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ILADEF > Decoding Complex Inflammatory Illness: ILADS’ Expert Insights for Comprehensive Understanding

Author: Dr. Cory Tichauer, ND

The International Lyme and Associated Diseases Society (ILADS) is a nonprofit, international, multidisciplinary medical society dedicated to the diagnosis and treatment of Lyme and other complex inflammatory diseases. With these educational blog posts from experts and members of our board, ILADS aims to promote awareness and understanding of health and wellness, especially as it relates to complex inflammatory diseases, so that we can all learn and grow together. If you have any questions or want more information, you can email us at

Disclaimer: Every patient is an individual with unique characteristics. This blog article is not medical advice. It does not constitute a physician-patient relationship. It is for educational purposes only. Do not try out what is in this article without medical advice, working with your licensed physician and licensed healthcare providers. 


From a young age, I was drawn to a career in medicine — specifically the puzzle of how to treat the growing numbers of abandoned and dismissed patients suffering with chronic, complex illnesses such as fibromyalgia, seronegative joint pain, recalcitrant headaches, chronic fatigue, neurodegeneration, psychiatric illness, and autoimmunity. After completing my premedical studies in neurobiology, choosing to enroll in an accredited four-year naturopathic medical school became the obvious choice for me to better understand the underlying cause of chronic illness and develop an integrative approach to treatment.  

It was not long after beginning practice in 2004 that I realized the magnitude of this undertaking. I soon realized that many of those suffering with these “functional” symptoms also had underlying infection(s) that were either the initial trigger or the ongoing cause of their suffering. Not uncommonly, these infections were vector-borne in origin. 

From 2007 to 2009, I had the privilege to work with some of the leading pioneers treating Lyme disease, and in 2010 I joined ILADS to both network with like-minded practitioners as well as to support my own thirst for knowledge. ILADS, particularly their scientific fundamentals workshop and physician mentorship training program, provided an evidence-based framework to better assist me in diagnosing and treating these infections. This was a critical step that helped me to develop a more well-rounded understanding of complex inflammatory illness.  

In this regard, ILADS provides more than just a primer on Lyme and other tick-borne diseases.  The complexity of these intracellular infections extends far beyond simply prescribing antibiotics or working with herbal antimicrobial therapies. The interactions of these organisms, the response of the host immune system, damage done to cellular and organ function, comorbid conditions, and the presence of environmental toxicants all factor into how each patient must be approached individually and given the time, attention, and care needed to properly diagnose, treat, and support their recovery. I consider ILADS the premier organization consistently educating and supporting both providers and the public to keep asking the deep, difficult questions underlying chronic illness and to continue seeking answers toward a common goal of restoring wellness.    

The Key Components of a Comprehensive Treatment Plan For Someone Dealing With Complex Inflammatory Disease

I’ve described my medical practice as a Venn diagram involving (chronic) infection, immune dysfunction, environmental medicine, and structural deficits. The challenge with each patient is understanding the interplay between these overlapping issues and how to create a proverbial fulcrum to disentangle things. 

In this paradigm, identifying the dominant and ancillary issues are the key components to developing a comprehensive treatment plan. For someone who was healthy until an ill-fated camping trip, focusing on the treatment of infection may be the most important component; whereas another who already has documented autoimmunity or chronic inflammation may need more attention to normalizing a healthy immune response. The person with hypermobility, neurovascular compression, or apnea will likely need treatment to stabilize these issues and, similarly, someone who has been sick since a prolonged mold or solvent exposure will almost certainly need to eliminate these toxins before their bodies will respond to other interventions. As with the Venn diagram, the chronically ill patient typically has several of these issues that interact and enable progression of disease.  

In each of these various scenarios, treatment will involve a myriad number of possible therapies that are designed to “unstick” the progression of illness and create a synergy to support this positive momentum in each individual. The range of options includes an ever-growing list that commonly includes prescription and herbal antimicrobials, biofilm therapies, immunomodulation, phospholipid exchanges and detoxification strategies, physical therapy, prolotherapy (an injection treatment used to relieve pain), dietary modification, biome restoration, anti-inflammatories, nutraceutical and epigenetic support, and neuropsychiatric stabilization.  

My Approach to Diagnosing Lyme, Tick-Borne, and Associated Diseases

I typically begin by gaining a thorough and detailed medical history over an initial several-hour appointment to establish risk factors such as a tick-bite, erythema multiforme (EM) rash, progressive onset of symptoms, and other pertinent information. Based on their responses, this is commonly followed by a lab assessment designed to provide context to their illness. I often describe this first round of lab testing as akin to throwing out a net in order to gain a broad view of the situation.  

For tick-borne diseases, I often start with a standard-of-care model involving antibody or immunoblot screening tests to see if the person has immune recognition characteristic of infection. This is typically paired with an assessment designed to look at the health of their immune system, including natural killer cells, T and B cells, and antibody production. If any of these results are ambiguous or concerning, I may suggest additional testing to provide clarity.  This might involve a different indirect test such as the T cell-based Elispot and/or direct testing such as a polymerase chain reaction (PCR) or fluorescence in situ hybridization (FISH). Of course, I may also be recommending imaging or other laboratory tests to better understand both their overall health status as well as other potentially contributing issues such as autoimmunity, chronic inflammation, viral reactivation, mast cell activation syndrome (MCAS), mycotoxin illness, hypercoagulation (a condition where blood clots too easily), endocrine dysfunction, and others.  

