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Let's Talk About Poop

Frank discussion of bowel issues and common questions about constipation on low-carb and keto.

Article by Anita Aldridge | 13 Dec, 2020

Article originally published on Ketovangelist.com on 12/22/16. It has been lightly edited for re-publication.

Watch Out! Lots of Bodily Functions in this post!

It’s all biology, and we have to deal with it every day. Parents or health professionals regularly have to deal with other peoples' biology as well. It may be a little embarrassing, but it's something we have to learn how to manage in a new way when we transition onto a ketogenic lifestyle: stubborn bowels and changes in bowel movements.

Bowel Health

Years of eating a SWD (Standard Western Diet) damages the gastro-intestinal tract. The amount of food and chemicals we push through our gastro-intestinal system has it working overtime. Some of us end up with either an over-active or an under-active system, resulting in difficulties such as GERD, Inflammatory Bowel, Diverticular Disease, Irritable Bowel, food and chemical intolerances, Crohns’, Colitis, Faecal Incontinence, constant constipation/irregularity and a number of other issues.

One of the reasons that it is important to be aware of our bowel health is that our mental health is directly affected by the health of our bowel. A large part of the hormones that regulate our well-being, our ability to self-soothe and regulate our emotions, have a direct relation to the bowel. This means that our bowel health is not just a small part of our general health, but a vitally important piece which helps us maintain our equilibrium and the rest of our body’s well-being.

If we have trouble, there are all sorts of chemical products we are told to use if things become "stubborn," but using chemicals does not help our gastro-intestinal tract to heal.

A ketogenic lifestyle, with appropriate amounts of healthy fats and the gelatines from bone broth, heal the lining of the entire intestinal tract (from go to woah!). High school science tells us it takes the body up to ten (10) years to completely replace each of its cells, with different parts of the body taking different lengths of time, depending on how much they have to work. For example, blood cells have a short life, because they have to work hard, bone cells grow and replenish slowly because their job is strength not energy.

When we consider the gastro-intestinal tract, it works hard under difficult conditions, and therefore its cells are replenished approximately every 5 days.(See: How Stuff Works) This means, we need to care for our GI tract, by being aware of the food we put into it, and maintaining our electrolyte levels so it is able to do its job properly.

How Do Electrolytes Help The Bowel?

The bowel is directly affected by our electrolyte levels. When we are eating a SWD, with all those processed and fortified foods, our kidneys receive and hold onto extra electrolytes and noticeable imbalances aren't common. When eating a ketogenic diet, which is naturally a bit diuretic, it is important to pay a little extra attention to electrolyte levels. When we cut out all the processed (and highly salted) foods we used to eat on the SWD, we need to be vigilant about replacing those salts we have eliminated.

Maintaining appropriate electrolyte levels keep all of our body healthy and assist our bowels to do their job; to transport waste effectively out of our system with the minimum of fuss and bother. Maintaining electrolytes is a simple and effective preventative which is far better for our overall bodily health than chemical interventions. It is also easier and cheaper to maintain your electrolyte levels than to try and intervene after a problem has occurred.

How To Maintain Your Electrolytes Properly

When we have transitioned onto a ketogenic lifestyle, we need to keep our electrolytes in order. Magnesium can be taken safely in a supplement, as long as you stay within the guidelines for recommended safe dosages. Try to find a magnesium complex, something which has the full range of magnesiums in it (Oxide, Phosphate, Amino Acid Chelate, Citrate etc) to cover all the great things magnesium can do. Your individual level of magnesium will depend on your ability to poop, your level of muscle relaxation for sleep and cramps.

DO NOT TAKE SEPARATE POTASSIUM SUPPLEMENTS UNLESS PRESCRIBED BY YOUR DOCTOR.

If you find you need extra potassium, the best way to get it is from potassium rich, keto-friendly foods like avocado or leafy greens.

