Tim Ferriss’ ketogenic diet hypothesis for Lyme disease
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Lyme disease is an infectious disease caused by bacteria of the Borrelia type, which is spread by ticks. The most common signs of infection are an expanding non-painful area of redness on the skin, fever, headache, and feeling tired. When Tim Ferriss contracted Lyme disease, he drew on his familiarity with the ketogenic diet to regain his health. While consuming a ketogenic diet, he observed that his cognitive function returned to where it was before his diagnosis. In this clip, Tim Ferriss describes his experience with Lyme disease, and how he used the ketogenic diet in conjunction with antibiotics to support his recovery.
- Rhonda: But back on the ketones since we're back on the ketone, I do want to get to the Lyme disease because it's a topic that I avoid. I've never talked about it.
- Tim: It's one I avoid too.
- Rhonda: I always have this knee jerk reaction because the signal to noise ratio is so small. I feel like there's just a lot of confusion.
- Tim: So much nonsense.
- Rhonda: But I'd be really interested because you're a very analytical person.
- Tim: I try to be.
- Rhonda: So obviously it's a real disease. People suffer from it. You can observe spirochetes under a microscope. So it's definitely real. It's just a lot of craziness that seems to be associated with it. But maybe you can talk a little bit about . . . because you mentioned going on the ketogenic diet to treat your Lyme disease. Can you talk a little bit about what you found in terms of your experience with Lyme disease and how you got to treating it with ketogenesis?
- Tim: Yeah. I can talk about it. So where to begin with this . . . First of all, I'd just like to agree with you and sort of emphasize for everybody that the amount of nonsense and charlatanism out there surrounding Lyme is just beyond belief. There are so many fraudulent companies and practitioners who are just printing money by either misdiagnosing people with Lyme or treating Lyme in the quackiest of quackery.
- Rhonda: Why Lyme?
- Tim: So here's my thinking. So I contracted Lyme on Eastern Long Island. If you look at the CDC map, the Center for Disease Control heat map for Lyme disease, that is ground zero. That's where the bomb went off. Lyme is named after Lyme, Connecticut. So it really has historically focused on that Northeastern area--Pennsylvania, Upstate New York, Hudson Valley. I think Lyme has become this popular topic of conversation for a few reasons. Number one, it's poorly understood on a lot of levels. So there are ample opportunities for non-scientists and quacks to sort of invent stories around it.
- Rhonda: That makes sense.
- Tim: Number one. Number two, it's scary. It involves a bug biting you and you catch this disease, so the media loves it. The media loves it. The media writes about it. Then the media sometimes correctly, often incorrectly lists the symptoms of Lyme disease--joint pain, depression, fatigue--it's like, "Well, that's one out of every two people in the United States at some point every year." And then people go, "Oh, my god. I've had my . . . " I got an email from a friend of mine who says, "My shoulder has been bothering me for a couple weeks and two of my friends said it might be Lyme." I'm like, Oh, god. I would bet $1,000 it's not Lyme disease. Given where you live, given the likelihood of having contracted it, it's just so unlikely for most people. Now, all of that having been said, Lyme is a real thing. Like you said, you can observe the spirochetes under a microscope. I think another reason it's popular to talk about is people love saying the word "spirochete." I'm not kidding. They love saying spirochetes. They imagine this screwdriver, this horribly evil like maleficent like spiral bug that like digs into your body and like the antibiotics come in and they're like, "Oh no, we're going to hide from the antibiotics." It's not that sentient.
- Rhonda: My husband's grandmother says spirochetes like at least every conversation that I have with her.
- Tim: People love saying spirochetes. So you get it.
- Rhonda: Yes.
- Tim: So for all these reasons it's popular to talk about. I think primarily because the symptoms overlap with a million other conditions. What I came to realize for myself is like yes, it's a real thing. It's almost certain after Western blot tests and ELISA tests and looking at all the diagnostics, which are really primitive, it's very likely that I already had Lyme disease at some point because I've been bitten by ticks hundreds of times. Almost everyone in my immediate family has had Lyme disease. On Long Island, it's just kind of like, "Suck it up. Take some antibiotics. You're fine. Move on with life." It's not viewed as like a huge crisis by everyone who gets it on Eastern Long Island because it's so common. So I shrugged it off. I took three or four deer ticks that were embedded off of me in the span of two or three weeks. It historically hadn't been a big deal. So I was like, "That sucks." Pick it off, make sure the head is not in there, move on. I did not develop what's thought of as the trademark bullseye rash. So I ignored progressively worsening symptoms for eight weeks where my joints started getting very sore, swollen. I had trouble getting out of bed in the morning. I started getting slow cognitively and had trouble recalling friends' names and just really common words and eventually got to a point where my assistant was like, "I've seen you sick. I've seen you tired. I've seen you burning the candle at both ends. This is none of those things. You need to see a doctor."
