Keto comes with many challenges.
It requires you to change your eating habits, raise your level of activity, and adopt a whole new way of looking at the world.
But in the midst of all the excitement of getting into the state of ketosis and the joy that comes from carving off the pounds, your digestion might not be cooperating with your new meal plan.
If you’re eating things on keto that you didn’t eat before, or if you’ve raised your consumption of dairy products, cruciferous vegetables, and nuts, you may be spending more time in the bathroom than you anticipated.
A change in your eating pattern requires the body to adapt to that new eating style, but constipation on keto can bring all of the benefits of ketosis to a screeching halt.
Symptoms of constipation are uncomfortable, annoying, and sometimes frightening. Myths and misinformation can keep you trying a variety of constipation cures that never corrects the problem.
Fiber supplements can be expensive and actually make your condition worse.
In this post, we’re going to take a realistic look at the causes and symptoms of constipation and offer a few remedies to fix the problem, solutions that really work.
What is Constipation?
Before you can create a constipation treatment plan, you need to know if you actually have constipation.
Many people believe they are constipated when they are experiencing bowel irregularity or having fewer movements due to ketosis.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, the criteria for constipation is:
- having less than three bowel movements per week
- stools that are difficult and painful to pass
- feeling like not all the stool has passed
- hard, dry, and/or lumpy stools when they do pass
Sixteen percent of the U.S. population have constipation symptoms. However, bathroom patterns are unique. There is no standard for digestion and elimination.
If you suddenly stopped going to the bathroom every day, once you entered into ketosis, that isn’t constipation.
Without all of those processed carbs coming in, you’re likely to go less just because you’ve cut out the junk you were eating before.
If you’re having three or more bowel movements per week and you are not in pain or struggling to pass them, then you are not constipated, even if you aren’t visiting the bathroom every day.
If you’re having only one or two bowel movements per week, are bloated, and straining to get some relief, then you might be constipated.
Being constipated is a very unpleasant physical experience with specific causes that need to be addressed and remedied as quickly as possible, so you can get back to enjoying your low-carb experience.
Causes of Constipation on Keto
The number one culprit associated with constipation is a lack of fiber in the diet. Tell almost anyone that you’re having trouble going to the bathroom, and they will tell you to eat more fiber.
But scientific research doesn’t back that up.
A lack of fiber in the diet was first presented in 1971 as a potential cause for diseases like colon cancer or diverticulitis.
It was actually the media publicity that fiber has received over the years that elevated its status to being essential for a healthy diet, as well as a cure for constipation.
The moisture content of stools remains at 70% to 75%, regardless of the amount of fiber you eat or the amount of water you drink.
Drinking more water doesn’t soften stools because the content of the small intestines and mid-colon is already a liquid.
It isn’t solid.
All indigestible fiber is suspended in fluid as it makes its way down the intestines until the contents reach the last stage of the colon and rectum. It’s there that part of the liquid portion is absorbed.
By the time that stools begin to form, the practice of adding more fibrous vegetables or fiber supplements to your keto diet would only add more volume to the problem.
Insoluble fiber increases stool weight and decreases colon transit time, but this won’t help an already jammed up elimination system.
Scientific evidence is that a lack of fiber and water doesn’t equate to constipation unless you are showing signs of dehydration.
While dehydration is certainly possible on keto, most people who seek help for constipation are already consuming tons of fiber.
In fact, studies have shown that reducing the amount of fiber in your diet, which makes stools smaller, can actually reverse constipation.
Smaller stools are easier to pass.
When asked to give up fibrous foods for two weeks, including all vegetables, cereals, fruit, wholemeal breads, and brown rice, bowel movements in study participants increased and symptoms of constipation disappeared, including bloating and pain.
When these same study participants added fiber back into their diet, the symptoms of constipation returned. Degree of severity directly related to how much fiber they returned to their diet.
For these individuals, a fiber-free diet was best.
However, a zero carb or fiber-free diet doesn’t work for everyone.
According to the American Journal of Gastroenterology, “Myths and misconceptions about chronic constipation,” some patients do need to increase their fiber intake to get relief.
There isn’t just one cause for constipation on keto, so you’ll have to do a bit of detective work and experiment on yourself to fix the problem, but you can make the job easier by starting with the most common suspects listed below.
