Lyme disease is an infection caused by spirochete bacteria — Borrelia burgdorferi — that is transmitted to people and animals through the bite of an infected deer tick, known as a black-legged tick. According to the Centers for Disease Control and Prevention (CDC), Lyme disease is the most common arthropod-borne illness in the U.S.
The bacteria introduced via the tick bite travels through your bloodstream and settles in various tissues and organs. Over time, it can cause significant symptoms. The American Lyme Disease Foundation (ALDF) describes Lyme disease as a “multisystem inflammatory disease that affects the skin in its early, localized stage, and spreads to the joints, nervous system and, to a lesser extent, other organ systems in its later, disseminated stages.”
Prevalence of Lyme disease
According to the CDC, an estimated 329,000 people are diagnosed with Lyme disease each year in the United States.
The CDC also states that age, gender, and outdoor exposure are risk factors in who gets Lyme disease. The condition is most common in boys under 15, and men between 40 and 60 — groups that are more likely to play outside and engage in outdoor activities.
Deer ticks that pose a risk for Lyme disease are primarily located in the Northeast and upper Midwest areas of the United States. The CDC has found that around 95 percent of cases occur in 14 states, including Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, and Wisconsin.
Symptoms of Lyme disease
Within the first month of exposure, Lyme symptoms can be similar to the onset of the flu, and include:
- General achiness
- Swollen lymph nodes
- Joint and muscle pains
The most distinctive Lyme disease symptom, however, is a skin rash called erythema migrans. This rash usually has a characteristic bulls-eye appearance around the location of the tick bite. The erythema migrans rash is estimated to occur in up to 80 percent of Lyme disease infections and can start as early as three days after the bite, or as late as 30 days, but typically shows up within a week. The rash is usually around six inches wide but can be up to 12 inches in width or more. It appears anywhere on the body, and usually lasts from three to five weeks. On darker skin, the rash may look more like a bruise.
In the early weeks and months after the initial tick bite, other symptoms can occur. They include:
Arthritis and joint pain and swelling, often affecting the knees and other larger joints
Pain in muscles
Facial paralysis or palsy, with a drooping appearance and/or loss of muscle tone in the face
Heart palpitations, irregular heartbeat
Periodic dizziness or shortness of breath
Inflammation of the brain and spinal cord
Pain, numbness, and tingling in the hands or feet
Brain fog and short-term memory problems
Changes in vision
Months or even years later after the initial tick bite, untreated Lyme disease can cause:
Arthritis, with pain and swelling of joints
Mental disorders, including depression
Cognitive and neurological impairment, such as confusion, short-term memory loss, and severe brain fog
Numbness in the extremities
Diagnosis of Lyme disease
New-onset Lyme disease is usually diagnosed based on symptoms, the presence of the erythema migrans rash, and possible exposure to infected ticks. In addition, there is recommended blood-testing known as the "two-step" process. The CDC outlines this testing process in their guidelines: “Recommendations for Test Performance and Interpretation from the Second National Conference on Serologic Diagnosis of Lyme Disease.” Specifically, the two steps include:
Step 1: The “EIA” (enzyme immunoassay) test or, less commonly, the Immunofluorescence Assay (IFA) is performed.
Step 2: If the EIA or IFA is positive, or inconclusive, the second test performed is an immunoblot test, also known as a “Western blot” test. If the symptoms are new-onset (less than 30 days), the IgM Western Blot is performed.
If symptoms have been present for more than 30 days, a positive or inconclusive EIA or IFA test is followed by the IgG Western Blot test.
Treatment of Lyme disease
Two key antibiotics — amoxicillin and tetracycline — are used to treat Lyme disease. Typically, a 10-day to a 21-day course is prescribed. In some cases, the antibiotics cefuroxime or doxycycline are used. In longer-standing cases of Lyme disease, intravenous (IV) antibiotics are sometimes used, in some cases for a longer period.
According to National Institutes of Health (NIH) research, most people recover from Lyme disease after a course of antibiotics.
Post-treatment Lyme disease syndrome
In some cases, Lyme disease symptoms such as fatigue, muscle aches, and cognitive issues persist for more than six months. This is called “post-treatment Lyme disease syndrome” (PTLDS), or post Lyme disease syndrome (PLDS). It is also sometimes referred to as “persistent Lyme disease” or “chronic Lyme disease.” Researchers estimate that around 10 to 20 percent of patients have PTLDS, with continuing joint inflammation and other Lyme symptoms for months or years after treatment.
Some experts recommend long-term use of antibiotics — including IV antibiotic therapy — to help resolve PTLDS.
Maryland/Washington, D.C.-based naturopathic physician Kevin Passero, N.D., works with many PTLDS patients in his practice, Green Healing Wellness. He recommends working with a knowledgeable naturopath or physician trained in nutritional medicine, to evaluate supplements that can complement medical treatment of persistent Lyme disease symptoms. Among the [supplements] that Dr. Passero often recommends to PTLDS patients are alpha lipoic acid for nerve support and nerve pain, cat’s claw for joint pain and inflammation, colostrum to help the immune system and gut, and turmeric for inflammation.
Probiotics are also crucial, says Dr. Passero, since PTLDS patients have often taken many antibiotics. According to Dr. Passero, the “body's balance of good bacteria in the gut has likely been disrupted. Probiotics help to restore healthy colonies back to the gut, which stabilizes gastrointestinal function and supports optimal immune health.” Dr. Passero also recommends a high-quality fish oil supplement, “as the omega 3 fatty acids naturally reduce inflammation in the body. They also support the brain and neurological system, which is important for all Lyme disease sufferers.”
Lyme disease, autoimmunity, and your thyroid
Why some people develop PTLDS is not known, but it’s thought that antibiotic-resistance and an autoimmune reaction plays a role. Some experts theorize that an autoimmune response is triggered by the Lyme disease infection, causing increased levels of antibodies that attack the joints. Some research has also shown that in the presence of a genetic predisposition to autoimmunity, Lyme disease may give rise to a number of autoimmune diseases that attack other tissues, organs, or glands, including Hashimoto’s thyroiditis.
Holtorf Medical Group founder, Kent Holtorf, M.D., is clear in his advice: “If you have been diagnosed with hypothyroidism, but are not seemingly responding to thyroid hormone replacement treatment, familiarize yourself with the signs and symptoms of Lyme disease.” Dr. Holtorf recommends that if you suspect Lyme disease, you should consult with a physician who has expertise in diagnosing and treating Lyme and PTLDS.
According to Lyme disease expert Daniel J. Cameron, M.D., master of public health, a promising treatment for PTLDS is low-dose naltrexone (LDN). He reports on a study that found that eight weeks of LDN therapy at 4.5 mg nightly reduced pro-inflammatory cytokines. Cytokines are substances secreted by immune cells that affect other cells, in this case, by promoting inflammation. Elevated levels of cytokines are characteristic of PTLDS patients. LDN is an innovative approach to treating a variety of autoimmune conditions, and LDN has been successfully used in Hashimoto’s and Graves’ disease patients. The LDN Research Trust has a helpful page with multiple interviews with physician and patients who have used LDN successfully in Lyme disease. You can also learn more about the history and use of LDN for a variety of conditions in patient advocate Julia Schopick’s book, “Honest Medicine.”
New treatments are also being explored for Lyme disease and PTLDS, especially when concurrent with autoimmune thyroid disease. As part of his advocacy for Lyme disease patients, Dr. Holtorf has called attention to cutting-edge research into disulfiram (Antabuse), a drug usually used to treat people with alcohol abuse problems. Disulfiram is showing promise as a possible PTLDS treatment, and more research is underway.