A discussion with the Lyme psychologist Huib Kraaijeveld was the trigger to discuss the role of the natural anti-inflammatory compound palmitoylethanolamide in the treatment of ‘chronic Lyme disorder’.
Huib Kraaijeveld is the author of several books on Lyme, among which ‘Shifting the Lyme paradigm’, and is the chairman of the ‘On Lyme Foundation’.
In our clinic we see many Lyme patients suffering from chronic pain and these patients in general report to feel blue, without energy, depressed and fatigued. These symptoms sometimes do not respond to adequate treatment. This is one of the reasons that patients may belief the causal agent, Borrelia Burdorferi is still active in their body.
However, it might be somewhat more complex. Science now differentiate between 2 Lyme-related syndromes:
1. Post-treatment LB syndrome (PTLBS), and
2. Persistent Borrelia burgdorferi sensu lato (s.l.) infection despite antibiotic treatment
In the first case the chronic symptoms are possibly related to a maladative response of the immunesystem to the Borrelia infection. Although the agent might be vanished from the body, the disharmonious immune system keeps on producing inflammatory compounds. This leads to a well known state of ‘chronic inflammation’. In the second case there is still a persistent Borrelia burgdorferi infection despite antibiotic treatment.
Post-treatment LB syndrome (PTLBS)
In the case of an adequate treatment and the parasite is eradicated from the body, the symptoms can linger on. This is caused by the chronic inflammation. In such case the symptoms do not respond to antibiotic treatment. The chronic inflammation is the cause of all lingering symptoms, from depression up to chronic pain and fatigue. These symptoms we can treat with the natural anti-inflammatory compound palmitoylethanolamide, widely available as a foodsupplement (PeaPure), or in Italy as food for medical purposes ( PeaVera). For Lyme arthritis this is a proven fact: “…patients may develop antibiotic-refractory
Lyme arthritis, when synovitis persists for months to years after antibiotic therapy, most likely due to autoimmunity triggered by the infection” (Adriana Marques,: Chronic Lyme Disease: A Review, Infect Dis Clin N Am 22 (2008) 341–360)
Palmitoylethanolamide in chronic Lyme: treating the chronic inflammation
In the case of a post-treatment LB syndrome (PTLBS) a treatment session of 3-4 months with palmitoylethanolamide (PEA) is quite relevant. Start of therapy with 3 times 400 mg PEA, and if not enough response after 1 month, double the dose. Most patients report feeling better within 2-4 weeks after start therapy. Step by step PEA will bring balance in the immunesystem and all chronic inflammatory symptoms will decrease in intensity and/or vanish.
In case of a ‘post-treatment LB syndrome (PTLBS)’ there is a big chance that symptoms indeed vanish. In the case of a ‘persistent Borrelia burgdorferi sensu lato (s.l.) infection despite antibiotic treatment’ symptoms will initially decrease, but will re-emerge soon. This is called in medicine an ex juvantibus method to differentiate between both Lyme-related disorders.
There are also patients who have late symptom-manifestations who can have a very slow response to therapy, sometimes taking weeks or months to recover after a adequate antibiotic treatment. Such patients should also benefit from the anti-inflammatory actions of PEA.
Further information on ‘chronic Lyme disease’.
Some doctors refer to subjective symptoms, remaining after adequate treatment, as “post–Lyme disease symptoms,” and if the symptoms last longer than 6 months, they call this “post–Lyme disease syndrome.”
In how far persistent B. burgdorferi infections exist is topic of much debate, and of great importance since sometimes it is suggested that this is a condition requiring long-term antibiotic treatment and may even be incurable. Long term antibiotic treatment as we know can do much harm.
The diagnosis ‘Chronic Lyme disease’ is used increasingly as a diagnosis for patients with persistent pains, symptoms of forgetfulness, fatigue, or all of these symptoms, with or without clinical or serologic evidence of previous early or late Lyme disease. This of course opens the door to a rather mixed basket. It is important to note that there are many so called nonspecific symptoms: fatigue, night sweats, sore throat, swollen glands, stiff neck, arthralgia, myalgia, palpitations, abdominal pain, nausea, diarrhea, sleep disturbance, poor concentration, irritability, depression, back pain, headache, and dizziness. Such nonspecific symptoms are seen in more than 10% of the general population, regardless of whether Lyme disease is endemic in the area!
In a review article in the New England Journal of Medicine it was stated that there are indeed chronic Lymies, without prven serology, who:
” could have potential benefit of treating them withantibiotics, beyond a placebo effect, would be attributable to the antiinflammatory or other nonantimicrobial effects of antibiotics.”
Especially such patients should be treated with palmitoylethanolamide rather than antibiotics, in order not to damage the microbioma of the gut and to be able still to reduce the inflammatory symptoms.
Literature Lyme and chronic Lyme
Huib Kraaijeveld. Shifting the Lyme paradigm. Stili publishing, 2014
Henry M. Feder et al. A Critical Appraisal of “Chronic Lyme Disease” N Engl J Med 2007;357:1422-30
Steere AC, Glickstein L. Elucidation of Lyme arthritis. Nat Rev Immunol 2004;4(2):143–52.
Coumou J, Herkes EA, Brouwer MC, van de Beek D, Tas SW, Casteelen G, van Vugt M, Starink MV, de Vries HJ, de Wever B, Spanjaard L, Hovius JW. Ticking the right boxes: classification of patients suspected of Lyme borreliosis at an academic referral center in the Netherlands. Clin Microbiol Infect. 2015 Apr;21(4):368.e11-20. doi: 10.1016/j.cmi.2014.11.014. Epub 2014 Nov 22.