- Rhonda: It sounds like dementia, like not remembering friends' names.
- Tim: Yeah. Things are really funny. If you look at the advanced symptoms of severe Lyme, it takes on dementia-like qualities, even cerebral palsy in some cases, really scary stuff. So long story short, then I get diagnosed with Lyme. When I walk into the clinic on Long Island, to give you an idea of how common it is, so this walk-in emergency clinic open on the weekend, they had a poster up that was like, "Hey, allow us to send your blood sample to such and such lab, Upstate New York, to do research on Lyme," and there's a picture of a tick, "And we'll give you a free $50 Amazon gift card." It's that common. But then the question was, "Okay, I have Lyme." I'm taking doxycycline. I do that for eight weeks or 12 weeks, whatever it was. I still feel really shitty. Now what?
- Rhonda: That's a long antibiotic course.
- Tim: Yeah. Some people take antibiotic for years, which I think is not the thing to do. This is where I am and I'll try to sum it up because this can be a very long conversation. I think that there are very, very credible scientists and infectious disease specialists who do not believe that chronic Lyme exists. Their position would be there's no evidence that the whatever it is, the borrelia spirochete cannot be eradicated with broad spectrum antibiotics like a doxycycline or something else. There's no evidence to suggest that they burrow away and hide and come back, hide in biofilm or whatever.
- Rhonda: Yeah, right.
- Tim: Right. Then you have people, and there aren't that many, but a handful of people who are like, "Well, it is possible that this Lyme could behave something like herpes simplex," where it's like a recurring infection essentially and maybe it takes root in the nervous system somehow and only comes back out in times of stress. There are people, credible doctors who have been like, "It's not completely beyond the realm of possibility that is has some recurring nature." Okay. Still, kind of descriptive, not prescriptive, what do we do? Right? Then the theory that I kind of came up with, and I'm sure other people have come up with it, but I haven't read it, I was like, "Well, let's look at the symptoms of Lyme. You have like depression, fatigue. What are other potential causes after a long course of antibiotics? Well, maybe you just completely scorched earth your microbiome among other things. So one of my theories is that what people perceive as chronic Lyme is in fact a collection of similar symptoms caused by the long course of antibiotics. So you should focus on prebiotics, probiotics. I have had a tremendous amount of difficulty, at least as measured in common stool testing and so on, in repopulating my gut diversity. It's been extremely hard. I have consumed just about every type of pre and probiotic imaginable. I've also tweaked my diet to be more favorable for certain types of gut repopulation. It's been really tough. I did like a three-month intense protocol of all sorts of stuff. So I'd love your thoughts. I did a follow-up stool sample analysis and it was still like, "No, you're fucked." I was like, "Wow . . . " depressing.
- Rhonda: So you're talking about measuring your fecal bacteria population using uBiome?
- Tim: Yeah. UBiome or there are others, like Rocky Mountain blah, blah, blah doctors data, whatever it was.
- Rhonda: Okay. There are other ones.
- Tim: Yeah. UBiome has a slightly different approach, but along those lines.
- Rhonda: I agree with you for one. First of all, I heard a podcast that you did with Jessica Richman from uBiome and I think you had talked about this and that's how I became first aware the link between . . . when you mentioned having this hypothesis that you thought possibly some of these symptoms of Lyme disease were a symptom of complete gut dysbiosis where you're taking several rounds of antibiotics and you are obliterating your gut bacteria, a lot of the good ones are going away. If you don't take a very strong probiotic immediately after antibiotics, it repopulates with all the bad stuff and it's really hard to get because they occupy space. They're sitting in what's called the mucin in the gut. They have to stick in the mucin to stay, otherwise anything you take will kind of just flow through. It's kind of like the flow through. So it's really hard to repopulate. I've been doing a lot of self-experimentation. I've been using uBiome to track my gut bacteria genotypes. But have you tried VSL3?
