Questions about the keto diet fill my inbox and DMs daily, so it's time to get the facts straight. The ketogenic (keto) diet is a high-fat, very-low-carb diet that shifts the body into a metabolic state called ketosis, where the body uses fat instead of carbs for energy.
If you follow the research, the health benefits of keto are pretty impressive, from weight loss to metabolic health. But, as with much of the medical world, most of the research has been conducted on men. Before following a keto diet, it's helpful to understand how keto could impact a woman's body differently.
In this article, we'll examine keto and women's health, including the risks and benefits, so you can decide if it's the right fit for you.
How to Decide if Keto Is Right for You
There's no way for me to tell you exactly how you will respond to the keto diet because we all have different genetics, ages, stress levels, sleep, and activity levels. As you will learn in this article, some can thrive on the diet while others may feel worse.
So here's my advice to advice to you if you want to try a keto diet:
- Ask yourself why you want to follow keto in the first place. Is it for weight loss? To lower blood sugar? Improve energy levels? Keep your answer in the front of your mind so after following it for a few weeks, you can answer whether or not it's helping you reach that goal.
- Pay attention to your body beyond the scale. How's your energy, mood, and sleep? Are you hyper-focused on your diet and can't think about anything else? If you notice any negative changes that last more than a few days, keto may not be a good fit.
- Check your menstrual cycle (which we will discuss below). Any changes may mean you need to take a pause because you could be stressing your body.
- Consider checking cardiovascular and blood sugar labs before and after following the diet for a few months.
In other words, it's vital that you think about your personal reasons and have ways to gauge your response to the keto diet. Don't go keto just because it's a trend or you want fast results.
With all that said, let's dive into the risks and benefits of keto.
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Potential Risks of a Keto Diet for Women
We will go into the benefits of keto in a minute (and you probably hear about these a lot), but let's look at the potential risks to start, because they're often less discussed.
Keto and Cholesterol
If you have a history of high cholesterol or heart disease, keto may not be the best choice. Some research does suggest that keto could increase total and LDL (bad) cholesterol, while other studies suggest that it could help increase HDL (good) cholesterol. A recent small study on healthy young women found that keto significantly increased LDL cholesterol after four weeks.
The differences are likely related to the type of fat in the diet (saturated fat from animals versus fats from plants like olive oil). Some people also have genetic predispositions or a family history where a high-fat diet is not recommended.
If you don't know how you do with a high-fat diet, you'll want to make sure to have your lipids checked regularly to see how your body responds.
Stress and Keto
Part of the benefit of keto is that it forces the body into a type of adaptive stress by restricting nutrients. Switching from carbs to fat for energy is why keto works so well for some people, but it can also be too restrictive for others, especially women.
Adaptive stress means a type of stress that your body has to overcome. But if your reserves are already depleted and you don't respond favorably, it can do damage.
As I'll discuss in more detail below, keto can be helpful or harmful to women's hormones because our hormone balance is so closely tied to the body's stress response. For some women, restricting carbs throws the body into a protective state that can shut off hormones that control your period and menstrual cycle.
Keto and Disordered Eating
Content warning — if you've ever been diagnosed with an eating disorder, I'm going to discuss keto and restriction here. You can skip to the next heading to avoid it.
Any diet that severely restricts a group of foods could increase the risk of disordered eating. Some people can easily follow a diet without falling into unhealthy patterns, but others can take a diet too far. Disordered eating patterns can include binging after over restriction or developing a fear of food or weight gain.
If food becomes an obsessive focus where it's all you think about, or you no longer get pleasure from eating, it's definitely time to consider another eating pattern.
Keto and Missing Nutrients
Simply choosing to follow a keto diet isn't the end of the story. Whether you are low carb, high carb, vegan, vegetarian, paleo, omnivore — any label at all — the quality of your food still matters.
According to a review of Japanese adults, keto diets high in processed animal products or inflammatory fats are associated with increased mortality. Still, another study found that plant-based keto was associated with lower cancer risks.
Further, it takes extra effort to make sure you get enough fiber while following keto. Fiber is a carbohydrate critical for hormone balance and a healthy gut, and studies suggest that low-carb diets have adverse outcomes on your gut health.
Who Should Avoid a Keto Diet?
With all of the above in mind, the keto diet isn't for every woman, especially in the following situations:
- History of an eating disorder
- Medical conditions that impact the kidneys or liver
- Medications that lower blood sugar
What are the Benefits of Keto for Women?
While there are risks for some, keto also has many associated health benefits.
Keto and Weight Loss
Weight loss is usually what draws women to keto in the first place after trying other diets that don't seem to work.
First, keto eliminates many processed and refined grains that contribute to excess weight. Women also find they are less hungry while following keto, and studies show it can reduce hormones that influence hunger.
Keto can also increase fat burning as the body uses stored fat instead of carbs for energy. A small study on women following a low-calorie keto diet found they lost body fat but also noted decreased food cravings after following the plan for 14 weeks.
The question remains whether these results last, but it could jump-start weight loss before transitioning to a more sustainable way of eating long term.
Keto and Blood Sugar Control
Since the keto diet reduces carb intake drastically, it significantly improves blood sugar and insulin response. In other words, keto can be good for your metabolic health.
Carbs are digested and absorbed as glucose. As glucose (blood sugar) rises, insulin is released to move glucose into your cells to be used as energy. But too much glucose can lead to weight gain, insulin resistance (where your cells become less responsive to insulin), and eventually type 2 diabetes.
