The spirochete that causes Lyme disease – Borrelia burgdorferi – and the associated tickborne infections such as Bartonella and Babesia can directly affect any organ system in the body, including the gastrointestinal tract. About 80% of the immune system is located around the digestive tract, so digestive health influences the immune response. Gastrointestinal symptoms of Lyme disease range from food intolerances to constipation.
Rarely does acute Lyme disease cause gastrointestinal symptoms, but occasionally nausea, vomiting, heartburn, and abdominal pain can occur. More commonly, digestive symptoms such as constipation, gas/bloating, and abdominal discomfort occur in chronic or late-stage Lyme disease. Lyme bacteria can directly infect the gastrointestinal tract causing inflammation that creates digestive symptoms. In turn, digestive issues can cause immune dysregulation increasing susceptibility to chronic infections. Whether digestive problems are a result of Lyme disease or increase the susceptibility to chronic infections, it is essential to address the underlying issues to restore health more quickly and effectively.
Lyme Disease and Leaky Gut Syndrome
Small intestine inflammation – more commonly known as leaky gut syndrome – is a condition where the spaces between the cells that line the small intestine become enlarged. This allows bacteria and food particles to enter the bloodstream triggering the immune system to respond by releasing inflammatory cytokines. The outer layer of bacteria that enters the bloodstream contains fat and a carbohydrate called lipopolysaccharide (LPS) that causes the immune system to react. Food allergies, alcoholism, stress, infections (including SIBO), toxicants, certain medications, and mast cell activation syndrome (MCAS) are some of the causes of increased intestinal permeability. Paradoxically, leaky gut syndrome also leads to an increase in food allergies since food proteins pass through the inflamed small intestine into the bloodstream creating an antibody response.
Leaky gut syndrome can lead to systemic inflammation which contributes to fatigue, headaches, joint pain, ADHD, and brain fog. Research has demonstrated leaky gut syndrome can contribute to autoimmune conditions. Since many of the symptoms related to Lyme disease are caused by inflammation, successfully treating leaky gut syndrome (if present) is crucial to reducing the systemic inflammatory burden.
Diagnosing intestinal hyperpermeability can be accomplished with a simple blood or stool test. Cyrex Labs has a panel called Array 2 that tests for antibodies against LPS and the proteins between the small intestine cells called zonulin and occludin. Cyrex produced a great video illustrating leaky gut pathophysiology. I prefer to test zonulin in the GI Map stool test. Inflammation in the gut is a dynamic state which can change depending on current exposure to food allergens, alcohol, bacteria, and more.
The goal of treating leaky gut is first to remove whatever is contributing to gut inflammation. Nutrients such as zinc carnosine and L-glutamine can also help heal the intestinal lining. Oral immunoglobulins help to neutralizes the LPS, which in turn reduces systemic inflammation.
Constipation in Lyme Disease
It is estimated that up to 25% of the world’s population struggles with constipation. Not only is constipation uncomfortable and can affect daily activities, but it can also predispose individuals to develop more severe health issues. What about people who are doing “all the right things” to prevent constipation – drinking plenty of water, eating plenty of fiber, and exercising regularly – but still experience constipation?
Constipation in Lyme has been referred to as “Bell’s palsy of the gut.” Just like facial paralysis that can occur in Lyme disease, the nerves that innervate the intestines can be affected causing a decrease in the muscular wave of contractions that usually move the contents of the intestines downstream. Chronic constipation ensues, and people end up taking magnesium, Dulcolax, or other laxative medications for long periods because the underlying cause of their constipation was never identified. Nerve dysfunction can occur elsewhere in the gastrointestinal tract, including the esophagus, which leads to difficulty swallowing.
When constipation or difficulty swallowing is related to nervous system dysfunction from Lyme disease, treating the infection also helps to improve nerve signaling. Prokinetic medications help with bowel movements but also serve as “physical therapy” for the large intestine by increasing the activity of intestinal muscular contraction.
