Summary & practical tips for gut health on a ketogenic diet

To summarize, there is no clear evidence that a well-designed high-fat or ketogenic diet is

detrimental to the gut microbiota or gut barrier function. In fact, keto-induced changes in the gut
microbiota and gut barrier may even be the reason we see so many benefits from ketosis.

Moreover, we don’t really know what constitutes a healthy gut microbiota, and ketones and
isobutyrate can replace the short-chain fatty acid butyrate that we typically think of as crucial for
gut barrier function. Several case reports indicate that a ketogenic diet may reduce inflammation and
improve quality of life in IBS and IBD.

I want to stress that I do not believe that a ketogenic diet is right for everyone. My intention with
this article was not to suggest that everyone with a gut issue should try a ketogenic diet. I simply
wanted to clear up a lot of the confusion and provide a more complete discussion of the evidence for
ketogenic diets in relation to gut health.

There are also right and wrong ways to do a ketogenic diet when it comes to gut health. A
ketogenic diet high in refined seed oils and processed meats is not going to provide the same
therapeutic benefit to the gut as one that includes healthy fats, pastured meats, and lots of non-starchy
vegetables.

On that note, here are my top seven tips to doing right by your gut when consuming a high-fat or
ketogenic diet:

1) Focus on high-quality fats, like avocados, avocado oil, olive oil, fatty fish, coconut oil, pastured
ghee, butter, tallow, etc. Try to get a mixture of monounsaturated, polyunsaturated, and saturated fat.*
Avoid highly processed and refined oils like canola, corn, and soybean oil.

**If you plan to remain on a ketogenic diet long-term, I recommend getting a full cardiovascular
profile after you have been on the diet for 1-2 months. A small subset of individuals  (“hyper-
responders”) will have an increase in LDL particle number and may need to tweak their fat intake or
consider a modified ketogenic diet to ensure they are not increasing cardiovascular risk.

2) Eat your (non-starchy) veggies! Just because you don’t necessarily need the butyrate doesn’t
mean you should skimp on vegetables. Try to get a variety of both raw and cooked veggies of all
types and colors.

3) Indulge with berries. Berries are a great low-carbohydrate source of prebiotic fiber to selectively
promote the growth of beneficial bacteria.

4) Drink coffee and eat cocoa. Polyphenols promote the growth of beneficial bacteria, so consume
coffee and cocoa as tolerated. Those with severe gut permeability or autoimmunity may want to avoid
these foods initially.

5) Consider nutrient density and eat nose-to-tail. Consume organ meats, shellfish, seafood, and be
sure to balance methionine-rich muscle meats with glycine-rich animal foods like collagen and bone
broth.

6) Experiment! The best way to know if keto works for you is to try it for a few weeks and see how
you feel. Pay particular attention to your energy, skin, mood, productivity, digestion, and bowel
movements.
7) Try “the keto zone”.Unless you have a good reason to be in nutritional ketosis, there is no need to
be in keto indefinitely. By maintaining a carb intake of 20-120 grams (depending on your activity
level), you can easily slip in and out of ketosis. In fact, this may help your gut and your microbiome
maintain peak metabolic flexibility.