Earlier this year I received an e-mail from Rainer Haarfeldt MD, a physician in Germany. He described how he managed to treat keto rash while staying in ketosis simply by increasing his carbohydrate intake by 10 – 20 gm per day.
While this wasn’t possible with me, the fact that it was effective with Dr. Haarfeldt definitely makes this a method worth considering.
My name is Rainer, I´m from Germany and I´m a medical doctor for internal medicine.
I´m engaged in endurance sports (mountain running, biking, cross-country-skiing)f or 35 years and work with many athletes (endurance sport).
I tried the ketogenic diet first in 2013 and suffered the keto rash after one week in ketosis till I stopped the diet (two months). I did it again in 2014 (March and April) and October and everytime the keto rash came after one week in ketosis. I couldn´t do anything against it.
First I want to thank you for the great job of making the homepage about the keto rash – it was a relief for me to see, that I was not alone with this problem.
I read about adding some carbs to avoid the rash and tried it this year. I started the ketogenic diet on February 1. After one week really low carb (about 20 g/d) the rash was there and then I started to add 250 ml vegetable juice (3.5 g carbs /100ml) – makes about 8g carbs per serving – in the morning and for dinner and the rash disappeared almost completely.
Then I went down on once a day and the rash came back.
Again twice a day – the rash disappeared. I check the ketosis with blood ketones and the ketonix sport and I was always! (two month) in ketosis – the ketone levels between 0.5 and 3.5 mmol/l.
When I was on a trip in the mountains,Ii used a bar with almonds and honey (about 10 g carbs) and it worked the same way. So, for me it was possible to stay in ketosis and avoid the keto rash with only slight changes.
Only wanted do let you know about it – may be, it can help other people to!
I asked a little more about his regimen to clarify things and this is how he responded:
You are completely correct! I normally eat really low carb during ketosis, because I hate to count and weigh my food. So mostly fat, moderate protein, nuts and so on. Salad and vegetables, I don´t like during ketosis, so I mostly avoid them. Fruits I don´t eat at all.
My fiber I get from inulin and self fermented sauerkraut. I guess, I eat not more than 20 to 30 g of digestible carbs a day.
The additional 10 to 15 g a day carbs from easily to digest sources stop the keto rash completely and I´m far away from falling out of ketosis.
For me there seems to be no connection between the ketone body – levels and the keto rash… I would rather suggest a connection to the gluconeogenesis occurring after sport sessions. The additional carbs seem to stop or slow down the gluconeogenesis somehow… (I also checked the blood glucose and the readings were much more stable and lower with the additional carbs).
Most recently he just sent me this update:
Thank you for your response. For me it´s no problem, if you mention my full name together with “MD”. If someone wants to contact me for further information or questions – no problem.
I have some more information for you. In July I competed in a 4-stage long-distance trail-running race (4-Trails) here in Germany/Austria. I wanted to test, if the ketosis is usefull for these long distance competitions.
I entered ketosis 7 weeks before the race, after one week the usual keto rash, which disappeared with the addition of about 10 to 20 g carbs (vegetable juice).
The training for the race was perfect, also more than 20 hours of training in week 4 before the race made no problems and I felt perfect and in very good shape and the keto-rash did not come back.
During the race the situation changed from the first day on. After the first stage the rash was back as strong as never before and during the next days my fitness decreased in an for me unusual way. The most important thing was, that my muscles did not properly recover after the stages and the keto rash became worse every day.
After the 3 stage I stopped the “experiment” and went out of ketosis. I could finish the race, but the result was not as good as expected.
After one day of normal nutrition (still paleo, but not ketogenic) – the rash started to disappear.
For me, this was a strong hint, that my assumption, that the keto rash is connected with gluconeogenesis, is true. Under normal circumstances (little bit more carbs, normal training) it was possible to avoid a higher rate of glucogenesis and thereby the ketorash.
During competition I slightly went over the intensity level, where my body is using only fat as fuel and I had to produce the needed carbs through gluconeogenesis. The needed protein my body took from my muscles (bad muscular recovery) and the higher rate of glucogenesis made the keto rash “explode”.
For the future I will use the ketogenic nutrition in times of basic endurance, high volume training, because its a perfect tool, to improve the fat burning efficiency of the human body. For competitions I will use the paleo carb backloading protocols (Cordain).
If you’d like to contact him directly he kindly provided his e-mail: