Keto Bhb Diarrhea: What's The Connection?

The keto diet is a high-fat, low-carb, and moderate-protein diet. It can be an incredible choice for weight loss, but it can also cause keto diarrhea, a common and unpleasant side effect. While the body adjusts to this new fuel source, diarrhea will likely subside after a week or two. However, if the body struggles to adapt to the high-fat content of this diet, diarrhea may be a long-term side effect.

High-fat content

The keto diet is a high-fat, moderate-protein, and low-carb diet. This is a significant shift from the standard American diet, and your body needs time to adjust to the new fuel source. The high-fat content of the keto diet can cause digestive issues, such as diarrhea, as your body works to break down and adapt to using fat as its primary energy source.

Bile Production

Bile is a product your body makes to break down fat. When you consume a high-fat diet, your liver must release extra bile, which acts as a natural laxative. This can push waste through your digestive tract faster than usual, leading to diarrhea. As your body adjusts to the high-fat content of the keto diet, the diarrhea should subside within a week or two.

Gut Microbiome

The keto diet can also impact the composition of your gut microbiome. Some studies have found that a high-fat diet may cause inflammation in the digestive tract, decrease beneficial fatty acids, and lead to unfavourable changes in the gut microbiome. These changes in gut bacteria can contribute to poor digestion and looser stools. However, it is important to note that more research is needed to fully understand the long-term effects of the keto diet on gut health.

Fat Digestion

The high-fat content of the keto diet can be challenging for some people to digest. The body takes longer to break down fat, and the sudden increase in fat consumption on the keto diet can disrupt digestion. This can lead to diarrhea as your body adjusts to the new diet.

Sugar alcohols

Common sugar alcohols include mannitol, sorbitol, xylitol, lactitol, isomalt, maltitol, and hydrogenated starch hydrolysates (HSH).

• They contain fewer calories than sugar (1.5-3 calories per gram compared to 4 calories per gram in sugar).
• They do not cause tooth decay like sugar does.
• They add texture to foods and retain moisture better.
• They prevent foods from browning when heated.

However, there are also some negatives associated with sugar alcohols. The most common side effect is the possibility of bloating and diarrhea when consumed in excessive amounts. This is because the small intestine doesn't absorb sugar alcohols well, so they often reach the large intestine without being properly digested, causing a laxative effect. People's tolerance for sugar alcohols depends on various factors, including body weight, health conditions, and the amount and type of sugar alcohol consumed.

Therefore, it is recommended to introduce sugar alcohols gradually into your diet and observe how your body responds. If you experience gastrointestinal symptoms caused by sugar alcohols, reducing the amount of foods and drinks made with them can help correct the problem.

Too much protein

A well-formulated ketogenic diet is low-carb, high-fat, and moderate protein. When cutting carbs, it can be tempting to increase your protein intake without increasing your fat intake. However, a high-protein diet can lead to diarrhea.

It is important to keep protein at about 10-20% of your daily energy needs and to add 'good fats' for satiety.

If your protein intake is higher than your fat intake, this can not only cause diarrhea but also keep your body from entering ketosis. It is 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.

If you suspect your protein intake is too high, add in more healthy fats like avocados or olive oil.

Gut microbiome changes

The keto diet can impact the composition of your gut microbiome, which has implications for digestion. Ginger Hultin, RD, a spokesperson for the Academy of Nutrition and Dietetics, notes that some small 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.

In fact, a 2019 study found that diets high in fat might cause inflammation of the digestive tract, a decrease in healthful fatty acids, and unfavorable changes in the gut microbiome. However, it's 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.

On the other hand, some studies have shown that a keto diet may have positive effects on gut bacteria. More high-quality research is necessary to determine the effects of the keto diet on gut health.

One study found that keto increased gut microbiome diversity in the long run, after five to six months in people with severe imbalance. Typically, a more diverse range of gut microbes leads to better digestion.

How to Support Your Gut Microbiome on Keto

• Add more fiber to your diet. Fiber can help relieve constipation or diarrhea. Good sources of fiber on keto include citrus, berries, avocado, broccoli, and chia seeds.
• Eat less dairy. As whole dairy products are high in fat, people starting on a keto diet may consume more of these than they previously did. This dietary change may reveal an intolerance to dairy, common symptoms of which are diarrhea, bloating, and gas.
• Ease into the diet. A sudden change in diet may disrupt the GI bacteria. Try easing into a keto diet by slowly reducing carbs and increasing fats to help your body adapt better.
• Stay hydrated. Drinking water can help improve constipation. If you're experiencing diarrhea, it's important to replace fluids. Drinking water and sugar-free electrolyte beverages can help replace lost fluids and electrolytes.
• Add probiotics and prebiotics. Taking a probiotic supplement or increasing the intake of probiotic- and prebiotic-rich foods may effectively support gut bacteria during a keto diet and reduce the GI effects of the diet.
• Eat fermented foods. Eating fermented foods, such as sauerkraut and kimchi, can help improve digestion, possibly reducing constipation or diarrhea.

Bile production

Bile is a substance produced by the body to break down fats. It also acts as a lubricant for the colon. When transitioning to a ketogenic diet, the body experiences a sudden increase in fat intake, which means the gallbladder needs to produce more bile for digestion. This shift from low to high bile production can be challenging for the body to adjust to.

Bile and the Keto Diet

The keto diet is a high-fat, low-carbohydrate diet that promotes the use of fat, including stored body fat, for energy instead of glucose. This shift in metabolism is known as ketosis. While keto can have benefits such as improved blood sugar control and weight loss, one common side effect is keto diarrhea.

Keto diarrhea is characterised by loose, watery stools and can be caused by several factors, including increased fat intake. The high-fat content of the keto diet means that the gallbladder has to produce more bile for digestion. Bile production is a costly process, and the body may struggle to keep up with the increased demand.

Bile Malabsorption

Bile malabsorption, or bile acid malabsorption, can occur when the body struggles to properly break down and absorb bile. This can lead to steatorrhea, a type of diarrhea caused by too much fat in the stool. Bile problems are more common in individuals with pre-existing digestive ailments such as IBS, IBD, Crohn's disease, celiac disease, or SIBO.

Managing Bile Malabsorption

If you are experiencing bile malabsorption, there are a few things you can do:

• Supplement with ox bile to assist with fat digestion until your gallbladder adjusts.
• Try a modified keto diet, such as the carnivore-adjacent diet or the cyclical ketogenic diet, which includes small amounts of fruits and root vegetables.
• If bile malabsorption persists, pharmaceutical drugs like cholestyramine, colesevelam, or colestipol can be effective treatments.

Nutrient Deficiencies

Fat-soluble vitamins, especially vitamin A and vitamin D, are important for maintaining bile production and gut health. Deficiencies in these vitamins can make it difficult for the body to upregulate bile production when starting a keto diet. Ensuring adequate intake of these vitamins may help prevent keto diarrhea.

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