- Category : Lyme Disease, SIBO
Lyme disease is a tick-borne infection caused by the bacterium Borrelia burgdorferi. It is known to have various co-infections, such as Babesia, Bartonella, and Ehrlichia. One lesser known, but significant association is the link between Lyme disease and Small Intestinal Bacterial Overgrowth (SIBO). In today’s article, I will explain why many patients with Lyme disease and coinfections develop digestive problems including SIBO, the differnt kinds of SIBO associate with Lyme Disease and a few strategies to start implementing to help you heal from SIBO and other digestive problems.
Keep in mind that as I talk about SIBO and other digestive problems caused by Lyme disease and lyme co-infections (gas, bloating, constipation, abdominal pain) I’m not referring to acute lyme disease, but rather, late stage chronic Lyme.Acute Lyme disease can cause nausea, vomiting, heartburn, and abdominal pain, but its not as common.
Understanding Lyme Disease
Lyme disease and lyme co-infections are transmitted to humans through the bite of infected tick. Within a few hours to days, symptoms being to show up and at first these symptoms might feel like one has been hit with the flu. Fever, fatigue, muscle aches, joint pain, headaches, and a characteristic “bull’s eye” rash. If left untreated or inadequately treated, Lyme disease and its associated co-infections, can progress and manifest as chronic symptoms affecting multiple systems, including the immune system, gastrointestinal (GI) tract, the Neurological system, the cardiovascular system and the musculoskeletal system. This is known as Chronic Lyme disease which many traditional doctors don’t accept. But for millions of people around the world the Chronic fatigue, Chronic joint pain, neurological issues, Autoimmune disease, and cardiac complications are often part of the Chronic Lyme complex that they suffer with.
The Role of Lyme Co-Infections
If you were bit by a tick, that tick bite often introduces additional pathogens, resulting in Lyme co-infections (*). Common co-infecting agents include the bacteria Anaplasma, Babesia, Bartonella, Rickettsia and many others.
These co-infections can exacerbate Lyme disease symptoms and contribute to a more severe and persistent illness. Lyme as well as Lyme co-infections can impact the GI tract, leading to dysbiosis, leaky gut, intestinal inflammation, Mast Cells Activation, and contribute to the overgrowth of bacteria in the small intestines (SIBO).
Why Am I So Bloated? Enter SIBO
Recent research suggests a significant correlation between Lyme disease, it’s coinfections, and the development of SIBO. (*)Small Intestinal Bacterial Overgrowth (SIBO) is a condition characterized by the overgrowth of bacteria in the small intestine. Normally, the small intestine has a comparatively low bacterial load when compared to large intestines. However, in the case of SIBO, an excessive number of bacteria, sometimes good and sometimes bad, can colonize the small intestine. This dysregulation can lead to a variety of digestive symptoms and nutritional deficiencies. There are several diferent types of Small Intestinal Bacterial Overgrowth that can be identified in patients with Lyme disease or Lyme coinfections. Let’s review the three types of SIBO.
1.Methane Dominant SIBO
In Methane dominant SIBO, the overgrowth of certain types of bacteria, particularly the archaea Methanobrevibacter smithii, and these bacteria leads to an excess production of methane gas.(*) This can have significant effects on gut motility and overall gastrointestinal function. Methane-dominant SIBO or Intestinal Methanogen Overgrowth (IMO), is harder to treat for several reasons, so often need more aggressive and longer treatment programs.
Generally speaking, methane dominant SIBO includes symptoms of constipation, bloating, gas, heartburn, but these symptoms may overlap with other forms of SIBO as well. Studies show people who suffer with Type II Diabetes, Anorexia and IBS have higher levels of Methanobrevibacter smithii (*),(*)
While hydrogen-dominant and hydrogen sulfide SIBO are typically associated with rapid motility, methane-dominant SIBO often (but not always) has the opposite presentation: delayed or slow motility, aka chronic constipation.
2.Hydrogen-Dominant SIBO
This is the most common type of SIBO, and like methane dominant SIBO, it presents with many of its challenges. With hydrogen-dominant SIBO, you may experience loose rapid bowel movements. As a result diarrhea and malabsorption are commonly experienced by patients with hydrogen-dominant SIBO.
