Ketogenic Diets and PCOS: Hope or Hype? [Podcast] - PCOS Diva
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Ketogenic Diets and PCOS: Hope or Hype? [Podcast]

PCOS Podcast 84 Ketogenic DietsWhat exactly is a ketogenic (keto) diet and why do people feel so strongly one way or the other about it? In this podcast, we discuss the pros and cons of keto diets, specifically for women with PCOS. Martha McKittrick reviews the current research, offers sage advice, and answers questions women commonly ask me about keto such as:

  • How is keto different from a low-carb diet?
  • Who should avoid keto and who should try it?
  • Is it sustainable?
  • Does keto dieting work for fertility?
  • What is the keto flu?
  • What should I know/do before I try it?

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Martha McKittrick is a Registered Dietitian, Certified Diabetes Educator, and Wellcoach® Certified Health & Wellness Coach. Specializing in PCOS for over 15 years, she has lectured across the country to medical professionals and women with PCOS, has been published in medical journals and wrote two chapters in a book on PCOS. She is on the Health Advisory Board for the PCOS Challenge. Martha has a private practice in NYC. She also specializes in weight management, diabetes, heart health, and IBS.

Website: Martha McKittrick Nutrition     PCOS Blog: PCOS Nutrition & Lifestyle Solutions 
Facebook: PCOS Nutritionist Martha McKittrick

Full Transcript: 

Amy Medling:                    On today’s podcast, we’re going to be talking about a topic that I think’s going to be really interesting to many Divas. There is a diet craze right now called the ketogenic diet. I’ve heard from many Divas that have lost a lot of weight on the ketogenic diet, then I’ve heard from many who are really frustrated because it’s just not working for them.

We’re going to sort of look at this diet and whether it’s … to help you determine whether it’s right for you. I’ve invited a previous guest on the PCOS Diva podcast, Martha McKittrick. I think she’s a perfect person to talk about this topic. She’s a registered dietician, a certified diabetes educator, and certified well coach, health and wellness coach.

She specializes in PCOS and has been doing so for over 15 years. She’s lectured across the country to medical professionals and women with PCOS, and she’s been published in medical journals and wrote two chapters in a book on PCOS.

I know she’s just come back from a ketogenic conference, so she has lots of great information to share, and I’m just so happy to welcome you back on the podcast, Martha.

Martha McKittrick:          Thanks, Amy. I’m really excited to be back. I love your podcast, and I think this is a really interesting topic to talk about, so thanks for having me here.

Amy Medling:                    I know, I’m so happy that you’re taking the time out of your schedule to just really let us know more about the ketogenic diet, and kind of the pros and cons. That’s what I’d really like to know about, but first, why don’t you explain, like what is the ketogenic diet? And how is that different from like your traditional low-carb diet?

Martha McKittrick:          Yeah, that’s a really good question. It’s funny, you’re probably wondering, oh, a registered dietician. She’s probably going to trash keto. I know a lot of my colleagues are really, really anti-keto. I’ve been practicing for a long time, and I just remember years ago when I was working at a major hospital, we had infants on a ketogenic diet to help control epilepsy. That’s actually when it started. It was like in the 1920s.

Basically, what they found out is when you put these children on this diet, which basically they were allowed to eat almost no carbs, a super high-fat diet, it actually helped to control their seizures. That’s when it started. So my kind of, I guess, initial reaction is, oh my god, this is a horrible diet. It’s full of fat.

Then Atkins came around and modified it a little bit, and it became more palatable, where years ago it was more, the children were consuming medium chain triglycerides and this kind of nasty fat, but with Atkins you were having steak and cheese and all that and, again, the dietician in me comes out, that’s horrible, it’s full of saturated fat, and how can that be good for you?

You look on Instagram and Pinterest and you’re seeing all these pictures of just fat, and carbs are bad. So I tried to put aside my rather conservative training, because I am open-minded, and I wanted to take a look at this ketogenic diet and see what it’s all about, and I actually followed it myself for five weeks, which I’ll talk about a little later, and like you said, I just came back from this low-carb conference in Breckenridge. It was three days of lectures on the ketogenic diet, showing some new research.

