"Your Meat-Heavy Diet Might Be Giving You 'Keto Crotch,'" an article 1 on munchies.vice.com announces, claiming "Doctors have confirmed that changing your diet can create new and interesting smells … down there." "'Keto Crotch' Might Be the Strongest Argument for Eating Carbs Yet," Emily Alford reports on Jezebel.com. 2
"'Keto Crotch Is the Seriously Smelly Side Effect of the Popular Diet," the New York Post declares, 3 and then goes on to confuse diabetic ketoacidosis — which causes bad breath — with nutritional ketosis achieved through a ketogenic diet. (The two have absolutely nothing to do with each other, as explained in my interview with Dorian Greenow and on ketogenic-diet-resource.com. 4 )
Countless other mainstream and not-so-mainstream news sources suddenly carry similar headlines, warning people that going keto can cause stinky discharges that will render you a social outcast — and that eating high-sugar foods like fruit juices and whole grains is the answer to these offensive odors.
Remarkably, an online search for the term "keto crotch" on the day of this writing produces an astounding 2,060,000 results. The question is, where's the proof to support this nonsense?
The Rise of 'Keto Crotch'
From what I can tell, the term "keto crotch" initially appeared on a reddit discussion board back in 2014, 5 and again in 2016, 6 and many of the articles now discussing this issue appear to be referring back to these brief anecdotes.
Since then, and up until February 24, 2019 — when Delish.com published Korin Miller's article, 7 "'Keto Crotch' Might Be a Surprising Side Effect of a Low-Carb Diet," republished that same day on Yahoo Finance with the more eye-catching headline, "'Keto Crotch' Is the Most WTF Side Effect of Going on the Diet" 8 — the term "keto crotch" was virtually nonexistent as far as I can tell, after digging through about a dozen search pages.
Miller, who appears to be one of the first journalists to use the catchphrase "keto crotch," is a freelance journalist whose work has appeared in a number of health and women's magazines.
She's also an SEO consultant and founder of the SEO company keepUP Marketing 9 that helps websites optimize their search results, and is the managing editor of the StyleCaster Media Group, 10 , 11 a "leading digital media and technology platform for fashion, beauty and lifestyle." 12 With these qualifications, it would seem reasonable to assume she has the know-how to make a story go viral. The reason why is a question that has yet to be answered.
The story started spreading the very next day, and by February 28, keto crotch articles were "everywhere." Yet not a single scientific study is brought forth in these articles, and a search of the medical literature turns up nothing. In fact, Miller's February 24 article specifies there's no medical evidence linking nutritional ketosis to foul-smelling private parts.
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Who Are Some of the Health Experts Commenting on 'Keto Crotch'?
Articles do, however, cite several health care providers, among them registered dietitian and nutritionist Lisa DeFazio 13 — whose commentary appeared in multiple news stories within 48 hours 14 — gynecologist Dr. Lauren Streicher and dietitian Andrea Hardy. 15
DeFazio offered a link to a 2009 study 16 in the Journal of Nutrition when questioned by a Twitter follower about the basis for her concerns, which found bacterial vaginosis was most prevalent among women who had the highest dietary fat intakes.
Streicher's comments, on the other hand, have been far more neutral, noting that dietary changes will temporarily alter the pH in the vaginal area in general, and that there's no medical evidence linking the ketogenic diet with infections or other odor-causing vaginal ailments. Huffington Post writes: 17
"'When I got the first call asking about this, I asked if they were making this up to write a story,' Lauren Streicher, medical director of the Northwestern Medicine Center for Sexual Medicine and Menopause and clinical professor of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine, told HuffPost with a laugh.
Streicher said that while it's certainly possible that diet can have an impact on vaginal health, there is no scientific evidence to prove it, and myriad of potential causes for odor to exist."
The problem with the study 18 cited by DeFazio is that the women also had high carb intakes, and carbs are primary drivers of infection and yeast. According to the authors of the study:
"[T]he mean [energy intake] exceeded the recommended daily allowance for adult women. Also, the energy, fat, and carbohydrate intakes of the women were considerably higher than those reported in NHANES (1999–2000) for women of comparable age."
