Diarrhea with keto diet

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People on the Keto Diet Have All Kinds of Problems Pooping

If you’ve ever tried the ketogenic diet—that high-fat, low-carb, “miracle” diet—you’ve probably found yourself in one of two camps:

Camp number one: Those who can’t poop.

Camp number two (pun intended): Those who can’t stop pooping.

I know because I once spent four months on the diet and, well, dear readers, I was in camp one. And it was a strain.

Here’s the thing though: Because many of us go keto based off the advice of our friends, not off the counsel of our doctors, it’s not our doctors we consult when things go south (or, ahem, won’t). Instead? We turn to our friends. But not our real-life friends. Oh no—too mortifying.

Instead we type “how do I make myself stop/start pooping” into the search bar and wait for Dr. Google to dispense its advice. Here’s a Google Trend graph of “keto constipation” and “keto diarrhea” queries in the US over the past five years. (It would appear that more people are dealing with diarrhea than constipation.)

Screenshot: Google Trends

“As the moderator of the popular Facebook support group ‘Dirty, Lazy Keto,’ I receive all sorts of private messages from followers that are too embarrassed to post their concerns to the group,” says Stephanie Laska, the author of Dirty, Lazy, Keto: Getting Started, How I lost 140 Pounds. “I’ve realized that everyone loves to document and share photos of every meal with the message board, and on the opposite end they become embarrassed to talk about bowel movements or constipation.”

Laska personally struggled with bowel issues when she started on Atkins, which allows fewer veggies and advocates for more protein than keto. Atkins also has many packaged meal and bar offerings, which Laska says really gum up the whole system. Now that she’s eating a modified keto diet, which includes a lot of low-starch veggies like spinach and kale, “I’m proud to share my bowel movements are healthy and regular,” she says.

Which made us wonder: Is there anything wrong with eating lots of fat and protein and very little fiber? Should we be concerned that a trendy diet people are supposedly doing for their health has a side effect so common that it’s spawned entire threads (massive poops! pencil poops! poop potions!) on Reddit? And, how solid (SNORT) is the advice that these groups are giving?

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Here’s the good news: Constipation isn’t going to kill you. “Being constipated is not carcinogenic or anything like that,” says Nitin Ahuja, a gastroenterologist and assistant professor of clinical medicine at Penn Medicine. You could live out the next 15 years of your life grunting it out on your porcelain throne and that alone wouldn’t cause any major issues, though constipation of can lead to hemorrhoids—which are engorged rectal veins that can be provoked with the pressure of straining and worsened by passing hard stool. And you might be walking around feeling like a plugged-up firehose 24/7, so there’s that. (Ahuja says he hasn’t seen people on keto coming in for poop help, but he wonders if that’s related to the fact that the diet isn’t supported by many in the medical community, and patients may not be telling him about their fat-first eating habits.)

While constipation isn’t dangerous, Ahuja has other concerns about the keto diet’s effects on your gut. For one thing, chronic constipation is likely a symptom that you’re not getting enough fiber. Fiber makes you poop. There are two types of fiber: Soluble fiber adds bulk, while insoluble fiber draws water into the stool and helps accelerate its movement through your intestines, Ahuja says.

“We know from epidemiological studies that high-fiber diets seem to be protective against colon cancer,” he says, adding that we also know that high levels of meat consumption can be a risk factor for the disease. Especially processed meats, like bacon, which is a favorite keto food. Of course, these studies just show correlation, not causation, so we can’t yet say for sure if it’s the meat or the fiber causing the risk or the reward.

Ahuja also worries about what a drastic diet change does to your microbiome. “I get hesitant to make comments on the microbiome because a lot of what we know is still based on speculation,” he says. However, recent studies have shown that people on the FODMAP diet, a research-based protocol for managing irritable bowel syndrome (IBS), can have shifts in their microbiomes in just three to four weeks. Ahuja can’t imagine a scenario where that’s not also the case on the keto diet. Why does that matter? While research is still in its really infantile stages, there’s some evidence that the microbiome plays a role in your immune health, your metabolism, and possibly even in your mental health.

Ahuja says the most common constipation remedies he sees bandied about online aren’t dangerous. Laska, for example, usually recommends that people get off the “keto junk food,” like super-processed bars and cheese for every meal. “The bottom line is that you can’t game the system. There are no loopholes with a keto diet. You have to make your carbs count in the healthiest way possible,” she says. If adding more kale or broccoli (two low-carb veggies with tons of fiber) doesn’t do it, adding things like flax or chia seeds may help, too, she says. (However, for the strictest of diets, chia seeds may take up a good chunk of your carb count for the day.)

That’s the advice that Rebecca (last name withheld for poop privacy reasons) from Durham, North Carolina, got last year when she tried out the diet. “I tried making some chia pudding but it’s kinda gross when you can’t properly sweeten it,” she says, adding, “I also considered drinking psyllium husk in almond milk, but the taste is nasty.”

In the end? She gave up on the diet. Not just because trying to poop was like a daily cardio session, but because she had less energy during her workouts, and she had to limit some of her favorite kinds of produce. “In reality, keeping net carbs to 50 grams or less is pretty disheartening for a banana-, fruit-, tuber-, and root veggie-lover like me.”

Then, of course, there’s the other side of the keto-poop coin: The folks who get the runs. These people are probably overwhelming their bodies with fat, Ahuja says. If your pancreas can’t break the fat down fast enough, you’ll end up with diarrhea. The solution in that case is simple: Slow your roll on the butter, bacon, and MCT oil (that stands for medium-chain triglycerides; it’s what people put in Bulletproof Coffee, alongside the butter). Again, Ahuja says that short-term loose stools are probably not dangerous, but are definitely annoying.

The takeaway here is that it’s probably not a horrible thing if you get your keto pooping advice from the Internet. However, Ahuja gives two stern warnings. You should see your doc if you can’t poop without using stimulant laxatives—which are something Ahuja likes to keep his patients away from because they can be habit-forming and may reduce your colon’s ability to do its job naturally if taken long-term. “The most common stimulant laxatives are bisacodyl and senna,” he says, adding that if you’re not sure what you’re taking is safe, talk to your doctor.

The second is that abusing laxatives has consequences. “I worry that the type of person who is likely to adhere to a really strict keto diet may also be the type of person who is likely to abuse laxatives.”

Finally, if there’s a sudden change in your ability to poop, know this: It may be a structural issue versus a dietary one. That’s something strangers on the Internet can’t help you diagnose. And please don’t let them try.

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For people who switch to keto, GI issues are among the most common side effects. Constipation, diarrhea, bloating, abdominal cramps and pain, and all kinds of other unpleasant digestive symptoms are unfortunately problems that keto dieters often have to consider.

For the first couple weeks, there’s a lot of value in giving your body a little time to get used to the new regime. But for people who are still suffering – or if it’s so bad that you just can’t stand the “get used to it” advice, here are 6 suggestions for getting your gut on board with the new regime.

1. Understand what’s normal and what isn’t.

A lot of people get worried when they switch to keto and their bowel habits change, but unless the change is causing you problems, you might not have any reason for concern.

For example, a lot of people find that they defecate less frequently and that they have much smaller stool volume on keto – but that’s totally fine. It just stands to reason that if you’re eating less bulky carb-dense food, then your stools will be smaller because there’s less to pass out the other end. There’s nothing to worry about here: it’s just the natural result of low-carb eating.

Here’s a quick checklist:

Normal:

  • My stools are smaller/lower in volume
  • My bowel movements are less frequent, but I don’t feel blocked up or uncomfortable

Not normal:

  • I have to strain to defecate
  • I’m gassy, bloated, or constantly belching.
  • I’m having abdominal pain/discomfort.
  • I’m having diarrhea.

So if you’re in Camp Normal, close the tab and go enjoy your happy GI tract. If you’re in Camp Not Normal, keep reading for some suggestions for making keto work better for your body.

2. Tone down the coconut products and other MCTs.

Coconut oil is rich in medium-chain triglycerides (MCTs), which are fats with particular properties that make them great for ketosis. MCTs are digested really fast and because of the way your body uses them for energy, having a lot of MCTs in your diet can help you maintain ketosis even with a higher level of carbs and protein.

But because they’re so rapidly digested, MCTs can also cause abdominal cramps and diarrhea. This is especially true if you’re not used to them and then suddenly start mainlining coconut oil and MCT supplements: it’s a big shock to the system.

The solution: ease up on the MCTs and MCT-rich foods, then slowly add them back in.

3. Know when increasing fiber can help…

Fiber doesn’t just “bulk up” your stools. Some types of fiber (soluble fiber) form a kind of lubricating “gel” in the colon that makes stool easier to pass. Other types of fiber feed the gut bacteria that control digestion, which can help keep things moving smoothly. If you cut back on those types of fiber, the sudden change might cause real problems, more than just the non-problem of having smaller stools. Other types of fiber in grains and legumes (insoluble fiber) also give the illusion of helping by irritating the lining of your colon and forcing it to produce mucus in response.

If you were previously eating a lot of fiber but cut down on keto, you might be experiencing symptoms either because the genuinely helpful fiber types are gone from your diet or because you’re not tearing up your colonic lining with tons of insoluble fiber any longer.

Getting more of the good fiber fiber from whole foods is clearly the front-line strategy here (if nothing else, you’ll be getting lots of good nutrition along with the fiber, which you can’t get from Metamucil!). Fiber-rich vegetables are the obvious first-line choice, but even fiber-rich vegetables come with some carbs attached, and the carb limitations of keto don’t always allow for huge piles of vegetables at every meal.

If adding more vegetables doesn’t help or isn’t an option, researchers running some studies on keto diets (like this one), have prescribed extra fiber for constipation, without reporting that this compromised the effects of the keto diet. One decent choice on the supplement front is psyllium husk.

4. …But also when reducing fiber can help.

#3 above applies to people who switched to keto from a “good” (by Food Pyramid standards) diet with tons of whole grains and vegetables. But maybe that isn’t you! Maybe you switched to keto from a diet of Hot Pockets and takeout. In that case, you might actually be having symptoms because you increased some specific types of fiber in your diet.

