The Keto Gut (part 2)

The Keto Gut (part 2)

This is part 2 of a 2-part post on how ketosis effects the gut (particularly for IBS sufferers).  For part 1, go HERE

So…..DO you need to supplement with probiotics when eating a paleo-ketogenic diet? Is the answer different for people with IBS issues?

To supplement or not to supplement?  This is a loaded question.  If you don’t have stomach issues, then you probably didn’t even give it any thought before now.  I wouldn’t have.  I’m not a big fan of supplementation.  The few supplements I own are taken sporadically, at best.

As I mentioned in part 1, a healthy gut has healthy microbes, and a damaged gut has an imbalance, or lack of sufficient microbes.  Bad microbes means bad digestion.  Bad digestion is a big part of IBS, (and SIBO, dysbiosis, leaky gut, inflammation…)–which can lead to a whole bunch of mineral and vitamin deficiencies, to food sensitivities, and of course pain and discomfort, aka, my 2pm bloat.

Is this kind of paleo-keto diet harmful, or lacking in foods to support a healthy balance of gut microbes, as people say it is?

Well, first, let me state that I’m talking about a paleo-keto diet, so it is a diet that still advocates real, whole food.  I am not talking about a Zero-Carb diet (where all you eat is animal products) or even a conventional keto diet (aka Atkins).  So is it really lacking in the necessary enzymes to sustain a healthy gut?  I’m still eating {low FODMAP} green veggies, plenty of them, and yogurt, and having the occasional carb-up with something starchy now and then (generally berries, squash, potato or plantains–which are rich in prebiotics which feed microbes).  How many green veggies are enough to keep the gut balanced?  How much starch?  How often?

That, my friends, really depends on your gut.  Every body is different.

Simply put, if you have a healthy gut and your stomach feels good, it’s enough.  If you feel like you’re digesting your food properly, then you have the right amount of gut microbes and you’re treating them just fine.  If your stomach is fine, just keep on doing whatever you have been doing because it’s working great.  Your stomach will let you know when it isn’t working.stock-illustration-21328873-stomach-character-ok

But what about those of us who suffer from SIBO, dysbiosis, IBS?

Is it enough to starve off the bad bacteria by simply avoiding the kinds of carbs that feed the bad bacteria (in other words, is it enough to eat keto because your stomach feels good, finally, now that you’re eating this way?)  Will it actually heal eating this way–or will it just cease to bother you?

There are a lot of keto-advocates who do recommend probiotic supplementation (Jimmy Moore, Leanne Vogel of Healthful Pursuit, and Mellissa Sevigny of I Breathe I’m Hungry, to name a few), regardless of your existing gut health.  But be cautious–there is an abundance of cheap probiotic supplements out there, and most of them use strains of microbes that will in no way help your gut, leading only to expensive poop and frustration. And for people with delicate digestive issues, beware of probiotics that contain high amounts of prebiotics (food for the microbes).  Because while a bit of prebiotics are a good thing, for a person in digestive distress, all the gas and bloating that comes from prebiotic supplementation is like throwing gas on a fire.

What about fermented foods?  Because you can’t go wrong with fermented foods, right?

I think that any gut, even a perfectly healthy one, could use a little of this–but beware!  It is totally possible to over-do the fermented foods thing.   Yes, I have totally caused a SIBO-like effect in my own body by going nuts with fermented foods.  Beware of improper or over-supplementation.

I think that if the gut is damaged, it certainly can’t hurt you to try a little probiotic supplementation.  With this kind of supplementation, timing is everything.  I know it says on the pill bottle ‘take with, or without’ food–but probiotics really work best when taken right before eating a meal that contains the kind of things that probiotics will consume.  Give your little microbes a healthy start in life, will you?

If you DO choose to try probiotic supplements, evidence points to choosing probiotics containing Lactobacillus plantarum.

This little bacterium has been shown to actually help heal intestinal permeability, which is a HUGE issue with just about any stomach and digestive issue.  These bacterium, by the way, seem to love feeding on fermented foods.  So it’s win/win.  Take your supplement with a little raw sauerkraut or a bit of yogurt before settling into your main meal.  See how your body accepts that.

There is, however, a point at which you have to stop micro-managing and let your body do the work on its own, as it is meant to do.  If eating a paleo-keto diet makes your stomach feel good, then keep it up!  The best way to heal your stomach is to avoid causing any further irritation, to go easy on it and give it time to heal.  Maybe that’s the secret to ‘curing’ your IBS with keto–just giving it the time it needs to heal itself.

The unfortunate truth is that you get your gut microbes from your mother, and they are pretty much dictated at birth.  You can improve them, temporarily, by doing all kinds of things.  But only temporarily.  They will eventually return to their own idea of ‘normal’ if left alone.  You can destroy them through a lifetime pattern of bad food and nutrition choices.  And maybe that is permanent, maybe it is not.  Maybe all the supplementation in the world can only bring your gut micro-biome back to its ‘normal’ state—that which you were born with, for better or for worse.  At least that’s better than the state they are currently in, right?

Ultimately, the impact of a low-carb diet on the gut is not well understood.  It makes sense that if you go for a very long time without the dreaded 2pm bloat or other IBS symptoms, you may feel ‘healed’.  Maybe, given enough time, the bad bacteria will starve and die off.  Unfortunately, here in Canada, most doctors don’t recognize the kinds of tests that can identify SIBO, and so they won’t actually treat for it with antibiotics or any other drug.  We’re kind-of on our own with diagnosis and treatment.  So the only proof of how healed your IBS is, is simply how you feel.  Abnormally low iron and B12 are signs of a leaky gut and dysbiosis, so a return to normal levels are a good sign–though low iron and B12 can also be caused by other underlying health issues–improvement in those numbers at any time is a good thing.

But the big question remains—can a low-carb/ketogenic diet CURE IBS?  Not from this perspective.  The diet can manage IBS quite well.  But if your goal is to one day return to eating crappy food, then no, it won’t do this for you.  Why would you want that?  It will, however, lower your food sensitivities by allowing your gut permeability to heal, and to reduce the levels of bad bacteria in your small intestine.  Combined with the proper supplementation, you can improve your ability to digest your foods, to absorb nutrients, and hopefully to reduce your body’s inflammation.  And maybe you can be lulled into believing you are cured.  Until that day when you head to McDonalds and try to eat a double quarter-pounder with fries and milkshake.  Ugh, makes my stomach hurt just thinking about that.  Don’t do that.


courtesy of Eat Out Well

This is the body you were born with, take it or leave it, it’s the only one you have, whether you were given a crappy digestive system, or whether you created a crappy digestive system, this is all you get.  All you can do is attempt to mitigate and alleviate.

I, personally, am loving how keto has helped me with my stomach issues.  Maybe, like it has with all other dietary changes, my IBS will return in time.  Or maybe not.  Maybe this is the end-all solution, finally.  There are not enough words to express my gratitude over the disappearance of my painful 2pm bloat.  For that, all of the ‘restrictions’ and ‘food rules’ relating to eating this type of keto-paleo diet are priceless.



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