Last year I was dealing with this nagging knee pain that just wouldn’t go away. I tried everything I thought I was supposed to do — resting it, taking ibuprofen, and even trying PT exercises I found on TikTok. For months I kept thinking, I’m doing everything right… so why isn’t this getting better?

Instead, it just got more frustrating. I started worrying something was seriously wrong. Had I made it worse trying to fix it on my own? Was I going to need surgery?

And honestly, the most frustrating part was feeling like I had already wasted so much time trying to solve the problem on my own.

Eventually I decided it was time to stop guessing. I saw an orthopedic doctor and started working with an actual in-person physical therapist who could assess what was really going on with my body.

Turns out I have arthritis in that knee (which as a side note is something people of all body types can have, even though so many people in larger bodies are immediately told they just need to lose weight which grinds my gears….my PT had so many strategies and exercises she gave me to help with it that have nothing to do with losing weight and that should be what everyone is getting when they have arthritis in their knees, regardless of body size)

My PT, her name was Jennifer, she showed me what was actually happening in my knee, what my body specifically needed, and how to move forward without continuing to spin my wheels.

It wasn’t the easiest process. It took time to go to 2 sessions per week and do the exercises consistently. It cost a lot of money in copays. But now I have a plan that works, realistic expectations for my body, and someone I can check in with anytime I need support.

I went from feeling stuck and frustrated, to having the exact steps I needed to move forward…and that’s what I want to give you here in this episode if you’re feeling stuck and frustrated with IE.

Before we dive into our main topic for today, you know what time it is…We’ve got some Wellness Woo to talk about. 

Wellness Woo is the stuff that diet and wellness culture tells us we should do in the name of health, but it’s really based on pseudoscience, exaggerated claims, or just nonsense. 

Today’s Wellness Woo is: The keto diet for serious mental health issues – s/o to Diana

The chatter around this came up recently from RFK junior (who is the embodiment of wellness woo btw) and his comments were featured in the media claiming that people can cure their mental illness with the keto diet. For context, this got lumped in with discussion about a pilot study from 2024 with 22 participants (which is really small to begin with) – and only 14 of them even entered ketosis. Pilot studies are only done to determine feasibility of an intervention, and whether it’s worth investigating further and pouring more money and resources into, also to test for safety. There was also a systematic review that was published in January looking at the studies done to date on the ketogenic diet for anxiety and depression, which I’ll talk about in a minute and is a very different scenario from severe mental illness like schizophrenia.

In the pilot study here’s a quote:

“The participants reported improvements in their energy, sleep, mood and quality of life.” – they did this diet for 4 months. Let’s think about how you feel when you first start a diet. And if you were signed up for a study where you were told that this diet might help improve your mental health. How do you think you’d feel about following the diet that you volunteered to follow, that you were told would make you feel better? The participants lost some weight, which comes with it’s own social currency and feelings of success. And they had the predictable temporary improvements in their bloodwork, just like we often see with dieting…but there’s nothing special about this that’s different from what we see in people who do pretty much any diet.

Let me also point out that it’s sometimes hard enough to get people with schizophrenia and bipolar disorder to consistently take their actual medications, let alone follow a super stringent diet.

It’s VERY difficult to sustain a true ketogenic diet long-term. I did a presentation on the ketogenic diet for epilepsy when I was in grad school, and as part of my presentation I brought in a sample ketogenic meal – and to this day I still remember what the plate of food looked like. It was some chicken, lettuce and mayonnaise. It was disgusting. Even salad dressing would have had too many carbs. 

In an article published in the Journal of Clinical Medicine, I quote:

“Initiation of the KD should occur in a hospital setting and with strict care of a physician and dietitian due to potential side effects of the diet and the possibility of exacerbating adverse effects of pharmacotherapy.”

Something I want to be very clear about here – and is really the point that I want you to take from this is that no diet can cure schizophrenia or bipolar disorder. If you or someone you know has one of these conditions it’s not their fault, and it wouldn’t go away if they just stopped eating carbs. Period. 

There was a systematic review published in January that brought this topic to the forefront again, where they pooled the results of 50 studies done on the ketogenic diet for people with anxiety and depression. Here were their conclusions:

In this systematic review and meta-analysis, KDs were associated with modest improvements in depressive symptoms, particularly with biochemical ketosis verification, while anxiety evidence was inconclusive. Given heterogeneity, comparators, and short follow-up, well-powered trials with standardized, verified protocols, structured support, and prespecified outcomes are needed to confirm efficacy and durability.  

