What I Wish I’d Known Before Starting a Ketogenic Diet


Before I was diagnosed with polycystic ovarian syndrome (PCOS), I’d never heard the word “ketogenic”. I’d never even been on a diet before, let alone one that would reduce my beloved carb intake. But according to functional medicine doctor Tom Sult, author of Just Be Well, adopting a ketogenic diet would sharpen my insulin sensitivity, helping to reset the cataclysmic hormonal response that, for me, led to irregular periods, lack of ovulation, polycystic ovaries, and—drumroll, please—infertility.

Not being able to have kids is a pretty good motivator for changing what you eat. The good news is, by the same mechanism as it works toward reversing symptoms of PCOS, a ketogenic diet can also help reverse type 2 diabetes. Studies, such as this one conclude that a ketogenic diet “improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants.” How’s that for promising?

For most people, though, going keto is not just a lifestyle change—it’s a lifestyle overhaul. It requires commitment, discipline, and a dramatic shift in perspective, recognizing that food truly can be medicine. In practice, keto means reducing your daily net carb intake to 20 grams or less. When the body can’t rely on glucose for energy, it breaks down stored fat into ketones and uses that instead—this is the metabolic state known as ketosis.

I’ve now been in ketosis for three months. Here’s what’s worked for me—and what I wish I’d known when I started.


  1. Information is key. At the recommendation of Dr. Sult, I bought The Art and Science of Low Carbohydrate Living and also stumbled across The Wicked Good Ketogenic Diet Cookbook. Wicked Good was particularly helpful in that it told me exactly what to throw out of my fridge and pantry (a sad day, indeed) and what to buy at the grocery store. It also includes handy lists of fruits, vegetables, condiments, and more along with their net carb counts. Once I moved through the emotional hurdle of binning my favorite foods and restocking with the right ones, it was much easier to get started.


  1. It takes a while to get into ketosis. I bought ketone test strips at CVS (but you can also find them on Amazon), and it took me a full week to get there. During that week, I felt like crap. I actually thought the diet might have been so effective that I was already pregnant, because I was fatigued and lethargic, with brain fog and a constant dull headache. But nope. Just my body coming to the slow, appalled realization that I was no longer feeding it carbs, and switching energy sources accordingly. In about 10 days, I felt better—the way I do when allergy season passes and I can think clearly again.


  1. Speaking of feeling better, I started the diet as an obedient patient, willing to try anything if it would help me regain fertility, but I didn’t expect to actually feel better than I did before. I felt fine before! Except, apparently, for the low-level brain fog I’d been living with, and the necessity to guzzle coffee after lunch, and the cystic breakouts that had taken over my chin, cheeks, and jaws. When I’m in ketosis, I’m clear-minded, clear-skinned, energetic, and focused. If I’d known this, I would have gone keto a decade ago, before insulin resistance had a chance to wreak havoc on my hormones.


  1. Before keto, I preferred fries and popcorn over cake and ice cream. Now, because I’m ingesting almost no sugar, I crave sweets—mostly berries, which are okay in small amounts, and the lost deliciousness of apples and bananas. But I won’t lie: I also dream about cupcakes and brownies. It didn’t occur to me until about 10 weeks in that perhaps there were companies that made sweet products I could actually eat! My favorites so far have been Good Dee’s Brownie Mix (1 net carb per brownie) and Keto Kookie’s snickerdoodle cookies (2 net carbs per serving). When I miss the texture of granola, I pour just a little Kitch’un No Grain-ola or Paleonola onto a bit of plain full fat Greek yogurt and berries, or I grab some Atkins Diet Harvest Trail dark chocolate peanut butter bars. When you don’t feel deprived, keto becomes a lot easier.


  1. Let’s talk about eating out. My husband and I meet for lunch almost every day, and I’m mostly able to make our old staples work for me. As a treat, or on an otherwise very low-carb day, a riceless Chipotle bowl with chicken, pinto beans, mild salsa, cheese, guacamole, and lettuce has 17 net carbs (and comes in under 500 calories). Most restaurants have burgers on the menu: pile on the toppings and order it without the buns. Jimmy John’s tuna club unwich has only 8 net carbs and a ton of fat. If you go out at night, you may want to opt for a juicy steak and side salad with Ranch dressing. Sushi lovers, go hard on sashimi, or look for riceless rolls. 
  1. Fat is your friend. If I’m feeling low-energy between lunch and dinner, I eat a handful of almonds or some broccoli with Ranch or blue cheese dressing; it takes only a few minutes longer to make guacamole, which I eat with jicama or sliced bell peppers. Wicked Stuffed has a great (and easy) recipe for chocolate peanut butter cups, but there are plenty of other fat bomb recipes online. My new favorite dessert is equally simple: two ounces of heavy whipping cream mixed with half a teaspoon of vanilla extract and a squeeze of liquid Stevia, whipped in a single-serve blender and served with a quarter cup each of raspberries, blackberries, and blueberries. For my morning caffeine fix, I blend a cup of coffee with half a tablespoon of grass-fed butter and a sprinkle of cinnamon—it truly tastes like a café treat.


  1. I use My Fitness Pal to track my carbs and macros. In the beginning, this is also a great way to start learning (and despairing of) the net carb count in foods you commonly eat.


  1. Need more motivation? If how you feel isn’t enough, make sure to weigh in and take photos before you begin this diet, then update them every week. Even if weight loss is not your goal (it wasn’t mine), your body will soon become more lean and toned, and unwanted pounds will drop without a single day of calorie counting.


Is a ketogenic diet a miracle cure? No. I’ll be the first to say it’s hard work, especially in the first month. But that work can pay off in profound ways, as it has for me, and I hope it does for you. 

*You can now preorder Carolyn Ketchum’s cookbook, The Everyday Ketogenic Kitchen!

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5 years ago

Hi Katie, may I please ask you some questions about the diet and fertility?

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