Chronic Fatigue: Unravelling the Mystery

Chronic Fatigue: Unravelling the Mystery

There are a number of modern diseases that are baffling medical science. Illnesses such as fibromyalgia, IBS and chronic fatigue are all poorly understood by doctors, which makes them very challenging to treat and in most cases patients are informed that their condition cannot be cured. Chronic fatigue syndrome (CFS) is a complicated disorder characterised by extreme fatigue that can’t be explained by any other underlying condition. 

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Lyme Disease Co-infections

Ticks can carry more than just Lyme disease. When people are infected with Lyme, they can also be infected with other nasty organisms from the same tick bite. We call these guys Lyme co-infections. Diagnosing Lyme disease should include checking for co-infections. Lyme co-infections further complicate an already complex condition. Each co-infection can alter the symptom picture, and can make primary Lyme symptoms much worse. Treatment programs have to be tailored to also target the co-infections, and recovery can take much longer. But without treating the co-infections, the patient cannot regain full health. Common co-infections include Babesia, Bartonella, Rickettsia, and Erlichia.

Babesia

Babesia is a parasite similar to the one that causes malaria. As in malaria, Babesia parasites infect the red blood cells and cause similar symptoms. Babesia infection can often have mild, nonspecific symptoms. It can also be severe and life threatening, especially in the elderly and in people who are immunocompromised. 

Acute infection involves fever, chills and haemolytic anaemia. Less severe cases may experience a more gradual onset of headaches, fatigue, loss of appetite, muscle and joint pain, high fever and shaking chills, nausea, and vomiting.

Lyme patients with Babesia co-infection also often experience blurry vision, ringing in the ears, dizziness and lightheadedness, shortness of breath and a feeling of pressure on the chest, night sweats, nausea, and sometimes Bell’s palsy. There is also a cycle of flare-ups every 4-6 days. Lyme patients who fail to respond to treatment can often have an untreated Babesia co-infection.

Bartonella

Bartonella are aerobic bacteria that like to live inside cells. As with Babesia, Bartonella infection can range from mild to severe. With Bartonella the onset of illness is slow. Signs and symptoms include swollen lymph glands, fever, fatigue, headaches, an unusual streaked rash, enlarged spleen, raised liver enzymes, and aches and pains in joints, muscles and bones.

Lyme patients with Bartonella co-infection can also experience light sensitivity, neurological symptoms including tremors and muscle twitching, racing heart, headaches, anxiety, agitation, new stretch marks, and tender nodules under the skin, usually on the shin, outer thigh and back of the arm. There can be rapid improvement following treatment, but the symptoms can return if treatment is stopped too soon.

Rickettsia

Rickettsia are a group or organisms that lie somewhere between bacteria and viruses. Rickettsial diseases range from mild illnesses to severe life-threatening infections. Common symptoms include headache, fever, chills, and aching muscles. Depending on the type of Rickettsia, there may also be a rash, cough, chest pain, runny nose, sore throat, nausea and vomiting, and abdominal pain.

Erlichia

Erlichia comes with a rapid onset of symptoms. These include muscle pain (but not necessarily joint pain), headaches, and neurological symptoms such as shooting pains and seizures. Tests may show a low white blood cell count and raised liver enzymes. We also usually see fast improvement with treatment.

Testing for co-infections

Testing for Rickettsia can be done by your GP and is covered by Medicare. Unfortunately, Australia is behind on the testing for Babesia, Bartonella, and Erlichia. For the most reliable co-infections testing we use IGeneX, a specialist Lyme lab in the US.

What is Blastocystis?

Blastocystis spp. infection- Blastocystosis

Blastocystis spp. is a group of parasites that is sometimes found in the lower intestine (large bowel). Infection with Blastocystis spp. is called blastocystosis. Blastocystis spp. is thought to be transmitted through oral-fecal contact from poor hand washing and hygiene practices, ingesting contaminated food or water, and exposure to animals.

Our understanding of Blastocystis has been revised several times. Up until 1996, Blastocystis was thought to be some type of yeast or fungi. It was only when Blastocystis DNA was studied that we realized it was a parasite. For a long time, we thought there was only one type of Blastocystis- Blastocystis homminis. We now know that there are actually 9 different subtypes, which are collectively called Blastocystis spp. 

There is still debate about whether Blastocystis spp. is even an infectious agent. This is because Blastocystis spp. can be found in the fecal specimens of many people who appear healthy and have no symptoms at all. There is a huge variation in the symptoms people experience, and how well treatment works. Why would there be such variation in symptoms and treatment response? Researchers suggest it is because of the different subtypes of Blastocystis having different effects in the body, and reacting differently to treatment.

