Dr. Richard Horowitz, MD, in Hyde Park, New York
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Dr. Richard Horowitz, MD, in Hyde Park, New York, has treated over 10,000 Lyme disease patients. Whoa. That's a lot of people. So when he recently spoke at a LIA (Lyme-Induced Autism) conference, I really listened. I figured, somebody who has treated thousands of people has got to know a thing or two about how to treat this confetti of infections we call Lyme disease.
I listened to Dr. Horowitz speak at a LIA webinar on April 18th and if you read my blog post from that day, you'll notice that I briefly mention Dr. Horowitz' approach to Lyme disease, which includes addressing what he calls the "three I's" of illness: Infections, Immune Issues and Inflammation.
And you thought it was just about killing some bugs. Or maybe you understand a thing or two about the other "I's", and are working on treating the aspects of healing that I am about to describe. Maybe you even incorporate some of Dr. Horowitz's strategies into your own healing protocol.
First, it is important to treat for infections,and not just the commonly known co-infections of Lyme disease, such as babesia, borrelia, and bartonella. Think categories and think big here! A multi-bug protocol involves treating: 1) Bacteria, from such diverse agents such as Q-fever (yup, I bet you didn't think of that one, did you?), 2) Parasites, including multiple strains of babesia. By the way, I have tested positive for five babesia infections, so just because you test negative for one of the two common strains, doesn't mean that you don't have babesia! As another rabbit trail (because I just can't help but hop from subject to subject), babesia patients, according to Horowitz, are four times sicker than those with just a borrelia infection. Not that I know of any lucky Joe Shmoe who has nothing more than a simple borrelia infection! 3). Viruses. Herpes-6 is a popular one found in Lyme patients, and anti-virals are not very effective against it. It is found to cause chronic fatigue; hence, treating it is vital for resolution of symptoms. 4) Candida. Take it for granted that if you have immune dysfunction, candida is going to be an issue. 5) Mold and fungus. These pernicious infections can be a big deal. Mycotoxins (from mold) can cause just as many symptoms as borrelia and other co-infections. Getting rid of them is important.
According to Dr. Horowitz, the most problematic, or most difficult, infections to eradicate include: bartonella, mycoplasma, chlamydia, rocky mountain spotted fever, typhus, tularema, and q-fever. (And, as Lyme disease sufferers, we are likely to have an assortment of these, as well as others). The difficulty in their eradication lies in the fact that all of the aforementioned are intracellular organisms; that is, they hide inside of human cells. I infer from this information that one of two things then happens; either the body attacks its own cells in an attempt to get the bugs, thereby creating auto-immunity in the body, or/and the bugs remain protected from certain treatments because the cell acts as a safe, comfy fortress for them to hide from the big, bad immune system. Also, not all antibiotics can reach organisms inside the cells, therefore multiple interventions are required to get rid of the ones that find refuge here.
For treatment of infections, Dr. Horowitz combines antibiotics with herbal protocol. I won't mention specifics of these protocol in this post for the sake of space and your sanity, but suffice it to say he believes that incorporating herbs such as smilax (sasaparilla), andrographis, stephania root and japanese knotweed into an antibiotic protocol can decrease a patient's possibilities for relapse. Not only do herbs fight infection, they also decrease inflammation and increase immune function.
Which brings me to the second "I": Inflammation, which, according to Horowitz, causes free radicals and oxidative stress that damage cell membranes, mitochondria, and nerve cells. Pro-inflammatory cytokines also create symptoms through other mechanisms. In addition to antioxidants, such as fruits and vegetables, magnesium, zinc, omega-3 fatty acids and CO-Q10 (see my post on April 18th), Dr. Horowitz advocates low dose Naltrexone (one of the new buzz drugs of 2008) to modulate cytokine response, and glutathione for "pulling" cytokines out. Glutathione, by itself and when taken daily, improves Dr. Horowitz's patients' symptoms by an average of 20%. That is significant.
Treating the third "I", Immune Issues, is just as important as dealing with inflammation and infections. It is, remember, your body that heals you; the drugs don't do it. They can only help. Thus, strengthening the immune system is paramount for healing. This is accomplished through multiple interventions, which also overlap and assist with the second aspect of healing--treating inflammation, (as inflammation is part of immune system response).
We all know that the infectious agents of Lyme disease are masters at making a mess of the immune system. Borrelia suppresses NK cell production; neurotoxins damage nerve and other types of cells; auto-immunity results from antibodies that are produced to infections that cross-react with our own tissue antigens, and the cumulative effects of environmental toxins and infections results in the destruction of cells, including those of the immune system. And this is just for starters.
A multi-faceted approach to strengthening the immune system includes:
1)Detoxifying the body, which includes the following components:
a) Ensuring that the body is well-hydrated
b) Loading up on antioxidants, through a healthy diet and with the help of alpha-lipoic acid
c) Supporting the liver with glutathione and glutathione precursors such as N-acetyl-cysteine, as well as B-vitamins (There are a multitude of ways to support the liver; however, I am mentioning only a few that Dr. Horowitz noted in his presentation)
d) Optimizing mitochondrial function (Where energy is made in the cell) with products such as CO-Q10, NT Factor, and NADH)
e) Minimizing toxic exposures by eating a "clean" diet, high in organic protein and vegetables; living in a clean-air environment, and so on.
f) Optimizing bowel health, with probiotics, fiber, and colon cleanses
g) Assisting and balancing bio-transformation with NAC, glycinate and B-vitamins
Dealing with heavy metal toxicity is likewise important. For this, Dr. Horowitz uses 100-200 mg of DMSA and a product called Algas (10 drops), along with split-cell chlorella and 600 mg NAC. Also DMPS, EDTA, and Med Caps DPO (which contains B-vitamins, NAC and alpha-lipoic acid).
