Keto Diarrhea: Is Carb Consumption The Culprit?

The keto diet is a popular choice for those looking to lose weight and increase their energy levels. However, it can also lead to some unpleasant side effects, such as constipation or diarrhoea. Diarrhoea can occur when starting a keto diet due to the high-fat content, which can be difficult for the body to digest, especially when consumed in large amounts. The body uses bile to break down fat, and this can act as a lubricant for the colon, causing waste to move through the digestive tract faster than usual and resulting in diarrhoea. Additionally, dietary changes can affect the composition of gut bacteria, which can also impact digestion and stool consistency. Other factors that may contribute to diarrhoea on a keto diet include sugar alcohols, lactose intolerance, incorrect macronutrient ratios, and too much magnesium. To alleviate and prevent diarrhoea, it is recommended to include probiotic-rich foods, reduce caffeine intake, stay hydrated, and make sure to get enough vegetables and healthy fats.

High-fat content

The keto diet is high in fat, with fat content ranging from 70 to 80 percent. This high-fat content can cause diarrhea for several reasons. Firstly, the body uses bile to break down fat, and bile acts as a natural laxative. Therefore, a diet high in fat requires the liver to release extra bile, which can push waste through the digestive tract faster than usual, leading to diarrhea.

Secondly, the high-fat content of the keto diet can be challenging for the body to digest, especially when transitioning from a standard American diet. This may cause a delay in the enzymes that digest fat, resulting in fat reaching the colon and being digested by bacteria. This process can lead to gas, bloating, and fat in the stool, causing looser stools and diarrhea.

Additionally, a high-fat diet may affect the gut microbiome. Some studies suggest that high-fat diets can cause inflammation in the digestive tract, decrease beneficial fatty acids, and negatively impact the gut microbiome. However, other studies have shown that the keto diet may increase gut microbiome diversity in the long run, which can improve digestion.

To manage diarrhea caused by the high-fat content of the keto diet, it is recommended to:

• Add more fiber to the diet, as it can help absorb water and firm up stools. Good sources of fiber include citrus fruits, berries, avocado, broccoli, and chia seeds.
• Drink plenty of water and electrolytes to stay hydrated and replace lost fluids.
• Avoid raw vegetables, as they can aggravate diarrhea symptoms.
• Incorporate probiotic-rich foods like sauerkraut, kefir, and cultured yogurt to promote a healthy gut microbiome.
• Reduce caffeine intake, as it can have a laxative effect.
• Take digestive enzymes to aid digestion and help normalize bowel movements.

Gut bacteria changes

The keto diet can impact the composition of your gut bacteria, which has implications for digestion. Some studies have found that after three months on the ketogenic diet, the bacteria in the gut change quite a bit, and this could cause diarrhea in some people.

The gut microbiome may also play a role in disease prevention and progression, according to research. High-fat diets have been shown to lead to fairly rapid and significant changes in the microbiome, but the long-term health implications of this are not yet known.

There is some indication that these changes may be associated with increased inflammation, though it hasn't been found to directly cause inflammation. In the context of epilepsy, these alterations in the microbiome may be why keto can help reduce the frequency of seizures.

In the long run, a keto diet has been found to increase gut microbiome diversity in people with severe imbalance. Typically, the more diverse the gut microbes, the better the digestion.

Tips to Relieve Symptoms

• Take a probiotic supplement or increase your intake of probiotic-rich foods to support gut bacteria.
• Eat fermented foods like sauerkraut and kimchi to improve digestion.
• Cut down on your intake of sugar substitutes, as these can cause gastrointestinal symptoms.

Keto flu

The keto flu is a group of symptoms that occur when the body is learning how to use fat and ketones for fuel instead of the usual carbohydrates and glucose. This is a result of the body going into a state of ketosis, which happens when there are insufficient carbohydrates in the body. During ketosis, the body breaks down stored fat to create molecules called ketones, which are used as fuel.

Symptoms

The keto flu can include symptoms such as:

• Diarrhea
• Nausea
• Bloating
• Headaches
• Fatigue
• Decreased appetite
• Tiredness
• Dizziness

Duration

The keto flu usually lasts for one to four weeks, while the body adjusts to the new diet. However, some people may experience long-term symptoms, especially if the high-fat diet is not easy for their body to digest or if there are negative changes to the gut microbiome.

Relief and Prevention

To relieve the symptoms of the keto flu, it is important to stay hydrated and drink plenty of water and sugar-free electrolyte beverages to replace lost fluids and electrolytes.