 

Signs and symptoms of blastocystosis

In people who do experience symptoms, signs and symptoms can include:

·         Diarrhea

·         Constipation

·         Nausea

·         Vomiting

·         Abdominal cramps

·         Bloody stools

·         Bloating

·         Excessive gas

·         Anal itching

·         Loss of appetite

·         Weight loss

·         Dizziness

·         Headaches

·         Depression

·         Fatigue

·         Rash

Diagnostic considerations

At The Health Lodge, if we suspect you have blastocystosis, we may be interested in performing some tests to give us more information. These include:

·         Testing for Blastocystis spp. A common method to test for Blastocystis spp. is by stool culture, however we prefer to use a variation on this method that involves extraction of DNA followed by polymerase chain reaction (PCR) testing. This is considered the most sensitive testing method.

·         Screening for nutrient deficiencies, as Blastocystis spp. can contribute to nutritional deficiencies, especially iron.

·         Screening for food allergies and intolerances. We find that many of our patients with Blastocystis infection also have food allergies or intolerances. Blastocystis spp. has been found to increase the permeability of the gut wall, which allows large proteins that are usually broken down to pass through into the blood stream. These proteins can interact with the immune system and trigger a reaction.

·         We may be interested in screening for Blastocystis spp. in patients with irritable bowel syndrome or irritable bowel disease (Crohn’s disease, ulcerative colitis). Blastocystis infection has been associated with these diseases, and it may be an underlying cause or contributing factor in some cases.  

Treatment considerations

Common treatment for Blastocystis infection includes the antibiotic metronidazole (Flagyl). However, the high failure rates of eradication using single drug therapy has led to the use of combination therapies of multiple antibiotic and anti-parasitic medications. At The Health Lodge, we find the best results are often achieved with a combination of antibiotic therapy and complementary therapies.

At The Health Lodge, our goals in treating Blastocystosis include eradicating the Blastocystis infection, correcting nutrient deficiencies, identifying and managing food allergies and intolerances, and repairing the gut wall and digestive function. We believe that a multidisciplinary team of health care professionals is essential in managing all the aspects of health. Depending on your individual needs, your multidisciplinary team may include general practitioners, psychologists, dietitians or nutritionists, naturopaths, osteopaths, and acupuncturists. This comprehensive and holistic approach is designed to support your physical, mental, and emotional wellbeing.

Lyme disease - Integrative Treatment Approach Part One

Lyme disease, or Lyme Borreliosis, is caused by a species of bacteria called Borrelia. It is transmitted to humans by ticks. Some ticks carry Borrelia, and when they attach and suck blood, they can regurgitate the bacteria into their host. The most common strain is Borrelia burgdorferi. This is the cause of most cases of Lyme disease in America. In Europe, the main strains are B. garinii and B. afzelii.

 

What are the symptoms of Lyme disease?

Borrelia bacteria are slow growing. Symptoms may take days or months to appear. In some cases, the disease may lie dormant for years, and surface after a stressful event such as illness, surgery, or physical or emotional trauma. One of the earliest and most defining signs of Lyme disease is a rash that spreads out from the site of the tick bite. The rash resembles a bulls-eye. At this early stage you may feel like you have the flu- fatigue, fever, headaches, muscle and joint aches and pains, and swollen lymph nodes are common.

The later stages of Lyme disease can take months or years to develop, and can cause problems in the joints, heart, and nervous system, and may affect mood and cognition.

 

Lyme disease in Australia, why the controversy?

The question of whether Australian ticks carry the bacteria that causes Lyme disease is controversial. The Australian government denies that Australian ticks carry the Borrelia bacteria, and suggests that people with Lyme disease must have contracted it while overseas. However, switched-on health practitioners are finding that not all patients with Lyme disease have been outside of Australia.

So why is there so much disagreement on Lyme disease in Australia? In 1994 a study by Russell and Doggett set out to answer the question of whether Australian ticks carry Borrelia bacteria. They collected 12 000 common Australian ticks and did not isolate any Borrelia DNA, concluding that Australian ticks do not carry the bacteria that causes Lyme disease. However, there were a number of issues in this study. Of the 12 000 ticks, only 1038 were actually tested for Borrelia. Russell and Doggett also worked on the assumption that only the burgdorferi strain of Borrelia causes Lyme disease, yet European studies have found that B.garinii and B.afzelii can also cause Borreliosis.

