Lyme Disease
Synopsis
Lyme Disease: A Natural-Health and Nutritional Reference
1. Definition and Overview
Lyme disease, also known as Lyme borreliosis, is an infectious condition transmitted through the bite of infected ticks, primarily caused by the spirochete bacterium Borrelia burgdorferi in the United States and various Borrelia species in Europe and Asia. It is a multisystem illness caused by infection with the spirochete and the body's immune response to that infection. It is the most common tickborne infectious disease in the United States.
Lyme disease is the most common vector-borne disease in the United States, with an estimated 476,000 Americans diagnosed and treated annually, according to the Centers for Disease Control and Prevention (CDC).
Lyme disease is most common in the Northeast, mid-Atlantic, and upper-Midwest regions of the United States. In the United States, Lyme disease is caused by the bacterium Borrelia burgdorferi and, rarely, Borrelia mayonii.
2. Transmission and Early Pathophysiology
The disease is transmitted to humans via tick bites, from infected ticks of the genus Ixodes. Transmission requires a tick to be attached to the host for more than 15 hours in most cases. During transmission, the spirochetes are deposited in the skin and then disseminated from the site of inoculation to other areas of the body.
The infected host's innate and adaptive immune system triggers macrophage- and antibody-mediated killing of the spirochetes. In some cases, the immune system can clear the infection without evidence of developing disease. However, due to sophisticated mechanisms by the spirochete to evade the host immune response, the infection may persist and develop clinically evident disease.
The host inflammatory response is responsible for causing tissue damage in organs, including the heart, nervous tissue, and joints. The spirochete itself is not known to be directly toxic.
Antibodies against spirochetal protein membrane epitopes have been shown to cross-react with neural and connective tissues. This molecular mimicry possibly generates an autoimmune inflammatory reaction.
3. Disease Stages and Clinical Presentation
The clinical manifestations of Lyme disease generally follow three stages of disease progression: early localized, early disseminated, and chronic disseminated.
Stage 1: Early Localized
The early localized phase of Lyme disease may present with an erythema migrans rash and low-grade fever. This stage usually occurs within 1 to 28 days following the tick bite. Initial symptoms often include a characteristic "bull's-eye" rash (erythema migrans), fever, and fatigue.
Stage 2: Early Disseminated
Early disseminated disease is associated with neurologic and cardiac manifestations. Neurologic Lyme disease manifestations include facial nerve (cranial nerve VII) palsy, lymphocytic meningitis, or radiculopathy. Cardiac involvement may consist of myopericarditis and heart block.
The spirochete may disseminate through the lymphatics or blood, showing a distinct tropism for the skin, heart, central nervous system, joints, and eyes. Any part of the body can be affected; spirochetes have also been demonstrated histologically in bone marrow, the spleen, lymph nodes, the liver, testes, and the placenta during early hematogenous dissemination.
Stage 3: Late Disseminated
Lyme arthritis is typically a late disease manifestation and may be monoarticular or pauciarticular, generally involving large joints, most commonly the knee, and occurring months after the initial tick bite.
Late-stage manifestations may include concentration issues, brain fog, and memory issues; nerve pain that feels like tingling, numbness, burning, or stabbing in the hands and feet (peripheral neuropathy); anxiety, depression, mood swings, and other neuropsychiatric issues; and sleep disturbances.
Borrelia encephalomyelitis is rare and can present with ataxia, seizures, hemiparesis, autonomic dysfunction, and hearing loss.
Some symptoms may also be related to autonomic nervous system dysfunction, such as dizziness, heart palpitations, exercise intolerance, nausea, slow motility, or temperature sensitivity.
Body Systems Involved
- Integumentary system: Erythema migrans rash; acrodermatitis chronica atrophicans in late European-variant disease.
- Musculoskeletal system: The epidemiology and pathophysiology of Lyme disease are directly related to the Borrelia burgdorferi spirochete and its effects on the integumentary, neurologic, cardiac, and musculoskeletal systems. Lyme arthritis is a common clinical manifestation and should be considered in the evaluation of patients with monoarticular or pauciarticular joint complaints in an endemic geographic area.
- Nervous system: The most common clinical manifestations of neurologic Lyme disease are facial nerve palsy, sixth nerve palsy, and lymphocytic meningitis.
- Cardiovascular system: Cardiac manifestations can include fainting from an abnormally slow heart rate, irregular heart palpitations, or difficulty tolerating exercise.
- Visceral organs: Spirochetes have been demonstrated histologically in bone marrow, the spleen, lymph nodes, the liver, testes, and the placenta during early hematogenous dissemination.
4. Co-infections and Complicating Factors
Inoculation of the bacterium Borrelia is sometimes associated with bacterial or parasitic co-infections, for example by microorganisms of the Bartonella, Rickettsia, or Babesia genus. Because the symptoms are not specific, clinicians should consider other conditions and infections transmitted by ticks (e.g., coinfection with Babesia microti and Ehrlichia). Coinfection has been reported in approximately 10% of patients.
