Empowered Health Podcast Episode 1: Earlier this month, the media began pumping out headlines about “keto crotch”, an unpleasant odor downtown plaguing women on the ketogenic diet. The timing of this media blitz and the lack of research on the phenomenon seemed suspicious, so we decided to investigate.

Show notes + Transcript

Emily: Hi, I’m Emily Kumler and this is the first episode of Empowered Health. Welcome. We are so excited to get this project started and we have to start with a little bit of a blip, which is that we have a really amazing editorial calendar lined up with fantastic episodes trying to unpack all kinds of really interesting health topics for women. But in the meantime this sort of whole Keto crotch storyline broke across, I don’t know, it’s like we have 28 different media outlets that reported in a matter of about three days that women on the Keto diet, we’re experiencing a terrible smell downtown. Now, this sort of came across a bunch of my feeds and I thought this is really interesting. I’ve been sort of on the periphery of the low carb sort of scientific community and eating community and I have never heard of this before. So, I of course like a lot of other people who were really interested in like, is this a thing or is this not a thing? And I came across this guy on Twitter who had basically cataloged all of the outlets that had published this and the sort of shocking headlines. And in the process of looking at his stuff, I ended up talking to him on the phone and he was sure that this was a story that had been planted to sort of discredit the Keto diet and be sort of misogynistic and body shaming women. And so I thought, you know what? This is really interesting because there’s so much in the health world that is confusing and I think especially women’s publications sometimes do a disservice to us by not thoroughly researching stuff. So I thought, let’s figure this out because I really care about women and I really care about the media and I really care about the integrity of information and getting good information to you all. So what we decided to do this episode was sort of crash this piece for you guys. So we put it together pretty quickly. We reached out to as many people that were quoted in these stories as we could, including some people on Reddit who literally posted five years ago. And were quoted in stories last week as if this was something that was happening to them right now. So without further ado, let’s kick it off. We’re going to start by talking to some of the reporters who covered the story. Jamie: Hi, my name is Jamie Feldman. I’m a reporter at HuffPost. I report on human interest stories as well as lifestyle, fashion, and wellness topics. Emily: So, how did you come across Keto crotch? Jamie: I actually got to it a little late in the game. It was first spotted on Reddit, which sent me kind of into a rabbit hole of Keto-related content on that forum because there’s a huge population of Keto enthusiasts that use the platform to talk about various things, weight loss struggles, and one of those struggles happen to be the now infamous Keto crotch. So, that’s kind of where it first came up and I started to see some buzz about it there. Emily: So had you read the story, I mean I know you cite Women’s Health as like the, you know, sort of the impetus for writing the piece. Is that how you came across it? Like is it, was it assigned to you? Did you see the story and say like what is this about? I’ve never heard of this before. What was the sort of- Jamie: I saw it in Women’s Health. I saw a couple of places had been talking about it and I’m kind of always skeptical. I take everything, especially when it comes to health topics that are buzzy or you know, kind of outlandish with a grain of salt. And I tried to approach them from the angle of trying to figure out if this is even real or if this is just something that kind of is sending the internet ablaze. So, I had a general interest myself to see if it was actually a real thing. And I think Keto and vaginal health are two topics that a lot of people care about. So, I kind of took it from there, started digging into it a little bit. Emily: So you weren’t assigned it, you found it? Jamie: Yeah, I found it. Emily: Okay. Because I think one of the things that I’m struck by, the more people that we’re talking to about this is that there is this sort of like, I don’t know whether it’s a conspiracy or it’s a real thing that, you know, this was a planted story essentially. Jamie: That’s what the doctor who I spoke to kind of made a joke about when I called her. She said the first person that called her about it, she asked them if they were just making up a story to get clicks, which I think there are many things on the Internet you can say that about, but I think that with any diet and with any person who’s saying, you know, this is something that I’m experiencing, it’s worth at least checking out a little bit. Emily: Yeah, no, and I think one of the things that I appreciated about your story was that you brought that skepticism into the piece. I mean, I think including that quote from the doctor was great, but I also was impressed by the fact that, you know, you sort of dialed it back a little bit to say like, is this real or is it not? Because when you go back to the Reddit stuff, one story we looked at the posts from like five years ago that made me sort of be like, this doesn’t seem like some sort of new, you know, interest. It seems like somebody maybe did go looking for this specifically and found this post from a really long time ago and then turned it into something. And so, I mean, I’m curious about it for the same reasons that you are, right? Which is that if it’s a real thing, like women probably want to know about it, but it does seem like there’s a massive, massive pushback from women in this Keto community who are saying, wait a minute. That’s not a thing. Jamie: Right. I think people are really touchy about Keto who are on it. People who are not on it are really skeptical to put it lately about the diet itself. So I think there’s some tension there. Emily: Right. Jamie: And I think that people in the medical community, I’m not in the medical community so I can’t speak for those people, but I think it’s probably at the point where now like every time something remotely comes up that maybe, I don’t really understand how Reddit works honestly, but you know, somebody clicks on something and all of a sudden it’s gotten up-voted from five years ago and it’s the top post on a page, it just, history kind of just repeats itself over and over again on these forums where maybe somebody was dealing with bacterial vaginosis and had just started Keto and was like, hmm, I wonder if these two things are connected and, I think, you know, it’s not an uncommon diagnosis for people and Keto is so popular now. Maybe people were reaching a little bit to make a connection to see if this is something that they can stop or they can, you know, kind of self-remedy. I’m not sure. Emily: Yeah, there was actually a really funny post where somebody said something like, if your vagina smells like rotten fish, don’t worry about your diet like just get to the emergency room. Like this is because of, you know, you may have bigger fish to fry, no pun intended. Jamie: There’s this one doctor who I follow, I really like her stuff and she’s, you know, she’s one of the biggest names that I follow that’s been really critical of Goop and Goop’s medical claims as it pertains to vaginal health. And she tweeted out my story and said make this stop. And I was like half upset that she appeared to be unhappy with my piece and half kind of like flattered that she was even looking at it because you know, I value her medical opinion. So that was kind of an interesting thing. Emily: Well, I think that’s another part of it. Like it’s part of the