Can the Ketogenic Diet Increase Your Risk of Developing Diverticulitis?

Understanding Diverticulitis and the Ketogenic Diet

The ketogenic (keto) diet has become increasingly popular in recent years as a way to lose weight, improve health, and simplify meal planning. However, some people wonder if keto may increase the risk for developing diverticulitis or make symptoms worse in those who already have it. This article will take an in-depth look at the potential link between the keto diet and diverticulitis.

What is Diverticulitis?

Diverticulitis is a condition where small pouches called diverticula form in the wall of the colon. When these pouches become inflamed or infected, it results in the condition known as diverticulitis. This often causes pain, tenderness in the lower left side of the abdomen, fever, chills, nausea, vomiting, and changes in bowel habits.

There are a few factors that are thought to increase the risk of developing diverticulitis:

• Low fiber diet - A low fiber diet can lead to constipation and hard stools that increase pressure in the colon. This extra pressure can cause diverticula to form.
• Obesity - Carrying extra weight increases pressure inside the abdomen.
• Lack of exercise - Inactivity can increase pressure and slow motility in the colon.
• Smoking - Smoking is associated with increased inflammation, which can worsen diverticulitis.
• Medications - Some medications such as steroids and NSAIDs can increase inflammation in the colon.
• Aging - The risk increases over age 40. Almost 50% of people over 60 have diverticulosis.

Recurring attacks of diverticulitis can lead to serious complications such as abscesses, perforations or tears in the colon wall, peritonitis, fistulas, or blockages. Preventing diverticulitis through diet and lifestyle changes is key.

Ketogenic Diet Overview

The ketogenic or keto diet is characterized by a very low carbohydrate, high fat intake designed to put the body into ketosis. Ketosis occurs when carbohydrate intake is restricted to usually less than 50 grams per day so the body must rely primarily on fat for fuel. This causes ketone bodies to be produced by the liver and used for energy instead of glucose.

Foods emphasized on keto:

• Meat
• Poultry
• Fish
• Eggs
• Non-starchy vegetables like leafy greens, broccoli, zucchini
• Full fat dairy
• Nuts and seeds
• Avocados and berries in moderation
• Oils like olive oil, coconut oil, avocado oil

Foods to limit on keto:

• Grains and starches - breads, pasta, rice, beans, potatoes
• Sugars and sweets
• Fruits other than berries
• Low fat dairy
• Starchy vegetables like peas and corn
• Ultra-processed foods
• Alcohol

People choose keto to help lose excess body fat, improve blood sugar control and neurological disorders, increase mental focus and energy, and mitigate hunger. However, it is a restrictive plan low in fiber that can affect digestion.

Can Keto Cause Diverticulitis?

There are a few reasons why keto may hypothetically raise the risk for diverticulitis or aggravate symptoms in those who already have it:

Low Fiber Intake

One of the characteristics of keto is eliminating carb-rich foods like whole grains, legumes, starchy vegetables, and fruits, which are key sources of fiber. The diet tends to be lower in fiber since it restricts many of these foods.

Fiber plays an important role in regulating bowel movements and healthy colon function. It adds bulk to stool and helps keep waste moving through the intestines. A low fiber intake on keto can lead to constipation and straining during bowel movements, which increases pressure in the colon. This rise in pressure can promote the formation of diverticula pouches and is thought to be one reason diverticulitis develops.

Most sources recommend getting 25-30 grams of fiber per day on keto. Focus on non-starchy veggies, nuts, seeds, avocado, and berries. Consider adding a fiber supplement like psyllium husk if needed.

Higher Fat Intake

The keto diet derives around 70-80% of daily calories from fat. Although primarily from heart-healthy unsaturated fats, some people speculate a very high fat intake could also play a role in diverticulitis development.

Some small studies show those who consume more animal fat and red meat tend to have a higher incidence of diverticulitis. The saturated fat and cholesterol in these foods may negatively impact colon health over time. However, most of this research is observational and controlled trials are needed.

People following keto are advised to focus on plant-based and monounsaturated fats like olive oil, nuts, avocado, and fatty fish, in place of large amounts of red or processed meat. Choose organic, grass-fed sources when possible.