Translation: It might help a little with depression, probably not anxiety, but we don’t actually know because the studies didn’t have consistent protocols, the length of the follow up was really short…and AGAIN as with any diet, the likelihood that people could follow this long-term seems questionable to me. There are a LOT of other things that we can do to help people with depression and anxiety, and I think that there are a lot more risks than benefits associated with this – because we know what happens when people weight cycle – that in itself correlates with higher levels of anxiety and depression, and worsens things like cellular inflammation and blood sugar which is likely part of the mechanism of action for why it looks like it helps with brain health. I think we need to zoom out and look at the bigger picture here.

So here’s my take – I think that the ketogenic diet for severe mental illness is woo. It might be a little helpful for depression, not sure about anxiety…but from a cost:benefit perspective, I don’t think it’s worth it and I think that it would likely cause more harm than it would do people any good.

The only time I would recommend a ketogenic diet is for someone with medication resistant epilepsy – aka for people whom meds don’t work. It would basically be a last resort type of thing. And usually this medical scenario only happens in children, and they often don’t have to follow it forever.

I also want to be clear that an actual ketogenic diet is very different from what most people think keto is. Most people who say they’re doing keto are doing low carb. Do I think you should try keto or low carb if you have depression? No. I think you should take your meds, go to therapy, get good sleep, be physically active, get sunlight each day, keep your vit D level in range, have strong social connections, and potentially take an n-3 supplement. These are solid evidence-based things that come with very little downside. 

There you have it – keto diet for serious mental health issues? Woo. 

Keto for depression or anxiety? Probably not. And even if the evidence were stronger I’d still tell you to do all those other things instead. I think there’s more value in having peace with food than there is in minor improvement from following a pretty extreme and unsatisfying diet.

If you have an example of Wellness Woo that you want to share, DM it to me!

Ok, that’s enough of that. Moving on to today’s main topic…Why You’re Stuck and Frustrated With Intuitive Eating (And The Exact Steps to Move Forward)

3 Reasons Why You’re Stuck and Frustrated

1. You don’t like your weight, you hate what you see in the mirror, and you’re still constantly negotiating with yourself about how you should try and lose weight again.

• If you’re thinking, “Katy, I get it, I already know that dieting doesn’t work, and that’s why I’m doing IE.” AND you’re also still terrified of gaining weight, what ends up happening?

• You half-listen to hunger.
• You stop eating at “acceptable” fullness instead of true satisfaction.
• You avoid certain foods “just in case.”
• You secretly monitor portions.
• You keep one foot in dieting.
• You weigh “just to check.”
• And then when intuitive eating “doesn’t work,” you think: “See? I knew it. I can’t trust myself” or “IE doesn’t work for people with MY body type or MY weight issues.” But the uncomfortable truth here? You weren’t actually doing intuitive eating.You were doing intuitive eating with a leash on – a leash that has you tethered to the scale and your fear of weight gain. You can’t and won’t rebuild trust with your body while constantly threatening it with restriction.
  

2. You keep trying to fix your eating…but that’s not the real problem – the way that you’re thinking about food is the issue.

Now we’re going under the surface…When you’re afraid to eat certain foods, is it really about the number on the scale? Is is that you’re worried that eating ice cream every night will cause weight gain? Is it that you’re worried that having pasta for dinner will make you fat? Is it about seeing the number go up, and that scares you?

Or is it about what you believe that number means?

For most people, the fear isn’t “I’m scared of 5 pounds.”

It’s:

• “If I gain weight, I’ll be unhealthy.”
• “If I gain weight, I won’t like how I look.”
• “If I gain weight, I’ll feel physically uncomfortable.”
• “If I gain weight, I’ll lose control.”
• “If I gain weight, I won’t be as worthy.”

The scale is just a symbol. It’s a chunk of metal that represents:

Health.
Control.
Safety.
Acceptance.
Lovability.

So when you avoid or shame yourself for certain foods, you’re not just avoiding calories or beating yourself up for being unhealthy. You’re trying to avoid what you believe those calories will turn you into.

She said: “I wake up every morning and the first thing I do is go pee and get on the scale, and  then I think ‘What am I allowed to eat today?’”

If the number was “good,” she felt disciplined. Worthy. In control.
If the number was “bad,” she restricted harder and punished herself.

And what she ate that day? Completely dictated by that number. She wasn’t able to listen to her body and do IE because the scale was interfering with it before she even started her day. 

The scale was her boss – her micromanaging, shaming, mean and nasty boss.

Over time, we shifted the focus.

Instead of asking: “What does the scale say?”

We asked: “What behaviors am I practicing today?”

• How can I honor my hunger?
• How can I stop at comfortable fullness?
• How can I move my body in a way that feels good?
• How can I nourish myself?
• How can I challenge food guilt?

