The Healthy Gut Podcast Episode 31

Lyme Disease

The Healthy Gut Podcast Episode 31

Lyme Disease and SIBO

This week Rebecca is joined by Dr Farshid Sam Rahbar to talk about Lyme Disease and SIBO. Dr Rahbar is an acclaimed gastroenterologist with a passion for using the ‘whole-person’ approach in treatment. Rebecca and Dr Rahbar talk about the link between Lyme Disease and SIBO, how it’s caused, its symptoms, risk factors and the treatments available. They also chat about how important it is to map out your own medical history, to determine which symptoms are digestive or non-digestive and how this may help if you are not responding to your SIBO treatment.

In Today’s Episode

In Episode 31 of The Healthy Gut Podcast, we discuss:

✓ How Lyme disease is caused and tips for avoidance

✓ Which to treat first, Lyme Disease or SIBO

✓ What are the treatment options available for treating Lyme Disease

✓ Whether Lyme Disease should be considered an underlying cause for difficult/chronic cases of SIBO

✓ What Ozone Treatment is and how it works

✓ What lifestyle modifications should be made to help treat Lyme Disease

✓ Dr Rahbar’s views on claims that Lyme Disease doesn’t exist (at all) in specific countries, despite people reporting Lyme-like symptoms

✓ Why knowing your what are digestive and non-digestive symptoms are is important when talking about your own medical history with your practitioner.

Resources Mentioned In Today’s Podcast

Connect with Dr Farshid Sam Rahbar

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Dr. Farshid Sam Rahbar is the founder and medical director of Los Angeles Integrative Gastronterology & Nutrition. As an acclaimed gastroenterologist, Dr. Rahbar combines his experience, knowledge, and highly-advanced techniques with the art of functional medicine, providing patients with all-encompassing and comprehensive approach to gastrointestinal health. Dr. Rahbar attended the University of Tehran in Iran and completed his residency training at St. Mary’s Hospital in New York, one of the most prestigious and well-known medical facilities in the world. In 2009, Dr. Rahbar founded LA Integrative Gastroenterology & Nutrition, where he combines Eastern and Western medicine to create a unique, “whole-person” approach to caring for the body, designed to optimize and improve a patient’s health. With his exceptional ability to patiently and keenly listen to his patients, insightfulness in discovering the root of what is causing their symptoms, and his unique blend of Western and holistic medicine, Dr. Rahbar has become one of Los Angeles’ most sought-after and beloved gastroenterologists, with a highly successful ability to treat a wide variety of disorders affecting the gut.

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Lyme Disease

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About The Host

Rebecca Coomes

Rebecca Coomes

Rebecca Coomes is an author, entrepreneur, passionate foodie and intrepid traveller. She transformed her health after a lifetime of chronic illness, and today guides others on their own path to wellness. She is the founder of The Healthy Gut, a platform where people can learn about gut health and how it is important for a healthy mind and body and coaches people on how to live well with SIBO. Rebecca is the author of the world’s first cookbooks for people treating Small Intestinal Bacterial Overgrowth (SIBO) and the host of the SIBO cooking show and The Healthy Gut podcast.

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Podcast Transcript

REBECCA:  Welcome to the Healthy Gut Podcast Doctor Rahbar. It is wonderful to be sitting here in your office in Los Angeles and I am really looking forward to today talking to you about Lyme disease and all of the other factors that go along with the condition like Lyme disease and SIBO. So welcome to the Healthy Gut Podcast.

DR. RAHBAR: Great. Thank you for inviting me. I appreciate it.

REBECCA:  M pleasure. so first of all, as I always start with my guests who come on to the Healthy Gut podcast, I really love to know why someone has ended up specializing in gastroenterology with an interest in things like Lyme and SIBO as well. So if you could tell my listeners are little bit about how you got to be where you are today.

[00:45] DR. RAHBAR:  Well, it’s just a sense of curiosity and realizing at times that what we were seeing in the office I could not explain based on the knowledge base that I was carrying prior to that thinking. Back in 2012, we had several patients who had dysbiosis both in the form of SIBO or fungal and we were dealing with it and they got better. But it was difficult to treat them. They did not behave like my other patient. They were a little bit easier to treat. And eventually somebody was smart enough that made a diagnosis a tick-borne illness for them and I had just a question – is this scenario something’s going to repeat itself?

