I started writing this as a reply on X to Greg Yang, co-founder of xAI, who recently stepped down from xAI to address his debilitating case of Lyme disease.
Ultimately, I decided that a blog post could provide more detail and allow proofreading by credible researchers, so here we are.
Before we dive in, a disclaimer: I’m not a doctor, nor do I play one on the internet. I was hesitant to publish this, as I know how much flak I’ll get, but the results and underlying science are just too interesting.
The following is for informational purposes only. Please consult with your doctor and read the warnings at the end.
TABLE OF CONTENTS
My Story
Salvation through Starvation?
Energy Production
Anti-Inflammatory Effects
Metabolic Psychiatry
How to Get Started + Future Non-Diet Options + Warnings
Additional Resources
MY STORY
Growing up on Long Island (see this link), I’ve contracted Lyme disease twice. Most of my childhood friends and neighbors have had tick-borne diseases. My second case of Lyme in 2014 was incredibly severe, but it was resolved in 4–6 weeks with an unorthodox approach: strict ketosis. I’ve now been 100% asymptomatic for more than 10 years.
I have since replicated the results with four out of four friends who were effectively disabled by Lyme disease. In this post, I’ll cover some of the science, simple how-to instructions, lots of open questions, and upcoming tech options that might offer some benefits of keto in a headset, no diet required.
Am I saying the ketogenic diet will work for everyone? Of course not. I am saying that, compared to a lot of complex or questionable treatments for Lyme, ketosis might be a simple “first, do no harm” approach with minimal downside for most people. Drugs often have off-target effects, and we’ve scientifically studied ketosis for more than 100 years.
Furthermore, ketosis has been a mainstay of human evolution for millennia. So perhaps it’s worth testing for a few weeks to see if you’re a responder? Lots of caveats with this, but I’ll unpack it.
Let’s begin with my personal case.
As mentioned, I twice contracted Lyme disease and co-infections on Long Island, confirmed with local testing, best-of-class lab testing in NYC, and lastly with specialists at the Stanford Infectious Diseases Clinic. I mention the three separate rounds of testing, as a lot of people are misdiagnosed with Lyme.
Many conditions have similar symptoms to Lyme disease, including Long COVID, Fibromyalgia, Chronic Fatigue Syndrome (CFS/ME), Multiple Sclerosis (MS), and Rheumatoid Arthritis (RA). Disambiguating takes proper testing from legitimate MDs, in my opinion.
There are simply too many charlatans and well-intentioned amateurs running around.
I had no rash in either instance, which is true in 20–30% of cases. Unfortunately, I believed the local folklore of “no rash, no Lyme” and, in the 2014 instance, I waited until symptoms were debilitating: severe joint swelling, slurred speech, forgetting common words and friends’ names, etc. I didn’t seek proper help until my assistant said, “Tim, I’ve seen you tired, I’ve seen you sick, and this is something else. You need to see a doctor.”
So, I did. Sadly, after proper diagnosis and courses of antibiotics, which I still believe are critical, most symptoms persisted. I operated at ~10% capacity for 9 months and was on the verge of accepting that my mind, body, relationships, business, and more might be handicapped forever. I felt like I had advanced dementia, fatigue often kept me bedridden, and arthritis-like pain wracked my entire body.
What happened at 9 months?
I started brainstorming subtraction. I’d already tried addition: adding drugs, supplements, and all manner of sketchy “alternative” options. If anything, some of them seemed to be generating more problems.
This is how I returned to the ketogenic diet.
Fortunately, I’d used the ketogenic diet in college for various sports experiments, and I decided to test whether or not picking a new fuel and harnessing anti-inflammation (more on these later) would improve things. I knew I could get into clinical ketosis within 3–4 days.
Within a week, all of my cognitive symptoms were gone.
After roughly 4–6 weeks of a strict ketogenic diet (<20 grams of carbohydrates per day), I completely and durably fixed all of my symptoms. It’s been more than a decade, and none of the symptoms have returned. It was a Hail Mary that worked.
And here is perhaps the most surprising part—I didn’t need to stay on the ketogenic diet. I went back to the slow-carb diet after 4–6 weeks of keto, and my diet has varied tremendously since. Whatever it did seemed to stick.
But there was one rub.
I had no satisfying explanation for why it worked.
I had a few plausible theories, sure, but nothing watertight. I knew the short-term effects of ketosis… but a durable fix? How was that possible?
The lights went on in late 2025 when I again interviewed Dr. Dominic D’Agostino, one of the world’s leading researchers and synthesizers of ketones.
Let’s start with the biggest missing piece he provided.
SALVATION THROUGH STARVATION?
Lyme disease spirochetes (Borrelia burgdorferi) are largely dependent on glycolysis for energy production, as they lack a tricarboxylic acid (TCA) cycle and oxidative phosphorylation pathways. In simple terms, the bacteria that cause Lyme disease primarily use carbohydrates for fuel. I had no idea and simply got lucky.
But is it really as simple as starving the bacteria out?
This might not apply to all cases, as such spirochetes can also use alternate fuels like glycerol and pull off all sorts of evolved tricks. LLMs seem to raise an eyebrow at the above theory, but we have at least an N (sample size) of 5 with a 100% success rate. It’s not a Randomized Controlled Trial (RCT), but a lot of compelling science starts with a few interesting case studies.
This glycolysis-dependent piece of the puzzle seems to be critical, but might there be alternate explanations for why keto seems to work? A few possibilities come to mind, and perhaps they synergize to produce the “remission” I and others experienced.
Below are a few leads.
ENERGY PRODUCTION
A ketogenic diet (KD) has a host of fascinating effects on mitochondria, the so-called “powerhouses” of the cell that generate most of your energy (ATP). This was one of my placeholder theories in 2014, as researchers started exploring this terrain seriously in the 1990s.
