Keto Diet and Gut Health: Can Keto Diet Cause Digestive Problems or is it recommended by doctors?

The ketogenic or ‘’keto’’ diet is a high-fat, low-carbohydrate diet that has recently become popular due to its purported health benefits. It involves cutting back on carbohydrates and getting your calories; mainly a lot of healthy fats and adequate amounts of protein. 

Dietary regimens, such as fasting, have been used for treating epilepsy for centuries. It is generally used for kids or adults with epilepsy who do not respond to seizure medications.

In the 1970s, Dr. Robert Atkins wrote a best-selling book that emphasized a low-carb diet known as the Atkins diet. The first phase of this diet was similar to the keto diet. The Atkins diet gained popularity in the late 1990s and enjoyed a good run over the next decade until it fell out of popularity. However, the trend emerged again several years later. Thanks to celebrity keto transformations and a slew of keto diet cookbooks and niche products.

This article looks into the science behind the keto diet and its effect on gut bacteria and its health, that is, the gut microbiome and other health aspects.

What is the Keto Diet and how does it work?

There are three energy sources in food; carbohydrates, fat, and protein. When you eat a meal, your body first breaks down carbohydrates, then fats, and finally proteins.

The ketogenic diet involves limiting your carbohydrate intake to 20 to 50 grams per day and loading up on fats. Although there are many versions of the ketogenic diet, the standard ketogenic diet (SKD) is the most extensively studied and recommended. It typically contains 10% carbohydrates, 20% protein, and 70% fat.

This puts your body in a metabolic state known as ketosis, or ketone-burning. Ketone bodies are chemicals that are produced by your liver when it breaks down fat. When you reduce your carbohydrate intake drastically, your glucose stores deplete. This reduces your insulin levels and your body burns stored fat for energy instead of carbohydrates, which is the body’s preferred source of energy. In other words, insulin is the deciding factor in whether your body will use carbohydrates or fat as fuel. Your body will utilize carbohydrates if you have high insulin levels and fat if you have low insulin levels.

When following a keto diet, it is important to consume protein in moderation as consuming too much protein can be converted into glucose and slow down your transition into ketosis. As for the carbohydrate content, some people count their total carbohydrate intake, while others count their net carbohydrates, which refer to total carbohydrates minus fiber. This is because fiber is undigestible and is not absorbed by the body. 

Performing intermittent fasting can help you achieve ketosis more quickly as this helps you manage spikes in your blood sugar levels. The most common method of intermittent fasting involves eating only for a period of 8 hours per day and refraining from consuming any calories for the remaining 16 hours. You can determine whether you have entered ketosis with the help of blood, urine, and breath tests, which measure the ketone levels of your body. Symptoms of entering ketosis include decreased hunger, dry mouth, increased thirst, and frequent urination. 

Foods you can Eat in a Keto Diet

Here are some of the healthy food options you can eat on a keto diet. 

1. Meat and poultry
   Meat and poultry are considered staples on a keto diet. These include pork, chicken, lamb, bacon, and ham. They are great sources of protein and can help you preserve muscle mass during the keto diet. If possible, choose grass-fed meat as it contains more conjugated linoleic acid (CLA) and omega-3 fats than grain-fed fed meat.
   
   
2. Fish and seafood
   Fishes like sardines, salmon, and mackerel are nearly carbohydrate-free and contain high amounts of omega-3 fatty acids. However, the amount of carbohydrates in shellfish depends on its type. While crabs and shrimp don’t contain any carbohydrates, oysters and scallops do contain some carbohydrates and should be consumed in moderation. 
   
   
3. Eggs
   Eggs are a great source of protein while being low in carbohydrates. They are known to increase feelings of fullness and promote satiety. Since most of the nutrition is concentrated in the yolk, it is best to eat whole eggs. Although egg yolks are high in cholesterol, they don’t appear to raise your blood cholesterol levels. 
   
   
4. Healthy fats
   There are many low-carb healthy fats that you can consume on a keto diet. These include cold-pressed olive oil, avocado oil, coconut oil, butter, heavy cream, and Greek yogurt. In addition to this, there is a wide range of keto-friendly cheeses, such as cheddar, feta, mozzarella, parmesan, and cottage cheese made from full-fat milk. Consuming dairy products during ketosis can help retain muscle mass and strength.
   
   
5. Vegetables
   Consuming vegetables is highly recommended on a keto diet as they provide you with enough nutrients and fiber and keep you from getting constipated. Some low-carb options include broccoli, mushrooms, celery, zucchini, cauliflower, and all green leafy vegetables. You can also consume sauerkraut, kimchi, and fermented vegetables for added health benefits.
   
