Lyme Disease with Dr. Darin Ingels: Rational Wellness Podcast 167

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Dr. Darin Ingels discusses Lyme Disease with Dr. Ben Weitz at the Functional Medicine Discussion Group meeting.

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Podcast Highlights

6:35 Dr. Darin Ingels contracted Lyme Disease, so he learned first hand about the condition and it took him three years to get his life back. Lyme is a bacterial infection caused by the Borrelia species with Borrelia burgdorferi being one of the more dominant species and it’s transmitted primarily through the bite of a deer tick.

8:20 In the early 70s there was a mysterious group of cases of Rheumatoid Arthritis in children in Lyme, Connecticut. They thought that it was a Rickettsial infection, which is a different type of infection, so they started sending samples to a doctor named Wille Burgdorfer, who was a Rickettsia expert who worked for the government in Colorado. It took him about 6 or 7 years to isolate that this was not Rickettsia, but an infection caused by a spirochete, which was named Borrelia Burgdorferi, after Willie Burgdorfer. There are at least five different subspecies of Borrelia burgdorferi and at least 100 different strains of Borrelia in the U.S. alone, and more than 300 strains worldwide. However if we run a Lyme test through a conventional lab like LabCorp or Quest, they are only looking for one species, one strain, Borrelia burgdorferi, so if your patient happened to be exposed to a different strain, there is a high probability it will miss it on that test.

9:47 Some doctors mistakenly think that Lyme Disease only exists in New England, buy Lyme does exist in Southern California as well as in Northern California and California is the 5th fast growing state for the number of Lyme cases in the US. In Southern California we do have hills, mountains, trees, and we have areas where ticks live. In fact, Lyme disease has been reported in all 50 states, including Alaska and Hawaii and there’s more than 300,000 new cases of Lyme disease each year in the U.S. And Lyme is the number one spreading vector-borne epidemic worldwide. Here is a picture of the Ioxodes tick that causes Lyme disease:

13:00 Lyme is a spirochete, which has a corkscrew shape, so it can penetrate other tissues and cells a bit different than other bacteria, and this results in many different kinds of symptoms. In fact, there are over 100 different symptoms, so Lyme is known as the great imitator, since it resembles so many other diseases. Borrelia is a shape shifter, since it can ball itself up like a slinky called a cyst form and there is a cell wall deficient form which looks like a long, straight line. Borrelia’s ability to shape shift allows it to evade the immune system.

14:12 Another interesting thing about Borrelia is that it has a very slow replication cycle. Most bacteria replicate every 10-20 minutes and Borrelia replicates every one to 16 days, which is one reason why Lyme often requires many months of treatment.

15:40 Most of us are unlikely to see patients with acute Lyme disease since this is when the patient is first bitten with the tick and 20-40% end up with a bulls eye rash and Dr. Ingels noted that in California he hardly ever sees a bulls eye rash. Symptoms can occur anywhere within 3 to 30 days following the tick bite, though many patients have no recollection of being bit by a tick. Symptoms of acute Lyme include headaches, neck pain, fever, swollen joints or spine pain, fatigue, heart palpitations, and others.

19:37 Chronic or persistent Lyme disease occurs after the acute infection, though the CDC refuses to acknowledge that chronic Lyme exists, even though there’s multiple studies out of Johns Hopkins University showing otherwise, and millions of patients living with chronic Lyme. Symptoms of chronic Lyme include fatigue, GO symptoms, memory loss, cognitive impairment, neuropathy tends to get worse and spread, burning sensations, feeling of creepy crawlies under the skin, wandering joint pain, light and sound sensitivity, dizziness, vertigo, sleep problems, Lyme carditis, (which can cause mitral-valve prolapse, heart block, heart palpitations, chest pain), balance, coordination problems, newly acquired dyslexia due to a type of brain inflammation, and endocrine disruptions (including hypothyroid, adrenal issues, and menstrual problems).

22:02 Lyme is the great imitator, so it may resemble autism, multiple sclerosis, ALS, chronic fatigue, fibromyalgia, mono, herpes 6, parvovirus, RA, lupus, and pretty much any autoimmune disease. So if you have been diagnosed with any of the above, you should consider if Lyme could be an underlying root cause. An autoimmune disease that is triggered by Lyme often looks different and CRP, rheumatoid factor, and ANA may all be normal, whereas we would expect them to be elevated. Some of these patients when they get tested, they will show evidence of Lyme and then you treat them and they get better.

24:07 While we are focusing on Lyme, there are a quite a number of other tick borne infections, including Babesia, which is a blood parasite and a cousin of malaria, Bartonella (aka cat scratch fever), Anaplasma, Ehrlichia, Mycoplasma, Rickettsia, Rocky Mountain spotted fever, Powassan virus, Colorado tick fever, Heartland virus, Tularemia, and Brucella.

25:16 The reason there is a rise in Lyme is because of climate change, which is also leading to an increase in other insect-borne illnesses, including Dengue virus, Zika virus, and Chikungunya virus. The World Health Organization published a paper and here is a similar paper with the same conclusion: “Ticking Bomb”: The Impact of Climate Change on the Incidence of Lyme Disease.

26:37 The diagnosis of Lyme disease is complicated. The CDC criteria is that you run an elisa antibody test for IgG and IgM antibodies and if it’s positive, then you should run a western blot, also looking at IgG and IgM antibodies. For a test to be positive, you have to have 5 out of 10 IgG bands or 2 out of 3 IgM bands. But sometimes Lyme patients don’t produce antibodies or don’t make an adequate response and for those that do, over time, immunity tends to wane, so it depends upon then their exposure was. There is no test that measures Borrelia directly in the body. Dr. Ingels prefers to use Medical Diagnostic Labs, because they do very comprehensive tick-borne testing and they bill insurance. IGeneX up in Palo Alto, California is also a great lab, its very expensive and outside of Medicare they don’t bill insurance. Dr. Richard Horowitz has developed a questionaire for Lyme called the MSIDS, Multiple Systemic Infectious Disease Syndrome questionaire: MSIDS.

32:42 Treatment for Lyme should start with diet and Dr. Ingels prefers to have patients follow a nutrient dense, alkaline diet. Darin points out that with the exception of the skin, the stomach, the bladder, and for women, the vaginal area, which are very acidic, to protect against outside invaders, by and large, the rest of your body is mostly alkaline. The enzyme systems work best and cell repair work best in an alkaline state. It’s not about the pH of the food, but how the food breaks down in your body. This has nothing to do with blood pH. Urine pH should be above 7.2 Dr. Ingels breaks down his dietary recommendations into three categories:

1. Foods that can be consumed as often as possible, including vegetables, avocados, citrus fruits, sweet potatoes, some nuts and seeds (almonds, brazil nuts, coconut, flax seeds, pumpkin seeds, sesame, chia, sunflower seeds), some grains, legumes, some oils (avocado, olive, coconut, flax, safflower), and some beverages.

2. Foods that should be restricted to 20-25% of the dietary intake, including some fruits, some nuts (pecans, hazelnuts) some grains (rice, oats, organic soy, rye, hemp), animal proteins like meat, eggs, fish, and some oils (sunflower, grapeseed).

3. Foods that you should avoid, like dairy, dried fruits, certain nuts (macadamia, peanuts, pistachios), junk food, artificial foods, processed foods, sugar, condiments (honey, jelly, mustard, soy sauce, vinegar), oils (corn, cottonseed, soybean, vegetable, hydrogenated fats), and beverages like coffee, which is very acidic, alcohol, black tea, and fruit juice. Then you need to get your gut healthy, which can be adversely affected by the long term used of antibiotics.

39:14 After getting the diet and the gut in order, the next step is targeting the Lyme and the coinfections. Antibiotics can be very effective following an acute infection, but the longer you are away from the initial exposure, the odds of antibiotics being effective go down. Antibiotics can disrupt your microbiome and can damage your mitochondria and Dr. Ingels has seen patients that come to see him who have been on antibiotics for many years. Dr. Ingels prefers using herbal protocols, which tend to be more effective than antibiotics, can kill Lyme in multiple forms, and they don’t damage your microbiome, are anti-inflammatory, and can also boost your immune system. The first botanical protocol that Darin likes is the Cowden Protocol, developed by Dr. Lee Cowden, a cardiologist. Here are some of the botanicals that may be included in the 5 to 9 month protocol that involves changing the herbs each month, that are designed to kill the microbes, support detoxification, and clear heavy metals:

  • Amantilla
  • Banderol-microbial defense
  • Burbur-detox
  • Cumanda
  • Enula
  • Magnesium Malate
  • Mora
  • Parsley-detox
  • Pinella-brain/nerve cleanse
  • Samento-microbial defense
  • Sealantro-metal detox
  • Serrapeptase
  • Sparga-sulphur detox

These herbs are liquid extracts and can be used easily in kids and you can easily titrate the dosages. The herbs that Dr. Ingels uses most often are Samento, Banderol, and Cumanda and he will recommend 15-30 drops in 1 oz of water twice per day for at least 6 weeks. If the patient has a herxheimer reaction, he may add Burbur. He may have patients start with 2-4 drops in 1 oz of water twice per day and slowly increase dosage by 1 drop every 3-4 days till they get up to 30 drops per day. If a patient has a herx reaction, then leave the dosage the same. For severe herxheimer reactions you can give 10 drops of Burbur every 10 minutes.

45:51 Zhang herbal protocol. The clinical protocol that Dr. Ingels took to help himself when he was suffering with Lyme disease after being on antibiotics for 9 months that were not helping and he has found to be the most effective for his patients with Lyme is the herbal protocol that was developed by Dr. Qincao Zhang, LAc and it includes the following herbs:

1. Artemisiae
2. Houttuynia (HH Caps)
3. Circulation P
4. Coptis
5. Cordyceps
6. Pueraria
7. R-5081
8. AI-M
9. Allicin

The downside to this protocol is that it is fairly expensive, since some patients are on at 5-6 products and this involves taking 15-20 capsules. The patient cost is at least $500 per month with Dr. Zhang’s herbs. Dr. Zhang’s protocol helps eradicate the infections, improves circulation, reduces inflammation and improves detoxification. It is one of the most comprehensive herbal protocols to address each aspect of Lyme Disease. Dr. Ingels pointed out that he tends to use Coptis for acute Lyme but not as much for chronic Lyme because it contains berberine, which might potentially disrupt the microbiome during long term usage.

49:56 There are other herbal protocols, like Byron White’s. His formulas are based on what you know your patient has. If your patient has Lyme, you use AL-Complex. If your patient has babesia they get A-Bab and if they have Bartonella they get A-Bart, etc.. These herbs are extremely strong and herxing reactions are very common. These are tinctures, so you should start with a low dosage, say 1 drop and slowly increase. Stephen Buhner is a well known herbalist who has a very good protocol for Lyme that includes Japanese knotwood, Cat’s Claw, Andrographis, Wireweed, and Yellow Dye Root.

