Your diet will go swimmingly using these easy-to-make recipes that feature sustainable, protein-packed fish.

Fish have a stacked nutritional resume (hello, mega-healthy omegas and muscle-building protein) that should place them at the top of your meal-prep roster. And even though research shows that women of childbearing age who regularly nosh on fish are at a lower risk of developing heart disease, very few women eat the recommended amount — of just 8 ounces per week!

Perhaps you’re concerned about contaminants and sustainability issues like overfishing or are worried that your paucity of fish-cooking skills means you’ll butcher that pricey halibut. Then there are the counter-side decisions you don’t know how to make: Should you buy wild or farmed? Frozen or fresh? Large fish or small?

Here’s the help you need to navigate these murky waters. Try these foolproof recipes using the healthiest, most sustainable fish and follow the fish-buying guidelines and you will never have to throw your meal overboard.


With 15 grams of high-quality protein per 3-ounce serving, cod is awesome muscle fuel. Cast your line for this swimmer and you’ll reel in a range of must-have nutrients, including phosphorus, selenium and potassium, as well as B6, which plays an essential role in dozens of enzymatic reactions in the body.

ECo-Smart: The most ocean-friendly choice is Pacific wild cod from icy Alaskan waters where measures are taken to prevent overfishing and the use of destructive fishing methods. Take a hard pass on Atlantic cod, which suffer from depleted stocks and which are permitted to be caught with high amounts of bycatch — fish or other marine species that are caught unintentionally with the target fish — which is often allowed to die and be discarded.

In the Kitchen: When it comes to cooking delicate fish like cod, it’s full-steam ahead. The liquid below your fish vaporizes, carrying heat to your meal and cooking it quickly but gently. Gussy up your steaming water with flavoring agents like citrus zest, ginger and herbs.

Bait-and-Switch: Good substitutes for cod are Pacific halibut, sole, lingcod, U.S. catfish, U.S. tilapia, barramundi and sablefish.

Cod Tacos With Strawberry Salsa

Hands-On Time: 20 Minutes
Cook Time: 7 Minutes

Makes 4 Servings


1 cup hulled strawberries, diced
1 yellow or orange bell pepper, diced
1 jalapeño or serrano pepper, seeded and chopped
½ small red onion, chopped
1/3 cup chopped basil or mint
juice of ½ lemon
1 cup water
1 tsp orange zest
juice of 1 orange
3 garlic cloves, peeled and smashed
1-inch piece ginger, peeled and sliced
1¼ lb Pacific cod
¼ tsp salt, plus a couple of pinches
¼ tsp black pepper
¼ tsp cayenne
8 corn tortillas, warmed
½ cup sour cream


In a large bowl, toss together strawberries, bell peppers, chili peppers, red onions, basil/mint, lemon juice and couple of pinches salt. Cover and refrigerate at least 30 minutes. To a medium-size pan or pot, add water, orange zest, orange juice, garlic and ginger. Line a steamer tray with parchment paper. Arrange fish fillets on tray and season with salt, pepper and cayenne. Set tray in pan/pot, making sure it rests above the liquid, then cover tightly. Bring liquid to a boil and steam until cod is just barely cooked through in the center, about 7 minutes. (Alternately, steam fish in an electric steamer.) Transfer steamed fish to a cutting board and allow to cool, then gently break flesh apart into 1-inch pieces. To serve, place cod on tortillas and top with strawberry salsa and dollops of sour cream.

Nutrition Facts (per serving): calories 288, fat 4 g, carbs 34 g, fiber 4 g, sugar 7 g, protein 30 g, sodium 283 mg


Rainbow trout has a mild taste and is a good swap for people who find salmon too “fishy.” Its rosy flesh is a top-notch source of omega-3 fats, which research shows can slash the risk for diabetes and heart disease. A palm-size serving of trout also gives you a quarter of your daily need for phosphorus, an important building block of strong bones. And since it’s a smaller fish, the risk of ingesting too many contaminants like mercury is low.

Eco-Smart: The trout you buy is almost certainly farmed, but fret not. The land-based tanks and raceways (man-made channels of flowing water used to mimic natural habitats) employed by most North American trout farmers cause fewer environmental woes than oceanic farming, which tends to sully wild waters with fish waste and which spreads diseases to wild fish populations.