The most likely culprits are FODMAPs. You can read more about these types of fibers here, but the short story is that some people can’t digest them properly.

Foods rich in FODMAPs include a lot of low-carb keto staples, like cauliflower (used as a substitute for grains in cauliflower rice, cauliflower pizza crust, etc.), broccoli, garlic, onions, and cabbage. So if you switch to keto and start eating a lot more vegetables, you’ll likely also be eating a lot more FODMAPs.

Not everyone is sensitive to FODMAPs. Some people can eat them with no problems. But in sensitive people, reducing FODMAPs can help manage problems like…

  • Diarrhea: People with diarrhea often see dramatic symptom improvements from reducing FODMAPs
  • Flatulence: This study found that adding “high-flatulence” FODMAP-rich foods (like garlic, artichokes, cauliflower, broccoli, and cabbage) to subjects’ diets caused a rapid increase in gas production and destabilized the subjects’ gut bacteria. On the other hand, a “low-flatulogenic” diet with minimal amounts of these foods rapidly improved gut symptoms.
  • Bloating and GI pain: in this study, subjects on a low-FODMAP diet experienced significantly lower bloating and other GI symptoms.

There’s an easy test to see if FODMAPs are causing your problems: focus on low-FODMAP vegetables like zucchini or spinach for a while and see if it helps. Here’s a simple chart of low and high-FODMAP foods from the Cleveland Clinic. If reducing FODMAPs helps, you can slowly add back FODMAPs foods into your diet to see how much you can tolerate.

5. Drink more water, especially mineral water

Mineral water is a great idea for keto anyway, because a keto diet increases your need for electrolyte minerals. But if you’re struggling with constipation, research shows that fluids might be just as important as fiber.

Some studies (like this one) have actually found that liquid consumption is a better predictor of constipation than fiber consumption. If you don’t drink much water, upping your game on the fluid front might be all the change you need. But this study took it to a new level by giving subjects magnesium-rich mineral water (half a liter or a whole liter per day, not all the water they drank). The mineral water significantly reduced constipation and improved subjects’ GI symptoms.

The great thing about this strategy was that the mineral water delivered the benefits of magnesium without the reported drawbacks. Magnesium is well-known as an osmotic – it draws water into the colon, which makes stools softer and easier to pass. But with most types of magnesium supplements, there’s a risk of going too far in the opposite direction and causing diarrhea. The mineral water group in this study reported softer stools and less constipation, but no diarrhea

6. Consider your supplement options

From a Paleo-keto perspective, it’s always ideal to get nutrition from food – and high-quality animal foods do provide plenty of essential nutrients for gut and digestive health – but there are some supplements that might be helpful for digestive issues on keto.

  • If your food feels like it’s sitting like a brick in your stomach or you get full too fast during meals, try digestive enzymes.
  • If you want general digestive support, try prebiotics or probiotics

You could also go in for probiotic foods, like sauerkraut and kimchi, which are delicious on top of helping your gut bacteria grow!

What’s your favorite trick for keeping your gut happy on a keto diet? A lot of things, like bone broth or ginger tea, have strong anecdotal support even though there aren’t many studies. Let us know your favorite home remedy on Facebook or Twitter!

This is not a “feel-good” post. We are going to talk about some of the not-so-pleasant side effects of transitioning into ketosis, especially looking at why ketones (and transitioning to ketosis, in general) can cause stomach pain. We will also talk about what you can do to solve the issues. Some are practical solutions; others have to do with summoning the mental strength to just deal with a little discomfort to get the rewards and results you want.

If Captain Jack Sparrow were doing the ketogenic diet, he would probably say. “The stomach pain is not the problem… it’s your attitude about the stomach pain which is the problem.”

I’ve been there too. The first time I ever tried exogenous ketones, I was about 16 hours removed from carbohydrates (In-N-Out burger) and I was feeling awful. I thought Perfect Keto would make it all better. I took a heaping scoop of Chocolate and waited 30 minutes. The results? Significant stomach issues, to put it kindly. I thought surely these ketones are bad and I quit my attempt to “go keto” on the spot.

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Why Ketosis Causes Stomach Pain

The short answer is dehydration. The process of keto-adaptation is going to dehydrate us. Remember that one purpose of taking exogenous ketones is to speed up keto-adaptation. This means taking ketones will also speed up the side-effects of keto-adaptation.

Why Does Ketosis Dehydrate?

Transitioning to keto means we are moving from using glycogen and carbs to using fat and ketones. There are two reasons this dehydrates us.

1) One of the main inefficiencies with glycogen and carbs is that it must be stored with water. It takes 4 grams of water to store a gram of glycogen. As you run through your glycogen you will lose tons of water (not literally tons but you get the point).

2) High insulin levels (on high carb diets) cause water retention by inhibiting sodium excretion. The keto diet lowers insulin levels, allowing excess fluid to be released.

Add these together, and we have the symptom of stomach pain. Other symptoms will include headaches, lethargy, nausea, brain fog and low motivation.

How to Cure Your Stomach Pain

Back to my story that the first time I tried keto and felt a little discomfort, I gave up immediately. Soon after, I did a little more research and found out that there are simple cures to the symptoms I was feeling. Also, it turns out the symptoms are incredibly common. Nearly everyone who does the ketogenic diet experiences the same symptoms at some point. It is so common that there are literally memes all over the internet about stomach pain when transitioning to ketosis (and they are awesome).

The cures are simple and fall into two broad categories: practical, and mental.

Practical Cures to Stomach Pain

Water – Drink an incredible amount of water. When you feel you have had enough, drink even more.
Salt – Add salt to your foods and drinks wherever possible.
Time – Remember, time takes time.
More Fat – Eating a ton of fat already? Good, eat even more. You don’t want to be low on energy (fat) during the transition.
Slowly Ramp up Exogenous Ketones – Don’t crush a full scoop the very first time like me.

Mental Cures to Stomach Pain

Remind yourself why you are doing this – Isn’t it interesting that all the symptoms we deal with are actually the inverse of the rewards we are seeking? Fatigue will be replaced with energy, brain fog will be replaced with extreme focus, low motivation will be replaced with a heightened sense of well-being.

Remember this is common – keep going, do not worry, and don’t play the victim and give up.

Dig deep – Again, don’t give up at the first slight discomfort like I did. Dealing with some pain is not going to kill you.

It’s remarkable that a little bit of stomach pain has very quick easy fixes, but it caused me to do something irrational, like give up. There is a deeper problem at hand as Captain Jack alluded to – it’s called rationalization.

The Issue Behind the Stomach Issues

Yes ketones and ketosis cause stomach problems, but the real problem is that it causes many people to quit or assume ketosis isn’t for them, or the diet sucks. Enter rationalization. This is the process of taking something irrational (my tummy hurts, therefore I’ll give up) and making it “rational” (this diet is not for me, and perhaps dangerous, and exogenous ketones are bad).

How to Deal With Rationalization Rationally

The first step would be to just notice your internal thought process at work. Instead of looking for simple cures like drinking more water, or adding more salt, or giving it some time, your head might be flying off a cliff. To deal with the problem behind the stomach problems, move down this list:

Remind yourself it’s normal – Everyone who does the ketogenic diet and takes exogenous ketones experiences this. You are unique, but just like everyone else is unique, too.

Don’t give up – Don’t give up because you are experiencing some slight pain and discomfort. On the other side of pain is the reward.

Check your motives – Why do you want to quit? Why did you start this diet in the first place? Does it make sense, or serve you in any way, to bitch about how you feel and why keto doesn’t work? It would probably make the most sense to see what symptoms you have and deal with them appropriately. Don’t hide a bad motive under a seemingly good motive and sabotage yourself.

Summary

Back to my story, I ended up trying ketosis again and this time I didn’t give up or panic about stomach pain. I drank tons of water and upped the fat and salt and gave myself space to feel a little uncomfortable.

The results are now the side effects I feel are tremendous energy, focus, and well-being. I still occasionally do feel stomach pain, and it is a reminder that ketosis is in action, and I should probably hydrate. 🙂

If you are going to do a strict ketogenic diet and take exogenous ketones, here’s what you can expect:

Initial Negative Side Effects

  • Dehydration
  • Stomach Pain
  • Brain-Fog
  • Low Motivation
  • Irritability

Eventual Positive Side Effects

  • Energy
  • Focus
  • Well-Being
  • Longevity
  • Low Hunger
  • Better Sleep

Do all the practical cures mentioned above – Water, salt, time, fat, and mental strength.

This may be harsh but everyone wants to “go keto” until it’s time to do what it takes. If you want it, get your butt up and make it happen. Use your pain to make a smart adjustment and take yourself to new heights and inspire others.

Keto Flu Explained: Why Low-Carb Diets Can Make You Feel Sick and Tired

Lots of people these days are interested in the ketogenic diet: It’s one of the most Googled weight-loss terms, and celebs like Kourtney Kardashian have touted its supposed benefits. But the high-fat, low-carbohydrate eating plan is not without its drawbacks.

Experts warn that the diet is extremely restrictive and not sustainable, and that it can lead to nutritional deficiencies, high cholesterol, or a serious condition called ketoacidosis. But even before long-term problems set in, many people who try the diet report other unpleasant side effects. These side effects even have a name in the weight-loss world: keto flu.

Keto flu is an unofficial way to describe how many people feel shortly after starting a ketogenic diet, and it can include both physical and emotional symptom—like nausea, cramping, lack of energy, and irritability, to name a few. It’s what happens when the body and the brain are forced to adjust to a sudden carbohydrate deficiency, says Abbey Sharp, RD, a Toronto-based nutritionist and blogger at Abbey’s Kitchen.

Proponents of the keto diet say that these flu-like symptoms are only temporary, and that certain remedies can help reduce or eliminate them altogether. But is it really worth subjecting yourself to, even if just for a short time? Here’s what our experts say.

RELATED: Keto vs. Atkins: Which Is the Better Low-Carb Diet?