53:30 Breaking down biofilms is another important aspect of treating Lyme. There are specific enzymes that can help to break down biofilms, including serrapeptase, nattokinase, and lumbrokinase. Interface Plus is a product from Klaire Labs that has EDTA and serrapeptase in it that works pretty well. Coconut oil contains monolaurin, which can break up biofilms. N-Acetyl Cysteine is an amino acid that breaks up mucus and has been shown to break up biofilms. Long term use of NAC can deplete zinc and copper, so you should also supplement with these.

56:12 Low Dose Immunotherapy can also be helpful for patients with chronic Lyme disease. It was developed by Dr. Ty Vincent and it helps to down-regulate the TH2 dominant immune response. It’s based on the concept of molecular mimicry. The goal is to promote tolerance to the offending antigen, using homeopathic doses of nosodes. The antigen we select is really depending on what we think is triggering the symptoms. If we think Lyme is the trigger, that’s what we use. If you’ve got someone, based on stool testing or organic acid testing, if it’s an overgrowth of candida or yeast, maybe you want to do the candida antigen. Maybe you want to do the strep antigen. We probably have about 40 different antigens we use right now, and I know Dr. Vincent keeps expanding that in experiments with different things, and every year it grows a little bit, based on what he and other doctors around the world have been finding. This is given as a sublingual administration every seven to eight weeks, depending on patient response.



Dr. Darin Ingels is a Naturopathic Doctor licensed in both the state of California and the state of Connecticut. His practice in Irvine, California, focuses on environmental medicine with an emphasis on Lyme disease, Pediatric Acute-onset Neuropsychiatric Syndrome (PANDAS) and chronic immune dysfunction. Dr. Ingels has published three books, including his most recent book, The Lyme Solution: A 5-Part Plan to Fight the Inflammatory Autoimmune Response and Beat Lyme Disease, and his websites are Wellness Integrative and DarinIngelsND.

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com. Phone or video consulting with Dr. Weitz is available.



Podcast Transcript

Dr. Weitz: Thank you for joining us this evening for our Functional Medicine group meeting on Lyme disease with Dr. Darin Ingels. I’m Dr. Ben Weitz, and I’m so happy that you’ve taken the time out from your busy schedule to join us, and hopefully to participate in our discussion tonight. If you’d like to ask a question, please type it into the chat bar, and we’ll get to it once Darin has finished his presentation. He’s going to speak for about 45 to 60 minutes, and after that, we’ve allotted approximately 30 minutes to Q and A. Please consider attending some of our future Functional Medicine discussion group meetings, which are going to continue to be virtual through Zoom at least through the end of this year, and probably the beginning of next year. Dr. August 27th, Dr. Chris Shade of Quicksilver Scientific will be speaking about heavy metal detoxification, and he’s an awesome speaker, so that should really be good. September 24th, please mark your calendar, another incredible speaker, Dr. Isaac Elias, on the survival paradox. October 22nd, we will do a deep dive into how to understand a GI map stool test, with Tom Fabian of Diagnostic Solutions. And November 19th, Dr. Steven Stanford Lewis will be speaking to us about some GI-related topic, yet to be decided. December we’ll be off, and then we’ll start up again in January of 2021.

Please join our closed Facebook page, Functional Medicine Discussion Group of Santa Monica, so we can continue the discussion beyond this meeting. Please check out my rational wellness podcast, which is dedicated to all things functional medicine. You can listen to it on your phone through Apple Podcast or Spotify, or you could watch it on YouTube and video recordings of most of our Functional Medicine meetings for the last three years can also be found on my Weitz Chiro YouTube page. I’ve now posted over 166 episodes on my podcast, and there’s some amazing information contained in these interviews with many of the top names in functional medicine, including this week’s interview with Dr. Joel Khan on Lipoprotein (a). So, please subscribe and give me a positive review on Apple podcasts. Metagenics is our sponsor this evening, so Kailey Oogaard, my Metagenics rep, is going to tell us about a few Metagenics products, after which I will introduce our speaker, Darin Ingels, and we’ll get started. So, Kailey, let’s see.

Kailey: Can you hear me?

Dr. Weitz: Yep.

Kailey: Hi everyone. Thanks Dr. Weitz. As Dr. Weitz said, I’m one of the local Metagenics reps in Southern California. There are about seven of us down here, from LA to San Diego, and I’m happy to put you in touch with your local rep if you would like to learn more about Metagenics, but I’d like to take this time to discuss one of our newer products, which is Hemp Advantage Plus. Hemp Advantage Plus features organic, broad-spectrum hemp extract, and a natural occurring bio-lipid, called palmitoylethanolamide, also know as PEA. PEA is an endocannabinoid-like molecule that interacts with the endocannabinoid systems, and PEA has been the subject of numerous clinical trials and studies, with results that support its clinical potential for safety and for patients with chronic pain and inflammation.

Studies have been conducted on chronic sciatic pain, fibromyalgia, osteoarthritis, and many other inflammatory conditions. If you’d like additional research about PEA, you can log on to the Metagenics Institute website, at www.metagenicsinstitute.com. There are lots of podcasts, research articles, and just hot topics out in the functional medicine world there. You can also contact your local rep to learn more, and if you don’t know your local rep, you can go ahead and shoot me a text. And my number is 310-321-8785. I hope that you all are doing well and I hope I get to see you all in person soon. Thanks Dr. Weitz.

Dr. Weitz: Absolutely. Thank you Kailey. So, our special guest for this evening is Dr. Darin Ingels, and he will be joining us for a discussion on Lyme disease. He’s got a presentation for us. Dr. Ingels is a licensed naturopathic doctor in both the State of California and the State of Connecticut. His practice focuses on environmental medicine, with an emphasis on Lyme disease, pediatric acute onset neuropsychiatric syndrome and chronic immune disfunction. Dr. Ingels has published three books, including his most recent, A Lyme Solution: A five-part plan to fight the inflammatory auto-immune response and beat Lyme disease. So, without further ado, Dr. Darin Ingels.

Dr. Ingels: Thanks Ben. All right, I’m excited to join you guys tonight. I wish we were all doing this in person, but this is the way life goes, so if you guys have questions, I think it would be best, if you go ahead and just go into the chat box and put your questions. When I get to the end of the presentation, we’ll just answer them all then. It will be easier than trying to disrupt the presentation. So, let me share my screen. Ben, you need to enable me to share my screen.

Dr. Weitz: Let’s see. What do I do?

Dr. Ingels: Go into the Zoom preferences.

Dr. Weitz: Multiple participants can share simultaneously, is that right?

Dr. Ingels: That should work.

Dr. Weitz: Okay. Did that work?

Dr. Ingels: There we go.

Dr. Weitz: Okay. Couple people reminded me to record.

Dr. Ingels: Okay, here we go. Hopefully you guys can see my screen. If there’s a problem, I can’t see the chat box, so just post it and Ben will let me know. Today, we’re going to talk about Lyme disease and co-infections, diagnosis and treatment options. I’ve got about 45 minutes plus of material, and then we’ll do some Q and A afterwards. Lyme disease is near and dear to my heart. I’m a Lyme patient. I contracted Lyme disease in 2002 and spent three years trying to get my life back, so I know what it’s like for so many of these patients to really have to struggle with what can be sometimes a very debilitating illness. So, to start off, just a little background on what is Lyme disease? Many of you already know this, but it’s a bacterial infection, primarily caused by Borrelia species, Borrelia burgdorferi being really one of the more dominant species, and it’s transmitted primarily through the bite of a tick, specifically the Ixodes ticks, which are the deer ticks. There are a lot of different ticks out in the world, deer ticks, dog ticks, wood ticks. The overwhelming majority of these cases are transmitted by deer ticks. Dog ticks, wood ticks and other ticks have really not been shown to be major carriers of Lyme disease. They carry a lot of other disease that can infect people and cause problems, but Lyme disease specifically is really more around the deer ticks. There is some evidence that perhaps other insects, such as mosquitoes and fleas, may transmit Lyme as well. To be honest, it’s really speculative. There’s literally just a few studies done in Europe on it. So, again the consensus is that the overwhelming majority of these cases are coming from tick bites.

Dr. Weitz: Isn’t there a study about a mouse being involved in this too? That the tick bites a mouse, a certain type of mouse?

Dr. Ingels: Well, ticks can bite any number of animal vectors. Mice are probably the primary carriers, more than the deer itself. We call it the deer tick, but mouse, rabbits, raccoons, any of these furry little creatures can potentially carry these ticks and potentially be reservoirs for Lyme. So, in the early seventies, there was a mysterious group of cases of RA in children in Lyme, Connecticut. So, if you didn’t know, Lyme disease is named after Lyme, Connecticut. And juvenile rheumatoid arthritis is a pretty unusual condition. There were also several adults in Lyme, Connecticut that were also having this arthritic flare-up. So, it took actually several years. They originally thought it was a Rickettsial infection, which is a different kind of bacteria. And then they started sending samples to a guy named Dr. Willie Burgdorfer, who was a Rickettsia expert. He worked for the government in Colorado, and it took him about six or seven years to isolate that it was a spirochete, and the rule is, when you discover the organism you get to name it after yourself. So, that’s why it’s Borrelia burgdorferi, named after Willie Burgdorfer.

We know there’s at least five different subspecies of Borrelia burgdorferi and at least 100 different strains of Borrelia in the U.S. alone, and really more than 300 strains worldwide. This becomes relevant, because when we talk about testing, we are generally testing for one species, one strain, Borrelia burgdorferi, that’s pretty much it. So, if you’ve ever run a test through LabCorps or Quest or your conventional reference lab, they are only looking at that one specific strain. So, if your patient happened to be exposed elsewhere and they have a different strain, there is a high probability it will miss it on that test and you’ll get a negative test. Which doesn’t exclude the possibility of Lyme disease, and I’ll talk a little bit more about that when we get to the testing section.

And for those of us in California, which is all of us, when I first moved here, I grew up in Southern California and moved away and lived in Connecticut for almost 20 years, and moved back about two years ago full-time, I’ve been shocked at the number of healthcare practitioners, doctors that tell patients, “Oh no, we don’t have Lyme disease in California.” That is the most ignorant statement, uninformed, and if you look at, even according to the CDC, they’ve identified California for the fifth fastest growing state for the number of Lyme cases in the country. The northern area, the Bay Area, is more endemic than Southern California, but again, we have hills, we have mountains, we have trees, we have areas where ticks do live, and we do see cases here. So, if your patient gets dismissed by another doctor, please be the one to do the diligent work and help identify it. Most of the cases, more than 95 percent, still come from New England and the central part of the U.S. However, Lyme disease has been reported in all 50 states, including Alaska and Hawaii. People travel, so even if you’re in a state like Arizona, that we don’t think about having really a lot of deer ticks, people in Arizona like to leave the heat, they travel, and they may have acquired it elsewhere, outside of the state they reside.

