Keto Flu And Diarrhea: What's The Connection?

The keto diet is a popular eating plan that involves eating vegetables, protein, and very few carbohydrates. While it can be an effective way to lose weight, it can also lead to some unfortunate gastrointestinal (GI) symptoms. One of these symptoms is keto diarrhea, which can occur when starting or following the keto diet. The keto diet is high in fat and low in carbs, and this drastic reduction in carbs can come as a shock to the body, leading to withdrawal-like symptoms similar to the flu, known as the keto flu. This transition period to a high-fat, very low-carb diet may be especially difficult for some people, and symptoms can range from mild to severe.

Diarrhea caused by a high-fat diet

The keto diet is a high-fat, low-carb, and moderate-protein eating plan. It is known to be an effective way to lose weight and improve health. However, it is associated with some unpleasant side effects, including diarrhea. This is sometimes referred to as "keto diarrhea".

Causes of keto diarrhea

There are several reasons why the keto diet may cause diarrhea:

• Fat intolerance: The high-fat content of the keto diet can be difficult for some people to digest. This is because fat takes longer for the body to break down and some people are not accustomed to metabolising large amounts of fat. As a result, the body tries to expel the excess fat, leading to diarrhea.
• Artificial sweeteners and sugar alcohols: The keto diet often involves the consumption of artificial sweeteners and sugar alcohols, such as sorbitol, maltitol, and xylitol. These substances are not effectively absorbed in the gut and can have a laxative effect, contributing to diarrhea.
• Gut microbiome disruption: The keto diet can impact the composition of the gut microbiome, which is important for digestion. Some studies suggest that the keto diet may cause changes in gut bacteria, leading to poor digestion and diarrhea.
• Laxatives and anti-diarrheal medications: While these may provide temporary relief, they do not address the underlying cause of the diarrhea. In fact, they may disrupt the gut microbiome and digestive system, leading to further inflammation and gastrointestinal issues.
• Dairy consumption: Dairy is known to cause gastrointestinal upset, and increasing dairy intake as part of the keto diet may trigger diarrhea.
• Incorrect food choices: A poorly formulated keto diet may include the wrong sources of dietary fats, too much protein, or excessive consumption of sugar-free products, all of which can contribute to diarrhea.

Relief and prevention of keto diarrhea

• Add more fiber: Soluble fiber can help to absorb water and calm diarrhea. Good sources of soluble fiber that are suitable for the keto diet include citrus fruits, berries, avocado, broccoli, and chia seeds.
• Drink more water and electrolytes: Diarrhea can lead to fluid loss and dehydration, so it is important to stay hydrated. Drinking water and electrolyte beverages can help replace lost fluids and electrolytes.
• Probiotics and prebiotics: Taking probiotic supplements or increasing the intake of probiotic- and prebiotic-rich foods can support gut bacteria and reduce gastrointestinal effects.
• Fermented foods: Eating fermented foods, such as sauerkraut and kimchi, can improve digestion and reduce constipation or diarrhea.
• Reduce sugar substitutes: Cutting back on sugar substitutes, such as artificial sweeteners and sugar alcohols, may help relieve gastrointestinal symptoms.
• Ease into the diet: Instead of making a sudden change, gradually reduce carbohydrates and increase fats to give your body time to adjust to the new diet.

When to seek medical advice

Keto diarrhea is usually a temporary issue that occurs during the initial transition to the keto diet. However, if it persists or is accompanied by other symptoms, it is important to consult a doctor. Seek medical attention if you experience severe or persistent diarrhea, dehydration, vitamin deficiencies, muscle deterioration, or electrolyte imbalance.

Artificial sweeteners and sugar alcohols

Artificial sweeteners such as sorbitol, maltitol, and xylitol may also be to blame for diarrhea. These non-nutritive sugars are not effectively absorbed in the gut and often reach the large intestine undigested, resulting in an unpleasant laxative effect.

To avoid diarrhea caused by artificial sweeteners and sugar alcohols, it is recommended to reduce the consumption of products containing these ingredients.

It is worth noting that chronic diarrhea can lead to health complications such as vitamin deficiencies, muscle deterioration, and electrolyte imbalance. Therefore, if keto diarrhea persists, it may be advisable to consult a healthcare professional or consider an alternative eating plan.

The keto diet and the gut microbiome

The ketogenic diet is a very low-carbohydrate, high-fat diet that has gained popularity in recent years for its proposed benefits in lowering inflammation, promoting weight loss, and improving heart health. The diet involves reducing carbohydrate consumption to less than 5% of total calories, which forces the body to use fat molecules, instead of carbohydrates, as its primary energy source. This shift in metabolism results in the production of ketone bodies, which are claimed to have numerous health benefits.

Research has shown that the keto diet has a significant impact on the gut microbiome, which refers to the microorganisms living in the gastrointestinal tract. The gut microbiome plays a crucial role in human health, influencing various aspects such as immunity, energy production, and metabolism.

The impact of the keto diet on the gut microbiome

The keto diet has been found to alter the composition and characteristics of intestinal microorganisms. Studies in both humans and mice have reported a decrease in the abundance of certain bacterial species, such as Bifidobacteria, and an increase in others, such as Bacteroides and Dorea spp. The keto diet has also been associated with a decrease in bacterial diversity and richness in the gut microbiome.

Potential benefits and risks of the keto diet on the gut microbiome

The changes in the gut microbiome induced by the keto diet may have both beneficial and detrimental effects. On the one hand, the keto diet has been linked to a reduction in pro-inflammatory microbes and an increase in beneficial bacteria such as Akkermansia Muciniphila and Lactobacillus, which are known to have anti-inflammatory properties. This suggests that the keto diet may have potential therapeutic benefits for autoimmune disorders affecting the gut.

