immune system's anti-inflammatory regulation system through an anti-inflammatory lifestyle.
• If you don't address Borrelia, Bartonella, and Babesia together, you have not addressed Lyme.
• Post-Lyme is the equivalent of Post-Alzheimer's - it doesn't exist.
• There is no Santa Clause and there is no magic solution - yet.
• The secret sauce of statin drugs is their anti-inflammatory effect; even though it isn't the best option.
• People with bad Lyme disease lose their sense of who they are, their meaning in life, and they can no longer perform.

Kristine Gedroic MD spoke on "Auto-Immunity and Lyme Disease" and shared:

• The microbiome is impacted by geography, age, diet, medications, breast fed vs. formula fed, and vertical transmission (C-section deliveries don't get the first exposure to beneficial flora from the birth canal).
• The microbiome plays a huge role in regulation of the immune system and detoxification.
• We are just a vehicle for bugs; there are more of "them" than there are of "us".
• What now seems obvious around the microbiome was considered heresy 10 years ago.
• Dendritic cells are work horses that can mount an innate and adaptive immune response.
• They are associated with autoimmune diseases; TReg cells are the brakes on NF-kb.
• There are both exogenous and endogenous stimuli of the dendritic cells.
• Exogenous include genetic manipulation, recognition of microbial products, and immunosuppressive mediators; endogenous include the tissue microenvironment, interaction with other immune cells, and the recognition of apoptotic cells.
• Bifidus creates butyrate which is important for reducing inflammation.
• Vitamin D plays a role with the microbiome; calcitriol stimulates the vitamin D receptors and turns on antimicrobial peptides.
• 25 Vitamin D circulates and is converted to Calcitriol (1,25) and binds to VDR to stimulate oxidative bursts. Calcitriol is immunosuppressive as it shuts down inflammatory cytokines. Pathogens block VDR receptors and beat calcitriol to the receptor.
• Microbes antagonize VDR and disable innate immune response.
• Proal authored a paper that suggested that autoimmune disease result from successive accumulation of pathogens into the microbiome.
• Looking at the microbiome of the mother may be key as it is passed down the maternal line.
• As calcitriol goes up, this causes an array of hormonal imbalances, binding at the thyroid receptors, androgen receptors, and glucocorticoid receptors.
• Treatment consists of restoring membrane stability, managing intracellular microbial burden, and feeding the microbiome.
• Cells should glisten like an oil drop. Toxins stick to ragged cells. An unhealthy cell is like a cell with hangnails on the surface.
• Recovering the mitochondrial membrane helps with fatigue.
• Phosphatidylcholine and short chain fatty acids (butyrate) are natures anti-inflammatories.
• Butyrate may help recovering circulation in people with cold fingers or Raynaud's.
• Phosphatidylcholine downregulates TNF-alpha and NF-Kb.
• Bile salts are important if there is reduce gallbladder function, dark circles under the eyes, etc. The liver may be full of gunk and we need the gallbladder to contract. The main antimicrobial of the gut is bile salts; these work well for SIBO.
• Chronic constipation is a sign of gallbladder dysfunction.
• Phosphatidylcholine is the lowest at the end of the colon.
• When we get Borrelia, our membranes our left without cholesterol and Phos Choline. Lipid exchange contributes to the pathogensis of Lyme.
• Butyrate modulates inflammation and lipid metabolism. Phenylbutyrate is a potent peroxisome proliferator that oxidizes long chain fats; it eats up long chain fats that we need to get rid of to recover the membrane.
• Butyrate may help with Borrelia treatment overall by addressing lipid rafts.
• Intracellular microbial burden may be managed with herbs, ozone, UVBI, and other tools.
• The biggest player in autoimmunity is mold and it is an intracellular player as well. When we breath in spores, we may live with them but cannot smell it anymore.
• For the microbiome, sugar cuts all the good lipids; reduce carbs except potatoes and legumes, add pre and probiotics, add bone broth.
• You are wasting your time if you don't stop eating gluten.
• Fermented vegetables can help to repopulate the gut.
• She uses an oral Power Drink with Body Bio Balance Oil (SR3 Oil), Phos Chol, and other ingredients. Some add Evening Primrose Oil which can also help with eczema and skin conditions.
• Immune regulation begins with the microbiome.
• An imbalanced microbiome leads to progress dysregulation of vitamin D receptors.
• Restoring health requires both reduction of intracellular microbial burden to release the vitamin D receptor and restoring membrane stability with Phos Chol and butyrate.

