More and more people are suffering from gastrointestinal issues in the United States. In fact, 60-70 million people have diagnosable digestive disorders; over a quarter million people die from GI diseases (including cancer) every year; and there are over 100 million outpatient visits every year to gastroenterologists. Many of these patients are diagnosed with gastrointestinal disorders such as SIBO (small intestinal bacterial overgrowth), GERD (gastroesophageal reflux disease), IBS (irritable bowel syndrome), colitis, and liver dysfunction.
But what happens when patients complete standard treatments for these ailments but still present with symptoms? This is when tick borne diseases should be taken into consideration. In his presentation at the 2015 ILADS conference, gastroenterologist Dr. Farshid Rahbar noted that by the time most of his patients see him, they have already been treated for GI issues, follow a restricted diet, and avoid stress; nevertheless, they still have symptoms including bloating/gas, abdominal pain, constipation, food intolerance, irritable bowel movements, and weight loss or gain. Ninety-nine percent of them have been diagnosed with something other than Lyme, yet Dr. Rahbar has seen a major increase in patients actually suffering from tick borne disease. Of 163 of his patients, 132 (81%) tested positive for tick borne disease, and 86 of those 132 (65%) had an abnormal SIBO test.
Why the high correlation between SIBO, other GI issues, and tick borne illness? Both inflammation and immune function can contribute to digestive symptoms in patients with tickborne infections. The gut is the largest organ of immune function in the body. The GI tract houses 80% of our immune system, and 70% of our lymphocytes, making it the first line of defense against infections. If the gut is compromised, our bodies have less ability to fight infections, and, conversely, infections like tick borne illnesses can compromise the gut. Gut flora directly impact the production of inflammatory cytokines, and are therefore essential silent contributors to Lyme.
So what are early symptoms to look for? In a review of gastrointestinal and liver problems associated with tick borne diseases, Lyme disease expert Dr. Richard Horowitz found that 5 to 23% of those with early Lyme had symptoms such as nausea, vomiting, abdominal pain, anorexia with loss of appetite, and hepatitis; some had enlarged liver or spleen. Other signs that Dr. Rahbar sees are parasites that are hard to eradicate; GERD-like symptoms not substantiated by diagnostic tests; throat symptoms with or without associated GERD;
“leaky gut” (increased intestinal permeability); hypochlorhydria, especially in a young person; unexplained chronic diarrhea; urinary symptoms; unexplained liver enzyme elevations; iron marker abnormalities without typical iron deficiency; electrolyte imbalance; and candida/yeast, particularly when it’s persistent in a female, or when a male patient presents with it (candida can also be a problem with antibiotics, so it’s important to replenish healthy bacteria when treating Lyme).
Gastrointestinal issues are also associated with other tick borne diseases such as ehrlichia, Rocky Mountain spotted fever, Q fever, and tularemia. As early as 2002, Infectious Disease doctors Ali Zaidi and Carol Singer concluded that “signs and symptoms related to the gastrointestinal tract may provide useful clinical clues for early diagnosis” of Lyme and these associated diseases. They found patients were misdiagnosed from everything to appendicitis to acute gall bladder infections—some undergoing unnecessary surgery—because doctors didn’t know to look for signs of tick borne illnesses. If you are experiencing unexplained or persistent gastrointestinal issues, consider ruling out tick borne infections as the underlying cause.
 Horowitz, Richard I. Why Can’t I Get Better? Solving the Mystery of Lyme & Chronic Disease. New York: St. Martin’s Press. 2013. (382).
 Rahbar FS. (2015, October). GI Manifestations and Treatment Options in Lyme and Common Co-Infections. Presented at International Lyme and Associated Disease annual conference, Ft. Lauderdale, FL
 Horowitz, 383.
 Syed Ali Zaidi, Carol Singer; Gastrointestinal and Hepatic Manifestations of Tickborne Diseases in the United States, Clinical Infectious Diseases, Volume 34, Issue 9, 1 May 2002, Pages 1206–1212, https://doi.org/10.1086/339871