Keto And Carb Consumption: Stomach Ache Connection?

The ketogenic diet, or keto, is a popular low-carb, high-fat, and moderate-protein diet. While it can lead to weight loss and improved insulin sensitivity, it can also cause some unpleasant side effects, such as keto stomach pain. This pain can be caused by dehydration, as the keto diet is diuretic, or by the body not yet being adapted to the diet, sending it mixed signals. The type of carbs consumed also matters, with highly processed carbs and those covered in industrially processed seed oil being more likely to cause stomach pain. Carbohydrate intolerance, or a more sensitive response to carbs after following a ketogenic diet, can also occur, leading to abdominal pain, bloating, gas, diarrhea, constipation, and fatigue.

Carbohydrate intolerance

The ability to metabolise carbohydrates varies from person to person and is influenced by a range of factors, including genetics, diet, activity levels, and weight. Some people are sensitive to insulin, which is beneficial as it allows blood sugar to move efficiently from the blood into the cells. However, for those with insulin resistance, the body struggles to move sugar from the blood into the cells, resulting in carbohydrate intolerance. This can increase the risk of developing prediabetes and type 2 diabetes.

Common symptoms of carbohydrate intolerance include:

• Erectile dysfunction
• Frequent urinary or vaginal infections
• Neuropathy (tingling and numbness in hands and/or feet)
• Weight gain, particularly around the waist
• Skin discolouration (darker skin around underarms, neck and skin folds)

The severity of symptoms depends on the extent of the intolerance and can range from mild bloating to severe diarrhoea. In cases of lactose intolerance, a type of carbohydrate intolerance, the undigested milk sugars remain in the digestive system and are fermented by intestinal bacteria, leading to gas, cramping, and bloating.

A low-carbohydrate diet is often recommended to manage carbohydrate intolerance. This involves reducing or eliminating high-carbohydrate foods such as:

• Baked goods (breads, bagels, pastries)
• Rice, potatoes, pasta
• Snack foods (pretzels, chips, crackers, candy)
• Sugary drinks (soda, fruit juice, sweetened coffee or tea)
• Breakfast cereals, jams, and other sugary foods

Instead, it is recommended to include more low-carbohydrate foods in the diet, such as:

• Meat, fish, and poultry
• Shellfish (shrimp, scallops, oysters, mussels)
• Eggs and full-fat dairy
• Non-starchy vegetables (asparagus, broccoli, cauliflower, eggplant)
• Leafy greens (spinach, kale, arugula, lettuce)
• Low-sugar fruits (avocados, tomatoes, blueberries, kiwi)
• Nuts, seeds, and nut butters
• Almond and coconut flour

Additionally, incorporating more lean proteins, healthy fats, and high-fibre foods can help manage carbohydrate intolerance by slowing digestion and promoting a more stable rise in blood sugar. Probiotics, prebiotics, and digestive enzymes can also improve gut health and enhance carbohydrate metabolism.

Temporary insulin resistance

Lifestyle Factors

Dietary Choices

A diet high in carbohydrates and saturated fats has been linked to insulin resistance. When consuming a high-carbohydrate meal, the body releases insulin to lower blood glucose levels. However, in a state of insulin resistance, the cells become less responsive to insulin, resulting in elevated blood glucose levels.

Medications

Certain medications can induce temporary insulin resistance. For example, steroids, blood pressure medications, and HIV treatments are known to cause insulin resistance. It is important to be aware of the potential side effects of medications and to monitor blood glucose levels, especially when starting a new medication.

Hormonal Disorders

Hormonal imbalances can affect how the body utilizes insulin. Cushing's syndrome, a rare condition characterized by excess cortisol, can counteract insulin's effects and lead to insulin resistance. Acromegaly, a rare disorder with high levels of growth hormone (GH), is another cause of insulin resistance. Additionally, hypothyroidism, which slows down metabolism, can also contribute to insulin resistance.

Prevention and Management

To prevent and manage temporary insulin resistance, it is crucial to adopt a healthy lifestyle. This includes eating nutritious foods, reducing carbohydrates and unhealthy fats, increasing physical activity, and losing excess weight if needed. These lifestyle modifications can improve insulin sensitivity, lower blood glucose levels, and reduce the risk of developing prediabetes and type 2 diabetes.

Dehydration

Firstly, glycogen, the stored form of carbohydrates, binds to water in the body. When you reduce your carb intake, your glycogen levels drop, and water is excreted from the body. Secondly, high insulin levels caused by a high-carb diet lead to water retention as insulin inhibits sodium excretion. The keto diet lowers insulin levels, allowing excess fluid to be released.

