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The Gerson Institute of Ayurvedic Medicine

The Ayurvedic Approach to Lyme Disease—Part 2: Treatment by Dr. Scott Gerson

The Ayurvedic Approach to Lyme Disease  (1).png

Review of Part One

In Part 1 of this 2-part article we learned that despite everything that we’ve been taught, the Borrelia burgdorferi spirochete is not the root cause of Lyme Disease. In fact, there isn’t any single microbe which is the root cause of any illness. I know that seems to defy logic. However, while it is true that this spirochete may indeed be the “trigger,” microbes simply initiate the sequence of events in an epigenetically-predisposed individual which eventually we recognize as an illness. Very few physicians recognize the true energetic (epigenetic) cause of Lyme disease or any chronic disease. They only recognize the outwardly manifesting symptoms of disease. Once observed, they then give it a descriptive name, usually referring to the tissue or organ which manifests the most prominent physical features of the disease (e.g. pneumonia- lungs, colitis-colon, breast cancer, etc.) or if the disease manifestation is too complex and multi-systemic, we baptize it with the name of its discoverer (e.g. Parkinson’s disease, Addison’s disease, Barrett’s esophagus, etc.) or, in the case of Lyme disease, its place of discovery. In any case, the whole idea that microbes cause disease is antiquated and wrong and these modern disease names are misleading and meaningless.

We also explained in Part 1 that it is epigenetics that is the key to understanding the pathology and cure of Lyme disease. An epigenetic trait is a predisposition for your DNA to either produce or not produce particular proteins (after all, that’s what DNA does: acts as a template for making specific amino acid chains, i.e., proteins). What determines which protein are made are the presence and positions of small, normally biologically inert molecules (-CH3, -COCH3, etc.) which attach to the long strands of our DNA in seemingly unimportant locations (far away from gene sequences) but which affect the folding patterns and geometry of the entire DNA strand.

Doshas and DNA.png

It is then this higher-order folding pattern of our DNA that determines the expression or non-expression of various genes. These tiny molecules, through covalent energetic bonding and hydrogen-bonding, changes the energetic conformation and hence the folding pattern of our DNA molecules. If that folding pattern results in a gene being “tucked inside” the chromatin structure, it will not be “available” to be translated into its protein (say a neuroinflammatory protein or a tumor suppressor protein); if conversely the folding pattern places that particular gene in an exposed location, it will be expressed into its protein. Although ultimately created by attachments of small molecules to our DNA, epigenetic marks are much more of an energetic phenomenon. They are essentially an energetic imbalance or dissonance. Doshic energetic forces, through the intermediary of the epigenome, determine how gene segments of DNA fold, are transcribed, and ultimately express themselves.

Our patterns of epigenetic marks (our “epigenome”), which regulates the expression of our genes, is induced by current environmental factors and also passed on to us from our ancestors at least several generations back. In other words, some of the tendencies towards health problems you have, including “Lyme disease,” could be the result of illnesses, diet, exposures, medicines, and emotional trauma experienced by your great, great, great…grandparents. And your own epigenome will affect the disease tendencies of your own children and your children’s children’s children.

However, unlike the gene sequence itself which is very difficult to change and only occurs due to mutations, deletions, and polymorphisms which are then largely instantaneously corrected back to the original healthy sequence by robust innate DNA-repair mechanisms, epigenetic marks can be much more easily modified. Extensive research has revealed that not only does one’s diet, exercise, and environmental exposures alter the epigenome, but that a person’s emotions, experiences, and thoughts can also directly affect DNA expression. Both mental stress and mental calm have been shown to cause chemical modifications in DNA and alter epigenetic marks.

