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red itchy neck its he chest its you back you’re starting the ketogenic diet and you’re getting this like painful itchy annoying rash and it makes you just want to throw in the towel and not do the ketogenic diet at all I totally get it that’s got to be the most uncomfortable thing and although I’ve never experienced the keto rash I hear from a lot of people that are dealing with it and I sense the frustration so I wanted to do this video that breaks down what’s causing the keto rash what is the keto rash and how can we take the steps to mitigate it but also to make sure that we’re doing the best thing for our health in the process you’re tuned in to the internet’s leading performance nutrition and fat loss channel those new videos coming out surrounding the world of keto fasting and everything in between on Tuesday Friday and Sunday at 7 a.m. Pacific time but I also asked that you hit that little bell button that way you’re gonna turn on notifications so you know whenever I go live or 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common denominator is actually ketones being present so what the keto rash is is a scaly kind of lesion like rash that appears generally on your neck on the middle of your chest and your back and generally the middle of your back it can start to spread to other areas of your body but it’s usually pretty localized there it’s not really painful it’s just itchy and annoying and it usually goes away after a couple of weeks and we’ll talk about the different stages in a minute but let’s go ahead and reference a study so we can understand the correlation between this for ego pigmentosa and the key a study those published in the Journal of the European Academy of Dermatology found that when they took a look at patients that had Perico pigmentosa 8 out of 16 of them were following a ketogenic diet or were fasting so correlation does not equal causation but this is about as close as we can get to finding a link so although it does mean that most people that have the Quito rash are probably showing signs of regrow pigmentosa it does not mean that everyone with Perico pigmentosa is on a ketogenic diet where it’s fasting there are people that can acquire this same condition or what seems to be the same condition without ever doing a keto diet it seems like the keto diet just brings it to light a bit more so what exactly is happening like what are the symptoms it starts out with having a bunch of little lesions like almost like acne like lesions that are super itchy again in your chest neck back the only happens is they start to spread and they turn into little patches and these patches become raised and almost firm be very disturbing for people to have my can be very alarming but let me tell you the keto rash is proven to be pretty safe it’s just a nuisance and then what happens is they start to scale okay they get kind of crusty and they start to kind of fall off your skin gets flaky so then what happens is it starts to scar and the scarring is called the reticulated hyperpigmentation fancy way of saying scarring and turning into freckle looking like things but these go away it’s not permanent just because basically you’re having a hyperpigmentation because of concentrated blood flow etc etc so what is causing this that’s what we have to know right that’s the telltale question if we know what causes something we can take the necessary steps to fix it that’s just the problem though we don’t really know what’s causing it we can just make some links now the cool thing is my team and I have done some research and we’ve really created a pretty solid link and I’ll get to in a minute that should help you out if you are suffering with the keto rash but first let’s go through some of these potential causes the first mentioned cause that you find on the Internet is going to be stored toxins that are in your fat that get released when you start to lose weight okay I get it that makes perfect sense and I’m not saying that anyone that came up with a theory is a bad person but this theory is flawed because when you lose weight on a ketogenic diet sure you have the fat toxins or the stalks that are stored in your fat that release but when you lose weight on any diet you have those same toxins that are released and people don’t see the symptoms so it’s more about the ketone the common denominator than anything the next one is one that I actually thought would be the most likely case until you start looking at some of the evidence and that’s allergens people go on a ketogenic diet suddenly they’re eating a bunch of dairy they’re eating a lot more eggs they’re eating a lot more nuts of these potential allergens so that would make sense if someone’s gonna have a histamine reaction or someone’s gonna even have an inflammatory reaction these foods they’re more than likely going to see it when they start eating more of them so that would make sense the hard part is and you start looking again at the studies they weren’t conclusive with people having allergens or histamine reactions but they were conclusive with ketones being the