It’s waiting for you.
Motionless, it remains perched on a twig extending across your footpath. All it needs is a warm-blooded creature like you to come along. Time is of the essence, however, as it has great risk of drying out and falling dead to the ground — that is the fate of most ticks.
To gain protection from temperature changes and drying out, a tick spends most of its life under leaf litter. In desperate need of a blood meal, it makes the arduous climb up and out onto the twig, even though the chance of completing its mission is extraordinarily small.
When you happen along and brush against the twig, the tick makes a great leap of faith, hoping to connect with skin, hair, or clothing. After a successful landing, it makes a spectacular dash to a soft, hidden place and immediately buries itself into your flesh.
On penetration, chemicals present in the tick’s saliva numb your skin and inactivate the first-response portions of your immune function, protecting both the tick and the microbes it carries. All ticks carry microbes. The possibility it’s carrying some form of Borrelia is relatively high. After all, Borrelia has honed a working relationship with ticks over millions of years.
Simultaneously, blood floods into the tick. Borrelia microbes present in the tick assess the blood to determine which type of host the tick has bitten. Borrelia can adapt to a wide variety of hosts, but each host is different. By sensing the blood, Borrelia can alter its genetic profile to adapt to the environment inside your body.
When Borrelia microbes enter your bloodstream, they’re ready and able. But because your human ancestors were well acquainted with Borrelia, your immune system is well prepared to fight them off. Though immune inhibitors present in tick saliva briefly give the microbes a slight advantage, they immediately find the first-responder cells of your immune system hot on their trail.
For this reason, Borrelia microbes clear the bloodstream quickly and penetrate deeply into tissues. With its corkscrew shape, Borrelia drills into joint cartilage and brain tissue. It can also enter and thrive inside many types of cells, thus gaining protection from immune functions and antibiotics.
It’s during this transition that symptoms of initial infection can occur. Typically, most people have a benign flu-like syndrome that lasts a week or more, but often, noticeable symptoms don’t occur at all. Rarely is acute infection with Borrelia ever enough to make someone bedridden. The fact that symptoms are typically mild is a strong indication that the human immune system is very familiar with Borrelia and immediately takes measures toward controlling it.
Common Symptoms of Acute Infection
Antibiotics taken during this period are known to reduce symptoms, but whether antibiotics eliminate Borrelia microbes is unknown. Borrelia is a master of penetrating spaces in the body where it’s shielded from the immune system and antibiotics. All too numerous reports of people developing chronic symptoms months after taking antibiotic therapy attest to the persistence of this insidious microbe.
Nature in Balance
What happens next depends on the health of your immune system. If your immune function is robust, you and the microbe enter a balanced host-microbe relationship. Overtly symptomatic illness does not occur — this is nature in balance.
The potential for Borrelia to cause illness is dependent on how well adapted the host’s immune system is to the microbe. In a well-adapted host, such as the white-footed mouse, illness almost never occurs; the mouse-tick-microbe relationship is many millions of years old. Though humans are not as well adapted as the mouse (therefore the potential for illness is higher than in the mouse), the relationship is still very well established.
If you think about it, a balanced relationship works best for the microbes. Consider the microbes’ motives for survival. To complete their lifecycle, an infected host must be bitten by another tick. This allows Borrelia microbes to enter a new tick. When that tick drops off and later bites another host, microbes are transferred to the new host and Borrelia’s mission becomes complete. The ongoing survival of the microbe species is secure.
In other words, Borrelia’s primary objective is turning its host into a mobile Borrelia-dispensing machine — not making the host sick.
Each time a tick bites an animal, the tick’s saliva circulates throughout the animal’s body. Chemicals present in saliva send the “all aboard” signal for any Borrelia microbes present in tissues. Upon sensing these chemicals, the microbes mobilize from deeper tissues, flood into the bloodstream, and get on board the new tick.[6] Allowing the host to live for a full and mobile lifetime allows for unlimited opportunities.
