Can you tell me about the basic tenets of the Lyme diet?

First of all, avoid refined sugars at all cost. Sugar is very immune suppressive and it also can feed candida. A lot of people with Lyme have candida issues, whether they’re on antibiotics or not. Antibiotics perpetuate the whole thing. Even if someone is not taking antibiotics, a lot of Lyme people can be prone to yeast issues. You want your immune system fighting as hard as possible, so anything to suppress immune function is not good. Even fruit sugar can be problematic in some people, especially those taking antibiotics who have candida issues. In these people, fruit has to be limited.

The second thing is to avoid gluten, because gluten is very inflammatory. A lot of people are gluten intolerant and don't know it. You don’t have to have digestive symptoms to be gluten intolerant. Again, it’s a source of inflammation in the body and gives the immune system one more thing to deal with.

Then the third is to reduce or eliminate dairy because dairy is inflammatory. I do find that people who eliminate dairy altogether do better. Again, a lot of people are intolerant but don’t know it. It’s pretty easy to check for with an IgG food sensitivity test. Even people who come back negative seem to do well without dairy. When you look at foods from an inflammation standpoint, referring back to the IgG test, any foods that one is IgG sensitive to, in other words has a sort of hidden intolerance to, is going to provoke negative effects on the body. So this can be “healthy” foods – it could be garlic, it could be bananas, whatever the case may be, so this is where the IgG test comes in handy: to help people isolate the foods that don’t work for them, and that can be a very individual thing.

Do you always have these tests done when you see a Lyme patient?

Most of the time I will have them do an IgG intolerance test. And if they don’t, a lot of my patients are very willing to work on diet, so they’re willing to be dairy free and sugar free and gluten free. A lot of them find that over time that’s one thing they are able to do to help themselves. People seek me out for a more integrative approach, so typically they’re motivated to take responsibility for their diet.

In your book you say once people understand how dietary changes will help them, they’re motivated. Is that what you have found?

Absolutely. A gluten-, sugar-, and dairy-free diet is very restrictive, so for people to go that far they’re desperate because they feel so badly. But it helps for people to understand what’s going on and make sense of it, and that helps to motivate them.

Do you have patients who can’t change their diet?

I have patients who don’t change their diet. I think everybody can if they desire to. In some people, the food sensitivities come with the illness. Some people seem intolerant to everything, so they have a really tough time. These people have to rotate certain foods. They’re swimming upstream until they get the infections under control and get the overall inflammation in the gut down. Slippery elm and aloe and glutamine and things of that nature help heal the gut.

Sugar is inflammatory?

The things I worry about more are sugar’s suppression of the immune system and feeding the candida.

Are there any sugars that are okay? What about honey?

From a candida standpoint, honey is still going to potentially feed yeast, for that matter, fruit sugars can feed yeast as well. If one’s looking at the good sugars and the bad sugars, I would say that honey and maple syrup are definitely better than refined cane sugar. There are some forms of honey - like manuka honey - that can actually be quite healing. With fruit sugars you get the benefit of fiber, and vitamins and minerals. Granted, not all sugars are created equal. There’s mixed research on agave. I encourage people to use stevia as a sweetener.

And you think stevia that’s fine?

Look, I do. I know there’s a bit of controversy about stevia. There are very few foods there’s not some controversy about. I feel quite comfortable with stevia. I know there’s a little bit of research that it’s helpful for the biofilms and actually helps the Lyme battle. But I think you have to eat a lot of it.

What about soy products: soy milk and tofu?

Again, there’s mixed research. I am okay with soy in moderation. The things that concern me about soy are some people do have an intolerance to it, in terms of breaking down the protein, and there’s the whole issue of genetically modified soybeans. I am very opposed to anything genetically modified. There’s also the issue of the phytoestrogens in soy and whether that’s a good thing or a bad thing. Soy plant based estrogens have weak binding effects and some mild estrogenic effects, which for some women is helpful because it binds up the receptors so that the stronger estrogens can’t have an impact. That can be a good thing. Then there’s other research that says soy could be a cancer risk because it stimulates those estrogen receptors. So because of the hormonal impacts of soy I don’t suggest people eat soy each and every day. But I do think that fermented soy such as tempeh can have beneficial effects on the system. Some soy milk - if it’s organic - is not the end of the world. Most of the soy in this country is GMO, but organic soy is not. That’s the issue I have with corn too. I have many patients who swear by being grain-free altogether - people who have taken a Paleo diet approach. It’s also interesting to look at the different blood types. Some blood types might fare better with lean protein. I’m a type O, and I thrive on fish and chicken and vegetables and oil – I don’t do well with carbs at all. People with type A blood seem to need a lot of carbohydrates for energy. So there may be something in that type of diet; it’s hard to say. In general, grains are harder on the system. A lot of grains are genetically modified and even things like oats, which are inherently gluten free, are contaminated, so unless they’re certified gluten free, they have to be excluded on a gluten-free diet.