In 1959 Mackerras isolated Borrelia from Australian kangaroos, wallabies and bandicoots. Russell and Doggett did not mention this study in their own work. In 1962 Carley and Pope discovered an Australian strain of Borrelia, called Borrelia Queenslandica. Again, Russell and Doggett made no mention of this in their study. In 1995 Barry, Wills and Hudson isolated and grew Borrelia bacteria from Australian ticks. They also tested people with symptoms of Lyme disease, and 20% were positive for B.garinii, B.afzelii or B.burgdorferi.

Given that three out of four studies isolated Borrelia species from Australian fauna, a review of the government position on Lyme disease in Australia would be wise. We need more research to fully understand Lyme disease in Australia, and more public awareness of Lyme disease, to ensure people receive the correct diagnosis and best treatment.

 

Why is Lyme disease so difficult to diagnose?

Aside from the clear roadblocks that the controversy of Lyme disease in Australia causes for diagnosis, a number of other issues make diagnosis difficult. Firstly, less than 30% of patients with Lyme disease can recall getting a tick bite. Secondly, the bulls-eye rash that is a defining feature of Lyme disease occurs in less than 30% of cases.

And the list of reasons goes on: Borrelia can live inside cells and inside the central nervous system, and so may not come up in blood tests, especially in chronic cases. The tests currently used are very poor at detecting Borrelia, and results may come back falsely negative. None of the tests, either in Australia or overseas, test for strains of Borrelia specific to Australia, like Borrelia Queenslandica.

Because Lyme is difficult to diagnose, and awareness of Lyme disease in Australia is poor, patients are being misdiagnosed. People with Lyme disease have been misdiagnosed with fibromyalgia, motor neurone disease, Parkinson’s disease, Alzheimer’s disease, and chronic fatigue syndrome.

 

The complexities of Lyme disease

Lyme disease is not your average bacterial infection. Ticks often carry other organisms, including Babesia, Anaplasma, Ehrlichia, and Bartonella. These can be transmitted to humans at the same time as the Borrelia bacteria, causing co-infection. It is incredibly important to test and treat these co-infections as well. Animal and human studies show that these co-infections can cause more severe and treatment-resistant Lyme disease.

Borrelia is also capable of creating a biofilm. A biofilm is a slippery, glue-like coating that some bacteria create to act as a protective shield. The plaque on your teeth is a type of biofilm produced by Treponema denticola, which causes gum disease. To create the biofilm, the bacteria clump together and build a complex matrix around themselves. They can do this on a range of surfaces including our soft tissues. Other organisms, including the co-infections common in Lyme disease, can live inside the biofilm. The biofilm protects the bacteria from attacks from the immune system and antibiotics.  The Borrelia biofilm is one of the reasons Lyme disease and its co-infections are so difficult to treat.

 

Diagnostic considerations for Lyme disease

At The Health Lodge, we understand that the diagnosis and treatment of Lyme disease is complex. Therefore, we suggest a comprehensive diagnostic work-up to gather information relating to your health, including:

  • Screening for Borrelia
  • Screening for co-infections
  • Testing for nutrient deficiencies. Practitioners have found vitamin B12 and magnesium deficiency are common in patients with Lyme disease
  • We may test levels of stress and thyroid hormones. Thyroid and adrenal function is often impaired in Lyme disease
  • Screening for markers of inflammation, as chronic inflammation is an issue in Lyme disease
  • Assessing the health of your detoxification organs. Lyme disease and its co-infections can release toxins that attack the body, especially the nervous system. It is very important that the liver, kidneys, and digestive system are working well to get rid of these toxins. Unfortunately, in many patients with Lyme disease, these detoxification organs are under-functioning.
  • Heavy metal screening. Heavy metals can be incorporated into the bacterial biofilm, and affect the body’s ability to detoxify.

 

Treatment considerations for Lyme disease

Treatment of Lyme disease can be a long and difficult journey. Many people with Lyme disease do not get the treatment they need due to misdiagnosis.  Lyme disease is incredibly complex, and best treated by a team of health practitioners. At The Health Lodge, our treatment plan for patients with Lyme disease may include:

  • Supporting detoxification
  • Breaking down the biofilm
  • Treating Borrelia and co-infections
  • Decreasing inflammation
  • Supporting affected organs and systems
  • Heavy metal chelation
  • Correcting nutrient imbalances
  • Psychological support

 

Your integrative team of health care specialists

We believe that a multidisciplinary team of health care professionals is essential in managing all the aspects of Lyme disease. The multidisciplinary team may include general practitioners, psychologists, dietitians or nutritionists, naturopaths, osteopaths, and acupuncturists. This comprehensive and holistic approach is designed to support the patient’s physical, mental, and emotional well being.

For enquiries call The Health Lodge on 02 6685 6445