Because epigenetic changes can be potentially reversed, the trajectory of chronic diseases including chronic Lyme disease can be altered. Pharmaceutical companies, as usual, are getting involved. They’re approaching the problem in the same old, reductionist paradigm and are developing epigenetic drugs aimed at single molecular targets, instead of taking a more holistic approach. These drugs are creating more harm than benefit. New epigenetic drugs include histone deacetylase inhibitors, histone acetyltransferase inhibitors, protein arginine methyltransferase inhibitors, DNA methyltransferase inhibitors, histone demethylase inhibitors, and sirtuin-activating compounds. So far, despite having received FDA approval, not one of these new drugs has been effective in treating or reversing any chronic disease. What is needed in conditions such as Lyme disease is a more holistic approach to the epigenome which is affected as much by diet, emotional states, and lifestyle as it is by chemicals and drugs. Which brings us to Part 2 of this two-part article: The Ayurvedic Approach to the Treatment of Lyme Disease.

Let me be honest and clear. The illness we call “Lyme Disease” is a very complex and difficult condition to treat. Although I have had good success in many cases with the protocol described here, the disease’s repercussions sometimes persist long after treatment of any kind, including Ayurveda. But I have seen profound improvements in the health of the majority of my patients who have undergone these treatments.


The Ayurvedic Approach to the Treatment of Lyme Disease

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Lyme Disease is often called “the great imitator”. It can mimic polyneuropathy, multiple sclerosis, ALS, brain tumor, encephalopathy, depression, OCD, autism, schizophrenia, dementia, fibromyalgia, Parkinson’s disease, and many other conditions. Back in the 1980’s when I started to see my first Lyme patients, it became clear to me that even appropriate early conventional antibiotic treatment was sometimes but not always effective. Borrelia burgdorferi and other spirochete co-infections can hide deep in the tissues of the body in biofilms where antibiotics have a harder time reaching them. This delay in eliminating these microbes results in time for doshic imbalances to emerge which leads to epigenetic alterations. These epigenetic changes then alter the set of proteins produced by the individual’s DNA leading to immune and biochemical abnormalities and a variety of symptoms--and a more challenging prognosis. Typically, Lyme patients have low WBC counts, high MCV, mildly elevated fasting serum glucose (due to insulin resistance), elevated LDL cholesterol (which is a neuroprotective response by the body), and low Mg. This persistent infection, coupled with an immune system weakened and corrupted by a long battle against the bacteria as well as other environmental chemicals and toxins, meant patients could become chronic and untreatable through the gold-standard antibiotic therapy. Further, I observed that 10 to 20 percent of adequately diagnosed and treated patients progressed to have persistent or recurrent symptoms following even several courses of antibiotics. This is because even if the pathogenic microbes are completely eliminated by antibiotics, the energetic and epigenetic changes persist. To further complicate matters, it soon became known that co-infections were often present: babesia, ehrlichia, Coxiella (Rocky Mountain Spotted Fever), bartonella (Cat-scratch fever), mycoplasma, lungworm, and various molds, and viruses!

By the 1990’s, “Lyme Disease” had become epidemic. Clearly it was not caused by any single pathogen or process.  What was needed was a more holistic approach, one that could up-regulate the body’s immune response to combat this complex multi-component disease. I already knew that all of us are exposed to parabens, phthalates, bisphenol A, glyphosate and a host of other epigenetic toxins too numerous to list. And, of course this is in addition to electromagnetic field (EMF) exposures we all suffer. So I began to consider how Ayurveda, and panchakarma in particular, might be used to treat these patients and over time developed effective protocols.


What is Panchakarma Therapy?

Panchakarma therapies are medical physiotherapies that promote intensified cleansing and bio-purification of the bodily tissues. Its main components include: (1) snehana, internal and external oiling of the body, (2) swedana, sweat therapies, (3) virechana, laxative therapy (4) nasya, nasal irrigation with herbal oils, (5) basti, herbalized enemas, (6) vamana, physician-supervised controlled vomiting, and (7) raktamokshana, removal of small quantities of blood.

Not all of these procedures are required for all patients. These procedures must be administered by trained therapists in a specific sequence for a specified period of time, usually six to fourteen days. In addition, although panchakarma is for the most part a delightful and comfortable—almost spa-like—therapy, there can be periods of discomfort associated with the profound release of toxins that does occur. This is similar but not exactly the same and much less intense than the dreaded Herxheimer reaction, caused specifically by endotoxin-release. Also, often an emotional release accompanies the physical purification (which is also why it’s essential that the therapy be supervised by an expert).


