Lyme Disease: The Symptoms, Tests, and Treatments Doctors Miss

0:00Dr. Mark Hyman:What if the fatigue, brain fog, joint pain, or these mysterious symptoms you've been chasing for years don't trace back to stress, aging, or burnout, but to a tick bite you don't even remember? Nearly half a million Americans are diagnosed and treated for Lyme disease every year, and it remains one of the most misunderstood illnesses in medicine. And many people never see the bullseye rash. Others are told it's all in their head. And for some, the symptoms persist long after treatment ends. Today, we're going deep on what Lyme is and what its co-infections are and why they're so often missed, and most importantly, how we diagnose and treat them comprehensively from a functional medicine perspective.

0:39We're going to cover herbs, supplements, the roles and the limits of antibiotics, and a

0:44Dr. Mark Hyman:few innovative therapies that are generating real interest that I think need a lot more research but that are, I think, hopeful and promising. I've used a number of patients with success, including things like ozone, hyperbaric oxygen therapy and hyperthermia, which is inducing the temperature of fever, with honest caveats that each one deserves. Now, if you're worried about prevention, you're newly diagnosed, or you're still searching for answers after years, this one's for you. So let's dive in. This episode was brought to you by Function. Get access to over 160 lab tests annually at functionhealth.com slash mark.

1:16Dr. Mark Hyman:What is Lyme disease really, and why it's rarely just a thing by itself. It's usually a part of a complex dysfunction in your body. Lyme disease is an infection that's primarily caused by a corkscrew-type bacteria, or bacterium, called Borrelia burgdorphae. It's transmitted through the bite of an infected black leg or deer tick. Now, part of what makes it so tricky is that the bite usually goes unnoticed. These ticks can be the size of a poppy seed, and most people never remember being bitten. Now, early on, Lyme can look just like the fluke. Fatigue, chills, fever, headaches, muscle and joint aches.

1:54Dr. Mark Hyman:And I saw a lot of these people in Nantucket when I used to work in the emergency room there and they'd come in with acute Lyme. It was pretty classic, but most people never get that. Some people get a classic presentation, but many people don't. Some people get the classic bullseye rash, but here's a big myth I want to bust. Most people don't get that rash and not every rash looks textbook. No rash does not mean no Lyme disease. As it spreads, Lyme can reach everywhere in the body, the joints, nervous system, the heart, your immune system. You can get migrating joint pain, brain fog, sleep disruption, nerve pain, palpitations, and a bone deep fatigue that sleep doesn't touch.

2:31Dr. Mark Hyman:I personally had Lyme disease and I've had one of the co-infections called Babesia. It's awful. And I had most of those symptoms and they're not fun. Now, here's the part conventional medicine often misses. And it certainly missed it in me. I often, you know, use my own healing as a way of helping others because I learned what works and what doesn't. But conventional medicine often misses that the ticks rarely carry just one organism. A single bite can deliver lots of co-infections. Some doctors all checked for Lyme, but that's fine. But they missed all these other infections. You might actually not have Lyme.

3:01Dr. Mark Hyman:You might have Babesia or Bartonella or Licky or Anaplasma or Mycoplasma. These can dominate the picture. Babesia, which is a malaria-like parasite. I have that one. It brings air hunger, night sweats, chills, and a heavy, can't-catch-my-breath fatigue. I mean, just so deep fatigue. Bartonella, another one, often shows up as anxiety or rage or mood swings or other weird neuropsychiatric symptoms. It can have foot pain. It's worse in the morning. It can cause stretch mark-like skin striae or skin lesions. Ehrlichia and anoplasma can look more like a severe flu, sometimes with low blood counts. That's why two people with tick-borne illnesses can look completely different and why so many people get passed from specialist to specialist without a clear answer.

3:45Dr. Mark Hyman:Now, their symptoms don't fit in one box. So how do we diagnose this? Well, this is where functional medicine thinks differently. Chronic Lyme is almost never just Borrelia or Lyme. It's a web of overlapping drivers, multiple infections, immune dysfunction, inflammation, environmental toxins, mold. I had that. Food sensitivities, nutritional deficiencies, mitochondrial dysfunction, hormonal imbalances, sleep and autonomic problems, and gut dysfunction. Pretty much everything. in real i always think of like syphilis was a diagnosis we learned in medical school that causes everything lyme disease is like that it just causes everything it's also a spirochete it's also this curly squirrely kind of curly bacterium which is like syphilis in but it's not sexually transmitted well although sometimes it's people say it can't be but that's another topic now these these infections rarely travel alone which is exactly why a single cause single drug model often falls short and fails to get these people better a careful symptom inventory is really important across all these symptoms.

