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Lyme disease is an infection transmitted by a bite from an arthropod (insect or spider) vector, such as a deer tick. Lyme disease isn’t classically associated with gastrointestinal symptoms, at least not in the early stages of infection. However, a growing number of individuals with Lyme disease report gastrointestinal symptoms, including abdominal pain, bloating, gut paralysis, diarrhea, and constipation. So what’s the connection between Lyme disease and gastrointestinal issues? Read on to learn how Lyme infection and treatment can contribute to gastrointestinal problems and how functional medicine and nutrition interventions can support gut healing.
The Link Between Lyme Disease & Gut Issues
70-80 percent of your immune system is located in your gastrointestinal tract (1), so it, therefore, isn’t surprising that this infection can significantly influence the gut and that the status of one’s gut health can influence the course of the disease in a bi-directional relationship.
Gastrointestinal symptoms are surprisingly common in acute Lyme disease, yet these gastrointestinal symptoms are often not symptoms that doctors have in mind when considering Lyme disease diagnosis. One study of 314 patients with acute Lyme disease found that 23% of patients suffered from anorexia, or loss of appetite (this is different from anorexia nervosa, the eating disorder), 17% experienced nausea, 10% experienced vomiting, 8% had abdominal pain, and 2% had diarrhea. (2) Less well understood is the impact of chronic Lyme disease on gut health and gastrointestinal symptoms.
Both Lyme infection itself and antibiotic treatment may disrupt the gut microbiota, causing symptoms and compromising immune function. A fascinating study found that Lyme disease patients who had undergone antibiotic treatment experienced distinct changes in their gut microbiotas characterized by dysbiosis, or an imbalance between “good” and “bad” microorganisms in the gut. (3)
Certain pathogens transmitted alongside Borrelia burgdorferi, including Bartonella, can also cause an array of gut symptoms. For example, Bartonella henselae may trigger bowel inflammation. (ref)
Left unaddressed, imbalances induced by Lyme disease infection or treatment not only lead to symptoms that reduce quality of life but may also compromise nutrient absorption and whole-body nutrient status and trigger systemic inflammation, causing symptoms ranging from brain fog to joint pain. Addressing Lyme disease gastrointestinal issues is thus essential for healing.
Next, let’s discuss some Lyme disease gastrointestinal symptoms.
Lyme Disease Gastrointestinal Symptoms
Early research suggested that 5-13% of patients with acute Lyme disease demonstrate gastrointestinal symptoms (so called “gastro lyme”), including loss of appetite, nausea, vomiting, and abdominal pain. However, chronic Lyme disease can also disrupt gastrointestinal function. Chronic Lyme disease gastrointestinal symptoms may include:
- Nausea: Chronic nausea and nausea after eating are common in Lyme disease. Nausea may stem from dysfunction of the autonomic nervous system, the branch of the nervous system responsible for controlling involuntary bodily functions, such as the heartbeat and digestive process. Borrelia burgdorferi is known to trigger autonomic nervous system dysfunction. (ref) In some individuals with Lyme, nausea may also be accompanied by vomiting.
- Gut paralysis: Lyme-induced gut paralysis may occur in the stomach, a condition referred to as “gastroparesis.” (ref) It may also occur in the small intestine, contributing to small intestinal bacterial overgrowth or SIBO. While the pathogenesis of dysmotility (impairment of the digestive tract muscles) in Lyme disease is not entirely understood, it may stem from nerve inflammation caused by direct invasion of Borrelia burgdorferi into nerve cells.
- Diarrhea: Diarrhea in Lyme disease may stem from antibiotic treatment or from the infection itself. Interestingly, the incidence of diarrhea is higher in people with vector-borne infections other than Lyme disease, including ehrlichiosis, tick-borne relapsing fever, and Rocky Mountain spotted fever.
- Constipation: Constipation may stem from Lyme disease gut paralysis or from shifts in the gut microbiota that occur due to antibiotic treatment for the disease.
- Abdominal pain: Lyme disease is known to cause abdominal pain, possibly through the effects of the infection on the nerves that innervate the gut. Hepatomegaly (enlargement of the liver) and splenomegaly (enlargement of the spleen) can also occur in Lyme disease and cause abdominal pain.