Small Intestine Bacterial Overgrowth (SIBO)
Likely the most common gastrointestinal disorder associated with Lyme disease and other tickborne infections is small intestinal bacterial overgrowth (SIBO). It is estimated 60-70% of people with Lyme disease have SIBO. The incidence of SIBO was as high as 81% in one gastrointestinal practice that screened patients for Lyme disease. Research has confirmed that SIBO causes 60-70% of IBS. This is promising because SIBO can be successfully treated leading to the resolution of IBS.
The incidence of SIBO was as high as 81% in one gastrointestinal practice that screened patients for Lyme disease!
In a normal state, the small intestine has very few bacteria. However, in SIBO there is an overgrowth of bacteria in the small intestine causing a range of symptoms. Bacteria can enter the small intestine either orally or can migrate from the large intestine into the small intestine. At the junction between the small and large intestine, the ileocecal valve keeps the contents in the large intestine from entering the small intestine. Ileocecal valve dysfunction allows bacteria to move into the small intestine. Antibiotics and excessive sugar consumption can also cause bacterial overgrowth in the small intestine.
The most common symptoms of SIBO are IBS-like symptoms of gas/bloating, abdominal discomfort, and diarrhea or constipation, or both. In SIBO, excessive bacteria in the small intestine ferment food that is consumed then produce gases leading to these symptoms. Bacteria overgrowth in the small intestine also leads to poor absorption of nutrients, which can contribute to fatigue, low iron, and low vitamin B12. Because SIBO contributes to inflammation in the small intestine, it can lead to leaky gut syndrome and its associated symptoms.
A lactulose breath test (LBT) measures gas collected from the breath every 20 minutes over 3 hours after consuming lactulose. If there are excessive levels of bacteria in the small intestine from SIBO, the bacteria will digest the lactulose and produce methane, hydrogen, or hydrogen sulfide. A rise in any of these gases in the small intestine indicates SIBO.
SIBO is treated with antibiotics or herbal regimens that have proven to be effective against the bacteria that produce the gas. Probiotics, special diets, and motility agents are also used in the treatment of SIBO.
Digestive Symptoms Related to Mast Cell Activation Syndrome (MCAS)
Bacterial overgrowth in the small intestine, in conjunction with the inflammation caused by leaky gut, primes the immune system that surrounds the digestive tract. Mast cells are part of the immune system and tend to be located where the “outside world” interfaces with the inside of the body. The skin, lungs and gastrointestinal tract are examples of these locations.
When mast cells are triggered by a variety of stimuli, they release histamine and other chemical mediators. In MCAS, mast cells are more prone to releasing their contents leading to a myriad of symptoms. The most common digestive symptoms experienced in MCAS are nausea and heartburn, but abdominal pain, diarrhea, and constipation also be present. MCAS also contributes to systemic symptoms and digestive dysfunction needs to be addressed if it is contributing to MCAS.
Other Digestive Issues That May Be Associated with Lyme Disease
Other digestive signs that give clues there may be an underlying infection like Lyme disease are candida (yeast) and parasite infections that are difficult to treat. Infection with Borrelia causes immune dysfunction, making it challenging to treat yeast or parasitic infections until Lyme is successfully treated.
The Lyme Disease and Digestive Symptom Connection
Since Lyme disease is a systemic infection, the bacteria can affect any organ or tissue in the body. The gastrointestinal symptoms of Lyme disease and its associated infections are related to inflammation, nerve damage, and mitochondrial dysfunction. These digestive symptoms or conditions may occur in isolation, but if systemic symptoms are present or the digestive disorders are challenging to treat, Lyme disease should be considered as the underlying culprit. In addition, treating digestive disorders improves the outcome of treating Lyme disease by reducing intestinal-mediated immune dysregulation.
Great informative information.
Thank you Sharon!
Almost 10-12 years ago I was told by a doctor in London that I had had lime disease. But that was all.No treatment was offered and that was that. However I have suffered many setbacks since then, including fantastic weight loss and mobility problems. Is it too late to do anything about it as it is becoming a real handicap?
