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Mental health problems are prevalent in Lyme disease patients, with over 340 peer-reviewed scientific journal articles documenting psychiatric symptoms associated with the disease. (1) A growing body of research indicates that neuropsychiatric symptoms in Lyme disease, including sudden-onset panic, depression, anxiety, anhedonia, and suicidality, are far from being “psychosomatic,” as many conventional doctors suggest. Rather, these symptoms have profound immunological and biochemical underpinnings that are amenable to diet and lifestyle changes.
In my personal struggle with Lyme disease in my late teens and early twenties, my mental health suffered immensely. The eating disorders, anxiety, depression, and anxiety I experienced during my Lyme battle took a significant toll on my health and relationships. However, as an inquisitive college student studying biomedical science, I knew that my mental health issues had to have a deeper, biochemical cause. I dove into the scientific literature and read everything I could about the neurological effects of Lyme and interventions that could help reduce the brain inflammation, oxidative stress, and neuronal dysfunction caused by the disease. I soon realized that diet and lifestyle have profound effects on brain function at a biochemical level; I began to incorporate specific interventions into my own treatment protocol and experienced major improvements. In this blog, I’ll share my favorite nutritional and lifestyle strategies for alleviating neurological Lyme dysfunction and restoring balance to the brain.
Note: The nutritional and lifestyle strategies outlined in this blog are intended to serve as adjunct support in the treatment of Lyme disease, not as a sole treatment modality. Acute and chronic Lyme disease are serious conditions that require the support of a Lyme-literate doctor. If you need help finding a Lyme-literature doctor, please check out the practitioner directory on the ILADS website.
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Lyme disease causes immune-mediated neurological dysfunction
Sickness syndrome is a medically-recognized response to infection characterized by anhedonia (the inability to feel pleasure) and depression. (2) These feelings aren’t just the result of being “under the weather;” they are actually a reflection of the body’s inflammatory response to pathogens. Lyme disease is no exception. A growing body of research indicates that Borrelia burgdorferi, the causative agent in Lyme disease, triggers neuropsychiatric dysfunction through several mechanisms:
Triggers the release of proinflammatory cytokines, increasing TNF-α, IL-1β, IL-6, IL-8, IL-12, IL-17, IL-18, interferon-gamma, neopterin, and C-reactive protein. Elevated levels of pro-inflammatory cytokines are found in suicide attempters and victims and people suffering from depression and anxiety. (3, 4, 5, 6)
Has direct cytotoxic effects on neurons (7)
Alters tryptophan metabolism, impairing serotonin function and increasing the production of tryptophan-derived neurotoxic metabolites such as quinolinic acid. High quinolinic acid is associated with “high suicidal intent.” (8)
Induces brain oxidative stress
Alters inhibitory/excitatory neurotransmitter balance in the brain
Nutritional strategies for alleviating “Lyme brain”
The nutritional strategies outlined here are not intended to serve as treatment for Lyme disease. Rather, they are beneficial adjunct treatments to use alongside a comprehensive Lyme disease treatment protocol.
Identify Your Trigger Foods
Identifying foods that trigger inflammation is the most important thing I have done to reduce Lyme-associated inflammation, depression, and anxiety. The consumption of foods that provoke an inflammatory response will keep your body in a state of chronic inflammation, unable to mount a successful attack against Borrelia burgdorferi.
Personally, I’ve found grains and dairy to be the worst offenders when it comes to the health of my brain; they give me almost instant brain fog and depression. I avoid dairy 100% of the time and only eat grains on very rare occasions. Food triggers vary from person to person, but gluten and cereal grains are common inflammatory triggers due to their effects on gut permeability and gut-brain axis activation. (9)
Incorporate Anti-Inflammatory Foods
Once you’ve removed foods that trigger brain inflammation, you’ll want to add foods to your diet that have anti-inflammatory activity and support healthy brain function. Listed here are a few of my favorites:
Berries (particularly blueberries and blackberries)
Extra virgin olive oil
Broccoli sprouts: These are rich in sulforaphane, a potent neuroprotective phytochemical.
These foods contain phytonutrients and fatty acids that inhibit brain oxidative stress, one of the key mechanisms by which Borrelia burgdorferi impairs neuropsychiatric health. Choose a few to incorporate into your diet each day.
