Archive for the ‘Gut Health’ Category

GI Issues With Lyme Disease

When patients consider taking long-term antibiotics for persistent Lyme disease, they need to weigh risks and benefits of treatment. Gastrointestinal risks can include the possibility of a C.diff infection, or candidaovergrowth, which is a yeast infection that occurs not just in typical places you imagine but also in the gut. A good Lyme Literate Medical Doctor (LLMD) will put a patient on probiotics and a specific diet to mediate these risks, or may decide to go the intravenous route to take pressure off the gut.

Medication is not the only way that the gut can be impacted by Lyme disease; the infection itself can cause gastrointestinal issues. In his book How Can I Get Better? An Action Plan for Treating Resistant Lyme & Chronic Disease, Richard I. Horowitz, MD notes that Lyme and co-infections can cause inflammation leading to issues such as abdominal pain, nausea, gas, bloating, constipation, diarrhea, or reflux disease, with occasional vomiting. He writes, “…a review of gastrointestinal and liver problems associated with tick-borne diseases found that in 5 percent to 23 percent of those with early Lyme borreliosis, patients presented with varied gastrointestinal symptoms, such as nausea, vomiting, abdominal pain, anorexia with loss of appetite, and hepatitis, and some even had symptoms of an enlarged spleen and liver.”[i] And that’s just in early Lyme—in later stages of the disease, spirochetes(Lyme bacteria) can burrow deeper into the gastrointestinal tract, causing more damage. Other tick-borne diseases can also cause their own gastrointestinal issues, often overlapping with Lyme symptoms when the patient is co-infected.

Because every case of tick-borne illness is different, some Lyme patients may not experience any gastrointestinal symptoms. When I was at my sickest with Lyme disease, babesiosis, ehrlichiosis, possible bartonella, and chronic active Epstein-Barr virus, I used to joke, “Well, at least my stomach feels okay.” Because I wasn’t experiencing abdominal pain or vomiting, I figured my stomach was the one part of my body that had gotten off easy.

In fact, many of the symptoms I experienced in other parts of my body, including joint and muscle pain, migraine headaches, fever, and fatigue, were directly related to weakness in my gut caused by disease. Unbeknownst to many people—myself included before I got sick—the gut is a major player in the immune system. Dr. Horowitz writes that the “GI tract houses 80 percent of our immune system and 70 percent of our lymphocytes, making it the first line of defense against infections.” He goes on to explain that “…the gut can hold as many as 100 trillion microbes, referred to as the microbiome.” The bacteria in each person’s unique microbiome “help to supply essential vitamins; fight dangerous pathogens; keep the immune system in balance and modulate autoimmune disease (like MS and rheumatoid arthritis); modulate hormones, appetite, weight, glucose metabolism, and diabetes; modulate cardiovascular risk, neurological and psychiatric diseases (like Parkinson’s and schizophrenia); affect epigenetics, modulate cancer risk and affect inflammatory reactions in the body, including allergies, asthma, Crohn’s disease, and colitis.”i

An imbalanced microbiome can lead to intestinal permeability, commonly called “leaky gut syndrome.” This can allow toxins pass into the gut, causing inflammation and changes in flora; it’s similar to what happens when the blood-brain barrier is compromised. A 2020 study done by researchers at Johns Hopkins University School of Medicine, Northeastern University, and University of California San Diego found that the gut microbiome of post treatment Lyme disease patients was distinctly different than the gut microbiome of healthy subjects.

Whether Lyme patients experience gastrointestinal symptoms or not, their microbiome is impacted by their infection(s), their medications, and their diet. A weakened microbiome means a weakened ability to heal. As Lyme patients, we can help strengthen our microbiome by taking probiotics to replace good bacteria that are killed by antibiotics (some patients also take an anti-fungal medication, which can have anti-spirochetal effects, too), and by sticking to “The Lyme Diet.” Gluten and sugar are particular menaces to the microbiome, and your doctor may also recommend other dietary changes or nutritional supplements to help you maintain gut health. As I’ve come to learn, it is central to overall health!

[i] Horowitz, Richard I., MD. How Can I Get Better? An Action Plan for Treating Resistant Lyme & Chronic Disease. New York: St. Martin’s Griffin, 2017 (327, 328-9).