Panchakarma Therapies: The Details

These are the main physiotherapeutic procedures employed and ideally is the initial intervention in Lyme disease if the patient has no contraindications--in which case it is deferred. Although treatments need to be customized for each patient, the general highlights include the following:

Purvakarma (Preparatory procedures)

Pippali Vardhamana

There are a small number of Ayurvedic herbal medicines which are sometimes prescribed to be taken according to a dosage schedule known as “vardhamana krama” meaning gradually escalating and then decreasing dosages. Pippali is used in this fashion to prepare patients for their main panchakarma procedures. The precise dosages are determined by the physician however in general begin with a starting dose of 250 mg (~1/8 teaspoon) on Day 1. Subsequently the dosage is increased by increments of 250 mg each day until day 7 (maximum dose 1750 mg / 7/8 teaspoon). Starting on Day 8, the dosage is reduced by 250 mg until reach the starting dose of 1/8 teaspoon on Day 13. The procedure then ends.

Day                1 2     3 4 5          6 7 8 9          10 11 12 13

Pippali  (mg)      250 500     750 1000 1250   1500 1750 1500 1250    1000 750 500 250

Dosage (tsp)      1/8 ¼    3/8 ½ 5/8     ¾ 7/8 ¾ 5/8      ½ 3/8 ¼ 1/8

Diet During Pippali Vardhamana

The diet during these 13 days was traditionally restricted to only white basmati rice prepared with added ghee and godugdha (cow’s milk). Your physician will modify your specific diet according to your tolerances and constitution.

The purpose of this preparatory procedure is to prepare the liver (yakrit nashini) for the intensive detoxification processes which will follow.


Seasonal Influences on Therapies

To some extent, besides each patients’ unique prakriti (doshic constitution), treatments are determined according to the season. Our climactic seasons are created by the sun’s dominance during the dry season (adana-approximately January 15 to July 15) and the moon’s dominance during the wet season (visarga-approximately July 15 to January 15). These climactic changes create predictable disturbances in the panchamahabhutas (five elements) and the doshas (bioenergies). Thus the doshas wax and wane throughout the year. First they accumulate, then become further aggravated, and then tend to subside again to normalcy. The first two of these stages (accumulation and aggravation occur automatically and are actually the first two early stages of disease manifestation); but the third stage (return to normalcy and balance) can be intentionally helped or hindered by our own behavior, which in turn is determined by our intelligence or ignorance. This understanding of the ebb and flow of seasonal doshic dominance is used in Ayurveda to determine which therapeutic procedures and medicines to administer.

 
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U.S. Dept. of Agriculture Plant Hardiness Zone Map

U.S. Dept. of Agriculture Plant Hardiness Zone Map

If you examine the U.S. Dept. of Agriculture Plant Hardiness Zone map, you begin to understand that different zones within the same continent are atmospherically very different and will produce different doshic and physiological changes and require different seasonal adjustments in Panchakarma procedures. For example, regardless of a person’s innate constitutional type, if undergoing Panchakarma treatment for Lyme disease in the Spring season, at least some measures should be taken to address the naturally aggravated Kapha dosha (vamana [therapeutic vomiting], dhoomapana [herbal smoke inhalation], Udvartana [dry massage] with powders of sandal, aguru, etc., paschimottasana (Seated Forward Bend), ardha matsyendrasana (Seated Half Spinal Twist), inclusion of small quantities of pungent and astringent tastes in the diet, etc.


Pradhanakarma (Main Therapeutic Procedures)

Although treatment will vary for each individual, these are the typical main therapeutic procedures which are useful in the treatment of Lyme disease.

  • Sarvābhyanga (Whole-body massage by two therapists simultaneously) with Vishagarbha tailam, Sahacharadi taila, Mahanarayana taila, or other constitutionally-appropriate medicated oil.

