Your Guide to the Ketogenic Diet for Lyme Disease


The ketogenic diet is currently all the rage for people seeking weight loss and enhanced physical performance. However, a ketogenic diet can also be beneficial for people with complex chronic illnesses that have a strong neuroinflammatory component, including Lyme disease. Read on to learn all about the ketogenic diet, its potential benefits for people with Lyme disease, and how to successfully incorporate the diet into your overall Lyme treatment protocol.

What is the Ketogenic Diet?

The ketogenic diet is a high-fat, moderate-protein, low-carbohydrate food plan. The typical macronutrient ratios are 60-75 percent of calories from fat, 15-30 percent from protein, and 5-10 percent from carbohydrates. By strictly reducing carbohydrates, the ketogenic diet prompts the body to shift its cellular fuel preference from glucose, found in dietary carbohydrates, to stored body fat and dietary fats. Carbohydrate restriction also increases hepatic production of ketones, small water-soluble compounds produced through the breakdown of fats in the liver that can be used by the brain, skeletal muscle, and heart for energy production. This process by which the body utilizes ketones for fuel is called ketosis.

The three ketones produced during ketosis – beta-hydroxybutyrate, acetoacetate, and acetone – can be measured in the blood using a ketone meter such as the Keto Mojo blood ketone meter. The optimal blood ketone range in nutritional ketosis is 0.5-3.0 mmol/L. The best times of day to measure your blood ketones are before lunch, before dinner, or at least 2-3 hours after eating a meal.

It may take some experimentation to find the macronutrient ratios that work best for you in terms of inducing nutritional ketosis while still maintaining energy, body weight, healthy sleep cycles, etc. This is something I help clients with in my clinical nutrition practice.

Benefits of the Ketogenic Diet in Lyme Disease

Ketosis regulates the activity of a variety of biochemical pathways that may benefit people recovering from Lyme disease.

Improves Blood Sugar Control

As I discussed previously in my blog Research Update: Blood Sugar and Lyme Disease, blood sugar control is essential for maintaining a robust immune response against Borrelia burgdorferi, the primary bacterium that causes Lyme disease. (1)

While eating a nutrient-dense, whole foods diet, exercising, sleeping well, and managing stress can do wonders for supporting blood sugar control, these measures may not be enough for some people. If you struggle with stubborn blood sugar dysregulation and have Lyme disease, a ketogenic diet may be helpful for you because it causes your body to rely on fats and ketones for fuel rather than glucose, thereby lowering your blood sugar and hepatic glucose production. (2)

Reduces Inflammation

Lyme disease is essentially a chronic, systemic inflammatory disease. The brain is hit particularly hard by inflammation in chronic Lyme disease. (3) Nutritional ketosis has profound anti-inflammatory effects on the brain and may thus help alleviate Lyme-induced neuroinflammation. (4)

Boosts Autophagy

Autophagy is the process by which your body cleans out damaged cells in order to regenerate new, healthier cells. Research indicates that autophagy is critical for alleviating inflammation triggered by Borrelia burgdorferi. (5, 6) Nutritional ketosis turns on biochemical signaling pathways that mediate autophagy, thereby helping your body eliminate damaged cells and potentially helping to dampen Lyme-induced inflammation. (7)

Enhances Cellular Energy Production

Chronic fatigue is a common symptom of Lyme disease. Some of this fatigue may be attributed to dysfunctional energy production in your mitochondria, the “power plants” of your cells. Research indicates that nutritional ketosis enhances mitochondrial function; (8) it may, therefore, help restore healthy cellular energy production and overall energy levels.

Should You Include Dairy on your Ketogenic Diet?

Although many people include dairy in their ketogenic diets, I find that most people with Lyme disease do best avoiding dairy due to its inflammatory potential. If you are unsure whether dairy adversely affects your body, I suggest doing some food journaling, a trial elimination diet, and food sensitivity testing to gain more clarity around the issue. These are strategies that I routinely use with clients in my clinical nutrition practice.

Who Shouldn’t Do a Ketogenic Diet?

There are a few subcategories of people with Lyme disease who, in my clinical experience, do not do well with a ketogenic diet:

  • People with severe leaky gut. Leaky gut causes a release of endotoxin into the systemic circulation, and endotoxin production can be exacerbated by a high dietary fat intake. (9) A moderate-carbohydrate diet rich in monounsaturated and omega-3 fatty acids, rather than the saturated fats commonly consumed on a ketogenic diet, may be a better option for these individuals.

