Ketone Diarrhea

[SarahB]

I recently switched over to keto due to migraines and discovering my APOE 3/4 status. Being gluten free and a tea-totaler, I thought my adjustment to a ketogenic diet would be easy. Unfortunately, I experienced about a month of epic diarrhea, and, no I wasn't infected with anything - the symptoms were in lock step with the ketone diet. I went on-line to find a fix. The common recommendations include:

1) Increase digestive support - Ox-bile and other digestive enzyme supplements, lemon water for additional hydrochloric acid. (These interventions did not help me.)

2) Reduce protein - Now that I'm monitoring my ratios, I find that I have trouble eating enough protein, so I don't believe protein was the issue. Also, I'm not a consumer of low carb protein bars and the like. However, one very meat (and thus protein) heavy day I became quite unwell, so protein may have been playing a role.

3) Omit Alcohol sugars - My alcohol sugar consumption is negligible.

4) Increase fiber - I added psyllium husk. It did not help.

5) All fats are not equal; monitor your fat consumption - Turns out, I can't really do coconut oil and don't even mention MCT. Avoiding these oils in favor of olive oil and avocado oil was very helpful. I have a large bottle of MCT that I plan to use for making sunscreen.

6) Feed your microbiome - My microbiome may have been in revolt. I discovered a blog that mentioned feeding the microbiome and tried the recommendations, buying green banana starch (a local product!) and making resistant starch rice. (I'd cite the blog, but I can't find it anymore) The resistant rice recipe involves cooking rice with a teaspoon of coconut oil (not enough to make me sick) and letting the rice cool over night. The green banana starch comes in a big canister. I mix one scoop (8gms) of green banana starch into yogurt/berries or a smoothy. I use a few tablespoons of rice in miso/kim chee soup. So that added carbs and some friendly bacteria.

The diarrhea quieted down after I fed the microbiome. (Not that things are back to normal, they're just not an emergency). But also, I believe at the same time I was keto-adapting. The adaptation process in general may have helped because symptoms were improving at the same time my urine ketones were dropping (Even with the slight boost in carbs, I was still in ketosis according to a breathalyzer and other signs).

Right now, tracking my ratios on Chromometer, I average 65L/17C/18P. I'm usually around 34mg/L on a breathalyzer. Hopefully, this level will be good enough (along with some other interventions) to keep the migraines at bay.

I only stuck with this diet because the migraines are that bad and my old medication turned out to be anticholinergic thus a risk for Alzheimer. So my motivation was really high. Besides, I don't really like sweets.

Anybody else have a similar experience?

[circular]

Your mileage may vary, but a teaspoon of coconut or MCT oil and negligible sugar alcohols are each enough to give me your issue. (Oddly, coconut also reliably triggers an ‘ocular migraine’ - no pain, just visual aura - for me.) Just in case you’re more sensitive to these than you think, you might try complete elimination. It could also be that something you normally tolerate doesn’t work for you in the context of the keto for some reason.

[TheresaB]

I don't know how much MCT you were taking, but MCT consumption should start at one teaspoon, then building up the dosage over time. If too much before the body has a chance to adapt, the liver will not be able to process the fat and will dump some of it back to the intestines, where it can cause stomach upset and diarrhea.

When transitioning into being ketogenic, the more common GI complaint is constipation, for which recommendations are to add non-starchy vegetables and psyllium seed husks. Interesting to see those same recommendations are also given for diarrhea.

[thjj]

I don't know how much MCT you were taking, but MCT consumption should start at one teaspoon, then building up the dosage over time. If too much before the body has a chance to adapt, the liver will not be able to process the fat and will dump some of it back to the intestines, where it can cause stomach upset and diarrhea.

When transitioning into being ketogenic, the more common GI complaint is constipation, for which recommendations are to add non-starchy vegetables and psyllium seed husks. Interesting to see those same recommendations are also given for diarrhea.

I've been in ketosis for a couple months now & my problem is somewhere in between diarrhea & constipation; this might be TMI for some, so you can stop reading now if you don't want to hear about my bowel issue:
I am not happy with my #2 being kind of mushy, grain-like, and frankly, messy. I have taken psyllium husks regularly for a couple years and this doesn't affect it apparently. I'm going to continue to do my "hard" keto for 1-1/2 more months (I only eat a few resistant starches like sweet potatoes, yams, & green bananas as a main source for carbs), and then will experiment more with food choices to improve the situation. Another negative side-effect has been the "keto rash" which looks just like this (this blog documents a guy's experience with this mysterious skin condition in detail):
http://bjjcaveman.com/2013/05/09/prurig ... ated-rash/

[Sgl9x]

"Another negative side-effect has been the "keto rash" which looks just like this (this blog documents a guy's experience with this mysterious skin condition in detail):
http://bjjcaveman.com/2013/05/09/prurig ... iated-rash"

I get this too sometimes... I increase my carbs slightly and it goes away but doesn't stay gone usually. Sometimes I get it and sometimes I don't, no matter how many carbs I eat though. Very unpredictable for me. I just live with it because I don't want to use hydro-cortisone. I've heard vinegar on the skin helps stop the itch. (I don't have it right now)

How many carbs do you eat a day?

[SarahB]

Theresa - I know just what you mean about messy. I'm experimenting with protein amounts/meat, which in my case may play a role.

[thjj]

"Another negative side-effect has been the "keto rash" which looks just like this (this blog documents a guy's experience with this mysterious skin condition in detail):
http://bjjcaveman.com/2013/05/09/prurig ... iated-rash"

I get this too sometimes... I increase my carbs slightly and it goes away but doesn't stay gone usually. Sometimes I get it and sometimes I don't, no matter how many carbs I eat though. Very unpredictable for me. I just live with it because I don't want to use hydro-cortisone. I've heard vinegar on the skin helps stop the itch. (I don't have it right now)

How many carbs do you eat a day?

I don't know the exact amount (I don't have a chrometer-I think that's what they're for) but my guesstimate is just under 50 g/day. btw, my keto rash flared up a couple days ago and turned into kind of welts

[Sgl9x]

[/quote]I don't know the exact amount (I don't have a chrometer-I think that's what they're for) but my guesstimate is just under 50 g/day. btw, my keto rash flared up a couple days ago and turned into kind of welts [/quote]

I only eat about 20 grams a day and my ketones never get over 3.00 mmol (now I am at 1.00 to 1.6). I see yours are at 4.00 mmol. This may have something to do with it. You are one of those people that can eat a substantial amount of carbs and still remain in ketosis. Increase your (good) carbs a little, not starches or sugar.