I began penning this as a reply on X to Greg Yang, co-founder of xAI, who not too long ago stepped down from xAI to handle his debilitating case of Lyme illness.
Finally, I made a decision {that a} weblog submit 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 attention-grabbing.
The next is for informational functions solely. Please seek the advice of together 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 buddies and neighbors have had tick-borne illnesses. My second case of Lyme in 2014 was extremely extreme, nevertheless it 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 buddies who have been successfully disabled by Lyme illness. On this submit, I’ll cowl a number of the science, easy how-to directions, plenty of open questions, and upcoming tech choices that may provide some advantages of keto in a headset, no food regimen required.
Am I saying the ketogenic food regimen will work for everybody? After all not. I’m saying that, in comparison with a whole lot of complicated or questionable remedies for Lyme, ketosis is a straightforward “first, do no hurt” strategy with minimal draw back for most individuals. Medication 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 when you’re a responder? Plenty of 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 Ailments Clinic. I point out the three separate rounds of testing, as lots of people are misdiagnosed with Lyme.
Many circumstances have related signs to Lyme illness, together with Lengthy COVID, Fibromyalgia, Power Fatigue Syndrome (CFS/ME), A number of Sclerosis (MS), and Rheumatoid Arthritis (RA). Disambiguating takes correct testing from official MDs, for my part. There are just too many charlatans and well-intentioned amateurs operating round.
I had no rash in both occasion, which is true in 20–30% of instances. Sadly, I believed the native folklore of “no rash, no Lyme” and, within the 2014 occasion, I waited till signs have been debilitating: extreme joint swelling, slurred speech, forgetting frequent phrases and buddies’ names, and many others. I didn’t search correct assist till my assistant stated, “Tim, I’ve seen you drained, I’ve seen you sick, and that is one thing else. You’ll want to see a physician.”
So, I did. Sadly, after correct analysis and programs of antibiotics, which I nonetheless imagine are essential, most signs persevered. I operated at ~10% capability for 9 months and was on the verge of accepting that my thoughts, physique, relationships, enterprise, and extra may be handicapped ceaselessly. I felt like I had superior dementia, fatigue typically stored me bedridden, and arthritis-like ache wracked my total physique.
What occurred at 9 months?
I began brainstorming subtraction. I’d already tried addition: including medication, dietary supplements, and all method of sketchy “different” choices. If something, a few of them appeared to be producing extra issues.
That is how I returned to the ketogenic food regimen.
Thankfully, I’d used the ketogenic food regimen 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 medical ketosis inside 3–4 days.
Inside every week, all of my cognitive signs have been gone.
After roughly 4–6 weeks of a strict ketogenic food regimen (
And right here is probably essentially the most shocking half—I didn’t want to remain on the ketogenic food regimen. I went again to the slow-carb food regimen after 4–6 weeks of keto, and my food regimen has various 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 after 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 concept and easily bought fortunate.
However is it actually so simple as ravenous the micro organism out?
This may not apply to all instances, as such spirochetes can even use alternate fuels like glycerol and pull off all types of advanced methods. LLMs appear to lift an eyebrow on the above idea, however we have now not less than an N (pattern dimension) of 5 with a 100% success charge. It’s not a Randomized Managed Trial (RCT), however a whole lot of compelling science begins with a number of attention-grabbing case research.
This glycolysis-dependent piece of the puzzle appears to be essential, however may there be alternate explanations for why keto appears to work? A couple of prospects come to thoughts, and maybe they synergize to provide the “remission” I and others skilled.
Beneath are a number of leads.
ENERGY PRODUCTION
A ketogenic food regimen (KD) has a bunch 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 critically within the Nineteen Nineties.
KDs can assist you produce extra mitochondria (biogenesis), enhance 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.
Might that handle a number of the fatigue signs of Lyme? Is 1–2 months enough to provide these adjustments and have them stick? Had been my later intervals of standard fasting—usually 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 would clarify my one-week turnaround of cognitive signs.
