About Richard Horowitz, MD
Dr. Horowitz is a board certified internal medicine doctor, The author of the new York times best selling book, “why can’t I get better, solving lyme and chronic disease.” In this episode he shares cutting edge diagnostic and assessment strategies for lyme and chronic disease.
Learn more about Dr. Horowitz's Best selling book, why can’t I get better, solving lyme and chronic disease
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02:50 Dr. Horowitz’ Lyme Journey: The Hudson Valley of New York, where Dr. Horowitz relocated, is has one of the highest incidence of Lyme disease in the US. No one explained the complexities of Lyme in medical school. Many of his patients got better with classic treatments, but about ¼ of them had a return of symptoms. Thus began his journey to heal his patients. He has now seen over 12,000 people with chronic Lyme.
04:53 Chronic Disease Mimic: Lyme can mimic autoimmune diseases because Lyme causes autoimmune reactions in the body. Autoimmune markers are produced, but blood tests are not always positive from Lyme.
06:02 Classic Symptoms of Lyme Disease: Lyme is caused by a bacteria called borrelia burgdorferi. Another borrelia, borrelia miyamotoi, is a relapsing fever spirochete and yet another is borrelia lonestari causes a bullseye rash. Half of the people infected with Lyme disease get no rash. Half of the people who get a rash, do not get a bullseye. When patients say that they have good and bad days, symptoms come and go, and joint pain, muscle pain and nerve pain (tingling, numbness and burning) migrates around the body. Women who have hormonal cycles may notice that symptoms worsen before, during or after their period. If they take an antibiotic for an unrelated issue, their symptoms get better, but return when the antibiotics have stopped or worsen and get better when the antibiotic is stopped. The latter is associated with a herxheimer reaction, when the antibiotic is killing off the bacteria.
08:06 Testing: The ELISA test will only detect half of the people with early Lyme disease. It is not reliable in late Lyme disease either. The western blot blood test checks for only one strain out of hundreds. If symptoms are apparent, on the western blot, check for markers on the outside of the bacteria: 23, 31, 34, 39, and 8393. GeneX lab uses 2 strains.
09:26 Multisystemic Illness: You might have day sweats, night sweats, and chills, which might be a symptom of another tick borne co-infection called babesia. You might also have light sensitivity, sound sensitivity, dizziness, and memory and concentration problems, can’t fall asleep, keep waking up in the middle in the night, be depressed or anxious, chest pain, and shortness of breath.
11:25 Multifactorial Cause: Patients with chronic symptoms after classical treatment for Lyme disease, often have a multifactorial cause for their illness. Dr. Horowitz calls this Lyme MSIDS. MSIDS stands for multiple systemic infectious disease syndrome. It represents 16 potential overlapping medical problems that contribute to persistent symptoms in Lyme patients.
11:50 Co-Infections: Other bacterial and viral infections and parasites can be transmitted by the tick with the Lyme disease. These people are much sicker because of these. They are also treated differently than the way we treat Lyme. Lyme msids patients often have associated immune dysfunction with inflammation, as well as toxin burdens. They may be nutritionally deficient, even though they are eating a good diet. Their hormones may be off. Lyme can affect the pituitary. Young men can have low testosterone. Women might have abnormal cycles. Your thyroid can be thrown off. 40% of people don’t have enough adrenal hormones. Mitochondria may have been damaged by free radicals and oxidative stress. They have leaky gut and food allergies. Their blood pressure is low. They have imbalances in their autonomic nervous system. We are under the false impression that there is one cause for one illness.
16:21 Infections and Toxins: We have 300 to 500 chemicals in our bodies. Lyme patients do not detoxify well. Chronic diseases account for 75% of healthcare costs and 70% of deaths in the US, but we do not have a comprehensive model.
17:42 MSIDS Applications: The comprehensive model of MSIDS can be used, should be used in autoimmunity, ALS, diabetes, and other chronic diseases. No one is really looking at the big picture. With diabetes, infections can be causing insulin to rise or free radical/oxidative damage can cause mitochondrial damage, influencing glycemic control.
18:41 The Three I’s: Infection, inflammation, and immune function may be the underlying cause for patients who do not get better.
