Constipation and Ketogenic Diets

constipated pufferfish licensed

Some people experience constipation on low-carbohydrate and ketogenic diets and worry that it is due to a lack of fiber. If you are one of them, take heart! Fiber is not the answer!  What is? Read on…

 

 

 

 

The authors of Keto Clarity, Jimmy Moore and Dr. Eric Westman, acknowledge that some people develop constipation on ketogenic diets, and offer some recommendations about how to address the problem, including drinking enough water, increasing non-starchy, fibrous vegetable intake, and using sugar-free candy containing sugar alcohols as a mild laxative.  I do agree that these approaches may certainly be helpful for some.  However, if you have tried these ideas and they haven’t worked for you, or if you have trouble with constipation no matter what kind of diet you eat, I would like to offer some insights that I hope you will find useful. Most people believe that constipation is caused by a lack of fiber in the diet, but this is actually not so.  My opinion, based on clinical and personal experience, common sense, and lots of reading of the scientific literature, is this:

Constipation is usually caused by something you ARE eating,

not by something you’re NOT eating

Lack of fiber does not cause constipation.  In fact, fiber can actually CAUSE constipation!  Take a look at this 2012 study that proves it:

Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms.                    Ho KS et al.  World J Gastroenterol 2012;18(33): 4593-4596.

“This study has confirmed that the previous strongly-held belief that the application of dietary fiber to help constipation is but a myth. Our study shows a very strong correlation between improving constipation and its associated symptoms after stopping dietary fiber intake.”

Plenty of people and animals have eaten mostly-meat/all-meat diets and do not suffer from constipation, and plenty of people eat high-fiber diets and even vegan diets and suffer from constipation.

If you are lucky enough not to have constipation on a regular diet and then develop constipation on a ketogenic diet, it is almost certainly not because you are eating more meat and less fiber.  Ask any gastroenterologist or physiologist and they will tell you this:  Meat and fat are easily and completely digestible!!  Fiber, on the other hand, is partially or wholly INdigestible by definition (for more information about the nature of fiber see my article entitled Pulp Fiction).  Unless you have certain uncommon digestive diseases such as pancreatic insufficiency or have had certain surgical procedures that interfere with normal digestion, such as gastric bypass surgery, you simply will not find undigested meat or fat exiting your body, whereas everyone is guaranteed to find plenty of undigested vegetable matter, right?

If you experience constipation on a ketogenic diet, it is not because you are eating less fiber; it is most likely because you have started eating something that you were not eating before (or a larger amount of something you didn’t eat much of before) that is hard for you to digest.  In order to eat a ketogenic diet, which is a high-fat, limited protein, ultra-low-carb diet, most people find themselves turning to high amounts of foods that are notoriously difficult to digest, including nuts, low-starch vegetables such as crucifers, and full-fat dairy products [to read about dairy foods and constipation, click here].These foods just so happen to be 3 of the top 5 causes of chronic constipation, regardless of what kind of diet you choose to eat.

One more consideration—sometimes food sensitivities can cause constipation in certain individuals, so if you have eliminated the 5 most common constipation culprits and still have difficulty, consider that you may be uniquely sensitive to something that most people have no trouble digesting.  Examples that come to mind are eggs and beef.  Eggs are among the top 9 common food sensitivity culprits, and beef can cause trouble for some people who don’t do well with dairy products because of a cross-reactivity related to cow proteins.  These are unusual experiences, but worth mentioning.

Many plant foods—especially stems, seeds, nuts, grains, and legumes—are challenging to digest (which is why herbivores—animals who eat an all-plant diet—have special digestive strategies such as chewing all day long and carrying around extra stomachs). Fruit, however, is easy to digest—so easy, in fact, that eating too much of it can cause the opposite of constipation! [To learn about the fascinating reasons why fruits digest so rapidly and how sugar alcohols can be used as laxatives, click HERE.]  Ketogenic diets tend to contain little if any fruit, because most fruit is too high in carbohydrate. However, there are some low-carbohydrate fruits that we think of as vegetables—foods like cucumbers, tomatoes, squashes, avocado, okra, and olives—that you can enjoy on your low-carbohydrate diet (so long as you count their carbohydrate content and don’t overdo it) that will aid speedy digestion.  Just remember: any “vegetable” that contains seeds is actually a fruit in disguise and should be easy to digest if ripe.

So if you experience constipation on your ketogenic diet, don’t blame the meat, fat, or lack of fiber. Take a look at what you’re eating and see if you can identify your culprit.  With a little tweaking, you should be happily on your way!

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Please note that after 30 days, Dr. Ede may not personally respond to comments, however comments shall remain open to encourage community discussion.
  • Alex

    This was a fantastic article. Thanks for writing it. It’s a common complaint with keto diets, but lack of fiber is not to blame.

  • Divadeb

    Wow! Thank you for this! When I first started low carb I tried adding fiber with really uncomfortable results! I have fixed my problem by adding magnesium citrate tablets and it has fixed the constipation problem and helps me sleep!
    I knew I wasn’t crazy!

  • Andrew Findlay

    I won’t to Keto anymore. My body (as with most) needs resistant starch to give home to microbiome and ensure a healthy digestive colony. Keto doesn’t do this (for me). The byproduct of this bacteria is butyrate which heals the colon which, although can be achieved by consuming butter, you won’t get on this diet.

    • Wout Mertens

      Andrew, actually if you eat resistant starches they don’t impact your blood sugar levels and they should get transformed to butyrates, so they should be compatible with ketogenic dieting.
      That said, I don’t really like the feeling I get when I’m in ketosis so I eat my starches instead 🙂

  • silver

    Hi there Dr Ede , I would like to share my experience and if u will get your feedback.. , I have a chronic disease called spondylithe ankylosant and chron disease , I take a biological medicine for that called remicade , so I think this disease is related to the gut . From 4 years till now I developed depression , I was first medicated with anafranil , then valdoxan , then mutabom m ( if I recall its called evalil there in us – a tryciclic antidepressant that as Amitriptyline 10mg + perphenazine 2mg) anyway in about 5 months ago I was only having half of the pill of mutabon m, I was felling nice as I was making lots of sports and having CBT sessions since the beginning . All after all ,in a few (2) months ago I was just taking 1/4 of the mutabon m pill felling nice and getting stronger at the gym. I started looking at the ketogenic diet as a mean to feel even better and to improve my gut which could cure my rheumatic disease as there is literature for that regarding the link of inflammation of the gut linked to starch and carbs . So over I month ago I started the diet , I started to become HIGHLY energetic but very irritable and couldn’t sleep for days , I thought I was beginning to go nuts as I had so much energy but at the same time rage and insomnia . I went to my psychiatry doctor and told him all about my anxiety and what that I couldn’t sleep . so I am now on zyprexa (olanzapine( 5mg) and 0.5mg of klonopin , all at night and besides all that I cant have a natural nice sleep , though now I sleep. I talked him about the diet but he doesn’t have knowledge of it , so I was wondering if you could give me some advise.. I am now eating some carbs and not having cetones in my urine(when I started I had them) . Do u think I could get back to the diet with no problem regardless of my medication now prescribed that I am on now? – zyprexa – since 2 weeks now and I am hoping to not having to take it for too long . please give me your advice , thank you (sorry for my bad English but I am Portuguese.. 🙂

  • Deborah Gordon, M.D.

    Nice post!

    Two other common conditions that lead to constipation are gut dysbiosis and undiagnosed hypothyroidism. Of course, the gut dysbiosis is common in folks who’ve eaten the standard American diet, and can be difficult to sort out. Hypothyroidism can be subclinical: your numbers look good, but a little thyroid hormone fixes the problem and your numbers look the same or perhaps better!

  • Marijke

    Constipation can be caused by lack of gut flora. In that case adding fermented foods or probiotics to your diet will help.

    • Anne

      You also need the correct prebiotic.. I.e. fibre… There are two types of fibre one that is just bulk and the other is what the good bacteria in your gut feed off of! When all is in balance there is no more constipation…..

      • Shend

        Didn’t work for me

  • Mel

    Hi Dr Ede
    I wonder if you can comment on coconut!! Since its touted as the worlds most miraculous food!! Just wondered about the predominant kind of fibre, whether many people report being intolerant to it etc? Is it as great as its made out to be? I find the oil makes me feel nauseous and too much coconut and I can’t sleep. Also just wondering if green fibrous vegies irritate your gut and cause constipation in some people, is spirulina likely to have the same result? Thanks Mel.

  • Philip Clax

    Interesting! On a keto diet I seem to do best with vegetables like zucchini (contains seeds…so it’s a fruit in disguise?) and usually do ok with cucumber too.

    What about the seeds/pseudo-grains such as chia and flax? Are these no good on keto?

