Could Going Keto Be
Killing Your Gut?

The low-carb, high-fat ketogenic diet is one of the hottest new crazes on the ever-growing market of diets. It’s been said to help you lose weight, burn fat, and get fitter faster.

It’s a runaway train of unending promises of health and happiness. But should we be ready to apply the brakes?

What is Keto?

In simple terms, a strict ketogenic diet is a diet that consists of mostly fats (80%), a little protein (15%), and a very low carbohydrate intake (often under 50 grams per day!). This puts your body in a state of ‘ketosis’, where it produces molecules known as ketone bodies (from fat) to use as energy.

The Dreaded ‘Keto Flu’

Anybody that has tried keto will be sure to tell you about the ‘keto flu’, a series of symptoms that occur when you make the change to the ketogenic diet. This often includes a series of nasty gut complaints, such as:

  • Constipation
  • Diarrhoea
  • Flatulence
  • Bloating

What Could Cause These Problems?

  1. Constipation Concerns (lack of fibre): Fibre intake is often lower in keto diets, due to lower fruit and veg consumption. While some greens and berries are allowed, the fibre obtained from these may not be enough. In ketogenic lab conditions fibre consumption is as little as 12 grams daily. The UK guideline is 30 grams of daily fibre minimum, so there can indeed be a deficit when going keto. Soluble fibre in particular is low, which smooths the transition of our stools (poo!).
  2. Diarrhoea Disaster: Many keto dieters consume MCTs as part of their routine, sometimes even added to their morning coffee. MCT stands for 'medium chain triglycerides', which are naturally found in coconut and palm oils. The problem is that MCT intake doesn’t allow your body to release bile (which helps digest fats) properly. This can lead to diarrhoea.
  3. Detrimental Dehydration: Because few carbs are being consumed, insulin levels fall in your body. Insulin is important for the body to hold sodium (that’s salt to you and me!). Losing sodium also means losing water… This can cause diarrhoea and also cause the cells of your gut lining to work less efficiently!
  4. Bacterial Imbalance: High fat intakes can change your gut bacteria. Unwanted changes may increase the risk of gastrointestinal damage and disease. We also know of different individuals having different enterotypes - that is, different predominant bacterial colonies. Some may be able to tolerate high-fat better than others, but this is not the case for all of us. In particular if high-fat intake doesn't go well with your system.
  5. Impending Inflammation: Studies have shown that certain groups of bacteria can be promoted by high fat diets that could cause inflammation, which may lead to gut damage.
  6. FODMAP troubles: Many of the vegetables allowed on the keto diet are FODMAPs. FODMAPs are sugar alcohols and short-chain carbs that are poorly absorbed by the body. This, in turn, can cause bloating and flatulence when broken down by our gut bacteria. Restricting the types of fruit and veg you consume can be a big problem when going keto.

These are just 6 of the many ways that you could be negatively affected when going keto. But there’s one more key consideration. We’re all unique individuals, which means that some people may respond far more negatively than others to this kind of diet, maybe even with vomiting, fatigue, and other unwanted symptoms!

The Bottom Line

The ketogenic diet was designed as a medical diet and could be harmful to implement yourself. That’s why knowing the dangers is vital...

And personalisation is key!

Here at The Health Sciences Academy, our team of scientists and our nutrition graduates understand the importance of reducing the risk of harm...

And when it comes to going keto, just know that it's not completely 'risk free' and that it's important to be aware of its side effects and contraindications. That’s why we’ll continue to extensively research the ketogenic diet in order to help you make informed decisions for yourself.

In the meantime, check out some of our Continuing Education trainings below in relation to ketosis, appetite, and brain performance.


Leave A Response

34 Comments

  • Luiggi

    Reply Reply September 13, 2018

    That’s why I don’t trust anyone else than the team at The Health Sciences Academy, they are amazing!!!!

  • Jack Holloway

    Reply Reply September 13, 2018

    Interesting article! There’s so much misinformation out there surrounding keto, so thanks for sharing the actual science!

  • Maria

    Reply Reply September 13, 2018

    Finally some sense surrounding the keto fad! Thank you guys!

  • Alicia

    Reply Reply September 13, 2018

    Good thing I read this! I was supposed to start with my Keto Diet. Thank you for educating me The Health Sciences Academy!

  • Barbara Seal, M.D., Ph.D.

    Reply Reply September 13, 2018

    Excellent article, and spot-on. It’s been frustrating seeing some of the leading researchers go behind this fad and support it all over the media. Well done, thanks for the interesting read!

    • dr johnson

      Reply Reply September 13, 2018

      i so agree with this… frustrates me MASSIVELY…….

  • Clark

    Reply Reply September 13, 2018

    Have been wondering a lot about Keto and whether I should try it or not. But there’s really something about it that just doesn’t sound right. Finally, some great reference before I finally decide!!! Thanks for the science!

  • Isaac Poulter

    Reply Reply September 13, 2018

    An eye-opening piece. I must admit I’d never considered that keto might do things like this. It makes you wonder where all the hype comes from!