- Food allergies and food sensitivities: New-onset food allergies and sensitivities are something I routinely see in my clinical nutrition practice amongst my clients with Lyme disease. These allergies and sensitivities may emerge from Lyme-induced immune dysfunction or from gut imbalances triggered by infection and antibiotic treatment. Research indicates that imbalances in the gut can contribute to both food allergies and food sensitivities, suggesting that gut healing may be crucial for attenuating or resolving these conditions. (ref, ref)
The Lyme Disease Candida Connection
Lyme disease can suppress immune function. This immunosuppression may render the body more susceptible to other infections or to colonization by microorganisms that are usually kept in check inside the body, such as Candida albicans, a type of opportunistic yeast.
While antibiotic treatment is often essential for patients with Lyme disease, it doesn’t come without risks. One of those potential risks is Candida overgrowth, which can occur when antibiotic treatment kills off probiotic organisms in the gut that usually keep Candida in check. Antibiotic treatment is associated with declines in the production of antimicrobial compounds called “short-chain fatty acids,” or SCFA, by beneficial gut bacteria. Reductions in these SCFA are associated with increased gut colonization by Candida albicans. (ref)
Eating a diet high in refined carbohydrates and sugars, including lots of bread, pasta, and cereal increases the risk of Candida overgrowth because Candida loves to munch on processed carbs. (ref)
Symptoms of Lyme disease-related Candida overgrowth can include:
- A white coating on the tongue or in patches elsewhere in the mouth, also known as oral thrush
- Vaginal yeast infections
- Low tolerance for dietary carbohydrates, including grains, legumes, fruits, and starchy vegetables
- Chronic bloating
- Food sensitivities
- Skin conditions, such as dry, scaly skin, psoriasis, and fungal toenails
- Oxalate sensitivity: Oxalates are substances that occur in various plant foods, including spinach and beets. Interestingly, certain fungal organisms, like Candida, can produce oxalate-like molecules. Therefore, when one has a Candida overgrowth in the gut, the influx of oxalate-like molecules created by these organisms can exceed the body’s capacity to metabolism them, causing people to react to oxalate-containing foods. So, ultimately, addressing the Candida overgrowth is vital for resolving the oxalate sensitivity.
Saccharomyces boulardii is a probiotic yeast that can help stave off Candida overgrowth during Lyme disease antibiotic treatment. It has direct anti-Candida effects, preventing Candida from adhering to the gut lining and creating biofilms, which protect Candida from antifungals and can thus make it more challenging to treat. (ref)
It is critical to try and prevent yeast overgrowth or, if it is already present, treat it promptly because uncontrolled Candida overgrowth can increase intestinal permeability (promoting leaky gut) and may even trigger gastrointestinal inflammation. (ref, ref)
The Lyme Disease-Gut-Chronic Fatigue Connection
Lyme disease is linked to chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME). Research indicates that changes in the gut microbiome underlie CFS and ME, suggesting a connection between these conditions. (ref)
How to Treat Gastrointestinal Lyme Disease
Treating chronic Lyme disease and co-infections is essential for resolving gastrointestinal symptoms that stem from the infection itself. However, there is much we can do and antibiotic treatment to support our gut health. First things first, we need to optimize the foods we’re eating!
Dietary Treatment for Digestive System Lyme Problems
The treatment of any gastrointestinal issues related to Lyme disease should start with an anti-inflammatory, gut-friendly diet free of common gut irritants. Foods that irritate and inflame the gut and should be avoided include:
- Gluten: Gluten is a common trigger for gut inflammation and can play a role in chronic bloating, diarrhea, constipation, abdominal pain, and IBS, among other gastrointestinal symptoms. (ref) I have found that many of my clients with Lyme disease feel their best when avoiding gluten, especially if they have gut issues.
- Conventional dairy products: Dairy products contain two proteins, casein, and whey, that resemble gluten. A body that is sensitive to gluten can thus react to dairy products, triggering gut inflammation. I find that many of my clients with Lyme disease do best avoiding conventional industrially-raised dairy products. However, some do well with goat or sheep milk dairy products.