Alternatively, if someone has clear or characteristic risk factors (such as a recent tick bite), I may also choose to trial a clinical intervention at their initial appointment either in addition to or in lieu of lab assessment. This may include natural antimicrobials targeted for Lyme patients, select antibiotic therapy, or a completely different treatment that is tailored to either improve the person’s health and/or give insight into other potentially contributing issues.  

Underlying Causes Behind Complex Inflammatory Illness

As per my Venn diagram analogy, the etiology of complex inflammatory illness is often multifactorial with more than one factor coming together to create the “perfect storm” of events. This might be a new or reactivated pathogen or infection causing damage to the system; a reaction by the body that causes chronic immune-driven inflammation or autoimmunity; an obstacle to recovery that interferes with healthy physiology and disrupts cellular biochemistry, such as mold toxins, solvents, or heavy metals; a mental-emotional trauma; or a breakdown of structural stability that affects organ function or contributes to dysautonomia (disorders that disrupt your autonomic nervous system), as seen in conditions like Ehlers-Danlos syndrome.  

Future Advancements in Treatment of Lyme Disease and Complex Inflammatory Disease

I believe the best outcomes are the product of treatment “synergy.” In this model, an integrative approach is nearly always superior to either a naturopathic or allopathic (treating symptoms and diseases using drugs, radiation, or surgery) stand-alone protocol. This method allows for the coexistence of both a health- and disease-based model where the provider is focusing not only on the treatment of what is wrong with the patient, but also ensuring that they are simultaneously addressing what is not right.  

While this might sound like a tongue twister, it simply means that the body is not always capable of self-resolving an infection, eliminating a toxin, or controlling an inflammatory cascade on its own. Providing both antimicrobial therapy while boosting immunity, supporting organs of elimination while giving binders, or prescribing anti-inflammatory medication while identifying and avoiding other contributing factors are all examples of this concept.  

From this perspective, I am hopeful that future advancements will focus less on perpetuating a mechanistic model where single interventions, such as a new antibiotic or immunotherapy, are scrutinized with as few variables as possible and move toward a more inclusive, vitalistic model where the proverbial whole is greater than the sum of its parts. For providers familiar with the treatment of Lyme disease, this is already self-evident in many ways. We know that antibiotics work better with biofilm therapy, and this combination works even better when a patient is given support to boost innate immunity. We know conditions like MCAS or long COVID respond best when inflammation and immune reactivity are reduced in conjunction with supporting the parasympathetic nervous system and restoring disturbed cellular and mitochondrial function. 

I also think that many natural therapies that have potential benefit are being overlooked due to a lack of research, which only further perpetuates the stigma and cycle of criticism that these treatments are ineffective. Unfortunately, in the world we live in today, there is very little funding for these research projects, as it is not possible to patent or capitalize from the results. I do think that traction is moving in this direction as patients and providers are beginning to realize that chronic inflammatory illness is best treated through a rational and synergistic approach. As an example, studies looking at the effectiveness (MIC assay) of herbal and “off-label” therapies for Lyme, Bartonella, or Babesia have already refined how supplement companies and practitioners tailor their products and recommendations. If given a little time and effort, these types of small-scale research projects and/or case presentations can create large waves that eventually benefit millions of people.  

At my clinic, we were fortunate to obtain a private grant that allowed us to study the effects of high-dose vitamin C in CDC+ Lyme disease patients [Tichauer, C. et al., 2024. High dose intravenous vitamin c for Lyme disease: a safety and tolerability study with an exploratory assessment of treatment efficacy. Medical Research Archives, [online] 12(1).]. While the sample size was small, the results were very encouraging and indicated significant improvement in both CD57+ lymphocyte and white blood cell counts. Anxiety, fatigue, depression, and pain were all ameliorated and three months after completing the study, all enrolled participants were negative on Elispot testing. This type of study paves the way to ask whether results would have been even better if done in conjunction with antibiotics, hyperbaric treatment, herbal antimicrobials, peptides, detoxification support, and others.  

Ultimately, the hope I have for advancing our understanding of chronic Lyme disease is to initially recognize that a diagnosis is more than just Borreliosis or a simple infection that can be resolved with a single antibiotic course. Lyme disease is a complex of issues that begins with an infection from Borrelia but, over time, grows to involve chronic inflammation, immune dysregulation, and potential autoimmunity; cellular and mitochondrial dysfunction; and tissue injury and neuropsychiatric stress. Until we can embrace the concept of Lyme as a constellation of issues that requires not only antimicrobial and biofilm therapies, but also supportive measures to restore the health of the patient and remove obstacles impeding cure, we likely will continue to focus resources on the same issues of bacterial persistence, morphological variants, and the potential co-infections. 

You can contact Dr. Cory Tichauer or set up an appointment at Bear Creek Naturopathic Clinic.