In other words, it appears these women were eating a standard American diet high in both fats and carbs, so the results cannot be attributed to a high-fat, low-carb diet such as the ketogenic diet. Not surprisingly, DeFazio recommends eating carbs to lose weight and keep it off, saying "low carb diets don't work long term." 19
DeFazio also welcomes media inquiries, stating she's "available for all magazine, newspaper, radio, television and website interviews," and "will accommodate you ASAP, even on short notice." 20 She's also a talent with Taylor Talent Services, 21 which specializes in "Helping brands, producers and marketers find the face of their products." 22
Ketogenic Experts Have Never Heard of 'Keto Crotch'
Ketogenic experts, on the other hand, myself included, have never heard of this complaint before now. In the video above, Dr. Ken Berry, 23 a self-proclaimed "keto friendly" medical doctor, shares his views on the topic.
As noted by Berry, carbs are in fact the primary driver of yeast infections , vaginosis , bladder infections and similar ailments, and women who struggle with these conditions who switch to a low-carb diet universally improve. "There's nothing about the ketogenic diet that's going to make you have vaginitis or vaginosis," he says. "It just makes no sense whatsoever."
Kristie Sullivan, Ph.D., 24 who has been on a ketogenic diet since 2013, and has spent years coaching people on the ketogenic diet, shared similar views: 25
"In nearly six years of following a strict low-carb diet, and interacting with literally hundreds of thousands via social media and my Facebook groups (over 250,000 people … ), I have interacted in nearly every discussion imaginable regarding personal health and low carb or keto.
Not once has the issue of foul vaginal odor been part of that conversation. Bad breath or changes in body odor are not uncommon concerns, but those tend to be experienced early in the adaptation phase and are not long term or ongoing issues."
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Another ketogenic expert, Megan Ramos, CEO of Intensive Dietary Management in Toronto, Canada, said in an interview: 26
" We've treated over 10,000 patients at this point. Approximately 65 percent of them are females. Not once did I have a woman bring up this issue with me.
As a matter of fact, we're seeing the opposite: women have less and less yeast infections and bladder infections, in particular our diabetic patients who normalize their blood sugars, and who stop taking their SGLT2 inhibitors (which is a drug that makes people pee out sugar)."
Where Did Keto Crotch Story Come From?
Considering the complete lack of scientific evidence to support claims that nutritional ketosis can cause vaginal infections, one has to wonder where this story originated from. After all, some arbitrary anecdote simply won't spread like wildfire for no reason, being picked up by major media simultaneously. Yet here are dozens of near-identical stories being featured in different magazines and news outlets on the same day.
Two individuals have stepped forward with an answer. In the video above, Berry explains how, when browsing through several women's magazines in a bookstore that carried the keto crotch story, he noted a curious pattern. Each of them had full-page ads for Weight Watchers, whose stock prices, incidentally, have plummeted by 80 percent since July 2018 — a drop attributed by Weight Watchers to the mass adoption of the ketogenic diet. 27 In his video commentary, Berry says:
"Rest assured … we see less and less things that could give you changes in odorous discharge when you eat keto. You don't get more of that, you get much, much less …
So, I think keto crotch is just the latest myth [pushed by] the big publishing houses who get a lot of their ad dollars from Weight Watchers and Biggest Loser and Jenny Craig. They would love for you to stop eating keto …
[I]f they can scare you with the latest scare tactic, which is 'keto crotch,' then they're successful and they're going to get more ad dollars from the big, carbohydrate pushing weight loss programs."
John Zahorik, a self-described "nutrition explorer," 28 has taken his investigation a step further. In a series of Twitter posts (this thread reader 29 offers the easiest to read view), Zahorik shows the links between Weight Watchers, its PR company Edelman, 30 some of the primary health experts interviewed about keto crotch, as well as some of the authors of these nonsense articles, Shireen Khalil 31 among them.
'Keto Crotch' — A Secret Weight Watcher's PR Stunt?
September, 2018, PR Week announced "Weight Watchers turns to Edelman to handle global consumer PR." 32 According to PR Week, "Weight Watchers wants to strengthen its reputation, better define and grow 'the Weight Watchers impact,' and increase revenue to more than $2 billion by the end of 2020 …" Other clients of Edelman include pasta giant Barilla, 33 and The Coca-Cola Company. 34
What they discovered here was that as carbohydrate ratios diminished, energy expenditure increased (meaning metabolism improved), prompting the team to conclude that low-carb diets "may improve the success of obesity treatment, especially among those with high insulin secretion." (For a review of and discussion about the strategy used to measure energy expenditure, see this Popular Science article.19)
According to screenshots taken by Zahorik, Khalil, Streicher and DeFazio are all Edelman PR followers on Twitter. 35 While that certainly doesn't prove they're working together, it suggests collaboration is a possibility. He also reminds people about the reality that is "native advertising" — marketing designed to look like news. 36 As reported by Conently.com in 2015: 37
" Native advertising — articles paid for and/or written by a brand that live on a publisher's site — has emerged as a powerful and popular new advertising tool over the past few years.