Salt is best found in a complex form like Himalayan Pink Salt or other rock salts because they contain trace minerals like potassium naturally. If you are on a budget, the next best way to supplement your salt is with an iodised salt (Lite Salt, Iodised Table Salt). A ketogenic body needs at least 2 teaspooons salt a day. Take your salt. Put it on all your food. Put it in your coffee. Eat it straight off your hand. Put it in water with a squeeze of lemon, or in ACV (Apple Cider Vinegar) or add it to pickle juice. (Don’t drink this all at once, or you might have disaster pants!!)

It's also important to get enough water, but do not go overboard. Drink to thirst, otherwise you risk diluting and flushing your electrolytes to dangerous levels.

Other Things To Know

If you are having problems with stubborn bowels, the best way to deal with it ketogenically is to be diligent about maintaining the proper levels of salt and magnesium Another thing to understand is that now we are eating keto, we are consuming less than half the amount of food (bulk-wise) and eliminating almost all the fillers we used to eat on a SWD. Once our gastro-intestinal tract heals, it is very likely that because of the smaller volume of food going in, and therefore the smaller amount of waste needing to be evacuated, our bodies will need to poop less often than once a day. This is normal.

Some of us might find we are only needing to evacuate our bowels once every two or three days. This is normal.

What is not normal, is pain or the other symptoms associated with constipation. Keep up your electrolytes and combined with the healthy fats we are eating, things should move properly, the way they were made to, with little fuss and bother. We need to learn to listen to the changes in this part of our body, too.

Your body is amazing, you are giving it the best chance to do the job it was made for. You are doing an amazing job. Keto on!

Editor's note: After consulting with our resident Nutritionist, Coach Kimmi Katte, we wanted to address some best practices for getting more immediate relief from true constipation. Please do not wait to begin addressing constipation, as prolonged constipation can lead to blockages and a trip to the hospital for a manual evacuation. Which is profoundly unpleasant. If you find yourself beginning to strain, it's time to start working on relief.

Coach Kimmi recommends supplementing with MCT oil if you are genuinely backed up and cannot go. If you are already using MCT oil, try increasing the amount you're taking in daily by half. Continue to be diligent about salt intake and magnesium especially. If that doesn't get things moving, or if you experience any pain or discomfort that is out of the norm or well beyond some run-of-the-mill constipation, please see a health care provider.

Conversely, some unlucky folks may initially have the opposite problem and experience diarrhea. If you are in the first two weeks of your keto journey, or if you are only experiencing an occasional loose bowel movement, Coach Kimmi recommends riding it out. Be sure to continue to drink water and salt your food so as to avoid any dehydration.

If you are experiencing more frequent bouts of diarrhea, and are past the first two weeks of keto, Coach Kimmi recommends increasing daily salt intake by 1/2 tsp for four consecutive days. If that does not relieve loose bowel movements you might consider adding in 1 tbsp slippery elm powder dissolved in a cup of warm water, two times per day. Slippery elm is very soothing to the gut and bowels.

Anyone experiencing diarrhea, regardless of severity, should be extra diligent about drinking water and getting in electrolytes so as to avoid dehydration. Coach Kimmi recommends drinking an additional two 8-oz glasses of water and increasing salt by a full teaspoon, all per day, for every five watery bowel movements experienced. Again, if you experience severe diarrhea or any other concerning symptoms, please see a doctor.

Lastly, some ketonians may experience "slimy" bowel movements, or may notice what appears to be an oil slick. This is usually due to digestive issues and a difficulty properly breaking down and absorbing dietary fat. In this case, Coach Kimmi recommends considering a digestive enzyme supplement that includes lipase.

Once again, we must stress that if you're having severe bowel trouble or experience anything that is alarming, please see your health care provider. Many issues that people may experience from time to time on keto can be relieved or eliminated with proper supplementation, but please know that not everything is caused by keto and there are many underlying medical conditions that may cause bowel trouble. Please continue to work with your health care providers to manage any known conditions or to uncover and treat any previously undiagnosed conditions.

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