*Updated by Eric Chan, ND April 2021
Ozone therapy is the most useful adjunctive, and in some cases, primary treatment for patients with lyme disease that I have found. While this page is more specific for the use of this treatment in patients with a history of lyme or similar infection, and persistent symptoms, you can read more about the mechanisms of ozone therapy and references in this linked page.
Rationale for ozone therapy in lyme disease
Ozone therapy plays an important role in my treatment of lyme disease. Chronic lyme is always a see-saw between an adequate immune system that holds the spirochetes at bay, and thus the patient is without symptoms, in remission, or has rid the infection, and between an immune system that is not able to keep spirochete numbers in check, and thus patients need longer courses of antimicrobial therapy, often natural and on occasion antibiotics.
Antimicrobials can be used to lower the burden of active infection (especially if elispot testing is found to still show active immune response against infection). Antimicrobial herbs can be very useful as they do not disrupt the gut bacteria as much as the prescription antibiotics. A gut microbiome further affected by medications may affect the immune system negatively as well.
Ozone therapy may speed up the ability of the immune system to catch up, improves symptoms and circulation, and protect the liver.
1) Effects on the immune system with ozone therapy
Vaccines are widely known to prevent certain diseases by inducing an immune response, and thus if a patient is exposed to the same infectious agent, then an antibody response is mounted and infection tends to be milder or not occur. It was thought previously that vaccines were only useful for prevention. After all, if a patient had the actual infection, that patient's immune system would theoretically be saturated with all the "antigen" or foreign material from the infectious agent, and thus a maximal immune response would already be stimulated.
It turns out however, that vaccines given during an illness can be curative also. The most likely explanation is that vaccines present infectious "antigens" in a slightly different form from the natural infection. A slightly different stimulation could mount a different, possibly more effective immune response. Another possibility is that different routes of administration (eg injection into the muscle) other groups of immune tissue become active and thus immune cells can bypass blockades that might be present in the natural infection.
In the case of chronic infections, ozone therapy theoretically introduces foreign lyme antigens from the blood into foreign sites such as the muscle and the fat, activating different immune sites (minor autohemotherapy.) The immune stimulation is aided by inflammation from the blood now outside of the blood vessel, fats in the blood, and of course by the ozone.
Ozone is also a mild, but very broad, cytokine inducer. Cytokines are chemicals that both stimulate and regulate the immune response, depending on the balance between them. The broad induction seems to have a regulatory effect in most cases, as seen by some patients responding with reduction in pain, fatigue, brain fog. In some cases, the broad stimulation temporarily worsens symptoms, and after a few treatments there is no clear improvement - in such cases the treatment is unlikely to be useful. One article linked here describes the use of ozone therapy in fibromyalgia, with subsequent response in pain. If you would like to see how ozone therapy can fit into a multifaceted naturopathic approach to fibromyalgia, the linked article has more detail as well.
To follow the immune system, the CD57 subset of natural killer cells of the immune system can be quantified. In lyme it is often low, with very sick patients being below 20, and average 40-60. Of note, there is newer research that shows CD57 can be associated with infections other than lyme, and also research showing CD57 may be more if an immunoregulatory cell and not directly associated with infection. You can read more about my approach to testing in lyme and similar illnesses in the linked article.
2) Ozone therapy: chronic infection and inflammation symptoms and circulation
Ozone therapy may be recommended for patients with brain fog, fatigue and joint pain. It also may be recommended when patients are having Herxheimer die off reactions with antibiotic therapy. Chronic infections typically increase inflammation in the blood, increasing the thickness and viscosity of the blood.
The mild stress of ozone on red blood cells helps them to increase their glutathione, and helps them to unload oxygen to the tissues. A course of ozone therapy is typically done twice a week for 3-6 weeks, and then sometimes maintained at every 2-4 weeks until well, or stopped in other cases. This can be one of the treatment options discussed for patients with circulatory problems, depending on the diagnosis.
