Keto And Mouth Sores: What's The Connection?

The ketogenic diet is a low-carbohydrate method of eating that has been linked to several health benefits. However, some people who adopt this diet experience mouth sores or canker sores, which are extremely painful and make everyday activities like eating and talking uncomfortable. While there is no conclusive evidence that the keto diet causes mouth sores, several factors related to the diet may contribute to their occurrence. These factors include vitamin deficiencies, increased stress from dietary changes, and the excretion of acetone, a ketone body, through the breath. Understanding the potential causes and exploring preventive measures can help individuals following the keto diet effectively manage and reduce the occurrence of mouth sores.

Keto diet and vitamin deficiencies

The keto diet is a popular way to lose weight by restricting carbohydrates and replacing them with healthy fats that the body burns and turns into ketones for energy. This process is known as ketosis. However, it is important to consider how the diet affects your body and whether you may develop vitamin deficiencies.

The keto diet involves eliminating entire food groups, such as dairy, bread, and cereal, which are good sources of vitamin B12 and folate. Research indicates that a deficiency in vitamin B12 and folate can make people more susceptible to recurrent mouth sores and ulcers. Therefore, it is important to rule out vitamin deficiencies as a possible cause of mouth sores when following the keto diet.

Vitamin deficiencies are one of the most common causes of canker sores. In addition to vitamin B12 and folate, other vitamin deficiencies associated with the keto diet include biotin (B7), selenium, choline, vitamins A, E, D, chromium, iodine, magnesium, and molybdenum. These deficiencies can occur because the keto diet restricts not only carbohydrates but also protein, which can lead to the elimination of nutrient-rich foods.

To prevent vitamin deficiencies while on the keto diet, it is recommended to include a variety of nutrient-dense foods, such as grass-fed and pastured meat, poultry, wild-caught fish, liver, spinach, kale, nuts, and seeds. Additionally, vitamin supplementation may be necessary to ensure adequate intake of essential vitamins and minerals.

It is also important to be aware of any nutrient deficiencies you may already have before starting the keto diet, as eliminating certain foods can exacerbate these deficiencies and cause additional health concerns. For example, a keto diet may be lower in fiber due to the elimination of whole grains, which can lead to constipation.

Overall, while the keto diet can be effective for weight loss, it is important to consider the potential risk of vitamin deficiencies and take appropriate measures to prevent them.

Increased stress from drastically switching diets

Switching to a ketogenic diet can be a significant change in how you eat. You may have gone from a high-carbohydrate or moderate-carbohydrate diet to a very low or no-carb diet. This shift in diet and metabolic processes can be stressful for the body. While adjusting to a ketogenic diet, you may experience side effects such as keto flu, which can add further stress.

Stress is a major factor in causing canker sores, and the combination of emotional stress and fatigue can create the perfect environment for mouth sores to develop. Some people may not feel stressed when the canker sores appear, but the sores may show up several days after a stressful event or situation.

The keto diet involves eliminating entire food groups, and it is common for people to replace dairy with nut-based milks and cut out bread and cereal. These foods are high in vitamin B12 and folate, and deficiencies in these vitamins are linked to a higher risk of developing canker sores.

Additionally, the keto diet can lead to dry eyes, mouth, and lips during the first few weeks. The body is inefficient at using ketones for fuel initially, and this can result in the excretion of acetone, a ketone body, from the breath. While acetone is not highly acidic, it is acidic enough to potentially contribute to the development of canker sores.

To reduce the occurrence of canker sores while on a ketogenic diet, you can try the following:

• Consume more vitamin B-12-rich foods or take supplements.
• Cut out foods that may cause allergies.
• Switch to a toothpaste that does not contain sodium lauryl sulfate (SLS).
• Reduce or avoid citrus and other acidic foods.

High levels of ketone excretion from the breath

The ketogenic diet is a high-fat, moderate-protein, low-carb diet designed to help the body achieve ketosis, a metabolic state that occurs when the body doesn't receive enough carbohydrates for energy and starts burning fat for fuel instead. When the body breaks down fat for energy, it converts fatty acids into ketones, which are natural chemicals that the body produces when burning fat for energy. These include acetoacetate, beta-hydroxybutyrate, and acetone.

Acetone, a ketone body, is excreted through the breath and urine during the initial stages of the keto diet, and this is known as "keto breath". It is characterised by a fruity or chemical smell, similar to nail polish remover, and can be accompanied by a metallic taste in the mouth. While this is a positive sign that the body has entered ketosis, it can be an unwanted side effect for some, causing social embarrassment.

Keto breath is usually noticeable within a few days to a week of starting the diet and typically lasts a couple of weeks. However, it can be managed or reduced in several ways:

• Drinking plenty of water to increase urination and flush out the ketones.
• Lowering protein intake as the breakdown of protein produces ammonia, which can also contribute to bad breath.
• Maintaining good oral hygiene by brushing teeth twice a day and flossing daily to reduce bacteria in the mouth, a contributing factor to bad breath.
• Using sugar-free mints or gum to mask the odour.
• Slightly increasing carbohydrate intake to reduce the level of ketones produced by the body.

Nut skins and acidic foods

Firstly, nuts are a great source of healthy fats, but some nuts have skins that are high in oxalates, which can cause mouth sores. Examples of high-oxalate nuts include peanuts, pistachios, and cashews. While these nuts are not prohibited on a keto diet, it is important to be mindful of their potential impact on oral health.

Secondly, acidic foods can also be a contributing factor to mouth sores. The keto diet emphasizes the consumption of certain acidic foods, such as meat, cheese, and nuts. While these foods are nutritious, their high acidity can irritate the mouth and increase the likelihood of mouth sores.

To reduce the risk of mouth sores, it is recommended to limit the consumption of highly acidic foods, especially those with a pH level below 4.6. This includes certain dairy products, high-sodium processed foods, fresh and processed meats, starchy foods like brown rice and oats, and carbonated beverages.

Instead, focus on including more alkalizing foods in your diet, such as most fruits and vegetables. These foods help to reduce acid levels in the body and prevent metabolic acidosis. Examples of alkalizing foods include soy products, potatoes, herbs and spices (except salt, mustard, and nutmeg), whole grains like millet and quinoa, and healthy fats like olive oil, avocados, nuts, and seeds.

Additionally, ensure you are getting enough vitamins, especially B12, folate, zinc, and iron. Vitamin deficiencies are a common cause of mouth sores, and the keto diet's elimination of certain food groups can lead to deficiencies.

In summary, when following a keto diet, be mindful of the potential impact of nut skins and acidic foods on oral health. Limit highly acidic foods, prioritize alkalizing options, and ensure adequate vitamin intake to reduce the risk of mouth sores.

Allergies

If you are on the keto diet and are experiencing mouth sores, it is important to rule out vitamin deficiencies. You can do this by getting bloodwork done to test your levels. If you are deficient in vitamin B12 and folate, you can take supplements to increase your intake.

It is also worth noting that some people have suggested that the keto diet may help alleviate or prevent mouth sores by reducing inflammation and sugar intake.

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