Many of my clients with Lyme disease and other chronic infections come to me with a lengthy list of food sensitivities. I do not doubt that there is a relationship between chronic infections and food sensitivities. I have experienced this connection firsthand, having dealt with severe histamine intolerance, salicylate sensitivity, FODMAP intolerance, and sulfur intolerance at various points in my Lyme journey. At one point, I was literally down to five foods that I could eat: Chicken, olive oil, apples, pears, and zucchini. This period was not a fun time in my life. Fortunately, I’m out of the woods now and have a deep interest in the Lyme-food sensitivity connection.
There are several mechanisms by which chronic infections, such as Lyme disease, may trigger food sensitivities:
Borrelia burgdorferi (one of the Borrelia bacteria involved in Lyme disease) and other infections can disrupt immune function. (1) The resulting shifts in the immune system, including chronic inflammation, may cause the body to react to things previously viewed as harmless, such as various foods.
Infectious organisms, such as Borrelia, can disrupt gut function. (2) Disruption of the gut microbiota contributes to a loss of oral tolerance, defined as the active process by which the immune system learns to tolerate orally ingested substances, including food. Disruption of the gut microbiota may thus lead to a loss of oral tolerance, with a subsequent loss of tolerance for foods that one previously consumed without issues. Gut microbiota disruption is also involved in the development of true food allergies (3) and may play a role in food sensitivities/intolerances (I use the words “sensitivity” and “intolerance” interchangeably), which is a response to a food mediated by substances other than IgE, such as histamine intolerance. (4)
Treatment for Lyme and other chronic infections via pharmaceutical antibiotics (and possibly, even certain antimicrobial herbs when taken in large doses over a long period of time) may disrupt the gut microbiota. The resulting changes in the gut microbiota may, in turn, trigger food sensitivities. One fascinating study identified a distinct gut microbiome “signature” in post-treatment Lyme disease patients compared to healthy controls, providing some clues as to how Lyme treatment might impact the gut. (5) The gut microbiota of the post-treatment Lyme patients was dominated by Blautia species, which are associated with autoimmunity and an increased relative abundance of Enterobacteriaceae, which harbor the pro-inflammatory cell membrane component lipopolysaccharide (LPS). When LPS “leaks” through a permeable intestinal barrier into the systemic circulation, it can trigger chronic inflammation and symptoms ranging from skin issues to brain fog. Finally, the patients also experienced a depletion of Bacteroides, a commensal member of the gut microbiota that plays indispensable roles in regulating the immune system and maintaining intestinal integrity. Whether these microbiota shifts were caused by treatment or preceded treatment is unclear, but this study certainly provides the impetus for further research.
How to Resolve Food Sensitivities
Address Chronic Infections with the Help of a Lyme-Literate Physician
You’ll need to address active infections to resolve food sensitivities. This requires the guidance of a Lyme-literate/tickborne illness-literate provider. I routinely partner with Lyme-literate providers to help clients; as the provider guides my clients through treatment for Lyme and other chronic infections, I work on addressing other possible contributors to food sensitivities, including:
Gut microbiota imbalances
Low stomach acid production
Heightened mast cell activity
Compromised acetylcholine signaling
Decreased intestinal mucin production
Decreased intestinal short-chain fatty acid production
Address Intestinal Microbial Imbalances
If you have a frank gut pathogen, you’ll need to approach treatment with a physician. However, subtler imbalances in the gut microbiota, including elevated levels of dysbiotic bacteria, a lack of beneficial gut bacteria, and yeast overgrowth, can all contribute to the development of food sensitivities and are amenable to nutritional, botanical, supplement, and lifestyle changes.
Address Mast Cell Activation
Mast cells are a class of white blood cells involved in allergic reactions and other aspects of immune function. A heightened state of mast cell activation is common in individuals with Lyme disease and other chronic infections because mast cells are a crucial part of antipathogen immune defenses. (6) Research indicates that mast cell activation deviates T regulatory cells (which usually help the body appropriately tolerate foods) down a path that leads to the production of Th2 cells, which are involved in allergic responses. Mast cell activation may thus play a role in the development of food allergies and sensitivities in individuals affected by Lyme and other infections. The stabilization of mast cells is a complex topic that deserves an article of its own; however, eating an anti-inflammatory diet is an important place to begin.
Support Stomach Acid Production
An important and relatively simple first step for addressing food sensitivities is to support stomach acid production. We need stomach acid to break down our food, and in particular, to break down food-derived proteins in foods into smaller, less immunogenic peptides. Once in the small intestine, these broken-down peptides are less likely to cross the intestinal barrier intact, enter the systemic circulation, and trigger an immune reaction. Mindful eating practices, betaine hydrochloride supplementation, and herbal bitters support stomach acid production.
Optimize Acetylcholine Signaling
You may also want to work on optimizing acetylcholine signaling along your gut-brain axis, which includes the enteric nervous system of the gut. Research indicates that critical cells involved in the induction of oral tolerance, goblet cells, can take up food antigens from the small intestine in an acetylcholine-dependent fashion. Impaired acetylcholine signaling may thus compromise oral tolerance to foods and contribute to food reactivity. (7) Acetylcholine is also necessary for the activity of the migrating motor complex (MMC), which keeps food and bacteria moving through the gut in a timely manner, helping to prevent bacterial overgrowth.
Acetylcholine signaling is enhanced by certain herbs, choline-containing compounds such as alpha-GPC, and mindfulness practices.
Enhance Intestinal Mucin Production
Mucin is a glycoprotein (a carbohydrate molecule attached to a protein) that lubricates and protects the gastrointestinal tract. Increasing mucin production in the intestine may alter the regulatory environment of the gastrointestinal tract, improving food tolerance. Specific probiotics may help here because they increase the intestinal production of mucins. (8) A knowledgeable healthcare provider can help you determine the right probiotics to meet your unique needs. In my clinical nutrition practice, I routinely assist clients with finding the best probiotic to meet their needs.
Increase Intestinal Short-Chain Fatty Acid Production
Increase your intake of fermentable carbohydrates. Large intestinal bacteria break down fermentable carbohydrates in our large intestine to make short-chain fatty acids (SCFA), such as butyrate and propionate. These SCFAs drive the activity of T regulatory cells, immune cells that help our bodies tolerate foods. Increasing SCFA levels in the gut may thus help improve aberrant immune responses to foods, improving food sensitivities. Inulin is a prebiotic fiber that drives intestinal microbial production of butyrate and propionate, two of the predominant SCFAs in the gut. Foods rich in inulin include artichoke, asparagus, garlic, onions, leeks, dandelion root, and chicory root. Resistant starch also increases SCFA production.
Both Lyme disease and food sensitivities are complex topics, and this article really only brushes the surface! However, I hope it has given you a helpful overview of how Lyme and other chronic infections may impact the development of food sensitivities, along with some ideas for where to start with resolving food sensitivities.
Do you have Lyme disease and struggle with food sensitivities? Consider working with me! I am currently accepting new clients in my clinical nutrition practice. If you’re interested in diving deep into improving your nutrition and health by working one-on-one with me, reach out to me here to schedule your discovery call. The discovery call will allow us to meet and talk together to decide if my nutrition services are the right fit for your needs. I look forward to connecting with you!