   
6. Plant-based milk
   Many varieties of plant-based milk are suitable for keto, including soy, coconut, cashew, and almond milk are keto-friendly. However, you must avoid oat milk as it is high in carbohydrates.
   
   
7. Protein shake
   Most protein shakes are keto-friendly, especially the ones that don’t contain added sugar. They are also a great option for vegetarians as it allows them to meet their protein requirements without consuming a lot of carbohydrates.
   
   
8. Dark chocolate and cocoa powder
   Cocoa is a great source of antioxidants and comes with a wide range of health benefits. You can consume dark chocolates with at least 70% cocoa content in moderation. However, it is best to consume dark chocolates sweetened with stevia or monk fruit as they are completely carb-free.
   
   
9. Low-carb fruits
   Although most fruits are high in sugar and are not recommended on a keto diet, some low-carb fruits are exceptions. Fruits such as strawberries, raspberries, blackberries, blueberries, kiwi, watermelons, and plums are low in sugar. These fruits are abundant in essential nutrients and phytochemicals that are important for health. Even if you are consuming keto-friendly fruits, it is important to be mindful of portion sizes. 
   
   
10. Nuts and seeds
    Most nuts and seeds are generally low in carbohydrates and high in fat. They are also high in fiber and can help you feel full for longer. The best options for a keto diet include almonds, walnuts, pecans, macadamia nuts, flaxseeds, pumpkin seeds, and chia seeds.
    
    
11. Beverages
    Beverages such as tea and coffee don’t contain any carbohydrates and are allowed on a ketogenic diet. They both contain caffeine, which is known to boost metabolism and improve physical performance. You can add heavy cream to your tea or coffee, but you will need to avoid milk, sugar, or any high carbohydrate flavorings. 

Sparkling water is another carbohydrate-free beverage and is a great alternative to soda. These refreshingly fizzy beverages may be flavored, but they generally don’t contain added sugars. Make sure to check the label to ensure it doesn’t contain any sources of carbohydrates.

Influence of Alcohol and Tobacco on Keto

• Alcohol
  The keto diet typically requires you to give up on high-carb drinks, such as soft drinks and alcohol. However, there are certain alcoholic drinks that contain little or no carbohydrates and are suitable for a ketogenic diet. These include wine, light beer, vodka, gin, and whiskey.
  
  In general, it is better to spend your carb budget wisely and save your limited daily allowance for nutritious foods, such as fruits and vegetables. Moreover, alcohol can get in the way of nutrient absorption and is best avoided during this phase. If you must drink on a keto diet, limit your alcohol intake to 1-2 drinks per day as too much alcohol can get you out of ketosis.

• Tobacco
  While there are other health concerns regarding smoking, it does not have any effect on blood glucose levels and will not affect your state of ketosis. 

Health Benefits of a Keto Diet

There is promising research that suggests that following a keto diet can help with certain conditions. If you want to treat any of these health conditions, you may seek your doctor’s advice to know if taking up the keto diet is a good option for you. 

1. Reduces inflammation
   Acute inflammation is your body’s natural response to infection and illness and helps to protect you from damage. However, chronic, or long-term chronic inflammation in the gut can trigger disease responses, such as inflammatory bowel disease (IBD), ulcerative colitis, and Crohn’s disease. Evidence suggests that a keto diet can help reduce inflammation in the body.
   
   A 6-month study conducted on 59 people showed that following a low-carbohydrate diet could reduce inflammatory biomarkers better than a low-fat diet ^[1].
   
   
2. May help with certain digestive disorders
   Certain types of carbohydrates, known as FODMAPs, can aggravate symptoms of irritable bowel syndrome (IBS). Since the keto diet is extremely low in carbohydrates, it can help treat IBS symptoms.
   
   A study conducted on 13 people showed that a low-carbohydrate diet improved IBS symptoms, such as abdominal cramps, diarrhea, and gas ^[2].
   
   What’s more, a case study conducted on a 14-year-old boy showed that a paleolithic ketogenic diet reduced the symptoms and abnormalities of Crohn’s disease ^[3].
   
   
3. Promotes weight loss
   The ketogenic diet is one of the most effective and quickest fat-burning diets that exist and is particularly beneficial for reducing belly fat. It makes your body utilize dietary fats as well as the stored fat in your body for energy. Additionally, it lowers your insulin levels, which leads to rapid weight loss.
   
   Reducing your carbohydrate intake and consuming more healthy and high-fat diets and proteins reduce appetite and food cravings. Many experts believe that this is due to increased satiety due to the high-fat content in the diet. However, studies have shown that the keto diet is effective for only 3 months, after which the weight loss effects plateau and you stop losing any more weight.
   
   A review of 11 studies found that people who followed a ketogenic diet weighed 5 lbs less than those who followed a low-fat diet for 6 months ^[4].
   
   
4. Improves cardiovascular health
   A high-fat diet to tackle heart disease may sound counter-intuitive at first, but a keto diet can have positive or negative effects on heart health, depending on your choice of fats. Remember, a keto diet doesn’t have to be just about red meat and fried foods. Consuming good fats, such as those from fatty fish, olives, avocados, nuts, and seeds is highly beneficial for improving one’s cardiovascular health as it increases the body’s HDL or good cholesterol levels.
   
   
5. May improve cognitive functions
   The keto diet causes ketones to become the primary energy source for the brain, which makes it a better fuel source than glucose. It also helps to reduce inflammation in the brain and promotes the synthesis of important neurotransmitters in the brain. This helps to improve your cognitive functions, such as attention, memory, thinking, and decision-making.
   
   A study conducted on children with epilepsy showed that the number of seizures reduced to less than 50% for more than half of the children following a keto diet and 16% became seizure-free ^[5]. 
   
   Furthermore, a literature review from 2019 suggests that the ketones produced in the body during a keto diet have neuroprotective effects, meaning that they can protect and strengthen nerve and brain cells ^[6].
   
   
6. Increases insulin sensitivity
   Keto and other low-carbohydrate diets regulate your blood glucose level and increase insulin sensitivity. This is attributed to the high levels of ketones in the body and not just the reduced carbohydrate intake. Moreover, excess weight causes your tissue cells to become resistant to insulin. Thus, weight loss from the keto diet itself can contribute to improved insulin sensitivity.
   
   
7. Reduces blood pressure
   High blood pressure is a common contributor to many diseases, such as kidney failure, heart disease, and stroke. Low-carbohydrate diets are effective at lowering your blood pressure. This can reduce your risk of various diseases and increase your life expectancy.
   
    
8. Reduces PCOS symptoms
   Polycystic ovary syndrome (PCOS) is a condition that may result in polycystic ovaries, ovulatory dysfunction, and the production of excess male hormones. It also leads to various adverse effects, such as acne and weight gain. A keto diet can improve markers of PCOS by promoting weight loss, restoring hormonal balance, and improving insulin resistance.
   
   A literature review of studies from 2019 showed that following a keto diet was beneficial for people suffering from hormonal disorders, such as PCOS and type 2 diabetes. Although they cautioned that the studies were too heterogenic for the diet to be recommended as a general PCOS treatment ^[7].

Side effects of the Keto Diet

Just like any other diet, the keto diet has its downsides. These include:

1. Potential nutrient deficiencies
   The keto diet involves restricting food items, such as grains, legumes, fruits, and starchy vegetables, which are abundant in essential nutrients and antioxidants. This may cause you to be deficient in certain nutrients. You can prevent nutrient deficiencies by keeping your diet as diverse as possible and through supplementations such as Keto Charge, learn more about this Keto BHB Supplement from here!
   
   
2. Keto flu
   Keto flu refers to a collection of symptoms that typically occurs during the first week of starting a keto diet. People often experience headaches, nausea, and fatigue, as a result of a sudden change in their eating habits. Luckily, these symptoms only last for up to a week for most people. Staying hydrated and maintaining high electrolyte levels in the body can help to recover from the flu quickly (or avoid it entirely).
   
   
3. May cause constipation
   The keto diet requires you to make a major shift in your macronutrient intake, which may cause you to be constipated, especially if you don’t consume enough non-starchy vegetables. To combat this problem, make sure that most of your carbohydrate intake comes from vegetables. If you feel constipated while following a keto diet, psyllium husk is a keto-friendly option that can help regulate your bowel movements. 

Foods to Avoid when on Ketogenic Diets

Here is a list of the foods that you must avoid (or limit) during a keto diet. 

1. Bread, pasta, rice, and other starchy foods
   Food grains, such as wheat, rice, and oats are very high in carbohydrates. While these foods are healthy in general, they are not suitable for people following the keto diet and may throw you off ketosis. You may experiment with keto-friendly bread made from almond flour, nuts, seeds, and eggs. You can also use non-starchy vegetables as a substitute for starchy foods. For instance, mashed or riced cauliflower can be used for potato-centered recipes.
   
