Keto Omad Diarrhea: Normal Or Not?

Diarrhea is a common side effect of the keto diet, which is a low-carb, high-fat eating plan. The diet can cause what is known as keto diarrhea, which can be caused by an increase in fat intake, a decrease in fiber intake, and changes in gut bacteria. The high-fat content of the keto diet can lead to an increase in bile production, which can act as a natural laxative and cause watery stools and diarrhea. Additionally, artificial sweeteners and sugar alcohols, which are commonly consumed on the keto diet, can also lead to diarrhea. For most people, keto diarrhea is a short-term issue that resolves as the body adjusts to the new diet. However, for some people, it can be a long-term side effect.

High fat content

The keto diet is a low-carb, high-fat diet. The body usually uses carbohydrates as an energy source, but when there are insufficient carbohydrates, it enters a state called 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 cause diarrhea, as the body may struggle to keep up with the sudden increase in fat intake. This can lead to steatorrhea, a specific type of diarrhea caused by too much fat in the stool. The fat may be malabsorbed, not broken down properly, and excreted in the stool.

Additionally, the keto diet often results in a decrease in fiber intake, as fiber is found in carbohydrates like fruits, legumes, starchy foods, and grains. This decrease in fiber can lead to diarrhea and other gut-related problems, such as changes in the gut microbiome and inflammation in the gut.

To alleviate keto diarrhea, it is recommended to:

• Increase fiber intake by consuming fibrous vegetables like broccoli, spinach, kale, and cabbage.
• Drink more water and electrolytes to stay hydrated and replace lost fluids.
• Avoid artificial sweeteners and sugar alcohols, as they can be hard to digest and cause an upset stomach.
• Introduce more vegetables and reduce the amount of fat in your diet.
• Eat fermented foods like sauerkraut and kimchi to improve digestion.
• Take probiotic supplements to support gut bacteria.

Keto diarrhea usually occurs during the initial phase of starting the diet and often resolves within a few weeks as the body adjusts. However, if diarrhea is severe and lasts longer than two days, it is recommended to consult a doctor.

Lack of fibre

Diarrhea is a common side effect of the keto diet, and it can be caused by a lack of fibre in the diet. When following a keto diet, it is important to be mindful of your fibre intake as most sources of carbohydrates, including whole grains, fruits, and legumes, are ruled out. These foods are typically good sources of fibre, so excluding them from your diet can lead to a fibre deficiency.

Fibre is essential for digestive health. It helps keep you regular by softening and adding bulk to your stools. It also feeds the good bacteria in your gut, aiding healthy digestion and nutrient absorption. Therefore, a lack of fibre can lead to constipation and other gut-related problems, such as changes to the gut microbiome, which can cause diarrhoea.

To avoid diarrhoea caused by a lack of fibre while on the keto diet, it is important to include fibre-rich foods in your meals. Some keto-friendly sources of fibre include avocados, chia seeds, nuts (such as pecans and almonds), flax seeds, collard greens, cauliflower, pumpkin seeds, coconut meat, raspberries, artichokes, and fermented foods like sauerkraut.

In addition to increasing your fibre intake, staying hydrated by drinking plenty of water and electrolytes can also help manage diarrhoea. However, if diarrhoea persists or is severe, it is important to consult a doctor or dietitian for further guidance.

Artificial sweeteners

Diarrhea is a common side effect of starting a keto diet. This is because the keto diet is high in fat and low in carbs, which can be hard for the body to digest. In addition, the keto diet often involves consuming more artificial sweeteners, which can be rough on the stomach and lead to diarrhea.

Some of the most common types of artificial sweeteners include:

• Acesulfame Potassium (Ace K)
• Aspartame
• Cyclamate
• Glycerol
• Glycyrrhizic Acid
• Hydrogenated Starch Hydrolysates (HSH)
• Isomalt
• Lactitol
• Maltitol
• Neotame
• Polydextrose
• Saccharin
• Sucralose
• Sugar Alcohols (Erythritol, Xylitol)

While artificial sweeteners can be a helpful way to reduce calorie intake, there are some concerns about their potential side effects. Some of the most commonly reported side effects include:

• Headaches
• Stomach pain, diarrhea, and other digestive issues
• Cravings for sweet foods
• Interference with weight loss

If you are experiencing diarrhea or other side effects from consuming artificial sweeteners, it is important to speak to a doctor or registered dietitian. They can help you understand the potential risks and benefits of artificial sweeteners and provide guidance on whether or not to include them in your diet.

Gut microbiome changes

The keto diet can cause changes in the gut microbiome, which can lead to digestive issues such as diarrhea. The diet's high fat and low carb content can reduce the number of good bacteria in the gut, leading to an imbalance. This imbalance can cause inflammation in the gut and unfavorable changes in the gut microbiome, resulting in digestive issues such as diarrhea.

The gut microbiome refers to the microorganisms in the gastrointestinal (GI) tract, mainly consisting of bacteria crucial to maintaining gut health and overall health. A healthy gut microbiome is essential for proper digestion, nutrient absorption, and supporting the immune system.

When a person starts the keto diet, they drastically reduce their carbohydrate intake and increase their fat intake. This change in diet can disrupt the balance of microorganisms in the gut, leading to an imbalance or dysbiosis. Dysbiosis is a state of imbalance in the gut microbiome, where potentially harmful bacteria outgrow beneficial bacteria.