4:42Dr. Mark Hyman:It often tells me more than any one test. Now, in testing, I'll be honest about the limitations. The standard two-tier approach was something called an ELISA test followed by Western Blot. It's designed for surveillance. It's not for catching every case. It misses early infection. It misses patients who don't actually mount an anti-diabody response. So I read it carefully. The IgM and IgE bands, including species-specific bands that strict CDC criteria live out, I pay attention to all of that. And when the picture warrants it, I use specialty labs like hygienics or infecto labs or galaxy diagnostics that test more broadly.

5:15Dr. Mark Hyman:And I test specifically for co-infections like Babesia. I use a smear. I use something called PCR, which measures for the actual organism DNA, for antibodies as well. And I remember also that there are different species. For example, Babesia has Babesia duncani and Babesia microti. So you've got to check for all the species. There's lots of Borrelia species. It gets quite complicated. So you really need a doctor who knows what they're doing. Barnella, very hard to capture on antibody testing. And anaplasma and lichia are important. But again, the tests are not perfect. Test result is only the beginning.

5:47Dr. Mark Hyman:From a functional medicine lens, I'm also assessing the whole terrain. Inflammatory markers, cytokines, immune function, looking for mold, mycotoxin exposures, looking for having metals, looking for nutrient status, hormones, mitochondrial function. Because the real question isn't only is Borrelia present or Lyme. is why is this person's body unable to recover? Treating Lyme and co-infections is important. Now, there's a comprehensive approach I want to go through here. And it's not the same for everybody, so it's very personalized. I want to be far more thorough than we go to in the usual conversation about Lyme because Lyme is rarely one drug for a few weeks, which is what traditional medicine believes, right?

6:24Dr. Mark Hyman:Just take doxycycline for three weeks, you're done, that's it. Doesn't work usually, unless you have acute Lyme. Then it usually works. Conventional medicine asks, the essential first question. How do we eliminate the infection? And it's right to do that, okay? But functional medicine adds a second question. Why are two people exposed to the same organism having such different outcomes? One recovers in weeks, the other is struggling for years. The answer usually lives in the whole system. So we treat on several fronts at once. We reduce the infectious burden, right? For early localized Lyme, that's conventional antibiotics, doxycycline, amoxicillin, cefiroxine, they're generally effective and well worth using.

7:03Dr. Mark Hyman:I mean, I'm definitely down on inbox for this if you get early. Caught early, a focused course is often curative. I never want anyone to skip appropriate treatment for acute Lyme. Really important. Don't go, I'm going to take herbs for that. Don't do that. It's too serious on the other end. And this is where I part ways with a purely conventional approach. It's when we deal with chronic persistent illnesses, which many people in traditional medicine don't even believe exist. chronic Lyme they think doesn't even exist. It does. I had it. Trust me. I know it does. And I've seen hundreds of thousands of patients with it.

7:35Dr. Mark Hyman:But here, I lean far less on long, escalating rounds of antibiotics and far more on a broad, integrative strategy. And part of the reason is biology. Borrelia doesn't only live as the familiar spiral. Under stress, it shifts into a dormant, round body form, and it hides inside biofilms where antibiotics really struggle to reach it. and where repeated prolonged courses of antibiotics often disappoint while disrupting your gut, your microbiome in the process. So they cause side effects and they don't really work. So for persistent disease, I think in terms of a layered arsenal with antibiotics as one tool among many rather than the whole plant.

8:11Dr. Mark Hyman:Co-infections still need targeted treatment because while clearing the Borrelia, or it's important while ignoring the BC or Barnella, that's going to stall your treatment. You've got to deal with all the infections. Here, both worlds have something to offer. Abesia, the prescription antibiotics like atoboquin with erycromycin, which is what I took, alongside herbal antiparasitics like cryptoleptus or artemisin, which I also took, did help. Bartonella, also antibiotics can be helpful, such as antibiotics like rifampin and azithromycin. And botanicals like Ceta, Acuta, and other ones that are very helpful, we can use.

8:46Dr. Mark Hyman:erlichian endoplasma. They're the clearest case for a short course of targeted antibiotic therapy, usually doxycycline. Then I lean on herbals, herbal antimicrobial therapies. This is often the backbone of persistent line care, and it's earned its place. It really can help. Several botanicals have real anti-borrelia data. Johns Hopkins lab tested herbs against the persistent phase of borrelia and found some outperformed standard antibiotics in the dish. Now, most strikingly, cryptoleptus alongside with Japanese knotweed, which is a source of resveratrol, cat's caw, Chinese skullcap, sweet wormwood or artemisia, which is actually used for malaria in Africa, and black walnut.