pushback that I’ve seen, at least in these like sort of online communities seems to be that the headlines are so convincing. Right. Whereas like when you read the articles, most of the articles are saying like, you know, no one’s studied this, we don’t know one way or another. Right. And I’m like, well, you know, reporters don’t really get to decide what their headlines are. And so, you know, that’s not always- you can’t really get mad at the reporter about that per se. Right. It’s like they’re kind of different situations. But yeah, I mean I think that there is something kind of interesting about the underlying validity of it and if it is mostly coming from like anecdotal experience, where did it start? And so I feel like we’re sort of trying to track that down and figure out like where did, how did this all come about? And like, is it something that women really need to think about or is it not? Jamie: Right. I think anything that is encouraging women to be mindful of their vaginal health, you know, if somebody’s clicking on that article, I have my own curiosities about my own vaginal health, click on stories to be like, hey, I wonder if this has something to do with me. And then if that gets someone into my article where they’re then reading about BV or other causes of something that would tip off the bounds of your Ph and then you have that knowledge, you can take it to your doctor like that. I don’t necessarily think it’s a bad thing. I think the buzz and the hysterics about it being attributed to this one specific thing is not great, but if there can be any education that hopefully people are not just looking at the headline, which I think often is an issue as well, then at least they’re getting some kind of real information that they can take with them. Emily: Right. And I think that that’s such a good point because I think that’s such a tricky balance, right? Because you look at like Barstool Sports, I mean like they’re taking it to a different level where it’s body shaming, right? It’s not healthy. It’s not productive, basically saying like if you date somebody who’s on a Keto Diet, they’re going to really stinky. Right? Yeah. You know? So I think it’s tricky, you know, once it gets out there. But yeah. So, I mean, I feel like the big things for me are that I have heard from people that it’s like, you know, this was a story that Weight Watchers planted because Weight Watchers was you know, losing all this money because of the Keto Diet. And I had people who literally said to me like, the reporters are getting paid to do this and it’s a PR stunt. And so I sort of, I mean I’m obviously very protective of women. I’m also very protective of the media in terms of integrity. And so I sort of was like, why don’t we talk to some of these reporters and have them say on the record how they found the story and sort of exactly what you’ve explained. So like just for the record, you weren’t paid by any PR firm to tell the story? Jamie: Absolutely not. That would cost me my job and my integrity and it’s not something that I would ever consider doing. Emily: So anyway, thank you very much for your time. Jamie: Likewise. Have a great day. Emily: The next person that I wanted to talk to was somebody from the Keto community. So there’s a doctor named Dr. Ken Berry who has a youtube channel and is a social superstar, and he’s a Keto doctor meaning that he’s like really into the Keto diet. And he I think prescribes it to his patients. And so I sort of thought, you know what, he would probably have a sample population on this diet and he could tell us if this is something that women complain about. And when you listen to this interview, pay attention to the fact that he says that actually he’s found the Keto diet helps women who suffer from chronic bladder infections and vaginosis and the other things that might cause bad odor. So here is Dr. Berry. Dr. Berry: My name is Ken Berry. I’m a board-certified family physician. I’ve been practicing medicine in a small town in rural Tennessee for the last 19 years. More and more as the years progressed had been recommending a low carbohydrate diet to help multiple different aspects of my patients’ health. Emily: Great. So we are talking today about Keto crotch, which I’m especially interested in because I feel like all of the sudden it seemed to be on every news feed nearby me, and I had never heard of it before. And so as a reporter that kind of sparks my interest. Like, oh, is this based on a study? Is this based on something? And it’s been really hard to, to actually sort of try to find the origin of this whole thing. And so I felt like you’d be a great source to talk to both about the validity of the claim as well as sort of what do you think has happened here? Dr. Berry: Well, I’ve been practicing medicine as I said earlier, for almost 20 years. And as I’ve come to recommend low carb and the ketogenic diet to my patients, I’ve noticed a distinct decrease in the frequency of recurrent bladder infections. I’ve noticed a decrease in the recurrence of vaginitis or infections and inflammations in the female reproductive system. I’ve noticed the decrease in bacterial vaginosis and these are, these are the things that cause a change in odor or a change in discharge for women. And so I’ve noticed that a huge decrease in the incidents of those things in my practice in patients who are eating low carb. Emily: That’s sort of anecdotal evidence. But how many women do you have in your practice? Dr. Berry: Hundreds. Hundreds and hundreds of women and scores of women who used to have a bladder infection six, seven, eight times a year. And now with low carb, they have one a year or none. And then the same goes with the bacterial vaginosis and the vaginitis both caused by yeast and bacteria. The incidents of all these things have plummeted in women who eat low carb. And so I also found it very fishy that, pardon the pun, that all these news articles hit at the same time as seemingly out of nowhere. And then flying completely in the face of my daily clinical experience of seeing these things plummet in how often they happen. And then to say, oh, the Keto makes this much more common. And so actually I’ve had some colleagues of mine look into this and it seems that a PR firm was hired, but I’ve been told this, that a PR firm was hired to basically write this story and to sift it out to the news media as fact. And I think if you read the articles, even the doctor that they quote says, I haven’t seen a single case of this, but it’s, it’s theoretically possible. Emily: Right. So I mean, I think to sort of take that a step farther, what is the impact of this from somebody who is a practicing doctor. Who’s obviously prescribing or trying to convince people to try out a low carb diet? Is it, have you had any personal experience where people, like patients have called and said something or you’ve had questions about it? Dr. Berry: Yeah, I’ve had so many questions. Phoned into the office and then sent to my Facebook page and to my other social media that I made a Youtube video about this, uh, just answering this and basically relaying my clinical experience, basically saying that, you know, this is not a thing. I’ve not seen a single patient who came into the office and said, Oh my God, I have Keto crotch. Or you know, oh my God, since I’ve started Keto, I have this terrible vaginitis or vaginosis or infection or bladder infection. I just don’t see that at all in my clinical practice. And then when I posted the youtube video, I think it’s got 150,000 views so far, and every single comment almost without exception is yeah, my fill in the blank got better with Keto. I had fewer yeast infections. I had fewer bacterial vaginosis flareups. I had fewer bladder infections. I had less chronic cystitis after I started Keto. And so, yeah, these are all anecdotal and these are all, you know, n = 1 experiments. But when you start to add up the thousands upon thousands of people that said my female pelvic issues got better when eating low carb Ketogenic, it kinda makes you wonder where this article came from. Emily: And so will the people who have suggested to you that a PR firm was hired and that the stories were sort of planted around, has anybody ever been able to give you any specific information about that? Dr. Berry: Yeah, and so I was told by a colleague who had looked into this that the Barilla pasta company had hired a PR firm and they actually, he actually named on a feed and said that this was, he had seen documentation that they had released this to 28 different media outlets. And that’s why it kind of all hit on the same day, basically going from zero to, oh my God, Keto crotch overnight. And, I think, if that’s true, which is complete and utter hearsay at this point, I think that, you know, if profit suffer enough, big corporations start to do desperate things to try to protect their profits. And I know that the ketogenic way of eating is cutting into the profits of such big corporations as Weight Watchers and some of the bigger processed carbohydrate food like product manufacturers. And I suspect that they’re starting to get a little nervous. And I would, I would predict, we will see more stories like this. Yeah. The ketogenic way of eating is exploding in popularity. Not because there are big corporations pushing it, making a profit from it because it’s literally spreading by word of mouth from person to person. When one person sees their neighbor has lost all this weight and feels much better, they’re immediately motivated to say, Hey, what are you doing? And I think that that kind of grassroots word of mouth movement is very hard for corporations to understand first of all. And secondly, it’s very hard to combat. And II predicted in the future we’ll see more and more news stories and you can call it fake news if you like, but I mean, I don’t see what it’s based on. So I don’t know how you couldn’t call it fake news. I think you’ll see more of these stories coming out in mainstream media with who knows, Keto mono-brow, Keto butt rot, Keto, you know, extra armpit hair, who knows what’ll be the next scare tactic. But it seems that they’re focusing on self-image things like, you know what, my breath is bad. I have, you know, an odor below the belt I have, you know, and all these things that would worry and scare people that you really can’t prove all, but it makes for very good scare tactics. Emily: Well, so I mean, as somebody who has done the ketogenic diet myself, I feel like you do notice a difference in your breath. Right? And so, it’s like acetone on your breath and then– Dr. Berry: Yeah, you can have a few days of breath that sorta smells like nail polish remover, but it’s not the breath of death that everybody’s talking about. It’s also the same breath that someone who is very dehydrated and has ketones on the breath. We can smell that in the emergency department. And I wouldn’t even describe it as an awful odor. It’s just a smell on your breath and it’s the ketones and it’s a perfectly normal and natural physiologic process when you’re in a state of ketosis. And I don’t think it’s necessarily a bad smell. Some people might. Emily: And so, it’s the same thing, right? In terms of when the ketones come out in your pee, they can smell a little sweet. It doesn’t smell like rotten fish or whatever they’re trying to say, but there is a little bit of change. Right? Dr. Berry: Exactly right. You can have that sweet little acetone odor, but it’s by no means, you know, a terrible smell. Emily: Okay. And so in terms of the best way for people, I guess to navigate this disinformation or the spreading of something like this, like how do you, how do you talk to patients about that in terms of what do you look for that are keys to something maybe being more propaganda than actual good advice? Dr. Berry: Really, there’s a, there’s a lot of research that still needs to be done about the proper human diet and what we should eat and what we should avoid. Of course, you know, the big food manufacturers want us to eat lots of processed carbs because that’s where they make the most profit. I however believe that we should eat lots of real natural whole foods like ribeye and broccoli and use butter instead of canola oil. There’s not a lot of profit to be made in those natural whole foods like that. And so I don’t think big food will ever be interested in those. But I just asked my patients have you noticed any, you know, Keto crotch. And to women, they’re like, well no, it’s actually better, but that’s the 100% the answer of the female patients that who have come and said, hey, have you seen the news article? And I’m like, yeah, have you had that? And like, no, it’s better actually. And so I see zero clinical evidence in my practice and I don’t see anything in the research literature that would back this up other than like you alluded to the day or two of the acetone breath or the sweet smell in your urine. Other than that, there’s literally no physiological process that would explain a foul vaginal odor because you’re eating Keto. It just doesn’t even make physiological sense. Emily: And then, you know, I guess the other reason that you’re an expert in this area is because you do have such a big sort of social media presence. And in terms of that, the feedback that you’ve gotten there, you also haven’t been alerted to this as an issue or a problem in that. Dr. Berry: Exactly. Yeah. We have thousands of followers on Instagram and Facebook and Youtube and almost without exception other than the day or two of transitional acetone on the breath or in the urine, everybody says everything below the belt is better with Keto, not worse. Emily: So, we wanted to talk to as many experts who are cited in these stories because knowing now that there is no scientific backing to this, no one has done any kind of nutritional study, clinical trial, looking at how the vagina responds to the Keto Diet, that this is all really circumstantial, pretty much all self-experimentation and that it actually doesn’t seem like the keto community is complaining about this at all. So we called up Dr. Sherry Ross who’s quoted in one of the first pieces on Keto Crotch from February 28th in the Daily Mail. And in that piece she talks about things like you are what you eat and there are certain foods that give off notable odors and she has a book called “She-ology”. And in that book there is apparently a chapter that’s called the tasty V. And that chapter looks at maybe how you eat different foods and it affects your taste and your smell. But pay close attention when she’s talking to me about how the foods that she’s mentioning that impact, taste and smell are not high fat foods. They’re things like asparagus or maybe even fruit being a positive smell maker. So I think there’s something really inherently very interesting here that people latch onto this idea that something is newsworthy and they want to find a way to get in the media. And so they kind of agreed that this is a problem when she doesn’t even seem to have any evidence that this is a big deal. Okay, here’s she is. Dr. Ross: My name is Dr. Sherry Ross. I have a private practice in Santa Monica, California. I’ve been here 25 years. I’m also a patient health educator expert. I’ve written a book called “She-ology”, which was in 2017 one of the most life-changing wellness books from prevention.com and women’s health magazine and love talking about women’s health issues. Emily: Great. We’re so excited to have you on. So just to get right into it, Keto crotch, is this really a thing? Dr. Ross: Absolutely, it’s a thing. You know, the truth is, it’s just a more fun way of bringing attention to an issue that women have been plagued with for years. I mean you are, what