Abdominal Pain, Ileus & Constipation Due to Lyme Disease  Podcast here


doctor examining woman with abdominal pain due to lyme disease

Welcome to another Inside Lyme Podcast. I am your host Dr. Daniel Cameron. In this episode, I will be discussing the case of a 65-year-old woman with abdominal pain, ileus/pseudo-obstruction and constipation due to Lyme disease.

Zulfiqar and colleagues first described this case in an article entitled “The many manifestations of a single disease: neuroborreliosis,” published in the Journal of Community Hospital Internal Medicine Perspectives.¹

A 65-year-old woman on hormonal therapy for estrogen receptor-positive breast cancer presented to the Emergency Department with sudden seventh nerve palsy, commonly referred to as Bell’s palsy.

One week prior, she began having burning back pain radiating to the abdomen, which had grown worse and over the past several months had suffered from constipation.

Stroke, herpes virus or Lyme disease?

The woman was admitted to the hospital for a suspected stroke. However, there was no evidence of a stroke by brain CT or MRI.

Doctors also suspected she had a herpes zoster infection and prescribed valacyclovir, an anti-viral medication.

The patient worked frequently in her backyard and was exposed to wooded areas. She also recalled having a rash on her stomach 11 days before being admitted to the hospital.

“Lyme serum antibody (IgG and IgM) was positive with confirmatory Western blot resulting in multiband reactivity,” the authors write. Spinal tap test results were also positive for Lyme disease.

The woman was diagnosed with neuroborreliosis, or Lyme disease and treated with oral doxycycline.

However, while hospitalized the patient developed diffuse abdominal pain, abdominal distension, and worsening constipation.

An abdominal x-ray showed mild ileus. “CT abdomen with contrast was done which suggested constipation without obstruction or ‘significant’ ileus,” the authors explain. A colonoscopy was also normal.

The woman was also diagnosed with Syndrome of Inappropriate Anti-diuretic Hormones (SIADH) based on a sodium of 129 and typical urine findings.

Abdominal pain, gastrointestinal problems in Lyme disease

The authors highlight several studies demonstrating a range of gastrointestinal problems, including abdominal pain, associated with Lyme disease.

“There have been many case reports in the past highlighting the atypical presentation of Lyme disease including, but not limited to pseudo-obstruction, constipation, back pain radiating to abdomen (radiculoneuritis) known as Bannwarth Syndrome as a manifestation of autonomic dysfunction related to neuroborreliosis,” the authors explain.

This patient also suffered from anorexia with a loss of 14 pounds. One study found that 23% of 314 patients with early Lyme disease suffered from anorexia.

Meanwhile, Shamim et al. reported two cases of patients who presented with severe constipation and hyponatremia in addition to other features of Lyme disease.

Lyme neuroborreliosis has also been reported as “the culprit of chronic intestinal pseudo-obstruction” in other studies, the authors explain. “The patients can develop worsening constipation and obstipation as diagnosis and treatment is delayed, leading to diffuse bowel dilation in the absence of mechanical obstruction.”

Lastly, “There have been a few case reports of SIADH associated with neuroborreliosis,” writes Zulfiqar.

Authors’ Conclusion: Lyme disease should be suspected in patients who are from Lyme endemic areas and present with abdominal pain, constipation and SIADH with or without cranial nerve palsy.

The following questions are addressed in this podcast episode:  

  1. Why was a stroke initially considered?
  2. Why was herpes zoster suspected?
  3. What are the causes of 7th nerve palsy?
  4. What is SIADH?
  5. What is ileus?
  6. What is Bannwarth Syndrome?
  7. How are GI issues related to autonomic dysfunction?

    Thanks for listening to another Inside Lyme Podcast. You can read more about these cases in my show notes and on my website As always, it is your likes, comments, reviews, and shares that help spread the word about Lyme disease. Until next time on Inside Lyme.

Please remember that the advice given is general and not intended as specific advice to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.

Inside Lyme Podcast Series

This Inside Lyme case series will be discussed on my Facebook page and made available on podcast and YouTube.  As always, it is your likes, comments, and shares that help spread the word about this series and our work. If you can, please leave a review on iTunes or wherever else you get your podcasts.

