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Basic Steps to Fix Fatigue in Lyme Disease and Mold Toxicity Image

Updated: 3/4/2024

How to Fix Fatigue in Chronic Lyme, Tick-borne Infections and Mold Toxicity

Most people with chronic tick-borne infections (Borrelia, Bartonella, and Babesia) and chronic mold toxicity have fatigue and low energy. There are basic steps that can correct this problem. These range from getting sleep to fixing and getting rid of underlying infections like Lyme, yeast, or viruses.

In this article I describe the basic steps that can fix this problem. Take these steps in the beginning and throughout a chronic mold toxicity or tick-borne infection treatment.

1. Sleep

To support sleep, use either supplements or prescription medicines. Do not mix supplements and prescription medicines together as a first treatment, though you can do so later.

Why These Actions May Help

Sleep is often disturbed in chronic Lyme disease. Lack of adequate sleep worsens pain, increases fatigue, and suppresses the immune system. It appears that in response to infection or mold toxicity, the excess inflammatory cytokines produced by the immune system decrease the output of sleep-inducing hormones to the sleep centers of the brain. Since lack of sleep increases cytokines, a restorative amount of sleep should ideally be 7-9 hours of sleep per night. Sleep in the few hours before midnight is most restorative.

Action Plan

Supplements

  • L-Theanine 100 mg 1 to 6 pills a night 1 hour before bed. Do not exceed 1,200 mg a day if using for nerve pain or anxiety during the day, as well. Excessive amounts in the day are very sedating; and/or
  • Herbal Sleep Combination 1 to 2 pills 1 hour before bed. Common herbs in sleep combination pills include valerian root, lemon balm, passionflower, hops, yams, wild lettuce, L-theanine, and others. My two favorite products containing some of these herbs are Sleep Formula by Karuna* and Circadian PM by Researched Nutritionals*.

You can either take these two supplements together or use in combination with the following prescription medicines, if needed.

Prescription Medicines

  • Zolpidem (Ambien) 10 mg 1 pill 30 minutes before bed. Use it if your primary problem is getting to sleep. It is short-acting; and/or
  • Trazodone 50 mg 1/2 to 2 pills 30 minutes before bedtime. Use this if your primary problem is staying asleep.

For more information about these sleep supplements and prescriptions, or for additional options about sleep hygiene, see Sleep in Lyme Disease: The Basic Steps. For information about sleep herbs and supplements, see Sleep: The Natural Medicines. For more information and sleep prescriptions options, see Sleep: The Prescription Medicines.

2. Diet

Why These Actions May Help

A paleo diet is low in simple sugars, which decreases the chances of developing intestinal yeast. It also promotes brain health and supports the energy factories, called mitochondria, found in every cell. Because the Paleo diet is low in sugar, it may decrease inflammation.

An elimination diet helps a person find which foods trigger allergies or inflammation reactions. If you are reacting to foods, consider trying an elimination diet first. Removing allergic and inflammatory foods from your diet also leads to decreased pain and improved energy.

Action Plan

Eat a paleo-based diet rich in organic foods, healthy fats, proteins, and vitamin rich vegetables. For more detailed information about the diet, see The Best Brain, Inflammation, Pain, Energy & Detox Diet Ever.

An elimination diet is another diet to consider starting. For detailed information, see Elimination Diet to Find Food Problems.

3. Cytokine Control

Why These Actions May Help

Cytokines are inflammatory chemicals made by the immune system in chronic tick-borne infections and mold toxicity. Nutritional supports like curcumin, resveratrol, black tea extract, NAC, and antioxidants found in a good multivitamin may lower cytokines. This can

  • correct many Lyme symptoms,
  • boost the immune system, and
  • limit Herxheimer die-off reactions.

On the one hand, cytokines are good because they turn on the immune system. They perform several functions that include:

  • making antibodies work more effectively,
  • increasing active white blood cells to fight infections,
  • recruiting white blood cells to the location of an infection,
  • turning on white blood cells to fight infections, and
  • decreasing viral and bacterial replication.