So, at that time when I hear and educated myself further and diagnosis and understanding of tick-borne illnesses and from there on we realized that this was a quite a common problem. A lot of patients who fall into the domain of chronicity and ongoing symptoms. They may have an underlying chronic infection that maybe underlying the scenario.

[1:59] REBECCA:  And it is interesting and I was saying to you just before we started recording that prior to seeing you speak last year at the SIBO symposium in Portland, I have never really heard of Lyme disease. I have heard of ticks. We have ticks in Australia but really my awareness of becoming quite unwell with tick-borne illnesses was pretty minima I would to say. Where I live in Australia it is cold and we don’t really have a lot of ticks. Not like our friends in the Northern warmer sub areas of Australia.

So Lyme disease I think has more of an awareness around it. It has had a bit of a positive (not positives, I don’t know why I am saying it) It’s sort of a bit of a PR coverage. SO this exposure of Lyme disease, if you could talk about what Lyme disease is but also more broadly in terms of tick-borne illnesses.

[2:50] DR. RAHBAR:  Absolutely. So it is very important to get the terminology and definitions correct here. The term Lyme disease in US it generally refers to an acute infection by Borrelia burgdorferi which is a spirochete type of bacteria. And this was first described back in 1990s from the East Coast, from the area where the Lyme was most noted. And from there, there was a definition of an acute Lyme presentation. Generally patients have a bulls eye rash and joint pains, maybe fever, other symptoms. But the clinical scenario is one of an acute illness.

However, experience now shows at least from what I have seen and my other colleagues that I have communicated with that the acute presentation may not be present and patients may acquire the bacteria and may go right into the chronic model and continue to do well or have some mild symptoms and live with it. But generally patients know something is not right. This type of condition may eventually be diagnosed as chronic Lyme and I am gonna call it, “Chronic Lyme” because the term chronic Lyme is not currently recognized in classical textbooks and ICD 10 and I do believe there is a push to eventually make a case definition for this scenario. So this could be recognized in the medical literature as well.

So you are gonna hear the term chronic Lyme but that is something that physicians like myself end up using for certain chronic presentations that patients would have. And we can talk about what the presentation would look like. Also, when there is an infection like this, I don’t want to call it necessarily a tick bite. There are other vectors, variety of vectors that can transmit infections and sometime they piggyback each other and they kind of go in and I call them co-infections. And there are bunch of other ones. I call them companion infections. So when you keep shaking you will find a variety of the infections maybe present. At least a foot print is there that the individual may be dealing with a variety of chronic infections in the body.

The clinical presentation depends the balance of the immune system and how the immune system is dealing with these infections and that is dictated by other factors – stress, sugar consumption, alcohol, lack of sleep, exposure to heavy metals, environmental toxicity and also exposure to bio-toxins. Part of that being mold exposure which may be very common in many parts of the world.

And the vectors being a tick or something of that nature, they are also very common and I think with the atmosphere change and the way our climate is changing there are some theories that these are becoming more aggressive. So it doesn’t really take very much for one to get exposed to this. And you don’t really need a tick bite. The majority of the transmission is done by nymph which is probably 1/10 of the size of a tick. And it’s very hard to see those things.

And some of these may survive a year around in different temperatures. Obviously, if the temperature is temperate, it’s humid, there are trees, there are bushes, there’s dirt. They love to hang out around there. So sitting on a rock, on a rock climbing experience maybe enough for one to pick up the bug. And if one has the proper genetic predisposition especially if there are issues with detoxification, patients may end up harboring these infections and presenting with a variety of chronic symptoms.

What we saw which at least in our experience was an eye opener because I have been in practice for 35 years, was only for the last 5 years that I started to see something I never saw before that patients with these type of tick-borne or vector-borne illnesses may primarily present with digestive problems. And among those when we look back to the data about 65 percent of the patients had SIBO. And among those we found out that the one that are high methane, they were particularly red flag. Indeed if I saw somebody with a high methane, I am going to now start to look for evidence of immune dysregulation and history that may suggest patient might have been in a proper environment to have acquired a tick-born or vector-borne illness.

