Guest post by: Dr. Lauryn Lax
Check out Part 1 Here.
Keto constipation is a common phenomenon experienced by people who transition to a low carb, high fat diet.
Keto diets are often low in fiber, the essential ingredient for helping us “do the doo,” found in carbohydrates, especially green things and other veggies. Even if you are eating cucumbers and salads, soluble fiber (i.e., prebiotic foods like starchy tubers and root veggies) is the “secret sauce” for helping us go #2. Without enough fiber, many folks find themselves stuck with tummy troubles like bloating and constipation despite eating a healthy, anti-inflammatory keto diet.
“What gives?!” they cry. Answer: Your body is clogged. It needs some carbohydrates to help push foods through.
However, that said, while high fat, low carb diets CAN cause constipation for some people, they can also improve the gut microbiome in others—ESPECIALLY folks who initially transition to keto from eating lots of carbs, sugars, processed foods, and other gut inflammatory foods.
Many people find they feel lighter, less bloated, and less constipated than ever on keto, simply by removing some of the inflammatory triggers.
Why do some people experience constipation, whereas others experience this gut boosting phenomenon?
Here are 5 Ways Keto Can Help Kick Constipation & Bloating to the curb, and how to support healthy digestion on a keto diet (regardless of which end of the spectrum you fall on) so you can feel your very best long term.
Keto Gives Bacterial Overgrowth a Break
Pathogenic bacteria LOVE (and feed off) sugars. Not just sugar from Hershey’s candy bars, but sugars found in even “healthy” foods like sweet potatoes, butternut squashes, carrots, beets, apples, and other fruits and veggies. These foods are NOT innately bad, however, when you have bacterial imbalances or overgrowth present, continuing to eat sugar (carbohydrate) based foods can seemingly make symptoms worse, not better. This is perhaps the biggest reason why many clinicians and “Candida cleanses” recommend low-carb or low-FODMAP diets, and many folks with gut dysfunction find they feel better on them.
A big reason why you may feel less bloated or like your bowels get “regular” on a keto style diet? Your gut bacteria and gut get a break from the foods your bacteria have been feasting on.That said, this feeling comes with a couple “devil’s advocates.”
First, while your gut health may feel better going “carb free,” any pathogenic bacteria aren’t necessarily being killed off by not eating carbs, but instead lying dormant. In order to truly address an underlying condition, like SIBO, fungal overgrowth or bacterial/parasitic infection, you need to target the pathogens, often times with a two-fold anti-microbial (supplemental or antibiotic) approach, coupled with smart intake of prebiotic and probiotic foods, some carbohydrates included . Prebiotic and carbohydrate foods can help “bring bacteria out” to play so your supplemental or antibiotic treatment can actually be effective.
Second, gut bacteria and fungi CAN also feed off ketone bodies—similar to the sugars from carbohydrates. Without butyrate (short chain fatty acids) found in prebiotic foods and fibers (like greenish plantains, cooked and cooled sweet potatoes, cooked and cooled Jasmine white rice, Jicama, onion and other veggies with resistance starch), long term reliance on ketones can swing back in the same direction as you were when you didn’t feel well eating more carbs and sugars. The takeaway? Address the underlying gut condition (if any).
Keto is a Natural Food Intolerance Test
Keto, like Paleo, naturally eliminates MOST non-real foods, emphasizing “real foods” (when you don’t over-rely on bars, shakes and ketone supplements, marketed as the “magic” for helping you get into ketosis). Keto ALSO naturally eliminates many (silent) gut inflammatory foods, lessening your intake of FODMAPS—starch and sugar containing carbohydrates that can fire up gut bacteria (back to point 1). Some FODMAPS include fruits like apple, apricot, cherry, mango, peach, pear, plum, watermelon, wheat, veggies like broccoli and other cruciferous veggies, legumes, and vegetable oils. Keto also allows you to test and see for yourself what carbohydrate heavy foods may have been triggering bloating or constipation symptoms prior to the diet. Gut bacteria often crave foods we are intolerant to, so if your sweet potato, ice cream, pasta or rice fetish gets the boot on keto, you may find you feel better.