common denominator so I still think it has something more to do with the result of the ketones in the body versus a histamine reaction now that being said histamine reactions are a different reaction right like you eat a food you have a histamine reaction you get itchy you take a benadryl goes away right but then there’s inflammatory sensitivities the hard part is that these inflammatory conditions are gonna manifest differently throughout different populations in different people so like if you took two people that had dairy sensitivities not allergies but sensitivities and they suddenly ate a bunch of dairy they’re not gonna both have the same keto rash right some person is gonna get you know a rash on their leg and another person might end it with overall inflammation that gives them a stomachache it’s just not this uniform keto rash so the allergen theory is pretty flawed the other theory that makes a lot of sense is the acetone theory so we have three different ketone bodies we have beta hydroxy butyrate we have a c2 acetate and we have asked to an acetone is kind of the like ugly redheaded stepchild of the ketone family right so it’s sort of a byproduct it’s a byproduct of excess acetoacetate so we create a lot of acetone in the beginning of keto and then eventually starts to wane off well acetone is excreted through our breath and through our skin so if we sweat we’re having high degrees of acetone coming out which could mean that you’re going to break out in a rash if you’re hypersensitive already so that’s a theory that makes a little bit of sense the hard part with that theory can’t really do anything about it you can’t really do anything about levels of acetone they’re just gonna go away in time so you have to deal with it and I hate to just say deal with it I’d like to give you some concrete ways to fix something but if that is the case you can just have to deal with it now then we have the gut biome link this is an interesting one probably one that makes the most sense when you start a ketogenic diet you are dramatically changing your gut biome bacteria that would normally thrive on carbs bacteria that would normally thrive on starches are suddenly having to die off and other bacteria like form acute eats and things like that are dying off and you’re having other ones that are growing right so you have this massive shift in the gut bacteria which can really make some changes in inflammatory markers within your body so what can happen is when the starch fed bacteria start to die off and they can have a massive die-off and that creates a surge of them for a little bit surge of them in your bloodstream as they die off and are excreted giving you symptoms just like this so if we’re having an issue with a specific couple of strains and gut bacteria that are dying off and entering the bloodstream that could make sense why we’re having a very localized rash that’s very very correlated with the specific gut bacteria again no concrete evidence but it makes sense which leads me in sort of the next thing neutrophilic infiltration neutrophilic infiltration is a series of white blood cells very specific white blood cells that come up to the surface and cause a specific reaction it’s an inflammatory response the thing is is this is a normal process and acne is a perfect example of neutrophilic infiltration but when you’re on a ketogenic diet you usually have a high degree of ketones that cluster up around the the bloodstream so what happens there and on the blood vessels what happens there is that can link to a pretty strong neutrophilic infiltration at that very specific spot which could make sense you have a lot of blood flow going your neck your middle back and then it’s making the ketones cluster there which is triggering some neutrophilic infiltration which is therefore causing and manifesting an overall rash again not a lot we can do about that but then one member of my team actually started doing some some interesting rabbit-hole going right he started going down some rabbit holes and started finding links and this was really interesting so we chatted about it and this is all hypothesize it’s not really solidly linked but we can connect the dots here because this isn’t heavily researched shifts in your gut bacteria themselves can trigger a neutrophilic imbalance a neutrophilic infiltration so when we start looking at the one cause that I mentioned with a gut bacteria being thrown off that can trigger a neutrophilic infiltration which can manifest in just that way so that actually makes sense the neutrophilic infiltration the combination that ketones that ni at the blood at the skin level within also the gut bacteria triggering that at the systemic level that could just be the perfect storm that triggers this neutrophilic infiltration that manifests as a keto rash so let’s treat the keto rash as if it was a neutrophilic infiltration that’s the best way to do it because it’s the only way we truly can because we don’t honestly know so how do we do this okay the first thing that you’re gonna wanna do drinking ginger and green tea okay it may not be the end-all be-all but it’s gonna