  • Bāspa Sweda/Sarvanga Sweda (Whole-body steam therapy) herbalized with nirgundi and dashmoola

  • Tapa Sweda (Dry heat from far infrared source; e.g. hot stones, hot sand, wood embers, etc)

  • Kalkas (Herbal pastes) of sariva, neem, nirgundi, (12 g each mixed with 75 ml milk + 30 ml ghee) + ½ cup cooked yellow mung dal + shuddha tankana (borax) as lepa (herbalized “mud”)

  • Shirodhara (Oil drip on forehead) with Brahmi taila or Ksheerbala taila

  • Shirovirechana aka Nasya (Nasally-administered liquid medicine) with Shigru tailam (Moringa oleifera), Daruharidra (Berberis aristata), Jyotishmati (Celastrus paniculate), Tulsi (Ocimum sanctum) or Anu tailam

  • Anuvasana basti (Oil-based enema) with bael (Aegle marmelos), Kustha (Saussurea lappa), Rasna (Pluchea lanceolata), Punarnava (Boerhaavia diffusa), among others.

  • Niruha Basti (decoction-based enema): Agnimantha (Premna mucronate), Brihati (Solanum indicum), Gokshura (Tribulus terrestris), Ashwagandha (Withania somnifera), Musta (Cyperus rotundus), Shyonaka (Oroxylum indicum), among others.


Diet and Nutrition

The ultimate aim of the diet in Lyme disease is to correct, in conjunction with the physical therapies and herbal medicines, the status of the epigenome. Unlike other reductionist approaches which utilize vitamins and supplements to address epigenetic methylation issues (e.g. folic acid, vitamin B12, B6, methionine, taurine, manganese, magnesium, zinc, molybdenum, etc) Ayurveda does this holistically and more effectively through the diet.

The diet normally advised (pathyam=compatible foods) for patients of Lyme disease is usually a modified Vata-Pitta pacifying diet. However, food which are heavier in quality, while useful to reduce Vata dosha, must be prepared in a way which makes them lighter and more easily digested. For example, grains such as rice and barley should be briefly dry-roasted before cooking them in the normal way; milk should be boiled and allowed to cool before drinking. The Lyme patient diet should include:

  • Vegetable juices and soups.

  • Coconut water and Coconut milk.

  • Juice of squash (33%), water (33%), ginger root (1 inch), garlic (1 clove), beetroot (1), spinach (handful), kale (handful), red pepper (1).

  • Cooked vegetables including: properly cooked root vegetables, squashes, zucchini, yam, tomato and pumpkin.

  • Ample cumin, coriander, black pepper, ginger, asafetida, garlic, fennel, saffron, and turmeric.

  • Small quantities of green salad with dressing of lemon juice, olive oil and a small amount of salt.

  • Kichadi (recipe made by cooking white basmati rice and mung dal, 1:1 or 2:1 proportion).

  • Warm milk (if tolerated) with mildly warming spices including cinnamon, cardamom, ginger and clove.

Lyme patients should reduce (but not necessarily in all cases entirely eliminate) the following food articles (apathyam=incompatible foods):

  • Hot (spicy) and fried foods; processed sugar; very bitter and astringent foods like brussels sprouts, cabbage, cauliflower, spinach, broccoli rabe and potatoes.

  • Reduce the quantity of raw foods to <20% of the diet.

  • Excessive black tea, coffee, alcohol, yogurt, chocolate, cocoa.


Ayurvedic Herbal Medicines

All of the plant-based medicines listed below, in addition to being natural antioxidants and anti-inflammatory agents, have a wide spectrum of other useful corrective biological functions. I feel it is important to note that many—even most—plants exhibit some type of anti-inflammatory or anti-oxidant effect in vitro, but it is difficult to predict or even measure whether that will translate into meaningful clinical benefit. Nevertheless, assessing in vitro neuro-inflammatory properties of Ayurvedic plants remains an important first step in determining clinical efficacy. However, Western scientists, in their misguided quest to find “biologically active molecules” to bring to market, do not understand the truly holistic way in which plant-based medicines function in the human being.

