Bell’s Palsy ~ the face and the gut?
Lyme disease, caused by a tick-borne spirochaete of the Borrelia species, is associated with facial palsy. It is increasingly common in England and may be misdiagnosed as Bell’s palsy. The attack on the nervous systems can, in acute Lyme, also trigger gastroparesis – nicknamed Bell’s palsy of the gut.
An interesting study was done in 2017 to produce an accurate map of Lyme disease diagnosis in England and to identify patients at risk of developing associated facial nerve palsy. The study looked at hospital episode statistics (HES) data that covered the period from April 2011 to March 2015. Its aim was to improve prevention, early diagnosis, and effective treatment.
The study found that hospital diagnosis of Lyme disease increased by 42% per year from 2011 to 2015 in England especially in higher incidence rural areas. A trend towards socioeconomic privilege and the months of July to September was observed. [The former might be because those in higher socioeconomic areas are more likely to push for a diagnosis (ed.)] Facial palsy in combination with Lyme disease is also increasing, particularly in younger patients, with a mean age of 41.7 years, compared with 59.6 years for Bell’s palsy and 45.9 years for Lyme disease. This younger group developing Bell’s palsy and Lyme disease may represent the typical age of hikers, walkers, and campers.
Cooper et al. concluded that healthcare practitioners should be highly suspicious of a Lyme disease diagnosis following travel in endemic areas, particularly in the summer months but increasingly also in winter as the climate changes. They suggested that patients presenting with facial palsy should be routinely tested for Lyme disease, especially when facial palsy occurs under 60 years of age.
However, palsy triggered by Lyme is not just limited to facial palsy. As the disease progresses more and more of the nervous system can become affected especially the vagus nerve system. In our clinic we commonly see bowel atony, bladder incontinence and pelvic pain. Alarmingly the entire gastrointestinal function can stall, endangering the patient through gastroparesis with dramatic weight loss. In our clinic, we often see this in young women, but not exclusively, and it is very hard to manage. One middle-aged male patient experienced severe gastroparesis for two years before being diagnosed with Lyme and seeking antibiotic treatment. Acupuncture can be helpful along with herbs, but vigilance to potential symptoms is really crucial to effective treatment and not losing time with solely traditional nutritional interventions.
Viral-induced gastroparesis is known to occur and can last from a few months and up to two years. Cases have been reported after shingles and even norovirus (Sawin-Johnson & Packer, 2019). Certainly if post-viral gastroparesis can occur it is perfectly rational to assume that bacterial infection could also trigger gastroparesis. Dr. Daniel Kinderlehrer (2021) also reminds us the Ehler-Danlos Syndromes, which in some cases can lead to a stretching of the intestinal tract, can also be implicated in gastroparesis. EDS is often found concurrently with Lyme as the bacteria undermines collagen and connective tissue structures in the body.
Dr. Virgina Sherr explained this succinctly in 2006. “Gastrointestinal Lyme disease may cause gut paralysis and a wide range of diverse GI symptoms with the underlying etiology likewise missed by physicians. Borrelia burgdorferi, the microbial agent often behind unexplained GI symptoms—along with numerous other pathogens also contained in tick saliva—influences health and vitality of the gastrointestinal tract from oral cavity to anus. Disruptions caused by GI borreliosis (Lyme) may include, amongst many others, distortions of taste, failure of other neural functions that supply the entire GI tract—paralysis or partial paralysis of the tongue, gag reflex, oesophagus, stomach and nearby organs, small and/or large intestines.” Her treatment protocol includes “All known Lyme-gut syndromes are treated by combining several effective antimicrobials (including use of azole medications with specific antibiotics) with agents that boost gut lining repairs and overall immunity enhancement. Azole medications are borreliacidal (against the anti-Bb spirochetal cyst form) medications such as metronidazole (Flagyl). Needed GI healing agents may include gut stimulants or relaxants, Ph agents, bile salts, nutriceuticals, immunity-enhancers, neurotoxin absorbents, and sterilizers of gut-specific microbes.” Her paper is well worth a read.