5. Post-Treatment Lyme Disease Syndrome (PTLDS)
Post-treatment Lyme disease syndrome (PTLDS) is defined by the Infectious Diseases Society of America (IDSA) as the presence of fatigue, pain, and/or cognitive complaints with functional impact that persists for more than six months after completing treatment for Lyme disease. These symptoms occur in 10%–20% of patients previously diagnosed with LD caused by the bacteria Borrelia burgdorferi and appropriately treated with a course of antibiotics.
The dominant hypotheses about potential mechanisms underlying PTLDS are immune inflammation and dysregulation and persistent infection and/or persistent antigenic debris.
Since the typical causative agent, B. burgdorferi, does not produce exotoxins, one theory suggests that the acute symptoms of PTLDS are due to both the innate and adaptive immune systems working to clear lingering bacteria. The associated symptoms including myalgias, stiffness, fatigue, and other symptoms are caused by the subsequent inflammatory cytokine release from the immune system.
Recent advances in medicine have furthered a deeper understanding of the biology of Borrelia, including the discovery of stationary, persister, and biofilm forms of Borrelia burgdorferi. These stationary forms in biofilms have been reported to be resistant to standard antibiotics and a primary source of inflammation.
Risk factors for PTLDS include delayed diagnosis and treatment, incomplete or short-course treatment, and the increased severity of acute Lyme disease. Disseminated neurocognitive symptoms such as Bell's palsy, headache, photophobia, other cranial nerve palsies, optic Lyme disease, or neck pain may also increase the risk of persistent symptoms post-treatment.
A positron emission tomography (PET) brain imaging study among patients with PTLDS demonstrated elevated microglial activation compared to that of controls, congruent with localized inflammation.
6. Herbs, Botanicals, and Natural Ingredients: Traditional Use and Scientific Evidence
A published review examined the evidence for the antimicrobial activity, safety, and drug-drug interactions of 18 herbal supplements that patients commonly use for treatment of persistent symptoms attributed to Lyme disease. The research team performed a narrative review by searching PubMed, Embase, Scopus, Natural Medicines databases, and the NCCIH website.
In vivo data and clinical trials are lacking for nearly all of the herbs discussed below. Many of the herbs that alternative and integrative practitioners use to treat Lyme disease have anti-inflammatory effects that may contribute to patients' perceptions of symptomatic improvement.
There have been various anecdotal reports on the use of herbal extracts for treating patients with persisting symptoms, with varying degrees of improvements. However, it is unclear whether the effect of the herb products is due to their direct antimicrobial activity or their effect on the host immune system.
6.1 Cryptolepis sanguinolenta (Ghanaian Quinine)
Traditional use: Cryptolepis sanguinolenta is a West African shrub with a long history of use in traditional medicine in Ghana, China, and India, particularly as an antimalarial and antimicrobial agent. Preparations are commonly made as root decoctions or tinctures.
Scientific evidence: Cryptolepis sanguinolenta showed strong activity against both growing B. burgdorferi (MIC = 0.03–0.06%) and non-growing stationary phase B. burgdorferi. In subculture studies, only 1% Cryptolepis sanguinolenta extract caused complete eradication, while doxycycline and cefuroxime and other active herbs could not eradicate B. burgdorferi stationary phase cells, as many spirochetes were visible after 21-day subculture. Cryptolepis sanguinolenta is generally well-tolerated, and few side effects have been documented in humans during its relatively long-term use in parts of China and India. These findings are in vitro only; no human clinical trials have been conducted on its use in Lyme disease.
6.2 Japanese Knotweed (Polygonum cuspidatum)
Traditional use: Japanese knotweed has been used in traditional Chinese and Japanese medicine (as Hu Zhang) for centuries to address inflammatory conditions, infections, and liver support. Its preparations include decoctions, tinctures, and standardized root extracts. It is a significant natural source of resveratrol.
Scientific evidence: In the Johns Hopkins in vitro study, Japanese knotweed was determined to be one of the most potent compounds against the replicating organism, with one of the lowest MICs. These active botanicals include Cryptolepis sanguinolenta, Juglans nigra (Black walnut), Polygonum cuspidatum (Japanese knotweed), Artemisia annua (Sweet wormwood), Uncaria tomentosa (Cat's claw), Cistus incanus, and Scutellaria baicalensis (Chinese skullcap) as botanicals showing activity against stationary phase B. burgdorferi in vitro. Evidence is restricted to laboratory studies; no clinical trials in Lyme disease patients have been published.
6.3 Sweet Wormwood (Artemisia annua)
Traditional use: Artemisia annua has been used in traditional Chinese medicine for over 2,000 years, particularly in the context of febrile illnesses. Its main active constituent, artemisinin, is the basis of widely used pharmaceutical antimalarials.