We know according to the statistics, that there’s more than 300,000 new cases of Lyme disease each year in the U.S. Remember that’s new cases. That’s not existing. That’s new, every year, so we are literally talking about millions and millions of people in the United States living with Lyme disease, many of which who don’t realize it. And in Europe, it’s about 65,000 cases a year. As you move to different parts around the world, some governments are very cognizant and recognize it. We find most governments are really blind to it and it’s overlooked. But we’ve got cases in Asia, Africa, and other continents outside of Europe and North America.

This is just a picture of the Ixodes tick. Out on the East Coast, Ixodes scapularis. Out here on the West Coast, it’s mostly Ixodes pacificus. Honestly, I’ve looked at pictures of both. I can’t tell the difference. They look kind of the same to me. They very much have this tear drop shape to them, with the sort of black back and sort of reddish orange lining. They look significantly different than dog ticks and wood ticks, which have a much rounder body and kind of a hard shell. If you push on a deer tick, their outside is as little softer. Part of the reason that Lyme disease is so difficult to pick up is these ticks are teeny, weeny tiny, about the size of a poppy seed. Maybe when it’s fully engorged, it’s as little bit bigger. I can remember seeing a tick on my arm, actually when I actually had Lyme disease, I thought it was just a fleck of dirt, and I went to flick it off and it started walking, so small I couldn’t see the little legs. So, it’s a good idea to keep a magnifying glass in your office. It’s rare that you’re actually going to be able to find a tick on someone, but if you do, having something to magnify to really help identify if that’s a deer tick can be really helpful.

It is the number one spreading vector-borne epidemic worldwide. So, we see this all over the world. We see more cases in terms of rate than … I mean there’s still more cases of malaria and things like that, but in terms of the rate of infection, Lyme disease is still the fastest growing. And because Lyme is a spirochete, the nature of these corkscrew shaped organisms is that they can penetrate other tissues and cells a little bit different than other regular rods or other types of bacteria. And as a result of that, it can cause many different kinds of symptoms. In fact, there’s over 100 different symptoms that are associated with Lyme disease. So, we call Lyme the great imitator, the great mimic, because it looks like so many other things. And I think that’s why it gets overlooked so often, because people think it’s an autoimmune disease. They think you have mono. They think you have a bad flu. It’s very easy to overlook it, but when you start to see these symptoms go on and on and on for a much larger period of time than what you would expect for some of these other infections, that’s where the red flag goes up that maybe it’s Lyme or some other tick-borne illness. So, Lyme itself, Borrelia, is a shape shifter. If you see these pictures, it’s always that long corkscrew shape form. It can literally ball itself up like a slinky, and that’s called a cyst form or round body form. There’s also the cell wall deficient form and what they call an uncoiled filaments form, which just looks like kind of a long straight line. And it’s ability to shape shift allows it to evade the immune system, it allows it to penetrate other cells and tissues, and again, that’s what makes it a little bit more unique than other types of bacteria out there.

And the other thing about Borrelia that’s really interesting is that it has a very slow replication cycle. Most bacteria replicate about every 10 to 20 minutes, and to put it in perspective, if you get tuberculosis, microbacteria tuberculosis replicates every 15 to 20 hours, so that is much slower than every 10 to 20 minutes. And if you get TB, you go on a triple antibiotic cocktail for nine to 12 months. Well, if you look at the research on Borrelia, it replicates every one to 16 days. So, for the life of me, I can’t figure out why the recommendation has always been two to three weeks of antibiotics for an organism that may replicate once during that life cycle. And considering the standard treatment is doxycycline, which actually is bacteria static, it’s not bactericidal, all it’s doing is stopping the organism from replicating, which means it needs to be in a replication phase to work. So, there’s a little bit of madness here that I can’t really get my head around. I don’t understand it, but this is sort of the politics of medicine and the politics of Lyme disease. But just understand that you’ve got an extremely slow-growing organism. So, as we start talking about treatment, that becomes relevant, because these courses of treatment do tend to go long term, often for many months, where it’s not like a sinus infection that you treat for seven to 10 days. Most Lyme patients are looking at many months of treatment.

So, I kind of break Lyme down into what I’ll call acute Lyme disease and chronic Lyme disease. This is just for simplification. In reality, there’s a lot of overlap. But your acute Lyme people, you’re probably not going to see very often unless you do primary care medicine, because these people are generally acutely ill. They’re sick. They’ve got headaches, stiff neck, fever, arthritis, neuropathy, muscle pain, fatigue, chills, lymphadenopathy, heart palpitations, shortness of breath, sometimes Bell’s palsy. The hallmark of Lyme disease is that classic erythema migrans or bullseye rash. The CDC says up to 70 to 80 percent of people who get Lyme disease get that rash. If you look at the literature, the literature suggests it’s probably closer to 40 percent, and those of us in clinical practice, who work with a lot of Lyme patients, it’s probably less than 20 percent. So, if you have a patient who has a bullseye rash, do not pass go, do not collect $200. It’s absolutely Lyme. There’s nothing else in the world that causes that classic rash. The absence of a rash, though, doesn’t exclude the possibility of Lyme disease. Whatever you learned in medical school, don’t let that be your guide about if someone does or does not have Lyme. The rash itself is not a reliable marker, and at this point, since I’ve been in California, I pretty much hardly ever see a bullseye rash. Now there are other rashes associated with Lyme that are not the bullseye rash. So, when you see a flat rash that’s red and spreading, that would still make me nervous, even if you don’t see the central clearing. I get a lot of messages from people, especially on social media. They take pictures of, is this a bullseye rash? They freak out. Remember when you get bit by a mosquito, you will get a histamine reaction, and histamine reactions do not always cause a uniform redness spreading away from the puncta, so people will often mistake it, because they see a little bit of clearing, thinking it’s a bullseye rash. Your biggest thing is when you get a typical insect bite, it usually goes away with 24 to 48 hours. At least the redness goes down, the swelling goes down. Mosquito bites, specifically, get raised. Tick bites are generally flat. They don’t get raised. You can usually feel another insect bite, if you get stung by a bee, you get bit by a mosquito, usually you will feel it. Ticks have a little bit of anesthetic in their saliva, so when they bite you, you don’t feel it.

So, that’s just a couple of quick, little ticks to differentiate, is it just another insect bite, like a spider bite or a mosquito bite, versus a tick bite? Most erythema migrans rashes are flat, they will spread. When I got bit, my rash spread for almost eight weeks before it started to dissipate. So, that is pretty common. So, here’s a picture of the classic bullseye rash, red in the middle, central clearing, another red ring. And again, if you were to see it early, it might be small, but it will continue to spread. And again, mine got to be almost 18 inches by the time it was done spreading.

Symptoms can occur anywhere within three to 30 days following a tick bite. CDC, again, says up to 70 percent of people get the EM rash; as I just mentioned, that’s not always the case. Most people have no recollection of being bit by a tick. These ticks actually like the dark, warm, moist areas of the body. So, behind the knees, under the armpit, the belt line, under the butt cheeks, hairline behind the ears. So, often they go to places that people don’t necessarily see. So, if you’re out hiking in the woods, you like camping, you like outdoor activities, make sure that you do thorough tick checks, particularly if you’ve got kids. It’s very easy to overlook, and remember they’re small, so just make sure you’ve got a place that has good light and you can really do a thorough inspection. So, I tell parents, if they go camping, strip your kids naked, go through every crack and crevice. They don’t like it, but it’s the safest way to ensure that they don’t get exposed. As I mentioned again, the symptoms are vague, look like a lot of other things, and misdiagnosis is very, very common.

So, if people miss that window of getting diagnosed to acute Lyme, it can progress more into what I’ll call chronic or persistent Lyme. As a political note, the government refuses to acknowledge that chronic Lyme exists, even though there’s multiple studies out of Johns Hopkins University showing otherwise, and millions of patients living with chronic Lyme. But their feeling is, three weeks of antibiotics and regardless of how you feel, you’re done. Whatever you’re dealing with, they now call it post-Lyme syndrome, but they don’t think it’s Lyme disease. They think it’s just something else, so kind of odd.

So, again, you can get the fatigue, but then you’re going to start getting more gastrointestinal problems, more neurological problems, memory loss, cognitive impairment, neuropathy tends to get worse and spread, sensory distortions, which is really a type of neuropathy, but burning sensations is a very common complaint, or this feeling of creepy crawlies under the skin, and wandering joint pain. Wandering joint pain is another hallmark of Lyme disease specifically. There’s nothing else we know in recorded literature that causes wandering joint pain. What that means is, one day it’s my left shoulder, then it’s my right knee, then it’s my right shoulder, then it’s my left ankle, and it just seems to keep moving. If you’ve got rheumatoid arthritis or other types of autoimmune arthritis, they tend to be the same joints. Now they can come and go in terms of their intensity, but they tend to be pretty consistent. But with Lyme, it can be completely different joints altogether. Light and sound sensitivity, dizziness, vertigo, sleep problems, general rheumatism. There is a thing called Lyme carditis, which can cause mitral-valve prolapse, heart block, heart palpitations, chest pain. So, I always send someone I’m suspicious has Lyme or if I know they have Lyme, we’ve already diagnosed it, if they’re complaining of chest problems, I always send them to the cardiologist, get a cardiac workup and make sure they don’t have Lyme carditis, because that can become very serious. Balance, coordination problems, people say, all of a sudden, I’m clumsy, I trip a lot, I drop things. What I call newly acquired dyslexia, where all of a sudden people start transposing their numbers, their letters, whether they’re writing or typing. The brain has an element of inflammation. I think it is a type of encephalitis that ensues, and that’s what triggers a lot of these neurological problems. And finally, we’ll see a lot of endocrine disruption, particularly underactive thyroid, hypothyroidism following Lyme is a pretty common occurrence, well documented in the literature. And sometimes we’ll see women having menstrual problems, adrenal issues and so forth.

So, as I mentioned, it’s the great imitator, looks like a lot of these things; autism, multiple sclerosis, ALS, chronic fatigue, fibromyalgia, mono, herpes 6, parvovirus, RA, lupus, name any autoimmune disease pretty much, and there is some association with Lyme. And if you look at this list, a lot of these things are descriptions. They don’t really tell you why. Rheumatologists, to their credit or to their fault, can help identify that there’s an inflammatory process going on in the body, but I don’t think they’re terribly good at telling you the why. And these people who get these labels, and say, “Well, I’ve got a diagnosis of MS.” You say to the neurologist, “Well why?” “Well, I don’t know. That’s just the way it is.”