Aparna Taylor ND spoke on "Herbal Medicine and the Lyme Patient: Modulating Immunity" and shared:

• Borrelia has an adaptive genome, quorum sensing, and other tools for evading the immune system.
• A tincture is extracted into alcohol and is usually 1 part herb to 4 or 5 parts alcohol (1:4 or 1:5).
• An extract is 1:1 or 1:2 herb to liquid but there is more processing and some alteration of the original plant.
• A tincture is the best form to give to most patients.
• Plants have a vital force and a vibration.
• There are herb / drug and herb / herb interactions that have to be considered.
• There may be interactions with large supplement protocols that we just don't know.
• Her top 10 favorite herbs are: Andrographis paniculata, Astragalus membranaceus, Eleutherococcus senticosus, Eupatorium perfoliatum, Galium aparine, Glycyrrhiza glabra, Passiflora incarnata, Withania somnifera, Zanthoxylum americanum, Zingiber officinale.
• Andrographis can be helpful for the liver and as an immune system support; will often kick colds right out.
• Astragalus helps to invigorate the chi. Slows lithium excretion. She uses it frequently in persistent and late stage Lyme.
• Eleuthero is Siberian Ginseng and is one of the best adaptogens for stress of most any kind. Stop if light sensitivity develops.
• For deep bone pain, Eupatorium can be helpful; also as a tea for Herxheimer reactions.
• Galium is Cleavers and is great for lymphatics and for psoriasis.
• Glycyrrhiza is licorice and used as a synergist for others herbs but not alone; helps to create a symphony. DGL can be used alone.
• Passiflora is Passion Flower and soothes the nervous system. Most patients are in sympathetic overdrive. Insomnia, anxiety, seizures, and neuralgia. Can help to wean people off of benzodiazepines.
• Withania is Ashwaganda and helps with stress, poor stamina, and cognitive dysfunction.
• Zanthoxylum is helpful for poor circulation, stagnation, and pain; supports lymphatics.
• Zingiber is ginger; best in fresh root form. It is a synergist and increases circulation. Helps with biofilms and can be used as a tea for Herxheimer reactions. 1 teaspoon of the chopped root simmered for 5-10 minutes with honey drank as a tea or cooled with carbonated water and drank may be helpful.
• Mentioned the book Medical Herbalism by David Hoffmann.
• In Canada, she likes Viridita and Finlandia herbs; in the US, Heron and Mountain Rose.  

Dr. Ed Breitschwerdt DVM spoke on "Bartonella and Comparative Infectious Disease Causation" and shared:

• Note: My article from Townsend Letter on this topic can be found at http://www.betterhealthguy.com/unraveling
• There is limited funding from federal agencies for Bartonella research.
• Every cell that is a component of the blood brain barrier can be infected with Bartonella.
• It has a slow dividing time and can take six weeks to see on a plate from a human blood sample.
• It can invade any cell that has been tested in a laboratory.
• It is a cousin of Brucella which is difficult to diagnose, can lead to infection with no antibodies, and difficult to treat; same for Bartonella.
• There are 36 different Bartonella species for which animals are the primary reservoirs.
• Stealth bacteria like Bartonella and H. Pylori can hide and persist for long periods of time.
• Sick veterinarians are the best model for what to look for in dogs and dogs are the best model for understanding Bartonella.
• If a dog has ANA, it has Bartonella antibodies.
• If it were not for AIDS, he would not be giving the lecture. Bartonella was isolated from bacillary angiomatosis and peliosis hepatis.
• Bartonella has been identified in vasoproliferative tumors; may induce VEGF.
• Bartonella is found in lymphadenitis, hepatitis, rhinitis, etc.
• There can be familial outbreaks - dogs/humans or cats/humans in the same household have been found to have the same Bartonella.
• Cats can handle most Bartonella henselae well, but not canine adapted Bartonellas that make their way to cats.
• 18% of 86 dogs at the University of Florida could isolate Bartonella.
• Bartonella melophagi was found in sheep keds and sheep blood.
• Most cat strains are relatively non-virulent.
• 50% of dogs and 50% of chronically ill human beings do not show antibodies.
• Sand flies, flees, rodent flies, bat bites, and many other vectors exist.
• Reservoirs include rodents, cats, dogs, wildlife, ruminants, and humans.
• You should ask every chronically ill patient if they have been bitten by fleas.
• Encephalopathy, meningitis, headaches, insomnia, hallucinations, visual defects, MS-like conditions, psychiatric illnesses, aphasia, and transverse myelitis may have a Bartonella component.
• Flee feces is a source of human infection.
• Without fleas, a cat is not a risk to the family. With fleas, all bests are off.
• Bartonella is amplified in the flea gut and more goes out than what came in. The organism survives at least 9 days in feces.