So, to answer your question, what is the ketogenic diet? Basically, it’s a diet that induces ketosis. What is ketosis? Ketosis is when your body is getting its fuel from fat. Normally, our bodies like to run on glucose, sugar. That’s how most of our bodies, our muscles function, our brains function, but the ketogenic diet is when you consume so few carbohydrates that you’ll lower your glucose levels and your insulin levels, and then your body is forced to use fat for fuel.

Basically, when you use fat for fuel, you produce something called ketone bodies. This becomes an energy source for the brain, the heart, the muscles, and your whole body. It’s basically you kind of change from being a sugar-burning machine to a fat-burning machine. That’s basically what the ketogenic diet is. It’s a very, very high-fat diet.

There’s different forms of ketogenic diets, like some to treat the children with epilepsy tend to be a lot stricter, but now it’s a little less strict, and on average, it’s about 70 to 75% of your calories are coming from fat, about 15 to 20% come from protein, and about 5 to 10% come from carbs. To make that easier to understand, most experts recommend that you stick to about 20 grams net carbs a day.

Amy Medling:                    What does that look like? Maybe you could walk us through sort of like a breakfast, lunch, dinner, snacks.

Martha McKittrick:          You know, it’s hard, because, like I said, I tried it myself, because I feel like I can’t talk about a diet unless I’ve actually been on it. The difference between the ketogenic diet and just a regular low-carb diet, and I hear a lot of women say I’m doing keto, then I kind of ask them and see what they’re eating, and they’re really not doing keto.

Because if you’re consuming a lot of protein, and that’s actually what Atkins diet is like, it’s a higher protein and a high-fat diet. When you consume extra protein, that can actually break down and turn into sugar, so that will throw you out of ketosis.

Like if you really want to be on a ketogenic diet, you’re probably best off, maybe at least in the beginning, testing your ketone levels, and you can do that through testing your urine, and you can get these ketone strips to test your urine, or you can get like a breathalyzer to test ketones in your breath, or you can test your blood. That’s the most accurate way to see if you have ketones in your blood.

70 or 75% fat, it’s really hard to do. It might sound like, oh, this would be a great diet if you love fat. You can have tons of steak and cheese and all that kind of stuff, but you know what, there’s a lot of protein in steak and cheese, and if you’re loading up on a lot of foods like that, you’re going to get above the recommended amount of protein to stay in ketosis.

To answer your question, what would you eat on maybe a typical day? Well, when I did it, I would have like one egg in the morning with a couple egg yolks. I would cook it in a lot of butter. I would throw in a little bit of vegetables in there. Then I would make a fat coffee. It’s funny, as a dietician I’m saying I put butter in my coffee. I swore I would never do that, but I put butter and medium chain triglycerides, or coconut oil, in my coffee.

Amy Medling:                    Yeah, or Bullet-proof coffee, which a lot of people think of.

Martha McKittrick:          Yeah, Bullet-proof coffee, yeah. I don’t have the numbers in front of me, but my fat content at breakfast was probably like about maybe 40 grams of fat or so. Basically, for me, I was having to add in extra fat where I didn’t really choose to do that, putting the Bullet-proof coffee and having lots and lots of butter in my eggs. So that’s an example for breakfast.

Then lunch, I would have a salad, but the thing also is you can’t eat a ton of vegetables on a ketogenic diet. Because if you’re trying to keep it to be 20, 25 grams of net carbs, it adds up really fast, because carbs in nuts, and there’s carbs in avocado. I love to put a ton of avocado on my salad, but that was bringing you above the level.

Amy Medling:                    Interesting, yeah.

Martha McKittrick:          What I did was, I kept track on an app. I think I used MyFitnessPal, because as the dietician, I wanted to be perfect with my numbers. I tracked all my macros and all that. I saw that it added up really quickly. So lunch could be a small piece of salmon, maybe like three ounces, with a lot of leafy greens, quite a bit of olive oil on the salad, about a half of an avocado.

I really used a lot of olive oil and olives to get my fat intake up there. So keeping the protein moderate and the carbs low, and then snack could be a handful of nuts, it could be some like almond butter on celery. Some people do things like cream cheese on celery, that kind of stuff. It’s really trying to get in as much fat as you can.

Amy Medling:                    And fat bombs, too, I know a lot of people do.

Martha McKittrick:          Yeah, people do fat bombs, yeah.

Amy Medling:                    It’s kinda like a coconut oil truffle, I guess you’d call it.