help you if you want to ride the storm you want to get through this rash ginger and green tea are powerful neutrophilic infiltration helpers they are gonna slow down that process okay the other thing that you can do is you can consume zinc you don’t wanna do a lot of it but consuming some zinc like 50 milligrams or so is gonna be perfect you can also use a zinc rub just like acne zinc rubs have a big effect that’s probably of the best things that you can do but systemically you’re going to want to take care of your gut bacteria you’re shifting the gears all of a sudden you’re on a keto diet and your gut bacteria is like whoa what the heck’s going on you want to stabilize and keep it under control so eating probiotic rich foods and prebiotic rich foods so lots of asparagus in the first couple weeks of keto it will help I promise you on multiple levels okay but the other thing that you want to do is you want to consume some sauerkraut consume kimchi these things that are keto friendly that helps support your gut bacteria so artichokes and asparagus for the prebiotics and then you’re gonna want to consume things that are gonna help you out in a probiotic fashion to drink a little bit of kombucha this stuff will help okay we haven’t tested it out with any individuals or any subjects but when you start connecting the dots it does make sense so it’s the best thing that we can do and I’m sorry that’s not a more concrete answer for you but that’s the keto rash in a nutshell as always make sure you’re keeping it locked in here in my channel I super appreciate you being here and keep it locked in for the next videos
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Are You Suffering From the Keto Rash? – Thomas DeLauer
The keto rash is a rare, inflammatory condition of the skin characterized by a red, itchy rash around the trunk and neck
The disease is of unknown origin and it’s often formally known as prurigo pigmentosa – dates back to 1971 where it was first reported in Japan
**It’s incredibly rare with a few hundred cases being reported in Japan and less than that being reported in the West – just now beginning to be more recognized here, with it being mentioned more on Keto forums**
It causes itchy, red bumps, typically on the neck, chest, and back – sometime, the bumps fuse together into a bigger raised red area called a plaque
More specifically, the rash tends to start on the back, neck, and chest (especially in the middle of the chest and back). – manifests as itchy, raised skin lesions that can be red, brown, or light pink in color depending on the stage it’s on
According to the research, people with prurigo pigmentosa usually go through 4 main stages:
Early lesions: During this stage, The skin shows light pink raised skin lesions that look like scratch marks. This stage is often overlooked because it just looks like a minor rash or scratch.
Fully developed lesions: This is the full blown rash people get worried about because it is much more aggressive. During this stage, the skin is infested with pronounced red skin lesions called papules, and sometimes the papules will include liquid-filled cysts or, more rarely, pus-filled cysts.
Resolving lesions: When the rash is receding, crusted and scaly papules will take the place of the red lesions. The papules will also start to get darker.
Late lesions: The skin is left with a net-like pattern of dark spots larger than freckles, called “reticulated hyper-pigmentation”. When this happens, the rash is almost fully healed. The pigmentation might remain long after the rash is gone, but the skin will eventually return back to normal.
Best case: goes away after a couple weeks; worst case: appears any time one enters ketosis
There are a lot of hypothesis as to why it occurs, but some can be debunked:
A popular claim is that the switch to burning fat is the cause as fat stores toxins, which then get released in large quantities when a person goes ketogenic
That’s clearly not the case – not all people who lose huge amounts of weight get a rash – so this can’t be the answer
Some people claim that the reason is down to the fact that when people switch to keto they end up consuming foods that they wouldn’t normally eat (or higher quantities than they normally would
Additionally, keto places an emphasis on foods like eggs, dairy, fish, and nuts and seeds, to name a few that are common food allergens
Another possible cause of keto rash is that your skin may be having a negative reaction to acetone
Simply, as acetone is excreted with our sweat, it exposes our skin to excess acetone and causes an inflammatory reaction, itchiness, and lesions on the skin that lead to keto rash
This can be done as more of a test to see whether ketosis is the cause of the rash –
Stop the production of hormone-like cytokines that direct a class of white blood cells known as neutrophils to cause inflammation
Andrographis is a herb that suppresses the infiltrations of neutrophils
Ginger and Green tea are also able to lower neutrophil count as well
1) Böer A , et al. (n.d.). Prurigo pigmentosa: a distinctive inflammatory disease of the skin. – PubMed – NCBI. Retrieved from