Keto constipation is real.
Despite the hype about low-carb ketogenic diets being good for “everything” (from brain health to metabolic boost) there is a dark side no one is really talking about: Constipation.
Constipation is defined as, “difficulty relieving the bowels.”
Although chronic constipation technically happens when you “don’t go” for 3 days or more in a row, in functional medicine, nutrition and general health world, constipation is a REAL DEAL if you aren’t going #2 every day.
And not just any doo—but a nice sausage-like, well-formed brown turd (like the Bristol Stool Chart below) and a feeling of complete elimination. (Like you can do a happy doggy dance!).
Unfortunately, low carb diets are notorious for impairing your natural-born abilities to “do the doo” like a normal human.
Here are 6 Reasons Why Keto Constipation Happens (plus 3 things you can do about it—now).
6 Reasons Why Keto Constipation Happens
Decreased Healthy Gut Bacteria
You gut is home to upwards of 15-30,000 different SPECIES of bacteria, and trillions of individual bacteria critters.
Gut bacteria DIVERSITY (different strains of bacteria) is associated with better health overall.
Ketogenic diets have been shown to improve gut bacteria diversity in the presence of disease as a “therapeutic” diet (such as Autism, Diabetes and Epilepsy ).
However, in healthier individuals and long-term dietary implementation, gut bacteria diversity appears to diminish, as well as increase systemic inflammation (1, 2 in the body—particularly without enough butyrate (prebiotic fiber) present.
Low-carb, high-fat and higher-protein diets can also a decrease beneficial bacteria, while spiking overgrowth of negative bacteria in the gut, if and when dietary “balance” is lacking (particularly DIVERSITY of healthy fats). (Singh et al, 2017).
In addition, while many people believe that carbohydrates and sugars alone are the culprits for breeding “bad” gut bacteria, “bad” gut bacteria can EQUALLY breed from ketone bodies (the substances formed in the body from fatty acids to replace glucose—sugar—on a keto diet). Excess ketone bodies (such as from long term ketosis) have been linked to symptoms of IBS—explaining close ties for some who experience constipation or other gut symptoms (loose stools, bloating, diarrhea) when following a Ketogenic diet. (Campbell et al, 2010).
The Bottom Line: Keto diets improve gut bacteria diversity in unhealthy, disease state individuals. For those who no longer have a disease or adhere to a long-term Keto diet however, healthy gut bacteria and diversity may lessen.
Lack of Pre-Biotic Fiber
By default, people on low carb diets aren’t eating a lot of color and plants—where most of the “push” for your food lies.
Each macronutrient we eat plays a unique role in your body and digestion:
- Fat=The “slippery slope” to help ease food down through the “tubes” of digestion
- Carbohydrates= The “bulk” to carry food through (and ride the slippery slope from fatty acids)
- Protein= The “building block” of your cells and muscles—essential for healthy cell metabolism and body structures/organs, as well as helps stimulate stomach acid and enzyme production (to break down food)
Ultimately, a healthy body desires balance from all food groups—and although it CAN create “glucose-like” energy from fats or proteins, or “protein-support” from broccoli and mushrooms, or extract fat from your chicken breast, ideally, it just wants the real deal so each macronutrient can stay in its lane and do their job—ESPECIALLY prebiotic foods (resistant starch carbs) to maximize healthy digestion.
Prebiotic foods are foods with fiber that “feed” healthy gut bacteria (probiotics), helping them populate the gut. Ketogenic diets, bent on keeping carbs to less than 20-net carbs each day often neglect many of these prebiotic fibers—found in starchier foods like cooked and cooled sweet potatoes/potatoes, Jasmine white rice, green tipped bananas and plantains, taro, onions, leeks, jicama and other starchy tubers. Resistant starches also help “push food through” your GI tract, and “cleanse” your system.
Prebiotic fiber has long been touted for promoting a healthier gut microbiome (Saha & Reimer,2014) Unlike other low-starchy carbs, like greens, cucumbers and celery (wonderful in their own right), pre-biotics help make our probiotics (healthy gut bacteria) STICK in our gut for the long term. Prebiotic fiber has also been shown in studies to significantly increase ketone production (body’s ability to burn fat for fuel) and boost metabolism (Vetali et al, 2010).
The Bottom Line: Resistant starch, pre-biotic foods support healthy digestion.
Bulletproof Coffee, Bars, Shakes, Cheese & Dry Foods
Aside from running low starchy fibers, many people on a keto or Atkins’ style diet fail to eat enough color and green things in general—hydrating foods that support elimination (poop)—NEGLECTING carbohydrates and fiber altogether.
Bring on the butter, bacon, eggs, nutbutter, shakes and coffee! Opting for more white, brown and tan colors on their plate (instead of rich greens, reds, oranges, yellows, blues and purples) can keep you clogged! While bacon, butter and eggs are NOT bad things by any means, if and when we keep putting these dry foods down the hatch—without some hydrating foods from leafy and colorful things—we run “dry” ourselves (i.e. constipation).
