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Antimicrobials for sensitive guts

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Posted 2/16/2023 12:47 PM (GMT 0)
I’ve recently been diagnosed with Lyme + coinfections. It seems to be congenital Lyme.

My main health problems are digestive issues. I can only eat 4 foods. I react to most foods and some supplements (MCAS type reactions).

I’m starting antimicrobial therapy (my doctor wanted to start with Borrelia) and I need advice on how to approach antimicrobials with a very delicate digestive system:
1) Herbal antimicrobials. I react to most plant foods so I’am afraid my MCAS won’t let me tolerate herbals. So far I’ve only tried Cistus Incanus tea and I’ve had a reaction. I will be trying other herbs soon. I read you can buy some liposomal herbs. Are they worth it? Are they easier on the gut?
2) Oral antibiotics. I tried Minocyclin for 7 days and my digestive system could tolerate it any longer. I tried Azithromycin and it was harder on my gut from day 1. I tried Tinidazole and i have MCAS reaction to it, can't take it.
Can someone recommend oral antibiotics that are well tolerated? Are there liposomal versions? Are they better tolerated?
3) IV antibiotics. I read they can also cause diarrhea even if you don’t ingest them, same as intramuscular. Any experiences with IV antibiotics and a very delicate gut? Should I try them?

Any advice is welcome. I don’t know how to start treatment.

Thank you!
Posted 2/16/2023 1:50 PM (GMT 0)
Hello, Sustancia. Welcome!!

Sorry you are having problems with MCAS and food sensitivity. Have you had that your whole life, or did it come on recently?

How were you diagnosed with Lyme and coinfections - what lab testing?
Posted 2/16/2023 2:16 PM (GMT 0)
What do you do to manage MCAS? Honestly I would stabilize that as much as possible before introducing anything that could upset your delicate GI tract. Assuming the antimicrobials are effective, your herxes could cause intense MCAS reactions all by themselves (even if the drug itself is tolerated well). Do you take cromolyn sodium, DAO, or other supplements and/or drugs that could allow you to function better?

Many doctors do not understand what a severe and limiting thing MCAS is. Does your doctor (who would be prescribing the pharmaceutical antibiotics or overseeing the herbal antimicrobial protocols) have a plan for how to help you stabilize mast cells?

Have you tried herbal antimicrobial protocols, such as Buhner? You could try each herb in tincture form, at only one drop, and titrate up very slowly, thus allowing you to manage herxes and identify any herbs you don't tolerate right away. You usually cannot start with tiny doses of pharmaceuticals, so maybe you'd be more comfortable with herbs for that reason.

One way to bypass this issue is to try forms of antimicrobial treatment that are not ingested. Have you looked into rife? The herxes (any herxes) still could give you monstrous MCAS flares, so you'd still want to start very slowly, but it would bypass the possibility of side effects and reactions to the treatment itself.

Really I would advocate getting your MCAS under better control first. In my experience, stabilizing mast cells resolved nearly all of the symptoms I had been attributing to tick-borne disease. (Could the MCAS and other dysfunction have been triggered or made more likely because of the chronic tick-borne infections? Sure. But antimicrobial therapies only ever made me feel worse, never better, because I needed to fix the dysfunction in my immune system, microbiome, and nervous system before I could get better.) If you have not read Toxic by Neil Nathan yet, then I highly recommend it. He's the first author I've found (or LLMD I've encountered) who genuinely understands MCAS and highly reactive bodies.

Good luck, and welcome to the forum!
Posted 2/16/2023 3:45 PM (GMT 0)
Thank you for the quick replies.

I was diagnosed via Arminlabs’ Elispot. I tested positive for Borrelia and negative for the rest, but my brother tested positive for Borrelia, Babesia, Bartonella, Mycoplasma and Chlamydia pneumoniae. The disease seems to be congenital, my mother is also sick (she will be tested soon). My brother is healthier than me, so I think that’s why his immune response is stronger in Elispot. He also tested positive for Bartonella igG with Galaxy Diagnostics while my Bartonella igG results were only equivocal. I also have symptoms compatible with babesia and bartonella and hematological alterations usually seen in Lyme coinfections (leukopenia, thrombocytopenia, slight liver enzimes elevations). My brother and mother share similar hematological alterations.

My main problem is inflammation around the abdominal area, I specially feel it around my colon.

I started having reactions to foods 6 years ago and they have gotten worse over the years and now I react to almost everything I eat. I get bloating and inflammation in the following minutes of eating something I react to. I have tried h1 antihistamines, quercetin and DAO in the past without success, they only mitigate part of the damage if I eat something I shouldn’t. The only good solution for my MCAS is avoiding triggers. No triggers, no inflammation. Maybe I could ask my doctor to try Cromolyn sodium and montelukast sodium, but I have very little faith. I believe the root cause of my MCAS is chronic infection.

The other problem I have in the digestive system, different to MCAS reactions, I think is related to endotoxemia (LPS translocation). Anything fermentable makes my digestive system worse (fiber for plants, collagenous tissue from meat or mannitol for Magnetic resonance enterography). And I think this is the main problem I have with antibiotics, they kill gut bugs, release LPS and other crap and they trigger a lot of inflammation in my hyperpermeable gut. I have read lately that IV antibiotics end up inside the gut too, via biliary excretion and can have a similar effect to oral. I think that’s what happens with Minocyclin, it gets absorbed almost completely and doesn’t hurt me in the beginning, but then, as it is released in the bile, it makes my gut worse.