- Tim: I have it in the refrigerator right now.
- Rhonda: Do you?
- Tim: Yeah.
- Rhonda: Okay. So the sachets are what I recommend because . . .
- Tim: Yeah. I have the capsules.
- Rhonda: The sachets have 450 billion, which is more than what the capsules have. 450 billion is ten times more than what most probiotics have. The thing about VSL3, very interesting, so it's the probiotic that I take. I'm taking it because I've had some gut issues that started in graduate school because I got MRSA.
- Tim: Yeah. That's not fun.
- Rhonda: Antibiotics were the prescription and I had several courses of strong ones. Finally, it kept coming back and I was like fed up.
- Tim: How do you get MRSA?
- Rhonda: I don't really know. I worked in a hospital.
- Tim: Is that methicillin-resistant Staph?
- Rhonda: Yes. Aureus. Staphylococcus aureus.
- Tim: Staphylococcus aureus, yeah.
- Rhonda: So I worked at a children's hospital.
- Tim: That's a good place to get it.
- Rhonda: They're everywhere in hospitals. Who knows where I got it? The point is I got it and it sucked. Finally after like, I don't know, three or four rounds of antibiotics, I would take it and it would go away and then a month later it would come back again and again. I was like, "I can't do this." So I read the literature, with the help of my husband Dan, that garlic and grapefruit seed extract, a concoction of things, I applied both topically and made a cream and I orally took and within 24 hours I got this thing to come to a head, pus out, it never came back.
- Tim: Interesting.
- Rhonda: But as a consequence of antibiotic use, I had serious gut issues, led to IBD. I've finally been able to recover.
- Tim: IBD, irritable bowel disorder.
- Rhonda: Inflammatory bowel, yeah.
- Tim: Inflammatory bowel disorder.
- Rhonda: But it's been a really, really long journey in tweaking my diet. Doctors, of course, I went to see doctors and they were just like, "Here, take an SSRI, it helps with the pain." I'm like, "I'm not going to take an SSRI.
- Tim: Yeah. No thanks.
- Rhonda: I walked out of that doctor, like, "You're insane." This was like a pelvic pain specialist doctor. So I've just had terrible experiences with doctors. Finally, I'm like, "Why aren't you asking me about my diet, fiber, things like that?" So I tweaked my diet and did lots of things. But VSL3 . . .
- Tim: With the uBiome testing, have you seen . . . I haven't done a follow-up test in a few months, but I have been taking VSL3, so now I'm optimistic hopefully.
- Rhonda: So I did a 30-day VSL3 course with the sachets, which are 450 billion and did a stool test. I'm still waiting for those results. My husband and I both, Dan, he's done a recent course of antibiotics. So I had him do his baseline and then right after, literally the day he stopped taking antibiotics, did a sample for uBiome. I got that data back, so I've been looking at that. So I'm going to talk about all that. It's really complicated and things in the literature are confusing and some people think some things and they're actually not true. So I've been looking at other people's uBiomes. I'm going to be doing a series of talks on this.
- Tim: Cool.
- Rhonda: I'm pretty excited.
- Tim: I'll check them out. May I add just a little bit of color on the ketosis?
- Rhonda: Yes.
- Tim: The color there is I began looking at fasting as a tool for many, many different reasons. And whether that be related to, say, longevity or the reason I was excited about it is I was looking at it as a reboot of the immune system, even shorter fasts, three days. I began playing around with fasting. Then, of course, you fast long enough and you go into pretty deep ketosis.
- Rhonda: Correct.