Not to mention, many of the supplemental products like (exogenous ketones, shakes, bars, nutbuttter packets) people turn to when they “go Keto” are filled with fillers, additives, soy, artificial sweeteners and chemicals—equally havoc-wreaking for your digestion.
Food quality also matters. Is your dinner from Tyson Farm’s conventional chicken farm? Your “butter coffee” made from Keurig or Starbucks’ finest grounds (and highly cross-contaminated with gluten). Your cheese from a high-pasteurized, hormone-infused dairy source? Chances are, your gut knows the difference.
The Bottom Line: Food quality matters. If you’re eating conventional meats and dairy, bars, shakes and processed Keto products, your bod (digestion) is naturally going to struggle.
Liver/Gallbladder Congestion
Do you ever get gas or a tummy ache after eating lots of healthy fats with your meal? Greasy stools or clay-colored stools? Pellets or rocks? You may have a sluggish or congested liver and/or gall-bladder —the organs essential for creating waste. When our detoxifying organs can’t do their job efficiently, “back up” (i.e. constipation) happens. In addition, your gallbladder is SPECIFICALLY responsible for digesting your fats and forming bile salts. If queasiness hits you when you eat a little too much coconut oil, or dig into a fatty steak, this could be because your gallbladder is not strong enough to break those fats down.
How do your liver or gallbladder go “bad?”
Common triggers to liver/gallbladder congestion include:
- History of low-fat diet
- Lack of (real food) fiber
- Low stomach acid
- History alcohol/processed food diet
- Toxin exposure (conventional beauty/cleaning products, tap water, plastics)
- Long term medication/NSAID use
- Poor quality meat/dairy
The Bottom Line: Fats cause digestive distress if your liver/gallbladder is sluggish.
Feast & Fast
All or nothing. Many people on a keto diet dabble with IF (intermittent fasting), fasting and intermittent feasting. Going from 16-hours to days without food, then “feasting” on everything in site (within their dietary constraints of course). Sure, this all or nothing style of eating CAN mimic the way humans DID eat for centuries (times of “feast” and times of “famine”) and serve many well…however, from a biological perspective, this “food dump” into your system with all of your daily calories at once (or within a shortened time frame) can ALSO be ALOT of “information” for your body to process at once. Couple this food dump (or feast) with “gut issues” (such as underlying bacterial overgrowth, low stomach acid or slow motility), and your ketogenic diet PLUS intermittent fasting may be a better THOUGHT than actual enhancement for your digestion.
The Bottom Line: Consider how well you digest your food and feel during your feeding periods. Bloated? Gassy? Constipated after a large meal post-fast, or trying to get all your energy needs in to a shortened time frame? Your digestion may not be able to handle larger meals at once and can benefit from smaller. Experiment.
The Elephant in the Room: Stress
Face it, it takes a fairly “rigid” or “Type-A” person to be able to stick with any diet for the “longhaul” (in fact, 97% of diets fail). For those who can “stick with it,” there’s often more to the story than just food—particularly for the constipation conundrum. From a human psychology perspective, often times, individuals who are able to “stick” with keto (for the longhaul), are also those who are able to: (1.) Wake up at 5 a.m. for their 5:30 a.m. CrossFit workout, (2.) Squeeze 80-hour work weeks into “40-hours,” (3.) Spin 3 plates at once…you get the picture. They often can “bite off more” than they can chew.
Challenge: Clench your fists—really tightly—for a moment….What happens? Fists swell? Get red? Palms sweat? Hands grow tired?—Stress.
Well, the same thing happens in your gut when your body is stressed—from staring at screens for hours on end, lack of sleep, low water intake, overtraining, under-training, lack of passion and connection in your life, burning a candle at both ends, running off coffee, etc. Your body (and gut) “clenches” on to that stress—giving way to constipation.
The Bottom Line: Stress is the #1 constipation causer. What areas are you
What to Do About It
3 quick-hit tips to bust constipation on a Keto diet:
- Prebiotic & Probiotic Up. Reach for a soil-based probiotic and partially hydrolyzed guar gum prebiotic fiber as part of your supplement routine.’
- Swig 1-2 tbsp. apple cider vinegar in water around meals.
- Incorporate at least 3 different colors at each meal & real foods. Consider a serving of prebiotic fiber each day (cooked and cooled sweet potatoes/potatoes, winter squashes and starchy tubers-carrots, taro, etc.
- Drink LOTS of clean, filtered water (aim for half your bodyweight in ounces)
- Replace coffee with herbal tea, like ginger, licorice or Dandelion
- Consider taking Ox Bile supplement if you feel queasy after eating fats
- Check in with your stress—be real. How’s your sleep? Are you pushing it too hard at the gym? Saying yes to everything? Neglecting your body cues in the name of Keto perfection? Permission to stop 1 stressor wreaking havoc on your health.