Dave Asprey’s Take on the Keto Rash

blog-148-2-300x300Dave Asprey, the Bulletproof Executive briefly discussed his thoughts on the keto rash in his most recent Q&A session.

Before going into this, I want to first thank Jasmine from jasminesvision.com for alerting me to this a few weeks ago.

Beginning at the 41:50 mark they address the question of:

“What are your thoughts on Keto rash and it’s causes or processes. It’s not everyone, so why some and not the others. Is that genetic? And is the only cure carb consumption. It would seem as though waiting it out as if it were a detoxing mechanism is risky, as it can cause scarring.”

You can listen to the full podcast here.  If you would prefer to read Dave’s complete answer, they have generously provided the full transcript here, although there are quite a few transcription errors…

With regard to scarring, Dave admits that he isn’t familiar with whether it can cause scarring or not, but suspects that scarring is more related to sun exposure rather than keloid formation.

In terms of causes, Dave thinks that it’s related to toxins, such as mercury, DDT, pesticides, estrogen disruptors etc. that are released when the body starts to burn fat…

OR it can happen with there is yeast or certain bacteria in the body.  Supposedly yeast and bacteria get stressed when they don’t get food or they get things that are bad for them, causing them to pump out a lot of toxins as a survival mechanism.

If you eat carbs, the fungus or bacteria in your gut that like carbs relaxes, and when they relax, they don’t release toxins, improving the rash.

He says you can try binding toxins like activated charcoal, calcium d-glucarate, glutathione, and chlorella or try taking antifungals.  He suggests a natural antifungal like grapefruit seed extract.  He also suggests berberine and garlic, but doesn’t really go into the mechanism of action.

My Thoughts


In all the literature I’ve come across, there has not been any report of scarring or keloid formation.  What does occur is hyperpigmentation, which basically means having dark spots where the rash occurs.  There is a dermatologic term called ‘postinflammatory hyperpigmentation,’ which is what I think this is.

The rash arises due to inflammation (from what we’re still not sure) and once that inflammation is gone, there is residual hyperpigmentation, hence postinflammatory hyperpigmentation.  The important thing to know is that this is temporary, and in my own personal experience completely fades within a few weeks, although I have noticed that the longer I allow the rash to hang around, the longer it takes for the postinflammatory hyperpigmentation to resolve.

This postinflammatory hyperpigmentation can also be related to sunlight, so Dave was spot on there.

Toxin Release from Fat Burning

Dave seems very confident that this is the cause which I find a little strange because there isn’t any evidence of this in the literature.  This doesn’t mean that it isn’t the cause, but I would personally need some amount of evidence before I could say for sure.

There are other suspected causes that have nothing to do with fat burning, such as heat, mechanical friction, emotional stress, and sweating to name a few.

A question that immediately comes to mind is: why doesn’t his occur when people lose weight without being in ketosis?

I’ve had some success with weight loss and body recomposition without being in ketosis with no trace of this rash.

I suspect that many of the folks that report keto rash have also had some success burning fat without using a ketogenic diet with no prior rash.

Again I’m not saying that this isn’t the cause, it’s just that I would like more evidence.  I’d love to see any sources available out there that discuss this (outside of forum posts and blogs).

Unhappy Yeast and Bacteria

From the way Dave explains things, I think he is primarily referring to the gut organisms as opposed to skin flora, but this can be open to interpretation.

While we have seen some studies that have found associations with skin organisms such as H. Pylori and Borrelia, there isn’t anything out there examining the relationship between this rash and gut flora.

I’d also like to see some evidence of this in the literature before fully accepting this as the explanation.  If anyone has any sources they can provide on this, please send them my way.

Binding Toxins

I’ve used Dave’s activated charcoal in my own experiments and didn’t really find this to be of any help for the rash.

I can’t say that I’ve had any experience with calcium d-glucarate, glutathione, and chlorella, so if anyone out there has tried these things please let us know how it worked out for you.


We know from the literature that the use of topical antifungals aren’t very effective.

