Episode 616: How Tick Bites Cause Disease: Monica Cipriani on Lyme Disease, Alpha-Gal & Tick Saliva

Monica Cipriani, welcome to the Tick Prevention Podcast.

Thank you, I'm happy to be here.

It's a long time coming, and as you know, Matt is the Lyme guy, I'm the tick guy. So it's been, it's, it's been a long time coming that you and I have had to have this conversation.

So I'm very excited.

Thank you for making your way out from, uh, from, uh, the other island in New York to—

means the better island—

to Long Island, uh, and thank you for joining us and teaching us how to tick drag, something I've never had the experience of doing.

I had so much fun today.

Yeah.

I'm sure the way I look and smell could vouch for that.

Well, so Monica, give folks a little bit of background. We call you Dr. Monica and you're on the cusp of becoming Dr. Cipriani.

Yes.

But you are now Dr. Cipriani, at least here on the Tick Boot Camp. So talk to us a little bit about your background and what you're currently studying.

Sure. So I started off in microbiology. So I have my bachelor's and my master's in microbiology. And then when I was deciding to get my PhD, I switched over to the epidemiology side of things. I'm a very big proposer for advocacy and education and policymaking, public health. So I thought it was better to switch over to the epidemiology side for what I want to do. And that's what I'm doing now. I focus on tick-borne research out of the state of Kentucky. So love that state. Shout out to my people.

Is there Lyme disease in Kentucky?

Rich, you know, if you ask clinicians there, they will say no, but there is Lyme disease there. There's black-legged ticks there. You know, they migrate and they are there. We have a good habitat for them as well, ecology for them as well, so they are there. But yeah, so I'm focusing, I focused on a lot of surveillance work where I was looking at underreporting, misclassification of Lyme disease, specifically. And then now I switched over to alpha-gal syndrome, and it's a little more translational. I'm looking at immunological components as well as the epidemiology and how those tie together and what the patient experience is for alpha-gal.

But this isn't really just academic for you, right? You are an academic. You are on the cusp of your PhD.

Yes.

But it is also very personal for you as well.

Yes.

So why don't we take off our academic hat and talk about why this is so personal, because Lyme disease has touched Many generations of your family.

Yeah, so I would say around 2012, we started to notice my mother was not herself. It was really alarming in a lot of ways because especially when she first started getting sick, Lyme disease wasn't really a conversation, right? It's still today sort of this diagnosis of exclusion rather than on a differential diagnosis. So almost 20 years ago, it was not even a thought. So little by little, we started to notice. It started off as hives. She would have them all over her body. She had joint pains. And then we started to notice a lot of brain fog, cognitive decline. If you are from Staten Island, there is a high school called Farrell High School. If you are born and raised on Staten Island, you know how to get there from any part of the island. And I will never forget, we were driving there one day. And she sort of pulled over and she just looked really confused and concerned. And she just looked at us and said, where are we going and how do we get there? And I think that's when we noticed there was something really wrong. And long story short, it turned into this series of doctors just rejecting every symptom and doctors telling her that it's psychological and doctors telling her Maybe it's MS, maybe it's, you know, just fibromyalgia. You could just have a lot of pain, chronic pain. And she suffered a really long time and she still battles very much so today. But I would say in 2012, that is when we finally got her diagnosis and the battle began. And that's when I, for the first time, was like, what is this? And how is this not something we're so alarmed about? And it became something where I was like, I need to know more about this and I need to know why this happened to you and why it was so difficult to be recognized. And then unfortunately, unfortunately, I do have a daughter and Well, you have 2 daughters. Well, yeah, I have 2 daughters.

And an awesome husband.

And yes, and they are my world. And a couple years ago— oh my goodness.

We can cry together.

A couple years ago, we started to notice that my very happy little girl was not herself. And We were living in Kentucky at the time, and I would say Kentucky is years behind some places with Lyme disease. So it started off same, very similar as my mother, where she had rashes. And I remember looking at her one day and I saw a very specific rash on her wrist, and I— What was it? looked at Andre and I said, this is very suspicious to me.

Let's give some context. Your husband Andre, he's a doctor.

Yes, he's a neuropathologist. And I looked at him and I said, this looks very suspicious. And, you know, she was sick already. She was very tired. She was very agitated, I would say, more than usual. And she was getting these rashes that were really intense. And her— she wasn't eating. She wasn't sleeping. So we took her to the doctor and I said to her pediatrician, I'm very worried about Lyme disease. And I showed her her wrist and she looked at me and said, Monica, she doesn't have Lyme disease. And little by little, and you know, I'm, sometimes I get so angry with myself because I knew that I should have at that moment press the issue a little more, but her doctor kind of convinced me like, you know, I think you're just overthinking. This could be a viral infection. You know, she's 2. You just had a very long trip. So I let it go, and it seemed her symptoms sort of reduced a little bit, and then very quickly they came back, and it was worse than it was before. And it took us on a series of, I would say, maybe 14 doctors and my daughter becoming very neurologically not herself. She was having a lot of cognitive confusion, which is very unusual for an almost 3-year-old at the time. She was having— she was very irritable. She was— her insomnia was— she was waking up, I would say, every hour. And she was scared. I mean, she was even at the point where she was telling us, you know, Mommy and Daddy, I don't feel good. I don't— this is—

I'm—

I don't feel good. I don't know why I feel this way. I don't want to feel this way anymore. So I just kept pressing the issue. And then she started saying things that were really alarming. where she would just start, my knee hurts, my hip hurts, my fingers are sparkling, my toes are sparkling. And I finally took her to a doc, a neurologist there, actually. And she looked at us and said, you're not getting the help you need here. You need to leave and you need to find help for your daughter. And we did. We left. We came to New York. And She got diagnosed with Lyme disease and we're working through that now. But it's an everyday process and I think that's why I'm so motivated in what I do because I can't— not only as a daughter it was traumatic, but as a mother watching your baby suffer and you just feel so hopeless and helpless. It's really gut-wrenching as a parent to have to deal with that. And I just— if my work could help at all answering questions that could lead to faster diagnoses or better treatment or just more recognition and education as a whole in the community where these conversations aren't so taboo to have, I won. Do you know what I mean?

I do, I do. And I think we are winning. And, you know, one of the things that Matt and I often celebrate over the now 5 years, almost 6 years we've been doing this podcast, is that it is getting better. Diagnoses are faster. It is not taboo. There are more competent doctors. We're seeing people recover at a faster rate. And that's not to say it's not a horrific journey. It is. But it's getting better. And we believe it's getting better because of people like you. People whose lives have been touched by this personally ultimately now use their talents and their gifts. And now the motivation of the personal elements, and in your case, both 2 of the most important women that anyone could ever have in their lives, a mother and a daughter, are now touched by this. So this is your calling. And you couldn't ignore this even if you wanted to.

That's right.

And your husband cannot ignore this even if he wanted to. And that's why we're making so many of the advances that we're making. Why I'm excited about this podcast, and not only because I've really come to enjoy you as a person, but I, I'm looking forward to this ongoing conversation we're having is because we've had many, many guests on this podcast who have shared their personal journeys. We've had many experts on this podcast who are, who are entomologists, who are, who are microbiologists, who are various types of medical doctors. But we've never had someone like you, right, where you have become passionate about the early element of what's happening in the tick bite Lyme disease journey. So let's talk about that. Let's talk about ticks and let's talk about what role they play here because they're a very unique element of this disease and I think it's an often overlooked element of the disease. So why don't we first define what ticks are and I think many people are surprised to learn that ticks are not insects.

