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.
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.