Martha McKittrick:          Yeah. I personally didn’t have a lot of time to cook and prepare meals, but if you have time to do that, there are a ton of recipes you can get on-line that give you a lot better ideas than what I just said.

The main thing I think I see with ketogenic diets is that a lot of women, they’re eating a lot of protein, and they’re not getting their fat up high enough to get into ketosis.

Amy Medling:                    So, then dinner, what would dinner be?

Martha McKittrick:          Dinner, I got some really fatty beef, when normally I would look for like lean ground sirloin. I went, I get the fattiest chuck I could find, and I sautéed it with a lot of oil, and it put it over zucchini noodles. Again, olives. Just try to get in the olive oil and the olives, things with the fat.

Amy Medling:                    Alright, to be honest with you, it’s kind of making me a little queasy. I don’t know. I mean, I love to hear your pros and cons, but I’m all for healthy fat, and I love avocado, and adding olive oil and coconut oil like to my smoothies, but I guess the fact that you’re not eating plentiful amounts of plant food, lots of vegetables, which I just think is so critical to successfully managing PCOS, all of that fiber, like where’s the fiber?

Martha McKittrick:          Yeah. Yeah. Actually, I ended up going off it, because all I wanted was an apple. I was dying for a Granny Smith apple. For me, it didn’t really work. I guess the question is really why are people doing it? And why might it be helpful?

Amy Medling:                    Yeah, definitely, because we know it is working. It may not be … It may be keto-ish, like Paleo-ish.

Martha McKittrick:          Or dirty keto. They call it dirty keto.

Amy Medling:                    Oh, I like that, yeah.

Martha McKittrick:          Yeah, dirty keto.

Amy Medling:                    Because I know it’s working. I see it in Divas. They’re losing lots of weight, those who have had hard times losing weight with other ratios of macronutrients. So, tell us why you think it’s working for some.

Martha McKittrick:          I mean, I think one of the main reasons why it’s working is when you are in ketosis, the actual ketones produce a bit of an anorexic effect, and it takes away your appetite. You just don’t get hungry. I’m the kind of person where in the morning, as soon as I get up, I’m hungry and I want to eat, but when I would have my fat bomb coffee, sometimes I didn’t even have breakfast, and I wasn’t even hungry until like 1, 1:30, or maybe I would have lunch, and I didn’t even really care if I had dinner. The ketones itself produce anorexic effect.

Also, when you’re actually in ketosis, and I guess one thing I want to say about that is that it takes you a while to become fat adapted. Now you can go on a ketogenic diet for a couple days, and maybe you’re in ketosis, but you’re not what’s actually called fat adapted.

It can take weeks to months for that to happen. What that means is that your body can become very, very efficient at running on fat for fuel, and you can actually burn double the amount of fat than you would if you weren’t keto adapted. Keto adapted is kind of the state that you would want to get to if you were going to be in ketosis. You have to be patient. Once that happens, you do burn a lot more fat.

So, what are the potential benefits? One is that it does speed fat burning; like I said, you’re burning double the amount of fat. It can take away your appetite. You’re just not as hungry. It curbs cravings, which I know is huge for PCOS Divas is carbohydrate cravings. It can cut that a lot, really.

There is an increased weight loss. Now, you can lose weight on really most healthy kinds of diets or eating plans that work for you, but they have done studies in people who are able to stay in ketosis do have increased rates of weight loss, so it can speed weight loss. Is that actually due to the hunger suppression from the ketones? Maybe. Is it due to your body using more fat for fuel? Maybe.

You also consume fewer calories, because if you’re feeling kind of full or satiated all the time, you don’t get that urge to keep snacking, so you actually consume fewer calories.

You can greatly decrease your blood sugar and your insulin levels, because now that you’re consuming minimal carbohydrates, your blood sugar’s not going up, you’re not having to make all that insulin, so someone with PCOS find their symptoms are improved because they’re making less insulin.

It can decrease risk of type 2 diabetes. Some studies have shown it can actually reverse type 2 diabetes. There’s a website your listeners might want to check out. It’s called Virta. It’s v-i-r-t-a. They have a great blog, and it really explains a lot about ketosis. There’s a really good blog post on ketosis and weight loss. It goes into a lot more of the science than we have time to get into. People in their study were able to reverse their diabetes.