They are not. So ticks are arachnids. They're similar to spiders, if you will. They, they're a species of itself where you would call them essentially vectors. They can vector different diseases. They're a part of the zoonotic family. They can transfer different diseases based off what they carry. So there's different species. Today in particular, we're probably going to be talking about the Lone Star tick, which is Amblyomma americanum. The deer tick, or the black-legged tick people know it as, which is Ixodes scapularis. That's what is responsible for Lyme disease. And then the American dog tick is another, you know, very common one. That is Dermacentor variabilis. So they are vectors that harbor many different pathogens. I think Lyme disease, alpha-gal syndrome, Those are the big ones we talk about, but if you look at something like, let's say, we'll take the Lone Star tick for example, it carries many things. So it's right now a hot topic because it's the trigger for alpha-gal syndrome, but it can also carry things like Stari ehrlichiosis, and it can carry viruses like the Bourbon or the Heartland virus. And a lot of these viruses are also things that people don't talk about as much as the bacterial infections. The Ixodes Ixodes scapularis or the black-legged tick could also cause a virus called Powassan virus. So there's a lot about ticks that can devastate people's lives other than just your typical Lyme disease conversation that people are so used to having. So I think they're— I'm glad we're having this conversation because I think ticks sort of need to be more in the forefront rather than just the pathogens themselves or the trigger like the alpha-gal allergy itself because they play a vital role role in how these diseases are even started. You know, they are very— the way they do things is actually very methodical and controlled, and they've evolved over time to figure out ways where they can establish bite sites and manipulate our immune system to establish these really vast infections or triggers like alpha-gal syndrome. So I do think ticks are something that need to be spoken about a lot more.

So let's talk about it in, in more basic terms because you had your professor hat on there and Dr. Cipriani was using all kinds of words that were not even English. I was, I was interested in breaking some of this down. So let's first talk about, let's talk about, you use the word vector. What's a vector?

A vector is something that carries diseases. So a tick, for example, we'll use black-legged ticks. So the tick is a vector for Lyme disease or Borrelia burgdorferi we'll use as an example, which is just the pathogen or the spirochete that causes Lyme disease. And these vectors can carry these diseases and transmit them to hosts. So hosts—

So let's pause there. So a vector is something that is harboring or has inside of it germs.

Yes.

And then, and then the germs inside of that vector Can be transferred to a host. How? And so, for example, with Lyme disease, I would be a host if a tick, which is, you're defining as a particular type of vector, has germs inside of it and it bites me, and when it bites me, it then spits those germs inside of me.

Yes, so if we're talking about, yeah, so the tick will attach onto you. Most likely it's, you've come in contact through it if you've Walked past it and it brushed by it and it was able to contact or adhere to you. And then it'll find a space on your body that's warm, has a good blood supply. That's usually— so it'll be usually found behind the knees is a big area, behind the scalp is a big area, under the armpits a big area, the genitals, especially in men, are a big area. So they do tend to go to those places, and what they'll do is they— will insert their mouthparts and they'll attach and that's when they'll start their feed.

Okay, so now you said they're— so you were defining them as vectors, which means that they are going to have germs inside of them that they're going to potentially spit into some host. And in this case, we're talking about humans. Why is that a problem? Where are these germs coming from and why is it a problem when these germs get spit into a human?

They're coming from prior feeds. So let's say for example a tick was feeding on a small rodent or a bird or a deer. Deer's one of the biggest ones that we could think of. They'll have their first feed and if that host is infected with one of these pathogens, from that feed the tick will be able to pick up that pathogen. And then from there on the next feed, so they usually have 3 feeding cycles, it will be The larval stage, which is when they're freshly hatched, they'll have their first feed, then they'll move into their nymph stage. They'll have another feed and then they'll move into their adult stage.

Okay, so let's break that down into, into rich language as opposed to Dr. Cipriani language. So, so a tick will go from being a baby.

Baby.

To being an adolescent.

Yes.

To being an adult.

To being an adult.

Okay. And what does a tick need to graduate from being a baby to being an adolescent and then graduate from being an adolescent to ultimately being an adult?

A proper blood feed.

Okay.

So it, it's just a proper blood feed.

Meaning the, the reason, the reason a tick is going to bite some animal, including us.

Yes.

And, and suck blood is because if it doesn't get a blood meal, it will not be able to grow from its adolescent, from its, from its childhood stage to its adolescent stage and from its adolescent stage to its adult stage.

Correct.

And so that's why it needs blood.

Correct. Okay.

What else does a tick need to survive?

A tick needs— it depends on the tick we're talking about. They all have different requirements. So we'll talk about the Lone Star tick today just because we found a lot today while we were dragging. So Lone Star ticks, for example, and at different stages as well, they need different things. So if you talk about baby Lone Star ticks, you won't usually find them questing, which is what is known as actively looking for a feed. we call it questing. They usually won't be actively looking for a feed if the temperatures drop below around 63 degrees. They like it warmer. So you'll find baby ticks for Lone Star, you'll find them in really dense wooded areas, high brush, forest, when I would say later summer, early fall. Then you'll look at the adults, you'll start seeing a substantial amount of questing behavior for the adults when the temperatures are warm. They favor a very warm environment compared to Ixodes or the black-legged ticks, which they can tolerate very cold environments. You can see adult Ixodes ticks out in winter temperatures if they don't drop below freezing. So it just depends on the tick species and their different requirements. Like the black-legged tick, they prefer leaf litter, dense leaf litter, and a lot of moisture. They need a lot of moisture. They have different humidity requirements that they prefer. So I think with the ticks, They, they need specific things per specific species and different life stages.

Okay. So to use another term with a Z, zoonotic?

Zoonotic. Zoonotic. All right.

So what is, what is, what is, what does zoonotic mean?

So a zoonotic disease is just essentially, and it's not just a tick-borne disease. A zoonotic disease is any disease that can be transferred from one type of animal to another, essentially. So you can—

So the challenge here that we're facing is, is that we have, we have an animal in the wild.

Yes.

We have a tick that will now bite that animal to get a blood meal in order for it to mature to the next stage of its development.

Yes.

And whatever germs are inside of that animal will then be sucked into this tick's gut. And now if a tick were to bite Monica, for example, it would be spitting into you the germs that came from the animal that had, that had, it had bitten and had its blood meal from.

Correct.

Okay. So why is that a problem? Why is it a problem for For example, the germs that are in a mouse to be spit into Monica. Why is that a problem for us and why is that something we need to focus on?

It's something we need to focus on just like we would have to focus on any type of infection, right? So it doesn't really matter where the infection's coming from. It's just the matter that our body is now exposed to something that's foreign. And that's— our bodies thrive, our immune systems thrive off health, right? That's how we, we have alarm systems to counteract all of these things that we come in contact with. So something like a tech— a tech— a tick that is incredibly small, that can feed and carry even smaller pathogens and organisms, it's actually evolutionary a great weapon against us because they can attach and transmit these things that we can barely even see, right? And if you think of something like Borrelia or other pathogens that are caused from tick bites, they need hosts to survive, right? It's like a virus or a parasite. They need us to survive. They need us to be able to replicate because they need somewhere to live. So that becomes a problem because they're just always looking for the next source of survival. And we're a great source for that.

We are. So, but let's, let's stay with this, this, this diversity of immunity, for example, right?

Sure.

In the human population, we have diversity of immunity, right?

Yes.

You may get sick when you come in contact with a certain germ. I may not get sick. I might get sick and you may not get sick. So even within the human population, we're going to have diversity of immune systems.

Correct.

But the immune system of a mouse, for example, is going to be very different than the immune system of a human, and the immune system of a deer is going to be very different than the immune system of a human. So, so when we, when we're talking about the zoonotic element of this conversation, we have to, we have to focus on that a little bit more, right? Because what's happening is we have, for example, most of the Borrelia, what is traditionally defined as the Lyme bacteria, will come from rodents, right?

Yes.

And rodents, for whatever reason, have an immune system. Mice in particular have an immune system that does not— I should say the immune system can manage that bacteria and a mouse will not get sick when it's harboring Borrelia, right? Whereas a deer, they will not even harbor Borrelia, right? Borrelia will not even reproduce in a deer, right? So because we have this diversity of immune systems, what's happening when a tick attaches to a mouse, for example, is you have a mouse who's not affected by the— Lyme bacteria. The tick bites that mouse. The mouse, again, for whatever, has evolved in a way so that its immune system can manage it. They now bite you and you do not have an immune system that has the capacity to manage this, right? And so that's the first issue I want to focus on. The second issue is there's going to be a combination of germs that are going to be—

Absolutely.