Scientific evidence: In vitro, 7 natural product extracts at 1% were found to have good activity against the stationary phase B. burgdorferi culture compared to control antibiotics doxycycline and cefuroxime; Artemisia annua (Sweet wormwood) was among them. Sweet wormwood, black walnut, and cat's claw resulted in higher MICs despite their antimicrobial activity against the non-growing forms. Evidence is in vitro only; no human clinical trials in Lyme disease have been published.
6.4 Cat's Claw (Uncaria tomentosa)
Traditional use: Cat's claw is a woody vine native to the Amazon rainforest and other tropical regions of South and Central America. It has a centuries-long history of use among indigenous Peruvian peoples for inflammatory and infectious conditions, arthritis, and immune support. Bark decoctions and extracts are the traditional preparations.
Scientific evidence: Seven of 18 herbs reviewed in one narrative review had evidence for in vitro activity against B. burgdorferi, including cat's claw. It was also among the active botanicals confirmed by the Johns Hopkins in vitro study. With the exception of oil of oregano, the compounds with in vitro anti-borrelial activity also have anti-inflammatory activity. No human clinical trials specific to Lyme disease have been published.
6.5 Chinese Skullcap (Scutellaria baicalensis)
Traditional use: Scutellaria baicalensis (Huang Qin) has been a cornerstone of traditional Chinese medicine for over 2,000 years, used for its antimicrobial, anti-inflammatory, and antipyretic properties. Root decoctions and extracts are the classical preparations. Its active constituent is baicalein.
Scientific evidence: These active botanicals — which include Scutellaria baicalensis (Chinese skullcap) — showed activity against stationary phase B. burgdorferi culture in vitro. Evidence is limited to in vitro data; human trials are absent.
6.6 Black Walnut (Juglans nigra)
Traditional use: Black walnut hulls have been used in North American folk and herbal medicine traditions as an antiparasitic and antimicrobial agent, typically in tinctures made from the green outer hull.
Scientific evidence: Juglans nigra and its constituents have been shown to have antioxidant, antibacterial, antitumor, and chemoprotective effects. Previous in vitro testing documented that Juglans nigra exhibited bacteriostatic activity against log phase spirochetes of B. burgdorferi and B. garinii and bactericidal activity against Borrelia round bodies. While compounds such as black walnut demonstrated activity, the researchers noted the clinically relevant side effect of skin pigmentation. No human clinical trials exist for Lyme disease.
6.7 Mediterranean Rockrose (Cistus incanus)
Traditional use: Cistus incanus is native to the Mediterranean region and has been used as a folk remedy in herbal teas (particularly popular in Greece and Turkey) for infections and inflammatory conditions.
Scientific evidence: Cistus incanus was among the 7 natural product extracts at 1% found to have good activity against stationary phase B. burgdorferi culture compared to control antibiotics doxycycline and cefuroxime in vitro. Evidence is restricted to laboratory studies; no clinical trials have been conducted.
6.8 Berberine
Traditional use: Berberine is an alkaloid found in multiple plants, including barberry (Berberis vulgaris), goldenseal, and Oregon grape. It has been used in traditional Chinese, Ayurvedic, and Native American medicine for gastrointestinal infections and inflammatory conditions.
Scientific evidence: Berberine was among 13 herbs with evidence of antimicrobial activity in vitro in a comprehensive narrative review of herbal supplements used for Lyme disease persistent symptoms. Some preliminary research suggests potential antimicrobial activity, but more studies are needed on its effects for Lyme disease. No human clinical trials are available for Lyme disease specifically.
6.9 Stevia (Stevia rebaudiana)
Traditional use: Stevia rebaudiana is a plant native to Paraguay that has been used by the Guaranà people for centuries as a sweetener and for medicinal purposes.
Scientific evidence: An early in vitro study (2015, published in PMC) compared the antimicrobial effect of S. rebaudiana whole leaf extract against various morphological forms of B. burgdorferi. The overall antimicrobial effectiveness of the Stevia extract on the different morphological forms of B. burgdorferi was comparable to the combination of certain antibiotics, though the results of this preliminary study cannot be extrapolated directly to clinical practice. However, when proper alcohol controls were applied, the Johns Hopkins group did not find Stevia rebaudiana to have any activity against B. burgdorferi. Results across studies are therefore conflicting, and no human data exist.
6.10 Andrographis (Andrographis paniculata)
Traditional use: Andrographis paniculata is a bitter herb used extensively in Ayurvedic medicine and traditional Chinese medicine, primarily for infections and febrile illnesses. It is commonly referred to as "King of Bitters."
Scientific evidence: Andrographis paniculata has been used to treat the spirochetal infection leptospirosis and is anecdotally used by patients with Lyme disease. However, in the Johns Hopkins in vitro testing, Andrographis failed to show any activity against B. burgdorferi. It is possible that Andrographis indirectly acts on the host immune system rather than the bacterium directly. The research team found inconclusive data regarding the antimicrobial activity of Andrographis. No human clinical trials for Lyme disease are available.
