Lyme Disease Inflammation is there…if you know how to look for it
Some of the most common symptoms of from Lyme Disease inflammation are joint pains, muscle pains, and headaches. For this reason many patients suffering with Lyme will be referred from the general practitioner to a Rheumatologist. The follow up panel will check for several autoimmune disease markers which are usually negative. They are negative because the problem is coming from Lyme Disease not from an autoimmune joint disease. Sometimes all the tests will be negative and the rheumatologist will still label you with either “Sero-negative Rheumatoid Arthritis” or “Undifferentiated Mixed Connective Tissue Disease.” Both of these diagnosis basically mean all your tests are negative but you are in pain and we don’t know what to do with you.
Tests a Rheumatologist/GP should run include
1. Celiac Panel
2. Rheumatoid Factor (RF) and CCP Ab for Rheumatoid arthritis
4. ESR/Sed Rate – considered the older “inflammation marker”
5. C-Reactive Protein – considered the current “gold standard inflammation marker”
To be clear this isn’t a bad list of tests to run for someone who has unexplained pain. Indeed it can come from diseases such as Rheumatoid Arthritis, Psoriasis, and Lupus. However, when all these tests come back negative, patients often get told “they have no inflammation”. This is absolutely wrong. If CRP and ESR are normal you can still have inflammation. Tick borne illness and Lyme Disease inflammation need to be strongly considered as the cause of your symptoms.
C-Reactive Protein and ESR – Useless For Many Lyme PatientsIf you talk to a main stream medicine about inflammation, there is practically an oversimplifed view of it. CRP and ESR are the two most standard and established tests for inflammation. They can be terrific markers….but for the most part Lyme Disease does not cause this type of inflammation.
While CRP is considered the “modern” standard inflammation marker, we know that it is useless in Lupus! Lupus produces a type of inflammation that does NOT cause an increase in CRP. Is it a surprise that other conditions also cause inflammation but can leave CRP normal? Fortunately there is a plethora of research on a variety of inflammatory markers. Let’s investigate some of them.
Lyme Disease Inflammation - MMP9 & VEGF
MMP9 is called matrix metallo proteinase 9. It is responsible for moving the immune system from the blood stream out into the tissues. This inflammatory marker causes patients to be in more pain and have what I refer to as the “push crash phenomenon.”
When patients with high MMP9 try to exert themselves through exercise or even to get through a work day or a school day….they often experience more pain and exhaustion after the task. That is, if they are able to push through to finish it at all. So many Lyme patients feel like they have to try so hard for seemingly normal things and it can take them them hours, or even days to recover from the exertion.
This “push crash phenomenon” happens as a result of MMP9 driving inflammation from your blood to your muscle and joints aggressively during activity. It makes exercise often like pouring gas on a fire.
VEGF – Vascular Endothelia Growth Factor
VEGF is a polypeptide that stimulates new blood vessel formation and increases capillary blood flow.
Low VEGF creates capillary hypoperfusion which means we are unable to adequately perfuse any capillary bed including the lungs. This means we have less efficient oxygen transmission and less efficient oxygen deliver in the capillary beds in the periphery. This creates a lower VO2 max not because the airways are restricted, but because the blood flow in and out of the lungs is hindered. This is a primary reason patients with CIRS have “post exertional malaise”. This means when they exercise they have poor oxygen delivery and thus burn through sugar in an anaerobic form (which is 5% as efficient as oxygen based metabolism). They quickly burn through their glycogen stores and this causes many patients to get in a pattern of being active, then “tanking” and taking hours or even days to recover.
High VEGF is highly suspicious of a Bartonella Co-infection as Baronella lives in the endothelial cells. By raising VEGF Bartonella creates more of its preferred environment. However, this extra blood vessel formation creates abnormal blood flows and results in the inability to deliver blood efficiently to where the body wants it. This can be why some patients with tick borne illness develop symptoms such as POTS.
Lyme Disease Inflammation – TGFB1
TGFB1 (Transforming Growth Factor Beta-1) is a cytokine which causes at least 3 major disruptions.
1. TGFB-1 increases blood brain barrier permeability and sets patients up for more neurological based symptoms. Once the protective barrier to your brain is broken the brain symptoms you can experience get much worse! Protecting your brain is a primary goal during recovery from tick borne illness.
2. TGFB-1 creates dysregulation of the Treg/Th17 immune system balance and sets patients up for autoimmune reactivityand loss of immune tolerance. This puts you at a higher risk for developing autoimmune diseases and reactions where your immune system is mistakenly harming your own body.
3. TGFB-1 induces inflammatory changes in the lungs by stiffening epithelial cells resulting in restricted airways and shortness of breath. Asthma testing will be normal, but patients can feel “air hunger” and simply fatigue from having innefficient oxygen.
So we found the inflammation…what do we do?
Not all types of inflammation respond to the same anti-inflammatory support. Let’s go through some things we have found work well for patients with these types of inflammaton. For MMP9 elevations and low VEGF some possible solutions are:
- Boswellia & Celery Seed: Together these can help reduce pain and increase detoxification through the kidneys. Boswellia is the anti-inflammatory found traditionally in Frankincense. It has a history of use for both autoimmune diseases and lung function. This is not surprising given that TGFB1 raises the rate of autoimmune disease and lung problems!
- Fish Oil (High Dose) 4-6grams/day. The big point here is the higher dose necessary to see change. Taking small doses of omega’s are not enough to make a difference. We always need healthy gallbladder function in order to absorb and utilize a higher fat, so patients with poor gallbladder function can struggle with this therapy. The number one question we get here is worries about high dose fish oils causing blood thinning, but this can be easily monitored ans has not been a problem clinically.
- Anti-inflammatory Diet – An anti-inflammatory diet is necessary to get rid of this type of inflammation. I believe this marker is one reason why so many patients with chronic pain see great improvement on a low carbohydrate diet, paleo diet, and grain free type diets. However, this diet is most useful after the Lyme or Tick Borne Illness has been eliminated. Doing the diet while you still have the active bug driving inflammation often doesn’t work and patients get very frustrated! Timing is vital! Because TGFB1 can cause drive autoimmune reactions many of these diets get labeled as diets that help “autoimmune disease”.
- Bilberry is an anti-inflammatory that has good research for eye health. It is known to support healthy circulation to the eyes. By supporting healthy blood flow, we shouldn’t be surprised to find this beneficial as the eyes are really external neuronal tissue. Almost anything good for the eyes is good for nerves. Being good for circulation and nerves means this can be extremely valuable in patients who particularly have circulatory and nervous system symptoms.
In Conclusion: Lyme Disease Inflammation
Lyme Disease does cause inflammation, but the normal CRP and ESR tests fail to find it. You must run more advanced inflammatory markers such as MMP9, TGFB1, and VEGF in order to find the inflammation. Helping your body overcome the inflammation is key to healing from this condition.