On the other hand, in chronic tick-borne infections like Lyme and mold toxicity the immune system makes too many cytokines, which is bad. Too many cytokines

  • suppress the immune system,
  • cause pain,
  • decrease hormone production from organs like the thyroid and the adrenal glands,
  • disturb sleep,
  • decrease brain function,
  • increase fatigue and tiredness,
  • waste muscles,
  • cause depression, and
  • decrease the function of various organs throughout the body, resulting in many other symptoms and medical problems.

At the beginning of treatment or when antibiotics are changed, the cytokines are made in even greater amounts, which causes a person to feel much worse. This is called a Herxheimer die-off reaction.

See Control Cytokines: A Guide to Fix Lyme Symptoms & The Immune System for more information and additional herbal medicine options to use in a chronic tick-borne infection or mold toxicity treatment.

Action Plan

Supplements

  • Curcumin 500 mg 1 pill 3 times a day. Choose a liposomal product. In such a product, the curcumin is microscopically wrapped in oil like sunflower oil to increase its absorption. My preferred liposomal curcumin product is Curcumin Phytosome by Thorne Research*; or
  • Anti-Cytokine Combination 1-2 pills 3 times a day. Anti-cytokine combinations include curcumin, resveratrol, black tea extract, and N-acetyl cysteine (NAC). My preferred anti-cytokine combination product is Cytoquel by Researched Nutrionals*.

Prescription Medicine

There are no effective and safe options.

4. Adaptogen

Why These Actions May Help

An adaptogen is a substance that helps the body deal with the harmful medical and emotional stress of being ill. Adaptogens have been used for centuries in Ayurvedic and Chinese medicine with greatly observed benefits. Based on animal experiments, ashwagandha may improve

  • energy,
  • immune function, and
  • adrenal and thyroid function.

It likely has additional benefits that have not been researched.

Action Plan

Supplement

  • Ashwagandha 400 mg 1 to 2 pills in the morning and 1 to 2 pills between 1-2 p.m. Taking ashwagandha late in the day may disturb sleep.

5. Hormones

Read the “Diagnose Based on Symptoms” section below to determine if you could have low hormones. 

Why These Actions May Help

Fixing low adrenals and/or low thyroid can help the immune system work better and possibly improve energy. A person could have normal range testing for each of the hormones, but still have clinically low hormones. Because of the unreliability of testing, treatment for low hormones should occur if there are clinical symptoms of low hormones as long as the treatment does not increase hormone levels above the upper end of normal.

Diagnose Based on Symptoms

If you have a number of these symptoms, consider using the natural medicine approaches for each respective problem.

  • Adrenal Insufficiency: fatigue, recurrent infections, poor recovery from infections, low blood sugar with shakiness and irritability relieved by eating, low blood pressure and dizziness on standing, afternoon crashing, and sugar cravings.
  • Low thyroid: fatigue, achiness, dry skin, cold intolerance, weight gain, constipation, and changes in menstrual periods.

Action Plan

     A. Adrenal Insufficiency

For adrenal insufficiency, start with the supplement or prescription medicine. It is possible to use both together if the symptoms of low adrenals persist.

Supplement

  • Ashwagandha 400 mg 1-2 pills in the morning and 1 to 2 pills between 1-2 pm. Taking late in the day may disturb sleep.

Prescription Medicine

In my practice, I rarely use prescription medicine for adrenal insufficiency because there is a very small risk of immune suppression using prescription hydrocortisone. However, the doses I recommend are the normal amounts the adrenal glands should make. I prefer ashwagandha because it is a supportive herb that does not suppress the immune system.

  • Cortef 5 mg 1 to 2 pills in the morning and 1 to 2 pills between 12 pm. Taking late in the day may disturb sleep.

     B. Low Thyroid

Supplements

  • Ashwagandha 400 mg 1 to 2 pills in the morning and 1 to 2 pills between 1-2 pm. Taking late in the day may disturb sleep; also use with
  • Zinc 20 mg, Selenium 100-200 mcg, and Iodine 200-300 mcg 1 time a day. These are often found in multivitamins, or you can supplement them individually.

