Lyme disease, contracted from the bite of a black-legged tick carrying Borrelia bacteria, is one of the fastest-growing infectious diseases in the United States. At least 300,000 people are newly diagnosed each year in the U.S., and a shocking 1.5 million have chronic Lyme disease. (1)
As a clinical nutritionist working with clients who have Lyme disease, I’ve seen firsthand how a Functional Medicine approach based on simple dietary changes can boost energy, support cognitive function, and alleviate chronic inflammation, reducing the impact of Lyme disease on my clients’ lives. While nutrition cannot cure Lyme disease, it can ease symptoms and improve your clients’ overall health, complementing their Lyme treatment protocols and accelerating the healing process.
As a dietitian or CNS, you are no doubt familiar with the abundance of conflicting dietary information available on the internet for just about every health condition! Unfortunately, Lyme disease is no exception. Dubious information on the so-called “best” diet for Lyme disease abounds online, with people promoting everything from strict vegetable juice “cleanses” to a meat-only carnivore diet. For the Lyme disease patient struggling with treatment decisions, chronic fatigue, pain, and brain fog, sorting through all this information can feel daunting. My goal is to offer you a no-nonsense nutrition approach, grounded in science and ancestral health wisdom, that you can implement with your clients to assist them in their recovery from Lyme disease.
For people with Lyme disease, making simple dietary changes can help boost energy, improve cognitive function, and reduce chronic inflammation. Find out how clinical nutritionist Lindsay Christensen uses diet and nutrition to support clients with Lyme. #nutrition #functionalmedicine
How Can Nutrition Support Lyme Disease Recovery?
Borrelia burgdorferi, Borrelia afzelii, and Borrelia garinii, the bacterial species responsible for causing the disease in the United States, Europe, and Asia, respectively, wreak havoc on the body via numerous mechanisms. As Chris discussed in depth in “Your Comprehensive Guide to Lyme Disease,” Borrelia and its coinfections can:
- Suppress immune function (2)
- Provoke chronic inflammation (3)
- Increase the risk of opportunistic infections (4)
- Cause joint pain and degeneration (5)
- Cause chronic fatigue
- Trigger cognitive dysfunction and neurobehavioral disorders, including anxiety and depression (6, 7)
- Trigger autoimmunity (8, 9)
Discussion of how nutrition can alleviate Lyme-induced physiological dysfunction is limited, even in the integrative medical community. However, a robust body of evidence indicates that strategic nutrition care can optimize immunity, alleviate inflammation, and support brain function and musculoskeletal health, thus suggesting its usefulness for Lyme disease patients.
This information gap is what led me to write a book specifically on nutrition support for Lyme disease recovery, The Lyme Disease 30-Day Meal Plan. In this article, I will share steps you can take to help your clients with Lyme disease improve their nutritional status and accelerate their healing process.
Step 1: Remove Inflammatory Foods
Borrelia burgdorferi induces an overwhelming inflammatory state in its host, in tissues ranging from the brain to the joints. (10, 11) Research indicates that nutrition has a profound impact on inflammatory balance within the body; therefore, since Lyme is an inflammatory disease, it is amenable to dietary changes.
When working with clients who have Lyme disease, I like to begin by having them remove inflammatory foods from their diets so that we can beneficially shift their inflammatory balance. There are three food groups that individuals with Lyme disease should avoid:
- Processed foods
- Refined carbohydrates and sugar
- Industrial seed oils
Processed foods, which comprise much of the Standard American Diet, are associated with increased risks of chronic inflammatory diseases and do no favors for the Lyme disease patient. (12, 13, 14) Refined carbohydrates and added sugars (Chris refers to these as “acellular carbohydrates”) promote an inflammatory gut microbiota, exacerbating chronic inflammation. (15) As Chris discussed in “How Industrial Seed Oils Are Making Us Sick,” industrial seed oils are potent inflammatory triggers that I also recommend Lyme patients avoid altogether.
Many Lyme Patients Do Well Avoiding Gluten and Dairy
In my clinical experience, most Lyme patients are better off avoiding gluten and dairy, along with the other inflammatory foods mentioned above. Gluten may exacerbate inflammation in people with Lyme disease by increasing intestinal permeability and inciting an inflammatory response. Gluten and dairy proteins share some structural similarities, which may explain why some gluten-sensitive Lyme patients also react to dairy products. (16, 17)
Step 2: Eat a Nutrient-Dense, Anti-Inflammatory Diet
Once inflammatory foods have been removed from your clients’ diets, help them build a nutrient-dense, anti-inflammatory dietary template by focusing on the following foods.