Now, it doesn’t mean cure diabetes, it’s reverse it, so it means a blood sugar gets normal as long as you keep losing weight and you stick to the plan. It can do that. A lot of people say they have more mental clarity when they’re on this. They’re doing a lot of research on using ketogenic diets for some neurodegenerative conditions like Alzheimer’s, Parkinson’s even, dementia, and ketones are very clean fuel for the brain.

I don’t know if they know exactly why it works, but a lot of women who do go on this diet say they have mental clarity. I didn’t necessarily experience mental clarity, but I know a lot of people say they do experience it.

Other possible benefits. Now, I know we all think of saturated fat as increasing risk of heart disease. I just know that’s how I was trained, and saturated fat’s bad, and it raises cholesterol, and that increases risk of heart disease; however, that belief is being questioned right now by a lot of experts, and we’re saying maybe that’s not true, just like we were kind of brainwashed that fat is bad, and eggs raise cholesterol. So newer research is saying maybe that’s not true. We don’t think it’s true.

Ketogenic diets or very low-carb diets might actually help decrease cardiovascular risk by raising the good cholesterol, the HDL, by lowering triglycerides. Now it might raise total cholesterol, but when you look at the breakdown, it actually can decrease the small dense atherogenic LDL cholesterol and increase the large fluffy LDL cholesterol.

What I want to say is this is like super individual, because some people genetically, if they do have a lot of saturated fat, it does increase risk of heart disease, so if you were going to go on a ketogenic diet and you had a history of high cholesterol or family history, I would definitely keep tabs on it, and I would want to get maybe like a more complete breakdown of your cholesterol; don’t just get the LDL, but get the whole breakdown, the different particle size and particle number, keep tabs on that.

Amy Medling:                    I was just going to say, too, we’re all bio-individuals, we’re all different, and I don’t think there’s any one size fits all approach to diet, and I think you’re right, you have to look at your genetics, and I think it’s good to experiment. It certainly doesn’t hurt to give this approach a try, and that’s why I’m just so glad you’re here kind of explaining it to all of us.

Martha McKittrick:          Yeah, and I agree with you a hundred percent, and that’s, I think one thing is that we just have to really realize is that we have different genetics; we have different gut microbiomes, different metabolisms, and maybe low carb, where keto works great for some people, and other people don’t need it. Everybody’s different, and gluten doesn’t work for some, and it works for others. We have to see what works best for our bodies, and just because somebody on Facebook is doing great on keto and you’ve tried it, and you feel miserable, don’t feel like you’re a failure, it’s not for you.

It’s certainly not my first choice for women, but I’m open-minded that some women do want to try it, so I guess my goal is to try and give advice on what’s the best way to do it if you are going to do it. There are some benefits. Again, this conference I went to, they showed a lot of really interesting work that they’re doing with ketogenic diets, so I think it’s super interesting.

Amy Medling:                    I didn’t want to interrupt you on the benefits, so I want to get back to that, but I’m just wondering about sustainability.

Martha McKittrick:          Yeah.

Amy Medling:                    It seems like this is one of those diets that you go on for a relatively short period of time. I just think in day-to-day life it’s hard to sustain something like this over the long haul.

Martha McKittrick:          I agree. I agree. I agree with you, but that being said, there is a small subset of people who it just really clicks with them. I mean, the first thing, you have to love the food. If you don’t love high-fat foods, it’s not the plan for you. What I did, I like fat, but I felt like I was forcing having to add fat in all my food when I really didn’t want to do it. You have to love the food, that’s number one.

I think you have to have people maybe in your life who are doing the same thing, like if you have friends who do keto, or you have family members that … socially, it’s hard. If you go out … We’re not talking Atkins where you have this massive 10-ounce steak; how are you going to get your diet to be 70% fat? How are you going to really get the fat intake up and keep the protein moderate?

It’s not a super easy diet to follow. On one hand, it made me cook more, so I don’t really cook that much so, in a way, it was good. I had food in my refrigerator, I had some leafy green vegetables, and I bought more protein, and I was cooking. So, in a way, that was good.

Let me see, I think I’m kinda finished with my benefits. I think the biggest thing is that it cuts carbohydrate cravings, it can help lower insulin and blood sugar greatly, might help with mental clarity, might help with mood swings. They have done some studies where it might help eliminate migraines. You can probably cut a lot of your medications that you’re on, especially diabetes medications.