In the Kitchen: One of the great worries about working with fish like trout and salmon is the fear of overcooking. Using lower cooking temperatures in the oven increases the time it takes to cook the fish, which means you can keep closer tabs on it, and the end result is a delicate texture and juicier meat.

Bait-and-Switch: Use trout in place of wild salmon and arctic char.

Recipe Hack: Use the leftover almond sauce on grain bowls, or thin it with some olive oil and use it as a salad dressing.

Trout With Herbed Almond Sauce

Hands-On Time: 15 Minutes
Cook Time: 15 Minutes

Makes 4 Servings


1/3 cup unsalted roasted almonds
¼ cup buttermilk (or milk)
½ cup plain Greek yogurt
1 shallot, chopped
1 cup baby spinach
1 cup parsley
1/3 cup fresh mint
1 tsp lemon zest
1 tbsp fresh lemon juice
¼ tsp cayenne
¼ tsp salt
¼ tsp black pepper
1½ lb rainbow trout fillets


Place almonds in a food processor and pulse into small pieces. Add buttermilk, yogurt, shallots, spinach, parsley, mint, lemon zest, lemon juice, cayenne and salt and process until smooth. Chill 30 minutes. Preheat oven to 300 F and line a baking sheet with parchment paper. Season trout with salt and pepper and place skin-side down on sheet. Bake 15 minutes, or until just barely cooked through in the thickest part of the flesh. Divide into servings and top with almond sauce.

Nutrition Facts (per serving): calories 334, fat 15 g, carbs 6 g, fiber 2 g, sugar 3 g, protein 42 g, sodium 262 mg

Rainbow trout is a good source of selenium, a trace mineral that promotes brain function, healthy immune system and fertility. When combined with vitamin e, selenium can act as an antioxidant to reduce the risk of cancer.


Nutritionally, this poor man’s oyster delivers a boatload of benefits, including quality protein, omega-3 fats and selenium. They also contain vitamin B12, which is vital for the health of your nervous system.

Eco-Smart: Farmed mussels are sustainable superstars with zero input aquaculture. Unlike farmed shrimp or salmon, which can require tons of feed and antibiotics to grow, mussels don’t need food or drugs. Moreover, they filter particulates from the water, actually making it cleaner, and don’t mind being packed tightly together so you can grow a lot of nutrition in a very small space.

In the Kitchen: Some people consider mussels a restaurant dish, but unlike most seafood, they are cheap and nearly foolproof to prepare. Most mussels are sold debearded and pre-cleaned to minimize teeth-rattling grit, and they keep well for a couple of days in your refrigerator in a bowl and covered with a damp paper towel. They’re sold alive, so never
keep them in a plastic bag, which suffocates them.

Bait-and-Switch: Use clams or cockles in place of mussels.

Italian Mussel Soup

Hands-On Time: 30 Minutes
Cook Time: 40 Minutes

Makes 4 Servings


1 cup farro
4 cups water, divided
½ tsp salt, divided
1 tbsp olive oil
1 tbsp unsalted butter
1 medium yellow onion, chopped
1 large carrot, chopped
2 garlic cloves, thinly sliced
1 tsp fennel seeds
½ tsp red chili flakes
¼ tsp black pepper
1 cup dry white wine
1 (28 oz) can fire-roasted tomatoes
1 tbsp fresh thyme
2 lb mussels
2 tbsp red wine vinegar
¼ cup sliced Kalamata or black olives (optional)
1/3 cup flat-leaf parsley, coarsely chopped


Bring farro, 3 cups water and ¼ teaspoon salt to a boil. Reduce heat to medium-low, cover and simmer 25 minutes, or until grains are al dente. Drain excess liquid. Heat oil and butter in a large saucepan over medium heat. Add onions and carrots and cook until soft, about 5 minutes. Add garlic and heat 1 minute. Add fennel, red chili flakes, remaining salt and black pepper and heat 30 seconds. Add wine, bring to a boil and simmer 3 minutes. Add tomatoes, 1 cup water and thyme. Bring again to a boil, then add mussels. Reduce heat to medium, cover and cook 3 minutes, or until shells pop open. Use a slotted spoon to remove mussels from soup; discard any that have not opened. Stir farro, red wine vinegar and olives (if using) into soup. Remove mussels from shells and add flesh and their juices to soup. Serve garnished with parsley.

