Milly Gaines
The ketogenic diet is a high-fat, high-protein, low-carbohydrate diet that has been associated with various health benefits. However, one of its drawbacks is that it can cause bloating, especially during the initial stage, known as the keto flu. This occurs when the body shifts into ketosis for the first time, and the gut adapts to the new diet, typically causing bloating within the first week. Bloating can be due to various factors, such as inadequate protein intake, low estrogen levels, or pre-existing hypochlorhydria (low stomach acid). Additionally, sugar alcohols, which are commonly used as sweeteners on the keto diet, can lead to bloating due to their poor absorption and fermentation by gut bacteria. Dehydration, food intolerances, and imbalances in electrolyte levels can also contribute to bloating. While bloating may resolve on its own as the body adjusts to the diet, there are measures to alleviate symptoms, including staying hydrated, adjusting fat and carb intake, and taking probiotics to support gut health.
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What You'll Learn
Dehydration and electrolyte imbalance
The ketogenic diet is diuretic, which means you will be urinating more frequently, and losing water and electrolytes in the process. This can lead to an electrolyte imbalance, which can cause dehydration. Electrolytes are minerals that aid in cellular and organ function and are essential for survival. They maintain hydration and acidity levels in the body, as well as help maintain muscle and nerve function. For example, calcium and magnesium play complementary roles in regulating muscle contraction. When this balance is off, you may experience muscle cramps and other symptoms of the "keto flu", such as nausea, diarrhoea, constipation, abdominal pain, and headaches.
To avoid dehydration and electrolyte imbalance, it is important to increase your water intake and consume keto-friendly foods that contain electrolytes, such as leafy greens, nuts, seeds, avocados, cucumbers, and celery. You can also take supplements, such as magnesium and potassium, to replenish electrolytes, but these should be a last resort. A general rule of thumb is to drink at least half of your body weight in ounces of water per day. For example, if you weigh 150 pounds, you should drink at least 75 ounces of water per day.
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Gut adjustment period
When you start a ketogenic diet, it is common to experience bloating in the beginning. This is due to your body adjusting to the new diet and the dying off of bacteria that prefer carbohydrates for energy. This adjustment period is known as the "keto flu", which can last for up to two weeks until your body fully adjusts to ketosis. During this time, your gut ecosystem is adapting to new foods, particularly if you've increased your sugar alcohol and MCT consumption.
The gut microbiome can change drastically in as little as three days of dietary changes. A 2013 study observed that an animal-based diet caused more significant gut microbiome changes than a plant-based diet. Changes in dietary fiber intake can also impact your gut flora. As a result, your gut may become overgrown with bad bacteria, which is a known trigger for bloating.
To help your gut flora adjust to the ketogenic diet, consider taking probiotics, which can support your gut by providing a healthy amount of good bacteria. Probiotics are only able to stay in the gut for a few days or weeks, so daily use is recommended to maintain the benefits of the probiotic strains. Probiotics can be consumed through drinkables, capsules, or certain foods.
It's important to note that bloating that lasts longer than a few weeks could be due to an underlying condition such as hypochlorhydria or low stomach acid. If bloating persists, it is recommended to consult a healthcare provider for further evaluation.
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Pre-existing hypochlorhydria
If you are feeling bloated on a ketogenic diet, it could be due to pre-existing hypochlorhydria, or low stomach acid. Hypochlorhydria is a condition in which the production of hydrochloric acid in the stomach is reduced. Hydrochloric acid is crucial for maintaining a low pH environment in the stomach, typically between 1.0 and 3.0. When hydrochloric acid levels are insufficient, the stomach pH rises, becoming more basic.
The prevalence of hypochlorhydria increases with age, with approximately 2-12% of the population experiencing low stomach acid, and older adults being more commonly affected. In patients younger than 60 years, the incidence of hypochlorhydria is around 2%, while in older patients, it increases to 5%. Additionally, women tend to have a slightly higher incidence of hypochlorhydria than men.
There are several factors that can contribute to hypochlorhydria. One of the common causes is an H. pylori infection, which can repress the production of stomach acid and, if left untreated, can lead to gastric ulcers and even initiate a pathological process resulting in gastric cancer. Other factors include chronic stress, which can decrease stomach acid production, and certain medications, such as long-term use of antacids, proton pump inhibitors (PPIs), and treatments for gastric cancer. Gastric surgeries, such as gastric bypass, can also reduce the production of stomach acid.
