I began penning this as a reply on X to Greg Yang, co-founder of xAI, who just lately stepped down from xAI to handle his debilitating case of Lyme illness.
Finally, I made a decision {that a} weblog publish might present extra element and permit proofreading by credible researchers, so right here we’re.
Earlier than we dive in, a disclaimer: I’m not a physician, nor do I play one on the web. I used to be hesitant to publish this, as I understand how a lot flak I’ll get, however the outcomes and underlying science are simply too fascinating.
The next is for informational functions solely. Please seek the advice of along with your physician and browse the warnings on the finish.
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Rising up on Lengthy Island (see this hyperlink), I’ve contracted Lyme illness twice. Most of my childhood associates and neighbors have had tick-borne illnesses. My second case of Lyme in 2014 was extremely extreme, but it surely was resolved in 4–6 weeks with an unorthodox strategy: strict ketosis. I’ve now been 100% asymptomatic for greater than 10 years.
I’ve since replicated the outcomes with 4 out of 4 associates who had been successfully disabled by Lyme illness. On this publish, I’ll cowl a few of the science, easy how-to directions, a lot of open questions, and upcoming tech choices that may provide some advantages of keto in a headset, no weight loss program required.
Am I saying the ketogenic weight loss program will work for everybody? After all not. I’m saying that, in comparison with a number of advanced or questionable remedies for Lyme, ketosis is a straightforward “first, do no hurt” strategy with minimal draw back for most individuals. Medicine typically have off-target results, and we’ve scientifically studied ketosis for greater than 100 years. Moreover, ketosis has been a mainstay of human evolution for millennia. So maybe it’s price testing for a number of weeks to see in case you’re a responder? Numerous caveats with this, however I’ll unpack it.
Let’s start with my private case.
As talked about, I twice contracted Lyme illness and co-infections on Lengthy Island, confirmed with native testing, best-of-class lab testing in NYC, and lastly with specialists on the Stanford Infectious Illnesses Clinic. I point out the three separate rounds of testing, as lots of people are misdiagnosed with Lyme.
Many situations have comparable signs to Lyme illness, together with Lengthy COVID, Fibromyalgia, Persistent Fatigue Syndrome (CFS/ME), A number of Sclerosis (MS), and Rheumatoid Arthritis (RA). Disambiguating takes correct testing from legit MDs, in my view. There are just too many charlatans and well-intentioned amateurs working round.
I had no rash in both occasion, which is true in 20–30% of circumstances. Sadly, I believed the native folklore of “no rash, no Lyme” and, within the 2014 occasion, I waited till signs had been debilitating: extreme joint swelling, slurred speech, forgetting widespread phrases and associates’ names, and so forth. I didn’t search correct assist till my assistant mentioned, “Tim, I’ve seen you drained, I’ve seen you sick, and that is one thing else. You must see a physician.”
So, I did. Sadly, after correct analysis and programs of antibiotics, which I nonetheless consider are vital, most signs continued. I operated at ~10% capability for 9 months and was on the verge of accepting that my thoughts, physique, relationships, enterprise, and extra is likely to be handicapped without end. I felt like I had superior dementia, fatigue typically stored me bedridden, and arthritis-like ache wracked my whole physique.
What occurred at 9 months?
I began brainstorming subtraction. I’d already tried addition: including medicine, dietary supplements, and all method of sketchy “different” choices. If something, a few of them gave the impression to be producing extra issues.
That is how I returned to the ketogenic weight loss program.
Fortuitously, I’d used the ketogenic weight loss program in school for numerous sports activities experiments, and I made a decision to check whether or not or not selecting a brand new gasoline and harnessing anti-inflammation (extra on these later) would enhance issues. I knew I might get into scientific ketosis inside 3–4 days.
Inside every week, all of my cognitive signs had been gone.
After roughly 4–6 weeks of a strict ketogenic weight loss program (<20 grams of carbohydrates per day), I fully and durably mounted all of my signs. It’s been greater than a decade, and not one of the signs have returned. It was a Hail Mary that labored.