KDs can help you produce more mitochondria (biogenesis), increase energy production, and arguably improve mitochondrial quality by recycling and replacing them (mitophagy). Net-net, this could be a reboot of your metabolic machinery—you’re remodeling your mitochondria.
Could that address some of the fatigue symptoms of Lyme? Is 1–2 months sufficient to produce these changes and have them stick? Were my later periods of regular fasting—typically three contiguous days of water fasting per quarter—key for reinforcing what the KD kicked off? We don’t really know.
But even if 1–2 months of KD isn’t enough to overhaul your machinery, there are acute energy benefits that could explain my one-week turnaround of cognitive symptoms.
Ketones supply an alternative fuel to glucose, and in some contexts (impaired glucose metabolism) ketones are vastly superior.1 Perhaps this is partially why, even if not in ketosis, I will take a ketone salt or monoester before recording podcasts: I’m significantly sharper without having to mainline caffeine in the afternoon and sacrifice sleep quality later.
There are documented cases of Alzheimer’s disease (AD) patients who respond incredibly well to exogenous (supplemental) ketones (listen to 2:21 here), and I’ve heard clinicians describe AD patients who normally fail the clock test (drawing a clock) but who can succeed without any difficulty after a single 10–30-gram oral dose of exogenous ketones. Something interesting seems to be happening. Alzheimer’s is sometimes referred to as “type 3 diabetes.” Could a ketogenic diet fix part of the underlying problem, or are ketones simply working around damage (e.g., amyloid plaques and tau tangles)?
I don’t know, but here’s what I do know: every time I cross ~1 mmol/L blood concentration of ketones as measured by any commercial ketone meter (e.g., Keto-Mojo or Precision Xtra), a light switch is flipped and I have extra gears. I’ve seen this repeatedly since my first keto experiments in the mid- and late 1990s. Of course, your personal threshold will likely differ, but I can turn this on at will with exogenous ketones; a 1–2-day water fast; or a 2–4-day, low-calorie KD.
Curiously, these extra gears seem to often kick in for many people who are not obviously glucose-impaired. Why? Perhaps it relates to the next bullet.
And perhaps people who aren’t glucose-impaired at the whole-body level (i.e., as assessed by standard blood tests) can nonetheless be glucose-impaired at the brain level? I’d bet money on it.
For related reading, see “Can Ketones Help Rescue Brain Fuel Supply in Later Life? Implications for Cognitive Health during Aging and the Treatment of Alzheimer’s Disease.”
ANTI-INFLAMMATORY EFFECTS
The primary circulating ketone, beta-hydroxybutyrate (BHB), appears to dial down inflammatory signaling through multiple pathways. In other words, some ketones have direct anti-inflammatory effects.
The next paragraph is technical, so feel free to skip, but there are some juicy bits.
BHB inhibits the NLRP3 inflammasome (a molecular trigger for cytokines like IL-1β), engages the HCA2/GPR109A receptor on immune cells, and may influence gene expression through epigenetic mechanisms like histone β-hydroxybutyrylation. The claim that BHB is a potent HDAC inhibitor is debated in the literature (if true, there are significant cancer implications), but net-net, for some people, ketosis seems to reduce systemic inflammation.
Lyme-induced inflammation can produce vasoconstriction and cause a range of problems (cold hands/feet, dysautonomia), but ketones (D-BHB and L-BHB) have a remarkable effect on improving cardiac output and blood flow by reducing peripheral vascular resistance. This is of personal interest, as both I and my mom have long-standing Raynaud’s Syndrome, but we never thought of any connection to Lyme. My mom has had both Lyme and alpha-gal syndrome, which was transmitted by the Lone Star tick. Now she can’t eat mammalian protein without risk of life-threatening anaphylaxis.
For more on the anti-inflammatory potential of ketones, I suggest you listen to this segment here from my very first conversation with Dominic.
Broadly speaking, anti-inflammatories can have some very fast effects. For instance, if you have minor aches and pains that make it a little painful to walk, you might be able to take two Advil and go for a pain-free walk 60 minutes later.
By extension, how quickly could the anti-inflammatory effects of ketones on a KD translate to less painful or pain-free joints? Smoother and faster cognition? Less or no fatigue? Once again, in my personal experience, all of these and more changed within a week of tipping past 1 mmol/L concentration of BHB as measured by a finger stick with a Precision Xtra or Keto-Mojo device.
Last but not least, guess what? Neuroinflammation impairs glucose metabolism in the brain, and impaired glucose metabolism worsens neuroinflammation.
Everything in this post seems tightly interrelated. That’s good news. Ketosis might be a hammer that hits several nails at once.
Related reading:
“Fasting-induced ketogenesis sensitizes bacteria to antibiotic treatment“
Summary: Fasting-induced ketogenesis can alter host metabolism in ways that increase antibiotic sensitivity in bacteria and modulate immune and inflammatory responses. In principle, these effects could enhance standard Lyme disease treatment by strengthening antibiotic efficacy and improving host immune function. Unlike the bacteria in this study, Borrelia burgdorferi is an obligate glycolytic (e.g. no TCA/ETC), so the rationale for Lyme management is stronger.
Summary: Though the malaria study is not about Lyme disease, it demonstrates that ketosis disrupts pathogen development and modulates host immune/inflammatory pathways. This causes an environment less favorable for the pathogen while enhancing host immune and mitochondrial resilience.
METABOLIC PSYCHIATRY
This section will overlap a lot with the preceding two.
Lyme disease is sometimes called “The New Great Imitator” because its symptoms overlap with so many conditions. Some are autoimmune, but many are psychiatric, including but not limited to depression, anxiety disorders, bipolar disorder, obsessive-compulsive disorder (OCD), and ADHD. There’s also emerging data that infection is linked to these disorders and other neurodegenerative diseases.
