In both my clinical experience and personal health journey, I found that addressing gut imbalances is a crucial stepping stone in the pathway to Lyme recovery. In fact, in my own decade-long journey with chronic Lyme disease, I found that I could not tolerate Lyme-specific treatments until I had improved my gut health. As I’ll get to shortly, this makes a LOT of sense when we consider the biological impacts of endotoxin, which is produced by Gram-negative bacteria in the gut, and other gut-derived imbalances on systemic inflammation and immune function. In my professional and personal experience, the resolution of gut imbalances can dramatically improve tolerance for Lyme treatments, allowing you to recover your health while also improving energy, mood, and overall quality of life.
Why Does Gut Health Matter for Lyme Recovery?
The gut is the seat of approximately 70-80% of your body’s immune system. It is also a vital interface between your external environment and the interior of your body. It is a crucial route of elimination for dead microbes, pro-inflammatory bacterial byproducts such as endotoxin, and a variety of toxins. In my clinical experience, the gut imbalances that I’ve found may need to be addressed to enable tolerable Lyme disease and coinfection treatment (without causing severe die-off or “Herxheimer” reactions) include:
Small Intestinal Bacterial Overgrowth (SIBO) or Intestinal Methanogen Overgrowth (IMO)
SIBO increases intestinal permeability (“leaky gut”) and inflammation, discussed below, potentially causing an influx of inflammagens into the systemic circulation. Inflammagens are defined as irritants that elicit inflammation. Biotoxins, such as those produced by Lyme and coinfections, are Inflammagens. If an individual already has a high endogenous inflammagen level due to SIBO, the release of further Inflammagens through Lyme treatment can overwhelm the body, causing die-off reactions. I’ve found that addressing SIBO first, thereby turning off the spigot of gut-derived Inflammagens, can improve tolerance for Inflammagens that are temporally released during Lyme treatment.
Methane-predominant SIBO, now referred to as “intestinal methanogen overgrowth” or IMO, often causes chronic constipation. Chronic constipation will preclude successful Lyme treatment by hindering the physical elimination of dead bacteria, parasites, and inflammagens via the stool. You do not want a backed-up sewage system when you’re trying to eliminate a bunch of inflammatory byproducts! Therefore, chronic constipation must be resolved before embarking on Lyme treatment, in my opinion. While there are many possible causes of chronic constipation, IMO is a significant cause of constipation and can be identified through SIBO testing.
Candida is an opportunistic microbe, meaning it is usually present in the gut at modest levels. However, when beneficial bacteria are knocked back by factors such as antibiotic use, Candida jump at the opportunity, quickly grabbing up more “real estate” in the gut. In excess, intestinal Candida skews the immune system towards Th2-dominant, allergic phenotype, activating mast cells. (1, 2) The subsequent chronic mast cell activation can make the body more reactive to just about everything, ranging from foods to Lyme medications and herbs. Addressing Candida overgrowth is thus crucial for improving tolerance to Lyme treatments. Research indicates that other fungal infections also trigger mast cell degranulation, suggesting a need to identify and treat other fungal intestinal infections. (3)
Overgrowth of Dysbiotic Bacteria
SIBO and IMO are just two examples of a gut microbiota gone awry. An overgrowth of other opportunistic or the presence of pathogenic bacteria (I collectively refer to these bugs as “dysbiotic” bacteria) can be just as disruptive to gut health and inflammatory status. A stool test can help you identify whether you’re dealing with a dysbiotic bacterial situation in your gut.
Breakdown of the proteins that bind intestinal epithelial cells together, known as “tight junctions,” creates an excessively permeable intestinal barrier. This condition, referred to colloquially as “leaky gut,” enables substances to leak from the intestinal lumen into the systemic circulation. One of the most common substances that is “leaked,” called endotoxin, is a highly inflammatory compound that can elicit a systemic inflammatory response. If you have a leaky gut and try to treat Lyme before repairing your gut, you’ll likely have a challenging time tolerating Lyme treatment. Why you may ask? Well, if your body is already bogged down with inflammatory byproducts that have escaped from your gut, adding more inflammatory stressors on top of that, as happens with Lyme treatment as we kill off bacteria and they secrete inflammagens, can quickly overwhelm the body and trigger symptoms ranging from fatigue to brain fog.