[8:14] REBECCA:  It’s incredibly interesting. Particularly given that I hear from a lot of people that methane dominant chronic have been going through multiple rounds of SIBO treatment with either very minimal change or no change to their readings when they are doing their breath tests and feeling pretty rotten. And I am one of the reasons why I am so excited to have you on the podcast today is so that we can  be talking about tick- born or vector-borne illnesses. So that people that are listening  can perhaps be thinking about this with their physician if they haven’t yet considered something like a chronic infection like this.

If we go back to the beginning in terms of how we actually can pick up this infection, how do the ticks o the nymphs get in to our system? Is it through consumption of an infected food? How does it actually work?

[9:13] DR. RAHBAR:   I am not aware of oral intake contributing to transmission of infection. I am not gonna say it is not possible but it is not something I come across. Sexual transmission has been described. It has also been challenged but it has been described and I think is an area of concern. In our practice we clearly have seen what I called family clustering. And you see a husband a wife having evidence of a vector borne illness then the children have it. What is the explanation? Where they exposed to the same tree and yard and pits at home? Or, there was sexual transmission between husband and wife and also transmission from the mother through utero to the child?

I don’t have all the answer but it is an area that is concerning. When I see one family member, I always ask for other family members.

[10:21] REBECCA:  that’s very interesting. And at the time of infection can you be aware that something has happened or can it in effect lie dormant or not noticeable to the human that something has infected them.

[10:40] DR. RAHBAR:  Well 95% of our patients did not recall a vector bite. 5% did went back to years before. So I do remember something of a bite. And some of the descriptions were more convincing than others. And sometimes they had a picture of the event. So we could look at it.

So I definitely thing that some patients are aware that something happened. But interestingly, whether they take antibiotics right after that or not take antibiotics after that under medical supervision they may continue to have symptoms or be well for a while and not go through the acute knowledge which I was trying to explain. So when somebody harbors these infections or they have the bacteria in them the clinical scenario can go to a situation where somebody is completely asymptomatic or they may become symptomatic down the line. Or, they may only have lab abnormalities. That is the way we have seen it in our data.

[12:01] REBECCA:  that is very interesting. And I would like to talk a little bit about mold exposure particularly any of us that have lived in wetter climate or humid climates can often experience mold. Readily, I lived in the UK for 7 years and one of the last placed I lived in was full of mold. The entire basement flat was just brimming with mold. How would a moldy environment lead to vector borne or tick infection?

[12:34] DR. RAHBAR:  Absolutely. First, I like to give the credit to Dr. Schumacher who has done a lot of the writings and the research in this area and has shared his experience. Our experience has evolved over the last few years in this area. Although I do not consider myself at this juncture a mold expert, we are seeing the association with tick borne illnesses more and more. The reality is that that the mold exposure is quite of a common problem. I mean I think water damaged buildings are common. And some people are susceptible to the exposure to the biological toxins that they are coming from the mold components. So once a person is exposed to them, they may continue to harbor these fungal elements in some parts of the body. Sinuses are common areas for this.

And I believe that actually in susceptible patients the presence of the mold, if it is active and there are biological toxins present it may create a chronic inflammatory condition and as part of that scenario if there is dormant Borrelia or Lyme sitting in the back it may cause activation of that illness as well.

So you could have a Hodge podge of basically 2 or more infections going on at the same time. And I truly believe that people who might have been stable after a tick bite for a while and then suddenly years later they became ill. I think there was probably risk factor or a trigger factor and that might have been again stress, high consumption of sweets, alcohol, lack of sleep or exposure to micro toxins.

[14:40] REBECCA:  And do they know how those stressors trigger the infection to become acute?

[14:51] DR. RAHBAR:  Well it’s not becoming acute. It is becoming more manifested in a chronic way. We know that a stress has an effect on the immune system. I mean at the beginning it may be associated with high cortisol level. Many of our patients particularly women that they have issues with recurrent yeast infections. They generally have stress type of pattern. Or at least we see we believe that their bodies are stressed. So somehow I suspect that changes the immune system and the balance it might have created previously with the other infections in place.

I mean that would be my explanation.

[15:36] REBECCA:  And for so many of my listeners, stress is unfortunately quite a large component of their life because they are chronically unwell. They are feeling quite stressed about the fact that they are chronically unwell. They are not feeling very good. They often have busy jobs. I’ve got a lot of mums listening to the podcast. They are busy women running entire families trying to keep a career going trying to manage their health. Stress can be a really big factor.