Marianne Middelveen MS spoke on "Morgellons Disease: A Filamentous Dermopathy Associated with Borrelia Infection" and shared:

• Morgellons can have colorful filaments. They grow in a net-like manner and are often under unbroken skin.
• Sir Thomas Browne described French children in 1643 with a similar condition.
• 1937-1938 - Karl Ekbom published about this condition in people with syphillis.
• In 2001, biologist Mary Leitao named Morgellons based on her son's condition.
• In 2010, it was discovered that there is an association between Lyme and Morgellons; 98% had Lyme.
• Similar to Bovine Digital Dermatitis; lesions in cattle were keratin - also spirochetal.
• Some suggest they are cotton or textiles. The filaments are collagen and keratin produced by epithelial cells.
• They are not fungal, not filamentous bacteria, not microfilaria.
• No cellulose or chitin in the fibers.
• Most have a heavy spirochetal burden.
• In a 25 patients study, 24 were positive for Borrelia.
• Some can have neuropsych symptoms.
• Treponemes could be implicated.
• H. Pylori was found in some specimens.
• Bartonella, Treponemes, and H. Pylori have all been found in the skin lesions.
• Morgellons lesions may resolve with long-term antibiotics.
• It is a true somatic illness associated with Lyme and not at all delusional in origin.
• At the break, I spoke with Ginger Savely who is an expert on Bartonella and she mentioned that it is not easily contagious, if at all. She noted that there is a layer of synovial fluid that builds up on the skin. Anything for Bartonella treatment seems to help.
• Another practitioner mentioned that Ivermectin has helped some patients.

Leona Gilbert PhD spoke on "Morphological and Biochemical Features of Borrelia Burgdorferi Pleomorphic Forms" and shared:

• Pleomorphism allows for the evasion of the immune system and is a consequence of persistent conditions.
• There are coccoid, rod, spirochete, and biofilm forms - two or more forms is pleomorphism.
• In Lyme, there are spirochetes, blebs and loops, round bodies, and biofilms.
• A spirochete averages 20 microns; a round body 3 microns.
• A decrease in spirochetes leads to an increase in blebs and round bodies.
• Human serum induces round bodies.
• Round bodies can go back to spirochetal forms.
• Round bodies have no metabolic activity but they do when they convert back to spirochetes.
• Round bodies are not "cysts".    

Phillip DeMio MD spoke on "PANDAS and PANS: Diagnosis and Treatment":

• Tics can be vocal or motor (often chest up).
• Group A Beta Hemolytic Strep involved in PANDAS.
• OCD, tics, evidence of strep (culture, high ASO, anti-DNase B), onset prepubertal, episodic symptoms and severity, ADHD, choreiform movements, and separation anxiety may be present.
• It is a medical problem, not a mental problem.
• Antibiotics, curcumin, naltrexone, and immunologic treatments may be used.
• PANS is a similar presentation but the trigger could be metals, molds, VOCs, Lyme and many infections but brain autoimmunity is the same key concept.
• PITANDS is a similar presentation but incorporates viruses into the list of triggers. May need antiviral herbs or Valtrex.
• Borrelia can make the immune system sick (immune suppression, pro-inflammatory, and autoimmunity).
• Borrelia can make you autoimmune; strep can as well. Lyme and strep are coinfections.
• Bartonella often presents with more clear psych disorders such as OCD.
• Scabies can transmit Bartonella.
• Bartonella treatment may help kids with PANDAS/PANS.
• There can be white streaks on saggy skin; Bartonella-like.
• The strep germ likes to live in lots of places and causes autoimmunity; can impact thyroid.
• Tests may include CBC, throat culture, Streptozyme, GI testing, IGGAME, Ig subclasses, anti-MBP antibodies, CMP, metabolic testing (adrenal/thyroid), nutritional markers.
• Platelets may be over 300,000; higher lymphocytes when deep autoimmunity is present.
• His team worked with the Enhansa team.
• When using antibiotics, consider probiotics or fermented foods.
• Penicillin, amoxicillin, Augmentin may be used.
• 1st and 2nd generation cephalosporins - Cephalexin or Cefuroxime or 3rd generation such as Cefdinir and Cefixime.
• Biaxin, Zithromax, or Erythromycin may be used; as may Clindamycin or Bactim/Septra.
• May use IV or IM penicillin, cephalosporin, or penams.
• Olive Leaf Extract, Uva Ursi, Oil of Oregano, Caprylate, silver with arabinosides like Larix or Aloe Powder to bind and discharge silver slowly down the GI tract may be used.
• Curcumin, LDN/UDN (ultra low dose naltrexone), IVIG, Actos, herbals, NSAIDS (COX-1, COX-2), steroids (he does not use) can help.
• Manganese - if high, adding naltrexone can lead to a Parkinson's like syndrome.
• There is a Th2 to Th1 shift with Actos.
• Motrin or Celebrex may help. Pulses licorice. Uses Boswellia.
• Diet is very important. Restrict carbs, phenols, salicylates. Yeast diets, allergy elimination, whole food.
• HBOT - OCD can get worse when strep is the cause; treat the strep. If you don't treat Babesia first, it can get worse with HBOT.

