People say they love pasta, but often what they really crave is the sauce. Not that pasta is merely a “filler,” however. Noodles offer a nice texture and lighter feel—putting the sauce in a proper proportion of taste and richness within the overall dish. That may be especially true with alfredo, one of the richest sauces around. Its creamy fullness is hard to resist, and with this low-carb zoodle recipe, you won’t have to.
Time in the Kitchen: 20 minutes
3 spiralized zucchinis
1 tub (250 g) organic cream cheese
1 cup macadamia milk
1 cup grated Parmesan cheese
pinch of ground nutmeg
1 tbsp. Italian parsley (optional for garnish)
salt and pepper to taste
Boil zoodles in sea-water-salty water for a few minutes and drain.
For sauce, heat cream cheese with 1 cup each milk and Parmesan in a nonstick pot. Bring to a soft boil.
Season with a dash of ground nutmeg, and salt and pepper to taste.
Put zoodles in serving dish or broil-safe dish if you wish to broil for a baked look as pictured.
Pour enough sauce on zoodles and broccoli to cover them. (Note: This recipe makes enough sauce to cover almost twice as many Zoodles as pictured. There will be plenty for leftovers!)
Top zoodle mixture with extra Parmesan, black pepper and chopped Italian parsley.
Broil if desired. Serve on its own or with baked chicken, and enjoy!
Nutritional Info (per serving):
Carbs: 5.2 grams
Fat: 20 grams
Protein: 8.7 grams
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While some keto or low-carb proponents claim fiber is useless at best and actively harmful at worst, I come down on the side that says fiber is probably helpful for most people. Some folks have persistently better responses to low- or no-fiber keto diets, and I won’t argue with that—I’ve seen it happen and I’ve read the studies where de-emphasizing fiber can actually improve constipation, for example.
I’ll just say that I have an opposite reaction, and, most importantly, I love eating a variety of plant foods that also happen to contain a ton of great nutrients in addition to fiber.
Do I buy into the idea that fiber is important because it is every human being’s responsibility to produce as much colonic bulk as humanly possible? No.
Do I think we should be consistently pushing the limits of our digestive tracts, performing feats of bathroom heroism so momentous they border on Herculean, and making sure the toilet bowl buckles beneath us? No.
The real value of fiber lies not in its coarseness, its tendency to form colonic bulk, to keep us topped off. The true value lies in its fermentability.A fermentable fiber is a prebiotic fiber—fiber that feeds our gut bacteria.
I won’t get into the many roles our gut bacteria play in our health today (I’ve covered that before. 1, 2, 3).
I will, however, explain why we need to be feeding our gut bacteria. Our gut bacteria form a physical barrier against incursions and colonization by pathogenic bacteria; they take up room along the gut lining so pathogens can’t. If we don’t feed our gut bacteria with prebiotics, it won’t be around to protect us. After antibiotic treatment where both good and bad gut flora are indiscriminately targeted and wiped out, pathogenic obesity-promoting bacteria take advantage of the open space. That’s a worst-case scenario, but it shows what can happen when the harmony of the gut is disturbed by antibiotics or, to a less extent, a lack of fermentable prebiotic fibers.
When our gut bacteria eat prebiotics, they also give off metabolites like butyric acid—a short chain fatty acid that our colonic cells use as an energy source and which improves metabolic health.
Gut bacteria also convert antinutrients like phytic acid into nutrients like inositol. The almond meal-obsessed keto eater would do well to have a powerful gut biome set up to convert all that phytic acid to inositol.
Now, some writers will come up with specific blends of fibers, powders and gums to create the “optimal” prebiotic diet for your gut bacteria, but that’s pretty silly. The gut is a complicated place. We’ve barely begun to even identify all its inhabitants. To think we know the precise blend of isolated fiber that will make them flourish, and then act on that, is a mistake.
A better option is to eat foods that contain fiber. Some of the prebiotic fibrous foods with the best nutrient profiles also happen to be extremely keto-friendly.
1) Almonds and Pistachios
Nuts are usually favored in health-conscious circles for a few reasons. They like the monounsaturated fat. They like the mineral profile, or the complete protein, or their ability to dissemble into nut meals and form baked goods. But what gets short shrift is the fiber content. Now, I can’t speak for other nuts, but almonds and pistachios in particular contain fiber with potent prebiotic effects. People who eat almonds and to an even greater extent pistachios end up with improved gut bacteria profiles.
2) Green Bananas
Ripe bananas are difficult to squeeze into a ketogenic diet. The green banana—an unripe one—is mostly resistant starch, a type of starch that cannot be digested and travels untouched until colonic bacteria metabolize it. It’s one of the best stimulators we know of butyric acid production. And sure, you could do a spoonful of raw potato starch to get your resistant starch, but the beauty of the green banana is that it also provides potassium, another nutrient that some find difficult to obtain and stay keto.
3) Wild Blueberries
Blackberries, boysenberries, raspberries, and strawberries are all loaded with fiber, and you should eat them. They’re lower carb than you think, they’re loaded with polyphenols, and topped with some real whipped cream they make a fantastic dessert. But wild blueberries are special. They’re smaller than other berries, which increases the amount of skin per ounce you get, and skin is where all the polyphenols and fiber lie. Heck, even the blueberry’s polyphenols have prebiotic effects on the gut biome.
A few years ago, I wrote a whole post on mushrooms. Suffice it to say, they’re quite wonderful, bordering on magical. I did not discuss the fiber they contain. It turns out that all the various mushroom polysaccharides/fibers, including beta-glucans, mannans, chitin, xylans, and galactans also act as potent prebiotics that improve the health of the host.
Your standard avocado has about 12-15 grams of fiber, if you eat the whole thing. I
Great with chili powder, salt, and lime juice, jicama is about 11 grams of carbs per cup, but half of those are inulin, a potent prebiotic fiber with a tendency to really ramp up butyrate production.
Onions are another fantastic source of inulin. They go into almost every dish of every cuisine, so there’s no excuse not to be eating onions.
I’ve been known to treat garlic like a vegetable, roasting an entire cast iron pan full until brown and sweet and chewy. They’re another great source of prebiotic fiber.
Leeks have more inulin than onions. Try them crispy in egg scrambles.
Broccolini is a major part of my favorite meal of the day—my Big-Ass Keto Salad. Broccoli (and cruciferous vegetables in general) has been shown to have modulatory effects on the gut biome.