Going to be absorbed by this tick, right? So depending on the animal that it's ultimately feeding on that's going to change what's ultimately going to be spit into us. And we may or may not have the ability to manage some or all of those germs. So focus on that element of biting an animal with a different immune system and/or an animal that is harboring different germs than we have the ability to manage, and then ultimately that being spit into us.

Sure. So I think there's also this element where The ticks, as humans, we aren't just coming into contact with the ticks and the pathogens that they're transmitting. Our immune systems are also having to deal with another layer of complications that a tick bite arises, that comes with it, right?

So— You mean the tick itself?

The tick's salivary proteins.

Okay, we're gonna get there. Hold up, pause on that and bookmark that piece and let's just stay with the—

Okay.

Let's stay with the, The problem of having animals in the wild and a whole diversity of animals in the wild, because we don't know what the tick is gonna feed on. It could feed on a bird.

We don't.

It could feed on a mouse. It could feed on a squirrel. It could feed on a deer. And there's a whole diverse set of animals who have very different immune systems than us.

Yes.

And then when the germ is going into the animal and it's now spit into us, our immune system may or may not have the capacity to manage that, right? So that's the problem that we're having when we're having germs go from the animal I also think it's a matter of how our immune system can flag things. Okay.

Our immune system is, it's a complete network of continuously looking for things that should not be in us, right? So it works differently than other animals' or organisms' immune systems do. It's constantly looking for things that it could tag and flag and tell our immune system to get rid of. Okay.

So, so, so, but in some cases our immune system will have— and I'll define the immune system as a set of software— we will have a set of software that will already be ready to respond to a germ. So the more often the human population has come in contact with a particular germ, the more likely it is that we will have in our innate immune system software that will be able to respond to that, right?

We constantly have in place the second or the moment that there is an injury, like let's say a tick bite, for example, within seconds and minutes, our body's already responding to that. So we are continuously all day, every day working with this software, this network that is constantly looking for foreign material, whether that is a germ, whether that is an injury, something that should not be there. We are constantly looking for it.

Okay. But in some cases, when our body is looking for something and to find something, it has an answer for that. that problem.

Yes, antibodies.

In some cases, when some foreign body comes into our system, it does not have an answer for that problem. It has to develop a solution for that problem, right? And that's the challenge that we're now going to discuss, right? Because we have a tick that's now fed on a mouse, for example. The tick now attaches to Monica and bites Monica, right? And now what's happening is the tick is attaching to you for some window of time. Let's talk about how long ticks will attach and what's happening while they attach. Because what's happening is it's spitting in you and it's sucking blood from you.

Yes.

It's spitting in you and it's sucking blood from you and it's spitting in you and it's sucking blood from you and it's going on, going back and forth. And the blood that's coming into the tick's gut is now also having an impact on the germs that are in the tick's gut.

Absolutely.

Right. So, so describe that part of the process. How is a tick finding you? And when a tick does find you, how does it ultimately attach to you and bite you?

So ticks have something known as a Haller's organ. And the Haller's organ, you can think of it as their sensory— it's a sensory organ. So they are— that's why you'll usually see ticks, you'll— when people talk about it, there's this stereotype that they're always on the brush kind of waiting. And essentially it is true because they use these sensory organs to detect detect things like body heat, carbon dioxide, different— they can detect your sweat. They'll detect different things on humans where they're waiting with essentially their arms out just to adhere to you when you brush by them. So it's—

Okay, so let's stop there. So the Haller's organ is generally on the front leg of the tick, right?

Yes, yes.

And, you know, I guess it's just an interesting, you know, they perceive differently than we do, right? I have eyes and what's happening is a light ray is bouncing off of you and it's bouncing to my eye and I'm able to see see you physically, right? And, and I can hear you because there, there are sound waves that are coming out of your mouth and coming into my ear. That's not how a tick works, right?

They are all sensory.

They have eyes, but they're— they don't really get to see much, right? They're on the sides of their heads, but they have these organs on their front, their front legs. And what they're doing is they're— they're— as they're waving their front legs, what they're doing is they're absorbing all of that energy. So, and, and, and so how are they profiling you? For example, if I were a tick and I were, I were I were waving my arms and my Haller's organs were now, what information is it gathering from me and how is it ultimately going to put me as a tick in a position where I can now grab onto you?

It will. So you'll have tick species that some of them will actually be able to sense you and start moving towards you. That's most likely the Lone Star tick. They're very aggressive questers. Then you'll have things like the black-legged tick who is a little more chill and laid back where they will wait for you to come towards them. But they both use the Haller's organ to sense us, right? So if we are near a Lone Star tick, it will be able to sense everything about us. Like I said, our carbon dioxide, our body heat, all of that stuff. And it could start moving towards you and the alarm will just start getting louder and louder and louder. Like you're closer, you're closer, you're closer until eventually you brush against it. Something like the black-legged tick, it will sense you walking by and that's when it will kind of just attach. But the Lone Star tick is very aggressive.

So the way I envision the perception of a tick is very much like watching, you know, the Predator movies where, where the Predator now doesn't see Monica but sees these, you know, these colors.

Yes.

Or, or sees, you know, the hormones that you're secreting or the, or the carbon dioxide that you're secreting. And, you know, our friend Reese, who we, who we were questing with today, questing, we were, we were tick dragging with today, talked about when you put dry ice in the middle of a field and all the ticks are running over to it and you'll have it, you know, if you had a canvas and you had dry ice on it because they're all attracted to that.

They're very attracted to the carbon dioxide.

So they're essentially like the predators in the Predator movie where they're receiving this, and you can't hide from them. It's not like if it's dark they're not gonna find you or if it's light they're not gonna find you, right? Because you're always gonna be releasing carbon dioxide, you're always gonna have hormones being released from you and they're going to be able to find you, right? And that's how they're finding you and that's how they're getting to you.

Yes.

Makes them even more creepy, all right? So now a tick has found you, right? They've, you know, used their Haller's organ to identify you. They're now moving towards you or waiting for you to ultimately come close enough so that they can grab you.

Yes.

So describe that process.

The process of them grabbing onto you?

Yeah.

So they'll grab onto you and then it depends on the stage as well. Like they're— so the larvae are a little more fragile compared to, you would say, an adult, but they'll grab onto you.

Baby ticks.

The baby ticks.

Yes.

Sorry. The baby ticks are a lot more fragile than the adult ticks. So it's a little harder for them to grab. In a very coordinated way, you would say. But what they would do is when they do grab onto, then they would start— their next step is, okay, where can we establish a bite site where I can start feeding? And they'll look for the warm places. So ticks don't jump, they don't fly, they don't do any of that, but they, they're good climbers. So they will crawl until they can find a space that they can establish a good bite site. So that's normally when you'll start seeing them crawl to look for that site.

But so, but let's— now let's, let's think about that for a minute, right? So, uh, they're, they're perceiving us in one way, we're perceiving them in another.

Yes.

Right? So we, we have, we have perception tools. We have eyes, we have ears, we have noses, we have mouth. Uh, so we, we have, we have our tools, they have theirs, right? So they have different tools from us where they now have different information coming to them where they can identify us day or night. No matter what, they're finding us, right? They now grab us. Now, why aren't I feeling a tick walking on me? You said it's walking on me and trying to find a, a place where, where they can hide. You know, I generally describe that as a fold. They're looking for a fold.

Yes.

And we can talk about that in a minute. But they're walking up my leg. Why don't I feel them?

They're so light and they're so fragile that I think the walking is just Due to the fact that they, first of all, they can do it quickly, but also it—

But I can feel something walking fast up my leg. Why don't I feel it? Why don't I feel it?