- Tim: So it was almost an accidental discovery for me whereby I had not been in nutritional ketosis for 10 years, 15 years. I did a lot of experimentation with the cyclical ketogenic diet when I was in college and competing as an athlete. Then I just stopped because it was kind of a pain in the ass and it was really boring. But then I did this fasting to help reboot my immune system. I'll keep it simple. So rebooting my immune system kicked over into deep ketosis and it just felt amazing. My cognitive function just went through the roof compared to what I had felt up that point after Lyme disease. I was like, "Well, this is very interesting, isn't it?" I said, "Well, I don't have to fast to be in nutritional ketosis. So let me now play around with ketosis and see what I can discover just by tracking and logging a lot of data." So I have my pet hypothesis about the gut biome and the antibiotics leading to symptoms that appear to be Lyme when in fact they're caused by something else. Another hypothesis, and the reason I'd like to dig into this, but I haven't come up with a great plausible explanation for this, is that Lyme or the antibiotics or both somehow interfere with carbohydrate metabolism. That's just a starting point. But because I've been public about the Lyme stuff because I was incapacitated, I had to tell people. I was like, "Sorry, I'm not going to reply to your email. I'm archiving 2,000 emails. Sorry." "Why?" "Lyme." And then people started coming out of the woodwork to be like, "Hey, my wife has Lyme. She's been debilitated. What should we do? What have you learned?" And the only advice that I gave a few people was like, "Look, there's a lot of BS out there." So number one is put your thinking cap on and be a good scientist to the extent possible. Number two is try a carb-restricted diet. Ideally, go into ketosis. All of the people who have gone into ketosis have had the same experience I have. Now, it's a handful of people. So the sample size is really small. These are people that like, "Cannot function, had to quit my job," serious cases, go into ketosis, "Wow, I feel like my old self."
- Rhonda: Have you measured any changes in gut bacteria after going into ketosis or after doing the ketogenic diet?
- Tim: I haven't. That is also a very interesting topic of discussion. So what effect does ketosis have on the gut biome or the repopulation, the rate or the diversity of repopulation? The short answer is I don't know. Part of it is, and this is where maybe I'm not being a thorough scientist. But I felt it worked so well to me that I'm so excited to get back to building things and creating things and being my old self that I haven't taken the time to dissect it to the extent I probably should.
- Rhonda: Your carbohydrate . . . I have this interesting hypothesis that sort of is related. People that have a severe imbalance of gut bacteria, let's say they have a lot less of the commensal bacteria which is making short chain fatty acids and metabolites like lactate that are feeding other good bacteria, they're feeding your gut cells. So you have less of those and you have more of the bacteria that are methane or hydrogen sulfate producing, so you get bloated, more of the more pathogenic type of bacteria. So you have this overgrowth of bad bacteria. The thing is let's say you eat something that's typically supposed to be good. You eat something that has a lot of fiber or like vegetables. So you're getting this fiber that's supposed to be not digested, but the bacteria can digest it and make it into this good stuff. Well, bad bacteria can digest that as well. So you're feeding this bacteria substrates to keep going and to make more of the bad bacteria.
- Tim: Right.
- Rhonda: Now, the interesting thing that I don't know is there are certain species of bacteria. There's phyla, class, species, it's incredibly complicated, but certain species only metabolize fat and I don't know which ones those are and if they're good or bad. It sounds like you've had a positive experience. But that would be really interesting to measure in general. But I'm glad you're feeling better.
- Tim: Yeah.
- Rhonda: The ketogenic diet is something that I'm interested in diving into and understanding more about.
Densely packed communities of microorganisms that live on or in inert surfaces as well as plant and animal tissues. Biofilms are spatially organized into three-dimensional structures and enclosed in a matrix of extracellular material that confers protection to the microbial community they house.
Bacteria that are beneficial or at least not harmful to the host, in contrast to pathogenic bacteria where the host derives no benefit and is actively harmed from the relationship. Roughly 100 trillion commensal bacteria live in the human gut. The term commensal comes from Latin and literally means “eating at the same table.”
A general term referring to cognitive decline that interferes with normal daily living. Dementia commonly occurs in older age and is characterized by progressive loss of memory, executive function, and reasoning. Approximately 70 percent of all dementia cases are due to Alzheimer’s disease.
A mood disorder characterized by profound sadness, fatigue, altered sleep and appetite, as well as feelings of guilt or low self-worth. Depression is often accompanied by perturbations in metabolic, hormonal, and immune function. A critical element in the pathophysiology of depression is inflammation. As a result, elevated biomarkers of inflammation, including the proinflammatory cytokines interleukin-6 and tumor necrosis factor-alpha, are commonly observed in depressed people. Although selective serotonin reuptake inhibitors and cognitive behavioral therapy typically form the first line of treatment for people who have depression, several non-pharmacological adjunct therapies have demonstrated effectiveness in modulating depressive symptoms, including exercise, dietary modification (especially interventions that capitalize on circadian rhythms), meditation, sauna use, and light therapy, among others.
