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JEY100 Sat, Oct-27-18 06:10

IBS and the keto diet
Long article and IBS guide:


IBS and the keto diet

When Audra Atkins-Reeves started the low-carb keto diet in October 2016, her only aim was to lose weight — and happily she found within five months she had lost 40 lbs (18 kg).

The 36-year old IT supervisor in California, however, discovered another welcome, unexpected benefit from her new way of eating: it almost completely eliminated her long-standing irritable bowel syndrome. Within a month of starting the keto diet her gut was remarkably calm, quiet, and cooperative for the first time in decades.

“Honestly, I’d never had a normal bowel movement almost my whole life,” said Atkins-Reeves, who alternated between extreme constipation and diarrhea (called IBS-C and IBS-D). Her doctor’s solution was to give her drugs for both, which she switched between.

Changing to a low-carb, high-fat diet completely resolved her constipation and reduced her formerly frequent attacks of diarrhea to less than once a month.

“My ketogenic diet now completely controls my IBS symptoms,” she says, noting that it even seems to have healed her gut’s old problems. “If I do ever cheat and indulge in some of my old triggers like ice cream or fruit, it doesn’t seem to cause an attack any more. In the past I would have been in the bathroom within an hour.”

Most of us are ecstatic to broadcast our success with weight loss or reversal of type 2 diabetes on the keto diet. We talk to friends and family enthusiastically about the pounds melting off, our blood sugar normalizing, our cravings gone and our minds becoming beautifully clear. We post our before-and-after pictures on Facebook and detail how now eating meat, cheese, eggs and butter is giving us a new lease on life.

But go into rapturous details about keto’s impact on one’s bowels? Not so much! Talking frankly and honestly about gastrointestinal issues is squeamish stuff, the last taboo. It’s tough to share the particulars of how a once-churning caldron of GI distress has quelled or the bloated pain of constipation eased, all by switching to a very low-carbohydrate diet.

And yet, for many it is a welcome, surprising benefit. Improvements in IBS symptoms are commonly reported in emails to Diet Doctor. Many keto themed blogs discuss the phenomenon as do multiple Reddit discussion threads.

Improvements in IBS symptoms are commonly reported…
A survey of doctors on this site, who recommend low-carb/keto eating, found that among their patients, it is very common to have a dramatic improvement, even a resolution of long-standing IBS symptoms. It is one of the most welcome side effects of the diet. Dr. Ted Naiman said he has seen it occur among “countless patients.” Dr. Sarah Hallberg, too, says “we see it all the time.”

So has Dr. Andreas Eenfeldt: “I remember one male patient in his late 20s who had suffered crippling IBS symptoms for most of his life,” he said. “I suggested he try a low-carb and high-fat diet, gave him a one-page pamphlet, and he agreed to give it a try. It was a quick ten-minute consultation. When I called him two weeks later, his GI symptoms were not only completely gone, for the first time he could remember, he’d also lost a surprising amount of excess weight. And all without a single medication.”

Dr. Evelyne Bourdua-Roy agrees: “It is super common. Most patients have given up hopes of getting a treatment, it seems. They’ve tried a lot of stuff, they have had a colonoscopy, they have had tests for food intolerances and celiac disease with no answers.”

But when they go on the low-carb high-fat (LCHF) diet, most see an improvement within two weeks or less, she says. Not only does Dr. Bourdua-Roy’s have the majority of her patients on the diet report significant improvement or a complete disappearance of their IBS symptoms, she has experienced it herself. “I have had a complete resolution of bloating, pain and excessive gas.”

I have, too. I now consider my mild IBS completely cured on the ketogenic diet. In my very first post for Diet Doctor I described how going low carb resolved not only my pre-diabetes, but resulted in barely a grumble from my sometimes grumpy gut. Like Atkins-Reeves, too, it seems the diet has even reset my underlying intestinal tolerance. Trigger foods that used to bother me, like runny eggs or raw spinach, don’t anymore.

