APPENDIX B: Protect the Integrity of Your Microbiome!

By this point, you may be a little bit paranoid about ticks and mosquitos — and you should be! Ticks and mosquitos transmit a wide range of different types of host-seeking microbes. Infection with a new microbe or reinfection with a microbe you’ve already been exposed to can throw your recovery into a tailspin.

Biting insects, of course, are not the only way to acquire new microbes. Microbes can gain access to your body by breathing them in, through food and liquid you consume, intimate contact with other people, and sometimes through the skin.

You want to add as few new microbes to your microbiome as possible. Stealth microbes are always waiting to slip in through a crack in the doorway — they are the ultimate opportunists — so don’t leave your door cracked!

Everyday things you can do to protect your microbiome:

• Wash your hands or use hand sanitizers (these products contain only alcohol, which is toxic to microbes, but not toxic to you) after being in public and exposed to other people.
• Avoid heavily crowded public places as much as possible.
• Stay home when you are sick. Please.
• Use precautions during intimate contact with another person.
• Avoid being a feast for biting insects.
• Cook or wash your food thoroughly.
• Drink filtered water.

Having a history of Lyme disease doesn’t mean that you have to stay inside…you just have to pick your outdoor adventures carefully. Open areas free of brush and low foliage reduce chances of tick exposure. If you enjoy hiking, pick trails that are well traveled and foliage that has been cut back. Mountain biking on trails reduces insect exposure. Beaches are tick free!

Mosquitos come out less in the daytime. If you enjoy camping, invest in a screened extension for your tent, and stay in after dark. Camp only in open areas. Campgrounds with bathrooms reduce exposure to ticks while using the bathroom (as opposed to going in the woods).

When you do venture into the outdoors, use protection.

• DEET is the most effective and longest acting insect repellant, but also the most toxic. Individuals with any chronic illness should avoid using DEET.
• Permethrin is an option for treating clothing (but not bare skin) before going outdoors. Permethrin is a synthetic form of natural pyrethrin that specifically targets the insect nervous system and has low toxicity to mammals.
• Essential oils are safe alternatives to synthetic chemicals. Citronella and lemon eucalyptus are the most well-known, but if you don’t care for the smell, lavender, juniper, oregano, clove, and geranium work as well. These oils compare well with DEET in effectiveness, but do not last as long and must be reapplied frequently. They can be combined for increased effectiveness. Mix the oils in a 1:4 ratio with water and alcohol (50/50 mix), and shake before applying to skin and clothing. Oils can also be mixed with sunflower oil, but it may stain clothing. Commercial products containing these ingredients can be found with an Internet search.
• Yarrow tincture is a non-essential oil option that works as well as DEET. It can be applied to skin or clothing.
• Skin-So-Soft and other perfume products also compared well to DEET in one study. These are also good non-toxic choices, if you happen to enjoy that particular fragrance. This research suggested that the fragrances mask the scent of certain skin bacteria, which are attractors for mosquitos (ticks and mosquitos are more drawn to some people than others). However, there was no comment about the effectiveness of these products against ticks.
• Be extremely vigilant about ticks. When walking or hiking, whenever you brush by vegetation, stop and check for the possibility of a tick crawling up your legs or body.
• Tick check. When you come home from the woods, immediately place your clothes in the dryer for 30 minutes. Ticks perish quickly in dry heat. Then put them in the wash. Check yourself very thoroughly by feel and sight before hopping in the shower for a good scrub down.
• Take herbs regularly. My personal observation (also confirmed by others) is that many herbs make you less attractive to ticks and mosquitos. Since taking herbs, I have noticed that I am less likely to be bitten by mosquitos than people around me. Finding ticks on my body after spending time outdoors has been rare since starting herbs, and I can’t remember the last time I had one embedded in my skin. All the antimicrobial herbs have value, but the best ones (in my opinion) are garlic and anamu.
• Be aware that pets regularly bring ticks inside. Have your pet regularly treated to reduce both ticks and fleas; all blood-sucking insects carry potential disease-causing microbes. The potential for harm to your pet is small compared to the misery they would have from being infested with fleas and other microbes from tick and mosquito bites. Protecting them also protects you.

If you do happen to be bitten by a tick:

• Remove embedded ticks carefully. The proper way to remove an embedded tick is by grasping it firmly with tweezers as close to the skin as possible and pulling it directly out. Do not use matches or other techniques.
• After removing an embedded tick, give your doctor a call. Antibiotics can help your immune system clear microbes, but may not eliminate them completely. The standard CDC recommendation for tick-bite prophylaxis is a single 200-mg dose of doxycycline, but only in high-risk areas. Considering that most anywhere there are ticks should be considered a high-risk area and ticks carry a wide variety of other microbes, this seems woefully inadequate. A more reasonable choice is doxycycline 100 mg twice daily for 2-4 weeks, especially if symptoms are present.
• Doxycycline covers for all the primary tick-borne microbes except Babesia. The medications used for treatment of Babesia infection are associated with significant side effects, so they are not ideal choices for prophylaxis. Metronidazole is an antiprotozoal drug that has been used successfully in veterinary medicine against certain species of Babesia. It is also well tolerated by humans and commonly used by humans for other purposes. If concern for Babesia is present, prophylaxis with Metronidazole 500 mg twice daily for 1-2 weeks may be a reasonable consideration (though this has not been tested in clinical studies). Metronidazole should not be used for more than 2 weeks.
• Frequent tick bites. If you happen to be in an environment where tick bites are a frequent occurrence, antibiotics with every tick bite is impractical. In this case, taking antimicrobial herbs continually may be your best protection.
• Herbal insurance. It’s not usual for people to show up with chronic Lyme symptoms 6 months after taking a course of antibiotics. Therefore, use of herbal therapy for an extended period (3 months to a year) is not a bad idea. The best choices are the primary antimicrobial herbs: andrographis, cat’s claw, Japanese knotweed, and stabilized allicin (garlic).

What about vaccinations? Flu vaccines can protect you from coming down with the flu, but they can also cause flare-ups of chronic Lyme disease symptoms. Flu vaccines stimulate antibody production, but as a tradeoff, may inhibit cellular immunity, allowing intracellular microbes to flourish. It’s really a personal choice. During mild years, the flu vaccine may be best avoided; wait for the years when severe flu outbreaks with new viruses are predicted. There is no effective vaccine against Lyme disease (and there probably never will be).

Maintaining a healthy immune system is the most important thing that you can do to protect yourself against all potential offenders and maintain a healthy microbiome!