  • Dillon

    Reply Reply September 13, 2018

    I tried this diet previously and wish I had been given more info about the gut symptoms before I started. Very useful compared to what other people don’t tell you

  • Beatriz

    Reply Reply September 13, 2018

    Cool info thanks. My brother did keto for a month. Had to go to the doctor every week to get his blood tested and checked out. Guess short term was ok for him. Once he lost the initial weight (wedding prep) went off keto and now he’s just paying more attention to his choices.

  • Kendra

    Reply Reply September 13, 2018

    I enjoyed reading the warning signs, thanks

  • anna

    Reply Reply September 14, 2018

    There are so many people that tries this diet and that supports it 200%, thanks for the science in this and how it affects the gut, this is so important, that´s why I only stick with The health sciences Academy :-) .

  • Karina L.

    Reply Reply September 14, 2018

    There’s no way I can live on fat bombs….

    I need my carbs and my mountains of vegetables, thanks very much!

  • anita mcskimming

    Reply Reply September 14, 2018

    Reduced all my inflammatory markers on keto. Feel so much better and lost a ton of weight. Constipation is easily sorted so is diarrhoea. But considering I suffered terrible irritable bowel before, so much so I would be in agony or on the toilet constantly, this diet has changed all that. Dehydration is easily sorted too as is salt loss. It’s not difficult to follow it and learn about it,

  • Rachel Peterson

    Reply Reply September 14, 2018

    Keto works- I’ve had extremely great success with it. No adverse reactions. This seems like just another way someone is trying to be the middle man and not allow the layperson to take their health into their own hands! The more research someone does THEMSELVES instead of just taking this mini “article” (lack thereof) as “fact”, the better off they will be. There is a lot to becoming keto adaptive- do your due diligence. I stand firmly pro keto.

  • Karen D.

    Reply Reply September 14, 2018

    Helpful information!

  • Joanne

    Reply Reply September 14, 2018

    This diet sounds remarkably like the Atkins diet, from a few years ago! Shame some people can’t see the damage they do to themselves inside, when trying to look good on the outside!!! Personally, I still believe balanced food group intake and lifestyle, including exercise, are the key to looking and feeling good. Just like anthing good coming to those who wait, you need to put in the effort and hard work to get the best out of yourself. There don’t appear to be any sensible, healthy, permanent short cuts. And I’ve tried loads!

  • Steph

    Reply Reply September 14, 2018

    This article isn’t correct.
    Protein is moderate not little on keto. Also there’s plenty of veg and fruit (berries) and plenty of fibre from them as well as from seeds.
    Also the sodium that is lost is replenished by adding salts generously to meals.
    I’ve been keto almost 2 years and reversed my diabetes, lowered my cholesterol and lowered my blood pressure as well as losing almost 100lb and being a healthy weight now instead of morbidly obese.
    My doctor fully supports keto and I’ve been monitored the whole time.
    Only positives have happened for me.
    I’ve never had mct oil. And don’t intend to.
    I’m the healthiest I have been in my life thanks to keto.

    • Steph – I’m so glad to hear you’ve done this with a doctor. That’s the whole point!

      A couple of things worth clarifying:

      1) Ketosis is achieved and monitored at about 15% protein. More than that, and gluconeogenesis may stop it.

      2) While some greens and berries are allowed when going keto, the fibre obtained from these may not be enough. In ketogenic lab conditions, fibre is as little as 12 grams daily (see citation above). The UK guideline is 30 grams of daily fibre minimum, so it’s easy to have a deficit when going keto unless you are more careful about this.

  • Aline Robinson

    Reply Reply September 14, 2018

    Hey Alex, thanks for the article. I heard that the Keto diet was used to treat epilepsy and was considering the option of getting my son who is 22 onto the diet to treat his seizures. What is your opinion?

    • Aline – My pleasure! Indeed, there’s quality research showing a reduction in seizure frequency and intensity. Always worth checking with a neurologist and asking about side effects and contraindications though, so your son can make an informed decision :-)

  • Jess

    Reply Reply September 14, 2018

    I don’t follow keto but I do follow low carb. The main thing for me is cutting out the sugar and everything that turns to sugar when it gets past your mouth and that includes bread, rice, potatoes and pasta. I do eat all my veggies because I love them. I have never been a big fruit eater so that part doesn’t bother me. The misconception that you have made in your article is that people doing this diet don’t eat veggies. They do! Not as full of the science as you claim it seems to me.

    • Jess – Pardon, who said vegs are not allowed?

      While not everyone going keto will eat greens and berries, in strict lab conditions some may be included.

      However, fibre can be as little as 12 grams daily (see citation above). This is nearly a third of the recommended guideline.

  • Ricky

    Reply Reply September 14, 2018

    Iv been on the Keto diet now for more than 6 month now.
    I had tests done and my cholesterol and blood glucose both went from 5.1 to 4.1. so this is great news for me.

    I did the advanced sport nutrition course from the Health Sciences Academy and before Keto I was eating according to their course content.