Could restricting carbohydrates be the key to your happier gut?

Read on for more information about what is known, and not known, about IBS in general and when carbohydrate restriction might be just the solution to tame your tumultuous tummy.

1. IBS is very common and very disruptive

Studies show that more than one in ten visits to family doctors and at least one in four to gastroenterologists are for IBS symptoms.
At least 15 per cent of the general population are estimated to suffer from IBS — typically twice as many women as men. That means some 75 million people in Europe and 48 million in the US are affected. Studies show that more than one in ten visits to family doctors and at least one in four to gastroenterologists are for IBS symptoms. It is second only to colds for missed days at work.1
But do we talk about it a lot? Nope. Most suffer in silence and many don’t even bring it up to their doctor. Dr.Bourdua-Roy, says that silence is very common among her patients. “Most of my new patients don’t even mention it… they have tried numerous modifications to their diet so most think it is useless to make another effort.”

The key defining symptoms of IBS are recurrent abdominal bloating, pain, diarrhea and/or constipation. Excessive flatulence, cramping, heartburn, nausea, vomiting, exhaustion, sweating, shivering, anal itching, and sudden incontinence can be part of the not-so-pretty picture, too.2

A few serious medical conditions can have symptoms similar to IBS: celiac disease, inflammatory bowel disease (Crohn’s and ulcerative colitis), and certain types of cancer, especially colon or ovarian cancer in which new GI symptoms come on rapidly, especially at a later age. While all are much rarer than IBS, these conditions should be ruled out before settling on the IBS diagnosis, international IBS guidelines say.3

The key factor that distinguishes IBS from other gastrointestinal issues is that diagnostic tests can’t find anything wrong – that is why it is often called a “functional” disorder, meaning it is based on symptoms after other causes have been ruled out.4

The takeaway: If IBS is causing a lot of distress, especially if symptoms are new, do have a doctor rule out other more severe health issues first. But if IBS is the eventual diagnosis, you are not alone. And a low-carb high-fat diet could easily help.

2. Subtle physiologic differences now being found

For years, because nothing aberrant could be found on colonoscopies or other diagnostic tests, doctors dismissed IBS and offered little help to patients. That may be one main reason why so many people with the symptoms keep quiet about it.

In fact, for decades IBS symptoms were often seen by the medical profession as largely psychosomatic — all in one’s head — which often caused those who suffered to be labelled as neurotic or as having psychiatric precursors, particularly anxiety and depression. Chronic stress is known to contribute to, and worsen, the disease; and anxiety and depression are often natural responses to a condition that can cause fear of public embarrassment or undermine quality of life, — especially when the symptoms are dismissed as psychological by still too many doctors.5

Research, however, is now pointing to a variety of subtle changes that each may underlie the development of IBS.
Research, however, is now pointing to a variety of subtle changes that each may underlie the development of IBS, such as an altered immune system, the presence of low-grade inflammation, the proliferation of nerve fibres in the intestinal wall or pre-existing genetic susceptibility.6
The takeaway: While stress can make IBS worse, it is not all in your head; genetic susceptibility and micro-organic changes, hitherto undetected by diagnostic tests, are likely at play. If your doctor gives you the old “nervous temperament” explanation for your symptoms, find a new doctor – and try cutting carbs.

3. FODMAPs: research shows cutting out short chain carbohydrates improves symptoms

Foods containing FODMAPs (chart)

In recent years a specific diet developed in Australia, called the low FODMAP diet, has been getting a lot of research attention, with some studies showing 75 per cent of people with diagnosed IBS had their symptoms improve on it. FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharide’s and polyols. That unwieldy name describes types of short chain carbohydrates found in many fruits, vegetables, legumes, grains, dairy products and some processed foods.7

FODMAPs are all carbs, and what they all have in common is that they tend to ferment in the small intestine, causing gas and bloating. They are also poorly absorbed by the gut wall and cause fluid to remain in the intestinal space, leading to diarrhea in those susceptible to IBS.

