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August 28, 2022

Keto Diet And Ulcers: Is There A Correlation?

Can Keto Cause Stomach Ulcers?

Keto diet and ulcers. Is there a link?

Some who try a keto diet will complain of gastrointestinal symptoms. This can include nausea, constipation, diarrhea, and abdominal discomfort.  It can also cause changes in stool color. Some individuals report having ulcers related to the keto diet, but they use the word “ulcers” to refer to any gastrointestinal discomfort especially upper gastrointestinal.

But, not all stomach pain is related to ulcers. While the keto diet can cause some gastrointestinal symptoms including stomach discomfort, does a keto diet actually cause ulcers?

Can a keto diet cause ulcers? The short answer is, “yes”.

What is an Ulcer?

Before we go much further, what is a stomach ulcer? A stomach or peptic ulcer is a sore in the lining of the stomach. Normally, the stomach produces just enough acid to break down food that has entered the stomach. But, if something alters the function of the stomach, the stomach acid can eat away at the lining of the stomach creating an ulcer. This alteration of stomach function can be precipitated by a bacterial infection known as H. Pylori, the use of nonsteroidal anti-inflammatory medications like ibuprofen and naproxen (there are many others), as well as oral steroids and SSRI antidepressants.


man holding stomach in pain


What are the Signs You Have an Ulcer?

The stomach is the predominant symptom of an ulcer. We say “stomach” we mean the upper abdominal area more or less in the midline (breast bone area). The pain is usually a burning sensation. Other symptoms include:

  • Stomach pain.
  • Vomiting especially when you have gone without food.
  • Nausea with or without vomiting.
  • Black or dark-colored stool. This represents bleeding from the stomach related to the ulcer, thus the term “a bleeding ulcer”.
  • Weight loss. This is secondary to loss of appetite related to stomach pain.
  • Bloating if the ulcer is related to infection with H. pylori.
  • Anemia. This is usually secondary to blood loss in the case of bleeding ulcers plus decreased absorption of iron in the diet.
  • Acid reflux. This occurs when acid in the stomach goes upstream into the esophagus and leads to heartburn.
  • Burping.

Keto Diet and Ulcers

There are multiple health benefits of the keto diet,  but it can create adverse effects on the body like an ulcer.

Whenever something is good people tend to overdo it thinking more is better, and we see that with the keto diet.

Stomach ulcers can happen on the keto diet, especially for those who take the keto diet too far. There are several reasons for the development of ulcers regardless of diet including bacterial infection. Below though are the reasons a keto diet may cause stomach ulcers.

  • Too high an intake of fat on a keto diet
  • Consuming too many keto fruit juices
  • Excessive daily calorie intake on the keto diet (usually resulting from pushing fat intake too high)
  • Not limiting alcohol on the keto diet
  • Little exercise

Thus, if you avoid those mistakes, you can avoid or reduce your chances significantly of getting ulcers on a keto diet. In addition to avoiding the five mistakes above, employ some of the following strategies to stay ulcer-free on the keto diet.

  1. Keep daily calorie intake to 2000-2300 cal max.
  2. Do not smoke or use alcohol.
  3. If you absolutely have to have some alcohol, consume no more than 2 drinks a day.
  4. Focus on eating small meals instead of larger meals.
  5. Exercise: both aerobic and strength training.
  6. Avoid sugars.
  7. No more than one fruit juice drink daily.
  8. Follow clean keto. This means avoiding processed foods as much as possible.
  9. Prepare your keto meals by adding more high-fiber keto foods like cauliflower, nuts, and seeds.
  10. Obtain and maintain ideal body weight.

If people follow the healthy rule of keto then they will never get stomach ulcers. Maintaining calorie intake and physical activity will keep keto stomach ulcers at bay.

Is A Stomach Ulcer Dangerous?

Stomach ulcers are potentially serious especially if they start to bleed. This can lead to anemia. Other potential dangerous effects of ulcers are trouble breathing, bloody vomit, dark stools, peritonitis (infection of the abdominal cavity), and obstruction of the upper GI tract.

