Many people who start the Keto diet – experience diarrhea, as well as other symptoms like stomach cramps and nausea. While for some – these symptoms disappear with time (within a few weeks in most cases) – for others, they never do. Take me as an example- after starting Keto (and later on switching to zero carb carnivore) – I had diarrhea after almost every meal. I was miserable. I was ready to eat carbs again – just to avoid the diarrhea that was destroying my life.
I searched the Internet for a solution – and found out many people experience the same problem- keto diarrhea. After more research – I came to the conclusion that there are many different reasons for it. So there is no one solution for all. In this article, I will tell you about the different things you can try to treat keto diarrhea.
Bile Acid Malabsorption (BAM)
On the carnivore diet you eat zero carbs and plants. On the Keto diet – much less plants than on a regular diet. Many people who follow the keto / carnivore diet find that when removing/decreasing plants in their diet – they experience diarrhea. As soon as they add plants back – it solves the problem. If this describes you – you probably have bile acid malabsorption! In my case, my keto diarrhea was caused by this. It took me a very long time to finally understand this.
Bile acid malabsorption (BAM) is a condition that occurs when your intestines can’t absorb bile acids properly (it can also happen as a result of bile acid over-production). These extra bilies in your intestines are toxic to the cells – and so the body tries to get rid of them – via diarrhea. This condition is very undiagnosed, but around 30% of people suffering from IBS – actually have BAM !
Bile Acid Malabsorption Treatment
This problem can be solved by taking bile acid sequestrants like Colestyramine, Colestipol or Colesevelam. These are medications that a Gastroenterologist doctor can prescribe to you. They absorb the extra bile acids, preventing diarrhea. If you do indeed suffer from bile acid malabsorption – these medications will very likely solve the diarrhea. It is important to remember that these bile acid sequestrants only treat the symptoms, and don’t solve the root cause of the issue.
Some vegetables act like “natural acid bile binders“, and eating them you can easily stay under 15-20g of carbs a day (staying in ketosis). Broccoli for example – is effective for binding acid biles. And it is easy to prepare – just microwave the broccoli (you can buy it frozen- cheaper and easier) for 7-10 minutes.
Another effective solution many people who suffer from BAM use – is psyllium husk. Psyllium is fiber made from the husks of the Plantago ovata plant’s seeds. It binds to the bile acid fairly effectively. Some people who suffer from bile acid malabsorption take a few grams of it with every meal.
From my research – Bile acid malabsorption (which as I mentioned – can cause keto diarrhea) can also be caused by vitamin deficiency. This paper – Regulation of Bile Acid Synthesis by Fat-soluble Vitamins A and D show how Vitamin A (mainly) and Vitamin D regulate bile acid synthesis. That’s why I now consume small amounts of beef liver (rich in Vitamin A as well as many other micro nutrients) with each meal.
Avoiding Drinking Before & After Meals
Many people, including me – have an urge to drink after eating. And in most cases – it’s not just a “sip”. Without noticing, you may drink 1-2 cups of water after eating. For many people – this is a contributing reason to the keto diarrhea they experience. I advise avoiding drinking water (or any liquids) 1 hour before and after eating. It really makes a difference. Me personally, after eating – I really want to drink water. Especially if the meal contained lots of salt (which I really like – especially naturally smoked salts). But with time – this urge becomes more controllable.
This is also a good solution for keto constipation – which some people experience on the keto diet. Drinking 2 cups of water with a fatty meal – can “loose” things up.
Using Lipase Enzyme Supplements
For a very long time – I was sure that “fat digestion enzymes” are just a waste of money. Some people even claim that taking enzyme supplements is useless, because the body can’t use them, and they are broken down into simple proteins. This is not true.
Most enzyme supplements contain different enzymes. Most of them (for example Amylase that breaks down carbs) are useless for us, keto eaters. What you are looking for is the Lipase enzyme. Lipase works on triglyceride molecules, removing the long-chain fatty acids that are attached to the molecule’s carbon backbone. Plant-based lipase enzyme supplements are not deactivated by the stomach (unlike not coated Pancreatin supplements) – so they are effective.
When looking for an enzyme supplement – read the label and make sure it contains Lipase. At least 1000FIP (one unit of enzyme activity is defined as that). This is the main helping enzyme for keto and diarrhea. There are several different kinds of Lipases. They differ as to which fatty acid chain is removed from the triglyceride molecule. I tried 2 different supplements: Lipazyme by Houston Enzymes and Lypo Gold by Enzimedica. Both work well. Lipazyme contains all 3 types of Lipase – which is very effective and might work better for preventing keto diarrhea.
Using Ox Bile
Some people who suffer from diarrhea on the keto (and carnivore) diet – find that supplementing with ox bile supplements solves their problem. This is especially common with people who had their gallbladder removed. If your body doesn’t produce enough bile acid – some of the fat you eat isn’t digested – causing a diarrhea.
There are plenty of ox bile supplements to choose from. One of them is the NutriCology Ox Bile. The most powerful ones usually contain 500mg of bile per capsule. For some – it may be too much (in that case – try 125mg capsules).
Keep in mind that as I mentioned, for many the cause of the problem is not lack of bile acid – but the opposite – producing too much bile acid / not absorbing it back normally. It’s called bile acid malabsorption. For those people – ox bile with only worsen the diarrhea. So you really have to understand the cause of your issue : is it too much bile, or not enough of it. The solutions for each case are very different.
Avoiding High Histamine Foods
Most people can tolerate foods that are high in histamines (for example : aged beef and aged cheese). But some (approximately 1% of the population) – have histamine intolerance. In their case – histamine is not broken down correctly in the body – and builds up as a result. That triggers an immune system response : shortness of breath, headaches, and diarrhea.
If you think you are sensitive to histamine – try to eat fresh as possible meats – for example – chicken and turkey. Regarding beef – try to find a local butcher that can supply you with fresh beef. Preferably-buy in bulk and freeze.
From my research – I came to the conclusion that histamine intolerance can also be a result of vitamin and mineral deficiency. Many people report that supplementing with magnesium helps their histamine problems. Online, you can find many magnesium supplements. In my opinion – the best form of magnsium is Magnesium Glycinate. It is easy on your stomach, and is well absorbed. I personally supplement with 400mg of elemental magnesium daily.
Eating Smaller Meals
If you’ve just started the Keto diet – your body is probably not used to digesting so much fat. Forget about “Keto Fat Bombs,” or stuffing yourself with extra fat and butter. Take it easy. There is nothing wrong with eating cuts of meat containing 10-20% fat. Don’t make the mistake of eating only very fatty beef ribs (or other cuts very high in fat) – especially when just starting out. Your body can’t digest unlimited amounts of fat at once. If you are overweight – you also want your body to “digest” and break down your own stored fats. So there is no need to eat huge amounts of meat and fat.
As the months go by, you will find that you can eat more at once – and digest it perfectly. Give your body the time to adjust.
Adjusting Salt
Too much or too little salt can also cause digestion problems – including nausea and diarrhea. Do you consume too little salt daily? Or are you overdosing salt with your meals? Try adjusting the salt amounts and see if that helps.
I hope this article will help you with the issue that many of us, keto eaters, experience. Feel free to share your ideas and other solutions in the comment section below. Make sure to check out other interesting keto related articles on our website. We also have many keto recipes you will enjoy!
Ox bile helped me very much. Enzymes didn’t.