The ketogenic diet has gained popularity as a weight loss method and for its potential health benefits. This diet is characterized by very low carbohydrate intake, high fat consumption, and moderate protein intake. The keto diet shifts the body's primary fuel source from glucose to ketones, which are byproducts of fat breakdown. While considered safe for most, the transition to ketosis can cause initial side effects, often called the "keto flu" or "carb flu." Bloating is a common and uncomfortable symptom that can affect your physical appearance. This article explores the causes of keto bloating and offers practical remedies to alleviate discomfort.
Understanding the Keto Diet and Keto Flu
The keto flu describes a set of symptoms that some people experience when starting a ketogenic diet. These symptoms, similar to those of the flu, result from the body adapting to a diet very low in carbohydrates. Reducing carbs forces the body to burn ketones for energy instead of glucose. This metabolic shift is called ketosis and can cause withdrawal-like symptoms.
Signs of the keto flu may appear within the first few days of cutting back on carbs. Symptoms can range from mild to severe and vary from person to person. While some people transition to a ketogenic diet without any side effects, others report symptoms such as nausea, vomiting, constipation, diarrhea, headache, irritability, weakness, muscle cramps, dizziness, brain fog, stomach or intestinal pain, muscle soreness, difficulty sleeping, and food cravings. These symptoms typically last a few days or, rarely, up to several weeks.
Does Keto Cause Bloating?
When your body shifts into ketosis for the first time, you might encounter some bloating. It typically occurs during the first week of your dietary change, along with other symptoms collectively known as the “keto flu.” It may be accompanied by other symptoms such as headache, constipation, and other types of stomach pain. Most people find that the shift in their body and the symptoms that they exhibit are the result of metabolic changes caused by the dietary restrictions of keto. While the keto diet may cause bloating in the short-term for some people, you can do a lot to minimize the long-term effects of the diet on your abdominal distension. Many of the changes are the result of a drastic change to your diet that affects your gastrointestinal tract. As a result, bloating and most of the other symptoms of keto flu should resolve within four weeks. By minimizing the shifts that your body must go through, you can effectively shorten the window during which you are most susceptible to bloat.
Common Causes of Keto Bloating
Several factors contribute to bloating when starting a ketogenic diet:
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Electrolyte Imbalance and Dehydration
A keto diet can cause you to rapidly shed water stores, increasing the risk of dehydration. This is because glycogen, the stored form of carbohydrates, binds to water in the body. When dietary carbohydrates are reduced, glycogen levels plummet, and water is excreted from the body. When following a ketogenic diet, levels of insulin, an important hormone that helps the body absorb glucose from the bloodstream, decrease. When insulin levels decrease, the kidneys release excess sodium from the body. Furthermore, the keto diet restricts many foods that are high in potassium, including fruits, beans, and starchy vegetables. Dehydration is easily linked to constipation and a lack of bowel movements can then lead to stomach distension and bloating.
Changes in Gut Microbiome
A ketogenic diet changes the composition of gut bacteria as they adapt to processing more fats and fewer carbohydrates. This shift can cause temporary digestive issues, including bloating. After going keto, it takes time for your gut’s ecosystem to adjust to new foods. This is especially true if you’ve increased your sugar alcohol and MCT consumption. To enjoy optimal digestion, you need to cultivate a healthy gut flora.
Increased Fat Intake
A high-fat diet requires a strong digestive response, and eating too much fat too quickly can overwhelm your system, leading to bloating and indigestion. If you consume more MCT oil than your liver can process at a time, the excess MCTs might end up back in your intestine and lead to digestive upset.
Sugar Alcohols and Artificial Sweeteners
Some foods marketed as "keto-friendly" contain sugar alcohols like erythritol, sorbitol, or maltitol, which can cause bloating and digestive discomfort. Although sugar alcohols such as xylitol and sorbitol have lower net effective carbs, you should still monitor their consumption since they’ve been associated with nutrition depletion. Sugar alcohols are notorious for having poor absorption which, in turn, can lead to more water retention in the large intestine. The result is a stomach that looks swollen and feels uncomfortable.
Insufficient Fiber Intake
When you start to restrict your carb intake, you may find that your fiber intake is too low. That’s because low carb diets like keto have you avoid many fiber-rich foods such as whole grains and fruits. Insufficient fiber in your diet can slow down digestion and cause constipation which can then lead to bloating.
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Food Sensitivities
When you shift to a keto diet, you trade in carb-heavy foods for proteins and healthy fat. In turn, you may be eating a lot of brand new foods for the first time. During this trial and error phase, you may encounter digestive issues or allergic reactions, including inflammation, swelling, itching, and bloating. A symptom could indicate a potential food intolerance. FODMAPs in keto-friendly foods such as nuts and seeds such as flax seeds, dairy, and high-fiber cruciferous vegetables such as Brussels sprouts might cause bloating because of inefficient digestion.
Eating Habits
Eating too fast can also cause you to swallow excess air, contributing to bloating. As you chew your food, your taste buds profile the food you're eating and signal to the rest of your digestive system to make the most of your meal. But in case of insufficient digestive enzymes, undigested fat, protein, and carbs may reach the large intestine leading to increased bacterial fermentation and gas buildup. Marinades and sauces often have ingredients that can affect your net carbohydrate intake.
Leptin Levels
Leptin is a hormone produced by fat cells that regulates your nutritional behavior (whether you feel satiated or not) and energy balance. Leptin has a natriuretic effect on your body. Natriuresis means to expel sodium from the body by increasing urine output.
Remedies to Minimize Keto Bloat
Luckily, there are ways to reduce its flu-like symptoms and help your body more easily navigate the transition period.