you eat is pretty much an idiom for all things body-related. This just brings it home because of course it’s low carb, high fat, so the body’s producing tons of ketones and you know, when your body’s producing ketones, it causes acetone to be produced. And that’s what exits the body. And you can smell it in the breath of someone who’s in Ketosis. They call it a fruity smell. But I beg to differ. I think it sort of has a funky smell from the breath. But every bodily fluid is affected. So your sweat, if you go to the gym, if you, you know, pass gas, the vagina has a different smell and a different taste as well. Emily: So I mean a lot of people are in the low carb community are saying that this is like sort of a conspiracy, right? Or that there’s, that there isn’t any, like massive group of women who are complaining about this. And it does like there is this idea that like when you start to pee out ketones, there is a sweet smell, but that it’s not a fishy, bad smell and that usually people are saying that lasts about two weeks and that there isn’t good nutritional research that eating a high fat diet while eating low carb is actually a contributor to this. So like one of the things that I wanted to try to figure out, is like where is this coming from? Dr. Ross: Well, I think it depends on what you’re eating because if you think about it, think about asparagus or beets. You know, as soon as you consume asparagus, you have an odor in your urine. The same with beets. Your urine can be red and even your bowel movements can be red. People who smoke, you know, or eat a heavy garlic diet or onions or tumeric, curry, it’s a long list of, of fermented foods, for example, can also cause, you know, sort of more offensive smells. Emily: Well, right? But none of those are low carb. Dr. Ross: Right. But it depends what you’re eating, what your diet is being consisting of. You know, and the truth is if your grocery list has the pineapples and mangoes and blueberries and green tea and cucumber, you’re probably not going to have such a problem. So I think it depends on what you’re really eating with spices as it relates to some of the, you know, fatty foods that you’re eating. Because if you don’t use, let’s say garlic or onions, which you probably could eat for the Keto Diet, it may not make your urine or your vagina haven an odor. So again, it comes down to really what you’re eating. Emily: But in some ways it sounds a little bit like you’re saying that it’s like it’s garlic, which could be in a like high carb, vegan diet, right? Could have a lot of garlic in it. Whereas somebody could be on a Keto diet where they don’t have any garlic and maybe that’s the difference. So it’s like the garlic is more of the culprit? Dr. Ross: I think it’s the spices, you know, certain spices that you may be using, you know, with your fats, may make a difference because you can, you know, certainly the meats that you’re eating, if you’re eating eggs, I don’t know, you know, it depends again, what exactly is your on your menu, right? So it’s going to vary per person. It’s not going to be for everybody. But you know, ketosis alone causes an odor. And I think it just depends on, you know, there’s so many things that affect the Ph balance of the vagina, right? Normally it’s acidic. Normally it sort of has like a metallic-y taste to it. But if you’re eating something different in your diet and you are in Ketosis, that could be coming out in the discharge and you know, it could be a fruity smell or it could be an offensive smell. But I think it also, there’s so many other factors that affects the Ph balance of the vagina. Right? So many things. Emily: Yeah. So, I mean, but I think that’s what I’m sort of trying to dial down on because there’s so many stories right now that are out about this and it’s really hard to know like where did they come? Like where did this even co, you know, like it wasn’t something that was even in the, you know, the landscape as far as like, and then all of a sudden it seemed like it was everywhere. So, you know, and it doesn’t seem like there’s really very much research that has looked into how does the ph of the vagina change on different diets and you know, so it’s sort of hard to say that this is actually a real thing because it’s all anecdotal. Is that right? I mean, you’re using the anecdotal experience of your practice, it sounds like. Dr. Ross: No, I bet. We know. We know that the Ph balance of the vagina is very delicate and we know that ketones, if you’re in ketosis, there is an odor in your, any bodily fluid, including your breath. So that we do know, now that alone can be something noticed by people who are very much good followers of the Keto diet. Right? If they’re in Ketosis, they’re checking their urine and they know that they’re in ketosis. So this is a known fact. Now how that, how that comes out as far as how a woman would notice it. If it’s something new, they may just notice it for the first couple of weeks while they’re on the diet and then they may get used to it. But I believe it’s a phenomenon that’s not somewhat anecdotal. I think it is a known phenomenon of how our diet affects our bodily fluids. Emily: Okay. And when you were quoted in the Daily Mail and then that story seems to be picked up and it was like republished kind of in a lot of different places. How did that, had you written something about it beforehand or how did the Daily Mail find you? Dr. Ross: Well, I do a lot of, I’m featured in a lot of articles and my books, “She-ology” has a chapter called the tasty V and it’s basically this conversation, uh, is what I speak about in this chapter of how our diet really reflects what happens in our body, in our odors. And you know, I had a patient come in a couple of weeks ago and, and she, uh, actually noticed that her boyfriend’s semen had a different odor to it. They both started the Keto diet and she said, you know, I noticed a different taste of his semen. So the ejaculate, vaginal discharge, I mean, all these things do change with what we eat. So I think it’s, you know, if, if women or men or eating fruit on the Keto diet and fruit, we know, tends to have a positive effect on the discharge, it has a positive effect on the taste as well. But they, people who are on the Keto diet may not be eating as much fruit. Emily: So it’s the absence of the fruit that is- Dr. Ross: It could be. I think it’s a combination because like I said, ketosis alone, you know, the low carb, high fat, your liver is going to produce a lot of ketones, right? That’s where the energy comes from. This is what the acetone is sort of a byproduct. This is how it leaves our body and it’s in our breath, urine, sweat, and the vaginal secretions as well. So there are things that are changing it, I honestly think it’s just a conversation that is more easily had in today’s world. Emily: You mean it’s just that people were shy about talking about it? Dr. Ross: I think they were shy about it. I think it’s a fad right now. The Keto diet, a lot of people are on it. There’s a lot of conversation about it. People are paying attention to, you know, different odors that their body changes. Everything that is associated with the diet. So I think the collective is really why this conversation is being had. But I think it’s a real phenomenon. I think it’s something that people are just paying more attention to. Emily: Was it something that you pitched the Daily Mail because of the chapter in the book or did they come to you? Dr. Ross: They came to me. They came to me. Yeah. I talk a lot about a lot of things related to the vagina and vaginal health and wellness. So that’s how they found me. I’ve done work for them in the past. Emily: Okay. And they don’t pay you for that? Dr. Ross: No. No. Emily: Okay. Dr. Ross: No, I wish they did, but yeah. Emily: Well no, cause I mean, I think it’s important to be clear, there’s