I just bought 4 anti-Lyme herbal tinctures to see if I can tolerate any of them and also I bought some liposomal herbs to test them too. I’m also on intramuscular penicillin 2.400.000 units per week, and I think my gut may be able to tolerate it (I’m not sure yet) because it is mostly excreted by the kidneys.

I haven’t looked into rife but I will. I will also take a look at Toxic by Neil Nathan. Thanks for the suggestions.
Posted 2/16/2023 5:17 PM (GMT 0)
Hi Sustancia

i think you are on the right track with LPS and leaky gut

i have lyme and bart and gut issues -
for a long time i have found that anything that adds more gut bacteria ( probiotics) feeds existing gut bacteria ( prebiotics ) or kills gut bacteria ( antimicrobials ) flares my symptoms

in terms of the mechanisms involved - we had a thread recently where bart in particular has a mechanism that could cause severe leaky gut via a signalling chemical HIF-1 - a protein on bartonella's surface called Bad-A is known to upregulate HIF-1.

ref treatment - i was pretty sensitive to treatment at first also - but i did find if i started extremely low with herbs i was able to gradually build up the doses without being incapacitated with herx like reactions ( or MCAS if that's what they are ) i am treating with herbs -mainly and latterly adding bromelain and lumbrokinase and methylene blue. with most things i had to start at a 40th to a 20th of target dose and step up very slowly - in case that helps
i think the advice to try to lower the MCAS reactivity to enable treatment to be tolerated better is good.
many people with co-infections are in this same boat - and have to find ways to get through the treatment reactions.

in general my reactions to strong antimicrobial herbs seemed stronger than antibiotics
some antibiotics - like Methylene blue for bart are often self administered - and can be dosed in increments if the user is making their own capsules - as i have done - and thsi allows a gradual ramp up

ref the Armin tests - if you had the CD57+ test - the head of AONM who acts as an agent for Armin in the UK told me that people with low CD57+ counts often have poor sensitivity on Armin Elispots

this is consistent in my case as my CD57+ was very low - around 1/10th of the average level - my Bart Elispot was negative - and yet i have bart clearly visible on blood smear slides.
see the link in my signature for more on that
Posted 2/16/2023 6:33 PM (GMT 0)
If you’ve never used TUDCA, I would try that. There are 3 brands I have used and listed in the order of perceived effectiveness:

CellCore TUDCA
Microbe Formulas TUDCA
Nutricost TUDCA

TUDCA helped my mold and chemical sensitivities and increased my tolerance to treatment. I did have symptom flares after starting it, but then I would experience improvements like you should with normal herxing instead of feeling inflamed all the time.

Are you able to take any kind of binders to bind the toxins in the bile?

The other things that I believe made me overly sensitive and unable to detox properly was mold/yeast and parasites. Treatment with Fluconazole and Nystatin and treating parasites with antiparasitic drugs helped, too.

I am dealing with an MCAS flare now after getting sick with some weird respiratory illness in December and taking 2 rounds of antibiotics for that. It’s a pain to deal with.
Posted 2/16/2023 7:54 PM (GMT 0)
I've found that it's possible to use antibiotics with shorter half lives that will clear out before my next meal, if you're willing to wait a few hours (well, more like 10-12 hours).

Unfortunately, minocycline lasts long enough that it would give me diarrhea no matter what.

Clarithromycin only lasts a few hours so that's a good alternative, but I found that bartonella was somewhat resistant to it unless combined with atovaquone. Unlike azithromycin, clarithromycin made my heart rate and blood pressure somewhat unstable, so watch out for that.

Mepron (atovaquone) never caused me any diarrhea, but this doesn't work on Lyme, only bartonella and babesia.

Rifampin generally clears out in a few hours. You can tell how long it lasts because it makes your pee a funny color. Unfortunately this drug can cause adrenal problems and bacteria are often resistant to it.

One thing that I found really helpful was attacking borrelia (Lyme) with valtrex (valacyclovir). Borrelia is highly vulnerable to this drug and does not seem to develop resistance or form persisters in response. Valtrex can cause diarrhea, but it will clear out overnight so I can take it before bed and eat in the morning without any problems.

Lyme/borrelia is also susceptible to sodium valproate, and this drug does not give me diarrhea, but does have other side effects which might be a problem for some people.

Disulfiram caused me some mild stomach upset, but not as bad as some antibiotics. Unfortunately disulfiram is rather risky for other reasons, and I couldn't tolerate it.
Posted 2/17/2023 12:31 PM (GMT 0)
Thank you for your answers.

WalkingbyFaith:
I tried TUDCA and didn’t notice improvements. I did a mycotoxin analysis of the urine here in Spain and it was negative. I can try binders, but I’m afraid to pull minerals and nutrients out of my body when I have no evidence that I have a problem with accumulation of toxins.
Regarding parasites I just ordered a stool parasite test just in case.
And regarding yeast/treatment with Fluconazole and Nystatin I’ve never been tested for yeast problems. What tests do you suggest?

Quin: Thank you for your suggestions and experiences with antibiotics.
Posted 2/17/2023 2:17 PM (GMT 0)
I had an Organic Acids Test (OAT) from Great Plains lab. It showed high levels of arabinose, which is a yeast metabolite. I had blood tests for Candida antibodies, and they were negative. I had long term exposure to mold and high levels of mycotoxins.

I improved after taking Fluconazole and Nystatin, especially from joint pain and stiffness. I improved much more after using TUDCA daily, especially from sensitivities to chemicals and just feeling toxin induced inflammation all the time. Then, I had additional improvements from muscle fatigue and exercise intolerance after doing 2 weeks of Ivermectin followed by 2 weeks of Alinia.
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