Keto-Fit Diarrhea: What You Need To Know

The ketogenic diet is a popular, effective way to lose weight, but it can also cause some unpleasant side effects, including keto diarrhea. This is characterised by loose, watery stools and can be caused by an increase in fat intake, a decrease in fibre intake, and changes in gut bacteria. The high-fat, low-carb nature of the keto diet means that it can be hard for the body to adjust to digesting large amounts of fat, which can lead to malabsorption and diarrhoea. The artificial sweeteners and sugar alcohols often consumed on the keto diet can also cause digestive issues.

High fat content

The keto diet is a low-carb, high-fat eating plan, consisting of less than 5% carbs, 10-30% protein, and 65-90% fat. This shift in metabolism is known as ketosis, where the body breaks down stored fat to create molecules called ketones, which it uses as fuel instead of carbohydrates.

The high-fat content of the keto diet can lead to keto diarrhea, as the body struggles to adjust to the increased fat intake. Fat takes longer to break down and be absorbed by the body, and when consumed in large amounts, the body may not be able to keep up, leading to malabsorption. This can result in steatorrhea, a specific type of diarrhea caused by too much fat in the stool. The high-fat content can also lead to an increased release of bile, which acts as a natural laxative, pushing waste through the digestive tract faster than usual and contributing to diarrhea.

Additionally, the sudden increase in fat intake can be challenging for the body to metabolize, especially for those who are not accustomed to a high-fat diet. This can result in the body expelling the excess fat through diarrhea. The type of fat consumed also plays a role, as some ultra-saturated fats, such as MCT-rich coconut oil, can speed up transit time and contribute to diarrhea.

To alleviate keto diarrhea caused by high-fat content, it is recommended to:

• Consider supplementing with ox bile or digestive enzymes to assist with fat digestion and absorption.
• Choose the right sources of dietary fat, favoring mono-unsaturated and saturated sources such as olive oil, coconut oil, and high-fat cheese.
• Ensure adequate hydration and electrolyte intake to support the body's fluid balance and prevent dehydration, which can be exacerbated by diarrhea.
• Gradually transition to the keto diet, allowing the body time to adjust to the increased fat intake and reducing the risk of digestive issues.
• Consult with a healthcare professional or registered dietitian to ensure the diet is tailored to individual needs and nutritional requirements, including adequate fiber and fluid intake.

Lack of fibre

The keto diet is a low-carb, high-fat diet that has become increasingly popular in recent years. While it can be effective for weight loss, it can also cause some unpleasant side effects, including keto diarrhea.

One of the main reasons for this is the sudden lack of fibre that comes with cutting out carbohydrates. Fibre is essential for healthy digestion and regular bowel movements. When you drastically reduce your carb intake, you're also reducing your fibre intake, which can lead to digestive issues such as constipation and diarrhea.

Why Fibre is Important

Fibre is a type of carbohydrate that the body cannot fully digest. It helps add bulk to stools and promotes regular bowel movements. There are two types of fibre: insoluble and soluble. Insoluble fibre, found in whole grains, nuts, and vegetables, is not digestible and helps to move food through the digestive tract. Soluble fibre, found in oats, beans, and fruits, dissolves in water and forms a gel-like substance that can help lower cholesterol and stabilise blood sugar levels.

The Impact of Keto on Fibre Intake

When following a keto diet, it is recommended to limit carb intake to less than 5% of total calories. This typically results in a significant reduction in fibre intake, as many high-fibre foods, such as whole grains, legumes, fruits, and starchy vegetables, are also high in carbs. This decrease in fibre can disrupt the gut microbiome, leading to an imbalance of bacteria and potential digestive issues.

Managing Fibre Intake on Keto

While it may be challenging to get enough fibre on a keto diet, it is not impossible. Here are some tips to help you manage your fibre intake:

• Include high-fibre, low-carb foods: There are still some low-carb foods that are good sources of fibre. These include nuts, seeds, leafy greens, and cruciferous vegetables like broccoli and cauliflower.
• Increase fat intake: Adding more healthy fats to your diet can help you feel fuller and improve digestion. Avocados, for example, are a good source of both fibre and healthy fats.
• Consider a modified keto diet: Some people find that a less restrictive form of the keto diet, such as the cyclical ketogenic diet or the carnivore-adjacent diet, allows for more flexibility in terms of fibre intake.
• Slowly reduce carbs: Instead of abruptly cutting out carbs, try gradually reducing your intake over time. This can give your body more time to adjust and minimise digestive issues.
• Consult a dietitian: Working with a registered dietitian can help you ensure you're meeting your nutritional needs, including fibre intake, while following a keto diet.