a lot of people who are sort of saying that this is some sort of rebuttal to the Keto movement and that, you know, this is something that is popping up in the news because people are trying to take away from the popularity of the Keto diet. And so, I mean, I just always want to be very clear that this isn’t something that you were paid for or benefit from, it sounds like. Is that correct? Dr. Ross: That’s true. Yes. No, I’m not. Okay. I love the conversation about women’s health and about the vagina and how our diet does affect our vagina and how it smells and how it tastes. So I think that to me was the most important piece of the story. Emily: Yeah. Well, and I think that too has been interesting because I feel like some people are saying this is sort of misogynistic and that this idea that like women could be losing weight on a diet that works really well, but now they’re going to be reluctant to try it because they’re going to be worried that it’s gonna make their vagina smell terrible. And you know, that really does a disservice to women in a way. And so, you know, I feel like people can look at this from very different vantage points and come away with really different ideas about what this is. And from my perspective, I was just really curious why was the story everywhere? All of the sudden it didn’t seem to come out of any kind of new study or research or um, you know, as we usually see when the media sort of starts to sweep something up whole cloth, it is coming from, you know, there’s some new nugget of information. Dr. Ross: Yeah. I mean I think, I think it could have started in a chat room where people were comparing, you know, how their bodies were changing and what they were noticing different about their bodies. To me any conversation that educates women on important aspects of especially their sexual health and their vaginal health is good. Um, and I was glad to be a part of it. I think it’s important for people to know, you know, what affects the vaginal discharge, you know, from alcohol use, you know, to things we eat. It’s important to know. So anything that brings attention is important and I like to be a part of it. Emily: Great. Well thank you very much for your time. I really appreciate it. Dr. Ross: Anytime. Thanks so much. Emily: I was really excited to talk to Bruce Lee, who’s the reporter who filed the story for Forbes in part because he’s the only one that linked Keto crotch to any medical research. He cites a study that was published in the Journal of Nutrition in 2007 that looks at high fat intake in women and an increase in vaginal problems, bacterial vaginosis. When you go back and look at the actual data in that study, what you find is that the women were eating a high carb diet and a high fat diet. They were of a lower socioeconomic group. They were in one area in the United States. I mean this is like food frequency questionnaires, total epidemiological kind of garbage study and very hard to make any conclusions out of it at all, but definitely you can’t say that they were on a low carb diet or that they were in ketosis because they’re eating hundreds of grams of carbohydrates. So I was sort of curious why did he cite that study as any kind of backup for this claim? Okay, here is Bruce Lee. Bruce: My name is Bruce Lee. I’m an associate professor at Johns Hopkins University. I’m also a regular contributor to Forbes and I write on a wide variety of different health-related medicine-related, wellness and a pharma-related topics. So basically any area that intersects or crossover with health. Emily: So how did you come across Keto crotch? Bruce: I started noticing the term started cropping up more and more, especially on different Internet bulletin boards and on social media. So for instance, if you look on Reddit, there’s a number of people claiming that they’re about this unusual smell and they dubbed it Keto crotch and that where it seems to be spreading. So I noticed it wasn’t just a few posts, it was quite a few posts. Emily: So one of the things that I was struck by is that those posts were from a long time ago, like some of them are from like five years ago. And the story caught on like wildfire. So like within a couple of days there were like 30 articles. And so one of the things that I was interested in talking to people about was both the side of it from women’s health perspective as well as from a journalism perspective of like when we all sort of feed off of each other and like is there really anything there or not? So you saw these posts or were you assigned the story? Like how did that come about? Bruce: Well, I saw the post, it was a combination of posting it on social media and yeah, some of those were from a while ago, but it’s also one of these things that has been present on social media recently. So yeah, it really came about by noticing it. The word was spreading. Emily: And so then did you go to your editor at Forbes and say like, I’d love to write a story about this? Bruce: Uh, no, I just decided to see what else was there and dig deeper. Emily: And so I think you were maybe the first person that, the study that you cited in your piece is the only research based information that I actually could find anywhere. And it doesn’t seem like those women were actually on a low carb diet. The 25th percentile of those subjects were eating like hundreds of grams of carbs a day. Bruce: The purpose of this study was not to evaluate low carb or high carb diets or what have you. It was just a rough correlation. So, you’re absolutely right. I mean the science is not there yet. Um, and that’s one of the things that I expressed that it’s hard to tell which of these, you know, people claim different things on the internet, but what’s really needed next is if this is really a phenomenon, then it needs to be studied a little more carefully. Emily: Was there any other information that you came across that made you think this was really a thing? Bruce: I looked through the information, in terms of science– it’s not clear. And one of the things that I urged in my article was that, okay, if you are having this problem, go see a doctor because you know, you can claim certain things and you can feel that there’s some things going on. And there may be something going on, but it’s not clear what the cause might be. So we all know that you can have odors from different parts of your body for different reasons. You know, certainly infections is one thing that you always have to be concerned about. There are also normal smells as well. You know, people are tuned differently. So when you smell something, you may or may not be tuned to it being a normal smell as well. The best thing to do, rather than talk about something on an Internet chat board or a bulletin board, is to go see a real doctor and say, okay, what’s going on? So several things could happen. One is the doctor might say, okay, you have a real medical condition, you have an infection or what have you, or no, this is a normal smell, or the, oh, this is something that we haven’t accounted for. We need to look at it more closely. So I think that’s the situation right now. The facts that we do know is that someone somewhere out there, people out there are posting this. And the question is, you know, what’s really going on? Emily: Well, yeah, and that’s the part I feel like that’s the most interesting to me because it seems like this was more, it feels like it was actually more generated than it was organically or spontaneously turned into something. You know, I mean, I feel like everybody who’s in the media knows that sometimes the story gets attention and then everybody’s like, Ooh, that’s catchy. I want to look into that or report on that. Or that’s something that you know, is getting a lot of clicks. So let’s see if we can make it into a story in some way. But what I’m hoping to do with my podcast is really