What happens when Lyme disease treatment focuses on infections, but patients continue struggling with debilitating symptoms? Could mold exposure, gut health, immune dysfunction, or other underlying health challenges be complicating recovery?
In this LIVE from ILADS interview, Tick Boot Camp co-host Rich Johannesen welcomes Dr. Sigrid Blehle, MD, MBA, PhD, Medical Director of Alviasana in Augsburg, Germany, to explore her integrative approach to Lyme disease, chronic infections, and complex chronic illness.
Recorded at the 2025 International Lyme and Associated Diseases Society (ILADS) Conference in San Antonio, Texas, this conversation examines why Dr. Blehle believes that identifying and treating infections is only one part of helping patients with complicated medical histories.
Dr. Blehle discusses her approach to evaluating environmental exposures, mold, heavy metals, gut microbiome health, immune function, nutritional status, and possible tick-borne infections before developing individualized treatment plans.
She also shares her experience with antibiotic therapy, herbal medicine, intravenous treatments, and other integrative interventions, while explaining how her multidisciplinary clinic works with patients from Europe, the United States, Africa, and Asia.
One of her most striking examples involves a patient who had already consulted 48 physicians before arriving at her clinic.
The central message of this interview is that patients with complex symptoms deserve careful listening, comprehensive medical histories, and individualized evaluation rather than assumptions about what is causing their illness.
Meet Dr. Sigrid Blehle: Lyme Disease Physician in Germany
Dr. Sigrid Blehle, MD, MBA, PhD, is a German physician and Medical Director of Alviasana, an integrative medical clinic based in Augsburg, Germany.
Her clinical interests include:
- Lyme disease and other tick-borne infections
- Complex and persistent symptoms following infectious illnesses
- Post-COVID conditions
- Environmental exposures, including mold
- Heavy metal exposure
- Mast cell activation syndrome (MCAS)
- Gut microbiome health
- Nutritional and metabolic concerns
- Genetic and immune-related factors
Dr. Blehle describes her clinic’s approach as comprehensive, emphasizing that patients frequently arrive with overlapping health concerns rather than a single clearly identified diagnosis.
She explains that many of her patients have already visited numerous physicians, undergone extensive testing, and tried multiple treatments before seeking care at Alviasana.
For these patients, her goal is to investigate potentially relevant contributors to their symptoms and develop a personalized treatment strategy.
When You’re the 49th Doctor: The Challenges of Complex Chronic Illness
Early in the conversation, Dr. Blehle shares the story of a patient who had already seen 48 doctors before visiting her clinic.
Dr. Blehle became the patient’s 49th physician.
The example illustrates a familiar experience for many people living with persistent, unexplained symptoms: years of medical appointments, conflicting explanations, unsuccessful treatments, and uncertainty about what to do next.
Dr. Blehle believes that patients with complex chronic illness often require a broader assessment of their health history.
Rather than assuming that every symptom has the same cause, she considers possible infections alongside environmental, nutritional, immune, and other medical factors.
Rich and Dr. Blehle discuss why listening carefully to the patient’s experiences is an essential first step.
For people who have struggled to find answers, a comprehensive evaluation can provide an opportunity to revisit overlooked questions and identify areas that may warrant additional investigation.
Why Dr. Blehle Believes Lyme Disease Treatment Requires a Broader Approach
One of the interview’s central themes is Dr. Blehle’s belief that treating suspected infections alone may not address every factor contributing to a patient’s illness.
She explains that her clinical approach considers the broader health picture, including possible environmental exposures and underlying medical conditions.
For example, a patient may have a history of tick exposure while also experiencing gastrointestinal problems, nutritional deficiencies, or symptoms associated with another illness.
Dr. Blehle believes these issues should be considered together when developing a treatment plan.
Her approach reflects her clinical experience and treatment philosophy. The interview does not establish that all the factors discussed cause persistent Lyme disease symptoms or that treating them improves outcomes for every patient.
Step One: A Comprehensive Patient History
Before ordering laboratory tests, Dr. Blehle begins with an extensive medical history.
She wants to understand not only the patient’s symptoms, but also their environment, travel history, previous illnesses, and treatment experiences.
Questions may include:
- Where does the patient live?
- Have they experienced known or suspected tick bites?
