1. Multi-factorial contributors to what we label Lyme spectrum disease
Dr. Kenneth F. Kochler, D.O.
Functional Medicine
VA Beach, VA.

2. Total Bacterial & Viral Body Burden
Lyme Species and co-infections
Lyme (not Lymes) Lyme Connecticut
Borellia (burgdorferi) a spirochete-classic Lyme
Bartonella-henselea
Babesia-Babesiosis-Babesia microti
Erlichia-Erlichiosis-chaffeensis & ewingii
Mycoplasma & Clostridia
Brucella
Fanciscella-tularensis (Tularemia)
Rickettsia-rickettsii (Rocky Mt Spotted Fever)

3. Lyme Borrelia burgdorferi-spirocete Bannwarth Syndrome?
Lyme, CT-1975 as “juvenile rheumatoid arthritis” by local Mothers
Called Lyme in 1982
Organisms harbored in the tick’s stomach

4. Babesia Malaria-like protozoan species Intra-erythrocytic-in RBC’s
Destroys RBC’s-anemia-jaundice-malaise
Asymptomatic in otherwise healthy hosts
Tick-transfusion & transplacental transmission
Victor Babes-1888-in cattle with febrile hemoglobinuria
Texas cattle fever-1893 (now cats & mice)
1st human case-1957-Yugoslavian cattle farmer
1st US case-1969-Nantuket Mass.

5. Ehrlichiosis All livestock
WBC Intracytoplasmic gram negative orgasm resembling Rickettsia
Human granulocytic anaplasmosis (HGA), granulocytes
formerly known as HGE (ehlichiosis)-moncytes
Type depends on infecting species & leukocyte type infected

6. Bartonella
A.L. Barton-1909-described organisms that adhered to RBC’s-Bartonia
Later- Bartonella bacilliformis-gram negative
Initially thought to be rickettsiae
B. henselea-catscratch disease

7. VIRUSES & VACCINATIONS
Hepatitis
H1N1
HIV
XMRV (newly researched retro virus)
Xenotropic murine leukemia retro-virus
An RNA > DNA virus discovered 2006 in
human prostate cancer tissue
67%Assoc with Chronic fatigue Syndrome
(2009-Whitmore Peterson Institute, NV)
Vaccination residuals due to vaccine viral contaminants (herpes type 6 & 7)

8. Heavy Metal Toxicity Body Burden
Mercury, Lead, Cadmium, Antimony, Arsenic, Aluminum, Nickel (include fluoride)
Heavy Metal toxicity masquerades as
AUTO-IMMUNE DISEASE
“neuro-endocrine disruptors”
Impaired enzyme & receptor function with yeast overgrowth (candida as an adaptation)
Assayed via NutrEval by Genova Diagnostics or Doctor’s Data RBC Elements

9. Mercury: Sources
Thimersol (50% Hg by volume) was the preservative in most vaccines until approx (current shift to aluminum)
Cumulative dose in vaccines from birth to age 5 years exceeded the EPA guidelines for safety.
Large population of older children and young adults have had significant exposure (Hg thermometers as a child)
Study on NYC adult population revealed 24.8% had blood levels at or exceeding 5ug/l, the NY State reportable level.
McKelvey W. Environ Health Perspect Oct;115(10):
Seafood, dental amalgams, and industrial output account for the major sources of exposure today. (Coal-fired power plants)
WHO. Methyl Mercury. Environmental Health Criteria, vol Geneva: World Health Organization, Sallsten G, et.al., J Dent Res 1996; 75: 594–8

10. Mercury Toxicity:
Low level chronic exposure can lead to nervous system
damage resulting in depression, anxiety & cognitive loss
Weiss B, Clarkson TW, Simon W. Environ Health Perspect 2002; 110 (Suppl 5): 851–4
Autoimmunity Issues
Paresthesias, insommnia, cognitive difficulties,
neuromuscular changes, headaches and anxiety, third cranial nerve palsy.