3.Hydrogen Sulfide SIBO
Hydrogen sulfide SIBO is a specific type of Small Intestinal Bacterial Overgrowth (SIBO) where there is an overgrowth of bacteria that produce hydrogen sulfide gas in the small intestine. This condition differs from traditional SIBO characterized by the production of methane or hydrogen gas. In cases of hydrogen sulfide SIBO, there is an imbalance in the gut microbiota with an overgrowth of bacteria that produce hydrogen sulfide as a byproduct of their metabolism.
These bacteria include species such as Desulfovibrio, Bilophila, and others capable of producing hydrogen sulfide. Hydrogen sulfide SIBO can present with symptoms similar to traditional SIBO, such as bloating, abdominal pain, diarrhea, constipation, and flatulence. However, some individuals with hydrogen sulfide SIBO may experience distinct symptoms like foul-smelling gas, odoriferous burps, and other sulfur-related symptoms.
Why Patients with Lyme Disease Develop SIBO and Other Digestive Problems
There are several factors why patients with Lyme disease develop SIBO and many other digestive problems we see. Here are a few of the reasons.
- Antibiotics: antibiotic treatments for Lyme disease and its co-infections are the main stay during the early stages of diagnosis. These antibiotics alter the gut microbiome, setting the stage for SIBO and other digestive problems.
- Motility Issues: Lyme neuroborreliosis occurs where the bacteria invade the nervous system, could affect the nerves that regulate intestinal motility, predisposing patients to SIBO.
- Neuroinflammation-Tick-borne diseases, such as Lyme disease, can trigger neuroinflammatory responses in the nervous system. When infected ticks transmit pathogens, such as Borrelia burgdorferi, into the bloodstream, these pathogens can cross the blood-brain barrier and cause inflammation in the brain and spinal cord. Symptoms with Lyme Neuroborelliosis often include, facial paralysis, Severe headaches, stiff neck and visual disturbances (*).
- Chronic inflammation from Lyme disease may damage gut lining integrity, leading to issues with bacterial translocation and overgrowth.
- Immune Dysregulation: Lyme disease and its co-infections elicit a strong activation of the immune system. , potentially affecting its ability to regulate gut bacteria.
“SIBO is a complication I often see in my patients with Lyme disease, Mast Cell Activation Syndrome (MCAS), Histamine Intolerance dysautonomia (dysfunction of the autonomic nervous system), mold toxicity, CIRS, and other complex chronic illnesses.”
Lyme Disease and Lyme Co-infections Can Affect Gut Health In Other Ways
Here are some additional ways in which Lyme disease can impact gut health:
Dysbiosis- Disruption of Gut Microbiome
As mentioned above, the primary treatment for Lyme disease involves antibiotic therapy. For patients with Chronic lyme disease, many of these patients are on long term antibiotic which can be devestating to the microbiome. While antibiotics can be essential for combating the infection, they not only kill the pathogenic (bad) bacteria, they unfortunately, severely disrupt the balance of GOOD bacteria in the gut. This disturbance will lead to gut dysbiosis and imbalances in the kinds of bacteria inhabiting the microbiome, better knowns as microbial diversity. When gut dysbiosis and the loss of diversity in the gut occurs, we experience a variety of problems related to digestion including SIBO.
Inflammation
Lyme disease can cause immune system dysregulation, leading to ongoing inflammation and altered immune responses. Studies show that Borrelia burgdorferi has been detected in the gastrointestinal tract, and based on this research suggests that the bacterium can directly invade the gut lining.(*),(*) This invasion can trigger an immune response, leading to chronic inflammation and damage in the gut. Recently Lyme disease has been clinicaly connected with Crohn’s disease (*).
With damage to the gut lining, Lyme disease stimulates the immune system, leading to the production of various pro-inflammatory cytokines, chemokines and histamine from Mast Cells in the gut. These molecules further contribute to gut inflammation by recruiting more immune cells to the gut and activating them, causing an immune response.
As the immune system becomes further dysregulated, the immune system eventual fail to control the growth of the opportunistic pathogens, exacerbating dysbiosis. While all of this is happening at the cellular level, patients with lyme eventualy start to experience digestive issues such as bloating, abdominal pain, and altered bowel habits and SIBO.
