We live in Connecticut which is home to Lyme and, ironically, Hadlyme. It seems there is not a person in the state who has not either had Lyme or at least known someone suffering from this brutal disease. It is an infection that brings with it a series of brutal symptoms that are both related to the actual Borrelia burgdorferi infection and secondary to our own immune response. There are so many schools of thought on this disease and how to both diagnose and treat it. Then there are the co-infections that must be contended with including Borrelia, Ehrlichia, Anaplasma, Bartonella, Rickettsial infections and Babesia.
Symptoms of Lyme Disease
Of those with Lyme infections more than half have at least one co-infection and approximately 30% have two or more co-infections. For some, Lyme presents as an acute illness that presents with flu-like symptoms such as fevers, fatigue, swollen glands, sore throat, nausea and vomiting, headaches, stiff neck, photophobia, bell’s palsy, neurological symptoms and the infamous bulls eye rash (Erythema migrans). Those with acute Lyme often respond well to antibiotics such as doxycycline. For some, this is enough to clear them of the infection.
Others either never present with an acute Lyme or they have more chronic presentation. Chronic Lyme patients experience a laundry list of symptoms that may include: bulls eye rash (erythema migrans), neck stiffness with headaches, light and sound sensitivity, memory and concentration problems, vertigo, dizziness, difficulty walking, tingling, numbness, burning sensations, fevers, sweats, chills, joint pain, dysautonomia (dysfunction of the autonomic nervous system), chemical sensitivities, inflammation, sex hormone imbalances, hypothyroidism, adrenal dysfunction, depression, anxiety, psychosis, autoimmunity, food sensitivities, interstitial cystitis (bladder pain/frequency), irritable bowel syndrome (IBS), chest pain and allergies. One could continue listing symptoms forever with Lyme. No two cases are exactly alike and the number of symptoms that may be generated by B. burgdorferi are seemingly endless. The only common thread amongst all patients is the presence of inflammation.
Lyme Disease and Food Sensitivities
A common problem in Lyme patients is having food sensitivities. This is because leaky gut syndrome is common in those with Lyme. This occurs often secondarily to antibiotic use which allows for overgrowth of pathogenic yeast such as Candida albicans, overgrowth of potentially pathogenic bacteria, and decreased levels of good bacteria. In this process, the tight junctions which separate the small intestine from our blood vessels are broken open allowing partially digested food particles into the blood stream. Here, our body perceives the food as an invader rather than a source of nutrition and mounts an attack. After repeated exposures, our body develops IgG4 antibodies that can cause various symptoms including reflux, gas, bloating, constipation, diarrhea, headaches and other symptoms.
The 4R Program
To combat intestinal permeability a 4R program should be undertaken. This includes the steps Remove, Replace, Reinoculate and Repair. Remove refers to the elimination of pathogenetic organisms such as bacteria, viruses, fungi, parasites, allergens, and toxins. In this step, it is important to use an elimination diet to help determine foods that may be problematic. At the very least, gluten and dairy should be removed. An autoimmune Paleo approach is often helpful. This includes removal of all dairy, grains, beans, nuts, seeds, high glycemic fruits, refined sugars, processed foods, pork, eggs, coffee, tea, caffeine and night shade vegetables. This is typically done for a six to 12-week period prior to reintroducing foods one by one to assess tolerance. For those who have histamine intolerance, this diet should be altered to decrease histamine levels (see below). If there are underlying infections in the gut this should be treated with appropriate natural antimicrobials.
Replace refers to replacing digestive enzymes, hydrochloric acid (HCL) and bile. This should be done with the guidance of clinical symptoms and, if available, the results of a stool analysis. Bile salts may be required for those without a gallbladder or for those with increased levels of fat in their stool.
Reinoculate is associated with the use of pre- and probiotics to help repopulate the gut. Finally, repair is associated with healing the intestinal permeability. Typical nutrients given to support this process include L-glutamine and zinc carnosine to heal the gut, antioxidant support, N-acetyl Cysteine/glutathione, and inulin. Various botanicals may be used to help soothe the mucosal membrane. These include slippery elm, aloe vera and marshmallow root.
Lyme Disease and Food Allergies
Most Lyme patients end up seeing me because they are experiencing allergy and sensitivity symptoms. There is a great deal of crossover between mast cell activation disorders (in which I specialize) and Lyme. This is because B. burgdorferi can directly cause mast cell degranulation. Mast cells are the cell within our immune system that carries histamine and other mediators including tryptase and heparin. Their job is to respond to allergens and inflammation. Typically, when the IgE receptor is stimulated by an antigen (typically a substance one is allergic to), the mast cell degranulates losing its histamine load. This can cause a variety of symptoms including congestion, runny nose, itchy/watery eyes, itchy skin, hives, asthma, coughing, wheezing, tachycardia, flushing, angioedema, changes in blood pressure, frequent/urgent urination, constipation, diarrhea, acid reflux, nausea, vomiting and even anaphylactic shock. I have seen onset of allergic symptoms in Lyme occur typically following an aggressive treatment such as IV antibiotics. This may start with hives following the antibiotic and may progress to symptoms even when not undergoing actual treatment. For many patients, this may result in loss of tolerance (allergy) to one or more types of antibiotics.