I’ve also had a few commenters chime in that they’ve tried topical grape seed extract or oral grapefruit seed extract without any followup, so I can’t really comment on the effectiveness of these.  Also I’m not sure if the commenters who mentioned grape seed extract actually meant grapefruit seed extract, or if grape seed extract is a completely separate thing…

If anyone has tried these out, I’d love to hear how things turned out.

Garlic and Berberine

I’m not sure why these would work.  I know garlic has antimicrobial effects so maybe that’s the reasoning behind garlic.

All I know about berberine is that it stabilizes and lowers blood sugars… so it seems counterintuitive that this would be helpful, since a lowered blood sugar would promote ketosis…

If anyone can shed any light on this, I’m all ears!

Connect With Others

More posts are also trickling in on the Keto Rash Facebook Community, so feel free to chime in over there. If you don’t have a Facebook account, you can try posting in the Keto Rash Forums.

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  1. A-K

    I’m sure you have come across this blog but if not it is worth researching (here is a lot to read on there) http://coolinginflammation.blogspot.de/2014/03/health-diagrams-ii-curing-autoimmunity.html

    I had a rash on my chin for about 15 years (from when I was 16 years old) called perioral dermatitis, this is supposedly related to Rosasea (“inflammation of the face”). They don’t quite know what causes it. It’s mainly women who gets it.. it’s not heredity, it’s not a virus and not a local bacterial inflammation. The only thing that seemed to rid it for the first 10 years was antibiotics and a lot of it (6 months at the time). Going low carb seemed to calm the outbreaks down slightly but going stricter would aggravate it! So it would never totally go away and my gut could not handle more antibiotics. I finally came across Dr. Ayers blog and from some of his casual suggestions of what could improve these kind of conditions (in theory of course) I set up this protocol (scroll to the end for the summary) http://matfysik.wordpress.com/how-to-heal-gut-flora/ Basically his idea was to go low carb, add antimicrobial components to the diet such as lactoferrin to destabilize the biofilm and and introduce a range of prebiotics. The rash just got worse and worse for the 7 weeks I followed this protocol and 7 days after I stopped and started eating normal low carb (not strict) the rash totally diapered, after being fixed on my chin for 2 years in a row at that point. Not a coincidence. 6 months later it started returning a little (after a week in Italy where I binged on pasta after being low carb for 6 years). Recently I started using some bioidentical progesterone cream (have PCO) and this also improved/got rid of the little rash that had been sneaking back. Gut flora composition and estrogen dominance, I think there is something there that disrupts the skin. – My thoughts. Thanks for reading if you made it all the way through! 🙂 /A-K (from Sweden)

    1. bjjcaveman@gmail.com (Post author)

      Thanks so much for sharing. I read every word of course.

      From what you describe I’m not entirely sure that your rash is the keto rash. Usually with keto rash it goes away when you eat carbs… whereas in your case it seems that the rash disappeared when you went low carb after you embarked on the gut healing protocol.

      I do find the possibility of a gut-skin connection very interesting… in fact lately I’ve been wondering about the normal skin flora and if that can be imbalanced… like how the gut biome can be imbalanced. Perhaps due to exposure to certain antibiotics or cleaning products etc alters skin flora, creating an environment for keto rash… but this is just speculation.

  2. Jim Jozwiak

    I would suggest experimenting with a higher level of dietary Retinol.

    1. bjjcaveman@gmail.com (Post author)

      What is the mechanism behind the benefit of retinol? This isn’t something I’ve heard of before, and I’d like to learn more.

      1. Ben Hoffman

        Retinol is an animal form of vitamin A which can have very potent effects on the skin. I used Retin A for acne when I was younger, which is derived from retinol, if I understand it correctly. It’s very effective at treating acne, but it’s also dangerous enough to require frequent blood testing for liver health while on it. As a teen, my face was greasy, but now I have dry skin, especially on my face. It’s been about 18 years since I stopped using it. Ok, backstory over.

        Now, if I take a single high dose of retinol orally or topically (20k IU, IIRC, but don’t quote me), the skin on my face becomes much better hydrated/lubricated for a couple of days and clears up if I have any minor blemishes. Obviously, N=1, but it would makes sense that a number of skin conditions might respond to retinol.

