Crohn’s disease is difficult to manage. The condition is long-term and requires drugs like steroids to keep you in remission. These drugs often have nasty side-effects, which makes the life of Crohn’s patients even more difficult.
The fact that there is no cure for the condition means some people need to take life-long medicines. If medicines stop working, patients might have to undergo surgery and lose a part of their bowel, making life even more difficult.
In such circumstances, it is no surprise that many diets have been touted as a cure for Crohn’s. One such diet is the ketogenic diet. So what is keto diet and can it cure your Crohn’s? Let’s find out.
What is Crohn’s disease?
Crohn’s is an autoimmune condition, where the body attacks itself (particularly the gut). This leads to symptoms like:
- Chronic, non-bloody diarrhea
- Abdominal pain
- Fat malabsorption
- Weight loss
Doctors don’t really know what causes Crohn’s. But just like every autoimmune disease, we know Crohn’s has two components — a genetic predisposition to the disease and an environmental trigger.
Some people argue that since Crohn’s is a disease of the gut, the diet we eat (and its effects on our gut microbiome) may very well be the trigger that has been eluding us. This is the basis of diet therapy for Crohn’s and why some people believe a keto diet can hush away your symptoms. So what is a keto diet?
What is a keto diet?
A keto diet aims to eliminate (or drastically reduce) your carbohydrate consumption. It replaces carbohydrates with fats, which are the main focus of the diet. Proteins are taken in moderate amounts as well.
Our bodies run on carbohydrates. When you deprive them of carbs (by eating a keto diet), you put the body in starvation mode. The body starts breaking down its fat stores and uses the fat you consume in diet to create ketone bodies, which are then used as a source of fuel.
This is why some people experience tiredness and fatigue when they start a keto diet — the body does not normally run on ketones.
So why do people think reducing carbohydrates can improve Crohn’s symptoms? Are carbs bad for Crohn’s? Let’s discuss.
Are carbs bad for Crohn’s?
We’ll preface this section by saying that no food item has been scientifically proven to cause Crohn’s disease.
Nonetheless, here’s a theory some people believe. Undigested carbohydrates promote the activity of certain bacteria in your gut. This leads to the release of toxins, which damage the lining of your gut. Since the lining of your gut has the enzymes necessary for carbohydrate absorption, the body can’t absorb carbs now. This sets up a vicious circle and may trigger your Crohn’s symptoms.
In this study, scientists measured the effect of specific carbohydrate diet (SCD) on Crohn’s patients. You can think of SCD as a more extreme version of the keto diet, where the goal is to completely eliminate all carbs from the diet. 33 participants reported that their symptoms went away completely, while many others reported improvement in their condition.
This study does support the theory that carbs are bad for Crohn’s patients (and that a keto diet may help you with your symptoms).
But that’s just one side of the theory. Other experts believe that getting around 20 grams of fiber (which is rich in carbs) daily can keep your Crohn’s symptoms in check. However, once you develop a flare-up, it’s best to reduce the fiber in your diet as too much of it can get stuck at a stricture. Strictures are narrowed areas of your bowel and they are common in Crohn’s patients.
This means we don’t have a clear answer to whether carbs are bad for Crohn’s patients. Let’s discuss what science has to say about the keto diet for Crohn’s.
Is a ketogenic diet good for Crohn’s disease?
We don’t have enough scientific literature to conclusively say whether a ketogenic diet is good for Crohn’s. However, several studies have reported improvement in Crohn’s symptoms with a keto diet.
For example, this case study describes how a 14-year old boy who didn’t benefit from Crohn’s drugs was able to discontinue his medications within two weeks of a keto diet. Another study looking at twelve children with Crohn’s reported reduced symptoms and inflammation in the subjects after 12 weeks of a keto diet.
This means while the scientific evidence for keto’s benefits is scarce, it’s certainly present and future studies will clarify things further.
At the same time, here’s an alternative explanation of the results of these studies. A ketogenic diet is low in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols). And it’s possible that a reduction in FODMAPs is the real reason behind reduced Crohn’s symptoms. FODMAPs are classically associated with irritable bowel syndrome but may also play a role in Crohn’s disease.
Here’s another caveat to consider. A keto diet requires you to eat large amounts of fats. Many Crohn’s patients have lactose-intolerance. Lactose is a sugar found in large amounts in fatty foods. So if you have lactose-intolerance, a keto diet may actually worsen your symptoms and cause bloating, nausea, and abdominal pain.
We understand that evidence for a keto diet for Crohn’s is mixed. You may be confused about how to use it for your Crohn’s symptoms, so here are some general principles.
How to use a keto diet for Crohn’s disease?
The best way to use a keto diet for Crohn’s is under the supervision of a doctor or nutritionist. That’s because as a Crohn’s patient, you may already be lacking calories and certain micronutrients. If you tinker with your diet without expert advice, you may develop malnutrition or dangerous symptoms from nutrient deficiencies.
You should also understand that a keto diet (or any diet, for that matter) is not a substitute for your Crohn’s drugs. You can try it to augment medical therapy, but you should never discontinue your Crohn’s drugs until your doctor tells you to.
Finally, if you’re not willing to go on a full-blown keto diet, consider an elimination diet. such as a low FODMAP diet. This is where you eliminate certain high-risk foods for Crohn’s and add them back to your diet one by one to catch the culprit that has been triggering your symptoms!