If you asked around among your friends and colleagues, you'd be hard-pressed not to find someone who's been affected by Lyme disease—the notorious infection caused by the bacterium Borrelia burgdorferi, which is transmitted to humans through the bite of a tiny infected black-legged or deer tick—or sometimes via co-infection through other tick-borne transmissions such as Babesia (parasite) or Bartonella (bacterium).
That's because Lyme is the number one tick-borne illness in the United States, with an estimated 300,000 people diagnosed1 every year, according to the Centers for Disease Control and Prevention (CDC). That is a conservative estimate.
Lyme disease left unchecked.
Since ticks are so tiny, many people don't even notice when they've been bitten. Because symptoms often mimic other health conditions such as chronic fatigue syndrome, multiple sclerosis, dementia, fibromyalgia, and even brain tumor, Lyme disease is often referred to as "The Great Imitator3" and can go misdiagnosed or undiagnosed for years.
This leaves many people struggling to manage their unrelenting chronic Lyme with no answers in sight when treatments for these other diseases don't end up working.
Symptoms of Lyme are global, spanning multiple body systems, especially the nervous, musculoskeletal, and cardiovascular systems. Days to months after the tick bite, later signs and symptoms of Lyme4 can include severe headaches, fatigue, neck stiffness, erythema migrans rashes, arthritis with severe joint pain, facial palsy, abnormal heart beat, shortness of breath, dizziness, inflammation of the central nervous system, nerve pain, brain fog, and memory loss (to name a few).
Why are we hearing more about Lyme?
So, why is there so much talk about Lyme disease right now? There are a few different reasons. First, Lyme is more common. CDC data shows us that cases of Lyme disease6 have significantly increased in the past 10 to 20 years. Researchers believe the major drivers for this increase in Lyme7 are the impact of climate change on broadening tick habitats and improvements in monitoring, detection and reporting of Lyme cases.
Also, celebrities like Avril Lavigne, Shania Twain, Amy Schumer, Alec Baldwin, and Justin Bieber candidly sharing about their battles with Lyme has brought this disease long overdue attention. But in my opinion, and from functional medicine's perspective as a whole, we may be hearing more about Lyme for other reasons too.
Our modern lifestyle, environment, and Lyme.
Because our genetics as humans have been stable for many thousands of years, we have to look at what has changed: the world around us. Many lifestyle choices and environmental factors have changed.
In my opinion, epigenetic or lifestyle factors like the processed foods we eat, epidemic proportions of metabolically unhealthy Americans, the depletion of nutrients from our soil, the pollution in the air we breathe, and toxins in the water we drink may be amplifying and perpetuating the impact that chronic infections caused by viruses, mold, protozoa, parasites, and bacteria (like Lyme disease) have on the body. As our earth is groaning in the form of climate change, so, too, is the human immune system from the onslaught of modern stressors.
Typically, mainstream medicine will diagnose the presence of Lyme through lab work—that is, if you notice a bite or if you or your doctor recognize your symptoms as possible Lyme indicators, Then the infection is typically treated with a round of oral or intravenous antibiotics.
But chronic Lyme that persists after antibiotic treatment (sometimes referred to as post-treatment Lyme disease syndrome8) or that's never diagnosed and treated to begin with goes largely unrecognized in conventional medicine. Thankfully, this battle with chronic Lyme is gaining recognition among the functional medicine community with the support of organizations such as the International Lyme and Associated Diseases Society (ILADS).
Lyme-literate functional medicine practitioners like me have a multipronged approach to chronic infections like Lyme. One of the tools we often use: food as medicine.
How I believe a keto diet supports Lyme healing.
The most effective food protocol for Lyme that I've found in my years of seeing many patients around the world is a mostly plant-based variation on the ketogenic diet that I call “ketotarian” (here's a sample shopping list and meal plan). By avoiding the common pitfalls of the conventional keto diet (lots of meat and dairy and not enough veggies), this dietary approach leverages the benefits of nutritional ketosis in the clean, sustainable way that I believe people with chronic infections need.
