Keto Diarrhea: How Long Does The Discomfort Last?

The ketogenic diet is a high-fat, low-carbohydrate, and moderate-protein diet. While it has been shown to aid weight loss, it can also cause gastrointestinal issues such as diarrhoea. This is known as keto diarrhoea.

Keto diarrhoea is usually not explosive but can be anything from looser bowel movements to watery stools. It is often caused by the body adjusting to the high-fat content of the diet, but it can also be caused by increased consumption of artificial sweeteners, changes to the gut microbiome, and increased dairy intake.

Keto diarrhoea usually resolves within a couple of weeks, but for some people, it can be a long-term side effect. If it does not resolve, it is recommended to seek advice from a healthcare professional.

The high-fat content of the keto diet

The keto diet is a high-fat, low-carb, and moderate-protein diet. The high-fat content of the keto diet can lead to several gastrointestinal issues, including keto diarrhea.

Fat takes longer to break down and be absorbed by the body than carbohydrates or protein. When you suddenly start consuming large amounts of fat, your digestive system may struggle to keep up, leading to malabsorption. This means that some of the fat is not broken down properly and is only partially absorbed or not absorbed at all by the body. As a result, this unabsorbed fat ends up in the colon and small intestines, leading to watery diarrhea. This type of diarrhea, called steatorrhea, is typically pale, foul-smelling, and coated in a thick, greasy film.

Additionally, to break down the high amounts of fat in the keto diet, the liver has to produce extra bile, which is a natural laxative. The excessive bile production can push waste through the digestive tract more rapidly, reducing the time for water reabsorption. This reduced transit time results in runny or loose stools, also contributing to diarrhea.

Keto diarrhea usually occurs during the initial phase of starting the keto diet, as your body is adjusting to the high-fat content. For most people, keto diarrhea subsides within a couple of weeks as their body adapts to the new diet. However, in some cases, keto diarrhea can be more long-lasting or even persistent throughout the duration of the keto diet.

Relieving Keto Diarrhea

If you are experiencing keto diarrhea, there are several steps you can take to relieve the symptoms:

• Increase your fiber intake by consuming high-fiber foods suitable for a keto diet, such as leafy greens, cucumbers, broccoli, and cabbage.
• Stay hydrated by drinking plenty of water and sugar-free electrolyte beverages to replace lost fluids and electrolytes.
• Reduce your consumption of dairy products, as they are high in fat and can contribute to diarrhea.
• Cut down on artificial sweeteners and sugar alcohols, which are known to cause digestive issues, including diarrhea.
• Gradually ease into the keto diet instead of making an abrupt change, allowing your body more time to adjust to the increased fat intake.
• Consider taking probiotic supplements or consuming probiotic-rich foods, such as sauerkraut and kimchi, to support a healthy gut microbiome.

If your keto diarrhea is severe, persistent, or accompanied by other concerning symptoms, it is recommended to consult a healthcare professional.

The use of artificial sweeteners

Artificial sweeteners are commonly used by people on the keto diet as a substitute for sugar. This is because the keto diet involves cutting back on high-carb foods like starches, desserts, and processed snacks, and reducing sugar consumption.

Types of Artificial Sweeteners

There are several types of artificial sweeteners that can be used on a keto diet. These include:

• Stevia: A natural sweetener derived from the Stevia rebaudiana plant. It is much sweeter than regular sugar, so less is needed in recipes. Stevia is available in liquid and powdered forms and can be used in various dishes, from drinks to desserts.
• Sucralose: An artificial sweetener that is not metabolized by the body. It is often used in baked goods as it is heat stable. However, some studies suggest that exposing sucralose to high temperatures may release toxic compounds.
• Erythritol: A sugar alcohol that is about 80% as sweet as regular sugar but contains only 5% of the calories. It has been shown to have a minimal impact on blood sugar levels. Erythritol is used in baking and cooking and can be substituted for sugar in various recipes.
• Xylitol: Another type of sugar alcohol commonly found in sugar-free gum, candies, and mints. It is as sweet as sugar but contains few calories and carbohydrates. However, consuming large amounts of xylitol can lead to laxative effects and stomach discomfort.

Potential Issues with Artificial Sweeteners

While artificial sweeteners can be a helpful tool for those on the keto diet, there are some potential issues to be aware of. One issue is that artificial sweeteners can be hard to digest and may cause digestive problems such as bloating, gas, and diarrhea. This is especially true for sugar alcohols like erythritol and xylitol, which can have a laxative effect. Additionally, excessive consumption of xylitol can be toxic to dogs.

Another concern is the potential impact of artificial sweeteners on weight gain and metabolic health. Some research suggests that consuming sweet-tasting foods and drinks may promote cravings for more sweet treats and contribute to long-term weight gain and metabolic issues. However, the effects of artificial sweeteners seem to vary from person to person, and not all studies have found a link between artificial sweetener use and negative health outcomes.

Recommendations for Use

When using artificial sweeteners on a keto diet, it is important to choose those that have minimal impact on blood sugar and insulin levels. Stevia, erythritol, and monk fruit are generally considered safe options. It is also important to be mindful of portion sizes, as consuming excessive amounts of some artificial sweeteners can lead to digestive issues. Finally, it is recommended to gradually reduce the amount of artificial sweeteners over time, as the keto diet often reduces cravings for sweet-tasting foods.

Dairy products

Firstly, it is important to note that dairy products are often high in fat, and a sudden increase in fat consumption can cause diarrhea. This is because the body needs to produce more bile to break down fat, and bile is a natural laxative. Therefore, an excessive amount of bile may push waste through the digestive tract faster than usual, leading to diarrhea.

