Keto Diet: A Solution For Stomach Issues?

The ketogenic diet is a very low-carb, high-fat, and moderate-protein diet that has gained popularity as a way to lose weight and improve health. While the diet is considered safe for most people, it's associated with some unpleasant side effects, including stomach issues.

The keto flu, a collection of symptoms experienced by some people when they first start the keto diet, can include stomach or intestinal pain, nausea, constipation, and diarrhoea. 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, leading to withdrawal-like symptoms similar to those experienced when weaning off an addictive substance. The keto flu usually lasts for a few days to several weeks, and its duration varies from person to person.

To alleviate the symptoms of the keto flu, it is recommended to stay hydrated, replace lost electrolytes, get enough rest, avoid strenuous activities, eat enough fat, and gradually reduce carbohydrate intake.

In addition to the keto flu, other factors that may contribute to stomach issues on a ketogenic diet include dehydration, insufficient water intake, and a lack of fibre in the diet. Consuming sugar alcohols, too much protein, and the wrong sources of dietary fats can also lead to gastrointestinal distress and diarrhoea.

Dehydration and keto

The keto diet involves cutting carbs and eating fat. It is a popular way to lose weight and improve overall health. However, it can also cause dehydration, especially when you are starting this diet. The nature of the high-fat and low-carb diet can cause an imbalance in electrolytes, leading to dehydration and other unpleasant symptoms.

When your body shifts into a metabolic state of burning fat for fuel, the liver creates ketones. These are water-soluble compounds made of fatty acids. Your body will use ketones for energy, releasing them into your bloodstream. Ketones have a diuretic effect, making you urinate more often and lose water.

Additionally, as your body switches away from using carbs as fuel, the liver also releases its glycogen stores. This form of glucose is stored with lots of water, which exits the body through urine, leading to dehydration. A low-carb diet also leads to the production of less insulin. Less insulin in the bloodstream signals your kidneys to excrete sodium at a higher rate.

Signs of Dehydration on Keto

Some signs of dehydration you may notice as your body adjusts to a keto diet include:

• Muscle cramps or spasms
• Feeling confused or having brain fog
• Fatigue and weakness
• Dizziness and lightheadedness
• Dry mouth and throat

• Drink plenty of water: Start your day with a glass of water and try to drink around 2-3 litres of water throughout the day.
• Keep water nearby: It's easier to remember to drink water if you keep a full glass near you.
• Buy a tracking cup or download an app: This can help you visually see how much you drink in a day.
• Increase electrolyte intake: Electrolytes help the body absorb and utilize nutrients. Include electrolyte-rich foods and drinks in your diet, such as leafy greens, avocados, nuts, low-sugar broths, and sports drinks.
• Eat whole foods: Include foods with high water content, such as leafy vegetables, avocados, cucumbers, and celery.

Lack of fibre in the diet

A lack of fibre in the diet is a common issue for people on the keto diet. This is because the keto diet is often criticised for its lack of fibre, and many fibre-rich foods are also rich in carbohydrates. By trying to avoid carbohydrates, people on the keto diet often inadvertently avoid fibre.

The Importance of Fibre

Fibre is important for everyone, regardless of their eating plan. It is indigestible plant material that passes through the digestive system, keeping you regular by softening and adding bulk to your stools. It also has benefits beyond bowel movements, feeding the good bacteria in the gut and aiding healthy digestion and nutrient absorption.

The USDA's 2020-2025 Dietary Guidelines for Americans set a goal of 28 to 34 grams of fibre a day, depending on age and sex.

High-Fibre Foods to Include in Your Diet

• Avocados: Half an avocado contains just 1.4 net carbs but a whopping 5 grams of fibre.
• Chia seeds: One ounce offers 9.6 grams of fibre and a net carbs total of 2.2 grams.
• Nuts: Pecans and almonds are good choices, offering just 1.2 net carbs per ounce and supplying 2.7 grams of fibre.
• Flax seeds: One tablespoon of ground flax boasts 2 grams of fibre and 0 net carbs.
• Vegetables: Collards, cauliflower, asparagus, broccoli, and cabbage are all high in fibre and low in carbs.
• Coconut: A small piece of coconut meat offers about 3 grams of net carbs and 4 grams of fibre.
• Berries: Raspberries are a good choice because of their fibre content. A half cup of fresh raspberries offers 4 grams of fibre and 3.3 grams of net carbs.
• Artichokes: One canned artichoke heart offers 1.7 grams of fibre and less than 1.9 grams of net carbs.
• Fermented foods: Packed with probiotics, these are good for the gut and low in carbohydrates. A half cup of sauerkraut supplies 2 grams of fibre and a little more than 1 gram of net carbs.

