Lymedoctor Newsletter 
March 2008 - Vol 1, Issue 1
Quick Links
Join Our Mailing List!


Welcome to our first issue of the Lyme Disease Solution Newsletter!  I certainly hope you find it useful.  Feel free to forward it to your friends.  There are three articles included for your review.  In the future you will be able to access archived issues via my web site: 


Dr. Singleton


book cover

In my new book, The Lyme Disease Solution, I discussed the fact that I recommend for my patients to avoid supplemental doses of certain "fat-soluble antioxidants" while taking Mepron (atovaquone).  This raised some questions with some readers, and for this reason I wanted to clarify the facts in this first issue of the LDS Newsletter.  In this first article I would like to address this complex issue.  (If you don't have Babesia, you might want to skip this article.)


There are two parts to this discussion.


(1)  First of all, let's understand what Mepron (atovaquone) is and how it works.  Mepron is a special type of antibiotic drug designed to treat certain types of infections such as pneumocystis, toxoplasmosis, and malaria.  Since Babesia organisms are related to malaria, this medication also is extremely effective against Babesia.  An excellent review can be found at:




The method by which Mepron works is to interfere with the ability of parasitic organisms (like Babesia) to successfully create energy.  It specifically does this by interfering with the Babesia's "mitochondria" (the energy factory of the cell).  It does this by reducing Babesia's ability to handle electrons properly, thus causing the mitochondria to malfunction resulting in "collapse of the mitochondrial membrane potential."  This results in an energy-depleted, pro-oxidant state, which can prove deadly to the Babesia parasite.


Here is where CoQ10 (a major fat-soluble antioxidant) and other fat-soluble antioxidants come in.  Mepron is actually a synthetic analog of CoQ10 and its mechanism of action is to block CoQ10's function in the Babesia mitochondria.  Therefore, it makes good sense to omit CoQ10 in supplemental doses when using Mepron.  However, the fat-soluble antioxidants all work together cooperatively and, therefore, one should not consider one without considering the others also.


(2)  Next let's discuss antioxidants in general and the fat-soluble antioxidants (like CoQ10) specifically.  An antioxidant by definition is a substance that reduces "oxidation."  As I discussed extensively in The Lyme Disease Solution, oxidation is a normal and necessary part of the way all life survives on this planet.  However, excessive oxidation leads to "oxidative stress" and free radical production which can be damaging.  Therefore, the Creator gave us antioxidants to counteract excessive oxidation through a process called "reduction."  The antioxidants are agents of "reduction."


There are two types of antioxidants - water-soluble and fat-soluble. 


The water-soluble ones are not of great importance in our discussion related to Mepron, so I just want to say a few words as a review of what I covered in the book.  The major water-soluble antioxidant coming from outside the body is vitamin C.   The major water-soluble antioxidant created within our body is glutathione.


Fat-soluble antioxidants, likewise, can come from external and from internal sources.  And just like their water-soluble cousins, they are critical to survival.  There are 3 major fat-soluble antioxidants:  CoQ10, alpha-lipoic acid, and vitamin E.  (I am not including vitamin A in this discussion because I don't believe it significantly impacts Mepron usage based on my experience.)  Let's discuss each separately, but remember they all work together cooperatively and synergistically.


            Co-Q10.   Also known as "ubiquinone", it is found virtually everywhere.  It can be made inside the body (with lessening amounts made as we grow older) and from outside sources (like foods and supplements).  Because it can be made inside the body, it is technically not a "vitamin", although in older people who cannot make sufficient amounts, it may need to be supplemented like a vitamin. 


Food sources of CoQ10 include:  mackerel, salmon, sardines, peanuts, beef, and spinach.  When my patients are on Mepron, I don't restrict food sources, rather only specific supplemental sources are restricted.


CoQ10 deficiency has been linked to congestive heart failure and neurodegenerative disorders such as Parkinson's, and supplementing with CoQ10 can reduce the progression of such disorders.  Statin drugs, used to lower cholesterol, are known to reduce the blood levels of CoQ10. 


Finally, CoQ10 plays a critical role in regenerating and perhaps protecting other antioxidants such as vitamin E.  Interestingly, vitamin E is used in CoQ10 supplement products to help preserve its antioxidant capacity.  Clearly the two are supportive of one another.


          Alpha Lipoic Acid (ALA).  This substance is often called the super antioxidant because it is both fat-soluble and water-soluble.  As a water-soluble antioxidant it importantly helps to increase levels of another critical antioxidant, glutathione.  As a fat-soluble antioxidant, it works to help CoQ10 by donating an electron to oxidized CoQ10. ALA has been demonstrated to prevent the formation of damaging pro-oxidants, while maintaining CoQ10 in its active antioxidant form to prevent peroxidation of susceptible biomembranes.  (And, theoretically, may support CoQ10 thereby counteracting Mepron's pro-oxidant effects against Babesia.)


