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.



Why Do I Need a Pneumonia Shot?

What Is Pneumonia?

Pneumonia means that the air sacs of the lungs cannot fill with air.
Pneu­mo­nia means that the air sacs of the lungs can­not fill with air.

Your lung con­tains many tiny sacs that are sup­posed to fill with air when you inhale. But if you have a lung infec­tion, those tiny sacs can fill up with pus or oth­er flu­id instead. Swelling of the tis­sue that sur­rounds the air sacs can also make it hard for the air sacs to inflate. This prob­lem is called pneu­mo­nia. If a case of pneu­mo­nia gets bad enough, you could suf­fo­cate. That is why pneu­mo­nia has always been a major cause of death.

For­tu­nate­ly, there are a few sim­ple things you can do to pro­tect your­self against pneu­mo­nia. One is to make sure that you get all of your rec­om­mend­ed vac­ci­na­tions, pos­si­bly includ­ing the pneu­mo­nia shot. The pneu­mo­nia shot pro­tects against sev­er­al strains of Strep­to­coc­cus pneu­mo­ni­ae, which is also called the pneu­mo­coc­cus. Pneu­mo­coc­cal vac­cines are giv­en to babies and to elder­ly peo­ple, as well as to any­one else who is at risk for pneu­mo­coc­cal infec­tion. The vac­cine is par­tic­u­lar­ly impor­tant for pro­tect­ing peo­ple against the antibi­ot­ic-resis­tant strains of pneu­mo­coc­cus.

The pneumococcus (Streptococcus pneumoniae)
Strep­to­coc­cus pneu­mo­ni­ae is also called the pneu­mo­coc­cus.

Strep­to­coc­cus pneu­mo­ni­ae is a fac­ul­ta­tive­ly anaer­o­bic organ­ism. That means that it thrives in an oxy­gen-rich envi­ron­ment, such as the upper res­pi­ra­to­ry tract, but can also live in oxy­gen-poor envi­ron­ments. As a result, it thrives in the human upper res­pi­ra­to­ry tract, which is its nat­ur­al habi­tat. How­ev­er, it can also invade deep­er tis­sues, such as the blood­stream, heart, joints, bones, and brain.

Since the pneu­mo­coc­cus nat­u­ral­ly lives in the human upper res­pi­ra­to­ry tract, it is just wait­ing for an oppor­tu­ni­ty to cause prob­lems. As a result, it often caus­es pneu­mo­nia and inva­sive infec­tions in the wake of some oth­er ill­ness, such as a cold or a case of the flu. Thus, the influen­za vac­cine can also help to pro­tect against pneu­mo­nia. Lung dis­eases such as emphy­se­ma, which is due to dam­age to the walls of the air sacs, can also increase the risk of lung infec­tions and death from pneu­mo­nia.

To pro­tect itself against the human immune sys­tem, the pneu­mo­coc­cus secretes a com­plex sug­ar called a poly­sac­cha­ride. This poly­sac­cha­ride forms a cap­sule around the bac­te­r­i­al cell. The cap­sule makes it hard for a white blood cell to grasp and swal­low the pneu­mo­coc­cal cell. The cap­sule also hides the bac­te­r­i­al pro­teins. Thus, it makes it hard­er for the body to rec­og­nize the bac­te­ria as a for­eign invad­er. The human immune sys­tem can make anti­bod­ies against the poly­sac­cha­ride. How­ev­er, each strain of pneu­mo­coc­cus has a dif­fer­ent poly­sac­cha­ride. As a result, the anti­bod­ies against one strain of pneu­mo­coc­cus will not pro­tect you against a strain with a dif­fer­ent poly­sac­cha­ride cap­sule.

Why Are There Two Types of Pneumococcal Vaccine?

Two types of pneu­mo­coc­cal vac­cine are avail­able. One type is the poly­sac­cha­ride vac­cine, which is made out of the poly­sac­cha­rides from 23 dif­fer­ent strains of pneu­mo­coc­cus. The oth­er type is a con­ju­gate vac­cine. It is made by bind­ing the poly­sac­cha­rides from 13 dif­fer­ent strains of pneu­mo­coc­cus to a bit of pro­tein called a con­ju­gate. The pur­pose of the con­ju­gate is to help the body devel­op a stronger, longer-last­ing immune response, even in chil­dren under 2 years of age.

Who Needs the Pneumonia Vaccine?

The pneu­mo­coc­cal con­ju­gate vac­cine is rou­tine­ly giv­en to babies at age 2, 4, 6, and 12 to 15 months of age, as well as to patients age 65 years or old­er. It may also be rec­om­mend­ed for patients age 2 years to 65 years of age if they have cer­tain health con­di­tions. The pneu­mo­coc­cal poly­sac­cha­ride vac­cine is rec­om­mend­ed for patients over 65. It may also be rec­om­mend­ed for younger patients who are at high risk for pneu­mo­coc­cal infec­tion.