A surge in ticks that carry the Lyme disease infection is expected this spring and summer, as I describe in my blog post "Lyme Disease: The Perfect Storm Is Headed Our Way."
Today I look at fighting back against Lyme disease, a persistent and challenging foe that should not be underestimated. To illustrate this I'd like to briefly mention a fascinating study I recently came across about Lyme's spread.
The movement of ticks that carry Lyme disease into new areas is being monitored at universities in the U.S. and internationally. At the University of Illinois, researchers are discovering the ways Lyme ticks are creeping into new environments.
As a result of the spreading ticks this season, many people will receive antibiotic treatment for tick bites or suspected infection. Yet controversy surrounds the issue of what is the optimal treatment for Lyme disease.
Some studies have shown that different strains of Borrelia, the bacteria that cause Lyme disease, differ in the way they respond to antibiotics.
In my own clinical experience, there is no single "best" treatment. People vary greatly in their response to antibiotic therapy and their tolerance for different antibiotics. The "Advanced Topics in Lyme Disease" published by Dr. Joseph Burrascano, a pioneering physician specializing in Lyme disease, is a good place to start in terms of getting up to speed on this difficult-to-treat infection.
Antibiotics are the standard therapy for Lyme disease. Like other drugs, the way they are taken can strongly influence the outcome of treatment. Interactions between antibiotics and food or supplements are very important and have been described in the medical journals. To help educate people about this research, I created a database of interactions that is accessible as a free online tool at pilladvised.com.
To further educate doctors and patients about negative interactions and beneficial ones, I've highlighted some of that information, as it relates to treatment of Lyme disease, below.
Information on drug/food interactions is also available from your pharmacist and often included in the patient-package insert when you buy medication. This should be checked for each individual drug being taken, because the dosage form (sustained-release vs. regular, for example) may influence the effect of food on drug absorption.
Here are highlighted interactions between some common antibiotics and food or supplements:
Food or Supplements May Affect Antibiotic Absorption
Doxycyline, the most commonly prescribed antibiotic for Lyme disease, forms complexes with minerals like calcium, magnesium and iron that impair antibiotic absorption. Because of their high calcium content, dairy products should not be taken within several hours of doxycycline. A glass of milk reduces doxycycline absorption by almost 30 percent.
Doxycycline should also be taken several hours apart from nutritional supplements containing minerals (calcium, magnesium, iron, zinc). Some herbal dietary supplements, like fennel and dandelion, are rich enough in mineral content that their consumption may negatively affect doxycycline absorption. The food and drug interactions that affect doxycycline are shared by other antibiotics in its class, like minocycline and tetracycline.
Penicillins are another class of antibiotics used to treat Lyme disease. They may also have their absorption impaired when taken with food, but by a different mechanism. Food causes most drugs to be retained in the stomach, where the presence of acid can cause penicillin to decompose. This effect is more likely to occur with penicillin V and ampicillin than with amoxicillin, which is more stable. Extended-release amoxicillin, however, may actually be more bioavailable when taken with food. Psyllium fiber, used to treat constipation, has been shown to bind penicillin, decreasing its absorption.
Two other classes of antibiotics often used to treat Lyme disease are also affected by food. These are cephalosporins, which include cefuroxime (Ceftin or Omnicef), and macrolides, which include claithromycin (Biaxin) and azithromycin (Zithromax). Food enhances absorption of cefuroxime and of the extended-release form of clarithromycin. Food impairs absorption of Zithromax capsules but appears to not impact absorption of Zithromax tablets Azithromycin can be irritating to the stomach. If you need to take it with food, request the tablet form.
Always check with your pharmacist on the best way to take the specific prescription you're been given. The difference can affect the success of treatment.
Clarithromycin is subject to an additional type of interaction. It may interact with herbal supplements. Clarithromycin is changed to an inactive metabolite by an enzyme called CYP3A4, which acts on it in the intestinal lining. The herb Echinacea, used as an immune stimulant, inhibits intestinal CYP3A4 and might increase absorption of active clarithromycin. St. John's wort, used to relieve depression, in contrast, increases CYP3A4 activity, and may potentially decrease clarithromycin absorption.
Antibiotics May Deplete Beneficial Bacteria And Nutrients
The human body is home to about 100 trillion bacteria. For every cell, your body harbors about 10 bacteria. Taking antibiotics can have a massive impact on your normal bacterial population, depleting sensitive organisms and allowing resistant ones to overgrow.
The most common effect is antibiotic-induced diarrhea, which may be prevented by the use of probiotics. The best-studied probiotics are Saccharomyces boulardii, a yeast, dubbed "yeast against yeast" in France, Lactobacillus rhamnosis GG, Lactobacillus plantarum and Lactobacillus sporogenes.
The normal gastrointestinal bacterial flora synthesizes B vitamins, biotin and vitamin K, which are absorbed and utilized by humans. Depletion of normal bacteria by prolonged antibiotic therapy may produce vitamin deficits. Bleeding caused by vitamin K deficiency has occurred as a result of cephalosporin antibiotics.
High-dose penicillin therapy can lead to increased excretion of potassium by the kidneys. When combined with antibiotic-induced diarrhea or poor appetite, this effect may lead to potassium deficiency, with fatigue and muscle weakness as primary symptoms.
When taking antibiotics for several weeks, it may be worthwhile to take probiotics and a multivitamin.
As I have highlighted here, research has revealed how antibiotic treatment can be impacted by foods, such as dairy, and supplements, such as calcium, and herbs. Antibiotics may also lead to nutritional deficiencies, and beneficial bacteria can be reduced.
