Borreliosis (Lyme Disease)
— A Balanced Guide to the Disease,
Treatment, and Controversy

Lyme borreliosis is the most common tick-borne disease in Europe. But few topics in infectious medicine are as controversial. Should antibiotics always be given? What happens when symptoms persist despite treatment? And does chronic Lyme disease even exist? This article provides a balanced overview of the disease, the conventional medical and naturopathic approaches, and the ongoing controversy.

What is Lyme Borreliosis?

Lyme borreliosis — also called Lyme disease — is caused by the bacterium Borrelia burgdorferi, a spiral-shaped bacterium (spirochete) that is transmitted to humans through the bite of infected ticks (Ixodes ricinus). In Europe, an estimated 65,000 to 85,000 cases are diagnosed annually, though the true number is believed to be higher, as many cases go unreported.

The most well-known early symptom is erythema migrans — a characteristic, ring-shaped red rash that expands from the bite site. The rash is painless and does not itch, which means many people overlook it. Unfortunately, up to 30% of those infected do notdevelop this rash, which can significantly delay diagnosis.

Stages of the Disease

Neuroborreliosis is the most serious manifestation and always requires hospital treatment. Symptoms include severe headache, neck and back stiffness, cognitive impairment (confusion, memory loss), and facial paralysis.

The Conventional Medical View

The conventional medical approach to Lyme borreliosis is based on international guidelines from IDSA (Infectious Diseases Society of America) and AWMF (Germany). According to these guidelines, treatment is short and targeted:

• Early Lyme: Doxycycline 200 mg daily for 10–14 days (or Amoxicillin 500 mg × 3 for 14 days). For children and pregnant women, Amoxicillin is used.
• Neuroborreliosis: Ceftriaxone intravenously 2 g daily for 14–21 days.
• Lyme arthritis: Doxycycline for 28 days. For persistent arthritis after antibiotics, NSAIDs or DMARDs may be considered.
• Acrodermatitis: Doxycycline for 21–28 days.

Two-Tier Testing

Diagnosis typically follows a two-tier process: First an ELISA test (sensitive, but non-specific), followed by a Western Blot (confirmatory) if ELISA is positive or borderline. The problem: In the early stage (within the first 2–4 weeks), the ELISA test is often false-negative, because the body has not yet produced detectable antibodies. Diagnosis should therefore be made clinically when erythema migrans is visible — regardless of test results.

PTLDS — When Symptoms Persist

Between 10–20% of patients treated for Lyme disease experience persistent symptoms such as fatigue, muscle pain, neurocognitive difficulties, and sleep problems — despite completing antibiotic treatment. This condition is called Post-Treatment Lyme Disease Syndrome (PTLDS). Conventional medicine recognizes PTLDS as a real condition, but does not consider it an active infection.

What Does the Research Say?

Four major randomized controlled trials have investigated prolonged antibiotic treatment for PTLDS:

• Klempner et al. (2001, New England Journal of Medicine): 30 days IV Ceftriaxone followed by 60 days oral Doxycycline showed no significant difference from placebo in quality of life.
• Fallon et al. (2008, Neurology): 10 weeks IV Ceftriaxone showed improvement in cognitive function, but the effect was modest and not sustained during follow-up.
• Berende et al. (2016, PLOS ONE): 14 weeks Clarithromycin + Hydroxychloroquine showed no significant effect compared to placebo.
• Cochrane Review (2024, updated): The latest review of all RCTs concludes that prolonged antibiotic treatment has no documented effect on PTLDS symptoms and carries an increased risk of adverse events.

The conventional medical conclusion is clear: Prolonged antibiotics do not help. But patients with PTLDS are left with their symptoms — and this is where naturopathic medicine comes into the picture.

The Naturopathic View

While conventional medicine focuses on killing the bacterium with antibiotics, naturopathic medicine takes a more holistic approach to Lyme disease. This includes both direct antibacterial herbs against Borrelia and support for the immune system, gut flora, and detoxification.

Herbs with Documented Anti-Borrelia Effects

A groundbreaking in vitro study by Feng et al. (2020, Frontiers in Medicine) tested a range of herbs against Borrelia burgdorferi in the laboratory. The results were remarkable:

• Cryptolepis (Cryptolepis sanguinolenta) — showed complete eradication of Borrelia in all forms, including persistent cyst forms. This is the herb with the most strongly documented anti-Borrelia effect.
• Japanese Knotweed (Reynoutria japonica, Resveratrol) — inhibits Borrelia growth and has anti-inflammatory properties. Often used as a basis in naturopathic protocols.
• Cat's Claw / Samento (Uncaria tomentosa) — widely used in the Lyme community to strengthen the immune system and fight the bacterium. The TOA-free form (Samento) is gentler on the gut.
• Cistus (Cistus incanus) — a polyphenol-rich herb that inhibits biofilm formation and supports the immune system.
• Garlic (Allicin) — allicin (the active compound in garlic) has been shown to sterilize Borrelia cultures in vitro.
• Myrrh (Commiphora myrrha) — traditionally used antibacterial agent, also active against Borrelia.

Well-Known Protocols

Several well-known naturopathic protocols for Lyme disease combine several of the above herbs:

• Cowden / Cunningham Protocol — developed by Dr. Lee Cowden and NutraMedix. Contains Samento, Banderol, Cryptolepis and other herbs in a comprehensive 3-month program.
• Buhner Protocol — developed by Stephen Buhner, author of "Healing Lyme". Focus on Japanese Knotweed (resveratrol), Cat's Claw, Andrographis, and Astragalus.
• Byron White Protocol — concentrated liquid extracts including Cryptolepis, Myrrh, and Garlic.

Supportive Treatment

In addition to direct antibacterial herbs, supportive treatment is crucial for supporting the body's healing:

• Vitamin D — essential for immune function. Many people in Northern Europe have vitamin D deficiency, especially in winter.
• Omega-3 fatty acids — reduce inflammation and support nerve function.
• Magnesium — often depleted in Lyme disease; relieves muscle tension and cramps.
• Probiotics — restore gut flora after antibiotics and strengthen the immune system.
• Liver support (Milk Thistle) — silymarin in milk thistle supports liver detoxification and protects liver cells.

Co-Infections

Ticks can transmit several diseases simultaneously. Two important co-infections in Europe:

• Babesiosis — a parasitic infection of red blood cells. Symptoms: night sweats, fever, shortness of breath (air hunger), hemolytic anemia. Treated with herbs like Cryptolepis and Artemisinin.
• Anaplasmosis — a bacterial infection of white blood cells. Symptoms: sudden high fever, headache, muscle aches. Often treated with Doxycycline.

It is important to test for co-infections, as they can complicate both diagnosis and treatment of Lyme disease.

The Chronic Lyme Controversy

Few areas in medicine are as polarized as the question of chronic Lyme disease. There are essentially two camps:

Lyme disease is rightly called "the great imitator", because its symptoms can resemble so many other diseases: multiple sclerosis, fibromyalgia, ME/CFS, rheumatoid arthritis, depression, and Alzheimer's. This makes both diagnosis and treatment extremely complex.

Many patients with PTLDS feel overlooked and dismissed by the established healthcare system. They experience that their symptoms are not taken seriously, and that they are labeled as "psychological." This feeling drives many toward naturopathic practitioners who take them seriously and offer a holistic approach.

A Reasonable Middle Path

As a naturopath with 12 years of experience, I see value in both approaches. My experience is that black-and-white positions rarely help the patient. Here is my assessment:

This content does not replace medical treatment. Always consult a healthcare professional for acute or serious symptoms.