Episode 604: Lyme 3.0: Beyond Killing Infections to Healing the Body – Dr. Todd Maderis | LIVE from ILADS

What if treating Lyme disease is only part of the recovery process—and the next frontier is helping the body repair the damage left behind?

In this LIVE from ILADS interview, Tick Boot Camp co-host Rich sits down with Dr. Todd Maderis, ND, founder of Marin Natural Medicine Clinic in Northern California, to explore what he calls “Lyme 3.0”—an evolving approach to complex chronic illness that looks beyond infections to consider immune function, environmental exposures, cellular repair, and long-term recovery.

Recorded at the 2025 International Lyme and Associated Diseases Society (ILADS) Conference in San Antonio, Texas, the conversation explores why some patients continue experiencing fatigue, brain fog, and neurological symptoms even after receiving treatment for Lyme disease and associated infections.

Dr. Maderis discusses the challenges of diagnosing multiple tick-borne infections, the possible roles of mold exposure and heavy metals, the relationship between long COVID and viral reactivation, and how his approach to treating complex chronic illness has evolved since 2012.

The interview also examines emerging diagnostic technologies, including testing from IGeneX, T-Lab, and Galaxy Diagnostics, along with Babesia, Bartonella, alpha-gal syndrome, and practical strategies for preventing tick bites.

His central message: Recovery may require more than identifying and treating infections. For some patients, understanding the factors contributing to persistent symptoms and supporting rehabilitation may be equally important.

Meet Dr. Todd Maderis, ND

Dr. Todd Maderis, ND is the founder and medical director of Marin Natural Medicine Clinic in Marin County, California, just north of San Francisco.

He began focusing on Lyme disease and tick-borne infections in 2012.

Over time, his practice expanded to include patients with complicated medical histories involving several overlapping health conditions.

His areas of clinical interest include:

• Lyme disease, Babesia, Bartonella, and other tick-borne infections
• Mold-related illness and environmental exposures
• Mast cell activation syndrome (MCAS)
• Chronic viral infections, including Epstein-Barr virus (EBV)
• Long COVID
• Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
• Autoimmune conditions
• Persistent fatigue, pain, and cognitive symptoms

Dr. Maderis explains that his approach has evolved as he has encountered patients with increasingly complicated combinations of symptoms and diagnoses.

He also shares research and educational information through social media to help patients better understand emerging developments in complex chronic illness.

What Is Lyme 3.0?

One of the most compelling parts of this conversation is Dr. Maderis's explanation of how Lyme disease treatment has evolved.

He describes three stages in the development of his clinical thinking.

Lyme 1.0: Focusing on the Infection

Early treatment approaches primarily emphasized identifying and treating the infectious organisms responsible for Lyme disease and associated conditions.

Dr. Maderis explains that clinicians initially focused heavily on reducing the infectious burden.

Antimicrobial treatment remains essential when a patient has an active infection requiring treatment.

However, he began questioning whether infection-focused interventions alone could explain every patient's ongoing symptoms.

Lyme 2.0: Recognizing Additional Health Conditions

As his practice evolved, Dr. Maderis increasingly evaluated patients for other medical problems occurring alongside tick-borne infections.

These included mold-related concerns, mast cell activation syndrome, chronic viral infections, and autoimmune conditions.

He describes learning about mold-related illness at an ILADS conference around 2013 as a turning point in his clinical career.

That presentation encouraged him to consider environmental exposures in patients whose symptoms were not fully explained by their existing diagnoses.

Lyme 3.0: Recovery, Repair, and Rehabilitation

Dr. Maderis believes the next stage involves understanding what patients may need after appropriate treatment of infections and other identified medical conditions.

He points to people who continue experiencing symptoms such as:

• Persistent fatigue
• Brain fog and cognitive difficulties
• Reduced physical endurance
• Neurological complaints
• Difficulty returning to previous activities

He discusses cellular and mitochondrial health as areas of interest when considering why some patients struggle to regain their previous level of functioning.

His concept of Lyme 3.0 emphasizes the importance of rehabilitation and recovery rather than viewing treatment exclusively as an effort to eliminate pathogens.

This is Dr. Maderis's framework, not an established medical classification or a validated treatment protocol. Persistent symptoms after Lyme disease treatment can have multiple causes and require individualized medical evaluation.

Why Some Lyme Patients Have Multiple Contributing Health Problems

Rich asks Dr. Maderis why clinicians appear to be identifying more complicated cases involving several infections or overlapping medical conditions.

Dr. Maderis believes several developments may be contributing to this observation.

Diagnostic technologies have evolved, clinicians have become more aware of tick-borne co-infections, and geographic patterns of tick exposure continue to change.

He also discusses environmental exposures and the possible effects of other illnesses on immune function.

Dr. Maderis groups the factors he considers into three broad categories:

Infectious factors: Tick-borne infections and other clinically relevant infectious diseases.

Environmental factors: Mold exposure, toxic metals, and other exposures that may warrant investigation.

Traumatic factors: Physical injuries, including head trauma, and psychological stress or trauma that may affect health and recovery.

He explains that some patients arrive with several potential contributing conditions rather than one straightforward diagnosis.

