by Dr. Bill Rawls
If you’ve tried everything to get well to no avail, chances are you’re feeling frustrated, confused, and exhausted. After all, which stone could you possibly have left unturned? Many people blame their persistent symptoms of chronic Lyme disease on the slimy collections of microorganisms known as biofilms, as suggested in the recent review article in Frontiers in Neurology.
But are biofilms really what’s stopping you from getting better? Here, we’ll take a closer look at these micro-communities to understand what they are and how they contribute to certain chronic illnesses. Though biofilms are interesting, the role they actually play in chronic Lyme disease may be minor.
What Are Biofilms?
Biofilms are colonies of microbes. They chiefly contain bacteria, but biofilms can also include protozoa and fungi. Biofilms form anywhere there is moisture and a surface. In other words, everywhere — including many surfaces inside the human body. The ring inside your toilet bowl and plaque on your teeth are examples of biofilm.
Certain types of bacteria initiate biofilms that can attach to a moist surface with specialized adhesion structures called pili. Once adhered to the surface, bacteria stick together and produce a matrix of slime called extracellular polymeric substance (EPS). After the matrix has been established, other kinds of microbes can join, creating a structured community. To get a sense of how a biofilm operates, imagine a crowded dance floor with bodies squeezed together, forming a uniform mass, swaying to the rhythm of the music.
A polysaccharide shell on the biofilms’ surface protects the organisms inside from starvation, drying out, the immune system, and antibiotics. The surface can include minerals, such as calcium, and blood products, including fibrin. Safe inside the biofilm, microbes are free to mingle and exchange information. Communication between bacteria, called quorum sensing, is accomplished by signaling molecules. Once a community is formed, particular groups of microbes take on specialized roles of performing metabolic functions for the entire unit. For example, water channels develop within the biofilm for moving nutrients and signaling molecules. The biofilm grows by cell division and recruitment of new individuals.
Reasons Microbes Form Biofilms
- Conserve nutrients and energy and avoid starvation
- Bypass the host’s immune system
- Avoid antibiotics
- Join forces with other microbes and increase the chances of long-term survival
In essence, the biofilm becomes an organism unto itself. Biofilms are as ancient as any lifeform. They were likely the bridge between single-cell organisms and higher multi-cell organisms.
How Biofilms Work
Biofilms cause illness by damaging the surfaces to which they attach. Additionally, if a biofilm matures and becomes massive enough, it can cause obstructions in organs or impede the function of medical equipment such as stents or catheters. Once a biofilm reaches a certain size (maturation II stage), it disperses, allowing inhabitants to spread and colonize other surfaces. As a means of survival, bacteria in the body are always trying to form new biofilms, and the immune system is constantly working to break them down.
The following graphic illustrates the 5 stages of biofilm development:
Common Biofilm Diseases
Typical biofilm diseases occur where there are surfaces and moisture present for the biofilm to form. Examples of biofilm diseases include:
- Bacterial vaginosis: Associated with biofilm in the vaginal wall.
- Chronic urinary tract infections: Biofilm on the bladder wall is a contributing factor.
- Middle-ear infections: Biofilms are linked to chronic middle-ear infections.
- Heart valve infections: Microbes may attach and form biofilms on heart valves or tissues surrounding the heart.
- Chronic vertigo: Caused by calcium deposits in the inner ear and may be a form of biofilm.
- Dental plaque and gingivitis: Classic examples of biofilm found in the mouth.
- Chronic sinusitis and chronic bronchitis: Associated with biofilm in sinuses and bronchial tubes.
- Arterial plaque buildup: Responsible for heart attacks and stroke, arterial plaques have many characteristics of biofilm and are often found to harbor bacteria.
- Hospital infections: Indwelling devices such as catheters are associated with biofilms.
Biofilms readily occur in the intestinal tract. In fact, the formation of biofilms in the colon and appendix is quite normal and supported by the immune system.
Is There a Link Between Lyme Disease and Biofilms?
There has been a lot of talk on Lyme forums about Lyme disease being a biofilm disease. This idea stems primarily from a study done in a lab showing Borrelia, the bacteria associated with Lyme disease, could participate in forming a biofilm.
No doubt, Borrelia can form a biofilm inside a test tube. Forming and participating in biofilm is a natural trait for almost any bacteria. Indeed, if you can’t join in on a biofilm, you’re not much of a bacteria. But most of the symptoms associated with chronic Lyme disease aren’t consistent with biofilm diseases. Biofilms cause localized symptoms primarily by damaging the surface they adhere to. Symptoms of chronic Lyme disease are systemic.
The symptoms of chronic Lyme disease and persistence against antibiotics are best explained by the fact that Borrelia is an intracellular bacteria. When the Borrelia spirochetes enter the bloodstream, they hitch a ride inside white blood cells and travel to tissues throughout the body, including the brain. Once they arrive at targeted tissue sites — heart, brain, joints, muscles — they emerge and infect other cells. Inside the cell, they can lose their wall and become an l-form bacteria. This, and being shielded inside the cell, provide protection from antibiotics and immune system functions.
The bacteria cannibalize the cell to generate new microbes and then emerge to infect other cells. Symptoms of chronic Lyme disease are caused not only by bacterial activity invading cells, but also by the immune system’s efforts to eliminate cells that have been infected with bacteria.