Well, it makes a lot of sense, and again, we’ve got as lot of ample literature showing that microbes are major triggers for autoimmune disease, not just MS in particular, but Klebsiella’s a major autoimmune trigger, strep is a major autoimmune trigger, so we have a lot of microbes that can do that, and Lyme just happens to be really effective at triggering autoimmune problems. And a lot of these autoimmune issues don’t fit the bill of what you typically think of with lupus and rheumatoid arthritis. Often, the CRP is normal, rheumatoid factor is normal, ANA is normal. I often do see the ANA will come in and out of being positive with people if you measure it over time. That’s pretty common with Lyme, but it’s always very low titer, and you do all the follow-up tests and everything comes back negative. So, it doesn’t really point to any one autoimmune problem, but again you will see that with Lyme. So, again when you see these patients that have these chronic labels without an understanding of really why, it should be probably at least part of your differential diagnosis to test appropriately and just make sure that tick-borne illness is at least part of the underlying cause. We all practice root medicine, we want to get to the cause of these things, and I’ve been shocked at the number of people I’ve seen who have been to 50 doctors, and nobody ever bothered to test them for tick-borne illness, and then we test and it lights up like a Christmas tree and you treat them and they feel tremendously better.

We’re focusing really on Lyme on this talk, but I at least want to mention that a lot of these ticks that carry Lyme do carry other infections. So, here’s just a short list of things that are pretty common. Babesia, which is a blood parasite, it’s a cousin of malaria. Bartonella, which we typically think of cat scratch fever, but it can be transmitted through a tick bite. Anaplasma, Ehrlichia, Mycoplasma, Rickettsia, Rocky Mountain spotted fever. Powassan virus, which has shown up in the last handful of years as a very deadly virus, unfortunately. We’ve seen most of those cases out in New England. Colorado tick fever, Heartland virus, Tularemia, Brucella. Every time I go to a Lyme conference, I swear this list of things that ticks transmit gets longer and longer, and it’s exhausting when you’re trying to do as workup with patients. So, just keep in the back of your mind that if you’re suspicious of a tick-borne illness, you probably want to test for the gamut. I will tell you I test for the things I see most commonly first. We see what happens, and then I do a second-tier testing. Instead of doing 50 tests at once, let’s take the top 10, the top 12, because those are the most likely ones anyway, and then if we run into a wall, then we can go back and look at all the other ones.

So, why is there a rise in Lyme disease? Well again, worldwide, we’re seeing an increase, not just in Lyme, but other insect-borne illnesses. We’ve had more Dengue virus. Remember Zika virus? That freaked everybody out for a long time, and it kind of just magically disappeared. Chikungunya virus in Central South America. Of course now, SARS-COV2. So, we’ve got these different infectious agents, particularly viruses that have been emerging for a number of different reasons, and really the World Health Organization attributes it to climate change. I didn’t put the list, or the reference here, and I apologize, but if you want to message me and I’ll send it to you. But the World Health Organization published a paper. It was actually pretty good, and basically because we’ve got a warmer climate, that allows, ticks in particular need the cold to get killed off, and New England, the central part of the U.S. has been warmer overall. They’re not getting those cold, cold winters to really kill off the ticks, and therefore the tick population continues to explode. Birds are migrating further away than they used to before, so they can carry these ticks to other places. [Here is a paper with this conclusion: “Ticking Bomb”: The Impact of Climate Change on the Incidence of Lyme Disease]

There was one study, it was done in Canada, where they found that birds in the U.S. can get as high as the Yukon, and so they can go pretty faraway, and therefore, these birds have the ticks on them, they go somewhere else, carry the tick. Now the tick is implanted somewhere else and it just starts a new tick population. So really, climate change is to partially blame for all of this.

So, the diagnosis of Lyme, I will tell you this is extremely controversial. The CDC has a very hard line on it, and understand that, when we talk about testing, the testing that is available out there through commercial labs was never designed to be diagnostic, ever. It was designed to monitor people that had known Lyme disease. So, once we discovered Lyme back in the early eighties, they developed a test not long after, and again, they wanted to monitor people who had the bullseye rash, the high fever, all the classic symptoms, and they wanted away to kind of monitor and see how their progress was going. So, if you go to the CDC’s website, they will tell you today that Lyme is a clinical diagnosis. It’s based on signs and symptoms and particularly people that live in endemic areas, and you kind of have to rule out everything else. You’ve got to rule out autoimmune disease. You’ve got to rule out other neurological issues, if they’ve got neuro symptoms. So, there’s a whole process of trying to pinpoint, is it Lyme? And as best, what these tests tell you is, has your patient been exposed. It does not tell you if they have Lyme disease.

I can promise you if we tested everybody in this country, we would find a huge number of people show evidence of exposure who have never had a single symptom. So, it’s kind of like SARS-COV2 right? We’re testing all these people that have no symptoms. I think there’s an analogy between Lyme disease that’s kind of scary, but very, very close, and it’s true for the Lyme testing. So, as I go through this, I will explain a little bit why that’s so. The typical CDC criteria is you run a screening test, which is an elisa test. It’s just an antibody test, IGG and IGM antibodies. If that test is positive it flexes over to a western blot, also looking at IGG and IGM antibodies. So, to call a test positive, you’ve got to have five out of 10 IGG bands or two out of three IGM bands. And that’s what they call a positive test.

And in 40 years of research and understanding more about these antibodies, some being very specific to Lyme, some of them being non-specific, I don’t know why we’ve never changed that criteria, and really just focused on the Lyme-specific antibodies. And the way I think of it, if you’ve got a Lyme-specific antibody, and it’s there and it’s strong, it’s kind of like being a little pregnant. I mean you are or you aren’t. What difference does it make if it’s one or two or three or four? Having evidence you’ve had exposure when you’ve got clinical symptoms is hugely important and relevant. So again, keep that in mind.

Some of the pitfalls of this test is a lot of Lyme patients are [inaudible 00:29:06] negative, which means they just don’t produce antibodies. Now, is it because they have an immune deficiency? Is it because they’re so far away from their initial exposure that their immunity has naturally waned with time? There’s any number of reasons that people don’t make antibodies or don’t make an adequate response, and as a result of that, this test might look negative. We don’t have good technology to date that measures Borrelia directly in the body. There was a lab in Pennsylvania that was doing a Lyme culture for a while. They got shut down by the FDA, so we don’t really have any direct Borrelia testing in the body. And for an antibody to be considered positive, it has to be at least 60 percent of the control. And I was a former microbiologist, medical technologist before I was a doctor. I used to do these western blots for a living, and then one thing that is very odd is that when you run pretty much any lab test out there, if you’re running a CBC or a chem panel, there’s always a low, a medium and high control to represent that there’s a gradation of what represents normal.

And with a western blot, there’s not. It’s black-white, yes-no. So, they set this threshold at 60 percent. What that means is that, the CDC’s perspective is that if you’ve got Lyme, you make a ton of antibody. You make a lot of it, and if you were to do this test within maybe a few weeks to maybe a month and a half or so of someone being exposed, you might expect that there would be a decent antibody response. But if you learn in immunology, over time, it’s that immunity wanes. If your exposure was a year ago, three years ago, 10 years ago, I wouldn’t expect to have the same level. So, it doesn’t reflect the nature of how antibody levels can change, and that’s why I said earlier, if you’ve got Lyme-specific antibodies, I think that’s relevant, in conjunction with a patient in front of you that actually has the clinical symptoms. So, most conventional labs don’t test for the breadth of antibodies associated with Lyme, so you can also miss people. There was a Lyme vaccine that was available, back in, I think, the nineties. It went off the market. It was out for maybe three years. Anybody who would have gotten that vaccine would test positive for the 31 antibody. So reference labs intentionally leave it off, because anyone who might have had the vaccine, they don’t want to call the false positive. But we now know that A) there’s not that many people who got the vaccine, particularly now, and that 31 antibody can be very specific to Lyme.

So, that’s where if you’re using labs that specialize in Lyme testing. I use specifically a lab out of New Jersey called Medical Diagnostic Labs. I like them because they do very comprehensive tick-borne testing, and the best thing is they bill insurance. IGeneX up in Palo Alto, California is also a great lab. They do fantastic testing. The only down side is outside of Medicare they don’t bill insurance, so it just gets to be another out-of-pocket expense for your patients. It can also take up to six weeks for people to produce antibodies, so depending on when you do the testing, if someone truly, you thought, had acute Lyme, if you test too early, it may just be that you missed that window yet. They haven’t made enough antibodies to show up as positive. So, I generally, if someone has a suspicious tick bite, I will wait at least three or four weeks before I do a blood test, just to make sure we hit the right window of actually picking up a positive.

ILADS has a different criteria. I don’t know if you guys know, the International Lyme and Associated Disease Society, they have their own criteria, where again, it’s more of kind of I explained, looking at these Lyme-specific antibodies and not really following the hard line five our of 10 IGG or two out of three IGM antibodies that the CDC sets. And again, really based more on clinical symptoms, but again, you do have to rule out other inflammatory, other autoimmune conditions as part of your process.

So, let’s jump in a little bit to talk about treatment. You’ve gone through this whole process. You’ve got this patient who’s got clinical symptoms. And I didn’t put a slide, but I should mention it, Dr. Horowitz, Richard Horowitz is kind of a Lyme guru in the U.S. He has a questionnaire called the MSIDS questionnaire. He has actually validated this questionnaire in clinical studies and found it is a reliable marker on the probability your patient has Lyme. So, if you have a patient that just can’t afford the testing, or for any reason, maybe that’s not available to them, you can always have them, it’s a free download online, they can take the questionnaire, and if they score high on it and they have the clinical symptoms, you can probably feel pretty good and I think you’ve got some teeth in justifying your treatment, because again, this questionnaire actually has been validated in clinical studies. So, there is evidence that this is a reliable way of identifying those people that have been exposed to a tick-borne illness. [Here is the Multiple Systemic Infectious Disease Syndrome questionaire: MSIDS.]

Dr. Weitz: One more time, the name of that questionnaire.

Dr. Ingels: It’s the MSIDS.

Dr. Weitz: Okay, thanks.