Dr. Chris Palmer, a Harvard Medical School psychiatrist at McLean Hospital, has developed what he calls “the brain energy theory of mental illness.” In my conversation with him on the podcast, he argued that mental disorders may, in many cases, be metabolic disorders of the brain. His core insight: when brain cells are metabolically compromised, they can become either underactive (shutting down from lack of energy) or hyperexcitable (misfiring when they shouldn’t).
In his model, a ketogenic diet may help by providing an alternative fuel source to struggling brain cells.
The keto–mental health connection isn’t new. Ketogenic diets have been used clinically for 100+ years to treat epilepsy. Centuries ago, churches sometimes locked “possessed” people in a room without food, and lo and behold, the “demons” disappeared after roughly enough time to metabolically switch to ketosis.
Ketogenic diets appear to act through multiple, sometimes overlapping pathways, including those affecting neurotransmission, inflammatory signaling, and gene expression. I bolded those we haven’t directly addressed in this piece.
Furthermore, the ketogenic diet dodges some of the metabolic and off-target side effects associated with many psychiatric medications, especially antipsychotics.2
For more on this, I recommend Chris’s book Brain Energy and our full conversation. I also chatted with Dave Baszucki, founder of Roblox, about how he used metabolic psychiatry to save his son, who is diagnosed with bipolar disorder.
HOW TO GET STARTED + FUTURE NON-DIET OPTIONS + WARNINGS
How to Get Started
In brief, if you’ve been diagnosed with Lyme, it might make sense to try 1–2 months of a strict ketogenic diet DURING or AFTER antibiotics but BEFORE you try speculative treatments with non-trivial or unknown downside risks.
Of course, speak with your doctors first.
ChatGPT and similar LLMs can help cover most bases and even meal plans, but be sure to specify “less than 20 grams per day of carbohydrates (CHO).” People can get cute with “net-carbs” and outsmart themselves. I prefer a wide margin of safety when stakes are high (e.g., Lyme symptoms).
If you like books, amidst a sea of terrible options, there are a few that are pretty good.
From Dr. Dominic D’Agostino:
- The Ketogenic Bible: The Authoritative Guide to Ketosis by Jacob Wilson and Ryan Lowery (384 pages; 4.6 stars)
- Clearly Keto: For Healthy Brain Aging and Alzheimer’s Prevention by Dr. Mary Newport (560 pages; 4.5 stars)
From a CEO I can’t name, who has access to thousands of patients who’ve tried a ketogenic diet in various forms:
- The Complete Ketogenic Diet for Beginners: Your Essential Guide to Living the Keto Lifestyle by Amy Ramos (158 pages; 4.2 stars)
- The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable by Stephen D. Phinney and Jeff S. Volek (Highly accurate but longer and more science-heavy) (316 pages; 4.5 stars)
My Personal Protocol:
For the most part, I think that trying to eat keto-friendly bagels and faux-desserts is the path to disappointing results.
Especially if you’re just doing a trial run for a few weeks, I like to keep it simple. Do fool-proof first, then, if you want, layer in clever and crunchy after at least two weeks of 1 mmol/L blood readings, and only then with constant ketone monitoring.
To jumpstart keto, I personally like to first do intermittent fasting (IF) for at least a week, only eating within an eight-hour window each day. IF alone can dramatically change your blood work, OGTT, and more. Note that it can take your body 1–2 weeks to overcome the first 12 hours or so of lower energy and occasional irritation, but when you do adapt, it pays long-term dividends.
If you adapt to IF, it’ll make future keto transitions a lot easier and likely eliminate any fogginess, low energy, or “keto flu” symptoms. It helps jumpstart your ketogenic machinery without extended ketosis.
But if you’re in a rush to test keto and want to bite the bullet, you can also just start with a lower-calorie keto diet. The sub-maintenance calories will dramatically speed things up.
In my case, I default to something like the below at a bodyweight of around 175 lbs.:
• 9am Morning – Coffee or tea with 2 tbsp heavy cream (NOT half and half)
• 11am Mid-morning – For the first week of keto and sometimes longer, I’ll mix KetoSpike cocoa exogenous ketone powder into my coffee or tea. This remedies early fatigue.
• Cardio, if any Zone 2 to be done
• ~2pm Lunch – Two cans of chub or jack mackerel mixed with 2 tbsp MCT oil + 2 tbsp apple cider vinegar + salt/pepper. Cheap, fast, and surprisingly good. This will clock in at around 500–700 calories.
• 5pm Weight training, if any
• 7pm or 8pm Big dinner. This will contain the rest of my calories for the day.
Chopped ribeye on huge salad with extra virgin olive oil, plus a side of creamed spinach
OR
Chicken and cheese plus keto-friendly veggies like broccoli and cauliflower
OR
Lamb chops plus keto-friendly goulash, etc.
You can always add fat with some additional heavy cream in a beverage, as has been done successfully for more than a century with epileptic kids, or a few dollops of sour cream or a dessert of keto-friendly cheeses.
• Post-dinner – Walk the dogs and curb any glucose/insulin response from the large meal.
That’s it. Once you’re in proper ketosis, you probably won’t feel much hunger. It’s quite liberating to reorient to hunger and eating that isn’t compulsive and full of snacking. If you really want to snack, eat more at meals. If you still want to snack, it’s habit and not physiology talking.
Postscript:
Supplements: I take electrolytes (sodium, magnesium, and potassium) as pills or packets at least twice a day. Especially if you’re new to keto, this will be important for avoiding dizziness, cramping, and sleep problems. Just ensure no sweeteners, maltodextrin, etc. are hiding in the product. You’d be surprised what some popular brands do.
Fat: Don’t try to do a low-fat, high-protein version of keto. For reasons we’ll skip here, it’s very hard to make work and not worth the gamble. Aim to consume at least 70% of your daily calories from fat.