Nutrition Facts (per serving): calories 515, fat 12 g, carbs 47 g, fiber 9 g, sugar 5 g, protein 42 g, sodium 726 mg


More flavorful than tilapia, the underappreciated catfish has a mere 130 calories per 3-ounce serving, making it very waistline-friendly. Nutritional perks include vitamin B12, selenium and phosphorus as well as thiamine, which is
vital for your metabolism.

Eco-Smart: According to the Monterey Bay Aquarium Seafood Watch program, U.S. farmed catfish is a green-light choice because indoor farming tanks minimize environmental impact. Wild blue catfish caught in the Chesapeake Bay is also a good choice, but send imported catfish from Asia overboard because of questionable farming methods.

In the Kitchen: A quick braise helps keep delicate catfish fillets tender and moist, and greatly reduces the chances of overcooking it into rubber. This is harder to do with direct heating methods like pan-searing.

Bait-and-Switch: Use cod, lingcod, Pacific halibut, sole, U.S. tilapia, barramundi or sablefish in place of catfish.

Salsa Verde Braised Catfish

Hands-On Time: 20 Minutes
Cook Time: 35 Minutes

Makes 4 Servings


1 cup long-grain brown rice
2 tsp grapeseed or canola oil
1 cup white onions, thinly sliced
¼ tsp salt
2 garlic cloves, minced
½ tsp cumin
¼ tsp black pepper
1 cup low-sodium chicken broth
1½ cups salsa verde
4 (4-6 oz) catfish fillets
juice of ½ lime
¼ cup unsalted roasted pumpkin seeds (pepitas)
½ cup cilantro, chopped


Cook rice according to package directions. Remove from heat, cover and set aside for 5 minutes, then fluff with a fork. Meanwhile, heat oil in a large heavy-bottom skillet. Add onions and salt and cook 4 minutes. Add garlic and cook 1 minute. Add cumin and black pepper and heat 30 seconds. Add broth and salsa verde and bring to a boil. Reduce heat and carefully place fish fillets in pan, spooning sauce over the top. Cover and simmer gently over low heat until fish is cooked through, flipping once, about 8 minutes. Squeeze lime juice over the top and remove from heat. Divide rice among plates and top with catfish. Spoon salsa verde sauce on top. Scatter on pumpkin seeds and cilantro.

Nutrition Facts (per serving): calories 478, fat 20 g, carbs 44 g, fiber 2 g, sugar 7 g, protein 28 g, sodium 636 mg


There are very few sources of omega-3 fats that are better than salmon, and a recent study from Tufts University found that people are more likely to age without health problems and disabilities when they have higher blood levels of anti-inflammatory omega-3s. Salmon also contains plenty of vitamin D and astaxanthin (which gives it its rosy hue), which is being studied for its cancer-fighting properties. Bonus: The National Academies of Sciences, Engineering and Medicine names salmon the best omega-3-to-mercury-ratio fish of any option at the fishmonger.

Eco-Smart: Salmon farming is becoming more eco-friendly, but issues such as antibiotic use persist. When possible, opt for wild Alaskan salmon like chinook or sockeye. These species are healthy with no overfishing or notable contaminant risks. Feasting only on krill and tiny crustaceans, wild salmon also have a healthier fatty-acid profile than their farmed counterparts, and their rich, buttery flesh can’t be beat.

In the Kitchen: Believe it or not, nuking your salmon is a guaranteed fast, delicious meal. Microwaving the fish in parchment packets traps steam to add moisture and promises meltingly tender flesh — without making your kitchen smell like low tide.

Bait-and-Switch: Try rainbow trout, arctic char or catfish in place of salmon.