  • Vance

    If you’re having problems with constipation on a ketogenic diet, try increasing your fat intake. Some extra butter and 2-3 tablespoons of olive oil should make a difference.

  • susan henderson

    Wish I could figure it out.There seems to be no answer to date for me and I have been constipated since birth. For years I have know that high fiber foods and milk guarantee constipation. This article might get me somewhere with a bit of food hacking. I can’t takeany form of magnesium for some odd reason and have tried only to find myself weak legs with no energy the next day. I have specific health issues and really need to get to the bottom of how my diet is playing a roll. I know Keto is best for my chronic depression and don’t tend to come out of it for fear of wanting to attempt suicide.all over again.

  • Jace, RD

    this does not make sense and is not backed up by any scientific evidence. If you are all following this diet – i think constipation is the least of your worries. You should all be aware that heart disease may be in your future as you are eliminating very important antioxidants and phytochemicals and adding a significant amount of unnecessary saturated fat that can have a significant effect on your risk for heart disease. Have you all noticed that your moods have changed and you are all more irritable?? Well your brain needs carbohydrates to function properly. Its like putting diesel in a toyota corolla – its not going to function and will in fact stop working properly. If you are eating a healthy diet with whole grains and fruits and vegetables as well a healthy intake of unsaturated fats then you are on the right track. Stop making food so complicated!!!

    • Mike

      Yeah just look at all that heart disease among the Greenland Eskimos. It’s backed up by plenty, try a Google search.

    • Knowledge Spreader

      Nothing you stated is true. Keto diets have been used to treat patients clinically over 80 years and research shows that keto diets decrease the risk for heart disease, protect against cell death, treat epilepsy and there is evidence from uncontrolled clinical trials and studies in animal models that the ketogenic diet can provide symptomatic and disease-modifying activity in a broad range of neurodegenerative disorders including Alzheimer’s disease and Parkinson’s disease, and may also be protective in traumatic brain injury and stroke among other ailments. Don’t take my word for it. Read about it http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2367001/ and http://www.nature.com/ejcn/journal/v67/n8/full/ejcn2013116a.html and http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/.
      Keto diets ARE full of antioxidants and phytochemicals AND human brains function beatifically and efficaciously using fat. https://www.psychologytoday.com/blog/evolutionary-psychiatry/201104/your-brain-ketones Stop confusing people with your propaganda!!!

    • Eric Ryan

      I rarely reply to posts but I couldn’t ignore this one. mainly because you seem to be insinuating that if people are going to eat any fat, that they should be eating unsaturated fats? Read a Google search! if you get a couple google searches under your belt then we can talk about moving on to maybe just maybe reading a book. Saturated> unsaturated. sure people go to the extreme with ketosis and tout that fruits have no place in their diets,but people can lead perfectly healthy lives where fruit is a dietary staple. but all in moderation. And all within an individual’s macros. To much sugar = bad (fruit contains a lot of sugar, and past a certain point…the body doesn’t care how “natural” the sugar is. Sugar is sugar.)To much carbs = to much glucose = essentially too much sugar = insulin resistance. When I first went full blown keto, the disappearance of brain fog was nothing I had ever experienced before. I had taken adderol before. And will never take it again. Because I’ve learned first hand that our brains were designed to perform, and if hey are not…it is because we are not feeding them what they need to to do so. Drugs are only masks and do not eliminate root cause. Saturated fat will not cause heart disease so you are wrong there. but I’ll give your props for challenging the thread. People should not blindly follow extreme diets. I did…and even though I started to experience extreme clarity and focus, I started shutting blood and going from shitting soup to cinder blocks back and forth for weeks. People need to find what works for them. For me…its been eliminating problem foods. Saying goodby to wheat for good, introducing a moderate amount of grass fed butter and mct oil, and eating 10-20 grams of fiber a day. That is my sweet spot. if I try to go super low car I usually don’t get enough fiber and get diverticulitis flare ups. If i stop eating saturated fats and start eating wheat and bread, the brain fog is invariable. Some things that work for some can be catastrophic for others. There are so many factors such as genetics, food sensitivities, gut bacteria etc. do what works for you but try and do some research on the dangers of today’s grains/processed foods, and the benefits of saturated fats.