It's just, it's something that I think some, you know, there are bugs also where sometimes we don't feel it often. They're just very, they're very lightweight in the way that they walk and they move and they're quick. But also when it comes to the biting, they have properties where you won't even feel the bite because they contain anti— they contain anesthetics.

Dr. Sabrina keeps running ahead. Listen, we just have a tick who hasn't really found a place to bite. You said it's walking up my leg and I can't feel it, right? Now why don't I see it, right? I mean, because there's—

They can also climb. Like a lot of times if they, a lot of times you have to think too that they're not walking on skin usually. They're walking on clothing. So a lot of times when you're feeling something crawling on you, it's directly on your skin. When you're talking about ticks, if they do contact onto you, most likely they crawled onto your pants or your boots or your shirt.

At some point they have to get to my skin and I do have sensory, I have sensory tools in my skin, so why don't I feel them?

Absolutely. But I also think that by the time they find a specific area on your skin after the clothing, it's less likely that you'll feel a fast-moving, more dense, if you will, walk on your skin, rather than they sort of found this site that's warm and folded and looks like a good blood supply where they can just Attach a lot quicker that way.

Okay, so now you've been excited to get to the attachment, right? So, but before we get there, why don't I see them? Why don't I see a tick? Why don't and holy cow was that made really clear today during the tick day, right? Why don't we see them and how have how have they can remember they've evolved in a way we've been Dr. Rawls in his book Unlocking Lyme argues that humans have been getting bitten by ticks as long as they've been humans, right? And we know that, right? And and and we've co-evolved with them and our immune system is trying to defeat what they're trying to do. They're, you know, they're changing so they can defeat what we and other animals are doing to try to identify them. So they walk really carefully. They don't bump into our hair, so because we would be more likely to feel them, right? Our senses are generally turning off. We can't feel everything all the time, right? And then, and then, of course, they're so small.

They are incredibly small.

So let's talk about So we went on a tick drag today.

They are incredibly small.

And I don't think anyone's going to be able to see them, but I was calling, you know, and your husband who became like Mr. Super Tick Dragger, we couldn't stop him. It was almost like he was like a Disney adult doing— I mean, you know, we have so many ticks in here, it looks like a snow globe.

Yeah, so these are larval, these are baby Lone Star ticks, and They are so small where I was even showing Matt before that they're smaller than some of the birthmarks that I even have on my body.

Which is why you can't find them, right?

Which is why you can't find them.

So, so the, so the, I mean, there are thousands of ticks in this vial. And I know that you can't see it on camera, but they're so tiny, right? And, and they've always been described, at least in the literature that I've seen, as being as small as a poppy seed. These are substantially smaller than a poppy seed. They're substantially thinner than a poppy seed. I mean, they are tiny, tiny little, little bugs.

Some of the baby ticks are so tiny that they can actually crawl up the hair, individual hair follicles on your skin. They're so tiny if they have a good grasp. And then also something like, as you said before, the adolescent stage of ticks, they're incredibly small also. So those are actually the ones that you usually would compare to a poppy seed, the nymph ticks or the adolescent type ticks. So if you think about the baby ticks, they're even smaller than that. So you're thinking of something that's even smaller than a poppy seed. So they are incredibly small. And I think it's something where this is where tick checks become so vital because it really is something where you're not looking in the naked eye, as you would say. It's— you need to look for these, especially with the nymph stage of ticks, they transmit a lot of disease just because they are so small. And unless you're actively looking for them, it's very hard to find them.

So the way they've evolved and the way they've, they've evolved to defeat our defense systems is they move in a way that we can't feel them on our skin.

Yes.

And they move in a way that we won't see them. And their color is such that it doesn't look like it's something that wouldn't be on our skin. And as a result of that, we'll go to your point about the tick check. The reason tick checks are so important is because we have to be, and we have to use our fingertips for the tick check, is because we have to use our multisensory advantages so that all the inputs come into our brain to ultimately see the tick, right? Because remember, in our brain, our brain is dark, right? And what's happening is ultimately an image is formed inside of our brain based on the sensory inputs.

Mm-hmm.

And if we're using our eyes and our hands together, we are substantially more likely to have the image of the tick form in our brain and we're more likely to find it and then be able to use our tools. So their perceptual tools are, are, have some advantages for them and they have developed in a way to defeat our perceptual tools that we use to ultimately find them.

Yes.

Okay, so now let's talk about, you know, the, the structure of a tick and how they're in a position where they find a place they want to bite us, that they have some unique tools that make it so that they can pierce our skin And we don't even feel it.

Yeah. So first and foremost, the ticks, if you look at something like the black-legged tick, it's almost scary when you see their mouthparts because it actually looks like barbed wire. And they will use that essentially to burrow right into your skin. And then that's how they start their feed. But—

But let's talk about the barbed wire mouth, right? Because you described that same way at lunch. And yes, it is like barbed wire. But what's, I think, fascinating about it is it's barbed wire where the, where the On the mouthpiece, it's flat, and it comes up and is barbed away from the mouthpiece, right? So it can pierce in, but then hold against the skin, right? So the barbs are against the skin or pulling it out of the skin, which is, again, it's a brilliant way it has evolved.

They— I was going to say, they've evolved in such a way where they have figured out many things that can combat a lot of our defenses. And I think that's where— I know I'm jumping to the gun, but I think that's where a lot of their— the bite is so vital for infection. It starts everything, right? Because they have so many molecular components to them that we're not only dealing with the pathogens they transmit, but we're dealing with their molecular components. And they have worked so hard to create these evolutionary weapons to establish a feeding but keep that feeding, right? And you, you hear a lot about people talk about the longer a tick feeds, the better the infection, which is correct. And, you know, when you start talking about feeding times, it gets a little controversial because there's stuff in literature, but there's also— We don't know for sure how long things have to be attached for, but of course, the longer they feed, the greater possibility and the increased risk of transmitting a disease and even the increased risk nowadays that we have to talk about with sensitization to alpha-gal syndrome. So.

So let's, let's pause there for a second. Right. So in order for a tick to grow from being a baby to an adolescent, adolescent to an adult, which is necessary for them to reproduce.

Yes.

And every species exists for the purposes of reproducing.

Yes.

they have to get a blood meal. But in order to be able to get a blood meal, they have to be able to find you, grab you, crawl on you, find a space to feed, pierce your skin, and now stay pierced on your skin for someone to have time, generally up to 4 days, right?

Yes.

Without you discovering this, this tick on you, right? So, um, so it's constantly engaging in different kinds of behaviors that are going to make it so that it can continue to suck your blood for a long period of time. Well, How does the barbed mouth help it to stay in place for that long period of time?

So the, the mouth itself establishes the connection and the piercing into your skin, and it can help establish keeping the tick there. But I think what's also very fascinating and important in this step is they have a lot of properties in their saliva that help them in that process.

So talk about that. Let's talk about first, why wouldn't I feel it? when it pierces my skin?

They have many anti-anesthetic properties in their saliva, right? So—

I mean, it's just wild. I mean, think about that.

It's wild.

It's spitting on your skin and it's putting an anesthetic—

An anesthetic, a very local anesthetic.

On your skin as it pierces, so you cannot even feel it.

No.

Okay.

And they have multiple— so there's this idea of fungus—

That's just wild, right?

It's wild.

I mean, that the spit has— the capacity to numb my skin before it pierces my skin so I can't feel it.

The tick saliva is probably the greatest evolutionary weapon that I have read about and learned about in my education because it is, like I said, people are so fearful of the pathogen itself, which absolutely we should be because they are different beasts in itself, but the ticks—

But if the tick doesn't suck, doesn't bite us, it can't get the pathogen out, right?

Exactly. If the tick could not develop something where it could very much manipulate our immune systems and very much manipulate our body's response to it, there's no establishment of infection.

So the first level of defense is our sense of feel, and it's defeated that. The second level of our defense is our visual capacity. It has defeated that. A third level of defense, because our skin is the most important part of our immune system, which protects us from the world, it can now numb our skin and pierce our skin and get to our bloodstream.

Yep.