        You don’t want to take that dose frequently, as even standard retinol (as opposed to plant sources) can be toxic.

        1. Ben Hoffman

          Oops, I was wrong about the drug in the last post. While I did use Retin A, the one that worked and was dangerous was Isotretinoin, or Accutane, which is another retinol derivative.

  3. Shari

    You question the possibility that the rash could be from toxin release. Based on my experience, that is what makes the most sense to me. Here’s why.

    I have dieted in the past without going into ketosis. I restricted carbs, but not to the extent to go into ketosis. I lost weight, I did not get a rash. The weight loss was slow, so the fat I burned, and the toxins they held, were easier for my body to process.

    Now that I am on a very low carb diet that puts my body into ketosis, I am getting the rash. I am loosing weight quickly (16 pounds in 25 days). My body has had to process a significantly greater amount of toxins in a short period.

    There have been other times, when not dieting, that I have gotten a small rash on my body. I was seeing a chiropractor at the time and, without telling her about the rash, and without her seeing it, she would perform an adjustment at the rash site. I tracked this for several visits and, every time she would adjust at the spot where I had a rash and, after the adjustment, the rash would go away. I finally mentioned this to her and asked her if, due to my back being out of place, could there be pressure that was causing toxins to come to the surface. She wasn’t certain this was the case because she had never heard of anything like this, but she thought it was entirely possible.

    I have sensitive skin that reacts to just about anything. With all the toxins I am likely releasing through my pores, it makes sense to me that my skin would react.

    I have spent the day following links and suggestions from your site and your visitors. One thing I looked into was clays. I noticed this statement from a site about the use of Sacred Clay (http://www.vitalityherbsandclay.com/index.php?option=com_content&view=article&id=386:sacred-clay-instructions-for-use&catid=79:product-instructions-for-use&Itemid=289): “The pain and discomfort of detoxing is most often due to toxins only partially removed from the body now hanging out in the tissues. If toxins are only partially pulled from the body (which can happen when using the clay by itself without salt) leaving some toxins still in the tissues, detox symptoms of low energy, sluggishness, irritability, spaciness, flu-like symptoms, achiness, rashes or an increase in pain, etc. may occur. Once removed, they cease to cause the discomfort.”

    I’m not sure yet what solution I’ll try first. The grapefruit seed extract looks like the easiest route, but the clay, while not as pleasant, may be more productive in pulling out the toxins that my skin appears to be reacting to.

    I’d like to reserve adding carbs back into my diet as a last resort because I like the fast weight loss I’m experiencing. Carbs will slow me down. I’m hoping I can ease the rash until I reach a healthier weight. Then I’ll gradually add the carbs back into my diet.

    1. bjjcaveman@gmail.com (Post author)

      Thank you very much for sharing! Please come back and let me know how things go for you and what you find works best!

      I myself have found a lot of success by using antibiotics. While I haven’t officially written about it yet, I took a 10 day course of doxycycline a little over a month a go which made my rash go away completely. On days I was back in ketosis… the rash never came back! Even now! Although I’m not in ketosis at the current moment because of all the Thanksgiving eating…

      I plan to write a fuller explanation in the coming weeks about my experience.

      I hope the clay and or grapefruit seed extract work for you!

  4. debbie schuelke

    Thank you for this information. I finally might have some answers of why i get a rash every time I do the paleo, Atkins and fat flush zone diet. This has been an issue for me for about 15 years whenever I do any of these diets. Nobody ever had an answer for me why I would get a rash. It would always start in the back of my neck then spread down my spine. Then it would move to under my chest and start getting lower until I are normal. Even if i ate just oatmeal that would help.