Grass-fed and organic animal proteins: Animal proteins contain the full spectrum of amino acids required for healthy physiological function, as well as iron and vitamin B12 for supporting energy production and cognitive function.
Wild-caught seafood: Wild-caught seafood is the richest dietary source of the anti-inflammatory omega-3 fatty acids EPA and DHA. It is also rich in selenium, required for antioxidant enzyme activity, and iodine, essential for thyroid function. I recommend that people eat at least two to three servings of low-mercury wild seafood per week.
At least three to four servings of non-starchy vegetables per day: Non-starchy vegetables provide dietary fiber, vitamin C, B vitamins, and phytochemicals with anti-inflammatory and gut health-supporting properties.
Moderate amounts of starchy vegetables and whole fruit: Sweet potatoes, white potatoes, winter squash, plantains, other Paleo-friendly starches, and whole fruits can be a healthy part of a nutrition protocol for clients with Lyme disease. However, the amount of starches and whole fruit your clients can eat depends on their blood sugar control; poor blood sugar control impairs the immune response to Borrelia burgdorferi. (18)
Nuts and seeds: Nuts and seeds provide trace minerals, vitamin E, and B vitamins. A recommended serving size is one handful of nuts or one-fourth cup seeds. Emphasize the importance of buying raw or lightly roasted nuts and seeds that are free of industrial seed oils.
Healthy fats: Healthy fats such as those found in olive oil, coconut oil, avocados, wild-caught seafood, and nuts and seeds help maintain a healthy inflammatory balance.
In my experience, gluten-free grains and legumes are a gray area for people with Lyme disease. Some people with Lyme disease do well with moderate amounts of gluten-free grains and legumes if their gut microbiome is unperturbed. However, those with gut issues such as SIBO or IBS may do best with a grain- and legume-free diet, at least until their gut symptoms have come under control.
Step 3: Support Immunity
The body requires an array of nutrients for proper immune function. Foods and nutrients that support the glutathione system, vitamins, minerals, and omega-3 fatty acids are critical for reinforcing the Lyme-compromised immune system.
The Glutathione System
The glutathione system includes glutathione, an antioxidant and cell-signaling molecule, and the enzymes responsible for its production and regeneration. The glutathione system is well known for its role in the detoxification of reactive oxygen and nitrogen species. However, emerging research indicates that it also plays a critical role in the immune response to B. burgdorferi, thus influencing the course of Lyme disease.
Nutrition is a powerful tool for supporting the glutathione system. The human body requires specific amino acids, vitamins, and minerals serve to produce glutathione. Furthermore, certain functional foods and phytonutrients upregulate the overall activity of the glutathione system.
The amino acids methionine, cysteine, and glycine are the building blocks of glutathione and are abundant in animal protein. Dietary glycine is the rate-limiting amino acid for glutathione synthesis and is low in vegetarian and vegan diets. (19) A low-protein vegan diet has been found to result in significantly lower blood levels of glutathione and is not ideal for people with Lyme disease. Vegans with Lyme disease who are not interested in introducing animal products to their diets need to be particularly diligent about obtaining enough dietary protein and even then may benefit from amino acid supplementation to support glutathione production.
Selenium is a critical cofactor for glutathione peroxidases, is involved in glutathione homeostasis, and modulates immunity. (20) I recommend that clients obtain selenium from whole foods, rather than supplements. Some of the best dietary sources of selenium include Brazil nuts, cod, shrimp, salmon, scallops, chicken, eggs, turkey, lamb, and shiitake mushrooms.
Magnesium deficiency depresses the immune response and the activity of the 300 other enzymatic pathways in the body that rely on it as a cofactor. (21) Your clients may benefit from supplementation with 300 to 400 mg of magnesium glycinate per day to support their magnesium status. Also, encourage them to eat magnesium-rich foods such as dark leafy greens, almonds, avocados, pumpkin seeds, cashews, and cacao/dark chocolate.
Vitamins C and E are antioxidant nutrients that work together to recycle oxidized glutathione, returning it to its functional state. Broccoli, cauliflower, brussels sprouts, bell pepper, citrus fruits, and strawberries are good sources of vitamin C. Vitamin E-rich foods include olive oil, avocados, nuts, and seeds.
Foods that Support Glutathione Production
A variety of whole foods have been found to support glutathione production. Cruciferous vegetables such as broccoli, brussels sprouts, cauliflower, and kale are rich in sulforaphane, a phytochemical that augments glutathione production. (22) Plants from the Allium genus, including garlic, onions, and leeks, induce the activity of glutathione S-transferase and glutathione peroxidase, critical enzymes in the glutathione system. (23)
The Nrf2 System
The nuclear factor erythroid 2-related factor 2 (Nrf2) pathway is involved in inflammation, the immune response, and glutathione production in the body. Several foods, including broccoli sprouts, berries, and green tea, activate the Nrf2 pathway, ultimately enhancing endogenous glutathione production. (24)
Interestingly, the Nrf2 activators exhibit biphasic effects; at low doses, they quench inflammation, while at high doses, they may incite inflammation. This dose–response curve suggests that doses of Nrf2 activators found in whole foods may be more beneficial than supplements, which typically provide supraphysiological doses of these compounds. (25)
Omega-3 Fatty Acids and Fat-Soluble Vitamins
Omega-3 fatty acids and fat-soluble vitamins are critical for supporting immunity in Lyme disease patients. Eicosanoids, derivatives of the omega-6 fatty acid arachidonic acid, are potent mediators of inflammation in Lyme arthritis. (26) Research indicates that inhibition of COX-2, an enzyme involved in eicosanoid metabolism, reduces Lyme arthritis symptoms without impairing bacterial clearance. (27) Omega-3 fatty acids are natural COX-2 inhibitors and anti-inflammatory agents, which suggests that they may help reduce inflammation in Lyme disease. (28) Encourage your clients to eat two to three servings of wild-caught seafood per week to support their omega-3 status.
Vitamin D is frequently low in patients with persistent Lyme disease, and a deficiency is associated with a poor healing trajectory. (29, 30) On top of that, Borrelia burgdorferi directly reduces vitamin D receptor expression in immune cells, increasing the need for vitamin D. (31) Supplementation with the active form of vitamin D has been found to inhibit the progression of Lyme arthritis. (32) Together, these findings indicate that vitamin D is critical for Lyme disease recovery. Daily sun exposure and the consumption of vitamin D-rich foods, including fatty cold-water fish and pastured egg yolks, support a healthy vitamin D status. However, supplementation may still be necessary for some individuals.
While vitamin D is crucial for your clients with Lyme disease, so are fat-soluble vitamins A and K2. Vitamin A has been found to support immune function in a preclinical model of Lyme disease, while vitamin K2 works with vitamin D to promote musculoskeletal health. (33, 34)
Step 4: Support the Gut, Joints, and Brain
Many chronic Lyme patients have undergone multiple rounds of antibiotics for the disease, significantly disrupting their gut microbiota. As nutritionists, we can help our clients with Lyme disease improve their gut health through several dietary strategies.
Encourage your clients to eat plenty of fermentable carbohydrates, such as sweet potatoes, artichokes, and onions. The carbohydrates in these foods serve as fuel for beneficial gut bacteria, supporting a healthy gut microbiome. A healthy gut microbiome, in turn, keeps inflammation at bay and support immunity. If your client also has SIBO or IBS in addition to Lyme disease, a high intake of fermentable carbohydrates may not be appropriate.
Fermented foods can also be incorporated to reintroduce beneficial bacteria to your clients’ digestive systems. However, as with fermentable carbohydrates, tolerance for fermented foods varies. Clients with histamine intolerance are better off avoiding fermented foods until the underlying causes of the intolerance are addressed.
Emerging research indicates that polyphenols also serve as an essential fuel for beneficial gut bacteria. Make sure that your clients eat plenty of colorful fruits and vegetables to optimize their polyphenol intake and promote a robust gut microbiome. (35)
Borrelia breaks down collagen and elastin fibers in connective tissue, causing damage to tendons, ligaments, and joints and contributing to the symptoms of Lyme arthritis. (36) The repair of damaged connective tissue can be supported nutritionally through the consumption of collagenous cuts of meat such as beef chuck. Supplementation with collagen peptides, which support connective tissue integrity and alleviate arthritic symptoms, may also be useful. (37) Vitamin C is a cofactor for the enzymes involved in collagen synthesis, so also make sure that your clients include plenty of vitamin C-rich foods in their diets.
