Keto and IBS: Is It a Good Idea to Go Low-Carb?
Irritable bowel syndrome (IBS), also called spastic colon, nervous colon, and mucous colitis, is a gastrointestinal disorder affecting 9%-23% of people worldwide. [1]
While the exact cause of IBS remains unknown, it can be triggered by processed foods, certain fruits and vegetables, most sugar alcohols, caffeine, and alcohol — among other things like psychological stress and anxiety. Key IBS symptoms include abdominal bloating, pain, cramping, diarrhea, constipation, and excessive gas. [2]
Recent studies have shown that gut dysbiosis or the disruption of the gut microbiome and inflammation contributes to the onset of IBS. [3]
If you’re dealing with IBS and are looking to improve your condition through dietary changes, you might be wondering if the keto diet can help. This article explores the relationship between keto and IBS, what the research says, foods to eat and avoid, and three natural remedies to support your IBS diet.
Keto and IBS: Does a Low-Carb Diet Help?
The keto diet naturally limits your intake of FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) — these are short-chain carbohydrates that are poorly absorbed in your small intestine.
As a result, the answer is yes, going keto can help ease IBS symptoms. In addition, you’ll need to watch out for some sources of FODMAPs that happen to be keto-friendly, such as onions, garlic, and lactose-containing foods and drinks. Overall, however, the keto diet is essentially a low-FODMAP diet, which improves IBS.
Another way that the keto diet may help with IBS is by reducing inflammation, another factor that plays a role in IBS. One study on inflammatory bowel disease (IBD) found that the diet protects the intestinal barrier and reduces the expression of inflammatory cytokines. [4]
Research Studies on Keto and IBS
Here’s a list of studies suggesting that low-carb diets may be effective for people with IBS:
- In a 6-week study, participants (mostly women) with moderate to severe IBS-D (IBS with diarrhea) were given meals with the following macro percentages: 51% fat, 45% protein, and 4% carbs. All participants reported adequate relief from IBS-D symptoms, especially during the last week of the diet.[ref ID = 5]
- A randomized, placebo-controlled, double-blind clinical trial found a significant decrease in clinical symptoms of IBS in all groups that followed a low-FODMAP diet. However, five participants who were given gluten supplementation on top of their low-FODMAP diet experienced worsening symptoms.[ref ID = 6] In other words, avoiding gluten (which is found in high-carb foods like bread, cereals, and baked goods) also helps to resolve IBS.
- Data from a 2021 study showed that the keto diet was able to reduce the effects of stress on the gut in Wistar rats with IBS. As you may already know, stress can result in the overactivity of the gut, which worsens IBS symptoms. [7]
Foods for IBS (Low-FODMAP, Gluten-Free, and Keto-Friendly)
This section lists foods helpful for IBS symptom relief that are low in carbohydrates. They’re also low-FODMAP and gluten-free. However, keep in mind that everyone’s body is different; some foods that work for others may not work for you, and vice-versa.
- Meats and eggs: top sirloin steak, top or bottom round roast, lamb, veal, pork tenderloin, chicken eggs (unless you have an egg allergy)
- Poultry: skinless chicken breast or thighs, turkey, duck, geese
- Fish and seafood: tuna, salmon, tilapia, sea bass, shrimps, mussels, and other shellfish
- Vegetables: spinach, kale, zucchini, tomatoes, green beans, choy sum, red bell peppers
- Fruits: blueberries, strawberries, cantaloupe, lemons, avocado (only in small amounts)
- Nuts and seeds: almonds, walnuts, pecans, Brazil nuts, chia seeds, sunflower seeds
- Fermented foods: tempeh, coconut milk kefir, unsweetened Greek yogurt (for those who can tolerate dairy)
- Sweeteners: pure stevia, monk fruit, erythritol
Tip: Keep a food journal. It could be a simple notebook or app where you can track what you eat or drink daily. This will allow you to further optimize your keto IBS diet by identifying which foods or ingredients you can tolerate or are more sensitive to.
Foods to Avoid (“Diet Triggers”)
Here’s a list of foods to avoid since they’re likely to worsen gas, bloating, pain, and other IBS symptoms. Note that most items on the list are high in carbs; however, some of them are keto-friendly but should also be removed from your diet if you’re looking to treat IBS.
- Grains: wheat, rye, barley, couscous, durum
- Dairy: milk, cheese, ice cream with lactose
- Foods high in fructose: processed foods, salad dressings, sweetened yogurt, canned fruits, canned soup, fast food items
- Vegetables: cruciferous veggies like cauliflower, broccoli, and cabbage
- Fruits: sweet fruits like apples, bananas, pears, watermelons, mangoes
- Sugar alcohols: sorbitol, mannitol, maltitol, lactitol [8]
- Caffeine: coffee, tea, cola, energy drinks with caffeine, dark chocolate bars and candies
- Alcohol: rum, cider, beer (unless gluten-free), dessert wines
Tip: While you’re avoiding these trigger foods, make sure you’re also stocking up with keto and IBS-friendly foods for breakfast, lunch, snacks, and dinner. Also, consider speaking with your healthcare provider about meeting your micronutrient needs — possibly through supplementation — to ensure that you won’t get any vitamin and mineral deficiencies due to eliminating certain foods in your diet.
