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Hyperbaric Oxygen Therapy for Chronic Lyme
Since the 1990s, hyperbaric oxygen therapy (HBOT) has been used as an effective adjunctive treatment for chronic Lyme disease, according to Chien-Yu Huang and colleagues. HBOT is the administration of 100% oxygen to patients in pressurized chambers. Breathing oxygen at atmospheric pressure above sea level (sea level = 1 ATA) increases the oxygen level in body tissues. Higher oxygen levels boost white blood cells' ability to kill pathogens and inhibit the growth of anaerobic bacteria. In 2014, Chien-Yu Huang et al.published a case report detailing the use of HBOT in a 31-year-old man with symptoms of chronic Lyme disease.
The subject of the case report displayed erythema migrans lesions (bull's-eye rash characteristic of Lyme) on his legs in January 2004. He also reported joint pain in his knees, shoulders, and temporomandibular joints. The man's Borrelia serology IgG was positive. His symptoms partially resolved after taking 500 mg amoxicillin twice daily for one month, but he continued to experience numerous symptoms for the next three years, including poor concentration, short-term memory loss, sleep disturbance, numbness in extremities, periorbital twitch, and migrating joint pain. These symptoms failed to clear despite further antibiotic treatment over a four-year period. The patient sought hyperbaric oxygen treatment in October 2011.
The man received 30 sessions of HBOT at 2.5 ATA for 1½ hours. His cognitive function and sleep improved within the first 10 sessions. Other nervous system symptoms, including numbness and eye twitching, disappeared with the second 10 sessions. Migrating joint pain resolved with the third set of 10 sessions. "Overall, completion of 30 sessions of HBOT caused noted longstanding Lyme-disease-related symptoms affecting most of the previously affected bodily areas to disappear," according to the authors. The study does not say if the improvement was permanent.
Author-journalist Jill Neimark and Byron White, ND – both of whom suffered with chronic Lyme disease – have benefited from using portable hyperbaric oxygen chambers in their homes. "These home chambers are approved by the FDA, are available by prescription from your doctor, and pressurize to low, safe levels," says Neimark. Using the portable chamber in conjunction with an oxygen concentrator and a medical pass-through can raise tissue oxygen levels up to 400%. Neimark and White have found that infrared sauna therapy works well with HBOT: "Tissue oxygen levels remain elevated for hours after a hyperbaric chamber session, and the infrared sauna heat increases circulation and stimulates the immune system. The two can be synergistic." Both therapies also boost parasympathetic nervous activity, which increases relaxation and healing.
HBOT and sauna therapy are just part of the treatment program that White uses to maintain his health and to help patients regain theirs. Diet, detoxification measures, and herbs are other components. Most importantly, patients with chronic illness need to pay attention to their bodies. White says, "'It is important to temper treatments like hyperbaric oxygen, ozone and sauna with your body's ability to handle the treatment.'"
Huang C-Y, Chen Y-W, Kao T-H et al. Hyperbaric oxygen therapy as an effective adjunctive treatment for chronic Lyme disease. J Chin Med Assoc. 2014;77:269–271. Available at www.jcma-online.com/article/S1726-4901(14)00042-2/pdf. Accessed April 24, 2015.
Neimark J, White B. Healing chronic illness at home: oxygen, ozone, sauna and detoxification for Lyme disease, fibromyalgia, chronic fatigue syndrome, and MCS [online article]. ProHealth. November 21, 2003. http://www.prohealth.com/library/showarticle.cfm?libid=10041. Accessed April 24, 2015.
Sexual Transmission of Lyme?
On January 25, 2014, a press release announced that Borrelia spirochetes had been cultured from semen and vaginal secretions from people who tested positive for Lyme. The study, presented at the annual Western Regional Meeting of the American Federation for Medical Research, proved that viable Borrelia burgdorferi (Bb) was present in human genital secretions. It did not prove that the infection could be transmitted during intercourse. Yet, a storm of headlines proclaimed that Lyme could be sexually transmitted. The study's authors were criticized for not being clear that their research was preliminary. The sensationalized headlines and subsequent outcry nearly made me discount the study's importance. Then, I found version three (April 27, 2015) of the research article, written by Marianne J. Middelveen and a team of US and Australian researchers. The article, published with comments from peer reviewers/referees, discussion from scientists, and rebuttals from the authors, makes interesting reading.
Middelveen and colleagues recruited 17 participants for their study. Four of them acted as controls; they had no history of Lyme and tested negative for Borrelia. All 13 in the patient group had a history of Lyme disease. Ten of them were serologically positive, 2 tested negative, and 1 had equivocal results. The patient group included 4 pairs of heterosexual partners. Genital secretions from all 17 volunteers were cultured for 4 weeks. The researchers used several methods for examining the cultures for spirochetes including light and darkfield microscopy, silver staining, immunohistochemical staining, molecular hybridization, and PCR analysis. "Immunohistochemical and molecular testing was performed in three independent laboratories in a blinded fashion. Positive and negative controls were included in all experiments," say the authors.