And right here is maybe probably the most shocking half—I didn’t want to remain on the ketogenic weight loss program. I went again to the slow-carb weight loss program after 4–6 weeks of keto, and my weight loss program has diverse tremendously since. No matter it did appeared to stay.
However there was one rub.
I had no satisfying rationalization for why it labored.
I had a number of believable theories, positive, however nothing watertight. I knew the short-term results of ketosis… however a sturdy repair? How was that doable?
The lights went on in late 2025 once I once more interviewed Dr. Dominic D’Agostino, one of many world’s main researchers and synthesizers of ketones.
Let’s begin with the largest lacking piece he offered.
SALVATION THROUGH STARVATION?
Lyme illness spirochetes (Borrelia burgdorferi) are largely depending on glycolysis for vitality manufacturing, as they lack a tricarboxylic acid (TCA) cycle and oxidative phosphorylation pathways. In easy phrases, the micro organism that trigger Lyme illness primarily use carbohydrates for gasoline. I had no thought and easily acquired fortunate.
However is it actually so simple as ravenous the micro organism out?
This may not apply to all circumstances, as such spirochetes may use alternate fuels like glycerol and pull off all types of developed methods. LLMs appear to boost an eyebrow on the above concept, however we now have a minimum of an N (pattern measurement) of 5 with a 100% success price. It’s not a Randomized Managed Trial (RCT), however a number of compelling science begins with a number of fascinating case research.
This glycolysis-dependent piece of the puzzle appears to be vital, however would possibly there be alternate explanations for why keto appears to work? Just a few prospects come to thoughts, and maybe they synergize to provide the “remission” I and others skilled.
Under are a number of leads.
ENERGY PRODUCTION
A ketogenic weight loss program (KD) has a number of fascinating results on mitochondria, the so-called “powerhouses” of the cell that generate most of your vitality (ATP). This was one in all my placeholder theories in 2014, as researchers began exploring this terrain significantly within the Nineties.
KDs might help you produce extra mitochondria (biogenesis), improve vitality manufacturing, and arguably enhance mitochondrial high quality by recycling and changing them (mitophagy). Internet-net, this could possibly be a reboot of your metabolic equipment—you’re transforming your mitochondria.
May that tackle a few of the fatigue signs of Lyme? Is 1–2 months adequate to provide these adjustments and have them stick? Have been my later durations of normal fasting—sometimes three contiguous days of water fasting per quarter—key for reinforcing what the KD kicked off? We don’t actually know.
However even when 1–2 months of KD isn’t sufficient to overtake your equipment, there are acute vitality advantages that might clarify my one-week turnaround of cognitive signs.
Ketones provide an alternate gasoline to glucose, and in some contexts (impaired glucose metabolism) ketones are vastly superior. Maybe that is partially why, even when not in ketosis, I’ll take a ketone salt or monoester earlier than recording podcasts: I’m considerably sharper with out having to mainline caffeine within the afternoon and sacrifice sleep high quality later.
There are documented circumstances of Alzheimer’s illness (AD) sufferers who reply extremely effectively to exogenous (supplemental) ketones (take heed to 2:21 right here), and I’ve heard clinicians describe AD sufferers who usually fail the clock check (drawing a clock) however who can succeed with none issue after a single 10–30-gram oral dose of exogenous ketones. One thing fascinating appears to be taking place. Alzheimer’s is usually known as “kind 3 diabetes.” May a ketogenic weight loss program repair a part of the underlying drawback, or are ketones merely working round harm (e.g., amyloid plaques and tau tangles)?
I don’t know, however right here’s what I do know: each time I cross ~1 mmol/L blood focus of ketones as measured by any business ketone meter (e.g., Keto-Mojo or Precision Xtra), a lightweight swap is flipped and I’ve further gears. I’ve seen this repeatedly since my first keto experiments within the mid- and late Nineties. After all, your private threshold will possible differ, however I can flip this on at will with exogenous ketones; a 1–2-day water quick; or a 2–4-day, low-calorie KD.
