See a Registered Dietitian (RD) Instead of a Lyme Literate MD (LLMD)

Many peo­ple have been told by an LLMD (Lyme-lit­er­ate med­ical doc­tor) that they have chron­ic Lyme dis­ease. How­ev­er, there is real­ly no such thing as an LLMD, and there might be no such thing as chron­ic Lyme dis­ease. Those patients prob­a­bly do have a chron­ic inflam­ma­to­ry dis­ease, but they have been given the wrong diag­no­sis and are get­ting the wrong treat­ment. Many chron­ic inflam­ma­to­ry dis­eases can be cured by a sim­ple change in diet. The only way to find out is to try an elim­i­na­tion diet and see what hap­pens. For advice on an elim­i­na­tion diet, peo­ple should see an RD (reg­is­tered dieti­tian) who works with their reg­u­lar doc­tor.

What is an LLMD?

An MD degree, which stands for med­ical doc­tor, means that the per­son has been grad­u­at­ed from an accred­it­ed school of med­i­cine. Often, med­ical doc­tors have oth­er cre­den­tials. For exam­ple, FACP means that the doc­tor is a Fel­low of the Amer­i­can Col­lege of Physi­cians. FACOG means that the doc­tor is a Fel­low of the Amer­i­can Col­lege of Obste­tri­cians and Gyne­col­o­gists. Those fel­low­ships are real, mean­ing­ful cre­den­tials. How­ev­er, there is no offi­cial orga­ni­za­tion that grants LLMD cre­den­tials. In oth­er words, LLMD is a pho­ny cre­den­tial. Let the buy­er beware.

Peo­ple seek out LLMDs for an under­stand­able rea­son. When sick peo­ple go to a doc­tor, they main­ly want the doc­tor to answer three ques­tions: What is hap­pen­ing to me? Why is it hap­pen­ing to me? and How can you make it stop hap­pen­ing to me? In many cas­es, the doc­tor can­not answer any of those ques­tions. As a result, des­per­ate patients often go from doc­tor to doc­tor until they find some­one who gives sat­is­fy­ing answers to at least one of those ques­tions. Often, it is a strug­gle just to find a doc­tor who believes that they are real­ly sick. Yet the answer that sat­is­fies the patient is not always cor­rect. As a result, peo­ple with mys­te­ri­ous chron­ic ill­ness­es become easy prey for prac­ti­tion­ers who provide false but sat­is­fy­ing answers. Many of the­se prac­ti­tion­ers use one catch-all diag­no­sis, which is a sin­gle diag­no­sis that is given as an expla­na­tion for every­thing that is going wrong in prac­ti­cal­ly every patient’s body. Since Lyme dis­ease can cause many odd symp­toms, it is use­ful as a catch-all diag­no­sis.

The doc­tors who call them­selves “Lyme-lit­er­ate” have been giv­ing patients the answers that the patients are des­per­ate to hear: Yes, you real­ly are sick. I know what is hap­pen­ing to you, and I will try to make it stop. The LLMDs then start the patients on a long course of antibi­otics, some­times intra­venous­ly. This long-term treat­ment is prof­itable for the doc­tor because the patients must make many appoint­ments. How­ev­er, the long-term antibi­otic treat­ment does lit­tle or no good and can cause seri­ous harm, includ­ing death. In oth­er words, the patients are given the wrong diag­no­sis. As a result, they get the wrong treat­ment, which prob­a­bly does more harm than good. Since the treat­ment involves overuse of antibi­otics, it pos­es a risk to everyone’s health. The long course of antibi­otics allows the patient to devel­op antibi­otic-resis­tant strains of bac­te­ria, which can then spread to oth­er peo­ple.

What is Lyme disease?

Deer tick
The deer tick or black-legged tick (Ixodes scapu­lar­is spreads the bac­teri­um that caus­es Lyme dis­ease.

Lyme dis­ease is use­ful as a catch-all diag­no­sis because it pro­duces chron­ic inflam­ma­tion. Thus, it pro­duces the same signs and symp­toms as many oth­er chron­ic inflam­ma­to­ry dis­eases. The first known cas­es of Lyme dis­ease were orig­i­nal­ly diag­nosed as juve­nile rheuma­toid arthri­tis because the patients had hot, swol­len, painful joints. Then, some­one thought it was odd that so many chil­dren from Old Lyme, Con­necti­cut, were com­ing down with the same rare, non­con­ta­gious dis­ease. The­se chil­dren had been play­ing in the woods, and some of them remem­bered hav­ing tick bites and rash­es.

Borrelia burgdorferi
Bor­re­lia burgdor­feri, the spi­ral bac­teri­um (spiro­chete) that caus­es Lyme dis­ease.

Even­tu­al­ly, a med­ical ento­mol­o­gist named Willy Burgdor­fer found the spi­ral bac­teri­um (spiro­chete) that caus­es Lyme dis­ease. It was named Bor­re­lia burgdor­feri in his hon­or.

Lyme dis­ease is a chron­ic inflam­ma­to­ry dis­ease. Unless you saw a tick or a rash, Lyme dis­ease looks and feels just like many oth­er chron­ic inflam­ma­to­ry dis­eases. The only way to tell the­se dis­eases apart is to do some lab­o­ra­to­ry tests. Unfor­tu­nate­ly, the lab­o­ra­to­ry tests are not always accu­rate.

A lab­o­ra­to­ry test is like a bur­glar alarm. It is sup­posed to go off when­ev­er there is a bur­glar in the house, but only when there is a bur­glar in the house. If it fails to go off when there real­ly is a bur­glar, the result is a false neg­a­tive. If the alarm goes off when there is no bur­glar, the result is a false pos­i­tive. LLMDs often rely on Lyme dis­ease tests that are non­speci­fic, which means that they pro­duce a lot of false-pos­i­tive results. In oth­er words, many of the peo­ple who have been told that they have chron­ic Lyme dis­ease may not have had Lyme dis­ease to begin with. Cur­rent­ly, a two-step process is rec­om­mend­ed for diag­nos­ing Lyme dis­ease.

In real cas­es of Lyme dis­ease, a 2- to 4-week course of antibi­otics is effec­tive in cur­ing the infec­tion. So far, we have no evi­dence that the bac­te­ria can sur­vive the rec­om­mend­ed course of antibi­otic ther­a­py. Of course, the antibi­otic can­not undo the dam­age that the infec­tion has done to the body. Thus, some peo­ple may con­tin­ue to suf­fer from symp­toms, even after their Bor­re­lia burgdor­feri infec­tion has been cured with antibi­otics. How­ev­er, this prob­lem should not be called chron­ic Lyme dis­ease. Instead, it could be called post Lyme dis­ease syn­drome (PLDS). But in many of the­se cas­es, the symp­toms may be due to some oth­er dis­ease. A patient can have more than one dis­ease at a time!

How can a registered dietitian help?

Many chron­ic inflam­ma­to­ry dis­eases are due to a rich, fat­ty diet. Often, the­se dis­eases can be cured by switch­ing to a low-fat, pure­ly plant based (veg­an) diet. A few plant-source foods can cre­ate prob­lems for some peo­ple. The most com­mon offend­ers are wheat, soy, nuts, cit­rus fruits, and straw­ber­ries. A reg­is­tered dieti­tian can help you plan an elim­i­na­tion diet to fig­ure out which foods might be mak­ing you sick.