Kraut gives you two in one. It’s a fermented food, which is great for the gut biome. And it’s cabbage, which is very fibrous. Even pasteurized kraut improves gut health.
12) Dark Chocolate
Dark chocolate, the good stuff with a high cacao content (85%+) and low sugar content, is an incredible source of prebiotic fiber. Eat more of it.
13) Animal Fiber
Obligate carnivores like cheetahs who don’t eat any plants (willingly) still have gut bacteria. These gut bacteria thrive on “animal fiber,” the gristle and cartilage and other bits of connective tissue that comprise a good 20-30% of the walking weight of a prey animal. Humans are not obligate carnivores, but eating the entire animal has been a mainstay of advanced hominid existence for millions of years. I find it very likely that something, someone, somewhere inside our guts is breaking down the animal fiber we eat—so you’d better be eating some!
Not so tough, is it? It’s not like I’m suggesting you load up on bran muffins, psyllium smoothies. I don’t want you dumping flax meal into everything or munching on those awful fiber gummies. Just eat some basic, healthy, low-carb plant matter—foods that don’t really scream “fiber”—and the rest will take care of itself.
What’s your favorite low-carb source of fiber? Let me know down below.
Thanks for reading, everyone.
Hernández E, Bargiela R, Diez MS, et al. Functional consequences of microbial shifts in the human gastrointestinal tract linked to antibiotic treatment and obesity. Gut Microbes. 2013;4(4):306-15.
Ukhanova M, Wang X, Baer DJ, Novotny JA, Fredborg M, Mai V. Effects of almond and pistachio consumption on gut microbiota composition in a randomised cross-over human feeding study. Br J Nutr. 2014;111(12):2146-52.
Jiao X, Wang Y, Lin Y, et al. Blueberry polyphenols extract as a potential prebiotic with anti-obesity effects on C57BL/6 J mice by modulating the gut microbiota. J Nutr Biochem. 2019;64:88-100.
Jayachandran M, Xiao J, Xu B. A Critical Review on Health Promoting Benefits of Edible Mushrooms through Gut Microbiota. Int J Mol Sci. 2017;18(9)
Nielsen ES, Garnås E, Jensen KJ, et al. Lacto-fermented sauerkraut improves symptoms in IBS patients independent of product pasteurisation – a pilot study. Food Funct. 2018;9(10):5323-5335.
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Thanks to the good folks at Paleohacks for today’s recipe.
Is it possible to go keto while omitting all dairy and animal products as well? It might seem difficult, but these 17 keto-friendly vegan and Paleo recipes can get you started.
The biggest challenge to going keto(and otherwise restricting your diet) is the frustrating perceived lack of variety when it comes to meals. We’re here to prove that even when following the keto, Paleo and vegan diets, you can still eat well.
From breakfasts, to snacks, to lunch, dinner and dessert, there’s something for every meal of the day. Enjoy fluffy coconut flour flatbread to sandwich your favorite toppings, or healthy mint chocolate fudge for a treat. You’ll find inspiration all over this list.
These five-ingredient, five-minute low-carb crunch protein bars are basically healthy candy bars. Plus, there are lots of modifications you can follow to best suit your diet.
This easy, fluffy flatbread will fool anyone—it’s just as good as the original, gluten-laden kind. Psyllium husk functions as the “egg-like” binder in this recipe, making it totally vegan in addition to Paleo and keto.
This simple Shamrock shake recipe is way better than the fast food original, but just as (naturally) green—thanks, avocado! Vanilla and mint extracts lend the shake its distinct flavor.
Need a craving-busting chocolatey treat? These chocolate espresso bombs use whole ingredients, including cacao powder, nut butter and espresso powder. They’re full of healthy fats that will keep you satiated in between meals.
This inventive bento box assemblage includes seaweed “noodles” with your choice of raw or toasted almonds, an herbaceous heirloom tomato and cucumber salad, protein-packed guacamole and chunks of coconut and carrot. It makes for one refreshing, colorful and healthy lunch!
Packed with Mexican spices like cumin and cilantro, this Mexican cauliflower rice makes the perfect accompaniment to any main dish.
Silky mint chocolate fudge that’s dairy and sugar-free? It’s true! This simple recipe is ready in under an hour and requires only a blender and a fridge.
The secret to these crunchy, chocolate mint, no-bake protein bars is the crunchy almond butter—but smooth almond butter will also work in a pinch. Adorn your bars with chia seeds, coconut, cacao nibs or almonds for added flavor and texture.
These chocolatey-coffee-nutty treats will keep you satiated all day long, thanks to the addition of almonds, flax meal, hemp seeds, almond butter and coconut oil. Be sure to omit the maple syrup or swap in a keto-compliant sweetener.
Don’t be fooled by the pictures—there’s no actual pasta to be found here! Kohlrabi noodles make for a flavorful, healthy dish, while a homemade, dairy-free Alfredo adds an ultra-creamy mouthfeel. This recipe uses pre-prepped noodles and cauliflower rice, but you can always make those at home with a food processor and spiralizer.
These fat bombs are loaded with puckering citrus flavor from lemon juice and zest as well as coconut butter, coconut oil and low-carb blueberries—or whatever berries you prefer.
Need a big bowl of comfort, with none of the guilt? This low-carb mac and cheese recipe uses hearty cauliflower in place of noodles, while tahini, olive oil and spices make it super creamy and tasty.
Well-spiced, creamy spinach gets whipped up quickly in the Instant Pot. Opt for coconut oil over ghee to keep it vegan, and serve over a bed of cauliflower rice.
These simple, uber-creamy and chocolatey fudgesicles take minutes to prep. Opt for stevia over the maple syrup and add more coconut milk to keep it keto.
Need a big bowl of Mediterranean-inspired, veggie-packed goodness? This salad boasts cauliflower, artichoke hearts, bell pepper, cucumber, tomatoes and more.
This simple tabbouleh recipe subs in cauliflower for traditional grains. It’s herbaceous, lemony and perfect to dip all your favorite vegetables in.
Missing bread on your restricted diet? This magic, low-carb mug bread comes together in minutes and requires only a handful of wholesome ingredients. Be sure to use a vegan egg substitute to keep it vegan.
Thanks again to Paleohacks for the awesome recipe list today. Have your own favorite low-carb plant-based favorites? Share below.