It also might help decrease inflammation, which sounds kinda weird, because you think an anti-inflammatory diet, you need a lot of fruits and vegetables and whole grains, which is true, you do, but when you have these ketone bodies, specifically beta hydroxybutyrate, it actually turns on a gene in your body that protects against oxidative stress and inflammation. Kinda cool stuff.

Amy Medling:                    Mm-Hmm (affirmative).

Martha McKittrick:          What would the cons be? I definitely have a lot of cons. I think the biggest one, Amy, is, as you said, it’s very restrictive, and its sustainability can be a tough thing.

Another big concern I have is a lot of women with PCOS already have somewhat of an unhealthy relationship with food, or an increased risk of eating disorders or whatever, and now you’re being told … Talk about restricting, you’re being told you can’t have an apple, and you can’t have any whole grains. It is very restrict … And you can’t even eat a ton of vegetables, because that might throw you out of ketosis.

It is super restrictive, but for some people, somehow, they’re able to just grasp this and maybe it gives them almost like a comfort or like they’re feeling like … I don’t know, they know their boundaries, and I don’t like to tell people to restrict or have boundaries, but it really connects with some people, and they feel safe, because they know this is what they can eat and it works for their body; it takes away some decisions.

Amy Medling:                    Let me ask you. Say there’s a woman listening who’s wanting to get pregnant, and her doctor tells her that they don’t want to start any treatment until she loses 30 pounds. Do you see this as a diet that you would go on to help you lose that 30 pounds quickly?

Martha McKittrick:          That’s a good question. That’s a great question. I guess my concern, and I think it’s possible. My concern would be is, I don’t think this is the best fertility kind of diet. I certainly wouldn’t recommend somebody be in ketosis while they’re pregnant or while they’re breastfeeding.

There’s a book out there, a dietician wrote it, and I think it’s called … I think her name is … Oh god, I’m blanking on her name, but it’s like Eat Real Food for Pregnancy, and she kind of advocates a super low-carb, possibly even a ketogenic diet. I think it’s Elizabeth Nichols, maybe her name is, and she kind of advocates this kind of a diet. I just don’t feel comfortable, a woman, if she’s trying to get pregnant, to be on such a restrictive diet and not get in these micronutrients.

A study just came out recently where I think women who are following ketogenic diets while they were pregnant, there weren’t good outcomes, and they’re thinking maybe it’s because the diets were deficient in folic acid, because you’re not really having any greens that have been fortified with folic acid.

At the very least I would say if you were going to do a ketogenic diet to get some weight off really fast, I certainly would take a prenatal, and I would make a very strong point to make the diet as nutritious as you possibly could and get in some really nutritious vegetables and some plant-based kind of fats and proteins, too.

Yeah, I probably would be more of a fan of maybe a very low-carb diet but not necessarily ketogenic diet if you were thinking of getting pregnant in the near future.

Amy Medling:                    Okay, so let’s say pregnancy, trying to conceive aside, do you think that this is a good way to try to lose … We know that if you lose just 10% of your body weight, it really improves PCOS symptoms. So do you think this is a good way to do it?

Martha McKittrick:          I think it’s an option. I like to give people lots of options. If somebody just wanted to bite the bullet and just stick to it, say I’m going to do it for eight weeks, sure, I think it’s an option. If a woman were to walk in my office and say, “What do you recommend?” I don’t think my first choice would be keto, but if you wanted to do it, I’d be on board with it.

Amy Medling:                    Now, do you have any sense of transitioning out of keto into something that’s a little more moderate?

Martha McKittrick:          Yeah, that’s a great question, actually. Yeah, you definitely would want to transition slowly, because if you’re on a diet that’s really, really low carb, and then you go back to significantly adding in more carbs, I think you would gain weight probably pretty quickly. I would ease into it just slowly get my carbs back up. Maybe now if we’re talking 25 grams of net carbs, maybe it would go up to slowly add in 15 grams per week. That’s just a thought.

Martha McKittrick:          I don’t like women to be obsessed with counting net carbs, and the only reason why I’m even talking about it right now, is really is because for keto, you have to.

Amy Medling:                    Right. Right.

