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Let me start by saying that if you’ve mastered the art of not caring what people think, congratulations. It’s a skill most people work on their whole lives. And some don’t even realize they’re side-stepping their dreams or apologetically .

Caring what other people think of us is normal. It’s a natural human response, kind of like salivating when you see a thick ribeye sizzling on the grill. We all want to be accepted (and not rejected) by our peers and loved ones, so of course we care what they think of us.

However, there’s a big difference between caring and constantly worrying about being judged. When you worry that others are judging you for your actions and decisions, self-defeating thoughts begin to bubble up more and more. Thoughts like:

• I shouldn’t have said that…
• I hope they don’t mind…
• I think they’re upset with me…
• I hope it’s not a bother…
• I’m not sure I should do this….

Sound familiar? Honestly, I deal with this kind of thing all the time with my clients. They fear their friends won’t want to hang out with them if they’re not throwing back nachos and beer every Friday. They wonder how their family will respond when they bring their own paleo side dish to holiday gatherings. And they worry what others will think of them if they decide a soul-sucking job isn’t enough for them anymore and decide to follow their passion for something more meaningful.

It’s Not Your Fault You Care So Much

In a study at Boston’s Babson College, 62% of students said their self-worth was strongly tied to what others thought. That means 62 out of 100 people cared more about what other people thought of them, than what they thought about themselves. Worrying about not being accepted isn’t just psychological (although research shows that rejection triggers the same neural pathways that are activated when you experience physical pain), it’s biological. It’s in your DNA.

The fear of rejection goes back to the hunter-gatherer days. If you were rejected from your tribe, you might not have the food, the warmth, or the protection needed to survive. Even though there aren’t the same dire consequences in the modern world, that worry can be extremely intrusive – especially if you’re currently stepping outside of your comfort zone or feel like you’ve done something to compromise your place in the world (i.e. losing a job, falling off the wagon, embarrassing yourself in public, or having a social mishap online).

Most of us are guilty of worrying how others will perceive our failures and shortcomings. However, studies show that we overestimate how much, and how badly people judge us in these situations. Researchers in this study divided participants into four groups and asked them to imagine being involved in one of four social blunders. The first group imagined experiencing an intellectual failure in public, the second and third groups were described by others in an embarrassing way, and the fourth group anticipated being judged more harshly than they actually were. Researchers found that when participants focused on their misfortunes and the feared consequences of their situations, they experience increased levels of social anxiety and became even more pessimistic regarding their expectations.

Basically, the more they thought about how bad it was, the worse they felt. But what’s really at the root of this experiment is the deeply uncomfortable feeling of shame.

What’s Shame Got to Do with It

Shame arises when you violate an expected standard or perceived moral code. It leads you to believe that you’re less worthy because you’ve made a mistake or done something you regret. And when it’s chronic, it can make you feel like you’re fundamentally flawed or “not enough.” All of which leaves you seeking external validation.

The problem is, no level of external validation can fill the void shame creates. Not only that, it puts you in a position to rely on other’s opinions of you, and keeps you doing whatever you can to keep positive reinforcement coming your way, avoiding conflict, negativity, and rejection at all costs.

5 Ways to Master the Art of Not Caring

If you feel like most of your actions and decisions are molded by how you think others will respond, it’s time to knock it off. This is my go-to plan for helping clients stop obsessing about what they assume people are thinking and start living life on their terms.

1. Spend Time Alone
   In order to know what’s truly important to you, you have to get other people’s voices out of your head. Take time to reflect on your values, your goals, and what makes you happy. Write it down, journal it, start a . It doesn’t matter how you do it, just do it.
2. Ask, “What’s The Worst That Could Happen?”
   Armed with the knowledge that you can’t please everyone and that most people are busy worrying about themselves anyway, ask yourself what’s the worst that could happen next time you want to do, be, or say something that’s authentically you. Chances are no one’s going to call you out or think badly of you. And if they do, just know that it’s a reflection of them, not you.
3. Let Go of Perfectionism
   When you shake the feeling that you’ve got to get things just right, you . Keep in mind that everyone makes mistakes. It’s part of being human and can be a huge catalyst for growth.
4. Develop Internal Validation?
   Allow yourself to feel what you feel, again, without judgement, or looking for someone to give you permission. Work on expressing yourself, having instead of criticism.
5. Know Other People Have Baggage Too
   Even if you’re convinced others are thinking negative things about you, it’s likely due to their own issues. Often times, people project their own insecurities onto their friends, family members, or colleagues because they’re struggling to process their own baggage. Share some empathy for your fellow human.