Use these nutritional supports first for one to two months before adding or trying the prescription medicine option below. Often, working with these supplements corrects the thyroid so you do not need to take thyroid prescription medicines.

Prescription Medicines

  • Desiccated Thyroid 1⁄2 grain or Armour Thyroid 1⁄2 grain 1 pill in the morning 30 minutes before anything else and on an empty stomach with water only. Increase every 3-4 weeks by ½ grain if low thyroid symptoms persist.

For more information about how to manage thyroid, even if your tests are normal, read my comprehensive article, It's Tricky—How to Diagnose & Treat Low Thyroid.

6. Essential Micronutrients

Why This Action May Help

In my opinion, to heal and feel better requires a multivitamin with an essential set of vitamins, minerals, amino acids, and antioxidants. A good multivitamin can improve functioning of the immune system; muscles; brain and nerves; hormones; organs, including the kidney and liver; and detoxification, in addition to decreasing inflammation. A multivitamin also may protect the body from the toxic effect of prescriptive antibiotics.

Action Plan

Supplement

  • Multivitamin. Use a vitamin that has numerous amino acids, antioxidants, minerals, and various vitamin Bs, including B12 and folate. I prefer Physician’s Daily by Researched Nutritionals*.

7. Treat Your Infections and Mold Toxicity

Ultimately to get rid of fatigue, you have to get rid of your infections and remove mold toxins if they are present.

  • At the beginning of treatment this means treating Lyme (borrelia), babesia, bartonella, and intestinal yeast. It may also include removing mold toxins.
  • Later in treatment at 6 months and beyond this can include viral infections. For more information see the chapters How to Diagnose, Infection Treatment Plans, and Mold and Lyme Toxin Illness.

8. Fix Mitochondria Cell Energy Factories.

Why These Actions May Help

If energy and fatigue do not greatly improve by six to nine months, it is time to fix the energy factories found in every cell. These are called mitochondria.

In chronic infections and mold toxicity, mitochondria get injured. There are two basic steps to fixing injured mitochondria. One involves fixing the damaged mitochondria membranes using phospholipids. The other involves fixing the mitochondria from the inside with the powerful antioxidant called glutathione and basic mitochondria nutrients.

Action Plan

Supplements

  • ATP 360 by Researched Nutritionals* 3 pills 1 time a day. This combination product contains phospholipids and essential mitochondria micronutrients.
  • Liposomal Glutathione 400 to 500 mg 1 to 2 times a day. My preferred glutathione product is Tri-fortify by Researched Nutritionals* because it has research showing it is well absorbed.

More Information. For additional information and ideas on how to repair the mitochondria see. How to Fix Mitochondria & Get Energy in Lyme Disease.

Disclaimer

The ideas and recommendations on this website and in this guideline are for informational purposes only. For more information about this, see the sitewide Terms & Conditions.

* These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

References

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  2. Lu K,  Gray MA,  Oliver C,  Liley DT,  Harrison BJ, Bartholomeus CF, Phan K L,  Nathan PJ. The acute effects of L‐theanine in comparison with alprazolam on anticipatory anxiety in humans. Hum. Psychopharmacol. Clin. Exp. 2004;19:457-465. doi:10.1002/hup.611
  3. Lyon MR, Kapoor MP, Juneja LR. The effects of L-theanine (Suntheanine(R)) on objective sleep quality in boys with attention deficit hyperactivity disorder (ADHD): a randomized, double-blind, placebo-controlled clinical trial. Altern. Med. Rev. 2011;16(4):348–354.
  4. Liu L, Liu C, Wang Y, Wang P, Li Y, Li B. Herbal Medicine for Anxiety, Depression and Insomnia. Curr Neuropharmacol. 2015;13(4):481–493. doi:10.2174/1570159X130415083112273.
  5. Gooneratne NS. Complementary and alternative medicine for sleep disturbances in older adults. Clin Geriatr Med. 2008;24(1):121–viii. doi:10.1016/j.cger.2007.08.002
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Diet:

See the references sections for The Best Brain, Inflammation, Pain, Energy & Detox Diet Ever and Elimination Diet to Find Food Problems.