    • Lynette Rall

      Nothing could be further from the truth, Jace! I belong to a Banting-group with 184 000 members, and the testimonials are unbelievable – people not being depressed anymore, not being diabetic anymore, getting off years and years of chronic medication for high-blood-pressure, cholesterol and epileptic-medication, to name but a few…..and losing weight in the process! A sustainable way of life, because we have loads of energy, are never hungry and we eat like kings….

    • JustSayin

      I agree. This article’s logic is simpleton logic.

    • Belinda C

      Once ones body begins to use the fats or fuel the mind is no longer irritable. If I incorporate fasting along with the Keto diet, I become less irritable. I am eating between 1:00Pm and 7:30 PM and eating 2 meals very low on carbs. I feel much better. I have 2 mugs of coffee with grass fed cow butter, coconut oil and cream. between 7:00 AM and 9:00AM. I usually have a fairly loose BM about 9:00AM daily. I am also recently drinking a glass of water in the AM with a tsp or two of Braggs apple cider vinegar. and in the afternoon around 3:00PM sipping on it between tasks at work. Odd thing is I have untill I added the coconut oil to my diet and probiotics, oh and bacon, I had chronic constipation and gas (OH MY!!!) . The keto diet is in use in our home to help my husband keep as low a dose of seizure medicine as possible and to control his type 1diabetes. Jace, you need to read current research or actually old and revived research about saturated fats and whole grains and so called healthy fats. Even a surgeon I have frequent contact with tells me that his patients do not do well with the high fiber remedies for constipation and he recommends Aloe Vera for relief of constipation. Besides being chronically constipated most of my life, I have been scatterbrained all my life. Guess what? My mind is clearer and I have much less brain fog since adding Turmeric and black pepper and butter and coconut oil to my daily diet regimen. anti-inflammatory and relieve the pain in my joints from repetitive strain injuries that the common prescription antiinflamation meds only temporarily dampened and complicated my chronic constipation. Nuff said. By the way, I am 67 years old and still hold a full time job and feel better than I have felt in many months. anonymous

  • LC

    Hi. Great site. People don’t get it because of what we’ve heard so often about fiber until or unless they actually fully experience it. I have tried every way of eating out there, I love research and self experimentation. I did to a “T” 100% raw primal (Aajonus Vonderplanitz) for a couple months many years back and it was amazing how easy and effortless digestion was, the interesting part is that i rarely had to eliminate, I could tell the meat and fat were completely and easily digested and there was nothing left to eliminate. It was a cool experience. I am a lean ectomorph so keeping weight on was very hard and so I moved on. I also cannot keep my weight up with LCHF, do you have any suggestions? Thanks. Thought I would share. Take care.

    • leap lo

      hello lc – I was wondering if it was true that when you went primal that there was nothing “left to eliminate” . I am in my 2nd month of lchf ketogenic diet and I now never see the meat,eggs,chicken I eat come out the other end!! I only see the green 20 grams of carbs i eat per day in the form of diearreah usually..
      I have been freaking out that I must have a blockage in my intestines somewhere!! Can it be that I am fully using almost 100% of all my meat and eggs and oil for fuel since i know run off primarily ketones for energy?? have you seen this in others also> ? please reply..thanks

      • Dear LC
        Apologies for the delay in responding and thank you for sharing your insights here. I am not sure I have much special wisdom to impart to you; if you were not able to maintain a healthy weight on a meat/fat diet or even with an LCHF diet, the only thing I can think of that might have helped would be trying to increase calories–fat first, protein second, and if all else failed, adding some “healthier” carb choices, such as starchy roots or low glycemic fruits. Everyone’s metabolism is a little different.

    • Veronica Nabizadeh

      Hi LC, I understand what you are going through. Have you read Dave Asprey’s Bullet Proof Diet book? It might provide you with an extra bit of knowledge in addition to this website which offers vasts information about our food intake and the effects of our consumption (Thank you Dr. Ede!!)

      Intermittent fasting has many benefits especially when Bullet proof coffee is consumed as your breakfast. You will need to buy grassfed butter, Bulletproof coffee and Brain Octane MCT oil. (Except for the butter, I purchase the coffee & oil on his website bulletproofexec.com) His website provides instructions on how to make your bullet proof coffee. The butyrates in butter actually feed the good gut bacteria so that it proliferates and not eating for 19 hours helps starve to death the bad gut bacteria. There is something quite magical about having regulated BM’s and I believe this regimen of eating will produce wonderous results for you. It has helped me! You can still follow your ketogenic diet. But, your eating window would be in a frame of 1p to 6pm or 5p to 10pm. Basically, choose a time frame that works best with your schedule. When you Bulletproof yourself in the morning, you won’t feel any hunger b/c the good healthy fats you are consuming will satiate you until you break your fast.