- Have they been exposed to mosquitoes or other biting insects?
- Have they traveled internationally?
- Did symptoms begin after an infection or travel?
- Have they lived or worked in buildings with water damage or visible mold?
- Have they received antibiotics or other treatments?
- What medical diagnoses have previously been considered?
- Which symptoms have persisted or changed over time?
Dr. Blehle describes how travel history can provide important clues.
For example, a patient may have become ill during or after traveling abroad, with symptoms continuing long after returning home.
She believes that understanding the timing and circumstances of symptom onset helps determine which diagnostic tests may be appropriate.
Her guiding principle is to use the medical history to select targeted investigations rather than ordering the same extensive laboratory panel for every patient.
Mold Exposure and Environmental Factors in Chronic Illness
Rich asks Dr. Blehle about the relationship between environmental exposures and chronic symptoms.
In particular, they discuss mold exposure in homes and workplaces.
Dr. Blehle explains that she asks patients about their living environments and considers possible mold exposure during the initial assessment.
When environmental concerns arise, she may recommend investigating the home for moisture damage or visible mold, including areas behind wallpaper or walls.
She also discusses using laboratory testing in her clinical evaluation.
Rich emphasizes the importance of identifying and reducing ongoing environmental exposures rather than focusing exclusively on testing the patient.
Does Mold Exposure Affect Lyme Disease Treatment?
Dr. Blehle shares her clinical belief that addressing suspected mold-related problems before antimicrobial treatment may improve the effectiveness of her broader treatment plan.
She describes using a similar sequence when she suspects heavy metal-related concerns.
These are her reported clinical practices, not established evidence that mold or heavy metal treatment improves Lyme disease outcomes.
Mold exposure can contribute to recognized health problems, particularly respiratory symptoms and allergic conditions. However, testing for mold-related illness is complex, and some commercially marketed body tests have not been validated for diagnosing illness caused by indoor mold.
The conversation raises important questions about environmental health while highlighting the need for appropriate medical assessment and evidence-based testing.
Heavy Metals, Genetic Factors, and Metabolic Health
In addition to mold, Dr. Blehle discusses investigating potential heavy metal exposures and selected genetic or metabolic concerns.
She explains that testing depends on the patient’s history and clinical presentation.
Her approach includes considering whether certain medical conditions or exposures may be contributing to symptoms.
Rich asks whether she evaluates the body’s ability to process or eliminate substances.
Dr. Blehle describes using genetic testing in selected circumstances rather than routinely ordering it for everyone.
This portion of the interview highlights the importance of distinguishing between documented toxic exposures, established medical conditions, and unproven explanations for chronic symptoms.
Heavy metal testing and treatment should be guided by clinically meaningful exposure histories and validated methods.
Gut Microbiome Health and Lyme Disease
One of the most detailed sections of the interview focuses on the gut microbiome, the community of microorganisms living in the digestive tract.
Dr. Blehle explains that many of her patients have previously undergone antibiotic treatment.
Because antibiotics can affect intestinal bacteria, she considers gastrointestinal health when planning additional treatment.
She believes the gut microbiome is an important part of evaluating patients with complex chronic illness.
Research has established connections between the intestinal microbiome and immune function, although the clinical significance of many commercial microbiome test results remains uncertain.
How Does Dr. Blehle Test the Gut Microbiome?
Dr. Blehle describes using stool testing to evaluate aspects of intestinal microbial composition.
She also discusses measuring substances such as histamine in stool samples.
She explains that she may address identified gastrointestinal concerns before beginning additional antimicrobial treatment.
Her goal is to consider digestive health and previous treatment effects as part of the overall care plan.
However, there is currently no universally accepted stool microbiome profile that defines optimal immune health or reliably predicts Lyme disease treatment outcomes.
The interview presents Dr. Blehle’s clinical approach rather than establishing that routine microbiome testing is necessary for Lyme disease patients.
Fecal Microbiota Transplantation: Could Restoring Gut Bacteria Help?
Rich asks Dr. Blehle about fecal microbiota transplantation (FMT), a procedure that transfers processed stool-derived microorganisms from a donor into a recipient’s gastrointestinal tract.
Dr. Blehle shares that she has treated one patient who underwent the procedure and appeared to benefit.