Ready to Stop Worrying What People Think?

There’s a huge difference between caring about your actions and getting sidelined by how you perceive you’re being judged. Whether the feeling is keeping you from reaching your goals, following your dreams, or just being true to who you are, follow these five steps if you’re tired of making decisions based on your fear of what others are thinking:

• Spend time alone
• Ask, “What’s the worst that could happen?”
• Let go of perfectionism
• Develop internal validation
• Know other people have baggage too

How about you? Do you care what other people think?

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Research of the Week

Overfeeding carbohydrates reduces antioxidant status, .

Eating more dairy in the elderly.

Women and obese people to disturbed neural responses after Splenda consumption.

originated in the Eurasian steppes.

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New Primal Kitchen Podcasts

Morgan talks to Dr. Mindy Pelz about a controversial topic: women and fasting.

: Alex Wisch wants you to realize that all that lies between your goal and you are the small steps.

Media, Schmedia

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At least they’re .

Interesting Blog Posts

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Men are at much greater risk from COVID .

Social Notes

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Everything Else

Wait… now where have I heard of before? I wonder what food component increases it in the body…

The popularizer/”inventor”/”creator” of the “Flow State” has .

Turns out that horses were domesticated . Cool to think about.

Things I’m Up to and Interested In

The case for having your vaccine administered by registered nurses rather than volunteers in parking lots: In mouse models, . This could explain a lot.

Well deserved: .

Cool video: between Nina Teicholz, Amber O’Hearn, Richard Morris, and Cynthia Thurlow about fat, protein, fat loss and much more.

Interesting study: .

Key words: Meat tax “.”

Question I’m Asking

How are meat prices near you?

Recipe Corner

• I strongly support the .
• , one of the greatest “salads” in the world.

Time Capsule

One year ago (Oct 16 – Oct 22)

• — All about it.
• — Have you heard?

Comment of the Week

“Mark, I’ve been reading this site for 10 years now and do believe this is a treasure trove. However, the idea that any type of ‘mandate’ would ever be a good idea, let alone coincide with the general ideals of personal choice touted on this blog, is patently absurd. No matter if exercise is a good thing. Everyone has the right to self determination. If that means a ‘sedentary life style’ (due to any conceivable situation, such as working 3 jobs to pay the bills), then so be it. In a time when busy-bodies seek to micromanage those around them rather than remove the splinters from their own eyes, I’m dismayed to see that and ‘exercise mandate’ would even enter this blogs forum.”

-I agree with on mandates. I was just curious to see what other people thought.

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We talk a lot around here about inflammation, and some of you have raised good questions (and answers) regarding what we’re really getting at. A continuing thanks for your comments and thoughtful responses.

So, what do we mean by inflammation when we harp on the evils of sugars, grains, trans fats and other nutritional fiends? Ah, the many sides of swelling: abscesses, bulges, distensions, engorgements, boils, blisters, bunions, oh my! Do swollen ankles and puffy black shiners really have anything to do with the inflammation of arterial walls? Can flossing possibly help prevent heart disease? Let’s explore.

What is inflammation?

Inflammation is your body’s response to infection and injury. When your body triggers an inflammatory response, the immune system musters immune cells to the site of the injury or infection to isolate the area, remove harmful or damaged tissue, and begin the healing process.

Behind the scenes, your body deploys your immune system. For an injury, you can experience any combination of redness, pain, swelling or heat. For an infection, you may experience some of the same things, at a larger scale. Fever is an inflammation response. Stuffy nose is swelling.

Anyone who has ever, say, walked into a door knows that with injury comes inflammation (and a little humiliation). We might be horrified at the visual effects that ensue, but it’s just the body’s natural and essential response to defend itself from infection or trauma. In fact, the swelling initiates the healing process itself. Remember, the body doesn’t care what you look like as long as it can regain your good health.

