Dave 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.
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.
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.
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.
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!