The best diet for Lyme disease

When asked by the Caudwell charity if there is a Lyme-specific diet my answer on behalf of the London Clinic of Nutrition was that ‘there is no single diet that fits all when dealing with Lyme disease and that the dietary recommendations are based on the person’s presentation.’

The core of any diet should be nutrient dense and rich in anti-inflammatory compounds. Having said that, there are three types of diets that I often recommend when dealing with Lyme disease:

1.     An elimination diet to identify any potential food triggers

2.     A low histamine diet if the person presents with histamine intolerance symptoms – Borrelia burgordferi has been shown to induce mast cell activation, the immune cells which release histamine and promote inflammation

3.     A low FODMAP diet, if the person presents with gastrointestinal disturbances

All three diets are types of elimination diets, i.e. they are followed for a short period of time only after which foods are reintroduced, but at the core they are nutrient dense and rich in anti-inflammatory compounds. 

Below I am going to go through each diet providing extra details.

Elimination diet

As the name implies an elimination diet eliminates a food or a group of foods, usually the most common allergenic foods, for a period of time, 3 to 6 weeks, and then reintroduces them into the diet one at a time while monitoring symptoms. If a food triggers any symptoms then that food is eliminated from the diet for a further period of time until it is safe to re-challenge it again and see if it still causes problems.

The most common foods that are eliminated are wheat/gluten, dairy, soy, egg, peanuts and shellfish. These are the most common food allergens but other foods can also be considered, such as corn, sugar, beef, and any other foods a person may suspect to be intolerant to.

The diet can be challenging but many of my clients often see significant improvements when done thoroughly even for a short period of time, like 3 weeks. Preparation is key and as is to remember that it is only for a short period of time.

Low FODMAP diet 

FODMAP stands for Fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These are types of short chain carbohydrates which are poorly absorbed and end up being transported down into the colon and get fermented by the intestinal bacteria leading to the common symptoms of Irritable Bowel Syndrome (IBS) – bloating, abdominal pain, excessive flatulence and altered bowel habits.

The diet was designed and studied extensively by the Monash University in Australia and it was found to be significantly successful in the management of IBS or IBS-like symptoms.

Depending on the severity of the symptoms, a complete restriction of all FODMAP subtypes is implemented for 6-8 weeks and no more than 10 weeks. The elimination phase is followed by a re-challenge phase, where FODMAP subtypes are slowly re-challenged while monitoring symptoms.

The strict FODMAP diet can bring significant relief in gastrointestinal symptoms and some people are reluctant to reintroduce foods back into the diet. However, the re-challenge is an important step, as the diet removes foods such as garlic and onion which are actually important for gastrointestinal health and general wellness. The aim of the diet is to calm down the gastrointestinal symptoms while working on identifying any potential causes of gut disturbances which can contribute to the full Lyme presentation.

Low histamine diet

Borrelia burgdorferi spirochete was shown to induce mast cells. These are type of cells found throughout the whole body but are highly concentrated beneath the skin surface and mucosal layers of the gastrointestinal, respiratory and genitourinary tract. Mast cells release a variety of pro-inflammatory mediators, including histamine.

Once formed, histamine is either stored or rapidly inactivated by diamine oxidase (DAO) in the gut or by histamine-n-methyltransferase (HNMT) in the nervous system and lungs.

Histamine also occurs naturally in many foods and DAO plays an important role in the degradation of histamine from food in the gastrointestinal tract, acting as a barrier against the entry of histamine into the body.

Histamine intolerance is a response by the body resulting from an imbalance between accumulated histamine and the inability to break it down.

If a client tells me that since they had a tick bite they became more sensitive to foods, especially fermented foods, preserved meats and fish and alcohol, especially red wine, then avoidance of histamine foods is recommended. People find that they are able to tolerate high histamine foods again once the Lyme disease is well managed. Diamine oxidase and methylation function may be supported at the same time.