  • leap lo

    HELLO Dr Ede (or anyone else who can help) I have been on the ketogenic diet for 2 months. Until I read this article I have been freaking out because I rarely if ever see any brown stool come out of me. I eat 80% meat,eggs,oil and 20% green leafy vegetables. When I eliminate I only see green vegetable matter usually in the form of diearrha…sometimes some yellow mucus like substance..1x a week I may have a type 6 brown bristol elimination….never the classic bannana type 4 stool…that I used to have on a SAD diet…..Is it true that meat,eggs,fat,oil can be completely absorbed by the intestines and used for energy? If this is true then a huge weight would be lifted from me because I am about to go get intestinal x rays to see if I have a fecal impaction!!
    20 hours of searching on the web and this is the only place I can find a comment like the one you wrote — “you simply will not find undigested meat or fat exiting your body, whereas everyone is guaranteed to find plenty of undigested vegetable matter, right?”

    there has to be other people that are in ketosis wondering were the last 35 eggs and 5 steaks are….because they are not coming out of me!! if anyone can respond it would help relieve a lot of stress!! is there a link to an elimination study? I started taking Miralax to get the food out of me but maybe there is nothing there to exit. I do not have abdominal pain….just gas, minor bloating, and the green diearhaa.
    thanks

    • Guest

      I would suggest that you stop eating the leafy green vegetables. You are clearly not able to digest them. I used to have the same problem. Then I gave up the salads and voila-no more undigested food. Our bodies do use meat, eggs, fat and they are thoroughly digested. You will not see pieces of them in your stool. If you like your veggies, try eating ONLY thoroughly cooked ones (nothing raw). They will digest easier.

      • Hello, leap lo

        I agree with the guest who responded to your comment already. I’m sorry for the delay in responding to you. It is possible to have digestive problems from meat and eggs and oils if you have special food sensitivities, but it is a LOT more likely that your problems are caused by vegetables, so it’s usually fastest to remove those first for a few days to see if that takes care of the problem. If it doesn’t, then look at eggs (some people are sensitive to eggs), and also take a look at the fats you are eating (vegetable oils and butter are more likely to cause problems than animal fat). The least likely cause is meat, but there are some people (especially people who are sensitive to dairy) who have trouble with beef, some people are sensitive to pork, and some people are sensitive to seafood.

  • Excellent insight. Thank you for sharing! ~Teraisa

  • Linda

    Water: oz equal to half your body weight. Probiotics: cycle through a variety of different ones to make sure your system gets what it needs. Digestive enzymes: with most meals. Magnesium oxide: at an amount that produces results. That combo will help most people get their elimination on track. Best of luck!

  • tori

    Hi Everyone, Ive been 8 days on ketogenic diet so far. Trace ketosis according to the urine sticks. But feel bursting with energy and rarely hungry. Loving it! However, ive only lost 2 lbs and think its because I haven’t been to toilet ( number two’s) all week. I do feel a bit bunged up to be honest. My diet is very low carbs, limited to a few red wines every few days. Could it be the cheese im eating? reading other threads, I see that cheese can bung you up, especially if you don’t normally eat it. Do I need a laxative and if so, which one please? Many thanks.

    • Hi Tori
      First of all, I think losing 2 pounds your first week is a great accomplishment (assuming you need to lose weight). Cheese is a very common culprit in constipation. You may want to take a quick look at my very short article on this topic for some helpful ideas: http://www.diagnosisdiet.com/common-constipation-culprits/

      • Lorraine

        hi dr. ede, I quit the dairy and all. Now on ketosis but can’t open for a week. Eating chicken, salmon and brazil nuts. Any culprit?

        • Hi Lorraine

          The culprit is probably the nuts–nuts are a very common cause of constipation, unfortunately:(

          • jannaM

            Nuts have the exact opposite effect on my body. If I eat a handful of cashews or almonds each day, I have literally no trouble moving my bowels.

          • Yes, absolutely–we are each different, so some of us do very well with nuts. I’m jealous! I wish I tolerated them because they are delicious:)

    • JustSayin

      Eat an apple (which contains fiber) and you’ll likely be fine. This article is just silly.

