What Causes Diarrhea on Keto Diet?

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hi I'm dr. Boz and I'm back again with a

second in four-part series on what can

possibly go wrong when you take on a

ketogenic diet this second part is all

about poo so if that grosses you out you

can skip to the next message but if you

have struggled with a ketogenic diet

I will bet that one of the symptoms

you've had has to do with your bowels

and this post is gonna respond to some

of those questions that I get from

patients all the time let's start with

what happens when your bowels slow down

that is constipation in the first post

about what can go wrong with a ketogenic

diet you talked about the keto flu and

getting very dehydrated that is another

factor that causes dehydration in the

bowels which is constipation the lack of

all that water in a short period of time

slows down what your bowels can do one

of the antidotes for the keto flu was

salt salted water and salt on your foods

this salt in a constipated state also

helps those bowels to loosen up and move

along when I look at some of the other

reasons patients on a ketogenic diet

transition and do really well they pee

that first ketone they're feeling ok

until about day four at the point where

they miss pooping I think I must do a

pretty good job of selling what the high

fat meats are and how tasty they are cuz

my patients seem to do that hook line &

sinker nobody misses but what they don't

do such a great job of is adapting to

some of those vegetables that do fit

into a ketogenic diet in fact I've had

some patients say do people really eat

that so I give you some suggestions

about what can happen in a ketogenic

diet on that first week when it comes to

bowels moving too slow so first we want

you using salted water that salt is

really important to stay hydrated number

two though is find some cabbage cabbage

is one of those vegetables that my

patients didn't eat much of before a

ketogenic diet and I encourage them by a

head of cabbage and put it in the fridge

you can't believe the ways you can use

that in a ketogenic diet

stay in ketosis and it helps with

constipation next I move on to something

called chia seeds

that's ch IA chia seeds these little

seeds are kind of like tapioca you

swallow them down and they expand

four or five times their size this keeps

the moisture in your guts from one end

to the other and really does a great job

at helping of constipation in patients

who've had a really significant trouble

I give them a formula of two tablespoons

of chia seeds every two to four hours

with a big glass of water this doesn't

take them out of ketosis boy it really

does help with that volume replacement

in your bowels to give them a nice

healthy bowel movement some of my

patients have said you know doc I got to

the 6th tablespoon and I was tired of

taking them so I quit but the next day

success moving on if you've had

constipation and you've tried the chia

seeds you've got some cabbage you've

eaten and you've got your foods being

salted and you're still struggling this

will pass but in the meantime reach for

milk of magnesia this is a

over-the-counter supplement of magnesium

that has marketed itself on the antidote

for constipation one of the salts that

you lose the most of the first few weeks

of ketosis is magnesium replacing

magnesium with milk of magnesia will not

only help your constipation it will

boost your magnesium levels within your

body I think it tastes terrible and of

course it causes diarrhea so patients

don't usually take it long-term their

bowel gets into a healthy rhythm and

they don't need it any longer but it

sure is a good trick to replacing

magnesium especially if you're

constipated let's move on to the loose

stools in fact when people tell me they

have constipation with a ketogenic diet

I almost consider it normal this should

happen but when patients come in and on

that third or fourth day they call the

clinic saying I can't handle this I have

such bad diarrhea this diet must not be

for me that one sends up a little

warning flag in my mind

explosive diarrhea after you start a

high-fat diet

tells your doctor and should tell you

that there's something

or going on most often the people with

this side effect of diarrhea within a

week of going Quito have a hidden

problem in their bowel they may have

complained of things like irritable

bowel or a tummy ache that happens after

they eat high fat or simply they just

have a sensitive stomach whatever term

they use to describe it it's usually a

hidden symptom that has far worse

consequences than it than they

understand you add back a high-fat diet

to these patients and bam they suffer

with consequences of explosive diarrhea

to the point they call angry back to our

office the most important message I have

for these patients is to wait don't quit

your body has a deep inflammatory

problem that we don't understand hidden

deep inside your bowels usually I'll

send those patients off for some blood

tests and the one I'm most curious to

look at is a vitamin D vitamin D is one

of the essential nutrients that your

body needs and although you can get it

from sunlight if you have a problem

absorbing fat your vitamin D will be in

the single digits it should be 40 or 50

but a vitamin D in the low 20s or in the

teens or heaven for sakes in the single

digits tells me you are not absorbing

fats correctly this stays hidden because

patients avoid fats they'll tell their

doctor you know what I just can't eat

those fatty foods every time I do it I

get explosive diarrhea the United States

government has spent a lot of money

trying to investigate this it's quite a

