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Dr. Boz Reverses Medical Problems with Healthy Keto Living
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Keto Diet 101: Bowel Trouble. Too Fast or Too Slow

Keto 101
Published21 Jun 2018
By Annette Bosworth
10173 Views
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Transition your eating from Standard American Diet to Keto and you can find POO the focus of your conversation. Some patients have their stools slow WAY down, Others find that every time they eat a high-fat meal, they have a date with the toilet.

BOWELS:  TOO SLOW [CONSTIPATION]

THIS PROBLEM AFFECTS PATIENTS: on day 3-4

THIS PROBLEM LASTS UNTIL: your bowels adapt to your new diet.

keto diet 101

Drinking salted water prevents the keto flu and also helps with changes happening in your guts. I’m referring specifically to your stool. Constipation and hard bowel movements occur naturally as part of the keto transition process.

With less water, your stools become dehydrated and harder. Drinking salty water helps lessen this problem.  

For the first couple of weeks, patients struggle with what to eat. My salesmanship for high-fat meat must work very well because they do a great job of loading up on fatty, greasy meat.

They produce ketones, but they also get constipated. A few minutes studying the number of carbs found in fruits and vegetables teach you that corn, cantaloupe, peas, bananas, and are all no-nos.   

My new keto patients usually aren’t that familiar with many keto-friendly vegetables. For example, cabbage, Brussels sprouts, and fresh spinach are all great additions to a keto diet.

Sadly, many patients look at me bewildered that others actually eat that stuff. They ate yummy fatty meats, successfully peed ketones and did a little dance. Everything’s awesome until day 4 when they couldn’t poop. 

Some patients got so constipated they gave up. Be prepared for this constipation challenge. Drink salt water.  Add cabbage early.

Ingest a spoonful of dry chia seeds with some water every 2-4 hours.  These little seeds swell up into a gelatinous substance and have helped many patients transition. This trick is tried and tested. One tablespoon every 2 hours followed by two cups of water has yet to fail my patients with this problem.

Several said they could not keep up with the spoonful of seeds that often and only made it to six tablespoons before they quit. However, the next day: success!!

If you’re still having a tough time with constipation, try Milk of Magnesia. This over-the-counter medication is the perfect fit for this problem. In the first weeks of keto, magnesium is the most common salt your body will lose. This magnesium-filled liquid medication helps replenish your missing magnesium while boosting your stools to soften up and move along.

BOWELS:  TOO FAST [DIARRHEA]

THIS PROBLEM AFFECTS PATIENTS: on day 3-4

THIS PROBLEM LASTS UNTIL: we figure out the cause of the loose stools.  

Most people on a keto program experience bowel problems in the form of constipation. Sometimes, people experience the other extreme: diarrhea. This is usually due to a pre-existing problem with their system.  

Over the years, the US government and corporations have spent millions of dollars researching ways to help people suffering from all sorts of bowel ailments. These range from irritable bowel to bacterial overgrowth, to leaky gut syndrome. One 1970s study treated irritable bowel syndrome with a high-fat diet.

It took six months for the study’s subjects to become regular. Still, the study showed that a high-fat low-carb diet is one of the cheapest and most effective ways to regulate runny stools and other bowel problems.

Unfortunately, the study was small and was not funded by a big pharmaceutical company. The study did not promote any medication. The outcomes from that old trial were so promising for this taxing problem that it led me to change how I approached my patients with bowel problems.

My experience with patients suffering from irritable bowel has taught me to stick to the plan of peeing ketones for three to four months before they turn the corner.

Did you know your small bowel or small intestines are supposed to be sterile? Sterile-as in no bacteria. Your large intestines are packed with bacteria. But your small intestines are supposed to be sterile. Anxiety, stress and chronic illness all lead to poorly functioning bowels.

Your small intestines can get so messed up that the bacteria normally found at the end of your intestines, in the large colon, wiggle their way into the upper portion of your digestive tract.

The bacteria in the small intestine reproduce without much resistance and grow rapidly. This is called small bowel overgrowth.  