High FODMAPS include fructose and fructans found in many fruits, vegetables and wheat products; lactose, a sugar found in milk and some, but not all, dairy products; galactooligosaccharides (GOSs) found in beans and lentils; and sugar alcohols (polyols) such as the artificial sweeteners sorbitol, xylitol and mannitol.8

Eating a low FODMAP diet has in the last few years become the front line therapy for IBS, in which patients usually work with a dietitian to first eliminate all FODMAPs in their diet and then slowly reintroduce them, one-by-one back into their meals to see which they can tolerate and which they cannot.9

More than 200 FODMAP studies now exist, with the majority showing improved symptoms for more than 75% of patients. However, most IBS specialists still also recommend, alongside low FODMAPs, the traditional diet recommended for years, which stresses small meals, regular food intake and avoidance of coffee and fat.10

No carbs equals no fermentation equals no IBS. It is simple and it works great.– Dr. Ted Naiman
Many patient discussion threads on the low FODMAP diet, however, call it difficult to follow, rigid, and depressing to figure out the more than 200 carbs that are “in” or “out.”
Dr. Ted Naiman notes that the general very low-carb diet is easier. “No carbs equals no fermentation equals no IBS. It is simple and it works great.”

The takeaway: Ample evidence now exists that short-chain carbohydrates called FODMAPs can cause problems with people with IBS, but the intricacies of the diet are challenging. A low-carb diet is a simpler way to eliminate the common FODMAPs.

4. Research evidence for a very low-carbohydrate or ketogenic diet

In 2009 a US team at the University of North Carolina, that included Dr. Eric Westman, specifically examined a very low-carb diet — less than 20g of carbs a day — for IBS. During the study, 13 people with diarrhea-predominant IBS started with a standard American diet for two weeks, then switched to a very low-carb diet for four weeks; 10 out of the 13 subjects (77%) had significant improvements, with the very low-carb diet improving their abdominal pain, reducing their diarrhea and improving their quality of life.11

“A very low-carb diet, or LCHF, is basically a low FODMAP diet with even fewer carbs,” said Dr Westman.

Currently a randomized clinical trial is recruiting in Sweden that will assign patients to one of three diets for four weeks: standard diet, a low FODMAP diet, and a very low-carbohydrate diet.12

The takeaway: Anecdotal evidence abounds and low-carb physicians constantly see IBS symptom improvement; formal research evidence is growing. Most people, if they are going to have IBS improvements on a low-carb ketogenic diet, see it within two to four weeks.

“The fact is that you will know quickly whether this works for you,” says Dr. Bourdua-Roy. “Try it for two weeks; take the Diet Doctor challenge. You will get the answer!”

If you have experienced improvement in your IBS symptoms with the LCHF or ketogenic diet, let us know in the comments.

Anne Mullens

Benay Thu, Jan-02-20 10:47

I have been on low carb now since the end of November and have seen variable results.

Continuing diarrhea I have attributed to the lectins in my salads

I have cut out the lectins - problem persists

Should I contact Anne Mullens on the Diet Doctor site?
She asked for comments on her post.

I have seen an MD who saw "nothing wrong."

Ms Arielle Thu, Jan-02-20 19:02

Comments dont usually illicit medical advice.

Perhaps eliminate the common trigger foods.... like FODMAP list.....and when everything ok, add vack one item to test.... a long process. I admire those that track down the culprit.
Otherwise, consider adding in beneficial mucrobes slowly.

jschwab Thu, Jan-02-20 23:39

I recently developed IBS symptoms while being more strictly low-carb. Following FODMAPS has helped a lot but I am still on a regimen of fiber (psyllium husks) and Miralax. It's sucks. But i am an ace at elimination diets.

JEY100 Fri, Jan-03-20 06:31

If you search the DietDoctor website for IBS and also Digestive Disorders (under the Health tab also) there have been many more guides and success stories since this one. Might find some new ideas.