Keto Can Balance Cortisol & Hormones
If you’ve been used to running off sugar, grains, and other sources of short-term energy (i.e. carbs), blood sugar and insulin resistance are natural byproducts. (Hello Standard American Diet.) In turn, blood sugar imbalances can trigger imbalances in our hormones as well—namely cortisol (our stress hormone) that rides the same wave of your blood sugar highs and blood sugar lows.
When your body is “high” on carbs or sugars, cortisol can equally be “high” on stimulation and adrenaline. When your body is “low” on carbs or sugars—along with low blood sugar symptoms (like headaches, shakiness before meals, hangriness), your cortisol can equally feel the stressful side effects.
What does this have to do with your digestion? Stress is the #1 driver of all body imbalance—digestive distress included. Constipation, bloating, bacterial overgrowth and IBS are all highly correlated with stress. Hence, for some people, transitioning to keto with a quality fat diet can ALSO be stress relieving for their former blood-sugar and cortisol imbalanced ways (1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113752/, 2 https://academic.oup.com/jcem/article/92/11/4480/2598960 , 3 https://link.springer.com/article/10.1186/1751-0147-52-31). The release of stress in turn allows digestive health to restore and improve.
Keto Enhances Nutrient Absorption
Fat is essential for maximizing the nutrition from the other foods we eat. Fat soluble vitamins (A, D, E and K) are like the glue for nutrient absorption, necessary to “hold on” to the different vitamins, minerals and macronutrients in foods. Healthy absorption also helps us create formed stools (as opposed to loose and watery or super hard), allowing only what is not necessary for the body out the back door.
Keto Lubricates the Digestive Tract to Help You Go
Keto diets are based on an average ratio of 40-60% healthy fats. If you were used to eating a low-fat, or not-enough-fat diet, then all of a sudden add coconut oil, avocados, grass-fed butter, ghee and other healthy fats to your diet, your digestive system says, “THANK-YOU.” Fats act like a “slippery slope” inside your intestines to help carry other food through your system. The result? You may find you actually can go! Your food doesn’t seem to sit or stay “stuck” in your gut and things move along more smoothly. In addition, healthy fats encourage healthy detoxification in your liver and gallbladder, ultimately improving digestion, the elimination of wastes in stools and inflammation. When we eat fat, it fires up the gallbladder stores to release bile, a digestive juice that helps us digest and absorb fat. On the flip side, when we DON’T eat fat (or enough of it), our bile sits in our gallbladder, backing up our liver and digestive process, and causing gallbladder attacks and other inflammatory conditions too.
The Big Bottom Line
Just like keto can cause constipation in some people, it can also improve gut health for others. Whether or not keto can help you in your gut microbiome department is really all dependent on where you’re coming from to start, as well as the sustainable approach you take with keto.
After an initial keto “reset”—shifting your body into fat-burning (vs. sugar burning) mode—some people find they can come back to balance just fine and find the “just right” (Goldilock’s) approach to carbohydrate and prebiotic intake that works for them, particularly women, long term.
As with most things diet and nutrition related, there is NO one-size-fits-all approach to healthy eating. In addition, you may find that at different times and seasons in your life, your diet may look different (for instance higher carbohydrate intake in your CrossFit and weightlifting days, and higher fat in your “I want to look good naked” or lifestyle-wellness, beach-walking focus days). Both seasons can be beneficial for your gut health, depending on simply checking in with your own gut and asking yourself: How do I feel?
Labels aside—keto or not keto—how is your bloating, constipation, gas and overall health affected by your digestion (skin, allergies, etc.)?
Whichever way your body feels best…go with that.
ABOUT THE AUTHOR
Dr. Lauryn Lax is a Doctor of Occupational Therapy, Nutritional Therapy Practitioner, Functional Medicine Practitioner, author and speaker, with over 20 years of clinical and personal experience specializing in gut health, intuitive eating, disordered eating, anxiety, hormone balance and women’s health. She’s based in Austin, Texas, and operates a virtual Nutrition & Functional Medicine practice, Thrive Wellness & Recovery, LLC. In addition, Dr. Lauryn is a published journalist and speaker, and her work has been featured in Oxygen Magazine, Women’s Health, Paleo Magazine, Breaking Muscle, CrossFit Inc, USA Today, ABC and CBS News. She loves nothing more than helping others “quiet the noise” in the health food and fitness world.
