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I am constipated…now what?

Keto and your bowels

The ketogenic lifestyle is an excellent way to keep your bowels happy and healthy. So if you had pre-existing bowel issues before starting keto you will notice that they resolve themselves quickly. Your body however usually needs some time to get used to this new way of eating. As a result, you may develop short-term constipation (and in some cases diarrhoea). Fortunately, this is usually temporary and these issues will disappear.

Sometimes people confuse constipation with a lower bowel movement frequency. Keep in mind though that so called ‘regularity’ or daily bowel movements are not necessary with keto: the fact that you eat very healthy foods with sufficient nutrients means that you will also produce less ‘waste’. So don’t let people wave their finger at you and try to convince you that you really should have daily bowel movements.

Possible other causes

In addition to simply having to get used to the lifestyle there may also be other reasons for constipation, or in some cases feeling bloated, having excess gas, changes in stool and reduced or increased bowel movements. These include salt deficiency, dehydration, food intolerances, your hormonal cycle, fluid retention due to exercise, lack of magnesium and/or potassium, a lack of fiber but above all too much fiber.

Certain medications can also cause gastrointestinal problems, so always consult the medical insert of your medications and, if necessary, your doctor. Switching to the keto lifestyle can also cause changes in your intestinal bacteria or candida die-off symptoms. And in terms of food sensitivities: dairy is often a culprit.

It is important to find out if you can pinpoint an actual cause and make dietary adjustments if necessary.

Which remedies can you try?

Extra fats
Just as the sudden increase in fats can cause (temporary) diarrhoea, too little fats can have just the opposite effect. Sometimes people are very reluctant to eat fats at the start of keto and do not reach their daily fat macro. I need to stress the fact that it is very important to eat healthy fats and to reach your fat macro every day. Also make sure there is plenty of variety in fats: besides the various oils, butter and ghee it is also advised to eat fatty animal protein sources, eggs, nuts and, in moderation, dairy.

Do you feel it is still not enough fat? In that case make sure to provide some extra fat, preferably in the morning on an empty stomach, this usually gets things going. Think of coconut oil, butter, MCT oil or olive oil. Flaxseed oil can also help. Stay close to the bathroom though, the effect can happen rather sudden.

Sufficient electrolytes
With the keto lifestyle you lose more fluids due to the decrease in your carbohydrate consumption. And with that fluid you also lose electrolytes: salt, magnesium and potassium. It is important to ensure a good balance at all times. If you don’t, constipation can be the result, in addition to the symptoms mentioned below. It is advised to follow these guidelines:

The recommended daily amounts mentioned below are only averages, however, your needs may vary from day to day and also depend on your bio-chemical individuality and nutrition. It is therefore advised to listen carefully to your body and not rely exclusively on numbers.

  • magnesium deficiency: e.g. headaches, leg cramps, low energy, etc.
    take a good ‘clean’ brand of magnesium in pill form, use magnesium oil spray on your skin or take a footbath with Epsom salt.
    recommended daily amount of magnesium: 300-500 mg
  • potassium deficiency: e.g. heart palpitations, feeling weak, low energy
    for potassium you can use LoSalt (available at all supermarkets), 1 or 2 times a day half a teaspoon is sufficient in case of symptoms.
    recommended daily amount: 3000-4000 mg
  • salt deficiency: e.g. feeling weak, low energy, light feeling in the head, dizzy when getting up quickly
    make sure your meals are salted with Himalayan or Celtic salt, if necessary you can eat some salt ‘as is’ or add it to water.
    recommended daily amount: 3000-5000 mg

A word about magnesium
Magnesium comes in all kinds of forms, as you can see in the image below. To specifically remedy constipation I recommend the oxide form. This is not absorbed by your body but does make your stool softer. It is still necessary to use the easily absorbable forms of magnesium to prevent the keto flu.

Extra vitamin C
A higher dose of vitamin C can have a laxative effect. This approach is safe and does not endanger your state of ketosis. Use a dose of 2000-3000 mg for a few days. It is advisable to do this during the day to prevent sleep issues.

Do not exaggerate your fibre intake
Tell your family doctor or your neighbour that you suffer from constipation and nine times out of ten you will be advised to eat extra fibre. Unfortunately, this is another medical myth: medical advice that has been used for years but has no effect at all and for which there is no medical evidence. In fact, too much fibre causes constipation.

If you make sure you eat enough vegetables and keep to the 25 grams of net carbohydrates you are getting more than enough fiber. It is not necessary to add products such as chia seed, psyllium or linseed to your diet.

Make sure you drink enough water
It is very easy to slip your mind, especially if you’re busy during the day, but drinking water is very important for your bowel movements. Are you always forgetting to drink and do you notice you are getting constipated? Make sure to install a water app on your phone so that you are reminded to drink water at regular intervals. What also helps is to put 2 full litre bottles of water in plain sight, for example at your workplace, and make sure they are empty at the end of the day.

Laxatives, yes or no?
It sounds easy: a pill and there you go, your constipation is gone. But taking pills also has disadvantages. Laxatives such as bisacodyl can make your bowels lazy by overstimulation which leaves you with a whole new issue. I strongly advise against them.

There are also laxatives that cause your stool to soften, such as Metamucil or lactulose. If you use those for an extended period of time your bowels get addicted to them. Stopping then becomes very difficult. They also often contain sweeteners and for that reason alone it is not advised to use them.

In case of longer term constipation, stomach pain or painful bowel movements it is always advised to contact your medical caregiver.

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