I think my stomach issues might be the microbiome in my gut. Seems the best explanation for the bloating and horrible diarrhea that I’ve been dealing with for over a month now. It didn’t hit until late August and I started keto in mid June. I ended up in the hospital a few days ago because my potassium fell to 3.3. I’ve read some articles that it can take months and some that say it’s permanent. I’ve been on keto before, but that was years before and I had a gallbladder back then. Had my labs done yesterday and all my levels are back to normal. Even had my stool tested and that was negative. Any insight would be greatly appreciated, because while I do feel better and the weight loss has been great, I’m about to call it quits. Living in fear of potentially craping my pants is not worth it.
Microbiome help
Without knowing your actual diet, it’s hard to say, but here are some general thoughts:
Most people have found their bowels behaving better on keto. For me, diarrhoea was common on my high-carb diet. It would alternate with bad constipation, oddly enough, and I never did figure out which foods triggered which condition. My bowel is a lot better behaved since I went keto. Now, I only get constipated when I don’t get enough salt, and diarrhoea occurs only when I am sick. (Or reacting to some ingredient; I have had problems from eating a particular dish at a particular restaurant.)
If you are eating too much of the wrong kinds of fats, this can be a problem. MCT oil has a known tendency to cause what we call “disaster pants.” Sugar alcohols, especially maltitol and xylitol, can also cause diarrhoea in a lot of people.
Too much polyunsaturated fat can cause queasiness and possibly bowel trouble. This is one of the reasons we recommend sticking with fats such as butter/ghee, bacon grease, lard, and tallow. They are pretty much evenly split between mono-unsaturated and saturated fatty acids, with a very small percentage of polyunsaturates.
You may need to supplement potassium, but it should be easier to do so if your sodium intake is in the proper range. A couple of recent studies both showed that people are at their healthiest when getting 4-6 grams of sodium/day, which translates to 10-15 g of table salt (sodium chloride), including the salt already present in food. Dr. Stephen Phinney recommends using so-called “lite” salt, which is a blend of sodium chloride and potassium chloride, as a good way to supplement potassium. But be careful not to overdo potassium; hyperkalaemia is just as deadly as hypokalaemia.
The presence or absence of a gall bladder should not impede your ketogenic diet. Most people on the forums who’ve had their gall bladders removed notice no problems with the fat in their diet, though a few people need to space their fat intake out over the course of the day. Some people also find taking bile salts to be helpful. As you probably already know, the bile needed to digest fat is actually secreted by the liver; the gall bladder merely stores it.
He might have been joking, but Prof. Benjamin Bikman once said in an interview, that fasting might be a good way to clear out our microbiome. You might try fasting for three or four days (certainly no longer than thatm without consulting your doctor) to see what happens. If you are still experiencing diarrhoea while fasting, then that would be a pretty good indication that the problem is not your diet, but something medical that needs attention.
Lastly, taking a fibre supplement is iffy. Some ketonians find it absolutely necessary, while others find it a detriment. A lot of people with IBS or Crohn’s disease find that fibre exacerbates their condition, rather than helping. Fortunately, the majority of us don’t find any particular benefit or harm from fibre.