Keto flu symptoms

There’s no scientific definition of keto flu, but it’s often described as flu-like symptoms that start soon after a person cuts carbohydrates largely out of their diet. (To enable “ketosis,” a sort of starvation mode in which the body burns fat rather than glucose, the ketogenic diet allows for only 2% to 5% of a person’s daily calories to come from carbohydrates.)

“Very often, people don’t feel well when they’re on the ketogenic diet, and it tends to be worse in the early period,” says Edward Weiss, PhD, associate professor of nutrition and dietetics at Saint Louis University. “This is something largely anecdotal—we don’t have studies on this—but it’s probably very real.”

A sudden drop in carbs can lead to a drop in energy levels, with some dieters reporting unusual fatigue, confusion, or brain fog. “The symptoms are from your brain needing to adjust to the new source of energy, while also trying to deal with a drop in electrolyte levels as you lose weight,” says Sharp. It can also cause nausea, stomach pain, cramping, and constipation, as well, due to the diet’s high-fat and low-fiber makeup.

Keto dieters also sometimes report bad breath or foul-smelling sweat and urine. “The smelly factor comes from the fact that acetone, a byproduct of ketone metabolism, seeps out of your body,” says Sharp. (Ketones, a type of acid, are byproducts of fat breaking down in the body.)

Cynthia Sass, MPH, RD, Health’s contributing nutrition editor, says that many of her clients who have tried the ketogenic diet have also reported irritability and changes in mood. And while people don’t necessarily feel hungry on the keto diet—thanks to its high allowance for fat and moderate amounts of protein—some do report serious sugar cravings.

Adopting a ketogenic diet may also hamper athletic performance, says Weiss, even though many athletes try it, thinking it will have the opposite effect. In a recent study in the Journal of Sports Medicine and Physical Fitness, Weiss and his colleagues found that after four days on a keto diet, participants performed worse on anaerobic exercise tasks—which involve short bursts of intense activity—than those who’d recently gone on a high-carb diet.

“Our participants were right in that period of feeling terrible,” says Weiss. “They were tired, hungry, lethargic.” But he and his colleagues suspect there’s a biological reason they performed worse, as well: They had higher levels of acid in their blood, a result of their bodies burning ketones.

RELATED: 6 Really Good Things That Happen to Your Body When You Quit Sugar

How long does the keto flu last?

“Most people find that you will feel better in a few days, or up to a week, once your body adjusts,” Sharp says. “Whether or not you want to put your body through that is a personal choice.”

As for athletic performance, the participants in Weiss’s study weren’t followed long enough to see if theirs improved after more than just four days on a ketogenic diet. But other research suggests that acid levels in the body tend to normalize after a few weeks, he says, while performance remains compromised.

RELATED: 13 Keto Breakfast Recipes That People Are Loving on Pinterest

Keto flu remedies

Keto blogs and weight-loss websites recommend taking precautions—like making sure you’re staying hydrated, getting plenty of sleep, and finding ways to manage stress—to reduce the unpleasant effects of the ketogenic diet on your body. Some also recommend electrolytes, ketone supplements, or bone broth (which is high in sodium and other minerals) to replace some of what the body is missing in the early stage of the diet.

Certainly, prioritizing sleep, hydration, and overall healthy habits can keep you from feeling even worse, whether you’re on the keto diet or not. But the experts we spoke with agreed that avoiding ketosis altogether is a smarter way to feel good while you’re trying to lose weight, rather than putting a Band-Aid on something that could have more serious consequences down the road.

“I don’t really recommend the keto diet in anything other than clinical disease management settings, because it is incredibly restrictive,” says Sharp. (The diet was originally used as a treatment for epilepsy, and scientists are also looking into its potential benefits for people with diabetes or insulin resistance.)

Research on low-carb diets has also shown that while people do tend to lose weight faster in the beginning, there is no long-term difference when compared with other diets of equal caloric intake. “In other words, if you enjoy carbs, a balanced diet that includes them can lead to just as much weight loss,” Sharp says.

RELATED: 6 ‘Bad’ Carbs That Are Actually Good For You

How to avoid keto flu

It is possible to cut back on sugar and carbs—and, yes, lose weight—without experiencing these nasty symptoms, says Sharp. “While you cannot achieve ketosis without a significantly reduced-carb diet, you can absolutely reap a lot of the potential glycemic benefits of a low-carb diet—without some of the downfalls, like keto flu—simply by choosing the right carbs,” she says.

The key is making sure the carbs you do keep in your diet are rich in fiber, like whole grains, vegetables, and fruits. And when you do eat those carbs, Sharp adds, pair them with some fat or protein; this slows their glycemic impact even more, preventing the blood-sugar spikes (and subsequent crashes) that lead to cravings and crappy feelings.

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Sass agrees: In a 2017 column, she recalled one man who became irritable and had trouble sleeping after adopting an ultra low-carb diet. “Those side effects subsided after he added back fruit, pulses, whole grains, and starchy vegetables to his diet,” she wrote.

Related Blog Posts

‍There are three common errors made with a poorly-formulated low carbohydrate diet that can cause stomach and intestinal upset and diarrhea: sugar alcohols, too much protein, and the wrong source of dietary fats.

‍Diarrhea is not a common side effect of a well-formulated ketogenic diet. If it occurs, it likely due to well-intentioned but incorrect food choices. But while sorting this out, it is important that you stay hydrated and replenish your electrolytes!

It is also important to note that there are many causes of diarrhea independent of a ketogenic diet, so contact your doctor if your diarrhea causes severe symptoms or lasts longer than a week.

You may need to take a closer look at what you are eating.

Ask yourself a few questions:

1. Are you a frequent consumer of sugar free beverages, candies, protein/diet bars, and sugar substitutes? These can cause diarrhea.

Sugar free and low carb products frequently contain sugar alcohols to give them a sweet taste while avoiding table sugar (sucrose). These sugar alcohols (xylitol, sorbitol, mannitol, maltitol, lactitol, and isomalt) have been known to cause gastrointestinal distress (Makinen, 2016). Of these, sorbitol is the least tolerated, but all of them can cause gas, nausea, and diarrhea if consumed above one’s level of tolerance. Thus, eating fewer products containing sugar alcohols may help with your diarrhea.

This video explains the connection between sugar alcohols and gastrointestinal distress:

2. Are you eating low carb, low fat, and high protein? Too much protein can lead to diarrhea.

Remember, a well-formulated ketogenic diet is low carb, high fat, and moderate protein. When cutting carbs, it can be tempting to increase your protein without increasing your fat, but the resulting high protein diet can lead to diarrhea (Speth, 1983). It is important to keep protein at about 10-20% of your daily energy need and add ‘good fat’ for satiety. More on what constitutes ‘good fats’ below. Read more on how much protein you need on a ketogenic diet

3. Are you choosing the right sources of dietary fat? Some oils can cause diarrhea.

While a little bit of omega-6 and omega-3 essential fats are required from our diet, more is not better. In particular, our digestive systems have a limited tolerance for vegetable and seed oils high in omega-6 fats. Early in our human research, we found out that feeding our patients a high fat diet made with soybean, corn, safflower, or sunflower oils promptly made them feel nauseated and caused diarrhea. Given that a well-formulated ketogenic diet eaten to maintain body weight provides 70-80% of one’s daily energy intake as fat, the majority of this fat intake needs to come from mono-unsaturated and saturated sources such as olive oil, high oliec versions of safflower and sunflower, coconut oil, lard, butter, cream, and high fat cheese.

Here are some fats and oils that we recommend:

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A keto diet is an incredible choice for weight loss, more energy, and creating a healthier, happier life.

However, it’s hard to live that new life stuck inside the bathroom.

Unfortunately, one unpleasant issue that can pop up alongside your new low-carb, high-fat lifestyle is diarrhea.

The HUGE list of keto friendly foods.

While this poop problem can be highly unpleasant, it doesn’t have to happen to you. Even if it does, you can take steps to stop the flow and start enjoying your ketogenic diet again!

Read on as we talk through how to avoid and stop keto diarrhea, as well as some causes you may not expect.

Can keto cause diarrhea?

Of course, if you are experiencing these symptoms or gearing up to start a keto diet, you’ll likely find yourself asking if it’s treatable or temporary. The short answer is yes.

Here are a few factors of keto that can lead to tummy trouble.

Higher Fat Intake

The simplest reason you may be experiencing digestive issues is the high-fat diet your body is now powered by. A ketogenic diet is a huge adjustment from the Standard American Diet, and your body needs some time to modify its processes, especially bowel movements.

Bile is the product your body makes to break down fat. It’s also a lubricant for the colon. So, your body may be pushing waste through your digestive tract faster than ever, which can cause diarrhea. As your body adjusts to this new fuel source, fat, your diarrhea will likely subside after a week or two.

Microbiome Changes

Dietary changes affect gut bacteria composition. Starting a keto meal plan certainly affects your microbiome, particularly in the stomach and intestines. As you can imagine, once the digestive tract is affected, your poop is too.

There’s good news, though. One study found that keto increased gut microbiome diversity in the long run, after five to six months in people with severe imbalance. Typically, the more diversity of gut microbes, the better the digestion is.

So, though this may be a short-term issue, in the long run, your GI system may thank you for going keto!

Keto Flu Side Effects

Diarrhea can accompany other side effects like nausea, bloating, headaches, fatigue, and decreased appetite in a phenomenon known as the “keto flu.”

In one study, 40% of participants experienced keto diarrhea at some point. However, the benefits far outweighed temporary loose stools and keto flu symptoms.

Again, there’s a positive aspect: these symptoms can subside in one to two weeks if you continue with a ketogenic diet (no “cheat days”), replenish your electrolytes, and avoid strenuous activity. Take care of your whole body, and your digestive system will thank you.

Sneaky Culprits Behind Keto Diarrhea

However, don’t be too quick to place the blame solely on your new eating plan. There are some other, less obvious culprits that may be creating your bowel movement blues.

Sugar Alcohols

If you’ve been on keto, you already know that not only can natural sugar derail your net carbs for the day, but added sugar is terrible for your overall health — particularly, your digestion. In an attempt to avoid it, many keto products and recipes feature sugar alcohols or other artificial sweeteners as a substitute.

