Inflammatory bowel disease (IBD) is a chronic condition that causes severe gastrointestinal symptoms and can profoundly impact quality of life. However, there may be hope for those who struggle with IBD. While research is still limited, many anecdotal accounts and a growing number of case studies suggest that the ketogenic diet may be effective in managing IBD and potentially even putting it into remission.
This article explores the potential benefits of ketogenic diets for IBD and emphasizes the importance of working closely with one’s doctor to ensure safety and optimize outcomes.
Understanding Crohn’s Disease and Ulcerative Colitis
There are two forms of IBD: Crohn’s disease and ulcerative colitis.
Crohn’s disease can affect any part of the gastrointestinal (GI) tract, causing inflammation that leads to varying degrees of diarrhea, abdominal pain, fatigue, weight loss, and malnutrition, requiring a tailored treatment approach based on disease severity.
Ulcerative colitis specifically targets the colon and rectum, resulting in long-lasting inflammation and sores (ulcers) in the lining of the large intestine. Symptoms include rectal bleeding, diarrhea, and abdominal pain that can significantly affect daily life and in some cases may require removal of all or a portion of the colon.
People with Crohn’s disease and ulcerative colitis may go through phases where their condition is relatively stable, alternating with flares when symptoms worsen and become more intense. Although the two conditions share several features, there are a few differences. In addition to occurring in different portions of the GI tract, ulcerative colitis affects only the innermost lining of the colon, while Crohn’s disease can affect all layers of the bowel wall.
Potential Benefits of the Ketogenic Diet for IBD
The ketogenic diet is a high-fat, moderate-protein, very low-carbohydrate way of eating. Switching to a ketogenic diet shifts your body’s metabolism from relying on glucose to using fat and ketones as its primary energy sources. Your liver starts producing more ketones from dietary fat and your own body fat when your carb intake is extremely low. Once your blood ketones reach a minimum threshold of 0.5 mmol/L, you are considered to be in nutritional ketosis.
Maintaining a state of nutritional ketosis could potentially be beneficial for people who have Crohn’s disease or ulcerative colitis for several reasons:
- Anti-inflammatory properties: Ketones, particularly beta-hydroxybutyrate, have powerful anti-inflammatory effects that may help reduce the chronic inflammation that occurs in Crohns disease and ulcerative colitis.
- Gut microbiome modulation: A ketogenic diet can positively influence the gut microbiota, which may help relieve IBD symptoms.
- Low-fiber impact: Preclinical research suggests that, in people who have IBD, a fiber-free diet may help reduce gut inflammation by discouraging the growth of harmful bacteria that need fiber to thrive and trigger disease. However, more studies are needed to confirm theses findings.
- Improved nutritional status: By reducing carbohydrate intake, ensuring adequate protein intake, and increasing healthy fats, individuals who follow a well-formulated ketogenic diet may experience better nutrient absorption and help prevent the deficiencies often associated with IBD.
Research Supporting Ketogenic Diets for IBD
There is currently very little human research on ketogenic diets for ulcerative colitis and Crohn’s disease. In fact, only a handful of case studies exist. However, the results of these case reports are promising:
- A recent case series examined the impact of animal-based ketogenic and carnivore diets in 10 adult patients with IBD (six with Crohn’s disease and four with ulcerative colitis). These individuals, who had not achieved remission with conventional treatments, reported significant relief of symptoms after following these dietary approaches. All 10 patients achieved clinical remission based on IBD questionnaire scores, and most of them were able to discontinue medications. In addition, they reported that their diets were pleasurable, easy to sustain, and greatly improved their quality of life.
- After suffering from severe Crohn’s disease symptoms that could not be adequately controlled with medication, a 14-year-old boy began eating an animal-based ketogenic diet with his parents’ support. This dietary change resolved his symptoms, reduced bowel inflammation, restored intestinal permeability, and led to the discontinuation of all medications.
Nick Norwitz, PhD, one of the authors of the case series described above, shared his experience using a ketogenic diet for his ulcerative colitis in a discussion with Doug Reynolds of Low Carb USA. Other people who have successfully used ketogenic diets for IBD have shared their success stories online, including on Reddit and Twitter.
Safety Precautions for Following a Ketogenic Diet with IBD
If you decide to try a ketogenic diet for IBD, it’s imperative that you do so under medical supervision. Crohn’s disease and ulcerative colitis features and severity vary from person to person. Adjustments in medications may be necessary as symptoms change with dietary modifications.
Ketogenic and carnivore diets can be nutritious when well planned. However, you should work with your doctor, dietitian, or nutritionist to ensure that you are meeting all of your nutrition needs. They can also help you determine the right amount of water, sodium, and other electrolytes to consume in order to prevent the keto flu or minimize its effects without exacerbating your IBS symptoms.
Additionally, avoid vigorous physical activity during the first few weeks to prevent fatigue or flares. It may take a month or longer for your body to fully adapt to using ketones and fat as fuel, so pay attention to how you feel and avoid overexertion.
Summary
The ketogenic diet shows promise for managing Crohn’s disease and ulcerative colitis by reducing inflammation, balancing gut microbiota, and potentially improving nutritional status. However, it is considered an experimental therapy and should be followed under medical supervision to ensure safety. Ongoing research will help define its role in treating these conditions, potentially offering relief and a better quality of life for those living with IBD.