In order to be able to suck blood, right? Now, part of what, part of what it's also done is like our skin will try to eject the, the tick, but because it has this barbed mouth, our skin cannot eject it. So it's defeated that element of our, of our immune defense, right? But what, what, what is stopping a blood plug from forming, right? Because anytime we have a cut on our skin, we don't bleed to death because a blood Yeah. What, what is the tick doing about that?

Tick salivary proteins also have many anticoagulants, and there's this idea of functional redundancy. So essentially functional redundancy just means that these ticks have different molecular components and biological components in their saliva where if the host is able to combat one of those and the immune system is able to combat one of those, they have another arsenal of molecules that can do the same job, right? So they have multiple anticoagulants. And the idea of the tick, it doesn't want to suppress our immune system. It wants to modulate it, right? Because immunosuppression would actually hurt the tick and it would stop feeding because there would be bacterial overgrowth. There'll be necrotic tissue, right? And it needs viable tissue to have an established feeding. So in order to do that, it has developed so many different biological components to it. It's a biological arsenal where it can combat that. So I think the biggest part is it has many different anticoagulant properties that— and many different actually vasodilating properties that allow blood feeding to continue, but also platelet formation to stop. And, and decrease.

So it has a natural blood thinner.

Yes, essentially.

It spits into, for example, again, we're using you. You're being bitten by the tick. I'm not gonna, I'm not gonna invite the bite myself, but it's now biting Monica. And so it's crawled up Monica, it's found a place where you have a fold. We, we see, we see folds, not only skin folds. Heavier people will have more skin folds, but even thin people, they'll find places, for example, women and bra straps or men in their, in their belt strap. Or we've had interviews with men who have bigger arms and they have a tight, um, you know, short sleeve shirt.

Yeah.

And, and it's going to go into— so it's going to find some kind of a place to hide. It's going to find a fold and it's now going to pierce your skin and it's going to anchor itself into the skin. And there's another, there's another property that we didn't talk about, about, about how the tick can anchor itself in there. It has a property where it actually creates a cement It cements itself into the skin. Talk about that.

So it's, that's just another part of establishment, right? So it's just another way that the tick has evolved to establish a connected bite site, I would say. So it forms sort of this, like you said, it's a cemented protection where even if the skin tried to reject it, it would be a lot harder for the skin to reject the tick. So that it's just another way for the tick to stay anchored into us. And along with that, I mean, there's so many— if you think about something like the black-legged tick, there's a really well-known salivary protein known as Salp-15, we call it. It not only can help the tick establish infection, but what it does is it actually will trick our immune system into thinking that that the Borrelia and everything being transmitted is self because it will actually cover the very specific components of the Borrelia bacteria that need to be transmitted to establish infection and trick the immune system into thinking that it's normal. So there's so many different components to the saliva that actually help in the establishment of infection and they can do so many different things.

All right, so we have this, you know, this, this fascinating bug that has evolved over the course of millions of years to defeat our immune defenses.

Oh yeah.

And it's now attached to you, and it's now feeding on you, and it's now sucking your blood. And, and it is— it has, it has spit with properties that will cement it in place, that will stop you from, from feeling any pain. What about itch? Does it have any tools that will stop you from itching?

Absolutely. So one of the greatest defenses for us is actually itching, right? Because that, that's how we know something's not right on our skin. So there's actually tick proteins. They're called lipocalins. They're a pretty large family of molecules that the tick saliva has, and it could suppress histamine. So if you don't have histamine, you're most likely not going to feel the pain and the itching that you would feel ordinarily. So lipocalins are a big family that they'll use in their saliva to combat that. So itching is, like I said, something that we use as one of our weapons.

One of our defenses.

And it's one of our defenses, and it's a great one, right? It's—

who—

no one likes itching. I despise mosquito bites because of it. So that's one of the greatest.

So it takes away our ability to feel pain.

Yes.

Takes away our ability to itch. Takes away your ability to, to ultimately eject it. It, it has tools that, that now are immunosuppressive, but not too much. Right?

They modulate. They want—

That's important, right?

Yeah, that's a very important piece because like I said before, they want the immune system quiet enough where it's not allowing us to establish a defense against it, but it wants it awake enough where it can have a viable feed.

All right. Now, what's happening, we talked about these germs that have been picked up by this tick when it's bitten some other animal with a different immune system and it's not, or maybe, maybe, maybe this is an adult tick, right? Maybe this is a tick that's had 2 feedings, right? And as a result of it having 2 feedings, now it has all kinds of germs, right? I mean, we saw one research paper that suggested that black-legged ticks could harbor up to 200 different germs. Right. We have not identified 200 tick diseases or germs that cause tick diseases, but we— but it could be up to 200, right? And it's now spit all of these germs into your system at the same time that your immune system has been modulated.

So I think that's part of the biggest problem with tick-borne illness is we now have, like I said before, we're not just combating the pathogens or the antigens like alpha-gal that it's expressing to us. We're now combating another army of defenses that we have to try and figure out. I think if you look at something like alpha-gal syndrome, it's very interesting and it almost paints a clearer picture because you can really see how immune modulation from the tick could really devastate how we respond to something that's so normal to us. So I think if you take alpha-gal syndrome, for example, we're exposed to alpha-gal all the time as humans. It's something that if you have especially an animal-based diet your whole life—

Every time you eat a piece of meat.

Every time you eat a piece of meat, but it's also in a lot of our products. I mean, it's in toothpaste, it's in shampoo, it's in a lot of our medications. You have a gel capsule. So I think something with alpha-gal, it's It's a real clear picture that we're now seeing this reprogramming of our immune system, that something we are so used to, we're now responding differently to it.

All right, let's pause there for a second. I do wanna get to alpha-gal, but I wanna stay, let's stay with Bartonella, for example.

Okay.

So there are a lot of different ways that we could have Bartonella injected into our system, right? I mean, for example, for many years we had cats in my house.

Cats, yep.

And anyone who has had a cat knows, or should know, that When a cat has fleas, Bartonella will be a bacteria that's in the fleas. In most cases, what's happening is a cat's claw will step onto the flea, and when it starts to knead, for example, on a human, what it's doing is injecting Bartonella into your system.

Yes.

Now, let's compare that to a tick that has Bartonella inside the tick. And rather than the Bartonella being injected into us by a kneading cat, It's now injected into us by a tick that has the saliva that has the anti— well, a whole bunch of principles into it, but certainly we'll talk about the, the immune-modulating principles. Do you believe that your immune system's capacity to respond to Bartonella being injected with a cat scratch as opposed to it being introduced to us by a tick bite The capacity in the sense of developing Bartonella? Yeah. So, I mean, because my argument to you will be is, is that it's much worse to have Bartonella spit into us when it's spit into us with a tick.

It's a direct injection.

Well, but why else is it different?

So I think it's different because— I think it's also different because you're— the delivery system is different. Okay.

And talk about— talk to us about the spit in particular, how that element of delivery system is very different than when you have a cat scratcher.

So when you have a cat scratcher also, like I said before, and I'll keep going back to this, when you have a cat scratch, you're not taking into account other factors, right? You don't have all of these other biological components that are now being transmitted into your body at the same time. When you're coming in contact with Bartonella through a tick bite, it's very different because you're coming into contact with Bartonella, with Bartonella, but also with all of these immune modulating proteins. So your immune system is always going to respond differently when it has many factors that it has to deal with.

Absolutely. The tick spit, It makes the game different when it's introducing Bartonella into your system because of the immunomodulating or immunosuppressing nature of the spit.

Yes.

And, and of course, the other, the other challenge that we have to focus on for one more moment, and we'll get to alpha-gal, is, is when a tick is attaching to you, it is spitting into you and then sucking blood out of you and spitting into you. And what's also happening is there are proteins from your blood that are now going to be surrounding the germs that are being spit into you, which also makes it more difficult for the immune system to respond to it, as opposed to when a cat, for example, is kneading you and introduces the Bartonella. So talk about that.