Salmon Broccoli Parcels With Horseradish Sauce

Hands-On Time: 15 Minutes
Cook Time: 5 Minutes

Makes 2 Servings


1 cup red onions, sliced
3 cups broccoli florets, sliced
2 (5-6 oz) skinless salmon fillets
salt and pepper, to taste
1 medium orange, peeled and sliced into ½-inch rounds
¼ cup plain yogurt
1 tbsp prepared horseradish
2 tbsp finely chopped fresh dill
2 tsp creamy Dijon mustard
2 tsp cider vinegar


Fold two 14-inch-by-18-inch sheets of parchment paper in half. Open sheets and place equal amounts of red onions and broccoli on one side of each sheet. Place salmon on top of vegetables and season with salt and pepper (to taste). Top with orange slices. Fold parchment sheet over fish and vegetables and crimp shut. Microwave packets on high for 5 minutes. Open a corner to check that salmon is cooked through in the thickest part. If not, microwave in 30-second intervals until cooked. Let packets rest, sealed, 5 minutes. In a small bowl, whisk together yogurt, horseradish, dill, mustard and cider vinegar. Open packets and serve fish topped with horseradish sauce.

Nutrition Facts (per serving): calories 361, fat 13 g, carbs 25 g, fiber 6 g, sugar 14 g, protein 37 g, sodium 159 mg 

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Research of the Week

Statins linked to diabetes, again.

A ketogenic diet helps relapsing MS patients lower fatigue, reduce depression, and lose weight.

Indigenous Australians traded pottery with Papua New Guineans for thousands of years.

A fatty liver epidemic in young people is bad news and simply shouldn’t be happening (but is).

Narcissists make better citizens.

New Primal Blueprint Podcasts

Episode 328: Dr. Loren Cordain: Host Elle Russ chats with the creator of the original Paleo Diet, Dr. Loren Cordain PhD.

Episode 329: Dr. Lindsay Taylor: Host Brad Kearns chats with Dr. Lindsay Taylor, PhD and co-author of the Keto Passport.

Health Coach Radio Episode 8: Kama Trudgen: Kama Trudgen runs health retreats for the indigenous Yolngu people of Northeast Arnhem Land, Australia, helping them reclaim health using traditional diets and lifestyle practices.

Each week, select Mark’s Daily Apple blog posts are prepared as Primal Blueprint Podcasts. Need to catch up on reading, but don’t have the time? Prefer to listen to articles while on the go? Check out the new blog post podcasts below, and subscribe to the Primal Blueprint Podcast here so you never miss an episode.

Media, Schmedia

Not grazing on junk all day long is “starving,” apparently.

Irish soil contains microbes that fight drug-resistant bacteria.

Interesting Blog Posts

Ancient animal urine could reveal the history of animal agriculture.

A sandwich with pickles instead of bread? Sure, why not.

Social Notes

Enter now to win a Cuisinart Airfryer, $200 in Primal Kitchen loot, and a $100 gift card to

My quick, effective road workout when I’m traveling light without gym access.

Everything Else

This seems like a good use of GMO technology: blight-resistant American chestnut.

Google pulls the plug on its glucose-monitoring “smart lens” they’d been working on since 2014.

Raw eggs in milk, carrots, steak, lamb chops, liver, and the odd ice cream sundae: Marilyn Monroe’s diet.

Things I’m Up to and Interested In

Virtual health summit you should attend: Habits to Thrive, a 7-day summit hosted by Deanna Wilcox, Anya Perry, and 17 other Primal Health Coaches.

Study I found interesting: Drug and alcohol use and life satisfaction.

Positive side effect I’m hoping develops: Scientists are mad that T-rex bones are going for millions on eBay rather than remain in the public trust. But what if high prices and private sales spur more finds and more discoveries?

I think there are better ways to lose weight: Than swallowing 3-dimensional cellulose matrix tabs that expand in your stomach and take up space.

I can’t think of a better way to gain weight: “…eating behaviors of modern consumers may be guided by a predominant goal to attain the subjective experience of complete fullness.”

Question I’m Asking

Some high-end coffee places are banning milk, sugar, and cream, arguing that the extra additions detract from the true coffee experience. What do you think of food establishments with draconian policies like that—snobs or real artisans?

Recipe Corner

Time Capsule

One year ago (Apr 14– Apr 20)

Comment of the Week

“What about a half scoop of metagenics thermaphaseprotein detox powder in water? Will this break my fast?”

– Depends which ThermaPhase tier you’ve reached. Tier 2 and below you’d better go a quarter scoop if you want to maintain the fast. Tier 3 ThermaPhase or higher actually extracts calories from you.