sort of demystify things about women’s health and look a little bit deeper into, you know, what are the really important stories and what are the things that are sort of grabbing attention but maybe don’t have the validity to them. And I think one of the things that was interesting about this Keto crotch conspiracy phenomenon, whatever we want to call it, is that the headlines were really sort of severe. Whereas most of the stories said like eh, there’s not much to this. Like, you know, it’s very anecdotal and most of the communities are now coming back and saying like, I’ve been on the Keto diet forever and I, you know, have never had a smelly crotch. And it’s sort of, it’s such a polarizing thing. It seems like, I mean, people are really responding to this in a profound way. Have you had any response to your story that you’ve been surprised by? Bruce: Well, I think this is, you know, the whole Keto diet itself has been quite polarizing because, I think from both directions. There’s been pushes in both directions, you know, there are people that are very, very strongly supportive of the Keto diet and so think you’re seeing a lot of information. That’s one of the reasons why I think this has been a bit polarizing. The bottom line is I think with a diet like that, we need to have more information. We need more scientific studies to really determine what the potential benefits and the side effects might be. And I think also yeah, certainly anytime you hear about any health issue, you know on the Internet you need to look more closely and say okay well you know what is potentially behind this and it, and there could be something behind it but you don’t know. You have to wait until health professionals actually evaluate people who are complaining about this issue and determine what might happen. So in theory, yes there could be a relationship between what you eat and your diet and many different things like your body odor, et cetera. There could be that relationship but it hasn’t been clearly established in this situation. Emily: I feel like that was one part of your story that seemed a little confusing to me because you definitely make the connection between that Journal of Nutrition article and more severe bacterial vaginosis. And so I was sort of curious about why you included that. Bruce: I basically explained what that, you know, if you do a literature search, that’s the one study that comes up that shows there might be a connection between, you know, the composition of your diet and potentially something that may lead to an odor. And you know, I was very clear that this is an association. This does not necessarily mean that there is a direct connection between the Keto diet and bacterial vaginosis. But if you look in the literature, that’s the one thing that comes up. So, and then I qualified it after that saying that if you feel that you have an odor or you feel you have a problem, don’t just post it on the bulletin board, you know, go a doctor because we basically need more information. I think it was a combination of like, if you’re looking at literature, that’s all you find. So I think it says things in both directions. One is that’s the only thing that you can find. So this is not an established phenomenon, but two, there is some suggestion that there might be some relationship or possibility. But you have to really take things with a grain of salt because it’s an association. That’s all it is. Emily: Well, yeah, and the data in that study, clearly it has the women eating a very high carb diet. You know, they might be eating a high fat diet, but it’s a high fat, high carb diet. It’s not a high fat, low carb diet. So that’s why I sort of was, when I went back and looked at the data and the study, I was sort of surprised that that was something that would be cited since that’s not a ketogenic diet. Right? Bruce: Well, but I think the point there is that yeah, it’s not the show that the ketogenic diet will lead to something. The point there was to really show that there’s a potential relationship between something that may result in a change in odor and the composition of the diet. That was really the larger picture because the question people is having, okay, well, you know, if I change my diet, you know, will that change other parts of my body? And there is a potential because this shows a correlation. So the point is not to prove that, you know, there aren’t studies out there that necessarily prove that a ketogenic diet will lead to a change in odor because those studies just haven’t been done. But if the question is it possible that it change in the composition of the diet will then affect something which may affect another part of your body that may change the smell? That’s the evidence that supports that possibility. But again, you know, there hasn’t been studies done specifically about a Keto Diet. Emily: Right? And this study in particular is not looking at that. Bruce: Exactly. Emily: But you could look at this study and you could say like, women who eat a high carb diet or women who are in a lower socioeconomic class, right? I mean like any of like healthy user bias stuff you could say is why their vaginas smell right? Bruce: That’s the issue with associations, yeah, associations don’t prove cause and effect. So I think the main thing is, you know what’s in the literature and that’s what’s in the literature so far. So more science needed, more studies are needed that. That was really the main conclusion that I had. Emily: Okay. And then the only other thing that I just wanted to ask you about was there have been some claims on Twitter and elsewhere that this was a planted story in that, not yours in particular, but the whole sort of wildfire of the Keto crotch stuff. You’re not paid by any PR firms or Bruce: No. Nope. Emily: You didn’t financially, like you don’t have any connections to Weight Watchers or any other like pasta companies or anything like that. Bruce: No Emily: Okay. I just feel like it’s important to everybody. I ask everybody I’ve interviewed, I’m asking that question of just to make sure that there isn’t any confusion about that in the public because I think that’s really important and does a big disservice to journalism in general. Bruce: Absolutely. Emily: So I really appreciate your time and sort of going through and explaining the origins of how you came about it and you know what it is and how it requires some more consideration and all of that. So thank you very much. Emily: So we tracked down Dr. Wider, who is a women’s health expert who seems to have some bestselling books and a radio show. And in her quotes with HelloGiggles, she is expressly says that there is no medical research indicating that Keto crotch is a real thing. But she does elaborate on the fact that anything is possible. We just don’t know medically that it’s the case. That quote ends up getting picked up and spread all around. So she becomes one of the experts that’s quoted repeatedly. It seems like she just did that one interview with a HelloGiggles and then it was replicated on shape and other places. Okay. Here’s Dr. Wider. Dr. Wider: Hi, this is Dr. Wider. I’m a women’s health expert. I’m an author and a radio host on Sirius XM radio. I’ve appeared on the today show, CBS News, ABC Nightline, et Cetera, and love to empower women with the necessary information to take good care of their health. I’ve written four books and including “The Savvy Woman Patient” and “Got Teens?:”, is my most recent, “the doctor moms’ guide to sexuality, social media and other adolescent realities.” Emily: Great. Thank you so much. Dr. Wider: Sure. Emily: So today we’re talking a little bit about Keto crotch, and one of the things that I’m particularly interested in is that this story sort of just blew up and it doesn’t seem like it’s actually based on much. And so I sort of, I feel like we’re trying to