Here’s the problem: many sugar substitutes, like sugar alcohols, can cause gastrointestinal disturbances in people unaccustomed to consuming them. Look for ingredients like sorbitol, erythritol, maltitol, or xylitol. These are typically used to cut down on carbs from sugar, but can do more than just lower your carb intake.

Sugar alcohols are difficult for the gut to absorb. This means that they’re often reaching the large intestine without being properly digested. At this point, they have a laxative effect, contributing to diarrhea.

If keto diarrhea strikes, look at how many sugar alcohols and substitutes you’re consuming. (A side note: some sugar alcohols (like maltitol) can still raise blood sugar in large amounts).

Lactose Intolerance

Many keto recipes use dairy as a key component to add in fats. This is no problem… unless you have a lactose intolerance. Even if you haven’t noticed significant problems in the past, increasing your dairy intake can uncover a food allergy.

In fact, diarrhea is a major symptom of lactose intolerance. If your keto diarrhea doesn’t improve over time, you may want to get allergy testing or try an elimination diet.

Incorrect Macros

Keto is meant to be a low-carb, moderate protein, and high-fat diet. Nevertheless, many inexperienced keto dieters end up eating high-protein and moderate fat instead. Without the proper macros, poop problems may arise.

If protein intake is higher than fat, this can not only cause diarrhea, but keep the body from entering ketosis. It’s important to be vigilant about looking at your ratios of carbs, fat, and protein, especially when starting this eating plan, in order to prevent diarrhea.

Want to make sure you’re getting a well-rounded, high-fat, moderate protein, low-carb diet? Here’s our meal prep plan.

Too Much Magnesium

One of the primary issues that new keto dieters encounter is an electrolyte imbalance. As the body flushes out stored water weight and adapts to running off of fats, it can lose a lot of electrolytes (which is part of the icky feeling of the keto flu).

In order to counteract this effect, most people take extra magnesium to refill their electrolyte supplies. However, magnesium increases stool frequency– the exact opposite of what diarrhea sufferers want. Take a break from this supplement, sticking to the magnesium in your diet, and see if your symptoms improve.

How to Stop Keto Diarrhea

So, now you know what may be contributing to your bathroom bombshells. What do you do to stop it? You have multiple options, depending on the source of the digestive issue:

  • Avoid munching on raw veggies, which can aggravate diarrhea symptoms.
  • Add in probiotic-rich foods like sauerkraut, kefir, and cultured yogurt that can reduce inflammation and rebalance the microbiome.
  • Cut back on on coconut oil and MCT oil, which can aggravate the GI system further.
  • Reduce caffeine, which can have a laxative effect.
  • Taking digestive enzymes may alleviate your diarrhea and speed your digestive system’s return to normal.
  • Hydrate to avoid further complications — loose stools can be extremely dehydrating, so increasing water intake is key for recovery. Aim for half your body weight in ounces.
  • Something that may alleviate a few keto flu symptoms is taking exogenous ketones while transition to a keto diet. This is primarily helpful if you’re just starting the diet due to their high mineral content.

Prevent Constant Diarrhea on Keto

Add in some bone broth to support the health of your intestines. If you suspect your protein intake is too high, add in more healthy fats like avocados or olive oil. Make sure you’re getting enough probiotics, ideally in your diet, though supplements are also an option.

Just because keto is a high-fat diet doesn’t mean all bets are off for nutrition. Be sure you’re still getting enough vegetables, not overloading on dairy, and watching out for large quantities of sugar substitutes. These simple adjustments can help prevent constant keto diarrhea.

Other Keto Diet Poop Problems

Other than diarrhea, constipation is the other frequent offender when it comes to keto diet poop problems. At the root of it, fiber intake is often to blame. It’s very common to suffer from a lack of fiber when switching to the keto diet from the SAD (Standard American Diet, which has a very appropriate abbreviation).

Most American adults already eat less than the daily recommended amount of fiber. The American Heart Association recommends 25-30 grams daily, but the average American only gets 15. Now, factor in that the Standard American Diet gets a large portion of its fiber from grains, and that the keto diet is low-carb. See the problem?

It’s not as easy as just adding more fiber into your diet and your poop problems will be solved. The issue likely stems from the fact that you have drastically changed the amount of fiber in your diet in a short period of time. Your body takes a while to adjust to the fiber amount you are feeding it.

You can try soluble fiber supplements if constipation is an issue, or add in high-fiber vegetables and foods to create a diet you can sustain for the long haul. Broccoli, flaxseed, chia seeds, leafy greens, and bell peppers can be eaten in moderation while staying low-carb. It is best to slowly change the amount of fiber in your diet rather than making dramatic changes.

Hydration and probiotics, as recommended above, will also help with constipation and regulating any stool issues. Supplementing magnesium can also help. (for the same reasons that it’s not recommended for diarrhea).

In Summary

  • Keto diarrhea isn’t always talked about, but it’s one of the common side effects of the ketogenic diet. Nevertheless, it’s preventable and can be treated.
  • The keto diet can contribute to these tummy troubles in the beginning stages as the body adapts to a high-fat diet, changes occur in the microbiome, or keto flu symptoms manifest.
  • Other sneaky culprits behind keto diarrhea can include sugar alcohols, lactose intolerance, incorrect macros, or too much magnesium.
  • There are many steps that will help avoid or stop keto diarrhea: avoiding raw veggies, adding in digestive enzymes and probiotics, skipping MCT oil and coconut oil until symptoms subside.
  • Preventing any future poop problems can include adding in healthy fats, eating a probiotic-rich diet, and limiting sugar substitutes.
  • Constipation, another issue that can happen at times, can be lessened by hydrating well, and supplementing with magnesium and salt.

Sources

Keto Diarrhea: Causes, Symptoms & Cure

Table of Contents

Keto is a very reliable weight loss diet. Going keto involves eating less than 50 grams of carbs per day and filling up on lots of fat and moderate amounts of protein. This macro ratio produces rapid weight loss and, with no carbs to use for energy, your body turns into a certified fat-burning champion.

Unfortunately, initially at least, the keto diet can cause a few side effects, collectively called the keto flu. These symptoms include fatigue, headaches, and stomach upsets. And yes, that includes keto diarrhea.

While this is not a pleasant subject to think about (or write about!), it’s enough of a problem that it needs to be addressed. The good news is that you don’t have to ignore or live with this symptom; there are several things you can do to cure or even avoid it in the first place.

It’s also important to know that keto diarrhea, like the other symptoms of keto flu, usually disappear all on their own when you complete the initial keto induction phase. Once you transition from using carbs for fuel to burning fat and ketones, your keto flu symptoms will quickly become a thing of the past.

What is diarrhea?

As a rule, your bowel movements should be regular, predictable, and firm. This is a good indicator that your digestive system is working correctly. With diarrhea, bowel movements are very watery and loose. You may also find that the urge to go to the bathroom is much less predictable. The occasional loose bowel movement is entirely normal, but if you find yourself rushing to the bathroom several times a day for a couple of days or more in a row, you have diarrhea and should take steps to fix the problem.

Diarrhea can have a big impact on the quality of your life. You’ll lack confidence in your ability to control your bowels and may be reticent to stray too far from a bathroom. Diarrhea may also be accompanied by cramps or pain in the abdomen. It can also cause dehydration. Dehydration is a common enough problem with keto so adding diarrhea into the mix could make matters worse. Dehydration is particularly worrisome for older people and those who live in hot climates.

Not all keto dieters get diarrhea. In fact, it’s a relatively rare keto side effect. But, because it’s such an unpleasant problem, it’s worth making sure that, if you do experience keto diarrhea, you can sort it out as soon as possible.

Causes of keto diarrhea

One of the reasons that the keto diet is so effective is that it causes some significant changes within your body. Unlike most diets that merely limit the amount of food you eat, keto makes your body function differently. However, as profound as these changes are, they do not happen overnight.

Initially, when you cut down on carbs, your body has to rely on its existing carbohydrate stores. These can last several days to a week or two. As these stores are depleted, your body gradually makes the transition to using fat and ketones for energy. During this period, your body is caught between a rock and a hard place – it’s running low on carbs but is not yet in full ketosis. This creates a degree of upheaval and causes all those keto flu symptoms.

Introducing or eliminating certain foods and food groups can have a big impact on your gastrointestinal system and health. Unlike most diets, where you just eat less of the foods you usually consume, with keto you will find yourself eating foods that may be unusual and not eating foods you are used to eating.

This is not unlike that other common cause of stomach upset – exotic food. Eating on vacation is a common trigger for diarrhea. It’s not that the food you eat is in any way bad or unhealthy; it’s just that it’s different. Your body may not react well to these keto diet food changes, and the resulting diarrhea is the outward sign.

In addition to what is best described as food sensitivities, diarrhea on the keto diet can also be caused by changes in your gut bacteria. Don’t panic, you are supposed to have bacteria in your gut, and it’s actually a good thing! These bacteria play a critical role in digesting the food you eat and maintaining your immune system. However, if your gut bacteria are disrupted, as can happen when you change your diet, diarrhea is often the result.

A significant increase in fat intake is also thought to be another cause of keto diet diarrhea. Most people, before going keto, follow a low to moderate fat diet. However, when you go low-carb, your fat intake will suddenly jump up to where 70-80% of your calorie intake comes from fat.

Fat takes a lot of work to break down and digest, and some people are better at it than others. Undigested fat enters your small intestines and colon and draws more water into your GI tract to help it move through your digestive system. This causes dreaded diarrhea. If this is the cause of your diarrheal symptoms, you may notice an oily sheen floating on the water in your toilet. The good news is that, as your body gets used to digesting fat, this symptom should soon disappear. There are also a few hacks that will improve your ability to digest fat – revealed later!

The final common culprit of keto diarrhea is artificial sweeteners and, in particular, sugar alcohols. Many keto dieters use non-sugar sweeteners so that they don’t have to live off anything other than meat, vegetables, and nuts. There are lots of keto-friendly-foods available where sugar and carbs have been replaced with artificial sweeteners.