9:27Dr. Mark Hyman:All these are very helpful, and they're well-known anchors in herbal anti-tick-borne infection protocols. And they usually shine for people who can't tolerate antibiotics or who need gentler, a longer arc with far less collateral damage to the gut. Look, when it comes to your daily habits, your skin tells the truth. The late nights, the stress, it will surface. The extra drinks and processed food, it'll show up. Because your skin is constantly responding to what's happening inside your body. I spent decades helping people understand that health isn't just something you feel. Sometimes it's something you see.

9:57Dr. Mark Hyman:And that's why when I think about skin health, I think about nutrition. I think about inflammation, hormones, and many factors working beneath the surface. That's exactly why we built Function. Function gives you access to 160 plus lab tests annually that measure signals in your blood, including nutrients, liver health, inflammation, and hormones. You can also complete your health baseline with an annual MRI that helps you see organs, tissues, and other changes. Check your health at functionhealth.com slash mark. And if you're one of the first 1 ,000 people this week, use the code mark2026 for a$50 credit for your$365 a year membership.

10:31Dr. Mark Hyman:I also use biofilm disruptors because these bugs hide in your cells. You've got to break through the biofilms in your system. Lumberkinase, seropeptase, natokinase, monolaurin, and acetylcysteine. These crack open the bacteria's hiding places so these antimicrobials and the herbal ones or the regular ones can actually reach these bugs. There's often other therapies which I've used myself and I'm often used in patients successfully, but I use them with caution. They need a lot more research. There's three things that come up. These are oxidative therapies. Oxidation is what actually your body uses to kill infections.

11:05Dr. Mark Hyman:So your body makes hydrogen peroxide in your cells. Your body makes ozone inside your cells, how it kills infections. That's what your body does naturally. Fever, your body has fever. That's how your body works. And it's sort of amplifying these natural processes in your body. And three of these therapies are, I think, worth considering. And they come up a lot in the Lyme world. I just want to talk about them because people are talking about them. And you should know at least my perspective. They have a promise, but they also have some caveats about them or warnings. First is ozone therapy. This is medical ozone.

11:37Dr. Mark Hyman:If you read the FDA's website, it says ozone is dangerous. Yes, it's deadly if you breathe it in. So don't do that. But medical ozone is delivered by drawing blood, mixing with ozone and returning it to the body. And it basically is an oxidative therapy. It's used by a lot of integrated practitioners for its effect on infections, pathogens, supports immune function, helps oxygen utilization. And some patients report meaningful improvement. I certainly found it helpful. But I'll be straight with you. There's no rigorous clinical trial evidence on this for Lyme disease, really. It isn't the standard care, and it must be done if you're going to do it with a properly trained practitioner.

12:14Dr. Mark Hyman:And if it's done wrong, it can be quite harmful. So I view it as something reasonable to explore with an experienced clinician, but not a proven cure. And then there's hyperbaric oxygen therapy. This is used in traditional medicine to deal with resistant infections and wound healing. It is a traditional medical therapy. And this is a situation where you breathe in high concentration oxygen under increased pressure. The rationale is kind of appealing. Borrelia prefers a low oxygen environment and also the tick infections. So saturating the tissues with oxygen may make the environment inhospitable to the tick infections.

12:47Dr. Mark Hyman:It also can calm inflammation. It can support healing, especially for a lot of neurological symptoms. The research in Lyme is limited, mostly small. So I hold it loosely. but that said, hyperbaric oxygen therapy or HBOT is well-established and generally safe for other conditions. The main risks are being, you know, ear and sinus barotrauma from the pressure, just like scuba diving. For some patients, it's a helpful piece of the puzzle. The next big one is hyperthermia. This is the oldest idea in the book. The fever is one of the body's own antimicrobial strategies and Borrelia is heat sensitive.

13:18Dr. Mark Hyman:Approaches range from gentle infrared sauna, which I use comfortably for circulation, detox support, overall resilience, and medical whole body hypothermia in specialized clinics, which raises core temperature substantially. The gentle end of it is low risk and supportive. The aggressive end carries real cardiovascular risk. It demands close medical supervision, has limited controlled evidence. So I would approach it with caution and expert oversight, never casually. But if you are quite sick and you're not getting better from anything else, it is a Hail Mary. The thread connecting all these three is that they're adjuncts, not magic bullets, and use thoughtfully inside a comprehensive plan under skill care, they may help.