19:44 Testing for Co-Infections: Complex chronically ill patients receive a screening questionnaire for Lyme disease. If this reflects a multisystem illness. A high score may mean a high probability of having Lyme or associated tick borne disorders. There can be many things that can cause the symptoms. Often there are 5, 6, or 7 reasons. If patients test positive for Lyme, they are then tested for babesia using a babesia panel: a titer called IFA (immunofluorescent antibody), a babesia FISH (fluorescence in situ hybridization) RNA test, or a DNA test called PCR (polymerase chain reaction). There are over 100 different strains of babesia in the US. They also test for bartonella, though there are 30 different species of bartonella. The look for mycoplasma, chlamydia pneumoniae, rocky mountain spotted fever, Q fever, typhus, and Brucella.
24:02 Additional Testing: Not only will Dr. Horowitz check for tick borne infections for patients who do not get better, he checks hormones: adrenals, DHEA/cortisol level, thyroids, and IgF-1 for growth hormone. He checks for nutritional deficiencies in iodine, magnesium, and zinc. He looks for food allergies and leaky gut. He will do a functional medicine panel with an ion test looking at the functionality of detox pathways. He may test for mold toxins and mitochondrial dysfunction. The answers are found using his 16 point map outlined in his book.
29:02 MSIDS Map App: Dr. Horowitz is developing an app that will store your questionnaire, treatments and blood test results. With permission, this information can be used to determine trends. Effectively lowering inflammation is one of the answers to curbing the chronic disease epidemic. He wants to open centers where doctors can be trained in his methodology.
35:06 The Jarisch-Herxheimer Reaction: Many people will get better with antibiotic treatment for Lyme disease. At a certain point, they get worse because their bodies are releasing the inflammatory molecules/cytokines. Your detox system is overwhelmed. This reaction may last for a day or weeks. Alkalizing the body helps.
36:44 Lyme Prevalence: Lyme and the co-infection borrelia miyamotoi, a cousin of Lyme disease, has spread across the US. Our current testing does not detect this other spirochete, which has the same symptoms as Lyme.
37:44 Sexual Transmission of Lyme: A published study found that borrelia burgdorferi were found in 100% of sperm samples and 50% of vaginal secretions tested. There may be sexual transmitted. Some are transmitted by blood transfusion.
39:22 Prevention: Wear light colored clothing. You can use permethrin spray on your clothing, made from chrysanthemum. If you are in a high risk area, at least 20% DEET is another strategy, though a good detox would be in order afterward.
40:32 Mother to Fetus Transmission: Lyme can be transmitted from mother to fetus. In France, they are finding that Lyme co-infections influence autism symptoms.
49:42 Dr. Horowitz’ Favorite Nutrient: Environmental toxins work as xenoestrogens. They are responsible, in part for breast cancer, uterine cancer, thyroid cancer, cervical cancer, lung cancer, colon cancer, and prostate cancer. Eat a healthy diet, eat organic, and eat lots of fruits and vegetables, mainly cruciferous vegetables. As supplementation to this, Dr. Horowitz uses N-acetylcysteine (NAC) to drive his glutathione pathways. He uses a long acting alpha lipoic acid twice a day. It helps with insulin resistance and upregulate glutathione pathways. He takes liposomal glutathione, Diindolylmethane, sulforaphane and broccoli compounds to support phase 1/phase 2 liver pathways and shift estrogenic compounds from the 4-16 hydroxy estrogens to the 2-hydroxy. He eats less fish because he does not trust the sources. Thus, he takes a mercury free omega 3 and omega 6. He takes a high quality phosphatidylcholine. He uses 3-6 beta glucan to build up his natural killer cells and T-cells. He takes high quality probiotics. Your microbiome is responsible for 25% or more of your detox of chemicals. He uses mineral supplements. He takes a methyl protect, resveratrol, zinc and curcumin to protect his DNA. He has and uses an infrared sauna. Dr. Horowitz has found that 25% of his patients were mineral deficient.
55:20 Dr. Horowitz’ Elevator Pitch: The healthcare system is broken. 75% of our healthcare cost is for chronic disease. 70% of the deaths in the US are from chronic disease. Look at the 16 point MSIDS model, because infections and toxins are not looked at by US doctors. Keep our heads out of the sand about emerging epidemics like Lyme.