  • Kat

    I hope you will respond given the last comment was a year ago. I’ve been reading everything on your site the last several days I’ve found you. So if I cut out fiber to switch to meats, fats, and juicing veggies but don’t go number 2 but 1-3 times a week dies that mean I’m constipated? Im coming from a whole food (only whole fruit eating but juiced veggies) vegan long term lifestyle. But im fed up with relying on fiber and natural laxatives to go everyday. on top of bloating, smelly gas everyday, and not having complete BM’s.
    Any thoughts on this or insight on how much fiber is really helpful for better bathroom visits?

    • Hi Kat

      It’s unclear to me from your question how you are eating right now: are you still eating a vegan diet or have you already changed your diet to meat, fat, and vegetable juices? A few thoughts in the meantime, though:

      Fiber isn’t always helpful with constipation and can sometimes make it worse (see my fiber page for more info: http://www.diagnosisdiet.com/food/fiber/).

      Meat and fat are easily absorbed and do not typically cause constipation, bloating or gas. Digestive problems are almost always due to specific plant foods or dairy products that get fermented by bacteria in the gut.

      Because meat and fat are so completely absorbed, diets that contain mostly meat and fat often result in a reduced frequency of trips to the loo for #2, but that doesn’t necessarily mean a person is constipated. If you feel good, frequency doesn’t matter.

      • Kat

        Thank you so much for replying : )
        Yes, still raw vegan (mainly fruits and veggies juices) with occasional fish. Honestly meats don’t excite me but broccoli, butternut squash, fruits Ect…makes me salivate. yet I’ve got embarrassing and painful symptoms (slow transit and diagnosed with tight sprincter muscles 🙁 – so I’m willing to learn to like meat and hopefully do well with atleast some fiber from produce, just not sure if eating any would benefit someone like me? Also Id like to know your opinion (no worries I won’t take it as “medical advice).

        • Hi Kat

          Sorry for the confusion re: “meat”–when I say meat, I mean the flesh of any animal, including fish, so if you only like fish, there is no need to eat any other kind of animal:) The plant foods least likely to cause constipation are fruits: http://www.diagnosisdiet.com/food/fruits/ , “fruit-vegetables” (vegetables with seeds are actually fruits–think squashes, tomatoes, cucumbers, etc) and non-cruciferous leafies (spinach, lettuce, etc). For a list of cruciferous veggies to avoid if you have constipation: http://www.diagnosisdiet.com/is-broccoli-good-for-you/ You may want to try changing your diet to fish, fruit, and fruit-veggies for a week or two to see how that goes. I would encourage you to include fish in your diet, as vegan diets are tough on the body: http://www.diagnosisdiet.com/diet/vegan-diets/

          Hope this helps! Feel free to keep us posted!

  • transplantwest

    Two days, I was lazy too much full fat cheese and a couple hand fulls of nuts. IMPACTED Stool. Awful. Oh and a multivitamin which had added iron which I didn’t notice. Thaks for the article.

    • Dear Transplantwest,

      At your service! Glad you find it helpful!

  • E.G.

    I love you Dr Ede. 🙂

  • Joy

    Chronic constipation was greatly improved by eliminating FODMAPS.
    Google it. Turns out for me, most stone fruits cause constipation. As well as
    garlic, and, onions. Fortunately, as with histamine intolerance the bucket theory
    applies to FODMAPS as well. Meaning one can learn how much they tolerate
    before symptoms get out of control.

  • Kryptik

    So let me get this straight… you are alleging that lack of fiber is not the reason for the constipation, and yet you prescribe eating fruits (high in fiber) to combat constipation? Ok. You also say that excessive (yes, extremely excessive) amounts of fat are not the cause of the constipation either. Let me ask you, of the 3 macronutrients, which digests the slowest? Which digests the fastest? Linking me to various pages of your blog do absolutely nothing to support your claims. And, you’ve provided zero scientific evidence to support your claims. You even admit that your brain needs glucose to function. Are you aware that a “limited” protein intake would absolutely not satisfy your body’s need for glucose? Only protein in excess of what is used to maintain current muscle mass (and any potential adaptation that someone interested in health would be trying to instigate) would be broken down into glucose, which is extremely inefficient for our bodies to do. your degree is in Psychiatry, not Nutritional Science. It’s criminal that you’re able to manipulate people into thinking otherwise.