Dr. Ingels: So, first and foremost, I think diet plays a huge role. I know we’re hearing this again with SARS-COV2, that people who are overweight, obese, diabetic, they are some of the highest risk people of getting SARS-COV2. I think these are also the highest risk people of getting Lyme disease. So, getting people to start eating healthy, nutritious, nutrient-dense foods is important. However, we know from the research that eating what I call an alkaline diet, I mean I didn’t start that. There’s plenty of books written about an alkaline diet, but it’s not really a diet, in terms it’s not calorie-restricted. It’s not a diet to lose weight. This is a way of people learning how to eat. And what I like about it is that it doesn’t restrict calories. It’s not really that restrictive. So, people can actually follow this. Some of the diets out there, like Keto for a lot of people, is really challenging. They can’t stick with it. This is a diet I find people will actually stick with, and the alkaline diet is based on the premise that as you eat certain foods and they break down in your body, they become alkaline-forming. So it’s really about shifting your tissues, your cells to be more alkaline.

I mean, with the exception of the skin, the stomach, the bladder, and for women, the vaginal area, which are very acidic, to protect against outside invaders, by and large, the rest of your body is mostly alkaline. So, we know that the enzymes systems work best, cell repair works best in really an alkaline state. So, it’s not about the pH of the food. It’s how the food breaks down in your body. So, for example, lemons, if you squeeze lemon juice on pH paper, it’s very acidic. However, when you drink lemon juice, it actually breaks down and makes your body very alkaline. We’re not taking about blood pH by the way. I get this from time to time, “Well blood pH is very tight.” That’s stupid. We’re not talking about blood pH. Yes, you’re right, blood pH is 7.2 to 7.4, up or down you’re dead. So, this has nothing to do with changing blood pH at all. This is really about changing cellular pH, and again there’s a lot of studies out there that validate this.

So, what I recommend for people when they’re transitioning their diet, just go ahead and buy that pH paper at the pharmacy. It’s really cheap, and 30 minutes after they eat, you have them go pee on the strip, and we really want to see their urine pH above 7.2. Some people like doing saliva pH. I find salivary pH is a bit more variable, because of all the other microbes in the mouth, but if that’s easier for people, that’s another way. But I do like the idea of doing urine pH better.

Just talking about some of the diets, I’ve really broken this down to three categories for people. The first category are foods that can be consumed as often as people like. I won’t go through all of these. I’ll let you read through it, but basically it’s mostly vegetables. Most vegetables, thank goodness, and seaweeds, are very alkaline forming. Avocados, the citrus fruits, by and large, sweet potatoes and so forth.

Some nuts and seeds, there are some grains, legumes, some oils, some beverages. I deviate a little bit away from the Gundry work about lectins. My personal opinion, I don’t think lectins are as pro-inflammatory as suggested, considering most of the world they’re staple food are high-lectin foods, and yet autoimmune disease allergies are extremely low in these countries. My clinical experience with Lyme patients is that they eat legumes, and outside of the normal farting, they actually do pretty well. So, I think that’s okay.

Category two are foods that I like to restrict to about 20, 25 percent of their dietary intake for the week, and you’ll see this is a lot of fruits, some grains, like rice and so forth. It’s all the animal proteins, meat, eggs, fish, some of the oils. And the reason is, when these foods break down is they’re either neutral to even slightly acidic. So, that’s why it’s not that they can’t have it. We just don’t want it to be the bulk of their diet. So, I think if you kind of go back to our true paleo forefathers, we didn’t kill every day. We killed when we could, so we still foraged off the land, ate mostly plant-based foods, and then had some mixed in animal protein, and I think this kind of reflects that a little bit better.

And people might say, “Well do I have to do 20 percent? What if I do 30 or 40?” And look, check your urine pH, and if you can maintain your pH in an alkaline state, then it’s fine. This gives you the opportunity for each of your patients to play around with what works best for them. There is no hard and fast rules here. Again, this is just my experience in working with Lyme patients that this works very well. It’s sustainable. It’s nutrient-dense, and it gives them all the things they need to heal.

And the last part here is really just foods to avoid. So, these are dairy products. There’s probably a million reasons we could talk about why to avoid dairy products, dried fruits, some of the nuts listed there, any junk food, artificial foods, processed foods, condiments, oils and beverages. The next one that gets a lot of my Lyme patients it coffee. Coffee is very acid-forming. Again, the pH of coffee itself is like two or three right? It’s very acidic.

So, I do have some people that will drink a little bit of coffee every now and then. And again, if they’re eating so well with the rest of their diet to balance it, then it’s fine. So, for your heavy coffee drinkers, maybe have them scale back. Someone told me that there is a low pH coffee. I have yet to find it yet. If it exists, great. Again, the easy way is just check urine pH and make sure everything is okay.

Beyond getting the diet, get the gut in good working order, the next step is really start targeting the Lyme itself, or some of these co-infections. So, I want to just talk through some of the herbal protocols that I use. I didn’t really talk about it, but I’ll just give you a quick synopsis. Antibiotics early on in Lyme disease can be very effective, and I’m certainly not opposed to it. However, when you get further and further away from your exposure, the odds of antibiotics being effective go down.

And I’ve seen patients literally have been on antibiotics for six years, eight years, 10 years, 12 years continuously to treat Lyme disease, and they have not improved. And you have to draw a line in the sand of when do you get to that point when the treatment is worse than the condition? And when you’re on long-term antibiotics, I guess depending on which ones you’re on, obviously you’re disrupting your normal gut microbiome, which you need to have a healthy immune system, and there’s also a greater potential to damage your mitochondria. And we know that Lyme itself can damage mitochondria.

So, for your Lyme patients that are tired, have problems with wound repair or tissue repair, if the mitochondria don’t work well, it’s going to be really, really hard to get over that hump, if they’re on hardcore antibiotics. With antibiotics, you’re really just targeting killing the bug or at least stopping the bug from replicating.

With herbs, herbs have so many other components in it, that they’re anti-inflammatory, they help promote better circulation, they help boost your immune system. So, we get multiple functions out of herbs that we just don’t get with antibiotics. So, a lot of potential upside, and there’s this myth out there. Let me dispel it very quickly. “Well, they’re not as strong as antibiotics,” and that’s not true at all. There is actually a handful of studies out there looking at herbs compared to antibiotics, albeit in vitro, and across the board, the herbs tend to be more effective than the antibiotics, and can kill Lyme in multiple forms, where antibiotics typically only address Lyme when it’s its uncoiled normal spirochete form.

So, the first protocol I want to talk about was developed by a Dr. Lee Cowden. Dr. Cowden here is a cardiologist out of Dallas, and he started working with a company called NutriMedics. They’re based out of Jupiter, Florida, and these herbs are all wild crafted out of Peru, down in South America and the Amazon jungle. So, I like these herbs for a lot of reasons. Again, clinically, they can be very effective. If you guys want to do a little bit more research. There’s a doctor named Eva Sapi. It’s S-A-P-I. She’s at the University of New Haven and she’s published a handful of studies looking at these herbs, specifically in vitro with Lyme against different antibiotics, doxycycline, rifampin, a couple of others, and again, she found that the herbs were actually more effective.

So, there’s some evidence that these are effective. Clinically, I’ve been using these for almost 20 years. I find they work really well for patients. These are liquid tinctures, so the other nice thing for your really sensitive people is you can do drop doses, and titrate up to a point where you start to see clinical benefit, without getting any kind of die-off reaction, Herxheimer reaction, or other side effect.

Dr. Cowden’s protocol himself, the way that he has it structured is that every month he kind of changes the protocol, the concept being, if we keep confusing the bug, maybe it won’t adapt. We don’t actually have any evidence that this organism can become resistant to herbs. It’s a little bit different than antibiotics, because herbs aren’t used nearly with the frequency of antibiotics. So, that has not been my clinical experience, and when I looked at Dr. Sapi’s work, there was really just a few of these herbs that were doing the heavy lifting in the whole protocol. So, what I have listed here are all the herbs that he includes in his protocol, and then the ones in bold are really the ones that I use most often. The combination is designed to, again, kill the microbes, support detox pathways, clear metals, basically make the terrain a more hospitable environment to do what you want to do. It’s a five to nine-month protocol, again of constantly changing herbs and again, they’re liquid extracts, so drop doses are possible. I use this with a lot of my kids, just because they don’t taste horrible, they’re drop doses, you can mix in water or a little bit of dilute juice, and again, it gives us a lot of flexibility to adapt it.

This is just my protocol on treating acute Lyme disease. I’ll let you read through the slide, but there is a difference between, if you’ve got someone who’s been exposed fairly recently, versus someone you think has more persistent Lyme. With acute Lyme disease, we basically go in at a fairly high dose to try and hit it hard right off the bat, and we’ll typically do a treatment for at least six weeks. Six weeks is the minimum. Because it’s a slow-growing organism, we don’t want to short ourselves. So, at least six weeks, and at six weeks we re-evaluate, how are you feeling. Sometimes we’re on longer, but really no less than six weeks.

For persistent Lyme disease, I just start at smaller doses and titrate up slowly. When people have had it longer, they’re disposition to Herxing or getting that die-off reaction goes up. So, if you just start slow and work your way up, drop by drop, again, it just minimizes that impact. Herxing with this particular protocol is not that common. Maybe 10 to 15 percent of people, where with antibiotics it’s much, much higher. Again, it’s a much more tolerable treatment. And again, I just have them titrate up one drop twice a day every three or four days. If there’s really no improvement in the way they feel, up to really 30 drops twice a day. They do have one formula here called Burbur or Burbur pinella. This is to help mitigate the detox reaction. If people start to Herx, this particular formula, they can take 10 drops every 10 minutes every hour, as frequently as they need to. There’s nothing toxic about it. It really is to help open up those detox pathways, and sometimes it really helps curtail that die-off reaction.

So, the advantages of this protocol, it’s really easy to administer, clinically it works and it’s pretty cost-effective. Those four tinctures I mentioned, for most people, at max dose, 30 drops twice a day will last them about a month. It will cost about $135 for their cost on all that, so it’s not terrible.

The disadvantages, again, you can get Herx reactions. As I said, they’re not really that common, but they’re more common than with some of the other protocols. It is a long, potentially long-term treatment. It does require multiple bottles and dosing schedules, so it’s a bit more labor-intensive, especially when people get to the higher doses. They pour their glass of water, and then they grab the one bottle and they count out 30 drops, grab the next bottle, count out 30 drops, and so forth. So, for people who hate counting drops, they don’t like it. But aside from that, it’s actually pretty simple.

The other protocol I want to talk about is developed by Dr. Zhang. He is a Chinese medical doctor and licensed acupuncturist in New York. When I had Lyme disease myself, after having been on antibiotics for nine months, I went and saw him, and after being on his herbs for three to four weeks, I was 80, 85 percent improved. So, the proof was definitely in the pudding with me, and I’ve since used his protocol. In fact, it is my primary protocol for Lyme patients, and I’ll talk about, again, the advantages and disadvantages. There is one major disadvantage to this protocol, and that’s cost, but it is the most clinically effective protocol that I use with my Lyme patients.

