Preventing Lyme Disease

By Paul E. Lemanski, MD, MS, FACP

Editor’s Note: This is the 110th in a series on optimal diet and lifestyle to help prevent and treat disease. Any planned change in diet, exercise or treatment should be discussed with and approved by your personal physician before implementation. The help of a registered dietitian in the implementation of dietary changes is strongly recommended.

Medicines are a mainstay of American life and the healthcare system not only because they are perceived to work by the individuals taking them, but also because their benefit may be shown by the objective assessment of scientific study. Clinical research trials have shown that some of the medicines of Western science may reduce the risk of Type 2 diabetes, heart attacks, strokes and cardiovascular death.

In the first 109 installments of the Non-Medicated Life, a healthy lifestyle has been shown to accomplish naturally for the majority of individuals most of the benefits of medications in the prevention of the chronic medical conditions mentioned above. In addition, however, healthy lifestyle choices may also help prevent you from contracting several infectious diseases, including Lyme disease. Because Lyme disease is so widespread, the transmission so insidious, and the consequences so serious when recognized only later in its course, it is important to determine how simple actions and behaviors may actually help prevent Lyme disease in the first place.

Lyme disease results from the transmission to a human of a cork-shaped microscopic organism called a spirochete during the blood meal of an infected tick. The Lyme disease spirochete, Borrelia burgdorferi, was first described in Lyme Connecticut in 1977 and became a reportable disease in the US in 1991; currently it is endemic in much of the Northeastern US.

Preventing Lyme disease, which does require some effort, begins with understanding its phases and the seriousness of it. Lyme disease is a multisystem disease with clinical manifestations divided into three phases: early localized, early disseminated, and late disease. Early localized disease may begin a few days to one month after a tick bite and manifestations may include a target or bull’s eye rash, fatigue, mild headache, myalgias, arthralgias, and localized lymph node swelling. Early disseminated disease may occur weeks to months after a tick bite and manifestation may rarely include heart electrical conduction abnormalities, mild heart failure, and inflammation of the sack surrounding the heart. 

Fifteen-percent of infected, untreated patients may also manifest neurological disease such as infection of the membranes surrounding the brain with headache and stiff neck, as well as peripheral nerve symptoms of numbness or weakness. Sixty-percent of infected, untreated patients may have migratory joint pains without frank swelling or redness. Late Lyme disease typically involves intermittent or persistent arthritis with pain, swelling, and warmth in one or more large joints. Lyme disease consequences can be disabling and life altering and make efforts at prevention all the more important.

As we acknowledge its seriousness, we must also point out that transmission of Lyme disease may be insidious. Individuals may present with late-stage Lyme and never recall a preceding tick bite. Lyme ticks are quite small, but if identified and removed the risk of transmission drops significantly. Moreover, treatment with a single dose of 200 mg of doxycycline within 72 hours of a bite may completely prevent infection. For this reason, prevention of Lyme disease begins with heightened awareness and a willingness to engage in careful self-examination especially after potential exposure in areas in which Lyme is endemic.

Heightened awareness begins with recognizing the habitat of Lyme ticks and considering avoiding those areas of high tick density. Ticks like to climb tall grasses and plants that allow them to hitch a ride when a passing human or dog brushes against vegetation. For example, if hiking or walking, staying to the center of a trail or path, away from vegetation can significantly reduce possible exposure. Heightened awareness also includes checking for and removing ticks from both humans and dogs after outdoor activities. While dogs may be immunized against Lyme and may wear an insecticide laden collar, it is still possible for Lyme ticks to hitch a ride and subsequently bite a human. 

Routinely removing clothes after outdoor activities allows for careful self-examination using a mirror to help in viewing your back; examination of your scalp can be aided by a comb to part hair or a willing helper. During such self-examination placing your clothes in a dryer on high heat for five minutes will kill ticks and allow the clothes to be used again without washing. For those who do not have someone to help, the practice of routinely bathing within two hours of outdoor activities can remove ticks before they have had a chance to settle and bite.

Prevention of Lyme disease is also aided by the use of protective clothing. Long pants, long-sleeve shirts, and light-colored clothing may allow ticks to be identified and removed before biting. If the clothes are also treated with the insect repellent permethrin, a study of 700 case patients and 1,000 controls, indicated an effectiveness of 40% in preventing Lyme disease. Among 82 outdoor workers studied in Rhode Island and Massachusetts, factory-impregnated permethrin clothing reduced tick bites by 58%.

Prevention of Lyme disease is also aided by the use of tick repellents on exposed skin. Products containing DEET have been shown to effectively repel ticks and are generally well tolerated and safe when used on intact, exposed skin. Picaridin, a synthetic compound, based on natural plant extract also is effective, but, perhaps, less so than DEET. The use of tick repellents on intact, exposed skin in combination with the use of permethrin impregnated clothing probably offers the best tolerated, most effective barrier protection against Lyme ticks.

Finally, it is important to point out that prolonged outdoor summer activities such as hiking in heavy brush, camping, and golfing with multiple forays into the rough, may expose an individual in endemic areas to a high-risk for Lyme disease; even in the absence of a tick bite or a symptom. It may, in my opinion, be a wise policy to discuss with your physician obtaining a blood test for Lyme at the end of a summer of such high-risk exposure.

In summary, Lyme disease is a multisystem disease with serious health consequences. It’s prudent to take steps to minimize high-risk exposure to Lyme ticks. Such steps include avoidance of high tick density habitats, a careful examination and early removal of Lyme ticks after exposure, a shower within two hours of exposure, the use of permethrin treated clothing, and the use of DEET or Picaridin on intact, exposed skin. After a tick bite in an endemic area, treatment with doxycycline within 72 hours of the bite may prevent infection. After prolonged, high-risk exposure, even in the absence of a bite or a symptom, your physician may recommend blood testing for Lyme disease.

Paul E. Lemanski, MD, MS, FACP (plemanski3@gmail.com) is a board-certified internist practicing internal medicine and lifestyle medicine in Albany. Paul has a master’s degree in human nutrition, he’s an assistant clinical professor of medicine at Albany Medical College, and a fellow of the American College of Physicians.