The high-fat ketogenic diet is nothing short of a nutritional phenomenon. However, because it leads to such major metabolic changes, many dieters and experts question how it might affect men and women differently. Here’s why women may need to take extra care when going keto.
Men On Keto vs. Women On Keto
Researchers and doctors have been studying and using the ketogenic diet since the 1920s—most notably for treating epilepsy. However, much of the body of research on keto was done on men (or animals).
Recent work has begun to look at keto and women. However, many of the studies only involve women who are obese or struggling with metabolic syndrome.
Not to mention, very little research has focused on keto’s long-term effects—in either men or women. (By that I mean following a keto diet for more than a few months, or even a year.)
Though we’ve seen keto help reverse obesity and type 2 diabetes in both men and women in the short-term, long-term ketosis may impact reproductive hormones, digestive and heart health, and liver function—especially in people with predispositions for heart and liver issues.
In women, specifically, long-term ketosis could potentially impact menstrual cycles, libido, and fertility.
Why’s that? Generally, women’s endocrine (a.k.a. hormonal) systems are more sensitive to changes in diet and exercise than men’s.
You see, hormone function is controlled by the complex interaction of the hypothalamus (part of the brain), pituitary gland, and adrenal glands. This system is known as the hypothalamic–pituitary–adrenal axis, or ‘HPA axis.’
Women’s HPA axes are very sensitive to calorie restriction and exhaustion. Thus, disturbances can alter the production of key reproductive hormones, like estrogen and progesterone, which have many roles in women’s health. When this happens, women may experience issues with menstruation, low mood, thyroid and adrenal health, and even fertility.
Since the keto diet essentially tricks the body into thinking it’s starving, some evidence suggests ketosis (along with fasting and low-calorie diets) can disrupt a woman’s HPA axis. Plus, sudden weight loss—which often comes along with the keto diet—may also impact estrogen production.
Are You A Good Fit For Keto?
Though a certain percentage of genetically ‘sensitive’ women may experience these hormonal issues on keto, not every woman will. Hormonal imbalances often pop up initially, but clear up as women become ‘fat-adapted’ (better able to use fat for energy).
I find controlled ketosis has many benefits for women with excess body fat to lose, a history of metabolic syndrome, hormonal issues tied to insulin resistance (such as PCOS, polycystic ovarian syndrome), and generally healthy women who want to address issues like sugar cravings, fatigue, and brain-fog.
However, since we still have much to learn about keto’s long term effects, many experts—myself included—recommend adults follow a ketogenic diet for two to six months. (A doctor may recommend and oversee longer use in special cases.)
I do not recommend keto for women who are already underweight, have ever had an eating disorder, have a thyroid disorder, or are pregnant or breastfeeding.
Advice For Women Interested In Keto
If you’re a good fit for trying keto, keep the following tips in mind to have a healthy experience.
1. Focus On Eating An Alkaline Ketogenic Diet
Eating a keto diet rich in nutrient-dense, unprocessed, alkaline foods can help curb many low-carb diet symptoms women often encounter. (Thank fatigue, moodiness, and insomnia.)
Alkaline foods may help with fluid balance, weight loss, detoxification, and bone health—and can also decrease inflammation.
Fill up on non-starchy vegetables, raw produce like greens, lean protein, and lots of healthy keto fats like avocado, olive oil, and nuts and seeds. Avoid excess meat and animal protein, dairy, alcohol, and caffeine, which are all highly acidic. Also, drink plenty of water, herbal teas, or bone broth to stay well-hydrated.
2. Make One Big Change At A Time
Though it may be tempting to combine keto with other health- and fitness-boosting protocols like intermittent fasting or HIIT workouts, be sure to take things slow. Making too many diet and lifestyle changes at once can overwhelm your endocrine and nervous systems. As a result, you may experience cravings and sluggishness.
Give your body a few months to adapt to one major change before making others. Track your progress in a journal so you can note any struggles or symptoms, identify patterns, and adjust course as needed.
3. Expect Some Side Effects At First
When first starting the keto diet, don’t be surprised if you deal with some temporary side effects. Together, these symptoms—which often include constipation, sugar cravings, menstruation issues, fatigue, and irritability in women—have been nicknamed ‘the keto flu.’
These symptoms should resolve themselves within a few weeks. However, if they linger or affect your quality of life, consider adding more calories or carbs to your diet. When in doubt, check in with a healthcare professional.
4. Limit Stimulants And Alcohol
For both women and men, the goals of a keto diet should be to balance blood sugar levels, improve mental clarity, increase energy levels, and support a healthy body weight.
Consuming too many stimulants, such as coffee and other caffeinated drinks, smoking, and drinking alcohol can mess with your mood, hormones, sleep, and hunger levels. They can also affect your body’s ability to stay in ketosis.
5. Prioritize Rest, Relaxation, And Sleep
Though you should certainly stay active while on keto, don’t push yourself too hard. Instead, I recommend taking daily walks outside and focusing on gentler forms of exercise, like yoga and pilates.
Though we all have different fitness levels and can handle different amounts of exercise on keto, women generally seem to be more impacted by over-training and not resting enough. That’s why it’s extra important that women decrease their workout intensity while on keto if they start feeling lethargic, sore, or burnt out.
It’s also crucial to get plenty of sleep (aim for eight hours a night) and manage stress. Both chronic stress and sleep deprivation can negatively affect thyroid and adrenal health.
The Bottom Line
While keto and other low-carb diets have much to offer women looking to shed excess weight, gain energy, and improve their metabolic health, you must listen to your body.
Though the first month of keto is a major adjustment often accompanied by wonky symptoms, if issues like missing periods, trouble sleeping, low libido, muscle soreness, headaches, cravings, and/or mood changes pop up after that, you likely need to eat more calories, more carbs, or both. In these cases, check in with a dietitian or functional medicine expert and consider eating a less-extreme low-carb diet that allows for 75 to 100 grams of carbs per day.
Dr. Josh Axe, D.N.M., D.C., C.N.S., is a doctor of natural medicine, clinical nutritionist, author, and member of The Vitamin Shoppe’s Wellness Council. Dr. Axe operates one of the world’s largest natural health websites, sharing healthy recipes, herbal remedies, nutrition and fitness advice, and information on essential oils and natural supplements. Dr. Axe founded one of the largest functional medicine clinics in the world, in Nashville, TN, and has served as a physician for many professional athletes.