   
2. Starchy vegetables
   Due to their high carbohydrate content, starchy vegetables, such as potatoes, sweet potatoes, yams, peas, corn, and beetroot should be avoided during the keto diet. If you crave starchy vegetables, you can grate them on top of your salad bowl instead of using them as one of the main ingredients in your dish. Alternatively, you can swap these vegetables for small amounts of jicama, which is comparatively lower in carbohydrates and is a good substitute for starchy vegetables. 
   
   
3. Legumes
   Despite being great sources of protein and other nutrients, legumes like lentils, beans, and chickpeas can be difficult to incorporate into a keto diet due to their high carbohydrate content, unless you eat them in extreme moderation.
   
   
4. Most fruits
   Despite being rich in nutrients and antioxidants, fruits like bananas, mangoes, oranges, and grapes are naturally high in sugars, primarily glucose and fructose. They can keep you from maintaining ketosis and should be completely avoided when following a keto diet.
   
   
5. Low-fat diet foods and spreads 
   While low-fat spreads and diet foods are often a staple for people on weight loss diets, they skimp on the fat, which fuels you on a keto diet. Moreover, these foods often contain added sugars to make up for the lack of fat. And although they are not good for you anyway, it is particularly important to watch out for these items when following a keto diet.
   
   Common reduced-fat foods include:
   • Fat-free or low-fat mayonnaise
   • Fat-free or low-fat yogurt
   • Low-fat salad dressings
   • Reduced-fat or skim milk
   • Low-fat peanut butter
     
6. Honey and syrups
   Honey and syrups like maple or agave are high in natural sugars. While they do contain some nutrients and antioxidants, they can easily exceed your daily carbohydrate limit. Thus, natural sweeteners should be avoided on a keto diet as they can spike your blood sugar levels and knock you out of ketosis.
   
   
7. Ketchup and other condiments
   Ketchup, sriracha, barbecue sauce, and many other condiments are packed with sugar and it is best to avoid them when following a keto diet.
   
   If you want to add more flavour to your meals, try vinegar-based hot sauces like Tabasco or other keto-friendly sauces without added sugars. Adding herbs and spices to your meals is also a great way to make your meals more nutritious and palatable without adding more carbohydrates to your diet. Whole-grain mustard and fat-rich mayonnaise are also great options. Just make sure to check the ingredients and carbohydrate content on the label.
   
   
8. Beer, cocktails, and mixed drinks
   Beer, cocktails, and mixed drinks are high in carbohydrates and provide little nutritional value. Besides, most of the carbohydrates in mixed drinks come from juices, sodas, and purees, which should be avoided on a keto diet.

Is the Ketogenic Diet doctor recommended?

Since the keto diet helps regulate your blood glucose levels, some doctors recommend it as a short-term treatment for obesity, epilepsy, and nonalcoholic fatty liver disease (NAFLD). 

However, the diet is not recommended for certain people, including:

• Women under 18 years of age and men under 21 years of age
• People taking medications for major health problems, such as kidney damage, heart disease, and diabetes
• Pregnant or breastfeeding women 
• In-season athletes

How long does it take for effects to manifest?

It usually takes 2-3 days for most people to enter ketosis. However, some people may take a week or longer. Ideally, a keto diet should last anywhere between six weeks to three months. This allows you to reap the health benefits of the keto diet while keeping its side effects to a minimum. 

Recommendations

1. While the keto diet may benefit weight loss and metabolic health, it can sometimes lead to digestive challenges due to its high-fat, low-fiber nature. Biotics 8 can complement the keto regimen, supplying the prebiotic fiber and probiotics needed to support a healthy gut microbiome amidst such dietary restrictions.

2. Given the specific nutritional focus of the keto diet, women considering this lifestyle may find particular benefit in Yourbiology Gut+. It provides a targeted blend of gut-nourishing ingredients that work to maintain digestive harmony and counterbalance the potential gut flora changes induced by a ketogenic dietary pattern.

Additional considerations on a Ketogenic Diet

1. Exercise
   Exercise boosts your metabolism and improves your energy levels. Evidence suggests that working out on a keto diet can boost your fat-burning ability. In addition to this, exercising can put you into ketosis faster by depleting your sugar levels and glycogen stores.
   
   Ideally, you should aim for low to moderate exercise 3-5 times a week. Yoga, jogging, swimming, rowing, and biking are some examples of workouts that are particularly beneficial on keto. Although you can include high-intensity workouts that you enjoy, it may be slightly more difficult when following a keto diet, since carbohydrates are the main source of energy for intense workouts.
   