Snacks: Be careful with snack foods, even keto-friendly-ish macadamia nuts, which can add up and knock you out of ketosis. Avocados also contain more carbs than you might think. Once mildly knocked out of ketosis, some people need multiple days to regain footing and end up feeling depleted, exhausted, and awful. For beginners, treat ketosis as binary and watch your exact grams of carbs. Play it safe so you don’t end up in metabolic purgatory.
Non-Keto Keto Options and Future Tech
Can you get some of the benefits of a ketogenic diet without eating meat, eggs, and cheese all the time? It sure would be nice.
And, yes, you can make a KD much more appealing, eating a surprising quantity of salads and greens, but I’m always looking for tools and approaches that might make its benefits more accessible.
Here are a few that I’m tracking closely:
Intermittent fasting by itself. At least a 16-hour window of fasting. Read up on neuroscientist Mark Mattson and “flipping the metabolic switch.” Here is one oldie-but-goodie, but note that Mark suggests 16–18 hours of fasting instead of the 12-hour onramp mentioned in that publication. This is also referred to as 16:8 time-restricted eating. 16:8 or 18:6 is a goldmine and perhaps my most surprising personal change of the last two years, in addition to accelerated TMS.
The “metabolic switch” relates to depleting your liver of glycogen, requiring around 16 hours for most people, which then leads to a more ketotic state.
Bioelectronic medicine (e.g., vagus nerve stimulation [VNS]). Dr. Kevin Tracey and others have described the “inflammatory reflex,” whereby vagus signaling can modulate immune activity. Early clinical work has explored VNS in inflammatory conditions (e.g., rheumatoid arthritis). This is not a Lyme treatment per se, but it’s plausible that a VNS device, particularly implants or an ear-based transauricular VNS (taVNS), could be used to decrease inflammation-driven symptoms. There are also some potentially interesting applications to chronic pain management via HMGB1 (special thanks to Ulf Andersson).
Caveat emptor – there is a LOT of BS out there related to vagus nerve stimulation.
Listen to my interview with Kevin, and I’m hoping to help make easier auricular devices more widely available soon. For a possible alternative route, also read up on the applications of famotidine (Pepcid) to the vagus nerve and the inflammatory reflex, which has applications to COVID and more. As always, speak with your doctors before using.
Ultra-low-intensity magnetic approaches (Fareon). Stealth startup Fareon has published preclinical work suggesting microtesla-range magnetic fields can influence neuroinflammation and disease models. This is early science, not clinical guidance, but I became an early investor in this company for a lot of reasons. One of them: I’m hoping it might offer some of the anti-inflammatory benefits of keto with simple, at-home hardware. Their tech is not yet available outside of trials, but I’m hoping to help expand that. You can sign up for their email list to be the first to know.
Others?
Do you have other ideas or suggestions? If so, please let me and readers know in the comments section of this blog post.
Caveats with Lyme Disease
It bears repeating: Many conditions have similar symptoms to Lyme disease, including Long COVID, Fibromyalgia, Chronic Fatigue Syndrome (CFS/ME), Multiple Sclerosis (MS), Rheumatoid Arthritis (RA), and more. Disambiguating takes proper testing from legitimate MDs, in my opinion.
It is also worth noting, however, that data suggest a ketogenic diet might help with symptoms of nearly all of the above(!):
MS → strongest early clinical evidence
Fibromyalgia → promising pilot data
CFS/ME → strong theoretical fit, weak trials
Long COVID → emerging hypothesis
RA → indirect anti-inflammatory benefit
Returning to the caveats, there is another risk lurking behind the label of “Lyme disease.” Some people go shopping for the Lyme diagnosis. If you keep seeing doctors long enough, especially once you venture into “doctors” at the fringe, I promise that you will eventually get a Lyme diagnosis. Some such patients are simply desperate for any explanation and treatment that can provide relief. Others are subconsciously hoping for an external cause for depression and lethargy caused by issues like a rocky marriage, alcoholism, social isolation, etc. It’s a lot easier to take pills or get IVs rather than fundamentally changing the tectonic plates of your life. I get it, and I’ve been there in different contexts.
In the case of Lyme disease, there are entire cottage industries that have popped up to happily take your money for endless treatment that won’t do much.
So, good to be aware and always ask: If I took Lyme off the table, what else might possibly explain this?
Keto Warnings
If you’re on insulin, sulfonylureas, GLP-1 agonists (e.g., Ozempic, Zepbound), or any SGLT2 inhibitor (the “-flozin” drugs), don’t attempt a ketogenic diet without clinician supervision, as carb restriction/fasting can trigger euglycemic ketoacidosis, and medication doses may need rapid adjustment.
In fact, please be sure to always speak with your doctor, m’kay?
Just note that you might need to offer them some reading on the ketogenic diet, as it isn’t a common intervention. This blog post or linked studies and podcasts offer a few starting points.
Also avoid DIY keto if you are pregnant/breastfeeding, have significant kidney/liver/pancreatic disease (including prior pancreatitis), or have a history of eating disorders.
All that said, overall, humans are incredibly well evolved to handle ketosis, especially for the brief periods of time necessary to notice before-and-after changes in the context of Lyme.
One final addendum from Dominic on ALS, at his request:
“FYI, my friend Deanna Tedone was diagnosed with rapidly progressing ALS 17 years ago (given 3 years to live, at most). Her dad, Dr. Vince Tedone, was a world-famous orthopedic surgeon who introduced arthroscopic surgery to the Southeastern United States He developed the Deanna Protocol, and we proved efficacy in mice: Metabolic Therapy with Deanna Protocol Supplementation Delays Disease Progression and Extends Survival in Amyotrophic Lateral Sclerosis (ALS) Mouse Model.
Deanna tested positive for Lyme disease, and we think this may have been the cause of her ALS. Their foundation is Winning The Fight, and they’re hoping to fund more research on the link between Lyme and neuro diseases.”
For now, that’s all, folks!
Illness and medicine can be squirrely beasts, and I myself have been tempted to give up at times. It can seem like the deck is stacked against you. But sometimes there actually is a simple light of hope at the end of the tunnel.
