This article discussed how severe diarrhea can happen during intermittent fasting. After learning from this, hopefully, you can avoid it.
Intermittent fasting
Recently, I tried to fast for 24 hours. I fasted for 36 to 48 hours months ago and could tolerate them, so I thought a relatively short fast would not be a problem.
As a baseline, I might have some loose stools for a brief period if I fast for 18 hours, and I ascribe that to gastric acid as it goes down the intestines.
During my most recent fast, I took MCT (medium-chain triglycerides) oil as I started to develop hunger. I took it to tide me over until mealtime.
Then I remembered I still had some ketone supplements with BHB salts (beta-hydroxybutyrate), so I mixed one scoop with water.
Those on a ketone diet use BHB salts to provide energy without carbohydrate or sugar intake. Aside from glucose, ketones are also used by the heart, brain, and muscles.
When it was time to eat, I decided to finish what was left in the jar of the ketone powder, which was about two more scoops.
After the meal, I started to have the runs. At first, it seemed like the usual loose stools, but it kept repeating and was watery.
Each episode was probably about half a cup to a cup in amount. There was no blood, and I also had abdominal cramping.
Apologies if the description sounds graphic, but this is the kind of info a doctor will ask a patient who comes in for diarrhea.
By early evening, I probably had ten episodes of the runs. The problem is the gastrocolic reflex.
Was there ever a time when you had to go number two right after a meal? That reflex comes from the stomach stretching, which stimulates the recto-sigmoid area to contract.
I would say that my gastrocolic reflex was particularly acute during that time. That’s why every time I drink water to replace my fluid loss at that time, I hoped that there is a clear path to the toilet.
Luckily, the two doses of Peptobismol and a tablet of Imodium took care of the problem.
So, what caused the severe diarrhea?
BHB and MCT Oil
There is a saying in medicine that the retrospective view is always 20/20.
The MCT oil and the ketone salts were the culprits.
If a patient complains of constipation to their doctor, once bowel obstruction has been ruled out, mineral oil and milk of magnesia are commonly recommended.
Mineral oil coats the inner linings of the gut and helps lubricate its contents to ease their movement down the large intestines.
The Keto/BHB salts that I took contained Magnesium BHB salts. Each scoop has 172 mg of magnesium per serving. Since I had three scoops, that totaled 516 mg.
Magnesium draws water into the intestines by osmosis, softens the poop, and makes transit down the gut easier. Even if the magnesium I had was much lower than the dose in a milk of magnesia (400mg/5ml), the poop becomes watery if the gut is empty.
That being the case, it took me a day to recover and allow the electrolytes in my system to stabilize. Muscles and nervous tissues depend on precise levels of electrolytes to function. Lots of sodium, potassium, chloride, and bicarbonate get lost with diarrhea.
Take Away Message
To be clear, I’m not discouraging using MCT oil or keto salts when fasting. Just be careful with them.
If loose stools happen, do not take Imodium or any anti-diarrheal if there is any fever, severe abdominal pain, or bloody stools. Always consult your physician if you have a medical problem.
Drink plenty of fluids with some sugar and electrolytes to prevent dehydration and kidney failure.
Below is the recipe for an oral rehydration solution that you may want to memorize or print and stick to your fridge door.
Another that I memorized since pre-med school is the United Nations recipe for Oresol (Oral Rehydrating Solution)
Fill a two-liter bottle of pop with clean water. Add 1 tablespoon sugar, 1/4 teaspoon of salt and 1/4 teaspoon of baking soda. If there is no baking soda, use 1/2 tsp of salt. Shake. Use as needed. Refrigerate to preserve.
It is always handy to have over-the-counter products like Pepto-Biosmol at home in these emergencies.
Uses of Bismuth
By the way, do you know that research has shown that Pepto-Bismol combined with NAC (N-acetylcysteine) can take care of SARS-CoV-2?
While reading about bismuth salts, I found that when combined with NAC, they can possibly take care of several hard-to-treat infections.
6 Potential Uses of the Bismuth + NAC combination
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