Bowel Irregularity

As mentioned earlier, ketos lack of high fiber foods often causes constipation. Research also indicates people following very low carb diets have slower colonic transit times. This means food moves more slowly through the large intestine.

Constipation and slowed motility allows waste to sit longer in the colon, putting more pressure on the walls. This again increases the risk of diverticula forming over time. Bowel irregularity on keto may also worsen symptoms in those with existing diverticulitis.

To help avoid constipation, make sure to drink plenty of fluids, exercise regularly, add more fibrous vegetables, consider probiotic foods like kefir or yogurt, and ask your doctor about magnesium supplements which may help draw water into the colon.

Gut Microbiome Changes

There is some research showing the keto diet causes changes to the populations of gut microbiome bacteria. Beneficial fiber-loving bacteria decrease while bacteria that live off fat and protein increase.

This shift away from beneficial bacteria may promote inflammation in the colon, which researchers believe could set the stage for diverticulitis. However, more studies need to confirm this theory.

To support healthy gut flora on keto, be sure to consume plenty of prebiotic fibers from low-carb vegetables, nuts, and seeds. Taking a probiotic supplement may also help populate the gut with friendly bacteria.

Potential Benefits of Keto for Diverticulitis

Although keto may have some drawbacks relating to bowel function and diverticulitis risk, it does offer some potential benefits:

Weight Loss

Carrying excess weight increases pressure inside the abdominal cavity, putting strain on the colon. Losing even a modest amount of weight can relieve some of this pressure and lower diverticulitis risk.

Many people are able to lose significant weight following the ketogenic diet due to feeling less hungry and more satisfied. This may indirectly improve diverticulitis symptoms.

Blood Sugar Control

Diabetes and impaired blood sugar control are associated with a higher incidence of diverticulitis. Keto can help manage blood sugar levels and insulin resistance in diabetics and prediabetics.

The very low carb intake minimizes spikes in blood glucose. Ketone bodies also provide an alternative fuel source besides glucose. This effect may alleviate pressure on the colon that poor glycemic control can cause.

Anti-Inflammatory

Systemic inflammation appears connected to colonic inflammation that gives rise to diverticulitis. Keto limits sugar, refined carbs, and ultra-processed foods that trigger inflammation.

Many of the emphasized foods on keto like olive oil, fatty fish, nuts, and avocado are rich in anti-inflammatory compounds. Some research indicates keto may lower inflammatory markers like C-reactive protein (CRP).

Tips for Following Keto with Diverticulitis

If you have diverticulitis but want to try the ketogenic diet, here are some tips to do so safely:

• Focus on getting 25-30 grams of fiber daily from low-carb vegetables, nuts, seeds, and a supplement like psyllium or glucomannan if needed.
• Drink plenty of fluids and herbal teas.
• Exercise regularly to support healthy motility.
• Include probiotic foods like kefir, kimchi, and unsweetened yogurt.
• Talk to your doctor about magnesium citrate for constipation.
• Limit red meat and processed meats which may contain compounds that irritate the colon.
• Choose plant-based fats like olive oil, avocado, nuts, and seeds as your main fats.
• Consider an anti-inflammatory supplement like turmeric or fish oil.
• Avoid dairy if you have casein or lactose sensitivities.
• Work with a nutrition professional to develop a keto meal plan tailored for gut health.

Monitor for changes in bowel habits, abdominal discomfort, or bleeding which could indicate a flare-up. Be prepared to modify your diet as needed.

The Bottom Line

Diverticulitis risk comes down to supporting healthy colon function through diet, lifestyle, stress relief, and managing other medical conditions. While keto lacks many high fiber carb sources, with thoughtful meal planning it may be possible to follow a modified ketogenic diet under medical supervision.

Focus on getting adequate fiber, proper hydration, exercise, probiotics, magnesium, and anti-inflammatory foods. Losing weight and keeping blood sugar in control on keto may also lower diverticulitis risk. However, keto may not be appropriate for all digestive conditions. Work closely with your healthcare provider to determine if keto aligns with your personal health goals.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.