  5. allo

    Thanks for this website which helped alart me to the link between the atkins/ketosis diet and Prurigo Pigmentosa, also provided links to studies which back up your suspicions. You do well to avoid blaming “toxins” and other such essentially made up theories! Quite why you give this Dave, who is no doctor by any means, so much prominence is beyond me although you do a good job of pointing out the flaws in his reasoning. Your theory is much more sound and has some solid science behind it, plus the strong anectobdal evidence that eating carbs makes it go away. Good info here, and the vast majority of GPs will not have ever heard this (most dermatologsist probably would not know of the link with diet I suspect). So this could prove vital for some. Well done! My GF has developed this we think, so we might send a full list of outcomes. You need more pics on this site. I suggest a Symptoms section also.

    As you note elsewhere, antibiotics are fairly well known to be antinflammatory it is possibly why they may help with acne, not just the anti bacterial action. So for me it makes perfect sense why it may help this condition – there is no mystery here, thoughts of bacteria, fungus, yeast and toxins seem well wide of the mark. From what I gleaned, the causative factors seem to be modulated neutrophils/white blood cell activity affected by ketones through as yet unknown or undescribed mechanisms as you also note elsewhere.

    1. bjjcaveman@gmail.com (Post author)

      Thanks for the kind words!

      You’re right, having a symptoms section would probably be helpful. I’ll try to add that in when I get the chance. Perhaps with pictures of the rash in various stages.

      Dave Asprey is currently gaining steam in the health space with his bulletproof branding, and a lot of people turn to him for issues about the keto rash, especially since the diet he advocates falls on the low carb / keto / cyclic keto spectrum, so I felt it was necessary to at least dedicate some space to this… after all, he has a much wider reach and bigger audience than I do.

      I’d love to see your list of outcomes, and wish you and your GF the best of luck in handling her issue!

      If you’d like to write a guest post on your experiences just let me know!

      1. allo

        Just a quick update. This rash of my GF’s came on after a full 4 weeks of the diet. After we learned about the potential link to keto, she started eating carbs. After 4 days it has all but completely cleared up.

        It suggests there no fungal element or anything else – it is exactly what you said, induced by a very low carb diet, something related to changes in metabolism. A post below mentions fungus, but then reports symptoms *opposite* to what your blog is about ie caused by low carb, not induced *by* it. I’m sorry for that poster as they have a distressing condition but it clearly isn’t the same disease/ailment.

        By the way. The GP had no idea about this. She firmly said it could be nothing to do with diet and prescribed an antibacterial, anti fungal cream. She was also going to move onto scabies as a treatment route if that didn’t work, while admitting it didn’t actually look like scabies.

        So, I think this really needs to get out there to followers of atkins and low carb diet. People could end up going down a long treatment path, and getting worried for no reason if you don’t make the connection.

        On a side note, I was on same diet, I had no such symptoms. So it affects some, not others. Well, that’s what we found.

        1. bjjcaveman@gmail.com (Post author)

          Thanks so much for the update!

          Right now, I don’t buy the whole fungus thing either, but it seems to be an idea out there that has some traction so…

          Have you and your GF decided what you’re going to do next? Continue keto?

  6. carolyn

    I started getting the Keto rash only after 4 weeks of being on the diet so I am increasing the carbs with whole grains. I wonder why some people get the rash and others on the Keto diet are not affected. What’s the difference in those peoples metabolisms?

    1. bjjcaveman@gmail.com (Post author)

      I wish I knew…. At this point no one knows the answer to this.

  7. Rowena James

    I have hypothyroidism and since I’m going through a divorce have been under a lot of stress. I started getting fungal skin infections on my arms, chest and under arms. I had been to my doctor for treatment for the fugal infection. I used the anti fungal topical cream mixed with cortisone. The rash cleared. To my dismay it returned after two weeks. Since I didn’t have any more money to go back to the doctor I used coconut oil to try and control the rash. I was also taking probiotics. During this time I found out about the health benefits and added ‘side effect’ of weightloss of the HFLC lifestyle. I embarked on this lifestyle and found a group that taught me a lot about ketosis. After a month my fungal infection cleared and I felt much better. I then ate cake at a party. To my dismay I ended up with these little blisters that covered my arms and were every bit as itchy as the fungal infection. I treated the rash with coaltar cream and am happy to report it has cleared. My skin is a bit dry though. I hope this has helped. I tend to agree with the idea of fungus being a culprit.