talk to as many people who have been quoted in the stories as well as, as many people have written the stories and sort of try to figure out why. First of all, why did this turn into such a big story? Is it a real thing? And you know, sort of how do women navigate these kinds of news blasts? Dr. Wider: Oh, I love this angle on this. I think this is such a good point actually. So, yeah, I was approached by several media outlets to comment on the Keto crotch phenomenon. And of course, you know, after receiving an inquiry about this, I looked it up in the medical literature and it doesn’t exist. It’s not officially recognized in any scientific literature. Um, you know, it’s not in the medical books and it’s not confirmed by science, but it’s definitely something people on the Keto Diet have been talking about. And it’s not an unrealistic side effect to a diet like this. You know, I think, um, what we eat absolutely affects our body. It affects our bodily fluids, it affects our breath, it affects, you know, anything our body may be emitting. So there was truth to what people are talking about. But why, this is wildfire, you know, I think it’s the kind of thing where if you mentioned genitalia, if you mentioned somebody’s crotch, if you mentioned something salacious like this, it tends to catch on in the press. And I think, you know, a lot of women are on the Keto diet. It’s one of the biggest fad diets right now in 2019 it really is sort of the Atkins Diet 2.0 a lot of experts have pointed that out in the news. It’s a lot of low carb, high protein diet and it looks there are iterations of it every few years and this is 2019/2018’s version of it. But there are side effects when it comes along with diets like this. This certainly is not one of the more medically important side effects. I would say there are other side effects with the Keto diet that should be on the top of everybody’s list potentially on the radar screen when it comes to worrying about, you know, what the downsides are of these fad diets. Emily: So I mean, I think one of the things that I have been struck by is that when people talk about the smell, and the acetone in the breath, some people say that only lasts for a little while. And if you go back to the reddit communities that sort of start that, you know, most of these publications have cited as like the voice of concern there from like five years ago. And so it’s not like this was like some massive red light or that exploded all of the sudden. And so like it really does feel like it kind of just dropped out of the sky and it was like on all my feeds and I have been sort of, you know, peripherally involved and interested in the science behind the low carb diet or going back to a natural foods diet, I guess I should say for like 15 years. And I’ve never heard of this. So I was like, this is really interesting. Like what is going on? Right. Dr. Wider: Yeah, it’s so, it’s such an interesting point. You know, sometimes we don’t know why things catch on. You know, if you ever read the book “Tipping Point” by Malcolm Gladwell, it’s, it’s very similar to that kind of phenomenon where sometimes this catches, you know, wind in the news and somebody else picks it up. And a lot of the women’s outlets, you know, a lot of the magazine, online magazine sites, will see something and it’s eye-catching because it’s not one of the topics people have discussed. But it is something that will, it’s like clickbait essentially. People are gonna read it because it’s salacious. Emily: And so, but I mean I think one of the things that I want to just make sure that, I have correctly from the medical perspective is that like those sources that we’ve talked to have basically said like things like garlic or asparagus can definitely change the way you smell downtown. Dr. Wider: Right. And that’s true for a man too, by the way. It’s not just a, you know, it’s not gender specific. Emily: You could be on a Vegan diet and not be low carb, right. Or not be high fat. And you would also smell stinky if you ate a ton of garlic. So that doesn’t seem like mutually exclusive. Dr. Wider: That’s correct. Absolutely. And I think there’s another part to the Keto diet from a medical standpoint that may potentially be changing the odor emitted from a woman’s body or a male body. You know, as you said correctly, foods absolutely change the odor of all our bodily fluids. And it’s not just spices like garlic and onion, you know, we can be things like tobacco or alcohol and there are even fruits that can change your bodily fluid odor to the positive like citrus fruits and even spices like cinnamon and nutmeg can do it. So our body is absolutely can reflect what we ingest. And there are different cultures that have stronger spices and people get used to those types of odors, whether it’s in the sweat, whether it’s in semen, whether it’s in our breath. But there’s another part of this actually, and that’s what I think they were trying to, or at least why this might have caught wind because there are two parts. One is the odor of our bodily fluids, but the other is the Ph route for the vagina essentially. And if you look at the purpose of the ketosis diet, right, or any low carb diet, you see that the aim of these diets is to keep your body in a metabolic state, which is known as ketosis. And that’s when your body, which normally burns carbs for energy is now in a restrictive carb atmosphere. It’s going to start to break down stored fat. And that’s why people start to see weight loss on diets like this. And the results are these ketones that are used as fuel. And that’s like one of the breakdowns products is acetone, which some people say you can smell on your breath and as you correctly stated, many bodies will adjust to this and you no longer have this metallic sort of odor coming from your breath on the ketone diet. Dr. Wider: You know, the Keto Diet. But when it comes to our Ph with you know, our genitals, um, there is a, there, there is potential that this type of diet maybe altering the Ph and in in a way if that’s true, not only will you, may you be emitting an odor, but you may, women may be lined up more for different types of infections. So there may be some other medical issue involved with a diet like this. Could women potentially have more vaginal infections? Could we maybe have more yeast infections to someone who have chronic yeast infections? Maybe they need to look at their diet and see what they may be leaving out. And that’s why I think this has a little credence to be, to be honest, because what we eat affects our overall body health. And so I think that there is potential there to look at our overall vaginal health and are we altering it dramatically by changing the fact that we’re not ingesting complex carbohydrates that we could see in a healthy diet. Emily: So I think that’s actually, I mean, I feel like that sounds to me like an area where there could be more studies done if somebody wanted to. I know in the Forbes piece there is a study that’s mentioned, and I looked it up and it’s like, it’s total garbage. I mean the, it’s in the Journal of Nutrition back from 2007 and it literally is like not, I mean the women are consuming a lot of fat, but they’re consuming a ton of carbs too. So it’s not, they’re not on a low carb diet. They’re on like a high fat, high carb diet. That was looking at like, you know, more cases of infection. Dr. Wider: I think it’s important to recognize that a lot of these studies haven’t been done. You know, when you look at the typical clinical trial, women are often times left out on that. And even in 2019, you know, the typical subject in many of these trials are white men. So I think most importantly for people, it’s very important to recognize, you know, this diet has been around for a very long time and it’s been used successfully for people with underlying ailments like epilepsy