tricky puzzle to solve it's hidden deep

in the bowels of our our bodies in a

place that we can't just quickly look at

and make a diagnosis there's a really

interesting study that was out of the

70s of a small population of people who

had irritable bowel syndrome they had

bowels that didn't work right and it

seemed to be chronic with a host of

symptoms that are kind of vague but

seemed to match up pretty closely in all

these patients the patients were put on

a high-fat diet and it took six months

for this side effect of diarrhea to go

away what was happening deep inside

their bowels was this

system to absorb those fats was finally

turning on it had been sleepy and

dormant for a very long time

hidden in the grime of inflammation

associated with inflammatory bowel they

had depression they had high anxiety and

they had this strange tummy pain

those were the irritable bowel patients

the longer they were on the high-fat

diet the less of those symptoms were

present when I look at patients who call

with this explosive diarrhea my staff

and I know those are the patients that

need this anti-inflammatory diet the

most we encourage them to hold on

we'll help you there are some ways to

get through this but if there's any

profile of patients that needs a

high-fat diet an anti-inflammatory diet

more than the than the average it's my

patients with irritable bowel syndrome

or something called small bowel

overgrowth let me explain that small

bowel overgrowth reflects that you have

an overgrowth of bacteria in your small

intestines the first section of your

bowels is supposed to be sterile as in

no bacteria that's kind of weird because

your your large intestine is got the

most bacteria of our whole system and

when your intestines are working

correctly those two parts say stay

separate but when your bowels get

depressed or you have anxiety or you

have malnourished or high stress

environments the bowels start to do a

little jig

there they don't move the food along as

well as they're supposed to and these

little bacteria creep from the large

intestine back upstream into the small

intestine man is that the perfect home

for them there's no competition they are

the only bacteria around and they over

grow dramatically this causes an injury

to that small intestine that injury

means they're not absorbing the foods

they should and that inflammation is in

part what happens to irritable bowel

patients as well as those who have small

bowel overgrowth these are the kind of

patients that show up saying doc I can't

have your keto diet I have explosive

stools again those patients are the ones

I slowed down the most for and really

pour into the education that this

diet is super important for their

situation so what do they do in the


don't worry there are some tricks the

first antidote is low modal the modal is

an over-the-counter anti diarrhea

medication that isn't meant to be used

long term but boy it really helps with

these patients it will slow down the

bowels enough that they can continue

their life as their bowels start to heal

taking time off of work because you tell

your boss that I'm on this new diet and

I can't be away from the toilet patients

say no way that's too embarrassing I'm

not gonna tell my boss that instead they

use little tricks like taking low modal

after every loose stool and indeed it

will slow down the rate of their bowel


next I tell them to take kombucha tea

kombucha tea is a fermented tea filled

with live bacteria this bubbly drink is

an amazing way to replenish some of the

bacteria that like to live in your

bowels this process is not often

tolerated very well by my patients with

irritable bowel it's really important

that those patients with irritable bowel

or bacterial overgrowth when they add

kombucha tea

I want them taking 1/4 of a cup a day

that's not very much

so not the big cannister simply 1/4 of a

cup a day in fact they're usually the

patients that say doc I can't take that

it makes me feel awful be aware there

are lots of things changing when it

comes to the bowels and bacterial

overgrowth and a small baauer bowel

injury that replenishment of bacteria

can be a wonderful cheap easy effective

treatment for improving that symptom

finally I get to one that is a little

difficult for patients to hear but if

you have an injury on your small

intestine from not being able to absorb

fats and we're trying to wake up those

cells to absorb the fats to decrease the

inflammation sometimes the best answer

is to give that bowel a rest yes give

that ball a rest which means stop eating

intermittent fasting can be one of the

best antidotes for my patients that

suffer from small bowel troubles when I

introduced this idea and they've

never been on a ketogenic diet they

think it's the most bizarre awful

assignment they've ever heard of the

fear of not eating becomes their new

focus and their new reason for anxiety

but I encourage them a bowel that is

injured in that small intestine area if

we can't get that to start absorbing

fats again

giving it a time of rest is a powerful

treatment plan I'll leave you with this

quote which is from Hippocrates the

Greek philosopher who was known as the

father of medicine and he says this

about intermittent fasting everyone has

a doctor in them we just have to help

him in his work the natural healing

force within each of us is the greatest

force in getting well to eat when you

are sick is to feed your sickness I'm

signing off today thanks for tuning in

I've got two more parts about what can

go wrong with a ketogenic diet if you'd

like to learn more about this you can

check out my book any way you can on

Amazon or audible until next time I'm

dr. Boz