The post Weekly Link Love — Edition 25 appeared first on Mark’s Daily Apple.

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It seems every “keto for women” forum abounds with stories about menstrual cycles gone wild in the first few months of keto. Irregular cycles, breakthrough bleeding, and periods lasting much longer than normal are common complaints. Sometimes these stories are cited as evidence that keto isn’t good for women, at least not premenopausal women, and that we need carbs for healthy hormones. Yet, many women don’t notice any changes in their menstrual cycles at all, while others report improvement in PMS symptoms and cycle regularity from the get-go.

What gives? Why do some women’s cycles apparently become wacky when they start keto, while others feel like keto is the key to period bliss? Can keto “mess up” the menstrual cycle?

We know that diet—what and how much we eat—can profoundly affect our hormones. This is true for both women and men. One of the reasons people are so excited about ketogenic diets is specifically because keto shows promise for helping to regulate hormones and improve cellular sensitivity to hormones such as insulin and leptin.

At the same time, women’s hormones are especially sensitive not only to dietary changes but also to downstream effects such as body fat loss. Furthermore, one of the ways women’s bodies respond to stressors is by turning down the dial on our reproductive systems. It’s reasonable to hypothesize, then, that women might have a tougher time adapting to or sustaining a ketogenic diet. Keto can be stressful depending on one’s approach, and that might negatively impact women’s reproductive health. But do the data actually bear that out, or is so-called “keto period” more misplaced hype than genuine fact?

Note that throughout this post, I’m going to use the term “reproductive health” to refer to all aspects of women’s menstrual cycle, reproductive hormones, and fertility. Even if you aren’t interested in reproducing right now, your body’s willingness to reproduce is an important indicator of overall health. When your reproductive health goes awry—irregular or absent periods (amenorrhea) or hormone imbalances—that’s a big red flag. Of course, post-menopausal women can also experience hormone imbalances that affect their health and quality of life (and low-carb and keto diets can be a great option for them).

Menstrual Cycle 101

Let’s briefly review what constitutes a normal, healthy menstrual cycle, understanding that everybody’s “normal” will be a little different. A typical cycle lasts from 21 to 24 days on the short end to 31 to 35 days on the long end, with 28 days being the median. Day 1 is the first day of your period and begins the follicular phase, which lasts until ovulation. Just before ovulation, levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), and estradiol (a form of estrogen) spike. Next comes the luteal phase covering the approximately 14 days from ovulation to menses. LH, FSH, and estradiol drop, while progesterone rises. Estradiol bumps up again in the middle of the luteal phase. If a fertilized egg is not implanted, menstruation commences, and the whole cycles starts over again. All this is regulated by a complex communication network under the hypothalamic–pituitary–gonadal (HPG) axis, which is closely tied to the actions of the adrenal (the A in HPA axis) and thyroid glands.

Across the cycle, fluctuations in body weight are common as fluid is retained and then released along with shifts in estrogen and progesterone. Changes in blood glucose are also normal, and insulin-dependent diabetics often find that they need to adjust their dose at different times of their cycles to keep their blood sugar in check. The most common pattern is higher blood glucose readings in the pre-menstrual period (the second half of the luteal phase), and lower readings after starting your period and before ovulation. This is generally attributed to the fact that progesterone, which is highest during the luteal phase, is known to reduce insulin sensitivity. However, different women experience different patterns, which can also be affected by other factors such as oral contraceptive use.

Normal fluctuations in insulin resistance and blood glucose can mean that women get lower ketone readings at certain times of the month than others. When these occur premenstrually—and so they tend to coincide with a period of (transient) weight gain and food/carbohydrate cravings—women often feel as though they are doing something wrong. Rest assured that these variations reflect normal physiology.

The many factors that affect your cycle and the levels of your sex hormones include: other hormones, gut health and microbiome, metabolic health (e.g., insulin sensitivity), environmental toxins, stress, sleep, immune health, nutrient deficiencies, activity level and energy expenditure, and age. Each affects the others, and all (except age of course) can be affected by diet. It’s no surprise, then, that it can be extremely difficult to pin down a root cause of menstrual changes or reproductive issues.