Acute Inflammation vs. Chronic Inflammation

Acute Inflammation

Walking into that door is an example of “acute inflammation,” a localized response characterized by compression of the surrounding nerves (ouch!) and collection of fluid in the area that helps bolster an immune response. The microscopic trainers are busy shouting orders, notifying the brain of wounded status, calling in the clotting response and going to work to reset things and get you taped up. They take care of business, you avoid all human contact for two weeks out of embarrassment, and you come out basically no worse for the wear.

Acute inflammation circumstances tend to be pretty run of the mill: sprained ankles, cuts and scrapes, bumps on the head, etc. In certain cases, however, inflammation takes on much larger significance, such as in the case of the major trauma of a car accident, significant burns, major allergic reaction or a previously localized infection that spreads to other parts of the body. Major and/or multiple sites of trauma and infection initiate a larger, systemic response.

In cases of severe trauma, the body elicits a massive inflammatory response. The immune system kicks into high gear, and white blood cells, among others, migrate to the injured areas. Receptors that sense the sweeping call to inflammatory action get in on the action. The blood supply to major organs, such as the lungs, is compromised. If left unchecked, organs failure can ensue.

Chronic Inflammation

Ongoing health issues such as diabetes, high blood pressure and autoimmune disorders can instigate what’s known as chronic, low-grade inflammation. This kind of inflammation doesn’t result in the immediate, sweeping response of trauma, but it keeps the body in a constant state of repair response. Immune cells (macrophages, monocytes, and lymphocytes) take charge, and a recurring, destructive process of tissue destruction and repair effort develops and continues until the source of the chronic inflammation is removed.

And there are serious consequences to this unchecked, ongoing inflammation. Neutrophils, one of the cells involved in inflammatory response, attack what they perceive as outside damage or invaders with the massive production of free radicals. They and other cells will keep pumping and spreading these free radicals throughout the body as long as they sense the inflammation. As you know by now, free radicals also destroy healthy cell walls and DNA, so there is collateral damage, too. The body’s general immune response (the ability to deal with daily exposure to bacteria, virus and fungus) is compromised because the system is kept busy tending to the incessant, active inflammation. Long-term effects of chronic inflammation can influence the development of many other conditions from Chrohn’s disease to cancer. And, of course, countless studies have connected chronic inflammation with the development of atherosclerosis (and, increasingly, insulin resistance). Remember we spoke recently about the devastation caused when arterial walls are inflamed and the body responds with a ““? Yep, chronic systemic inflammation is a big factor there, too. Even to the extent that chronically inflamed gums might be a tangential cause of heart disease – and if not a cause, at the very least an accompanying symptom of systemic inflammation.

Frightening scenario, eh? The good news is that a CRP or C-reactive protein test can offer you and your doctor a better sense of your inflammation picture. Another test called hs-CRP may offer a detailed picture of inflammation as it relates to heart disease risk. If you get these tests, be sure to do so when you don’t have a recent injury or illness, since CRP can linger from the acute response, too.

Inflammation FAQs

How can you reduce inflammation?

You can reduce inflammation by going for walks, spending time in nature, eliminating seed oils high in omega-6 fats, eating more seafood or taking fish oil, losing excess body fat, exercising regularly, getting 7-8 hours of sleep every night, and eating plenty of protein.

What foods cause inflammation?

Whether a food is inflammatory depends on many factors, such as a person’s genetics, health status, exercise and sleep habits, gut health, and underlying baseline nutrient status. Foods that cause inflammation in almost everyone are refined grains, refined sugar, and .

Other people may have issues with specific foods or food categories, like . It’s highly individual, though.

What causes inflammation?

Any insult or injury. Every cut, every bug bite, every scrape and scratch, every broken bone or sprained ankle causes inflammation. Every time you eat food you’re intolerant of or allergic to causes inflammation. If you breathe in pollen and you have seasonal , that causes inflammation.

How to reduce inflammation in the body fast?

To reduce inflammation quickly, high dose can help. Turmeric with black pepper can reduce inflammation quickly as well. Black seed oil is another good option for reducing body inflammation fast.

Do tomatoes cause inflammation?