Ketones provide another 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 instances of Alzheimer’s illness (AD) sufferers who reply extremely nicely to exogenous (supplemental) ketones (hearken 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 problem after a single 10–30-gram oral dose of exogenous ketones. One thing attention-grabbing appears to be taking place. Alzheimer’s is typically known as “kind 3 diabetes.” Might a ketogenic food regimen 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 industrial ketone meter (e.g., Keto-Mojo or Precision Xtra), a lightweight change is flipped and I’ve further gears. I’ve seen this repeatedly since my first keto experiments within the mid- and late Nineteen Nineties. After all, your private threshold will seemingly 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 degree (i.e., as assessed by customary blood assessments) can nonetheless be glucose-impaired on the mind degree? I’d wager cash on it.
ANTI-INFLAMMATORY EFFECTS
The first circulating ketone, beta-hydroxybutyrate (BHB), seems to dial down inflammatory signaling via a number of pathways. In different phrases, some ketones have direct anti-inflammatory results.
The following 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 via epigenetic mechanisms like histone β-hydroxybutyrylation. The declare that BHB is a potent HDAC inhibitor is debated within the literature (if true, there are important most cancers implications), however net-net, for some individuals, ketosis appears to scale back systemic irritation.
Lyme-induced irritation can produce vasoconstriction and trigger a variety of issues (chilly fingers/toes, dysautonomia), however ketones (D-BHB and L-BHB) have a exceptional impact on enhancing cardiac output and blood circulate by decreasing peripheral vascular resistance. That is of private 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 danger of life-threatening anaphylaxis.
For extra on the anti-inflammatory potential of ketones, I counsel you hearken to this phase 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 slightly painful to stroll, you may be capable of 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 sooner 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 follow a Precision Xtra or Keto-Mojo system.
Final however not least, guess what? Neuroinflammation impairs glucose metabolism within the mind, and impaired glucose metabolism worsens neuroinflammation.
Every part on this submit appears tightly interrelated. That’s excellent news. Ketosis may be a hammer that hits a number of nails without delay.
METABOLIC PSYCHIATRY
This part will overlap quite a bit with the previous two.
Lyme illness is typically referred to as “The New Nice Imitator” as a result of its signs overlap with so many circumstances. Some are autoimmune, however many are psychiatric, together with however not restricted to despair, nervousness issues, bipolar dysfunction, obsessive-compulsive dysfunction (OCD), and ADHD. There’s additionally rising knowledge that an infection is linked to those issues and different neurodegenerative illnesses.
Dr. Chris Palmer, a Harvard Medical College psychiatrist at McLean Hospital, has developed what he calls “the mind vitality idea of psychological sickness.” In my dialog with him on the podcast, he argued that psychological issues could, in lots of instances, be metabolic issues of the mind. His core perception: when mind cells are metabolically compromised, they will develop into both underactive (shutting down from lack of vitality) or hyperexcitable (misfiring after they shouldn’t).
In his mannequin, a ketogenic food regimen could assist by offering another 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 generally locked “possessed” individuals in a room with out meals, and lo and behold, the “demons” disappeared after roughly sufficient time to metabolically change to ketosis.
Ketogenic diets seem to behave via a number of, generally 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 food regimen dodges a number of the metabolic and off-target negative effects related to many psychiatric drugs, particularly antipsychotics.
For extra on this, I like to recommend Chris’s ebook Mind Vitality and our full dialog. I additionally chatted with Dave Baszucki, founding father of Roblox, about how he used metabolic psychiatry to avoid wasting his son, who’s identified with bipolar dysfunction.
HOW TO GET STARTED + FUTURE NON-DIET OPTIONS + WARNINGS
Easy methods to Get Began
In short, when you’ve been identified with Lyme, it’d make sense to attempt 1–2 months of a strict ketogenic food regimen DURING or AFTER antibiotics however BEFORE you attempt speculative remedies with non-trivial or unknown draw back dangers.
