Keto for women: What you need to know

From the desk of Nicki Violetti

I know a lot of women who have achieved their goals using the keto diet. For most, this means they’ve lost weight, taken control over carb cravings, or simply have better energy throughout the day.But I also hear from plenty of men who have succeeded in similar ways. Both men and women have the same basic machinery to burn fat, make ketones, and navigate life with little carbs.The keto diet is not a sex-specific diet. I think most people get that. But that doesn’t mean differences don’t exist. And these differences mostly revolve around reproductive health.Let’s talk about female reproductive health. Depending where you are in life as a woman, you’ll have different nutritional needs. If you’re postmenopausal, for instance, you’ll have different needs than if you’re <a href="https://drinklmnt.com/blogs/health/electrolytes-while-pregnant-or-breastfeeding" target="_blank" rel="noopener noreferrer">pregnant or breastfeeding</a>—or if you’re trying to conceive.Even within these groups, there’s massive variability. One 50-something woman might feel great on keto, while another might feel lousy. Even if she’s doing everything right.We’re all different. No two people have the same genes and same upbringing. We need to remember this and stay flexible with our dietary approach.Me? I’ve dabbled with the <a href="https://drinklmnt.com/blogs/health/ketogenic-diet-what-you-need-to-know" target="_blank" rel="noopener noreferrer">keto diet</a>, but most days I’m more of a low-carb Paleo-ish person. I don’t go crazy with the carbs, but I also don’t consciously track them. That’s just what works best for me and my body.Today isn’t about me, though. It’s about all the women on (or considering) a keto diet. I hope you find my thoughts helpful.<h2>What Is the Keto Diet?</h2>The keto diet (short for ketogenic diet) is a low-carb eating plan in which you consume under 10% of your daily calories from carbohydrates. For most people, 30 grams of net carbs is a good limit. (Note: <a href="http://drinklmnt.com/blogs/health/a-guide-to-net-carbs-on-keto" target="_blank" rel="noopener noreferrer">net carbs</a> = total carbs – fiber – sugar alcohols/2). Keep in mind this is just a guideline, a highly active individual may be able to consume 100-150g of carbs per day and still be “keto.”It follows that most of your calories will come from fat and protein. There’s a wide range of <a href="https://drinklmnt.com/blogs/health/redefining-keto-diet-macros" target="_blank" rel="noopener noreferrer">keto macro recommendations</a>, but I suggest leaning towards higher protein intakes (around 30% of calories) and keeping fat intake around 60% of calories.As a general rule, most women should shoot for at least 100 grams of protein per day. After hitting that target, fill in the rest with healthy fats like olives, nuts, olive oil, avocados, butter, animal fat, etc.Eating more protein on keto may not maximize ketones, but it’s a great move to promote satiety and keep muscle on your frame. And yes, there’s plenty of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146906/" target="_blank" rel="noopener noreferrer">evidence</a> that a high-protein keto diet is compatible with fat loss.Unless you’re eating keto for therapeutic reasons, <a href="https://drinklmnt.com/blogs/health/how-to-measure-success-on-keto" target="_blank" rel="noopener noreferrer">ketones aren’t the point anyway</a>. Feeling, looking, and performing well should be the focus.<h2>Keto for Women: Risks, Benefits, and Considerations</h2>How is keto different for women? To answer, we need to look at three facets of female reproductive health.<h3>#1: Fertility and the menstrual cycle</h3>Due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4313585/" target="_blank" rel="noopener noreferrer">reductions in hunger hormones</a>, women tend to eat less on keto. They unintentionally restrict calories.What concerns me is that a woman’s reproductive cycle is highly sensitive to calorie restriction. So if a young woman is under-eating on keto, it could mess with her cycle. Yes, if losing some extra body fat is the goal, one needs to reduce calorie intake. But take that too far and women in particular tend to see increased problems.Rapid weight loss (common on keto) can also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3635052/" target="_blank" rel="noopener noreferrer">trigger</a> changes in estrogen, the primary female sex hormone. Also a potential disruptor of the menstrual cycle.Finally, carb restriction on keto has been linked to reductions in thyroid hormone. This may also <a href="https://pubmed.ncbi.nlm.nih.gov/9238278/" target="_blank" rel="noopener noreferrer">interfere</a> with menstruation, but then again, keto appears to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5028075/" target="_blank" rel="noopener noreferrer">improve</a> certain thyroid disorders. And all that said, it’s also possible that adequate sodium intake will mitigate this thyroid issue, at least for most.Also, a keto diet <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372867/" target="_blank" rel="noopener noreferrer">has been shown</a> to normalize sex hormones and promote weight loss in women with polycystic ovary syndrome (PCOS). So it’s not all bad news.