Remarkable weight loss but unshakable Keto constipation issues



Fairly self-explanatory title, but I feel like some context might be helpful.

In January 2019, I started my keto journey. I was at a high of 69.2 kg with 19% body fat (according to my smart scales, which are admittedly of questionable reliability). By April 2019, I was at a low of 58.2 kg and 11% body fat. I was absolutely astounded by how effortlessly I was losing weight, and actually wondering how I could edit my diet to stop losing weight. (Not too many diets can lay claim to this issue!)

And then, unexpectedly, disaster. Long story short, I was painfully constipated for three days and ended up going to the emergency department at hospital being (basically) unable to function. Thankfully they flushed me out. Curiously, the nurse who assisted me was also on a keto diet, and recommended fibre supplementation and drinking lots of water.

However, my parents were worried, and advised me to go off keto for a period of time. I didn’t go nuts on carbs (kept below 100g or so) and I didn’t consume any processed foods, except oats. In terms of carb-heavy foods, I consumed 1/2 cup of oats per day, as well as higher-carb fruit and veggies like apples, carrots, raspberries, blueberries and strawberries. However, I slowly started to put weight on again, and I’m currently at 61kg. Realising this about a month ago (June), I decided to slowly reduce my carb intake again.

I finally feel like my weight is under control (based on a week of data), but I’ve started to feel constipated again. I’m still passing one or two bowel motions per day, but they’re hard work. By contrast, when my dietician put me on a low-FODMAP diet, my bowel motions were near-effortless. And I certainly don’t want another emergency room disaster.

I feel like I’m doing all the right things by keto:

  • Eating enough green veggies (five serves per day, often up to eight or nine)
  • Drinking 2-3L water per day
  • Ample magnesium supplementation (3.75g of chelated magnesium = 600mg of elemental magnesium per day)
  • 3 tablespoons of MCT oil per day (poured onto meat-and-veg stew)
  • 5g of psyllium husk per day (sprinkled onto meat-and-veg stew)
  • Ample nuts (almond butter, macadamias, brazil nuts) and seeds (chia, flax)

Current foods that are higher in carbs:

  • 10-15g oats per day (6 - 9g carbs)
  • 1 punnet raspberries per day (5g carbs)
  • (Sometimes) 1 packed pre-chopped carrot sticks per day (7.5g carbs)
  • 20-40g nut butter per day (2-4g carbs)

TL;DR: I’m on keto and I’ve experienced amazing results that I don’t want to lose, but it keeps making me constipated and I don’t know what to do!

(Allie) #2

What’s your salt intake like? Too little sodium is often the cause of constipation and is most often overlooked.

Personally I’d be tempted to go back to the way you were eating when you had the amazing weight loss, but making sure your sodium intake is high enough. Fibre really is over-rated and there’s plenty of research that shows it does more harm than good. Some people seem to need it, but most do better without it.

(Carl Keller) #3

2+ teaspoons of salt per day should be adequate.

As for fiber:

The role of dietary fiber in constipation is analogous to cars in traffic congestion. The only way to alleviate slow traffic would be to decrease the number of cars and to evacuate the remaining cars quickly. Should we add more cars, the congestion would only be worsened. Similarly, in patients with idiopathic constipation and a colon packed with feces, reduction in dietary fiber would reduce fecal bulk and volume and make evacuation of the smaller and thinner feces easier. Adding dietary fiber would only add to the bulk and volume and thus make evacuation even more difficult.


@CarlKeller is faster at typing than me. :grinning: :clap:

The problem here may be the fibre based on what you have provided.

There is a general misunderstanding about fibre in a low carb diet.

Please search keto and fiber or fibre in these forums.

There are also video resources, such as Dr. Zoe Harcomb’s presentation on fibre in low carb diets.

The nurse in the emergency room may have sent you down the wrong path in terms of added fibre in the diet.

For some people on a standard western diet the fibre is needed to transport potentially toxic, highly digestible food stuffs and food-like substances through the small intestine where there is the risk that they are absorbed. There is benefit of fibre in the diet for those eating a standard western food pyramid style, or junk food driven diet. The diet many low carb eaters switched from.

People can unwittingly increase their fibre consumption on a keto diet leading to constipation episodes.

What I’m saying seems counterintuitive.

Did someone, probably someone espousing “common sense" rather than research, also ever say, if you eat fat you get fat? But I’m trusting that didn’t ring true for a low carb eater. So a seemingly counter-intuitive claim, counter to popular wisdom, about fibre and its role in constipation should not be too easy to dismiss.

In the scenario described we see: green leafy vegetables + whole fruit + nuts + seeds + psyllium. That is a big dose of fibre.

The magnesium may be of benefit for its laxative effect as well as its increased requirement in a lower insulin body state.

I’ll let you do the research about fibre. It may be best to reduce it to resolve constipation symptoms.


Psyllium husk is a complete disaster for me- completely backs me up. How long have you been taking it?

(Not a cow) #6

IMO the best source of fibre for the ketogenic woe is an avocado. Has both soluble and non-soluble fibre about 9 grams in total. I don’t like that feeling of constipation either so I have found that by using psyllium husk capsules, like metamucil or other store brand name, about 1/3 of the listed dose, keeps me regular, without a struggle. That’s about 2.75 grams per day, which is less than what you sprinkle on foods already. Too much fibre and or too much dairy can act as a block so be careful with your choices.

This video has some good idea’s.

Oh ya, forgot to mention that a large 16 ounce glass of water, first thing after I get up, starts everything moving in the right direction, and also a good re-hydration after a nights sleep.

(Hyperbole- it’s the best thing in the universe! ) #7

(BostonterrierLvr) #8

I had my gallbladder removed years ago and always had diarrhea pretty much every day. I got used to it and when I did Atkins and lost over 100 lbs I had no issues at all with constipation. But when I decided to go Keto I had maybe 3 or 4 days of constipation which really surprised me. I increased salt and water and it passed and no problems since.

(Old Baconian) #9

Too little sodium causes constipation, for a reason that Dr. Phinney explains in one of his videos, but which I’ve forgotten (one of these days I’ll have to re-watch all my bookmarks and categorize them). The sweet spot for maximum health is 4-6 grams of sodium daily, which is 10-15 grams of sodium chloride, or 2-3 U.S. teaspoons. This amount includes salt already present in food, btw. Ignore governmental advice; the U.S. recommendation is particularly inadequate.

I can tell whether I’m getting enough salt by the effect on my digestion. Too much salt has an effect, as well; a different effect, but a noticeable one, lol!

P.S.—Migraines are another symptom of low sodium, btw.

(Michael - Don't expect miracles and you won't be disappointed.) #10

I think all the bases have been covered already. So I just want to emphasize that you don’t need to eat lots of leafy greens and fibre (in your case psyllium) and they may, in fact, be making things worse. I do have one thing to add, however, that may prevent any further emergency room visits. MCT oil and/or powder can be used as laxative in sufficient quantities: 2 or 3x your daily dose of oil listed in the OP taken at once and/or 20-30 grams of the powder dissolved in warm/hot water. I’m just guessing at the quantities, so adjust to get the desired result. If you can do so without throwing up take it on an empty stomach. If not, eat something first.

OK, a second thing. There might be some specific food item that is causing the problem. In my case, early on I discovered that cream cheese did it for me. I love cream cheese but I know if I eat too much or too frequently it will result in plug ups. Therefore, cream cheese has become only an occasional and minor treat.

(Old Baconian) #11

Am I the only person tempted to insert a Monty Python reference here? :bacon:

(Susan) #12

Okay! I have been having this problem myself, but I think I finally figured out the problem for me.