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For example, the anti-inflammatory activity of Brahmi (Bacopa monniera, Linn.) is well-established. One mechanism of its effect is by inhibiting the release of both IL-6 and TNF-α (previously mentioned inflammatory cytokines) by its saponin triterpenoid fraction. Bacoside A is by far the most abundant saponin triterpenoid in Brahmi and has long been considered responsible for its biological activity. However, in study after study purified Bacoside A does not inhibit the release of these proinflammatory cytokines! This underscores the complexity and holistic nature of how plants interact with human biology. Brahmi contains more than 300 constituents. There are at least 20 other bacosides alone, besides Bacoside A, not to mention glycosides, alkaloids, polysaccharides, and many other classes of molecules. Clearly many different phytochemical constituents of the Brahmi plant work together in concert to exert its anti-neuroinflammatory effect and improve central nervous system function.

Another example of this reductionist thinking which you should resist is the purported benefits of curcumin, the “active ingredient” in turmeric (Curcuma longa, Linn.). At last search, I found over 1500 PubMed references to curcumin and inflammation. As a result, hundreds of isolated curcumin products (along with small quantities of piperine to improve its absorption) are being sold. The basis of these products, beside the profit motive, is that curcumin has been shown in the laboratory to have measurable anti-inflammatory action. But in clinical use, curcumin has not been shown to be nearly as effective as predicted. This is obviously because like Brahmi, turmeric root owes its anti-inflammatory activity in humans to a whole symphony of components.

Please keep this in mind as you read the list of medicines below.

**Please always seek guidance from a qualified Ayurvedic Physician for individualized regimen and dosage schedule before taking any Ayurvedic medicines.**

  • Dashamularishtam 15ml (1 Tbsp) 2X/day

  • Turmeric churna + Triphala churna (50:50 combination) + pinch of pippali ½ teaspoon 2X/day

  • Shuddha (pure) guggulu (Commiphora mukul) as 70% 5:1 hydroalcoholic extract 25 drops 3X/day

  • Kaishore guggulu as 70% 5:1 hydroalcoholic extract 25 drops 3X/day Vāta + Pitta reduction)

  • Yogaraj guggulu as 70% 5:1 hydroalcoholic extract 25 drops 3X/day (Vāta + Kapha reduction)

  • Triphala guggulu as 70% 5:1 hydroalcoholic extract 25 drops 3X/day (Vāta + Kapha reduction)

  • Lajjalu (Mimosa pudica) + Damanaka (Artemesia vulgaris) 60:40 combination, as 60% 5:1 hydroalcoholic extract

  • Chyawanprash 1 tsp 2X/day

  • Āmalaki churna (Emblica officinalis) 3 grams added to 3-6 oz. warm milk + 1 tsp honey

  • Nāgakesara [flowers] (Mesua ferrea) 2 grams with warm water 3X/day or as 40% 5:1 hydroalcoholic extract 25 drops 3X/day

Herbal mixture (I):

Guduchi (4 parts) Pippali (3 parts) Kantakari (2 parts) Dhanyaka (1 parts) Tulsi (2 parts) Maricha (1 parts)

45% 3:1 hydroalcoholic extract 25 drops 3X/day

Herbal mixture (II):

Ashwagandha (4 parts) Vidari (3 parts) Shatavari (2 parts) Pārijāta (1 parts) Nirgundi (2 parts) Chitraka (2 parts) 50% 3:1 hydroalcoholic extract 25 drops 3X/day

Nāgara-Yastimadhu-Haldi-Nirgundi-Pippali Kwath (Ginger-Licorice-Turmeric-Nirgundi-Pippali Tea) is a good alternative to NSAID’s or aspirin to relieve minor aches and pains. Steep 1 teaspoon each of these four powders in 5-7 ounces of hot water for 10 minutes. Strain. Consume 2 cups /day.

[note: Apart from its Vata and Pitta pacifying effects, licorice root has anti-inflammatory actions comparable to cortisone, but without the harmful side-effects. Caution: If overused (>4 cups daily), licorice can elevate blood pressure and reduce serum potassium. Do not use this herb on a daily basis for more than seven consecutive days and avoid it if you have high blood pressure. After seven days simply eliminate it from this formula.


