Keto for SIBO and IBS: Why It Can Make It Worse
The internet is filled with claims on the ketogenic diet being a miracle cure for various health issues, including Small Intestinal Bacterial Overgrowth (SIBO) and Irritable Bowel Syndrome (IBS). And while the Keto Diet can be beneficial for some individuals, promoting it as a blanket solution for SIBO and IBS is misleading and potentially harmful. This article aims to examine the claims made in favour of keto and highlight the potential downsides.
The Ketogenic Diet and Gut Health
The ketogenic diet is characterized by very low carbohydrate intake and high fat intake, which induces changes in the gut microbiome. And these changes aren't all that beneficial, which has been concluded in a systematic review looking at over 250 studies. The effects can also vary significantly depending on individual factors. While it's true that a ketogenic diet will reduce FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) which are known to trigger symptoms in some individuals with IBS and SIBO, this is only one piece of the puzzle.
Why Keto Is a Bad Idea for SIBO and IBS
There are many reasons why the Keto Diet could be a bad idea for people with digestive issues. Here are the main ones:
Lipopolysaccharide (LPS) release and Inflammation
LPS is a potent endotoxin that triggers inflammation throughout the body, exacerbating symptoms in individuals with SIBO and IBS (amongst others) who already experience high inflammation.
The ketogenic diet is high in saturated fat content which is a significant concern. Saturated fats can increase intestinal permeability ("leaky gut"), allowing increased passage of lipopolysaccharide (LPS) released from gut bacteria into the bloodstream. In other words, more intestinal permeability due to a high fat diet (and also gluten by the way) is leading to a greater absorption of lipopolysaccharide (LPS) from the gut into the blood. No bueno.
Bile Acid Malabsorption (BAM) and Poor Bile Outflow
Some individuals with SIBO and IBS also experience bile acid malabsorption or poor bile outflow. The ketogenic diet's high-fat content places a greater demand on the liver and gallbladder to produce and release bile for fat digestion. If bile acid production or outflow is already compromised, this increased demand can worsen symptoms like diarrhea, bloating, and abdominal pain.
Nutrient Deficiencies
Restrictive diets like keto can lead to nutrient deficiencies, especially if followed for an extended period of time. Individuals with SIBO and IBS often already struggle with nutrient absorption due to an inflamed small intestinal lining. Further compromising nutrient intake through a restrictive diet can worsen existing deficiencies and negatively impact gut health.
Gut Dysbiosis
While reducing FODMAPs can be helpful short-term, the ketogenic diet's impact on the gut microbiome is not always positive. The drastic shift in macronutrient intake disrupts the balance of gut bacteria, leading to dysbiosis (or LIBO) and worsening symptoms. The great reduction in fiber intake, common in keto, negatively impacts gut microbiome diversity.
Bottom line: It's crucial to remember that SIBO and IBS can be complex conditions with diverse underlying causes and symptom presentations. What works for one person may not work for another. The ketogenic diet, while beneficial for some, is not a one-size-fits-all solution and may even exacerbate symptoms.
When Keto Might Be Helpful (and Why)
While not ideal for SIBO and IBS, the ketogenic diet has shown promise in other contexts. It's important to understand that these benefits are often unrelated to gut health and are based on different mechanisms:
Epilepsy
The ketogenic diet was originally developed in the 1920s to treat epilepsy, particularly in children who didn't respond well to medication. The exact mechanism isn't fully understood, but it's thought that the diet's metabolic effects alter brain activity, reducing seizure frequency.
Neurological Conditions
Some research suggests that the ketogenic diet may be beneficial for other neurological conditions, such as Alzheimer's disease and Parkinson's disease. The potential benefits are thought to be related to improved mitochondrial function, neurotransmitters’ balance, and reduced inflammation in the brain. However, more research is still needed to confirm these effects.
Weight Loss
The ketogenic diet can lead to significant weight loss in individuals due to its appetite-suppressing effects and metabolic changes. However, this weight loss is not always sustainable, and the diet can be difficult to maintain long-term. It’s important to note that weight loss is not always a positive outcome for individuals with digestive issues.
Important Note: Even in cases where keto might offer benefits for a specific condition, it's crucial to consult with a nutrition professional before starting this diet. They can help determine if the ketogenic diet is appropriate for your individual circumstances and guide you on how to safely implement it.
Alternative Approaches for SIBO and IBS
Instead of relying on a potentially harmful and very restrictive diet, a more holistic and individualized approach is recommended for managing SIBO and IBS. This can include:
Low-FODMAP Diet: A temporary, carefully managed low-FODMAP diet can help identify trigger foods and alleviate symptoms. This approach is far more nuanced than simply following a keto diet, but please note that it’s also meant as a short-term diet for symptom management (not treatment).
Targeted Dietary Interventions: Working with a dietitian or nutritionist specializing in gut health can help create a personalized dietary plan that addresses specific nutrient needs and help you identify and avoid your trigger foods.
Herbal Antimicrobials and Supplements: Certain herbals (such as oregano, allicin, berberine, etc.) and other supplements can be part of a treatment and gut healing protocol, as well as reduce inflammation. Please note that these can be very potent, and I always recommend working with a knowledgeable gut health practitioner.
Lifestyle Modifications: Other aspects such as stress management, nervous system regulation, adequate sleep, and regular but gentle exercise are crucial for overall gut health.
Medications: Antibiotics, prokinetics, and other prescription interventions may be necessary for managing SIBO and IBS, depending on the individual's condition and needs.
The ketogenic diet is not a magic bullet for SIBO or IBS. While reducing FODMAPs might offer temporary relief for some, the potential negative consequences of the Keto diet related to inflammation, bile acid metabolism, nutrient deficiencies, and gut dysbiosis cannot be ignored.
A comprehensive, individualized approach that addresses the underlying causes and symptoms of these conditions is far more effective and safer than relying on a potentially harmful dietary fad. Always consult with a health practitioner before making significant dietary changes, especially if you have existing health conditions.