Bartonellosis / Rifampin / Buhner's Protocol

I'm a first-time poster but I'm extremely grateful for the information and experiences that you've shared because I've learned so much by lurking. More than that, you've helped to make me feel far less alone in dealing with Bartonellosis.

I was diagnosed in January via Galaxy titer tests and strong clinical symptoms of seizure-like episodes, twitching, hallucinations, tinnitus, chest pain, blood pressure spikes, fasciculations, tremors, cognitive issues, anxiety, mood-swings, out-of-control eczema, lightning-bolt pain in my hands and feet, etc. I tested negative for Lyme, babesia, and other TBDs through Igenex labs.

I'm currently on Rifampin and Azithromycin and am considering--on my own--adding Buhner's herbal bart protocol to the mix. (I also take Pristiq/desvenlafaxine for depression.) My concern is the alcohol-based tinctures in combination with Rifampin because I believe they're contraindicated. Does anyone have experience with that?

I read in Buhner's book that the protocol is broken down into three components (cytokine disruption, organ protection, and immune enhancement) and the herbs/supplements are: Japanese knotweed, EGCG w/ quercetin, l-arginine, cordyceps, sida acuta, red root, milk thistle seed, hawthorn, rhodiola/ashwaganda combo, isatis/houttuynia/alchornea combo.

Starting all of them all at once terrifies me but I'm unsure of which would be best to start first, going very slowly and adding them one by one. My instinct is to start with the organ protective ones first but I don't really have any rationale for that.

Many thanks for your help.

I think starting with organ protection is a good idea - start with one at a time - don’t start all at once - if you have a reaction - you won’t know which one caused it.

Thanks so much for your responses, Girlie. I'm taking the abx twice daily so your timing suggestions are helpful.

The symptom overlap with yours is interesting although I don't have POTS and my tinnitus is the ringing kind. I had additional ones too but didn't list them, the biggest being significant hair loss, internal tremors and seriously disturbed sleep coupled with an insane level of anxiety.

Fortunately, many of my symptoms have diminished significantly since being on medication but I'm still not overly confident in my LLMD so I'm trying to be as proactive as possible.

Thanks for raising the possibility of other coinfections emerging over time. It's definitely on my radar and I'll consider biofilms, too. There's so much to think about that it's been overwhelming at times!

Hi and welcome!!

Glad to hear you say “many of my symptoms have diminished significantly since being on medication.” That’s a good sign.

I wanted to put this out to you in case you’re not aware - mold and bartonella can cause many of the same symptoms and mold exposure can make bartonella/Lyme/other infections much worse.

If you currently or previously lived or worked in a water damaged building, please look into CIRS and mold as contributing factors to your illness. If the onset of your symptoms coincided with moving or vacationing or working in a new building, then chances are much greater that it’s a factor.

Not trying to confuse you or steer you away from treating bartonella. Many people (myself included) struggle with both mold and one or more tick borne infections. It would be a disservice for me not to bring up mold after reading the symptoms you have.

You could start with Japanese Knotweed, it hits Bartonella and is anti-inflammatory. If you haven't used herbs before start with 1 drop and go slow, because they are strong.

from experience - the ones on your list most likely to trigger strong herx like reactions are the main anti-microbials in the protocol
-sida
-houttuynia
-alcornea
-Isatis
( in order of highest herx first)

I use tinctures I make myself from herbs I buy mostly from LymeHerbs.EU
10 drops of Sida 1:5 tincture is enough to start a herx for me -

isatis - is good - but should only be taken for max 3 weeks at a time - as buhner advises - or it results in very unpleasant liver ducts swelling that will keep you up at night and ruin your days for around a week after you stop, till it settles down. that was my experience - sometimes after only 2 weeks - esp if you already have liver issues( i do)

most of the others are mild or no herx with me - except maybe hawthorn - i can take it as a tea without issue - but I find the tincture definitely provokes a herx like reaction.

you will generally know if you are going to get a herx like the reaction from something after around 3 days of taking a low dose - and the next day if the dose is higher.

so whenever i try something new ( new to me) - i wait 3-4 days since adding anything else - and don't add anything additional for 3-4 days later - if in doubt longer.

