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Keto Diet Constipation Is a Legit Issue—Here's How to Deal

keto-diet-constipation-digestion-issues.jpgPhoto: Wove Love / Shutterstock

Unless you've been living under a rock the last six months, you're well aware that the ketogenic diet is all the rage right now. While people are game to talk about the benefits of the trendy eating plan, its risks, and whether it's a smart option for vegans, there's one topic that still feels taboo: poo.

Before I tried the keto diet myself, I read everything I could about different keto food options, how to work out on keto, even common mistakes people make. I thought I was going into my month-long journey of ketosis with eyes wide open. But after the first few days—and while battling a mild case of the keto flu—I realized something pretty major: I had yet to experience a bowel movement.

As someone who's pretty, uh, regular in that department, I was concerned. I mean, nobody wants to experience any serious GI discomfort. So, like any millennial would, I did a quick Google search to see if keto constipation is a thing. Turns out it totally is.

If this über-trendy diet is supposed to be so good for you, then why does it back you up? Is there any way to avoid it, or are all keto-goers doomed to be constipated?

The Main Cause of Keto Constipation

Because the ketogenic diet requires a big shift in macronutrient intake, it causes problems if you're not eating in a balanced way, says Zandra Palma, M.D., a functional medicine expert at Parsley Health.

While there isn't just one element of keto that leads to people feeling backed up, for many, the lack of carbohydrates—including grains, fruits, and, yes, bread—could mean you're eliminating your main dietary sources of fiber, says Dr. Palma. And fiber, as a broad category, includes prebiotic fiber, which is the food for our microbiome.

"Reducing prebiotic fiber can alter the composition and diversity of species of bacteria that live in our large intestine," explains Dr. Palma. "[These bacteria] support our metabolic, immune, and cognitive health—and also help keep things moving." (Fiber is super important for your health for all these other reasons too.)

Many people also shy away from plant-based foods while on the keto diet, either because the veggie's carb count is too high, or because they're turning to animal protein to help hit the high daily requirements of protein and fat. But veggies tend to be high sources of fiber, so quickly stripping those from your diet can lead to keto constipation, says Dr. Palma.

That's why "the most medicinal way to approach a ketogenic diet is by embracing colorful, fibrous-rich vegetables and greens as the base for each meal," says Dr. Palma. Try cruciferous vegetables (such as broccoli, cauliflower, and Brussels sprouts) and leafy greens, which are all very low-carb and high in fiber. "A doctor-recommended prebiotic supplement or insoluble fiber (such as psyllium husk) can be added if it's difficult to reach your fiber goals while maintaining ketosis," she says.

Plus, whether you're on the keto diet or not, it's likely that you're not hitting those daily fiber goals. The average American consumes just 16 grams of fiber a day, but the goal for optimal digestive support is closer to 40 grams a day, adds Dr. Palma. (Here's what you need to know about getting enough—and even too much—fiber.)

Another reason to get more fiber: Animal studies suggest that the nutrient can help mitigate the potentially harmful effects of a high-fat diet like keto. In a study from the Journal of Microbiology and Biotechnology, researchers found that when mice were given insoluble dietary fiber from pears, it improved the structure of their gut microbiota and protected against the effects of a high-fat diet that could otherwise be harmful.

Why You Should Hold Off On Dairy

When people talk about the upsides of a keto diet, one of the main points is that foods that are typically banned on restrictive diets—such as butter, cheese, even yogurt—all get the green light thanks to their high amounts of fat. But "these foods are high in lactose, which is a naturally occurring sugar that is hard for most people to digest," says Dr. Palma.

According to the National Institutes of Health, it's estimated that up to 75 percent of the population is unable to digest dairy properly, partly because of lactose. Dr. Palma says this mucks up your intestinal health and, in turn, contributes to inflammation—which can cause all sorts of health problems if the inflammation becomes chronic.

That doesn't mean you have to shift these foods to the no-go list, though. Dr. Palma says it's okay to enjoy dairy in moderation, but it doesn't need to be a part of every meal and should be limited to one serving to help keep digestion in check.

How to Fix Keto Constipation

All of this is good to know if you're trying to avoid keto constipation, but what if you're already suffering? Dr. Palma suggests trying the following tactics to get your digestive system back to normal.

Add more fiber. This one's a given. Other than eating more fibrous foods, Dr. Palma suggests sprinkling ground flaxseed into your meals or adding chia seeds or acacia fiber to a morning smoothie to help increase your daily count.

Drink lemon water + apple cider vinegar. When you first wake up, make a cup of hot lemon water mixed with 1 teaspoon of apple cider vinegar. Dr. Palma says it'll help boost digestive function and help with hydration. Remember: You want to stay hydrated on keto; otherwise, you could experience a decrease in digestive and brain function along with lower energy levels.

Stretch first thing. "Taking time to stretch and connect with your body before a busy day helps activate your parasympathetic nervous system, which is where digestion thrives," says Dr. Palma. (Try this yoga routine you can do without getting out of bed.)

Embrace mindful eating. That means taking two deep, conscious breaths before each meal, sitting down without distractions, and chewing well. "The secretion of enzymes to break down protein, fat, and carbohydrates occurs when we begin to think of and smell food," says Dr. Palma. "In order to optimize digestion, we must slow down to chew our food properly." She suggests setting small goals that help you eat more mindfully, like putting your fork down at least five times before your meal is done. (Here's a full guide to how to eat mindfully.)

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