In Chinese medicine, they don’t use herbs singly. These are all formulas, so each one I’ve listed here, even though I’ve listed an herb, like artemisia, it’s actually a formula with artemisia, a formula with houttuynia and so forth. Artemisia is a well-established antimicrobial, as is houttuynia. Circulation P, as the name suggests, helps promote better circulation, breaks up immune complexes. Coptis is an herb they’ve used in Chinese medicine for years, as an antimicrobial. Cordyceps is a medicinal mushroom to help boost the immune system and adrenals. Pueraria is an herb they use a lot, actually, for a lot of sinus infections, but it also helps open up the blood vessels. It’s great for brain fog. R5081 is to help boost the immune system. BAIM is an anti-inflammatory formula, so that’s for inflammation. And allicin, which is a garlic extract, is also a very potent antimicrobial. I don’t really use the allicin much anymore, only because of the social issue that it makes people reek and smell like garlic all day, and they hate it. So, I used to take allicin and my patient would just look at me like, “Dude, did you just have a pizza in here?” So, there is this social issue around it. If people don’t mind it, it’s very effective, but I don’t use it as much, because most people are still functioning in the world and they don’t like smelling like pizza.

The goal of the protocol, again, treat the infection, improve circulation, reduce inflammation, improve detoxification, boost the immune system. I will use actually all of these protocols. All my protocols, I actually give a minimum of two months, especially if it’s chronic. Six weeks if it’s acute, two months if it’s chronic. At two months, if we haven’t seen the needle move at all, then it’s time to move on and try something else. But I tell all my Lyme patients that have had it for a long time, anywhere from three months to a year is normal treatment. Sometimes it’s longer, so just kind of prepare them mentally that they’re in for the long game in most cases.

Here’s my protocol for acute, for Dr. Zhang. Again, I’ll let you read through that. And by the way, if you guys want copies of these slides, just message me and I’m happy to send you a .pdf of all these slides. And then for persistent Lyme disease, with the Zhang protocol, there’s not as drastic of a difference. There’s just a little bit of a difference in the the types of herbs I use. I use coptis initially for acute Lyme disease. I don’t use coptis as much for chronic Lyme disease, because if they’re on it longer, it has a greater disposition to disrupt the gut microbe biome, so that’s really the big difference between the two.

Advantages, again, clinically beneficial, Herx reactions are actually not that common. I think those combination of herbs actually work well to offset any potential side effects. The disadvantage is it’s kind of of difficult to administer, because you’ve got to take a lot of capsules. Each formula is one capsule three times a day. Some people are taking five or six of his formula, so 15 to 20 capsules a day. And when they’re already taking a lot of other supplements, it just starts to add up. So, a lot of people like the Cowden stuff, because at least it’s not capsules, they can drink it. In this case, these are capsules and some people prefer it. So, you can just talk about your patients, and gain, as I mentioned earlier, the biggest downside is just cost. Patient cost on these herbs run about $500 or more a month. So, for people who might be on a budget, this may not be the best option, but if money is not the limiting factor and they don’t mind swallowing capsules, this is really my go-to protocol.

There are other herbal companies out there. Byron White is an herbalist. He’s developed different formulas. The biggest difference is that his formulas are really based on what you know your patient has. So, if they have Lyme disease they get AL Complex. If they’ve got Babesia, they get A-BAB. If they have Bartonella, they get A-BART. So, each one of his formulas are really targeted towards the bug. He also does have formulas for detox and so forth, so that one is not so much a protocol as you the practitioner picking and choosing what you think is appropriate for that patient. These herbs are very strong. Herxing is extremely common with these herbs, so we use teeny, tiny doses of these herbs. They are liquids; they’re tinctures. So, again, if you’re going to use these, have them start really small, one drop a day, one drop twice a day. Go up very slowly. Most patients don’t tolerate more than six to eight drops twice a day. So again, it’s very concentrated herbs and they pack in quite a punch. Again, these therapies are really targeted towards the organism and just a little bit different than the Cowden stuff. Advantages again, clinically it works for some people, very easy to administer, because usually there’s less product, less drops. Disadvantages is Herxing is pretty common. Again, it’s still long-term treatment. And each bottle is pretty expensive. Each bottle to the patient is around $100, so if they are getting multiple bottles, that can add up pretty quickly.

Other herbs that I at least want to mention. Steven Buhner has written two excellent books on treating Lyme with herbs. He’s an herbalist. I highly recommend picking up his books if you’re interested in using herbal medicine in your practice and you already don’t. He uses Japanese knotweed, Cat’s claw, andrographis, wireweed, yellow dye root. Hopkins actually published a study earlier this year looking at, I think, it was 17 or 19 different herbal extracts, and just looked to see which ones were most effective in treating Lyme. And Japanese knotweed and cryptolepis were actually at the top of that list. So, good evidence that these herbs work well as well. The problem with the Buhner protocol I had at least early on is that he never had one company that made all the different herbs, so you, as the doctor and the patient, had to go find different companies that made each individual one and put it all together. So, it was just kind of labor-intensive to get it put together, but now I think there’s a couple companies that make everything. I think Research Nutritionals makes a lot of these herbs and so forth.

Beyond Balance is another great company. I use a lot of their herbs. It’s a little bit more akin to some of the Byron White stuff, that there are herbs that are developed by Susan McCamish, who is an herbalist, and there’s one for Bartonella. Actually, there’s I think three for Bartonella, two for Borrelia, three for Babesia. So, there’s a couple of different formulas. A lot of herbs for detox and those kind of things, so I like them a lot. The other big thing with their herbs, to be aware of, is that all of their extracts are in glycerine. Most other companies when they make tinctures, they put them in alcohol. If any of your patients are using disulfiram to treat Lyme, they have to stay away from alcohol. They get really sick, so you don’t want to use any of these tinctures that contain alcohol, if your patients are on disulfiram, but you can use Beyond Balance, because they’re in glycerine and it’s perfectly safe.

And there’s a lot of other herbs out there, again, to help support the immune system, have antimicrobial effects. They’re anti-inflammatory, help improve circulation, reduce pain. So again, if you look at the fundamental aspect of what these herbs are doing, there’s a lot of overlap between these different protocols.

Breaking down biofilms, another important aspect of treating Lyme, a lot of bacteria in your body make biofilm. That, by itself, is not abnormal. In fact, it’s essential for these bacteria to survive. It so happens that Lyme is exceptional, or Borrelia is exceptional at making biofilm. So by breaking down that biofilm, it’s easier for us to, whatever we’re using as our therapy, plus your own immune system, to actually get to the microbe. And if you look at some of the studies on biofilm, you have to use up to 250 percent the amount of drug to get the same effect when biofilm is in place versus when it’s not in place. So again, biofilm itself is not abnormal, but we do want to help break it down to make our treatment more effective. There’s a lot of enzymes on the market that break down biofilm. I use a lot of serrapeptase. I use nattokinase. I use lumbrokinase. I know they have different price points. I think if you look at the research on cardiovascular disease and the fibrinolytic effect of enzymes, lumbrokinase is the most effective by about tenfold over nattokinase. Serrapeptase is probably somewhere in between. But lumbrokinase is an excellent biofilm disruptor, and when we think about biofilm, it’s not like popping a balloon. It’s really dissolving, so it’s a different process. When they say biofilm busters, again, we’re not just popping it. It’s just really breaking it down. I kind of have a discussion with patients about what they feel comfortable with, a bottle of nattokinase is probably $20 and change. Serrapeptase is probably around $40. Lumbrokinase is about $100. So again, if it’s a cost factor, lumbrokinase may not be the best option, but it does work quite well. Interface Plus is a product from Klaire Labs that has EDTA and serrapeptase in it. I’ve used that quite a bit and it works pretty well for people too. The trick to [inaudible 00:55:24] all these biofilm disruptors is you do want to get these enzymes between meals, so we don’t want them to become digestive enzymes for their food. We do want them to break down their … to get absorbed into the bloodstream without food.

Coconut oil itself is actually a natural biofilm disruptor. I don’t ever really give it as a supplement. I just tell them, just use coconut oil in your cooking and use it on your food, and most people can get a decent amount of coconut oil in that case.

N-acetyl cysteine, NAC, this is an amino acid that we use a lot to break up mucus in the body. It does help break up biofilm. 200 to 600 milligrams TID. Just be aware if you’re going to use NAC long term, it can deplete zinc and copper, so make sure they’re supplementing with those. And also make sure you don’t ever give NAC to anyone who’s got a stomach ulcer. It will make them significantly worse.

Low-dose immunotherapy, this was developed by Dr. Ty Vincent. If you guys haven’t been exposed to LDI, I know there’s a handful of us here in Southern California, I know Dr. [inaudible 00:56:23] has been using LDI. We use LDI, and the concept behind this is that, if your immune system starts treating the organism as an antigen, sorry as an allergen instead of a pathogen, that changes the part of the immune system that gets engaged. And that’s what really triggers these autoimmune reactions, so we want to alter the way the immune system is reacting to these bug. We want to down-regulate, really that TH2 dominant response that drives allergy and autoimmunity. So, we don’t wasn’t to interfere with TH1 that’s going to go right after the organism and eradicate it. And we find that that’s exactly what this does, is it seems to modulate that reactivity.

It’s based on the concept of molecular mimicry. There’s something in the molecule that’s similar to our own tissue, so in the immune systems effort to get rid of, in this case Lyme disease, it actually starts cross-reacting with your joints, your brain, your nerves. When I was writing my book, I came across all these references showing how Borrelia targets these different human cell tissues, and it just makes a lot of sense of why we get this broad scope of different systems, because again, it does target those different tissues.

So, again, this is a way to try and help modulate that immune response. The goal really is to promote tolerance to the offending antigen, using homeopathic doses of nosodes. So, if you guys aren’t familiar with homeopathy, a nosode is basically a homeopathic microbe. They take strep, they stake staph, they take whatever it is, it’s been irradiated, it’s killed, it can’t reproduce, it can’t cause disease, and then you just dilute it out in homeopathic dilutions. And then we mix it with an enzyme called Beta-glucuronidase, and this enzyme was found actually kind of by mistake, that whatever you mix it with would actually help build immune tolerance to it.

LDI stems out of another therapy called LDA or low-dose allergy therapy. It used to be called before that enzyme potentiated desensitization, and it was a way of treating allergies, like food allergies, mold allergy, pollen allergy, dust, dog and so forth. And so, Dr. Vincent had been doing LDA, kind of said, well it makes sense that what’s happening with microbes is very similar to what’s happening with these other allergens. So, he just started experimenting with different nosodes, and found clinically it was working really well, and we’ve now been doing it for six or seven years, and there’s maybe a couple hundred doctors around the country that have trained with him on doing it.