The ketogenic diet is not a panacea, but its applications beyond weight-loss are compelling. For some, like me and my friends, they can be life-changing.
I sincerely hope this post is helpful.
All the best to you and yours,
Tim Ferriss
Thanks to everyone who proofread this post. Any remaining mistakes are mine. If you spot errors or have corrections, please leave a comment below.
ADDITIONAL RESOURCES
- Dr. Dominic D’Agostino — All Things Ketones | The Tim Ferriss Show
- Dr. Dominic D’Agostino — How to Use Ketosis for Enhanced Mood, Cognition, and Long-Term Brain Protection | The Tim Ferriss Show
- Dr. Chris Palmer — Optimizing Brain Energy for Mental Health | The Tim Ferriss Show
- David Baszucki, Co-Founder of Roblox — Ketogenic Therapy for Brain Health | The Tim Ferriss Show
- Dr. Kevin J. Tracey — Credible (vs. Bogus) Vagus Nerve Stimulation | The Tim Ferriss Show
- Brain Energy: A Revolutionary Breakthrough in Understanding Mental Health—and Improving Treatment for Anxiety, Depression, OCD, PTSD, and More by Dr. Chris Palmer
- The Great Nerve: The New Science of the Vagus Nerve and How to Harness Its Healing Reflexes by Kevin J. Tracey
- Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease
- Alzheimer’s Disease Is Type 3 Diabetes–Evidence Reviewed
- The ketone metabolite β-hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease
- Ketogenic diet as a metabolic treatment for mental illness
- Transcranial microtesla magnetic fields suppress neuroinflammation and neuronal oxidative stress burden
- Metabolic Mind
- Fareon
- Lyme neuroborreliosis – epidemiology, diagnosis and management
- EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis.
- Pathogenesis of Lyme neuroborreliosis: borrelia-induced inflammation and modulation by tick salivary protein.
Footnotes:
- “Ketone Supplementation: Meeting the Needs of the Brain in an Energy Crisis“
and “Effects of Ketone Bodies on Brain Metabolism and Function in Neurodegenerative Diseases” ↩︎ - “Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial” ↩︎



Comment Rules: Remember what Fonzie was like? Cool. That's how we're gonna be — cool. Critical is fine, but if you're rude, we'll delete your stuff. Please do not put your URL in the comment text and please use your PERSONAL name or initials and not your business name, as the latter comes off like spam. Have fun and thanks for adding to the conversation! (Thanks to Brian Oberkirch for the inspiration.)
Hey, Tim, thanks for this article. I’ve heard that, for these purposes, once you’ve ‘healed’ your target condition (or remission, whatever), it may be possible for you to return to a less restrictive diet, such as Mediterranean. Do you continue to eat a Keto diet? Have you made any changes since you started it? TY
Kate, thank you for pointing out a glaring omission! I should have made this obvious and just added this text to the blog post:
“And here is perhaps the most surprising part — I didn’t need to stay on the ketogenic diet. I went back to the slow-carb diet after 4-6 weeks of keto, and my diet has varied tremendously since. Whatever it did was durable.”
Thank you so much for the valuable comment!
Tim
Hi Tim, great stuff as usual. I just did a couple weeks of keto with a three-day water only fast in the middle. During that period, when my keto levels were high, I noticed I got zero cognitive boost from my once daily afternoon nicotine lozenge. I replaced afternoon coffee with one lozenge years ago for better sleep. Maybe there’s a link between the cognitive boost of nicotine and ketosis? Or even a use for the keto diet in quitting a nicotine addiction. Anyway, thought that was interesting. Thanks for all the amazing content over the years.
Super interesting. I’ll look into it. Thank you for sharing. How have you prevented your nicotine dose from escalating over time? I’ve seen a lot of friends starting with the intention of micro-dosing who end up addicted and dependent after a month or two. Would be curious to hear how you approached this.
Yeah, I’ve noticed the same thing with friends and colleagues, especially the ones that use Zyn. Luckily, I’m not prone to addictive behaviors, and I viewed it strictly as an afternoon caffeine replacement. I’ve used both 2 mg and 4 mg but never higher than that. I don’t notice much difference in those doses personally. I use the generic Amazon brand nicotine lozenge, which never dissolves fully, so I just keep it tucked in my lip for an hour or more. This routine of 2 cups of coffee in the morning and 2 mg of nicotine in the afternoon works great, and I rarely use nicotine on the weekends, only if I need to focus on a mental task.
Shout out to you and Peter Attia for all the great advice and motivation to self-experiment!
The groups I am in say that nicotine isn’t addictive, but additives used in products are to blame. Have they tried clean nicotine sources?
Quickly chiming in: I am using nicotine also complementary to caffeine with a shorter half-life (~2h vs 4-6h), hence less sleep disruption, and different mechanisms of action (increase of dopamine vs inhibition of adenosine receptors) for focused work bouts in the afternoon, before speaking engagements, or before/in meetings or talks as listener to increase attention.
I use nicotine gum over other formulations because of dosage precision and controlled absorption.
Dosage precision: I can halve the smallest 2 mg unit to achieve a precise 1 mg dose, unlike patches or lozenges which are higher dosed and cannot/shouldn’t be divided. Non-tobacco based nicotine pouches are very popular but have extremely large doses.
Controlled absorption: Unlike sprays that deliver a full dose immediately under the tongue, which then enters directly into the bloodstream, gum allows the user to pause the release by “parking” the gum.
Warnings still apply: I stick to low doses and avoid frequent use. Nicotine is highly addictive, and tolerance builds quickly, requiring more for the same effect. Never source it from tobacco or vaping! Additionally, I advice against nicotine pouches due to their “extremely” high dosages. Watch out for potential long-term increases in blood pressure due to its vasoconstrictive effects.