What the Research Tells Us About Keto and Menstruation

As I said at the outset, there are lots of anecdotes, both positive and negative. In my experience, most women whose cycles seem to go crazy when they start keto find that things get back to normal—and often a better version of normal—after a few months.

First, it’s tricky to determine the effects of keto per se, since many people combine a ketogenic diet with calorie restriction (intentionally to lose weight or unintentionally due to the appetite suppressing effects of keto) and with fasting (intermittent and/or extended). Each of these can independently impact the factors listed above, lead to weight loss, and affect the menstrual cycle and reproductive health.

So, is there any evidence that keto itself causes changes to menstruation?

The scientific evidence is scant….

The one statistic you’ll see floating around the interwebs is “45% of (adolescent) females experience irregular menstrual cycles on keto.” This statistic comes from one small study of adolescent girls using a therapeutic ketogenic diet to treat epilepsy. Six of the twenty girls reported amenorrhea (loss of period) and three were diagnosed with delayed puberty. However, the ketogenic diet used for epilepsy is different and usually much stricter than an “everyday” keto diet needs to be, and epilepsy is frequently associated with menstrual dysfunction regardless of diet.

To extrapolate the findings of this study and argue that nearly half of teenage girls (or women generally) are likely to experience menstrual problems from going keto is a huge leap.

The fact is, I’m unable to find any studies done in healthy human females (or mice for that matter) demonstrating that otherwise normal menstrual cycles are disturbed by going keto.

5 Ways Keto-Related Factors *Might* Affect Your Menstrual Cycle

With the limited amount of research looking directly at keto and menstruation, let’s look first at whether there are direct effects of carbohydrate restriction or elevated ketone production on the menstrual cycle. Those are the defining characteristics of keto and what differentiates keto from other ways of eating. Then we can examine indirect effects that occur due to factors such as weight loss. These are not unique to keto, though they might be more likely on a ketogenic diet compared to other ways of eating.

Carbohydrate Restriction

There is no real body of evidence that looks at ketogenic levels of carb restriction and menstruation, but there are some clues. In this small study, functional hypothalamic amenorrhea (FHA) was associated with dietary fat restriction; women with FHA actually ate non-significantly more carbs than matched controls and nearly identical total calories. Likewise, in this small study, FHA was associated with lower fat intake but no significant difference in carb intake.

This meta-analysis looked at the effect of low-carb (not keto) diets on markers of reproductive health among overweight women. The researchers found four studies that examined effects on menstruation; all showed improved menstrual regularity and/or ovulation rates. Of six studies that looked at levels of reproductive hormones, five reported significant improvements.

Carb restriction also results in decreased insulin production. Hyperinsulinemia and insulin resistance are frequently associated with polycystic ovarian syndrome (PCOS), one of the leading causes of female infertility and a frequent cause of menstrual irregularity. There is currently a lot of interest in using keto to treat PCOS, but only one small study has so far directly tested the effectiveness of a ketogenic diet to treat PCOS, with positive results.


No studies have looked at the direct effects of ketones on menstruation.

Weight Loss

Of course weight loss is not unique to keto, but keto can be very effective for weight loss. Some women experience rapid weight loss when first starting a keto diet. Weight loss in and of itself can impact menstruation through a variety of pathways. A key way is by reducing the hormone leptin. Leptin’s main job is to communicate energy availability to the hypothalamus—high levels of leptin tell the hypothalamus that we have enough energy on board, which also means we can reproduce. Low leptin can disrupt the menstrual cycle and is linked to hypothalamic amenorrhea.

Body fat loss can also affect estrogen levels since estrogen is both stored and produced in adipocytes (fat cells). While fat loss in the long term will decrease estrogen production, it is possible that rapid fat loss might temporarily raise estrogen levels and can also affect estrogen-progesterone balance. These transient changes in estrogen levels might underlie some of the menstrual irregularities women report.


Stress can impact the menstrual cycle in myriad ways. Cortisol acts on the hypothalamus and pituitary glands, affecting hormone levels, sleep, immune function, and gut health, to name a few. Diets can be a source of stress, both at the physiological and psychological levels. Keto has a reputation for being especially stressful because it is more restrictive than other low-carb diets, but this can be mitigated by following the Keto Reset tips for women.

