5 Ways to Prevent and Treat Keto Diet Related Constipation

Prevent and Treat Keto Diet Related Constipation

Anytime we are exposed to either a new environment (i.e. during travel) or when starting a new diet, it is not uncommon for your gut to go through some changes of its own. One of the more frequently reported side effects of embarking on a ketogenic diet is constipation. However, if you were to ask three different people how they would define constipation, you would likely get three very different answers. The Cleveland Clinic defines constipation as small, hard, difficult, or infrequent stools1. In the general population, the term ‘infrequent’ can range from an ‘every other day’ (vs multiple times a day) bowel movement (BM), to one occurring ‘weekly’ or even bi-weekly’. In other words, everyone’s body has its own ‘personal pooping pattern’, and constipation is a fairly subjective condition.

A very important thing to remember for anyone new to a ketogenic diet is the fact that a change in BM’s should automatically be considered a natural reaction to a change in one’s eating habits. For many, embarking on a Keto eating style can result in a drastic change in their daily intake, resulting in both extremes of the BM spectrum. In the case of constipation, it is likely a typical adaptive response for a gut accustomed to a high carbohydrate, lower protein, highly processed (low fiber) diet. Suddenly switching to eating high fat, and even eating a moderate protein intake, can trigger bowel irregularity. If the regularity of your bowel movements has changed, but you’re not actually experiencing pain, bloating, or discomfort, this might be completely normal and you might not need to do anything for the time being. In essence, it can actually be ‘normal’ for your ‘BM’s to be ‘abnormal’ and stressing out about the whole thing doesn’t help the situation.

If constipation is one of the biggest challenges facing new Keto dieters, especially in the beginning stages, then perhaps the best advice would be prevention. If you arm yourself with the right information, you can be sure you are ‘moving in the right direction’ and minimize any potential for this common problem actually occurring.

The following are 5 measures you can take to prevent, or minimize, the likelihood of constipation on a ketogenic diet:

1. Drink more water. Although it might come as no surprise to some, the ketogenic diet has a diuretic effect (promoting increased urination) so you need to make sure you’re drinking enough fluids to keep you hydrated. Constipation is also related to dehydration in the colon (large intestine), making adequate hydration even more critical in order to avoid water being withdrawn from the colon. Your individual water needs depend on many factors, including your health, how active you are and where you live. So how much fluid does the average, healthy adult living in a temperate climate need? The National Academies of Sciences, Engineering, and Medicine determined that an adequate daily fluid intake is about 15.5 cups (3.7 liters) of fluids a day for men and about 11.5 cups (2.7 liters) of fluids a day for women2.

2. Eat more fiber. There are two types of fiber, soluble and insoluble. Both are important for maintaining normal bowel movements. Soluble fiber keeps stool soft because it absorbs water and insoluble fiber adds bulk to the stool. Adding fiber to your diet should be done very gradually. Too much fiber all at once may cause cramping, bloating, and constipation—the very same issues you were hoping to avoid. In addition, when adding fiber to your diet, be sure to increase fluids (at least 64 ounces per day) to prevent constipation. The Institute of Medicine recommends a daily fiber intake of 25 grams for women and 38 grams for men3. In order to reach this fiber goal while following a healthy ketogenic diet, one should aim for 4-6 cups of low-carb density vegetables a day. Some examples of nutrient-packed ‘Keto-friendly’ vegetables are: Arugula, asparagus, avocado (technically a fruit), broccoli, cabbage, cauliflower, celery, cucumber, kale, lettuce, mushrooms, spinach, summer squash, and tomatoes. In addition, take advantage of the numerous high-fiber ‘super foods’ such as psyllium husk powder, ground flaxseed, chia and acacia gum. Each of these plant fibers can be easily incorporated in a wide variety of recipes.

3. Get Moving! If you are not physically active (and have no precluding health conditions), starting to participate in some form of exercise can also be very helpful. Physical activity can help to address both constipation and some underlying causes that are known to lead to the development of constipation.

4. Drink Hot Coffee or Tea—or any hot beverage. While too much caffeine can be bad for you, there are many benefits that a limited daily intake of caffeine can bring. Caffeine is an all-natural stimulant that helps to activate muscles of the gastrointestinal tract, enabling the stool to move more easily through the tract, thereby helping to prevent or relieve constipation. If you prefer to abstain from caffeine, drinking non-caffeinated hot beverages can also help by widening blood vessels in the digestive system and helping to increase both blood flow and activity in the gut.

Fearless Tip: If you are a Starbucks lover, here are 5 Keto-approved drink orders!

5. Boost Your Magnesium Intake. Magnesium is highly effective as a mild laxative while also offering short-term relief from acid indigestion by helping to neutralize stomach acid. In addition, it can help reduce muscle cramps, difficulty sleeping and irritability, and can have a calming effect on the nervous system. Because constipation can be aggravated by stress—this includes the biological stress associated with adapting to the Keto Diet—magnesium can be a very helpful tool in easing that process. Keto-friendly foods that are rich in magnesium include nuts, seeds, some fatty fish (like mackerel and sardines), avocado and leafy greens. If you have any doubts about the adequacy of your magnesium intake, it might be worth looking into taking a supplement.

Fearless Tip: Magnesium is an amazing supplement to take while on Keto. Not only can it treat constipation, it can also help prevent and treat Hair Loss, Fatigue, and Keto Flu symptoms.

If you’re hoping to prevent constipation on your Keto Diet journey, or if you’re already experiencing discomfort from constipation, such as bloating, gas, pain, and hard stool, you can try the above suggestions and see if your symptoms improve. Take one or two of these steps at a time, as you should definitely allow your body time to adapt to your new eating style! Problems like constipation, although challenging, tend to resolve in time.

  1. https://my.clevelandclinic.org/health/articles/4090-detecting-and-treating-diseases-of-the-colon-and-rectum
  2. http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=10925
  3. https://www.cnpp.usda.gov/sites/default/files/nutrition_insights_uploads/Insight36.pdf
Mary Paley

Fearless Dietitian; 30+ years as a professional dietitian; Master’s Degree in Nutrition and Dietetics at the MGH Institute of Health Professions; Lead research dietitian for several major pharmaceutical companies; Currently focused on health and wellness and the benefits of ketogenic diets for both obesity and diabetes management. MS, RDN, CDE, LD/N

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