6.11 Astragalus (Astragalus membranaceus)
Traditional use: Astragalus root has been used in traditional Chinese medicine for over 2,000 years, primarily as an immune tonic (adaptogen) and for its purported antiviral and antibacterial properties.
Scientific evidence: Astragalus was among 13 herbs with evidence of antimicrobial activity in vitro in a comprehensive narrative review. Evidence is limited to in vitro studies; no human clinical trials exist specifically for Lyme disease.
6.12 Oil of Oregano and Thyme
Traditional use: Oregano and thyme have been used in Mediterranean folk medicine and herbal traditions as antimicrobial, antifungal, and preservative agents, both in culinary and medicinal applications.
Scientific evidence: Oregano and thyme oils have shown some in vitro activity against B. burgdorferi, but clinical evidence is lacking. Oil of oregano and peppermint were among 13 herbs with evidence of antimicrobial activity in vitro in the comprehensive review. No human clinical trials for Lyme disease are available.
Summary of In Vitro Botanical Evidence
"This study provides the first convincing evidence that some of the herbs used by patients such as Cryptolepis, black walnut, sweet wormwood, cat's claw, and Japanese knotweed have potent activity against Lyme disease bacteria, especially the dormant persister forms, which are not killed by the current Lyme antibiotics," according to Dr. Ying Zhang from the Johns Hopkins Bloomberg School of Public Health. Further studies are needed to identify the active constituents of the effective botanicals and evaluate their combinations for more effective eradication of B. burgdorferi in vitro and in vivo.
Critical limitation: Clinicians should be cautious, as many of the identified compounds have drug interactions and additive effects that could lead to increased risks for bleeding, hypotension, and hypoglycemia. All evidence cited above is in vitro (laboratory cell culture) unless explicitly stated otherwise. In vitro antimicrobial activity does not confirm clinical efficacy or safety in humans.
7. Nutrients and Micronutrients: Scientific Context
Important caveat: There have been few studies testing the effect of supplements on PTLDS symptoms. The nutrients below are discussed in the context of general inflammatory and immune physiology relevant to Lyme disease; none has been demonstrated in high-quality Lyme-specific randomized clinical trials to alter the course of infection or PTLDS.
7.1 Vitamin D
Omega-3, magnesium, zinc, quercetin, curcumin: while these have general anti-inflammatory properties, there is no strong evidence specifically for Lyme disease prevention or treatment. Regarding vitamin D specifically, it plays a well-documented role in immune modulation. Vitamin D deficiency can negatively impact immune function, making the body more susceptible to infections and worsening inflammation-related symptoms, such as joint pain and arthritis in chronic Lyme. No Lyme-specific intervention trials with vitamin D have been published.
7.2 Omega-3 Fatty Acids
Omega-3 fatty acids, particularly EPA/DHA, have properties that may help support joint health and maintain healthy inflammation levels associated with chronic Lyme. Numerous placebo-controlled studies investigating fish oil's effects on chronic inflammatory conditions demonstrate significant advantages, such as reduced disease severity and a decreased reliance on anti-inflammatory medications. As chronic Lyme may be influenced by inflammatory pathways and may induce inflammation-based symptoms, fish oil supplementation may help support these symptoms. These inferences are extrapolated from research on other chronic inflammatory conditions; Lyme-specific trial data are absent.
7.3 Magnesium
Magnesium deficiency can lead to fatigue, anxiety, insomnia, lowered stress tolerance, and muscle weakness, potentially intensifying similar symptoms seen with Lyme disease. No clinical trials have evaluated magnesium supplementation specifically in Lyme disease or PTLDS patients.
8. Dietary Patterns and Factors
8.1 Anti-Inflammatory Dietary Approach
There is no specific diet for Lyme disease, though some evidence suggests that anti-inflammatory foods can help. No specific diet is proven to help with PTLDS, but a 2022 study suggests that an anti-inflammatory diet may help reduce the symptoms. This is because chronic inflammation may be the mechanism, or one of the mechanisms, responsible for PTLDS.
Research on anti-inflammatory diets in the broader population is informative. Cross-sectionally, the majority of analyses reported an association between higher Mediterranean and anti-inflammatory diet scores and lower inflammatory markers. Evidence of an association between dietary patterns and inflammatory markers longitudinally is limited, with the majority of longitudinal studies reporting no association.
Anti-inflammatory foods, such as nuts and seeds, fruits and vegetables, and other whole foods may help reduce inflammation in the body and alleviate Lyme disease symptoms. Other foods, such as processed foods high in salt, fat, and sugar, may increase inflammation.