Several factors contribute to the development of dysbiosis during the keto diet:

• Decreased fibre intake: The keto diet's restriction of carbohydrates can lead to a decrease in fibre intake, as fibre is primarily found in carbohydrate-rich foods such as fruits, legumes, starchy foods, and grains. Fibre is essential for promoting the growth of good bacteria and maintaining a healthy gut microbiome. A lack of fibre can lead to a decrease in the abundance of good bacteria, disrupting the balance of the gut microbiome.
• Increased fat intake: The high-fat content of the keto diet can be challenging for some people to digest. The body needs to produce more bile to break down and absorb the increased amount of fat. Sometimes, the gallbladder can release too much bile at once, leading to watery stools and diarrhea. Additionally, bile acts as a natural laxative, so an excess of bile can speed up the movement of waste through the digestive tract, causing loose and frequent bowel movements.
• Artificial sweeteners and sugar alcohols: The keto diet often includes artificial sweeteners and sugar alcohols, which can be hard on the gut. These sweeteners are not effectively absorbed in the gut and can reach the large intestine undigested, causing a laxative effect and contributing to diarrhea.

The gut microbiome changes during the keto diet can lead to digestive issues such as diarrhea, bloating, and constipation. These issues can be short-term while the body adjusts to the new diet or more long-term, lasting the duration of the diet.

To mitigate these gut microbiome changes and improve digestive health while on the keto diet, the following strategies can be implemented:

• Increase fibre intake: Focus on consuming at least 25 grams of fibre daily from low-carb sources such as avocado, nuts, seeds, and non-starchy vegetables.
• Choose the right types of fat: Experiment with different types of fat to see what works best for your body. Some people do better with more saturated fats from animal sources, while others tolerate plant-based monounsaturated and polyunsaturated fats better.
• Identify and avoid trigger foods: Pay attention to how you feel after eating different foods, and try eliminating any suspects for a few weeks to see if your digestive issues improve. Common trigger foods include sugar alcohols, high-FODMAP foods, spicy foods, caffeine, and dairy products.
• Incorporate easily digestible vegetables: While leafy greens and cruciferous vegetables are nutrient-dense, they can be harsh on a sensitive digestive system. Opt for gentler, easily digestible vegetables such as cooked zucchini, steamed carrots, and peeled and seeded cucumbers.
• Stay hydrated: Diarrhea can lead to dehydration, so it is crucial to drink plenty of fluids, especially water and electrolyte-rich beverages, to replace lost fluids and electrolytes.
• Add probiotics and prebiotics: Taking a probiotic supplement or increasing the intake of probiotic- and prebiotic-rich foods can support gut bacteria and reduce the gastrointestinal effects of the keto diet.
• Ease into the diet: Instead of making a sudden change, slowly reduce carbohydrates and increase fats to give your body time to adapt and minimise digestive issues.

Bile production

The gallbladder is a small pouch that sits just below the liver and is responsible for storing and releasing bile, a substance produced by the liver that helps to break down fats in the diet. During a meal, the liver sends bile directly to the gut for digestion. However, between meals, bile is redirected to the gallbladder for storage.

A high-fat meal can be harder to digest as there may not be enough bile available, which can lead to digestive issues such as gas, bloating, and diarrhea. This is why some people experience diarrhea when starting a keto diet, as it is high in fat.

Tips to Manage Fats and Avoid Digestive Issues:

• Start with a moderate amount of fat and slowly reduce carbs at the same time.
• Stay hydrated but avoid drinking fluids during meals and 30 minutes before and after eating, as this may flush out the enzymes needed for digestion.
• Consume MCTs (medium-chain triglycerides), a type of fat that does not require bile for digestion and absorption.
• Pair fat with soluble fiber, which helps slow down digestion and allows for better absorption of nutrients. Examples include pumpkin, sunflower, flaxseed, and chia seeds.
• Consume smaller, more frequent meals to allow for a better distribution of bile to dietary fat, resulting in improved digestion and absorption of nutrients.
• Consider supplements such as digestive enzymes and bile salts, which can aid in the digestion of fats.
• Try consuming ginger with meals, as it has been found to enhance fat digestion.
• Utilize shakes and smoothies, which are easier to digest as they are already in a blended/drinkable form.

Other Factors Contributing to Diarrhea on a Keto Diet:

• Increase in fat intake: Fat takes longer to break down and digest compared to protein and carbs. When you suddenly consume a lot of fat, your digestive system may struggle to keep up, leading to malabsorption and diarrhea.
• Decrease in fiber intake: Insoluble fiber bulks up your stools and helps prevent diarrhea. On a keto diet, you may be consuming less fiber, which can contribute to diarrhea.
• Artificial sweeteners and sugar alcohols: These are often found in keto products and can be hard to digest, leading to bloating and diarrhea.
• Changes in gut microbiome: The keto diet can impact the composition of your gut bacteria, which can affect digestion and lead to diarrhea.

General Tips to Manage Diarrhea on a Keto Diet:

• Add more fiber to your diet, especially soluble fiber, which helps calm diarrhea by absorbing water. Examples include citrus, berries, avocado, broccoli, and chia seeds.
• Drink more water and electrolytes to stay hydrated and replace lost fluids.
• If diarrhea persists, consider reducing the amount of fat in your diet and introducing more vegetables.
• Consult a healthcare professional if diarrhea is severe, lasts more than a few days, or is accompanied by symptoms of dehydration.

Diarrhea can be a common side effect when starting a keto diet due to the high-fat content and other factors mentioned above. However, it is not always explosive or acute and usually resolves within a few weeks as your body adjusts to the new diet.

Combining keto with OMAD (one meal a day), an intermittent fasting approach, may also contribute to diarrhea as your body may be more sensitive to food after a prolonged fast. It is important to listen to your body and make adjustments as needed.

Some people find that adding more fibrous vegetables, such as spinach and broccoli, to their meals helps alleviate diarrhea on keto and OMAD. Staying hydrated and managing stress levels can also help.

Frequently asked questions