I Love Keto too!

My great grandfather’s last name is DeCiantis. It is derived from the Italian word “ciancia” meaning “plump”, “round”, or “rotund”. As a surname, it was likely used as a nickname for someone who was round or plump in stature (at least according to the internet). The region in Italy where the DeCiantis hail from is incredibly poor. Some people’s bodies have adapted over time to store more fat as a survival mechanism. Part of my lineage developed this ability. My mother always struggled with her weight. She did not consume a lot of food or large portions of food but she was always struggling. One thing we did eat A LOT of growing up was carbs. When I was young low fat diets were the rage. We can now see how low fat/high carb diets are actually terrible for some people.

It has been highly researched women with PCOS have a metabolic disorder. No one can explain why this is but it’s known that women with this disorder have issues with obesity and insulin resistance. It’s easy for a thin physician to tell a patient to ‘just lose weight’ and point to a study that shows losing weight helps regulate the ovary and the menstrual cycle. Lots of things are easier said than done. Based on my extensive clinical experience, the best and easiest diet for women with any metabolic disorder or PCOS is keto. You will be able to lose weight without trying if that is an issue for you.

Keto is a special type of low carb diet. Carbs just don’t work for your body if you have PCOS. I used to race my motorcycle when I was younger (I know crazy). When I was racing, I would use a different fuel since that makes the engine perform better and faster. Formula 1, NASCAR, etc, doesn’t use the same gas as what you get at your local gas station. If you have PCOS, you are almost like a high performance car and can’t put just anything in your engine. You can power your body from either glucose or ketones. There’s a lot of books out there that go deeper into the science of this. One I recommend by a fertility doctor is this.

Your carbs need to be less than 10% in order for your body to generate ketones and burn fats vs burning glucose. We want our cells to get energy from ketones vs glucose when we have a metabolic issue. For keto, fats need to be 70-80% of your diet with protein being 20-25%. The typical American diet is 65% carbs, so this is a radical adjustment. Most people at first freak out about eating more foods that have cholesterol in them. Cholesterol is not bad for fertility. The precursor to your hormones is cholesterol, which means your body cannot make estrogen, progesterone or testosterone if you don’t have enough cholesterol. If you want to grow 30 eggs during IVF, you need more cholesterol. If you are struggling with infertility, forget about heart disease or cancer at this moment. 100% focus on fertility. Don’t think about how heart disease runs in your family, etc. That’s not your problem now. I always tell patients that someone training for a marathon is eating a radically different diet than someone training for a weightlifting competition. Eat for what your end goal is now, which is fertility, not heart disease. This doesn’t have to be your forever diet (even though there’s a lot of info out there how keto is a heart friendly diet, but I won’t argue that point now).

It’s very difficult to get started with keto since it’s not something most people grew up with. There aren’t restaurants that are well known that are keto focused in NYC. This is the one time I recommend for a few months doing a meal delivery to get familiar with the diet. One company I like that has keto meals is Factor 75. Their portions I find to be a bit small if you are a very active athlete but it’s a great way to see how to get more fat in your diet. Eating keto is also very hard to do all the time. Some people do keto cycling, which is eating keto for 5-6 days, then taking a day or two off but still eating low carb on your break days. I’ve actually seen great results with keto cycling. A cookbook my patients have recommended to me written by a fertility doctor is this.

I wish I could tell you why life is not fair and why some people need to be more vigilant about their diet. It’s not fair that some people can eat crap all day, be surrounded by toxins, not exercise, consume copious amounts of alcohol, and have no health problems. We just have to deal with the cards we’ve been dealt.

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Stop Counting Calories or Measuring Your Portions

After I graduated with my Master’s in Engineering, there were hardly jobs anywhere in the NYC metropolitan area so I did like most engineers do and moved to Silicon Valley. Silicon Valley has a very different demographic makeup than the NYC metropolitan area. The majority of people I lived by and worked with were from somewhere in Asia. I had always assumed that Asian people must be thin because they ate smaller portions. When I started spending my time eating breakfast, lunch and dinner with new friends and coworkers, I saw that this was the farthest thing from the truth.

My coworkers brought their breakfast, lunch and dinner in (sometimes the workdays are long) and the portion sizes were actually pretty decent in size. I couldn’t believe it. Whenever there was free lunch at work, everyone went crazy and grabbed an insane amount of food. Nobody cared about portion control. Hardly anyone at any age was overweight. The biggest difference was everyone was predominantly eating healthy home cooked meals. No one was eating any processed or prepared foods. No one was eating a Snickers bar or Lays potato chips. Whenever someone compares the US to anywhere abroad about portions they are usually comparing going out to a restaurant in the US to a restaurant abroad. No one talks about comparing a typical home cooked meal. Since most medical devices are early clinically tested or manufactured outside the US, I have spent an insane amount of time traveling globally. The restaurant portions are not astronomically different globally as people love to say they are. I was consuming more than average calories at the time since I was training for marathons, half marathons and triathlons and I never felt I was not given enough food when I ate out at a restaurant or at a manufacturing facility’s cafeteria. It’s unfair to only compare a place like Claim Jumpers to everything else. After living and working in Silicon Valley, along with extensive global traveling, I started to question the portion mantra people constantly use to explain why Americans are overweight.

