Keto Diarrhea: What To Expect And Why

The ketogenic diet is a popular, effective way to lose weight. However, it can lead to an unfortunate side effect: keto diarrhea. This is caused by a variety of factors, including an increase in fat intake, a decrease in fibre intake, and changes in gut bacteria. The high-fat content of the keto diet can be hard for the body to digest, leading to malabsorption and resulting in watery stools. A lack of fibre in the diet can also lead to constipation, and artificial sweeteners and sugar alcohols in keto products can have a laxative effect. Changes in gut bacteria due to a lack of prebiotic fibre can also cause an increase in the frequency of diarrhoea. However, keto diarrhoea is usually temporary and can be remedied by staying hydrated, increasing fibre intake, and making other dietary changes.

The keto diet is high-fat and low-carb

The Keto Diet: High-Fat and Low-Carb

The keto diet is a low-carb, high-fat diet that has gained popularity in recent years. The basic idea behind the diet is to restrict carbohydrate intake, so the body switches from burning glucose (sugar) for energy to burning fat, including stored body fat and dietary fat. This shift in metabolism is known as ketosis.

When you cut out carbs, your body enters a state of ketosis, where it burns fat for energy instead of glucose. This can lead to weight loss as your body burns through stored fat. However, this drastic change in diet can also have some unpleasant side effects, including keto diarrhea.

Keto diarrhea is characterized by loose, watery stools and is a common side effect of the keto diet, usually experienced in the beginning phase. It occurs due to several factors, including an increase in fat intake, a decrease in fiber intake, and changes in gut bacteria. The high-fat content of the keto diet can be hard for the body to digest, leading to malabsorption and diarrhea. Additionally, the sudden lack of fiber from cutting out carbs can also contribute to diarrhea.

• Add more fiber to your diet: Include high-fiber, keto-friendly foods such as non-starchy vegetables (broccoli, artichokes, collard greens), avocado, and nuts.
• Drink more water and electrolytes: Stay hydrated to compensate for the fluid loss from diarrhea and to avoid dehydration.
• Take a fiber supplement: Experiment with different types of fiber supplements, as people have varying responses to each.
• Try fermented foods: Include sauerkraut, kimchi, yogurt, kefir, and kombucha, which contain natural probiotics to support gut health.
• Stay away from artificial sweeteners: Avoid sugar alcohols and artificial sweeteners, as they are hard to digest and can cause bloating and diarrhea.
• Introduce more vegetables: If diarrhea persists, reduce the amount of fat you eat and add more vegetables to your diet.
• See a doctor: If diarrhea persists for more than a few days or is severe, consult a doctor to rule out other potential causes.

Artificial sweeteners and sugar alcohols

Sugar alcohols such as xylitol, sorbitol, maltitol, and lactitol are common culprits of gastrointestinal distress. They are often present in sugar-free and low-carb products, including beverages, candies, protein/diet bars, and sugar substitutes. These sugar alcohols can cause gas, nausea, and diarrhoea if consumed in large quantities or above one's level of tolerance.

Artificial sweeteners can also be difficult to digest and may cause an upset stomach and diarrhoea, especially when consumed in large amounts. It is important to note that not everyone will experience diarrhoea from artificial sweeteners and sugar alcohols, and the severity and duration of symptoms can vary. However, if you are experiencing diarrhoea while on the keto diet, it is recommended to avoid products containing these sweeteners and sugar alcohols to see if that resolves the issue.

Additionally, it is worth noting that the keto diet may also impact the composition of your gut microbiome, which can have implications for digestion. The reduction in fruits, vegetables, and other plant foods while on the keto diet may decrease the abundance of good bacteria in your microbiome, potentially leading to increased diarrhoea and other negative side effects.

Changes to your gut microbiome

The keto diet can impact your gut microbiome, which has implications for digestion. The diet is high in fat and low in carbohydrates, and this shift can cause an imbalance in your gut microbiome.

According to Dr. John Riopelle, a gastroenterologist for Kaiser Permanente, the standard American diet is high in carbohydrates, so switching to keto puts you at the opposite end of the spectrum. This sudden change can be a shock to the gut, and the lack of fiber in the keto diet can lead to constipation. Lindsey Albenberg, DO, a gastroenterologist at the Children's Hospital of Philadelphia, adds that a high-fiber diet promotes diversity in the gut microbiome, which is associated with health.

