Dr. Justin Marchegiani and functional medicine practitioner Evan Brand break down Lyme disease, tick co-infections like Bartonella and Babesia, and the increasingly discussed alpha-gal syndrome — exploring why gut health, mold exposure, and adrenal function may matter just as much as any tick-specific protocol when it comes to how the body responds to a tick bite. From safe tick removal techniques and immune-supporting herbs like astragalus, reishi, and cat's claw, to natural prevention options like picaridin, this episode offers a whole-body functional medicine lens on tick season that goes well beyond the bite itself.
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Dr. Justin Marchegiani: And we are live. It's Dr. J in the house. Today we're going to be talking about ticks going wild. It is spring, it is here, everyone's outside, they're playing in the grass, they're out doing sports, and ticks are a thing that happens. We see it all the time with our patients. Evan, welcome to the show, man. How are you doing?
Evan Brand: Hey, man. Glad to be here, and I'm doing well. Luckily, there are fewer ticks in Florida, at least where I've been, so I've been really happy about that. Back in Kentucky, even in February, there would be ticks coming out if you had a warm day. The leaves were not even on the trees yet in Kentucky, but yet the ticks were out.
And I've told my story here many times, but I've tested positive for Lyme, Bartonella, and Babesia, and it's been challenging, I won't lie. I don't know if you can ever fully get rid of these bugs. I think Bartonella and Babesia you can. Lyme — which is Borrelia burgdorferi — there's some controversy about whether you can fully get rid of it or not. I think the goal is to get on top of it and get your immune system to a point where it's not creating any issues. So this idea of a forever protocol — I don't think it has to be forever, but you are definitely going to have to factor in some things, whether that be immune support, gut support, or actual herbs to address the infections.
Dr. Justin Marchegiani: And depending on what's happening in your life — it could be a death, a divorce, a family situation, a financial problem, or stress around your kids — I have seen people flare up their Lyme symptoms under intense stress. This is why we're going to unpack all of this today. We'll talk about some adaptogenic herbs, things you can do to directly support your system against the bugs, and things you can do to keep your system strong.
Evan Brand: When it comes to Lyme and the various co-infections — Borrelia, Babesia, Bartonella, Ehrlichia — I've seen too many people get tick bites and have no issues at all, while others do. So there's definitely a correlation, but not necessarily a direct causal relationship. What I look at is where that person's immune system is. The people who are already sicker are at higher risk when they get a tick bite. And what does that tell me? It tells me that weakened and compromised immune systems make it harder to handle the stress of that tick bite.
Dr. Justin Marchegiani: Just like anything else, right? If you have healthier, stronger adrenals, you're going to be able to handle the emotional stress of the day, and food that isn't perfect. The weaker your immune system is, the more you have to be on top of sleep, diet, nutrition, and gut health. Because remember, the gut is where 80% of your immune system lives. If we have immune stress going on in our gut and then we add a tick bite with a co-infection on top of that — on top of our inflammation, histamine, and stress bucket — now that could put you over the top and symptoms start to happen.
I don't think it's a one-to-one causal relationship. I've had too many experiences where that's not the case. I've also seen too many people go to ILADS doctors who are hyper-focused on the Lyme or the co-infection, and there are so many other issues still going on with that patient. Gluten sensitivity, gut permeability, weakened adrenals, very little DHEA, beaten-up neurotransmitters, still not digesting protein, other gut infections — H. pylori, Blastocystis, parasites, C. diff — but they're hyper-focused on the Lyme infection and everything else is still off. That's why we have to look at the big picture. Look at the co-infection — I'm not saying don't — but look at the whole picture.
Evan Brand: We've seen people get way worse going to Lyme experts. That's why we look at Lyme and co-infections, but we don't call ourselves the Lyme guys, because we know this is one puzzle piece in a larger system and we have to look at the whole thing. My story involved new babies, being up in the middle of the night, mold exposure — all of these other things. If I had gone all in on Lyme, I never would have gotten fully better. I had to address everything else, and my gut was a big piece as well.