To survive, Borrelia needs only to exist quietly inside a host’s body until another tick comes along. Low concentrations of the microbes are adequate to complete the mission; overwhelming the host with infection is not required. In fact, an overwhelming infection is counterproductive. If the host is deathly ill, then it is less likely to go wandering through the woods. This decreases the chances of new tick bites. If the host doesn’t get bitten by another tick, then Borrelia has failed; the life cycle has reached a dead end.
ESSENTIAL LYME DISEASE FACTS
Figure 2 - Tick Life Cycle
Borrelia, the Ultimate Stealth Microbe
Borrelia has very sophisticated mechanisms for manipulating the immune system to allow it to exist indefinitely. It’s always trying to stay one step ahead of immune functions.
A master of disguise, it can modify its surface proteins almost continually to keep the immune system guessing. Borrelia can shift its genes to adapt to any environment within a host. It can adapt to different tissues (heart, joints, brain, skin, etc.) such that different strains of the microbe often occur within the same host. Because every person’s internal ecology is slightly different, a Borrelia infection is different for every person.
Borrelia microbes are very adept at using their corkscrew shape to penetrate cells, where they form vacuoles that fill with new microbes, one of the ways the microbe reproduces. Unlike most bacteria, however, they grow very slowly, creating new generations only every 8-12 hours (unlike other pathogenic bacteria that typically produce a new generation every 20 minutes).
Cell types that Borrelia microbes can infect include white blood cells. This enables the microbes to catch a ride to established sites of inflammation, such as arthritic joints. There, they will find abundant collagen, a favorite food source, already broken down and ready to be scavenged.
They can also penetrate between cells and slip into the space between layers of cells that make up tissues (called the extracellular matrix). There, they not only find substances that can be used for food (collagen, chondroitin, hyaluronic acid, and other substances), but also find protection from the immune system.[7]
If things really get hostile, individual microbes can curl up inside protective outer membrane sheathes and form antibiotic resistant dormant cysts (also referred to as round forms or persister cells).[8] When under extreme assault from the immune system or confronted with antibiotics, Borrelia microbes progressively shift from spirochetes to round forms (cysts).
In other words, the harder Borrelia microbes are hit with antibiotics or immune function, the more they encyst. As the microbes shift from active to encysted, symptoms decrease...but the relief is only temporary. After the hostile environment resolves, cysts quickly form new active spirochetes.
And then...there are biofilms. Borrelia, like most other bacteria can join with other microbes to form colonies shielded by a protective coating. Biofilms are extremely common in nature. The ring around your toilet bowl and the plaque on your teeth are prime examples.
Though you hear a lot about biofilms in Lyme disease forums, Lyme disease is not a primarily a biofilm disease. Biofilms require a surface on which to form (teeth, heart valves, joint linings, lumen of blood vessels, lining of the intestinal tract,[9] ventricles in the brain). Symptoms related to biofilm occur because of obstruction or damage to the surface. Though Borrelia may persist in biofilms (making it resistant to antibiotics and immune function), the symptoms of Lyme disease are primarily related to manipulation of the immune system by the microbe to generate inflammation.
How Borrelia Causes Symptoms
To survive, Borrelia microbes must scavenge essential nutrients from the host. To get at these resources, they manipulate chemical messengers of the immune system called cytokines. Using cytokines, they can shift immune functions away from attacking microbes and toward causing inflammation in tissues. Inflammation breaks down tissues and releases vital nutrients to the microbe’s ultimate benefit.
Because collagen is the primary nutrient Borrelia requires for survival, the microbes prefer collagen-rich tissues, such as joints, brain, muscle (heart muscle especially), eyes, and skin. Most symptoms associated with chronic Borrelia infection originate in these areas.