So what exactly is the question? Like, where are you—

Well, the question is, why is it so much worse to have Bartonella introduced into your system from a tick bite as opposed to it just being from a cat scratch?

Well, like I said, I think the cat scratch, they're not— it's not necessarily this back-and-forth connection that you're having with the cat scratch. It's a scratch, and then it kind of—

Your immune system can respond to it immediately.

Yeah, your immune system responds to it immediately. It's an injury, and it's—

There's no suppression.

There's no suppression. It's there. There's no modulation. It's a scratch. Your immune system knows, let's go to this site, let's figure it out, sort of how, you know, if you if you get a cut and you end up developing MRSA or something like that, you're contacted with, you're in contact and you have this break or injury in your skin where you're coming in contact with these pathogens, but it stops there. Where if you look at something like tick feeding, not only is it a contact, but you're looking at a lot of factors. So you have the salivary proteins, you have this back and forth between the tick and your own proteins and your own immune system, but then you also have where— you could have a contact and transmission for days. Do you know what I mean? So the potency is so different. The transmission and the viral load— I mean, I'm sorry, the bacterial load is so much higher than if it's just kind of a very one-time scratch.

Okay. So let's talk about one more thing before we get to alpha-gal. And I know you're excited to talk with me about that. And let's— so one of the things that we learned from Jim Malik, the farmer we interviewed, today, or Reese, the, the, the, the documentarian today, he said that during the course of his time as a farmer, he had, he had come, he had come in contact with nymph ticks and he didn't find them until they were feeding on him for some period of time. Like he'd find them on the belt and find many of them.

Yes.

Couldn't even find them because they were so small. So talk about what's happening with the tick as it's bringing in the blood and how is that changing the body and how is it You know, again, an interesting evolutionary response to them essentially being like a balloon.

So the ticks actually have, the tick salivary glands, there's a concept known as silome switching. So what the tick can actually do, which is so fascinating and mind-blowing, is it will actually change the genes that it's expressing and the molecules that it's expressing depending on the response or the immune system response or just the feeding timing that it has. So it can actually start to either figure out when to express certain salivary components versus when to suppress some salivary components. So I think that's another way that it can establish feeding for so long is because it knows I need, you know, I need more amylases, which is just another molecule in its saliva where it will continue Feeding because it stops blood clotting. So it will produce them when it needs it. Or, okay, we can slow that down and I need more anticoagulant because I need to make sure that they don't know I'm here. Or, oh no, it looks like there's a lot of immune cells coming here. Let me start pushing out some immune defenses from my salivary glands. So it has so many properties that it can actually spit out, as you will, during the feeding process. Yes, that could be directly based on what it needs at that given time to establish and keep the feeding.

Okay. But now another thing that's happening though is, right, again, our immune— part of our immune process is our visual process. Part of it is our, you know, whether we're going to feel something on our body. Part of it is whether we're going to feel it when we touch it, right? And one of the experiences that we've shared here on TIC Boot Camp is that one of the early experiences I had with Matt was He, he was bitten by a tick. The tick had been feeding on him for a long time, although they didn't know. He was freaking out. He came flying here to my office, right? And there was what looked like to be an adult tick, but it wasn't an adult tick, right? When we ultimately sent it off to be tested, and we, and we first sent the picture to Tick Encounter Resource Center, um, and then ultimately it to be tested, it turns out it was a baby tick.

Mm-hmm.

But it looked like an adult tick because it was feeding on him for so long that it just blew up, right? And it has the capacity It became like a balloon. And Matt didn't find it for a couple of days. He found it after he touched it. You know, he happened to put his hand across it. So, you know, it's got to, you know, a tick has to be in a position where it can't be found in a number of different ways.

Absolutely.

And we're continuously trying to find it. And again, the sooner you find a tick and the sooner you remove it, the less likely it is you're going to get sick for a lot of different reasons. And we can talk about that. So why is the length of time a tick is feeding on you going to make it more likely that you're going to get sick? And why do most researchers suggest that at least the Borrelia bacteria will not be injected into a host, in this case, the tick, black-legged tick who has Lyme, has the Borrelia bacteria, Lyme bacteria inside of it, is now feeding on you. Why wouldn't it get— generally spit that into you until about 24 to 36 hours after it had first bitten you?

So the idea that researchers talk about is the fact that it's slow moving from the midgut to when it finally reaches the mouthparts to be injected into your body. And I think it's something that it's still worth questioning if that's an established timeline or it's just more so an average that is supported. I think with any tick-borne illness, it's pretty unsafe to say that this is the window that you need to be safe.

Right.

So I think that's something that we need to be a little cautious on because I don't want people thinking that if they got bit by a tick and they've only noticed it and, oh, it must have been yesterday, that they're okay. Because it's very much an average because the idea is that it's a little slow moving from the midgut of the tick where they harbor these pathogens to actually get into the body. So I think that's part of the reason why. As far as—

and you don't know how long it's been feeding on you just because it looks like it's really small. I mean, these, again, looking at our, our, our snow globe here.

We actually have it engorged in one somewhere.

So we'll see if we can find that. I don't know if it'll show up on the camera, but, you know, I mean, these things are, I mean, thousands of thousands of ticks are in this thing and we can't see any of them. And, you know, and ultimately it'll be feeding on you for a long time before you ultimately have the ability to find it. Right. But it, but again, the germs are so small that are inside of it that They're so small. They're inside. They're inside.

Well, just like look at how little these are and imagine how much smaller these germs are.

Right.

So it's just the whole process of tick-borne illness alone, everything that surrounds it. It's so incredible what they can actually really do to us, the tick and the pathogens themselves. So there's a lot that our immune system and our bodies in general are just encountering when it comes to this.

So let's, let's focus on alpha-gal now.

Sure.

That's the— that seems to be the area that your research is bringing you. Talk to us about why alpha-gal has become a passion, even though your mom and your daughter do not have alpha-gal, at least seemingly.

Alpha-gal became such a passion for me. I think it started off— it's very interesting. It was very interesting to me just in general, but it was— it's so I guess fascinating as a researcher to look at something that is a disease that essentially everyone is experiencing and having different experiences, but they are— it's triggered by the same thing. And it's almost a question of, well, why? I mean, you look at other infections, right? You'll look at even Lyme disease. It's very different for every— for many people, but there's a lot of similarities to it. And there's a lot of you know, the prognoses of Lyme disease or Rocky Mountain spotted fever or ehrlichiosis or other tick-borne illnesses, it kind of follows a very similar pattern where we don't see that with alpha-gal syndrome. We see so much that is different from person to person with alpha-gal syndrome, but it's also the first time where we're seeing that an allergy is being triggered from Okay, so let's pause for a second again for the folks who are new to this community.

What is alpha-gal syndrome?

So alpha-gal syndrome is essentially, it's more commonly known as the red meat allergy and the red, it's essentially where you get bit by a tick, specifically the Lone Star tick. There is some research that other tick species like the black-legged tick could cause it, but for now, let's focus on the Lone Star tick. It's essentially where you have a bite from a Lone Star tick and you become sensitized to what's known as the alpha-gal sugar. And it's a sugar that we see in all mammalian meat, all mammalian products, something we've been exposed to for many generations as humans.

So any mammal meat. So it's going to be cows.

Beef, pork, lamb.

Deer.

Deer. Yeah, venison. So any mammalian meat or something that has a mammalian derivative in it. So it could be, like we were talking about before, gelatin, so gel capsules in medications, or it could be any derivative that you can see in cosmetics. A lot of cosmetics use some type of mammalian derivative, so it could be found in that as well. And what happens is you have this tick bite, and essentially it triggers this sensitization to this specific sugar, and you develop, quote unquote, an allergy to this sugar. So when you come in contact or exposed to this sugar, you have a range of symptoms that could be as mild as you have a little throat scratch, or you don't really realize anything, but it— you can see all the way through anaphylaxis in some people.