or potentially diabetes successfully. And people have been successful on this diet and weight loss. But again, you know, I’m really into moderation, especially as someone who tries to inform people. I love to see people have a diet that’s well rounded and not restrictive necessarily of one food group as being good or bad because I find at least in my experience, people have an easier time maintaining, you know, long term weight loss and longterm good habits rather than restricting something. And then when they come off the diet, unfortunately they tend to rebound more often than not with weight gain. So at the same time, you know, there are pros and cons to everything, but I do believe that it’s important to take a look at all the data and to be educated in terms of what you’re looking at. But certainly keto crotch, you know, is one of these things that I think people will definitely want to read about and it will catch your eye. But I don’t know how much science is behind it. Emily: It’s interesting to talk to you about this too because I feel like you’re such an advocate for women’s health that like when you see something like a story like this, like some people have made the argument that anytime women are talking about vaginal health, it’s a good thing. Right? And that like, absolutely. To demystify the stuff and we need to be able to have conversations about it without feeling shameful or whatever. But the flip side of it is if somebody is on a Keto diet and now they feel really awkward because they’re dating and they’re out at a restaurant and you know what I mean? You’re like, this is actually like we did, nobody made the headline, didn’t say like, you know, men will go limp on a keto diet, right? Like, absolutely it was just female. Yeah. I think there’s something about that that’s interesting to me as well. I sort of was curious how you like, when you see headlines like that that are, you could read a sexist or you could read as empowering. Like how do you, how do you sort of navigate. Dr. Wider: I think this is such a great question. You know, I think for me from my standpoint, I think information empowers people and I didn’t come, you know, I made very clear when I was quoted in a lot of these articles that there was, this was not officially recognized in any scientific literature and it’s not confirmed by science and it’s not medical books. But I think that, you know, when it comes to empowering women, I love to vaginal health. I really believe in that. And so I wouldn’t steer away from this because I don’t feel like this is shameful to women. I didn’t really look at it that way in terms of getting a quote. You know, when I was quoted in this, I can understand some people maybe being critical of that. And I didn’t really consider that aspect of it before I spoke to you to be honest. But I do think, you know, foods can change our bodily fluids and I don’t think there’s any shame involved in that. And I don’t think women should feel shameful in any way, shape or form. You know, I really believe that, you know, in terms of the infection side of this, or if our ph changes or if you feel that you have an odor coming from below, this may be why, you know, and for me, I felt like I was giving women the knowledge that potentially this may be due to their diet. Did I look at, you know, how many studies did we do? I was, I was very clear that I didn’t feel that this was, you know, something that was in the medical books, but I felt like enough people were discussing it, that there was probably a critical mass of people noticing it rather than this was planted there as a PR stunt to shame women. That was more my feeling that I was giving women the tools to make their own decisions. Emily: And then just for the record, you weren’t paid by any of the publications or a PR agency to say anything? Dr. Wider: Absolutely not. No, and I’m not, I’m never, never, ever, you know, I think it’s great that you’re questioning this. I think it’s so important. I’m, I’m, you know, in terms of being, you know, I love to give people the information, but, you know, I really earnestly approached this and not in an, I didn’t even think about some of the things that you were saying. And I think they’re valid. You know, I think that there’s definitely the other side to look at with this. But at the same time, you know, if you look at the vagina demystified the way that I do and try to impart to readers into people that read the stuff that I’m involved with and listened to the on the radio. My primary goal is to empower women with information. And that was my, you know, that was definitely my angle in all of this. Emily: Well, so thank you for explaining, you know, your perspective on all of it and also on, you know, some of the things that women should think about as they, you know, consider the diet and also as they read the news. Dr. Wider: Definitely. And I think what you’re bringing up is so important that we need to have a watchful eye and be skeptical about things that we read. Even if you see them in every publication, it’s important to know when and where science is behind stuff. And that’s why it’s important to put out valid and accurate information. You know, and I usually try to put people towards very reputable online sites especially because there’s so much information online that we have to sift through as consumers. Emily: Absolutely. Well thank you so much. I don’t want to take up any more of your time, but I’m really grateful for this. Dr. Wider: Absolutely. Thanks so much. Emily: One of the things that really bugged me about the story is that I think women are misled so often and I think so often in the media we’re told to jump on a story and report something and that often when there isn’t actually something to report, you sort of feel this impetus to answer the call for information. And I think in nutrition especially, there’s this idea of you know, the whole eggs are good, eggs are bad, what do we believe? What do we not believe? And the science behind so much of this stuff is really, we don’t know. And so I hate the idea that people are making women feel like potentially a diet that could be lifesaving, that could help them lose weight, that could balance out their metabolism in ways that they haven’t been able to do before is body shaming them into feeling like they’re going to be really stinky and that’s already an embarrassing topic that women don’t want to get into. So I was struck talking to some of these, you know, the journalists as well as the experts where people were saying like this is great cause it’s sparking a conversation about vaginal health. And I think in some ways it is, but in other ways you look at like Barstool Sports and other places that are reporting on this and there totally, shaming women and making people potentially feel really awkward for being on a date and saying you’re on the Keto Diet and then worrying that the guy that you’re on the date with is going to think you’re really stinky. I think there’s unintended consequences from the stuff that goes far beyond just the sort of grabby headline. And so the guy who I talked to who was the, you know, sort of the Twitter guy who put it all together for me in a way, what was really interesting was that he was saying this was like super misogynistic and at first I didn’t really see that part of it, but the more that I’ve gotten into this, the more I agree. I think that there is something about going after women and going after vaginal smells that is particularly a body shaming kind of thing. That is awful. I’m Emily Kumler and that was Empowered Health. Thanks for joining us. Don’t forget to check out our website at empoweredhealthshow.com for all the show notes, links to everything that was mentioned in the episode as well as a chance to sign up for our newsletter and get some extra fun tidbits. See you next week.