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I’m continuing my crusade of keto mythbusting. Recently, there was keto crotch, then keto bloat, and today I’m returning to one of the O.G. myths—keto body odor. Yes, it seems detractors of the keto diet are hell-bent on making you think your body will become a stinky, bloated mess if you dare to drop your carbs below 50 grams per day…but is it true?
Here’s the spoiler: Yes, people in online keto diet forums occasionally complain about an unpleasant change in body odor when they first go keto. There is no scientific evidence that it actually happens, nor a clear, compelling explanation for why it would. Moreover, the anecdotal (and it’s all anecdotal) evidence suggests that if it does occur, it is rare and temporary. In other words, the whole idea of keto body odor seems to be exaggerated—shocking, I know.
That said, significant dietary changes canresult in other physiological changes that may manifest in a variety of ways. Since nobody wants to be the stinky kid, let’s take this opportunity to look at what might be plausible about keto body odor and what to do if you think you’ve been afflicted.
What Causes Body Odor?
First, let’s clarify what’s meant by “body odor.” In the medical literature, the term is used in reference to aromas associated with breath, urine, feces, vaginal secretions, sweat (usually from the axilla, or armpits), and general bodily essence as it were. Because it’s such a broad term, the causes are also extremely varied. For the purposes of this post, I’m going to use the term “body odor” to mean aromas from sweat and general bodily funk, since that’s what’s usually meant by keto body odor.
Body odor arises when odorless compounds leave the body through glands in the skin and interact with microbes living on the skin’s surface. The microbes then release chemical compounds—what we actually detect as body odor. Typically, commercial deodorants target both pieces of the equation by using antiperspirants to minimize the excretion of the odor precursors and by creating an unfavorable environment for the microbes living on the skin. There is also a genetic component to how much individuals secrete compounds that cause body odor.
Although a huge industry is built around trying to help people mask their natural odors—and suggesting that body odor is always the result of poor hygiene—bodily scents are actually quite important. Just as other animals do, humans use olfactory cues for recognizing kin, making judgments about others’ personality traits and attractiveness, and even for detecting fertility. Although we rarely recognize it, the data suggests that smell probably factors into all our face-to-face social interactions.
Body odor can also result from illness. Before the use of sophisticated modern disease detection techniques, doctors were taught to use their sniffers as a diagnostic tool. Even today, smell can be an important clue that an individual is unwell. Often these odors emanate from the breath or urine, but certain infectious and metabolic diseases can be associated with distinctive body odors. In addition to perceptible body odor, the human olfactory system can detect infection and sense illness in others, presumably an important means of preventing the spread of communicable disease.
Diet and Body Odor
The whole notion that a keto diet can cause body odor rests on the assumption that how we smell is affected by what we eat. It turns out that there is scant evidence that that is actually the case.
When I’ve taken up the question of keto diet and body odor previously, I noted that there are really only two human studies that speak to this. One small study found that women judged men’s body odor more negatively when they ate a diet that contained red meat compared to when they abstained from red meat. However, the diets differed in other ways as well. In contrast, a different study found that women rated men’s body odor more positively when the men reported eating more fat, meat, and eggs, and more negativelywhen they ate more carbs. Hmm.
Besides those two small studies, evidence that diet impacts body odor seems to come primarily from studies on guinea pig urine and meadow voles—not exactly the most compelling in my opinion.
Nevertheless, the common belief persists that certain foods will make you stinky: garlic, onions, cruciferous vegetables, and spicy foods especially. However, there is no evidence that this is actually the case beyond the obvious bad breath and, ahem, flatus that these foods can cause. In fact, the one study I found on the subject reported that garlic counterintuitivelyimprovedbody odor.
So, Can Keto Make You Stinky?
As you can see, there’s minimal evidence at best linking body odor to diet, and none of it has to do with the keto diet itself. Nevertheless, the belief that keto causes body odor persists…thanks to the few complaints from some in the keto community (and, just maybe, those who have nothing to do with keto but want to cause a stir). While I don’t want to dismiss anecdotal evidence out of hand, I have noticed that once people go keto, their diet is immediately to blame for every weird smell, twitch, or symptom. It’s remarkable really.
In the interest of fairness, let’s look at the explanations that are typically offered for why keto might cause body odor:
Is It the Protein?
The first hypothesis is that keto dieters smell funky because they’re eating a lot more meat. As I already mentioned, there are only two small studies that speak to this, and the findings conflict. The idea at work: protein metabolism yields ammonia as a byproduct (true), which builds up because of eating “too much protein,” resulting in body odor.
To which I object… First of all, it’s not necessarily true that going keto means eating more meat. My version of a keto diet certainly isn’t a steak-and-bacon fest—I still eat tons of veggies. If anything, my observation is that keto folks by and large remain fearful of eating “too much” protein lest it kick them out of ketosis. (The issue is not nearly so simple as that, as I’ve explained.) In any case, even if you’re eating a good deal of meat, a healthy liver should be able to convert the amount of ammonia generated into urea and send it off to the kidneys to be excreted as urine.
Maybe It’s the “Detoxing”?
Toxins such as environmental pollutants accumulate in adipose tissue, a.k.a. fat cells, and these toxins are then released into the bloodstream when people burn fat. Because the keto diet often results in increased burning of body fat, the theory goes that the body is “detoxing” all these pollutants, and that’s what causes body odor. Detoxing is a controversial subject, and while itistrue that some of these toxins can be excreted through the skin, the actual amounts are fairly small (the majority get excreted via urine and feces). Plus, it’s not evident that the toxins that are excreted through the skin cause any particular odor. And wouldn’t any diet that actually does what it’s supposed to—i.e. burn fat—be subject to the same “stinky” detox effect? I think we can safely chuck this claim.
Are Ketones a Cause?
Maybe ketones themselves make you smelly? This one has the most potential validity, as it’s well documented that acetone—one of the three ketone bodies—gets excreted when you’re in ketosis. However, it’s the cause of the familiar keto breath, not body odor per se. I’ve seen no evidence linking acetone to actual body odor.
What To Do About It
Ok, I hear you saying, “Mark, I see that you’re skeptical, but I’m telling you… I stink!” What can you do about it?
