Long Covid & Lyme Clinic
Long-Covid Webinar
Here I speak with Dr Jack Lambert (Infectious Disease Specialist) and Rebecca Traylen (ANutr) on Long-Covid, the risk factors and what research shows
How I support in Long-Covid
Over the past few years I have been seeing many patients with Long Covid symptoms. I have put together some core herbal principles that I have been using to support a recovery. As with all long term health issues, we need to go back to the foundations, the building blocks of that patient and look for any dysfunction. We need to use herbs to support each step and carefully support each body system.
In Long Covid patients I look at the microcirculation, supporting and repairing veins, using lung and energy tonics and herbs to support brain function. I also look at down regulating inflammation, repairing and supporting immunity and working with my patient on giving the body time to repair and recover.
The Herbs
I usually start working with a foundation mix of herbs and mushrooms to enhance immune support and start to repair the bodies own defence mechanism.
Foundation herbs include Yarrow, Boneset, Echinacea, Pau d arco, elderberries and withania. Blends of these herbs will support white blood cell count, deal with lingering infection, and start to repair the microcirculation.
Many patients have residual lung problems, and we need to support the lungs and microcirculation. A lung tonic may contain: eyebright, ribwort plantain, mullein, fumitory, and rosemary. Warming herb teas, such as our Winter Spice tea, contain ginger, cinnamon, liquorice, clove, lemon balm, Echinacea and bilberry and will give immune support and help with hydration and mucus production.
Reducing Inflammation
Reducing inflammation is key to recovery. Supplementwise, I advise zinc, vitamin C and also probiotics such as Probio7 AB21. Many doctors are looking at Low dose naltrexone as a treatment option for Long Covid patients. My go to herbal equivalent is Curcumin and Boswellia capsules. These are a practitioner strength extract of turmeric with the addition of black pepper and frankincense.
Mushrooms
To support both the immune system and the circulation I prescribe medicinal mushrooms. My 5 mushroom blend, called Multishroom Powder contains reishi, chaga, coriolus, maitake and mesima mushrooms. Taken as a drink this tasty blend will give long term immune support.
A Paced Recovery
Over many years of working with patients with chronic fatigue, I know that we need a paced recovery. We need a set of boundaries around the patient that allows them to set goals and expectations that are manageable. All too often we find patients have a good day, they do too much and then they find themselves back to square one. By managing their daily activity and limiting their daily energy expenditure they will give their body time to heal and recover. So, the key to working with Long Covid is to help the patient manage expectations and to move at a steady pace. One’s body will recover, but we need to systematically repair the body’s defence mechanisms and deal with any underlying tissue damage.
It is a mistake to underestimate the disease that is Covid. Whilst this virus may be new to us, the effect of viruses on the body is well known by herbalists. We work not only on killing the pathogen, but on supporting defence mechanisms and building resilience. Herbal blends and formulas for Long Covid and immune support can be blended individually for patients after a consultation with one of our herbal team. We always advise a consultation so that we can help patients manage the complex task of building back their immune system and building resilience.
How I support in Lyme Disease
Hindsight is a wonderful thing. In my case hindsight is the benefit of having been in clinical practice for almost thirty years and being able to reflect back on some of the cases that I saw years ago.
I now know that some of the patients I saw 25 years ago who presented with ‘chronic fatigue syndrome’ possibly had Lyme disease. The symptoms of the two diseases have, on the surface, many similarities - fatigue, joint pain, odd skin sensations, brain fog and general health decline.
What Lies Beneath
However, it is under the surface that the differences lie and, although Lyme Disease is not a new disease, our understanding of it has developed over the last 30 years or so. In the 1980s, Willy Burgodofer, a leader in the field of medical entomology, discovered that a bacterium called a spirochete (carried by ticks) was causing Lyme Disease. The spirochete was duly named Borelia burgdorferi.
The disease was first reported by Public Health England in the 1980s, but was not widely diagnosed or understood by many general practitioners. It is estimated that about 2,000 -3,000 cases are confirmed through testing each year, but many more are diagnosed on symptoms alone. In England and Wales laboratory confirmed cases have risen since reporting began in 1986. Between 1997 and 2000 there were 0.38 per 100.0000 population, up to 1.64 in 2010 and up to 2.70 cases per 100.000 population in 2017.
NICE (the National Institute for Health and Care Excellence) guidelines state that the terminology around Lyme is varied and poorly understood, and that there is poor quality evidence on both diagnosis and treatment. The NICE guidelines aim to increase awareness and, over the past 10 years, we have seen a big increase in awareness of Lyme and of tick borne illness. Many parks and wild areas have information boards about Lyme, and many more people are aware of the disease.
Not All Ticks
Not all ticks are carriers, possibly up to 18-20%, and it seems, also, that not all people are susceptible. Although many ticks are carried by sheep and deer, we are also finding that dogs carry ticks, as can birds, mice, voles and other mammals. It is also thought that Lyme Disease may be transmitted by mosquitos and other biting insects.
The Big Tick Project, launched in 2015 by the naturalist Chris Packham, in partnership with MSD Animal Health and Bristol University, concluded that a third of all dogs had ticks attached. The study also showed that there was a strong tick presence amongst urban dogs.
Herbal Medicine and Lyme Disease
Over the last few years, many of the patients presenting in my clinic already have a clear idea that Lyme disease is the cause of their health problems. Many have memories of a tick bite, or have already undergone treatment but are still experiencing symptoms. There is also a proportion of people who have received negative blood tests for Lyme from the NHS but who are still experiencing symptoms.