If your problem started right after going keto, rather than before, this narrows down the list of potential causes.
But as you can see, there are still several reasons for constipation that are directly related to keto:
- eating too many or not enough vegetables
- eating too much or too little fiber
- gastrointestinal disorders, like IBS or celiac disease
- taking calcium supplements
- magnesium deficiency
- dehydration (not drinking enough water)
- food sensitivities, such as gluten, dairy, or nuts
Keto tends to be high in dairy products and isn’t always gluten-free, especially if you’re experimenting with alternative flours or using low-carb products like tortillas and flatbreads for sandwiches.
Many flour alternatives are high in wheat gluten or wheat starch, due to their low carbohydrate content.
But avoiding gluten isn’t as simple as just eliminating wheat, barley, or rye from your diet.
Most nuts and all dairy products have been processed on shared equipment or packaged in shared facilities, which makes them prone to cross-contamination.
Cross contamination with gluten is the major issue on ketogenic diets that most keto dieters ignore.
For the same reason, contamination with gluten at home is also a major problem.
Since ketogenic diets are dehydrating, you can have electrolyte imbalances if you don’t like drinking water.
Plus, taking supplements will be an issue if calcium intake isn’t properly balanced with magnesium and sodium intake isn’t properly balanced with potassium.
Most supplement imbalances are caused by taking a single nutrient instead of using a supplement designed to give you all of the electrolytes in properly balanced proportions.
Constipation comes with a variety of symptoms, none of which are very pleasant:
- hard, distorted belly
- bloating and inflammation or swelling
- bowel pressure and pain
- feeling like you always need to go, but can’t
- one or two bowel movements per week
- dry, lumpy, hard-to-pass stools
- stools that are painful to pass
- feeling like all of the stool didn’t pass
- anal fissures, tears, bleeding
- blood in stools
- impacted stool
Some of these symptoms can be quite frightening.
Impacted stool is when you absolutely can’t go to the bathroom and need medical intervention for relief.
This is life-threatening, so you’ll need to seek medical help right away if you go more than a week without movement.
Blood in stools is a result of small tears.
This is not internal bleeding or life-threatening, but the tears can get infected, so you don’t want to ignore the problem.
Best to check in with your doctor if you experience blood in your stool.
Hemorrhoids occur from pushing too hard.
Straining to move stool can put extreme pressure on the walls of the blood vessels, causing them to enlarge and bulge.
How to Get Rid of Constipation on Keto Diet
If you don’t like vegetables and are getting most of your carbs another way, you might want to try upping your fiber intake.
However, the average American diet doesn’t really contain much fiber, so when considering whether fiber is a viable solution for you, be honest with how you used to eat before going keto.
If you came from a background of highly refined white flour products, semolina pasta, and white rice, fiber probably isn’t your problem now.
This would only be applicable for those who were eating plenty of whole grain breads, cereals, and brown rice before going keto.
Also take a good look at the possibility of dehydration.
Since going into ketosis caused you to lose a lot of water for the first couple of weeks, you might be in a slightly dehydrated state and need to up your water intake.
Take a realistic look at how much water you drink. If it’s less than one half of your current weight in ounces, then try drinking more and see if it fixes the problem.
Next, consider any supplements that you’re currently taking.
Electrolytes need to be in proper balance with each other.
Just popping a couple of potassium pills or taking a magnesium supplement just before going to bed can throw all of the other electrolytes out of balance.
Magnesium is a mild laxative, so it’s often recommended by keto dieters to solve constipation issues, but overdosing on magnesium for its laxative effect is more like using a bandage, rather than finding a cure.
Some individuals are definitely low in magnesium. In a survey done in 2005, 48% of the U.S. population were consuming less than the recommended amount of magnesium, which was a huge drop from earlier surveys.
But this was attributed to an increase in calcium, rather than an actual magnesium deficiency.
An increase in dairy products (typical on a low-carb diet) and/or calcium supplements will throw your magnesium level out of balance, so you need to check that out.
More likely, however, is that you’re eating something that you weren’t eating before, or you’re eating more of something that you were only eating a small amount of before going keto, such as fiber.
Food sensitivities and difficulties with digestion are actually a major cause of constipation.
When foods are difficult to digest, it slows things down, but sensitivities also create intestinal inflammation, which can interfere with elimination.