Martha McKittrick:          I don’t normally make women count their vegetable carbs. Actually, I had a patient come into my office a couple weeks ago. She was so upset. She thought she couldn’t have eggplant because it had like 4 grams of carbs versus 3 grams of carbs, and I was like, “Oh god, this is just not good.” Yeah, so I think people could transition, do keto, get some weight off if you want to, and then transition into like a little more of a livable kind of a plan.

Amy Medling:                    When you were on the ketogenic diet, did you see any … I know you said you didn’t really have the clarity that some people experienced, but were there any upsides for you?

Martha McKittrick:          I thought it was interesting, because I do have a lot of carbohydrate cravings. I mean, I don’t have PCOS, I’m not insulin resistant, but I definitely crave carbs a lot. By being on such a high fat diet, like they almost went away. I had lunch and I was fine. I wasn’t looking for some office snacks, to see what kind of chocolate was hanging around. No, I definitely had less cravings, for sure.

I also thought it was pretty interesting, because I’m a big-time cyclist, and I was able to do a lot of long rides having like minimal carbs, and normally I have a ton of carbs when I ride, so I guess my body was kinda eating its fat for energy. I thought that was really interesting, too.

I felt fine, but I just missed foods that I liked that I couldn’t fit into the diet.

Amy Medling:                    Well, I have to be honest. I don’t think I could do it. I mean, I do enjoy a cup of Bullet-proof coffee every now and then, but I know myself and, gosh, just experimenting with food over all of these years, that I have to be really careful of that restrictive … especially when you start counting carbs and calories, it kind of triggers me back into that perfectionist like, gosh, if I go over my allotment, then I sort of throw in the towel.

In the way that I sort of teach how to eat with the PCOS Diva lifestyle, it’s more of an intuitive eating, feeling how food makes your body feel, and eating lots of nutrient-rich vegetables. That’s what works for me. I’m glad that you were able to talk about your experience on the ketogenic diet, because I don’t think I’m going to try it, and I won’t be able to talk about my experience.

Martha McKittrick:          Yeah, it was interesting. Sometimes I hang out on some of the Facebook, the groups and stuff. I’ll see a woman say, “Oh, I blew it. I had a piece of bread. I blew it,” and she’s just beating herself up. That’s not good. I feel bad. It just shouldn’t be that way, so I’m with you, where it needs to be what works for you, listen to your body, what kind of foods do you like.

I guess kind of an upside is, I mean, I think adding more fat to foods helps, kind of that’s one of my take-home points, is that I know some women tend to still be a little fat phobic, so add more fat to your meals. You don’t have to be keto to lose weight. I think that’s another thing I want to kinda stress is, you don’t have to. You can do a healthy diet. It doesn’t have to be keto. It doesn’t have to be super low carb. You want healthy kinds of carbs, but don’t be fat phobic.

Amy Medling:                    Yeah, some butter on your vegetables,

Martha McKittrick:          Yeah, have some butter.

Amy Medling:                    Makes it more delicious.

Martha McKittrick:          And you can have … We’re getting past the whole saturated fat is bad thing. What I think is worse, are refined oils. Corn oil, soybean oil, all that kind of stuff. That, to me, is not so good. I think it’s probably…

Amy Medling:                    Could you talk about that for a minute? We have a few more minutes.

Martha McKittrick:          Yeah, I’ll talk about that. I also just want to really quickly talk about other reasons why they might not be good, I think it’s kind of important to know. If you are doing a ketogenic diet, there is something called the keto flu that can happen in the beginning, and that can be headache, constipation, you feel tired, lightheaded, poor sleep, no energy at all, and it’s really important that you take enough fluid when you’re on a ketogenic diet, and that you have enough sodium.

So maybe have a couple cups of like salty broth a day, because you’re losing a lot of liquid, you’re losing a lot of fluid, and you can get an electrolyte imbalance, so you want to have the sodium, you want to have magnesium, like get in some leafy greens. It could be actually pretty dangerous, so beware on that.

It’s not a nutritionally balanced diet. You’re definitely missing, lacking in a lot of foods. One of my concerns, and I know I was actually talking to Dr. Gretchen, who you had on your show the other day. We were talking about this is, gut health. There’s not a lot of mention with ketogenic diets and gut health. I know you’re a big proponent of foods good for the gut.