   
2. Sleep
   Getting adequate and high-quality sleep is important if you want to get the best results from this diet. This is because sleep allows your body to repair itself and regulates your hormones. A lack of sleep can increase your cortisol levels and cause food cravings, which can make the keto diet less effective. Aim to get at least 6-7 hours of sound sleep every day.
   
   
3. Supplementation
   • Electrolytes: On a keto diet, you are prone to electrolyte imbalance as you tend to lose potassium, phosphorus, magnesium, sodium, and chloride during ketosis. Natural sources of electrolytes include non-starchy vegetables, bone broth, and sea salt.
   • Omega-3 fatty acids: They are highly anti-inflammatory and have positive effects on triglyceride and insulin levels. They also aid muscle recovery after a workout. You can get omega-3 fats from salmon, walnuts, and flaxseeds.
   • Medium-chain triglycerides (MCT) oil: It is a type of fatty acid naturally found in coconut oil that helps metabolize fats to be used as a fuel source. Since MCT is not present in many foods, supplementation can help you reap the benefits of these fats. 
   • Digestive enzymes: A blend of digestive enzymes that break down proteins (proteases) and fats (lipases) and help improve digestion. It can also help reduce post-workout muscle soreness. 

Conclusion

The keto diet works by changing the way your body uses food. Although it is one of the emerging diets, the diet seems to have numerous health benefits. Not only can it boost your metabolism and help you lose weight, but it can also improve human gut microbiota and health, reduce blood sugar and blood pressure, and lower your cholesterol. However, due to its restrictive nature, it is more suitable for a short period of time.

For keto to be effective, it is important to keep your carbohydrate intake well below a threshold. As a result, many otherwise healthy foods are considered off-limits when following a keto diet, including grains, legumes, starchy vegetables, and most fruits.

In general, the more you avoid processed and ready meals, the more effective your diet will be. Therefore, it is highly advisable to eat homemade food during this diet so that you have more control over what you eat. 

References

1. Jonasson L, Guldbrand H, Lundberg AK, Nystrom FH. Advice to follow a low-carbohydrate diet has a favourable impact on low-grade inflammation in type 2 diabetes compared with advice to follow a low-fat diet. Ann Med. 2014 May;46(3):182-7. doi: 10.3109/07853890.2014.894286. Epub 2014 Apr 30. PMID: 24779961; PMCID: PMC4025600.
   
   
2. Austin GL, Dalton CB, Hu Y, Morris CB, Hankins J, Weinland SR, Westman EC, Yancy WS Jr, Drossman DA. A very low-carbohydrate diet improves symptoms and quality of life in diarrhea-predominant irritable bowel syndrome. Clin Gastroenterol Hepatol. 2009 Jun;7(6):706-708.e1. doi: 10.1016/j.cgh.2009.02.023. Epub 2009 Mar 10. PMID: 19281859; PMCID: PMC2693479.
   
   
3. Csaba Tóth¹, Andrea Dabóczi¹, Mark Howard², Nicholas J. Miller², Zsófia Clemens^1,3
   
   
4. Mansoor N, Vinknes KJ, Veierød MB, Retterstøl K. Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: a meta-analysis of randomised controlled trials. Br J Nutr. 2016 Feb 14;115(3):466-79. doi: 10.1017/S0007114515004699. PMID: 26768850.
   
   
5. Zupec-Kania BA, Spellman E. An overview of the ketogenic diet for pediatric epilepsy. Nutr Clin Pract. 2008 Dec-2009 Jan;23(6):589-96. doi: 10.1177/0884533608326138. PMID: 19033218.
   
   
6. Rusek M, Pluta R, Ułamek-Kozioł M, Czuczwar SJ. Ketogenic Diet in Alzheimer’s Disease. Int J Mol Sci. 2019 Aug 9;20(16):3892. doi: 10.3390/ijms20163892. PMID: 31405021; PMCID: PMC6720297.
   
   
7. Stocker RK, Reber Aubry E, Bally L, Nuoffer JM, Stanga Z. Ketogene Diät: evidenzbasierte therapeutische Anwendung bei endokrinologischen Erkrankungen [Ketogenic Diet and its Evidence-Based Therapeutic Implementation in Endocrine Diseases]. Praxis (Bern 1994). 2019 Jun;108(8):541-553. German. doi: 10.1024/1661-8157/a003246. PMID: 31185843.