- Industrial seed oils, including corn, canola, cottonseed, grapeseed, soybean, safflower, and sunflower oils. These oils contain oxidized lipid byproducts that disrupt the gut microbiota and inflame the gut. (ref)
- Refined sugars and carbohydrates: Simple sugars and other simple carbohydrates fuel the growth of pro-inflammatory gut bacteria. (ref, ref)
In my clinical experience, the most gut-friendly diet for supporting gastrointestinal healing and Lyme disease recovery is a Paleo diet. Don’t let images of hunter-gatherers gnawing on chunks of meat dissuade you from reading on and trying Paleo! A Paleo diet can take many forms; I prefer to think of the Paleo diet as a template centered around several fundamental principles that can be customized to meet an individual’s unique needs, whether that person is a red meat-lover or a pescatarian.
A gut-healing Paleo diet for Lyme disease includes the following foods:
- Animal protein: Choose from beef, bison, chicken, turkey, pork, eggs, and fatty cold-water fish. Choose grass-fed red meat and organic or pastured poultry and eggs as often as possible; these types of animal protein tend to be lower in toxins (such as synthetic hormones and antibiotic residues) and richer in nutrients than factory-farmed beef, poultry, and eggs. Try to choose wild-caught fish as much as possible since farmed fish contain many toxins based on what they are fed and how they are raised. If you need to purchase farmed fish, farmed Norwegian and Scottish salmon are the best farmed fish options because they are raised in the ocean rather than above-ground tanks. Nowadays, grass-fed meat, organic poultry, and eggs are widely available at many grocery stores.
- Non-starchy vegetables: Try to eat at least three servings (approximately 3 cups) of non-starchy vegetables each day. Examples of non-starchy vegetables include broccoli, cauliflower, kale, brussels sprouts, lettuce, spinach, onion, mushrooms, celery, spaghetti squash, and zucchini.
- Whole fruits: Whole fruits are a great way to satisfy a sweet craving without consuming inflammatory refined sugars. Try to focus mainly on lower-sugar fruits, which will be less likely to trigger yeast overgrowth. Examples of good fruits to choose from include blueberries, blackberries, raspberries, strawberries, avocado (yep, avocado is technically a fruit!), apples, and peaches.
- Starchy tubers, squashes, and root vegetables: You may incorporate the following non-grain carbohydrates, including sweet potato, white potatoes, winter squashes (acorn, butternut, delicata, and kabocha squash), root vegetables (parsnips, carrots, rutabaga, celery root, beets), and plantains, which are like a starchy banana.
- Healthy fats: Choose healthy fats, such as extra virgin olive oil, avocado oil, ghee, and coconut oil. Avocado, olives, nuts, and seeds are also healthy fat-containing foods to include.
The Paleo diet also excludes all grains, including gluten-free grains, and legumes, because these foods have a low nutrient density and contain antinutrients that can compromise gut health. Antinutrients are compounds that reduce the body’s ability to absorb essential nutrients. Examples of antinutrients include lectins, phytates/phytic acid, and saponins. Grains and legumes are particularly high in antinutrients compared to other foods. In some cases, antinutrients also interfere with food digestion by inhibiting digestive enzyme activity and can increase leaky gut.
Some people with Lyme and gut issues will tolerate modest amounts of gluten-free grains, like oats and quinoa, and legumes, such as chickpeas. However, these foods ideally shouldn’t comprise most of one’s diet due to their gut-disrupting potential.
To optimize the gut healing process, it is crucial to also incorporate specific gut-healing foods, including:
- Fermented foods: Fermented foods are rich in probiotic bacteria that exert benefits in our gastrointestinal systems transiently as they move through the gut. Examples of fermented foods include sauerkraut, kimchi, beet kvass, water kefir, coconut yogurt, and for people who tolerate dairy products, dairy-based yogurt, and kefir. Many people benefit from consuming fermented foods daily since the effects of the probiotic bacteria in these foods are transient. When purchasing fermented foods, be sure to select them from the refrigerated section, NOT the condiments aisle. Fermented foods with live, active probiotic cultures must be refrigerated to maintain the viability of the probiotics. For example, the sauerkraut in the unrefrigerated condiments aisle is not a fermented product but is cured in vinegar and doesn’t contain live probiotic cultures.
- Prebiotic foods: Prebiotics are substances that support the growth and activity of beneficial bacteria in our digestive tracts. Examples of prebiotic foods include garlic, onion, leeks, chicory root, dandelion greens, berries, and green tea.