No spirochetes were found in cultures from the control participants, but moving spirochetes were observed in genital culture concentrates from 12 of 13 patients. Molecular hybridization and PCR testing confirmed that the spirochetes were strains of Borrelia. The authors report, "PCR sequencing of cultured spirochetes from three couples having unprotected sex indicated that two couples had identical strains of Bb sensu stricto in their semen and vaginal secretions, while the third couple had identical strains of B. hermsii detected in their genital secretions." This finding supports the possibility that Lyme can be sexually transmitted. It is not proof. Some clinicians have noticed a higher failure rate of antibiotic treatment in their sexually active Lyme patients. It is possible that these patients are being reinfected by untreated partners, but more research is needed.
Controlled studies investigating sexual transmission of Borrelia in humans are unethical. (Remember the Tuskegee syphilis studies?) Consequently, researchers will have to rely on less direct means of studying this possibility.
Berndtson K. Health & hype: on sexually transmitted Lyme disease [online article]. Surviving Mold. March 18, 2014. https://www.survivingmold.com/community/health-hype-on-sexually-transmitted-lyme-disease. Accessed April 22, 2015.
Lyme disease may be sexually transmitted, study suggests [online press release]. January 25, 2014. Available at www.prweb.com/releases/2014/01/prweb11506441.htm. Accessed April 22, 2015.
Middelveen MJ, Burke J, Sapi E et al. Culture and identification of Borrelia spirochetes in human vaginal and seminal secretions [v3; ref status: approved 1, not approved 2, http://f1000r.es/5ag] [online article]. F1000 Research. 2015;3:309. http://f1000research.com/articles/3-309/v3#article-reports. Accessed April 22, 2015.
Recent studies refute the longstanding belief that intact skin prevents microbes from crossing the epidermis to living cells below. These studies found bacterial genes and DNA located in the dermis and subcutaneous layer of normal, intact skin. Over the past decade, researchers have learned that some commensal skin bacteria secrete compounds that inhibit excess inflammation during injury. Other secreted compounds directly affect the body's immune responses. Richard L. Gallo of University of California-San Diego School of Medicine and colleagues questioned how commensal skin bacteria influenced the immune system if their only contact were dead skin cells of the epidermis. The researchers examined sequential horizontal sections of normal human skin with qPCR and found bacterial 16S rRNA genes below the maximum depth of hair follicles in facial skin and below sweat glands in palm skin. "This means that the skin acts as a filter (rather than a barrier), and controls the balance of the dermal microbial communities," says Gallo.
In addition to their effect on the body's immune response, commensal bacteria enhance skin health by inhibiting pathogen growth. Pathogenic microbes have a harder time acquiring nutrients and space for growth when skin has an abundant population of commensals. Also, many commensals, including Staphylococcus epidermidis, secrete antimicrobial compounds that deter pathogens. Given the right conditions, however, many protective commensals can cause infection.
"In healthy adults, the amount of diversity seen in skin commensal bacteria is staggering," say James A. Sanford and Gallo. They cite a study, led by N. Fierer, that found 4742 species-level bacterial phylotypes on the hands of 51 healthy young adults with an average of 150-plus phylotypes on each palm. The phylotypes widely differed from person to person and even from a person's right hand and left: "… hands from the same individual shared only 17% of their phylotypes, with different individuals sharing only 13%." Other studies have shown that inhabitants of the same home (people and pets) have more similarity in commensal skin bacteria than strangers do.
Not surprisingly, microbiota composition on diseased skin differs from that found on healthy skin. Researchers have not yet determined "whether alterations in the microbiome lead to disease, or whether underlying conditions result in an unbalance in microbial communities," say Sanford and Gallo. However, a May 2012 investigation of skin microbiota and atopic dermatitis (AD) noted a decrease in microbial diversity during AD flare-up (up to 90% of detected microbes were Staphylococcus species) and increased diversity when the flares resolved with treatment. The association between dysbiosis and psoriasis is less clear cut.
Gallo writes, "Given the abundance and distribution of bacteria both at the surface and within us, it is most logical now to consider the human body as a heterogeneous collection of organisms hoping to work towards a common good."
Fierer N, Hamady M, Lauber CL, Knight R. The influence of sex, handedness, and washing on the diversity of hand surface bacteria. Proc Natl Acad Sci USA. November 18, 2008. Available at http://www.pnas.org/content/early/2008/11/12/0807920105.full.pdf. Accessed May 15, 2015.
Gallo RL. Our microbial self: essential functions for commensal bacteria on the skin. Old Herborn University Seminar Monograph 28. The Epidermis of Man: Co-Existing with Commensals. 2015:33–42. Available at http://www.old-herborn-university.de/publications/books/OHUni_book_28_article_3.pdf. Accessed April 28, 2015.
Kong HH, Oh J, Deming C et al. Temporal shifts in the skin microbiome associated with disease flares and treatment in children with atopic dermatitis. Genome Res. May 2012;22(5):850–859. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3337431. Accessed May 14, 2015.
Sanford JA, Gallo RL. Functions of the skin microbiota in health and disease. Semin Immunol. November 30, 2013;25(5):370–377. Available at www.ncbi.nlm.nih.gov/pmc/articles/PMC4219649. Accessed April 28, 2015.
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