The treatment for such ulcers is also potentially dangerous as well.  While there are many different types of medicines to treat ulcer pain, they do come with both long-term and short-term side effects. Proton-pump inhibitors, the most commonly prescribed medications to treat gastric reflux can cause the following long-term side effects:

  • Kidney disease and failure
  • Clostridium and pneumonia infections
  • Hip, wrist, and spinal fractures.
  • Esophageal and gastric cancers.
  • Heart attacks and strokes.
  • Dementia and depression.

So, it is best to avoid the development of ulcers.

Keto Diet and Non-Ulcer Stomach Issues

Stomach cramps and pain are the common symptoms of the first week of keto which can cause your stomach to ache some. There are several reasons why you may have stomach discomfort on a keto diet.

  1. First, the keto diet contains high-fat foods. Our digestive system takes time to adapt to absorbing a large number of fats which causes stomach pain.
  2. Secondly, the keto diet dehydrates our body, it’s another common reason for stomach pain.
  3. Thirdly, some people have a history of bowel disorder problems which may become any time there is a change in the diet including a change to a keto diet.

Does Keto Cause Mouth Ulcers Or Canker Sores?

Is there a link between the keto diet and canker sores like there is between the keto diet and ulcers?

There is no definite evidence that a keto diet causes canker sores, but some individuals experience a canker sore flare-up after starting a keto diet. A canker sore is a painful mouth ulcer that is usually white or yellow surrounded by inflamed tissue. Canker sores are usually a nuisance but the pain from them can be very real. Fortunately, most of them heal in one to two weeks.

The exact cause of canker sores is unknown but may be triggered by stress, B12 deficiency, certain foods, and allergies.

Transitioning to a keto diet can be stressful for the physiology of some. Some individuals will develop the keto flu (not the real flu) which also produces stress.

Does Ketogenic Diet Cause Gut Inflammation?

The keto diet has been shown to alter the gut microbiome in a positive way reducing intestinal inflammation. It has been shown that on a keto diet, there is a decrease in the bacteria family known as Bifidobacteria.


man in plaid shirt holding his gut inflammation

Is Keto Good For Ulcerative Colitis?

A keto diet is potentially suitable for ulcerative colitis and/or Crohn’s disease due to its ability to reduce gut inflammation.

What Are Some Keto Foods That Are Easy On The Stomach?

First, eat smaller meals. Eat fermented foods like sauerkraut and kombucha to keep H. pylori from becoming an issue. Consume more fibers.

Can Keto Diet Cause Colon Issues?

Yes, it can. See our article on Ketosis Poop.

Is There A Better Diet For Ulcers?

For ulcer prevention and/or treatment, eat more cruciferous vegetables like cauliflower, cabbage, radishes, broccoli, and Brussel sprouts. Tumeric can help heal ulcers. It is an Indian spice found in curry but supplemental forms of it also exist. Raw honey is unique despite being high in sugar. It is rich in antioxidants which counteract the inflammation associated with ulcers. Garlic has antibacterial activity making it useful against H. pylori. Aloe vera has been useful in healing stomach ulcers.

Also, be sure to avoid certain foods like black and hot peppers, caffeine, coffee, alcohol, tea, chocolate, carbonated beverages, refined sugars, citrus fruit and juice, fried foods, tomatoes, peppermint, omega-6 fats, and mild and dairy products.

Now you know practically everything about the keto diet and ulcers.




The Canker Sore Keto Correlation And How To Fix It



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Dr. Joe Jacko

Dr. Joe is board certified in internal medicine and sports medicine with additional training in hormone replacement therapy and regenerative medicine. He has trained or practiced at leading institutions including the Hughston Clinic, Cooper Clinic, Steadman-Hawkins Clinic of the Carolinas, and Cenegenics. He currently practices in Columbus, Ohio at Grandview Primary Care. Read more about Dr. Joe Jacko

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