Lipid Exchange: The Important Final Step in Treating Chronic Infection and Lyme Disease
By Cory Tichauer, ND
Article first appeared in Focus
Lipid replacement therapy clearly represents a very, very important step in the recovery and healing of patients from chronic infections and their associated neurotoxins.
Dr. Cory Tichauer has a bachelors in neurobiology and behavior from Cornell University and a doctorate from the five-year program at National College of Natural Medicine. Dr. Tichauer believes that healing is accomplished through the rational and sequential stimulation and elimination of toxins from specific organs and tissues. For the past five years he has focused on chronic infectious disease, with a specialty in tickborne illness. His wide knowledge base incorporates the work of pioneers such as Ritchie Shoemaker, MD, Patricia Kane, PhD, Steven Harris, MD, Dickson Thom, ND, Dietrich Klinghardt, MD, Christine Green, MD, Eric Gordon, MD and many others.
Focus: Before we talk about lipid replacement therapy and how you use it in your practice, tell us how you came to specialize in chronic tickborne infection.
Tichauer: I did not choose it, it chose me. I was seeing very ill patients, and I wanted to help them get well. Attempting to understand what could cause multi-system, chronic symptoms, I found that, all too often, Lyme, tickborne illnesses, persistant infection and biotoxin exposure were involved. I am a member of ILADS (International Lyme and Associated Diseases Society), which contends that tickborne illness can be chronic and that often, a single course of antibiotics is not adequate. Sometimes months, and in the most severe cases, years of treatment are necessary, with breaks for restoring the microbiome and detoxification. In contrast, the IDSA (Infectious Disease Society of America) contends that it takes only 3-6 weeks to eliminate borrelia and other tickborne organisms from the body, and that any remaining symptoms are due to a “post-lyme” syndrome.
Focus: What is your treatment approach?
Tichauer: I’ve seen about 300 Lyme and tickborne infection associated patients in the last five years, and most of them need longer and more aggressive therapy. I employ an integrative approach where I combine natural therapies with pharmaceutical medicine. Sometimes I don’t use antibiotics at all, but sometimes it is necessary, and my approach is one of getting results. I do whatever it takes to help my patients get well. Often we employ breaks in the antimicrobial therapy to appropriately detoxify a patient. Infections such as Lyme are very high in neurotoxins, and as Dr. Ritchie Shoemaker has discovered, a subset of patients finds it difficult to effectively eliminate these neurotoxins. We can determine that by testing their HLA (human leukocyte antigen) subtypte (see http://www.survivingmold.com/diagnosis/lab-tests). There are also associated biotoxins, such as those from mold, that can be equally difficult for such patients. Still other patients suffer from the direct effects of intracellular bacteria such as Mycoplasma and Chlamydia pneumonia that are actually embedded in the cell. These intracellular infections directly produce toxins that lodge in the lipid membranes, of both the cell and the mitochondria within the cell. We also see the toxins lodging in the bile, liver and biliary tree.
Focus: It sounds extremely challenging. What is the typical course of therapy and when do you employ lipid replacement therapy?
Tichauer: Not surprisingly, I see a lot of lipid dysfunction as a result of toxins and infection depositing in fat and then crossing into cell membranes. They then disrupt countless functions in the body by disrupting the electrical potential of the cell membrane itself via its sodium and calcium channel receptors. The toxins also impact enzymatic reactions. Toxins can uncouple fatty acids from their associated phospholipid and then disrupt membrane integrity.
I want to pause here to examine just how significant lipids are in all bodily processes. If we think about the body, every cell is surrounded by a phospholipid bilayer. The brain is composed of up to 60% phospholipids, and the individual dendrites and axons can be as high as 80%. Phospholipids are responsible for a lot of cell to cell communication. Neurotransmitters in the brain, in order to be expressed, are wrapped in a phospholipid vesicle. With that understanding, lipid replacement therapy clearly represents a very, very important step in the recovery and healing of patients from chronic infections and their associated neurotoxins.
Focus: What practical results have you seen with lipid replacement therapy after effective antimicrobial treatment?
Tichauer: Good question. The fact is, that even after a completely successful antimicrobial intervention, which may have lasted as long as a few years in extreme cases, patients will still come to me complaining of fatigue and brain fog. Even if their other symptoms have cleared up, they don’t necessarily feel healthy and energetic. I tell them that yes, after all you’ve gone through, you still have toxins deposited into the cell membranes, and it’s time to address that. I also tell them to be patient, that lipid replacement therapy and therapies to bind the toxins don’t work overnight. Mitochondrial function doesn’t change overnight. It takes months to improve and stabilize function.
I believe the body wants to heal, and will do so if given the necessary help. I employ lipid replacement therapy in order to let the body replace oxidized lipids with fresh, healthy lipids. It’s what I’d call naturopathy 101—that the body is always attemptingto return to center, it is homeodynamic. The body will recognize and integrate those healthy lipids while eliminating the damaged, oxidized lipids. I use phospholipids along with a classic 4:1 ratio of Omega 6 to Omega 3 fatty acids. And since the body will be shedding the oxidized lipids and associated toxins into the bloodstream, I also use sodium alginate and modified citrus pectin to bind those up and help the body eliminate them. I may then use cholestryamine, or otherwise, a combination of chlorella and butyrate, to bind and eliminate these and other toxins as they pass through the liver and into the bile. I also sometimes utilize calcium betonite clay before bedtime.
Focus: What is one of your more dramatic patient stories?
Tichauer: Many cases come to mind, particularly those patients who recover from severe neurologic symptoms and chronic pain. Right now, I am thinkin of a patient I just saw this morning, actually. This patient was very, very ill with Bartonella and Borreliavalidated by culture and western blot. After almost a year of intermittantantibiotic therapy most of her joint pain and neurologic symptoms were markedly improved, but she still had fatigue and braiin fog. I put her on lipid replacement therapy and there’s a very noticeable difference. I’ve seen this repeatedly. She said, “Wow, I really feel like my body needed this. I really felt my energy start to change. My mood is more stable and my brain fog is improving.”
Focus: Any other tidbits of wisdom in treating or preventing tickborne illness?
Tichauer: Yes, I have a few. First of all, even in early infection, the doses of antibiotics must be sufficient to produce an effective antimicrobial action against their target organism. . Secondly, the time release form of doxycycline, Doryx, is often more effective, because blood levels will not drop in between doses. Thirdly, I have worked with a local compounding pharmacy to develop an antibiotic cream in a base similar to that used for hormone creams. I did this after reading an excellent study in which topical Azithromycin, applied to the site of a tickbite for 3-5 days, was effective in preventing transmission of Lyme Disease (Knauer J, et al. Evaluation of the preventive capacities of a topically applied azithromycin formulation against Lyme borreliosis in a murine model. Journal of Antimicrobial Chemotherapy online, Sept. 15, 2011.). When the spirochetes enter the body it usually takes them a few days to acclimate to the human host and become motile and invade systemically. During that time they are generally still centered around the area of the bite. I spent almost six months working with my local compounding pharmacy to develop an effective annhydrous antibiotic cream in a base that will allow it to penetrate through the skin. For my nature-loving patients who are active outdoors and exposed to ticks, I prescribe this at the beginning of tick season to keep in the refrigerator. If they get a tickbite, they apply it to the site once a day for 3-5 days. Whether this prevents every case, I can’t say for certain, but it seems highly effective thus far based on patient reports and follow up labwork. It’s relatively innocuous unless you have a rare Azithromycin allergy, and does not disrupt the microbiome the way oral antibiotics do.
Focus: That’s brilliant. Thank you so much for your insights and the care you are giving patients with tickborne illness.