Some individuals are intolerant of nightshades, which include tomatoes, peppers, eggplants, and potatoes. Common symptoms of nightshade or tomato intolerance include joint pain, stomach upset, nighttime tremors, and other reactions typical of allergy.

We’ll say what we’ll always say. (Systemic) inflammation sucks. Get rid of simple carbs. Eliminate . Get some exercise (but not too much). Embrace a Primal anti-inflammatory diet. Check ’em out in the archives, and share your comments.

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Every “keto for women” forum abounds with stories about menstrual cycles gone haywire in the first few months of keto. Common complaints include:

• Irregular menstrual cycles
• Breakthrough bleeding
• Sudden changes in menstrual cycle length, especially periods lasting much longer than normal

Keto critics love to cite these stories as evidence that keto isn’t good for women. After all, for premenopausal women, menstrual cycle activity acts as a barometer for overall health. Menstrual cycle disruptions are usually a sign that your body is under some kind of stress.

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or learn the basics of this popular diet without the guesswork or tedious macro-counting.

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can be stressful depending on your approach, or at least the body can perceive it as such. Premenopausal women’s bodies are especially sensitive to dietary changes. The reproductive system’s job is to ensure that a potential pregnancy would be safe for parent and fetus. Any signs that could portend food scarcity or nutrient deficiencies, and the body responds by on reproductive capacity.

Keto diets require you to strictly limit or remove high-carb foods, including some nutrient-rich offerings like fruits, beets, and sweet potatoes. Keto dieters very often restrict calories as well, intentionally or not. Thus, it’s reasonable to hypothesize that women might have a tougher time adapting to or sustaining a ketogenic diet. Maybe this so-called “keto period” phenomenon is a sign that (pre-menopausal) females shouldn’t be doing keto. Or maybe menstrual changes aren’t a big deal in this context. 

What does the science say? What is it about keto that affects the menstrual cycle?

Can Keto Affect Your Period?

Let me reassure you from the get-go that there is no evidence that keto diets cause any systematic or lasting harm to menstruating folks. Anecdotally, many people don’t experience any menstrual changes at all, while others find that PMS symptoms improve and their cycles become more regular as soon as they start keto. Even if you’re one of those people whose cycle becomes wonky (that’s the accepted scientific term, right?), chances are good that things will return to normal, or even improve, after a few months. Still, it’s natural to feel alarmed any time your bodily functions change unexpectedly.

One statistic you’ll see floating around online is that “45 percent of females experience irregular menstrual cycles on keto.” This statistic comes from a single small study of adolescent girls using a therapeutic ketogenic diet to treat epilepsy. Six of the twenty girls experienced amenorrhea (loss of period) and three were diagnosed with delayed puberty. That sounds bad! Don’t rush to judgment, though. It would be a mistake to conclude that nearly half of teenagers, much less females of all ages, are likely to experience keto-related menstrual problems based on this one study.

The ketogenic diet used for epilepsy is different and much stricter than the typical (non-medical) keto diet most people follow. Moreover, epilepsy is frequently associated with menstrual dysfunction, regardless of diet. I’m unable to find any studies documenting menstrual or reproductive issues in healthy females, or even in female mice for that matter, on keto diets. In fact, the (admittedly scant) research seems to point to the opposite—keto diets having positive effects on menstruation and reproductive health.

However, we do have abundant stories from people whose periods changed for the worse when they started a keto diet. The question is why.

What Is a Normal Menstrual Cycle?

Let’s briefly review what constitutes a 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 cycle 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 and thyroid glands.

It’s perfectly normal for blood glucose levels and body weight to fluctuate throughout the month as hormone levels change. Generally, blood glucose levels are lower at the beginning of the cycle and higher in the pre-menstrual period (the second half of the luteal phase). 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. You may also get lower ketone readings at certain times of the month—usually coinciding with a period of (transient) weight gain and carbohydrate cravings.

Rest assured that these fluctuations reflect normal physiology and don’t mean that you’re doing something wrong. Most individuals experience these ups and downs every month but don’t notice them until they start measuring blood glucose and ketones. They’re mostly tied to the cyclical nature of estrogen and progesterone and aren’t anything to worry about. What’s potentially more worrisome is when you start a keto diet and all of a sudden your period is longer or shorter than normal, your cycle becomes irregular, or you skip a period altogether.