8.2 Mediterranean-Style Diet
A Mediterranean-style dietary pattern has been discussed in the context of Lyme disease management. An anti-inflammatory Mediterranean-style diet is considered better than a traditional Western diet high in processed foods made with refined sugars and flours. The Mediterranean style emphasizes fresh fruits and vegetables high in antioxidants (e.g., dark leafy greens, berries, avocados), lean proteins (mostly wild), oily fish (e.g., salmon, herring, sardines), nuts and seeds, fiber-rich whole grains (e.g., brown rice), legumes, and healthy fats like extra virgin olive oil, eggs, and flaxseed, while minimizing foods that can cause inflammation, including sugary drinks, desserts, margarine, and processed foods.
8.3 Processed Foods and Refined Carbohydrates
Processed foods, which comprise much of the Standard American Diet, are associated with increased risks of chronic inflammatory diseases and do no favors for the Lyme disease patient. Refined carbohydrates and added sugars promote an inflammatory gut microbiota, exacerbating chronic inflammation.
8.4 Gut Health and Probiotics
Lyme infection itself, not to mention antibiotic treatment, can disrupt gut bacteria, potentially leading to digestive symptoms. Gut health is integral to immune health, and many Lyme patients experience digestive issues. Probiotic-rich foods such as yogurt, kefir, sauerkraut, and kimchi help to restore healthy gut bacteria, supporting digestion and immune function. A healthy gut microbiome is essential for absorbing nutrients and keeping the immune system in balance. Studies on probiotics specifically in Lyme disease patients are not available; these recommendations are extrapolated from broader gut health research.
9. Lifestyle Factors Discussed in the Literature
9.1 Mind-Body Practices and Stress Reduction
Kundalini yoga has been examined as a potential treatment for PTLDS; yoga has been shown to alleviate fatigue, pain, sleep disturbance, and cognitive impairment. Additionally, contemplative practices have been theorized to mediate these symptoms due to their effects on the autonomic nervous system and attenuation of the stress response. In 2022, Murray et al. conducted a preliminary randomized study to determine the adherence to and potential benefit of Kundalini yoga for PTLDS. A total of 29 participants were randomly assigned to either eight weeks of Kundalini yoga in group sessions or a "waitlist" control group. This study was preliminary and small, and its findings must be interpreted with caution pending larger confirmatory trials.
9.2 Sleep
An anti-inflammatory diet, anti-inflammatory supplements, and getting adequate nutrition may help some people with their symptoms. Getting enough sleep and managing energy levels may also help reduce fatigue or help a person manage daily activities.
9.3 Exercise
While exercise may have general health benefits, there is no evidence that intense exercise specifically prevents or treats Lyme disease. Pacing strategies and graded activity may be relevant given the fatigue burden of PTLDS, though Lyme-specific exercise trials are limited.
10. Evidence Quality Summary
- In vitro (laboratory) studies: The strongest volume of evidence for natural agents in Lyme disease is at this level. Several botanical extracts — notably Cryptolepis sanguinolenta, Japanese knotweed, sweet wormwood, cat's claw, and Chinese skullcap — show measurable anti-borrelial activity in culture. This research evaluated a panel of botanical medicines and natural products commonly used by some patients to manage their persisting symptoms of Lyme disease and found that some of them have strong activity against B. burgdorferi. In vitro findings cannot be extrapolated to human efficacy or safety.
- In vivo animal studies: Limited and largely preliminary; not reviewed in depth here due to scarcity of high-quality published data in Lyme-relevant models for nutritional compounds.
- Human clinical trials: More research is necessary to find effective treatments and help people recover from PTLDS. No randomized, controlled human clinical trials of adequate size and quality have evaluated the botanical agents or specific nutritional protocols discussed above specifically for Lyme disease or PTLDS outcomes.
- Dietary pattern evidence: Limited to general anti-inflammatory diet literature and cross-sectional observational data; no Lyme-specific dietary intervention trials have been published.