I have spent a considerable amount of time in Europe since medical devices are first tested there frequently and engineers are sent to support this. There is also a lot of medical manufacturing there that I had to support. When I was spending months on end there, I also noticed people were eating a normal healthy amount of food and not the small portions “experts” say we should be eating. I started to wonder why it’s easy to stay healthy abroad but more challenging in certain parts of the US. For example, if I was sent out to the Cleveland Clinic for an extended amount of time, my weight would change pretty fast.

The energy unit of the Calorie (or the Joule) hasn’t been around that long. The unit Calorie was first discovered in the early 19th century by a French physicist named Nicolas Clément, who used it to measure the amount of heat generated by an electrical current. The unit Joule was discovered in the mid-19th century by the English physicist James Prescott Joule, who is also known for his work on the first law of thermodynamics, which states that energy cannot be created or destroyed, only converted from one form to another. Prior to this, no one knew how much energy was in food. No one was able to count calories prior to the 19th century. Calories are just the measured heat energy given off something that is burned. Everything has calories. If a human tried to live off a plant based diet of eating leaves and grass, they’d die of starvation, even though grass is a high calorie food (look at how big cows are). It’s obvious how we process foods goes beyond calories. Humans survive off an extreme range of diets. The types of foods we eat, not the calories, play a major factor in our weight.

Humans have also consumed more calories in the past than we do now for tens of thousands of years. Farmers and factory workers needed twice as much calories as us to do manual labor. It wasn’t until the mid 20th century that humans have adopted a sedentary lifestyle. Besides jobs not needing as much physical labor, the invention of cars, modern appliances and climate controlled housing reduces our need for calories. Our bodies need a lot more calories to regulate our body temperatures when it’s very cold or hot out. Women don’t need to beat a rug outside anymore, or go walk down to a well to fetch some water. Historically, portions would have been much bigger that what we eat now. In the bulk of the world now where people are sedentary, humans have adapted effortlessly to this and not gained weight since eating non-processed foods allows the body to self regulate itself. It’s only in the US, where food is heavily processed, where we struggle.

If you don’t want to count calories or do portion control, stop eating processed foods. Make your food from scratch. If you want bread, buy some wheat (ideally European), get some yeast, salt, water and make it. I make pasta with my Kitchen Aid. I make ice cream with an ice cream maker so I have total control over the ingredients. When I’m craving more sweets, I make a cake or cookies with ingredients I can pronounce (good luck even understanding some of the ingredients in a store bought dessert). If I want potato chips, I slice a potato with my food processor or by hand and fry them in tallow, coconut or avocado oil. I don’t have time to train for half Ironmans and other endurance events anymore since I’m a busy mom with not much help and I have not ballooned in weight since my body self regulates from eating home cooked meals. Even though I was consuming 3-4X the amount of calories when I was training, my body didn’t struggle with adjusting to eating a lot less food. It came very naturally. Our bodies can regulate themselves. The #1 problem for most people is going out to eat too much or buying packaged foods. People did not count calories for the majority of human existence and we don’t need to either.

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I Love Paleo

The easiest and best diet for fertility is Paleo. Paleo has exploded in popularity and has many variations. I’m a fan of Chris Kresser and Mark Sisson. They make this very accessible. I highly recommend their books and websites to get started with this lifestyle.

Paleo isn’t about only eating what a caveman ate. It’s about eating how our ancestors have ate over thousands of years. A lot of the foods we eat have only been around for less than one hundred years such as canola oil, modern wheat, pea protein, most forms of soy, etc. I usually tell patients to try and eat how their ancestors would have eaten 500 years ago. If your ancestors ate dairy then, it will probably be ok for you. Even though most people’s ancestors ate wheat, the wheat we have available in the US is a frankenfood. Please read Grain Brain & Wheat Belly since that is far too much info for a blog. Cut out wheat and gluten for now and reintroduce back heirloom wheat after baby.

People ask me if rice, quinoa or potatoes are OK? They might be. It really depends on you. I would start by eating a minimal variety of foods and trying the strictest version of the diet first. Then in a month I would start adding in more non-processed foods slowly and see how your body feels. Modern processed foods, such as the Impossible Burger, are never ok.

I would say one of the most important aspects of Paleo is eating in season. It’s not natural to eat salad all year round. One of the best things I’ve ever done is join a local CSA (community supported agriculture). It forces you to learn how to eat in season and how to cook things you probably have never heard of. Some people struggle in winter, but that’s what preserved food (either through canning or drying) was used for. Also, fermented foods have historically been a major part of people’s diets and are great in winter.

I’m very weary of farmers markets, especially in NYC. While their offerings look great, it’s obvious a lot of it is coming from outside of NY. I’ve seen so much produce being sold in February that can’t possibly been grown in NY or a greenhouse in NY. You really need to do your homework with that. Also, don’t blindly trust supermarkets like Whole Foods. Corn syrup is a very modern invention and it can be found all throughout that store.

