1. Raj Patel, M.D. Biofilms, Methylation & Heavy Metal Detoxification in Lyme Disease

2. Raj Patel, M.D. Overview Overview A.Biofilms  Gastrointestinal physiology  Definition of Biofilms  Examples  Prevalence  Treatment B. Heavy Metals  Prevalence  Signs & symptoms  Testing  Treatment options  Methylation in non-responders C. Conclusion

3. Raj Patel, M.D. B. Biofilms in Lyme Disease 1. GI Physiology: Structure of normal intestinal lining

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5. B. Biofilms in Lyme Disease 1. GI Physiology: Structure of intestinal lining in Gluten intolerance

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7. B. Biofilms in Lyme Disease 1. GI Physiology Microbial Flora I. One hundred trillion bacteria in gut comprises 500 different species II. Disruption early leads to immune problems, allergies, and autoimmunity later III. Functions: modulates immune system destroys toxins introduced with food suppress growth of pathogenic bacteria production of key vitamins digestion and absorption of carbohydrates prevention of allergies prevention of inflammatory bowel disease

8. Raj Patel, M.D. B. Biofilms in Lyme Disease 2. Definition a. Community of bacteria and other organisms surrounded by a extracellular polymeric substance (EPS) b. EPS is composed of DNA, protein, and polysaccharides. Its negative charge attracts Ca/Mg/Fe to strengthen it c. Organisms within a biofilm can communicate and exchange genetic material. d. EPS provides resistance to antibiotics requiring 100-1000X higher levels for eradication. “Testing the susceptibility of bacteria in biofilms to antimicrobial agents.” Antimicrobial Agents and Chemo. Nov 1990 e. EPS provides this organisms protection from UV exposure, pH changes, heavy metal toxicity, and phagocytosis.

9. Raj Patel, M.D. B. Biofilms in Lyme Disease 3. Examples of Biofilms a. Teeth b. Catheters and IV Lines c. Stagnant pools of water, rivers and streams d. Contact lens e. Polluted areas f. Blood (Fry et al)

10. Raj Patel, M.D. B. Biofilms in Lyme Disease 4. Prevalence of Biofilms a. Autism Spectrum Disorders b. Chronic Lyme Disease c. Chronic Fatigue Immune Dysfunction Syndrome d. Fibromyalgia e. Autoimmune Illness

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12. Raj Patel, M.D. B. Biofilms in Lyme Disease 3. Examples of Biofilms

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15. Raj Patel, M.D. B. Biofilms in Lyme Disease 5. Role of EDTA in Dissolving Biofilm a. EDTA serves to bind and remove the Ca/Mg/Fe holding biofilms together b. Staph biofilms could not be eradicated by Vancomycin or EDTA alone. Together the two agents successfully removed the biofilm (Kim 2005) c. EDTA and Gentamycin are 1000X more effective at killing Pseudomonas than either agent alone. This effect is completely blocked when Ca or Fe are added (Banin 2005)

16. Raj Patel, M.D. B. Biofilms in Lyme Disease 6. Treatment of Biofilms a. Enzymes b. EDTA c. Antimicrobials Antifungals d. Fiber Brown Algae Modified Citrus Pectin Activated Charcoal Zeolite e. Probiotics Prebiotics (fresh fruit, legumes, chicory, FOS, inulin) Supportive nutrients (slippery elm, okra, NAG, ecklona cava, colostrum) f. Drainage g. GO SLOW