3) Ozone therapy protects the liver
The creation of peroxides from ozone therapy, on reinfusion intravenously, delivers a mild stress to the liver. The mild biochemical stress stimulates the liver to increase its glutathione, the main antioxidant it uses for detoxification. It has been shown to protective in cases of hepatitis. Animal studies on ozone (and selenium) reduced liver injury in alcohol toxicity in rats, as well as reduced injury in acetaminophen toxicity in mice.
Another study done in humans, looked at liver enzyme reduction (a marker of improvement for liver inflammation) as well as hepatitis C RNA levels in chronic hepatitis C patients. They compared 40 sessions of ozone therapy for hepatitis to milk thistle therapy:
Results: There were significant improvements of most of the presenting symptoms of the patients in the ozone group in comparison to the conventional group. ALT and aspartate transaminase (AST) levels normalized in 57.5% and 60% in the ozone group, respectively, in comparison to 16.7% and 8% in the conventional group, respectively. Polymerase chain reaction (PCR) for HCV RNA was negative among 25% and 44.4% after 30 and 60 sessions of ozone therapy, respectively, in comparison to 8% among the conventional group.
Conclusions: Ozone therapy significantly improves the clinical symptoms associated with chronic hepatitis C and is associated with normalized ALT and AST levels among a significant number of patients. Ozone therapy is associated with disappearance of HCV RNA from the serum (-ve PCR for HCV RNA) in 25%-45% of patients with chronic hepatitis C.
References for ozone therapy
Studies on the biological effects of ozone: 5. Evaluation of immunological parameters and tolerability in normal volunteers receiving ambulatory autohaemotherapy.Bocci V, Luzzi E, Corradeschi F, Paulesu L.Biotherapy. 1993-1994;7(2):83-90. A reasonable Approach for the Treatment of HIV Infection in the Early Phase with Ozonetherapy (Autohaemotherapy). How 'Inflammatory' Cytokines may have A therapeutic Role. Bocci V.Mediators Inflamm. 1994;3(5):315-21.Bocci V, Zanardia I, Valacchi G, Borrelli E, Travagli V. 2015. Validity of Oxygen-Ozone Therapy as Integrated Medication Form in Chronic Inflammatory Diseases. Cardiovasc Hematol Disord Drug Targets. 2015;15(2):127-38.
Giunta R, Coppola A, Luongo C, Sammartino A, Guastafierro S, Grassia A, Giunta L, Mascolo L, Tirelli A, Coppola L. 2001. Ozonized autohemotransfusion improves hemorheological parameters and oxygen delivery to tissues in patients with peripheral occlusive arterial disease. Ann Hematol. 2001 Dec;80(12):745-8.
Valacchi G, Bocci V. 2000. Studies on the biological effects of ozone: 11. Release of factors from human endothelial cells. Mediators Inflamm. 2000;9(6):271-6.
Inal M, Dokumacioglu A, Özcelik E, Ucar O. 2011. The effects of ozone therapy and coenzyme Q₁₀ combination on oxidative stress markers in healthy subjects. Ir J Med Sci. 2011 Sep;180(3):703-7.
Wu XN, Zhang T, Wang J, Liu XY, Li ZS, Xiang W, Du WQ, Yang HJ, Xiong TG, Deng WT, Peng KR, Pan SY. 2016. Magnetic resonance diffusion tensor imaging following major ozonated autohemotherapy for treatment of acute cerebral infarction. Neural Regen Res. 2016 Jul;11(7):1115-21.
Smith NL, Wilson AL, Gandhi J, Vatsia S, Khan SA. 2017. Ozone therapy: an overview of pharmacodynamics, current research, and clinical utility. Med Gas Res. 2017 Oct 17;7(3):212-219.
Molinari F, Simonetti V, Franzini M, Pandolfi S, Vaiano F, Valdenassi L, Liboni W. 2014. Ozone autohemotherapy induces long-term cerebral metabolic changes in multiple sclerosis patients. Int J Immunopathol Pharmacol. 2014 Jul-Sep;27(3):379-89.