Like CoQ10, the body is able to synthesize small amounts of ALA and therefore it is not considered a vitamin.  Organ meats (like liver, kidney and heart), meats (skeletal muscle), spinach, broccoli and potatoes are excellent food sources of ALA.  Incidentally, when supplementing with ALA it is important to take a good source of B-complex vitamins, particularly one that contains vitamin B1 (thiamine) and biotin.  As with CoQ10, I don't recommend limitation of foods with ALA, rather just limiting supplementation with ALA on days of Mepron usage.


          Vitamin E.  Vitamin E is the collective name for 8 naturally occurring molecules - 4 called tocopherols and 4 called tocotrienols.   Unlike the other 2 fat-soluble antioxidants that I discussed above, vitamin E is a true vitamin because we humans cannot manufacture it ourselves.  It must come from food with the best sources being:  nuts (especially almonds but also pistachio, walnuts, and peanuts), wheat germ oil, cooking oils, greens (especially dandelion and turnip), fruits (mango and kiwi), avocado, and broccoli.


In my discussion above concerning CoQ10, I mentioned the supportive role of vitamin E and CoQ10 with one another.  My recommendation while on Mepron is to generally avoid supplemental vitamin E doses over 50-100 IU.  I don't recommend restricting foods with vitamin E however.  Once you have completed the course of Mepron, much higher doses (e.g., 400-800 IU) are acceptable.  


Two cautions:  always use a natural form of vitamin E and not a synthetic form (and best if "mixed tocopherols") and always take supplemental vitamin C when using vitamin E supplements because vitamin C prevents oxidized vitamin E from causing damage to the body's tissues.


          Other Fat-soluble Antioxidants.  There are several naturally occurring fat-soluble antioxidants that I want to mention for the sake of completeness.  While I don't recommend restricting these while on Mepron, I want you to be aware of them.  They are:

  • Lutein (spinach and kale)
  • Beta carotene (carrots, canteloupe)
  • Lycopene (tomatoes)
  • Zeaxanthin (spinach, kale)

In summary, when taking Mepron (atovaquone) there are good reasons to avoid supplemental doses of the major fat-soluble antioxidants, particularly CoQ10.  Clinical experience has taught me that some limitation of other major fat-soluble antioxidants may also useful in helping Mepron do its job more effectively. 


Finally, don't worry - if you took all of these fat-soluble antioxidants when you took Mepron in the past, it's fine.  It just may have taken you a little longer on the Mepron to get the job done, that's all.  If you're on Mepron currently, discuss this with your health care provider and come up with the plan that is right for you.

finger with knot

Have you misplaced your keys, again?  Or, are you increasingly forgetting important appointments, persons or assignments?   Does your "auto pilot" not work anymore?  Are you having difficulty recalling things that once came to you easily?  Everyone knows that most people forget things from time to time.  And, as we get older, memory retrieval slows down.  However, when this forgetfulness occurs in a consistent pattern that affects your ability to function, you are experiencing some degree of memory loss.  And, as you also well know, this is an almost universal symptom of chronic Lyme disease.


Many factors, working together, affect memory. While memory loss can be frustrating, the good news is that research has found that 70 percent of our risk of developing memory loss is based on factors we can control. Of course, getting appropriate treatment for any physical problems, such as Lyme disease and hormonal imbalances, is always crucial in decreasing forgetfulness, or brain fog. In addition to the proper treatment of Lyme and the co-infections, other critical controllable factors include: stress reduction, getting adequate sleep, our overall physical health, proper nutrition, exercise, and our environment.


And - did you realize that keeping your brain active can have the same effect on your mind as a workout can on your body? 


Reduce stress.  We all experience some degree of stress.  In our every day lives, we must deal with stressors that may include job, traffic, family, and personal illness or injury.  Did you know that not all stress is bad?  Properly controlled stress can help meet physical challenges and provide extra strength and energy to cope.  However, chronic aspects of stress are harmful, and can lead to a sense of helplessness or loss of control.  Having chronic Lyme is a major stress.  Chronic stress can release hormones into the brain and block access to stored memory. 


While your "Lyme stress" is hopefully being reduced by proper management of the tick-borne illness, it is important that you work on the stress factors that you can control.  To reduce stress, your daily regime should include: deep breathing exercises, relaxation techniques, meditation, affirmation or inspirational reading.  Don't forget to include regular physical exercise for stress reduction.  Also, keep in mind that letting go of any issues around anger or unforgiveness, will reduce stress levels significantly.  See Chapter 9 of The Lyme Disease Solution for further information on practical methods of reducing stress.


