Keto & Constipation

When we embark upon a Ketogenic diet, the typical approach from the layperson is to go ‘hey, net 25g carbs, cool, I’ve got this’, however there’s a huge array of other important information that you should research before you plunge into a keto lifestyle, and one of them involves your butt. What goes in your mouth, must come out, and you’re about to change how your body goes about doing this.

When you restrict your diet to 25gNET carbs/day, your body will burn off its remaining glycogen stores, primarily stored in the liver, however there is also some stored in the muscles, just not as much. This process takes approximately 2-3 days. Now, your body has been incredibly reliant on carbohydrates for essentially its entire life. It has used carbohydrates as the quickest, easiest path for storing and retaining sodium. This sodium storage helps us stay hydrated and perform our cellular processes, flush waste products etc. Without carbohydrates, we have to supplement sodium continually throughout the day as it is now readily and rapidly excreted in urine. Meaning one swig of salt in the morning is not enough, it must be gradually consumed in small quantities. Salt is an emetic, large quantities will make you nauseated, and potentially may induce vomiting.

Your bottoms best friend!
Your bottoms best friend!

Why is this relevant to constipation? Your large intestine’s primary function, apart from being an incredibly strong muscle that moves waste to the rectum for elimination, is to re-uptake fluid. When you are dehydrated it will take every drop of useable water that was passed to it from the small intestine, and bring it back into the body for recycling. Your body is good at ensuring that you don’t die, it prioritises organs in order of importance for essential life function. It will do damage to the colon before it does damage to the brain or heart. It doesn’t care that this pain cause you the organism pain and discomfort, if you still continue to live.

A lot of people will be coming here from a HIGH fat medical ketosis mentality. We are an ADEQUATE fat nutritional ketosis group. High fat diets aren’t good for you with the exception of a diagnosis of epilepsy (or other serious neurological disorder, in which case you must be strictly supervised by a GP, dietician and neurologist), and they will play havoc with your gut intestinal health, stripping the gut lining of essential epithelial cells, you may also increase your cholesterol, gain weight, and experience reflux, gastritis, hair loss, muscle wastage (it’s a long list of bad things to be discussed at another time). High fat diets generally result in two rectal experiences, constipation, or explosive diarrhea.

If you’re eating high fat, chances are, your carbohydrate consumption from dark green leafy vegetables isn’t the bulk of your allowance, your fibre intake may be low, too low to help form adequate clusters of fecal matter to be pushed through the intestine. If this sounds like you, do me a favour and weigh out 75g of baby spinach, or kale, or lettuce. It’s one gram net carbs. It fills half a dinner plate. Apart from helping with satiety, they’re an incredibly important pre-biotic for the good bacteria in your gut. If it’s not in your diet, it really should be.

Now, what happens to your butt and digestive tract if constipation becomes a recurring long term issue? What happens if we play the wait and see and don’t actively resolve this before it becomes an even worse issue?

  • Anal fissures: the sphincter muscle that closes off your colon from the world can tear and bleed, this is painful, it takes about a week to heal, and if your constipation is everyday, it won’t heal, it will hurt to walk, hurt to sit and it will be very, very painful to excrete fecal matter.
  • Colon Haemorrhoids: When you strain for a long period on the toilet, you can pop out the veins in your colon, and expose them to the passing compacted fecal matter, this can tear the veins and cause bleeding, extreme pain, and can be life long.
  • Rolling constipation: Stool can become deposited inside pockets of the intestine and hard stool can roll over the top of hard stool and eventually it can become compacted and cause a blockage. If the blockage can not be treated with medication, which is not only incredibly painful, it will have to be surgically removed.
  • Femoral hernias: extreme straining on the toilet can cause intestines to actually be pushed through the abdominal wall and they can herniate which requires surgical repair. If the hernia becomes stuck, and the intestine loses blood supply, that section can die and will have to be removed. An uncomplicated surgical repair of a femoral hernia is 6-8 weeks recovery.

So coming to the end of this, what can we do to alleviate constipation?

Supplement your electrolytes:

  • Magnesium citrate 300mg/day
  • Sodium 5000mg-7500mg/day
  • Drink 2-3L of water per day.
  • Eat the majority of your carbohydrates from low carb fibrous vegetables.


  • Take enemas without the express instruction of a GP
  • Consume large quantities of artificial sweetener, coffee or MCT: these will cause a large build up of mucous, and water build up (and eventual loss) in the small intestine, as this passes through your intestine, it will causes diarrhea around the compacted stool, and while you may feel you have been ‘cleared out’, your colon will still be compacted with fecal matter. You will still be constipated, you will have solved nothing, and you will have made yourself more dehydrated.
  • Wait more than 3 days of the issue being unresolved before consulting a medical professional.

Hopefully this helps get things moving again! If you liked this and our other articles, why not jump on our Facebook group Keto for Beginners – Australia and introduce yourselves!