Keto Diarrhea: What's The Timeline And How To Cope?

The keto diet is a high-fat, low-carb, and moderate-protein eating plan that has gained popularity in recent years. While it can be an effective strategy for weight loss and improved blood sugar control, one of its unpleasant side effects is keto diarrhea. This occurs when the body struggles to adapt to the high-fat content of the diet, leading to loose, watery stools. The good news is that keto diarrhea tends to be temporary, usually resolving within a few weeks as the body adjusts to the new diet. However, for some people, it can be a long-term issue.

There are several reasons why keto diarrhea may occur. Firstly, the high-fat content of the diet can be hard for the body to digest, especially if there is an increased intake of dairy products, which are encouraged on the keto diet. This can lead to greasy stools that are difficult for the body to absorb. Secondly, the use of artificial sweeteners and sugar alcohols, which are commonly used in keto-friendly products, can cause digestive issues such as bloating and diarrhea when consumed in excess. Thirdly, the keto diet may disrupt the gut microbiome, leading to inflammation and changes in the populations of healthy gut bacteria, which can further contribute to digestive problems.

To prevent and manage keto diarrhea, there are several strategies that can be employed. These include gradually easing into the keto diet rather than making an abrupt change, increasing the intake of soluble fiber, staying hydrated, and reducing the consumption of artificial sweeteners and sugar alcohols. Additionally, adding probiotic and prebiotic foods or supplements can help support gut health and digestion.

High-fat content

The keto diet is a high-fat, low-carbohydrate, and moderate-protein diet. The diet is designed to restrict carb intake so that the body switches from burning glucose for energy to burning fat, including stored body fat and dietary fat. This shift in metabolism is called ketosis.

The high-fat content of the keto diet can lead to keto diarrhea, which is a common side effect of the diet. Fat is harder to digest than protein or carbohydrates and takes longer to break down. When you suddenly consume a lot of fat, your digestive system may struggle to keep up, leading to malabsorption. This can result in steatorrhea, a type of diarrhea caused by too much fat in the stool. The stool may appear pale, foul-smelling, and coated in a thick, greasy film.

Additionally, the keto diet often leads to a decrease in fiber intake, as fiber is found in carbohydrates like fruits, legumes, starchy foods, and grains. Insoluble fiber helps to bulk up stools and prevent diarrhea. Therefore, a low-fiber intake can be a contributing factor to diarrhea.

The high-fat content of the keto diet can also impact the gut microbiome. The diet limits the intake of fruits, vegetables, and other plant foods that provide prebiotic fiber for the healthy probiotic bacteria in the gut. This can lead to a decrease in the abundance of good bacteria, potentially causing digestive issues like diarrhea and inflammation in the gut.

To alleviate keto diarrhea, it is recommended to:

• Add more fiber to your diet, such as citrus, berries, avocado, broccoli, and chia seeds.
• 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 bloating and diarrhea.
• Introduce more vegetables and insoluble fiber, such as psyllium, to your diet.
• Eat more probiotic-rich foods, such as yogurt, kefir, kimchi, and kombucha.

Artificial sweeteners

The keto diet is a high-fat, low-carbohydrate diet that can lead to a person's body entering a state of ketosis, where it burns fat for energy instead of carbohydrates. This diet can have some unpleasant side effects, including keto diarrhea, which is characterized by loose, watery stools. One of the causes of keto diarrhea is the high-fat content of the diet, which can be hard for the body to digest. Another cause is the sudden lack of fiber that comes with cutting down on carbohydrates. Additionally, the keto diet can impact the composition of the gut microbiome, leading to poor digestion and diarrhea.

To avoid keto diarrhea, it is recommended to add more fiber to the diet, drink plenty of water and electrolytes, and slowly increase the amount of fatty food consumed while decreasing foods containing sugar alcohols. It is also important to note that not everyone will experience keto diarrhea, and the severity and duration of symptoms can vary.

Dairy products

Firstly, increasing your dairy intake may reveal a lactose intolerance, which often presents with diarrhea, bloating, and gas. Even if you haven't noticed any problems in the past, an increase in dairy consumption can uncover a food allergy. If your keto diarrhea doesn't improve over time, it is recommended to get allergy testing or try an elimination diet.

Secondly, dairy products in most grocery stores may contain unhealthy additives such as gums, synthetic nutrients, and low-quality milk and cheese laced with additives. These additives can potentially cause GI issues. To avoid this, opt for raw and/or A2 milk, which contains a more digestible form of protein than conventional A1 dairy. Goat or sheep's milk are also good alternatives, as these animals produce A2 milk.