11. Sources: Color pigment (dyes & paints) Cigarette smoke Ni-Cd batteries
Cadmium:
Sources: Color pigment (dyes & paints)
Cigarette smoke
Ni-Cd batteries
Phosphate fertilizers
Jarup L et al. Health effects of cadmium exposure—a review of the literature and a risk estimate. Scand J Work Environ Health 1998; 24 (Suppl 1): 1–51
WHO. Cadmium. Environmental Health Criteria, vol Geneva: World Health
Organization, 1992
Toxicity: Kidney damage
Osteoporosis
Cancer-thyroid & Prostate
Jarup, L. Br. Med. Bull. 68: (2003)

12. Lead: Sources: Gasoline (Worldwide major source but not in US)
Lead in drinking water primarily due to the presence of lead
in certain pipes, solder, and fixtures.
In kids toys and lead based paints in old homes (and especially in paint that is not interstate transported)
Toxicity: Decreased IQ
Memory deterioration
Cancer
Anemia
Peripheral nerve symptoms
Hypertension especially in menopausal women
WHO. Lead. Environmental Health Criteria, vol Geneva: World Health
Organization, 1995
Steenland K, Boffetta P. Am J Ind Med 2000; 38: 295–9

13. Sources: Wood preservative Fish Pesticides/food Industrial exposure
Arsenic:
Sources: Wood preservative
Fish
Pesticides/food
Industrial exposure
Toxicity: Cancer-lung, bladder, & kidney
Peripheral neuropathy
Anemia
GI Effects
WHO. Arsenic and Arsenic Compounds. Environmental Health Criteria, vol Geneva: World
Health Organization, 2001
Chilvers DC, Peterson PJ. Global cycling of arsenic. In: Hutchinson TC, Meema KM (eds)
lead, Mercury, Cadmium and Arsenic in the Environment. Chichester: John Wiley & Sons, 1987; –303

14. Testing for heavy metals: (Redistribution to the RBC’s)
Blood levels useful for acute exposure, but an unreliable tool for chronic
low level exposures.
Mercury has affinity for fatty tissue and is rarely found in serum.
The half-life of lead in blood is about one month whereas the
half-life in bone is years. (35)
WHO. Lead. Environmental Health Criteria, vol Geneva: World Health Organization, 1995
Difficult to accurately assess total body burden. Urinary porphyrins
have some utility – currently probably the best clinical test available.
Hair Mineral Analysis may be helpful, but show false negative in
individuals with compromised detoxification pathways
Provocative challenge-involves administering a test dose of a chelator
(DMPS, DMSA, or EDTA) and measuring pre- and post- fecal &/or
urine for heavy metals.

15. Nutritional support during chelation essential
Heavy Metals (con’t)
Treatment:
Nutritional support during chelation essential
I. Gut binding agents-Bentonite, Charcoal, Zeolite, chlorella, garlic
Cholestyramine-low dose, pulsed, with caution
II. Mineral replacement-depending on the chelator used, replace
minerals aggressively with special attention to Ca & Mg
with EDTA (Suppositories) and Cu & Zn with DMPS/DMSA
III. Antioxidant support-necessary to quench free radicals generated
during heavy metal removal. Supplement with A, C, E, Zn,
selenium, and reduced glutathione.
IV. Hepatic support

16. GLUTATHIONE ADEQUACY
Genomics to determine GST enzyme pathway adequacy (glutathione-S-transferase)
Serum Glutathione levels-baseline determination is a must (but largely unknown or forgotten by most physicians) Lab Corp offers this testing and is included in the Genova NutrEval
The MASTER ANTIOXIDANT of the body!
Excellent for natural metal chelation (which impacts Lyme disease)

17. METHYLATION Methyl group (-CH3) donator
Needed for phase II liver detox via COMT
Defects = elevated Estrogen & catecholamines
Role in: NEUROTRANSMITTER chemistry, cardiovascular disease, cancer, metal detox, and B-12 & Folate metabolism
SAMe, TMG, methyl B-12 & THF
SNP on COMT, MTHFR C677T (47% incidence in caucasians)
Cystathione-beta-syntase enzyme: B-6/P-5-P & GSH

18. Methylation Cycle 5,10 MTHF Methionine SAM SAH 5 MTHF HomocysteineMg Zn
SAM
MSR
Methionine
Synthase
MTHR
B12
SAH
5 MTHF
Homocysteine
Homocysteine
P5P
CBS
Cystathione
P5P
Cysteine
Taurine
Glutathione