Well, since there isn’t a clearcut cause, I can’t give a clearcut answer, but I’ll tell you what the general wisdom says:
First, you can support your body’s own detoxification pathways as I describe here. Your body should be able to do a fine job taking out the garbage—it’s designed to do so and is efficient at it—but hey, why not drink some coffee and throw some broccoli sprouts on your salad. This is a “can’t hurt, might help” situation.
Same thing goes for taking some nice epsom salt baths, another common recommendation. Whether there is any truth to their detoxifying nature, you’ll get a nice dose of transdermal magnesium with a hefty side of relaxation. Throw in some essential oils and olive oil and soak your cares away… hopefully taking some of the b.o. with it.
You can also experiment with eating less protein and more carbs, but I dosee potential downsides to both. You definitely don’t want to eat too little protein, since it serves such a vital role in healthy functioning, and you don’t want to add back too many carbs if being in ketosis is your goal. That said, especially with regard to the protein you probably have room to play around, so feel free to experiment if you want. I’m not overly optimistic that this is the answer, but I’m always a fan of finding what works for you.
Or, take a wait and see approach. Mostketo side effectscome and go as people become keto-adapted. If your problem is ketobreath, not body odor per se, you can try chewing on some fresh herbs or taking chlorophyll supplements, but these will just mask the issue.
Lastly, if it is very noticeable and very bothersome, you can—and probably should—consult your doctor. If you are excreting significant ammonia, which usually happens via the breath, this is a sign of liver or kidney problems that need to be diagnosed asap.
The Bottom Line…
Because switching to a keto diet can initiate a profound metabolic shift, some people might experience side effects. And, sure, it’s conceivable that transient changes to body odor might be one of them. The lack of evidence that body odor is strongly affected by diet (as well as my own experience interacting with the thousands of people in my community who have tried keto) leads me to believe that this is a minor problem at most—and one that most people won’t experience at all. If it’s affecting you, feel free to try to solutions I described above. They might not resolve the problem immediately, but at least they’ll likely have other positive benefits.
Ok, what say you? Are your friends giving you a wide berth now that you’re in ketosis, or are you chalking this up to yet another thing the haters are blowing out of proportion?
Groyecka A, Pisanski K, Sorokowska A, et al. Attractiveness Is Multimodal: Beauty Is Also in the Nose and Ear of the Beholder. Front Psychol. 2017;8:778.
James AG, Austin CJ, Cox DS, Taylor D, Calvert R. Microbiological and biochemical origins of human axillary odour. FEMS Microbiol Ecol. 2013 Mar;83(3):527-40.
Natsch, A. What Makes Us Smell: The Biochemistry of Body Odour and the Design of New Deodorant Ingredients. CHIMIA Intl J Chem. 2015 Aug;69(7-8):414-420.
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Move over, keto crotch. There’s a new fear-mongering anti-keto media blitz forming: keto bloat.
According to the “good scientists” of the Kellogg company food lab, an unprecedented number of young people are walking around with bloated guts and colons packed to the brim with impacted fecal matter, and it’s all because they’ve embraced ketogenic diets and “forsaken” fiber.
If this sounds like nonsense, that’s because it is.
Are millions of keto dieters suffering from bloating and constipation? I can find no evidence of this.
Is fiber necessary to prevent bloating and constipation? It’s complicated. I’ll explain later. But probably not.
Does the ketogenic diet necessarily exclude fiber? Not at all.
Are ketogenic diets as commonly practiced low in fiber? No.
What Is “Bloat” Anyway?
There are two things that people refer to as bloat: constipation and abdominal distension.
Constipation has different components. It’s being unable to make a satisfying bowel movement. It’s also feeling like you have to poop but are unable to. It’s being able to poop only a little bit. It’s struggling on the toilet bowl. Mostly, it’s being unhappy with your performance on the toilet.
Abdominal distension also can be different things. It might be trapped gas. It might be feeling “heavy” or “full.” It might mean your pants don’t fit after eating.
So, “bloating” can be any or all of these. You can pass hard small stools and feel like you’re bloated. You can poop just fine but have a lot of gas and feel like you’re bloated. You can spend hours on the toilet with not much to show for your effort and be bloated. So “Keto bloat” is difficult to pin down. That makes it easy to make claims and hard to disprove.
Let’s see how frequent bloating and constipation occurs in the ketogenic diet literature.
What Does Research Say About Constipation?
In a study of children with epilepsy placed on an olive oil-based ketogenic diet, about 25% of the subjects experienced constipation. So, was ketosis slowing them down? Not exactly. Those who experienced constipation were actually less likely to be in ketosis. Constipation went up as ketone readings went down, and epilepsy symptoms returned. Constipation improved as ketone readings went up and epilepsy symptoms subsided.
In adults with epilepsy on a ketogenic diet, constipation occurred in just 9% of patients. The authors note that this rate is lower than some other ketogenic studies and attribute the difference to “the heavy focus on importance of fiber from nutrient dense (fiber rich) vegetables, nuts, and seeds.” Note that they weren’t getting fiber from pills and powders. They were eating nutrient-dense foods that just so happened to contain fiber.
Another ten-year study compared the classical ketogenic diet, MCT oil-based ketogenic diet, and modified Atkins keto diet. They were all equally effective at reducing epilepsy symptoms in children, but the occurrence of constipation varied greatly. It was most common in the classic keto diet and medium chain triglyceride-based diet, both of which restrict protein. In the modified Atkins diet, which does not restrict protein, constipation was much rarer. Another study on the modified Atkins diet had similar results, with just 2 of 26 subjects reporting constipation.
Constipation does seem to be a common occurrence. However, the majority of keto diet studies are in epileptic populations following very strict clinical Keto diets. The extreme nature of these therapeutic ketogenic diets—extreme protein (7% of calories) and carbohydrate restriction—makes them an imperfect representation of how most people are eating Keto. And in studies of less-extreme, more realistic versions of the diet, such as modified Atkins (which allows more protein) or the version with “heavy focus” on vegetables, nuts, and seeds, constipation occurs at a much lower rate.
What Does Research Say About Bloating?
The only instance of something approximating bloating in the ketogenic diet literature occurred in studies using medium chain triglyceride-based diets. These are ones that use huge amounts of MCT oil to increase production of ketone bodies. It works great for curbing epilepsy symptoms, but it can also cause cramping, diarrhea, and abdominal pain. That’s not bloating per se. It’s literally the closest I could find.
Causes Of Bloating While Keto?