To combat dehydration, it is recommended that you drink plenty of water and other fluids. You should also add salt to your food and drinks, as this can help to replace lost electrolytes.

Other symptoms of dehydration include:

• Headaches
• Lethargy
• Nausea
• Brain fog
• Low motivation
• Fatigue
• Muscle cramps
• Diarrhea

Withdrawal symptoms

Carbohydrates are the body's primary source of energy. Therefore, when you stop eating carbs, your body has to adjust to functioning without them. This adjustment period can cause withdrawal symptoms, including physical pain and nausea. The severity of these symptoms depends on how drastically you reduce your carb intake and how long you were on the keto diet. If you have been on the keto diet for six weeks or less, consuming carbs is more likely to cause stomach pain and other symptoms like severe headaches and back pain.

The good news is that these withdrawal symptoms are temporary and usually subside within a few days to a week. During this time, it is important to stay hydrated, get enough electrolytes, and ensure adequate sleep. It is also crucial to gradually reduce your carb intake instead of going "cold turkey." Additionally, slowly reintroducing carbs, starting with low-glycemic foods, can help your body adjust.

• Drink plenty of water: Water is crucial in alleviating stomach pain and constipation.
• Increase electrolyte intake: Electrolytes such as magnesium, potassium, and sodium are essential to prevent dehydration and related issues.
• Get adequate sleep: Sleep helps regulate your body's glucose levels.
• Gradually reduce carb intake: Instead of abruptly cutting out carbs, slowly lower your consumption over a few weeks.
• Choose the right carbs: Opt for complex carbs like whole grains, fruits, and starchy vegetables instead of simple carbs like table sugar and honey.
• Manage constipation: If you experience constipation, increase your fiber intake from whole foods, drink plenty of water, and consider taking a fiber supplement like psyllium husk.
• Be mindful of FODMAPs: Some people are sensitive to FODMAPs, which are found in keto staples like cauliflower, broccoli, garlic, onions, and cabbage. Reducing FODMAP intake may help with diarrhea, flatulence, and bloating.
• Digestive enzymes and supplements: If food feels like it's sitting in your stomach, try digestive enzymes. Probiotics and prebiotics can also provide general digestive support.
• Track your progress: Use tools like a continuous glucose monitor or a ketone breath meter to understand how your body is responding to carb reduction.

Lack of electrolytes

A ketogenic diet, or "keto diet", is a very low-carb, high-fat diet. The body is forced to burn fat for energy instead of carbohydrates, which are broken down into ketones. This process is called ketosis.

When you start a keto diet, your body goes through a transition period. This can cause a set of symptoms, commonly referred to as the "keto flu". The keto flu is not a real flu, but rather a collection of symptoms associated with the body adapting to a new diet. These symptoms can include fatigue, muscle cramps, and stomach discomfort.

One of the main causes of the keto flu is a lack of electrolytes. Electrolytes are minerals in the body that aid in cellular and organ function. They are essential for survival and help to maintain hydration and acidity levels, as well as muscle and nerve function.

When you drastically reduce your carbohydrate intake, your body begins to process electrolytes differently. Insulin levels remain lower on a keto diet, causing the kidneys to excrete more sodium. As your body loses sodium, the balance of other key electrolytes, such as potassium and magnesium, can also be affected. This electrolyte imbalance can trigger keto flu symptoms such as dizziness, brain fog, headaches, and constipation.

To prevent or alleviate keto flu symptoms due to a lack of electrolytes, it is important to increase your intake of these minerals. Here are some ways to do this:

• Consume more table salt or sodium chloride in your foods. Himalayan sea salt is a good natural salt additive.
• Eat salty snacks or drink performance drinks with a high sodium content during training or other events.
• Include potassium-rich foods in your diet, such as spinach, avocados, mushrooms, and meat.
• Take a potassium supplement if you are unable to get enough potassium from your diet.
• Take a magnesium supplement if you are deficient. Magnesium is involved in many important life processes, including muscular contraction, controlling blood pressure, and preventing chronic diseases.

It is important to note that supplementation should not be your main source of minerals and micronutrients. Try to get these nutrients from your diet first, and only use supplements if necessary. Additionally, not everyone will experience keto flu symptoms when transitioning to a keto diet. However, if you do experience symptoms, addressing your electrolyte intake may help alleviate them.

Frequently asked questions