On the other hand, the keto diet's restriction of carbohydrates, which are an important energy source for the gut microbiota, may negatively impact the growth and function of certain bacterial species. Additionally, the high-fat content of the keto diet may lead to an increase in bile production, as the liver needs bile to break down fats. Bile acts as a natural laxative, and excessive amounts can lead to diarrhea and other gastrointestinal symptoms.

Practical recommendations for preserving gut health on the keto diet

To preserve gut health while on the keto diet, it is recommended to:

• Introduce plant-based proteins and reduce the intake of animal protein.
• Include fermented foods and beverages, such as yogurt, kefir, kimchi, and fermented vegetables, which can improve gut microbiome diversity and function.
• Consider adding specific prebiotics and probiotics to support the growth of beneficial bacteria.
• Reduce the intake of omega-6 fatty acids and increase the consumption of omega-3 fatty acids to improve the ratio and promote a healthier gut microbiome.
• Avoid artificial sweeteners, as they have been linked to negative effects on gut health and the gut microbiota.

How to manage keto flu symptoms

The keto diet can cause flu-like symptoms, often referred to as the "keto flu", as your body adapts to the withdrawal of carbohydrates. Symptoms can include diarrhoea, constipation, nausea, fatigue, and insomnia. While these symptoms are usually temporary, there are several ways to reduce their effects.

Transition gradually

If you plan to start a keto diet, try cutting back on carbs slowly while increasing your fat and protein intake. This can help you ease into the diet and make the transition smoother.

Stay hydrated

Drinking enough water is essential for good health and can also help reduce keto flu symptoms. The keto diet can deplete your water stores, putting you at risk of dehydration and electrolyte imbalances. Staying hydrated helps replace lost fluids and minimises symptoms like fatigue.

Adjust your workout routine

While exercise is important, strenuous activity can worsen keto flu symptoms. Focus on lighter activities such as walking, yoga, or stretching instead.

Get enough electrolytes

When your body dumps water during ketosis, it often dumps electrolytes too. This can be more common when insulin levels decrease. Electrolytes may be the solution if you're experiencing symptoms like fatigue, muscle cramps, or body weakness. Adding more salt to your food or drinking sports drinks that are high in electrolytes can help your body adjust to ketosis.

Moderate caffeine intake

Caffeine is a stimulant that can negatively affect sleep. As insomnia is a common symptom of keto flu, reducing your caffeine intake can help lower this risk.

Eat the right foods

• Focus on alkalizing foods: Fresh vegetables, especially green leafy greens, avocados, mushrooms, radishes, artichokes, and cucumbers, are alkalizing and can help reduce inflammation and restore nutrient balance.
• Eat enough fat and calories: Staying in ketosis requires getting about 80% of your calories from fat. Examples of healthy keto-friendly fats include coconut oil, olive oil, MCT oil, grass-fed butter, ghee, and fattier cuts of meat.
• Consume enough salt: Including more salt in your diet can help reduce keto flu symptoms. This is why some people add bouillon cubes to water to make a quick broth.
• Get your B vitamins: B vitamins are important for energy production and cognitive health. Nutritional yeast is a great way to get more B vitamins, but they can also be found in organ meats, grass-fed meat, salmon, pastured eggs, and poultry.

Rest and recover

Don't be too hard on yourself if you're feeling unmotivated to exercise or are struggling with your workouts. It's normal to need to reduce your exercise load until you feel better. Make sure to get plenty of sleep and take breaks to relax during the day. Lighter forms of exercise, such as walking or yoga, can also help you get through this rough period.

The keto flu: what it is and why it happens

The keto flu is a collection of symptoms experienced by some people when they start a ketogenic diet. The ketogenic diet is a very low-carb, high-fat, and moderate-protein diet. It is considered safe for most people but has some unpleasant side effects, including the keto flu, which is also known as the "carb flu".

The keto flu is so-called because its symptoms can feel similar to the flu. These symptoms are caused by the body adapting to a new diet consisting of very few carbohydrates. The drastic reduction in carbohydrates can come as a shock to the body and may cause withdrawal-like symptoms, similar to those experienced when weaning off an addictive substance.

The body normally burns carbohydrates (glucose) for energy. When carb intake is drastically reduced, the body is depleted of stored glucose and instead turns to burning fatty acids for energy. This is called ketosis. Ketosis can be reached by starvation and fasting, as well as by adopting a very low-carb diet.

Symptoms of the keto flu can include stomach or intestinal pain, nausea, dizziness, sugar cravings, cramping, muscle soreness, irritability, diarrhea or constipation, trouble sleeping, poor focus and concentration, and brain fog. These symptoms can range from mild to severe and usually last a few days to several weeks, but in extreme cases can last up to a month.

The keto flu is thought to be caused by genetics, electrolyte loss, dehydration, and carbohydrate withdrawal.

How to ease keto flu symptoms

• Drink plenty of water to stay hydrated and help with symptoms like fatigue and muscle cramping.
• Replace electrolytes, as the keto diet restricts many foods that are high in potassium, such as fruits, beans, and starchy vegetables. Salting food to taste and including potassium-rich, keto-friendly foods like leafy greens and avocados are good ways to maintain a healthy balance of electrolytes.
• Get plenty of rest. Lack of sleep causes levels of the stress hormone cortisol to rise in the body, which can negatively impact mood and make keto-flu symptoms worse.
• Avoid strenuous exercise. Light activities like walking, yoga, or leisurely biking may improve symptoms.
• Make sure you are eating enough fat and carbohydrates. Transitioning to a very low-carb diet can cause cravings for restricted foods. Eating enough fat will help reduce cravings and keep you feeling satisfied.

Frequently asked questions