Troubleshoot Diarrhea on a Low Carb, Keto Diet

Low Carb / Keto Resource

When transitioning into a low carb, keto diet, there are some funky things that happen with your digestive tract. As always, the preliminary stages are a time to adjust to your new way of eating.

Usually, with a dramatic increase in fat and reduction in carbs, most people will experience a period of loose bowels or diarrhea, which is normal. There are claims that this effect is candida die-off, but I've yet to find literature in which that is verified.

These symptoms last just a couple of days. For others, this period is lengthened and it can be a little trickier.

If you are experiencing diarrhea, you could try the following:

1. Drink more water

Many people don't realize that when you start a low carb, keto diet that your body is flushing water much more rapidly than you have before. When this happens, it's extremely easy to be dehydrated. Make sure you are drinking enough water to stay hydrated. You will notice that you will go to the bathroom a lot more frequently, but this is also an adjustment period. After a week or so, your body will be used to the increase in water intake and will level off.

2. Consume more electrolytes

This goes along with the previous statement. When water is flushed from the body, electrolytes are also excreted through the urine. If the electrolytes aren't replaced, you could very easily become dehydrated and develop diarrhea, among other things. Some good ways to replenish these electrolytes is to eat avocado, consume salty bone broth daily and if that isn't cutting it, try taking Lite Salt with your food (this can replace your regular table salt). Drinking bone broth will also contain collagen which could help bulk up stools and aid in the gut-healing process.

3. Add probiotics and fermented foods

Probiotics are excellent for bulking up stool and for raising your immune system. While it's ideal to get probiotics from food, there aren't too many options available for low carb, keto diets because of sugar contents. Try some raw sauerkraut or small amount of pickled carrots. If food seems to be too difficult, try a high-quality probiotic supplement like PRO-15 by Hyperbiotics.

4. Adding more fiber

This step is NOT recommended for anybody with IBS (irritable bowel syndrome). Since low carb, keto diets are very high in fat, some people forget to make room for vegetables. Unless you have a severely damaged gut, IBS or intolerances, you should try and include a reasonable amount of veggies, twicy daily. Broccoli, cauliflower and avocado are superb for bulking stool.

5. Use digestive enzymes

This step could be the make or break moment with a low carb, keto diet, especially if you have a hard time digesting fats or proteins. Some try and up their fat and are inevitably left with weeks of projectile, yellow diarrhea (a sign of fat malabsorption). This is especially true if you've had your gallbladder removed. If it's clear you are not digesting fat, try a digestive enzyme supplement like this one from NOW Foods. For fat specifically, you want to make sure you find one that has Ox Bile in the ingredient list.

6. Adding HCL (hydrochloric acid) for increased stomach acid

Despite the numerous attempts that a physican might try to push acid reflux medications on you, you will want to avoid these if possible. These supplements will suppress natural stomach acid, which is more often than not, a bad thing! You need sufficient stomach acid levels (along with digestive enzymes) to properly break down food. Use a HCL supplement like this one from NOW Foods.

For tips on HCL supplementation, check out this great article on SCD Lifestyle.

7. Test for allergies, FODMAPS, parasites or SIBO (small intestinal bacterial overgrowth)

Testing for allergies, parasites and SIBO can be a long and possibly expensive process, but when you're trying to dial in on your problems, it could be a necessary step.

For allergies and intolerances, it's important to realize that there are certain foods that could be attacking your system, as opposed to helping it. I would first start with an elimination diet removing all common allergens (wheat, eggs, fish, dairy, nuts, peanuts, shellfish, and soy) for a period of time (2-4 weeks). If you are noticing positive changes and want to start adding these foods back into your diet, choose one and tread slowly. Take note of how you feel. If you are still feeling great, move onto the next one.

If at any time you feel adverse reactions to these foods, chances are you have an allergy or intolerance to these foods.