Her confidence stopped being tied to a number and started being tied to her choosing behaviors that were caring and supportive of what her body needed.

And because of this, she now focuses on how she’s showing up with food and movement, rather than focusing on what the number on the scale says. In fact, she hardly ever weighs herself anymore. 

The scale doesn’t get to decide her mood, her menu, or her worth.

That’s how we do this work from the inside out, and focus our energy on the things that are actually going to help you feel happy and healthy and like you’re taking care of yourself. So let’s talk about how to DIRECTLY address those food fears about how you’re afraid that things like cookies, or chips or pizza are going to cause you to gain weight…

Let’s say your deeper fear is: “I’m going to overeat if I allow myself to have that.”

That’s where honoring fullness comes in (which let’s remember is principle 5 of IE – and we break down and make sure you’re correctly implementing all of the principles in my IEE program)

Intuitive eating is not “eat everything in sight forever.”

It’s:
Eat with permission.
Notice satisfaction.
Stop when your body feels comfortably full.

These are SKILLS of IE. And you build these skills by practicing, not by avoiding the foods. Each of the 10 principles of IE has a set of skills attached to it. And rather than telling yourself to keep chocolate out of the house because you can’t trust yourself with it, what if we worked on how to eat chocolate without going overboard – which entails you being able to do a whole bunch of the principles of IE all at once – honoring your hunger, choosing satisfaction, separating out physical vs emotional hunger, having peace with the food, challenging the food police, honoring fullness…I just listed off about half of the principles of IE. THAT’S how to overcome your food and weight gain fears – by bringing all of this together like pieces of a jigsaw puzzle. 

If your fear is:

“I won’t like my body.”

That’s where respecting your body comes in (principle 8)

Body respect is not pretending you love everything.
It’s choosing not to punish your body.
It’s dressing your here-and-now body, not the body you wish you had, or the body you used to have.
It’s feeding it, based on what your body needs TODAY, not what you ate yesterday, or what you plan to eat tomorrow, and not based on what the scale said. .
It’s choosing to treat your body with kindness and respect, even on the days you don’t like how it looks..

If your fear is:

“I’ll feel sluggish and gross.”

That’s where movement and gentle nutrition come in. (principles 9 and 10)

Not as punishment.

But as support.

Movement to feel strong, energized, and mentally clear.
Gentle nutrition to help your body feel good physically, and function well medically.

You don’t solve fear by restriction.

You solve fear by building skills and making sure you’re CORRECTLY implementing ALL 10 of the principles of intuitive eating. You can’t just be cherry picking which ones you like, or which ones feel safest to you – you need to implement ALL of them, including the one about body image (principle 8)…which brings me to the 3rd reason you feel stuck and frustrated…

3. You’re labeling your body as bad/wrong, just like you are with food.

“I’m not asking to be a supermodel. I just want to fit into my old clothes.”

This one sounds reasonable – like you’re not asking for too much, and therefore it should be doable, because you’re not wanting to diet to look a ceratin way – you’re just wanting to wear clothes that you used to be able to fit into and therefore it’s a realistic expectation. That might not be true. 

Because underneath it is a resistance towards accepting that bodies change.

Your body at 18, or 28, or 38.
Your body pre-kids.
Your body pre-pandemic.
Your body pre-hormonal shifts.
Your body while you were on your most successful diet.

I can’t tell you what your current set point weight range is (at least not without having a whole lot more data about you like I would a private client, and even then it’s an educated guess). Here’s what I CAN tell you with full certainty: Bodies change across the lifespan. I literally took a class in graduate school called “nutrition across the lifespan” and it was an entire semester talking about how our bodies and our body’s needs change throughout life as we get older. 

We were talking recently inside NDC group coaching about how hard body acceptance is, and how hard it is to let go of that incessant thought about losing weight – and how part of the work that we all have to do is confront our own internalized fat phobia.

That is not a personal failure on your part that your body has changed. It’s biology, and it doesn’t do us a whole lot of good to fight against it. The other reality that we must acknowledge here is that while dieting might have temporarily made you smaller, the #1 outcome of most diets is being at a higher weight than when you first started, and over time it drives your set point weight range up and up and up. So going back to dieting to try and get back in your old smaller clothes might work for a hot minute, but it’s probably going to backfire on you – and that’s why we need to quit taking that tired old approach. Just because you used to be that size doesn’t mean that’s the size your body is meant to be now. 

When you bargain with “just my old jeans,” you’re telling your current body:

“You’re not acceptable until you look like a previous version of yourself or until you lose weight.”