Thirdly, some people may be consuming too much dairy on the keto diet, leading to an overload of fat and calories. This can cause digestive issues and prevent the body from entering ketosis. It is important to be mindful of your ratios of carbohydrates, fat, and protein, especially when starting the keto diet, to prevent diarrhea.

To summarise, while dairy products are a key component of the keto diet, consuming too much dairy or having an intolerance to certain dairy additives may lead to diarrhea and other GI issues. It is important to monitor your dairy intake and opt for high-quality, additive-free dairy products to avoid potential digestive issues.

Gut microbiome disruption

The gut microbiome refers to the microorganisms in the gastrointestinal tract, including bacteria, archaea, and eukaryotes. The gut microbiome is fundamental to human health, with its metabolites playing a key role in modulating disease risk. Dysbiosis, where the microbiota's configuration adopts an abnormal state, is implicated in the development of cardiovascular disease, metabolic disorders, inflammatory bowel disease, and some cancers.

The ketogenic diet has a general "anti-microbial" effect, reducing bacterial count. The extreme macronutrient profile of the ketogenic diet instigates compositional shifts in the gut's microbial community. The diet's low-carbohydrate, high-fat composition reduces bacterial abundances.

Bifidobacterium

The ketogenic diet's persistent negative impact on Bifidobacterium is concerning, with obesity, type-2 diabetes, and depression highlighted as potential consequent risks. Bifidobacterium is a prolific GABA producer, and its abundance is positively associated with human health. Bifidobacterium is also a key producer of conjugated linoleic acid, which is anti-inflammatory and inhibits colon cancer cell growth and proliferation.

Firmicutes

The ketogenic diet may also reduce the abundance of Firmicutes butyrate-producing bacteria, including Eubacterium rectale and Roseburia. These bacteria are important for colonic health, and their reduction may be detrimental.

Short-Chain Fatty Acids (SCFAs)

The ketogenic diet reduces total faecal SCFAs, acetate, and butyrate. SCFAs are predominantly produced through carbohydrate fermentation by specific species. SCFAs are beneficial, supporting gastrointestinal integrity and immune system regulation.

Th17 Immune Cells

The ketogenic diet may also reduce intestinal and visceral fat pro-inflammatory Th17 cells. Th17 cells are critical for fighting off infectious disease but are also known to promote inflammation in autoimmune diseases.

Other Effects

The ketogenic diet may also decrease the abundance of Lactobacilli, Faecalibacterium prausnitzii, and Bacteroides.

Electrolyte imbalance

The keto diet can lead to an electrolyte imbalance, which can have several negative consequences for your body and brain. Electrolytes are minerals that carry an electric charge, and they include sodium, potassium, magnesium, chloride, calcium, phosphate, and bicarbonate.

Symptoms of Electrolyte Imbalance

An electrolyte imbalance can cause:

• Muscle cramps
• Headaches
• Fatigue
• Brain fog
• Increased cravings
• Muscle cramping
• Thirst
• Diarrhea
• Constipation
• Irregular heartbeat (heart arrhythmia)
• Confusion
• Loss of alertness
• Poor judgment
• Seizures

Causes of Electrolyte Imbalance

There are several reasons why you might experience an electrolyte imbalance when starting the keto diet:

• Fluid Loss: The keto diet can result in a diuretic-like response, leading to frequent urination. This is often why people experience rapid weight loss in the first week. Exercise, especially in hot weather, can also cause fluid and electrolyte loss.
• Not Eating a Wide Variety of Whole Foods: Relying on processed foods while on keto can lead to micronutrient deficiencies, including electrolytes.
• Taking Certain Medications: Some medications can cause your electrolytes to drop further, including Amphotericin B, corticosteroids, and insulin.

Preventing Electrolyte Imbalance on Keto

• Eat Whole Foods That Are High in Electrolytes: Include foods like coconut water, avocados, beef, chicken, eggs, spinach, clams, salmon, lettuce, tomatoes, yogurt, and almonds in your diet.
• Obtain Electrolytes With Keto-Friendly Electrolyte Supplements: Consume sugar-free and keto-friendly electrolyte drinks to support your workout performance and recovery.
• Pay Attention to Your Thirst: Thirst is a sign of mild dehydration, which can make you feel tired and dizzy. Address thirst immediately by drinking water or an electrolyte drink.
• Slowly Transition to the Keto Diet: This may prevent keto flu symptoms and electrolyte imbalances while also building sustainable habits. Start with a low-carb diet, eating up to 150 grams of carbs per day, for a week before going full keto.
• Talk to Your Doctor if You're Taking Medications: If you're taking antibiotics, corticosteroids, or insulin, notify your doctor about your plan to start the keto diet.

Frequently asked questions