Cytokines:

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  3. Butler T. (2017). The jarisch-herxheimer reaction after antibiotic treatment of spirochetal infections: a review of recent cases and our understanding of pathogenesis. Am. J. Trop. Med. Hyg. 96:46–52. 10.4269/ajtmh.16-0434
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  5. Gulcubuk A, et al. Effects of curcumin on proinflammatory cytokines and tissue injury in the early and late phases of experimental acute pancreatitis.. Pancreatology. 13(4):347-354.
  6. Krysta K, Krzystanek M, Bratek A, Krupka-Matuszczyk I. Sleep and inflammatory markers in different psychiatric disorders. Journal of Neural Transmission. 2017;124(Suppl 1):179-186. doi:10.1007/s00702-015-1492-3.
  7. Lee DW, Gardner R, Porter DL, et al. Current concepts in the diagnosis and management of cytokine release syndrome. Blood. 2014;124(2):188-195. doi:10.1182/blood-2014-05-552729.
  8. Linus Pauling Institute, Oregon State University. Curcumin. Micronutrient Information Center; Phytochemicals website. lpi.oregonstate.edu/mic/dietary-factors/phytochemicals/curcumin Accessed August 18, 2018.
  9. Lu SC. Glutathione synthesis. Biochimica et biophysica acta. 2013;1830:3143-3153
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  14. Shachar I, Karin N. The dual roles of inflammatory cytokines and chemokines in the regulation of autoimmune diseases and their clinical implications. J Leukoc Biol. 2013;93(1):51–61. doi: 10.1189/jlb.0612293.
  15. Sinha R, Sinha L, Calcagnotto A, Trushin N, Haley JS, Schell TD, Richie Jr JP. Oral supplementation with liposomal glutathione elevates body stores of glutathione and markers of immune function. European Journal of Clinical Nutrition. 2018;72:105–111.
  16. Strle K , Drouin EE, Shen S, El Khoury J, McHugh G, Ruzic-Sabljic E, Strle F, Steere AC. Borrelia burgdorferi stimulates macrophages to secrete higher levels of cytokines and chemokines than Borrelia afzelii or Borrelia garinii. The Journal of Infectious Diseases. 2009;200(12):1936–1943, doi.org/10.1086/648091
  17. Strle K, Sulka KB, Pianta A, Crowley JT, Arvikar SL, Anselmo A, Sadreyev R, Steere, AC. T-Helper 17 cell cytokine responses in Lyme disease correlate with Borrelia burgdorferi antibodies during early Infection and with autoantibodies late in the illness in patients with antibiotic-refractory Lyme srthritis, Clinical Infectious Diseases. 2017;64(7):930–938. doi.org/10.1093/cid/cix002
  18. Zhao F, Gong Y, Hu Y, Lu, M, Wang J, Dong J, Qiu F. Curcumin and its major metabolites inhibit the inflammatory response induced by lipopolysaccharide: Translocation of nuclear factor-κB as potential target. Molecular Medicine Reports. 2015;11:3087-3093. doi.org/10.3892/mmr.2014.3079

Adaptogen:

  1. Mishra L, Singh B, Dagenais S. Scientific Basis for the Therapeutic Use of Withania somnifera (Ashwagandha): A Review. Altern Med Rev 2000;5(4) 334-346.
  2. Liao LY, He YF, Li L, et al. A preliminary review of studies on adaptogens: comparison of their bioactivity in TCM with that of ginseng-like herbs used worldwide. Chin Med. 2018;13:57. Published 2018 Nov 16. doi:10.1186/s13020-018-0214-9

Hormones:

  1. Mishra L, Singh B, Dagenais S. Scientific Basis for the Therapeutic Use of Withania somnifera (Ashwagandha): A Review. Altern Med Rev 2000;5(4) 334-346.
  2. Liao LY, He YF, Li L, et al. A preliminary review of studies on adaptogens: comparison of their bioactivity in TCM with that of ginseng-like herbs used worldwide. Chin Med. 2018;13:57. Published 2018 Nov 16. doi:10.1186/s13020-018-0214-9
  3. Jefferies, W. (2004). Safe uses of cortisol. Springfield, Ill.: Charles C. Thomas.
  4. Wiersinga WM, Duntas L, Fadeyev V, Nygaard B, Vanderpump MPJ. 2012 ETA guidelines: the use of l-t4 + l-t3 in the treatment of hypothyroidism. Eur Thyroid J 2012;1:55-71.
  5. Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, Cooper DS, Kim BW, Peeters RP, Rosenthal MS, Sawka AM. Guidelines for the Treatment of Hypothyroidism. Prepared by the American Thyroid Association Taskforce on Thyroid Hormone Replacement. Thyroid 2014;24(12):1670-1751.
  6. Canaris GJ, Steiner J, Ridgway C. Do Traditional Symptoms of Hypothyroidism Correlate with Biochemical Disease? J Gen Intern Med 1997;12:544-550.
  7. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanik JI, Pessah-Pollack R, Singer PA, Woeber KA. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012;18(6):988-1028.
  8. Burch HB, Burman KD, Cooper DS, Hennessey JV. A 2013 survey of clinical practice patterns in the management of primary hypothyroidism. J Clin Endocrinol Metab 99: 2077-2085.
  9. Kelly G. Peripheral metabolism of thyroid hormones: a review. Alt Med Review 2000;5(4):306-333.
  10. Bianco AC, Kim BW: Deiodinase: implications of the local control of thyroid hormone action. J Clin Invest 2006;116:2571-2579.
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  13. Lukaczer D. Advanced assessment and treatment of thyroid dysfunction. Oral presentation at: The Institute for Functional Medicine Hormone Advanced Practice Module; July, 2017; Chicago, IL.
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  18. Risdahl JM, Khanna KV, Peterson PK, Molitor TW, Opiates and infection. J Neuroimmunol 1998;83:4-18.
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Essential Micronutrients:

  1. Teitelbaum, J. Chapter 6: "N" — Nutritional Support, the Building Blocks of Good Health. In: From Fatigued to Fantastic!. 3rd ed. New York, NY: Penguin; 2007.

Mitochondria:

  1. Nicolson GL. Mitochondrial Dysfunction and Chronic Disease: Treatment With Natural Supplements. Integr Med (Encinitas). 2014;13(4):35–43.
  2. Ellithorpe RR, Settineri R, Nicolson GL. Reduction of fatigue by use of a dietary supplement containing glycophospholipids. J Am Nutraceut Assoc 2003; 6(1): 23-28.
  3. Nicolson GL, Ellithorpe RR, Ayson-Mitchell C, Jacques B, Settineri R. Lipid Replacement Therapy with a glycophospholipid-antioxidant-vitamin formulation significantly reduces fatigue within one week. J Am Nutraceut Assoc 2010; 13(1): 11- 15.
  4. Ribas V, García-Ruiz C, Fernández-Checa JC. Glutathione and mitochondria. Front Pharmacol. 2014;5:151. Published 2014 Jul 1. doi:10.3389/fphar.2014.00151

Heavy Metals:

  1. Jaishankar M, Tseten T, Anbalagan N, Mathew BB, Beeregowda KN. Toxicity, mechanism and health effects of some heavy metals. Interdisciplinary Toxicology. 2014;7(2):60-72. doi:10.2478/intox-2014-0009.
  2. Sears ME. Chelation: Harnessing and Enhancing Heavy Metal Detoxification—A Review. The Scientific World Journal. 2013;2013:219840. doi:10.1155/2013/219840.
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About The Author

Marty Ross, MD is a passionate Lyme disease educator and clinical expert. He helps Lyme sufferers and their physicians see what really works based on his review of the science and extensive real-world experience. Dr. Ross is licensed to practice medicine in Washington State (License: MD00033296) where he has treated thousands of Lyme disease patients in his Seattle practice.

Marty Ross, MD is a graduate of Indiana University School of Medicine and Georgetown University Family Medicine Residency. He is a member of the International Lyme and Associated Disease Society (ILADS), The Institute for Functional Medicine, and The American Academy of Anti-Aging Medicine (A4M).

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