The microbes are also fond of myelin, a fatty substance that forms a sheath around nerves. Myelin is like the plastic coating on a copper wire; it insulates the nerve from other nerves and allows impulses to be conducted properly. Without it, nerve function is impaired, causing a wide range of neurological symptoms (symptoms like those seen in multiple sclerosis are common).
Symptoms associated with Borrelia infection are more related to cytokine-generated inflammation than direct damage by the microbe. Inflammation at specific tissue sites causes local symptoms such as arthritis. Cytokines circulating throughout the body are responsible for nonspecific symptoms such as fatigue.
For the most part, the intensity of the immune reaction (cytokine production) dictates the intensity of a person’s symptoms, not the concentration of microbes. In other words, it doesn’t take a high concentration of microbes for someone to be very sick. The fact that Borrelia microbes typically exist in very low concentrations in the body is one reason why Lyme disease is so difficult to properly diagnose.
A Healthy Immune System Is Not Naïve
If the immune system had never encountered Borrelia before, all the microbe’s fancy maneuvers would be absolutely devastating. But Borrelia’s complex adaptations did not occur overnight. It is the result of Borrelia and host immune systems “one-upping” each other; the microbes finding new ways to outsmart the host immune system, and the host immune system responding with innovative solutions to counteract the new threat — on and on for thousands upon thousands of years, one adaptation matched by another. Each adaptation is recorded in host genes and passed from generation to generation.
In this regard, the human immune system is very savvy to Borrelia’s tricks and eminently qualified to deal with them. This is an old game, and the human immune system is an equal or better match for Borrelia. A healthy immune system can seek out and destroy it, wherever it may hide.
Then is even true of cysts (round forms) and biofilm. Borrelia is not the only microbe that forms cysts, and the human immune system is well equipped to deal with them. Neutrophils, one of the champions of all immune cells, are very adept at killing cysts. These white blood cells create a net that captures all types of microbes (big and small) and cysts. Once captured, the neutrophil secretes enzymes and substances to kill and digest the foreign invader (Menten-Dedoyart 2012). A healthy immune system is the best answer to Borrelia cysts.
The same is true of biofilm; advanced life forms wouldn’t be able to exist without effective mechanisms of breaking down biofilm. Microbes of many varieties are constantly trying to form biofilms in the body, and a healthy immune system is constantly breaking them down. A healthy immune system is also the best answer to biofilms.
The immune system will make every effort to eradicate the microbes completely, but often the tug-of-war between the microbes and the immune system ends in a stalemate (the host becomes a carrier). Despite not being able to eradicate the microbes completely, however, a healthy immune system can keep the microbes marginalized such that harm is minimized, and symptoms do not occur.[10]
This is nature as intended; a balanced relationship works well for microbes such as Borrelia (but not necessarily the host). All creatures have balanced relationships with a huge variety of microbes, even some that have potential to cause harm.
Illness only arises when the immune system is in a weakened state and is unable to suppress the natural aggressiveness of the microbe. How sick someone becomes is dependent on how weak the immune system is and the natural aggressiveness of the microbe. Borrelia is more aggressive than microbes that are considered normal flora, but much less aggressive than many microbes that can cause severe acute illness.
Once infection with Borrelia becomes established, however, a vicious cycle of immune compromise is perpetuated by the microbes, and chronic misery can set in for a lifetime.
The degree and types of symptoms associated with chronic infection are highly variable; Borrelia infection is different for every person. The range of symptoms is dependent on the species or strains of Borrelia present in the host, the host’s total of microbes[11] (other potential pathogens present), the weakness of the host’s immune system, and the genetic makeup of the host (some people may be more susceptible to Borrelia than others).
Symptoms of Chronic Borrelia Infection
Stages of Lyme Disease
Classically, Lyme disease is divided into three phases: Early Localized Disease, Early Disseminated Disease, and Late Disseminated Disease.
The Centers for Diseases Control (CDC) and the Infectious Diseases Society of America (ISDA) also recognize Post Lyme Treatment Syndrome (PLTS), in which individuals who have been “adequately treated” with antibiotics remain symptomatic. Neither of these groups recognize the term “chronic Lyme disease”.
