AMMONIA TOXICITY EDUCATION
Updated: 7 days ago
I have had my own struggles with ammonia, and my doctor helped me find what worked for me. I wanted to explain what ammonia is and how it can affect us, in case it is affecting you too.
Short on time or energy? A quick-view graphic with the key points is at the bottom of this post.
Looking for things that may help? Read my AMMONIA TOXICITY - POSSIBLE SOLUTIONS post:
WHAT IS AMMONIA?
Ammonia is a normal waste product in everyone's body. Most of it is made in the gut, where healthy bacteria break down the protein from the foods we eat.
HOW THE BODY CLEARS IT
- The liver changes most ammonia into a waste product called urea.
- The kidneys then send the urea out in our urine. This process is called the urea cycle.
- The liver can also turn some ammonia into glutamine, and our muscles help with this too.
- When all of this is working well, ammonia does not build up in the blood.
WHAT CAN CAUSE HIGH AMMONIA
- Liver disease is the most common cause.
- Kidney disease or kidney failure.
- Rare urea cycle disorders, which are passed down in families.
- Reye syndrome, a rare illness seen mostly in children.
- Certain medicines.
- In people with liver disease, changes in gut bacteria and loss of muscle can make it harder for the body to clear ammonia.
HOW IT CAN AFFECT THE BRAIN
Ammonia is harmful to the brain, which is why the body works so hard to clear it. When it reaches the brain, support cells called astrocytes try to handle it. Liver researchers explain that too much ammonia can lead to swelling of these cells, strain on cell energy (the mitochondria), and inflammation.
Signs of high ammonia can include:
- Feeling irritable or having mood swings
- Low energy, trouble staying alert, or being very sleepy
- Headache or vomiting
- Changes in behavior
- Confusion, including not being sure of the time, where you are or who you are
- Poor coordination that makes walking or talking harder
- Seizures
WHAT LYME DOCTORS REPORT
- Dr. Richard Horowitz wrote in 2018 that several of his patients with memory and thinking problems had high ammonia, even though they did not have serious liver disease. He felt methylation problems, mitochondrial problems, or too many ammonia-making bacteria in the gut may play a part, and he said factors like these still need study.
- In 2025, Dr. Horowitz again listed liver problems with high ammonia among the many things linked to memory and focus problems.
- Dr. Bill Rawls has written that bacterial die-off can release ammonia and other byproducts that are hard on the nerves and may make brain fog worse. He says gut imbalances like SIBO and candida overgrowth can add to this too.
- Dr. Susan Marra, a Lyme-literate naturopathic doctor, wrote in 2025 that she believes most patients whose Lyme and coinfections affect the brain and nerves have ammonia building up in the brain. She feels blood levels can look normal because the ammonia may be held in brain tissue (doctor's view, not yet studied).
DO THE LYME BACTERIA MAKE AMMONIA?
You may read that the Lyme bacteria make ammonia. This has not been confirmed in people. A 2022 lab and mouse study looked at arginine, an amino acid that some bacteria break down and release ammonia from. The Lyme bacteria did not use up arginine, either in the lab or in infected mice. So for now, this is an idea that still needs study.
TESTING
- Ask your doctor about an ammonia blood test. It is usually drawn from a vein in the arm. Sometimes blood is taken from an artery instead.
- Your doctor will tell you how to get ready. You may be asked to fast for several hours (liver experts recommend at least 4 hours), skip smoking for several hours, and avoid hard exercise and alcohol beforehand.
- Your doctor may ask you to pause certain medicines before the test. Please never stop a prescription without talking with your doctor first.
- The sample needs careful handling. Liver experts recommend keeping it on ice, spinning it down within 15 minutes, and testing it within 2 hours. When processing is delayed, the result can read falsely high.
- Ammonia levels can also shift with what you ate, muscle mass, exercise and medicines, so one test is only part of the picture.
- If your result is high, your doctor will usually order more tests to find the cause. If it is normal and you still have symptoms, your doctor can look for other causes.
My lab tests post (ammonia is the first topic):
WHEN TO GET HELP RIGHT AWAY
Very high ammonia can harm the brain. Get medical help right away for sudden confusion, not knowing the time or where you are, being very sleepy or hard to wake, seizures, or new trouble walking or talking.
RELATED POSTS
YUCCA ROOT
L-ORNITHINE
BRAIN FOG EDUCATION
HEAD PAIN / HEAD PRESSURE - POSSIBLE SOLUTIONS (and EDUCATION)
LIVER HEALTH and LYME
SOURCES
The role of ammonia in chronic liver disease. Hepatology Communications, 2026.
Dr. Susan Marra, Ammonia Toxicity in the Brain of Tick-Borne Disease Patients, June 2025.
MEDICAL DETECTIVE #5: Kris Kristofferson had chronic Lyme–not Alzheimer’s. How can you tell the difference? Dr. Richard Horowitz, LymeDisease.org, January 2025.
Ammonia Levels. MedlinePlus (National Library of Medicine), September 2023.
The arginine deaminase system plays distinct roles in Borrelia burgdorferi and Borrelia hermsii. PLoS Pathogens, March 2022.
Older sources, still worth reading:
Dr. Bill Rawls, How to Overcome Lyme Brain: Causes and Solutions for Brain Fog, February 2020.
Precision Medicine: The Role of the MSIDS Model in Defining, Diagnosing, and Treating Chronic Lyme Disease/Post Treatment Lyme Disease Syndrome and Other Chronic Illness: Part 2. Dr. Richard Horowitz and Phyllis Freeman, Healthcare, November 2018.
Disclaimer: Rise Above Lyme makes no claims about any possible benefit of using any product mentioned within this site. Always consult with your doctor before adding anything. The information shared is based on personal experience, years of accumulated researched resources from Lyme Literate doctors and polls conducted within Lyme groups from actual patient experience using these solution ideas.
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