Clinically, I have found for a lot of my patients it has been a game changer in their Lyme treatment. If you’re ever interested in learning this, I can get you the information to contact Dr. Vincent. He’s got some online YouTube videos you can watch for free. He does have a training course coming up in September that’s going to be virtual. It was supposed to be in Hawaii, but travel right now is almost impossible, so it’s going to be virtual, and you can go through and get all the details on how to do this in your practice. It’s a fairly easy thing to utilize. There is an art to it, where you’ve got to learn how to figure out where to start people with their doses. Generally, kind of like, if you’ve got a sensitive person, you’re starting them on a drug, you start them on a low dose and then incrementally go up in small amounts until you hit that target dose.

The antigen we select is really depending on what we think is triggering the symptoms. If we think Lyme is the trigger, that’s what we use. If you’ve got someone, based on stool testing or organic acid testing, if it’s an overgrowth of candida or yeast, maybe you want to do the candida antigen. Maybe you want to do the strep antigen. We probably have about 40 different antigens we use right now, and I know Dr. Vincent keeps expanding that in experiments with different things, and every year it grows a little bit, based on what he and other doctors around the world have been finding.

This is given as a sublingual administration every seven to eight weeks, depending on patient response. So, the nice thing about this too is, they’re doing all these things every day, this is something they don’t have to do every day. It’s really about every two months. And when you hit the nail on the head, often we’ll see changes within 24 to 48 hours. Although it may take longer, in some cases, to see the full benefit, it doesn’t usually take that long to see if we’ve really hit the right dose.

Pulse electromagnetic frequencies, I just want to mention. PEMF, we actually utilize this in the office. This is basically a device that helps put a resonant energy that matches your normal human cell vibration, and if you think about pushing a child on a swing, every time you keep pushing the same direction, it moves them further and further. It’s kind of the same thing. So, our bodies get exposed to so many frequencies that are against us, WiFi and cell phones and things of that nature that probably inhibit our own natural frequency. This is a way of kind of restoring that.

We’ve got over one million receptors on any given cell, and applying the right EMF can really help stimulate these receptors to alter cell function. The goal is really to find the right frequency that stimulates the body towards better health. We always talk about the chemistry of the body, and we pretty much ignore the physics of the body. I think getting down at that level of intervention, it’s nice, because it’s safe, it’s easy. You don’t have to worry about side effects. It’s a very gentle way to try and help facilitate tissue repair in a very easy way. There are professional devices. There are devices they make for people’s homes that they can do at home.

The professional devices obviously give you more options and different ways to treat people, but again, for people who like the therapy, there are plenty of companies out there that make devices you can use at home. The benefits is improved circulation, decrease pain, reduce inflammation, faster recovery after injury, faster healing of skin wounds, and acceleration of nerve regeneration. So much of this is important for our Lyme patients, that again, I’ve found some people do remarkably well with this therapy.

Like physical therapy, they do need to do it somewhats frequently. We recommend doing two sessions a week when they come to our office. If they’ve got a machine at home, they can probably do it every other day, but you don’t necessarily need to do it every single day to get the benefits.

Germans have published a ton of research on this. There’s literally over 1,600 studies on the use of PMF. These devices are FDA approved in the U.S. So, again, this is something that can be very beneficial for people who have access to it. And in your own practice, may be something worth adding in too, as another tool to put in your tool chest for your patients.

Low-dose naltrexone, I like. I’ve been using it for a long time. I’m actually a part of the LDN Trust, which publishes a book and several research studies on their website. And the naltrexone is an opioid antagonist, but at low doses it actually enhances and dodges opioid production. So, basically gets your brain to make its own natural opioids. The short-term block in these receptors for four to six hours leads to an increased level of endogenous opioids for up to 20 hours.

So, we typically give this at bedtime for that very reason, so by the time daytime rolls around, those endogenous opioids are already circulating. This is all off-label use. There’s actually over 40 studies using it off-label for cancer, MS, fibromyalgia, autism. Unfortunately, there’s no studies on Lyme disease specifically, but a lot of us in the Lyme world do use this for our patients, particularly those who have pain issues, sleep issues, muscle issues. Here’s just a list of some of the studies that have been published. Again, you can read through that.

But again, what I like about it is that the side effect profile is excellent. The biggest side effects you typically see, tend to circle around sleep. Some people will talk about getting wild, vivid dreams, but outside of that, it’s very well tolerated. I’m a naturopathic doctor. I’m supposed to tell you drugs are bad, and I’m telling you, I use a lot of this medication. I think it’s great.

The other thing is it’s very cost-effective. We have a compounding pharmacy here in [inaudible 01:04:25] that makes a three-month supply for about $45. So, even for people that are on a tight budget, this is doable. It takes about three months to get the full benefits once you start people on it. So, just tell them, if you’re going to use it, to give it a little bit of time, and we’ll typically start with one milligram at bedtime, and every two weeks go up by one milligram. You can go as high as six milligrams. I find most people, somewhere between three and four and a half milligrams where they hit their sweet spot.

If you start to get up to five or six milligrams and they don’t feel any different after two weeks, you’re barking up the wrong tree, and at that point I would ditch it.

Just to summarize, our treatment approach, obviously we want to treat the organism if it’s acute. We want to treat these other immune distractors, if they’ve got food allergies, environmental allergies, because it drives that TH2 pathway. We want to promote better detoxification, fix these endocrine problems that get disrupted, make sure they’re sleeping well, get their inflammation under control, get their diet and nutrition under control, help their mitochondrial function if you think it’s been disrupted, get their circulation moving, boost their immune system. These are the fundamental things I think about when I’m dealing with Lyme patients.

It’s sort of naturopathic medicine 101, functional medicine 101. A lot of these things you’re already doing in your practice are very easy to apply. But hopefully the things we’ve talked about tonight will give you just a few more tools to add to the tricks. This is the book I wrote called The Lyme Solution. If you guys are interested, please feel free to pick up a copy. The information in it, I think, as a … it was written for patients, but I think as a practitioner, there’s a lot of great information. It goes into a lot more detail about the things we talked tonight, especially the herbs, what they do, why we use them, their chemical action.

All the references are in there. It’s a very well-referenced book. I have almost 300 references in there, so it’s not just my professional experience. It’s backed up by research as well. And just conclusion, here’s my information if you need to … if you want to follow me, in my information I talk a lot about Lyme and tick-borne illness. If you’ve got follow-up questions, there’s my e-mail address and phone number. And I think that concludes the talk tonight, so I’m open to any questions.

Dr. Weitz: That was a lot of information Darin.

Dr. Ingels: Let me stop sharing my screen here and we’ll turn it back over to the video.

Dr. Weitz: So, let’s see. Some of the questions that have come in about sharing the slides with me, and I can send it out in an e-mail. Something about weaponized ticks released by the Department of Defense.

Dr. Ingels: Well, you know, that’s been hearsay. The thing with that is that there’s a little place called Plum Island off the coast of Connecticut, which is a government research facility, so the theory has always been, is that, something got off the island, got to Connecticut, because Lyme, Connecticut is sort of across the pond, the Lond Island Sound from Plum Island. It’s all hearsay, and then Kris Newby came out with a book, last year maybe or the year before, where she interviewed Willie Burgdorfer, seems to suggest that ticks were being weaponized.

It’s hearsay. Maybe it was, maybe it wasn’t. At the end of the day, at this point it doesn’t matter. For people who have been infected, that’s what we have to deal with, so we don’t really know. There’s no concrete evidence that that’s a fact at all. She took some of Willie Burdorfer’s words and I think twisted it a little bit to make it sound like it was fact. Look, we know our government does things to weaponize viruses and bacteria. I’m not sure the benefit of weaponizing a tick. Again, that’s not my area of expertise, but to date, we have yet to really see any hard evidence that that’s true, unfortunately.

Dr. Weitz: Which PEMF device do you use?

Dr. Ingels: We have one from a company called Lenyosys. They’re based out of Ford Lauderdale, Florida. There’s a lot of good companies. There is another company based out here in Southern California. If you guys are interested, off the top of my head I forget the name of the company, but if you message me I’ll send you their information, a contact with their rep.

Dr. Weitz: So, is the type of PEMF device you have the one where you lay on a mat, or is it the coils that you put on-

Dr. Ingels: Yeah, so the one that we have, there is a big mat that you put behind your back. We do it in a recliner chair, and then depending on the protocol we’re using, there’s different leads that’s you connect to their wrists, their chest, their ankles, and so each protocol tells us where you need to connect each lead. What that one is doing is it’s basically getting the feedback through the skin during the protocol, so that one is a little bit different. Some of the coils, you put around your body or on your body. Yeah, so there’s a lot of different variations of PMF devices. Talk with different reps and again, the price ranges are enormous. I had been talking with Lenyosys for years before we actually bought our machine.

We bought their professional machine. It’s called the Cellcom. It’s $18,000. A lot of these good ones are about that price range, and then we charge, I think, $75 a session when people come in. Because it’s a set it and forget it. Once you get them set up, you set it and then you walk out of the room. You don’t have to stay in there with them, so our tech, our MA sets them up and then leaves.

Dr. Weitz: And what’s the main benefit that patients notice?

Dr. Ingels: With the PMF? Well, it depends what their primary symptoms are. Sometimes it’s improved energy, better mental clarity, better sleep, less anxiety, they feel less stressed. We put an adrenal protocol in all of our Lyme patients, because they’re all stressed. They’re sick, they don’t feel well, and yeah, sometimes circulation. I had a woman who came in, she was a new patients, she came in in a wheelchair. She could walk, but it was very hard for her. She did one session of PMF for about an hour and a half, and she stood from the table, she pushed her wheelchair out. She didn’t get in it. She’s like no, I’m fine, and then she walked out. I’m like, oh, well that was amazing for one session. So, that’s my N of one, and the asterisk, the result is not typical, but again, for people who are sensitive, that may be enough.

Dr. Weitz: So, you use your Lyme protocol to try to treat the Lyme. When do you start looking at things like heavy metals and mold and some of these other things? Is that something you tend to look at once the original protocol is not getting the results you want, or is it based on history, or …?

Dr. Ingels: Well, in reality, we’re talking about Lyme disease. In clinical practice, we’re always looking at everything. If I have someone who, based on their history, has occupational exposure, I may test for heavy metals at the same time. If I know that they’ve been in a mold-damaged building or I’m suspicious, I’ll test them for mycotoxins. We’ll do mold allergy testing. It’s not like we’re only looking at Lyme. We’re looking at the whole person, so I’m doing all this simultaneously.

Dr. Weitz: But let’s say you find mold and mycotoxins or Lyme and heavy metals, do you treat one and then the other? Is there a certain order? Do you treat them all at the same time?