  1. Zulfiqar S, Qureshi A, Dande R, Puri C, Persaud K, Awasthi S. The many manifestations of a single disease: neuroborreliosis. J Community Hosp Intern Med Perspect. Jan 26 2021;11(1):56-59. doi:10.1080/20009666.2020.1831746


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Clinical Considerations of Clostridia Bacterial Concerns Go here for presentation (Approx 22 Min)

Part 1: Clinical Considerations of Clostridia Bacterial Concerns – Pathogenicity Mechanisms

Biocidin Education Series

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Candida & Lyme

Strategies and treatments for Lyme patients to avoid Candida overgrowth

When I was a teenager, I used to get yeast infections during the summers because I was always in a wet bathing suit. At least, that was the rationale I was given by doctors and other females, and it made sense. What I didn’t know then was that recurring yeast infections can also be a sign of a weakened immune system, something that would come back to haunt me in college when I started wrestling mysterious flu-like symptoms. The yeast infections persisted then, too.

People generally don’t talk about yeast infections because they seem like a private topic. But we should, because candidiasis—a fungal infection caused by yeast (Candida) overgrowth—is not exclusive to females or the vagina. In fact, many men and women alike suffer from Candida overgrowth and may not even know it. Candidiasis often occurs in the gut, causing symptoms typically associated with the gastrointestinal tract such as bloating, constipation, diarrhea, gas, blood sugar swings, and cravings for sweets; and those that aren’t, such as fatigue, depression, dizziness, itching, and hives. Candida can also manifest in the mouth as thrush, causing bad breath, a funny taste, soreness, white lesions, or a pasty white tongue.

I was first diagnosed with intestinal yeast overgrowth when I was wrestling a bad case of mononucleosis that slipped into chronic active Epstein-Barr virus. The naturopathic physician I was seeing told me excessive Candida could cause fatigue, inflammation, and headaches. In more serious cases, systemic candidiasis can, according to the Centers for Disease Control and Prevention (CDC) affect the blood, brain, heart, eyes, bones, and other parts of the body.

So, what does this have to do with Lyme disease? Many Lyme patients may already be dealing with candidiasis infections that are exacerbating or causing some of their symptoms. Coupled with Lyme disease, these symptoms become overwhelming. Moreover, antibiotics, a standard and critical treatment for Lyme, cause Candida overgrowth because they kill off the good bacteria in the gut. As Richard Horowitz, M.D. explains in Why Can’t I Get Better? Solving the Mystery of Lyme & Chronic Disease, “Although we all normally have Candida organisms present in our gastrointestinal tract in limited amounts, taking antibiotics for bacterial infections will encourage an overgrowth of Candida…Furthermore, many Americans have diets high in sugar and refined carbohydrates, which help promote yeast overgrowth.” Immune suppression due to stress—common for Lyme patients—and other factors such as medications that decrease the acidity of the gastrointestinal tract can also lead to Candida issues.

What can Lyme patients do to avoid and/or treat Candida overgrowth?

Diet: We often hear of the “Lyme diet” to treat inflammation, which it does. It also combats Candida overgrowth. I have had success by eliminating simple sugars, gluten and wheat, and alcohol. In his book, Dr. Horowitz also recommends eliminating malt, vinegar, carbohydrates (including fruit early in treatment), all yeast-containing foods (most bread and cheeses, mushrooms), and fermented foods. How extreme you need to be with this diet depends on how acute your infection is. Because I am still on low-dose antibiotics, I have stuck to a gluten-free, low-sugar, alcohol-free diet while in remission. I avoid mushrooms and most yeasty foods but do eat dark chocolate, cheese, and whole grains. Talk to your Lyme Literate Medical Doctor (LLMD) about the best dietary changes for you.

Probiotics: When you’re on antibiotics, you must take probiotics to replenish your system with good yeast. However, you must take the probiotics at least two hours before or after the antibiotics, or the antibiotics will kill the probiotics.