Lyme Disease and Mast Cell Activation
For a particularly unlucky subset of Lyme patients they may develop mast cell activation syndrome (MCAS). This is a disorder where the immune system over reacts to various stimuli causing them to appear to be allergic to many things in the world around them. There is no real increase in the amount of mast cells as found in mastocytosis patients. Rather, the mast cells can either become both more active and produce extra inflammatory mediators, or they are simply more easily triggered to degranulate. It is also possible that they may release a variety of types of mast cell mediators. This is caused by abnormal expression of certain proteins that alter mast cell behavior. Those with MCAS may react to foods, chemicals, pollen, and medications. Typically, this person has no more actual IgE allergies than anyone else. However, even IgG antibodies associated with delayed food sensitivities can have the same effect on mast cells in those with MCAS.
Symptoms of MCAS include: fatigue, weakness, fever, environmental sensitivities, weight loss/gain, anaphylaxis, brain fog, sinusitis, rhinitis, burning mouth pain, dyspnea (labored breathing), cough, wheezing, increased mucous, tachycardia (heart beat above 100 beats per minute), palpitations, fainting, episodes of low blood pressure, non-cardiac chest pain, diarrhea, abdominal pain, constipation, nausea, vomiting, gastroesophageal reflux, cramping, bloating, gastritis, enlarged liver, enlarged spleen, increased cholesterol, bladder pain, osteopenia/osteoporosis, pain, degenerative disk disease, itching, flushing, rashes, hives, dermatographia (skin writing—scratching the skin results in a raised red welt of hives), edema, swollen lymph nodes, headaches, depression, anxiety, sleeplessness, vertigo, tinnitus (ringing in the ears), polyneuropathy (degeneration of peripheral nerves), and paresthesias (abnormal skin sensations). Evaluation for MCAS includes serum tryptase (an increase of 20% from baseline to reaction), serum histamine, 24-hour urinary N-methylhistamine, and 24-hour urinary 2,3-dinor 11-beta prostaglandin F2 alpha.
Often there are specific elements to food to which those with MCAS react. This may include:
- Sulfur is found in foods such as cruciferous vegetables, eggs, onions and garlic. This is related to a genetic polymorphism to CBS C699T or a vitamin B6 deficiency.
- Oxalates are an element in certain plants such as spinach, Swiss chard, potatoes and sweet potatoes. Often those with genetic hyperoxalurias or those with Candida and other yeast infections may become intolerant.
- Salicylates is a chemical found in most vegetables and herbs and is the active ingredient in aspirin. Sensitivity is very difficult and may be associated with leaky gut syndrome and dysbiosis as bacteria may also produce salicylates.
- Gluten is a protein found in grains such as wheat, barley, rye, kamut, spelt and contaminated oats.
- Histamine is produced from the breakdown of the amino acid histidine into histamine in animal proteins. It is also found in fermented foods, citrus fruits, tomatoes, peppers, etc. (see complete list below).
- Food colorings, preservatives, MSG and artificial sweeteners
While mast cell disorders are typically treated with H1 blockers (antihistamines including Benadryl, hydroxyzine, Xyzal, Claritin, Zyrtec and Allegra), H2 blockers (Zantac, Pepcid, Tagamet), mast cell stabilizers (Chromolyn sodium and Ketotifen) and leukotriene inhibitors (Monteleukast), there are many natural remedies that may be helpful. Some helpful possibilities include:
- Quercetin is a natural mast cell stabilizer. Choose a formula without bromelain which can worsen MCAS.
- Vitamin C is required to break down histamine. Supplementing smaller doses (500 mg) several times per day can help improve absorption.
- Holy basil is a natural antihistamine that is very calming since it supports the adrenals. Try one to two cups of holy basil tea per day.
- A low histamine diet is a must for those with MCAS. High histamine foods including alcohol; fermented foods; mature cheeses; smoked foods; shellfish; nuts; chocolate; vinegar; wheat; tomatoes; citrus fruits (lemon, lime, orange, tangerine, grapefruit and pineapple); prepared, boxed and canned foods; older, aged or ground meats; poultry skin; and black, white and green tea, coffee and other caffeinated beverages.
- Certain probiotics including Lactobacillus Rhamnosus and Bifidobacterium longum are helpful in breaking down histamine in the gut.
- Fish oil is a natural leukotriene inhibitor and may help with the respiratory symptoms associated with MCAS.
Jessica Pizano is the owner of Fit to You, LLC, which offers clinical nutrition and nutrigenomic counseling, as well as personalized training programs. Her concentrations include genetics and nutrigenomics, general health and fitness, weight loss, food allergies/sensitivities, autoimmune disease, obesity intervention, and Pilates. She earned a master’s degree in human nutrition at the University of Bridgeport. She is a certified nutrition specialist through the Board for Certified Nutrition Specialists. She is continuing her studies at Maryland University of Integrative Health where she is pursuing a doctor of clinical nutrition and is also an adjunct faculty member teaching nutritional genomics. Currently, Jessica practices nutrition counseling, nutrigenomics, and personal training in her studio in Avon. She may be contacted at (860) 321-7234 or online at: www.fittoyouct.com.