13:58Dr. Mark Hyman:Used as a standalone shortcut, probably not a good idea. The next thing to think about is what we call a die-off reaction or the Herxheimer reaction. This is not uncommon when you're killing bacteria. We saw this first with syphilis when we would give antibiotics like penicillin. We'd see the body go into a kind of a terrible inflammatory reaction. People would get quite sick from the treatment. This happened to me. You know, I kill the bugs with antibiotics. I often feel quite ill. And there's a way to manage that. So how do you manage that? As the microbes die, the breakdown products flood the system.

14:29Dr. Mark Hyman:The symptoms can temporarily flare. It's called the Herxheimer reaction. It's not a sign to push harder. It's a sign to support drainage and detoxification. And the fundamentals do most of the work. Stay hydrated, have regular bowel movements, lots of fiber, liver support, foods, herbs, movement, sweating through general exercise, sauna. On top of that, I lean on something called glutathione, which is either oral or liposomal, sometimes IV or nebulized for neurologic symptoms. That's an important molecule of detoxification in your body. N-acetylcysteine also supports glutathione, alpha-lipoic acid, milk thistle, other binders like charcoal when mold or heavy toxins are in play.

15:07Dr. Mark Hyman:That can be helpful. But just remember, going low and slow beats going fast and crashing every time. The next thing you want to focus on is restoring the gut. Roughly 70 % of the immune system lives in and around the gut. Most Lyme patients arrive with it in disarray from the infection, from chronic inflammation, from all the antibiotics they might have taken or any antibiotics they've taken in their past. And when the gut's leaky and the microbiome is depleted, the immune system gets more reactive. Inflammation climbs, nutrient absorption falls, recovery stalls. So it's important to rebuild the gut.

15:38Dr. Mark Hyman:Targeted probiotics, saccharomyces is especially important. They call it saccharomyces biliardii. It's especially important when antibiotics are being taken because it helps reduce the yeast overgrowth, prebiotic fibers, glutamine, lots of other things that can help the gut barrier repair of the leaky gut, removing foods that drive inflammation, gluten, dairy, things like that. Healing the gut, really important. When you do that, other symptoms can quietly start to improve. The next thing we want to do is calm inflammation. Inflammation is supposed to be the immune system response. That's okay.

16:07Dr. Mark Hyman:The problem is when it won't switch off. Even after when the infection is addressed, a stuck inflammatory response can keep generating fatigue, joint pain, brain fog, and poor sleep. Nutrition is the most powerful lever. A whole foods, anti-inflammatory pattern, rich in vegetables, quality protein, healthy fats, vital nutrients with plenty of omega-3s, and stable blood sugar is really important. And then there's other supplements that can be helpful. Curcumin, resveratrol, these are anti-inflammatory, special things called specialized pro-resolvent mediators are really great. They can help the body actively resolve inflammation rather than just suppress it.

16:44Dr. Mark Hyman:Also, rebuilding cellular energy is really important. This is mitochondria. The complaint I hear most isn't tiredness, it's exhaustion. The kind that sleep doesn't fix. That makes thinking, working, exercising just feel impossible. Now, under prolonged immune stress, the mitochondria, these tiny little engines inside yourself, well, they falter. So I support them directly with things like CoQ10 or ubiquinol, NAD +, precursors like NRR or NMN, acetylcarnitine, D-ribose, magnesium, D-vitamins, something called PQQ, alongside deeper work on sleep, stress physiology, and inflammation. If you don't restore the body's ability to make energy, recovery stays incomplete.

17:21Dr. Mark Hyman:The next thing you want to do is modulate the immune system and the nervous system. Two pieces I never skip. First, immune system support and modulation. It's like vitamin D, vitamin C, zinc, medicinal mushrooms like maitake and reishi and so forth, and increasingly low-dose naltrexone, which can gently recalibrate an immune system that's either overwhelmed or stuck. And second, you want to work on the nervous system. Chronic infection holds the body in a sustained danger state, and a dysregulated threat-sensing nervous system perpetuates inflammation and the symptoms long after the bugs are handled.

18:00Dr. Mark Hyman:Things like vagal toning, breath work, limbic retraining, sleep, and stress work aren't extras. They're part of the medicine. And that's what comprehensive looks like. We're not just killing a bug. We're rebuilding a person. And as far as ticks go, prevention is still the best medicine. With all that said, all the things we just talked about, the best treatment for Lyme is never getting it. And tick exposure isn't just for deep woods. People get bitten in their own backyards, gardening, walking the dog at the park. There's a few high yield habits. Wear long sleeves and pants in brush areas. Tuck your pants in your socks.