<h3>#2: Pregnancy and breastfeeding</h3>When a woman is pregnant or nursing, she needs more calories, not less. Calorie restriction can lead to negative consequences for both mother and child.Another reason keto may be suboptimal during this time? It minimizes insulin, a key growth-promoting hormone.Low insulin is great if you’re trying to burn fat, but not so much if you’re nourishing a baby. That’s why I think pregnant and breastfeeding women shouldn’t restrict carbs too severely.<h3>#3: Menopause</h3>Most women enter perimenopause in their late 40s and officially stop having their period (<a href="https://www.ncbi.nlm.nih.gov/books/NBK507826/" target="_blank" rel="noopener noreferrer">menopause</a>) in their early 50s. During this time, estrogen levels plummet, frustrating symptoms (hot flashes, night sweats, mood swings, etc.) can flare, and fat may accumulate around the belly.I’m hesitant to recommend keto for women struggling with menopause. It could add unnecessary stress, but I think this is highly individual. In the low-carb community, you may find a lot of perimenopausal women rocking a ketogenic program. So again, I think this is a case of knowing yourself and staying aware of whether or not something is working for you or not.We have seen, however, that keto can help with weight loss after menopause. In one <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551320/" target="_blank" rel="noopener noreferrer">study</a>, obese postmenopausal women lost 20 pounds after 25 days on keto.<h2>Keto Benefits for Women</h2>Most women make the switch to a keto diet for weight loss. For many of them, it works. The evidence isn’t in short supply. For instance:<ul><li style="font-weight: 400">Women with endometrial or ovarian cancer <a href="https://academic.oup.com/jn/article/148/8/1253/5064353" target="_blank" rel="noopener noreferrer">lost</a> significantly more belly fat (16%) on a keto diet compared to a low-fat diet.</li><li style="font-weight: 400">Overweight women with PCOS <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7045520/" target="_blank" rel="noopener noreferrer">lost</a> over 20 pounds after 3 months on keto.</li><li style="font-weight: 400">Obese women <a href="https://academic.oup.com/jcem/article/88/4/1617/2845298" target="_blank" rel="noopener noreferrer">lost more weight</a> on keto than on an (intentionally) calorie-restricted low-fat diet.</li></ul>Keto promotes weight loss, in large part, by increasing satiety and subsequently <a href="https://pubmed.ncbi.nlm.nih.gov/12679447/" target="_blank" rel="noopener noreferrer">decreasing caloric intake</a>. When you eat fewer calories than you expend, you lose weight.Along with weight loss, the other keto benefits revolve around the metabolic state promoted by carb restriction: <a href="https://drinklmnt.com/blogs/health/how-to-get-into-ketosis" target="_blank" rel="noopener noreferrer">ketosis</a>. The benefits of ketosis include:<ul><li style="font-weight: 400">Improved blood sugar regulation</li><li style="font-weight: 400">More stable energy (a result of blood sugar stability)</li><li style="font-weight: 400">Enhanced mental acuity (from the brain using ketones)</li><li style="font-weight: 400">Potential therapeutic effects for <a href="https://nyaspubs.onlinelibrary.wiley.com/doi/full/10.1111/nyas.12999" target="_blank" rel="noopener noreferrer">Alzheimer’s</a> and certain <a href="https://academic.oup.com/jn/article/148/8/1253/5064353" target="_blank" rel="noopener noreferrer">cancers</a> (including breast cancer)</li><li style="font-weight: 400">Improved hormonal health in women with PCOS</li><li style="font-weight: 400">Reduced systemic inflammation</li></ul>A quick caveat. Some of these benefits may only apply if you’re transitioning from a high-sugar diet. If you’re already eating a whole foods <a href="https://drinklmnt.com/blogs/health/keto-vs-paleo" target="_blank" rel="noopener noreferrer">Paleo diet</a>, you’ve already won most of the nutrition battle. Keto might not make a huge difference.Still, keto may be worth playing with if you’ve hit a weight loss plateau, want to see how your brain runs on ketones, or are curious how ketosis affects your energy.