The ketogenic diet, or keto diet, has gained popularity as a method for weight loss and potential health improvements. It involves drastically reducing carbohydrate intake and increasing the consumption of high-fat foods, with moderate protein intake. This shift forces the body into a metabolic state called ketosis, where it burns fat for energy instead of glucose. However, the dietary adjustments associated with the keto diet can sometimes cause side effects, including mild constipation.
Understanding the Keto Diet
The keto diet requires consuming very few carbohydrates, usually less than 50 grams per day. This restriction depletes the body's glucose stores, prompting the liver to convert fatty acids into ketone bodies, which cells use for energy. The transition to ketosis may offer health benefits such as improved blood sugar control, reduced triglyceride levels, and lower total cholesterol levels. Some evidence also supports its use in treating neurodegenerative and neuroinflammatory conditions like Alzheimer’s disease, migraine headaches, and epilepsy.
Why Constipation Occurs on Keto
Several factors contribute to constipation on a ketogenic diet:
Adjustment to Fewer Carbs and More Fat
Our bodies are designed to digest carbs, fats, and protein. When carbohydrate intake is drastically reduced, as in the keto diet, digestive issues like constipation can arise. Some people may have difficulty transitioning to the very high-fat content of the diet, which can also cause GI upset.
Not Enough Fiber? The Fiber Myth
While it's commonly believed that a lack of fiber causes constipation, some research suggests that fiber can actually worsen it for some individuals. Meat and fat are easily and completely digestible, whereas fiber is partially or wholly indigestible. However, keto diets often restrict high-fiber fruits, vegetables, and grains, which can still contribute to constipation in some people. Fiber adds bulk to stools by drawing water into the intestines, which helps keep stools soft and bowel movements regular. Without enough fiber, constipation may be more likely.
Read also: Easy Low-Carb Cheese Crackers
Transitioning Too Quickly
Drastic changes to a person’s diet can negatively affect their digestive system and even cause symptoms, such as nausea or constipation. The body needs time to adjust to a diet. Gradually transitioning to a low carbohydrate diet over a few weeks may help prevent undesirable digestive side effects.
Food Sensitivities
Sometimes food sensitivities can cause constipation in certain individuals. If you have eliminated common constipation culprits and still have difficulty, consider that you may be uniquely sensitive to something that most people have no trouble digesting. Examples that come to mind are eggs and beef. Eggs are among the top nine common food sensitivity culprits, and beef can cause trouble for some people who don’t do well with dairy products because of a cross-reactivity related to cow proteins.
Identifying Culprit Foods
If you experience constipation on a ketogenic diet, it is most likely because you have started eating something that you were not eating before (or a larger amount of something you didn’t eat much of before) that is hard for you to digest. In order to eat a ketogenic diet-a high-fat, limited protein, ultra-low-carb diet-most people find themselves turning to high amounts of foods that are notoriously difficult to digest, including nuts, low-starch vegetables such as crucifers, and full-fat dairy products.
Many plant foods-especially stems, seeds, nuts, grains, and legumes-are challenging to digest. Fruit, however, is easy to digest-so easy, in fact, that eating too much of it can cause the opposite of constipation!
Symptoms of Constipation
Constipation is characterized by:
Read also: Keto Calorie Counting: A Detailed Guide
- Fewer than three bowel movements per week
- Hard, dry, or lumpy stools
- Pain or difficulty passing stools
- Partially passing stool, which is called incomplete evacuation
Keto-Friendly Solutions for Constipation
If constipation persists or is particularly bothersome, several keto-friendly strategies can help manage symptoms:
Lifestyle and Dietary Adjustments
- Staying Hydrated: Adequate water intake is crucial for softening stools and promoting regular bowel movements.
- Exercising Regularly: Physical activity stimulates bowel function and helps prevent constipation. Walking after meals can be particularly beneficial.
- Eating High-Fiber, Low-Carbohydrate Foods: Though limited, some keto-friendly foods are high in fiber, such as cauliflower, cabbage, nonstarchy vegetables, nuts, seeds, and limited amounts of berries.
- Don't Blame Lack of Fiber: If you are lucky enough not to have constipation on a regular diet and then develop constipation on a ketogenic diet, it is almost certainly not because you are eating more meat and less fiber.
Keto-Friendly Laxatives and Stool Softeners
If lifestyle and dietary changes are insufficient, consider these options:
"Mushers" (Osmotic Laxatives)
These medications draw water into the stool, making it easier to pass:
- Polyethylene Glycol (MiraLAX®): A flavorless powder that can be easily added to water. It is typically the first line of treatment.
- Milk of Magnesia (Magnesium Hydroxide or Citrate): Also draws water into the stool.
- Insoluble Fiber: Acts in the digestive system by bulking and softening the stool because it is not dissolvable in fluids. Instead, insoluble fiber absorbs fluids in the gut and sticks to other waste materials to make softer stool.
"Gliders" (Lubricants)
These help stool move through the colon by lubrication:
- Mineral Oil: Lubricates the stool and helps it retain water.
"Pushers" (Stimulant Laxatives)
These irritate the colon to stimulate contractions and expel stool:
Read also: Magnesium Supplements for Keto
- Senna (Senokot®): Made from the leaf of the Senna alexandrina plant.
- Glycerin and Bisacodyl (Dulcolax®) Suppositories: Inserted into the rectum to lubricate and stimulate the colon.
Important Considerations for Laxative Use
- Consult a Healthcare Professional: Before starting any new medication or supplement, especially if you have underlying health conditions.
- Monitor Carbohydrate Content: Be aware that some fiber supplements and laxatives may contain carbohydrates that could interfere with ketosis.
- Adequate Water Intake: Essential for all laxatives and stool softeners to work properly.
Gradual Transition to Keto
One way you can prevent constipation is by introducing the keto diet gradually. For instance, you can start off with a daily carb intake on the higher end, around 50 g, and then slowly reduce your carb intake as your digestive system adjusts. This approach can take a bit longer for you to reach ketosis. But you may be more likely to stick with the diet if you have fewer side effects.
Choose Whole Foods
Another way to prevent constipation with the keto diet is to make sure the fats and proteins you eat come from whole foods. Eating a lot of processed meals and fast foods can put extra stress on your GI system. Processed foods usually do not provide much nutritional value. Also, they’re typically low in fiber, which you need to keep your gut in good working order.
It’s essential to make sure you’re regularly eating keto-friendly, high fiber foods like nonstarchy vegetables, including greens, broccoli, asparagus, and cauliflower, nuts and seeds, avocados, chia and flax seeds, and unsweetened coconut.
Other Remedies
- Bowel Training: A method where you pass stools at the same time every day.
- Hot beverages: People who want fast constipation relief can also try drinking hot beverages, especially caffeinated ones like coffee or regular tea.
- Occasional Supplements: Commercially available constipation supplements with psyllium husks or guar gum, when used occasionally and as directed, are safe for most people.
When to See a Doctor
If your constipation is not better after 3 weeks, be sure to make an appointment with a doctor. They can work with you to find the best treatment. Long-term constipation can lead to complications, including anal fissures, hemorrhoids, and abdominal pain.