Because artificial sweeteners and sugar alcohols are not digested and absorbed in the gut, they often reach the large intestine and, on arrival have a laxative effect. That’s why, if you read the small print on things like sugar-free mints and gum, you’ll see a warning stating that overconsumption can lead to gastric distress.

How long does keto diarrhea usually last

If you suffer from keto diarrhea at all, it usually only lasts as long as it takes your body to enter full ketosis. This can take a few days and up to a week or two depending on several factors. To get through keto induction as fast as possible and reduce the duration of keto diarrhea, make sure you take the following steps:

1. Cut your carbs and keep them low – if you consume more than 50 grams of carbs per day, you run the risk of delaying ketosis and prolonging your diarrheal symptoms. Use a food tracking app to make sure you aren’t eating more carbs than you should. For best results, keep your carb intake to between 20-30 grams per day.

2. Do some exercise – speed up your descent into ketosis with exercise. Exercise depletes your muscle glycogen stores. The sooner you use those stores, the sooner you’ll get into ketosis.

3. Eat enough fat – low fat keto diets are not usually very effective. Eating a lot of fat may be a foreign concept to you, but it’s what you need to do to burn fat and lose weight. Eating more fat will get you into ketosis faster than eating too little. Use your food tracking app to make sure that 70-80% of your calories come from fat.

4. Try fasting – fasting will get you into ketosis faster than keto alone. When you skip meals, your body is much more likely to use stored carbs for energy. Fasted exercise, i.e., working out on an empty stomach, will also speed up your descent into ketosis.

5. Use some keto diet supplements – there are several keto supplements that will help you get into ketosis faster. Good choices include:

  • Alpha lipoic acid (ALA)
  • Conjugated linoleic acid (CLA)
  • Cinnamon
  • Chromium
  • L-carnitine
  • L-glutamine
  • Magnesium
  • Exogenous ketones

To clarify, the sooner you get into ketosis, the sooner your keto diarrhea will stop. However, if you are in ketosis and you still have diarrhea, it could be that you are struggling to digest all the fat you are eating or may be intolerant to one of the foods you are eating. Don’t give up yet – there are still solutions available.

How to prevent or cure keto diarrhea

Struggling with keto diarrhea or just want to avoid it in the first place? Here are some practical tips that should help!

1. Go easy on sugar-free foods

Sugar-free foods may seem like a godsend for keto dieters, but they may be doing more harm than good. Remember, even though calorie and carb-free sugar substitutes won’t affect ketosis, they can cause gastrointestinal distress, especially when consumed in large amounts.

A lot of keto diets make the mistake of trying to replicate their pre-keto diet with sugar-free foods and end up consuming way more artificial sweeteners and sugar alcohols than they should. While you should have no problem with the occasional can of diet soda and a few sticks of sugar-free gum, if you are consuming lots of these products, you are much more likely to suffer from diarrhea.

Eating fewer products that contain artificial sweeteners and sugar alcohols may help relieve or prevent keto diarrhea.

2. Don’t overdo the protein

Remember, keto is a high fat, moderate protein, and very low carb diet. That’s how it works! However, some dieters are tempted to eat more than the recommended 20-30% protein, and this can lead to diarrhea. To digest and utilize protein effectively, your body needs an abundance of fat. Eating too much protein means you’ll invariably end up eating less fat, and this may increase your risk of diarrhea.

3. Eat the right fats

While keto is undeniably a high-fat diet, it’s important to remember that not all fats are created equal. There are several different types of fats, and your body digests and tolerates some better than others.

Saturated fats are very stable and inert. Your body likes to use saturated fats for energy and energy storage. Contrary to popular belief, eating saturated fat won’t clog your arteries or give you a heart attack! In fact, saturated fat has anti-microbial properties that mean it’s actually good for your intestinal health.

Monounsaturated fats are more reactive which means your body can use things like olive oil and avocado oil for a range of critical physiological functions. Monounsaturated fats are considered to be very heart-healthy.

Polyunsaturated fats are considered to be the healthiest of all the fats. Highly reactive, your body likes to use fats like soybean, corn, safflower, or sunflower oils for a range of chemical and cellular reactions.

While it would appear that you should consume lots of polyunsaturated fat, moderate amounts of monounsaturated fat, and limited amounts of saturated fats, the reverse is actually true. To lose weight and avoid diarrhea, the majority of your fat intake needs to come from monounsaturated and saturated sources such as olive oil, high oleic versions of safflower and sunflower oil, lard, butter, cream, and high-fat cheese.

Two facts that are especially useful on the keto diet are MCT (medium chain triglyceride) oil and MCT-rich coconut oil. Both are easy to digest and consuming them should help prevent and alleviate diarrhea.

4. Don’t go fiber-crazy

Fiber is an important food substance on the keto diet. Eating less bread, rice, pasta, and potatoes may mean you inadvertently eat less fiber than usual, and this could lead to constipation. Aware of this potential problem, a lot of people go overboard on things like laxatives and supplemental sources of fiber such as psyllium husks or powder.

Unfortunately, overusing these supplements can tip the balance too far the other way, leading to diarrhea.

If you do suffer from constipation, eat more fibrous veggies, drink more water, and get some exercise to relieve the problem gently. MCT oil and coconut oil may also help. However, unless the problem persists, avoid “heavy hitters” like laxatives and other bowel boosters as they could turn your constipation into diarrhea.

5. Watch out for common food allergens

Going keto will probably mean you have to start eating foods that, until now, you didn’t eat very often. This could be a cause of diarrhea. Eating more eggs, nuts, full-fat dairy, or other common keto foods could be your intestinal nemesis. Eliminate common food allergens one by one to determine if one of them is triggering diarrhea.

6. Balance your electrolytes

During your transition into ketosis, your body loses a lot of water. As glycogen is used for energy, your muscles and liver release a lot of water, and that water must be excreted. All that extra peeing means your body also expels minerals called electrolytes. If your electrolytes become unbalanced, you may suffer from diarrhea. The electrolytes are:

  1. Chlorine
  2. Calcium
  3. Magnesium
  4. Potassium
  5. Sodium

Rebalance your electrolytes by eating plenty of low-carb non-starchy vegetables, using an electrolyte supplement, or making your own homemade ketoade. Here is a keto electrolyte drink recipe to try. It makes six servings, and each one contains only 1.7 grams of carbs and six calories.

  1. 5 cups water or herbal tea of choice. You can also use coconut water
  2. ½ cup lemon or lime juice
  3. ½ teaspoon potassium chloride (or you can use lite salt or cream of tartar)
  4. ¼ teaspoon pink Himalayan sea salt
  5. 2 tablespoons Natural Calm magnesium supplement
  6. Calorie/sugar-free sweetener to taste

Drink one serving per day with food.

7. Use digestive enzymes

If your diarrhea is the result of problems digesting fat, a supplement called a digestive enzyme may help. The enzyme that digests fat is called lipase. In addition, you may benefit from increasing bile acid production. Bile acid helps emulsify fats for easier digestion. Increase hydrochloric acid (HCL), which is the trigger for the liver to produce bile, by consuming one tablespoon of apple cider vinegar, three times per day.

8. Eat more probiotic and fermented foods

Gut bacteria imbalances can cause diarrhea. Repopulate and boost your healthy intestinal flora and fauna with probiotics and fermented foods. Good choices include:

  • Kefir
  • Sauerkraut
  • Tempeh
  • Kimchi
  • Miso
  • Kombucha
  • Pickles
  • Buttermilk
  • Natto
  • Probiotic supplements

Contrary to the popular kids’ rhyme, there is nothing funny about runny diarrhea. While a mild or occasional attack is common and nothing to worry about, a prolonged attack could leave you dehydrated and questioning whether you should even leave the confines of your bathroom. Diarrhea at night can also disrupt your sleep.

Not all keto dieters suffer from diarrhea, but it happens often enough that at least a few people will have loose bowel horror stories to share. The good news is that keto diarrhea is neither inevitable nor untreatable. In fact, in a lot of cases, you can fix or even avoid it quickly and easily.

However, if your diarrhea is severe, doesn’t respond to the interventions outlined in this article, or lasts more than a week, you should discuss your symptoms with your doctor as it could be a sign of something that would benefit from medical treatment.

Why Keto Can Make You Constipated or Give You Diarrhea — and How to Deal

If you’ve been following the ketogenic (“keto”) diet, your excitement for the eating plan might be tempered by a common — but not often talked about — side effect: constipation or diarrhea.

“Any time you make a big change to your diet, there’s the chance it will affect your gastrointestinal health,” says John Riopelle, DO, a gastroenterologist for Kaiser Permanente in Lone Tree, Colorado.

Given the standard American diet is high in carbohydrates, switching to a keto diet puts you at the opposite end of the spectrum. Based on a typical keto diet food list, this approach is high in fat (70 to 80 percent), moderate in protein, and very low in carbs — many people stick to 20 to 50 grams (g) daily. What’s more, everyone’s colon is unique, which is why some people may be stricken with constipation, others with diarrhea, and still, some may not notice a change at all, says Dr. Riopelle.

The biggest issue? “When it comes to gastrointestinal symptoms on a keto diet, I worry most about the lack of fiber in the diet, which can lead to constipation,” explains Lindsey Albenberg, DO, spokesperson of the American Gastroenterological Association and gastroenterologist at The Children’s Hospital of Philadelphia in Pennsylvania. And when you’re allotted so few carbs in your diet, you’re leaving out fiber-rich sources, like fruit, vegetables, whole grains, and legumes.

RELATED: Why the Keto Flu Happens and How to Manage the Symptoms

In fact, even without restricting carbs, Americans on average already fall short of their daily fiber quota. Men and women eat an average of 18 and 15 g, respectively, of fiber daily, according to recent data from the National Center for Health Statistics. The recommendation is 38 g of fiber daily for men and 25 g daily for women according to The Institute of Medicine.