Personally: I limit myself to one gum per day and not more than 5 per week.
I hope this helps.
Cheers, Stephan
Tim – Thank you so much for this. Brain health is something I pay close attention to. My mom passed after 15 years of Alzheimers in August and my husband suffered a brain injury following cardiac arrest 8 years ago. I’m very curious about ways to keep my brain healthy. Interestingly I just finished my 3rd round of a 5- Day Fast mimicing system, generally follow intermittent fasting16/8, and wear a CGM to monitor my glucose levels. I’m no longer pre-diabetic and workouts are so much stronger now too. Fasting and keto keep my glucose levels low and stable. I also notice how sharp my mental focus and productivity become while in a state of ketosis. I will pass this post along to my local team of medical professionals involved in Alzheimers research. More people need to consider this possibility.
Thank you, Betsy. There is a lot to the Fast-Mimicking Diet (FMD). I may very well do a version of this — Dr. D’Agostino’s described “sardine fast” — once every month or two as my keto maintenance schedule. Just figuring out how to mitigate possible muscle loss if doing it frequently.
Tim, this article is a trove of inspiration. Also a great experience, very inspiring for many people experiencing CFS/CEID/ME/Lyme symptoms. I believe the symptoms might be the same, as well as the triggers – but in different combinations – thus triggering a systemic respons – very much in line with the metabolic theory of disease. Including cancer, with dr.Seyfried, being one of the biggest proponents and popularizers.
I have a couple of remarks and questions for you, that I believe are important:
– Ketone BOHB levels and ketosis. You write about the 1 mmol of ketones in the blood. I believe It shows that you are most probably at the upper stage of ketogenic adaptation. I hypothesized the 4 stages of ketogenic adaptation, defining them as the relationship to morning glucose levels in my coming book. And we can only measure our own adaptation stage if we learn our own patterns of cortisol levels changing in the morning hours, Dawn/Somogyi effect. I made an app to help my clients visualize this.
Q: did you try to assess the stability of your morning glucose, right after waking up?
– Vasoconstriction and Raynaud + Natural VNS regulation. I need to add my 5 cents here. There are substantial synergetics with diminishing CO2 chemoreceptor sensitivity or raising your CO2 partial pressure in your arterial blood, which is essentially the same. My article in Elsevier 2019 article, still the only one existing about the synergetics of ketosis and Buteyko method: “Buteyko Breathing Technique and Ketogenic Diet as Potential_ Hormetins in Nonpharmacological Metabolic Approaches to Health and Longevity”.
Q: I know that you have during the last 15 years had some people with Buteyko experience on your podcast. Did you implement some of their ideas into your long term everyday practice?
– About ketogenics for cancer. The most important case study by Dr.Seyfried was made in the 2021 report of a patient with IDH1-mutant Glioblastoma (GBM) who managed their tumor for over 80 months using only Ketogenic Metabolic Therapy (KMT) and surgical debulking, bypassing standard chemo- and radiotherapy. I believe the full truth is that it was only possible because of the synergetics created by combination of ketosis with the Buteyko method. I was forced to remove almost everything about daily structured breathing retraining with my client from the article. I’m mentioned only by “thanks” in the Acknowledgements part of the study and removed from the authors list one week before the study was published – despite many years of daily work with the client. I have big respect for Dr. Seyfried work 🙏 And a steadily diminishing one for the “evidence based” science. Btw, this effect is replicated in several other cases with the same diagnosis – without a case report.
I tried to present on many conferences, both on cancer and low-carb, to explain the need to connect the dots of optimizing different realms as breathing and nutrition in order to attain synergetics. But most people want single realm targeted approaches. They prefer specialists to multi-instrumentalists. And the single realm approaches are still prevailing. And most of them are about food. It might be much more palatable for most people? Pun intended.
Generally (since 2020) I feel the overall need to switching from the focus on intensive cancer-support – over to prevention programs. Focusing entirely on working with people that not only understand the need to take 100% responsibility for their health in their own hands – but also have a testicular fortitude to actually do it. Supporting with life change (primarily) and exercise with an integrative metabolic approach, NPMA, as described in my 2019 study. Being a systems engineer, I care mostly about the energy coefficient (I/O) and the overall (allostatic) resilience in any complex system.
We need to take 100% responsibility for ourselves. Anything other than that is a fallacy right now. I like the fact that the person that inspired me with my own life-change, also have the same stand point.
That became a bit longer than initially intended 😉
PS: Tim, your first book changed my life in so many realms. Thank you 🙏
Thank you so much for the super thoughtful comment, resources, and questions, Misha! I’ll also get reacquainted with the Buteyko method.
All the best,
Tim
Tim- Fantastic article. Can I share it, giving you credit of course, with my substack followers?
Sure thing, Bob. Please just give credit and link back to this post, as I’ll be adding more scientific links and resources. Thanks for asking.
Thanks Tim. Do you have any experience or insight as to whether the keto approach works on the typical infections that often accompany lyme (Babesia, Bartonella, Anaplasma, Ehrlichia, etc)? and how successful it might be for any of these without the use of antibiotics?
Great question, and I don’t know the answer. Some of the paper and study links I just added to the post from Dr. D’Agostino might shed some light on this, as some relate to other parasites (e.g., malaria).
I have Bartonella & babesia & your post inspired me to start keto – I am 2 weeks in & I will let you know at 90 days in how my infections are going
Great article, thank you so much for this and all your work! It has genuinely impacted my life for the better.
Just wondered for future additions if there are any more insights and thoughts on perhaps mitigating downsides or ideal frequencies for the 20-30% of folk that seem to get terrible bloods off keto.
I’ve done it before when felt in a slump (previously tick bite and at different time overlooked glandular fever as an adult and get intermittent periods of tiredness despite good basics – diet, sleep, physical activity end up lingering).