Borrelia burgdorferi shares similarities in its molecular structures with proteins found in the gut. This resemblance can lead to immune system cross-reactivity, where the immune cells mistakenly attack both the bacterium and the gut’s own tissues. This process, called molecular mimicry, can contribute to gut inflammation but also initiate autoimmune disease (*), (*),(*),(*)
Increased Permeability
Lyme disease may increase circulating immune complexes (CICs) and consequently increase intestinal permeability, commonly referred to as “leaky gut.” (*) The gut lining serves as both a physical barrier, but also an immunological barrier. This barrier prevents unwanted molecules such as circulating immune complexes (CICs) and pathogens from entering the bloodstream. When the gut becomes leaky it allows the translocation of circulating immune complexes, bacteria and toxins from the gut into the bloodstream, triggering systemic inflammation.(*)
Disruption of Gut Motility
Lyme disease and its coinfections can impact gut motility, affecting the movement of food and waste through the digestive tract. The walls of the gastrointestinal tract contain smooth muscle, which contracts to propel food and waste through the digestive system. Inflammation can disrupt the coordination and strength of these smooth muscle contractions, leading to slowed or inefficient movement of content. This can result in delayed transit time and contribute to symptoms such as constipation or slowed bowel movements.
Constipation in chronic Lyme disease can happen for a number of reasons. Sometimes it due to the changes in the microbiome caused by antibiotics and the small intestinal bacterial overgrowth that follows post antibiotic treatment.
Inflammation can also affect the balance of neurotransmitters, which are responsible for transmitting signals between nerve cells. Disruptions in neurotransmitter function, such as decreased levels of acetylcholine or serotonin, can influence gut motility. These neurotransmitters play important roles in regulating muscle contractions and coordinating gut movements.
Malabsorption
In cases of chronic Lyme disease or chronic SIBO, I often see malabsorption of nutrients. The disrupted gut function can impair the absorption of essential vitamins, minerals, and other nutrients from food. This can contribute to deficiencies and further exacerbate symptoms related to malnutrition.
Alpha-galactose Syndrome
Lyme disease and digestive problems can also present as Alpha-galactose syndrome. Alpha-galactose syndrome, also known as Alpha-gal syndrome or AGS, is a condition characterized by an allergic reaction to a sugar molecule called alpha-gal.
This syndrome is triggered by the bite of certain ticks, primarily the lone star tick (Amblyomma americanum) in North America, though other tick species may also be associated with it. When a person is bitten by a tick carrying alpha-gal, the tick’s saliva transfers the alpha-gal carbohydrate into the person’s bloodstream. This causes the individual’s immune system to produce specific antibodies known as IgE antibodies, which recognize and bind to the alpha-gal molecule. The allergic response in alpha-galactose syndrome is unique as it typically occurs several hours after consuming red meat or other animal-derived products that contain alpha-gal, such as beef, pork, lamb, and, in some cases, dairy products.
Symptoms can range from mild to severe and may include hives, itching, swelling, stomach cramps, diarrhea, nausea, vomiting, or respiratory symptoms like wheezing and difficulty breathing. In severe cases, anaphylaxis, a life-threatening allergic reaction, can occur.
Strategies to Help You Heal From SIBO, Lyme Disease and Lyme Co-Infections.
Today, I talked alot about why patients with Lyme Disease and Lyme co-infections develop SIBO and other digestive problems. If you think you may be struggling with SIBO, Lyme or Lyme Coinfections, I want you to know that there is hope.
With the right testing and treatment program, your gut microbiome can improve. As the gut microbiome, Leaky Gut, Inflammation, Dysbiosis improves, not only will your bloating, constipation, and pain improve, but you will also probably notice that many of your past food sensitivities begin to slowly and gradualy dissapear. Eating starches, carboyhdrates and grains won’t cause many of the SIBO symptoms you have come to be familiar with.
It’s not going to happen overnight as it takes time, but with determination, and the right team in your corner, you can get well again. Let me review with you some basic strategies to help you get off the ground floor.
1.The Low FODMAP diet
The low FODMAP diet eliminates fermentable short-chain carbohydrates to ease digestive discomfort and give the microbiome time to recover. Think of lunch buffet with good bacteria, bad baceria, and opportunistic bacteria all sitting arournd the table waiting to be served. Instead of feeding them FODMAPS (carbohydrates), by restricting and eliminating FODMAPS, the bacteria go hungry and die. You have taken away the lunch buffet. While a low FODMAP diet is not a long term solution and it will not fix the problem, it is often necessary to implement in the early stages of SIBO treatment. Heres are two videos you should consider watching.