References
- StatPearls: Lyme Disease — NCBI Bookshelf, NIH
- About Lyme Disease — Centers for Disease Control and Prevention (CDC)
- Lyme Disease — National Institute of Allergy and Infectious Diseases (NIAID)
- Lyme Disease — U.S. Department of Health and Human Services
- Lyme Disease: Background, Etiology, Pathophysiology — Medscape
- Evaluation of Natural and Botanical Medicines for Activity Against Growing and Non-growing Forms of B. burgdorferi — Frontiers in Medicine / PMC (Feng et al., 2020)
- Evaluation of Natural and Botanical Medicines for Activity Against Growing and Non-growing Forms of B. burgdorferi — Frontiers in Medicine (Full Text, 2020)
- A Comprehensive Review of Herbal Supplements Used for Persistent Symptoms Attributed to Lyme Disease — PMC (2023)
- Unorthodox Alternative Therapies Marketed to Treat Lyme Disease — PMC (2015)
- Effectiveness of Stevia Rebaudiana Whole Leaf Extract Against the Various Morphological Forms of Borrelia Burgdorferi in Vitro — PMC (2015)
- What Makes It Tick: Exploring the Mechanisms of Post-treatment Lyme Disease Syndrome — PMC (2024)
- Post-treatment Lyme Disease as a Model for Persistent Symptoms in Lyme Disease — PMC (Frontiers in Medicine, 2020)
- Lyme Disease and Post-treatment Lyme Disease Syndrome: Current and Developing Treatment Options — PMC (2023)
- Posttreatment Lyme Disease Syndromes: Distinct Pathogenesis Caused by Maladaptive Host Responses — Journal of Clinical Investigation (Steere, 2020)
- Recent Progress in Lyme Disease and Remaining Challenges — Frontiers in Medicine (2021)
- Inflammation, Biofilms and Dietary Measures in Post Treatment Lyme Disease Syndrome — Fatigue: Biomedicine, Health & Behavior (2022)
- A Distinct Microbiome Signature in Posttreatment Lyme Disease Patients — PMC (2020)
- Lyme Disease and the Orthopaedic Implications of Lyme Arthritis — PMC (2013)
- Assessment of Dietary Patterns Represents a Potential, Yet Variable, Measure of Inflammatory Status — PMC (2019)
- Dietary Patterns and Associations with Biomarkers of Inflammation in Adults: A Systematic Review of Observational Studies — PMC (2021)
- Lyme Disease Signs and Symptoms — Johns Hopkins Lyme Disease Research Center
- Lyme Disease Stages and Symptoms — Harvard Health / T.H. Chan School of Public Health
- Efficacy of Short-Term High Dose Pulsed Dapsone Combination Therapy in PTLDS — PMC / Antibiotics (2022)
Natural Remedies
Ingredients
- andrographisScientific
Andrographis (Andrographis paniculata) is widely used in integrative Lyme disease protocols for its potent anti-inflammatory and immune-modulating properties via andrographolide. While a 2020 Johns Hopkins in vitro study found it did not directly inhibit B. burgdorferi, it is included in a comprehensive 2023 PMC review of 18 Lyme-relevant herbs. Traditional and clinical use focuses on immune support and anti-inflammatory action for persistent Lyme symptoms.
- andrographolideScientific
Andrographolide, the primary bioactive diterpene lactone of Andrographis paniculata, drives the herb's potent NF-κB inhibition and anti-inflammatory effects relevant to chronic Lyme disease. It is central to Lyme integrative protocols for immune modulation and cytokine reduction. Research has shown it can modulate host immune responses potentially impacting B. burgdorferi clearance. Evidence is primarily mechanistic and in vitro.
- astragalusScientific
Astragalus (Astragalus membranaceus) was included in the 2023 University of Maryland comprehensive review as one of 13 herbs with in vitro antimicrobial activity relevant to Lyme disease, plus potent immunomodulatory properties. It enhances T-cell and natural killer cell activity potentially relevant to B. burgdorferi clearance. Used in TCM for immune strengthening and widely incorporated into integrative Lyme protocols. No Lyme-specific clinical trials exist.
- baicaleinScientific
Baicalein is a bioactive flavonoid from Scutellaria baicalensis (Baikal Skullcap) with documented in vitro activity against all morphological forms of B. burgdorferi and B. garinii, including spirochete, rounded, and biofilm forms. It was confirmed as the most effective phytochemical against biofilm-forming Borrelia in a 2015 PMC study. Additional neuroprotective effects are relevant to neurological Lyme manifestations.
- baicalinScientific
Baicalin, the glycoside form of baicalein from Scutellaria baicalensis, has in vitro activity against B. burgdorferi and B. garinii, including biofilm and rounded forms, as documented in PMC studies. It has anti-inflammatory activity via NF-κB inhibition confirmed in multiple in vitro studies. Baicalin also has documented neuroprotective effects relevant to neurological Lyme disease manifestations.
- baikal skullcapScientific
Baikal Skullcap (Scutellaria baicalensis) and its flavonoid baicalein demonstrated in vitro anti-borrelia activity against multiple morphological forms of B. burgdorferi and B. garinii, including biofilm. It was among the 7 most active botanicals in the 2020 Johns Hopkins in vitro study. Active constituents baicalin and baicalein also have documented neuroprotective and anti-inflammatory effects relevant to neurological Lyme. Employed in Traditional Chinese Medicine for over 2,000 years.
- berberineScientific
Berberine, an isoquinoline alkaloid found in goldenseal, barberry, and Coptis, was included in the 2023 University of Maryland review as one of 13 herbs with in vitro antimicrobial activity relevant to Lyme disease. It modulates gut microbiome dysbiosis and intestinal barrier function, both commonly disrupted in chronic Lyme. It has anti-inflammatory activity via NF-κB inhibition. No clinical trials exist specifically for Lyme disease.
- black walnutScientific
Black walnut (Juglans nigra) was identified as one of seven botanicals with superior in vitro activity against stationary-phase B. burgdorferi in the 2020 Johns Hopkins Frontiers in Medicine study. Its active constituents include juglone (naphthoquinone) with documented antimicrobial properties. Evidence is currently limited to in vitro data. Clinical use comes from integrative Lyme practitioners, notably the Buhner herbal protocol.