Research has shown that high-fat diets lead to rapid and significant changes in the gut microbiome. Juliana Tamayo, M.S., R.D., an editor for FitnessClone and a clinical dietitian, notes that the keto diet restricts carbs, which means a decrease in fiber intake. This can lead to gut-related problems like changes to the gut microbiome, diarrhea, and inflammation in the gut.

The gut microbiome plays a crucial role in immune and metabolic function, and it may also be involved in disease prevention and progression. Karie Cassell, R.D., a dietitian and author of The Domino Diet, explains that without fruits, vegetables, and other plant foods, the healthy probiotic bacteria in the gut don't have the food they need to thrive. As a result, the keto diet has the potential to worsen overall digestive health by reducing the number of healthy bacteria in the microbiome, leading to an increased frequency of diarrhea and other unpleasant side effects.

To help prevent and manage these gut-related issues, it is recommended to increase your fiber intake, drink more water and electrolytes, and add insoluble fiber, like psyllium, to your diet.

Lack of fibre

The keto diet is high in fat and low in carbohydrates, which means that it is also low in fibre. Fibre is important for colonic health and helps the organ to function properly. Fibre adds bulk to stools and helps the colon work like a muscle to move things through more easily.

The keto diet restricts carbs, so you're likely eating less fibre, which comes from carbs like fruits, legumes, starchy foods, and grains. Fibre-rich foods promote the growth of good bacteria in the gut, and a decrease in carbs has been shown to affect the gut microbiome by decreasing the abundance of good bacteria. This can lead to gut-related problems like diarrhoea and inflammation in the gut.

The average American adult consumes 10 to 15 grams of fibre per day, which is well below the recommended daily intake of 25 grams for women and 38 grams for men. The keto diet can make this problem worse, as it cuts out many fibre-rich foods.

However, there are some keto-friendly high-fibre foods that can help increase your fibre intake, such as non-starchy vegetables, avocado, nuts, chia seeds, and ground flaxseed.

In addition to increasing your fibre intake, staying hydrated is also important for managing diarrhoea. The Institute of Medicine recommends that women consume 91 ounces of fluid per day and men consume 125 ounces, including water and other beverages.

If you're experiencing diarrhoea on the keto diet, it's important to give your body time to adjust to the new diet. However, if symptoms persist or worsen, it may be a sign that the keto diet is not suitable for you, and you should consult a doctor.

Increased fat intake

The keto diet is a high-fat, low-carbohydrate diet. As a result, when switching to keto, you will likely be consuming a greater amount of fat than you are used to. This can cause diarrhea as your digestive system struggles to keep up with the increased fat intake.

Fat takes longer to break down in the body than carbohydrates or protein. When you start eating a lot of fat, your digestive system can have trouble keeping up, and some of the fat may be malabsorbed—not broken down properly and, thus, not completely absorbed by your body—and excreted in your poop. This can lead to steatorrhea, a type of diarrhea caused by too much fat in the stool. Steatorrhea is typically pale, foul-smelling, and coated in a thick, greasy film.

The time it takes for your body to adjust to digesting high amounts of fat can also lead to slight malabsorption diarrhea, which usually resolves with time. However, if your body is having trouble adjusting to the higher fat intake, you may want to consider supplementing with ox bile to assist with fat digestion until your gallbladder has time to adjust.

In addition, the type of fat you consume on the keto diet can also contribute to diarrhea. Ultra-saturated fats, such as MCT-rich coconut oil, can speed up transit time in the digestive tract, leading to diarrhea.

To help prevent or alleviate diarrhea caused by increased fat intake on the keto diet, you can try the following:

• Supplement with bile or digestive enzymes: If your body is struggling to adjust to the higher fat intake, supplementing with ox bile or digestive enzymes like amylase and lipase can assist with fat digestion.
• Choose different types of fat: Avoid ultra-saturated fats like MCT-rich coconut oil, which can speed up transit time and contribute to diarrhea.
• Eat more fibre: Fibre can help add bulk to your stool and improve colon function. Include high-fibre, keto-friendly foods like non-starchy vegetables, avocado, and nuts.
• Stay hydrated: Proper hydration is crucial when transitioning to a keto diet. Drink plenty of water, and consider adding electrolytes to help replace lost fluids and maintain adequate hydration.
• Make gradual changes: Instead of making a sudden switch to the keto diet, try gradually increasing your fat intake and decreasing your carbohydrate intake to give your body more time to adjust.

By making these adjustments, you may be able to prevent or alleviate diarrhea caused by increased fat intake on the keto diet. However, if diarrhea persists or becomes severe, it is important to consult with a healthcare professional.

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