Curiously, these further gears appear to typically kick in for a lot of people who find themselves not clearly glucose-impaired. Why? Maybe it pertains to the following bullet.
And maybe individuals who aren’t glucose-impaired on the whole-body stage (i.e., as assessed by commonplace blood exams) can nonetheless be glucose-impaired on the mind stage? I’d wager cash on it.
ANTI-INFLAMMATORY EFFECTS
The first circulating ketone, beta-hydroxybutyrate (BHB), seems to dial down inflammatory signaling by way of a number of pathways. In different phrases, some ketones have direct anti-inflammatory results.
The subsequent paragraph is technical, so be happy to skip, however there are some juicy bits.
BHB inhibits the NLRP3 inflammasome (a molecular set off for cytokines like IL-1β), engages the HCA2/GPR109A receptor on immune cells, and should affect gene expression by way of epigenetic mechanisms like histone β-hydroxybutyrylation. The declare that BHB is a potent HDAC inhibitor is debated within the literature (if true, there are vital most cancers implications), however net-net, for some folks, ketosis appears to cut back systemic irritation.
Lyme-induced irritation can produce vasoconstriction and trigger a spread of issues (chilly palms/ft, dysautonomia), however ketones (D-BHB and L-BHB) have a outstanding impact on enhancing cardiac output and blood circulation by lowering peripheral vascular resistance. That is of non-public curiosity, as each I and my mother have long-standing Raynaud’s Syndrome, however we by no means considered any connection to Lyme. My mother has had each Lyme and alpha-gal syndrome, which was transmitted by the Lone Star tick. Now she will’t eat mammalian protein with out threat of life-threatening anaphylaxis.
For extra on the anti-inflammatory potential of ketones, I counsel you take heed to this section right here from my very first dialog with Dominic.
Broadly talking, anti-inflammatories can have some very quick results. As an example, when you’ve got minor aches and pains that make it a bit painful to stroll, you would possibly be capable to take two Advil and go for a pain-free stroll 60 minutes later.
By extension, how shortly might the anti-inflammatory results of ketones on a KD translate to much less painful or pain-free joints? Smoother and quicker cognition? Much less or no fatigue? As soon as once more, in my private expertise, all of those and extra modified inside every week of tipping previous 1 mmol/L focus of BHB as measured by a finger stick to a Precision Xtra or Keto-Mojo gadget.
Final however not least, guess what? Neuroinflammation impairs glucose metabolism within the mind, and impaired glucose metabolism worsens neuroinflammation.
Every thing on this publish appears tightly interrelated. That’s excellent news. Ketosis is likely to be a hammer that hits a number of nails directly.
METABOLIC PSYCHIATRY
This part will overlap lots with the previous two.
Lyme illness is usually referred to as “The New Nice Imitator” as a result of its signs overlap with so many situations. Some are autoimmune, however many are psychiatric, together with however not restricted to melancholy, nervousness problems, bipolar dysfunction, obsessive-compulsive dysfunction (OCD), and ADHD. There’s additionally rising information that an infection is linked to those problems and different neurodegenerative illnesses.
Dr. Chris Palmer, a Harvard Medical Faculty psychiatrist at McLean Hospital, has developed what he calls “the mind vitality concept of psychological sickness.” In my dialog with him on the podcast, he argued that psychological problems might, in lots of circumstances, be metabolic problems of the mind. His core perception: when mind cells are metabolically compromised, they’ll change into both underactive (shutting down from lack of vitality) or hyperexcitable (misfiring once they shouldn’t).
In his mannequin, a ketogenic weight loss program might assist by offering an alternate gasoline supply to struggling mind cells.
The keto–psychological well being connection isn’t new. Ketogenic diets have been used clinically for 100+ years to deal with epilepsy. Centuries in the past, church buildings typically locked “possessed” folks in a room with out meals, and lo and behold, the “demons” disappeared after roughly sufficient time to metabolically swap to ketosis.