Lance Liotta MD, PhD spoke on "Nanotrap Urinary Test for Lyme Disease: Lyme Borreliosis Antigen Testing" and shared:

• There is a miniature lobster trap that contains a bait that can contain any molecule from a body fluid.
• Allows 1000 fold increase in sensitivity.
• Serologies have common false negatives.
• They chose to look for OspA.
• The sequence they look for is found in a long list of Borrelia organisms.
• They have proven that there is no cross-reactivity with other tick-borne diseases or viruses.
• They have buy-in from both sides.
• A significant proportion of patients expected by the IDSA to be negative were actually positive in the urine.
• Treated patients reverted from positive to negative.
• OspA is a Borrelia antigen shed in the urine only in the presence of active infection with symptoms present.
• Not yet commercially available.

There was a brief Q&A where I learned:

• Bartonella lives in the endothelium, erythrocytes, and macrophages; it has bacteriophages.
• Filaments in Morgellons are not contagious.
• 200-400mg of Mortin may be used daily in a child with PANDAS/PANS.
• OCD is both infection and autoimmunity.
• Great Plains RBC Elements can look for manganese toxicity.
• Nitrous oxide and Propofol impact the mitochondria negatively.
• De Mio uses a soft chamber for HBOT and uses probiotics and antioxidants prior.
• Borrelia has been found in vaginal and seminal samples.
• PANS may be treated with IVIG. Antibodies do kill germs but communicate and reset the immune system. There are 12-15K donors for a dose.
• UDN is a transdermal; some have such low endorphins that any dose of LDN can be too high. To get manganese down, IV chelation, zinc, and magnesium may help.
• Round bodies may be treated with amoxicillin, Doxycycline, a change of pH in either direction, and Biocidin.
• A movie is being made about Morgellons; learn more at http://www.morgellonsmovie.com/. 

Lisa Nagy MD spoke on "The First 5 Days of Transformative Treatment - Environment Medicine Clinical Approach - Presented to Veterans Health Subcommittee - US Congress 2015" and shared:

• Genes, hormonal problems, total toxic exposures make a difference.
• Veterans benefit from environmental medicine - molds, vaccines, toxic exposures, pesticides on clothing.
• If many in the same house are ill, think mold; think environmental exposures.
• Get patients out of scents for 4 days from perfumes, detergents, fabric softeners, etc. You cannot tell if you are chemically sensitive until the 5th day.
• People often become more sensitive as they are getting well.
• Quinolones may cause aortic dissection in some people.
• Chemically sensitive people may not tolerate antibiotics well and may need smaller doses and an every 4 day rotation.
• Molds, chemicals, EMFs, oral galvanism, and endocrine issues must be considered.
• Galvanism makes POTS and EMF intolerance worse.
• When you breathe in VOCs, it can lead to more dysautonomia.
• Outdoor air pollution can lead to autonomic nervous system changes.
• Patients know their symptoms and hold the keys - listen and don't interrupt.
• Many perceived as hypochondriacs may be environmentally ill.
• Mold is found in 70% of the patients. Chemicals, metals, EMFs, all add to the total load.
• Biotrek and RealTime Labs both have urinary mycotoxin tests that may be helpful. Pure Air Controls can test for trichothecenes.
• 40% with mold issues have depression.
• Smart meters may lead to headaches and electrical sensitivity.
• POTS - heart rate goes up 20 beats per minute when standing.
• Hypoadrenal - blood pressure below 100/60; possibly Addison's.
• Dark circles under the eyes may be from food allergies.
• Mentioned the Oasis Bedroom - Edelson's book Living With Environmental Illness - page 160
• Moldy air can kill your rat; in studies, female rats died. Men ussually do better and it may be 5 years later before they become ill. Testosterone being given to the female rates kept them from dying.
• Normal venous pO2 should be 20-30. 40 is bad; 50 is severe and needs oxygen.
• Advanced Labs - monoclonal positive is Lyme. Polyclonal could be relapsing fever or similar.  60% were positive for Lyme in her study.
• Alletess Mold Panel is called the Nagy Panel.
• Fungitell from Quest may help to identify mold exposure.
• Trichothecenes testing may not be as advanced at Biotrek.
• May have people fast for 4 days and then bring foods in one at a time. Likes patients to work with nutritionist Ron Overberg from Dallas.
• Oral potential meter is a good tool to test for galvanism.
• Oxytocin can be great for pain.
• Growth hormone may be indicated in those with low IGF-1.
• Sauna/supplement therapy may be used. After a sauna, binders may be taken.
• Mustard, ketchup, beer all have Brewer's yeast.
• If you feel worse or tired after a sauna, you may need to back off or you could make yourself worse.
• Potassium may help with electrical sensitivity.
• Lithium stabilizes cell membranes.
• LDI for Lyme from Dr. Ty Vincent has 83 Lyme antigens and has been a great success. Watch the videos from AAEM.
• Biomat for pain at home is a great tool.