Okay, say you are dealing with constipation or bloating on a keto diet. What could be going on?
Not Enough Food
Constipation is often a consequence of low energy status. Everything that happens in the body requires energy, and if energy levels are low or energy availability is poor, basic functions will suffer. Bowel movements are no exception. The muscles and other tissues responsible for moving things along your digestive tract use energy. If you aren’t providing adequate amounts of energy, you’re depriving your tissues of the ATP they need to work best and sending your body a signal of scarcity which will only depress energy expenditure even more.
Low carb diets in general and keto diets in particular are very good at causing inadvertent calorie reduction. Great for fat loss, but some people take it overboard and go too far. I’m talking 800-1000 calories a day on top of CrossFit. That’s a recipe for disaster.
Water and Mineral Loss
When you go Keto for the first time, you shed tons of water. For every gram of glycogen you lose, you drop 3-4 grams of water. You also lose sodium and potassium with the water, and you need extra magnesium to regulate your sodium and potassium levels.
The water content of stool is what gives it that smooth texture we all desire. If you’re dehydrated, even mildly, you’ll have less water available for your bowel movements and be more likely to suffer from constipation.
Drink a big glass of salty water with lemon juice in the morning and sip on salty broth throughout the day. Zucchini is a great source of potassium, as is avocado.
Also, if you’re going to eat more fiber, you need to increase water intake for it to work.
Too Much or Too Little Fiber
The relationship between fiber and constipation is mixed. Some interventions do seem to help. Psyllium husk and flaxseed have both been shown to improve constipation. Galactooligosaccharides, a class of prebiotic fiber, improve idiopathic constipation. And inulin, another prebiotic fiber, improves bowel function and stool consistency in patients with constipation.
But there’s also evidence that more fiber can make the problem worse. In one 2012 study, patients with idiopathic constipation—constipation without apparent physiological or physical causes—had to remove fiber entirely to get pooping again. Those who kept eating a bit or a lot of it continued to have trouble evacuating. The more fiber they ate, the worse their constipation (and bloating) remained. Another review found mixed evidence; some people get less bloating and constipation with more fiber, others get less bloating and constipation with less fiber.
Personally, my toilet performance is stellar with or without a constant intake of voluminous levels of plant matter. Most days I eat a good amount—Big Ass Salads, broccoli, sautéed greens, berries—but on the days I don’t, I don’t notice any difference. I’m suspicious of the widespread calls for bowel-rending levels of fiber as the universal panacea for all things toilet, and I’m also suspicious of the people who claim fiber is unnecessary or even harmful.
Fiber helps some people and hampers others. There’s no one-size-fits-all with fiber, especially since there are many different types of fiber.
Too Many Sugar Substitutes
I get it. There are some interesting candies out there that cater to the Keto set and use various sugar alcohols—non-alcoholic, low-or-no calorie versions of sugar—artificial sweeteners, and fibers to recreate popular treats. It’s fun to eat an entire chocolate bar that tastes pretty close to the real thing and get just a few net carbs. But that’s a lot of fermentable substrate your gut bugs are more than happy to turn to gas.
If you want the opposite problem, you can always turn to Haribo sugar-free gummy bears.
FODMAPs stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols—the carbohydrates in plants that our gut bacteria usually mop up. Most people have gut biomes that can handle FODMAPs; indeed, most people derive beneficial short chain fatty acids from their fermentation. But some people’s gut biomes produce too much fermentation when they encounter FODMAPs. Fermentation begets hydrogen gas, which gathers in the gut and causes great distress. Common complaints of the FODMAP intolerant are bloating, stomach pain, and visits to the toilet that are either unproductive or way too productive—all of which fall into the bloating category.
The myth is that Keto people are eating salami and cream cheese for every meal. The reality is that many people go Primal or Keto and find they’re eating way more vegetables than they ever have before. These are great developments, usually, but if you’re intolerant of FODMAP fibers, you may worsen the bloating.
What Can You Do?
Eat enough protein. Most people can get away with eating 15-25% of their calories from protein and still stay in ketosis. Most people can eat even more protein and still get most of the benefits of fat-adaptation. The keto studies which had the lowest rates of constipation were far more tolerant of higher protein intakes.
Eat FODMAPs unless you’re intolerant. Most people can eat FODMAPs. In most people, FODMAPs improve gut health and reduce constipation and bloating. But if your gut blows up after a few bites of broccoli or asparagus, consult the FODMAPs list and try a quick FODMAP elimination diet.
Make sure you’re truly constipated. Your stool volume and frequency of toilet visits will decline on a normal ketogenic diet because there’s less “waste.” Make sure you’re not misinterpreting that as constipation or bloating. If there’s less poop, there’s less poop. If there’s more poop but it’s just not coming, and you have to go but can’t, that’s when you have an issue.
Experiment with fiber. Fiber clearly has a relationship to bloating and constipation. You just have to figure out what that looks like in your diet.
If you’re bloated and constipated on a high-plant Keto Diet, eat fewer plants.
If you’re bloated and constipated on a low-plant Keto Diet, try eating more plants. If that doesn’t help, go zero-plant.
If you’re bloated and constipated on a zero-plant Keto Diet, try eating more plants. .
We all have to find our sweet spot.
So, to sum up, “keto bloat” is mostly a myth. There’s a glimmer of truth there, but it’s highly exaggerated. Constipation is common on the most restrictive clinical keto diets, while eating fiber from whole plant foods, being less restrictive with protein, and making sure you’re drinking enough water and eating enough calories and electrolytes seems to avoid the worst of it.
What’s been your experience with bloating and constipation? How have you handled it?
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Müller-lissner SA, Kamm MA, Scarpignato C, Wald A. Myths and misconceptions about chronic constipation. Am J Gastroenterol. 2005;100(1):232-42.
Guzel O, Uysal U, Arslan N. Efficacy and tolerability of olive oil-based ketogenic diet in children with drug-resistant epilepsy: A single center experience from Turkey. Eur J Paediatr Neurol. 2019;23(1):143-151.
Roehl K, Falco-walter J, Ouyang B, Balabanov A. Modified ketogenic diets in adults with refractory epilepsy: Efficacious improvements in seizure frequency, seizure severity, and quality of life. Epilepsy Behav. 2019;
Liu YM. Medium-chain triglyceride (MCT) ketogenic therapy. Epilepsia. 2008;49 Suppl 8:33-6.