Balance blood sugar
Blood sugar swings, referred to as “glycemic variability” in the scientific literature, has a significant impact on mood, with higher glycemic variability (larger blood sugar swings) associated with higher anxiety and anger and lower quality of life. (10) High sugar consumption, which produces large blood sugar swings, is also associated with an increased risk of recurrent depression. (11) High blood sugar also impairs the immune response to Borrelia burgdorferi, making it doubly harmful for the Lyme-affected brain. (12) Balancing blood sugar, on the other hand can greatly improve mental health in those with Lyme disease.
To keep blood sugar balanced throughout the day, I recommend eating a high-protein, low-carbohydrate breakfast and either consuming the majority of your daily carbohydrates at lunch or dinner; research indicates that this eating approach significantly improves blood sugar control (13), and may, in turn, improve your brain function.
Importantly, people’s blood sugar responds differently to various foods; for example, a sweet potato may work fine for one person but cause a significant blood sugar fluctuation in another. To determine which foods work best for your body, I recommend tracking your fasting and postprandial blood sugar for several days using a tool such as the Keto Mojo Blood Glucose and Ketone monitor. Check your fasting blood glucose immediately upon waking; ideally, it should be below 90 mg/dL. For postprandial blood sugar measurements, follow these instructions:
Test your blood sugar right before lunch.
Test your blood sugar one hour after lunch.
Test again 2 and 3 hours after lunch.
Record your results and what you ate at lunch; this will help you see how the foods you normally eat affect your blood sugar level.
Blood sugar should be less than 140 mg/dL one hour after a meal, less than 120 2 hours after a meal, and back to your baseline fasting blood glucose level three hours after your meal. If it does not return to normal in this timeframe, you may need to change the type of carbohydrates you consume, the macronutrient composition of your meal, and/or incorporate some insulin-sensitizing foods and nutrients into your diet. Some of my favorite insulin-sensitizing and blood sugar-lowering nutraceuticals are berberine, cinnamon, and alpha-lipoic acid. This is a complex topic but one that I can help you with via my clinical nutrition services.
Optimize tryptophan metabolism
Tryptophan is the amino acid precursor to serotonin, a neurotransmitter with significant effects on mood and behavior. Inflammation alters tryptophan metabolism, skewing tryptophan towards the production of pro-inflammatory mediators rather than serotonin. One of these pro-inflammatory mediators, quinolinic acid, is neurotoxic and associated with severe depression and suicidality. (14, 15)
Treating Lyme disease with the help of a qualified Lyme doctor will reduce overall inflammation and should help improve tryptophan metabolism. However, nutritional interventions can also help normalize tryptophan metabolic pathways. Ensuring an optimal intake of vitamin B6 is crucial, as B6 deficiency increases the production of quinolinic acid and another inflammatory metabolite, kynurenine. (16)
Flavonoids from colorful fruits and vegetables also inhibit quinolinic acid-induced oxidative stress in the brain. (17) Berries, purple sweet potatoes, apples, and onions are particularly rich sources of flavonoids.
Berries are rich in flavonoids that quench neuroinflammation. They are a delicious way to “feed” your brain! Try adding berries to a smoothie with coconut milk, MCT oil (a special type of oil with brain-boosting benefits), nut butter, and some stevia or monk fruit sweetener.
Want to find out whether inflammation is affecting your brain? The organic acids test I use in my clinical nutrition practice measures quinolinic acid and other inflammatory tryptophan metabolites, helping me narrow down which nutrition interventions will be most valuable for my clients with Lyme disease.
DHA and Astaxanthin
One of my favorite supplements I’ve found for alleviating neuroinflammation is Cymbiotika DHA + Astaxanthin. DHA, an omega-3 fat, is the predominant structural fatty acid in the brain and has potent anti-inflammatory effects. Astaxanthin is a fat-soluble antioxidant found in microalgae, krill, wild salmon, and several other forms of wild seafood that ameliorates neuroinflammation caused by toxic bacterial byproducts in the gut. (18) If you also suffer from mold illness, the combination of DHA and astaxanthin will be doubly beneficial, as these nutrients inhibit the production of inflammatory cytokines in response to mycotoxins. (19, 20)
Fasting, intentionally going without food for a specific period of time (generally 12 hours of more) reduces inflammation and improves blood sugar control and may thus help improve mental health.
