Keto Rash Is the Latest Side Effect of the Low-Carb Diet—Here’s How to Treat It
On the keto diet? Experts explain how to keep your skin from breaking out. By Samantha Lauriello/HEALTH.COM
When it comes to the keto diet, you either love it or you hate it. But even the biggest keto devotees admit that the high-fat, low-carb plan can have some unwanted side effects (think stinky breath, diarrhea, and flu-like symptoms).
Lately, we’ve been hearing about a new side effect to add to the diet’s rap sheet, and it’s called keto rash. Here’s everything we know about this red, itchy body rash some keto followers wind up with, including the main symptoms and most effective treatments.
Keto rash symptoms
Keto rash, officially known as prurigo pigmentosa, is a rare form of dermatitis, or skin inflammation. It appears as raised, red, itchy bumps on the skin that take on a web-like appearance. The rash may resemble contact dermatitis, or an allergic reaction, but it can be distinguished by the brownish discoloration of the skin that remains after the inflammation subsides. Keto rash can show up anywhere on the body, but it’s more common on the chest, back, and neck.
What about the keto diet causes it?
Experts aren’t sure, but there are a few theories. “Because the keto diet is 75% to 90% fat, people may be eating large quantities of common allergens, including dairy, eggs, and seafood,” Cynthia Sass, RD, Health contributing nutrition editor, tells Health. “These foods can also be triggers of food sensitivities, which are non-allergic reactions that cause the immune system to release inflammatory compounds which in turn lead to reactions, including skin inflammation and joint pain.”
Another possible cause, according to Sass, is that the diet’s lack of fiber and plant-based foods alters gut bacteria in a way that increases the production of inflammatory compounds. “A high intake of red meat, another common pattern in a keto diet, can do the same,” she adds. Yet another theory has it that the keto diet exposes the body to a larger chemical load, thanks to the emphasis it places on meat and dairy.
“In my opinion, keto rash is a sign that your body is not responding well to the keto diet,” she says.
How to treat keto rash
In many cases, keto rash can be eased by adding carbs back into your diet. But if you’re not ready to give up on keto, Sass advises that you “prioritize plant-based monounsaturated fats, like extra virgin olive oil and avocado, over cream and butter.” She also suggests eating at least five cups of veggies per day, adding back a few servings of fresh fruit, limiting or eliminating red meat, and consuming small portions of nutrient- and fiber-rich whole carbs, such as lentils, quinoa, potatoes, and oats.
Debra Jaliman, MD, New York City-based dermatologist, tells Health that reintroducing foods like fruits and veggies to your diet will also provide your body with essential vitamins your skin may have been missing while on keto. “The best diet for the skin is one that’s varied with antioxidants,” Dr. Jaliman says. She also recommends eating a moderate amount of healthy omega fats, which can be found in foods like salmon, flaxseeds, and soybeans.
If your keto rash doesn’t go away by making these tweaks to your diet, speak with your doctor. Some antibiotics, such as minocycline and doxycycline, can treat prurigo pigmentosa. Your doctor can also help you get to the bottom of what caused the rash in the first place and made it noticeable when you started keto.
This article was medically reviewed by Rachel Lustgarten, RD, CDN, a clinical dietitian and member of the Prevention Medical Review Board, on April 19, 2019.
The keto diet has blown up as an ultra-low carb eating plan that can help you drop pounds fast—but its effects on your body go beyond weight loss.
A typical keto diet is comprised of 80 percent fat, 15 percent protein, and a mere 5 percent of calories from carbohydrates. If you consume 2,000 calories a day, that means just 100 of them are coming from carbs—including healthy carbs like fruits and vegetables. When you eat this way, it triggers ketosis, which means your body has burned through all its carbs and needs to begin burning fat for energy.
It’s true: Following a strict high-fat, low-carb regimen can help move the number on the scale, but there might be some other keto diet side effects that you aren’t aware of. Some of them are positives, but a few could be unpleasant—or even dangerous. Here’s what you should know about keto diet dangers before you decide to try it for yourself. ADVERTISEMENT – CONTINUE READING BELOWYou might get hit with the “keto flu.”
Keto flu is a real thing. Cutting your carbs to the bone and going into a state of ketosis (where your body burns fat for energy) can bring on a cluster of uncomfortable symptoms, such as headaches, fatigue, muscle aches, nausea, and diarrhea. The side effects are the result of your body transitioning to using fat as its primary source of energy instead of carbs, explains Kristen Mancinelli, MS, RDN, author of The Ketogenic Diet. Once it adapts to the new fuel source (usually within a week or two), you’ll start to feel better.ADVERTISEMENT – CONTINUE READING BELOWInitial weight loss could come back.
The keto diet is notorious for delivering a quick initial slim down. That’s because carbs hold on to more water than protein or fat, says Becky Kerkenbush, RD, a clinical dietitian at Watertown Regional Medical Center. So when you stop eating them, all that extra H2O gets released through urination. As a result, the scale might read a few pounds lower, and you may look a bit leaner.
That first drop might be mostly water weight. But research suggests that the keto diet is good for fat loss, too. An Italian study of nearly 20,000 obese adults found that participants who ate keto lost around 12 pounds in 25 days. However, there aren’t many studies looking at whether the pounds will stay off long-term, researchers note. Most people find it tough to stick with such a strict eating plan, and if you veer off your diet, the pounds can easily pile back on.ADVERTISEMENT – CONTINUE READING BELOWConstipation could be just around the corner.