Media companies like BuzzFeed, The New York Times, The Wall Street Journal, and The Atlantic have all invested heavily in the creation and distribution of native advertisements on behalf of brands, with many charging over $100,000 for a native advertising campaign."
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Indeed, PR companies not only create recognizable ads and native advertising (ads not recognized as such), they also do news placement on behalf of their clients. In many cases, such news stories will feature actual science that happens to benefit the client's position.
In this case, however, the "news" is anything but. It's pure fabrication, and appears to be aimed at implanting a highly memorable mnemonic device 38 into the public consciousness. After seeing the term "keto crotch" hundreds of times, you'd be hard-pressed to not instantaneously think of a stinky crotch every time you hear "ketogenic diet."
Already, people have made comments on social media saying the mere possibility of this malodorous condition has dissuaded them from going keto, and there's little doubt this is the exact aim of this fake news campaign.
Zahorik points out the Edelman firm is in fact a master at creating these kinds of viral campaigns, a key part of which is "Leveraging top-tier influencers to integrate a brand's key messaging directly into the content target audiences are consuming" (per tweet from Edelman 39 ).
"The thing that made this campaign different from typical 'branding' efforts is that this was a SECRET effort to DESTROY the brand of the COMPETITION," Zahorik writes. 40 "What was the source of this alliterative affliction in these 'articles'? Answer: People on the internet were talking!"
Big Business Is Clearly Afraid of Keto Success
While the evidence implicating Edelman and Weight Watchers in the creation of this "keto crotch" myth is still circumstantial, the timing sure seems suspiciously convenient. The very same day the keto crotch myth exploded on the internet (February 28), CNN Business reported on Weight Watchers' financial demise, stating: 41
"CEO Mindy Grossman attributed the problem to the keto diet, a popular eating regimen that makes bread and other carbs taboo. She said during a call with analysts … that keto is 'becoming a cultural meme' and she even called it a 'keto surge.'"
Let's face it, the media is owned by industry, and leveraging of social media influencers can make fake news and unsubstantiated claims like this spread like wildfire. While there's no evidence to support this obnoxious story, there's an incredible amount of published literature showing the health benefits of a ketogenic diet.
For example, ketones have a biological impact similar to that of fasting, 42 including accelerated autophagy and mitophagy, improved glucose metabolism, reduced inflammation, clearing out malfunctioning immune cells, 43 and reduced IGF-1 (one of the factors that regulate growth pathways and growth genes and is a major player in accelerated aging and cellular/intracellular regeneration and rejuvenation).
Ketogenic Diet Basics
I strongly believe adopting a cyclical ketogenic diet — which means after you have achieved metabolic flexibility, you cycle in and out of eating foods high in healthy fats, with moderate protein and low net carbs (think nonfiber carbs) — can benefit most people. It's very effective for weight loss, and as discussed earlier, works with your body in such a way as to improve regeneration and renewal.
Maintaining net carb (total carbs minus fiber) intake at or below 50 grams allows you to enter into nutritional ketosis (the metabolic state associated with an increased production of ketones in your liver, which is the biological reflection of being able to burn fat). However, we are all different in how we respond to foods, so expect this amount to vary from person to person.
Some people can be in a full fat-burning state with full ketosis at a level of nonfiber carbs that's higher than 50 grams, sometimes even as high as 70 or 80 grams. However, if you're insulin resistant or have Type 2 diabetes, you may need to limit your net carbs to as little as 20 or 30 grams per day.
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To find your personal carb target, it's important to measure not just your blood glucose but also your ketones. One of the most accurate and least expensive ketone measuring devices on the market right now is Keto Mojo. This will give you an objective measure of whether or not you're truly in ketosis, rather than just relying on counting the grams of carbohydrates you consume.
Using a nutrient tracker will radically improve your ability to understand your ketogenic diet nutrient targets and assess the nutrient value of your food choices. There are a number of trackers available, but my first choice is Cronometer.com/Mercola . That's my revision of the basic Cronometer tracker, and it's already set to default to macronutrient levels that will support nutritional ketosis.
Once you've confirmed that you're in ketosis, start the cycling procedure described earlier, where you add in higher net carbs and protein once or twice a week, ideally on days you're strength training. Intermittent fasting works very well with a ketogenic diet as well, and can further speed up and optimize your results. You can learn more about the benefits of a ketogenic diet from my books, " Fat for Fuel ," and " Ketofast ."