    After being on the keto diet I feel so good that I would not go back to any other diet.
    I have more energy, no after lunch slump, less food cravings, less body fat, lower resting heart rate and I feel great.

    I always struggled with constipation, bloating and flatulence, things that is claimed that you could have when on keto. Yet I dont have any of these symptoms anymore while on Keto.

    All the symptoms mentioned above are followed by COULD!!. Keto is the best thing Iv ever done and all my family and friends that have tried it agree.

    Rather first try it and give it a proper chance and verify that you are truly in Ketosis using a testing device.

    As far as keto flu is concerned, this only lasts between 1-4 weeks generally.

    All studies done in the last few years show that the keto diet really great. If you could prove based on clinical studies otherwise, I would be more than willing to listen.

    • Ricky – glad it’s working for you. Yes, keto risks are often ignored and little explored, though we’re seeing more evidence in recent years. The list of possible risks is getting rather long, but here are some examples:

      – Those of us who cannot metabolise ketones properly (e.g. CPT2 gene errors) may develop a fatty liver from this. This is currently being investigated further. Citation here.

      – Ketogenic dieting caused subclinical hypothyroidism within 12 months, thought to originate from decreased conversion of T4 to T3. Previous studies showed the same. Citation.

      – Ketogenic dieting increased arterial stiffness parameters, which may worsen preceding cardiovascular disease. Other studies cited within this one show heart risks too.

      – There are many other genetic and microbiomic contraindications for keto, and we share some of these here: https://thehealthsciencesacademy.org/nutritional-genetics-and-epigenetics-ce-2017198/

  • Lynne B Tagawa

    Reply Reply September 14, 2018

    I’ve been on a ketogenic diet to control seizures for 17 years. The first week was hard, as my body adjusted to burning fat. But after that I’ve felt great. At first I limited protein, as of course the theory is that at some point protein will be metabolized as sugar. But I gradually increased by protein (because of my body weight and the formula I was only getting 30-35 grams a day, not enough). Current understanding on the keto diet for seizures is that protein isn’t the big deal they thought. Getting sufficient protein is essential for protecting muscle mass during weight loss (which did happen for me, just a bit). I have discovered that a keto diet can be healthy or not–the basic definition is the ratio, saying little about what you’re actually eating. If you’re eating grass-fed beef, plenty of leafy greans, fermented foods at least occasionally, organic dairy, and good fats in the form of avocados, walnuts, etc., it can be extremely healthy.

    • Lynne, we’re glad to hear it’s helping with your seizures with no side effects, which sadly is not the case for everyone else as we’re seeing from clinical evidence. Since everyone responds differently, speaking with a neurologist is the best route. Keep us posted!

      THSA Team

  • John

    Reply Reply September 15, 2018

    I’m with you Alex. I think people with special circumstances like weight lose benefit the most from a Keto diet. Since I took your “Nutritional Therapy” course years back, I feel great with just exercise, my green shake everyday, and cutting out processed and non organic foods.

    • emma PT

      Reply Reply September 15, 2018

      same here, John.. also now studying for the Clinical Weight Loss certification, learning about personalization for different types of clients is wonderful

  • Michael Hare

    Reply Reply September 17, 2018

    Alex, what do you think of candida, the candida diet, and the coconut oil you use, 2 tablespoons a day. I hope you can reply. Thank you for your articles. I enjoy reading them.

    • Michael – Thanks for your questions!

      1) Regarding the Candida Diet: Many of the core principles of the diet encourage good behaviours like reducing sugar consumption, consuming healthy fats and proteins. However, it is important to note that most people don’t have a problem with Candida. Candida is often present naturally in our guts, and for most people is part of a normal, healthy gut ecosystem. Only when somebody has a compromised immune system or has been on a long course of antibiotics does it generally become a problem. Many who promote the Candida Diet blame Candida for all kinds of things, without good evidence that it is the actual cause. There is no good scientific evidence that the Candida Diet is beneficial to most of us, and candidiasis caused by Candida overgrowth is a serious condition that requires medical intervention.

      2) Regarding coconut oil: Whilst there is preliminary evidence that it could be beneficial for at-risk individuals (those with weak immune systems, or those who have received long-term antibiotics), there is no indication that it is beneficial for everyone. There are also other factors to take into account regarding coconut oil, such as its extremely high saturated fat content and some people may have issues with this, in particular when there’s genetic or familial risk. We break this down here: https://thehealthsciencesacademy.org/science-catch-up/science-catch-up-32/#topic1

      In a nutshell, recommending coconut oil to remove or eliminate Candida is not proven to have a benefit for most of us and may even come with other attached health risks.

      Hope this helps!

      Ewen, THSA Research Team

  • Lee Ching

    Reply Reply September 18, 2018

    Hi Alex, thanks for this article. It is very useful to me. How about intermittent fasting? What are the research information so far on the benefits and/or risks of intermittent fasting? Am keen to learn about the science-based information on this because it seems more people are hopping into it. Thanks.

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What If You Don’t Go To University

It’s August, which means it’s that time of the year again: A Level Results Day.

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