She emphasizes that this experience involved only one patient.
Rich also recalls interviewing patients who described improvements after undergoing fecal microbiota transplantation during their recovery journeys.
The discussion raises questions about the relationship between the gut microbiome, antibiotic exposure, and long-term health.
FMT has established clinical applications for selected cases of recurrent Clostridioides difficile infection. It is not an established treatment for Lyme disease or post-treatment Lyme disease symptoms, and it carries infectious and other risks.
Dr. Blehle’s anecdote should not be interpreted as evidence that FMT is effective for Lyme disease.
Evaluating Liver, Kidney, Thyroid, and Nutritional Health
Dr. Blehle explains that her initial evaluation commonly includes laboratory testing to assess general health and organ function.
Depending on the patient, this may involve:
- Liver function tests
- Kidney function tests
- Complete blood count
- Differential white blood cell count
- Vitamin and nutritional assessments
- Thyroid-related testing
- Selected metabolic or genetic investigations
She also describes using an electrocardiogram (ECG) and abdominal ultrasound as part of her clinic’s evaluation.
These assessments can provide information about a patient’s overall medical condition and help clinicians consider treatment risks.
Dr. Blehle emphasizes that she wants a broad understanding of each patient’s health before making treatment decisions.
Testing for Lyme Disease and Tick-Borne Coinfections
After reviewing the patient’s history and general health, Dr. Blehle discusses testing for infections.
She explains that she considers a variety of bacterial, viral, fungal, and parasitic conditions depending on the patient’s symptoms and exposure history.
Organisms and infections discussed include:
Tick-Borne Bacteria and Parasites
- Borrelia species, associated with Lyme disease and other borrelial infections
- Babesia species, which can cause babesiosis
- Bartonella species
- Ehrlichia species
- Anaplasma species
Other Bacterial Infections
- Yersinia
- Chlamydia pneumoniae
- Chlamydia trachomatis
- Campylobacter
Viral Infections
- Epstein-Barr virus (EBV)
- Cytomegalovirus (CMV)
- Human herpesvirus 6 (HHV-6)
- Parvovirus
Other Potential Conditions
- Toxoplasmosis
- Selected parasitic infections
- Candida-related conditions
Dr. Blehle explains that she does not routinely order one standardized infectious disease panel for every patient.
Instead, she selects tests based on her assessment of the patient’s medical history and symptoms.
An important distinction: Not every organism mentioned is transmitted by ticks, and a positive antibody test does not necessarily establish an active infection. Test results must be interpreted alongside symptoms, exposure history, examination findings, and the known accuracy of the test.
For additional information about diagnostic challenges, explore Tick Boot Camp’s Lyme Disease Testing Resource.
Why Dr. Blehle Uses ArminLabs for Lyme Disease Testing
Rich asks Dr. Blehle which laboratories she uses when evaluating Lyme disease and potential coinfections.
She explains that she frequently works with ArminLabs, a laboratory based in Germany.
Dr. Blehle describes having a longstanding professional relationship with the laboratory and familiarity with its testing methods.
She also uses other laboratories when additional information is needed.
Rich shares his positive experiences speaking with Dr. Armin Schwarzbach and expresses appreciation for his work in tick-borne disease diagnostics.
The conversation highlights the importance of understanding which tests are being ordered, what they measure, and how their results inform clinical decisions.
Different laboratory methods have different strengths, limitations, and levels of clinical validation. Patients should discuss the implications of testing with qualified healthcare professionals.
Building an Individualized Lyme Disease Treatment Plan
Once the medical history, examination, and testing have been completed, Dr. Blehle schedules a follow-up discussion to review the results.
She explains that the next step is developing a personalized treatment plan.
Depending on her assessment, the plan may include:
- Prescription antimicrobial medications
- Herbal treatments
- Nutritional support
- Selected supplements
- Management of identified medical conditions
- Monitoring of symptoms and laboratory findings
- Additional interventions offered at her clinic
Dr. Blehle describes preparing separate plans for prescription medications and supplements when appropriate.
She also explains that treatment decisions are discussed with other members of her clinical team.
The goal is to tailor care to the patient’s presentation rather than assume that everyone requires the same treatment.