Natural Remedies to Support Your Keto and IBS Diet
Keto as a dietary change can go a long way toward reducing IBS symptoms, in addition to helping you achieve healthy blood sugar levels and weight loss. Yet, there are also other interventions to try along with your diet so you can experience optimal relief:
- Stress reduction: Mindfulness-based stress reduction, which combines meditation and yoga, greatly improves IBS symptoms. [9] You can also do deep breathing to calm down. Slow down and remember to take time off for yourself.
- Probiotic supplements: These are live microorganisms that prevent the overgrowth of harmful gut bacteria and regulate your bowel movements. [10] When choosing a probiotic supplement, pick one that’s keto-friendly and designed for your type of IBS (IBS with diarrhea, IBS with constipation, or IBS with mixed bowel habits).
- Regular exercise: Working out not only enhances your body’s fat-burning potential and transition to ketosis, but it also reduces IBS symptoms and helps you to feel more in control over the disease. [11] If you’re new to the keto diet, start slow. Low-intensity workouts such as light jogging, cycling, swimming, and yoga are great options.
Adopting a Keto Lifestyle with IBS
Irritable bowel syndrome or IBS can interfere with your life in many ways, and symptoms can range from mild to severe. The good news is that a healthful diet such as keto can be a good approach for IBS relief, especially if you’ve followed other diet strategies, but they failed.
If you’re trying the keto diet for the first time, consider reducing your carb intake gradually or at a pace you’re comfortable with. This allows you to get properly adapted without causing too much stress physically and mentally, which could aggravate IBS symptoms.
Combining a keto diet with other remedies like exercise, stress management, and taking a probiotic supplement (based on your doctor’s or dietician’s recommendation) could lead to noticeable improvements in your health.
References
Saha L. (2014). Irritable bowel syndrome: pathogenesis, diagnosis, treatment, and evidence-based medicine. World journal of gastroenterology, 20(22), 6759–6773. https://doi.org/10.3748/wjg.v20.i22.6759
Cleveland Clinic. (2020). Irritable Bowel Syndrome (IBS). https://my.clevelandclinic.org/health/diseases/4342-irritable-bowel-syndrome-ibs
Andrews, C.N., Sidani, S., Marshall, J.K. (2021). Clinical Management of the Microbiome in Irritable Bowel Syndrome. Journal of the Canadian Association of Gastroenterology, 4 (1), 36–43. https://doi.org/10.1093/jcag/gwz037
Kong, C., Yan, X., Liu, Y. et al. Ketogenic diet alleviates colitis by reduction of colonic group 3 innate lymphoid cells through altering gut microbiome. Sig Transduct Target Ther 6, 154 (2021). https://doi.org/10.1038/s41392-021-00549-9
Austin, G. L., Dalton, C. B., Hu, Y., Morris, C. B., Hankins, J., Weinland, S. R., Westman, E. C., Yancy, W. S., Jr, & Drossman, D. A. (2009). A very low-carbohydrate diet improves symptoms and quality of life in diarrhea-predominant irritable bowel syndrome. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 7(6), 706–708.e1. https://doi.org/10.1016/j.cgh.2009.02.023
Crosby, L., Davis, B., Joshi, S., Jardine, M., Paul, J., Neola, M. Barnard, N.D. Ketogenic Diets and Chronic Disease: Weighing the Benefits Against the Risks. Front. Nutr. https://doi.org/10.3389/fnut.2021.702802
Chimienti, G., Orlando, A., Lezza, A., D'Attoma, B., Notarnicola, M., Gigante, I., Pesce, V., & Russo, F. (2021). The Ketogenic Diet Reduces the Harmful Effects of Stress on Gut Mitochondrial Biogenesis in a Rat Model of Irritable Bowel Syndrome. International journal of molecular sciences, 22(7), 3498. https://doi.org/10.3390/ijms22073498
Mäkinen K. K. (2016). Gastrointestinal Disturbances Associated with the Consumption of Sugar Alcohols with Special Consideration of Xylitol: Scientific Review and Instructions for Dentists and Other Health-Care Professionals. International journal of dentistry, 2016, 5967907. https://doi.org/10.1155/2016/5967907
Naliboff, B. D., Smith, S. R., Serpa, J. G., Laird, K. T., Stains, J., Connolly, L. S., Labus, J. S., & Tillisch, K. (2020). Mindfulness-based stress reduction improves irritable bowel syndrome (IBS) symptoms via specific aspects of mindfulness. Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society, 32(9), e13828. https://doi.org/10.1111/nmo.13828
Dale, H. F., Rasmussen, S. H., Asiller, Ö. Ö., & Lied, G. A. (2019). Probiotics in Irritable Bowel Syndrome: An Up-to-Date Systematic Review. Nutrients, 11(9), 2048. https://doi.org/10.3390/nu11092048
Johannesson, E., Ringström, G., Abrahamsson, H., & Sadik, R. (2015). Intervention to increase physical activity in irritable bowel syndrome shows long-term positive effects. World journal of gastroenterology, 21(2), 600–608. https://doi.org/10.3748/wjg.v21.i2.600