Arnaud MJ. Mild dehydration: a risk factor of constipation?. Eur J Clin Nutr. 2003;57 Suppl 2:S88-95.
Noureddin S, Mohsen J, Payman A. Effects of psyllium vs. placebo on constipation, weight, glycemia, and lipids: A randomized trial in patients with type 2 diabetes and chronic constipation. Complement Ther Med. 2018;40:1-7.
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It’s Monday, everyone! And that means another Primal Blueprint Real Life Story from a Mark’s Daily Apple reader. If you have your own success story and would like to share it with me and the Mark’s Daily Apple community please contact me here. I’ll continue to publish these each Monday as long as they keep coming in. Thank you for reading!
My Primal story starts in 2014. I had a one-year-old baby. I was healthy. I was taking vitamins and supplements and I did exercise. I jogged and lifted weights. I only gained 10 pounds during my pregnancy because of my exercise routine.
The problem was my diet. But I didn’t know that. It all started with my skin and my teeth. I had eczema, red inflamed skin on my face, neck, knees, etc. and I always had cavities every time I went to the dentist. And I had THE best, the Absolute BEST Dental hygiene. I flossed after every meal. I water picked at night. I brushed my teeth 3 times a day. And without fail, every time I went to the dentist there would be a new cavity.
So. I am at the dentist. It’s 2014. He tells me that I have a cavity and he was going to fill it. I was very upset. I said “NO.” I told him not to fill the cavity. I told him I was going to heal it. The dentist is taken aback. He laughed at me.
I went home and Googled “How to heal a Cavity”. And it took me to this oil pulling sight. And it was a domino effect from there. I bought a book called Heal Cavities and Cure Tooth Decay, and I read that book cover to cover. And that book mentioned another book called The Paleo Manifesto, and it also talked about diet and how cavities start from the INSIDE out. So I immediately went out and bought The Paleo Manifesto and read that cover to cover. And that book took me to (you guessed it) The Primal Blueprint. I read that book cover to cover.
I already had a good exercise routine. But those books helped me to clean up my diet which led me to clean up my makeup routine, soap, shampoo, dental routine. It was a complete 180. I went totally green. Also the Primal Blueprint helped me to raise my exercise game and take it from good to Great.
And from there, I gained lean muscle mass. I STOPPED having and getting cavities. My skin cleared up and my eczema completely went away.
After I read Cure Tooth Decay and Heal Cavities, The Paleo Manifesto, and The Primal Blueprint, I STOPPED brushing my teeth so often and so hard. Everything in moderation. I started oil pulling in the morning. I started brushing and flossing my teeth ONLY at night before bed. And I started using mineralized tooth powder. From Primal Life Organics or Raw Dakota Tallow. And just by doing these 2 things, my tooth sensitivity went away immediately. And I started to notice that I could eat hot and cold foods again without any pain. I did this same routine for 6 months and now this is my normal routine. Since I started taking care of my teeth like this, I have NO sensitivity. My enamel that I spent my entire life eroding has come back. I have NOT had a cavity since 2014 and my gums are beautiful and healthy. I no longer dread going to the dentist.
My skin care changed a lot. After reading those books and going Primal/Paleo. I stopped immediately using conventional skin care. I started ONLY using castile soap from head to toe. I started using an acidic toner on my face to bring back the acid mantle that I spent my entire life eroding. I mix up equal parts (1 to 1 ratio) of raw, unfiltered apple cider vinegar with the mother and water. And I spray that on my face at night after I wash my face with the castile soap. And I use tallow as my face cream. From Raw Dakota Tallow or Vintage Traditions. And I do use conventional makeup. I have tried healthy, green makeup, but that is expensive and doesn’t do the same job as the regular conventional makeup. But since I started taking care of my skin this way ALL of the redness and eczema went away completely.
So in these pictures you can see me without makeup and the top picture is my clear, healthy skin now and the bottom is the red, inflamed skin from before. And you can see the lean muscle mass in the gray dress as opposed to the portly me on the Ducati before I went Paleo/Primal.
I do lift weights every other day and I do cardio every other day. My cardio is walking with alternating sprints. And I never miss a workout. But I never train super hard. I stand at work all day and I do a lot of slow movement throughout the day.
I do eat organic when I can. But that is not always possible. So I do eat conventional produce and meats. But I eat nose to tail. And I eat a lot of colorful veggies. I stopped eating sugar entirely. Cold turkey. I STOPPED eating all carbs and sugar. I did that for 6 months and then started slowly bringing back carbs, but healthy carbs like sprouted and fermented sourdough breads with European butter. I follow and maintain a Paleo/Mediterranean diet. My family is from Spain so I do eat a lot of ancestral food and I do drink wine. I was always a steak girl but now I eat lots of healthy vegetables with the steak. I eat lots of dark chocolate. But my treat is white chocolate.
Since I went Paleo/Primal (and I ONLY did this to heal a cavity) I am the healthiest I have ever been. I am 41 and I look like I am 26, and I feel like I am 26. This lifestyle, this way of life is really a lifesaver. Looking back now, I can see how the Standard American Diet and health care and personal care (dental and skin) are slowly poisoning the American people and were slowly eroding my health. This journey is NOT easy for some people. It was easy for me. In order to do this you have to be comfortable doing your own research and you have to be comfortable questioning what you have been taught, conditioned to think and you have to be comfortable questioning what you have been told.
I always took a multivitamin. But after reading these books and doing my research I started talking Fermented Cod Liver Oil, and High Vitamin Butter Oil. I take collagen. I take Iodine (Triodine) I take a really good multimineral (Concentrace minerals) I take a good multivitamin, I take Fermented Skate Liver Oil. But NOT all at once and NOT everyday. Every other day. I take a combination of these.
Do what works for you. I am NOT orthodox paleo/primal/Mediterranean. Living a life like this is amazing.
I would NOT recommend this but, it in my experience it can be done. After having appendicitis, and routine (best case scenario) appendectomy you can snow blow your driveway. I had appendicitis and the appendectomy on Tuesday. I went home from the hospital on Tuesday night at 9:30 p.m. I slept till noon on Wednesday and then I got up and started walking around. I had a good high fat, high protein lunch. And then I snow blowed my driveway (I live in Layton, Utah and we get a ton of snow where I live and it had snowed for 2 days straight). I did that because I figured that Grok did NOT have the luxury of being injured and then laying on the couch all day long and watching T.V. I figured that Grok would be up and walking around. At least foraging for food, for his tribe.