I’ve never felt as consistently sharp or energetic in my life as I did when doing keto but my blood markers Inc. tryglicerides went through the roof so was advised to stop. I’d love to find a an ideal frequency to get best of both. Also got the horrific itchy rash after about 10 days whilst feeling peak brain power 😆
If there are any thoughts on blood panels or markers worth testing with regard to legitimate diagnosis that would be highly useful too. It does seem a minefield to try and find a practitioner and often I end up requesting tests or specific markers myself and trying to retroactively compare.
Good question, Andy. I’m a cholesterol hyperabsorber, so I do take medications (e.g., Nexlizet) that help keep my lipid panel from going haywire. This is true overall and especially true on keto, when I tend to consume a lot more fat, including saturated fat. Of course, speak with your doctor, as “bad lipids” can be highly variable, depending on your specifics.
Might be worth asking your doctor about a comprehensive lipid panel so you can track changes over time.
Boston Heart and Labcorp both have sterol testing, which helps you and your doctor understand synthesis/absorption. It’s easier to order through BH, but Labcorp can take them and send them out to Mayo Clinic.
Not medical advice; just my personal experience. Please do speak with your doc!
Tim
Hi Andy, This is an important issue for many since a meaningful minority of people seem to feel dramatically better on keto (mentally and energetically) while their blood markers move in the wrong direction. Part of the confusion is that “keto” isn’t one diet: lipid responses vary a lot depending on fat sources, protein intake, fiber, and overall metabolic context.
In my own case, shifting to a more modified ketogenic approach (more fish and marine fats, higher fiber, adequate protein, and strategic use of MCTs/exogenous ketones) coincided with improvements in ApoB, LDL, HDL/ApoA1, and triglycerides, suggesting that cholesterol absorption and lipoprotein handling, not just fat intake, can matter a lot in low-carb states.
For people who feel their best in ketosis but struggle with labs or side effects (like triglyceride spikes or keto rash), cycling or periodic re-feeding may be a reasonable middle ground. It’s also helpful to look beyond a basic lipid panel, markers like ApoB, ApoA1, triglycerides, and HDL ratios often provide more context than LDL alone. If you have an NPC1L1 mutation (like me), ezetimibe monotherapy is often effective- my ApoB, LDL, HDL/ApoA1, and triglycerides all improved remarkably. (posted here: https://www.instagram.com/p/C4WMbHUu_My/?utm_source=ig_web_copy_link&igsh=NTc4MTIwNjQ2YQ==)
Big Picture: Keto can be a powerful tool, but it’s not plug-and-play. When cognition/energy improve but labs worsen, the answer is usually personalization and refinement of macros, food selection, supplements, exercise, and in some cases targeted lipid lowering drugs.
Tim, do you have POTS, Ehlers-Danlos, symptoms of hypermobility, or any evidence of possible veinous compression? Your lower back pain, for example. You’ve mentioned that it’s worse when doing “museum walk” vs vigorous walking. Would be awesome if you could have someone on to talk about POTS, or any of these associated disorders. These conditions cause a huge amount of human suffering bc physicians are unaware.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10883079/
Dysautonomia following Lyme disease: a key component of post-treatment Lyme disease syndrome?
Brittany L Adler 1,*, Tae Chung 2, Peter C Rowe 3, John Aucott 1
1Division of Rheumatology, Johns Hopkins University, Baltimore, MD, United States
2Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
3Department of Pediatrics, Johns Hopkins University, Baltimore, MD, United States
Dr. Peter Rowe would be an amazing guest for you and/or Attia!
Thanks, Homer. This Dr. Peter Rowe? https://en.wikipedia.org/wiki/Peter_C._Rowe
https://profiles.hopkinsmedicine.org/provider/peter-rowe/2704456
try teasel root tincture. Cured my 20 year case of lyme. Costs $30. Worth a shot!
I bought just 1 bottle of teasel. I started at 3 drops a day in water for teasel and increased by 1 drop a day until plateauing at 30-40 drops. I continued until herxing subsided plus 2 weeks (roughly 2 months in total). I had lyme for 20 years before trying this. I also bought jason’s ticked off and followed the instructions for that. The herxing is pretty brutal. Epsom salt baths help a lot though.
Where did you get it?
Type in Hawaii Pharm Teasel on amazon
thank you so much
Brilliant article and Thankyou for the resources.
I am in Western Australia and I imagine many of your followers are international. Lyme is still largely poopooed here and the Lyme disease society not much use.
1. PLEASE post where those of us outside America can get RELIABLY tested for Lyme and cofactors. I have heard there is a good lab in Germany and even had their order forms. But…brain fog!
2. When you were really ill did you have any means of recording or quantifying symptoms aa a baseline eg the level of fatigue. I am at that 10%function you mentioned. Or baseline blood tests for inflammation, etc.?
3. Are there any American Lyme specialist mds that would do international telehealth appointments?
4. Whilst I will order a bunch of books you listed they will take time. I lead a very mobile life with no chance of changeing that anytime soon. Do you have any preferred protein balls or similar to take along?
5. I have no idea how to follow to get anyreplies as am posting off a link from 5 bullet Friday link.
6. I have seen you link to the eectrolytes you reccomend would you post that link please.?
7. Are there any unusual biomarkers you would test for eg brain, artery plaque, biothermal scaes for inflammation etc.
8. For context, i have spent much time in the bush all over the world am f 63, cptsd from military frontline, diagnosed cirs(mould), an immune system in full battle with itself, am slim, fit, but diabtes 2 running away with itself and nothing doctors can do regulates it, fasting blood sugar 11.9 hbA1c 10. That said I have refused Ozempic. Severe brain fog, apparent onset of severe adhd in last year, extreme fatugue, etc. Your blog post coudl save my life.
Tim! Try the MRT food allergy test done through the blood (it checks your immune’s response to almost 200 foods). It changed my life regarding another auto-immune problem. So did the accompanying LEAP diet.
I’ve also been researching 21+ day fasts in supervised, controlled fasting clinics..