Thyroid Function

Thyroid dysregulation is another common cause of menstrual irregularities, and there remains a pervasive belief that keto is bad for thyroid health. Indeed, the thyroid is sensitive to nutrient deficiencies and caloric restriction, and thyroid hormones, especially T3, do frequently decline on keto. However, as Mark has discussed in a previous post, changes in T3 levels might not be a problem, especially in the absence of other problematic symptoms. Moreover, many practitioners now use keto as a cornerstone in their treatment of thyroid disorders.

What Should I Take From These Findings?

The first takeaway: there just isn’t much direct evidence about how keto might affect your menstrual cycle, positively or negatively. We have some studies suggesting that low-carb diets improve some aspects of menstruation and reproductive health, but keto is more than just another low-carb diet. Ketones themselves have important physiological properties, such as being directly anti-inflammatory, which might positively impact women’s reproductive health.

Second, the ways that keto is likely to (negatively) affect menstruation aren’t unique to keto, they’re common to any diet: hormone shifts mediated by energy balance, stress, and weight loss.

Furthermore, since keto is so often combined with caloric restriction, time-restricted eating, and fasting, even the anecdotal evidence might not be able to tell us all that much. If a woman is eating ketogenically, in a big caloric deficit, and doing OMAD (one meal a day), and her leptin plummets, how are we to know what really caused it? We don’t have good evidence that otherwise healthy women start a well-executed ketogenic diet and end up messing up their menstrual cycles.

That said, women do need to be cognizant of the sum total of the signals they are sending their bodies when it comes to energy availability and stress. A lot of women come to the keto diet with a history of adrenal, thyroid, metabolic, and reproductive issues. It’s important that they’re extra careful about how they approach keto. Done correctly, it might be just what the doctor ordered. I encourage any woman who’s dealing with other hormonal issues to work with a medical practitioner to tailor a keto diet to her unique needs.

But I’m Telling You, Keto Made My Period Go Haywire!

Ok, I believe you, really! But changes do not necessarily equal dysfunction. It is normal to experience hormone fluctuations when you make a massive—or even a relatively small but important—shift in your nutrition. Sometimes those fluctuations are unpleasant or unwanted, such as a period that lasts 14 days or one that arrives a week before you planned while you’re on vacation. However, that doesn’t make them bad from a health perspective. We need to respect that our bodies are dynamic systems. Changing the input will invariably change the output, and the system might need a few months to adapt to a new normal.

If your cycle goes wonky but you’re otherwise feeling good, give it a few months to sort itself out. If after a few months it’s still all over the place (or definitely if you’re having other disruptive symptoms), enlist help. In the meantime, check to make sure you’re not short-changing yourself nutritionally or calorically. Scale back on fasting efforts, and consider shifting more toward a traditional Primal way of eating.

At the end of the day, if you go keto and experience negative effects, stop. Keto is super hyped right now, but if your body is sending you clear signals that keto is not a good approach for you at this time, don’t do it. You can always try again later. It might be that your first attempt at keto didn’t work, but with a few adjustments and some experimentation over time you can find a version of keto that works for you.

Thanks for reading, everyone. Do you have comments, questions, or feedback? Let me know below.



Comninos AN, Jayasena CN, Dhillo WS. The relationship between gut and adipose hormones, and reproduction. Human Reproduction Update 2014; 20(2): 153–174.

Fontana R, Della Torre S. The Deep Correlation between Energy Metabolism and Reproduction: A View on the Effects of Nutrition for Women Fertility. Nutrients. 2016;8(2):87.

Klok MD, Jakobsdottir S, Drent ML. The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review. Obesity Reviews 2007;8(1):21-34.

Meczekalski B, Katulski K, Czyzyk A, Podfigurna-Stopa A, Maciejewska-Jeske M. Functional hypothalamic amenorrhea and its influence on women’s health. J Endocrinol Invest. 2014;37(11):1049–1056.  

Tena-Sempere M. Roles of Ghrelin and Leptin in the Control of Reproductive Function. Neuroendocrinology 2007;86:229-241.

The post Keto and the Menstrual Cycle: Is There Reason To Worry? appeared first on Mark’s Daily Apple.

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