That keeps you living in comparison instead of in reality. What we need to focus on instead is being kind and compassionate towards your here-and-now body, especially on the days that you don’t particularly like how it looks, and on the days where you still wish you were smaller. We can’t just magically make those feelings go away – but we can challenge the lie that you’re telling yourself that you’re not asking for too much to be a smaller version of yourself – because that might not be where your body wants to be at this phase of your life. And if it is where you’re meant to be, that will happen on its own as a byproduct of you mastering all the skills of the IE principles that we’re talking about and working on. But you’ve got to open your mind to accepting that your body chooses its set point weight range, not your brain, and that set point range will change over the course of your life. So let’s stop bargaining with ourselves to justify that the desire for weight loss doesn’t count as dieting because it seems like a reasonable goal – this lie will keep you stuck with one foot in the diet mentality, and therefore it will block you from actually doing the rest of the IE principles correctly. These are the super sneaky ways that the diet mentality has a chokehold on us – where we’ll bargain with ourselves and try to convince ourselves that what we’re doing is fine because it’s not an extreme diet, or it’s not a formal diet like WW. Dieting thoughts and behaviors will have the same impact on you as actual dieting does.

Step-by-Step How to Move Forward if I Were In Your Shoes

Step 1: I’d Stop Trying To FeelBrave And Focus On BehavingBrave

You don’t become braver by waiting for fear to disappear.

You become braver by practicing the behaviors anyway.

• Not weighing.
• Eating consistently.
• Including carb, protein, fat, fiber.
• Not compensating.
• Wearing clothes that fit.
• Getting in the photo.

Courage is behavioral, not emotional. So I would double down on behaviors. Motion changes emotion. Let’s go.

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Step 2: I’d Identify Which Principle I’m Avoiding

If I was still stuck, it’s not because intuitive eating “isn’t working.”

It’s because I’m avoiding one of the principles.

Usually it’s one of these:

• I’m not fully honoring hunger.
• I’m not fully making peace with food.
• I’m still chasing weight loss in the background.
• I’m still telling myself the story that my body is better and more worthy if I’m thinner
• I’m ignoring fullness cues.
• I’m using movement as punishment.
• I’m labeling foods as good/bad.

I would get brutally honest about which one I’m skirting around.

Because intuitive eating only works when all 10 are integrated, and not cherry-picked.

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Step 3: I’d Get Support Instead Of White-Knuckling It

This is the big one.

If I’ve been trying to piece this together on my own…
Listening to podcasts.
Reading books.
Doing free challenges.

And I’m still stuck? I would stop pretending I can DIY something this layered.

Because this work is nuanced.

It’s psychological.
Behavioral.
Physiological.

You need structure.
Coaching.
Accountability.
Correction.
Integration.

That’s not weakness. That’s wisdom. The world’s most successful leaders like Warren Buffet have coaches, advisors, mentors and teachers. They don’t waste time trying to figure things out on their own when they could get support that collapses time and helps them reach their goals faster and with less frustration.

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Step 4: I’d Commit To Mastery, Not Dabbling

You cannot master intuitive eating casually.

You master it by:

• Working through all 10 principles.
• Applying them to vacations, stress, holidays, real life.
• Untangling your specific blind spots.
• Getting coached through resistance.
• Practicing over time.

That’s exactly what we do inside Intuitive Eating Exploration using the official workbook as our roadmap. Not conceptually. Practically. Skill-by-skill – and then TALKING about it and unpacking the places that you are missing the mark, experiencing blind spots, and applying diet mentality to this framework.

And if this all makes you nervous still…that’s ok. I get it. Some of you are listening to this episode and it’s starting to click for you like it hasn’t before – and I love that for you. But the emotional high will fade if you don’t have a way to stay plugged in and actually do what we just talked about and take these steps.

And if it still hasn’t clicked for you, and you still have a lot of “Yeah, buts” in your mind, or hangups on why you can’t accept your body…THIS, my friend, is the messy middle. And is it uncomfortable? Heck yes. Does it get better – only if you keep going, rather than bailing or gradually slipping backwards – which is most likely what will happen if you don’t have a game plan for what you’re going to do next from here. My question to would be what’s your plan? How are you going to keep your head in the game? How are you going to identify your blind spots? How are you going to troubleshoot what is and isn’t working? How are you going to make sure that you’re fully implementing all 10 of the principles – and that you’re doing it correctly? What’s your plan? I want you to write down what you are going to DO to get unstuck. If you want things to be different, you need to DO something different. Otherwise what we just talked about here was kind of a waste of time. 

Alright, that’s a wrap for this episode. If you have questions or need support, my DMs are always open. In case nobody has told you today – you are worthy just as you are. We’ll talk again soon.

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