The most common food sensitivities associated with constipation are:
- wheat and gluten
- casein protein in dairy products
- cruciferous vegetables, like broccoli, cauliflower, and cabbage
- legumes, including green beans and soy
- nuts and seeds
Most of these foods are very commonly eaten on keto.
In fact, when dieters discover that cheese is very low in carbs, and Greek-style yogurt is now available in low-carb varieties, their consumption of cheese and yogurt (both high in casein protein) go way up.
In addition to the higher intake of dairy, most low-carb products use vital wheat gluten and/or wheat starch, due to their high-protein, low-carb content.
Nut and coconut flours are also popular in low-carb baking. Both are extremely high in fiber.
Black soybeans are high in fiber and often used to replace the pinto and kidney beans in making a keto-friendly chili.
The easiest way to find a food sensitivity is to perform an elimination diet.
You eliminate the potentially offending food for 2 to 4 weeks and then reintroduce the food to see if the old symptoms return.
But doing this one food at a time can be a long, lengthy process and if you have constipation, you need to find some relief right away.
A better solution is to cut back to a bare-bones keto diet and then work your way forward.
For those with severe constipation on keto, you might need to go back to the basics of:
- meat, poultry, fish, and eggs
- healthy fats like coconut oil, olive oil, and butter
- minimal vegetables and salads
While vegetables are generally found in abundance on almost all low-carb diets, for this test, you’ll need to stay away from cruciferous vegetables, so popular with keto dieters, and keep your vegetable intake down to a bare minimum.
Cruciferous vegetables are high in fiber, so they are usually very low in net carbs:
- bok choi
- brussels spouts
- chinese cabbage
- collard greens
In addition, skip the dairy and give your body a week or two to clear itself of any wheat and dairy allergens.
By the end of one to two weeks, you’ll know if you’ve been eating something that is causing your constipation.
Once your digestion returns to normal, slowly add foods back into your keto diet one at a time, so you can see how your body reacts to each one.
This will show you which foods are actually causing your constipation.
What Food to Eat to Not Get Constipated?
If you want to cut down on your chances of getting constipated, you’ll need to stick to the basics throughout most of your weight loss journey.
Limit your intake of ketogenic products to special occasions, and try to avoid processed foods as much as possible.
Any dramatic change in your eating pattern can result in temporary constipation until your body adjusts to the new pattern, so stay aware of how your body is responding to each new low-carb ingredient or recipe you try.
Make meats, poultry, fish, and eggs the center of attention, provided you don’t have an egg sensitivity.
Since meats are fiber-free, and supply lots of healthy fats, they are a good choice for those who have problems with constipation on keto.
Limit your intake of vegetables and try to use fruits like berries and botanical fruits more often in your daily carbohydrate allowance.
While botanical fruits are often considered vegetables, they have seeds and develop from the ovary of a flowering plant, so they are technically classified as fruits. Types of botanical fruits allowed on keto include:
- sweet peppers
- snow peas (pea pods)
In contrast, vegetables come from the other part of the plant, which includes the stem, roots, and leaves.
If you have problems with constipation, you also don’t want to cut back on the fat too much.
While fat calories are how you increase or decrease your rate of fat loss, keto dieters who struggle with constipation should go with a smaller calorie deficit and use plenty of coconut oil, olive oil, and butter in your cooking.
You also might want to include more salads than vegetables, due to the high-fat dressing. Some keto dieters have reported that upping the fats helped to reverse their constipation.
However, keep in mind that raw vegetables used in salads or for dipping can be very difficult to digest and actually make constipation worse.
In addition to food, make sure that you stay well hydrated. Drink half your weight in water and add a slice of lemon or lime to make it more palatable.
Also, watch your intake of coffee, tea, and caffeinated sodas since they have diuretic properties.
Switching to a ketogenic diet can be quite challenging, especially if you have to battle the unpleasantness of constipation on keto.
While the symptoms of constipation can be uncomfortable and sometimes scary, taking the necessary steps to discover which foods are creating the problem and which foods are benign can go a long way toward helping you get your health back on track.
Sticking to basics can make ketogenic dieting more simple and offers a great way to fine-tune your diet to fit your metabolism and digestion.
Just remember to slowly add any additional foods or low-carb ingredients and beverages to your diet, so you can stay on top of any adverse reactions.