I am healthier than I have ever been in my life, and I have the energy to play with my 5-year-old and keep up with him.
I will Never, Ever go back to what I did and thought and believed before going Primal/Paleo. And it really is a domino effect. Once you start down this journey it will simply but take over every aspect of your life.
I want to thank MDA, The Primal Blueprint, Raw Dakota Tallow, The Paleo Manifesto and Cure Cavities and Heal Tooth Decay, as well as myself for my Amazing transformation. I was always skinny, but I am in PERFECT health because of this journey.
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Because people don’t have enough diets to choose from already, there’s a new one on the scene: the Pegan diet. Actually it’s not that new—Dr. Mark Hyman started writing about it back in 2014, but it’s gained traction since he published his latest book last year,Food: What the Heck Should I Eat?
According to Hyman, Pegan is a somewhat tongue-in-cheek play on the fact that it’s not quite Paleo and it’s not really vegan, hence Pegan. It claims to combine the best of both diets, namely a focus on eating lots of vegetables, as well as an emphasis on sustainable agriculture and ethical and ecologically sound animal farming.
Setting aside the obvious issue that it’s 100% possible to be a vegan who eats few to no vegetables, or to be a paleo dieter who cares naught about the environment, Pegan is touted as being easier to stick to than either vegan or paleo (presumably because Pegan allows for consumption of foods not allowed on either). Frankly, trying to frame it as a bridge between the two hasn’t proved to be a seamless, happy compromise based on social media conversation, but that’s probably of little surprise to anyone here.
I’ve had some readers ask me about the merits of Pegan and whether it offers any particular advantages over paleo/Primal, and I’m taking up that question today. (Note that I’m only focusing on the Pegan diet proposed by Dr. Hyman, not the “Pegan 365” diet offered by Dr. Oz. The latter isn’t paleo at all, allowing whole grain bread and pasta, corn, tofu, and a weekly “cheat day.” You can imagine my response to this version.)
Defining the Pegan Diet
These are the basic tenets of the Pegan diet in a nutshell:
Focus on sourcing high-quality food –Prioritize organically grown and pesticide-free produce as well as meat, eggs, and fats from pasture-raised and grass-fed animals and finally sustainably harvested seafood. Choose seafood with the lowest possible mercury content. Buy local when you can. Avoid CAFO meats and foods containing chemical additives.
Eliminate processed modern food-like substances and franken-fats –Processed carbohydrates have a high glycemic load and lead to excessive insulin production. Refined vegetable and seed oils such as canola and sunflower are pro-inflammatory. Avoid all such products.
Go gluten-free –Even if you don’t have celiac disease or an obvious gluten sensitivity, modern wheat is still a frankenfood, and gluten can damage the gut. Occasional consumption of heirloom wheat (e.g., einkorn) is ok if you tolerate it.
Go dairy-free –Dairy is problematic for most people and is best avoided. If you do decide to include some dairy, consider choosing goat and sheep milk products instead of cow. Grass-fed butter and ghee are acceptable.
Make vegetables the centerpiece of your diet –Vegetables (mostly non-starchy) should comprise 75% of your diet.
Enjoy healthy fats –Focus on omega-3s, as from small, oily fish. Eat plenty of healthy fats from grass-fed and pastured meats and whole eggs, nuts and seeds, avocados, and coconut products. Use olive oil, avocado oil, and coconut oil for cooking.
Eat meat sparingly –Dr. Hyman uses the term “condi-meat” to emphasize that meat should be a side dish, not the focus of the meal. He recommends no more than 4 – 6 ounces of meat per meal.
Include gluten-free grains and legumes in small quantities –You may eat ½ cup of gluten-free grains like amaranth or quinoa, plus ½ – 1 cup of legumes (preferably lentils) per day. If you are insulin resistant, you should limit these or refrain altogether.
Limit sugar –Avoid refined sugar and conventional “treats.” The bulk of your vegetable intake should be from non-starchy varieties, and opt for low-glycemic fruit. Natural sweeteners like honey should be used only sparingly for the occasional treat.
How Does Pegan Compare to Primal?
If you’re reading this and thinking, “Gee, Mark, this sounds an awful lot like the Primal diet,” I agree. While there are some differences between Pegan and Primal, they aren’t particularly dramatic:
Primal allows full-fat dairy consumption. Pegan discourages but doesn’t outright ban dairy.
I don’t actively encourage people to consume gluten-free grains and legumes, but I’m not as strongly opposed to them as others are in the ancestral community. I’ve said before that I consider quinoa, amaranth, wild rice, and legumes to be moderation foods (when well-tolerated, which is more an individual thing). They deliver pretty substantial carb hits relative to their nutritional value, but they certainly aren’t the worst options out there. I don’t think they should be dietary staples by any stretch—and daily consumption is too much in my opinion—but if Primal folks want to eat them occasionally, I’ve seen it work for people.
The biggest difference is in regard to protein. The Pegan diet explicitly limits protein consumption, while the Primal Blueprint recommends moderate protein consumption tailored to your activity levels, goals, age, and medical needs. On the surface, this might seem like a substantial difference, it’s probably not very disparate in practice. If a Pegan eats 3 eggs for breakfast, a large salad with 4 ounces of sardines at lunch, and 4 ounces of skin-on chicken thigh at dinner, that gets him or her to about 70 grams of protein, not counting the (admittedly incomplete) plant protein from the salad and any additional veggies included with breakfast and dinner, plus nuts and seeds. That’s within the realm of Primal guidelines, albeit less than I’d recommend for some populations.
That said, if Pegans are taking the whole “treat meat as a condiment” mantra to heart, they are probably at greater risk of underconsuming protein compared to the average Primal eater. This could present a problem for athletes and older folks looking to preserve lean mass. Likewise it is surely harder to get enough protein while also practicing time-restricted eating—and perhaps only eat one or two meals per day—and trying to follow Pegan guidelines. That isn’t a knock against Pegan per se, just a cautionary note.
Finally, while we’re on the subject of protein, I must object to Dr. Hyman’s appeal to environmentalism as a reason to limit meat consumption. I’mnot at all convinced that raising livestock taxes the environment more than monocropping acres and acres of corn and soybeans.