There’s plenty of articles about how fertility is plummeting. One of the major reasons for this is diet. By going back to a nutrient dense and healthy way of eating, your body will get healthy without much effort.

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I do not support the Mediterranean diet for most people.

The Mediterranean diet is a fantasy made up diet by a white man, Ancel Keys. Ancel Keys’ research has been heavily scrutinized in our modern times. Ancel was fond of vacationing in Southern Europe and he put together a diet that Julius Caesar, Socrates, Cleopatra and the Medici family would not recognized.

First, let’s just look at a map of the Mediterranean.

Half of the Mediterranean is Northern Africa. Ansel wasn’t vacationing there. Ansel Keys was born in 1904 so foods common in Northern Africa like teff, cassava, yuca, sorghum or millet would be very foreign to the average white American in his time. Besides this (you can read more about the whiteness of the Med diet here), most of the foods concocted to be part of the Mediterranean diet are not native or traditional to Italy or Greece for most of humankind. For example, tomatoes, corn and potatoes are native to the New World and have only been in Europe for 500 years. Eggplant is native to Asia and has only been in Italy for a relatively short time. Vegetable oils like corn, soy, canola and peanut have only been around since the industrial revolution. The reason why people live longer in some areas vs others has a lot to do with other factors such as exercise and quality of life. There are people that eat every diet imaginable on this planet and thrive.

People have historically ate what can be grown in their region. If you live in the mountains or far inland, ocean fish is not going to be a staple of your diet. If you lived far north, butter is going to be used instead of olive oil. The mixing of eating every world cuisine is a very modern phenomena. It was not possible before cheap air travel and refrigeration for this to happen. I believe most people’s health problems are from eating a city diet of mixing cuisines daily. Even though most people where I live are fairly thin (Manhattan), most women have a thyroid dysfunction and I would guess about 90% of women are taking a medication to treat that. Thyroid dysfunction is a major cause of infertility. It’s not natural and has never been done til very modern times to one day eat Thai food, the next eat Ethopian, then Chinese, then Italian, then Scandinavian, then French with a splash of American at the end.

Unless your ancestors are from Italy or Greece, the Mediterranean diet is probably not for you.

The easiest thing you can do is eat a diet mainly of the foods your ancestors ate. Making exceptions a few times a week is not a big deal but the majority of your meals should be what your great grandparents ate. If you look at people that have recently immigrated here, that is what they do. You don’t see the levels of obesity or other health problems with recent immigrants that you see with the average American. They aren’t eating a global cuisine every day.

Yes, I know it’s boring but it’s an easy way to get healthy without even trying. When I was growing up, I used to hate it that my old school Puerto Rican father wanted to eat rice and beans everyday. Now I get it. It was the olden ways of eating. People didn’t eat something radically different everyday. People ate what was in season combined with what can be stored year round in their climate. Lettuce doesn’t grow all year round. It’s not normal at all to eat salad year round. People of European ancestry should not be eating tropical fruits. It’s more sugar that what was ever in a traditional European diet and terrible for women with PCOS. People of Asian ancestry for the most part should not be consuming cow’s dairy. Many of my Asian American patients try to fight lactose intolerance. It’s not worth it.

For effortless health, eat the foods your ancestors ate. Stop trying to eat a diet that was developed by a white man and primarily tested on white people.

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THERE IS NO ONE RIGHT DIET FOR EVERYONE

If you search around on the web for ‘fertility diets’, you’ll see anything from plant based to carnivore. Some people will even mention the Harvard Nurses Study, which basically asked normal women to remember what they ate the past year (expecting someone to remember what they actually ate in the past year and not having any sort of recall bias is a blog post in itself). The Harvard Nurses Study did not evaluate the impact of diet on a population with a disease, such as PCOS. We all know women prone to PCOS are not like the general population when it comes to diet.

What diet should you do?

Before you start any sort of diet, the biggest impact you can make to your health is cooking all your meals. Stop going out to eat. Stop getting coffee at your local coffee shop. Stop going to the juice bar. Stop buying premade meals. Stop meal deliveries. Going out once or twice a week is fine but you have to stop finding excuses why you can’t do this for the majority of your meals.

In NYC, the commercial rents are insane. These restaurants and other businesses need to make a profit somehow. They do that by not using the best ingredients possible. Plus they want repeat business so they are going to add in more salt and other additives that make the food taste better. Don’t be fooled by healthy looking food businesses.

Try making everything you want to eat by scratch. Make your coffee from high altitude beans at home. If you want French fries, cut up a potato and fry them. If you want cake, don’t make it from something that came in a box. Gather some flour, butter, sugar, eggs and milk and make it like they did 500 years ago.

Cooking all your meals will take you about a month to get used to. Find new ways to socialize with friends other than going out to eat. The secret to success is to make larger batches to freeze and reheat. Also meal prepping on the weekends can make the weekdays less hectic. Before you switch what you are eating, get used to doing this first.

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