Constipation is a common side effect of low-carb eating plans, including the ketogenic diet. Severely curbing your carb intake means saying goodbye to high-fiber foods like whole grains, beans, and a large proportion of fruits and vegetables, says Ginger Hultin, MS, RDN, Seattle-based nutritionist and spokesperson for the Academy of Nutrition and Dietetics.
Combine that with the fact that your body is excreting more water, and you have a potential recipe for clogged pipes. You can keep things moving by getting some fiber from keto-friendly foods like avocado, nuts, and limited portions of non-starchy vegetables and berries, says David Nico, PhD, author of Diet Diagnosis. Upping your water intake helps, too.ADVERTISEMENT – CONTINUE READING BELOWThere’s also a side effect called “keto breath.”
When your body goes into ketosis, it will start to produce by-products called ketones. This includes acetone—yes, the same chemical found in nail polish remover, which your body actually naturally makes on its own, according to a 2015 review of research. Because acetone is a smaller molecule, it tends to make its way into your lungs. You’ll eventually exhale them out, resulting in “keto breath.” Your mouth might also have a metallic taste, but it won’t last forever as you adjust to the diet. Just be diligent about brushing your teeth!ADVERTISEMENT – CONTINUE READING BELOWYou’ll probably be thirsty all the time.
Don’t be surprised if you find yourself parched while you’re on the keto diet. Excreting all that extra water will likely cause a spike in thirst—so make it a point to drink up, Mancinelli advises. There’s no hard and fast recommendation for how much water you should be having on a keto diet. But in general, aim to drink enough so your urine is clear or pale yellow. If it’s any darker, bump your intake. ADVERTISEMENT – CONTINUE READING BELOW…but your appetite won’t be as ravenous.
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Weight loss often means feeling hungrier and fighting off more cravings, but that doesn’t always seem to be the case when you go keto. People report less hunger and a diminished desire to eat after adopting a ketogenic diet, according to an analysis of 26 studies. Experts don’t fully understand why, but it’s thought that very low carb diets could suppress the production of hunger hormones like ghrelin.ADVERTISEMENT – CONTINUE READING BELOWAnd your skin might clear up!
Plagued by pimples? You may start to notice a difference in your skin on the keto diet, especially if you were a former sugar addict. Consuming lots of empty carbs is linked to worse acne—in part because these foods trigger inflammation and signal the release of hormones that up the production of pore-clogging oils, according to a review published in the Journal of the Academy of Nutrition and Dietetics. Some findings suggest that curbing your carb intake could help solve these problems, improving your skin as a result.ADVERTISEMENT – CONTINUE READING BELOWPlus, many say they feel less brain fog.
It’s no secret that carbs—especially refined ones like sugary cereals, white bread and pasta, or sweet drinks—cause your blood sugar to spike and dip. So it makes sense that eating less of them can help keep things nice and even. For healthy people, this can translate to more steady energy, less brain fog, and fewer sugary cravings, Mancinelli explains. ADVERTISEMENT – CONTINUE READING BELOWYour A1C levels could even improve.
If you have diabetes, better blood sugar control could help lower your A1C levels—the measurement of glucose in our blood—and even reduce the need for insulin, according to a scholarly review of ketogenic diets. (Just don’t go off your meds without speaking to your doctor first!)
The one important caveat: Eating keto also ups the risk for diabetic ketoacidosis, a life-threatening condition where fat gets broken down too fast and causes the blood to become acidic. It’s much more common in people with type 1 diabetes, but if you have type two and are eating keto, talk with your doctor about what you should be doing to diminish your risk.ADVERTISEMENT – CONTINUE READING BELOWBuuut your kidneys might get stressed.
The kidneys play an important role in metabolizing protein, and it’s possible that eating too much of the nutrient can have a negative impact on kidney function. While ketogenic diets are supposed to be much higher in fat than they are in protein, many keto eaters make the mistake of loading up on lots of meat, Mancinelli says. The result? You could end up eating way more protein than you actually need.
Here’s the tricky part: There’s no definite answer for how much protein you’d have to eat before you run into trouble. “It really depends on how much protein a person is consuming versus how much they need, as well as the health of their kidneys at baseline,” Hultin says. That’s why it can be helpful to speak with a nutritionist or doctor who can help you tailor your diet before going keto.ADVERTISEMENT – CONTINUE READING BELOWAnd your heart disease risk factors could change.
Eating an ultra-low carb diet is linked to a lower rate of obesity and type 2 diabetes, along with improved HDL cholesterol, all of which can translate to a lower risk for heart disease.
But your heart health might depend on what you actually eat. Research published in the New England Journal of Medicinesuggests that low-carb diets based mostly on plant sources of fat and protein (like avocados or nuts) can lower heart disease risk by 30 percent. But those benefits didn’t hold for people who ate mostly animal-based proteins and fats. (Think: bacon, butter, and steak.)
Plus, the American Heart Association says that going overboard on saturated fat—which can be easy to do on a keto diet if you eat a lot of meat, butter, and cheese—can up your risk for heart problems. While you’re on the keto diet, you should have your cholesterol levels and heart health assessed by a doctor on a regular basis, Hultin says.The bottom line?
Eating a keto diet can have some short-term health perks. But in the long run, it also has the potential to create some serious health problems. That’s why many experts say you shouldn’t attempt it on your own. “In general, if a person follows a ketogenic diet, they should only do so for a brief time and under close medical supervision,” says Hultin.