The Perfect Storm of Chronic Complex Illness
My path is ever evolving and my understanding of the root causes of chronic, complex health problems continues to expand. I was recently at the annual conference of the International Lyme and Associated Disease Society (ILADS) conference in Chicago.
Any person or practitioner who believes that chronic Lyme disease is bogus should attend a few sessions at an ILADS Conference. If that person were even slightly open-minded, they would likely change their opinion on the subject. The attendees and presenters are well-educated legitimate doctors, researchers and scientists doing incredible work in an effort to figure out the intricacies of chronic disease.
I am grateful that so many brilliant people are doing work in so many areas. One of those essential individuals is Neil Nathan, MD who just published an important book called Toxic, Heal Your Body from Mold Toxicity, Lyme Disease, Multiple Chemical Sensitivities and Chronic Environmental Illness.
If you have chronic, complex health problems and feel lost in the medical world, get this book. If you’ve already seen ten doctors and five alternative practitioners and still struggle with ill health, get this book.
There are many situations in health where an initial trigger leads to a snowball effect.
One of the most important areas is each individual’s toxic load. For some, depending on their level of exposures and their innate clearance potential, toxins can build up in the cells and tissues. This then interferes with the function of those organs like the liver that clear the toxins. That person gets sicker and sicker over time.
The next scenario has to do with infectious agents. As with toxins, there is significant variation in terms of exposure and each person’s innate ability to manage potentially pathogenic microbes. Infectious agents have evolved a stunning variety of mechanisms to enhance their chances of survival in a human host. Some of these interfere with the effectiveness of the immune system itself. This makes the person more vulnerable not only to other exogenous organisms they might encounter, but also to reactivation of the variety of dormant viruses like strains of the Epstein Barr Virus (EBV).
This is a major aspect of tick-borne illness where many are exposed not only to a Borrelia species (the primary type of bacteria associated with Lyme disease), but also to a variety of other organisms from the same tick or other ticks.
Many people with chronic Lyme disease that are not responding to treatment actually have a Bartonella infection as the primary issue. The classic triad for a chronic Bartonella infection is: pain (especially to the extremities), neurological symptoms (numbness, tingling, headaches, tremors, speech difficulties, etc.) and mental health issues (anxiety, depression, etc.).
There are many strains of each microbe that can cause illness and disease and most of these would not be part of standard testing through a mainstream lab.
Antibiotics are often used to treat infections. This can be beneficial, but also can create a variety of other problems that then need to be managed including small intestinal bacterial overgrowth (SIBO), systemic Candida/fungal overgrowth and other imbalances of flora often referred to as dysbiosis. Antibiotics wipe out those bacteria that are the easiest to clear so it also selects for bacteria resistant to antibiotics and other treatments.
Toxins and infections can trigger other aspects of immune dysfunction (that will ultimately be diagnosed as an autoimmune condition) via a Th1/Th2 imbalance. One of the major questions for those with autoimmunity is whether the immune system has been triggered into a dysfunctional state but the initial trigger is gone or whether autoimmunity represents a hyperactive response to a chronic, active infection.
Many with chronic health problems have hypersensitive, hyperactive and otherwise dysfunctional mast cells often referred to as Mast Cell Activation Syndrome. Mast cells mediate much of the immune and inflammatory response and treatments may be needed to quiet them down for the person to recover.
Yet another important aspect comes from the work of Robert Naviaux and what he terms the Cell Danger Response (CDR). This is crazy complicated subject matter and, in my opinion, Naviaux should win the Nobel Prize in Medicine for his achievements. The simplified version is that when cells are infected with viruses they have a programmed response that shuts down the cellular activity so the virus can’t replicate. The cell wall becomes less permeable to keep the virus inside. The cell sends warning signals to other cells that there is a threat. Ultimately, the cell destroys itself to protect the rest of the body.
From Toxic, “[As part of the CDR,] the behavior of the host is altered to limit the spread of infection: fatigue forces us to rest, and we sleep more to conserve energy.” The Cell Danger Response involves a long list of changes to cellular biochemistry, but one important aspect of CDR is that it favors sequestration of toxic heavy metals. This is yet another of the snowball effects of the chronically ill.
Testing to clarify each person’s toxic load while trying to identify the primary infectious agent is a focus of any set of interventions. If the infections is cleared and the person undergoes individualized detoxification, turning of the Cell Danger Response can also be essential for a person to completely recover.
Any stress to the body can lead to deficiencies and imbalances of minerals. This often needs to be addressed. Overload (especially of minerals like iron and copper) can be more important than deficiency.
Many with complex issues have problems with their gut that interferes with digestion and absorption leading to more profound nutrient deficiencies that also increases the person’s vulnerability.
Chronic health problems also often lead to limbic system dysfunction and that can be the last deepest layer to address for someone to make a full recovery.
Phew. This is daunting set of problems, of course, and explains why we struggle. Even the most dedicated integrative, functional, and holistic provider working with a motivated patient can have difficulty making consistent progress.
Neil Nathan covers all of these areas and many others in his book, Toxic. I would buy one book for yourself, but also consider buying one or more others so you can gift them to any practitioners you have seen who might be interested in a deeper understanding of chronic health problems.
Andrew Lenhardt, MD