Here’s why that matters: “Fiber is important for colonic health,” says Riopelle. The organ simply functions better when it has some fiber. “I explain to patients that the primary job of the colon is to be a sponge and absorb all the water you’ve consumed and fluids secreted during the digestive process. Fiber adds bulk to the stool and helps the colon work like a muscle to move things through ,” he says.

But instead of constipation, perhaps things are moving through a little too fast, and now you’re constantly running to the bathroom. While diarrhea may not be as common as a reaction to the keto diet, it, too, is possible. “There may be a delay in enzymes that digest fat to respond to the increasing amount of fat in your diet. If fat doesn’t get broken down in your small intestine the way it’s meant to, it travels into your colon and activates bacteria that can lead to gas, bloating, and fat in the stool,” he says. Extra fat in the stool causes a looser stool.

Another potential problem is acid reflux. “Fats take the longest to empty out of the stomach, so they keep people fuller, longer. On keto, delayed stomach emptying may leave your stomach full all the time, triggering abdominal discomfort and an increase risk of regurgitation and heartburn,” says Dr. Albenberg.

That said, these effects are often short-lived. Your gastrointestinal (GI) tract will likely adjust, but the time it takes to do that differs for every person, says Riopelle. Still, there are warning signs to see a doctor, which we will discuss in a minute.

RELATED: What’s the Difference Between Acid Reflux and GERD?

Is Keto Dangerous for Digestive Health?

Everyone knows that constipation is uncomfortable for sure, but can it harm your health? Aside from the risk of hemorrhoids due to constipation, the issue is that constipation is simply a sign that something’s off in your body, says Albenberg.

Then there’s the potential issue that changing your diet may affect your gut microbiome, the vast network of microorganisms in your digestive tract, which has been linked to immune and metabolic function, and may play a role in disease prevention — or progression, according to a review published in January 2016 in the journal Current Opinion in Gastroenterology. “Research in animals, and some human data, shows that high fat diets lead to fairly rapid and significant changes in the microbiome. Yet we don’t necessarily know what that means for long-term health,” says Albenberg. (It’s also important to note that the high-fat diets used in these studies are often Western-type diets that are high in both fat and sugar, so they don’t perfectly replicate the keto diet.) There is also an indication that these changes may be associated with increased inflammation, but it hasn’t been found to directly cause inflammation, she adds.

Adding to the complexity is that, in the context of epilepsy, it’s because of these alterations in the microbiome that keto may help reduce the frequency of seizures, notes a preliminary study published in May 2018 in the journal Cell that observed these effects on mice. Meaning in certain contexts and when medically appropriate, these changes can actually be helpful, says Albenberg. But many people today who are trying keto aren’t doing it as part of a seizure disorder treatment.

For those new to keto, it’s the lack of fiber to watch out for. “We know a high-fiber diet promotes diversity in the gut microbiome that’s been associated with health,” says Albenberg. Fiber travels through the colon and provides food for gut bacteria, which then produce short-chain fatty acids that nourish colon cells and are thought to be anti-inflammatory, she says.

It’s these short-chain fatty acids that have been shown to improve blood glucose regulation in people with diabetes, per a preliminary study published in March 2018 in the journal Science. What’s more, a certain type of fiber, called soluble fiber, may help control blood sugar and improve insulin sensitivity, according to the American Institute for Cancer Research, which can be important for those who have prediabetes or type 2 diabetes.

Then there’s cancer prevention. People who consume just 10 g of fiber daily have a 10 percent lower risk of colorectal cancer; eating three servings of whole grains daily dropped that risk by another 17 percent, according to a review published in the journal BMJ.

And finally, fiber aids weight regulation. Not only does it increase feelings of fullness (leading to lower caloric intake), but it also promotes the growth of good bacteria, which may help protect against obesity, noted animal research published in January 2018 in the journal Cell Host & Microbe. Of course, you’re not a mouse, but a human study published in February 2015 in the Annals of Internal Medicine found that people who made the sole change of adding more fiber to their diets were able to successfully lose weight.

On the flip side, it’s worth noting that while keto may take away many fiber-rich carbohydrates, it also eliminates the highly processed and refined carbohydrates (crackers, snack mixes, desserts). The potential health risks all come down to the individual. For instance, for an obese person who has an unhealthy diet and has been advised to jump-start weight loss quickly, a short course of the keto diet under doctor supervision may be appropriate, says Albenberg. Beyond that, though, “I don’t see keto as being a great long-term solution, simply because it is just too low in fiber,” she says.

RELATED: What Are the Benefits and Risks of the Keto Diet?

When to Worry if You’re Having Tummy Trouble on the Keto Diet

If you’re new to the keto diet, it’s not abnormal that an intense dietary swing would change your bowel habits, so you may need to give your GI system time to adjust, says Amar Naik, MD, a gastroenterologist at Loyola Medicine in Chicago. You can do that safely, as long as you don’t have any red flags, like blood in your stool.

Also watch out for severe or constant abdominal pain, or diarrhea that’s more than six times a day or waking you up at night, says Riopelle. If symptoms persist more than two or three weeks, see your doctor to make sure that things are okay.

Your Gut-Friendly Action Plan for Following Keto

If you’re committed to the keto diet, here’s how to work through GI symptoms and help prevent them in the first place:

Choose keto-friendly high-fiber foods. Many people on a keto diet count so-called net carbs, which are grams of total carbs minus grams of fiber. That’s great news for people who are looking to get more fiber in their diet, as it will give you more wiggle room to meet or get close to your quota. High-fiber, keto-friendly foods include nonstarchy vegetables, like broccoli (1 g fiber, 2 g net carbs per ½ cup), artichokes (7 g fiber, 6.5 g net carbs per medium-sized artichoke), and collard greens (1 cup of cooked, chopped greens has 7.5 g of fiber and 3 g net carbs). Some fat sources also have a lot of fiber, like avocado (1 whole avocado has 13 g of fiber and 4 g of net carbs) and nuts (1 ounce of almonds has 3.5 g of fiber and 2.5 g of net carbs).

RELATED: A Detailed Guide to Almonds and Reaping Their Benefits

Load up on fermented foods. These contain natural probiotics to support gut health, and are handy if you’re on a restricted diet, says Albenberg. A couple of keto-compliant choices are cabbage-based: sauerkraut (1 cup has 4 g of fiber and 2 g net carbs) and kimchi (1 cup is about 2.5 g of fiber and 1 g net carb).

Take a fiber supplement. First, a warning: It’s difficult to get all the fiber you need from supplements alone, says Albenberg. So, make sure your keto diet is well planned so that it includes high-fiber foods, too. That said, go ahead and try a fiber supplement. Experiment with different types, as people have varying responses to each, says Riopelle.

Try a whole food “supplement.” Some foods have so much fiber, they’re basically a supplement. That includes 1 oz of chia seeds (10 g fiber, 2 g net carbs) and 2 tablespoons of ground flaxseed (4 g fiber, less than ¼ g net carbs).

RELATED: Should You Use Exogenous Supplements to Put Your Body in Ketosis?

Stay hydrated. Adequate water intake is key to moving things along. The Institute of Medicine recommends that women get 91 oz of total fluid from beverages and foods daily and men get 125 oz.

Ask your doc about using a short-term laxative. Normal bowel frequency ranges from three movements daily to one every three days, says Riopelle. If you’ve gone beyond what’s normal for you, you can talk to your primary care physician about whether a stool softener or stimulant laxative on a short-term basis might be right for you.

Don’t count on probiotics. It may be tempting to pop a probiotic supplement and count on it to sort out your digestive health. But there’s not much evidence that commercial probiotics impact GI health in a meaningful way — and many do nothing at all — says Albenberg. For this reason, focus your efforts on fiber.

Don’t count on coffee, either. For some people, a cup of coffee does stimulate a bowel movement for those who are stopped up, but it’s not true for everyone, says Riopelle. It’s okay if coffee has this effect, but the point is, this isn’t a reliable go-to fix.

Low-carb and keto
side effects
& how to cure them

  1. It’s been known for decades that when insulin levels drop —as they do when carb intake is very low—the kidneys excrete more sodium and water, although the exact mechanism isn’t clear:

    American Journal of Physiology. Renal Physiology 2007: Insulin’s impact on renal sodium transport and blood pressure in health, obesity, and diabetes

    Diabetalogia 1981: The effect of insulin on renal sodium metabolism ↩

  2. This is based on clinical experience of low-carb practitioners and was unanimously agreed upon by our low-carb expert panel. You can learn more about our panel here. ↩

  3. This is based on clinical experience of low-carb practitioners and was unanimously agreed upon by our low-carb expert panel. You can learn more about our panel here . ↩

  4. This is based on clinical experience of low-carb practitioners and was unanimously agreed upon by our low-carb expert panel. You can learn more about our panel here . ↩

  5. This piece of advice is based on theory and consistent experience from clinicians using it, and people testing it.

    There’s also some support from a study that found only minor increases in side effects in low-carb participants who were advised to drink bouillon:

    Nutrition & Metabolism 2008: The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus ↩

  6. A low-carb diet is high in natural fats, including saturated fat. Although the issue remains somewhat controversial, several recent systematic reviews of randomized controlled trials and large observational studies have failed to show a connection between eating saturated fat and increased heart disease risk:

    Open Heart 2016: Evidence from randomised controlled trials does not support current dietary fat guidelines: a systematic review and meta-analysis

    Nutrition Journal 2017: The effect of replacing saturated fat with mostly n-6 polyunsaturated fat on coronary heart disease: a meta-analyses of randomised controlled trials
    ↩

  7. A systematic review of 14 trials found that eating very low carb appears to be more effective than more modest carb restriction for fat loss:

    Obesity Reviews 2016: Impact of low-carbohydrate diet on body composition: meta-analysis of randomized controlled studies ↩

  8. This is based on clinical experience of low-carb practitioners and was unanimously agreed upon by our low-carb expert panel. You can learn more about our panel here . ↩

  9. Diet Doctor will not benefit from your purchases. We do not show ads, use any affiliate links, sell products or take money from industry. Instead we’re funded by the people, via our optional membership. Learn more ↩

