Relationship Between Gut Biome and Keto Rash?

Recently posted in the Forums, a reader with keto rash wonders if there is a connection with a stool analysis that was done previously.

Hi Philip,

Thanks for your website – it’s good to know I’m not the only one that has suffered. I too get a rash when I embark on a high fat, low carb diet. It’s happened to me at least twice now and usually comes on about 1.5 weeks or so into the change in diet. For me it starts in my arm pits and then spreads across my trunk, although my skin as a whole feels very hot/irritated.

The first time it happened I went to my GP because I was worried I had aggravated my psoriasis (usually just small patches on my elbows). My GP confirmed it didn’t look like psoriasis, said it was some kind of dermatitis, and gave me some hydrocortisone cream to try. Didn’t help, neither did coconut oil, or almond oil. Anyway, after a few sleepless nights I decided to give up the diet being pretty sure my skin problems were related. Sure enough, the rash went away.

Just recently I have tried again but this time not being quite so low carb (still eating my low GL granola, natural yogurt and berries for breakfast!) in the hope it would prevent the rash. Still, after about 2 weeks this time the rash started to kick in. Recognising the signs and not wanting to go through that again I have just upped my carb intake. How I wish my body had a diagnostic button I could press!!

Anyway, the main reason I’m posting this is to let you know about a stool analysis I had done a while back lest it may be of use. It showed that I had (and probably still have as I have done nothing to try and eradicate it as yet) five additional bacteria present in my gut, including high levels of Pseudomonas Aeruginosa (PA) and Acinetobacter bacteria, the former being a probable pathogen. Levels of Lactobacilli and Bifidobacteria were also on the low side. In addition, the test showed elevated levels of long chain fatty acids and phospholipids in the stool suggesting fat malabsorption in the small bowel and possible pancreatic insufficiency.

The report indicates the PA bacteria may be susceptible to Ciprofloxacin, and also possibly to Uva-Ursi, Plant Tannins, Berberine, and Oregano Oil in order of in vitro effectiveness. I haven’t to date tried any of these, instead preferring to let sleeping dogs lie. though I’ll keep notes if I do decide to try any of these. Maybe the pathogenic bacteria and/or the fat malabsorption are linked to the keto rash?

No yeast was found but apparently that does not mean there is none present in my gut. That is another thing I wonder about. Maybe the additional fat is feeding the bad bacteria and/or yeast and so causing it to proliferate? One of the things I like about eating this way is that my chocolate cravings go away. Maybe the reason for that is that whatever is causing those cravings is being very well satiated by the increased fat intake?! Just one of the many theories I’ve pondered, maybe you or others following this forum have their own thoughts/insight on this?

It would be interesting to find out whether these bacteria and/or fat malabsorption are a common thing amongst those of us who get the rash. I can forward on the report for your records if you feel it may be of use but I think this is a fair summary of it.

Keep up the good work.

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  1. Beth

    This is very interesting, thank you for posting. I had the rash twice and I just increased carb intake to bring it back down. However, I did talk to a dermatologist about this, just socially, and she suggested I might have something called a “leaky gut.” I think this is a little on the alternative side and not completely accepted by general medicine, but it sounds similar to your conclusions. Perhaps google this, that is, that we have compromised our ability to absorb nutrients. On another note, however, she said since I have the unfortunate tendency to get the the rash then I will most likely get it again if I go low carb.

  2. Asuru

    This is very interesting as far as I am concerned. I had low carb/high fat diet for many years, but I didn’t have any problems with keto rash. Then one of my relatives went very sick, was in the intensive care and infected with Acinetobacter bacteria there. I was accompanying him, and they told us to be very careful because of the bacteria. In the mean time I started to get the rash. I didnt think much at the time, I was thinking may be this is from the bacteria etc., but the dermo told me that it was stress related. Anyway, fast forward 4 yeras, rash coming and going, finally founf this page and now I eat a little bit more carb and less fat, and my rash is under control. Just wanted to add to your bacteria theory.

  3. miche16

    Hi there

    I had the rash when I first embarked on a water fast. The doctor was stunned and said that it may be related to something in my gut because my tongue was also white which is an indication of fungal/yeast overgrowth. I dont know if anyone else has noticed that at all. I am convinced that there are bacteria/fungas that are stored in the fats around the stomach which ‘rebel’ when that fat is being broken down. I have previously lost weight by going veggie declaring that I would rather give up meat than carbs! now I am Keto plus doing intermittent fasting because I have had a persistent layer of fat on my stomach. I think people who have had a very carb heavy diet are more susceptible.

    Now the rash is not so itchy but rather like a burning sensation even when my body temperature changes it get more painful. So how am I combatting it? Topically I have applied organic coconut oil with Black seed oil and emu oil. Black Seed oil is a very powerful anti fungal and anti microbial. I used this last time to get rid of the white tongue and rash rather than the medication the doctor gave me.I break my fast by drinking warm water with 4 tablespoons of coconut oil and 3 teaspoons of black seed oil. Its been 2 days and the rash has not spread and it has calmed down dramatically in sensitivity.. I have not eaten carbs at all to change it. Today I drank half a cup of Kefir as this is the best probiotic around and to help to eradicate whatever is thats inside. I hope this helps someone. I really strongly recommend black seed oil

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