Above article was updated Dec. 2019.

Ms Arielle Fri, Jan-03-20 10:21

Watched a DrWestmann presentation yesterday on the science of keto. Improvement in IBS was firmly in the " improved" catagory. Perhaps something other than " keto" is driving IBS.

Meme#1 Fri, Jan-03-20 11:55

Originally Posted by Benay
I have been on low carb now since the end of November and have seen variable results.

Continuing diarrhea I have attributed to the lectins in my salads

I have cut out the lectins - problem persists

Should I contact Anne Mullens on the Diet Doctor site?
She asked for comments on her post.

I have seen an MD who saw "nothing wrong."

My suggestions to you would be to stop eating raw vegetables on a regular basis.
In the book "Fiber Menace" the doctor explains that when the veggies are raw, the cells remain unbroken so the body cannot absorb the nutrients anyway. Then it ends up in your large intestines undigested.

The only way to break open those cells is to cook the vegetables. People think putting them in a blender ahd making a shake will do t but it does not. The cells still remain intact. Only cooking breaks open the cells so that the body can begin digesting it in the stomach and then small intestines.

Ms Arielle Fri, Jan-03-20 12:47

And adding microbes to aid in digestion. Thats why fermented vegetables became the norm before canning.

Daily unpasturized apple cider vinegar ..... even my mom got approval from her doctor.

Benay Tue, Jan-14-20 06:15

Thanks Meme

This would mean no more salads

Just had another overwhelming bout with severe stomach cramps -- I think it was the ground beef patties. No raw veggies

Benay Fri, Nov-26-21 08:41

Problem persists
Stool specimen reveals no bacteriological cause - which is good to know
Raw vegetables eliminated
only occasional raw fruit avocado - no symptoms
I suspect an allergy to palm oil
I read labels to make sure it is not listed (Atkins meals uses it a lot)
Problem persists
Definitely an issue of eliminating foods
apparently I am missing something
keep trying
embarrassing not being able to get to the bathroom on time
Cleanup messy
eliminated all grains AKA Wheat Belly
I hope it's not aging - that is incurable and unpreventable
No gas bloating or cramps
sudden onset with no warning

Nancy LC Fri, Nov-26-21 09:00

I had IBS always since going low carb. I did find a number of foods I don't do well with: eggs, tuna, almonds, avocado. Cut out lots and it would get better, but always return.

Inexplicably since doing DDF the IBS-D is mostly gone. I'm wondering if perhaps my bowels didn't like all the fat I was eating when I was low carb. The only 2 things that have changed significantly is I am eating less (quantity), and I am cutting down on fat. Still eating the same foods, more or less.

cotonpal Fri, Nov-26-21 11:52

I had severe gastrointestinal problems that at their worst kept me virtually housebound unless I stopped eating entirely. My success story talks about how I got it under control.

Benay Sat, Nov-27-21 06:54

Jean, thanks for posting your story.
I am shocked! You had to eliminate both chicken AND beef????
My staples!
I am off dairy, grains, avocado, raw veggies etc
but cutting out chicken and beef too?
I am left with pork and fish - my least favorite foods.
But if that is what it takes - then it is certainly worth a try.
And you are right - 2 to 3 Imodium do not stop it for long
I know when I eat too much bacon, I develop large dark bruises on my shins. Have no idea why. I microwave so I lose a lot of the fat
Thanks again
I just have to "bite the bullet"

cotonpal Sat, Nov-27-21 07:07

Benay - I have been able to add beef back but I still avoid chicken. The foods that bother me may not be the foods that will bother you. I do eat turkey without any problem. I used to avoid raw vegetables, in fact most vegetables raw or cooked, because of the fiber, but I no longer have to avoid fiber. It seems when I eliminated all the offending foods, after a time, fiber from vegetables was no longer a problem. It has certainly all been worth it for me not to have to worry about leaving the house or even leaving the bathroom.

Benay Sun, Nov-28-21 05:05

Thanks Jean

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