Coconut! I started being constipated after Keto, so I added tons of salt (didn’t help, but the salt has helped my leg cramps and I am keeping it, it helps for sure, just didn’t help me for the constipation). Then I eliminated all sugar substitutes (as they were making me not lose weight) then I eliminated dairy (still constipated and stalled), eliminated coffee (not a big deal as I have never really liked coffee, was drinking because I was trying Keto coffee and for the caffeine), I was frustrated, was trying to do a Fat Fast, the pains were terrible in my stomach, I thought what is going on… well Coconut seemed to be the culprit.

Yesterday, I took a big Tablespoon of Pink Himalyan Salt, 4 cups of boiled water, 2 more mag cit pills, and broke my fast at 48 hours and had 2 sausages hubby had barbecued, and a small spinach salad, and I went 3 times in a row (was loose but manageable) and now I have decided no Coconut for a while, to see if this is indeed what was causing my issues.

I take all this daily; some of them way more recently, some since starting Keto. Before Keto I was only taking my prescription Singulaire for my asthma and the Omega3’s daily. The others I added since Keto.

A lot of people mentioned adding the Meg Cit pills, I was taking them, but when I took to more, that seemed to help. The bottle says 2 a day, I have been taking 2 in the morning, maybe the trick is one in the morning and one in the evening before bed (as Ilana_Rose suggested). Maybe because I am still so overweight, at my bulk I need the 4, not sure, but the 4 yesterday worked.

So, I would suggest you buy Magnesium Citrate, and take that daily, and salt, whatever type you choose. I take the Pink Himalyan, @amwassil told me last night that Redman’s Real Salt is the best (you can buy it from Walmart), @KidKeto said that Truffle Salt is the best (not sure where we can buy that one).

Regardless which of these salts you wish to use, it seems important to get some, so this is what has worked for me, and I was in mega pain yesterday so I had to do something. I hope you can utilize the ideas on this thread and get some relief as well =).

(squirrel-kissing paper tamer) #13

I think you got a bunch of good advice, especially in regard to adding salt. I just wanted to stop in and say congratulations on the success you had and that it sounds like your body likes low carb and reacts quickly to it. Good for you.

Also, that sometimes I get a little too wild with the salt and have what I can only describe as water butt. It’s like I accidentally ate a saline laxative. Probably TMI, but might help someone suffering from severe constipation. That is all. :grin:

(Cristian Lopez) #14

Yeah I’m a fan of drinking my salt! But trust me, you don’t want to add a savory salt like truffle salt to a home batch of keto-aid. :sweat:

(Susan) #15

I cannot drink salt in water, because I am not a fan of anything salty… I eat it directly and then gulp down 32 ounces of water, I do that twice a day, and more when I am Fasting.

Where do you buy the Truffle Salt?

(Consensus is Politics) #16

“…And now for something completely different…”

(Consensus is Politics) #17

OK… I figure its a typo, and it should read 500mg, but it says 500ml x2, 3x a day! LMAO!

Thats an aweful lot of ACV at one time 1 litre of ACV 3x a day… [and I thought I was extreme :cowboy_hat_face: ]

Keto Vitae!

(Susan) #18

eeek yes, it should be mg =) thanks for the correction =).

(Karen Sharkey) #19

I’m almost into my third week of keto eating, and I’m having the opposite effect: diarrhea like nobody’s business. I can’t leave the house in the morning at all. Previously, for years, my diet has been low fat. Now all this fat is really greasing the pipes, so to speak! I’ve also been low salt because of high blood pressure. Is it OK to take a medication for diarrhea? I’ve also had IBS, during which attacks you’re not supposed to take these medications, so I wonder if keto is the same. I don’t feel well most mornings now, and my exercise routine has gone out the window (except for swimming, which I do everyday it’s not storming), I’m so tired. I’m 70, so maybe it’s just taking me longer than you younguns to adjust?

(Susan) #20

Some people on here say the Coconut gives them the runs; so if you are taking it, maybe stop? I have stopped because it was giving me constipation and making me stall losing weight. I am 54 and post menopausal too. For sure everyone’s body is different. Maybe reduce the fats a bit? You might be getting too much lubrication? I hope it settles down for you =).