In conclusion, while the keto diet can be effective for weight loss, it is important to be mindful of the potential impact on your fibre intake. By making conscious food choices and ensuring adequate fibre intake, you can help minimise digestive issues like keto diarrhea and promote a healthier gut microbiome.

Artificial sweeteners

Sugar alcohols, a common type of artificial sweetener, can be harder to digest and may cause bloating and diarrhea when consumed in excess. This is particularly true for those on a keto diet, as they often consume higher amounts of sugar alcohols and other artificial sweeteners while restricting their carb intake.

Some examples of artificial sweeteners that are commonly used in a keto diet include:

• Stevia
• Sucralose (e.g. Splenda)
• Erythritol
• Xylitol
• Monk fruit sweetener
• Yacon syrup

While these sweeteners can help individuals following a keto diet satisfy their sweet tooth without consuming carbs, it is important to be mindful of the potential side effects. Consuming too many artificial sweeteners can lead to bloating and diarrhea, especially for those who are sensitive to these substances.

Therefore, it is recommended to consume artificial sweeteners in moderation and be aware of how your body reacts to them. If you experience any negative side effects, such as diarrhea, it may be necessary to reduce your intake or switch to alternative sweeteners that agree with your digestive system.

Gut microbiome changes

The keto diet can have a significant impact on the gut microbiome, which can lead to keto diarrhea. The gut microbiome refers to the microorganisms in the gastrointestinal tract, mainly consisting of bacteria that are important for health in many ways, including helping the body digest food and absorb nutrients.

Keto Diets and Gut Microbiome Changes

The keto diet is a high-fat, low-carbohydrate diet that can cause a shift in the gut microbiome. This shift can lead to a decrease in beneficial bacteria, such as Bifidobacteria, and an increase in pro-inflammatory bacteria, such as Th17 cells. The reduction in Bifidobacteria may be due to the low carbohydrate content of the keto diet, as these bacteria feed on carbohydrates.

Impact on Digestion

The decrease in beneficial bacteria and the increase in pro-inflammatory bacteria can affect digestion and lead to diarrhea. The high-fat content of the keto diet can also be difficult for the body to digest, leading to malabsorption and diarrhea. The low-carbohydrate content of the keto diet can also lead to a decrease in fiber intake, which is important for bulking up stools and preventing diarrhea.

Artificial Sweeteners and Sugar Alcohols

The keto diet often includes the consumption of artificial sweeteners and sugar alcohols, which can be hard to digest and cause bloating and diarrhea. These sweeteners are often found in keto-friendly products and can be consumed in excess, leading to gastrointestinal distress.

Long-Term Effects

The gut microbiome changes caused by the keto diet can have long-term effects. If the keto diet is not properly managed, it can lead to ongoing malabsorption and nutrient deficiencies. It can also worsen digestive health by reducing the healthy bacteria in the microbiome, leading to increased frequency of diarrhea and other side effects.

Relief and Prevention

To relieve and prevent keto diarrhea, it is recommended to:

• Increase fiber intake by consuming more citrus, berries, avocado, broccoli, and chia seeds.
• Stay hydrated by drinking water and electrolytes.
• Add probiotic-rich foods such as yogurt, kefir, kimchi, and kombucha to the diet.
• Avoid artificial sweeteners and sugar alcohols.
• Ease into the keto diet by slowly reducing carbs and increasing fats.

Bile acid malabsorption

There are three types of bile acid malabsorption:

• Type I: This occurs when there is a problem in the part of the small intestine (ileum) where re-absorption takes place. Causes include inflammation or removal of the ileum due to conditions such as Crohn's disease or cancer treatment.
• Type II: This is primary bile acid malabsorption, where no definitive cause can be found.
• Type III: This results from other diseases or conditions within the abdomen, such as gallbladder removal, coeliac disease, chronic pancreatitis, radiotherapy, or small bowel bacteria overgrowth.

The main symptom of bile acid malabsorption is diarrhea, which can be frequent and may be pale, greasy, and hard to flush away, or unusually coloured (green, yellow, or orange). Other symptoms include bloating, cramping abdominal pain, and excessive wind.

Frequently asked questions