As another rabbit trail...Dr. Horowitz believes that broccoli sprouts are the most effective herbs for opening up phase two liver detoxification pathways (Liver detox takes place in two phases).
2) Healing allergies, by avoiding common food allergens such as wheat, dairy, corn, nuts, and shellfish. (Indeed, you are lucky if you are able to incorporate even one of the above into your diet. Many Lyme disease sufferers cannot have ANY of these. And that is my opinion, not that of Dr. Horowitz). Also, allergies are often related to candida and leaky gut syndrome, so healing the gut can often alleviate allergy problems. Enzyme therapy and NAET (an allergy technique) are likewise beneficial.
3) Treating nutritional and enzyme deficiencies, with essential vitamins, minerals, fatty and amino acids. In my humble opinion, nutrient deficiencies in Lyme disease sufferers are so severe that taking supplements is necessary, in addition to eating a balanced, healthy diet which includes protein, fats and plenty of low-glycemic vegetables.
4) As mitochondrial membranes are particularly susceptible to free radical damage, supporting energy production with CO-Q10, NADH and L-carnitine can also give power to the immune system.
5)Dealing with the psychological factors of Lyme disease. Dr. Horowitz notes that many patients with chronic Lyme disease have a history of depression, anxiety, OCD, post-traumatic stress syndrome and abuse. What's more (and how lovely), Lyme can cause previous psychological patterns to intensify, or cause new ones to emerge. I definitely found this to be true in my own experience with Lyme disease. Dr. Horowitz suggests medication, stress reduction techniques such as Tai Chi or yoga, calming herbs and Journey work (Brandon Bays) as protocol for treating this aspect of illness.
6)Treating endocrine abnormalities. Lyme affects the HPA, or hypothalamus-pituitary-adrenal axis in profound ways, and supporting it with hormones and nutrients is vital for recovery. I was not surprised when Dr. Horowitz confirmed a suspicion that I have always held; that healing from Lyme disease cannot happen if you have adrenal insufficiency. According to Horowitz (and I concur with his opinion) adrenal insufficiency in Lyme can be caused by any form of chronic stress, whether physical, emotional, psychological, environmental or as a result of infectious agents. Getting a saliva cortisol test through Aeron, Metametrix, Genova or Diagnostek is one reliable way to ascertain adrenal fatigue. A complete thyroid panel is also necessary, as the thyroid and adrenals work in concert with one another, and Lyme affects thyroid function as well. Blood tests are acceptable for thyroid testing, although Dr. Horowitz notes that the "normal" ranges for results on blood tests may not be valid indicators of thyroid function. As with adrenal cortisol tests, often, patients must have hormone levels that fall within the higher range of "normal" in order to see clinical improvement.
7) Fixing sleep disorders. If you don't sleep, your body won't re-generate and heal. Plain and simple. There's no way out of the Lyme labyrinth if you don't get restorative sleep, because a lack thereof correlates directly with impaired immune function. Dr. Horowitz suggests Lyrica, trazodone, gabitril, seroquel and Xyrem as medications that will encourage deeper stages of sleep. (In my limited research on this subject, and in my experience, I have found that no drug encourages stage 4 REM sleep, but I could be wrong!...Except, perhaps for that Xyrem stuff, which would knock out an elephant). In any case, medications can help when all else fails. Dr. Horowitz also advocates balancing neurotransmitters with 5-HTP and other interventions to aid with sleep.
8) Healing autonomic nervous system dysfunction. This also relates to treating endocrine abnormalities. Taking salt (particularly sea salt), at a minimum of 3-4 grams per day is important. Taking Florinef (for aldosterone deficiency) and Cortef (for cortisol deficiency) may also be necessary.
9) Healing Gastrointestinal disorders. You want to know if you have leaky gut? Avoid gluten products, and see how you feel. When your gut "leaks", gliadin, the protein found in gluten, gets into the bloodstream, causing inflammation. You don't feel good, and this is a great indication that it's time to throw that croissant out the window. Other indications of leaky gut and hence malabsorption, according to Horowitz,include lab results that show low levels of calcium, magnesium, B-12, iron, potassium, and albumin. Other tests such as Anti-gliadin AB and TTG can also be helpful.
10) Dealing with elevated liver enzymes.
Most Lyme patients, at some stage during illness, have elevated liver enzymes. Well, are you surprised? The liver has a lot of work to do getting borrelia and associated gunk out of the body, and thanks to Leaky Gut, it doesn't have the tools it needs to do its job properly. Dr. Horowitz recommends milk thistle, Hepa #2 (a traditional chinese medicine remedy) NAC, (n-acetyl cysteine) and alpha lipoic acid for improving liver function.
11) Conditioning the body with exercise.
According to Dr. Horowitz, patients need to be on a regular exercise program, as soon as their physical condition permits. But start slow!
12)Dealing with issues of drug use and addiction.
No, the doc isn't talking about crack here, but rather the fact that narcotics, while they may help patients who have severe pain, when taken too often, also interfere with regenerative sleep. Rebound pain and headaches often result which then become part of a chronic symptom complex that becomes difficult to treat. He advises patients trapped in this cycle to consider a pain management specialist and detoxification program.
Posted on 11/18/10, 09:59 am
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The leader of one of my local support groups has traveled from MD to NY twice a year for the past 9 years to see Dr Horowitz . He says Dr H is one of the MDs that was interviewed in Under Our Skin. The one with the really loud tie.
There's alot of jucie meat in your post.
A new person who was very sick recently dropped in on a support group I attend. He was getting 2-3 hours of sleep a night. Less if he didn't medicate himself with Percocet or Pot. He's worried about getting addicted to the Percocet. I found myself saying that the Pot was probably safer than the Percocet. I wonder what Dr Horowitz would say?
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