Lack of Beneficial Commensal Gut Bacteria
A healthy gut contains various commensal microorganisms, defined as microbes that generally reside in the gut. Scientific research indicates that commensal microorganisms act on our immune system to induce protective responses that defend us against invasion and colonization by pathogens. Importantly, these protective responses are not limited to the gut; the presence of beneficial commensal microorganisms in the gut may also bolster immune defenses against extra-intestinal pathogens, such as those that cause respiratory infections. (4) While there is not yet any research (that I’m aware of) looking at the gut microbiota, commensals, and their effects on protection against or the resolution of Lyme disease or other tickborne infections, I suspect that the levels of these microbes in the gut may play a critical role in how our bodies respond to Lyme disease and coinfections. Of course, increasing the levels of beneficial microbes in our guts through food and probiotics will also reduce intestinal permeability (5), improve SIBO (6), and attenuate Candida overgrowth (7), thus addressing other gut imbalances that can compromise successful Lyme treatment. Emerging research indicates that diet is the most impactful way to modulate levels of beneficial bacteria in our gastrointestinal systems over the long term. (8) This finding suggests that a “food first” approach to boosting beneficial microbes is essential!
Low Stomach Acid
Stomach acid is an essential first line of defense in your body against ingested pathogens. It is technically a chemical barrier, a substance with a low pH capable of killing pathogens that have been consumed through food or water or caught in the mucus of the airways and swallowed. Stomach acid also plays a vital role in protein digestion and the absorption of micronutrients, including iron, zinc, calcium, and vitamin B12. Insufficient stomach acid thus opens up the gut to possible infections. Low stomach acid also compromises the absorption of critical nutrients involved in the immune response, such as zinc.
Maldigestion and Malabsorption
Impaired digestion and absorption of fats, proteins, and both fat-soluble and water-soluble micronutrients is another crucial gut-related factor that can preclude successful Lyme treatment. For example, suppose you are not digesting fats properly and cannot absorb sufficient vitamin D (even with supplementation) to support immunoregulatory processes in your body. In that case, your immune system may have a challenging time overcoming chronic Lyme and/or coinfections until the fat malabsorption is resolved.
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Gut Treatments Must be Personalized
Addressing SIBO or IMO, Candida overgrowth, and leaky gut will reduce endotoxin leakage from the intestine into the systemic circulation, reducing chronic inflammation. A lower baseline level of chronic inflammation creates more room in the body’s “inflammation bucket” when inflammation temporarily increases with antibiotic and botanical antimicrobial treatments for Lyme, thus improving tolerance and allowing you to complete the courses of Lyme treatment you need.
Bolstering levels of beneficial microbes in the gut improves immune regulation. A well-regulated immune system is better able to target and overcome infections such as Lyme disease. Increasing beneficial intestinal bacteria through diet and probiotics can help to alleviate SIBO, leaky gut, and Candida overgrowth, reducing the inflammation triggered by these conditions.
Improving stomach acid production bolsters your gut’s frontline defenses against intestinal pathogens that cause inflammation and immune dysregulation. Improving digestion and nutrient absorption allows your body to obtain the nutrients it needs for robust immune function.
There is no one-size-fits-all approach to treating gut imbalances. Instead, the best treatment approach for an individual should be based on stool and/or SIBO testing results while also considering the individual’s symptoms, diet, and lifestyle factors. In my private practice, I routinely guide my clients with Lyme disease through gut treatments to help restore their gut health, ultimately setting them up for success with Lyme disease treatment. My treatment approach includes (but is not limited to) antimicrobial botanicals, immunoglobulins, probiotics, digestive enzymes, herbal bitters, binders, and mind-body techniques for improving the function of the gut-brain axis.
Do you have Lyme disease and struggle with gut issues? 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!