After all, converse together with your docs first.
ChatGPT and related LLMs can assist cowl most bases and even meal plans, however you should definitely specify “lower than 20 grams per day of carbohydrates (CHO).” Individuals can get cute with “net-carbs” and outsmart themselves. I favor a large margin of security when stakes are excessive (e.g., Lyme signs).
If you happen to like books, amidst a sea of horrible choices, there are a number of which might be fairly good.
From Dr. Dominic D’Agostino:
From a CEO I can’t identify, who has entry to hundreds of sufferers who’ve tried a ketogenic food regimen in numerous varieties:
My Private Protocol:
For essentially the most half, I believe that making an attempt to eat keto-friendly bagels and faux-desserts is the trail to disappointing outcomes.
Particularly when you’re simply doing a trial run for a number of weeks, I prefer to maintain it easy. Do fool-proof first, then, if you need, layer in intelligent and crunchy after not less than 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 not less than 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 may possibly take your physique 1–2 weeks to beat the primary 12 hours or so of decrease vitality and occasional irritation, however if you do adapt, it pays long-term dividends.
If you happen to adapt to IF, it’ll make future keto transitions quite a bit simpler and sure get rid of any fogginess, low vitality, or “keto flu” signs. It helps jumpstart your ketogenic equipment with out prolonged ketosis.
However when you’re in a rush to check keto and need to chunk the bullet, you can too simply begin with a lower-calorie keto food regimen. 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 generally 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 executed
• ~2pm Lunch – Two cans of chub or jack mackerel combined 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 Large dinner. This can include the remainder of my energy for the day.
Chopped ribeye on enormous salad with further virgin olive oil, plus a facet of creamed spinach
OR
Rooster and cheese plus keto-friendly veggies like broccoli and cauliflower
OR
Lamb chops plus keto-friendly goulash, and many others.
You possibly can all the time add fats with some extra heavy cream in a beverage, as has been executed efficiently for greater than a century with epileptic youngsters, or a number of dollops of bitter cream or a dessert of keto-friendly cheeses.
• Put up-dinner – Stroll the canine 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 stuffed with snacking. If you happen to actually need to snack, eat extra at meals. If you happen to nonetheless need to snack, it’s behavior and never physiology speaking.
Postscript:
Dietary supplements: I take electrolytes (sodium, magnesium, and potassium) as capsules or packets not less than twice a day. Particularly when you’re new to keto, this shall be necessary for avoiding dizziness, cramping, and sleep issues. Simply guarantee no sweeteners, maltodextrin, and many others. are hiding within the product. You’d be stunned what some widespread 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 well worth the gamble. Intention to eat not less than 70% of your every 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 include extra carbs than you may assume. As soon as mildly knocked out of ketosis, some individuals want a number of days to regain footing and find yourself feeling depleted, exhausted, and terrible. For novices, deal with ketosis as binary and watch your precise grams of carbs. Play it secure so that you don’t find yourself in metabolic purgatory.
Non-Keto Keto Choices and Future Tech
Are you able to get a number of the advantages of a ketogenic food regimen 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 all the time on the lookout for instruments and approaches that may make its advantages extra accessible.
Listed below are a number of that I’m monitoring carefully:
Intermittent fasting by itself. At the least a 16-hour window of fasting. Learn up on neuroscientist Mark Mattson and “flipping the metabolic change.” Right here is one oldie-but-goodie, however observe that Mark suggests 16–18 hours of fasting as an alternative 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 change” pertains to depleting your liver of glycogen, requiring round 16 hours for most individuals, which then results in a extra ketotic state.
Bioelectronic medication (e.g., vagus nerve stimulation [VNS]). Dr. Kevin Tracey and others have described the “inflammatory reflex,” whereby vagus signaling can modulate immune exercise. Early medical work has explored VNS in inflammatory circumstances (e.g., rheumatoid arthritis). This isn’t a Lyme remedy per se, nevertheless it’s believable {that a} VNS system, notably implants or an ear-based transauricular VNS (taVNS), could possibly be used to lower inflammation-driven signs. There are additionally some probably attention-grabbing functions to power ache administration by way of HMGB1 (particular due to Ulf Andersson).