Tom Moorcroft DO spoke on "Nutritional Approaches to Patients with Chronic Tick-Borne Illness" and shared:

• Many things we carry with us; mold in the sinuses, bugs in the gut.
• Sugar is eight times more addictive than cocaine and can have a 6-8 week withdrawal period.
• Standard American Diet leads to inflammation, autoimmunity, depressed immunity, brain fog, fatigue, sub-optimal performance.
• Food may be the driver of the inflammatory processes in the body.
• Carbs make us fat. High fructose corn syrup is a major one and leads to higher triglycerides.
• LDL can be high and when carbs are removed, the LDL drops and the HDL goes up.
• He likes Bulletproof Coffee; fat stimulates proper brain function.
• Cholesterol is a precursor for D, bile acids, and steroid hormones.
• Metabolic Endotoxemia results from LPS from gram negative bacteria.
• An imbalance of gut microbes can lead to obesity, metabolic syndrome, allergy, autism, inflammation, immune system breakdown, coronary artery disease, and back pain.
• Stress can alter the GI tract and microbiome.
• Diets, prebiotics, probiotics, and antibiotics can impact the gut microbiota.
• Autoimmunity is interpreting self as foreign - attempts to destroy it. Conventional medicine attempts to make the immune system weaker which helps the immune system but makes the overall problem worse.
• Terry Wahls had MS and was in a wheelchair and treated with diet.
• 70-95% of risk for autoimmune disease is diet, toxin exposures, and activity level.
• Look for the factors that led to loss of tolerance.
• Lectins are non-digested proteins that bind to cells in the intestines. They increase permeability.
• Wheat, kidney beans, soybeans, peanuts, and milk are examples of foods that increase intestinal permeability.
• Partially digested food proteins and remnants of gut bacteria with LPS leech into the bloodstream.
• Paleolithic diet improves blood pressure, cholesterol, glycemic control, detoxification, decreases inflammation, and decreases autoimmunity.
• VO2 max is lower in Western Society. Athletes may have high cortisol levels which leads to illness and deterioration.
• Both those with chronic illness and chronic exercise are in sympathetic overdrive, without rest and recovery, and chronically "bonking". There are similar hormonal imbalances and nutrient needs.
• Introduce fats and more proteins; low glycemic carbs.
• Ketogenic diet has a major fuel source that is ketones and fats instead of carbs and glucose. It is more of a fasting state which may lower LPS.
• Long-term, a ketogenic diet may help to decrease weight, BMI, triglycerides, LDL, blood glucose, and increase HDL.
• Ketogenic diets lowered fever and inflammation in endotoxic rats.
• Wahls created the Ketogenic Paleo diet which has helped with MS, Parkinson's, traumatic brain injury; 6-9 cups of veggies per day.
• Dr. Moorcroft put people on a ketogenic diet and they had Herx reactions - biofilms are mostly fat. Maybe the body is burning up the stuff we don't need and giving it to where we do need it. Could a ketogenic diet reduce biofilms?; theory at this stage.
• Organic, whole food, no GMO, no processed foods, minimize grains and dairy, low glycemic, fats are important.