So we've had folks on this podcast who have shared with us that they've gone into anaphylaxis. We had one, uh, one podcast guest share with us that, uh, she and her wife had gone to a wedding. They went, uh, they went— it was in the middle of Arkansas. They went into, into the middle of a river, And they had a steak meal at the wedding reception. The next morning, they're out in the middle of a lake and one of the women goes into anaphylaxis and almost dies.

Mm-hmm.

It was a horrific, horrific— so that's how extreme it can be. We had another podcast guest, one of the 2 Alpha Gals, who shared a story with us that she went into anaphylaxis. her husband, who's actually a doctor, but, you know, again, it's his wife, she was— and he almost put the, you know, the EpiPen through her leg. I mean, like, he, like, you know, stabbed her. I mean, that's how extreme this can be, right?

That's why it's so— it became something where I very quickly realized, wow, this is terrifying, because as you saw today, I mean, look how many Lone Star we collected, right? I mean, this is on people's properties. This is people's everyday life. If you're someone who likes going outdoors or works outdoors, this is a very big occupational hazard as well. It's something that alters your entire life, right? So it's not just something where if you look at an ordinary food allergy, I'm not saying that those aren't terrifying and those aren't scary. They are. But you have a specific target in most cases. So if I know I'm allergic to almonds, my target is almonds.

You exclude almonds.

I exclude almonds, right? And a lot of that is how I can stay safe. But with alpha-gal syndrome, it's not just about what can I avoid food-wise? It's a complete change of your entire life. And do I feel safe in my everyday environment, right? Because it's— you have to now start asking questions that you would never ask before. You know, do I have to worry about going to a party and it'd be a barbecue and I inhale fumes that I could react to, or I have to go to the ER because I don't feel good. Oh my goodness, am I going to have a medication that I could react to? Right? So you start asking these questions where you have to live—

Can I wear leather? Can I wear a wool sweater?

It's so many questions where it's— you start to live a life of exclusions and adaptations and alterations and just every single day have to constantly be on high alert.

We had one guest share with us that she has not been out to a meal in a restaurant with her husband and her children in years.

Yeah.

Because going into a restaurant where mammal meats are being produced will put her in a position where she can suffer anaphylaxis. It's literally destroyed her life. I mean, she cannot socialize with her husband and her children because of this allergy.

I would say a sinister allergy. And really, it's a sinister attack on your immune system in a lot of ways because somehow this tick has developed a way to completely change the way your immune system responds to something that is so common in our everyday lives as humans.

So let's talk about that, right? So one of the things you and I debated about in the past was whether or not this was an allergy that was caused by the tick spit, in particular the tick spit of certain Lone Star ticks?

Yes.

Or is it the result of the tick having a recent blood meal and the, and the blood and the spit combining into the bite? And it's the combination of the, of the, of the sugar from, let's say for example, the tick was feeding on a deer. And after feeding on a deer, then feeds on Monica. Right. Is it just the Lone Star spit or is it the— is it the sugar from the blood meal that's being spit into you or is it the combination of the two? Because I don't think we have that defined.

We don't have it defined. And I— and there's a lot of hypotheses that are going around what could really establish the alpha-gal trigger, as you would say. The only thing I would have to say about the blood itself is because we're exposed to alpha-gal so much already, it's not something that would be— the alpha-gal alone from the blood of something like a deer wouldn't be enough to trigger it, right? I think a lot of alpha-gal syndrome has to do with the delivery system. So if you think of— let's go back to food allergies. If you if you have a food allergy, most likely the reason why you have that food allergy is because the first time you encountered it was in an inflammatory or an injured state that changed your immune system into thinking, this isn't normal, we don't like this. Essentially, that's what an allergy is. And I think with alpha-gal syndrome, that begs the question of, is it the delivery system that we're now being exposed to alpha-gal? Because normally, if you're exposed to alpha-gal, it's in very controlled settings for your body, right? You're ingesting it or, you know, you're washing it on your hair. It's not really coming into contact and you're not really coming in contact with it in an injured or inflammatory state, as you will. But if you come into contact with alpha-gal syndrome and it's now in this state where it's an injury and it's very inflammatory and you have all of these immune modulating proteins that the tick is bringing to the table as well, That changes the game.

Okay, so let's talk about that, right? Because you're arguing that there are almost as many presentations as there are people that have presentations, right? Some people get bitten by a Lone Star tick. I've been bitten by many Lone Star ticks.

Absolutely.

In fact, my tick bite that triggered the creation of this podcast was a Lone Star tick, right? And that Lone Star tick had been feeding on me for some period of time, and we ultimately sent that tick out to be tested. I did not get— I did not get— thank God I didn't get alpha-gal because I love meat, right? I've been bitten by Lone Star ticks several times since then, and it's never resulted in me getting, getting the allergy, right? So, um, whereas, you know, we just gave the example of the woman who almost died in the middle of a lake in, in, you know, in Arkansas, and, and we have everything in between, right? So why is there so much diversity, first? And two, why didn't we ever hear about these these allergies until recently?

So unfortunately, that's something that is a part of alpha-gal where there's so many questions that are still having to be answered. Unfortunately, we don't know specifically why, let's say you get bit by a Lone Star tick and I get bit by a Lone Star tick. And yes, maybe I become sensitized, but I don't develop symptoms that would act as if I have alpha-gal syndrome specifically, where you might have come in contact with the tick and you develop it, right? I think a large part of alpha-gal syndrome too is also everybody's base immune system, right? We all have different immune systems in general and we all have different levels of how they work and are— do we have autoimmune disease, right? Like, we have to look into so many things with alpha-gal syndrome where it's— you have to ask these questions of why is there so much clinical heterogeneity that we see in alpha-gal syndrome? And what I mean by that is why are there so many differences that we see in alpha-gal syndrome? Why is it that some people can get bit and be fine. Some people get bit and they have mild symptoms. Some people get bit and they have these really scary anaphylactic reactions. And I think there's so many components to that. And unfortunately, it's just something we don't fully know yet. And these are the questions that we want to know and that we're asking. And I think that's why it's such a hot topic right now, because we're searching for that.

For sure. So, you know, one of the things that I argue to one of my friends recently who has a child with a peanut allergy is I never remember during my childhood— again, that's in the '60s and the '70s, I'm an old man— I never remember somebody with peanut allergy.

Peanut allergy.

Literally no one. And then all of a sudden they started popping up all over the place. And I'm just wondering whether or not there are some parallels here between the, the, the, the number of allergies that seem to be cropping up in, in our modern society that we had never seen before and now the increase in all kinds of places, using the peanut allergy as one example and alpha-gal as another example.

I think that's a great avenue to look at as well. I also think that there's a lot about our environment now that's different, right? So there's a lot of exposures that we have now that kind of alter our immune systems in itself, right? We're constantly kind of in this fight-or-flight state depending on where we are, what we're exposed to, a lot of our food, diet's a huge factor in this as well. Vaccinations unfortunately can be a factor in this as well. There's so many things that play a role into what can manipulate and sort of reprogram and reshape how our immune system responds to things, so I think—

We're swimming in a toxic soup, we really are.

I think it's just a matter of our immune systems are trying to tackle on so much, and this is just another level of something that it's trying to tackle, and sometimes it just gets overloaded, and sometimes what that looks like is we develop symptoms that look like allergies just because this is how our immune system is thinking it needs to respond.

I want to explore one last piece with you. I would keep you here all day and all night because I find this to be fascinating, and I really appreciate how much you're teaching the folks who listen to this podcast about the, the tick bite element of their, of their Lyme disease journey. Male versus female immune systems. One of the things that we learned during COVID is is that the male and female immune systems are different. We learned from, I think, an interview we did with Dr. Rawls, is that most of the immune system is developed on the X chromosome. And as a result, women generally have a more robust immune system. And what we also learned during COVID was that the female immune system can shut down faster than the male immune system because the female immune system has to, of course, take into account the possibility of a foreign body being born and ultimately—

Mm-hmm.

being formed inside of a woman. Do you see any differences between the male and female immune system impacting alpha-gal and increasing or decreasing the likelihood of a man or a woman getting that disease?