I should point out that there are no published research studies (yet) on the efficacy of the ketogenic diet in people with Lyme disease, so I am sharing insights from my clinical experience and observations. Here, I'll explain how a clean keto diet can be a major piece of the healing puzzle for people struggling with Lyme disease and other chronic infections:
Studies suggest that oxidative stress can contribute to mitochondrial dysfunction9 in the immune cells of Lyme patients. Dysfunction of mitochondria, the energy powerhouse of cells, can manifest as fatigue10, a hallmark Lyme symptom.
In animals (rodents), a ketogenic diet has been shown to support mitochondrial health by increasing mitochondrial biogenesis11, or the production of new mitochondria, through a process called autophagy, or “mitophagy”12 in the case of mitochondria. Literally translating as "self-eating," autophagy is your body's natural cleaning system and the primary process for removing damaged mitochondria. A ketogenic diet and intermittent fasting (which enhances ketosis) are two tools that increase autophagy in mechanistic studies of animals.
Long-term exposure to the Lyme pathogen has been suggested to trigger autoimmune diseases13 such as rheumatoid arthritis and other joint-related conditions through pro-inflammatory processes. This means reducing inflammation is likely crucial for helping to manage Lyme disease and reducing its debilitating symptoms. Fortunately, this is something a plant-heavy ketogenic diet excels at.
Ketones, including beta-hydroxybutyrate, are not just a form of fuel for the body. They're also signaling molecules and epigenetic modulators, which various cell culture studies have shown to activate anti-inflammatory pathways14 while inhibiting inflammatory pathways like the NLRP3 inflammasome15. Whether this effect occurs in humans following ketosis is unknown at this time.
Methylation is a crucial biochemical process involved in all cells of the body, including your body's hormonal, detoxification, and inflammatory pathways, which are important to optimize to manage Lyme. The MTHFR gene mutation, which is estimated to affect 30 to 40 percent of the American population, impairs methylation. A ketogenic diet, especially the plant-heavy ketotarian approach I recommend, is filled with dark leafy greens and cruciferous vegetables that are rich in folate and sulfur compounds, both of which are important for healthy methylation.
A robust immune system is important to help mount an attack against a Lyme infection. Since close to 80 percent of our immune system16 is in our GI tract, many Lyme disease experts agree that the gut microbiome is a key player in strengthening the immune system.
The fiber content of non-starchy vegetables (which you can eat freely on a keto diet as they're naturally low in carbohydrates) provides prebiotic fiber17 and fuel for good gut bugs (probiotics). Ini contrast, sweets and processed foods lack valuable nutrients and fiber for gut health. Too much sugar has also been shown to promote inflammation18 in the gut microbiome, so an ultra-low-sugar diet like keto would help support normal inflammation and healthy gut immune function.
Bottom line on using keto for Lyme.
While studies are needed in humans to truly determine the benefits of a ketogenic diet for Lyme disease, we do know that many of the underlying mechanisms or pathways implicated in Lyme disease may be helped with a high-fat, moderate-protein, low-carb keto diet. That's why I recommend a properly formulated, plant-centric keto diet as a nutritional strategy to support the Lyme healing process.
If you personally suffer from Lyme disease, you may want to consider seeking out a functional medicine practitioner who's familiar with Lyme and low-carb diets to help guide you through the process.
Will Cole, IFMCP, DNM, D.C., is a leading functional medicine expert who consults people around the globe, starting one of the first functional medicine telehealth centers in the world. Named one of the top 50 functional and integrative doctors in the nation, Dr. Will Cole provides a functional medicine approach for thyroid issues, autoimmune conditions, hormonal imbalances, digestive disorders, and brain problems. He is the host of the popular The Art Of Being Well podcast and the New York Times bestselling author of Intuitive Fasting, Ketotarian,The Inflammation Spectrum, and the brand new book Gut Feelings: Healing the Shame-Fueled Relationship Between What You Eat and How You Feel.