Food Freedom Friday Edition 316 - Dealing With Bloating
Any dietary shift can cause (hopefully temporary) gastrointestinal issues like gas, abdominal distension, or constipation, especially if you are eating a lot of new foods. You also may be getting a lot more or a lot less fiber, or you may be consuming different types of fiber.
Gastrointestinal issues including bloating, cramps, and diarrhea are common side effects of overdoing the MCT oil that some use to increase ketone production and improve constipation.
Constipation does seem to be a relatively common occurrence on low carb ketogenic and carnivore-type diets. Studies have found that constipation was the most common adverse effect of ketogenic diet. These studies are often performed on those following a therapeutic keto diet, with its extreme carbohydrate and protein restriction. This barely resembles the keto and low carbohydrate diets popular today. In studies of less extreme, more realistic versions of these diets, such as modified Atkins (which allows more protein) or a version with more focus on vegetables, nuts, and seeds, constipation happens at a much lower rate.
It’s unclear how widespread this problem is on the low carbohydrate diet spectrum, particularly among people who eat a “well-formulated ketogenic diet,” meaning one that includes a diverse array of plant foods alongside animal products combined with healthy fats.
What might be causing bloating if not constipation?
Too Little (Or Too Much!) Little Fiber
Low carbohydrate and ketogenic diets are not inherently low- or no-fiber diets. You can get plenty of fiber from enjoying a variety of vegetables, nuts, and seeds.
That being said, the relationship between fiber and constipation is decidedly mixed. Sometimes higher fiber intake does seem to help. Psyllium husk and flaxseed have both been shown to improve constipation. Galactooligosaccharides, a type of prebiotic fiber, improve idiopathic constipation, and inulin, another prebiotic fiber, has been shown to improve bowel function and stool consistency in patients with constipation.
There is, however, also evidence that more fiber can make the problem worse. In one study, patients with idiopathic constipation (constipation without apparent physiological or physical causes) had to remove fiber entirely to get pooping again. Those who kept eating a bit or a lot of it continued to have trouble. The more fiber they ate, the worse their constipation (and bloating) remained. Another review found mixed evidence; some people get less bloating and constipation with more fiber, others get less bloating and constipation with less fiber.
There is no one-size-fits-all with fiber, especially since there are many different types of fiber. It does seem possible that constipation could occur if you change the sources of your fiber when changing your diet, even if the overall levels don’t change dramatically. The gut microbiome starts to shift rapidly within a day or two of changing your food choices. If you need some bowel support, try adding a serving of psyllium to a smoothie (start with 1 teaspoon of ground husks), or mix it in a small amount of water and drink it – this is often effective if not all that pleasant). If the problem worsens, try the opposite. Limit your fibrous veggies for a day or two and see if that helps. You can then slowly reintroduce them and monitor your symptoms.
Not Enough Food
Constipation is often a consequence of too little cellular energy. Everything that happens in the body requires energy, and if energy levels are low or energy availability is poor, basic functions, like bowel movements will suffer. The muscles and other tissues responsible for moving things through your digestive tract use energy. If you fail to provide adequate amounts of energy, you risk depriving your tissues of the ATP they need to work best. This also sends your body a signal of scarcity which will only depress energy expenditure even more.
Low-carb diets in general, and keto diets in particular, are very good at causing inadvertent calorie reduction. This is a fantastic tool for fat loss, but some people create too much of a caloric deficit. An example would be 800-1000 calories a day on top of a vigorous exercise routine. That is simply a recipe for disaster.
Dehydration and Mineral Loss
When initially reducing your carbohydrate load, you release a lot of water. For every gram of glycogen you lose, 3-4 grams of water is released along with it. Along with the water, you lose sodium and potassium, and you need extra magnesium to regulate your sodium and potassium levels.
The water content of stool is why is has that smooth texture you ideally are looking for. If you are dehydrated, even mildly, there is less water available for your bowel movements and you are more likely to suffer from constipation.