[16:07] DR. RAHBAR:  Absolutely. We always try to consider that as part of the equation when we speak to the patients. And I think it is also important to know that because the treatment protocols would require some time that you remove the individual from the stressful environment or show them some coping skills to deal with what is going on.

[16:32] REBECCA:  I talk a lot around stress reduction on many episodes of the healthy gut podcast just because stress really doesn’t do us many favors when we are dealing with such chronic stress levels.

[16:47] DR. RAHBAR:  Absolutely. And you know the illness itself becomes part of the stress. You know just not feeling well, having difficulty to deal with issues, financial matters. And it just keeps adding up.

So support system in these scenarios is very very important.

[17:04] REBECCA:  let’s talk about how if somebody suspects they may have Lyme disease or vector borne illness, what is the first step in terms of trying to identify if indeed you have that.

[17:20] DR. RAHBAR:  Well the first thing I believe should be done is taking your history basically mapping out what is digestive, what is non-digestive symptoms, which one tends to predominate, how did it start, what makes it better, what makes it worst. And try to do a lifestyle modification to see if you can improve the sense of well-being.

Admittedly, it is not about treating the tests. It is about treating the patient. So if you work with somebody and you optimize the gut function, clearing the dysbiosis and correcting nutritional deficiencies and they felt better. I am not sure if I want to jump in to a treatment. I will continue to support the immune system. On the other hand, sometimes we do those things and still somebody may have difficulty with eating, maintaining weight, sleep issues, anxieties, thought process cognition, memories. And those patients they probably have more active infection, presence of cytokines, and the infection is to be treated.

[18:29] REBECCA:  And is there one test that is conducted to say, “Yes you definitely have a tick-borne illness?”

[18:39] DR. RAHBAR:  The simple answer is no. there is no one test. And I personally do not rely on one test and I don’t believe other physicians do. The methodology we have at this time is not perfect. They are expensive. There is lot of controversy in this area. Some labs, they do a great job but they may not be accepted by another group pf scientists. So the controversy in this area continues and I certainly hope that these podcast will eventually ignite some interests at the University level to bring scientists into putting money and research into this.

So the same way that we resolve hepatitis C to treatment with one pill, that is what I like to see to happen for this. We need investors and we need research.

[19:36] REBECCA:  Yeah, and really there needs to be that groundswell of interest in order for that to happen doesn’t it?


REBECCA:  yeah. Let’s hope this podcast can help towards that.

Treatment? You have talked around lifestyle. Looking at how a person can modify lifestyle behaviors perhaps reducing stress, putting better support systems in place and also looking at the immune system in supporting gut function, are there any other treatment options available? Is it a case of taking perhaps antibiotics if it is a bacterial infection? What else is available to people?

[20:12] DR. RAHBAR:  Generally speaking, the type of treatment is dictated by the gravity of the illness. And the response to the initial gut optimization and lifestyle modification. I would say about 1 out of 10 of our patients, it is a small number but is still could be significant. They did not require further steps. Further steps to treat the infections again may be diversified to those that would be antibiotic-based and those that are probably not antibiotic-based. For patients that are somewhat less ill, I personally would tend to use non antibiotic approaches. But that also depends on what we are dealing with. For example, Babesia in our experience is one of the most difficult ones to treat. And it may require more traditional treatments.  Having said this there are a variety of protocols available out there and herbal based which comes from the experience of very astute physicians that put it together and some patients I believe benefit from that.

Once there is a failure on one treatment method, which there will be somewhere along the line, one can choose another method. I have also been impressed by some of the resource we have seen in our patients with treatment with ozone treatment. Even though it is not part with standard treatment, but it is something I have hear more about. And we had experience with a few patients and ozone treatment, if patients can tolerate this, I believe may have some role with or without the ultra violet light treatment in treatment in these patients with vector-borne illnesses.

[22:01] REBECCA:  My listeners haven’t heard about ozone treatment before because we haven’t talked about it. Will you be able to explain what it actually is?

[22:16] DR. RAHBAR:  It is basically using O3 instead of O2 which has somewhat of an oxidizing effect but at the clinical level it may actually function as an anti-inflammatory and as anti-infectious if you will.  I am by no means the expert in this here and I think the credit goes to Dr. Robert Rowen who did a beautiful presentation at the last Lyme conference. There were a few physicians also in Los Angeles area who do provide this service but the mechanism of action may not be completely known but I believe it is anti-infective and anti-inflammatory if you will.