If you go to the Lyme guy, it's likely you're going to miss the mitochondrial issues, the neurotransmitter issues, the parasites, the dysbiosis, the SIBO, the mold toxicity. How many people are going to a Lyme expert and not getting asked about their environment? “Hey, do you have water leaks in your home? Do you have mold in your basement?” Because that could make or break your entire protocol, and it could be that Lyme isn't even the biggest piece of the puzzle.
Dr. Justin Marchegiani: Now we do need to talk about alpha-gal. Let's unpack that, because this has been a very popular topic this year. A lot of people are blaming a famous billionaire for it, but alpha-gal has been happening long before 2026.
Alpha-gal is when people develop a sensitivity to red meat based on a tick bite — correct?
Evan Brand: That's right, and it's typically transmitted by the lone star tick. There is some debate about whether other ticks can transmit it, but the lone star is the one with the little yellow dot on its back. They call it the lone star tick, but you can see them up in Kentucky — they're not just in Texas or the South. They are spreading rapidly, and with mild winters, they spread further.
Essentially, you'll react to mammal meats, and it could be mild symptoms — itchiness, hives — or it could be a swollen throat or a full-blown anaphylactic reaction. So it can be potentially life-threatening depending on the severity. However, for most people who get bit by ticks, it's the co-infections I see more commonly — Bartonella, Babesia — which can cause their own host of problems: anxiety, depression, chronic fatigue, migrating joint pain, insomnia, headaches, migraines, floaters in your vision. If you have weird symptoms that don't make sense and have confused doctors, that's where we usually come in and unpack some of this.
Dr. Justin Marchegiani: How do you know it's actually alpha-gal driven by a tick? Is it just the history of a tick bite followed by meat sensitivity, or is there a diagnostic marker?
Evan Brand: You can get a panel done. We work with some partner labs, and we can often get discount codes for listeners. The alpha-gal panel runs about $125 and includes four different biomarkers: the beef IgE, the alpha-1,3 galactose, the lamb, and the pork. Based on those results, that's how they'll flag you.
Dr. Justin Marchegiani: So how are they assuming the cause is the tick? If someone is developing a food allergy, they're sensitive to a sugar — the alpha-galactose. But how are they making the connection that the cause came from the tick?
Evan Brand: What happens is when you get bit by the lone star tick, you're actually getting injected with that alpha-1,3 galactose. I don't believe there are other sources of that, so that's how they implicate the tick. But it is still somewhat of an assumption, because I've seen so many people with chronic gut issues end up developing food allergies to everything. So you have to ask: chicken or egg? Was it the tick? Was it a gut issue? What started the cascade? That's kind of where I get stuck as a functional medicine practitioner — trying to identify the most likely root cause unemotionally.
Dr. Justin Marchegiani: When I look at people's histories, I very rarely see: healthy, healthy, healthy, tick bite, then downhill. There's usually already a downhill trajectory, something happens, and then it accelerates. So the history tells you a lot. If I see someone who was great, great, great, tick bite, then downhill — that tells me a lot more about what's going on. But also, what was their diet like? Were they living in a moldy home? It could have set the table for other problems.
It's like the bodybuilder who deadlifts 500 pounds no problem, then bends over to pick up a piece of bread off the floor and blows out a disc. Did the bread really blow out the disc? You've got to look a little bit deeper to get to the root cause.
The CDC has been posting about this. They said there were over 100,000 cases of alpha-gal syndrome diagnosed by a lab from 2010 to the end of 2022 — roughly 20,000 new cases per year. Allergy rates in the Southern US are about 32% higher than elsewhere.
Evan Brand: I still think when it comes to alpha-gal and other issues, we have to look at Roundup and glyphosate exposure, because that makes the gut more permeable. The more permeable the gut is, the more likely you are to develop food allergenicity to anything you're eating. Other infections, moldy environments, obviously ticks as well. I'm not saying it's only one thing — let's put everything on the table and cross it off the list.