Antibiotics vs. Herbal Treatments for Chronic Lyme Disease
Rich asks Dr. Blehle how she approaches antimicrobial treatment.
She explains that her clinic uses both prescription antibiotics and herbal treatments.
According to Dr. Blehle, some patients receive antibiotic-based treatment plans, while others pursue herbal approaches.
She describes her typical treatment timelines as:
- Antibiotic-based approaches: Approximately 8–12 months
- Herbal approaches: Approximately 18–24 months
These durations represent Dr. Blehle’s reported clinical practices, not standard treatment recommendations or evidence that prolonged therapy is effective for every patient.
Established antibiotic regimens for Lyme disease are generally substantially shorter and depend on the specific clinical manifestation.
Prolonged antimicrobial treatment can carry important risks, and the evidence does not support routinely extending antibiotics for persistent nonspecific symptoms after recommended Lyme disease treatment.
Likewise, herbal products vary in composition, safety, and supporting clinical evidence.
Patients should discuss treatment decisions with appropriately qualified clinicians.
IV Antibiotics, Infusions, and Integrative Therapies
Dr. Blehle describes several interventions available at Alviasana.
These include:
- Intravenous antibiotic treatment in selected cases
- Vitamin C infusions
- Amino acid infusions
- Ozone therapy
- Magnetic field therapy
- Light-based therapies
- Other individualized supportive treatments
She also mentions a temperature-based treatment transcribed as “hypothermia.” The recording does not make clear whether she intended to describe hypothermia or hyperthermia, so the exact intervention would need confirmation.
Dr. Blehle explains that she does not believe every patient requires intravenous antibiotics.
She reserves them for selected situations based on her clinical assessment.
It is important to distinguish between therapies with established medical indications and experimental or insufficiently validated approaches.
For example, IV antibiotics may be indicated for certain manifestations of Lyme disease, but they are not automatically necessary for persistent symptoms. Ozone therapy and magnetic field therapies are not established treatments for Lyme disease.
The interview provides an overview of services described by Dr. Blehle rather than evidence that each intervention is safe or effective for Lyme disease.
What Does Recovery From Lyme Disease Look Like?
Toward the end of the interview, Rich asks Dr. Blehle how her team determines whether a patient has recovered.
She explains that her clinic considers both symptoms and follow-up testing.
Dr. Blehle describes using a period of at least four months without symptoms and with negative test results as part of her clinic’s approach to assessing recovery.
She also discusses patients returning periodically for additional testing because they fear their infections may return.
However, Lyme disease antibody tests can remain positive for months or years after successful treatment, and repeat serology is not a validated test of cure.
Consequently, Dr. Blehle’s described testing criteria should not be treated as a universally accepted definition of Lyme disease recovery.
The discussion nevertheless highlights an important patient concern: How can someone regain confidence in their health after years of debilitating symptoms and uncertainty?
Tick Boot Camp’s PARM Framework for Healing
Rich introduces Dr. Blehle to Tick Boot Camp’s PARM framework, developed from patterns observed across hundreds of patient interviews.
PARM stands for:
P — Prehabilitation
Preparing the body and mind for the recovery process.
This phase emphasizes understanding the patient’s health status and addressing barriers that may affect their ability to participate in care.
A — Assist
Using appropriate medical treatment and supportive strategies to address diagnosed infections and other relevant health concerns.
R — Rehabilitation
Supporting recovery of physical function, cognitive abilities, and overall quality of life.
Depending on the patient’s needs, rehabilitation may involve physical therapy, occupational therapy, cognitive rehabilitation, or other individualized interventions.
M — Maintenance
Maintaining healthy habits, monitoring for new concerns, and reducing the risk of future tick exposure.
This includes practical prevention strategies to help protect against reinfection.
Dr. Blehle explains that the general structure is consistent with the way she approaches her patients.
She also describes using an additional period of herbal treatment toward the end of some treatment plans.
Her endorsement reflects her clinical perspective. PARM is a patient-informed framework for organizing recovery experiences, not a validated medical protocol.
For practical tick prevention and post-bite guidance, visit Tick Boot Camp’s Tick Bite Blueprint.
The Importance of International Collaboration Through ILADS
Dr. Blehle explains that she has attended approximately 10 ILADS conferences in the United States and Europe.