<h2>Tips for Women On Keto</h2>If you decide to try a ketogenic diet, here are a few pointers to help you succeed:<h3>#1: Get enough calories</h3>On the keto diet, your appetite is naturally suppressed. This can help with weight loss.But too much calorie restriction can be <a href="https://rbej.biomedcentral.com/articles/10.1186/s12958-020-00681-1" target="_blank" rel="noopener noreferrer">problematic</a> for fertility. It can lead to irregular periods, hormonal disruptions, and other problems with your cycle. The solution isn’t to mainline cashews 24/7, but rather to eat well at mealtimes. If you find your weight is dropping faster than you’d like, add in some low-carb munchies.<h3>#2: Don’t push the fasting</h3><a href="https://drinklmnt.com/blogs/health/how-does-intermittent-fasting-work" target="_blank" rel="noopener noreferrer">Intermittent fasting</a> has become quite popular these days. There are definitely <a href="https://drinklmnt.com/blogs/health/benefits-of-fasting" target="_blank" rel="noopener noreferrer">benefits</a> to fasting for 12, 14, or 16 hours, but I think many women push it too far. It’s important to listen to your body. More fasting is not inherently better by any means.When you compress your feeding window too much, it’s hard to squeeze in enough calories. Especially on keto, which also assists in achieving calorie deficits.My advice is to be careful with the <a href="https://drinklmnt.com/blogs/health/intermittent-fasting-on-the-ketogenic-diet" target="_blank" rel="noopener noreferrer">keto and fasting combination</a>. Go keto first and ease into fasting slowly, working your way up hour by hour.Somewhere between 13 and 16 hours is usually about right. See what works for you.<h3>#3: Don’t skimp on protein</h3>This is the biggest mistake that I see women making on a ketogenic diet. They cut the carbs, load up on fat, and skimp on protein. Then they lose muscle and struggle to stay active.It’s understandable. Most keto advice covers <a href="https://drinklmnt.com/blogs/health/redefining-keto-diet-macros" target="_blank" rel="noopener noreferrer">macros</a> as a percent of calories. To get 60% of your calories from fat and 30% from protein sounds like a plate full of fat, right?It’s not. Since fat has 9 calories per gram and protein only has 4, there should be a larger volume of protein on a 60/30 plate than calorie-dense fat.Don’t skimp on protein. It’s the most important macro on keto.<h3>#4: Get enough electrolytes</h3>When I give keto tips, I have to mention <a href="https://drinklmnt.com/blogs/health/what-are-electrolytes-and-why-are-they-important" target="_blank" rel="noopener noreferrer">electrolytes</a>. Being electrolyte deficient (especially in sodium) is a primary cause of headaches, <a href="https://drinklmnt.com/blogs/health/what-causes-keto-brain-fog" target="_blank" rel="noopener noreferrer">brain fog</a>, muscle cramps, fatigue, and other <a href="https://drinklmnt.com/blogs/health/what-causes-keto-flu-and-6-keto-flu-remedies" target="_blank" rel="noopener noreferrer">keto flu symptoms</a>.Keto flu makes a lot of women quit their keto journey. It’s unfortunate because it’s easily preventable.That’s why my husband (Robb Wolf) and I love sharing <a href="https://drinklmnt.com/products/lmnt-recharge-electrolyte-drink" target="_blank" rel="noopener noreferrer">LMNT</a>—our salty electrolyte drink mix—with the low-carb community. Every day we hear how much it’s helping people. It’s gratifying.<h3>#5: Eat whole foods</h3>If you’re going to do keto, do it right. Don’t do <a href="https://drinklmnt.com/blogs/health/dirty-keto-lazy-keto-wont-help" target="_blank" rel="noopener">“lazy keto” or “dirty keto”</a> with processed meats and vegetable oils. You might lose weight, but you won’t do your long-term health any favors.Clean keto is simple. Just eat whole foods like meat, fish, olive oil, butter, avocados, non-starchy veggies, nuts, and eggs.Real foods provide the vitamins, <a href="https://drinklmnt.com/blogs/health/electrolyte-rich-foods-and-when-to-supplement" target="_blank" rel="noopener noreferrer">minerals</a>, fatty acids, and antioxidants needed to support your beautiful self. Plus they taste better than processed junk anyway!<h3>#6: Be flexible</h3>Doing everything right on keto? Still not working for you?  That’s okay. Maybe you need to bring back carbs.Keto isn’t the best diet for everyone. As I mentioned earlier, I function best on a Paleo template that includes 50-75 grams of carbs per day.Don’t force keto if it’s not working. Be flexible with your diet and gentle with yourself. That’s the path to less stress and better health.