With keto, carbs remain so low that blood sugar and the need for insulin drops significantly. A meta-analysis found that the keto diet successfully improved glycemic response and lowered A1c (a test that correlates with blood sugar levels over two to three months) for people with type 2 diabetes.
Keto and Cancer Treatment
There's some indication that keto could be beneficial during cancer treatment, although if you have cancer, it should be discussed with your care team before starting.
One study found that following a keto diet helped women with ovarian or endometrial cancer maintain lean muscle but reduce fat and circulating insulin. Another study on women with cancer found the keto diet helped reduce food cravings while improving energy and physical function.
Keto's Effect on Women's Hormones
Let's get into my favorite subject: hormones.
I've already touched on keto and insulin, but as a reminder, insulin is the hormone that lowers blood sugar. High insulin can make it more challenging to lose weight and eventually lead to type 2 diabetes.
Keto can stop that process in its tracks by significantly reducing the need for insulin. Other nutrients like protein and fat don't raise your blood sugar, minimizing the need for insulin.
Women with PCOS often deal with insulin resistance or high blood sugar, so keto could help (although cutting down on refined carbs while majorly increasing sources of soluble fiber, polyphenols and resistant starches may also do the trick). A study on women with PCOS found that keto improved insulin resistance, body weight, and overall hormone balance.
But once again, much of what we know about keto is based on studies on men. In recent years, there've been a few more studies on women, but most are short-term.
In practice, I've seen that while there are certainly blood sugar balancing health benefits, keto can also impact other hormones that control women's health.
Cortisol and the Keto Diet
Since keto can increase your body's hardwired stress response, it can increase cortisol, your primary stress hormone. Here's the kicker: carbohydrates may support a healthy stress response, according to some research.
More cortisol makes it harder to lose weight, which is why I'm not surprised when I hear from women wondering why their male partner or friend had no trouble losing weight on keto, but they in turn gained weight. Sometimes this happens from eating too many calories, but it can also indicate elevated stress hormones. Especially if that fat is in the belly.
Keto Could Impact Estrogen Balance
We need fiber to efficiently remove and detox estrogen from our bodies. Fiber is also critical for healthy gut bacteria that help balance our hormones. We need balanced hormones for so many reasons and if weight loss is on your mind, throwing off your estrogen isn’t a good thing.
Thyroid Hormones Are Sensitive to Glucose
Going too low carb can also lead to issues with your thyroid because you need glucose to make thyroid hormones. Throwing off the ratio of thyroid hormones could potentially cause hypothyroidism, leading to weight gain.
Keto Diet and Your Menstrual Cycle
Since keto impacts your hormones, your menstrual cycle could also be negatively affected. Excessive weight loss or nutrient depletion can tell your body to shut off reproductive functions like ovulation, so you don't get your period.
Will this happen to every woman who follows keto? Not necessarily. Some women notice benefits to their cycle from keto, including improved PMS symptoms. So it really depends on your individual response. But anytime you notice irregular cycle changes, it's a warning sign that your body is stressed out.
How Keto Affects Fertility Levels
If your hormones are thrown off, keto could impact fertility and make it more challenging to get pregnant. Your body is smart, so if it feels stressed by nutrient depletion, it also knows that it's not a safe environment to grow a baby.
That said, some studies have found that keto could actually help women with insulin resistance, especially with PCOS, get pregnant.
A review found that low carb and keto diets, with or without calorie deficits, improved the chance of pregnancy for women with PCOS. However, it's not clear from the study whether the effect is mainly due to low carb or simply cutting out processed foods and refined flours – two foods that majorly inflame anyone, but especially women with PCOS.
Keto and Menopause
Perimenopause and menopause may be good times to consider going keto. Fertility and the menstrual cycle are no longer a concern, but blood sugar imbalances and weight gain increase as estrogen levels drop.
Studies suggest that insulin resistance is also linked to hot flashes, so going low carb to support blood sugar could potentially be a natural way to manage these changes.
However, it's also important to note that research shows that menopause increases the risk of heart disease, so the potential effect of cholesterol that I mentioned earlier should be considered on a case-by-case basis.
Adjusting the Keto Diet to Work for Women
Since women are different from men, adjusting keto to support women's hormones could be a way to optimize the benefits.
Some women feel better cycling keto, where they follow a traditional keto diet pattern most of the week but choose one or two days to increase carbs. This pattern could reduce the chance of overly stressing the body and help with feelings of deprivation.
Prioritizing plants, including fiber-rich veggies and plant-based fats like avocado, olive oil, nuts, and seeds, is vital for healthy hormone balance for all diets, not just keto. But using these high-fat plants in addition to high fat fish like salmon and sardines can ensure you make food choices that support long-term health.
Keto Diet for Women: The Takeaways
- The keto diet has health benefits for women, like weight management and blood sugar balance.
- But before starting a keto diet, women should consider potential risks like the impact on cholesterol, disordered eating patterns, or missing out on essential nutrients.
- The keto diet could impact stress and sex hormones that influence your menstrual cycle and fertility. For some women, the nutrient restriction is too stressful on the body, but for others, it could improve blood sugar and make it easier to get pregnant.
- Every woman will respond differently to the keto diet, so the best way to understand whether keto is right for you is to pay attention to how your body feels if you try it. Cholesterol and blood sugar labs could also be helpful to measure long-term health.
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