Why Can’t I Get a Positive Lyme Test? Limitations of Antibody Testing – Part 1: Suppressed Immune Function

I am fond of saying that everyone in Maine has a little bit of Lyme. Though there is some seasonal fluctuation in the tick population, in a year such as this, when ticks are out in full force, it is virtually impossible to not have some exposure. What matters is the state of the individual’s immune system when the bite occurs.

A robust immune system reacts to a bite in the textbook manner. The person develops a visible immune reaction around the bite and constitutional symptoms such as fatigue, flu-like symptoms, arthritis, Bell’s Palsy, and others may show up fairly quickly. These are the easy cases that result in an accurate diagnosis and symptoms typically resolve with antibiotics.

Unfortunately, the textbook reaction that leads to appropriate diagnosis and treatment only occurs in a small fraction of Lyme cases. If the patient’s immune system is at all suppressed, from mental stress, other infections, allergies, genetics, or poor lifestyle practices, symptoms will not be as evident. When the immune system does not mount this initial reaction to a bite, the infection has the potential to become chronic, complex, undetected, and difficult to diagnose even with the correct blood work.

In this blog post, we explore the most common reason that laboratory testing is negative for Lyme even with all of the symptoms of an infection present. The most common reason for a “false negative” Lyme test is that the immune system is not strong enough to give us an accurate answer. The two most commonly used methods of testing for Lyme are the Lyme Antibody screen and the Western Blot.

Both are based on the immune system’s reaction to the infection, measured in antibodies. Antibodies are proteins that the immune system makes in response to an infection. The Western Blot divides the Lyme antibody into 10 different protein strands, thereby increasing the sensitivity of the test significantly.

For a positive diagnosis, the CDC requires that either the Lyme screen or five or more proteins on the Western Blot are positive. ILADS, or the International Lyme and Associated Diseases Society, requires three or more proteins in the Western Blot are positive for diagnosis. In conventional medicine, if your Doctor suspects Lyme, they will order a Lyme Antibody screen with a “reflex” to Western Blot.

This means that if and only if the Lyme Antibody screen is positive, the Western Blot will then be run. If the antibody screen comes back negative, a Conventional Doctor will rule out Lyme and start to look for other reasons for your symptoms, and/or offer symptomatic treatment. Hence, if your immune system is not strong enough to produce the antibody response necessary to make the test positive, your infection will be undiagnosed.

As a Naturopathic Doctor, my job revolves around treating patients with compromised immune systems. After 12 years in practice, I can now spot a patient who is not likely to be able to mount the immune response necessary to produce an accurate Lyme test. Patterns that I often see in these patients include frequent colds and flu, recurring urinary tract or yeast infections, diverticulitis attacks, recurring sinus and lung infections, frequent shingles, oral cold sores, and the list goes on.

I also have observed a connection between allergies and poor immune system function. I will address this further in future blog posts on histamine dominance, but if respiratory allergies, asthma, IBS, eczema, psoriasis, or auto-immunity are problematic for you, then your immune system is likely spending too much energy making histamine-based allergies and not enough making antibodies and other useful immune functions.

If Lyme is at the top of my differential diagnosis for a patient and I suspect they may also have a compromised immune system, aside from running a Western Blot, I also check the patient’s total antibody pool. This is a measure of how many total antibodies, not just to Lyme, are in the patient’s system. The level tells me if the patient is making enough antibodies to use the Western Blot as a diagnostic tool.

If the patient is not making enough total antibodies, it is highly unlikely that we will get a positive Lyme test even if there is an infection there. In these cases, the first project becomes priming the immune system to make more antibodies in general. We do this not only to get an accurate diagnosis but also so that the patient’s immune system can start to fight infections appropriately.

Depending on how sensitive the patient is, this strategy can involve basic nutrients, herbs, and natural sources of antibodies from bovine colostrum. As these strategies are implemented, signs that the immune system is “waking up” are often apparent. The patient has fewer colds and recurring infections (UTI, yeast infections, pneumonia, etc.)

They may start to show signs of inflammation including fatigue and joint pain. These are indications that the immune system is starting to “notice” the Lyme infection. This is a delicate process that often requires many adjustments. I recommend doing this under the guidance of a Lyme Literate Doc.

Stay tuned for my next blog post on this subject:

Why Can’t I get a positive Lyme Test? Limitations of Antibody Testing Part 2: Biofilm Presence in which we explore how long-term Lyme infection can keep itself hidden from the immune system.

Corrie Marinaro, ND is the Owner and Medical Director of New England Naturopathic Health in Waterville, Maine. Her clinic specializes in the treatment of chronic diseases in all age groups, including tick-borne illness, Mycotoxin illness, and complications arising from these root causes. The medical opinions expressed in these blog posts are the result of her 12 years of experience diagnosing and treating chronically ill patients.

These posts are intended to provide some insight to sufferers of chronic disease, their families, and communities that support them. Strategies outlined in these posts are intended to be implemented under the supervision of a medical professional. For more information about Dr. Marinaro’s practice, please visit naturopathicme.com.