Like every lecture I go to, they talk about the gut microbiome and linking to mental health, and 70% of the immune system. If you’re on a diet now where there’s very little fiber, and plant-based fiber, what’s that doing to your gut microbiome? And I think we just don’t know long term. We don’t know. So what I could caution you is if you were going to do the ketogenic diet, is to do your best to get in different kinds of fiber. We call these prebiotics, and these are … it’s kind of like food for the probiotics.

So, you would get in different kinds of vegetables and garlic and onions, asparagus, chicory root, glucomannan that you get in shirataki noodles. That has a lot of prebiotics. You could even take a prebiotic supplement, a low-carb prebiotic supplement. Feed your good bacteria.

We just don’t know enough about that yet. Again, like I said, they’re linking gut bacteria to mental health. Not everybody experiences mental clarity on the ketogenic diet. Some people don’t feel good.

Amy Medling:                    Or even fermented foods, is there a place for those?

Martha McKittrick:          Oh, sure. Absolutely. You could get in some kimchi, miso, naturally fermented pickles, these are all low-carb foods that could fit into a ketogenic diet. So that’s an option.

Another thing I want to say in terms of a caution is, if you have a medical issue, like if you’re on medication for high blood pressure or for diabetes, make sure you just double check with your physician, because if you are having kind of rapid fluid losses or rapid weight losses, you could get some kind of serious health issues if you stay on your regular dose of medication without adjusting it. And there are certain medical conditions that if you have, you should not be following a ketogenic diet, so that’s another caution.

As I mentioned before, make sure you keep tabs on your cholesterol profile, and those are my main cautions. Like you said, maybe if you wanted to, you could do it short-term. You don’t have to do this for life. It’s an option. It’s not something I think everybody should do, but it’s an option.

Amy Medling:                    Mm-Hmm (affirmative). So how would you have a sense whether it’s right for you, after evaluating everything that you said?

Martha McKittrick:          I think if you’re healthy, healthy meaning you don’t have gallbladder issues or any issues where you couldn’t go on this kind of diet, and if you like the kind of foods that are on the diet, if you like fat, it’s enjoyable food for you. If you want to spend some time maybe preparing foods, if you have that time. And if you have insulin resistance which, obviously, most women do, and if you have a fair amount of weight that you want to lose, if you have a lot of carbohydrate cravings, then you can give it a try.

Again, I’m not a proponent of it, but I’m open to people trying if they choose to, and you don’t have to count all your macros and do all that. I would just kind of start out maybe slowly, just cutting back on obviously most carbohydrates. Mainly you would want to do vegetables, protein, and add a little more fat to your food. Then once you’ve done that for a while … If you did want to track your macros or if you did want to test for ketones, you could just go to your local pharmacy and get the ketone, the urine testing, so you could test and see if you have ketones in your urine. That’s what I did. That’s an easy way to start.

Pay attention to how you feel. If you do it and it’s stressing you out, you’re probably getting stressed just listening to me.

Amy Medling:                    I am.

Martha McKittrick:          It should be something that feels good, and that you feel positive about. The majority of people, probably 95% of people, this is not right for, but 5%, it’s the best thing in the world. This conference I went to, people stood up, it changed their lives. They got rid of their diabetes, they got off medication, they lost a hundred pounds, they feel fantastic. You know what? If that works for you, that’s awesome. Just try and make the diet as healthy as you can. That’s all I would say.

Amy Medling:                    So, speaking of healthy as you can, let’s circle back to the healthy fats versus the unhealthy fats before we wrap up.

Martha McKittrick:          Yeah, that’s a good point. You want to try and get some plant and animal fats, if you want animal fats. Some people want to be vegans, but this is tough to do as a vegan, this kind of diet, but you want to get plant and animal fat, so we’re talking avocado, nuts, seeds, nut butters. You can have some coconut, as well as meat. I would try not to do a lot of processed meats. Like I know when you look on Pinterest and Instagram, there’s tons of bacon and all that kind of stuff. I’m not a huge fan. You can have a little bit. I would rather see you get some grass-fed beef and some hormone-free other kinds of animal products, but definitely add in the plant-based fats, as well.

We’re limiting processed meats and focusing more, like I said, on the grass-fed. You want to include gut-healthy prebiotics in there, like we talked about before, and some probiotics. Limit use of artificial sweeteners. I know, Amy, both you and I agree on that, right?