Self-Oil Massage

Whole body massage with various nut- and seed-derived herbalized oils is one of the cornerstones of Ayurvedic treatment. These massage procedures can both be administered by trained professionals or be self-administered, although the benefits may vary. Many Ayurvedic oils used for this purpose utilize sesame oil as the main base oil. Sesame oil alone, as well as other similar seed oils (without the addition of other herbal ingredients), has been shown to exhibit potent anti-inflammatory activity both in vitro and in vivo. In the nervous system sesame oil reduces microglial activation and decreases neuroinflammatory cytokines which promote neuroinflammation (Interleukin-6, Interleukin-1β, and Tissue Necrosis Factor-α). Researchers have identified sesamin and sesamol, two bioactive components of sesame oil, as responsible for these effects, but I suspect it is the holistic effect of the whole oil that is active. Certainly more clinical studies are needed to evaluate the effect of topical oil application on circulating neuro-inflammatory cytokines in Lyme disease but preliminary studies and my own clinical experience point to its potential as an adjunct therapy for this condition.


Meditation and Pranayama

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In the traditional Ayurvedic and Yogic lifestyle, meditation and pranayama (breathing exercises) are used together. There is a burgeoning literature which shows them, both alone and together, to be an effective intervention for various stress-associated disorders such as posttraumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD), anxiety, depression, and others. In recent years their spectrum of beneficial effects has broadened even more. Breathing practices are particularly effective in ameliorating certain pain syndromes. One study in which women performed breathing exercises 30 minutes daily every day for 3 months resulted in statistically significant improvements in pain on tender points of fibromyalgia. Many similar studies involving many other clinical syndromes are in the scientific literature. I have taught and prescribed variants of several ancient Ayurvedic breathing practices to hundreds of Lyme disease patients with remarkable results.

Anuloma viloma (aka “alternate nostril breathing”), although it is only one of many pranayama techniques, has received a lot of attention in the scientific literature. A recent small randomized controlled study showed that this technique decreased some but not all inflammatory cytokines in the saliva in subjects who performed anuloma-viloma 10 minutes a day along with an additional 10 minutes of yogic chanting (Aum). In addition there is a fairly extensive literature examining the effects of “mindfulness meditation,” derived and modified from the ancient Theravada Buddhist tradition, on inflammatory markers. This and other forms of meditation have been shown to reduce many mediators and markers of inflammation in humans including cortisol, C-reactive protein, TNF-α, IL-6, and NF-kB. The various effects and benefits of meditation, pranayama, and other non-pharmacologic mind-body interventions in Lyme disease are likely mediated through the epigenetic down-regulation of proinflammatory genes and biochemical pathways.


Lifestyle Shifts

  • Avoid extended periods of worry, anxiety, fear, stress and grief.

  • Sleep no less than 7 ½ hours each night. Detoxification and regeneration of the CNS only occurs in the deep non-REM portion of each sleep cycle.

  • Perform gentle self-Abhyanga massage with warm Narayana or Vishagarbha oil mixed with sesame oil (50:50) daily; as minimum: apply to feet at night for 1 hour.

  • Sip hot water frequently throughout the day (ushnodaka); drink approximately 4 cups/ day.

  • Leave the house for minimum periods of 20 minutes on most days.

  • Anuloma-viloma pranayama for 5-10 minutes daily followed by 15 minutes shavāsana (“corpse pose”).


Conclusion

Many patients diagnosed with Lyme Disease can be helped by improved nutrition, appropriate and professional detoxification procedures, proper exercise, lifestyle modification, and special Ayurvedic herbal preparations. As more Ayurvedic physicians turn their attention to this disabling syndrome, the future prognosis is now improving for those affected by this condition. In addition, recent scientific studies suggest that specific areas of the brain and specific environmental- and neuro-chemicals (i.e. aluminum, mercury) may be involved in the pathophysiology of this condition and research in these areas are ongoing. As we continue to unravel the intricate connections between the epigenome, the environment, nervous system, immune system, and the mind the successful treatment of Lyme disease will almost certainly involve the integrated approach that Ayurveda has championed for centuries.