[23:02] REBECCA:  That is very interesting. Let’s talk about the connection with SIBO, is there a clear pathway in terms of why SIBO and Lyme disease are a vector borne illness can be so interlinked and why particularly you are saying such prominence with people that have chronic or high methane SIBO and also Lyme disease?

[23:30] DR. RAHBAR:  Well first of all credit goes to Dr. Mark Pimentel who did a beautiful research on identifying potential cause for post infectious IBS and presence of the vinculin antibody and the model of autoimmunity that is triggered by food poisoning. However, the same group published not too long that the methane producers may not follow this rule. And that has been also our experience that presence of the methane maybe phenotypic manifestation. It means it’s a way of seeing something. It may not be the primary problem. That means if the methane is there, the bacteria is really active but it is only implying that something is wrong. We still need to learn how we got there.

So the vinculin antibodies and the cytotoxin be that as mentioned, those markers may not be very helpful in patients who are methane producer. When I see methane I usually think about immune dysregulation. So I look for a cause. Among those, the majority have had evidence of vector-borne illness. However, some patient did not. A few did not but they did have evidence of micro toxins. And it appears that mold exposure with or without presence of other chronic infections may also be a player in this here. And other interesting scenario to consider is a lot of patients with evidence of micro toxins or mold exposure, they may have sinus related symptoms. They have generally chronic low grad sinusitis or allergic type symptom. It looks like they just live with this. And when we started to culture many of our patients we noticed that they have abnormal bacteria or some fungi present here.

And if they have post nasal discharge, I speculate and I don’t believe this is well published that when they are sleeping at night they will be swallowing some of the post nasal secretions and perhaps that is feeding the gut because we found that a lot of our patients were very difficult to treat and they keep showing high numbers of gas producing bacteria. They all so bad sinuses. So to help them we may have to different locations. Even though I am a GI doctor but I need to think about is about is the sinus a source?

So we have now started to develop collaboration with our ENT physicians who help us in managing that department.

[26:28] REBECCA:  that is very interesting. And I am thinking of myself in fact that prior to clearing my SIBO I had a constant nasal drip which I put down to having had my nose broken yet now that my SIBO has gone, I don’t have it. It is very interesting and I used to get chronic sinus infections. And they have all cleared up as well. So there is definitely, whether that one caused the other or there is just a correlation, it is interesting.

[27:00] DR. RAHBAR:  If there is food sensitivity it may add to sinus symptoms. So definitely one can feed another. It could be a vicious cycle. Many patients who have maybe milk or gluten or egg protein sensitivity. They may be more congested. They produce more biofilm, more mucus. It just becomes a source of bugs to grow you know. And I think you know you feed the bug and you have more food sensitivities, more leaky gut and you are back in a vicious cycle. At least theoretically it is a model that I think about it.

[27:33] REBECCA:  definitely. Do you see with the lab results that people with SIBO that have high methane generally have lower numbers coming through in hydrogen or can they also  that may have a vector borne illness? Or do you find that they can also have high hydrogen, high methane chronic illness?

[27:55] DR. RAHBAR:  Any of those patterns in my opinion would be possible. Indeed we can have very high hydrogen and that is by itself is an indication there is something wrong. I mean my flags would be up looking for something if I see numbers over hundred for hydrogen. And if they are both elevated even more concern. And if they keep switching from one end to another again that would be another pattern that would concern me. And if we talk about methane I generally talk about methane above 10. And the higher the methane is the more concern at this I would have in my mind.

[28:36] REBECCA:  it is interesting. I actually had somebody send through who has just been recently been diagnosed with SIBO and they said I have all sorts of things sent through to me. And I was looking at their numbers and I was like, “Wow!” Their hydrogen was 120 something. At its peak, their methane sort of sitting in to the thirties, forties. And I was thinking, “My gosh there is a lot going on in this person’s small intestine,” when you see those kind of numbers.

I know I get asked a lot by people, if I have Lyme should I be treating Lyme? Should I be treating SIBO? What comes first? Is it chicken and the egg? Or do you have a clear treatment plan for when you have a SIBO and a Lyme or vector borne illness patient?