Intermittent fasting alleviates cognitive dysfunction caused by inflammation; I personally experienced profound anti-inflammatory effects when I began intermittent fasting several years ago. (18) Several years ago, I practiced intermittent fasting for 16 hours every day, with an 8-hour eating window. This strategy significantly alleviated the depression I was experiencing related to Lyme disease. Today, I take a different approach, fasting for a minimum of 12 hours every night between dinner and breakfast the next day. You can learn more about the benefits of fasting for Lyme disease in my blog Intermittent Fasting for Lyme Disease Recovery.
Lifestyle strategies for Lyme neuroinflammation
The importance of sleep for reducing Lyme neuroinflammation and improving neuropsychiatric health cannot be overemphasized! Sleep disruption induces neuroinflammation and impairs learning and memory, processes that are already compromised in many Lyme disease patients. (19) If you struggle with sleep, try the following strategies:
Avoid artificial light exposure for at least 1-2 hours before bed. Blue light is a well-established disruptor of melatonin production and circadian rhythms, delaying sleep onset and reducing sleep quality. Wear blue light-blocking glasses 1-2 hours before bed to limit your exposure to blue light.
Sleep in a completely dark room. The reasoning behind this is the same one for wearing blue-light-blocking glasses; light pollution in your bedroom at night can make it difficult to fall asleep and obtain high-quality sleep.
Keep your bedroom cool – around 67 degrees is optimal.
If the above strategies aren’t enough to get you sleeping well, you may need some temporary nutritional support. I recommend LipoCalm by Quicksilver Scientific – it’s a blend of GABA, the body’s “rest and repair” neurotransmitter, and a blend of sleep-inducing botanicals.
Sleep is an essential “nutrient” for reducing Lyme-induced neuroinflammation. Personally, improving my sleep hygiene and making time in my schedule to get a solid 7-8 hours of sleep every night has allowed me to make great strides in my recovery.
I plan to write a separate blog post on the benefits of meditation for Lyme disease recovery, but I’ll just cover the neuropsychiatric benefits here. Mindfulness meditation alters immune function, decreasing proinflammatory cytokines that adversely impact mental health. (20) Meditative forms of exercise, such as Tai Chi and yoga, are beneficial for major depressive disorder. (21) While I love yoga and its effects on my brain, it’s been hard to fit into my schedule lately, so I’ve been using a meditation app called Waking Up instead with great results. I recommend committing to two 10-minute meditation sessions per day using an app such as Waking Up, or one of the many other options out there.
Yes, I know it can feel extremely difficult, if not impossible, to exercise when you’re in the midst of struggling with neurological Lyme symptoms. However, failing to move your body will only exacerbate depression, anxiety, brain fog, and other neurological symptoms; the key is to find a form of exercise that work for you wherever you are in your healing journey.
Exercise offers multiple neurological benefits to Lyme patients:
Exercise activates the lymphatic system, your body’s system for removing waste products from your cells and regulating immunity. The lymphatic system doesn’t have its own internal pump like the cardiovascular system does (aka your heart). Rather, it relies on the voluntary movement of your skeletal muscles to stimulate lymphatic fluid transport and filtration. The lymphatic system is closely related to the glymphatic system, a microvascular system that removes waste products from the brain. Exercise promotes glymphatic clearance of amyloid beta, a harmful protein, from the brain and reduces astrocyte and microglia activation, improving brain function! (22)
Exercise initiates the endogenous release of brain-derived neurotrophic factor (BDNF). BDNF is a neuroprotective molecule that has anti-inflammatory effects on the brain. (23)
Exercise stimulates the release of feel-good neurotransmitters. By promoting the release of dopamine, norepinephrine, and serotonin, neurotransmitters that play key roles in the regulation of mood, exercise offers a drug-free means for improving the depression and anxiety that so often afflict Lyme disease patients.
When I was still really sick with Lyme symptoms, I still made an effort to exercise regularly either by going on walks in nature or doing gentle yoga. Both forms of exercise significantly improved my mood; in fact, I credit a consistent walking routine and yoga practice with getting me through some of the most trying years in my Lyme battle. Don’t underestimate the power of movement to help you heal!
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