When patients have small bowel overgrowth, it is not uncommon for them to lose out on fatty vitamins normally absorbed there. Because their small bowel gurgles with abundant, unwanted bacteria, they can’t absorb any fat-based nutrients.

I’ve started patients on a ketogenic lifestyle not knowing that they had small bowel overgrowth. A week into the change and they are miserable with uncontrolled diarrhea. They call the clinic upset and declare, “This just is NOT the diet for me!”

After checking their lab results as well as a detailed history, it turns out they often have had loose stools after eating fat for the better part of a decade. These patients report avoiding all fat because it always gives them explosive diarrhea.

Such eruptions after each greasy meal kept them malnourished from their avoidance of fat. They go on for years without understanding what was truly happening to their system. One day, they happen to have their Vitamin D checked. Their results were so low that it could only mean they have not been absorbing any fat for years.

Fat absorption failure means you absorb no fat-based vitamins. Vitamin D is one of those vitamins.

I advise patients of mine who suffer diarrhea after switching to a high-fat diet not to give up. Why? They need this anti-inflammatory diet more than most of my other patients. If you suffer from loose stools or explosive diarrhea after going keto, give your body time to adjust.

Don’t give up! Your bowel has grown used to the low-fat life you used to lead.  The mechanism to absorb fats has been sleepy or even shut down altogether. Turning these cells back on takes time. A few months!

The health of your brain and bowels depend on your ability to persevere. If your bowels flare up when switching to high fat, please know that it is more than just an annoyance. Something more is going on. See a gastro specialist. Extreme intestinal inflammation mentioned above can last weeks.

The lack of adequate fat enzymes also takes times to correct. Give your body time to adjust. Years of this hidden problem led to the chronic swelling of your bowels’ inner lining. It takes time to mend that chronic wound inside your guts.

Keto Diet 101: Solutions Available

If you get diarrhea within days of switching to keto, you have a problem with inflammation or absorption. Don’t quit. Fix it. To tide you over, I recommend the following:

Loperamide:  (Also called Imodium) This over the counter medication slows down bowel movements. Most people cannot put their life on hold to deal with intense diarrhea. It takes time to fix this problem. In the meantime, don’t take all this suffering lying down. Control your symptoms. Take Loperamide. It will settle the symptoms down while we work through the problem without hurting you.  

Kombucha Tea: This ancient drink is bubbly and fermented with healthy live bacteria in it. Most of my diarrhea patients reversed their bowel problems when they repopulated their gut bacteria. Many patients spend thousands of dollars on this process. Save your money.

Drink 1/4 cup of this tea a day until the diarrhea is resolved. Notice that I said ONE-FOURTH OF A CUP.  Too much of that bacteria is often not tolerated by those struggling with bowel problems.

 

For my friend’s recipe on BONE BROTH that wins the BEST BROTH award – see the image below.

Finally, the surefire antidote that transitions my diarrhea patients through the roughest part can be unsettling for patients to hear: intermittent fasting. Yes, I am referring to the term for NO EATING. Before you transition your body chemistry to keto, any kind of fasting sounds like a strange idea.

Once you produce ketones, your appetite decreases. My diarrhea patients have an unknown injury inside their guts. That lining needs to heal. The answer? Rest. In other words, intermittent fasting. Fasting is a universal remedy for many medical problems.  

When I suggest this to patients, they often resist due to fear of going without food. To help them begin to consider the option, I remind them that animals instinctively fast when they are ill. Rest your guts to allow time for healing. Stop eating.

 

The ancient Greek physician Hippocrates, regarded as the father of medicine, said this about fasting, “Everyone has a doctor in him; we just have to help him in his work. The natural healing force within each one of us is the greatest force in getting well. To eat when you are sick is to feed your sickness.”