Many thanks
David Minett
David,
I am sorry to hear about what you have gone through. I believe it is never too late begin to heal. Find a Lyme-literate physician who can help you identify and treat the causes(s) of your symptoms!
I think I may have MCAS and am waiting on test results as I have many of the symptoms and am completely miserable. I am in my 30’s now but years ago as a teenager I was treated for Lymes. I’ve never had a problem with it since but could dormant Lymes still cause MCAS? Also, I have recurrently had yeast infections. Could I likely have leaky gut and most importantly, could the treatment of leaky gut cure or reduce the MCAS?
Sabrina,
Persistent infections like Lyme disease can contribute to MCAS. It’s hard to say of you have leaky gut, but I strongly recommend getting properly tested. Too often I see patients who are told they have leaky gut but have never been tested. If someone is positive, I like to re-test after a few months of treatment to see if treatment was successful so a patient can stop the treatment. Yes, leaky gut syndrome can contribute to MCAS.
I was diagnosed with lyme disease on 11/23/2020. I have fast heart rate, high blood pressure, arm numbness, burping, brain fog, anxiety, panic attacks. It is a nightmare. Im getting treated for it, 21 days on doxycycline 100 h daily. I think i had lyme disease for a long time because i also have IBS symptoms and acid reflux, recurrent yeast and awful back pain when i lay down on my back for a long time. Does it get better after the antibiotic treatment?
Vianca,
I am sorry to hear about you have been suffering with symptoms for so long. Yes, it does get better after successful treatment. Unfortunately, three weeks of doxycycline is often not effective for chronic Lyme disease. Read the articles I have written about proper testing for all Lyme co-infections and other possible associated conditions such as mold illness. Also, find a Lyme-literate physician to help you. It can be a journey, but it does get better!
Working as a field ecologist in Massachusetts, I contracted and then was successfully (although I’m not so sure now) treated with doxycycline for Lyme Disease 4 or 5 times over the past 20-25 years. In 2018, I got it again. However, the standard doxycycline regimen was ineffective. I developed the hallmark symptoms of PTLDS – profound and ongoing fatigue, arthritic-like pain and neuropathy in my hands and forearms, cognitive problems, depression/anxiety and digestive IBS-like symptoms. I somehow managed to get an appointment with a physician who is widely considered a preeminent Lyme researcher and expert. I felt like I was being granted an audience with the Pope himself! At the conclusion of the examination he offered the following: “You have post treatment Lyme Disease Syndrome. We don’t know a lot about it and there’s not much I can do for you.” He referred me to a program. The specialist who examined me there was very thorough and he demonstrated first-hand to me how my balance and the sensitivity in my hands and feet were in decline as well. However, he too could offer no tangible treatment options. He suggested increased exercise, getting a dog and possibly some physical therapy in a pool. Although I offered both experts a detailed description of the IBS-like symptoms I was experiencing, neither doctor seemed to think they were significant or indicated the need to further investigate the battle going on in my gut. It’s now 2021 and my symptoms are serious enough to prevent me from working. I spend much of each day on the couch or in bed. A strong support system of family and friends, counseling and Zoloft have kept me from further mental decline. But both physically and cognitively I am a shell of my former self. I used to work 10 hour days outdoors in 90 degree heat and single digit cold with little difficulty. Now I’m happy if I can do an hour of yard work without needing to retreat to either the couch or the toilet. After hundreds of hours of research into all things PTLDS, this article has finally given me a new direction in which to turn my ongoing quest for answers and maybe some relief, if not an outright return to feeling like my old self. So thank you!
I am sorry to hear you have been through so much, and glad this article has given you some direction.
I wish you all the best!