Proper Nutrition Affects Memory.  Unlike muscles, the brain cannot store energy; therefore, it must be constantly replenished with nutrients. Foods that are rich in antioxidants are great "brain foods" because they protect and nourish brain cells. You have heard it before, but it merits repeating again and again "eat plenty of vegetables and fruits."  Vegetables such as carrots, squash, collard greens, kale and artichokes are excellent sources, as are fruits - especially those with a deep hue such as berries, pomegranates, and cherries.  Other high anti-oxidant foods include beans and nuts.


Omega-3 fatty acids are a crucial component in brain function and brain health.  They are essential to human health but cannot be manufactured by the body, and must be obtained from food. Omega-3 fatty acids can be found in fatty fish, such as salmon, and nut oils. Extensive research indicates that omega-3 fatty acids reduce inflammation and help prevent risk factors associated with chronic diseases such as heart disease, cancer, and arthritis. These essential fatty acids are highly concentrated in the brain and appear to be particularly important for brain memory, performance, and behavioral function.  It is important that both EPA and DHA components be present in any omega-3 supplements.  I recommend that chronically ill people use fish oil rather than flax oil (or similar oil) to assure that they are getting the proper amount of EPA and DHA.


Other dietary considerations that play a role in memory loss or brain-fog include:

  • B-vitamin deficiency which can cause symptoms of memory loss, brain-fog or confusion, especially a deficiency in thiamine, B-6 and B-12. Whole grains and beans provide excellent sources of B-vitamins.
  • Avoid excessive intake of simple carbohydrates and sugar.  This is especially an important consideration when on antibiotics and when there is a diagnosis of candida or yeast infection.
  • Avoidance of artificial sweeteners. In my clinical experience, the use of these products contributes to multiple neurological symptoms, including brain fog.
  • Eat foods that are high in brain anti-inflammatory components like ginger, curcumin, and of course oily fish.


Exercise your brain. This section is not optional. The brain has an amazing ability to create new connections and bypass damaged areas.  But you have stimulate and signal the brain to do so.  Do something new every week.  Find 20 minutes, four times a week to do a variety of mentally stimulating activities. Give yourself many opportunities to recall information.  You may find the following web site helpful: www.mybraintrainer.com.  Other suggestions are:

  • Memorize poetry, Bible verses or the words to your favorite songs.  I know you don't feel like it, but do it anyway!
  • Learn a new function on your cell phone or computer
  • Find ways to meet and talk to new friends
  • Play Sudoku.
  • Do brain teasers and play brain games
  • Limit TV. When you watch television, your brain goes into a neutral / passive state.  This is not helpful.


Get Adequate Sleep.  You know how important it is, but do you get  enough of it?  Most of us don't.  Sleep plays a key role in preserving memory and also aids in learning.  Inadequate sleep causes a decrease in mental functioning, and memory is especially affected. Studies find that sleep helps secure memory, and aids in learning. 



Inadequate sleep and sleep disorders are common health problems in the U.S. Up to 70 million people may be affected, most of whom are undiagnosed and untreated.  Studies suggest that most adults need between 7 - 9 hours of sleep per night.  The amount of sleep you need to function optimally may be different for you, than for someone else of the same age and gender.  Of course, you should let your doctor know if getting adequate or restful sleep is a problem for you.  But, there are some steps you can take to enhance your sleep.  (I cover this much more thoroughly in The Lyme Disease Solution.)

  • Establish consistent sleep and wake schedules, and maintain them, even on weekends.
  • Create a regular, relaxing bedtime routine such as soaking in a hot bath or listening to soothing music - begin an hour or more before the time you expect to fall asleep. 
  • Create a sleep-conducive environment that is dark, quiet, and cool, with a comfortable mattress and pillows.
  • Do not eat meals at least 2-3 hours before your regular bedtime.
  • Regular exercise enhances sleep, but avoid exercising just before your bedtime.
  • Avoid ingesting caffeine and alcohol products several hours before bedtime. Additionally, avoid stimulating activities such as TV, electronic games, computer usage, and so forth.
  • If you are a smoker, it is crucial that you give up smoking


Regular Exercise Boosts Memory.  In addition to the other numerous benefits of exercise, we now know that a regular exercise program enhances the capacity of the brain to increase learning and memory and to prevent memory loss.  Research shows that with regular physical activity you actually produce more oxygen that is delivered to your brain, helping it to function better.  Studies show that exercise, such as regular walking, or gardening for about 30 - 45 minutes, 3 - 4 times a week will provide a benefit for most people.


Think positive thoughts.   You will be amazed at how peaceful positive thoughts will bring about a peaceful and related mind and body where sleep is facilitated.  Think on the good things of life, the things we have to be thankful for, and the things that we can do (not jus the things we can't do because of Lyme.)  Keep a journal for self reflection, and make your environment brain-friendly (i.e. through music, color, or aromas,) to better manage your own memory.