Ketogenic diets seem to behave by way of a number of, typically overlapping pathways, together with these affecting neurotransmission, inflammatory signaling, and gene expression. I bolded these we haven’t straight addressed on this piece.
Moreover, the ketogenic weight loss program dodges a few of the metabolic and off-target unwanted side effects related to many psychiatric drugs, particularly antipsychotics.
For extra on this, I like to recommend Chris’s e book Mind Vitality and our full dialog. I additionally chatted with Dave Baszucki, founding father of Roblox, about how he used metabolic psychiatry to save lots of his son, who’s identified with bipolar dysfunction.
HOW TO GET STARTED + FUTURE NON-DIET OPTIONS + WARNINGS
Get Began
Briefly, in case you’ve been identified with Lyme, it would make sense to strive 1–2 months of a strict ketogenic weight loss program DURING or AFTER antibiotics however BEFORE you strive speculative remedies with non-trivial or unknown draw back dangers.
After all, converse along with your medical doctors first.
ChatGPT and comparable LLMs might help cowl most bases and even meal plans, however you’ll want to specify “lower than 20 grams per day of carbohydrates (CHO).” Individuals can get cute with “net-carbs” and outsmart themselves. I desire a large margin of security when stakes are excessive (e.g., Lyme signs).
In the event you like books, amidst a sea of horrible choices, there are a number of which can be fairly good.
From Dr. Dominic D’Agostino:
From a CEO I can’t title, who has entry to 1000’s of sufferers who’ve tried a ketogenic weight loss program in numerous varieties:
My Private Protocol:
For probably the most half, I believe that attempting to eat keto-friendly bagels and faux-desserts is the trail to disappointing outcomes.
Particularly in case you’re simply doing a trial run for a number of weeks, I prefer to maintain it easy. Do fool-proof first, then, in order for you, layer in intelligent and crunchy after a minimum of two weeks of 1 mmol/L blood readings, and solely then with fixed ketone monitoring.
To jumpstart keto, I personally prefer to first do intermittent fasting (IF) for a minimum of every week, solely consuming inside an eight-hour window every day. IF alone can dramatically change your blood work, OGTT, and extra. Be aware that it could possibly take your physique 1–2 weeks to beat the primary 12 hours or so of decrease vitality and occasional irritation, however once you do adapt, it pays long-term dividends.
In the event you adapt to IF, it’ll make future keto transitions lots simpler and certain eradicate any fogginess, low vitality, or “keto flu” signs. It helps jumpstart your ketogenic equipment with out prolonged ketosis.
However in case you’re in a rush to check keto and need to chunk the bullet, it’s also possible to simply begin with a lower-calorie keto weight loss program. The sub-maintenance energy will dramatically velocity issues up.
In my case, I default to one thing just like the under at a body weight of round 175 lbs.:
• 9am Morning – Espresso or tea with 2 tbsp heavy cream (NOT half and half)
• 11am Mid-morning – For the primary week of keto and typically longer, I’ll combine KetoSpike cocoa exogenous ketone powder into my espresso or tea. This treatments early fatigue.
• Cardio, if any Zone 2 to be completed
• ~2pm Lunch – Two cans of chub or jack mackerel blended with 2 tbsp MCT oil + 2 tbsp apple cider vinegar + salt/pepper. Low-cost, quick, and surprisingly good. This can clock in at round 500–700 energy.
• 5pm Weight coaching, if any
• 7pm or 8pm Huge dinner. This can comprise the remainder of my energy for the day.
Chopped ribeye on large salad with further virgin olive oil, plus a aspect of creamed spinach
OR
Hen and cheese plus keto-friendly veggies like broccoli and cauliflower
OR
Lamb chops plus keto-friendly goulash, and so forth.
You may at all times add fats with some extra heavy cream in a beverage, as has been completed efficiently for greater than a century with epileptic youngsters, or a number of dollops of bitter cream or a dessert of keto-friendly cheeses.