    • Dear Kryptik

      1. Fruit can speed digestion not because it contains fiber, but because it contains sugar alcohols. Please see my fruits page for more information: http://www.diagnosisdiet.com/food/fruits/

      2. Fat, protein, and simple sugars are thoroughly and completely digested (this information is readily available in physiology textbooks) whereas fiber is poorly digested by definition (and readily apparent upon inspection of stool contents, where one will not find undigested meat or fat except in cases of pancreatic enzyme deficiency or other serious health problems). For more information please see my fiber page: http://www.diagnosisdiet.com/food/fiber/

      3. Yes the brain needs some glucose at all times but protein is easily and efficiently turned into glucose by the liver: http://www.diagnosisdiet.com/food/carbohydrates/ When I say limited protein, I do not mean inadequate protein. By limited I mean eating what your body requires–including enough to generate glucose.

      4. I would never discredit information based on the credentials of the source, rather on the quality of the information. I learn things every day from my patients, my friends, my colleagues, and my readers, many of whom have no nutrition credentials. Nutritional scientists do not have a corner on the truth. Far from it–many are miseducated and rely on either outdated or epidemiologically-based information, which has been leading the public astray for decades.

      • kryptik

        1. Bananas, blueberries, strawberries, pineapple, citrus fruit, cantaloupe, honeydew, etc. all contain negligible amounts of sugar alcohols that don’t even warrant consideration. Yet, they all have fiber and support healthy digestion.

        2. You just proved my point with the fiber comment. The whole idea of fiber is that it is indigestible, and therefore serves as a vehicle to efficient excrete waste out of the body. Fiber is ONLY found in carbohydrates, and most abundantly in fruit.

        3. Protein is much more difficult to convert into glucose than carbohydrates. it requires much more energy. Eating only enough protein to generate glucose is ridiculous. You could just as easily eat the protein requirements for your lean body mass, and then include enough carbohydrates to support healthy brain function.

        4. Your sources are links to your own blog!!! That’s absolutely not a credible source. You’re right, Nutritional Science (the most advanced study of human biology) doesn’t corner the truth at all. But, they study. They don’t write a blog based on their own misconceptions and then reference said blog as a credible citation while debating the facts presented by said blog. You are completely wrong. And, I wrote a Microsoft Word document that I’ll be happy to e-mail you that says you’re wrong.

        • Dear Kryptik

          You are welcome to a different opinion, of course, so we’ll have to simply agree to disagree at this point. I would not expect anyone to simply take my word at face value, which is why the vast majority of articles on my site, including the ones I linked to above, contain references at the bottom. All articles written since 2015 contain anchored references within the text that link to full references at the bottom. For those not able to find references, sometimes you have to click on the plus symbol next to the word “references” at the bottom of articles in order for the reference list to display. This Ketosis and Constipation article does not include its own references because it links to my fiber post, which includes 17 references.

  • Chris Schoeman

    Hi Dr Ede,

    Thanks for your article, certainly some very helpful hints and things to watch out for.

    I’ve been having trouble with constipation since switching over to a high fat diet. I’ve systematically tried eliminating all the culprits you mentioned but none of them seem to have helped. It got to a point where after having a particularly large meal my body just rejected food and I spent a weekend throwing up and having diarrhoea at the same time 😐

    After trolling the internet I stumbled upon comments of people with similar symptoms on a ketogenic diet. According to the information, some people may have difficulty digesting fat especially if they have been on a high carb diet for most of their life – seems like our bodies may have stopped creating certain digestive enzymes that are needed to break down fat due to never having needed those enzymes in the last 20+ years of high carb eating…

    Have you ever come across something similar? Apparently Betaine HCL and/or Apple Cider Vinegar have helped some people experiencing these issues. Would you recommend either of these as digestive aids?

    Thanks in advance.

    • Hi Chris,

      Yes, some of us have trouble digesting excess fat. I don’t have any experience with those supplements, unfortunately. It would be very helpful to know what you were eating on your high-fat diet–not just the amount of fat, protein and carbs, but also which kinds of foods you were eating. I don’t know if I can figure it out but I’d be happy to try.

      • Chris Schoeman

        Thanks for the reply!

        I’ve been aiming for a ratio of about 30% protein, 30% carbs, 40% fats. I find my body does much better in cyclical ketosis as opposed to all out low carb.
        Meats include red meat, beef, chicken and pork and plenty of eggs (have tested and I’m fairly certain I have no egg allergy). I try to get grass fed as far as possible but it’s difficult and expensive in the city.
        Carbs from potatos, white rice, butternut, pumpkin, sweet potato and the like. Veggies include brocolli, cauliflower, carrots, green beans, and some green leavy stuff. Fruits mostly apples, bananas, pears, strawberries, blueberries, pineapple… some days my carbs ratio will go up to closer to 40%
        Fats include fish and nuts (once again don’t seem to be sensitive to either of these) but by far the largest intake is MCT oil and grass fed butter in my coffee every morning… this high morning fat intake is what’s been causing the digestive problems.

