Dante Carrillo
The ketogenic diet has gained popularity for its ability to help people lose weight quickly. However, one common side effect that is less often discussed is keto diarrhea. Keto diarrhea can be caused by several factors, including the high-fat content of the diet, changes in gut microbiome, and the use of artificial sweeteners and sugar alcohols, which are hard to digest. While keto diarrhea is a common issue, it is not permanent and can be addressed by increasing fiber intake and staying hydrated. However, if diarrhea persists, it is recommended to consult a doctor as it can lead to dehydration and indicate other potential health issues.
| Characteristics | Values |
|---|---|
| Reason | The body might not be able to digest fats properly |
| Composition of gut microbiome | The keto diet can impact the composition of gut microbiome, which has implications for digestion |
| Artificial sweeteners | Artificial sweeteners like sugar alcohols are harder to digest and can cause bloating and diarrhea |
| Dehydration | Diarrhea can lead to dehydration |
| Lack of fiber | The keto diet is low in fiber, which can cause constipation and increase digestive distress |
| Dairy | Dairy can cause gastrointestinal upset |
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What You'll Learn
High-fat content
The ketogenic diet is a low-carb, high-fat eating plan, with fat intake contributing to 65-90% of total calorie intake. This is a significant increase in fat consumption for most people, and it can take time for the body to adjust to digesting larger amounts of fat.
When the body is unable to break down fat in the small intestine, the fat travels to the colon, where it is digested by bacteria. This process can lead to bloating, gas, and fat in the stool, resulting in looser, more watery stools, or diarrhea.
The high-fat content of the keto diet can also cause a delay in stomach emptying, leading to abdominal discomfort, acid reflux, and an increased risk of regurgitation and heartburn.
Additionally, the keto diet's impact on the gut microbiome may play a role in causing diarrhea. Research shows that high-fat diets can lead to rapid and significant changes in the gut microbiome, and these changes may be associated with increased inflammation.
It is important to note that everyone's tolerance for fat is different, and some people may be more susceptible to diarrhea when following a high-fat diet like keto.
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Lack of fibre
The ketogenic diet is a low-carb, high-fat diet that can lead to diarrhoea. This occurs because the diet can cause a lack of fibre, which is essential for gut motility and function.
The keto diet typically involves getting up to 80% of calories from fat and only 20 to 50 grams of carbohydrates per day. This drastic reduction in carbohydrates can lead to a lack of fibre, as many fibre-rich foods are also rich in carbohydrates. As a result, people on the keto diet may not be getting enough fibre, which can cause digestive issues such as constipation and diarrhoea.
According to Suzanne Dixon, a registered dietitian, "One of the single biggest challenges for many people on the ketogenic diet is constipation. Without adequate fibre, the GI tract can come to a screeching halt." She also notes that fibre is crucial to gut motility and function, so when fibre intake is limited, digestive distress increases.
There are, however, some keto-friendly foods that are high in fibre. These include:
- Nuts, such as pecans and almonds
- Seeds, such as pumpkin seeds and flax seeds
- Low-carb vegetables, such as cauliflower, broccoli, cabbage, and Brussels sprouts
- Fruits, such as raspberries and avocados
- Artichokes
- Fermented foods, such as sauerkraut
By incorporating these fibre-rich foods into their diet, those following the keto diet can help prevent and manage GI symptoms, such as constipation and diarrhoea.
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Artificial sweeteners
The ketogenic diet is a high-fat, moderate-protein, and very low-carbohydrate diet. While it has many health benefits, including weight loss, it can also cause gastrointestinal issues such as nausea, bloating, and diarrhea.
Sugar alcohols, a type of artificial sweetener, have been found to be particularly problematic for some people. Sugar alcohols include xylitol, sorbitol, mannitol, maltitol, lactitol, and isomalt. These sweeteners can cause gas, nausea, and diarrhea, especially if consumed above one's level of tolerance. They are also harder to digest and can cause an upset stomach, followed by diarrhea.
To avoid diarrhea caused by artificial sweeteners while on the keto diet, it is recommended to reduce the consumption of products containing these sweeteners, increase fiber intake, and consider taking a probiotic supplement to support healthy gut bacteria. It is also important to stay hydrated and replenish electrolytes.
While artificial sweeteners can be a helpful way to reduce sugar and carbohydrate intake, it is important to be mindful of the potential side effects and consume them in moderation to avoid gastrointestinal distress.
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Gut microbiome changes
The ketogenic diet is a very low-carbohydrate, high-fat diet that aims to shift the body's metabolism to using fat as its primary energy source instead of carbohydrates. This shift in metabolism leads to the production of ketone bodies, which are believed to have a direct impact on the gut microbiome.
