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From the Townsend Letter
July 2016

Clinical Insights from the Sophia Health Institute
by Dietrich Klinghardt, MD, PhD, and Dr. Christine Schaffner
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Sophia Health Institute (SHI) is located outside Seattle, Washington, and specializes in the treatment of complex chronic illness. Dr. Dietrich Klinghardt founded SHI. Dr. Schaffner is both leading physician and clinic director at SHI together with a team of physicians and practitioners on the front line in treating patients who have often failed in both conventional and alternative therapies. This patient population inspires innovative treatment approaches and drives us to continually reevaluate their current working diagnosis and therapy model.

The goal of this article is to share clinical pearls from the team at Sophia. We hope that it opens a dialogue among practitioners in the field, so that we can continue to share successes, failures, and resources – and provide the most elegant path to healing for our patients.

The Four Guiding Principles
Dr. Klinghardt has distilled his 40 years of clinical experience and digesting information from seminars and think tanks into four guiding principles in the treatment of any chronic condition:

Principle 1: Balance the Impaired Metabolism. The first step is to support the patient's biochemistry and imbalanced metabolism. Many of the epigenetic influences caused by trauma and toxic exposures two or three generations ago add to the stresses of modern day life, which together creates deficiencies in key nutrients that are important cofactors for many metabolic pathways. Past toxic exposures in our chronically ill patients lead to imbalances in the endocrine system. Many patients need thyroid, adrenal, and reproductive hormone support. Treatments on this level should also address kryptopyrroluria, methylation, hypothyroidism, adrenal fatigue, perimenopause, lipid disorders, and more.

Principle 2: Detoxification. It is imperative for patients to have open routes of elimination so that they not only address the exposure and impact of environmental toxicants (glyphosate, aluminum, mercury, lead, etc.) on the body, but also can tolerate treatment. The primary organs of elimination include the intestines, liver, kidneys, lungs, and skin. In addition, many patients have impaired bile secretion and elimination. It is important to introduce detoxification strategies that patients are able to tolerate as one of the first steps to any effective protocol. Treatments may include coffee enemas, colon hydrotherapy, sauna therapy, castor oil packs, lymphatic drainage, intestinal binders, and drainage remedies.

Principle 3: Immune Modulation. Immune modulation is a strategy to bring the immune system back in to balance. Patients with chronic illness often have chaotic immune systems with some aspects being upregulated (i.e., TGF beta 1 in mold, C3a in Lyme, etc.), others being downregulated (low WBC, low CD57 in Lyme, etc.). Treatments on this level include neural therapy, homeopathy, acupuncture, craniosacral therapy, sauna therapy, the use of many herbs and low-dose immunotherapy (LDI; a form of applied homeopathy).

Principle 4: Decreasing the Pathogen Load. The last step in an effective treatment requires a solid method to diagnose biofilm-dwelling pathogens and microbes hiding inside the neurons (herpes viruses, Borrelia), inside the cells of the immune system (Mycoplasma, Borrelia), and in body compartments other than the blood, where most physicians are searching in vain for the illness-causing microbes. Treatments may include herbs, different methods of intravenous therapy, or pharmaceuticals.
Provoked Urine PCR Lyme Panel
During a visit from the lab that is now called DNA Connexions, personnel shared with us their ability to do polymerase chain reaction (PCR) testing on a number of pathogens including Lyme and relevant coinfections. Samples that they can test include blood, root canals, urine, and jawbone. In that meeting, a lightbulb came on for Dr. Klinghardt. We know that many of the Lyme-related microbes live inside biofilm communities deeply embedded in the client's tissues. What if we had our patients do a deep tissue bodywork provocation test – a Rolfing session – followed by taking a urine sample? And so we did, and the results surprised us: out of over 100 samples, only 2 patients had no Lyme-related DNA in their urine. Most of our patients tested positive for Babesia, Bartonella, Borrelia, and others.

As clinicians who treat chronic illness, we all know the controversy and challenges of demonstrating a patient's diagnosis purely on lab work. We often have to use a detailed history, clinical signs and symptoms, and alternative diagnostic strategies to come up with an effective treatment plan.

PCR testing is a highly sensitive technique that demonstrates the presence of infectious agents. Another benefit of PCR is that it does not depend on the immune system to produce antibodies. Some of the challenges of PCR testing are that it does not distinguish between dead and alive pathogens. In addition, there can be false positives with amplified DNA. Traditionally PCR Lyme tests are often negative in symptomatic patients, because they are testing the blood and we know Lyme does not live in the blood.

One of the main areas where Lyme lives is in the connective tissue. By stimulating the connective tissue through deep bodywork, such as Rolfing, or vigorous movement, microbes travel from the connective tissue through the lymphatic system. The lymph is moved into the blood and then excreted through the urine. The first urine post Rolfing is the perfect lab sample.

