The connection between Lyme disease, an Inflamed Brain , and Fibromyalgia Syndrome

Townsend Letter for Doctors and Patients, April, 2007 by Gina L. Nick

In past issues of Townsend Letter (October 2006; November 2006), I introduced a condition I've named Sickness Syndrome (I also refer to it as "Inflamed Brain"), which causes depression, anxiety, and sleep disorders. Sickness Syndrome is the result of an increase in inflammatory cytokine levels in the periphery, (1) sometimes caused by infection (the type of cytokines depend upon the type of infection), which then leads to local production of inflammatory cytokines in the brain.

Research has shown that cortisol is the main brake in the production of inflammatory cytokines, both at the periphery and in the brain. However, while its production is enhanced by cytokines, its negative feedback on cytokines production and action is operational only if there is no cortisol resistance (2,3) occurring when chronic stress inhibits cortisol's effectiveness in regulating levels of inflammatory cytokines in the body. (4)

Infection, Fibromyalgia Syndrome, and Sickness Syndrome

Cortisol resistance has also been documented in Fibromyalgia Syndrome (FMS) patients who are also more likely to suffer from a compromised stress response system. (5,6) Interestingly enough, research shows that in approximately 50% of patients who have FMS (a condition that affects approximately two percent of the US population and is seven times more likely to affect women than men), their FMS symptoms began after a specific event, most often some form of physical or emotional trauma. This greatly increased their chance of experiencing a defect in the hypothalamic pituitary adrenal axis, while reducing their ability to tolerate stress in a healthy way, ultimately leading to the expression of Sickness Syndrome or an Inflamed Brain. (7)

This is further supported by statistics demonstrating that approximately 30% of FMS patients have major mood disorders, (8) key indicators of Sickness Syndrome. Moreover, if FMS patients were then infected with Lyme disease, their system would have limited mechanisms in place to regulate the number of inflammatory cytokines produced due to the infection. Consequently, the patient would likely experience an Inflamed Brain or Sickness Syndrome symptoms such as anxiety, depression, and sleep disorders, with antidepressant medications such as fluoxetine considered standard treatment for FMS-caused depression. (9)

Regardless of whether Lyme infection caused the FMS (increased inflammatory cytokines from infection leading to symptoms of FMS and an Inflamed Brain) or FMS has caused one to be more susceptible to Sickness Syndrome/Inflamed Brain if infected with Lyme, the naturopathic approach would be to treat the cause of the depression, in this case, cortisol resistance. The treatment needs to focus on normalizing adrenal gland activity and supporting healthy cortisol levels and receptor sensitivity in an effort to normalize its negative feedback on inflammatory cytokines production and action.

This can be done through the clinical use of herbal medicines and nutraceuticals such as Holy Basil, adrenal gland extract, vitamin C, DHEA, pregnenolone, and ashwaghanda to repair adrenal gland activity and normalize the hypothalamic pituitary adrenal axis, along with incorporating whole foods in the diet.

Fibromyalgia Symptoms and Treatment Options

Rheumatoid disorders such as FMS are accompanied by painful and sometimes debilitating symptoms, which can include pain and stiffness in the neck, shoulders, upper and lower back, and hip areas as well as sleep disturbances and psychological distress. There is no known cause for this disorder, although psychological stress, nutritional imbalance, immune and endocrine dysfunction, and biochemical abnormalities in the central nervous system may all been implicated in its onset.

Patients with FMS may also suffer from rheumatoid arthritis (RA). RA is a chronic condition causing pain, stiffness, swelling and loss of function in joints, and inflammation in body organs. RA affects more than two million Americans, 75% of whom are women, with the age of onset typically falling between 20 and 45 years. Diagnostic criteria used to confirm the condition include prolonged morning stiffness in the joints, characteristic nodules under the skin, joint erosions apparent on X-rays, and presence of rheumatoid factor in the blood. There is no cure for this condition--or more accurately, there is no cure recognized by the American College of Rheumatology and the medical community-at-large.

However, we do have the ability to remove key factors associated with the rheumatoid disorders and consequently eliminate important barriers imposed by these conditions that make living unpleasant. Because inflammation is a major factor of rheumatoid symptomology, researchers have studied ways in which diet may mitigate inflammation by reducing the intake of arachadonic acid, a polyunsaturated fatty acid (PUFA), and increasing the intake of eicosapentaenoic acid (EPA), fiber, and antioxidants present in whole foods.

We know that metabolites of arachadonic acid mediate PUFA signals associated with the autoimmune reactions seen in rheumatoid disorders. Specifically, leukotrienes, lipoxines, hydroxyl fatty acids, and prostaglandins, which are derived from PUFAs, increase the activity and formation of pro-inflammatory adhesion molecules, cytokines, chemokines, and colony-stimulating factors. Obviously removing dietary sources of arachadonic acid (for example, beef, lamb, pork, and chicken) will reduce these pro-inflammatory factors, which, incidentally, also contribute to Inflamed Brain.