I would start with the below - add one at a time a few days apart:
Japanese knotweed, ( no herx for me and worked up to 20g of dry powder a day )
EGCG w/ quercetin, ( no herx for me - but upset my stomach a bit)
l-arginine, ( no herx - sometimes a mild increase in head ache/ pressure for 1hrs after but tolerable )
cordyceps, ( no herx unless i eat a lot of the powder - 3ml 4x a day of tincture is fine )
red root, ( not sure on thsi one as i tokk it with Hawthorn berry tincture and defo gave me a herx at buhner doses)
milk thistle seed, ( no herx for me )
rhodiola/ashwaganda combo ( no herx for me at 2.5ml 3x per day of each )

rifampicin speeds up the cytochrome P450 enzymes in the liver that are responsible for processing many drugs and other detoxification.
this means it tends to lower the blood plasma levels of other drugs taken with it that are detoxified in the liver by the same pathway.
I'm not sure if its contraindicated with small amounts of alcohol as i don't think there is a conflict there.
other medications could be effected - generally, by reducing their effectiveness your GP/ primary care physician shuld know if your depression meds are in that class.

i take all of buhners lyme protocol plus all of the Bartonella protocol as tinctures and would consume around the equivalent of 3 double whiskeys a day if i dint take measures to reduce the alcohol content.

i use a small electric heating mat sold for warming replile cages - it heats to only body temperature and uses only a few watts and reduces teh alcohol in my tinctures to less than half

also, macrolides generally slow down that same pathway and therefore the azithromycin may actually help counter that effect anyway.

FWIW - CBD did nothing for me and several others I knew who tried it.

It was popular a few years ago (2016?)

I never had flu like symptoms either - prior to treatment and during treatment.
I never had fatigue - it wasn’t one of my symptoms. In fact that’s why I was “certain” I didn’t have lyme.

I never had a fever during treatment until I went on DrJ’s Persisters protocol. It happened like clockwork on the Friday evening after my last dose of rifabutin/Ceftin/dapsone/daraprim.

During treatment my herxes were usually an uptick in my pain and muscle twitches as well as worsening vibrations, anxiety and a few others.

Herxes vary from person to person - if you get an increase of current symptoms and/or new symptoms during treatment - it’s likely a herx.

Zbreezy said...
For anyone willing to share may I ask how many times a day and what time of day do you take the herbs in relation to the abx? Any opinions of how effective the combination is? I haven't found much on the combo just herbs or abx alone.

the half-life of most antibiotics in the blood is over 8 hrs and the dosing regime is usually designed to keep the blood plasma levels fairly constant.

similarly, with herbs - most are taken at regular intervals throughout the day and the idea is to keep the levels in the body pretty constant

as a result, I don't think the exact timing between herbs and antibiotics should matter much - and I haven't found any issues with combining them.
some herbs are believed to increase the effectiveness of antibiotics in a synergistic manner.
licorice and Chinese Skullcap root are some of the best-known synergists acc to Buhner
others help the distribution and circulation of the abx in the body - eg Japanese knotweed

generally, I take my tinctures about 10mins before I eat and then a final dose on an empty stomach before bed
then antibiotics and any other supplements etc with my meals ( this is often advised with ABX to avoid/ lessen nausea symptoms eg macrolides )

Girlie, your comment about your experience with flu-like symptoms is very reassuring to me. I keep reading about feeling flu-like (extra scary during these times!) during a herx but it didn't resonate with me at all.

Aerose91, thank you for your input about what/how to introduce. As I mentioned, the anxiety that I experience is so terrifying to me that triggering a huge anxiety/ herx episode (versus something more manageable) is what I'm hoping to avoid with the low and slow approach.

Also, I thought your question about MCAS was interesting. I'm starting to think that it's part of my problem--and that the "eczema" that I've dealt with since childhood and that's worsened significantly in the past few years and especially months is actually that--a problem with histamine. Food triggers were what set it off at a very young age (chocolate, tomatoes, peanuts) and it's gotten worse over time to include all legumes, and all nightshades, vinaigrettes, etc. Now coffee and even my Japanese green tea seem to be on the list and cause itchiness in my mouth, too. (Can't I just have one or two things that I like??? lol) Right now I'm living on broccoli, collard greens, onions, mushrooms, olive oil, a small amount of grass-fed beef, pork, eggs, and not much else.

Garzie, I know you were replying to Zbreezy but thank you for the more technical perspective that you always bring to your posts.

WbF, thank you so much for the mold testing specifics. I've seen many of your past posts and know that you've struggled so much with it AND bart. Loski01 suggested testing too and I will definitely pursue it because I can't stand being this way indefinitely. I need as many answers as possible.