Do you feel that people can do fine without dietary supplementation, or do you have your patients take protein shakes or specific nutrients?

There’s a couple of ways to answer that. One is that really good nutrition can go a long, long way. However, our soils are not what they used to be and our food isn’t as vitamin and mineral rich as it used to be, so I do have most of my patients supplementing. When push comes to shove I use supplements because Lyme patients need help with adrenal function or inflammation or brain chemistry support with amino acids – those kinds of things. That’s more important than using your basic multivitamins and minerals, although I do have a couple of multi-style like supplements. I do suggest fish oils. I do look at vitamin D because a lot of people are low. I recommend probiotics of course, if patients are on antibiotics, antimicrobials, even herbs or essential oils. The supplementation I do with my patients focuses more on their Lyme symptoms than where their diet may be deficient; we have to plug the holes.

Since Lyme patients are so often fatigued and ill, do you have any tips for them or direction in how they can put this diet into effect?

It helps to use simple approaches. I am a big fan of protein shakes. If all you can do in the morning is to get some almond milk, or rice milk, or hemp milk, and some protein powder and blend that up or put it in a shaker and drink that first thing – even if you have cereal an hour later – at least you’ve had the protein boost and that will keep blood sugar stable and help keep the adrenals happy. So I try to encourage people to simplify things. At Trader Joe’s for example, you can buy packages of vegetables cut up and ready to go, and organic stir-fry mixes. If you get a chicken breast and you throw that and the vegetables in a pan with some coconut oil, you’ll have a healthy dinner without too much effort. It certainly doesn’t need to be elaborate. Sometimes people will buy meat that’s already cooked. Places like Trader Joe’s cater to people who don’t want to do everything from scratch. You can get already cooked organic chicken pieces that you can throw into a salad or turn into a stir-fry. Keep it simple, that’s the key.

What is your rationale behind recommending organic food? Is it because of pesticide residues and toxins?

Correct. Pesticides, antibiotics, hormones – anything that they might use in poultry or meat. I am a proponent of organic meat, not only for those reasons – the hormones and antibiotics and such - but because grass-fed beef has a much healthier fat content. When cattle can roam and graze in pasture they have a much higher content of omega-3 fatty acids. Now, most cattle is fed grain and hay, which is why some people are eating bison. I don’t think red meat in itself is evil, but if it’s factory-farm raised you’re not going to have the healthy content. In terms of produce, I do think it’s important not to have the pesticides and fertilizers and other chemicals. And of course, the more organic food you can eat, the less genetically modified foods your diet will contain.

Tell me what your issues are with GMO (genetically modified) foods?

I haven’t done extensive research, but from my understanding genetically modified foods can actually alter our DNA. There are DNA strands of the genetically modified organisms that can weave their way into our DNA. And given that every single cell, every protein, every muscle, everything in our body is manufactured from the DNA template, it then figures that our tissues and organs and chemicals in our body are not going to be as healthy because genetically they’re not what they’re meant to be. I can go to Australia and eat a bit of gluten and that’s fine. I can go to Europe and eat a little gluten and that’s fine, but I wouldn’t in the States. Our food supply is very problematic now and we’ve got so many people who are sick because of their diet. It's not only nutritional issues, but the toxins in foods - the fertilizers and the chemicals. I do think organic food is getting more accessible and affordable.

Can you tell me about your detox diet?

There are a couple of different contexts for detox. If I had a patient who came in and was starting out on a treatment path and we just wanted to get back to baseline, I keep it fairly simple, but the nutritional part is key. I would remove all the known allergens in diet: soy, corn, peanuts, gluten, dairy, also eggs, which I see a lot on food sensitivity tests, citrus, too, so I would really pare the diet down to basics. I do have a detox powder - vitamins and minerals and herbs and amino acids – things that specifically support detoxing – and I would use that in conjunction with a fiber blend at night to help sweep the bowels and get the toxins out through the bowels. And then, depending on the situation, I might do an anti-candida, anti-parasite formula. I might use extra kidney and liver herbs; I’d add to it whatever is relevant. Then, from a lifestyle standpoint, I’d do dry-skin brushing. So essentially, a few minutes before a shower you use a boar hairbrush and brush the skin upwards toward the heart. Also, Epsom salt baths are helpful, as is drinking lemon juice and water. I now put the essential oil of lemon in water, and that has an even more potent detox effect. Detox for Lyme is ongoing, it’s not just, hey, do this for 21 days. You need to work on detoxing throughout the entire length of treatment.

How about caffeine and coffee?