18:35Dr. Mark Hyman:Now, I know it's unfashionable, but it's very effective. Stay on cleared trails. Use an EPA approved repellent and then do a tick check after any time outdoors. Check your scalp, your underarms, your waistline, behind your knees, your groin, anywhere clothing fits snug because they like to hide there. Check your kids and your dogs too. If you find one attached, don't panic. Transmission usually takes hours, so proper removal matters. Grasp it with the fine tip tweezers right at the skin, pull straight up with steady pressure, don't twist or squeeze, and then clean the area with alcohol. And here's the functional medicine layer.

19:07Dr. Mark Hyman:You can't control every exposure, but you can improve the host. Sleep, a nutrient-dense anti-inflammatory diet, regular movement, stress management, and a healthy microbiome won't make you immune, but they build the strongest possible terrain for your body to meet a challenge and to recover from it. Now, where is the science heading and what's life after treatment? Well, there's reason for real optimism here. The federal government is now investing heavily in tick-borne disease research, and public-private efforts like LIMEX are pulling scientists, clinicians, technologists, and patients together to push on better diagnostics, including AI tools that can spot the subtle overlapping patterns Lyme is famous for hiding behind.

19:49Dr. Mark Hyman:The goal isn't to replace clinicians, it's to give us sharper tools for earlier, more accurate diagnosis. And then there's the hardest group, the people who do everything right and still don't fully recover. Persistent fatigue, cognitive trouble, pain, sleep problems. We still don't fully understand why, although immune changes, lingering inflammation, unaddressed co-infections, nervous system dysfunction, and metabolic disruption all appear to play a role. The bottom line, when it comes to Lyme, prevent what you can and diagnose early when you can't. But recovery is rarely just about killing the infection.

20:23Dr. Mark Hyman:A functional medicine approach treats the whole person, clearing the infections and co-infections, calming inflammation, restoring the gut, rebuilding energy, supporting detoxification, and steadying the immune and the nervous systems, and reaching for antibiotics when they fit, and for herbs and well-chosen integrative therapies when they serve the bigger goal. Now, if you spend time outdoors, take prevention seriously. If you're struggling with unexplained symptoms, get a comprehensive evaluation from someone who knows tick-borne illness. Remember, you are the CEO of your own health. Healing means looking past the diagnosis to understand and work with your own unique biology.

20:57Dr. Mark Hyman:If you enjoyed today's episode, don't miss my upcoming conversation with Lyme disease expert, Dr. Richard Horowitz. We dive into why so many people stay sick and we look at the hidden drivers of chronic illness and a whole new way of thinking about inflammation and recovery and healing. It drops this Wednesday. And until then, here's a preview of what's to come. In fact, you know, I recently published an article in the Journal of Alzheimer's Disease Reports. We can get to this just briefly about, I reversed for the first time ever in the world, the most sensitive and specific biomarker for Alzheimer's, P-Tau 217.

21:29So again, we're dealing with neuroinflammation, but where did it come from? In my patient, it was coming from multiple MSIDs factors. It was Lyme. She had exposure to Babesia Bartonella. She had heavy metals. She had metabolic syndrome. She had food allergies. We need to treat it all. But interestingly enough, we were finding that when we treated the Lyme disease with the nine weeks of dapsone combination therapy, and she was sick for 15 years, by the way, with positive rheumatoid factors, with joint pain, some cognitive issues, which she didn't think were bad, completely reversed P-Tau-217. Now, what's interesting is that the Cochrane report, which came out about one week before my article got released, said, hey, we have no good things to treat Alzheimer's at this point.

22:07The article comes out one week later. And what I did is I proved the hypothesis, right? We're in the middle of an Alzheimer's epidemic where the NIH said that 42 % of people over 55 years old are now going to become demented. I mean, it is really frightening, especially when they say we don't have answers. So there was always, they looked at autopsy studies of Alzheimer's patients and they would find biofilms, amyloid and phosphorylated tau in the brains. So there was an association, but they couldn't say causation. This is the first time I proved causation by completely reversing this biomarker, P-Tau 217, with this nine-week protein.

22:41And this woman was, by the way, was sick for 15 years. And the symptoms got better. Her symptoms, her joint pain got better. Rheumatoid factor reversed because it wasn't rheumatoid arthritis. It was from the Lyme bacteria driving rheumatoid factors. What about her memory?