The brain is one of the most severely affected organs in chronic Lyme disease. Borrelia promotes brain inflammation, impairs neuronal energy production, and creates biofilm in the brain of its host, causing cognitive dysfunction. Several nutritional interventions can help support brain health in people with Lyme disease.
Metabolomics research indicates that Lyme disease is associated with changes in the metabolism of tryptophan, an amino acid. Rather than being metabolized to serotonin, tryptophan is diverted towards the production of neuroinflammatory metabolites. (38) Vitamin B6 helps redirect the process, converting tryptophan into serotonin. Vitamin B6 is abundant in salmon, eggs, chicken liver, beef, sweet potatoes, bananas, chickpeas, and avocados.
Choline, a vitamin-like nutrient, is also critical for cognition. It has anti-inflammatory actions in the brain and is associated with higher cognitive performance. (39) Choline is found primarily in egg yolks, beef liver, and chicken liver; it is present in smaller amounts in cruciferous vegetables and lentils.
DHA, an omega-3 fatty acid, has anti-inflammatory effects on microglial cells, which are inappropriately activated by B. burgdorferi. (40, 41) Seafood consumption, rather than fish oil supplementation, shows the most consistent brain-health benefits.
Vitamin B12 supports healthy cognitive function and may be low in Lyme patients if they have impaired digestion. Animal proteins are the superior choice here for boosting low B12 levels, though small amounts of B12 are found in dried purple laver (nori) and wild mushrooms. (42)
Antimicrobial Herbs and Spices
In recent years, the scientific community has begun to study the anti-Borrelia effects of natural compounds. Cinnamon and oregano extracts have been found to inhibit the production of Borrelia biofilm. (43) Garlic oils and hydroxytyrosol, a phenolic phytochemical in olive oil, inhibit the growth of “persister” Borrelia. (44, 45) Regularly incorporating these functional foods will not only add flavor to your clients’ diets but may also make them less hospitable hosts!
Special Diets and Lyme Disease
The Ketogenic Diet
The ketogenic diet may seem like the latest diet fad. However, for some people with severe neurological Lyme disease, a ketogenic approach may indeed be beneficial. A ketogenic diet has been found to curb neuroinflammation and may thus help correct this underlying disturbance in Lyme disease. (46)
The Autoimmune Protocol (AIP) Diet
Chronic Lyme disease may trigger autoimmunity in some people. (47) Individuals with Lyme disease and autoimmune disease may benefit from the autoimmune protocol (AIP), a nutritional approach intended to alleviate autoimmunity by removing foods that frequently trigger an immune response. AIP is an extension of the Paleo diet. In addition to eliminating grains, legumes, industrial seed oils, and refined sugar, it eliminates foods that can trigger intestinal inflammation and food intolerance, including coffee, dairy, eggs, nuts and seeds, nightshade vegetables, and alcohol. You can learn more about AIP in “5 Steps to Personalizing Your Autoimmune Paleo Protocol.”
Customizing Diet and Nutrition for Clients with Lyme
The dietary template outlined here can do wonders in helping your clients with Lyme disease experience symptom relief. However, Lyme disease patients are a complicated bunch, and some may require a more customized dietary approach due to digestive health issues, food sensitivities, and nutrient deficiencies.
Functional lab testing can help you tailor nutrition protocols to the needs of your clients, helping them get back on their feet faster.
I hope you find these nutritional strategies useful as you work with clients who have Lyme disease!
The rates of chronic disease are skyrocketing, and our current approach to healthcare can do nothing to stop them. That’s because our current system is based on disease management, not true healthcare. The conventional approach means giving a patient a pill to mask symptoms rather than addressing diet and lifestyle—the primary factors in health and disease.
We need a new approach to healthcare, and that’s Functional Medicine. The Functional Medicine approach is based on preventing and reversing chronic disease, not simply managing symptoms. It’s investigative, holistic, and patient-centered—and it provides a more effective and fulfilling experience for practitioners.
The ADAPT Practitioner Training Program can help you learn how to incorporate Functional Medicine principles into your practice. Our course gives you the training, framework, and path forward you need to create your own Functional Medicine practice. Find out if our program is right for you.