Secondly, dairy products are known to cause GI upset and are a common food intolerance. Symptoms of dairy intolerance include diarrhea, bloating, and gas.

If you are experiencing keto diarrhea, it may be worth removing or reducing your consumption of dairy products. You could also try an elimination diet to see if you have any food intolerances.

If you want to continue consuming dairy, you could try switching to raw and/or A2 milk, which may be easier to digest. Goat or sheep's milk are also options, as these animals produce A2 milk.

It is also important to note that not all keto diarrhea is caused by dairy products. Other causes include sugar alcohols, incorrect macronutrient ratios, and too much magnesium.

Keto diarrhea usually only lasts for a couple of weeks while your body adjusts to the new diet. However, for some people, it may be a long-term side effect. If you have diarrhea for longer than a week, or if it is severe, you should consult a doctor.

Disruption of the gut microbiome

The gut microbiome is the collective genome of the microorganisms that inhabit the large intestine, or colon. The community of microorganisms is called the microbiota and is made up of mostly bacteria but also viruses, fungi, and protozoa. The gut microbiome plays a crucial role in human health, with its metabolites playing a key role in modulating disease risk.

The ketogenic diet has been found to have a significant impact on the gut microbiome. The diet's extremely low carbohydrate and high-fat content instigates compositional shifts in the gut's microbial community. Studies have shown that the ketogenic diet reduces bacterial abundances and diversity, with a persistent reduction in the abundance of Bifidobacterium, a beneficial bacteria, being of particular concern.

The decrease in Bifidobacterium can be attributed to the reduced intake of non-digestible carbohydrates (NDCs) on the ketogenic diet. Bifidobacterium strictly metabolises carbohydrate substrates as its energy source, and as such, its abundance is negatively impacted by the reduced intake of NDCs. Additionally, the increased levels of ketone bodies induced by the ketogenic diet have been found to directly inhibit the growth of Bifidobacterium.

The reduction in Bifidobacterium, as well as other butyrate-producing bacteria, may have detrimental effects on colonic health. Bifidobacterium plays an important role in maintaining intestinal barrier function and facilitating a healthy microbial composition through cross-feeding metabolites to butyrate-producers and competitive exclusion of pathogenic bacteria. A decrease in Bifidobacterium has been linked to an increased risk of inflammatory bowel disease, colorectal cancer, obesity, type-2 diabetes, and depression.

Furthermore, the high-fat content of the ketogenic diet can increase intestinal permeability, causing "leaky gut". This is due to the diet's effect on the genes that code for proteins that comprise tight junctions, the seals between intestinal cells. Leaky gut can lead to endotoxemia, triggering inflammation and increasing the risk of diabetes, weight gain, and oxidative stress.

In summary, the ketogenic diet's disruption of the gut microbiome, specifically the reduction in Bifidobacterium and other beneficial bacteria, may have negative consequences for colonic health and increase the risk of several chronic diseases.

How to overcome keto diarrhea

Keto diarrhea is an unfortunate side effect of the keto diet, but there are several ways to overcome it.

Avoid problem foods

If a particular food provokes symptoms, avoid it. It might be tricky to work out which food is causing the issue, so try keeping a food journal to help you work out which foods are causing specific symptoms. Alternatively, try an elimination diet, where you cut out all potential problem foods and then slowly reintroduce them one by one to see how your body reacts.

Be careful with fiber

Fiber is important for good digestion, but if you have diarrhea, try reducing your fiber intake to see if that helps.

Try probiotics

Probiotics are supplemental microbes that can help reduce inflammation, strengthen the gut barrier, and fight gut pathogens. Try taking a probiotic supplement or eating fermented foods like sauerkraut, kefir, and cultured yoghurt, which contain beneficial organisms to help balance your microbiome.

Cut back on artificial sweeteners

Artificial sweeteners and sugar alcohols can be rough on the stomach and are known to cause digestive distress. Try cutting them out to see if that helps.

Ease into the keto diet

Rather than making a sudden switch to keto, try easing into it by slowly reducing carbs and increasing fats to help your body adjust.

Stay hydrated

Drinking water and sugar-free electrolyte beverages can help replace lost fluids and electrolytes.

Cut back on dairy

Whole dairy products are high in fat, so you may be consuming more of them than usual when starting a keto diet. This may reveal a dairy intolerance, which can cause diarrhea, bloating, and gas. Try switching to plant-based, vegan alternatives.

Try prebiotics

Taking a prebiotic and probiotic combined supplement can help support the health and optimal composition of your gut flora.

Eat fermented foods

Fermented foods such as sauerkraut, kimchi, kefir, tempeh, and buttermilk contain natural probiotics, which can help populate your digestive tract with the healthy bacteria you need for optimal digestion.

Cut down on coconut oil and MCT oil

Coconut oil and MCT oil can have a laxative effect, so try cutting back on them to see if that helps.

Avoid raw vegetables

Raw vegetables can aggravate diarrhea symptoms, so it's best to avoid them until your symptoms improve.

Add in some bone broth

Bone broth can help support the health of your intestines.

Add in more healthy fats

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

Get enough probiotics

Make sure you're getting enough probiotics, either through your diet or supplements.

Limit sugar substitutes

Sugar substitutes can be difficult for the gut to absorb, so try to limit your intake.

Try soluble fiber supplements

If constipation is an issue, try taking soluble fiber supplements or adding in high-fiber vegetables and foods in moderation.

Hydrate and take probiotics

Hydration and probiotics can help with constipation and regulating any stool issues.

Supplement with magnesium

Supplementing with magnesium can help with constipation. However, it can also increase stool frequency, so if you have diarrhea, it's best to stick to the magnesium in your diet rather than taking supplements.

Frequently asked questions