Neurologist Elena Frid, MD, discusses the latest Lyme disease findings, Lyme misinformation, how to protect yourself against Lyme disease, and how to treat ongoing Lyme symptoms. Serena Marie, RD, explains how to become a fat-adapted runner and how to transition away from fueling with carbohydrates.

Featured Guest: Elena Frid, MD

Pleate note: Always consult your physician. The following interview is not intended to replace the advice of your physician or medical care provider.

The mid-Atlantic, northeast region of the United States, among other areas, faces a great risk for Lyme disease—of an endemic (regularly found among particular people or in a certain area) proportion. Neurologist, Dr. Elena Frid, who specializes in Lyme disease, joins Kari to inform listeners about this horrible disease.

• For the last five years, Dr. Frid has treated adult patients with Lyme disease, and she feels that ultimately Lyme disease is a neurologic condition.
• She has attended different conferences, such as the International Lyme and Associated Disease Society (ILADS) conference.
• She has attended such events as the Hugged by Global Lyme Alliance and has become part of their medical advisory board.
• Lyme disease is a bacterial infection and is a very elusive type of organism. It is often very difficult for doctors to diagnose. For more information, go to the Lyme section of Dr. Frid’s website.
• To find a Lyme-literate physician in your area, visit org.
• There are certain laboratory tests and physical exam findings that you can undergo, but not everyone will test positive even if they do have Lyme disease.
• The testing that’s available now may be up to 50 percent inaccurate, according to Frid.
• She sees symptoms at the onset of the disease, such as low-grade fever, fatigue, chills, aches, headache, joint pain.
• The typical rash that occurs may actually happen in less than 50 percent of patients, and many times the rash isn’t the classic bull’s eye rash that people are told to look for.
• People can also develop neurologic symptoms when symptoms go undiagnosed for weeks or months, such as debilitating headaches, facial weakness (Bell's palsy), numbness or weakness in limbs, muscles aches and twitches, difficulty moving, debilitating fatigue, dizziness, nerve pain, and so on.
• Listen to your body, and you will know that something is wrong. Don’t excuse symptoms as just stress.
• To diagnose Lymes disease, doctors should consider the patient’s history, a physical exam, and blood work, as well as MRIs or nerve testing.
• Blood tests may be 50 percent inaccurate, and if you get tested within 4 weeks of a tick bite, the test is only 30 percent accurate.
• The criteria established by the Centers for Disease Control and Prevention (CDC) is very strict. Frid recommends getting to know more about the blood testing and speaking to Lyme-literate physicians, especially if you’ve had a thorough medical workup for your symptoms and all other tests come back negative.
• She recommends going to org to find Lyme-literate physicians.
• In terms of geography, Lyme disease is more prevalent in the northeastern states like NY, CT, PA, and NJ. However, Lyme has been reported in every state in the United States, according to Frid.
• If you do find a tick on yourself, you can send the tick in to be tested to bayarealyme.org.
• Ticks are extremely small. Adult ticks are only the size of a poppy seed.
• You should check for ticks after you’ve been outdoors in grassy, wooded areas. Have a partner check for you, particularly around the groin area, between your toes ,under your armpits, behind the ears and knees, and in the hair line.
• To remove a tick, grab it by the head and pull it out. Use a magnifying glass and tweezers. You can save the tick in a plastic, sealed bag.
• Many Lyme-literate physicians are now saying that the literature that says you are not prone to Lyme disease if a tick has been attached for 72 hours or less is incorrect.
• If you go into an emergency room and they say you don’t need to worry since the tick has only been attached for an hour or two, you might want to seek a second opinion.
• To prevent getting Lyme disease, wear proper clothing, such as long-sleeve shirts, long pants, socks, light-colored clothing, and closed-toed shoes. You can pretreat your clothing (by soaking) with a permethrin pesticide that binds to the fabric. There are natural repellents too, such as Buzz Away.
• To protect your yard, you can use fencing and mulch.
• The CDC acknowledges the fact that patients may have chronic Lyme symptoms even after adequate diagnosis and treatment. The body develops antibodies and is essentially fighting itself.
• Some Lyme-literate doctors believe that it could be or is an ongoing infection that was never fully treated. They believe that you need to be treated for six to eight weeks instead of just two to three weeks after exposure to a tick. The bacteria multiplies every four weeks.
• If you are exposed to a tick, especially in those endemic regions, Dr. Frid suggests starting treatment even before testing the tick.
• Frid recommends a healthier diet for patients, but she wants to emphasize that if you do have Lyme symptoms, you cannot treat it just with diet. You have to treat it appropriately and then supplement with smart food choices and physical activities.
• She recommends foods that increase good bacteria in your gut (refrigerated fermented foods, yogurt). She suggests staying away from a lot of sugar or grains and making smart decisions.
• Besides medication and nutrition, you can work out as long as you are able.
• To support loved ones with Lyme disease, you can simply be there for them and believe them. Some Lyme patients have a hard time convincing others that something is wrong, because physically they may look fine. Be patient with the expectations for treatment durations (which can take up to one to three years) and help the patient be an advocate for him or herself.
• After any elective surgical procedures (tooth extraction, labor and delivery, gall bladder removal), due to stress on your body, Lyme symptoms may become accentuated and out of control.
• Frid says that the answer to whether someone can give Lyme disease to someone else through sexual contact is unclear.
• At this time, there is no Lyme disease vaccine for humans.
• She believes that this disease should really be called tick-borne illnesses, because there are other infections that may be transmitted through ticks including bacteria and viruses that may take a long time to treat.
• She recommends a four-step approach to know when to come off of medication. There is no set time frame, since every body is different:
  • Once you’ve been on antibiotics, recheck your blood work to make sure that the antibodies are clearing or have cleared.
  • Make sure that you’ve been asymptomatic for two months while you’re still on antibiotics.
  • You’ve had an illness unrelated to Lyme disease during this period that has not exacerbated your symptoms.
  • When you know/feel that it’s all gone.

