Using the Ketogenic Diet to Reduce Inflammation

By Wayne Persky

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Researchers at the University of California, San Francisco, recently published a study about using the ketogenic (keto) diet to help reduce inflammation in autoimmune disorders based on its effects on gut microbiota and immune modulation (Alexander, et al., 2024).1 For IBD patients, including microscopic colitis (MC) patients, this should be a topic of interest, since their clinical symptoms are the direct result of chronic inflammation.

And a comparison of the ketogenic diet with the elimination diet recommended by the Microscopic Colitis Foundation (and discussed in detail on their discussion and support forum) for the past couple of decades, shows that the elimination diet is indeed, a specialized form of the ketogenic diet designed to minimize carbohydrates, and eliminate the food sensitivities so common with MC. The research article points out how the ketogenic diet could be a promising approach to manage inflammation, with a few key considerations based on the study's findings.​

Ketone bodies act as anti-inflammation agents.

The ketogenic diet leads to the production of ketone bodies, especially β-hydroxybutyrate (βHB), which has been shown to have anti-inflammatory effects. For patients with autoimmune diseases like MC, this is significant because βHB can reduce immune activation. Specifically, βHB was found to help mitigate the activation of pro-inflammatory T helper 17 (Th17) cells in mice with multiple sclerosis (MS), suggesting a similar benefit might be possible for MC patients, whose inflammation also involves immune system overactivity. By reducing the activity of Th17 cells, which are involved in many autoimmune processes, βHB could help reduce the chronic inflammation seen in MC.

Gut microbiome modulation:

The study discovered that βHB influenced the gut microbiome by promoting the growth of specific beneficial bacteria, such as *Lactobacillus murinus*. This bacterium, when enriched in the gut, produces indole lactic acid (ILA), a metabolite that further reduces immune activation. For MC patients, fostering a gut environment that promotes anti-inflammatory bacteria like *L. murinus* could be valuable for reducing colonic inflammation. A ketogenic diet that supports the production of βHB and, in turn, encourages beneficial bacterial activity might create a less inflammatory gut environment, reducing symptom severity for MC.

βHB supplementation may be beneficial.

One of the significant findings of the study was that βHB supplementation alone provided benefits similar to the keto diet in reducing inflammation. This research was done based on a mouse model, but if research on humans supports this approach, MC patients might be able to consider βHB supplements as a way to reduce their inflammation (and their clinical symptoms). For MC patients who have difficulty following a strict ketogenic diet, βHB supplements might offer a more practical alternative. Or, more importantly, for those who are unable to attain remission despite following a strict elimination diet for an extended period, βHB supplementation might provide a way to gain relief from symptoms.

This approach reduces the need for powerful medications.

MC is often managed with anti-inflammatory medications, immunosuppressants, and corticosteroids. Incorporating the ketogenic diet or βHB supplementation may help reduce dependence on these drugs, and minimize the risk of the possible side effects that are sometimes associated with them. Given that many medications can have side effects that exacerbate digestive symptoms or further disrupt the gut microbiome, βHB supplements could serve as a complementary approach to conventional treatments. By reducing inflammation through dietary intervention, patients are typically able to experience improved outcomes with fewer medications and, subsequently, fewer side effects.

This research at least partially validates our MC diet recommendations.​

For almost 20 years (since the creation of our MC Discussion and Support Forum) we've recommended using a a modified version of a ketogenic diet especially modified to avoid the common food sensitivities associated with MC as a way to control the symptoms of MC, and put the disease into remission. According to this research, our recommended treatment has been correct all along.

And if future research is published showing that the human response to the ketogenic diet is similar to the response demonstrated by the mouse model used in existing research (in other words, if the human response to the keto diet is shown to result in βHB production), then maybe we will be able to add a recommendation of βHB supplementation to our treatment guidelines.

Reference

1. Alexander, M., Upadhyay, V., Rock, R., Ramirez, L., Trepkam K., Puchalska, P., . . . Turnbaugh, P, J. (2024). A diet-dependent host metabolite shapes the gut microbiota to protect from autoimmunity. Cell Reports, 114891. Retrieved from https://www.cell.com/cell-reports/fulltext/S2211-1247(24)01242-7