So this is actually something that researchers, especially in epidemiology research, are looking into, because I think demographics plays a huge role in this as well. And that's something where my research comes into play also, is we're looking at a factor like that, and then the next question is why. Right? So with alpha-gal syndrome, it's still so early where we're trying to answer these, as you would say, basic questions, because they are basic questions, right? Is the female or the male population affected more, or is an age group affected more? Is, you know, is a race affected more? Is a population of workers versus non-workers affected more? These are questions that something like epidemiologic research that I'm doing currently will look into, and we can start to develop patterns and see patterns. And then from there, we can develop more structured questions to answer things like that. I think that in general, it could play a component to it, right? But I think there's still so many things that are a part of alpha-gal's story and a part of the immune story of alpha-gal that we just are not going to be able to answer that until we have more data. And we need the data to then really sit back and be like, okay, we have this and we're seeing these patterns and we can't establish causal relationships right now, but we at least have all these correlations where now we can sit back and say, okay, these are the really important questions that we have to ask in order to take the next step in combating alpha-gal syndrome.

So, on this podcast, we always end by talking about not just the journey of achievement, where Monica has achieved as much as she has in studying and developing the resources that she has and developing the skills she said she has developed. We also talk about the journey of transformation, how this has been transformative for you, how you've become a different person as a result of going on this journey. And I can't help but to see some parallels here that, that I want to discuss with you. Hopefully we will not be crying together again as we, as we talk about this, right? But the first parallel that I want to focus on is you have a mom who has Lyme disease and you have a daughter who has Lyme disease, but you don't have Lyme disease, right? And one of the questions I want to ask you from the standpoint of this experience is not only did it direct you and your talents and your passion and all of this brilliant capacity that you have to studying this disease and the immune system, but I'm wondering whether it also raises a question about whether or not there was a congenital component, that perhaps your mother did pass Lyme disease on to you and perhaps you did pass that disease on to your child congenitally. And the reason it's not presenting in you, despite it presenting in your mom and your daughter, is because you have a more robust immune system or a different immune system than your mother has. and your daughter has, as opposed to your other child who does not have Lyme disease, and perhaps, you know, that could have been a part of the journey. So give me your thoughts on the congenital nature, because our listeners will go bats if I don't have that conversation with you, because it's a really important part of many, many people's journeys. And, you know, one of the first questions that women always ask us— well, one of the first questions that young women always ask themselves and then ask us is, can I have a child and will I be passing this on? And again, in the spirit of the journey of transformation, is that a question that you're asking yourself? And do you think this is going to give you insights into learning how to define better ways of treating alpha-gal?

So I think that it is very dangerous as researchers to eliminate any possibility. So when we talk about congenital Lyme disease, we're talking about a very stealthy organism and we're talking about an organism where, you know, I've spoken a lot about tick salivary proteins, but I could have 5 podcasts alone on what Borrelia could do and how fascinating it is and how smart it is and how evolved it is. And it's aside from Lyme disease, if you look at Borrelia, I mean, it is so— it's an incredible pathogen. And one of its greatest abilities is to very quickly get into tissue. And if Borrelia has the capability to get into all of our tissue, it kind of begs the question where, why could it not get in through the placenta? Do you know what I mean? So what about the placenta is so great compared to our other organs that it can't get through it? So unfortunately, I do think that there is a congenital component that needs to be looked into more and spoken about more. And I do think that's still still a controversial field, unfortunately. But I do think it's something that should be less controversial because, like I said, if it can cross the blood-brain barrier and if it can get into our other organs, why not the placenta? I think that's a very big question. And then as far as my mother to me and as far as me to my daughter, I don't often think about my mother to me as much. And I go to sleep every night wondering about me and my daughter. And, you know, I'm someone who I have been doing tick drags for a very long time, and I started years before I was even pregnant. So unfortunately, it is a possibility where, who knows, maybe I did get bit by a tick and I just— that day was an off day for me and I didn't do a correct check. I didn't use the proper protocols, right? And it just— you miss it.

You're—

I'm a human. So I do ask myself sometimes whether there's that component. I never got tested.

But Monica, this, this is not me trying to ask you to explore a mother's guilt. I mean, look, you're an Italian woman. You're going to feel guilt no matter what, right? I'm asking you to think about it in terms of why God put you in a position where you are now directing your gifts and talents to a particular field. You could be— look, you could have your PhD in anything. I think you could have gotten an MD very, you know, very easily.

I think people deserve—

A whole bunch of other places you could have gone. But from the standpoint of why you were transformed into one of the people who's going to cause this disease to be solved, I think the immune piece of this is really vital.

Vital.

And that's exactly where you are, right?

Right. Vital. And I also think that for me, I've watched personally, which of course that affects me more, but I've also watched just through all of the people that I've met. And the one thing I can say across the board of tick-borne illness, whether it's Lyme disease, Bartonella, babesiosis, now alpha-gal syndrome, is they all felt like they weren't heard. And they all felt like at some point in their journey, medically, even on the public health side, they weren't being listened to. They didn't have a voice. And a lot of times with people, you know, I'm from Staten Island, right? A large part of my community is union workers or stay-at-home mothers or, you know, blue-collar workers. And they're not these people who will every day go out and search for the next greatest scientific answer.

Right.

So sometimes they're now going into these doctors' offices and they have a doctor telling them, this is what it is, I went to medical school, I'm right. And again, doctors don't know what they don't know sometimes with certain things, so you can't fault them as well. But as a person who doesn't have the knowledge to back that up for themselves, it's almost very easy to trust the doctor rather than yourself.

Well, but of course they're going to trust the doctor. And, and, and Monica, which is why I sort of hinted why I'm glad you're not a medical doctor as opposed to a research PhD, right? The reason, the reason it's important for you to be a researcher rather than a medical doctor is because medical doctors are going to be trained based on the results of researchers.

Absolutely.

And the results of researchers ultimately, when they, when they are replicated, become generally accepted medical practices, which then give doctors not only the frameworks that they learn in medical school, but the frameworks they're allowed to use when they treat patients, right? They're always going to look through a prism Right? So if you were a clinician, yeah, you might not be gaslighting patients in the same way that they feel gaslit, but maybe you would be because you were not looking through a different prism. Whereas as a researcher, you now get to bring to clinicians the tools they need to see what they couldn't see before, but more importantly, safely treat what they now can treat without being concerned about being sued by lawyers like me. Although I don't do medical malpractice work, so please don't hate me doctors, but even more importantly, not have to worry about medical boards suspending their licenses, which we've seen over and over and over again, right? So that's why the researchers are vital. That's why you need to be a researcher, and that's why you need to be where you are, because even though your husband is, is a brilliant medical doctor, he can only work within generally accepted medical practices, and they need to change because we haven't done enough research in the Lyme arena.

I agree.

Isn't that why you are where you are?

It is where— it is why where I am. I think language in certain fields needs to be changed. I think understanding certain things in fields should be changed. And I think there's this also, there's this component where communication needs to be better across fields, especially clinical and public health fields. And I think that's where my work becomes so vital to me is—

Vital to us?

Yeah, exactly. Like just whoever I can help. It's just more so where there's this communication that's not being translated across fields. And there's this communication where you can see on the public health side and the epidemiologic side that there's so much devastation in people's lives that go through this, but it's not being translated in the clinical community.

So that's why, although, although the research part of this world is not as glamorous, it's more glamorous to be the doctor who's seeing patients. It's more glamorous to be the person who has the highest status in our society. Medical doctors do. and on many levels rightfully so. But the most important work, the work that is going to touch more patients, the work that's going to result in the resolution, is going to be worked on by people like you, right?

Thank you, Rich. I really appreciate that.

Well, I'm really glad we finally had a chance to talk.

Me too.

This was really a great conversation, and thank you for coming out to Long Island, the better island.

I knew he was going to throw that in there.

And teach us what it looks like to have a—

Tick bomb.