I shall write more about treatment protocols later in the year. We are currently following four patients with Lyme induced vagus nerve/gastroparesis issues and hope to clarify a herbal treatment strategy over the next few months. In the meantime, a few observations: If symptoms start in a patient, I recommend the swift addition of restorative nerve herbs and Lion’s mane mushroom and the avoidance of alcohol tinctures – alcohol is known to aggravate the condition – using granules instead. Ginger capsules taken before meals can help improve gastric emptying (Wu, 2008; Hu, 2011), as do peppermints sucked after a meal, gum chewed after a meal and post-prandial exercise. The addition of fibre like psyllium husk can often exacerbate the condition and slow gut motility even further. One patient who suffered with severe faecal impaction found relief in a combined approach of peanut oil enemas to soften the stools (recommended by gastroenterology), with Rumex crispus in particular which helped peristalsis and the light use of Napiers Aperient Tea (senna leaf and yarrow). Ultimately herbs like hypericum, Scutellaria lateriflora, centella and astragalus will help to repair nerve function and some of the traditional Chinese and Japanese Kampo blends such as Rikkunshito (Stansbury, 2020). The use of a tVNS machine has been trialled in one patient, following the work of McNearney (2013), without much noticeable effect.
We’d love to hear below from other practitioners with some really good herbal protocols for treating this condition.
Cooper, L., Branagan-Harris, M., Tuson, R., & Nduka, C. (2017). Lyme disease and Bell’s palsy: an epidemiological study of diagnosis and risk in England. The British journal of general practice : the journal of the Royal College of General Practitioners, 67(658), e329–e335. https://doi.org/10.3399/bjgp17X690497
Full text accessed 6 July 2021 at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409434/pdf/bjgpmay-2017-67-658-e329.pdf
Hu, M. L., Rayner, C. K., Wu, K. L., Chuah, S. K., Tai, W. C., Chou, Y. P., Chiu, Y. C., Chiu, K. W., & Hu, T. H. (2011). Effect of ginger on gastric motility and symptoms of functional dyspepsia. World journal of gastroenterology, 17(1), 105–110. https://doi.org/10.3748/wjg.v17.i1.105
Kinderlehrer, D. (2021). Recovery from Lyme Disease: The Integrative Medicine Guide to Diagnosing and Treating Tick-Borne Illness. USA: Skyhorse Publishing
McNearney, T. A., Sallam, H. S., Hunnicutt, S. E., Doshi, D., & Chen, J. D. (2013). Prolonged treatment with transcutaneous electrical nerve stimulation (TENS) modulates neuro-gastric motility and plasma levels of vasoactive intestinal peptide (VIP), motilin and interleukin-6 (IL-6) in systemic sclerosis. Clinical and experimental rheumatology, 31(2 Suppl 76), 140–150.
Sawin-Johnson, K. N., & Packer, C. D. (2019). Norovirus-induced Gastroparesis. Cureus, 11(12), e6283. https://doi.org/10.7759/cureus.6283
Sherr, V. (2006). “Bell’s Palsy of the Gut” and other GI manifestations of Lyme and associated diseases. Practical Gastroenterology, 30, (4).
A pdf of the article can be accessed online here: http://www.lymepa.org/02%20BELLS%20PALSY%20of%20the%20GUT–Sherr.pdf
Stansbury, Jill. (2020). Herbal Formularies for Health Professionals, Volume 4: Neurology, Psychiatry, and Pain Management, including Cognitive and Neurologic Conditions and Emotional Conditions. USA: Chelsea Green Publishing Co.
Wu, K. L., Rayner, C. K., Chuah, S. K., Changchien, C. S., Lu, S. N., Chiu, Y. C., Chiu, K. W., & Lee, C. M. (2008). Effects of ginger on gastric emptying and motility in healthy humans. European journal of gastroenterology & hepatology, 20(5), 436–440. https://doi.org/10.1097/MEG.0b013e3282f4b224