- cat's clawScientific
Cat's claw (Uncaria tomentosa) extract has demonstrated in vitro inhibitory activity against growing and stationary-phase (persister) forms of Borrelia burgdorferi, outperforming standard antibiotics doxycycline and cefuroxime in a 2020 Johns Hopkins study. It also has immunomodulatory and anti-inflammatory properties relevant to chronic Lyme symptoms. A small clinical study of 28 advanced Lyme patients showed potential benefit. Oxindole alkaloids and quinovic acid glycosides are its primary bioactive constituents.
- cistusScientific
Cistus (Cistus incanus, Mediterranean rockrose) was one of seven botanicals shown to exceed doxycycline and cefuroxime against stationary-phase B. burgdorferi in the 2020 Johns Hopkins in vitro study. It also inhibits biofilm formation without harming healthy cells. Its polyphenol-rich extract is used in integrative Lyme protocols, particularly in Europe. Evidence remains at in vitro level.
- cordycepsScientific
Cordyceps (Cordyceps sinensis) was one of 18 herbs reviewed in the 2023 University of Maryland narrative review for persistent Lyme disease symptoms, showing in vitro antimicrobial activity and potent immunomodulatory and anti-inflammatory properties. It is used in integrative Lyme protocols, particularly the Rawls protocol, for immune modulation and fatigue reduction. No Lyme-specific clinical trials exist.
- cuspidatum rootScientific
Japanese knotweed root (Polygonum cuspidatum) was one of the two most potent botanicals against B. burgdorferi in the 2020 Johns Hopkins in vitro study, with the lowest MIC values. Its active compounds resveratrol and emodin exhibit direct anti-borrelia, anti-inflammatory, neuroprotective, and blood-brain barrier-penetrating properties. It has been a central herb in the Buhner Lyme protocol. Evidence is primarily in vitro with no clinical trials completed.
- eleutheroScientific
Eleuthero (Eleutherococcus senticosus, Siberian ginseng) was one of 18 herbs included in the 2023 University of Maryland Lyme disease narrative review. It is used in integrative Lyme protocols as an adaptogen to restore immune function, stamina, and stress resilience depleted by chronic Lyme. It also promotes lymphatic circulation. Limited anti-borrelia in vitro activity was found; its value is primarily immunomodulatory and adaptogenic.
- garlicScientific
Garlic and its active constituent allicin have demonstrated in vitro antimicrobial activity against B. burgdorferi. The 2023 University of Maryland narrative review included garlic among 13 herbs with in vitro antimicrobial activity relevant to Lyme disease. It has also been studied for activity against persister forms of B. burgdorferi. Research shows broad-spectrum antimicrobial and anti-inflammatory properties. No human Lyme clinical trials exist.
- garlic bulbScientific
Garlic bulb (Allium sativum) contains allicin and related organosulfur compounds with documented in vitro antimicrobial activity against B. burgdorferi. It appears in comprehensive reviews of herbal supplements used for persistent Lyme disease symptoms. Its anti-inflammatory and immune-modulating properties are also relevant. Used extensively in integrative Lyme disease management protocols.
- knotweedScientific
A Johns Hopkins Bloomberg School of Public Health in vitro study (published in Frontiers in Medicine) found Japanese knotweed among the most active plant extracts against Borrelia burgdorferi, including dormant persister forms not killed by standard antibiotics. Knotweed outperformed doxycycline and cefuroxime in this screen. A 2021 study further demonstrated activity against Bartonella. Evidence is in vitro only; no human RCTs exist.
- lemon balmScientific
Lemon balm (Melissa officinalis) was included in the 2023 University of Maryland comprehensive narrative review of 18 herbal supplements for persistent Lyme symptoms, showing in vitro antimicrobial activity. It is used in integrative Lyme protocols primarily for its antiviral and anxiolytic properties addressing neurological and mood-related Lyme symptoms. Active rosmarinic acid and flavonoids provide anti-inflammatory and antiviral mechanisms.
- luteolinScientific
Luteolin, a widely distributed flavone, demonstrated in vitro bacteriostatic and bactericidal activity against B. burgdorferi spirochetes in a 2016 PMC study, and reduced biofilm-like colonies at 200–500 µg/ml. It also has potent NF-κB-mediated anti-inflammatory effects relevant to chronic Lyme symptoms. It is present in Thyme, lemon balm, and other Lyme-relevant herbs.
- monolaurinScientific
A 2015 in vitro study (Journal of Applied Microbiology, Goc et al.) found that monolaurin was one of the most effective tested compounds against all morphological forms of Borrelia burgdorferi and Borrelia garinii — spirochetes, round body forms, and biofilms. GML combined with cis-2-decenoic acid also showed synergistic antispirochetal effects. No human clinical trials exist.