[29:21] DR. RAHBAR:  as a general principle I believe that gut optimization should be done first, nutritional replacement, correction of malabsorption because your drugs or nutrients are gonna go through that gut anyhow and if patients have intolerances, it is gonna be difficult to treat the tick borne illness. So generally speaking, I help my colleagues that they treat the vector borne illness when I refer a patient that we have done our homework with patient to optimize the gut dysbiosis. Whatever we can do to make the patient feel better before they go into an attack mode if you will.

Having said this, occasionally I have reversed the scenario. When we felt that we could not go further, I told the patient that you know we have to reverse the scenario. It would not be wise to do the same thing, the same thing that does not work. And we may have to go and try to deal with the tick borne illness and then come back and look at the gut dysbiosis.

In our experience the patients who are referred by Lyme and vector borne treating doctors only 15% among those had positive SIBO test. So it looks like if one goes to the treatments, the SIBO may just get wiped off.

[30:52] REBECCA:  that is very interesting.

DR. RAHBAR: SO I could see clearly if I got referral samples from… because we do get samples from Germany, from East Coast and the number of SIBO patients were a lot less.

[31:09] REBECCA:  very, very interesting. And my next question is around let’s think of those chronic, particularly methane dominant SIBO patients who are on round 8, round 10, round 12 of treatment and there is no real improvement in either symptoms or numbers. Do you have any advice for them on what they could be looking at with their practitioner if they are just not getting anywhere?

[31:37] DR. RAHBAR:  well after the 2nd or 3rd round, I believe if I am not seeing eradication, I am not sure if I want to just come up with another round of treatment because the chances are that that patient would have a recurrence. You may be able to eradicate or you may have a recurrence.

Whether I want to keep treating them, it depends on the degree of symptoms that they have. if they are highly symptomatic, I may want to treat them again and see if I can give them some relief. Sometimes I see high methane and patients have very little symptoms and this is one of the challenges that the correlation to the symptoms is not 1 to 1. And it may be more than the presence of the methane is a bio marker of something being wrong.

[32:31] REBECCA:  Yeah. And so that is really about playing private investigator in your own body looking at what else is happening.

What are the treatments that you like to use when it comes to SIBO treatments?

[32:47] DR. RAHBAR:  I mean the standard treatments are out there. I mean we also do some alternative treatments which is my modification of what I have seen from the literature. I mean you can call it Rahbar’s way of doing it. It is not adequately published. I don’t know if what detail I want to go into that but we generally start with traditional treatments and I do give both options to the patients. I mean what is available out there now, it is the Rifaxamin with our without Neomycin generally if there is methane present. And if we suspect a fungal element I may also use an anti-fungal concurrently. I generally do not use probiotics at the beginning. As we get later on we may introduce probiotics cautiously.

And again lifestyle modifications. Alcohol is a risk factor for recurrent that has been well demonstrated. Slow eating habits, avoidance of eating and or drinking, in my opinion within 2 or 3 hours before going to bed. Using prokinetics and elemental diet. These are all options out there.

[34:06] REBECCA:  it is interesting. I was, before meeting with you today, I was conducting an interview with Dr. Lisa Shaver and one of the things we were talking about was around slowing down our eating and one thing that I learned to do through my own process of recovering was to slow down eating because I had been a speed eater for most of my life. And I can’t tell you the difference that that made just that simple act of slowing down. It had an enormous impact on how I felt, How I digested my food and…

[34:40] DR. RAHBAR:  Absolutely. Cheap and easy.

[34:45] REBECCA:  One of the freest and easiest things I did in that whole treatment process.

[34:47] DR. RAHBAR:  and another one that I always tell my patients is hot water.  I think the heat actually to me activates the enzymes. Have a soup or broth or hot water or light colored tea with your meal as opposed to cold water. In small amounts. I think you will see additional benefits with that.

[35:09] REBECCA:  and is that to be consumed whilst eating so along with the food?

Dr. RAHBAR: absolutely with your food.

REBECCA:  That is very interesting. That is another free thing to try.

There is some debate around whether Lyme disease or even really tick borne illnesses exists and just very recently in Australia we have a debate show that airs late at night and there was a whole panel of specialists and people debating the existence of tick borne illnesses in Australia with certain physicians saying it does not exist. Lyme disease does not exist and these illnesses that you claim simply do not exist. What is your advice to someone who is listening that might be in a country like mine where it really isn’t recognized yet they feel that perhaps that they might even remember an incident or they feel that this is really resonating in this podcast today and they would like to explore it further but they are meeting with resistance. Do you have any advice for them on what they could do?