Dr. Justin Marchegiani: There are some interesting graphics on the mechanism. It looks like it's partly a mast cell reaction. They're showing the sensitization, the glycoprotein injected from the tick, and at the bottom the basophils and mast cells being activated. So they're almost considering it a form of tick-borne mast cell activation.
Either way, right now the most important thing is getting the gut dialed in. The gut is where a lot of your immune system is. If you have an immune response to the alpha-galactose or any other proteins you're eating, work on getting the gut better. Work on enzymes, work on stomach acid, work on the six Rs. Remove the bad foods. Use an Instant Pot so foods are easier to digest — it pre-digests the food. Rotate your foods so you're not getting exposed to the same things every day. Get your enzymes, your acid, and your bile support dialed in. Make sure your motility is solid and you're having a bowel movement every single day.
Also topically — if we get a tick bite, what are some things we can do, Evan? Green clay?
Evan Brand: Yeah, green clay is probably the most effective topical option. But first, most importantly: don't burn the tick and don't twist it. I can tell you confidently from plenty of tick bites that those things don't work, they make it worse, and you can get a piece of the tick stuck inside you. I've seen plenty of pictures and emails from people saying they went to the ER for a tick bite because they tried to twist it, burn it, or pinch it, and ended up needing it dug out.
Don't do that. Just use tweezers — steady, firm pressure. Hold it there steadily, and the tick will eventually release on its own. You pull everything out cleanly. You can save the tick if you want — Dr. Justin has mentioned tickreport.com in the past if you want to send it in.
After you pull it out and confirm everything is clear, make a poultice. You can use plantain leaf, but typically a green clay with a little bit of water applied directly to the site works well. Buhner also discussed adding an andrographis tincture to the clay. So it's an andrographis and green clay combination. You leave it on for a few hours — it dries to a nice paste over the wound. You can put a Band-Aid over it if you want to sleep with it on. The idea is that you're drawing out whatever you were exposed to. This is probably not 100% effective, but it's better than nothing.
Then you begin immediately with oral astragalus root — three grams per day for a month. This is not medical advice. This is what Stephen Buhner's protocol called for, in the context of supporting the immune system. We're not talking about treating anything. This is about supporting your immune system so it can handle the stress in your body.
Dr. Justin Marchegiani: Astragalus is an immune support herb. Astragalus does not kill Lyme — all it does is ramp up the immune system so you can fight harder on your own. Now, a lot of doctors are still going to recommend doxycycline after an acute tick bite. I personally have not taken it, and looking back I'm not sure — coulda, shoulda, woulda. For me personally, I focused on the natural approach to get my immune system up. I haven't tested recently, but years ago I did test positive, and now I can manage symptoms well enough to enjoy daily life, be a good dad, be a good husband. I really don't have any Lyme symptoms unless sleep falls apart or I have major mold exposure in a moldy hotel or Airbnb — then I'll feel some of what I used to experience come back.
You may need doxycycline if you're starting to get acute symptoms — chills, fever, achiness, a bullseye rash. If you don't have those symptoms, a conventional doctor often won't prescribe it anyway. But in either situation, supporting your immune system is a good idea.
Does it have to be green clay? Can we use bentonite clay or activated charcoal?
Evan Brand: Any clay should work. It's still going to give you that adsorbent quality.
Dr. Justin Marchegiani: Adsorbent, meaning it electrically pulls material out via charge — like a magnet to iron filings. Absorbent is more like a sponge. It's good to have both of those properties. You can use a clay mask with activated charcoal or bentonite clay to pull that out. There are also some excellent Amish drawing salves that contain comfrey, charcoal, and clays that can be very helpful.
I also like reishi mushroom — Ganoderma lucidum — really powerful immune support. Astragalus, ginseng, and adrenal tonics like ashwagandha are all very good for supporting the immune system. Have you seen the little plunger-style tools for pulling material out of a bite site?
Evan Brand: I have. I haven't needed them recently — luckily I haven't had a tick attached to me in a while. The last time I did, standard fine-tipped tweezers were enough. I just kept steady pressure and it popped out. They do let go on their own. The idea of having to dig it out shouldn't happen unless you kill the tick while it's still in you — then it becomes a problem, because you're also squeezing the infection into yourself.