Hi Tim, a big thank you from a snowy Yorkshire England for this post😊. It’s fantastic. as always your earnest desire to have useful, well thought out but also organic/evolving conversations I just find really refreshing.. as someone who has navigated the disappointing landscape of conversation and treatment for autoimmune/raynauds/comnective tissue disorder -very common story-and pushed for Lyme testing years ago after a tic bite whilst living in Africa, I feel this has given me the nudge to bite the bullet more fully on keto. The longer that existing day to day with no significant change goes on, the less important diagnostic labels become and the more open I am to practical even if initially challenging solutions.
Also was very interested in your conversation with Dr Palmer as have supported a parent with severe bipolar disorder since my childhood and I can’t help but see the metabolic links even not understanding the science. especially even on a basic level seeing both parents continue to feed low dopamine with sugar consistently! Anyway, no need to respond to this. I just think that you probably have a very tall order on yourself to get the written word right (understandably) but please do remember, there is so much power in intention and connection as well /and whilst I know that you have to be careful because science is involved and opinion, Tim ferriss and his team are well respected and make a difference by just being Fonzie like people! Thank you. 🤩
Hi Tim. Big fan. Great post. To understand what someone once in my life was going through, I wrote a book called “Love, Hope, Lyme: What Family Members, Partners, and Friends Who Love a Chronic Lyme Survivor Need to Know,” and started the Love, Hope, Lyme podcast. I give away the pdf of the book for free. Can you come on the show to discuss this? Many chronic Lyme survivors are living lonely lives praying for peace, healing, and support. Your message would help many. Thank you.
hi Tim – I am myself a Lyme survivor and did spend 10 years and millions ( unnecessary) in order to heal myself and my kids. It is an incredible challenge indeed – I have so many additions to your solid protocol but one I would add here for people in need is researching DRY FASTING and Dr Filinov. It goes to the starvation idea but at an all different level of cellular healing. Also, an enormous part of the process is to make sure one lives out of mold – and that should not be understated. If Greg wanted to connect with me to share experiences I am happy to help. you can share my email. FP
Tim, thank you for sharing your experience! There’s a young guy in my church (early twenties) who has a pretty debilitating lymes diagnosis, he’s already considered late stage and losing feeling in some limbs.
I sent this his way – I’ll let you know how he responds to strict Keto!
Side note, the four hour work week changed my life – I was struggling with low paying jobs I hated and it gave me the courage to dream bigger – I started a digital business and am now doing 100k+ months. I can’t thank you enough man.
Be blessed!
Could following a ketogenic diet really help manage Lyme disease symptoms long-term, or is it more effective as a temporary supportive approach alongside conventional treatments?
Antibiotics are often highly effective at clearing Lyme disease when used early, but their efficacy drops when bacteria are shielded by biofilms, persister states, or poor tissue access. Antibiotics work best when immune function, tissue perfusion, and metabolic health are optimized. Metabolic strategies such as ketogenic states may serve as adjuncts by improving host resilience, mitochondrial redox balance, and immune competence—thereby creating conditions more favorable for antibiotic action (with approaches like HBOT potentially acting in a similar supportive role). Notably, preclinical and emerging clinical work is already leveraging ketogenic metabolic therapies to enhance immunotherapies such as PD-1/PD-L1 inhibitors and CAR-T cells in cancer, making this a conceptually aligned and biologically plausible extension rather than a fringe idea.
Hi Tim, your story is incredibly moving. We’re thrilled to see how the nutritional ketogenic lifestyle is helping reverse the health challenges you’ve faced. Testing is a key part of that process — supporting accuracy and driving real-time decisions. It’s an honor to be even a small part of your journey through the use of our meter. Thanks for sharing your experience so honestly.
— Christi T, Keto-Mojo
Were any of the 4 friends women? Those friends who also successfully reversed their Lyme symptoms with the keto diet?
Hi Tim,
I wanted to reach out to express my gratitude for the work you do, as well as share something I would love for you to have a look at.
There aren’t many thinkers and voices I admire and value more than yours. I came across you through The 4-hour Work Week about a year ago and have probably listened to every podcast of yours since.
There is some personal detail which I’d prefer not to share publicly (I believe I provided my personal email when commenting should you be able to reach out privately there), but I have always been a big reader and had the desire to one day write, although I had no idea what. I recently decided to through caution to the wind and write a couple of Substack pieces – the process of doing so was so incredibly fun, and I would really like to continue to do so.
Quite literally the pinnacle would be for you to read the pieces I have put out and share your thoughts and guidance with me directly. I realize the likelihood of that happening is infinitesimally small, but there’s nothing to lose from trying!
In keeping with the “Comment Rules”, I won’t include a link to my Substack page, but if you search my name (Morgan Kelly), you should find it!
Hearing back from you would mean the world.
Kindest regards,
Morgan Kelly – a huge fan
Thank you Tim! Brilliant inputs. Can you please clarify if Babesia and Bartonela also disappear with keto diet or you need to do something else. And the confections such as EPV, CMV and others also reverse?
Great article now for some quibbles <20 grams of carbohydrates per day isn’t the less then or equal to symbol pointing the wrong direction? And the ketoynic diet from 100 yrs ago oddly enough was used as the only treatment for Type 1 diabetes.
Would like to know if any flair ups happened unexpectedly after a period of time or is everything standing the test of time
Hi Tim,
I’m curious, did you ever test for Lyme, etc. afterwards?
I’m asking this because one theory for recovery of Lyme is that you don’t have to eradicate it to “heal”. It is thought that when you get it below a certain threshold, the immune system can cope with it or suppress it.
It would be interesting to know if you are free of Lyme after the ketogenic diet or that your immune system is keeping it in check.
Thanks for the useful blog, I’m 5 days in now with the ketogenic diet. I have Lyme now for 12 or 13 years.
Regards,
Niels