If you want to learn more about understanding the ketogenic diet, check out the book ANYWAY YOU CAN on Amazon or Audible by Annette Bosworth, MD.

keto ebook cta

RESOURCES:

  1. Mavropoulos, J. C., et al. “The Effects of Varying Dietary Carbohydrate and Fat Content on Survival in a Murine LNCaP Prostate Cancer Xenograft Model.” Cancer Prevention Research, vol. 2, no. 6, 2009, pp. 557–565., doi:10.1158/1940-6207.capr-08-0188
  2. Nikaki K, Gupte GL.; Assessment of intestinal malabsorption; Best Pract Res Clin Gastroenterol. 2016 Apr;30(2):225-35. doi: 10.1016/j.bpg.2016.03.003. https://www.ncbi.nlm.nih.gov/pubmed/27086887
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    7 Comments
    1. Avatar
      Candy Grammel December 16, 2019 at 4:03 AM Log in to Reply

      I hit the wrong button and this disappeared.If this is a duplicate, please ignore.I am 64.I have the diarrhea issue.I have done Keto before and didn’t have this issue but have had diarrhea with spinach and thought that was oxalates. But this seems to be Mast Cell related as I know Keto is high histamine and Mast cell issues go with Ehlers Danlos, Lipedema, and dysautonomia that I suffer from but it could just be digesting fats. I do think my gallbladder is having trouble as I have pain sometimes in that area. My diarrhea turns to liquid after a couple of quick runs to the toilet following a meal. I have found a probiotic strain that stabilizes mast cells and it does help if I don’t eat too much meat/fat at a meal but if eating what I should on Keto, even two pills can’t stop it. I don’t have the problem with eating carbs or the SAD diet.I can’t leave the house after eating and can’t eat out at all. I try to do OMAD so I can be home when this happens. Its not a great way to live. If I go to my drs, they will tell me to stop Keto but I believe it is the best chance to help with the Lipedema and reverse the trend that I am on. I am about 40-50 pounds overweight. I am not diabetic and do not have high blood pressure yet. Last week had blood work done, morning fasting glucose of 106 while stressed is highest ever, A1C=5.6, C-peptide=2.4, Insulin=11.4,LP-IR less than 25, total cholesterol 225 but triglycerides=73, I always struggle with Vit D now a whopping 33.6 (fat absorption problem aided by genetics? but would like higher). Taking 10k per day for a year got me up to 65 a few years ago), Homocysteine down to 9.8, hsCRP=1.26. I am reading your book and listen to your Youtubes. I have purchased the ForA meters but waiting to get Keto going with out diarrhea. I make it about 4 days or so and just can’t take the diarrhea even though my ketone sticks turn dk pink, so I back off and add more carbs to slow the diarrhea down and then no ketosis. I also ordered the BHB pills but haven’t started taking because not sure of diarrhea link even without stevia. Should I start on BHB with stevia or the pill anyway? I will try the Imodium from this article. If you have any other suggestions please let me know. Thank you for all the help you give.

    2. Avatar
      Leslie August 18, 2020 at 4:49 PM Log in to Reply

      Omgosh, I’m so grateful for your work. I just took chia seed as you describe and it immediate removed discomfort I’ve been getting from acid reflux I’ve been experiencing since increased fat intake from Keto.

    3. Avatar
      Bonny Alllen October 12, 2020 at 11:56 AM Log in to Reply

      You never mention how long to do the Chia seed every 2 hours . I did this and did Stop the Diarrhea but the Constipation comes back . Its live a never ending cycle. First Constipation then diarrhea. HOW Can I get gut back to normal. This is Chronic problem for me.

    4. Avatar
      Charlotte Same December 15, 2020 at 4:39 AM Log in to Reply

      Is keto diet good for someone with high cholesterol . My concern is meat high in cholesterol and fat.

      • Avatar
        Dr Boz March 8, 2021 at 1:48 PM Log in to Reply

        Charlotte,

        Fat is your friend. Watch this video I think it twill help you get started.
        https://youtu.be/bsHqa4-g3Tw

    5. Avatar
      Tami Proctor September 5, 2021 at 4:03 PM Log in to Reply

      Thank you Dr Boz I have been following your recommendation for using chia seeds and they work wonderfully! I have spent years at type 1 and have never found anything as helpful.
      BTW since we are on this subject I recently had a colonoscopy and my diverticulosis has healed after nearly 4 years of keto!

      • Avatar
        Annette Bosworth M.D. October 18, 2021 at 1:00 PM Log in to Reply

        Wow. That’s a story worth sharing with others Tami!!

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