19. BIOFILMS
A community of bacteria, parasites, etc imbedded in an extracellular polymeric substance (EPS) aka slime
Composed of DNA, protein & polysaccharides
NEG CHARGED, and attracts Ca/Mg/Fe to strengthen its matrix
Organisms communicate and exchange genetic material (QUORUM SENSING)
EPS creates antibiotic resistance requiring X concentration of the drug & prevents phagocytosis (WBC organism eradication)

20. BIOFILMS
NIH states that 80% of all chronic infections are biofilm mediated (ie: chronic sinusitis)
This jello-like shield created by bacteria protects against environmental stress and promotes propagation (it’s everywhere: teeth to ship hulls) (Imagine the water-mold issue)
Chemical signals serve as intelligent communication (Quorum Sensing)
Unless biofilms are managed, hosts are subject to unending recurring symptoms from infection

21. BIOFILM & LYME
Once bacteria have joined into biofilm communities, they can no longer be effectively targeted by the immune system. They persist as a chronic infection and inflammatory process. High dose antibiotics and steroids may offer temporary relief, yet the infection never is totally eradicated. Initial organisms are commonly Staph and parasites.

22. BIOFILM & LYME
Borrelia may undergo genome-wide genetic exchange, including plasmid transfers. Virulence can rapidly be enhanced.
Conjugal plasmid transfer ability from Escherichia coli to Bartonella has been established and documented to transfer antibiotic resistance genes.

23. ENDOCRINOPATHIES Hormone decline & Imbalance = aging
Insulin Resistance = aging
Hypoadrenalism w/ decr cortisol = fatigue
Hypothyroidism w/ decr Free T3 & incr rT3
Hormone imbalances: male and female hypogonadism (declines in DHEA and testosterone = aging)
Growth Hormone (IgF-1) decline = aging
Melatonin & Melanocyte Stimulating Hormone
(decline as markers for immune deficiency)

24. NUTRITION
MINERALS-especially magnesium & selenium Trace MINERALS: rhubidium, indium, cesium VITAMINS-especially C, mixed fractions of E (gamma), D3 (25-hydroxy) storage pool & 1,25 di-hydroxy (active w/ receptor) (Marshall Protocol) AMINO ACIDS-especially cysteine, glycine, glutamine (GSH) , methionine & taurine

25. GENOMICS DNA MUTATIONS POLYMORPHISMS
SNP(S) single nucleotide polymorphisms
Defective or incomplete GENE expression
Inadequate enzyme & receptor function
Impaired biochemistry and cellular respiration
Fatigue & degenerative disorders
Assayed via Genovations (Genomic testing)
by Genova Diagnostics

26. SO WHAT CAN WE DO? Nutritional Assessment-NutrEval (Genova)
Heavy Metal Assessment-NutrEval
Essential Fatty Acid Assessment for cell membrane integrity and function-NutrEval
Hormone Assessment-NeuroScience
Neurotransmitter Assessment-NeuroScience
Proper mineral and vitamin supplements after assessment-NutrEval
Glutathione assessment-NutrEval
(search NutrEval)

27. What else? Yeast management Metal detox via chelation
Biofilm management-
EDTA, Proteolytic Enzymes ( Natto or Lumbrokinase), Inter-Face Plus by Prothera
Chinese Herbs that penetrate biofilm: Berberine extract from Coptidis Rhizome (Goldenseal)
Herbs that interfere with Quorum Sensing:
Red & blue berries, kale, oregano, basil, rosemary,
turmeric, ginger, garlic.
Probiotics

28. MORE HERBS Allicin/Garlic (Allicillin) Aloe, Artemisia absinthium
Echinacea, Grapefruit Seed Extract
Mushrooms, Astragalus, Andrographis
Ashwaganda, Boswellia, Neem
Manuka Honey?