• Add more fiber to your diet: Fiber can help relieve constipation or diarrhea. Good sources of fiber on a keto diet include greens, cucumbers, broccoli, cabbage, avocados, nuts, and chia seeds.
• Eat less dairy: A sudden increase in dairy intake can reveal an intolerance to lactose, which can cause diarrhea, bloating, and gas.
• Ease into the diet: Instead of making sudden changes, slowly reduce carbs and increase fats to help your body adjust better.
• Take probiotics and prebiotics: Probiotics and prebiotics can support gut health and reduce the gastrointestinal effects of the keto diet.
• Eat fermented foods: Fermented foods such as sauerkraut and kimchi can improve digestion and reduce constipation or diarrhea.
• Reduce intake of sugar substitutes: Cutting back on sugar substitutes can help relieve gastrointestinal symptoms.
• Stay hydrated: Drinking enough water is crucial for preventing constipation and replacing fluids lost due to diarrhea.

Sugar substitutes

When following a ketogenic diet, it can be challenging to sweeten food and drinks due to the reduction in sugar consumption. However, there are several sugar substitutes that can be used to sweeten your favourite treats without impacting blood sugar levels or kicking you out of ketosis.

Stevia

Stevia is a natural sweetener derived from the Stevia rebaudiana plant, which is native to South America. It is considered a nonnutritive sweetener, meaning it contains little to no calories or carbs. It is also generally recognised as safe (GRAS) and can be used to sweeten everything from drinks to desserts. However, it is much sweeter than regular sugar, so recipes will require less stevia to achieve the same flavour. Stevia may also lower blood sugar and blood pressure, so it is important to consult a healthcare provider before use.

Monk Fruit

Monk fruit is a natural sweetener extracted from a plant native to China and Southeast Asia. It is recognised as safe by the FDA and is 100-250 times sweeter than table sugar, yet it contains no calories or carbs. Monk fruit also contains compounds called mogrosides, which are antioxidants that account for much of the fruit's sweetness. These mogrosides may also stimulate the release of insulin, which can help manage blood sugar levels.

Erythritol

Erythritol is a type of sugar alcohol that is found naturally in fruits like grapes and watermelon, as well as some fermented foods like cheese and soy sauce. It is about 60-80% as sweet as regular sugar, yet it contains only 5% of the calories. Erythritol has also been shown to have no impact on blood sugar levels and may even help lower them. It can be used as a substitute for table sugar in beverages and recipes, but it may leave a cooling sensation on the tongue, which may be unpleasant in large doses.

Xylitol

Xylitol is another type of sugar alcohol that is as sweet as table sugar but contains fewer calories and carbs. It can be easily added to tea, coffee, shakes, or smoothies, and it can also be used in baked goods. However, it tends to absorb moisture, so you may need to add extra liquid to your recipe. Xylitol has been associated with digestive problems when used in high doses, so it is important to scale back your intake if you experience any adverse effects.

Sucralose

Sucralose is an artificial sweetener that is not metabolised by the body, meaning it passes through undigested and does not provide any calories or carbs. It is 400-700 times sweeter than sugar, so only a tiny amount is needed to sweeten foods and drinks. However, sucralose may not be suitable for baking, as it can produce harmful compounds when exposed to high temperatures. It is also important to note that the impact of sucralose on blood sugar levels is not well established, and there are concerns about its potential negative impact on the gut biome.

Yacon Syrup

Yacon syrup is made from the roots of the yacon plant, which is commonly grown in South America. It is rich in fructooligosaccharides (FOS), a type of soluble fibre that the body cannot digest. This means that yacon syrup contains about half the calories of regular sugar, and studies suggest that it may help lower blood sugar and insulin levels. Yacon syrup works well as a sweetener in coffee, tea, and salad dressings, but it is not recommended for cooking, as FOS can break down at high temperatures.

It is important to remember that not all sweeteners are created equal, and some may have negative side effects or impact blood sugar levels. It is always a good idea to consult a healthcare professional before making any significant dietary changes.

Incorrect macros

The keto diet is a low-carb, moderate-protein, and high-fat diet. However, many new keto dieters make the mistake of eating a high-protein and moderate-fat diet instead. This incorrect macro ratio can lead to tummy troubles, including diarrhea.

To prevent this, it is important to be vigilant about tracking your ratios of carbs, fat, and protein, especially when starting the keto diet. The ideal keto diet should be 70-80% fat, 10-20% protein, and 20-50g of net carbs (total carbs minus fiber and sugar alcohols) daily.

If you are experiencing diarrhea, check your protein intake and adjust your diet to include more healthy fats like avocados or olive oil.

In addition, a well-formulated ketogenic diet should include a variety of vegetables, which can provide important fiber to support digestive health.

Frequently asked questions