I've seen people squeeze the body of the tick as they're trying to pull it out, and they're literally squeezing its saliva and fluids into the wound. You want to get as close to the skin as possible — essentially grab near where the head meets the body, not the body itself. If you grab the body, you're squeezing the contents in.
Dr. Justin Marchegiani: If you live anywhere with grasses, you're going to encounter ticks. I've seen videos going viral of people covered in nymphs — the really tiny ones that can be as small as a speck of pepper. Those are the hardest to deal with because they're almost too small to grip without squeezing the body. But progress, not perfection with those.
On the anatomy — you want to grab right where the head meets the body. If you squeeze where the main body is, you're squeezing the fluids into you. For tick removal kits, I've used the Tick Check Premium tools. They have a fork-style scoop for adult ticks and angled fine-tip tweezers for smaller ones. The angled tip gives you more surface area. I'd definitely recommend having these in your first aid kit, along with the illustrated guide that comes with them, because in the moment your brain goes blank and it's helpful to have a visual reference.
Evan Brand: Absolutely. Some ticks were almost too small for the fork tool, so I had to switch to tweezers. You should have both. You should also have the clay and a bottle of astragalus — a bottle can last for years.
Other things to have on hand: picaridin. A lot of people talk about permethrin, but permethrin is quite toxic. You can get permethrin-treated clothing where apparently you're not directly exposed to the chemical itself, but I'm not a fan. I prefer picaridin — P-I-C-A-R-I-D-I-N. It's a mimic of piperine, which comes from black pepper, and it's the most effective thing I've found when going out into the grass, garden, hiking, camping, biking, anywhere in the woods. I've even heard of people getting ticks in their driveways — you don't have to be in the jungle.
Picaridin is something you can spray onto your clothing and onto your skin. I haven't had any adverse reactions reported from it, and it's very effective against mosquitoes as well. Sawyer makes it — S-A-W-Y-E-R — at around 20%. CDC recommends it against mosquitoes, ticks, biting flies, and fleas. It's virtually odorless and, unlike DEET, it won't damage your gear. It's been the best-selling insect repellent in Europe since 1998.
DEET I'm not a fan of at all. If you're in a really high-tick area, you might need to use multiple approaches. But picaridin is my top recommendation. I personally bought the lotion version rather than the aerosol because I didn't want aerosolized spray around the kids. The pump spray is another non-aerosol option.
Dr. Justin Marchegiani: I like that. I'm not saying you need to be wearing this stuff every day, but know your local area. If there's a particular trail or woods you like and you keep coming out with ticks on you, heed the old warning: an ounce of prevention is worth a pound of cure.
Evan Brand: That's it, man.
Dr. Justin Marchegiani: So in the end, if you have a Lyme or tick issue, you've got to look at the gut. If it's acute, see your conventional MD — doxycycline may be recommended, especially with a bullseye rash or acute symptoms. We want to work on supporting your immune system. We gave you a couple of options with the picaridin, and also things like cedar oil — natural compounds you can use. Topically, the tick removal kit, the green or bentonite clay. And some of the immune-supporting natural compounds we discussed.
Also look at your gut, your diet, and mold exposure. There could be deeper things weakening your immune system that we can help identify and address.
Evan, thanks for being on the podcast today. Evan sees patients worldwide at evanbrand.com. I'm Dr. J at justinhealth.com, and I also see patients worldwide. We work with these issues all the time. If you want that support, we are here for you. Love to see your comments below.
Evan Brand: If you guys need help, let us know. We'll be happy to take a look. We'll talk to you about the latest testing strategies, how we can look at co-infections beyond blood work. A lot of blood work is inaccurate — antibody testing is not the only thing out there. We'll help you with that. Justinhealth.com, evanbrand.com. Let us know how we can help. Stay safe and check your butt cracks.
Dr. Justin Marchegiani: Awesome. Have a good one, guys. Take care. Peace.
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