• Publish-dinner – Stroll the canines and curb any glucose/insulin response from the massive meal.
That’s it. When you’re in correct ketosis, you most likely received’t really feel a lot starvation. It’s fairly liberating to reorient to starvation and consuming that isn’t compulsive and filled with snacking. In the event you actually need to snack, eat extra at meals. In the event you nonetheless need to snack, it’s behavior and never physiology speaking.
Postscript:
Dietary supplements: I take electrolytes (sodium, magnesium, and potassium) as tablets or packets a minimum of twice a day. Particularly in case you’re new to keto, this can be necessary for avoiding dizziness, cramping, and sleep issues. Simply guarantee no sweeteners, maltodextrin, and so forth. are hiding within the product. You’d be shocked what some standard manufacturers do.
Fats: Don’t attempt to do a low-fat, high-protein model of keto. For causes we’ll skip right here, it’s very arduous to make work and never definitely worth the gamble. Purpose to eat a minimum of 70% of your each day energy from fats.
Snacks: Watch out with snack meals, even keto-friendly-ish macadamia nuts, which may add up and knock you out of ketosis. Avocados additionally comprise extra carbs than you would possibly suppose. As soon as mildly knocked out of ketosis, some folks want a number of days to regain footing and find yourself feeling depleted, exhausted, and terrible. For newcomers, deal with ketosis as binary and watch your precise grams of carbs. Play it protected so that you don’t find yourself in metabolic purgatory.
Non-Keto Keto Choices and Future Tech
Are you able to get a few of the advantages of a ketogenic weight loss program with out consuming meat, eggs, and cheese on a regular basis? It positive can be good.
And, sure, you may make a KD way more interesting, consuming a shocking amount of salads and greens, however I’m at all times searching for instruments and approaches that may make its advantages extra accessible.
Listed here are a number of that I’m monitoring carefully:
Intermittent fasting by itself. A minimum of a 16-hour window of fasting. Learn up on neuroscientist Mark Mattson and “flipping the metabolic swap.” Right here is one oldie-but-goodie, however notice that Mark suggests 16–18 hours of fasting as a substitute of the 12-hour onramp talked about in that publication. That is additionally known as 16:8 time-restricted consuming. 16:8 or 18:6 is a goldmine and maybe my most shocking private change of the final two years, along with accelerated TMS.
The “metabolic swap” pertains to depleting your liver of glycogen, requiring round 16 hours for most individuals, which then results in a extra ketotic state.
Bioelectronic drugs (e.g., vagus nerve stimulation [VNS]). Dr. Kevin Tracey and others have described the “inflammatory reflex,” whereby vagus signaling can modulate immune exercise. Early scientific work has explored VNS in inflammatory situations (e.g., rheumatoid arthritis). This isn’t a Lyme remedy per se, but it surely’s believable {that a} VNS gadget, notably implants or an ear-based transauricular VNS (taVNS), could possibly be used to lower inflammation-driven signs. There are additionally some probably fascinating functions to continual ache administration through HMGB1 (particular because of Ulf Andersson).
Caveat emptor – there’s a LOT of BS on the market associated to vagus nerve stimulation.
Take heed to my interview with Kevin, and I’m hoping to assist make simpler auricular units extra broadly obtainable quickly. For a doable different route, additionally learn up on the functions of famotidine (Pepcid) to the vagus nerve and the inflammatory reflex, which has functions to COVID and extra. As at all times, converse along with your medical doctors earlier than utilizing.
Extremely-low-intensity magnetic approaches (Fareon). Stealth startup Fareon has revealed preclinical work suggesting microtesla-range magnetic fields can affect neuroinflammation and illness fashions. That is early science, not scientific steering, however I grew to become an early investor on this firm for lots of causes. Certainly one of them: I’m hoping it would provide a few of the anti-inflammatory advantages of keto with easy, at-home {hardware}. Their tech is just not but obtainable exterior of trials, however I’m hoping to assist develop that. You may join their e-mail record to be the primary to know.