Drink a big glass of salty water with lemon juice in the morning and sip on salty broth throughout the day. Zucchini and avocado are both great sources of potassium.
Furthermore, if you are choosing to eat more fiber, you need to increase water intake for it to be effective.
Low Carbohydrate Sugar Substitutes
There are some interesting candies, chocolates and treats that are promoted as low carbohydrate. These generally tend to use various sugar alcohols (non-alcoholic, low-or-no-calorie sweeteners), artificial sweeteners, and fibers to recreate popular treats and that sweet taste so many seek out. It can be fun and delicious to eat an entire chocolate bar that tastes almost exactly like the real thing with only a few carbohydrates. However, this innocent-ish looking indulgence contains a lot of fermentable product that your gut bacteria are more than happy to turn to gas. The sugar alcohols ending in -ol like erythritol, maltitol, and xylitol are especially likely to cause gas and bloating.
FODMAP Intolerance
The pervasive myth that a low carb diet means eating bacon, salami and cream cheese for every meal. The reality is that many people who choose this way of life find themselves eating way more vegetables than they ever have before. These can be great developments, usually, but if one is intolerant of FODMAP fibers, you may worsen the bloating.
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols.. These are the carbohydrates in plants that your gut bacteria usually use as food. Most people have gut biomes that can handle these FODMAPs - most people derive beneficial short-chain fatty acids from their fermentation. However, some people’s bacteria produce too much fermentation when they encounter FODMAPs. Fermentation creates hydrogen gas, which gathers in the gut and causes great distress. Common complaints of FODMAP intolerance include bloating, stomach pain, and visits to the toilet that are either unproductive or way too productive. Needless to say, all of these symptoms can create quite severe bloating.
What You Can Do
Eat enough protein. Most people can get away with eating 15-25% of their calories from protein and maintain ketosis or a fat burning state. Most people can eat even more protein and still get most of the benefits of fat-adaptation. The studies which had the lowest rates of constipation were far more tolerant of higher protein intakes.
Avoid FODMAPs if you are intolerant. Most people can eat FODMAPs. These FODMAP containing foods improve gut health and reduce constipation and bloating. But if your gut reacts poorly after a few bites of broccoli or asparagus, consult a FODMAPs list and try a quick FODMAP elimination diet.
Check your consumption of common food culprits. This includes sugar alcohols and MCT oil, as well as dairy. Many people end up increasing their dairy intake once they give themselves permission to fully enjoy healthy fats. If you find yourself spending more time than usual in the dairy aisle or at the cheese store, try taking a break from dairy and see if your problems resolve.
Experiment with fiber. Fiber clearly has a relationship to bloating and constipation. You just have to figure out what that looks like in your diet.
If you are bloated and constipated on a high-plant low-carbohydrate diet, try eating fewer plants.
If you are bloated and constipated on a low-plant protocol, try eating more plants.
If neither of those helps, try a very low or zero-plant carnivore-type diet.
Try adding magnesium. Electrolyte supplementation is always important, especially when starting a low carbohydrate/keto/carnivore diet. Magnesium in particular can help move things along if you are having trouble with bowel movements. Try a small serving of magnesium oxide or citrate ehich tend to have the greatest laxative effect. Increase the dose until it starts to work.
Are you truly constipated. Your stool volume and frequency of toilet visits will decline when reducing your carbohydrate load because there’s less “waste.” Make sure you are not misinterpreting that as constipation or bloating. If there’s less stool, there is less stool. If, on the other hand there is stool and it feels like it is simply not coming, and you have to go but can’t, you have an issue.
In Summary
When significantly reducing your carbohydrate intake, whether low carb, keto or carnivore, bloating may occur for some people, but the scope of the problem is often highly exaggerated. Constipation is the most common cause, particularly if your protocol is very restrictive. You can support your bowel function by:
Experimenting with the amount of fiber you are eating fiber from vegetables, nuts, and seeds
Being less restrictive with protein
Making sure you are well hydrated and drinking enough water
Eating sufficient calories
Getting adequate electrolytes through food and supplements