The DNA Connexions Lyme Urine Panel tests the following pathogens:

  • 4 different genes associated with Borrelia burgdorferi;
  • 8 coinfections: Babesia microti, Babesia divergens, Babesia duncani, Bartonella bacilliformis, Bartonella henselae, Bartonella quintana, Borrelia miyamotoi, Borrelia recurrentis, Ehrlichia chaffeensis, and Anaplasma phagocytophilum.

Some patients have added on the DNA Connexions Full View Panel. This test includes over 88 different pathogens, including bacteria, viruses, fungi, and parasites. It evaluates HPV 16, HPV 18, botulism, and tetanus.

Since we have been using this test, we have a few interesting clinical anecdotes. One patient had his neurologist send a sample of cerebrospinal fluid from a spinal tap to the lab. In his urine sample, he was positive for Borrelia burgdorferi OSP B and OSP C, plus Babesia divergens, while his CSF was positive for Babesia divergens and Bartonella bacilliformis. Another patient sent in synovial fluid from her inflamed knee joint. Her results showed elevated Entamoeba species, HPV 39, HPV 56, and HPV 58.

It is too early for us to share our conclusions on how to use this test to guide clinical treatment. So far we have used this test to confirm that the patient really does suffer from Lyme disease and that we are on the right track with treatment. It is also validating for patients who have not had a strong positive Lyme or coinfection test to see positive PCR results. We welcome other clinicians to start using this test in practice and share their observations.

With our current knowledge, the ideal Lyme workup would include the following lab tests:
The IgM and IgG western blot lab will demonstrate the presence of antibodies to Lyme and coinfections. The conventional teaching states that IgM may be positive from week one of initial infection up to 6 to 8 weeks later and IgG is typically positive a few months after initial infection. However, insiders know that IgG and IgM oscillate forth and back in chronic Lyme and IgM can be positive at any time during the course of illness.
Provoked Urine PCR Lyme Panel will demonstrate the presence of Lyme and coinfection DNA and is the most reliable test.
The CD57 is controversial among physicians; however, we find that it often correlates with how the patient feels and can be used to guide clinical treatment.
The LTT-ELISPOT lab test (lymphocyte transformation test) measures activity of T lymphocytes and can be used to monitor the effectiveness of treatment. The iSpot Lyme test measures T lymphocyte activity toward Borrelia burgdorferi. Armin labs also offers an ELISPOT lab for not only Borrelia but also coinfections, Chlamydia trachomatis, TB, and viruses.

Glymphatic System
The recent discovery of the glymphatic system seems to be a key piece in understanding our patient's symptoms and strategies for treatment.

The glymphatic system is named after the role of glial cells in removing fluid waste products from the brain. It is a brainwide pathway that facilitates the exchange of cerebrospinal fluid (CSF) along para-arterial channels to exchange with interstitial fluid (ISF) along paravenous pathways.

Glial cells, specifically astrocytes, play a key role in removing waste products from the brain. Astrocytes form a network of conduits using projections called end-feet that surround arteries and veins inside the brain. The end-feet have aquaporins (water channels) to move CSF in the brain through arteries and ISF out of the brain through veins.

Researchers have demonstrated that the space between brain cells increases during sleep because the brain cells are shrinking to only 40% of their daytime size. The increased space allows for increased removal of toxins from the brain. We often use liposomal melatonin as not only a sleep aid but also a strategy to detoxify the central nervous system. Melatonin has been shown to remove mercury, aluminum, cadmium, viruses, parasites and bacteria from the brain – at night during deep sleep.Melatonin –not glutathione – is also the most potent antioxidant the brain uses to heal itself.

If waste is not properly removed from the brain due to aging, injury, or lack of sleep via the glymphatics it accumulates and may be a cause of neurodegenerative disease.

The lymphatic pump action is created by the swallowing mechanism. We swallow about 3000 times per day. To swallow we have to close our lips and bring the teeth together. A loss of vertical height of our teeth – caused by aging and wear and tear – causes a significant loss of ability of the glymphatic system to drain metabolic waste from the brain and a decrease in acetylcholine production.

The lymph flows downstream from the brain through the cribriform plate to the adenoids, from there to the tonsils, from there along the anterior cervical blood vessels to the interior jugular vein and subclavicular large vessels. Any obstruction in this pathway will cause back-up of waste in the brain with severe consequences. At Sophia we use procaine injections to open blocked lymphatic vessels (tonsil and adenoid injections), manual treatment to the anterior neck vessels, occlusal dental splints, endothelial healing agents (Deep Purple from BioPure), and more.

Professor Marco Ruggiero introduced us to a technique using therapeutic ultrasound to help facilitate drainage of the glymphatic system. The ultrasound uses low-intensity, subthermal mechanical waves to target the deep cervical lymph nodes. By improving the lymph drainage in these nodes, the glymphatic system is better able to drain and remove waste from the brain. In addition, there are three acoustic target points on the brain that ultrasound can be used to help facilitate brain drainage. They include two temporal areas and the occipital foramen.

We also teach our patients a self-treatment of the glymphatic system consisting of rhythmic cranial compression done at night, a self-unblocking massage to the anterior neck vessels, and liver compressions to facilitate the breakdown and transport of mobilized toxic material.

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