[36:15] DR. RAHBAR:  it is hard for me to answer that question. I am actually not in the proper position. I am hoping that from what we share somebody’s attention will come forward and are willing to do addition research in this. I mean my purpose in doing all of this is to see if we can ignite somebody’s interest to take on the project and see if we do need to investigate this.

The reality is that I mean this is the story of the big elephant in the room. And the controversy goes across the continents. But I don’t think people are stupid. The patients we have seen are extremely intelligent, extremely methodical. And there is a huge amount of energy behind these people trying to express their concern.

I think it is worth for the authorities to consider at least listening to this and see what is it needs to be done to say yey or nay   .

[37:36] REBECCA:  Just in terms of… for people listening, to understand whether they might have been at risk for infection, what are some common tick areas. You did mention trees and you said that sitting on a rock if you are rock climbing might also put you at risk. Are there any other aspects that people should be mindful of where they could pick up an infection?

[37:49] DR. RAHBAR: First of all in our experience, the European genes to me is a source of susceptibility. Just an observation. I am not trying to be judgmental. Almost 80% of our patients have been Caucasian females. So I am a little bit concerned when I see a patient of that background. The second thing is that that is really an illness where most part of people are outdoor, athletic people, nature oriented. They like hiking, camping, being out or they like the nature. I do too. And if you have the proper genetic predisposition then we are susceptible to this.

And one has to take extreme precautions when you are out there. Nowadays, if you have an astronaut suit, put it on and zip it up. Or, read some guidelines online as how you can actually prevent exposure to these bugs. Outdoor activity, bushes, trees, grass. These are the areas where they are.

[38:59] REBECCA:  And can we see them? You did talk about nymphs which I would imagine are very small. Are they visible to the naked eye?

[39:06] DR. RAHBAR:  the nymphs I think are very difficult to see. I think the majority of the time that is the problem. I mean ticks we can see but I’ve had patients who reported to me they had one on their thigh and they had their long pants on and they saw at night. How did they get there? It must have been crawling up? Apparently it could be very subtle.  I hope I gave you your answer

[39:38] REBECCA:  Yeah. Lot’s to think about. And it is funny in Australia we talk about dogs getting bitten by ticks of dogs and cats and how sick they can get but there is nothing really about how sick humans can get with tick bites. I don’t know what that is.

[39:52] DR. RAHBAR: First of all let me make you a quick comment here. Dogs they do get Lyme disease right? And glomerulonephritis is actually one of the major manifestations in dogs and it kills. So dogs with a kidney disease is suspicious. If I had to have a dog I prefer not a black dog because I would never see the tick on them. I would also not invite the dog to come to the bed because it makes it challenging. If your dog goes outside I think it would be helpful if they don’t drive them into the bushes where the dirty areas are as well. If you have grass perhaps you could change it to artificial if it is a small area.

And cats are more dangerous because you don’t need ticks with cats. You need fleas. And fleas they transmit particular Bartonella and it is a lot more contagious than the Borelia but more contagious and two can mimic each other.

[40:55] REBECCA:  So interesting. And people like myself who are real dog and cat people and I am just thinking when I had a dog and a cat to stop the dog from rolling around. As soon as you wash the dog out they go and roll around and dirt and wanted to make themselves dirty again. And…

DR. RAHBAR: And bring them in. and wash them before they come in.

REBECCA:  well my dog and cat slept in bed with me when I was growing up and I am just thinking of all the possible exposures.

DR. RAHBAR: But you look healthy so I am not so worried.

REBECCA:  I am a risk factor. I am Caucasian. My bloodline is all European and I am female. So it puts me at risk but I am in pretty good risk these days.

DR. RAHBAR: My apologies.

REBECCA:  Dr. Rahbar it has been so interesting talking to you today about Lyme disease, tick borne illnesses, vector borne illnesses, SIBO. If people who are listening to the podcast would like to reach out and connect with you how best can they do that?

DR. RAHBAR: the best thing to do is send a brief email to our general email inbox. If we can answer it we will try to do that.

REBECCA:  Lovely and I will have that linked in the show notes. Dr. Rahbar it’s wonderful to have you on the podcast today.

DR. RAHBAR: thank you so much for inviting me. I really appreciate that.


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