ketogenic

Summary: There are a few mechanisms by which having elevated blood ketones could be therapeutic for IBD, and one case report demonstrated benefit of ketone salts in the context of a low-carb (but not ketogenic) diet for Crohn’s disease. Exogenous ketones can reliably elevate blood ketones as well as or better than a ketogenic diet, without the potential attendant downsides of such a diet. Ketone esters elevate blood ketone levels more than ketone salts, and may be better tolerated, but are also more expensive. MCT oil (particularly pure caprylic acid) can promote ketogenesis in the liver, but has a limited ability to do so compared to exogenous ketones. All of these supplements have various strengths and weaknesses and may be worth experimenting with for someone with IBD who is attempting to achieve therapeutic ketosis, whether in the context of a ketogenic diet or not.

This article is part of the IBD Index. Last updated on May 2, 2022.

In my (rather lengthy) article about the ketogenic diet, I discussed the background, risks, and potential benefits of a ketogenic diet in the context of IBD. Ketone supplements have become popular as both an adjunct to a ketogenic diet and as a way to get some of the benefits of ketone metabolism without the stringent dietary restrictions. But do they actually work? Are they safe? And are they worth trying if you have ulcerative colitis or Crohn’s disease?

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Summary: Ketogenic diets have exploded in popularity for weight loss and overall health optimization. While we are still sorely lacking in clinical research on ketogenic diets for IBD, there are a few compelling mechanisms – particularly modulating intestinal immunity and overcoming energy starvation in colonocytes – indicating that ketosis could be a helpful therapeutic strategy for some people. However, there are also some risks, with a potential increase in hydrogen sulfide production being a particular concern since hydrogen sulfide is often already elevated in people with IBD. Therapeutic effects of the diet are likely mediated both metabolically (by emulating fasting) and via the microbiome, but both of these mechanisms appear to be highly context-dependent, contributing to significant disparity in results across the existing literature on ketogenic diets in health and disease. In the context of IBD, my current assessment is that a strict ketogenic diet could be helpful as a short-term strategy for certain people, but is unlikely to be an optimal long-term strategy.

This article is part of the IBD Index. Last updated on April 27, 2022.

As the name would suggest, a ketogenic diet is a diet that promotes the metabolic state of ketosis. This is generally accomplished by consuming very few carbohydrates, a moderate amount of protein, and getting most calories from fat.

Note that I discuss the carnivore diet separately, because while a carnivore diet is necessarily ketogenic, its defining feature is the elimination of all plant foods, which is not necessary on a non-carnivore ketogenic diet.

For information about exogenous ketones (including brands), MCT oil, and some comments about breath vs. urine vs. blood testing for ketosis, check out my article on ketone supplementation.

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Ketone Supplements for Ulcerative Colitis and Crohn’s Disease

Ketogenic Diet for Ulcerative Colitis and Crohn’s Disease