Some experts are starting to use the term, Lyme Borreliosis instead of Lyme disease, but that determination depends on a positive lab test for Borrelia — false negative tests are common, and many people who carry Borrelia do not have a positive test. They may also harbor a variety of other microbes.
As with so many things in the world, Lyme disease is hard to put into black and white. It is mostly a big gray zone when it comes to definitions, and nothing about Lyme disease can be considered classic.
People with early localized disease often do not experience a rash or any symptoms, and symptoms associated with early disseminated disease are highly variable. Symptoms of Lyme disease in general vary widely between individuals because the microbe acts differently in every person it meets.
Many people experience late-stage symptoms despite being treated with antibiotics. Because testing is far from being one hundred percent accurate, it’s virtually impossible to define whether antibiotics eradicate the microbe from the body.
Amidst all the confusion, most people who think they have Lyme disease refer to themselves as having chronic Lyme disease. They don’t care about definitions...they’re just sick and want to be well.
Because most people reading this consider themselves as having chronic Lyme disease, that term will be used for the remainder of this book.
Typical Presentation of Chronic Lyme Disease
There are a lot of people out there who consider themselves as having chronic Lyme disease, and the numbers are growing every day. Some of them have had a positive test indicating Borrelia infection, but many of them base the diagnosis on having all the symptoms of chronic Lyme disease, but have a negative test. Testing for Borrelia is notoriously unreliable.
The typical person claiming chronic Lyme disease (negative or positive testing) does not remember a tick bite and did not experience (or at least remember) acute symptoms. This is because the vast majority of people who are bitten by ticks carrying Borrelia are healthy.
Most Borrelia infections are transmitted by nymph ticks, which are very small and often unnoticed. If the person bitten does have a healthy immune system, initial symptoms are mild (if present at all), and the microbe and the host end up in a stalemate situation — the microbe persists in the person’s tissues, but doesn’t do enough harm to cause easily recognized symptoms (they become asymptomatic carriers).
Knowing how many people worldwide are harboring Borrelia without having symptoms is impossible; the number may be quite high. (Remember, a non-debilitated mobile host works best for the microbe.)
The asymptomatic carrier state can last indefinitely. If immune function remains robust, symptoms do not occur. If immune function starts breaking down for any reason, however, the infected individual gradually develops symptoms associated with chronic Lyme disease.
This is how it happened for me. I spent most of my youth in the woods; I loved the outdoors. Considering the number of tick bites I encountered, the chance that I didn’t pick up something is remote.
But I didn’t get sick...at least initially. I was healthy until my mid-forties when stress caught up with me. By then, I had been doing night call delivering babies (the worst type of call a doctor can take) for 24- to 36-hour shifts every second to third night for many years. I was also balancing a growing family and community involvement. Sleep became so much of an afterthought that I finally lost the ability to sleep altogether. Everything crashed. Over several years, I progressively developed every symptom of chronic Lyme disease.
In the beginning, I talked myself out of it being Lyme disease because all the experts said that Borrelia didn’t exist in ticks in eastern North Carolina where I grew up. They were wrong.
The most convincing evidence suggesting Borrelia has been in North Carolina for a long time came from a gentleman I met years later. He was about 10 years my senior when I saw him as a Lyme disease patient. He related a story of knowing the exact day he was infected with Borrelia.
He had been hunting in eastern North Carolina 23 years prior to the day. He came out through heavy brush, and the next day picked off over 150 “seed” ticks embedded in his skin. From that point on, his health gradually deteriorated. Years later, he had a definitive positive test for Borrelia along with a variety of other tick-borne microbes. He had never been out of North Carolina.
This period in his life would have corresponded to the time that I was very active outdoors and being bitten by ticks regularly.
ESSENTIAL LYME DISEASE FACTS