Sometimes people will be adding in lots of artificial sweeteners to make these little keto desserts and all that stuff, since you can’t have sugar. I’m not a fan of artificial sweeteners, so I would discourage you from using those.

Amy Medling:                    What do you think of things like monk fruit or stevia?

Martha McKittrick:          You know, they haven’t done as many studies on stevia as they have on sucralose or Splenda. It’s like every time you read the news, they’re doing a new study on Splenda that’s showing it might have some pretty negative effects.

Amy Medling:                    That’s Splenda, right.

Martha McKittrick:          Yeah. I haven’t read much about stevia. Is it because they’re not doing studies on it? Or the studies they’re doing aren’t panning out the same as Splenda? I think all added sweeteners, whether natural or artificial, should be limited. I’m not saying don’t do stevia. I guess of the sweeteners, stevia might be a better choice.

I’m not sure of the carbohydrate content of monk fruit. I’d have to look that one up. If it’s low, yeah, it would be okay but, again, I think … We also want to get out taste buds away from craving something sweet.

Amy Medling:                    I agree with that.

Martha McKittrick:          Keep your fibers high as possible on a ketogenic diet as much as you can without throwing yourself out of ketosis. I would even consider taking, as I said before, some kind of a prebiotic supplement. There’s one I have, it’s called Prebiotin, and it’s just prebiotics, and it pretty much has like maybe one or two grams of carbs, and it’s pure fiber, and it’s like a really healthy kind of fiber that’s really good for the gut.

I think just paying attention to how your body feels. If this kind of plan makes you feel good, then do it for a while. If it doesn’t, don’t feel like you need to do it.

Amy Medling:                    This has all been such great information. I definitely learned a lot from this podcast. Thank you so much, Martha. I want you to just let us know where we can find out more about your work, and I’m sure if somebody really wants to work one-on-one with you on this, you could be of tremendous help with a very specific diet, helping figure out how it could work in her life.

Martha McKittrick:          My website is Martha McKittrick When you go onto the website, I do have a blog that you can sign up for, and I do post about once a week, so you could sign up for the blog. I’m also on Facebook at … I almost forgot my name- PCOS nutritionist Martha McKittrick.

Just to be clear, like my thing is not ketogenic diets, I’m more about healthy diets that aren’t as restrictive, working with the individual person, looking at whole lifestyle and sleep and exercise and mental health, so this is just one little, I guess, tool in my toolbox if somebody wanted to learn more about it, but I’m more about other kinds of healthy plans than this.

Amy Medling:                    Yeah, and it is. It’s so much more than just one diet; it takes a holistic approach, and you’re right, it’s mindset, it’s sleep, and lifestyle. This is just one little, like you said, tool.

Martha McKittrick:          Just one little tool, yeah.

Amy Medling:                    And I hope that that’s how people listening are going to view this type of diet moving forward.

Martha McKittrick:          We need more research. We don’t have enough research on the long-term effects of a ketogenic diet, that’s the whole thing. We don’t have the research, but you know what? If you follow it, and you feel great, and you’ve lost weight, and you’ve lowered your insulin and your blood sugar and it’s working for you, then it’s probably good to do it.

Amy Medling:                    Yeah, and I’ve love to hear from you if it’s working for you. It’s great to have that information. Thanks again for joining us.

Martha McKittrick:          Thanks so much.

Amy Medling:                    I’d love to have you back on. I’d love to talk about vegan diets. I know that’s another whole different approach, but you need a lot of guidance around that type of approach for PCOS, as well.

Martha McKittrick:          Absolutely. Thanks so much.

Amy Medling:                    Okay, great. Thank you, and thank you everyone for listening. I look forward to being with you again soon.


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  1. Martha, I’m not sure what keto diet you were on but it doesn’t sound much like mine. But then I have PCOS, insulin resistance, possible hypothyroidism and am morbidly obese, so yes results may vary. I also eat vegetables every day and fruit regularly. I’m not big on apples but if i want any I’ll have some – just not a whole one. I mostly stick to blueberries because they’re my favourite. There are things I can’t/won’t eat (including some vegetables) but I couldn’t eat them before anyway, queue huge carb cravings and massive blowouts. Funnily enough that bacon thing is a huge myth – I’ve actually reduced the amount of bacon I eat considerably.

    Apart from all that though, I’m sure I heard you say that keto has been around nearly 100 years but it’s unproven?