His challenge is determining which findings are clinically significant and which require treatment.

The conversation highlights why complex cases benefit from careful differential diagnosis rather than assuming every symptom has the same underlying cause.

Lyme Disease, Long COVID, and Epstein-Barr Virus Reactivation

Rich and Dr. Maderis discuss whether COVID-19 can influence previously controlled infections.

Dr. Maderis references research investigating the relationship between SARS-CoV-2 infection, immune changes, and Epstein-Barr virus reactivation.

Some studies have identified associations between EBV reactivation markers and long COVID.

He raises the possibility that changes in immune function following COVID-19 could also affect other infections.

However, the extent to which SARS-CoV-2 may cause reactivation of Borrelia infection remains uncertain.

The discussion illustrates an important research question: How do multiple infections and immune responses interact in patients experiencing prolonged symptoms?

Dr. Maderis believes clinicians should remain aware of emerging findings while recognizing that the science continues to develop.

Why a Positive Lyme Antibody Test Doesn't Always Mean Active Infection

Rich and Dr. Maderis discuss the distinction between detecting an infection and detecting evidence of a previous immune response.

Antibody tests measure the immune system's response to an organism rather than directly identifying whether that organism is currently present.

Antibodies against Borrelia can remain detectable for months or years after successful treatment.

This means a positive antibody test does not necessarily establish an active infection.

Conversely, testing early in an infection can produce negative results before detectable antibodies have developed.

Dr. Maderis believes clinicians must interpret results alongside symptoms, medical history, exposure risk, and other clinical findings.

This distinction is particularly important for patients who undergo repeated testing while trying to understand persistent symptoms.

Advanced Lyme Disease and Co-Infection Testing

Dr. Maderis explains that he uses several specialty laboratories when evaluating patients for Lyme disease and associated infections.

He discusses how different testing methods may provide different types of information.

IGeneX: Lyme Disease and Co-Infection Panels

Dr. Maderis describes IGeneX as one of the foundational laboratories he uses when evaluating patients for tick-borne infections.

The laboratory offers testing for Lyme disease and several associated infections.

He explains that he frequently orders comprehensive panels during initial evaluations when the patient's history supports investigation for multiple tick-borne pathogens.

T-Lab: Direct Detection Methods

Dr. Maderis also discusses T-Lab, which uses specialized microscopy and molecular methods intended to detect organisms more directly.

He contrasts these methods with antibody-based testing.

The potential advantage of direct detection is that it attempts to identify evidence of the organism rather than relying solely on the patient's antibody response.

However, the diagnostic accuracy, clinical validation, and appropriate use of individual specialty tests must be evaluated carefully.

Galaxy Diagnostics: Bartonella Testing

Dr. Maderis identifies Galaxy Diagnostics as another laboratory he uses, particularly when investigating Bartonella infection.

He discusses the laboratory's expanded Bartonella testing methods and describes a patient whose infection was detected after earlier testing through other laboratories had been negative.

This experience reinforced his belief that different testing methods may sometimes produce different findings.

For a deeper exploration of Bartonella diagnostics, Tick Boot Camp previously interviewed Nicole Bell of Galaxy Diagnostics about the challenges of detecting tick-borne infections.

No single test can definitively diagnose or exclude every tick-borne disease. Patients should work with qualified clinicians to determine which tests are appropriate and how results should be interpreted.

Mold Exposure, Mycotoxins, and Chronic Illness

Dr. Maderis explains that environmental medicine became an increasingly important part of his practice after attending an ILADS presentation on mold-related illness.

He now considers environmental exposures when evaluating selected patients with complicated symptoms.

The interview distinguishes between investigating a patient's environment and assessing possible exposures within the body.

Testing the Home for Mold

When a patient's history suggests possible mold exposure, Dr. Maderis may recommend an initial home screening.

Depending on the findings, he may suggest a more thorough evaluation by a qualified environmental professional.

The conversation emphasizes identifying possible sources of exposure rather than relying exclusively on medical testing.

Urine Mycotoxin Testing

Dr. Maderis explains that he uses urine mycotoxin testing in his practice.

Mycotoxins are substances produced by certain molds, and exposure can occur through different environmental and dietary sources.

However, the clinical usefulness of urine mycotoxin testing for diagnosing mold-related illness remains uncertain. Such tests are not established as reliable diagnostic tools for determining whether a person's symptoms are caused by indoor mold exposure.

A comprehensive assessment should consider exposure history, environmental conditions, symptoms, and established medical diagnoses.

Heavy Metals, Immune Function, and Environmental Testing

Dr. Maderis also discusses exposure to toxic metals, particularly lead and mercury.

He explains that certain metals can remain in the body long after an exposure has ended.

Lead and mercury can produce significant health effects, including neurological and other systemic complications.

Dr. Maderis considers these exposures when a patient's history or symptoms suggest they may be relevant.

He also acknowledges an important limitation: clinicians cannot routinely test for every chemical encountered in the environment.

The discussion reinforces the importance of selecting tests based on credible exposure history and established clinical indications.