Parasites and SIBO can be detected from bloodwork and other clinical tests through your doctor or by a third-party. These can get pretty expensive, so I would only suggest these if all of the previous steps didn't work. If you find growths or parasites, work with a doctor or healthcare professional to solve or manage your issue.

FODMAPS are short chain carbohydrates (oligosaccharides), disaccharides, monosaccharides and related alcohols that are poorly absorbed in the small intestine. It's best to avoid FODMAPs for a period of time and slowly add them back in (if desired). Common FODMAPs include: garlic, onions, nuts, sugar alcohols, and more. For a list of FODMAPs, check out this awesome page for IBSDiets.org.

For some great supplemental information, check out this great guide on Natural Health Protocol.

8. A different approach

When all else fails, a different approach might be the only option left. Remember, a low carb, ketogenic diet is NOT for everyone. People react to different things and one set of guidelines does not work for every body.

If a low carb, keto approach isn't for you, I would suggest trying the Paleo Autoimmune Protocol from the Paleo Mom or the Perfect Health Diet.

These plans emphasize similar views on nutrition and food, but include starches like rice, sweet and white potatoes. Personally, I find that my digestion is best when my meals include starch.

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21 Comments

  1. Secret Squirrel on July 19, 2017 at 11:33 am

    I think I’m having trouble digesting fat (yellow liquid’s been coming out of me for a while – sometimes a bit green). Would I be better taking pure ox bile? Or is it better to take the full range of enzymes?

    • Dominic on August 25, 2017 at 1:40 pm

      I would try a full range that includes ox bile. Yellow stool is often a sign of fat malabsorption. How long into Keto are you? This can be normal if it only happens for a few days or so as the body adjusts to a diet higher in fat.

  2. Toni Fava on October 16, 2016 at 1:15 am

    My stomach is upset from this
    With diarrea
    Taken 1/2 pack for 6 days

  3. Dee Nicol on April 14, 2016 at 4:44 am

    Dominic
    Its my third day. I go to toilette for diarrhea-like or loose stools around 30-60 mins straight after almost every meal.
    I am losing weight, feeling great, thirsty all the time. What shall I do?
    Thank you

    • Dominic on April 28, 2016 at 1:19 am

      Keep hydrated and make sure you’re getting enough electrolytes! My favorite way to consume them is pickle juice. 🙂

  4. Sandy on February 28, 2016 at 1:35 am

    Hi Dominic
    I have been keto for about three and a half weeks and I take a digestive enzyme before meals now. I am noticing that I am tired, fell asleep this aft for 2 hours, which i never do – how long does this fatigue last for?
    Also I have a thyroid problem (I take medication) – and have heard that the keto diet can be hard on thyroid and adrenals – is this true, and if so, what to do about it?
    And lastly, most of the time when i check ketones in urine, I am only mild ketones (with only 2 or 3 times over last few weeks being in the high zone) – and I don’t know why it fluctuates since i stay pretty close to 12g of carbs or less with lots of fat and protein at every meal. Any ideas?

    many thanks
    Sandy

    • Dominic on March 11, 2016 at 2:11 pm

      Sounds like low electrolytes. Drink some broth!

  5. Cathy F. on January 17, 2016 at 2:54 am

    I thought my problem was to much fat but it looks like it is the amount of protein so the digestive enzyme for that is working thankfully most of the time (I had my gallbladder removed in 2008). I do MUCH better with some type of carb though. I get this gurgling noise in my lower left area of my abdomen and that is when I know I am in trouble :). It has been a trial and error thing for me and trying enzymes, portion sizes etc.