Robert Mozayeni MD spoke on "Clinical Experience in Bartonella Infection: Diagnosis, Treatment, and Outcomes" and shared:

• Bartonella is small vessel disease.
• Ticks, fleas, lice, cats, and even dust mites may transmit Bartonella.
• Symptoms result from endothelial inflammation, small vessel inflammatory disease, and collagen-bound Bartonella.
• Bartonella has been found after a blood meal in mosquitoes but it has not been proven whether or not they can transmit Bartonella.
• Transmission is through blood transfusion, organ transplant, saliva, animal bites, and animal scratches.
• Reservoirs include dogs, coyotes, cats, humans, horses, deer, mice, voles, wood rats, black bears.
• He does not find a high rate of valvular damage but there is a theoretical risk.
• Infection leads to inflammation which leads to fibrin deposits and biofilms which leads to flow impairment and ultimately symptoms.
• Any neuropsychiatric symptom could be associated with Bartonella - anxiety, cognitive impairment, execution function impairment, memory impairment, processing speed impairment, labile mood; it is not a dementia.
• Symptoms may include dysautonomia, POTS, low pulse pressure, fasciculations, tremors, muscle pain, joint pain, headaches, fatigue, and decreased stamina.
• In one study with 296 patients; 205 were women that had small vessel disease, 41% were PCR positive and 62.5% serology positive for Bartonella. Of those with Lyme, 33% were positive for Bartonella by PCR; 50% of a group with psychiatric disorders; 85% of a group with neurological disorders.
• With the Galaxy Diagnostics testing, there is an enrichment process and then a PCR is done.
• In a group with high risk for Bartonella, only 24% were PCR positive as compared to Mozayeni's 41%.
• Perinatal transmission has occurred; though he followed six pregnancies of treated women and umbilical cord blood testing was negative in 5 births with one being actively pregnant.  The children are all well, but have not been tested.
• Endocrine dysfunction is common - adrenals and thyroid. Patients only do well with thyroid support that does not include T4 as T4 goes directly to rT3 in these patients. If one is more tired with T3, you may not have done enough to support the adrenals.
• If you have not first normalized the adrenals and thyroid, you cannot use Rifampin or Mycobutin. The single biggest reason people fail Rifampin treatment is related to the adrenals and the impact on the cytochrome pathways.
• There may be transient neutropenia with treatment. He has seen no persistent liver enzyme elevations or neutropenia when the antibiotic treatment has been continued.
• Some may experience deep pain in the connective tissues 1-2 weeks after treatment begins.
• He may use Clarithromycin and then add Rifampin; may switch to Mycobutin/Rifabutin.
• Intracellular drugs are needed; Bicillin may push Bartonella into RBCs.
• Treatment is of a long duration generally with a ramp up followed by six months.
• He does not find that IVs are needed and PICC lines and similar internal devices may serves as a site for the growth of these organisms.  PICC lines have been found to develop biofilms with Bartonella.
• Need drugs that are bactericidal and not just bacteriostatic; Gentamicin is bactericidal but does not go intracellular where it needs to go.
• Antibiotic therapy can induce adrenal insufficiency; a common problem with Rifampin.
• Have to consider resistance vs. persistence (biofilms).
• There have been 9 confirmed cases of persistence after > 6 months of double antibiotic therapy; this number is likely higher.
• Laboratory considerations may include mild liver function enzyme elevation, decrease in WBC, elevated C4a (higher if IFA positive for Bartonella), mild or normal hsCRP.
• If IFA and PCR positive, the C4a will be even higher. If IFA negative, there may be a high CRP.
• Non-specific IgM activation of the Borrelia Western Blot may be seen. This should be considered in interpretation of a Lyme Western Blot in a patient infected with Bartonella. The immune system may be non-specifically activated.
• He has seen PCR positive results for Bartonella from breast cysts.
• Relying on antibody testing to diagnose or track progress may not be helpful.
• IFA is an indirect test and not reliable for diagnosis; only 20-30%.
• Culture is sensitive and specific.
• Skin biopsy culture raises sensitivity.
• They are working on extending the number of days for the culture but this is not yet commonly available.
• Bartonella may cause false positive IgM Lyme Western Blots.
• Quinolone drugs are not used as the risk of tendon issues is significant. They also may shorten telomere length and theoretically reduce lifespan. Cipro causes QT prolongation and may result in C. Difficile. He uses Perque DigestGuard and has never seen a case of C. Diff when using this probioic; generally two at lunch and bedtime away from antibiotics.
• Bartonella infects bone marrow and bone marrow stem cells.
• Bactrim is a folic acid inhibitor and may work against us from a methylation perspective; also some do not tolerate sulfur.
• In some cases, he may use a small amount of hydrocortisone; stays under 20mg per day which is similar to the physiological levels that the body should normally produce.
• With neurological symptoms, he treats Bartonella or protozoa.
• Focus should be on microcirculation and functional medicine.
• Herxheimer reactions with Rifampin start after about one week.
• Ivermectin could be helping with Bartonella, Brucella, and protozoa.
• He uses the ISAC panel in some people to look at blood coagulation.
• Lubrokinase, baby aspirin, alkalinizing with high dose vitamin C may help with hypercoagulation.
• Bartonella could be associated with stroke or TIAs.
• Bartonella damages collagen and may lead to premature aging and skin sagging; may impact human longevity. Some patients may react badly to surgeries with hardware or to frequency-based anti-aging treatments.