The concentrations of cells that have been infected with bacteria, compared to normal cells, is not great. Considering the bacteria are a hundred times smaller than our cells, even millions of bacteria spread out among the trillions of cells in the body isn’t a high concentration of bacteria — tissues are only lightly peppered with infected cells. To take out infected cells nestled among normal cells, the immune system targets the abnormal cells with antibodies, but in the process, there is collateral damage to normal cells. In other words, autoimmunity. Research suggests that the autoimmune phenomenon may be a significant driver of symptoms of chronic Lyme disease.
In addition, bacteria manipulating the immune system to generate cytokines and inflammation may be another contributing factor to Lyme disease symptoms. Inflammation breaks down tissues and allows the bacteria to access vital nutrients from our cells.
The fact that chronic Lyme symptoms are most consistent with Borrelia existing as an intracellular bacteria suggests that this is the primary reason as to why Borrelia is persistent in the body. Participation in biofilm and being able to form an antibiotic resistant cyst form likely also contribute to antibiotic resistance, but these may not be primary factors.
Biofilms may be most relevant to intestinal symptoms that usually accompany Lyme disease and skin diseases like Morgellons that’s sometimes associated with the tick-borne infection. Calcium deposits in the inner ear causing dizziness may also be related to biofilm.
Dealing with Biofilms
Though Lyme disease is not a standard biofilm disease per se, there’s nothing wrong with supporting the body’s ability to deal with biofilms during any illness. A healthy immune system is the best way to slow the formation of biofilm in the body. The immune system is always breaking down new biofilms that start to form — it’s part of the everyday struggle of life.
The following are my preferred herbs and supplements to supports the body’s efforts to break down biofilms:
Proteases are enzymes that break down proteins. It is thought that proteases may be beneficial for breaking down the outer coating of a biofilm, especially in the gut. Common natural proteases that are available in supplement form include bromelain (from pineapple), nattokinase, and serrapeptidase. Proteases also break down immune complexes in the blood and reduce inflammation.
2. N-Acetyl Cysteine (NAC)
A potent antioxidant and anti-inflammatory, n-acetyl cysteine (NAC) is known to break up mucus and may also play a role in dissolving biofilms. It also protects nerve tissue and liver function.
3. Antimicrobial Herbs
The best way to overcome chronic Lyme disease, including the possibility of biofilm formation, is persistent use of herbs with antimicrobial properties. The herbal advantage is that herbs suppress pathogens without disrupting normal flora and therefore can be used for prolonged periods of time (years) without adverse side effects. Herbs also protect cells from free radical damage and other stressors, modulate immune system functions, reduce inflammation, and erode away at biofilms. Common herbs with documented activity against Borrelia include Japanese knotweed, cat’s claw, and Chinese skullcap.
The Bottom Line
Ultimately, the idea that patients must aggressively hammer away at biofilms with harsh drugs and treatments to see improvements in symptoms may not be a sustainable or beneficial approach for most people. Blasting biofilms with strong chemicals and potent antibiotics has the potential to backfire because it can disrupt the balance of normal flora in the body and inadvertently suppress immune system functions.
In contrast, by supporting a healthy immune system with herbal therapy and a few select supplements, you can etch away at biofilms that may be present, while addressing other more significant underlying causes of your symptoms until they’re gone without setting yourself back for days or weeks at a time.
1. Supi et al, Characterization of Biofilm Formation by Borrelia burgdorferi, In Vitro, PLOS-one, Oct 24, 2012
2. Karatan E, Watnick P, Signals, Regulatory Networks, and Materials That Build and Break Bacterial Biofilms, Microbiology and Molecular Biology Reviews, June 2009, Vol 73 (2), P. 310-347
3. Lennox J, Biofilm Development, Biofilms: The Hypertextbook, Web, May 2011
4. Costerton, Stewart, Greenburg, Bacterial Biofilms: A Common Cause of Persistent Infections, Science, May 1999, Vol 284 (5418) p. 1318-1322
5. Sapi, MacDonald, Biofilms of Borrelia burgdorferi in chronic cutaneous borreliosis, Am J Clin Pathol, 2008, 129, p. 988-989
6. Hoyle, Costerton, Bacterial resistance to antibiotics: the role of biofilms, Prog Drug Res, 1991, 37, p. 91-105
7. Kurti, Munderloh, Ashstrand, Colony formation and morphology in Borrelia burgdorferi, J Clin Microbiol, 1987, 25, p. 2054-2058
8. Figure copyright 2006 Keith Kasnot, MA, CMI, FAMI
9. Image source: http://nutritionreview.org/2014/08/gingivitis-gum-health/
10. Di Domenico EG, Cavallo I, Bordignon V, et al. The Emerging Role of Microbial Biofilm in Lyme Neuroborreliosis. Front Neurol. 2018;9:1048. Published 2018 Dec 3. doi: 10.3389/fneur.2018.01048
11. Datar A, Kaur N, Patel S, Luecke D, Sapi E. In Vitro Effectiveness of Samento and Banderol Herbal Extracts on the Different Morphological Forms of Borrelia Burgdorferi. Townsend Letter, the Examiner of Alternative Medicine. July 27, 2010.
12. Rudenko N, Golovchenko M, Kybicova K, Vancova M. Metamorphoses of Lyme disease spirochetes: phenomenon of Borrelia persisters. Parasit Vectors. 2019;12(1):237. Published 2019 May 16. doi: 10.1186/s13071-019-3495-7
13. Markova ND. L-form bacteria cohabitants in human blood: significance for health and diseases. Discov Med. 2017 May;23(128):305-313. PMID: 28715646.
14. Rivera OJ, Nookala V. Lyme Carditis. 2020 Oct 3. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 31536195.