What Causes Menstrual Cycle Changes on Keto?

The many factors that affect sex hormones and the menstrual cycle include:

• Other hormones, such as metabolic hormones
• Gut health and microbiome
• Metabolic health, e.g., insulin sensitivity)
• Environmental toxins
• Stress
• Sleep
• Immune health
• Nutrient deficiencies
• Activity level and energy expenditure
• Age

It’s no surprise, then, that menstrual changes and reproductive issues can be extremely difficult to pin down. Unfortunately, there’s almost no research into keto diets and their effects on the female reproductive system. There is, however, some evidence regarding carbohydrate restriction, which is a defining characteristic of keto, as well as other correlated factors like weight loss.

Does Carbohydrate Restriction Affect the Menstrual Cycle?

Based on the available evidence, the answer seems to be yes, and the effects are beneficial.

By definition, ketogenic diets restrict carbohydrate intake, usually below . While no studies have focused on keto diets, a handful have examined the effects of low-carb-but-not-keto diets on markers of reproductive health among overweight women. A meta-analysis concluded that in four out of four studies, low-carb diets improved menstrual regularity and/or ovulation rates. Furthermore, out of six studies that measured reproductive hormones, five reported significant improvements.

Polycystic ovarian syndrome (PCOS) is one of the leading causes of female infertility and a frequent trigger of menstrual irregularity. People with PCOS have high rates of hyperinsulinemia and insulin resistance. Restricting carbohydrates decreases the insulin burden in one’s diet, so a lot of people are experimenting with keto to overcome their PCOS. Only one small study has so far directly tested the effectiveness of a ketogenic diet to treat PCOS, but the outcome was promising.

Weight Loss and Period Changes

Many folks rapidly when first starting a keto diet. Weight loss can impact menstruation through a variety of pathways, one of which 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 you have enough energy on board, so it’s safe to reproduce. Low leptin can disrupt the menstrual cycle and is linked to hypothalamic amenorrhea.

Body fat loss can also affect estrogen levels since 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 people report.

Stress

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 on a physiological and psychological level. Keto has a reputation for being especially stressful because it is more restrictive than other low-carb diets, but you can diet-related stress by following the Keto Reset .

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 , 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. If you’re experiencing persistent menstrual issues, though, it’s always a good idea to ask your doctor to test your .

What Should I Take From These Findings?

The first takeaway is there isn’t cause for alarm. If anything, studies suggest that low-carb diets improve some aspects of menstruation and reproductive health. Much more research is needed, but ketones themselves have important physiological properties, such as being directly anti-inflammatory, which might positively impact women’s reproductive health.

Second, factors that potentially disrupt the menstrual cycle—namely weight loss and stress—aren’t unique to keto, they’re common to any diet. Furthermore, many people combine a ketogenic diet with calorie restriction and fasting, both of which can independently lead to weight loss, cause stress, and affect the menstrual cycle and reproductive health. That makes it incredibly difficult to conclude that keto per se causes “keto periods.”

That said, people do need to be cognizant of the signals they are sending their bodies when it comes to energy availability and stress. Women who come to the keto diet with a history of adrenal, thyroid, metabolic, and reproductive issues should be extra careful about how they approach keto. I encourage anyone who’s dealing with other health issues to work with a medical practitioner to tailor a keto diet to their unique needs.

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

I believe you! Remember, though, changes do not necessarily equal dysfunction. It is normal to experience hormone fluctuations when you make a massive—or even a relatively small but profound—change to your diet. Sometimes those fluctuations are unpleasant or unwanted, such as a period that lasts 14 days or one that arrives a week early 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 an input will invariably change the output, and the system might need a few months to adapt to a new normal.

If your cycle becomes irregular but you’re otherwise feeling good, give it a few months to sort itself out. 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. If after a few months it’s still all over the place, talk to your doctor. Definitely do so immediately if you’re having other concerning symptoms.

At the end of the day, if keto isn’t working for you, stop. Keto gets a lot of hype, much of it deserved, but it doesn’t work for every body at every time. 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 self-experimentation, you can find a version of keto that works for you.

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