Ray Stricker MD did "Lyme Disease: The Year in Review" and shared:

• He reviewed publications from September 2014 to September 2015.
• Lyme is six times more common than HIV and 20 times more common than Hepatitis C.
• Morgellons was find in 6% of those with Lyme in Australia.
• Borrelia transmission can happen in less than 16 hours.
• 237 bacterial genera commonly detected in ticks in one study; not including virus, fungi, or other organisms.
• Migratory songbirds play a role in the dispersal of Borrelia.
• Viable Borrelia burgdorferi have been found in genital secretions and suggest that Lyme could be transmitted by intimate contact person to person.
• Up to 97% sensitivity on the Western Blot with IGeneX double strain testing and IGeneX criteria.
• Antibiotic treatment results in a small group of surviving cells called persisters; combinations of known antibiotics did not kill persisters.
• Morgellons is a true somatic illness associated with Borrelia that cause Lyme.

Stephen Croucher PhD spoke on "Depiction of Lyme Disease in the Media: The United States and China" and shared:

• Tick-borne disease is on the rise in China.
• There are between 275-350K new cases a year in the US with only 30K reported to the CDC.
• You can only market drugs on TV in the US, New Zealand, and Canada. It is not allowed in other countries.

Steve Phillpis MD spoke on "Autophagy Induction: Potential Cure or Curse" and shared:

• Autophagy is the cellular clearance mechanism to throw out the trash and clean up the cell.
• It helps to reduce the formation of cancers but can also help cancer cells if cancer already exists.
• It helps to control intracellular infection though some organisms take advantage of this such as Bartonella, Brucella, and Coxiella. For many infections, induction of autophagy is beneficial to help remove these from the cells, but for some, it could be problematic.
• Rapamycin or Sirolimus is a macrolide that has been found to be immunosuppressant.
• Rapamycin inhibits mTOR1 and mTOR2. MTOR is mammalian target of rapamycin is a protein encoded by the MTOR gene that regulates growth and proliferation of cells and autophagy.
• Stimulating MTOR reduces autophagy.
• MTOR signaling is involved in aging and neurodegeneration.
• Rapamycin prevents the detrimental effects of sucrose in the brain.
• MTOR is the central pathway to aging, obesity, cancer, and autoimmune diseases.
• Rapamycin has been useful against cancers.
• Rapamycin inhibits mTOR1 ad MTOR2 with chronic exposure.
• There are MTOR dependent autophagy inducers such as Vitamin D, Metformin, tetracyclines, curcumin, EGCG, and caloric restriction. There are MTOR independent autophagy inducers such as trehalose, carbamazepine, valproic acid, and lithium (though this one stimulates MTOR).
• Trehalose is found in many foods such as mushrooms; metabolized into glucose and safe for consumer products.
• He talked about chronic CNS infections, inflammation, insulin, and dementia. Chronic infections and inflammation result in accumulation of abnormal proteins. Alzheimer's results in amyloid plaques. Parkinson's results in a-Synuclein. TDP-43 is found in ALS and FTLD (frontal temporal lobe dementia).
• Parkinson's has been documented with Brucella, Bartonella, and Borrelia. Inflammation is associated with ALS.
• If you have amyloid, a-Synuclein, or TDP-43, what do you do? Autophagy is the key.
• Restoring MTOR signaling with rapamycin rescues cognitive deficits and ameliorates amyloid.
• In Alzheimer's, Carbamazepine has resulted in improvements and reduction of plaques in mice. It is a non-MTOR autophagy inducer.
• Trehalose, another non-MTOR autophagy inducer, also has been shown to reduce plaques in mice studies. Vitamin D clears plaques in mice.
• Dr. Phillips theorized that liposomal trehalose could be a useful therapeutic option for these these conditions if a compounding pharmacy would make it.
• Lithium seems to help the SOD model of ALS as well as TDP-43.
• Rapamycin is an immune suppressant.
• MTOR is central to many age related disorders.
• MTOR inhibition may slow or halt the aging process.
• Induction of autophagy can be both beneficial and harmful.
• Plaquenil inhibits autophagy. Other medications such as macrolides and Rifampin may also.