  10. This recommendation is based on the research of Drs. Volek and Phinney, who have conducted dozens of trials in people following very-low-carb diets. ↩

  11. In a study of people with type 2 diabetes who ate 20 or fewer grams of carbs per day, slightly more than half complained of constipation at some point during the trial:

    Nutrition & Metabolism 2008: The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus
    ↩

  12. This is based on clinical experience of low-carb practitioners and was unanimously agreed upon by our low-carb expert panel. You can learn more about our panel here . ↩

  13. Diet Doctor will not benefit from your purchases. We do not show ads, use any affiliate links, sell products or take money from industry. Instead we’re funded by the people, via our optional membership. Learn more ↩

  14. Clinical Nutrition ESPEN 2019: Effect of flaxseed or psyllium vs. placebo on management of constipation, weight, glycemia, and lipids: a randomized trial in constipated patients with type 2 diabetes
    ↩

  15. Taking a standard dose of magnesium hydroxide is considered safe for people with normal kidney function and can be expected to produce a bowel movement within several hours:

    Clinics in Colon and Rectal Surgery 2010: Medical management of constipation
    ↩

  16. Breath ketone meters measure the amount of acetone in your breath in order to confirm that your body is burning fat and producing ketones:

    Obesity 2015: Measuring breath acetone for monitoring fat loss: review

    Ketones can be used to help fuel the brain when carbs are limited or even avoided altogether: Food for thought: does the brain need carbs? ↩

  17. This is based on clinical experience of low-carb practitioners and was unanimously agreed upon by our low-carb expert panel. You can learn more about our panel here . ↩

  18. Most studies on ketogenic diets limit carbs to less than 50 grams per day in order to promote nutritional ketosis:

    The British Journal of Nutrition 2013: Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials

    Experienced clinicians have reported that patients are often unable to remain in ketosis when consistently eating more than 50 grams of carbs per day, although this may vary based on physical activity, fasting and insulin sensitivity.
    ↩

  19. International Journal of Obesity 2011: The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomised trial in young overweight women

    Cureus 2018: Intermittent fasting: the choice for a healthier lifestyle
    ↩

  20. This is based on clinical experience of low-carb practitioners and was unanimously agreed upon by our low-carb expert panel. You can learn more about our panel here . ↩

  21. This is an untested and unproven hypothesis ↩

  22. International Journal of Obesity and Related Metabolic Disorders 1983: Adrenaline: a physiological metabolic regulatory hormone in humans?
    ↩

  23. This is based on clinical experience of low-carb practitioners and was unanimously agreed upon by our low-carb expert panel. You can learn more about our panel here . ↩

  24. In one study, increasing magnesium intake by 50% helped reduce symptoms in people with frequent heart palpitations:

    Journal of the American College of Cardiology 1997: Antiarrhythmic effects of increasing the daily intake of magnesium and potassium in patients with frequent ventricular arrhythmias ↩

  25. This has been shown in several high-quality trials:

    Obesity Reviews 2012: Systematic review and meta-analysis of clinical trials of the effects of low carbohydrate diets on cardiovascular risk factors
    ↩

  26. Journal of Human Kinetics 2017: Low-carbohydrate-high-fat diet: Can it help exercise performance? ↩

  27. Metabolism 1983: The human metabolic response to chronic ketosis without caloric restriction: physical and biochemical adaptation
    ↩

  28. This is based on several personal reports from people who have exercised during the keto-adaptation period.
    ↩

  29. Sports 2019: Keto-adaptation and endurance exercise capacity, fatigue recovery, and exercise-induced muscle and organ damage prevention: a narrative review
    ↩

  30. This has been shown in both obese people and athletes:

    Obesity Reviews 2016: Impact of low-carbohydrate diet on body composition: meta-analysis of randomized controlled studies

    Sports 2018: The three-month effects of a ketogenic diet on body composition, blood parameters, and performance metrics in CrossFit trainees: a pilot study
    ↩

  31. Journal of the American Medical Association 1976: Alopecia in crash dieters
    ↩

  32. This is based on clinical experience of low-carb practitioners and was unanimously agreed upon by our low-carb expert panel. You can learn more about our panel here . ↩

  33. Indian Journal of Dermtalogy, Venerology and Leprology 2013: Telogen effluvium ↩

  34. Journal of Clinical & Diagnostic Research 2015: Telogen effluvium: a review ↩

  35. Low-carb diets that contain both animal and plant foods typically provide adequate amounts of all vitamins and minerals:

    BMJ Open 2018: Assessing the nutrient intake of a low-carbohydrate, high-fat (LCHF) diet: a hypothetical case study design
    ↩

  36. This is based on clinical experience of low-carb practitioners and was unanimously agreed upon by our low-carb expert panel. You can learn more about our panel here . ↩

  37. In many low-carb studies showing health benefits, people are advised to eat a moderate amount of protein and as much fat as needed to feel satisfied:

    Diabetes Therapy 2018: Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year: an open-label, non-randomized, controlled study

    Applied Physiology, Nutrition and Metabolism 2017: A 12-week low-carbohydrate, high-fat diet improves metabolic health outcomes over a control diet in a randomised controlled trial with overweight defence force personnel
    ↩

  38. Nutrition Reviews 2019: Effects of carbohydrate-restricted diets on low-density lipoprotein cholesterol levels in overweight and obese adults: a systematic review and meta-analysis

    British Journal of Nutrition 2016: Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials

    Cardiovascular Diabetology 2018: Cardiovascular disease risk factor responses to a type 2 diabetes care model including nutritional ketosis induced by sustained carbohydrate restriction at 1 year: an open label, non-randomized, controlled study ↩

  39. Some studies suggest that smaller LDL particles are more harmful because they may be more likely to become trapped in the arteries:

    Current Vascular Pharmacology 2014: Insulin resistance, small LDL particles, and risk for atherosclerotic disease ↩

  40. Cardiovascular Diabetology 2018: Cardiovascular disease risk factor responses to a type 2 diabetes care model including nutritional ketosis induced by sustained carbohydrate restriction at 1 year: an open label, non-randomized, controlled study

    Circulation 2010: Dietary intervention to reverse carotid atherosclerosis
    ↩

  41. In studies, some people eating low-carb diets have experienced a 30-44% increase in LDL cholesterol:

    Atherosclerosis 2018: Effect of a low carbohydrate, high fat diet on LDL cholesterol and gene expression in normal-weight, young adults: a randomized controlled study

    Sports 2018: The three-month effects of a ketogenic diet on body composition, blood parameters, and performance metrics in CrossFit trainees: a pilot study
    ↩

  42. This is based on clinical experience of low-carb practitioners and was unanimously agreed upon by our low-carb expert panel. You can learn more about our panel here . ↩

  43. Consuming a lot of saturated fat has been shown to increase the number of LDL particles in some people:

    PLoS One 2017: Effects of a very high saturated fat diet on LDL particles in adults with atherogenic dyslipidemia: a randomized controlled trial ↩

  44. The American Journal of Clinical Nutrition: Short-term modified alternate-day fasting: a novel dietary strategy for weight loss and cardioprotection in obese adults

    Metabolism: Alternate day fasting (ADF) with a high-fat diet produces similar weight loss and cardio-protection as ADF with a low-fat diet ↩

  45. A study in people with metabolic syndrome found that consuming fish oil and olive oil for 3 months significantly lowered their LDL cholesterol levels:

    Nutrition 2015: Effects of extra virgin olive oil and fish oil on lipid profile and oxidative stress in patients with metabolic syndrome
    ↩

  46. A 2017 review of the evidence of statin use in primary prevention by TheNNT.com showed after 5 years, no lives were saved by statins, 1 in 104 prevented a heart attack, while 1 in 50 developed diabetes and 1 in 10 developed muscle damageThennt.com 2017: Statin Drugs Given for 5 Years for Heart Disease Prevention (Without Known Heart Disease)> ↩

  47. This is commonly reported by people on a keto diet. However, there isn’t much scientific research yet to explain why tolerance seems to be reduced, just theories:

    Low carb and alcohol #6: Lower tolerance, worse hangovers ↩

  48. Moderate protein is roughly 1.2-1.7 grams per kg of ideal body weight per day. Learn more: How much protein should you eat? ↩

  49. In a randomized trial of people who ate a high-protein, low-carb diet for six months, uric acid levels declined, especially in those who were obese:

    American College of Rheumatology 2014: High-protein diet (Atkins diet) and uric acid response

    There’s also some interesting early research suggesting that a ketogenic diet may help reduce gout flares, although much more study is needed:

    Cell Reports 2017: β-hydroxybutyrate deactivates neutrophil NLRP3 inflammasome to relieve gout flares
    ↩

  50. Most studies have found no differences in uric acid levels among people on low-carb diets vs. low-fat or control diets

    Diabetes Metabolism Research & Reviews 2018: Effect of low-carbohydrate diet on markers of renal function in patients with type 2 diabetes: a meta-analysis

    Yet some low-carb researchers and clinicians have reported that some people who start eating low-carb diets experience an initial temporary rise in uric acid levels that could potentially slightly increase gout risk.
    ↩

Going keto can be great for losing weight, increasing energy, and improving your health, but when too much focus is on the macros, you can end up with keto constipation. Fortunately, keto constipation can be quickly remedied by increasing your consumption of low carb veggies like broccoli and cabbage and supplementing with key minerals like magnesium.

In this article you will discover:

  • Keto constipation cure #1: Eat more veggies
  • Keto constipation cure #2: Add key minerals

Keto Constipation Cure #1: Eat More Veggies

If you’re suffering from digestive issues like constipation or diarrhea, it’s likely you’re not getting enough fiber and fiber comes from vegetables on the keto diet.

It’s a common misconception that the keto diet consists of just meat and cheese. Yes, many veggies have carbs, but here’s the secret to getting tons of nutrient-rich veggies:

  • There are plenty of naturally low-carb vegetables to choose from
  • You count net carbs on a ketogenic diet and;
  • Veggies are a great conduit for delicious fats like avocado, olive oil, and MCT oil

Net carbs are calculated by taking the entire number of carbs per serving and subtracting the grams of fiber per serving.