Dr. Ingels: I treat simultaneously. If they’re both problems for patients, I have heard other practitioners say, well you have to treat the mold before you treat the Lyme. That makes no biological sense. It’s never the way that I practice. I treat them simultaneously and I find that works perfectly fine. If we’re giving people glutathione to mobilize, which his good for their nervous system and Lyme anyway, and then we’re still using a binder to help pull out mycotoxins, it’s perfectly fine to do in conjunction with a Lyme treatment. It gets to be kind of a pain, because sometimes people are taking more stuff than I would prefer, but I don’t think it’s fair to patients to make them wait if they’ve got a problem that you’re not specifically addressing. My approach is really just to try and cover as many bases without overwhelming them.

Dr. Weitz: And how often do you have to work on gut health?

Dr. Ingels: Always. Yeah, I mean, gut health is an ongoing thing. My feeling is, depending on the nature of what their gut was prior to us working together, I want them to have one to two healthy bowel movements a day, no indigestive food, blood, mucus, easy to pass, they’re not straining. So, if we can get to that point, then I kind of feel like our work with the gut is good. And at that point, they’re maintaining it through their diet and lifestyle. They’re eating good nutrient-dense foods. They’re getting good sleep to promote better peristalsis. They move their body. So, as long as they can maintain it with their lifestyle, then I don’t think we have to keep giving them tons of stuff to keep healing the gut.

Dr. Weitz: And since Lyme is a chronic disease, do you find that after six months or a year, patients need refreshers or is there sometimes maintenance dose of herbs that people take long-term?

Dr. Ingels: Well, not unless they’re having symptoms again. Now, I’ve had plenty of patients that get to a point where they’re pretty much symptom-free, they’re doing great, and then some big stressor hits their life, whether it’s a death of a family member, a divorce, whatever it is, and then we’ll see relapse of symptoms. So, I think stress is that one trigger for a lot of Lyme patients that can make them slide back very quickly, even if they’ve been doing well for a very long time. The patients I’ve seen who really take to task their ability to maintain their diet and lifestyle, even when those stressful events happen, they are less prone to the effects of it. The people who let themselves go a little bit and get kind of lacks on that stuff, are more prone to it. So, yeah, my goal is to get people to the point where they’re functioning at a high level and hopefully symptom-free. It’s challenging, but it does happen. I also tell my Lyme patients, “Don’t ever go on social media.” It’s the worst place for a Lyme patient. Especially these Facebook groups that are Lyme groups. They’re allowed to come to mine, because I monitor it, and if there’s stuff that’s really negative or really misinformed, I either comment on it or I just flat out delete it. So, I think people need to be very wary, because they’re getting so much information off the internet and Facebook, and in the Lyme world, there’s a lot of misleading information.

Dr. Weitz: Now, it looks like you find a protocol of herbs and then keep the patients on that for quite a period of time, but it’s kind of a naturopathic principle that I hear a lot of practitioners talk about, and I’ve gone back and forth on this myself, but is that, you need to constantly rotate the herbs, because otherwise you stop getting response if you continue to use the same herb?

Dr. Ingels: Yeah, and as I mentioned, that I’ve never really seen. The reason for me to change a protocol is it’s just not working, or if someone’s having a side effect. They’re just not tolerating it well. But as I said, I give it that two month mark. Again, we’re trying to find what works best for each patient, and that’s a function of what they tolerate, and that’s, of course, factors of their genetics, how well their liver detoxifies, all these other external factors.

So, it’s a constant fine-tuning of whatever. We need a place to start, and once we start on that path, as I said, with herbs, we give it two months to give it its full time to really see how it works. Because sometimes, as I said, people will start the first month, there’s not a lot of progress, and people get very discouraged, and then they get to week five, week six and then they turn a corner. I don’t want to keep switching so quick that we can’t say that it really didn’t work. We may not have given enough time, but I kind of feel like I have a good sense of how long each thing should take to get the kind of results we want to see, and if we’re not seeing that, we need to change.

What makes me crazy is when I see practitioners that start people on a protocol, they’re not six months into it, there’s no improvement at all, and they want to keep waiting for the corner to turn. At that point, it ain’t going to happen. Give yourself a reasonable timeframe. Make sure you’re clear with your patients that this is what I expect, and if we don’t see the kind of improvement we’d like to see, then we’ll switch gears.

Dr. Weitz: Is there part of your protocol that’s particularly designed to strengthen immune function or specific supplements that are out there that are specifically to strengthen parts of the immune system?

Dr. Ingels: Yeah, and some of that is accomplished through the herbs, but I still, it’s really patient-specific. Most of our Lyme patients are Vitamin D deficient, so most of my patients are getting Vitamin D as supplements, and of course, encouraged to be out in the sun. There’s a lot of them taking Vitamin C, some of them take Vitamin A. A lot of them take zinc, so yeah, we’re still doing a lot of things nutritionally to help support their immune system. So, yeah.

Dr. Weitz: Do you use things like colostrum or bovine serum?

Dr. Ingels: Yeah, I don’t really use a lot of colostrum, for no really particular reason. It’s just something I’ve never really used in my practice. I tend to use more of the nutrients for those things. Alan Gaby was my nutrition teacher when I was a med student, and he literally wrote the textbook on nutritional medicine, so mine tends to be probably more nutrition-oriented.

Dr. Weitz: Right. Somebody asked, do we need to retest to know that we successfully are-[crosstalk 01:17:52]

Dr. Ingels: That is a great question. I don’t know who asked it, but thank you for asking that. No, don’t ever retest them again. Honestly, and this is why, I’m not being facetious. The problem is, we know from the research that Lyme antibodies can stay elevated for 20 years after you’ve treated someone, and it will not change your treatment. And what it’s going to do is it’s going to make you and your patient crazy. I used to test every couple of months, and we’d see antibody levels go up and down, even if the patient was improving or not improving. So, you always feel like you’re chasing these antibodies. The likelihood of getting someone completely antibody free, it’s not zero, but it’s pretty close to it. They will probably have IGG antibodies their whole life and they will come, potentially, in and out of being IGM positive. I was exposed 18 years ago. I actually did my Lyme test, just for fun, about a month ago, and it looks like I have acute Lyme disease.

Dr. Weitz: Wow.

Dr. Ingels: So, don’t use it as a marker. Unfortunately, there’s not a single, reliable blood marker that we can use to tell whether somebody is better or not. Now, if you do your standard chemistries, someone did have a high CRP, maybe we will see it come down. But outside of that, CD57, a lot of doctors like to tout it as being a reliable marker for Lyme. It’s not. And I have yet to see a single person that ever had their CD57 checked before they had Lyme. So, they come in and say, [inaudible 01:19:12], you’ve got chronic Lyme because you have a low CD57. So, yeah, I mean I have not found a single marker that we can reliably use to monitor people’s progress. This is the slippery part of managing Lyme patients, is that you’ve just got to go with their symptoms. I think having them take that questionnaire periodically is a good way to see how they’re progressing. In my book, I have an abbreviated version of the MSIDS questionnaire. If people want, you can photocopy it if you like and hand it out to your patients, but that’s a really easy way to monitor in between, without doing more complicated testing. Just where are you at?

And it’s good for patients too, because they live with themselves. It’s like watching grass grow sometimes. Day to day, they don’t necessarily see the progress, but over the course of weeks and months, you start asking about, well what about your neuropathy? “Oh yeah, I forgot I had that. Oh yeah, I guess that’s gone, because I still have joint pain.” So, it’s a good way to keep tabs, and it’s also for documentation standpoint. It’s good to have them fill out that questionnaire periodically and just put in your chart as a way of monitoring their progress.

Dr. Weitz: Is that questionnaire in place of an MSQ or you use an MSQ as well?

Dr. Ingels: No, it’s different than the MSQ.

Dr. Weitz: Okay. Couple people asked about Rife, and somebody asked about Magnawave.

Dr. Ingels: I don’t know what Magnawave is. I think the Magnawave, correct me , I think it’s a thing you put on your wrist. I think that’s what it is. You can chime in if that’s what it is.

Rife, I’ve had patients who have used Rife, who have actually reported they feel a lot better. I had one patient I worked with for a long time in New York, and she got marginally better, but not 100 percent. And then she kind of disappeared from my practice, and she popped up in California five years later. And when I first saw her, she was very feeble, she walked with a cane, very disabled. And she walks in next time, no cane, strong, I didn’t even recognize her. And I said, “Well what did you do?” And she said, “Well I stopped doing everything and I did Rife every day for two years.”

Dr. Weitz: Wow.

Dr. Ingels: So, again, N of one. Take it for what it’s worth. I have several other patients around here in Southern California who have Rife machines. Again, I think it’s a tool. I don’t think I would rely completely on Rife, but it’s another tool. I think the concept behind it makes sense. The whole thing is you’re putting a frequency in the body to disrupt the organism, much like an opera singer breaking a glass with their voice. It’s the same kind of concept. There’s a practitioner here in Orange County who has been doing Rife for 40 years very successfully. So, again, it’s not the first thing I go for, but if you’ve got patients asking about it, if they’re interested, I don’t see really a lot of harm to it, and you can buy some of these Rife machines for under $1,000. They’re not super expensive. They’ve just got to learn how to dial in the right frequency. The FDA doesn’t like it at all. They think it’s nonsense, but I never argue when people tell me they do something and they get better. And I’ve had enough people over a 21-year career telling me that they did it and they felt better, and I’ve rarely ever had someone tell me that they tried it and it made them worse.

Dr. Weitz: Somebody asked about CellCore, it’s another line-

Dr. Ingels: Yeah, it’s another company. I’ve not used their products, in particular, but if you look at the ingredients, again, there’s a lot of similar concepts behind the products in there. Again, I don’t have any experience using their particular products. I’ve got about eight other companies I work with and they all work well, so I’ve never had to deviate to try something new. But yeah, if you’ve used it and it works, then I think they’re fine.

Dr. Weitz: Okay. So, I think that’s a wrap.

Dr. Ingels: That’s a wrap. Well, thank you guys very much for joining us tonight, and as I said, if you guys are interested in getting a copy of the slides, just e-mail me and I’ll be happy to send those to you. Absolutely.

Dr. Weitz: And if we want to contact you, what’s your website?

Dr. Ingels: All that is on the last slide. Well, my website is just DarinIngelsnd.com. And all of my information is there if you’re interested.

Dr. Weitz: Okay. And your book is available through Barnes and Noble and Amazon.

Dr. Ingels: The book, Amazon, Barnes and Noble, not that you can go anywhere to buy a book anymore.

Dr. Weitz: Thank you Darin.

Dr. Ingels: All right. Great. Thanks Ben.

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