The final presentation was a panel Q&A where I learned:

• High CD57 may be other infections than Borrelia; not common. In 5 patients that Dr. Phillips had with high CD57, the CD57 normalized with treatment. Low CD57 can be tick-borne diseases. They are now exploring subsets of CD57 to see if they can more clearly identify the impacts of Borrelia specifically.
• Dr. Mozayeni mentioned that when there is Mycoplasma, there is often Bartonella.
• Bartonella symptoms can be neurovascular and cognitive impairment.
• It has not been proven if striae are Bartonella, but they can often find Bartonella in skin cultures. Dr. Stricker noted that striae may also be Rickettsia.
• C4a is a non-specific inflammatory marker.
• Dr. Mozaeyni mentioned that with IFA and culture testing, sensitivity is estimated to be 80-90%.
• Skin biopsy may be the best way to test for Bartonella. They will increase the culture from 8 days to 21 days.
• Striae do become less visible and look like any stretch mark, but collagen is damaged and may not ever fully resolve.
• Dr. Stricker mentioned that he treats pregnancy with amoxicillin and has had no evidence of Borrelia transmission.
• If the Nanotrap is positive, one may not want to get pregnant or at least be on daily antimicrobials.
• Sodium butyrate may be helpful for the microbiome.
• Dr. Stricker mentioned that the biggest advance in Lyme treatment has been the smart phone; to document rashes.
• C4a goes up during a Herxheimer reaction.
• Anaplasma is only known to be tick-borne which raises the likelihood of tick exposure and possibly Lyme disease vs. flea-induced Bartonella.
• Dr. DeMio mentioned use of the Gupta Protocol to assist is resolving symptoms of autism and OCD. He further noted that in children with Lyme and tics, treat the infections.
• Dr. Phillips mentioned that radiofrequency treatments may be able to access microbes in biofilms. Some people that got partial improvement with antibiotics did well with radiofrequency treatment; though side effects are unknown.
• Dr. Stricker mentioned that frequencies can be used to explode spirochetes in a dish, but there is a spectrum of frequency that may also damage normal cells.
• Dr. Mozayeni had one case of Bartonella from bed bugs. Dust allergen extract has been found to have Bartonella.
• For those treating Bartonella that cannot tolerate Biaxin or Zithromax, Clindamycin with Doxycycline may be a backup option. Doxycycline does not work well by itself at all and Dr. Mozayeni does not like Doxycycline + Rifampin.
• For biofilms, bismuth, silver hydrosols may help. Lubrokinase, Serrapeptase, NAC, or IV glutathione. Some use Lumbrokinase in the morning and Serrapeptase in the evening.
• There is no good data for Bartonella or Borrelia transmission from mosquitoes though it may not be impossible; it may be insignificant. Bartonella has been recovered from mosquitoes.
• Babesia may be the tip of the iceberg of a broader protozoal problem.
• Dr. DeMio mentioned that Coxsackie virus mutates. Zinc and selenium may help to reduce the mutations. Elderberry, Olive Leaf Extract, Uva Ursi, Grapefruit Seed Extract, and Caprylic may help; often three are used.
• Getting kids with autism to speak is still a problem. You have to find their lesions - GI, immune, hormonal, etc. Methylation: If methyl B12 and 5-MTHF is too much, use less. DMG can help with speech. Blood flow to the frontotemporal is poor. HBOT, IV Secretin, and oxidative therapies may help. Germanium, vasodialators, Lubrokinase, Vitamin E.
• Nanotrap showed 41% positive rate in a group believed to have Lyme.
• Rickettsias in California are more like European Rickettsias.
• Dr. Stricker mentioned that it may be best to avoid the flu vaccine especially if any history of reactions. Coverage last year was 8% in adults.
• Sexual transmission happens in animal models. There is some evidence in humans. If the patient is treated, they are probably not contagious but an untreated partner may reinfect the patient.
• Situation with Lyme in Norway is worse than in the US - 20% of the population tests positive.

Disclaimer: While I attempted to accurately represent the statements of the various speakers, it is possible that the above contains errors or inaccuracies. If you have any corrections to the content listed above, please Contact Me.