Anti-fungal medication: For persistent candidiasis, some LLMDs prescribe anti-fungal medication, some of which have also been known to be effective against Lyme bacteria. They are not without side effects (some can cause liver or heart damage), so doctors use these sparingly and in low and/or pulsed doses, and you should have regular bloodwork to test your liver and other functions while you’re on these medications.

Monitor symptoms and adjust accordingly: I can tell when yeast levels are getting high because I get a pasty tongue, have vaginal symptoms, or feel some gastrointestinal discomfort. This usually happens after I’ve cheated by eating several gluten-free brownies (naturally sweetened, but the sugars still add up). I will then be extra-careful with my diet in the following days, and it sometimes helps to eat something that tastes acidic, like grapefruit or tomato but is alkaline once digested (you’re trying to keep a healthy pH balance).

Don’t cheat: With some diets, especially those that are just about losing or maintain weight, having a “cheat” day once in a while won’t have too many adverse effects. That’s not true with Lyme disease, especially if you are dealing with an acute infection. Eating a regular pizza or a chocolate chip cookie will probably make you feel horrible for a few days, and that’s not worth it. There are plenty of great alternative foods available.

If you find yourself craving sweets or experiencing unexplained fatigue or digestive symptoms, talk to your doctor about Candida, especially if you are being treated for Lyme disease.

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Opinions expressed by contributors are their own.

Jennifer Crystal is a writer and educator in Boston. Her memoir about her medical journey is forthcoming. Contact her at


Opinions expressed by contributors are their own. Jennifer Crystal is a writer and educator in Boston. Her memoir about her medical journey is forthcoming. Contact her using her email.



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Both my husband and I took diflucan, an anti-fungal medication twice a week throughout our entire treatment journey (over 5 years).  I believe this saved us from many problems antibiotics can cause.  We also tried to limit sugar.  We also took a strong, refrigerated probiotic daily as well as a prebiotic (feeds the good guy bacteria), specially formulated for Lyme/MSIDS patients with many and varied strains of bacteria.  

Study of a Potential Test for Persistent Lyme Disease


Study of a Potential Test for Persistent Lyme Disease

Thanks to the enthusiastic response from the Lyme community, this study has met its current enrollment goal. Therefore, Flightpath Biosciences’ Study of a Potential Test for Persistent Lyme Disease will not be accepting any more applications at this time.

We’ll keep you posted as the project proceeds or if we reopen the study for further enrollment.

For questions related to this study, please contact:


Fatigue, muscles aches, brain fog—are these symptoms of chronic Lyme disease, or merely side effects of the daily grind of human existence? It’s hard to tell. 

Chronic Lyme disease, also known as post-treatment Lyme disease syndrome or PTLDS, is incredibly hard to diagnose because symptoms vary greatly, and there is currently no biological test to detect the disease.

Now, Kim Lewis, University Distinguished Professor of biology and director of the Antimicrobial Discovery Center at Northeastern, has proposed a new way to objectively diagnose this elusive disease by analyzing the microbes in a patient’s gut. 

(Go to link for article)



Lewis states there are about 800,000 people in America living with PTLDS.  I have written before about this confusing moniker that it means different things to different people.  For instance, microbiologist Holly Ahern states there are two groups of patients: those diagnosed and treated early and those diagnosed and treated late.  The PTLDS label only concerns the first group and only represents about 10-20% of people going on with persistent symptoms.  These low percentages are typically what researchers are referring to.  The label leaves out a much larger group (30-40%) that is diagnosed and treated late.  

This second group represents nearly all the patients I work with that never gets addressed by research because their cases are sticky, hard to define, and by nature don’t fit well into a research study design.

According to Lewis, people with PTLDS have an abundance of a type of bacteria called Blautia and a suppression of a type of bacteria called Bacteroides (which explains why Lyme/MSIDS patients suffer with inflammation, digestion, improper immune responses, depression and anxiety).

Unfortunately, this bacterial disregulation is also seen in many other diseases.

Flightpath is also working on making an oral form of the antibiotic azlollicin available, which has demonstrated in vivo efficacy in mice by significantly inhibiting the growth of drug-tolerant Borrelia burgdorferi (Bb) bacteria better than doxycycline (the standard of care), and reducing inflammation.