2.Probiotics
Probiotics can help to increase good bacteria in the gut — and chase out the bad bacteria. The right probiotics can reduce inflammation, support the immune system, increase levels of short chain fatty acids and crowd out the trouble makers.
I usually recommend a variety of different types of probiotics in the treatment of SIBO, but they are introduced in different stages of the treatment program. I recommend you read this article and watch this video as timing and introduction of these probiotics is essential. Not everyone with SIBO can handle probiotics in the early stages, so this is somethign you will need to discuss with your functional medicine doctor.
Read this article to better understand why if you tried probiotics and they were not tolerated why this happened.
3.Herbal Antimicrobials
Most of the time when you treat SIBO, you will need to follow some variation of a 4R gut healing Protocol.
The 4 R Gut healing protocol is a comprehensive approach used to restore and optimize gut health. It’s used in patients who have SIBO, Parasites, Leaky Gut, fungal/yeast overgrowth. The protocol focuses on four key principles, each starting with the letter “R” (hence the name).
These principles include: Remove, Replace, Re-inoculate, and Repair. To learn more about my 4R protocol for SIBO, Leaky Gut and Parasites you can read this article.
During the remove phase of the protocol, there are a variety of herbs and herbal blends that can be used to treat SIBO and SIFO. The protocol should be individualized but some examples of these antimicobial herbs include Berberine, Monolaurin, Grapefruit Seed Extract, Olive Leaf extract, grape extract, Wormwood, Gentian, Goldenseal, Barberry, Pumkin Seed extract to name just a few. Antimicrobial Herbs should be taken under the guidance of a functional medicine practitioner who can help determine the most appropriate testing, and treatment plan for you. You should also be familiar with die off as this happens most often with patients who have chronic lyme and C0-infections. Here’s an article on die off also known as a Herxheimer reaction or just a Herx Reaction.
4.Improve Motility
SIBO first and foremost is a motility disorder, and this is why an understanding of why the motility disorder is an issue and what’s contributing to it becomes important. Hormones like Cortisol, Estrogen, Progesterone and Thyroid Hormones all influence various aspects of digestion and motility. Other things to consider when you have SIBO, Lyme and coinfections are the effects of chronic inflammation, Liver congestion, Neurotransmitters imbalances and Vagal nerve dysfunction. Understanding the root causes of motility disorders is complicated as there are many causes.
Patients with both hydrogen and methane dominant SIBO benefit from prokinetics. Prokinetics are often a missing piece of the puzzle when it comes to the treatment of SIBO and Lyme disease.
Natural prokinetics include Bitters, Betaine, Taurine, Ginger, Fennel, Artichoke Leaf Extract, 5-HTP, Triphala, Magnesium, curcumin, melatonin, peppermint oil. You can learn more about “Natural” prokinetics in this article.
Presciption medications that act as a prokinetic, include metoclopramide and cisapride. Metoclopramide is a peripheral cholinergic agonist and dopamine antagonist. This means that Metoclopramide, increases acetylcholine levels and blocks dopamine receptors from being stimulated. The prokinetic effects are limited to the upper gastrointestinal tract, esophagus, and stomach. Unfortuntely, These medications come with a long list of side effects which include making you feel dizzy, drowsy, trouble with thinking or controlling body movements, fatigue, chills, racing heart, chest pain, increased blood pressure, loss of appetite, trouble sleeping, changes in mensturation and many other symptoms. For this reason, I recommend you try natural prokineticsfirst and work on improving the vagus nerve.
To learn more about ways to improve your Motility, I wrote this article, “7 Tips to improve your Migrating Motor Complex”
Here’s What You Should Remember About Today’s Article on SIBO, Lyme disease and Lyme Co-infections
SIBO is a common complication seen in many patients with Lyme disease, Mast Cell Activation Syndrome (MCAS), Histamine Intolerance dysautonomia, mold toxicity, CIRS, and other complex chronic illnesses. The gut can be an important place to start when you suffer with Lyme or Lyme co-infections. Antibiotics from the treatment of Lyme disease often leave behind an aftermath of dysbiosis, inflammation, Leaky gut, motility issues and other gut related problems that I mentioned. Having the right testing and the right team in your corner can help dig you out of what seems to be a never ending series of set backs. Dont give up, just find the right team. With time, hard work, consistency and perseverence, you should see improvement in your health in as little as four to six months.