Stay Hydrated
Drinking enough water is necessary for optimal health and can also help reduce symptoms. Staying hydrated can help with symptoms like fatigue and muscle cramping. Replacing fluids is especially important when you are experiencing keto-flu-associated diarrhea, which can cause additional fluid loss. Prioritize drinking more water or sugar-free sports drinks and by taking electrolyte supplements. Water is typically the best elixir for your body. Most guidelines suggest that people need about eight glasses or 64 ounces of water per day.
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Replace Electrolytes
Replacing dietary electrolytes may help reduce keto-flu symptoms. Getting adequate amounts of these important nutrients is an excellent way to power through the adaptation period of the diet. Salting food to taste and including potassium-rich, keto-friendly foods like green leafy vegetables and avocados is an excellent way to ensure a healthy balance of electrolytes. These foods are also high in magnesium, which may help reduce muscle cramps, sleep issues, and headaches. To address insufficient hydration and electrolyte dumping at the start of the keto diet, you might want to try adrenal cocktails.
Avoid Strenuous Exercise
While exercise is important for staying healthy, strenuous exercise should be avoided when experiencing keto-flu symptoms. Fatigue, muscle cramps, and stomach discomfort are common in the first week of following a ketogenic diet, so it may be a good idea to give your body a rest. While these types of exercise should be avoided if you are experiencing the keto flu, light activities like walking, yoga, or leisurely biking may improve symptoms.
Get Adequate Sleep
Fatigue and irritability are common complaints of people who are adapting to a ketogenic diet. Lack of sleep causes levels of the stress hormone cortisol to rise in the body, which can negatively impact mood and make keto-flu symptoms worse.
Make Dietary Adjustments
Those who are having trouble adapting to the ketogenic diet may have to eliminate carbohydrates gradually rather than all at once. Slowly cutting back on carbs while increasing fat and protein in your diet may help make the transition smoother and decrease keto-flu symptoms. To help your gut flora adjust to keto and thrive, consider taking probiotics.
Add MCT Oil to Your Diet
One research study demonstrated that adding MCT oil to the diet accelerates the use of ketones and minimizes the discomfort of keto flu symptoms. MCT oil can easily be added to a cup of coffee or tea without making much of a difference in taste. If a cup of java isn’t your go-to in the morning, a splash of MCT oil can also be added to a low-carb smoothie, whipped into a salad dressing, or simply taken straight from the bottle. Use a couple of teaspoons per day, and you may find that weight loss is dramatically improved compared with use of other oils such as olive. However, going overboard on MCTs can cause bloating, as well as nausea, diarrhea, vomiting, and cramps. To make sure you get your MCT consumption just right, introduce it into your diet slowly and talk with your doctor or registered dietitian. Avoid consuming more than the daily recommended dosage. Also, see if your body responds better to MCT powder.
Cut Back on Sugar Alcohols
Cut back on the amount of sugar alcohols that you consume. Instead, try other keto-friendly sweeteners such as low-carb fruit flavoring, monk fruit, or stevia.
Optimize Fiber Intake
Focus on adding non-starchy vegetables (leafy greens) and cruciferous vegetables (cauliflower, broccoli, and cabbage) to every meal. These veggies can help get “things” moving. Another source of protein-rich fiber comes from seeds and nuts. Flax, chia, and almonds are high-fiber and low-carb friendly. Psyllium husk and similar fiber supplements can help you get enough fiber intake in your diet.
Eat Slowly and Mindfully
Eating slowly and making mindful food choices is ALWAYS a good idea, especially if you’re aiming for weight loss. To slow your roll when it comes to eating, turn off distractions (like TV and, yes, your phone) while you eat. Put down your fork and pause between bites, taking time to completely and thoroughly chew your food.
Limit Certain Foods
If you’re sensitive to dairy products or lactose, keep your intake very limited. Choose lactose-free alternatives (making sure they’re also low-carb). Note that many folks can tolerate cheese and yogurt, even though they may struggle with milk and ice cream. Some packaged "keto" foods are highly processed. They may contain additives that can lead to digestive issues, even though they are low in carbs. Stick with whole foods and options that contain just a few ingredients whenever possible.
Consider Probiotics
Probiotics are fantastic for balancing your gut flora with good bacteria. If you've long struggled with digestive issues, try incorporating more probiotic-rich foods into your meals. Probiotic foods include fermented foods like kimchi and sauerkraut. If you suspect you're not getting enough probiotic foods in your diet, discuss probiotic supplements with your healthcare professional. They may recommend a probiotic with live strains, making it more effective for your gut microbiome.
When to Seek Medical Advice
While keto-flu symptoms are commonly reported by those shifting to a ketogenic diet, if you are feeling particularly unwell and experiencing symptoms like fever, prolonged diarrhea, or vomiting, it’s best to contact your doctor to rule out other causes. Although the ketogenic diet may be helpful for many people, it’s not suitable for everyone. For example, the ketogenic diet may not be appropriate for pregnant or nursing people, children, and teens unless it’s being used therapeutically under medical supervision. Also, those with diabetes, kidney disease, liver disease, or pancreatic conditions who are interested in following a ketogenic meal plan should consult their doctor to determine if this diet is safe and suitable for their specific needs. Lastly, this diet may not be appropriate for individuals who are hypersensitive to dietary cholesterol, who account for around one-quarter of the world’s population. Persistent or severe bloating could indicate an underlying issue. If bloating lasts longer than a few weeks, is accompanied by severe pain, or affects your ability to eat and function normally, it may be time to consult a healthcare professional.