Example: 1 cup of broccoli = 6 grams carbs – 2 grams fiber = 4 net carbs

And if you’re not into calculating net carbs, here’s an idea of some low-carb veggies to add to your meal plan:

  • Greens
  • Avocado
  • Squash
  • Bell peppers
  • Eggplant
  • Asparagus
  • Broccoli
  • Mushrooms
  • Lettuce
  • Green beans
  • Cucumbers
  • Celery
  • Cabbage
  • Radishes

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Keto Constipation Cure #2: Add Key Minerals

In addition to constipation, many brand new keto dieters find themselves experiencing fatigue, brain fog, and the dreaded keto flu. As you’re transitioning to using fat as fuel, it’s inevitable that you’ll experience some discomfort, but it doesn’t have to be debilitating.

One of the reasons you may not be feeling “regular” is a mineral imbalance. The keto diet can have a diuretic effect in the first week or so, which increases your excretion of key minerals like sodium, potassium, calcium, and magnesium.

To fix this, find a stevia-sweetened electrolyte supplement with magnesium, potassium, and calcium. Shoot for about 2,000-4,000mg of sodium, at least 300mg of magnesium, and 1,000mg of potassium per day to help alleviate constipation, fatigue and other symptoms. One of our favorite mineral supplements is Natural Calm Plus Calcium. It comes in unflavored as well as Raspberry-Lemon versions and it definitely “gets things moving” when you hit the right dose!

UP NEXT: Not Losing Weight on Keto? 4 Common Reasons You’re Not + Solutions

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Keto Diarrhea: How To Fix It

Ok, let’s get it out in the open. We are going to be talking about your poop. A lot.

I’ve been putting off writing about this. I am not entirely comfortable talking about it. And diarrhea isn’t even a very common problem with the ketogenic diet.

But it does happen when you’re on your way to ketosis, and it can be quite concerning if you are the one going through it.

So, I got over it, and here I am, talking to you about diarrhea.

Shall we get started?

The Keto Flu and Keto Diarrhea

For those that experience diarrhea while on the keto diet, the diarrhea symptoms generally occur at the same time as they are going through the keto flu side effects (except for those lucky few who don’t experience the keto flu!).

However, diarrhea isn’t necessarily one of the keto flu symptoms.

The keto flu will disappear after about two weeks, as your body adjusts to the ketones and this new way of fueling your body.

But the diarrhea won’t go away unless you address the cause.

Possible errors when following the keto diet

If you have recently embarked on the keto diet, and have been experiencing stomach and intestinal upset, there may be one of three possible errors you are making with your diet.

Have a look to see if you are doing any of these keto diet mistakes. It may end up being a very simple fix, and your stomach will soon be back to normal.

Are you consuming sugar-free beverages, sugar-free candies, and/or sugar-free bars?

Sugar substitutes come in two forms – artificial sweeteners and sugar aclohols.

Many people are sensitive to sugar alcohols.

Sugar alcohols like xylitol, sorbitol, mannitol, maltitol, lactitol, and isomalt can lead to gastrointestinal distress, especially sorbitol. Cramping and bloating, in addition to diarrhea, are common when ingesting too much of these sugar alcohols.

Are you eating too much protein?

If you are not tracking very carefully, it is easy to end up eating too much protein.

High amounts of protein can lead to diarrhea.

If a lot of your protein is in the form of dairy (protein shakes), then it may be the case that you are lactose intolerant.

And if your increase in protein is combined with a reduction in fibrous veggies, then that could also be the cause.

Are you eating healthy sources of fat?

Considering the bulk of your calories come from fat, it is vital that you are choosing healthy versions to eat.

Our digestive systems have difficulty with vegetable and seed oils that are high in omega-6 fats. This can lead to digestive upsets and diarrhea.

We should rather stick to high quality mono-unsaturated and saturated fat sources. This includes olive oil, butter, cream, and high-fat cheeses.

Possible causes of diarrhea while on keto

The diarrhea may be just your gut reacting to the change in diet – especially if your body is used to heavily processed high carb foods. It is common for your GI system to react to a big change in diet.

If this is the case – then know that it is just temporary. Your body will adjust.

It is not always possible to know that your body just needs a bit of an adjustment period, so if you experiencing keto after transition to keto diet, I recommend you go through the possible errors we discussed above.

Are you consuming too many snacks and drinks that contain sugar alcohols, too much protein, or unhealthy fats?

If so, eliminate or drastically reduce your intake of these food items.

If you still experiencing symptoms, then move on to these possible causes, and steps to fix it.

Possible causes of keto diarrhea and how to prevent it

One cause could bile. Yes – bile!

Bile is used by your body to break down fats. It is made in the liver. If your fat intake increases, then your body starts to make more bile. This bile lubricates the colon, which can then lead to diarrhea.

Cut back on added fats. This includes butter, MCT oil, coconut oil, and creams. Rather focus on getting your fats from naturally fatty foods (such as avocado, meat, and nuts).

Once your body has had time to adjust, you can slowly start adding in the other fat sources,

Too much magnesium

An electrolyte imbalance is a big concern for those following a low-carb eating plan, and many people supplement vitamins and minerals – including magnesium.

Too much magnesium, however, can cause digestive problems.

If you have been taking magnesium supplements, stop taking them, and rather get your magnesium from your food. Bone broth is an excellent source of magnesium. Try to stick to 3000mg a day.

Food intolerance

If you notice that your stool is particular color (for example, it is coming out green or yellow), it may be because your body is not able to digest certain foods. If you noticing any whole chunks, then this is a definite sign that there is something your body is not tolerating.

Start keeping track of when this happens. You should be able to pick up pretty quickly what it is that your body can’t handle. To make it easier to find the culprit, keep your meals very simple and just have one type of vegetable per meal.

How to deal with the symptoms of keto diarrhea

While you are trying to work out the cause of your diarrhea, you can follow these steps to improve the symptoms.

Increase your fiber intake.

You can do this by adding more leafy green and other low-carb vegetables to your meals. Dietary fiber is important for digestive health and regular bowel movements. It increases the stool bulk, which will then reduce the diarrhea symptoms.

Add probiotics you your meals

Probiotics help maintain a healthy balance of gut bacteria. Probiotics are linked to a number of health benefits, including digestive health.

When you gut has too many bad bacteria and not enough good bacteria, it can lead to digestive issues. The probiotics balance everything out.

You can take probiotics as a supplement in capsule form, or in powder form to sprinkle over your food.

Drink plenty of water

When you are on the keto diet, you should be drinking plenty of water anyway. And if you are suffering from diarrhea, you should be drinking of plenty of water. So this point is doubly important.

In fact – I am going to write it out again.

Replenish your electrolytes

You will be losing electrolytes as well as fluid due to the diarrhea, so it is important to replenish both.

Just water won’t be good enough.

You can replace your electrolytes by drinking a homemade or good quality store-bought bone broth. (Just make sure to add it to your magnesium allowance for the day.)

What about medication

There are medications available, like Immodium, that are designed to help with the symptoms of diarrhea. But while it may provide short-term relief, it doesn’t help much if you don’t know the root cause.

What if the diarrhea doesn’t improve?

If you have followed all the suggestions laid out above, and you still have the symptoms after a week, OR the symptoms are severe, go see a doctor.

It may be the case that there are other causes for your diarrhea, that are not connected to the keto diet.

You don’t have to do this alone

Dealing with keto diarrhea is worse when you feel like you’re going through this alone. But big changes are easier to deal with when you can share what you’re going through – even if it means you end up discussing diarrhea!

This is one of the great things about Keto Bootstrap. We’ve built a community of people that are on their keto journeys that are always around to help you. You are never going to be alone on your journey with us and that’s probably the most important feature of Keto Bootstrap.

​In general, there are 3 main reasons why you may be experiencing diarrhea during the keto diet: increased fat/MCT intake, sugar alcohols, and excessive magnesium supplementation.

  1. ​Increased fat/ MCT intake – This is probably the first and the most common reason why your body is experiencing sudden diarrhea. It’s your body’s way to adjust to the high-fat content that you have started to eat. This is especially true if you are taking added fats like MCT oil or coconut oil (2). These products are known to be the source of diarrhea by their own, if taken too much too sudden. Your gut isn’t used to it yet. Your body is using bile to break down fats. So, if you increase fat intake, your body needs to make more bile which is also a lubricant for the colon. And since your colon is more lubricated, well, you get the picture.
  2. Sugar alcohols – The keto approach is focused on high fats and focusing on reducing the amount of carbs eaten from the menu. With carbs, you will remove everything sweet from your diet, because well, at the end of the day all sweets are very high carb. Sugar is also the easiest way to kick yourself out of ketosis, no matter how much or how little you consume. The only choices you have left with are sugar-free and low-carb products, which most are pumped up with sugar alcohols which give them the sweet sweet heavenly taste. The most popular sugar alcohols are xylitol, sorbitol, mannitol, maltitol, lactitol, and isomalt. They have also known to be causing gastrointestinal distress.
    All of these can cause gas, nausea, and diarrhea if consumed more than your body can tolerate. Simple conclusion, the less you eat sugar alcohols, the better it will help your diarrhea. Most sugar alcohols don’t stimulate insulin release in the body. One reason for that is that half of these sugar alcohols are not properly absorbed through the digestive tract. The more you eat them the more symptoms it will cause in your GI tract.(2,3)
  3. Magnesium supplementation – This is the main reason why many experience diarrhea during keto at first. It has nothing to do with the keto diet itself, rather the supplementation of magnesium i. Supplementing with Magnesium Citrate irritates the bowels and induces diarrhea. Diarrhea, abdominal cramps and bloating are common side effects of exceeding the suggested daily quantity of magnesium supplementation. (4)
  4. Other – There can be other reasons why you are experiencing diarrhea, which has nothing to do with the ketogenic diet. For example, you may be experiencing food allergies, SIBO (small intestinal bacterial overgrowth), food intolerance or something completely else.

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