The gut microbiome refers to the diverse community of microbes, including bacteria, yeast, and viruses, that reside in the human gut. The ketogenic diet has been found to cause significant changes in the composition of the gut microbiome, with studies reporting an increase in certain bacterial species and a decrease in others. For instance, an increase in the bacterial species Akkermansia and Parabacteriodes was observed in mice on a ketogenic diet, along with a decrease in γ-glutamylated (GG) amino acids. Additionally, the ketogenic diet has been shown to reduce the levels of common gut bacteria, such as Actinobacteria, Bacteroidetes, and Firmicutes, and significantly decrease the probiotic Bifidobacteria.
The impact of the ketogenic diet on the gut microbiome may be due to the reduced consumption of carbohydrates, which are the gut bacteria's primary source of fuel. This shift in diet can lead to "keto-flu," with symptoms such as extreme tiredness, aches, nausea, and brain fog. However, these symptoms are usually temporary and resolve within a few days as the body adapts to using fat as its primary energy source.
The changes in the gut microbiome due to the ketogenic diet may have potential health benefits. For example, the decrease in Bifidobacteria is associated with reduced intestinal inflammation, suggesting potential therapeutic benefits for autoimmune disorders affecting the gut. Additionally, the ketogenic diet has been found to alleviate symptoms of diarrhea-predominant irritable bowel syndrome (IBS-D). However, it is important to note that the impact of the ketogenic diet on the gut microbiome is complex and may vary depending on individual factors such as age, health, medication, and baseline diet.
While the ketogenic diet can lead to diarrhea, there are some strategies to mitigate this issue. Reducing fiber intake, adjusting magnesium consumption, and allowing the body time to adapt to the new diet can help address diarrhea caused by the ketogenic diet. Probiotics can also be beneficial in supporting gut health and promoting a healthy balance of gut bacteria.
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Dehydration
The keto diet is also associated with gastrointestinal disturbances, such as nausea, vomiting, constipation, and diarrhoea, which can further contribute to dehydration. Diarrhoea is a common but less frequently discussed side effect of the keto diet. It occurs due to the high-fat content of the diet, which can be challenging for the body to absorb. Additionally, a lack of fibre in the keto diet can lead to digestive distress and constipation, which can also impact hydration levels.
To prevent dehydration, it is crucial to focus on proper hydration when starting the keto diet. This involves consuming adequate water, salt, and other electrolytes. Bone broth is recommended as it supplies water, electrolytes, and other essential nutrients. Staying hydrated is especially important for individuals experiencing diarrhoea, as the condition can lead to further fluid loss.
It is important to note that dehydration is a potential early complication of the keto diet, and it is more commonly experienced within the first four weeks of starting the diet. However, it is typically not a persistent issue, as the body adjusts to the new dietary pattern.
If you are experiencing dehydration or diarrhoea while on the keto diet, it is advisable to consult a healthcare professional or a registered dietitian to ensure you are properly supported and guided through the process.
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Frequently asked questions
The ketogenic diet is a low-carb, high-fat eating plan that consists of less than 5% carbs, 10-30% protein, and 65-90% fat. It works by sending your body into ketosis, a metabolic state in which you burn fat instead of glucose for energy.
The ketogenic diet can cause diarrhea, often referred to as "keto diarrhea", due to several reasons:
- High-fat content: The high-fat content of the diet can lead to steatorrhea, a type of diarrhea caused by too much fat in the stool.
- Changes in gut microbiome: The diet can impact the composition of gut bacteria, which are crucial for proper digestion.
- Artificial sweeteners: Keto-friendly products and desserts often contain artificial sweeteners like sugar alcohols that are harder to digest and can cause diarrhea.
- Lack of fiber: The diet's restriction of fruits, vegetables, and plant foods can result in a lack of prebiotic fiber, affecting the healthy probiotic bacteria in the gut.
Keto diarrhea can cause frequent loose or liquid bowel movements. It may also lead to dehydration due to fluid loss, with symptoms such as dark-coloured urine, dry skin, headache, dizziness, and excessive thirst. In some cases, individuals may experience additional gastrointestinal issues like painful cramping, bloating, and constipation.
To manage keto diarrhea, it is recommended to:
- Increase fluid intake: Consume plenty of water, soups, and fruit juices to stay hydrated and replenish electrolytes.
- Modify diet: Reduce artificial sweeteners and sugar alcohols. Include foods like citrus, berries, avocado, broccoli, and chia seeds, which are limited on the ketogenic diet but can provide some fiber and support digestion.
- Consult a healthcare professional: If diarrhea persists for more than a few days or is severe, consult a doctor. They can advise on more serious interventions to prevent dehydration and rule out other potential causes.
No, keto diarrhea is not a permanent issue. In most cases, it is a temporary side effect that may resolve as the body adjusts to the diet. However, if diarrhea is caused by changes in the gut microbiome, it might be more ongoing.