The treatment for hypochlorhydria depends on the underlying cause and severity of symptoms. Doctors often recommend dietary modifications and supplements, such as betaine hydrochloride (HCl) supplements, sometimes taken with the enzyme pepsin. If H. pylori infection is the cause, a course of antibiotics may be prescribed. It is important to consult a healthcare provider to determine the appropriate treatment plan for hypochlorhydria and ensure proper management of any associated conditions or medications.
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Food intolerances
It is important to note that bloating is a common occurrence at the beginning of the keto diet. This is due to the body adjusting to a new diet and the dying off of bacteria that prefer carbohydrates for energy. This initial keto bloat usually occurs during the infamous "keto flu" stage, which can last for around two weeks.
However, if bloating persists, it may be due to food intolerances or allergies. Food intolerances are a common cause of bloating, and they can inflame the digestive system, leading to bloating immediately or hours after eating. Dairy and gluten are common food intolerances that can cause bloating, along with gas-producing foods such as beans, apples, and certain artificial sweeteners. Vegetables high in dietary fiber, such as Brussels sprouts, broccoli, and cabbage, can also cause excess gas and bloating.
Food allergies can also trigger digestive problems and bloating. Dairy products, for example, can be a source of discomfort due to lactose intolerance or an allergy to casein, the primary protein found in milk. Nuts are another common offender, triggering allergic responses ranging from mild itching to severe anaphylaxis. Tree nut allergies, especially almonds, are among the most common food allergies and feature heavily in many ketogenic menus.
If you suspect that your bloating is due to food intolerances or allergies, consider an elimination diet to remove potential irritants such as dairy, gluten, eggs, processed foods, and carbonated drinks. Food allergy testing can also help uncover hidden allergens, and a registered dietitian can help you choose foods that support your gut microbiota.
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Excessive consumption of sugar alcohols
The ketogenic diet is a high-fat, high-protein, low-carbohydrate diet. It involves restricting your daily carb intake to around 20 to 50 grams, allowing your body to enter a state of ketosis, where it burns fat for fuel instead of carbohydrates.
Sugar alcohols are sweeteners commonly used in low-carb, keto-friendly, sugar-free, or diet-friendly foods. They occur naturally in some fruits and vegetables but are mostly manufactured in a lab. Chemically, they are sugar molecules with a hydroxyl group attached. Sugar alcohols are popular among keto dieters as they satisfy their sweet tooth without impacting blood glucose levels and providing fewer calories than sugar.
However, excessive consumption of sugar alcohols can lead to bloating. Sugar alcohols are only partially digested, and their side effects are dose-dependent. The more you consume, the worse the symptoms will be. Maltitol, sorbitol, and isomalt are sugar alcohols that can cause gastrointestinal issues and increase blood glucose levels. Erythritol, commonly found in keto baked goods and drinks, is a better option as it has a glycemic index of 0 and causes minimal GI issues. Xylitol, often found in chewing gum, is generally well-tolerated but can cause a slight increase in blood glucose levels.
If you are experiencing bloating due to excessive sugar alcohol consumption, consider reducing your intake of these sweeteners. Additionally, keeping a food diary can help pinpoint specific foods that may be causing digestive issues and bloating. It is also recommended to consult a registered dietitian to choose foods that support your gut microbiota.
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Frequently asked questions
It takes time for your gut to adjust to new foods. Your body enters a state of ketosis when you restrict your daily carb intake, and this shift can cause bloating.
Dehydration is a common cause of bloating. Sugar alcohols, which are often used as sweeteners in keto-friendly products, can also lead to bloating as they are not easily absorbed by the body.
Bloating can manifest as a swollen belly, stomach pain, gas, flatulence, feeling too full, or constipation.
You can reduce bloating by staying hydrated, cutting back on sugar alcohols, and eating slowly.
If bloating is accompanied by nausea, diarrhea, constipation, or abdominal pain, it may indicate an underlying digestive problem. It is important to consult a healthcare professional in such cases.