Suspected toxic metal exposure should be evaluated using validated testing methods. Unnecessary testing or unproven detoxification treatments can create additional risks.

Babesia on the East Coast and West Coast

Rich asks Dr. Maderis whether he has noticed changes in Babesia infections among his California patients.

Dr. Maderis explains that clinicians historically associated Babesia microti more strongly with the eastern United States and Babesia duncani with the West Coast.

However, he believes geographic assumptions can be misleading.

He reports encountering different Babesia species in his practice and mentions growing clinical interest in Babesia odocoilei.

Rich shares that he has also observed more Babesia-related concerns in the Lyme disease community on Long Island.

Their discussion highlights the importance of considering geography, travel history, tick exposure, and appropriate diagnostic methods.

Babesiosis is a potentially serious tick-borne disease, particularly for older adults and people with weakened immune systems.

The geographic distribution and human disease significance of individual Babesia species vary, and emerging laboratory findings should not be confused with established population-level prevalence data.

Alpha-Gal Syndrome and the Lone Star Tick

The conversation shifts to alpha-gal syndrome, a potentially serious allergic condition associated with sensitization to a sugar molecule called alpha-gal.

In the United States, alpha-gal syndrome is strongly associated with bites from lone star ticks.

Affected individuals may experience delayed allergic reactions after consuming certain mammalian meat products or encountering other alpha-gal-containing substances.

Dr. Maderis explains that he had not encountered a confirmed case in his California practice at the time of the interview.

Rich contrasts that experience with the prevalence of lone star ticks on Long Island and in other parts of the eastern United States.

They also discuss reports of alpha-gal syndrome on Martha's Vineyard and the possibility of changing tick distributions.

Because alpha-gal syndrome can cause severe allergic reactions, suspected cases should be evaluated by an appropriately qualified healthcare professional.

Could Genetically Modified Mice Help Prevent Lyme Disease?

Rich asks Dr. Maderis about a proposed strategy involving genetically modified mice on Martha's Vineyard.

The idea involves altering the relationship between mice, ticks, and Borrelia bacteria to potentially reduce the transmission of Lyme disease.

Mice are important reservoir hosts for certain tick-borne pathogens, making them a focus of disease-prevention research.

Dr. Maderis expresses concern about introducing genetically modified animals into the environment.

He favors emphasizing established prevention strategies and public education.

This exchange illustrates the broader debate surrounding emerging environmental approaches to reducing tick-borne disease risk.

Potential ecological interventions require careful scientific evaluation, environmental oversight, and community engagement.

How to Perform a Thorough Tick Check

The interview concludes with one of its most practical discussions: preventing tick bites.

Dr. Maderis and Rich agree that regular tick checks are an important part of reducing exposure to tick-borne diseases.

Rich explains that he checks himself twice daily and emphasizes the importance of using both sight and touch.

Dr. Maderis recommends examining the entire body after outdoor activities, particularly when spending time in wooded, grassy, or other tick-prone environments.

Important areas to inspect include:

• Behind the knees
• Under the arms
• Around the waist and groin
• Behind and inside the ears
• Along the scalp and hairline
• Around the back and other hard-to-see areas

Children may need help from a parent or caregiver, while adults can benefit from a partner checking areas they cannot easily inspect.

A shower after outdoor exposure can help remove unattached ticks and provides an opportunity for a thorough examination.

Rich also describes using his fingertips to feel for small attached ticks that might be difficult to see.

If you find an attached tick, remove it promptly with fine-tipped tweezers, grasping it close to the skin and pulling upward with steady pressure.

For a step-by-step guide to prevention, removal, and what to do after a bite, explore the Tick Boot Camp Tick Bite Blueprint.

Key Takeaways

• Lyme 3.0 emphasizes recovery and repair. Dr. Maderis believes some patients need additional evaluation and rehabilitation after treatment of identified infections.
• Complex chronic illness may involve overlapping conditions. Tick-borne infections, environmental exposures, and other diagnosed medical problems can complicate evaluation.
• Long COVID and viral reactivation remain important research topics. Their relationship with persistent symptoms continues to be investigated.
• Testing methods have different strengths and limitations. Dr. Maderis discusses antibody-based testing, direct detection, and specialty laboratories.
• Mold and toxic metal exposures warrant evidence-based assessment. Testing should be guided by medical history and validated methods.
• Babesia and alpha-gal syndrome deserve greater awareness. Tick-borne health risks vary by geography and exposure.
• Persistent symptoms deserve careful evaluation. Continued fatigue or cognitive difficulties do not automatically establish ongoing infection.
• Prevention remains essential. Regular tick checks and prompt tick removal can reduce the risk of tick-borne illness.

About This LIVE from ILADS Interview

This conversation was recorded at the 2025 International Lyme and Associated Diseases Society Conference in San Antonio, Texas.

Rich interviews Dr. Todd Maderis about his evolving approach to Lyme disease and complex chronic illness, including infection-focused treatment, environmental medicine, diagnostic testing, and rehabilitation.

The discussion also explores the changing landscape of tick-borne infections and the importance of public education.

Discover more interviews with physicians, researchers, and advocates through Tick Boot Camp's LIVE from ILADS podcast series.