Others?
Do you have got different concepts or solutions? In that case, please let me and readers know of this weblog publish.
Caveats with Lyme Illness
It bears repeating: Many situations have comparable signs to Lyme illness, together with Lengthy COVID, Fibromyalgia, Persistent Fatigue Syndrome (CFS/ME), A number of Sclerosis (MS), Rheumatoid Arthritis (RA), and extra. Disambiguating takes correct testing from legit MDs, in my view.
Additionally it is price noting, nevertheless, that information counsel a ketogenic weight loss program would possibly assist with signs of almost all the above(!):
MS → strongest early scientific proof
Fibromyalgia → promising pilot information
CFS/ME → sturdy theoretical match, weak trials
Lengthy COVID → rising speculation
RA → oblique anti-inflammatory profit
Returning to the caveats, there may be one other threat lurking behind the label of “Lyme illness.” Some folks go looking for the Lyme analysis. In the event you maintain seeing medical doctors lengthy sufficient, particularly when you enterprise into “medical doctors” on the fringe, I promise that you’ll finally get a Lyme analysis. Some such sufferers are merely determined for any rationalization and remedy that may present reduction. Others are subconsciously hoping for an exterior trigger for melancholy and lethargy attributable to points like a rocky marriage, alcoholism, social isolation, and so forth. It’s lots simpler to take tablets or get IVs fairly than essentially altering the tectonic plates of your life. I get it, and I’ve been there in several contexts.
Within the case of Lyme illness, there are whole cottage industries which have popped as much as fortunately take your cash for limitless remedy that received’t do a lot.
So, good to bear in mind and at all times ask: If I took Lyme off the desk, what else would possibly probably clarify this?
Keto Warnings
In the event you’re on insulin, sulfonylureas, GLP-1 agonists (e.g., Ozempic, Zepbound), or any SGLT2 inhibitor (the “-flozin” medicine), don’t try a ketogenic weight loss program with out clinician supervision, as carb restriction/fasting can set off euglycemic ketoacidosis, and drugs doses might have speedy adjustment.
In actual fact, please you’ll want to at all times converse along with your physician, m’kay?
Simply notice that you just would possibly want to supply them some studying on the ketogenic weight loss program, because it isn’t a typical intervention. This weblog publish or linked research and podcasts provide a number of beginning factors.
Additionally keep away from DIY keto if you’re pregnant/breastfeeding, have vital kidney/liver/pancreatic illness (together with prior pancreatitis), or have a historical past of consuming problems.
All that mentioned, general, people are extremely effectively developed to deal with ketosis, particularly for the temporary durations of time crucial to note before-and-after adjustments within the context of Lyme.
One last addendum from Dominic on ALS, at his request:
“FYI, my good friend Deanna Tedone was identified with quickly progressing ALS 17 years in the past (given 3 years to dwell, at most). Her dad, Dr. Vince Tedone, was a world-famous orthopedic surgeon for the Yankees. He got here up with the Deanna Protocol, and we proved efficacy in mice: Metabolic Remedy with Deanna Protocol Supplementation Delays Illness Development and Extends Survival in Amyotrophic Lateral Sclerosis (ALS) Mouse Mannequin.
Deanna examined constructive for Lyme illness, and we predict this will have been the reason for her ALS. Their basis is Successful The Combat, and so they’re hoping to fund extra analysis on the hyperlink between Lyme and neuro illnesses.”
For now, that’s all, of us!
Sickness and drugs could be squirrely beasts, and I personally have been tempted to surrender at occasions. It might seem to be the deck is stacked towards you. However typically there really is a straightforward mild of hope on the finish of the tunnel.
The ketogenic weight loss program is just not a panacea, however its functions past weight-loss are compelling. For some, like me and my associates, they are often life-changing.
I sincerely hope this publish is useful.
All the very best to you and yours,
Tim Ferriss
Due to everybody who proofread this publish. Any remaining errors are mine. In the event you spot errors or have corrections, please depart a remark under.