Caveat emptor – there’s a LOT of BS on the market associated to vagus nerve stimulation.
Hearken to my interview with Kevin, and I’m hoping to assist make simpler auricular units extra extensively accessible 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 all the time, converse together with your docs 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 medical steerage, however I grew to become an early investor on this firm for lots of causes. Certainly one of them: I’m hoping it’d provide a number of the anti-inflammatory advantages of keto with easy, at-home {hardware}. Their tech is just not but accessible outdoors of trials, however I’m hoping to assist develop that. You possibly can join their e-mail listing to be the primary to know.
Others?
Do you may have different concepts or ideas? If that’s the case, please let me and readers know of this weblog submit.
Caveats with Lyme Illness
It bears repeating: Many circumstances have related signs to Lyme illness, together with Lengthy COVID, Fibromyalgia, Power Fatigue Syndrome (CFS/ME), A number of Sclerosis (MS), Rheumatoid Arthritis (RA), and extra. Disambiguating takes correct testing from official MDs, for my part.
It is usually price noting, nonetheless, that knowledge counsel a ketogenic food regimen may assist with signs of almost the entire above(!):
MS → strongest early medical proof
Fibromyalgia → promising pilot knowledge
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 danger lurking behind the label of “Lyme illness.” Some individuals go looking for the Lyme analysis. If you happen to maintain seeing docs lengthy sufficient, particularly when you enterprise into “docs” on the fringe, I promise that you’ll ultimately get a Lyme analysis. Some such sufferers are merely determined for any rationalization and remedy that may present aid. Others are subconsciously hoping for an exterior trigger for despair and lethargy attributable to points like a rocky marriage, alcoholism, social isolation, and many others. It’s quite a bit simpler to take capsules or get IVs somewhat than basically 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 total cottage industries which have popped as much as fortunately take your cash for infinite remedy that received’t do a lot.
So, good to bear in mind and all the time ask: If I took Lyme off the desk, what else may presumably clarify this?
Keto Warnings
If you happen to’re on insulin, sulfonylureas, GLP-1 agonists (e.g., Ozempic, Zepbound), or any SGLT2 inhibitor (the “-flozin” medication), don’t try a ketogenic food regimen with out clinician supervision, as carb restriction/fasting can set off euglycemic ketoacidosis, and medicine doses may have speedy adjustment.
In actual fact, please you should definitely all the time converse together with your physician, m’kay?
Simply observe that you just may want to supply them some studying on the ketogenic food regimen, because it isn’t a typical intervention. This weblog submit or linked research and podcasts provide a number of beginning factors.
Additionally keep away from DIY keto if you’re pregnant/breastfeeding, have important kidney/liver/pancreatic illness (together with prior pancreatitis), or have a historical past of consuming issues.
All that stated, total, people are extremely nicely advanced to deal with ketosis, particularly for the temporary intervals of time vital to note before-and-after adjustments within the context of Lyme.
One last addendum from Dominic on ALS, at his request:
“FYI, my pal Deanna Tedone was identified with quickly progressing ALS 17 years in the past (given 3 years to reside, 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 optimistic for Lyme illness, and we expect this may occasionally have been the reason for her ALS. Their basis is Successful The Struggle, 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 medication will be squirrely beasts, and I actually have been tempted to surrender at occasions. It might appear to be the deck is stacked in opposition to you. However generally there really is a straightforward mild of hope on the finish of the tunnel.
The ketogenic food regimen is just not a panacea, however its functions past weight-loss are compelling. For some, like me and my buddies, they are often life-changing.
I sincerely hope this submit is useful.
All the most effective to you and yours,
Tim Ferriss
Due to everybody who proofread this submit. Any remaining errors are mine. If you happen to spot errors or have corrections, please depart a remark under.
