The ketogenic diet, characterized by high fat and low carbohydrate intake, has gained popularity for its potential benefits in weight loss, epilepsy management, and even as a complementary therapy for certain cancers and inflammatory diseases. However, emerging evidence suggests a complex relationship between the ketogenic diet and fungal infections, particularly yeast infections like Candida vulvovaginitis. This article explores the potential connections between the ketogenic diet and yeast infections, examining both anecdotal reports and scientific studies.
Understanding Candida and Vulvovaginitis
Candida species are common commensal organisms that reside in the skin, gastrointestinal, and genitourinary tracts of humans. While typically harmless, disturbances in the microbial ecosystem can lead to Candida overgrowth, resulting in infections like vulvovaginal candidiasis (VVC). VVC is characterized by intense pruritus, erythema, swelling, and a thick, white vaginal discharge.
The Ketogenic Diet: A Metabolic Overview
The ketogenic diet shifts the body's primary fuel source from glucose to fat. This metabolic shift, known as ketogenesis, occurs during fasting, starvation, or when carbohydrate intake is severely restricted. During ketogenesis, the liver produces ketone bodies, which are then used as energy by various tissues in the body.
"Keto Crotch": Anecdotal Reports of Vaginal Changes
Some individuals following a ketogenic diet have reported experiencing increased vaginal odor and discharge, a phenomenon often referred to as "keto crotch." While not yet a subject of formal scientific investigation, these anecdotal reports raise questions about the potential impact of the ketogenic diet on the vaginal microbiome.
Potential Links Between Ketogenic Diet and Bacterial Vaginosis (BV)
The symptoms associated with "keto crotch" bear similarities to those of bacterial vaginosis (BV), a common vaginal infection characterized by a disruption in the balance of vaginal flora. In BV, lactobacilli, which are crucial for maintaining an acidic vaginal environment, are replaced by other bacteria.
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A diet high in fat may cause a high vaginal pH. The typical vaginal pH during reproductive years is around 4.5 pH. A vaginal pH of more than 4.5 may be an indicator of BV. A 2007 study found that participants who had a diet high in fat also had an average vaginal pH of 5.1. The study suggests that a diet high in fat may increase the risk of bacterial infections related to BV by increasing the risk of other bacterial growth.
A 2020 review reinforced the links between a diet high in fat and the occurrence of BV, noting that saturated fats may be a significant link. As the keto diet consists of consuming large amounts of fats and small amounts of carbohydrates, there may be a link between the diet and BV. A diet high in fats may change the vaginal pH, leading to an environment in which BV can occur.
Symptoms of BV include:
- Thin vaginal discharge that may look white or gray
- Burning, itching, or pain in or around the vagina
- A strong, fishy odor
- A burning feeling when urinating
The Ketogenic Diet and Candida: A Complex Relationship
While some evidence suggests a potential link between the ketogenic diet and BV, other research explores the potential of the ketogenic diet as a therapeutic intervention for fungal infections, including Candida.
A study examined whether a ketogenic diet could serve as a successful treatment intervention in murine models of Cryptococcus neoformans and Candida albicans infection in combination with fluconazole-a low-cost, readily available antifungal therapy. Mice fed a ketogenic diet prior to infection with C. neoformans and treated with fluconazole had a significant decrease in fungal burden in both the brain and lung compared to fluconazole treatment on a conventional diet. During C. albicans infection, kidney fungal burden of mice in the keto-fluconazole combination group was significantly decreased compared to fluconazole alone. Along with higher concentrations of fluconazole in the plasma and brain tissue, fluconazole efficacy was maximized at a significantly lower concentration on a keto diet compared to a conventional diet, indicating a dramatic effect on fluconazole pharmacodynamics. These findings indicate that a ketogenic diet potentiates the effect of fluconazole at multiple body sites during both C. neoformans and C. albicans infection and could have practical and promising treatment implications.
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Case Report: Ketogenic Diet for Candida Vulvovaginitis and Hidradenitis Suppurativa
A case report describes long-term therapeutic management in a 33-year-old diagnosed with Candida vulvovaginitis and vulvar hidradenitis suppurativa 47 months previously. Nutritional intervention in the form of an all-meat ketogenic diet may be considered therapy in the management of both diseases, as successfully seen in this case report.
The patient, a 29-year-old white American female with no significant past medical history including any gynecological history, presented with vaginal canal appeared erythematous with thick, white, curd-like discharge. Additionally, three hyper-pigmented, scarred, minimally raised vulvar plaques with subcutaneous sinus tracts were all leaking fluid. Gynecological cytopathology confirmed the presence of fungal organisms morphologically consistent with Candida albicans.
The patient was given a referral to the dermatology department for surgical removal of the cutaneous lesions and prescribed fluconazole for her Candida vulvovaginitis. Despite insistence from healthcare providers, the patient refused the standard of care, nor did she schedule an appointment with a dermatologist. Instead, she replaced the directed treatment with the implementation of a zero-carbohydrate all-meat ketogenic diet, consisting predominantly of grass-fed beef ribeye steak and ground beef patties. The patient strictly adhered to the diet, using Trividia Acetoacetic Acid reagent strips for urinalysis to monitor her urine acetoacetic acid value (mmol), as well as the keto-mojo Glucose and Ketone kit to monitor plasma levels. The patient reported that 43 days following the initiation of an all-meat ketogenic diet program, all symptoms ceased. On follow-up, no signs of vulvovaginitis or hidradenitis suppurativa were reported or appeared on physical examination.
Potential Mechanisms of Action
Possible mechanisms by which an all-meat ketogenic diet might reduce Candida spp. growth and eliminate symptoms of vulvar Hidradenitis are:
- Metabolic Advantage: Ketone body metabolism provides normal cells with a metabolic advantage over fungal cells due to increased change in Gibb’s Free Energy of ATP hydrolysis from approximately −56kJ/mole to −59kJ/mole.
- Enhanced Immune Function: A more energized arsenal for phagocytes as a result of ketosis improves the elimination of Candida spp. overgrowth.
- Anti-inflammatory Effects: Restricted Ketogenic diets are also anti-inflammatory and can therefore minimize chronic inflammation.
Other Side Effects of the Ketogenic Diet
The keto diet may cause a variety of side effects. Short term side effects include keto flu, which typically resolves within a few weeks. Keto flu symptoms include: nausea and vomiting, headaches and dizziness, insomnia and fatigue, and constipation. Another side effect is “keto breath.” People may describe keto breath as being fruity or smelling like nail polish remover. Keto breath occurs due to acetone exiting the lungs when someone is following the keto diet. Long-term effects of the keto diet may include: hepatic steatosis, or fatty liver, hypoproteinemia, or abnormally low level of protein in the blood, kidney stones, and vitamin and mineral deficiencies.
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Considerations and Recommendations
Given the conflicting evidence and anecdotal reports, it is crucial to approach the ketogenic diet with awareness and caution, especially concerning vaginal health.
- Consult a Healthcare Professional: Before starting a ketogenic diet, it is essential to consult with a doctor or registered dietitian, especially if you have a history of vaginal infections or other health concerns.
- Monitor Vaginal Health: Pay close attention to any changes in vaginal odor, discharge, or discomfort while following a ketogenic diet.
- Consider Probiotics: Probiotics may help maintain a healthy vaginal microbiome and potentially reduce the risk of BV or yeast infections.
- Practice Safe Sex: Practicing safe sex and avoiding douching the vagina may lower the chance of contracting BV.
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