In my opinion, Pegan could simply be called “vegetable-centric Paleo with permission to eat small amounts of quinoa and lentils if it suits you.” That isn’t catchy, though, so Pegan it is.
That said, I appreciate how Dr. Hyman for his version of the Pegan Diet emphasizes that there is no single diet that is exactly right for each individual and, like me, he advocates for self-experimentation. Dr. Hyman also speaks out against diet dogmatism and encourages his followers to focus on big-picture health. These are obviously messages I can get behind.
The Bottom Line
I’m a fan of anything that gets people thinking about food qualityinstead of just robotically tracking macronutrient intake and/or plugging calories into a magic weight-loss formula. Supporting sustainable agricultural practices, eating locally and seasonally, and avoiding environmental pollutants have always been part of the Primal Blueprint recommendations. In short, there is a lot I like about the Pegan diet.
However, I don’t agree that the Pegan diet is necessarily easier to implement than vegan or Paleo, which is supposed to be one of its big draws. If you’re a vegan who gets by on bagels, pasta, and Oreos, or a Paleo person who dutifully eschew grains but relies on the myriad processed, packaged Paleo food options, Pegan isnotgoing to be easier. Changing your diet to focus on carefully sourced “real food” is still going to be a massive shift. It’s going to be much more expensive and time consuming to prepare your meals, and it will probably be incredibly burdensome at the beginning.
Sure, being able to include a small serving of gluten-free grains and legumes might make life a little easier for Paleo folks… but how much really? (For this reason I’d be skeptical if you’re considering using the Pegan diet to lose weight.) Are a lot of Paleo folks really falling off the wagon because they are feeling deprived of ½ cup of lentils? Dr. Hyman has said that his issue with Paleo is “some use the paleo philosophy as an excuse to eat too much meat and too few plant-based foods.” I’m not really seeing this pervasively in the Paleo/ancestral community, to be honest (intentional carnivore dieters notwithstanding). This strikes me as an attempt to solve a problem that didn’t need solving.
Truthfully, the things I like about Pegan are all the ways in which it is similar to Primal, which are many. Both Primal and Pegan have vegetables as the base of their food pyramids. They similarly emphasize the importance of choosing healthy fats and oils, avoiding grains and processed modern junk foods, and moderating carbohydrate intake (which Dr. Hyman frames as maintaining low glycemic load, but the effect is the same). Still, for many people the tighter Primal guidelines around carbs are probably better suited for weight loss and even weight maintenance.
Most days, if you were a fly on the wall in my kitchen, you’d see me eat a big-ass salad for lunch and a piece of meat with several types of vegetables on the side for dinner, and you wouldn’t be able to discern if I was Primal or Pegan. Then again, those nights when I tear into a giant steak would you most certainly be able to tell… and, trust me, I’m not giving those up any time soon.
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Chayote squash is having its day in the sun as of late, but it’s been used for centuries in Latin American cooking and baking. The chayote squash (also known as mirliton squash) is a mild-tasting, relatively low carb, and versatile fruit with a good dose of vitamin C. Because of its hardness, you’ll definitely want to eat it cooked, but the end result will be worth it: a tender but slightly crisp fruit that bears a resemblance to pear or jicama and that takes on the particular flavors of any recipe—sweet or savory.
Note: there’s a little extra prep involved with chayote, but we think the additional few minutes are well worth the approximately 50 grams of carbs spared (full recipe).
Time In the Kitchen: 20 minutes
5 cups chayote squash
1 tbsp cream of tartar
5 tsp cinnamon
1 tbsp lemon juice
1/2 cup Swerve (or equivalent of favorite sugar-free sweetener (e.g. monk fruit, etc.)
Preheat oven 350 ºF/175 ºC
Prep the squash. (This video has a good rundown of the process.) In a nutshell, cut the top inch off the fruit and let the liquid bubble up on the exposed flesh of the fruit. Rub the cut top piece over the exposed area for a full minute to draw up and out more liquid. This will create a froth as pictured. After the full minute, wipe off this froth with a clean paper towel. (Although the liquid/froth is completely safe, it may cause a mild tingly feeling if you get it on your fingers.)
Cut the fruit in half and remove the seed, along with the white flesh directly around it.
Cut squash into 1/4 inch slices.
Place in pot along with cinnamon, arrowroot or cream of tartar, lemon juice and sweenter. Cook over medium heat for about 10 minutes so that the squash starts to become tender.
Pour into ramekins.
Put all the crumble topping ingredients into a food processor and pulse until the butter is well incorporated and it looks good and crumbly.
Pour over top of squash.
Bake 30 minutes (or 45 minutes if baking as an 8-inch pie)
Nutritional Information (per serving)
Net Carbs: 8 grams
Fat: 28 grams
Protein: 12 grams
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People don’t talk about oxtail stew these days, but it’s a true Primal-worthy classic. With an arguably richer taste than beef and more succulent feel when cooked for stew or soup, oxtail might just become a new favorite. But the real difference (and reason behind the appealing stewed texture) is the ample connective tissue—an incredible source of collagen for the benefit of skin, hair, joint health, performance and more. (Since we used bone broth here in lieu of water or regular stock, this recipe is one of the best you can make for collagen content.) You’ll enjoy warming up with this gelatinous, flavorful and hearty dish on a late winter night. And you might consider making an extra batch: it tastes even better the next day.
Time In the Kitchen: 25 minutes (plus cook time)
2 pounds grass-fed oxtail
1 1/4 cup beef bone broth
1/4 cup Primal Kitchen® Barbecue Sauce
1 lb. small red potatoes (about 6), cut into bite-size pieces
4 large carrots, cut into 1-inch-thick slices
1 large onion, cut into bite-size pieces
2 slices nitrate-free bacon, cut into 1-inch pieces
Salt and pepper to taste
Heat Instant Pot on Saute and crisp chopped bacon. Remove and drain on paper towel.
Season oxtail and sear on all sides in bacon fat (3 min per side).
Add in other ingredients and cook 45 minutes on Manual High (Sealed). Let vent 15 minutes.
For slow cooker: cook bacon and sear oxtail in separate pan. Then cook all ingredients in slow cooker on low for 8 hours.
Nutritional Information (per serving):
Net Carbs: 24.6 grams
Fat: 36 grams
Protein: 67 grams
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