And this is where it starts to get complex. If Lyme infection always presented with the classic bull’s eye ring and associated symptoms, diagnosis would be much simpler. However, one can be bitten by a Lyme carrying tick and have no symptoms for a few weeks, have no bulls eye rash and simply present with flu like symptoms and the ticks themselves are so tiny that spotting them on the skin can be difficult.
And even if you have the classic bull’s eye rash, and get the recommended antibiotic treatment, there are different opinions on how long to treat for and at what dose. I have patients who have been given the standard 21 days of antibiotics and other patients who have been given just two weeks. I even had one patient who went to A&E over a weekend and was given a three day course. The NICE guidelines are clear, but many patients, especially those who have a longer time lag from bite to diagnosis feel that that 21 days of antibiotic treatment is too short a time and many start to look elsewhere for support.
Symptoms of Lymes
When working with patients I find that we very broadly have two groups of symptoms. The ‘acute’ symptoms that have usually developed within a few weeks of being bitten and ‘chronic symptoms’ that can develop over years.
Chronic patients are often infected not just with Borrelia burgdorferi, but also with other tick borne infections that are transmitted by the same type of tick. Anaplasmosis and babesiosis are two such tick borne pathogens and it is possible to be co-infected with them at the same time. It may be that the combined effects of these co-infections give a more serious presentation of Lyme Disease. Some practitioners feel that this presents with more secondary symptoms, such as flu like symptoms.
Some of the Lyme symptoms I see in clinic: (this is not an exhaustive list, simply the main symptoms experienced)
Acute: often within the first month of having been bitten
Bull’s eye rash (erythema migrans) up to 30%
Fever, chills, flu like symptoms, headaches, light sensitive
Sore throat, swollen glands, aching muscles
Aching joints, heart palpitations anxiety
Chronic: this can be months or even years after being bitten
Fatigue
Poor concentration and memory loss
Abdominal upset, pain, diarrhoea, nausea
Dizziness, vertigo, ear problems
Skin sensations, tingling
Sweats
Skin irritation
Low mood
Neurological symptoms
Testing for Lyme
Testing for Lyme and co-infections can be a bit of a minefield. If there is a bull’s eye rash, most patients are not offered a blood test as this is considered a positive Lyme indicator and they are simply treated with antibiotics. If they are offered a blood test, it will be an ELISA test. If this is positive, or if symptoms remain 12 weeks after a negative test, an immunoblot test (Western blot test) is done.
If the test is done too soon after a bite it may come up as a negative. So if you get a negative test result and you still have symptoms, get tested again. Many people consider that having a positive from both ELISA and Western Blot tests is a more accurate diagnosis.
But, these tests are not always accurate and not enough is known as to why this is. There are theories about the different speeds with which individuals develop antibodies to the disease: that they are infected by a strain of the bacterium that is not recognised by the test; that their immune response may be altered for other reasons; or simply that the test was performed too early.
It is important to be aware of all of these possibilities in a clinical setting and to work with patients to try and establish a correct diagnosis. As with many chronic health situations, the patient has often done a huge amount of research and may have looked outside of the NHS for solutions. I find patients are using labs in Germany and other countries to get blood tests done to try to confirm Lymes and look for any co-infections. However, this can lead to problems with NHS GPs not recognising the results from overseas labs, leaving patients feeling that they are in an impossible situation.
My Clinical Approach
In all clinical situations I look at the ‘foundations’ of my patient. I always describe it as the building blocks of the patient’s health. If a patient’s ‘foundation’ is weak then they can often struggle to cope with medicine, be they herbs or allopathic drugs. I liken it to trying to sow seeds in the garden without preparing the soil. To help with this, I would include advice on nutrition and social/lifestyle situations that can all have an impact on the person’s foundation.
So, my first medicine would usually be a ‘foundation’ formula. This may include herbs to soothe the digestion, regulate bowels as well as herbs for immune support, nervous system support, gentle adaptogens and carminatives. Chamomile, fenugreek, yarrow, liquorice, rosemary, echinacea, rose, schisandra, turmeric, marigold, milk thistle and rhodiola are some of my most used herbs in foundation formulas.
Once we have established the patient’s dose tolerance and worked on building the ‘foundation’, I move on to more targeted formulas for specific situations – the second phase. Anti-parasite herbs and anti-bacterial herbs need to be introduced as well as support for gut flora with pre and probiotics. A paced recovery program is put in place including a gentle detox with skin brushing, and detox baths. Even enemas can help. Astragalis, Japanese knotweed, cat’s claw, high strength garlic, wild indigo, golden seal and sweet wormwood are some of the herbs I use in second phase formulas.
I think it is important that we don’t try to look for a standard protocol to manage every Lyme patient. Some of the better known Lyme experts talk about using herbs that are expensive and often difficult to get hold of. I see many, many patients who self treat, spending huge amounts of money, stopping and starting herbs and supplements and struggling with self management. Treating oneself is hugely difficult. As a herbalist, were I unwell, I would always seek advice from another practitioner, whatever my health issue. With Lyme Disease, many patients have been ignored or misunderstood for so long, they are nervous about taking advice. However, with a structured approach and support with lifestyle, diet, herbs and supplements, we can often achieve positive health outcomes.