(the LID)


If you haven't tried beans in a while, then maybe now is a good time to consider them.  They come in many varieties, they are full of nutrients, they are tasty, and economical.  They are often referred to as Nature's perfect food.  Beans, peas, and lentils are part of the family of legumes.  These foods are loaded with vitamins and minerals, high in fiber, a great source of protein, and low in fat,   Research studies link consumption of beans to a reduced risk of heart disease, high blood pressure, and some types of cancer.  Some studies rank red, pinto, and kidney beans as the highest antioxidant foods.


I consider beans high-powered nutrition.  A half cup serving of beans provides about 7 grams of protein.  Many varieties of beans are great sources of the B-vitamins, folate and thiamine.   Most bean varieties are great sources of other key nutrients, including calcium, magnesium, potassium, phosphorus, manganese, zinc and iron.  Beans contain an average of 25 grams of primarily complex carbohydrates per serving. 


One half-cup serving may also contain up to 7 grams of fiber.  Deficient intake of water and fiber are among the most common nutritional problems in our country today. (Current recommendations suggest that adults consume 21-38 grams of dietary fiber per day, depending on age and gender.)  Another major benefit of beans is that they have a low glycemic index, and produce a moderate increase in blood glucose and insulin levels.  This makes them particularly helpful in the metabolic control of diabetes and "metabolic syndrome". Some studies have shown that the slower release of glucose and the increased satiety from beans may also enhance the effectiveness of weight-reducing diets.


Another advantage of beans is that they can be stored for a relatively long period of time. They will keep their quality for 6-12 months, perhaps even longer, if stored correctly, in a cool, dry place. They are sold in many forms and varieties.  Lima beans provide an example of fresh seeds, and dried seeds include black-eyed peas.  Beans are generally easy to prepare.  They are versatile and can be served as the main entrée, added to soups or stews, or served as a side dish. 


Among the most common complaints about beans is their tendency to produce flatulence (excess gas).   Dried beans should be soaked in water for about 8 to 10 hours, before cooking, replacing the water every few hours.  Adding a little baking soda (1 or 2 teaspoons) will also help.  Soaking with water and baking soda, and then slow-cooking the beans will help reduce the gas-forming compounds, and make them more digestible.  If the above fails, try using over-the-counter products containing enzymes which help break down the complex carbohydrates in beans.


In addition, cooking with herbs and spices such as fennel, anise, turmeric, lemongrass, dill, oregano, rosemary, cilantro, and bay leaf may also reduce the gas and intestinal symptoms associated with eating beans.  The Lyme Inflammation Diet (from The Lyme Disease Solution, Chapter 5) introduces beans and legumes including, lentils, peas, pinto, kidney, black, and navy in Phase II of the 4-phased meal plan.  (Soy and soy products are not introduced into the diet until Phase III.) The goal of the Lyme Inflammation Diet (LID) is to support immune function by eliminating pro-inflammatory and allergenic foods.  The LID emphasizes antioxidant rich foods, slow digesting carbohydrates, high fiber, quality fats and protein foods that reduce inflammation in the body.


The following bean recipe fits well into Phase II of the Lyme Inflammation Diet. 


Black-eyed Pea (or Lentil) Salad with Basil Dressing



3 cups canned or cooked black-eyed peas (drained) Lentils may be used in place of black-eyed peas

1/4 teaspoon sea salt

1/2 cup finely chopped onion

1/2 cup finely chopped celery

1/2 small sweet red bell pepper, finely chopped (add only when in Phase III of the LID)


Basil Dressing


1/4 cup cider vinegar

3 tablespoons chopped fresh basil, or 1 teaspoon dried

2 medium cloves garlic, crushed

1 1/2 teaspoons honey

1/4 teaspoon sea salt

3/4 cup extra virgin olive oil

Garnish with fresh basil or parsley



In a serving bowl, combine black-eyed peas (or lentils), sea salt, chopped onion, celery, and red bell pepper (remember:  add red bell peppers only if in Phase III of the LID). Set aside.


In a small bowl or other container, whisk together the vinegar, olive oil, basil, garlic, honey, remaining 1/4 teaspoon salt.  Combine basil dressing with black-eyed pea or lentil mixture.  Allow to marinate for at least 1 hour.  Enjoy!
Have a great month and I'll send you the next LDS Newsletter in about a month.  Again, feel free to forward this email to a friend that you think could use the info.
Next month I plan to cover the following important topics:
  • a comprehensive review of Dr. Bransfield's article:  Lyme Disease, Comorbid Tick-Borne Diseases, and Neuropsychiatric Disorders,
  • a discussion of an important nutritional product called "acetylglutathione",
  • a detailed article about a little-known condition called "pyroluria", and
  • much, much more
Stay positive and be blessed!
Dr. Singleton