  • People with many food sensitivities. If you already struggle with numerous food sensitivities, the last thing I want to do is tell you to cut out more foods with a ketogenic diet. In this situation, I would rather work first on correcting the underlying causes of your food sensitivities, and then work on reintroducing foods.

  • People who are underweight or on the edge of being underweight. The ketogenic diet can induce significant weight loss, which is why I do not recommend it for people who are already on the low end of the weight spectrum.

Lyme Diet-Friendly, Ketogenic Shopping List:

  • Wild-caught or sustainably-sourced seafood

  • Organic or pastured eggs

  • 4-5 servings of non-starchy vegetables per day such as broccoli, cauliflower, kale, green onion, spinach, swiss chard, bell peppers, mushrooms

  • Organic nuts and seeds (ideally, these should be soaked before consuming)

  • Blueberries, blackberries, and raspberries

  • Coconut products: Coconut oil, coconut butter, coconut aminos, coconut wraps (I’m a huge fan of Thrive Market’s coconut flakes cereal)

  • Avocados and avocado oil

  • Olives and olive oil

  • Cacao powder: Cacao polyphenols have demonstrated neuroprotective, anti-neuroinflammatory properties in several studies. (10, 11) Enjoy organic cacao powder in smoothies or chia pudding to support your brain and please your taste buds! I like Thrive Market Organic Cacao Powder.

  • Mold-free coffee such as Kion coffee or Bulletproof Upgraded coffee

  • Organic loose-leaf green tea: Green tea contains catechins, natural antioxidants with antimicrobial effects against common Lyme co-infections such as Babesia, Epstein Barr virus, and Candida albicans. (12, 13, 14) I like to avoid tea bags due to the risk of tea bag contamination with microplastics. (15) I use a stainless steel tea ball and loose leaf tea instead.

  • Herbs and spices with anti-Borrelia properties such as cinnamon, oregano, and garlic. (16,17)

Supplements for Supporting Ketosis


Berberine is a compound found in the roots of Berberis genus plants that upregulates biochemical pathways that mediate the health benefits of ketosis, including the AMPK pathway. (18) Supplementing with berberine may, therefore, help you enter nutritional ketosis faster.

Berberine also demonstrates neuroprotective benefits and is comparable to the diabetes drug metformin for supporting healthy blood sugar control. (19, 20) I like Thorne Research Berberine-500.


Magnesium is one of the body’s electrolytes and can become depleted by the diuresis stimulated by nutritional ketosis. Magnesium deficiency is also common in the general population, possibly due to declining soil levels of the nutrient. Magnesium is a critical cofactor for cellular energy production, enhances insulin sensitivity, and supports detoxification and brain function. I recommend that all my clients supplement with approximately 300-400 mg of magnesium per day in addition to eating magnesium-rich foods such as dark leafy greens. Magnesium threonate has shown the most benefits for the brain, while magnesium glycinate is well-tolerated by those with gut issues.


The diuresis (extra urine production) that accompanies nutritional ketosis can cause a depletion of electrolytes, resulting in uncomfortable symptoms such as headaches and muscle cramps. If you choose to implement a ketogenic diet in your Lyme disease recovery, I recommend supplementing daily with a keto-friendly electrolyte powder such as Ultima Replenisher.


It is unclear at this time whether the ketogenic diet induces significant changes in the gut microbiota. However, given the fact that the diet reduces your intake of starchy carbohydrates that are normally fermented by beneficial gut microbes for fuel, it is possible that nutritional ketosis may reduce levels of some beneficial gut bacteria.

To support a healthy gut bacterial population, I recommend that all my clients take a high-quality probiotic. My favorite brand is Klaire Labs. Please do NOT order Klaire Labs probiotics from Amazon, as they typically do not come refrigerated and most likely contain microbes that are no longer viable. You will need to order Klaire Labs probiotics through a practitioner. I offer a 10% discount on these probiotics (and a wide range of other professional-grade supplements) to all of my clients through my Fullscript account.

One final note: I do NOT recommend that people follow a strict ketogenic diet over the long-term, unless they have epilepsy, which is the medical condition for which the ketogenic diet was originally implemented. In my opinion, a ketogenic diet should be used therapeutically, over the short-term, while underlying causes of cognitive dysfunction and neuroinflammation are addressed. Cyclic ketosis is a better option over the long-term, since it allows you to experience the health benefits of ketosis while still allowing you to eat healthy carbohydrates that feed your gut bacteria and keep you feeling sane! 😊

Are you dealing with Lyme disease and interested in trying a ketogenic approach to healing? 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 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!

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