Question: In one of your recent research articles, you discuss “Lessons from Lyme Disease.” Many chronic Lyme patients experience symptoms very similar to CFS and FM, and in fact, it is not unusual for someone with Lyme disease to be mis-diagnosed with CFS or FM. Could you discuss this issue, and talk a bit about how you diagnose and treat patients with Lyme and other spirochetal diseases?

Trevor Marshall, PhD: Whether the inflammation (which gives rise to the CFS and/or FM symptoms) is caused by Borrelia, Bartonella, Chlamydia, or any other bacterium with the ability to change into these tiny pleomorphic shapes (also called “L-forms,” “Cell Wall Deficient,” “Cystic,” “Mycoplasma”), the inflammation needs to be treated the same way. The microbes seem to be resistant to standard antibiotics, even IV antibiotics, and have to be killed by our immune system itself. We have defined what is necessary to achieve that.

Diagnosis can often be done from bloodwork assay. If the level of 1,25-dihydroxyvitamin D in the blood is elevated (above 38-45pg/ml), or the 25-hydroxyvitamin-D depressed (below 20 ng/ml) then it is pretty certain that a Th1 process is in play (note: all blood must be frozen during transit to the labs for these tests to be accurate).

Sometimes it is quicker and cheaper to apply the angiotensin blockade as a “therapeutic probe.” If there are profound psychic and systemic effects from using Benicar, a drug which usually only changes the blood pressure, then that is a pretty good indication of the presence of Th1 inflammation, and an indication it is worth starting on our protocol.