- Bone broth, collagen, and gelatin: Bone broth, collagen, and gelatin are rich in amino acids, such as glycine and proline, that keep the crucial layer of cells lining our intestines intact. You can easily make bone broth at home using whole chicken or beef bones purchased from the meat counter at your local grocery store. The unique amino acids found in these foods can help repair leaky gut and maintain a robust intestinal barrier. (ref) Collagen peptides can be taken in a supplemental form. You can use grass-fed gelatin, such as Great Lakes gelatin, to make gut-healing gelatin gummies at home.
Learn the specific foods to eat (and 3 to avoid) to support your recovery from Lyme Disease.
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Gut Testing & Treatment
Implementing a gut-friendly diet is a crucial first step towards addressing Lyme disease’s gastrointestinal symptoms. However, it often isn’t enough by itself to resolve particularly stubborn gut issues, such as chronic diarrhea, chronic constipation, severe bloating, and gut paralysis. In the case of severe gut issues, completing gut testing and a customized gut protocol under the guidance of a qualified practitioner will often yield the best results.
Examples of gut testing that a functional practitioner may order include:
- A stool test: Stool tests assess the composition of the large intestinal microbiota. Stool tests also show markers of gut inflammation, digestion, and intestinal permeability.
- A SIBO test: This test assesses for small intestinal bacterial overgrowth (SIBO), a form of dysbiosis that occurs in the small intestine.
I may also order gluten sensitivity testing and additional food sensitivity testing for some clients since gluten sensitivity and other food sensitivities can contribute to ongoing gut inflammation.
I frequently order stool testing in my nutrition practice. SIBO testing is something I order less often, primarily because many of my clients come to me already having done SIBO testing. Based on the results of stool and SIBO testing, I will formulate a customized gut protocol for my clients that may incorporate:
- Nutrients to repair leaky gut, such as L-glutamine and zinc carnosine
- Probiotics, to balance the intestinal microbiota
- Prebiotics, to support the growth of beneficial gut bacteria
- Antimicrobial herbs to address bacterial, fungal, and parasitic imbalances
- Digestive support supplements, including betaine HCl (for stomach acid support), digestive enzymes, and herbal bitters to support bile flow
- Anti-inflammatories, such as curcumin and specialized pro-resolving mediators (SPMs) to quell gut inflammation
People with dysmotility related to Lyme disease may benefit from additional interventions that support gut motility, including pro-motility substances such as ginger root and acetylcholine-enhancing nutraceuticals, like alpha-GPC and Huperzine A; acetylcholine is a crucial neurotransmitter involved in gut motility. In addition, some people may benefit from practicing exercises that stimulate the vagus nerve, such as gargling, humming, and even using a tongue depressor (like the one your doctor places in the back of your mouth when they ask you to “say ahh”).
Treatment for Lyme Disease-Associated Candida Overgrowth
People suffering from Candida overgrowth related to Lyme disease infection or treatment should avoid the inflammatory foods listed above but also consider making the following adjustments to their dietary habits:
- Consider a low-carbohydrate diet for a while. This will deprive Candida of the simple sugars it thrives on. Next, consider eating a completely grain-free and legume-free diet with carbohydrates derived exclusively from root vegetables, sweet potatoes, winter squash, non-starchy vegetables, and small amounts of low-sugar fruits, such as wild blueberries and avocado. It is possible to take “anti-Candida” diets to extremes, so I strongly recommend working with a qualified nutritionist or dietitian if you’re struggling with Candida overgrowth and trying to eat to support healing.
- Incorporate functional foods with antifungal properties. Unrefined coconut oil contains lauric acid and caprylic acid, unique fatty acids that exert anti-Candida properties. (ref) Garlic, thyme, and rosemary are common kitchen herbs with antifungal properties that can assist with Candida management. (ref, ref, ref)
Diet alone often isn’t enough to address significant Candida overgrowth. In the case of stubborn Candida overgrowth, it is essential to work with a practitioner who can order testing and implement treatments for Candida overgrowth. I regularly work with clients to address Candida overgrowth using strategic herbal formulas, probiotics, therapeutic fatty acids, and dietary changes.
Lyme disease is an underappreciated cause of gastrointestinal issues. Diet, functional gut testing, and comprehensive gut protocols can significantly improve gut symptoms alongside antibiotic and herbal treatments for Lyme disease.