A broad-spectrum antibiotic used in the treatment of bacterial infections. Doxycycline, commonly called “doxy,” is a bacteriostatic drug that slows bacterial growth by inhibiting protein production. The World Health Organization considers doxycycline an essential medicine because of its widespread applications and its use as a treatment against biothreats such as anthrax, tularemia, and plague.
An unhealthy change in the normal bacterial ecology of a part of body, e.g., the intestines or the oral cavity.
A molecule composed of carboxylic acid with a long hydrocarbon chain that is either saturated or unsaturated. Fatty acids are important components of cell membranes and are key sources of fuel because they yield large quantities of ATP when metabolized. Most cells can use either glucose or fatty acids for this purpose.
The genetic constitution of an individual organism. The combination of genotype and environment determine an organism's physical characteristics – known as the phenotype.
A metabolic pathway in which organisms produce ketones. Ketogenesis occurs primarily in the mitochondria of liver cells via the breakdown of fatty acids and ketogenic amino acids. Insulin is the major hormonal regulator of ketogenesis; however, glucagon, cortisol, thyroid hormones, and catecholamines can induce greater breakdown of free fatty acids, thereby increasing the substrates available for use in the ketogenic pathway. The primary ketones used by the body for energy are acetoacetate and beta-hydroxybutyrate.
A diet that causes the body to oxidize fat to produce ketones for energy. A ketogenic diet is low in carbohydrates and high in proteins and fats. For many years, the ketogenic diet has been used in the clinical setting to reduce seizures in children. It is currently being investigated for the treatment of traumatic brain injury, Alzheimer's disease, weight loss, and cancer.
Lactate is thought to participate in a sort of "lactate shuttle" where, after being produced in muscle from exercise, it is transported in to tissues like the heart, and brain, where it is used as an energy source. Lactate is one of many molecules that falls under a loose group of molecules referred to as exerkines, a broad group of exercise-induced hormonal-like factors. Evidence suggests that lactate is the preferred fuel of the brain. Additionally, rodent studies suggest that lactate mediates some of the benefits of exercise on learning and memory via inducing neuronal brain-derived neurotrophic factor (BDNF) expression.[1] In clinical studies, lactate shows promise as a treatment for inflammatory conditions including traumatic brain injury and as a means to deliver fuel to working muscles.
- ^ Helge, Jørn Wulff; Moritz, Thomas; Morville, Thomas; Clemmensen, Christoffer; Dela, Flemming (2020). Plasma Metabolome Profiling Of Resistance Exercise And Endurance Exercise In Humans Cell Reports 33, 13.
An infectious disease caused by bacteria of the Borrelia type which is spread by ticks. The most common sign of infection is an expanding non-painful area of redness on the skin, fever, headache and feeling tired. Lyme disease is the most common disease spread by ticks in the Northern Hemisphere and is estimated to affect 300,000 people a year in the United States and 65,000 people a year in Europe.
The thousands of biochemical processes that run all of the various cellular processes that produce energy. Since energy generation is so fundamental to all other processes, in some cases the word metabolism may refer more broadly to the sum of all chemical reactions in the cell.
The collection of genomes of the microorganisms in a given niche. The human microbiome plays key roles in development, immunity, and nutrition. Microbiome dysfunction is associated with the pathology of several conditions, including obesity, depression, and autoimmune disorders such as type 1 diabetes, rheumatoid arthritis, muscular dystrophy, multiple sclerosis, and fibromyalgia.
A mucopolysaccharide or glycoprotein that is the chief constituent of mucus secreted by the epithelial cells lining the gut in order to produce a barrier preventing infection by microorganisms inhabiting the gut.
In general, anything that can produce disease. Typically, the term is used to describe an infectious agent such as a virus, bacterium, prion, fungus, or other microorganism.
A class of drugs that are typically used as antidepressants in the treatment of major depressive disorder and anxiety disorders. Some of the drugs that fall under this classification include: Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil, Pexeva), Sertraline (Zoloft).
Sometimes called the protein immunoblot. Used to detect specific proteins in a sample of tissue homogenate or extract. It uses gel electrophoresis to separate native proteins by 3-D structure or denatured proteins by the length of the polypeptide. The proteins are then transferred to a membrane (typically nitrocellulose or PVDF), where they are stained with antibodies specific to the target protein.
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