Keto Stool Changes: What To Expect And Why

The ketogenic diet is a popular choice for those looking to lose weight, but it can also bring about some unpleasant side effects, including gastrointestinal issues. The high-fat, low-carb nature of the keto diet can cause constipation or, less commonly, diarrhoea. This is due to the lack of fibre in the diet, as well as the body's struggle to adjust to the high fat content.

The keto diet can also lead to other gastrointestinal symptoms, such as nausea, bloating, and abdominal pain. These effects are usually short-lived, but if they persist or worsen, it is important to consult a doctor.

Constipation

How to Relieve Constipation

• Drinking plenty of water and staying hydrated is key to moving things along and preventing constipation.
• Taking a fiber supplement can help, but it's important to first try to get all the fiber you need from your diet. High-fiber, keto-friendly foods include non-starchy vegetables like broccoli, artichokes, and collard greens, as well as avocados and nuts.
• Load up on fermented foods like sauerkraut and kimchi, which contain natural probiotics to support gut health.
• Taking a magnesium supplement can help with constipation, but it's important to first consult with a doctor as taking supplements without medical advice can be dangerous.
• Ask your doctor about using a short-term laxative if constipation persists.

When to See a Doctor

If you're new to the keto diet, it's normal to experience changes in your bowel habits, but if symptoms persist for more than two to three weeks, or if you have any red flags like blood in your stool, severe or constant abdominal pain, or diarrhea that happens more than six times a day, it's important to consult a doctor.

Diarrhea

Secondly, artificial sweeteners and sugar alcohols, commonly used in keto-friendly products, can cause digestive problems. These include sorbitol, xylitol, maltitol, and erythritol, which have a laxative effect when consumed in excess.

Thirdly, the keto diet may disrupt the gut microbiome, altering the composition of gut bacteria and causing poor digestion and diarrhea. This is supported by small studies that found significant changes in gut bacteria after three months on the keto diet.

Additionally, the high-fat diet may be difficult for some people to digest, leading to diarrhea. This is especially true for those transitioning from a low- or moderate-fat diet to the high-fat keto diet.

To relieve keto diarrhea, it is recommended to:

• Add more fiber to the diet, such as citrus, berries, avocado, broccoli, and chia seeds.
• Drink plenty of water and electrolytes to stay hydrated and replace lost fluids.
• Reduce the consumption of artificial sweeteners and sugar alcohols.
• Ease into the keto diet by slowly reducing carbs and increasing fats, allowing the body to adjust.
• Include fermented foods like sauerkraut and kimchi to improve digestion.
• Consult a healthcare professional if diarrhea is severe, persistent, or accompanied by other symptoms.

It is worth noting that while diarrhea may be a temporary adjustment issue, it could also indicate deeper bodily stress. If diarrhea persists or becomes a long-term side effect, it may be best to reconsider the keto diet, as chronic diarrhea can lead to health complications such as vitamin deficiencies, muscle deterioration, and electrolyte imbalance.

Stool appearance changes

Starting a keto diet can lead to several changes in stool appearance, ranging from constipation to diarrhea. These changes are due to the high-fat, low-carb nature of the keto diet, which can affect the digestive system in several ways.

Constipation

Constipation is a common issue on a keto diet due to the lack of fiber. Fiber-rich sources like fruits, vegetables, whole grains, and legumes are limited on keto, and the average American already falls short of their daily fiber intake. This can lead to harder stools and less frequent bowel movements.

Diarrhea

Diarrhea can also occur on a keto diet due to several factors. Firstly, the high-fat content of the diet can be difficult for the body to digest, leading to loose stools. Secondly, artificial sweeteners and sugar alcohols commonly used in keto products can cause gastrointestinal disturbances. These sugar substitutes are often not properly digested and can have a laxative effect. Additionally, a delay in the enzymes that digest fat may lead to fat reaching the colon and being broken down by bacteria, resulting in bloating and fat in the stool.

Stool Colour and Smell

The high-fat content of the keto diet may also cause stools to be lighter in colour. Additionally, high-fat foods can slow down the movement of stool through the gastrointestinal tract, leading to more pungent-smelling bowel movements.

Other Factors

Other factors that may contribute to stool appearance changes on a keto diet include the impact on the gut microbiome. The keto diet can affect the composition of gut bacteria, which may have implications for digestion. Additionally, individual factors such as lactose intolerance or incorrect macronutrient ratios (too much protein, not enough fat) can also play a role in stool appearance changes.

Stool frequency changes

Starting a keto diet can lead to an increase in stool frequency, resulting in diarrhoea. This is due to the high-fat content of the diet, which can be difficult for the body to digest, especially if you are transitioning from a low- or moderate-fat diet. The body uses bile to break down fat, and bile also acts as a lubricant for the colon, so the increased presence of bile can push waste through the digestive tract faster, leading to looser stools.

The high-fat content of the keto diet can also cause a delay in the enzymes that digest fat, meaning that fat may not be broken down in the small intestine as it should be. Instead, it travels to the colon and is digested by bacteria, which can lead to bloating, gas, and fat in the stool.

Another cause of increased stool frequency could be the use of sugar substitutes, which are often used in keto products and recipes to avoid the use of natural sugar. Sugar alcohols such as sorbitol, erythritol, maltitol, and xylitol can be difficult for the gut to absorb, and so they reach the large intestine without being properly digested, causing a laxative effect.

Increased stool frequency may also be caused by an imbalance of macronutrients. The keto diet should be low-carb, moderate protein, and high-fat. However, some people new to the diet eat high-protein and moderate-fat instead, which can cause diarrhoea.

Finally, the keto diet can affect the gut microbiome, which may also lead to diarrhoea.

Hemorrhoids

The keto diet is a high-fat, low-carb, and low-fibre diet, which can lead to constipation. Constipation is a common cause of hemorrhoids. The lack of fibre in the keto diet can lead to harder stools, which are more difficult to pass, requiring more straining. This straining can then lead to hemorrhoids.

However, it is important to note that not everyone who starts the keto diet will experience constipation or hemorrhoids. Some people may even experience the opposite problem of diarrhoea, which is also associated with the keto diet.

If you are experiencing hemorrhoids due to constipation while on the keto diet, there are some things you can do to help manage and prevent them:

• Increase your fluid intake. Staying hydrated is important for keeping things moving through your digestive tract.
• Take a fibre supplement. While the keto diet is naturally low in fibre, adding a supplement can help to soften stools and make them easier to pass.
• Eat more high-fibre, keto-friendly foods. Non-starchy vegetables, like broccoli, artichokes, and collard greens, are good sources of fibre. Avocados and nuts also contain fibre and healthy fats.
• Load up on fermented foods. These contain natural probiotics, which can support gut health. Try sauerkraut or kimchi.
• Try a whole-food supplement. Chia seeds and ground flaxseed are high in fibre and can be easily added to your diet.
• Talk to your doctor about using a short-term laxative or a stool softener.
• Avoid straining during bowel movements. If you feel like you are straining, try a squatting position, which may help to reduce the occurrence or severity of hemorrhoids.

Remember, it is always a good idea to consult with your healthcare provider before making any significant changes to your diet, especially if you are experiencing any negative side effects.

Frequently asked questions