Supplements

If you can't get enough fibre through diet alone, supplements can help bridge the gap to ensure you get the daily recommended intake.

Diarrhoea and constipation

Additionally, the high-fat content of the keto diet can also contribute to diarrhoea. This is because the body may not be able to keep up with the breakdown and absorption of the large amount of fat included in the diet. The unabsorbed fat reaches the small intestine and colon, pulling in more water and resulting in watery diarrhoea.

To treat and prevent diarrhoea and constipation while on the keto diet, it is recommended to:

• Increase fibre intake with keto-friendly, high-fibre foods such as non-starchy vegetables, nuts, seeds, and berries.
• Drink plenty of water to stay hydrated and promote waste removal.
• Consider reducing dairy intake, as dairy is known to cause GI upset and can lead to constipation.
• Take a fibre supplement, although some nutritionists advise against this as they may contain too many carbohydrates, interfering with ketosis.
• Ease into the keto diet by gradually reducing carb intake, giving your body time to adjust.

It is important to note that chronic diarrhoea can lead to health complications such as vitamin deficiencies, muscle deterioration, and electrolyte imbalance. If you experience persistent diarrhoea or constipation, it is recommended to consult a healthcare professional.

Stomach pain

The keto diet is very low in carbohydrates, high in fat, and moderate in protein. This means that when you're on the keto diet, you're eating a lot more fat than you're used to. This increase in fat intake can lead to stomach pain and other gastrointestinal issues.

• Drink plenty of water. The keto diet can cause you to rapidly shed water stores, increasing the risk of dehydration.
• Replace electrolytes. The keto diet can lead to a loss of electrolytes, especially sodium and potassium. Try salting your food to taste and including potassium-rich, keto-friendly foods like green leafy vegetables and avocados.
• Get enough sleep. Lack of sleep can cause levels of the stress hormone cortisol to rise, which can negatively impact mood and make keto-flu symptoms worse.
• Eat enough fat. Transitioning to a very low-carb diet can cause you to crave carbohydrates. Eating enough fat will help reduce cravings and keep you feeling satisfied.
• Cut out carbs slowly. If you're having a difficult time adapting to the keto diet, try eliminating carbohydrates gradually, rather than all at once. Slowly cutting back on carbs may help make the transition smoother and decrease keto-flu symptoms.
• Take it slow with exogenous ketones. If you're taking exogenous ketones, start with a small dose and work your way up. Taking too much too soon can cause stomach pain and other side effects.
• Be patient. The keto flu is usually temporary, and symptoms typically last a few days or up to several weeks. However, for some people, symptoms may last up to a month.

If you're experiencing severe or constant stomach pain, or if your symptoms persist for more than two or three weeks, it's important to see a doctor to make sure that everything is okay.

Nutritional concerns

The ketogenic diet is a very low-carb, high-fat, and moderate-protein diet. While it is considered safe for most people, it is associated with some unpleasant side effects. The keto diet restricts many foods that are rich in potassium, including fruits, beans, and starchy vegetables. This may lead to an inadequate intake of vitamins, minerals, and phytochemicals.

The keto diet is mainly low-carb and high-fat. This rule of thumb greatly reduces the number of vegetables and fruits allowed in the diet. A shortage of vegetable and fruit intake reduces the fiber a person eats, which may lead to constipation and further health issues.

The keto diet can also cause acid reflux. Fats take the longest to empty out of the stomach, so they keep people fuller for longer. On keto, delayed stomach emptying may leave your stomach full all the time, triggering abdominal discomfort and an increased risk of regurgitation and heartburn.

Additionally, the keto diet can cause dehydration. The human body produces ketones during the process of breaking down fat. To get rid of the ketones, people on the diet drink more water and have more frequent urinations. Because of the more frequent urinations, people feel dehydrated. Thus, people experience flu-like weakness.

Some people on the keto diet may also experience diarrhea due to a lack of fiber and an increased amount of fat. However, the diet's health risks are individual, and you should see a physician only if symptoms persist or worsen. Taking fiber supplements, eating fermented foods, drinking water, and taking other steps can help prevent and manage GI symptoms.

Frequently asked questions