She values the opportunity to learn from physicians and researchers who work with patients experiencing complex symptoms.
At the 2025 conference, she was particularly interested in presentations addressing:
- Mold and environmental exposures
- Brain metabolism
- Neurological function
- Emerging clinical and scientific perspectives
- Education for physicians treating tick-borne diseases
Dr. Blehle also discusses her efforts to expand physician education in Germany and other European countries.
She believes that more doctors need opportunities to learn about tick-borne diseases and complex chronic illness.
Her goal is to help build a larger network of clinicians who can recognize relevant conditions, evaluate patients thoroughly, and provide appropriate care.
Explore additional conversations with healthcare professionals through the Tick Boot Camp Doctors Podcast Collection.
International Lyme Disease Care at Alviasana
Although Dr. Blehle practices in Augsburg, Germany, she explains that Alviasana works with patients from around the world.
Her clinic has welcomed individuals from:
- Germany and other European countries
- The United States
- Africa
- Asia
She notes that the clinic’s website is available in multiple languages, including English, German, and French.
Patients interested in learning more about her medical practice can visit the Alviasana official website.
The interview does not establish whether particular treatments are available or appropriate for every international patient. Individuals considering care abroad should evaluate the provider’s credentials, proposed treatment evidence, risks, costs, and follow-up arrangements.
Key Takeaways From Dr. Sigrid Blehle
- A detailed medical history matters. Dr. Blehle begins with patients’ symptoms, exposures, travel, previous diagnoses, and treatment experiences.
- Complex symptoms may have multiple contributors. She evaluates potential infections alongside other medical and environmental concerns.
- Mold and environmental exposures deserve appropriate consideration. The interview explores how living conditions may affect health, while the effectiveness of mold-directed treatments for Lyme disease remains unproven.
- Gut health is part of her clinical approach. Dr. Blehle considers gastrointestinal symptoms, previous antibiotic use, and stool testing.
- Infectious disease testing should be individualized. She selects tests based on patient history rather than relying on one standard panel.
- Not every positive infectious disease test indicates active illness. Clinical interpretation is essential.
- Treatment decisions vary among patients. Dr. Blehle discusses antibiotics, herbal medicine, and other interventions offered at her clinic.
- Prolonged treatment requires careful evaluation. Her reported treatment timelines are not standard recommendations and must be considered in light of available evidence and potential risks.
- Recovery involves more than a laboratory result. Symptoms, function, quality of life, and clinically appropriate follow-up all matter.
- Physician education is important. Dr. Blehle works to expand professional learning opportunities in Germany and Europe.
- International collaboration can encourage new research questions. ILADS brings together clinicians and researchers from different countries.
- Patients deserve to be heard. Her story about becoming one patient’s 49th physician underscores the challenges faced by people seeking answers.
Resources Mentioned in This Episode
Guest and Clinical Resources
- Alviasana – Dr. Sigrid Blehle’s Medical Clinic in Augsburg, Germany
- International Lyme and Associated Diseases Society (ILADS)
- ArminLabs – Laboratory Testing
Tick Boot Camp Educational Resources
- Lyme Disease Testing: Understanding Diagnostic Challenges
- Tick Bite Blueprint: What to Do After a Tick Bite
- Tick Boot Camp Doctors Podcast Collection
- Tick Boot Camp Lyme Disease Podcast
About This LIVE from ILADS Episode
Recorded at the 2025 ILADS Conference in San Antonio, Texas, this episode features Dr. Sigrid Blehle, MD, MBA, PhD, Medical Director of Alviasana in Augsburg, Germany.
Together with Tick Boot Camp co-host Rich Johannesen, Dr. Blehle explores comprehensive patient evaluations, Lyme disease testing, tick-borne coinfections, mold exposure, heavy metals, gut microbiome health, immune function, antibiotic and herbal treatment approaches, and the importance of individualized care.
The conversation also examines Tick Boot Camp’s PARM framework and the need for continued physician education and international collaboration.
For patients who have visited countless doctors without finding answers, this episode reinforces an important message: Your symptoms deserve thoughtful investigation, your experiences deserve to be heard, and meaningful improvements in health and quality of life remain possible.
Listen to more patient stories and expert conversations on the Tick Boot Camp Podcast.