I’ve been known to say: One cup of coffee in the morning is okay. Look, if my patients are doing all the right things with gluten and dairy, and their one last pleasure is a cup of coffee in the morning, I’m not absolutely opposed to that. What isn’t good is slogging three to six cups a day to survive. That’s clearly a sign of adrenal fatigue, which needs to be addressed. So if it’s one cup, like having your ritual one cup of coffee in the morning, I’m not absolutely opposed to that. Where I see a huge red flag is when the pot is on and you're still drinking a cup at four in the afternoon just to get through the day.

How about green tea?

Green tea has caffeine but it’s got other health giving properties. It’s very high in antioxidants, so I would say it’s better than coffee. but again, if you’re drinking 12 cups to get through the day then that’s still a sign you have to work on the adrenals.

Do your patients require personalized treatment, tweaking the basics but with modifying each protocol?

In The Beginner’s Guide to Lyme I've listed some of my fundamental protocols, but it is very individualized and a lot of it has to do with levels of sensitivity. Let’s look at smilax, an herb I use a lot. The standard dose of smilax is 30 drops twice a day. A lot of people can jump straight to that dose and be fine, but if I have a really sensitive person I’ll have them do one drop in a liter of water and have them take a few sips the first day. So there’s quite a range. There are things I use like Soothe and Relax, and Energy Multiplex, and some supportive formulas where most people can take the recommended dose. Some of the herbs, like smilax, which should help to reduce Herxheimer reactions, every so often can actually provoke a herx in a sensitive person. So there are things like that to watch out for. Then of course how aggressively we can treat with antimicrobials, that is all individual. I’m a big one for using herbs in the beginning to tease out coinfections. Very often I’ll have my patients use an herb that I often use to treat Borrellia and ten days later, add an herb for Babesia, then ten days later add an herb for Bartonella, just to gauge their response to each step to really tease out, okay, which coinfection is dominant and what’s contributing to what symptoms.

So pharmaceuticals are not necessarily part of the protocol?

Not always, although I will say that historically most of my patients have done antibiotic therapy with me (Editor's note: California Naturopathic doctors can prescribe antibiotics). I love using natural herbs. But I’m not convinced that herbs alone can get people well. So if people are doing herbs in conjunction with high-dose Vitamin C by IV, or maybe either ozone or hyperbaric oxygen therapy or rife therapy – combinations of things can be really good. I’ve started using essential oils and I’ve had very good results using them.

How do you use essential oils?

I use them internally, so I have people do certain remedies that support detox - antioxidants and things like that. Some of the essential oils come in soft gels for the patient to swallow. There are very specific oils you can do that with; not all essential oils are created equal. I’m very confident in the purity of the brand I use. I would not be able to support a patient using a random brand off the shelf. This is a caution I would throw out there.

You have companies that you use for these oils?

Yes, I have a company that I use for the oils. I have another company that I work with to create herbal formulas, whether they be detox support or antimicrobial formulas or things like that. I have other companies where I’ve picked and chosen their products based on the results I’ve had from them. I’m a huge fan of a company called Research Nutritionals – I love their stuff. The majority of the stuff I use is either Research Nutritionals for supplement support and I have my line of herbal medicines that I’ve put together.

Since you wrote the book, has anything changed or have you found new direction?

I think I can comment about the people who are going grain free and the health of that. My position was always: brown rice, quinoa, wild rice are going to be your best friend, if you need some carbohydrates. And there are definitely still people I recommend that to, but I have really learned over the last couple of years, how well people do when they’re really grain-free. So that would be one thing. I would encourage readers to have the IgG food sensitivity test, so they can try to individualize diet for them.

Do you have to have a doctor order that?

You do. There’s a couple of labs I use for that: Great Plains labs is one; U.S. Biotech is another. Most open-minded M.D.s or naturopathic doctors are willing to do that.

Do you have any other thoughts for Lyme patients?

Yes, I think encouragement in the nutritional part is needed. Even though it feels overwhelming in the beginning to make dietary changes, it’s self-reinforcing. As soon as people feel a little bit better through dietary changes, they have more capacity to do the shopping, to figure out what they need. My advice is to start with baby steps; choose one thing and every week or every two weeks, choose one thing and work that into the routine. Whether that’s eating more fermented foods one week, trying to get some really good sauerkraut, introducing that, or doing a protein shake in the morning. Break it down into manageable parts. Don’t feel like you have to be gluten, dairy, and sugar free by tomorrow. Just choose one thing at a time that you can manage and do that, and gradually over time, you’ll feel better just from what you are putting in your mouth. If people get overwhelmed they’ll do nothing, so the advice is: a little bit is better than nothing, even if it’s just one small change, it’s all a step in the right direction I’ve found with my patients that’s empowering for them. You know, Lyme itself is so dis-empowering. So people who can tackle the dietary piece feel more in control of their health.

Nicola McFadzean, N.D., works with Lyme patients in her San Diego, California office, RestorMedicine.