Thank you Dr. for this article. I got Lyme in 1990, treated by antibiotics but nethertheless I got Lyme arthritis in 2006. It last for 18 months with many crises, I had pain in my joins (knees, pelvis, ankle, then column) and myalgies, difficult to walk, impossible to fold, and I was really tired. After some months I begin to have gastritis very painful with terrible burn in my chest, nose, eyes. Since then I had few other arthritis crisis sometimes after stress (physical), but less violent. Unfortunately for me, now I am cured for cancer relapse since 4 years, and I have continous chemo (intravenous, then in tablets). Now my gastritis is almost always chronical, although almost no join pain (But I have bone pain because of cancer lesion, so my pelvis is just always painful), but my infectiologist is frighten to give me antibiotics together with all chemo for not tiring me too much. But those gastralgias are terrible, of course no type of medicine is functioning onto them, and I am chronically intoxicated by chemo. Can I find in your book how to get help for my digestive tract in my particular context?
I have CVID (Common Variable Immune Deficiency) so my body doesn’t produce antibodies. What test can my Immunologist or PCP perform that doesn’t rely on testing for antibodies, as my body is unable to produce them on its own. I have had 2 Lyme tests in the last 10 years, but only recently did I learn about my CVID, so I am concerned I have had this for a long time. Vertigo, GI issues, hand and feet “pins and needles” and numbness, horrible joint pain, always feel like I have the flu. Any ideas on how to move forward would be much appreciated.
CVID can be diagnosed a couple of ways. Do you have low immunoglobulins? IgG? IgM? It would also depend on which Lyme test you had done. Were you tested with a specialty lab and were you tested for all co-infections? There is a lot to consider before you could definitively rule out a tickborne infection as the cause of your symptoms.
I have had headaches, IBS, muscle pain stiff neck for probably 12 years. I do remember being bit by a tick as a child . It made my glands swell and I got severely I’ll. I was wondering if I could still have Lyme disease in my body. I was never tested or treated for Lyme. No Dr can explain why I go through severe headaches daily.
Lyme disease or another tickborne infection can definitely be causing your current symptoms. I recommend getting properly tested for Lyme and associated infections with a specialty lab like Igenex.
This is great info.
Last Saturday my body went down hill fast; aches in muscles and joints, fever, sweats, tired all day. I thought I had the flu. I was told I have Lyme disease even though my test came out negative. My doctor put me on Doxyxycline ASAP (100 mg 2x a day). I take them with 2 pro-biotic pills to help my stomach as I was told this medication can cause stomach issues. I have only been on them for four days so far.
What I never expected was not going to the bathroom. I do not feel constipated, I just don’t have the urge to go, but I know I could. I did go after 5 days with the help of some Docolax, but here we are 3 days later and it starting all over again.
This info really makes sense and more than likely confirms that I do have Lyme Disease. I still feel achy at times especially if I do any activity (long walk or minor house work). I really hope these antibiotics take care of this.
Thank you for this info.
I’ve had to rely on daily enemas to empty for the last 11 years. It’s a 3 hour arduous process. I’m only 33. Been on disability for 11 years. Fibromyalgia, tinnitus, ibs, you name it. I had positive Cyrex Leaky Gut, did the Apex Protocol and diet for 8 months, didn’t help. Positive breath test and positive for Lyme and coinfections via Igenex. What does one prioritize first when it comes to antibiotics, Lyme or SIBO? Been doing lyme herbals for 2 years with no improvements.
Hi Max,
I am sorry to hear about your chronic illness. I do not know your specific case (nor can I give medical advice to someone not under my care), but I always treat SIBO in my patients before Lyme.
Talk with you doctor to come up with an approach that works for you.
In health,
Dr M
I have been suffering horribly for 4 years. First I was diagnosed with mold exposure, leaky gut and then Lyme, babesia, bartonella and MCAD. I think I also have EBV that’s been reactivated. I’m pretty sure I have SIBO too because of all the bloating, esp after meals.
Really need to find a good Lyme-literate doctor. Are you accepting new patients? Do you offer telemedicine visits?
Please let me know. Thank you.
Hi Carol,
I am sorry to hear about your suffering. I am accepting new patients. You can use the link Become a Patient and someone will contact you.
In health,
Dr. M