        • Hi Chris

          I know that quite a few people experience digestive problems with MCT oil, but if that’s not the issue, it could be the butter or the nuts. Even if you don’t test positive for a true allergy to any of the foods you’re eating they could be bothering you, but it sounds as if you’ve already tried the no-dairy and no-nut experiments and noticed no improvement.

          If you’re not eating strict keto (limited protein and ultra low carb), there’s no need to eat high fat, so you may want to try skipping the butter and MCT oil in the morning altogether.

          What often works is to strip the diet down to all (fresh or frozen unprocessed) meat, poultry and seafood for a few days to a week or so, and then add back one food at a time to see if you can identify your culprit. Most people will feel good on the all-meat diet but if you don’t, you may be reacting to a particular animal food. Beef, seafood, and pork are the animal foods most likely to bother some people.

  • jEN

    I WAS WONDERING IF PRESCRIPTION MEDS HAVE A IMPACT ON LCHF DIET AND I HAVE HYPOTHYROIDISM. HAE BEEN STRUGGLING WITH SAME 10 LBS FOR 2 MONTHS. WHAT I AM DOING WRONG? I EAT MOSTLY VEGGIES AND PROTEIN. I FEEL BETTER NOW SINCE I STARTED DIET. CAN YOU HELP?

    • Hi Jen

      It would be helpful to know which medicines you are taking and how much protein, fat, and carbohydrate you are eating. I can take a look at your answers and see if I can help. Also, in the next month or so I’ll be publishing a post that includes answers to frequently asked questions about keto diets, including reasons why some people have trouble losing weight and what you can do to troubleshoot the diet.

  • Gerardo Parra

    Every time that I go to a low carb or keto diet I get very constipated I ended up in the hospital because I couldn’t handle the pain. Most of the times mi number are the next ones.

    Protein 190 gr fats 60gr carbs 100.

    As the week’s progress and I stop loosing weigh I drop my carb 10 grams a week so mi final number could be protein190 fats 45 carbs 20.

    When im doing keto what I do is the next: Protein 110 fats 126 carbs 31 ( fiber 9)

    My food choices are what people call bro diet. So its chiken, rice( when im trying to putt weight) broccoli or lettuce and fats fish oil and coconut oil. Fisho no more than 10 g a day.

    As I mentioned I have a huge issue with constipation and after a week or 2 the pain is unbearable, I just don’t know what im doing wrong. Of course I tried fiber and got worse, my familily doctor suggested Laxaday but I got bloated right the way. Also I got my thyroid checked and everything’s was fine.

    I have to say that ones I do keto, my cravings are under control and I feel better over all just I haven’t found the way how to manage the constipation.

    I will appreciate your response.

    Oh btw

    Im male 33yeard old

    • Jane

      Try the SloMove Tea, found in the deli section of your grocery store. You may be amazed.

    • Matthew Trentadue

      That’s not really low carb. Your protein is way too high, and fat is too low. Greatly reduce your protein and carbs, and up your fat. The extra fats should help with your constipaion, especially if your using healthy sources like coconut oil and grass-fed butter.

  • Jane

    For constipation, I use the Smooth Move tea, found in the deli section of the grocery store. Because I’m sedentary, I used to need it once a week. Now, on the keto diet I have to drink it every three or four days. Still, it works for me.

    • Belinda

      Since my husbands brain hemorrhage,( 3.5 years ago caused by statin drugs), he is frequently constipated and we use smooth move tea about once a week. This was a fact even before we discovered the Keto diet a little over a year ago.
      Also a preparation H suppository at bedtime will help the situation if constipated already.
      Annomyous

  • joseph1972

    Maybe I am just weird but the only thing I changed in my diet was removing all carbs from my evening dinner and adding a bulletproof coffee to my breakfast instead of a high fiber, high protein cereal with orange juice. My lunch and snacks stayed the same, chicken wrap with bacon and spinnach and mixed nuts for snacks. Now I am constipated beyond belief, to the point of it being extremely painful to go to the restroom.