- oreganoScientific
Oregano (Origanum vulgare) oil was identified as having significant in vitro activity against B. burgdorferi in the 2023 University of Maryland review—notably the only herb in that review with confirmed anti-borrelia activity but lacking documented anti-inflammatory properties. Carvacrol and thymol in oregano oil disrupt bacterial membranes and eradicate persister cells. It was also active in a 2018 Antibiotics study on essential oils against Borrelia persisters.
- peppermintScientific
Peppermint was included in the 2023 University of Maryland systematic review of 18 herbal supplements for Lyme disease, showing in vitro antimicrobial activity and potent anti-inflammatory properties relevant to persistent Lyme symptoms. Its active constituent menthol and essential oil compounds contribute to antimicrobial effects. It is used in integrative Lyme protocols for symptomatic and anti-inflammatory support.
- quercetinScientific
Quercetin demonstrated bacteriostatic and bactericidal anti-spirochetal effects against B. burgdorferi in in vitro PMC studies. It inhibits NF-κB and pro-inflammatory cytokines relevant to Lyme disease-related inflammation and arthritis. Its biofilm-disrupting properties and ability to potentiate antibiotic effects have been documented. Present in many Lyme-relevant botanicals including Japanese knotweed and Baikal skullcap.
- reishi mushroomScientific
Reishi mushroom (Ganoderma lucidum) was one of 18 herbs evaluated in the 2023 University of Maryland comprehensive Lyme disease review, showing in vitro antimicrobial and strong immunomodulatory activity. It is used in Lyme protocols for immune regulation, inflammation control, and antiviral support. Its triterpenoids and polysaccharides modulate cytokine pathways relevant to chronic Lyme.
- resveratrolScientific
Resveratrol, the primary polyphenol of Japanese knotweed (Polygonum cuspidatum), has documented in vitro activity against B. burgdorferi log-phase spirochetes and B. garinii. It inhibits NF-κB-driven pro-inflammatory cytokines, crosses the blood-brain barrier to address neurological Lyme, and inhibits matrix metalloproteinases used by Borrelia for tissue invasion. PMC studies confirm direct anti-spirochetal and anti-inflammatory mechanisms relevant to Lyme disease.
- sweet wormwoodScientific
Sweet wormwood (Artemisia annua), source of artemisinin, demonstrated in vitro activity against stationary-phase B. burgdorferi persisters in the 2020 Johns Hopkins Frontiers in Medicine study, outperforming doxycycline. Its synthetic analog artesunate showed improvement in short-term memory impairment in a small Lyme disease pilot study. It has over 2,000 years of traditional medicinal use. Evidence remains primarily in vitro with limited clinical data.
- teaselScientific
Teasel root (Dipsacus fullonum) has been used in traditional Chinese medicine (Xu Duan) and Western herbalism for Lyme disease, particularly for Lyme arthritis. In vitro studies show lipophilic fractions of Dipsacus sylvestris root inhibit B. burgdorferi growth. A 2022 PMC study identified iridoid sylvestrosides III and IV in teasel leaves as active anti-Borrelia compounds. Evidence is primarily in vitro and traditional; no clinical trials exist.
- thymeScientific
Thyme (Thymus vulgaris) was identified as one of seven botanicals with in vitro anti-borrelia activity against stationary-phase B. burgdorferi in a comprehensive review. Thymol, its primary active constituent, and carvacrol have documented antimicrobial effects against multiple bacterial forms. It appeared in the 2023 University of Maryland review with confirmed anti-borrelia activity, one of the few herbs beyond the Johns Hopkins 7. Research in Antibiotics (2018) also showed essential oils including thyme eradicate persister cells.
- milk thistleTraditional
Milk thistle (Silybum marianum) is widely used in integrative Lyme disease protocols for hepatoprotective support, addressing liver stress from both Borrelia toxins and long-term antibiotic therapy. Silymarin (its active flavonolignan complex) has potent antioxidant and anti-inflammatory properties. Over 2,000 years of traditional use for liver protection, with clinical evidence supporting hepatoprotection in drug-induced liver injury applicable to Lyme antibiotic regimens.
- red rootTraditional
Red root is a component of the well-known Buhner Protocol for Lyme disease and co-infections, used specifically to support lymphatic clearance of Borrelia-related debris and address the splenomegaly associated with tick-borne illness. This use is documented in herbal literature and widely adopted in integrative Lyme care. No controlled clinical trials specifically on red root for Lyme disease have been published.
- sarsaparillaTraditional
Sarsaparilla (Smilax species) has been used in traditional herbal medicine for Lyme disease for decades, popularized by Stephen Buhner's herbal protocol. It is valued for binding to bacterial endotoxins (lipopolysaccharides) from dying B. burgdorferi, aiding their excretion and reducing the Herxheimer reaction. The 2023 University of Maryland narrative review evaluated sarsaparilla among 18 Lyme-relevant herbs, finding anti-inflammatory but inconclusive direct anti-borrelia evidence.