Serena Marie, RD Go-to, real-food dietician answers a listener’s question about fat-adapted running and how to transition from being a carb-fueled athlete to a fat-fueled athlete.

• Serena’s information is based on the following literature and her blog post “Real Food Fueling for Runners”.
  • “Utilization of lipids during exercise in human subjects: metabolic and dietary constraints”
  • “Fat Metabolism During Exercise: A Review. Part III: Effects of Nutritional Interventions”
  • “Strategies to enhance fat utilisation during exercise”
• In order to transition from being a carb-fueled athlete to someone who relies on fat to fuel, it’s important to do a few things prior to race day.
  • Regularly engage in fasted cardio.
  • Practice doing fasted runs with caffeine.
  • Perform endurance exercise on a regular basis.
  • For seven to ten days prior to race day, transition your diet to being a high-fat diet where 60–70 percent of your calories come from fat.
• You can go over an hour or two during a run without consuming calories by using your own body fat (your own endogenous fat stores) to fuel. You might just need to take something with electrolytes in it during a long run.
• Question: How do you get used to and comfortable doing fasted runs?
  • Answer: Take a little bit of dark chocolate or a scoop of peanut butter or coconut oil along as you transition to being totally fasted when running.
• The first few runs during your transition could be difficult. But remember that every body is different. Your magnesium becomes depleted in the body very quickly, so it’s important to supplement with magnesium. Serena and Kari also talk about magnesium deficiency in “Teri Goetz” (Episode 54).
• Dark, green leafy vegetables and bitter chocolate both have good amounts of magnesium in them.
• If you don’t choose a diet high in fat, it’s still possible to still do well doing fasted cardio.
• If you can do fasted runs, it suggests that your body is good at being fat adapted.

Gratitude Jar (Woot! Woot!)

Serena is grateful when listeners contact her via social media! She and Kari have so much fun interacting with listeners, so please tweet Serena at @SerenaMarieRD and Kari @KariGormley. You can also connect on Facebook via The Running Lifestyle Show page.

Kari is extremely grateful that she can reach out to rock stars like Dr. Elena Frid to get all the latest information concerning key topics.

Next week, Kari interviews the TRLS April Book Club author, Laura Vanderkam, who wrote 168 Hours: You Have More Time Than You Think You Do. Vanderkam will chat about her book, answer questions, talk about her running journey, and is also the featured Runner of the Week.

Contact:

Elena Frid: Website: NeuroAssociatesNY.com or ElenaFridMD.com Bio: Dr. Elena Frid is an American board certified neurologist who holds double board certifications from The American Board of Psychiatry and Neurology (ABPN) and The American Board of Clinical Neurophysiology (ABCN). Dr. Frid helps patients (18+) with diagnosis, treatment, and management of disorders affecting the nervous system, muscles, peripheral nerves, spine, and the brain. She is also a Lyme Literate specialist who sees patient with Neuroborreliosis and other tick borne diseases and works close with Infectious Disease specialists and Primary Care physicians to encompass the best possible treatment. Dr. Frid received her BA/MD degree from Rutgers Medical School, NJ and her residency, chief resident and fellowship training in Neurology and Clinical     Neurophysiology from North Shore University Hospital-Hofstra North Shore LIJ School of Medicine, NY. She is currently a medical director at Neurology Associates of New York, a private practice in New York City on the Upper East Side.

Serena Marie, RD: Website: www.SerenaMarieRD.com Facebook: /SerenaMarieRD Twitter: @SerenaMarieRD Instagram: SerenaMarieRD

Kari Gormley: Facebook: The Running Lifestyle Show Twitter: @KariGormley Instagram: @KariGormley