Keto Sweeteners: Which Ones Cause Stomach Pain?

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, including stomach pain. This is often referred to as the keto flu and is caused by the body adapting to a new diet consisting of very few carbohydrates.

There are several reasons why an individual may experience stomach pain when following a ketogenic diet:

- Dehydration: The keto diet can lead to dehydration as the body releases and uses stored carbohydrates for energy, and turning fat into energy uses a lot of water.

- Lack of fiber: The keto diet involves cutting out common sources of fiber, such as whole grains and cereals, which can lead to constipation and increased abdominal discomfort.

- High-fat foods: Eating a lot of fat, especially if an individual usually consumes a low-fat diet, can lead to stomach aches.

- Artificial sweeteners: While non-calorie artificial sweeteners won't kick someone out of ketosis, they can upset the stomach, especially sugar alcohols such as erythritol, xylitol, mannitol, and maltitol.

- Exogenous ketone supplements: These supplements are used to help individuals get into ketosis faster and achieve a deeper state of ketosis, but they can cause stomach aches if too much is consumed too soon.

- Not enough fluid: When switching from carbs to fats, the body gets rid of excess fluid, so it is important to replace this fluid to stay hydrated.

- Too much protein: This can cause stomach pain, especially if the stomach's acidity is not at a pH between 1 and 3, as a highly acidic stomach is needed to break down proteins.

The keto flu, including stomach pain, is usually short-lived and can be treated by staying hydrated, replacing electrolytes, getting enough sleep, and gradually cutting down on carbs.

Dehydration

There are two main reasons why you may become dehydrated when starting a keto diet:

• Glycogen storage: Glycogen, the stored form of carbohydrates, binds to water in the body. Each gram of glycogen is stored with four grams of water. When you cut carbs, your body releases and uses stored carbohydrates for energy, along with the water they are stored with.
• Water retention: High insulin levels caused by a high-carb diet lead to water retention by inhibiting sodium excretion. The keto diet lowers insulin levels, allowing excess fluid to be released.

Together, these two factors can lead to dehydration, which in turn can cause stomach pain, as well as other symptoms such as headaches, lethargy, nausea, brain fog, and low motivation.

How to cure dehydration

To combat dehydration when starting a keto diet, it is recommended to:

• Drink plenty of water.
• Add salt to your food and drinks.
• Eat more fat.
• Slowly increase your intake of exogenous ketones.

Lack of fibre

The keto diet is a low-carb, high-fat diet that limits daily non-fibre carbohydrate intake to 20 to 50 grams. This is a drastic reduction compared to a typical carbohydrate intake of 150 to 250 grams. As a result, the keto diet can make it harder to get adequate amounts of essential nutrients, including fibre.

Fibre is essential for digestive health. It keeps 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.

The keto diet's restriction of carbohydrates, including whole grains, fruits, and legumes, can lead to a fibre deficiency. This can cause constipation, leaving you with harder, more stubborn stools and a bloated gut.

To avoid these issues, it's important to include fibre-rich foods in your keto diet. Some good sources of fibre that are compatible with the keto diet include:

• Avocados
• Asparagus
• Broccoli
• Brussels sprouts
• Pistachios
• Flaxseed
• Chia seeds
• Nuts, such as pecans and almonds
• Collard greens
• Cauliflower
• Pumpkin seeds
• Coconut meat
• Raspberries
• Artichokes
• Fermented foods like sauerkraut

High-fat foods

Eating high-fat foods can cause stomach pain for a variety of reasons. Here are some of the most common causes and what you can do to find relief:

Indigestion

Indigestion is a common issue after consuming high-fat foods. Fat takes longer to digest than other macronutrients, so your gastrointestinal tract has to work harder, which can lead to feelings of cramps, bloating, nausea, and even diarrhea. To alleviate indigestion, stop eating, as consuming more fat will only worsen the discomfort. Over-the-counter antacids can help, and natural remedies such as ginger or licorice root tea may also provide relief.

Irritable Bowel Syndrome (IBS)

IBS is a condition that can cause abdominal pain after eating fatty foods. It is characterised by a disordered brain-gut interaction that sends pain signals during meals. Other symptoms may include abdominal pain, bloating, cramping, frequent gas, constipation, or diarrhea. Fried foods can trigger these symptoms, but other foods may also be culprits. Mild IBS can be managed by avoiding trigger foods and managing stress. If symptoms persist, your doctor may recommend medication.