As a vegetarian/vegan for over 30 years I had horrible digestive issues…gas, bloating and generally uncomfortable most of the time. I was crazy thin but my belly looked bloated most of the time. I made a very gradual transition to paleo/primal and eventually what I call “borderline keto” and all that stuff pretty much went away. As long as I’m eating enough non-starchy veggies I don’t have any issues with constipation. I take Natural Calm before bed to help me sleep and I know that helps as well.
Hi Dr.Lax and Robb!
I wanted to point out a small correction regarding the claim made about Candida maltosa being able to feed off ketones. This fungi hasn’t been shown to feed off of acetone, acetoacetate or beta-hydroxybutyrate (technically not a ketone but a carboxylic acid), which are the ketones relevant to human health.
Candida maltosa has been shown to feed off the aliphatic ketone dodecane-2-one. Does this mean a higher concentration of ketones in the blood will fuel the Candida? I don’t know, but so far we don’t have evidence of that as far as i know.
The one thing that help to keep my bathroom visits regular is apple cider vinegar.
I will mix 2 tablespoons with some warm water and down it. Taste horrible but works like a charm
Hello. I’ve been on Keto for more than a month now and I’ve been feeling bloated and constipated. I’ve gone tot he doctors. Because I was worried but no help. Does anyone know how I can get rid of that?!
I’ve been ‘regular’ for 45 years on a vegetarian diet, briefly a vegan diet and a vegetarian LC diet since 2003. Regularity for me, i.e. at least once per day, seems to depend mainly on high intake of fruit and vegetables. Other plant foods don’t seem to have enough fibre to make a difference. I think LC makes almost no difference as long as the fruit and veg. intake is adequate.
I felt very uncomfortable in brief periods in the past when I was constipated. In hindsight, I put it down to not eating enough fresh vegetables to keep me regular.
If one eats enough potassium, one needs to eat a lot of fruits and vegetables. So the problem in effect resolves itself. Vegetables such as lettuce, Brussels sprouts, cauliflower or cabbage are very high in fibre and low in energy, whatever the sources of fat and protein in one’s diet. I’d advise anyone who isn’t regular to try eating 500 g/day or more of fresh salad, steamed broccoli and/or similar.
It’s not all about fibre and indeed it probably has nothing to do with fibre. Check out Volek and Phinney on this. Constipation on the keto diet is almost always associated with sodium levels; as the liver excrete more sodium, and glycogen stores diminish, the body becomes relatively dehydrated and absorption of fluid from the colon is up regulated causing constipation i.e. stone like stools that are difficult to pass. This keto constipation has absolutely nothing to do with Viber because people on a completely meat based diet don’t generally suffer constipation if they are getting sufficient electrolytes, particularly sodium. Don’t take my word for it. As I say, check out Phinney and Volek on this.
And what if you are still bloated and constipated on keto while making sure you get good levels of electrolytes (Na, K and Mg)?
Might need to try adjusting what you’re eating some, and take some digestive support (like Now Foods Super Enzymes capsules or something similar).
I watch my macros on keto, this is month 6 – I make sure I get enough Na, K and Mg and I’m so bloated it’s like I have a basketball shoved under my ribs.
I’m thinking about going back to my old way of eating – at least I could sleep and didn’t feel so absolutely awful all the time. The bloat is so bad I feel like it’s making my heart palpitate at night from all the pressure. I have to sleep sitting upright like I did when I was 7 months pregnant.
I just started digestive enzymes this week and I feel like the bloat is WORSE. I’ve tried cutting out several normal “problem foods” and nothing is helping.
I’m sure I’m not eating enough fat but I keep worrying this bloat is a gallbladder issue, so I stopped the coconut oil, butter in broth etc.
I don’t even want to eat anymore, I’m thinking about intermittent fasting to see if that gives my gut a break – but I am loving the weight loss results on keto.
Yeah, you can try eating differently and see if it helps. Definitely do what works for you.
Some good probiotics might be helpful too. I’ve been liking the Primal Probiotics from Primal Blueprint lately.