  6. Marijke on June 15, 2015 at 12:41 pm

    Hi dominic,

    I’m in week 7 of a ketogenic diet. I started getting diarrhea at the end of the fifth week, after drinking water with a tablespoon of salt added to it. I have not felt great on keto, went from weak to even weaker with every week. With the diarrhea came intestinal cramps and … hemorrhoids. I went to the doctor (a homeopath) last Friday and her hypothesis is that I’m not tolerating the amount of fat I’m eating. I’ve started to add some gentle carbs (no gluten!) to my diet again and that does help with the weak feelings. I’m planning to explore what kind of amount of carbs I can eat without 1) getting food cravings again and 2) gaining weight.
    I seem to be one of those people who aren’t doing that well on full keto… What I’m really bothered with right now is my ongoing loose stools (they are slightly better than the osmotic diarrhea from a week ago) and the intestinal cramps I get after every meal. I’m forcing myself to eat but with some nausea on top of all this, eating has not been much of an enjoyable experience lately.

    Any thoughts how to soothe my apparently over-irritated gut?

    Thanks

    Marijke

    • Dominic on June 19, 2015 at 12:27 am

      Marijke-

      I experienced the same. My body does a lot better with small amounts of starch at every meal. Just test to see what works for you.

      Dominic

    • Rebecca on March 27, 2016 at 4:21 pm

      I have a really bad stomach! I’ve had gi issues for 17 yes now. I at first had burning, cramping from the high fats! I had to keep mylanta with me to sooth my tummy, it took about 2 1/2 weeks to adjust. I’m great now and have had no problems with that again.

  7. Jeremy on April 13, 2015 at 6:32 pm

    I’ve been moving toward the ketogenic diet for close to six months the last month I would 100% sugar free (that includes extremely low carbohydrate intake) and that’s when I started having loose stool in the last 30 days I haven’t had one solid stool. I’ve also eliminated all dairy, corn, grains of any kind & gluten I eat mostly only grass fed meats and I do the bulletproof coffee and intermittent fasting.

    • Dominic on May 7, 2015 at 3:48 pm

      Are you eating fiberous veggies?

      • Mary on January 5, 2016 at 12:18 am

        Can not eating enough veggies prevent stools from bulking up – causing watery stools?

        • Dominic on January 6, 2016 at 2:53 am

          Mary-

          It could temporarily until your body adjusts to not using them. There’s a whole different section of low-carb, high-fat known as ZC (zero carb) and many people don’t eat any veggies and still have fine stools. It’s trial and error!

          Dom

  8. K on April 3, 2015 at 5:35 pm

    I’m on day 10 of low carb and have been in ketosis since day 3. I’ve had diarrhea since day 4 – worse on some days than others. I’ve taken fiber supplements for the past 2 days and if anything, it’s gotten worse in the past 2 days. I was thinking about adding some beans to my diet to add a bit more carbs and see if that helps. Digestive enzymes seem like my best bet though, maybe? It seems I’m having trouble digesting the fat.

    • Dominic on April 3, 2015 at 10:51 pm

      If you can, wait it out. It’s still early to be adapted but I completely understand your pain. If the digestive enzymes don’t help, consider drinking more electrolytes or adding a probiotic!

  9. ana on April 3, 2015 at 6:45 am

    Thank you for sharing! Made my problems first week understandable and easier to go trough. And thank you for laughs! 🙂

    • Dominic on April 3, 2015 at 10:51 pm

      So glad this helped you 🙂

  10. Lauren on December 1, 2014 at 7:08 pm

    Hi Dominic! I’ve done keto in the past, and I’m thinking of coming back to it (fell off the wagon, gained all the weight back, stomach is torn up again) but the bathroom problems alwasy tripped me up. I had my gallbladder taken out a few years ago, and it makes keto difficult. You mentioned digestive enzymes, and I’ve heard of them before, but I was never quite sure how they worked. Do you take them before eating, or just whenever? Once a day or multiple times? I really feel like digestive enzymes might be the solution to my keto problems, and I would love to heal my stomach! Thanks for making such a great site!

    • Dominic on December 3, 2014 at 12:34 am

      Lauren-

      I find that taking them before any meal that has a decent amount of fat really helps. I usually take them at every meal since my diet is fairly high in fat.

      Dominic

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