Gastritis

Gastritis is the inflammation of the stomach lining, often caused by bacterial infections, alcohol abuse, overuse of non-steroidal anti-inflammatory drugs, or sudden illness or injury. Greasy foods can aggravate gastritis, leading to symptoms such as feeling uncomfortably full after eating, nausea, vomiting, bloating, or black or tarry stools. Antibiotics are typically used to treat gastritis caused by bacterial infections, and antacids can help reduce discomfort during treatment.

Gastroparesis

Gastroparesis is a condition where the stomach muscles move food through the gastrointestinal tract more slowly than normal. Greasy foods, due to their high-fat content, can slow down digestion even further, leading to bloating, nausea, and vomiting. This condition is commonly seen in people with diabetes or those who have undergone abdominal surgery. Lifestyle changes, such as choosing lower-fat foods, eating smaller meals, and thoroughly cooking fruits and vegetables, can help manage gastroparesis.

Gastroesophageal Reflux (GERD)

GERD occurs when the esophagus malfunctions, allowing stomach acid to flow backward. High-fat meals can trigger GERD symptoms, including upper abdominal pain after eating, heartburn, chest pain, difficulty swallowing, and regurgitation or vomiting. Losing weight, avoiding fatty and spicy foods, eating smaller meals, and keeping your head elevated while sleeping can help manage GERD. Over-the-counter or prescription medications may also be necessary.

Stomach Ulcers

Stomach ulcers, or peptic ulcers, are sores that form on the inside lining of the stomach or upper small intestine. They can cause burning stomach pain after eating, heartburn, or nausea. Ulcers may be caused by bacterial infections and can be treated with antibiotics. Acid blockers, such as proton pump inhibitors or histamine (H2) blockers, can also be prescribed to aid healing. Avoiding trigger foods is essential for managing symptoms.

Gallstones or Gallbladder Disease

The gallbladder aids in the digestion of fats. Gallstones are hard pieces of cholesterol that can cause blockages, leading to abdominal pain and nausea after consuming fatty foods. Other symptoms of gallbladder issues include intense pain in the middle of the abdomen. Pain medications and antibiotics can provide temporary relief, but the permanent solution is often the removal of the gallbladder through minimally invasive surgery.

Pancreatitis

The pancreas, like the gallbladder, plays a crucial role in fat digestion. Pancreatitis occurs when the pancreas becomes inflamed, often due to heavy alcohol consumption or gallstones. Symptoms include abdominal pain, nausea, vomiting, and radiating pain up the back. Medical attention is necessary, and medications or surgery may be required to remove blockages or damaged portions of the pancreas.

Artificial sweeteners

However, it is important to note that artificial sweeteners may be combined with other ingredients that can cause stomach pain. For example, sugar alcohols, which are often found in combination with artificial sweeteners, can lead to gas, bloating, and diarrhea in some individuals since they are not completely absorbed in the intestines and can ferment in the large intestine.

In addition, a recent study presented at Digestive Disease Week found that artificial sweeteners had "marked effects" on the duodenal microbiome profile, with non-aspartame sweeteners showing a decrease in microbial diversity and an increase in the relative abundance of certain bacteria.

Therefore, while artificial sweeteners themselves may not cause stomach pain, they can be found in products that contain other ingredients which may trigger digestive issues in some individuals.

Exogenous ketone supplements

There are two main types of exogenous ketone supplements: ketone salts and ketone esters. Ketone salts are ketones bound to a salt, typically sodium, potassium, calcium, or magnesium. They are available in powder form and mixed with liquid. Ketone esters are the purest form of ketones and are packaged in liquid form. They are less common and more expensive than ketone salts but are more effective and work faster.

While exogenous ketone supplements may help reduce appetite and lower blood sugar levels, there is limited evidence to support their effectiveness for weight loss. Additionally, they can be costly, and consuming too much may be dangerous due to the high amounts of minerals they contain.

It is important to consult a doctor before taking exogenous ketone supplements, especially for individuals with medical conditions or those taking other medications.

Frequently asked questions