29. CYTOKINES This is what you actually causes your demise
Cytokine determination to assess level of inflammation (significant amounts produced in adipose tissues of the body)
NeuroScience has cytokine panel testing
Cytokines are managed by downregulating inflammation
CRP and EFA adequacy are markers

30. Transfer Factors
Peptides of low molecular weight (approximately 5 kDa) and perhaps RNA
Made by Th1 CD4+ Helper T-cells
Present in colostrum
Three components - Antigen specific region, region that binds to Th1 Helper T-cells, and a connector
Can strengthen cell-mediated immunity against specific pathogens
Can be used to immunize against specific pathogens
Aaron White, PhD
Using Transfer Factor to Strengthen Cell-Mediated Immunity
Integrative Healthcare Symposium 2010

31. Definition of transfer factor
Borkowsky and Lawrence (1979):
“‘Transfer Factor’ was originally coined as a convenient shorthand to describe the material or materials present in leukocyte extracts or dialysates of skin test-positive donors that had the capacity to transfer cutaneous delayed type hypersensitivity responses to skin test-negative human subjects.”
Now commonly used in the plural – “transfer factors”
Aaron White, PhD
Using Transfer Factor to Strengthen Cell-Mediated Immunity
Integrative Healthcare Symposium 2010

32. Potential future uses of transfer factors
List of known pathogens growing and includes a variety of intracellular agents (mycoplasma; cell-wall deficient bacteria; XMRV, HHV6 and other viruses).
Transfer factors can be (and are) custom made for pathogens
Many pathogens suppress Th1 immunity (HIV, Lyme) and require cell-mediated immunity to be beaten.
Transfer factors strengthen cell-mediated immunity.
Could be helpful for autoimmune conditions involving too much Th2 (e.g., lupus) but seem less likely to be effective against those involving too much Th1 (e.g., multiple sclerosis).
Cancer treatment
Could be used to support or even replace many vaccines, which skew the immune system in the Th2 direction.
Aaron White, PhD
Using Transfer Factor to Strengthen Cell-Mediated Immunity
Integrative Healthcare Symposium 2010

33.
A small clinical trial study showed a better increase in CD57 counts using both Multi-mmune and LymPlus transfer factors simultaneously.
Patients taking 2 capsules of Multi-immune 2 X daily showed a 600% increase in NK cells

34. STRATEGIES-HOW TO DECIDE
Lyme testing in this country is poor
Many false positives and negatives
Inadequate band assessment
PCR (Polymerase Chain Reaction) via
w/ special staining
Live Blood Analysis is medically outlawed
James Schaller, MD favors IGeneX western blot
(does a single + band constitute Lyme spectrum disease? Not good for the insurance companies)
* Zyto Bio-Resonance Scan
Rapidly assessment of stressors and balancers

35. PERUVIAN RAIN FOREST HERBS
Sorted-out via Zyto
Provided by NutraMedix
Excellent response to these broad spectrum anti-microbial, anti-viral, anti-fungal, and anti-inflammatory herbal tinctures
Samento and Banderol were discussed as excellent remedies for Lyme in the July 2010 issue of the Townsend Letter

36. NutraMedix

37. NutraMedix

38. Homeopathy Deseret Biologics (Des Bio) www.besbio.com
Series Remedies: Borrelia, Brucellosis, Chlamydia, Condyloma, Coxsackie, CMV, Epstein Bar, Giardia, Hepatitis, Herpes Simplex, Zoster, Mycoplasma, Parvovirus, Toxoplasmosis, RMSF, Bartonella, etc.
WOW!
Nothing to loose!...
Detox, Drainage….
Energique-
Single remedies

39. LYME TREATMENT FAILURE

40. CONCLUSION Lyme is not the hub of he wheel It’s a spoke
Lyme spectrum illness management is extremely complex and intricate
Therapy needs to be prioritized and individualized
You cannot get where you want to be with just unending antibiotics…

41. Treatment of gut and systemic biofilms in Lyme
Treatment of gut and systemic biofilms in Lyme Disease can greatly reduce the reservoir of Borrelia and its associated co-infections resulting in a greatly diminished risk of relapse
Heavy metals are ubiquitous. They can compromise immune function, promote overgrowth of candida, as well as dysbiotic gut flora.
Judicial heavy metal detoxification, either once the lyme/co-infection load has been reduced, or concurrently, with appropriate methylation support as needed, may improve outcome and potentially reduce the likelihood of relapse