    1. allo

      This doesn’t sound like the “keto rash” as it happens when you eat carbs, not avoid them..

      Sorry to go off on one, but have you ever been tested for Coeliac disease? Dermatitis Herpetiformis is a fairly rare skin condition “chronic blistering skin condition,[3] characterised by blisters filled with a watery fluid.” (wiki)

      It is found in some people with Coeliac disease and is very itchy. It can come on at any age. Sufferers do not always have the full symptoms of Coeliac disease (ie your gut may not be in that bad shape, you may still get the rash triggered by gluten). Doctors are not usually very well informed, it took me years to get a diagnosis, during which I suffered quite a lot from itch.

      It may be gluten in a cake triggered it, and that it cleared when you avoided carbs (ie including gluten), though it doesn’t resolve immediately. Look it up, your fungus theory might be a complete red-herring.

  8. Ellie

    I have first went on to a keto diet in 2008, I didnt know enough about it at the time & had an extremely severe reaction to it. Symptoms were migraine, severe fatigue, my body ached all over, nausea, head fog, hives and to top it all off I couldnt breathe. I had no idea I was so far into ketosis I had become acidic, I ended up in hospital for a week with a near fatal asthma attack and ended up weighing 7.5 stone- Im 5’8″ so not a good look. I am still on the ketogenic diet because I feel sick and bloated eating carbs, only now I monitor it with urine analysis sticks. I would recommend anyone doing a keto diet to monitor themselves in some way and also keep a food diary. What I have found is that I run into problems if there are not enough vegetables, particularly greens in the diet. Do not underestimate the effect the microbes in your gut has over your entire body. If you do not supply your gastro intestinal flora with enough fibre and whole phyto nutrients it can disrupt your immune system, your serotonin levels your energy levels, and pretty much your entire body. It isnt good be to far into keto either- there is an optimum for fat burning, exceeding this level appears to make the body acidic, I have noticed that low pH particuarly with high specific gravity means I feel ill. Another extremely important thing to remember is to drink enough, if you are dehydrated whilst in keto it will cause problems, it shows as a high specific gravity. I can often reverse issues of “keto flu” by drinking several cups of luke warm water with a small pinch of sea salt so you dont flush out all your electrolytes. From previous experience I am wondering if keto rash is caused by inflammation due to prolific growth of certain types of microbes in the gut caused by eating protein and fats. The reason anti biotics calm it all down is because they indiscriminately kill a wide range of microbes, however as you proceed with the diet the problems comes back. I am currently experimenting with eating cabbage, peas, green beans on a daily basis and also introducing wild greens, ie stinging nettles (cooked)chick weed, cleavers, purslane, dandelion. This should increase the quantity and diversity of gut flora, which should I hope stabilize any inflammatory immune system response. I haven’t taken antibiotics since 2008, when I removed sugar and processed foods from my diet. I am able to fight off colds and even bacterial infections using garlic and Thyme(garlic is also a probiotic). Sometime I deviate from the keto protocol, but I always return because I feel better for it.

    1. bjjcaveman@gmail.com (Post author)

      I think you’re really onto something in that keto can really do a number on gut flora.

      It really is an interesting theory regarding the link between gut bacteria and keto rash. that could explain why taking antibiotics can actually treat it.

  9. william chirigotis

    If you suffer skin problems you need gelatin. Collagen will also work miracles. Its the aminoe profile thats missing in some diets and adding it to my diet changed my health so much . I encourage you to try it!

  10. Rolf

    I know what you’re talking about with the enaitg and I’m not even sick! UGH! I sort of wish I was to have some type of excuse. Well, wait no I don’t!~ LOLAnywho, hopefully you’ll get to feeling better soon and get back on track quickly with the enaitg and exercise! Hopefully it’ll give me a little inspiration as well! UGH!

  11. sam

    Why are there no i’s in any of these comments? Intentional? Swedish translation errors? Everyone has the same key stuck on their keyboard?

Comments are closed.