Lyme disease presents many challenges, from prevention and diagnosis to treatment. Given the scope of the problem, more research, education and prevention should be done to fight Lyme disease.
And Lyme is not limited to the U.S. While Lyme disease was first observed in Lyme, Conn., it is now recognized as an international problem, with infections in the UK, France, Spain, Italy and other countries.
Now I'd like to hear from you:
Please share your experience fighting Lyme disease.
Have you been tested for Lyme or other tick-borne diseases?
Have you received treatment for Lyme, and has it helped?
Let me know your thoughts by posting a comment below.
Leo Galland, MD
Important: Share the Health with your friends and family by forwarding this article to them, and sharing on Facebook.
Leo Galland, MD is a board-certified internist, author and internationally recognized leader in integrated medicine. Dr. Galland is the founder of Pill Advised, a web application for learning about medications, supplements and food. Sign up for FREE to discover how your medications and vitamins interact. Watch his videos on YouTube and join the Pill Advised Facebook page.
References and Further Reading
Preac Mursic V, Marget W, Busch U, Pleterski Rigler D, Hagl S, "Kill kinetics of Borrelia burgdorferi and bacterial findings in relation to the treatment of Lyme borreliosis." Infection. 1996 Jan-Feb;24(1):9-16. Max v. Pettenkofer Institut, Ludwig-Maximilians-Universität München, Germany.
Agwuh KN, MacGowan A. "Pharmacokinetics and pharmacodynamics of the tetracyclines including glycylcyclines." J Antimicrob Chemother. 2006 Aug;58(2):256-65 Department of Medical Microbiology, Old Medical School, Leeds General Infirmary Great George Street, Leeds LS1 2EX, UK.
Kshirsagar NA, Ankalesaria PS. "Effect of food on doxycycline absorption." J Postgrad Med. 1987 Jul;33(3):117-9.
"Comparative effect of different types of food on the bioavailability of cefaclor extended release tablet." Khan BA, Ahmed T, Karim S, Monif T, Saha N, Sharma PL. Eur J Drug Metab Pharmacokinet. 2004 Apr-Jun;29(2):125-32
Karim S, Ahmed T, Monif T, Saha N, Sharma PL. "The effect of four different types of food on the bioavailability of cefaclor." Eur J Drug Metab Pharmacokinet. 2003 Jul-Sep;28(3):185-90
Guay DR, Gustavson LE, Devcich KJ, Zhang J, Cao G, Olson CA. "Pharmacokinetics and tolerability of extended-release clarithromycin." Clin Ther. 2001 Apr;23(4):566-77. Institute for the Study of Geriatric Pharmacotherapy, College of Pharmacy, University of Minnesota, Minneapolis 55455, USA.
"Mechanistic study of the azithromycin dosage-form-dependent food effect." Curatolo W, Foulds G, Labadie R. Pharm Res. 2010 Jul;27(7):1361-6
Gorski JC, Huang SM, Pinto A, Hamman MA, Hilligoss JK, Zaheer NA, Desai M, Miller M, Hall SD. "The effect of echinacea (Echinacea purpurea root) on cytochrome P450 activity in vivo." Clin Pharmacol Ther. 2004 Jan;75(1):89-100. Department of Medicine, Indiana University School of Medicine, Indianapolis, 46202-2879, USA
Alitalo et al. "Hypoprothrombinaemia and bleeding during administration of cefamandole and cefoperazone." Ann Clin res 1985; 17: 116-9.
Shimada et al. "Bleeding secondary to vitamin K deficiency in patients receiving parenteral cephem antibiotics." J Antimicob Chemother 1984; 14 (Suppl B): 325-330
Gill et al, "Hypokalemic metabolic alkalosis induced by high-dose ampicillin sodium." Am J Hosp Pharm 1977; 34: 528-31
Surawicz et al, "Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: A prospective study." Gastroenterol 1989; 96: 981-88
Vanderhoof et al, "Lactobacillus GG in the prevention of antibiotic-associated diarrhea in children." J Pediatr 1999; 135: 564-48.
Armuzzi et al, "The effect of oral administration of Lactobacillus GG on antibiotic-associated gastrointestinal side effects during helicobacter pylori eradication therapy." Aliment Pharmacol Ther 2001; 15: 163-69.
LaRosa et al, "Prevention of antibiotic-associated diarrhea with Lactobacillus sporogens and fructo-oligosaccharides in children. A multicentre double-blind vs placebo study." Minerva Pediatr 2003; 55: 447-52.
Leipner et al, "Therapy with proteolytic enzymes in rheumatic disorders." BioDrugs. 2001;15(12):779-89.
Luerti & Vignali, "Influence of bromelain on penetration of antibiotics in uterus, salpinx and ovary." Drugs Exp Clin Res 1978, 4: 45-48.
Full Text: "Diet and Inflammation" Leo Galland, MD, Nutr Clin Pract December 7, 2010 vol. 25 no. 6 634-640
Power Healing: Use the New Integrated Medicine to Cure Yourself. Leo Galland, M.D. 384 pages, Random House
The Fat Resistance Diet Leo Galland, M.D.
This information is provided for general educational purposes only and is not intended to constitute (i) medical advice or counseling, (ii) the practice of medicine or the provision of health care diagnosis or treatment, (iii) or the creation of a physician -- patient relationship. If you have or suspect that you have a medical problem, contact your doctor promptly.
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