Keto diets can be disheartening for women, especially when they witness their male co-workers or partners shedding pounds with relative ease. I first tried to lose weight with a ketogenic diet several years ago. It simply didn’t work for me, unlike my husband who managed to quickly lose several pounds. Neither did keto work for countless women in my practice who came to me for help. I had to come up with a new approach and over the last two years, have developed and tested a modified version of the classic ketogenic diet that takes into account individual differences and female physiology.
My approach investigates why women’s bodies respond to food differently than men’s when it comes to losing weight, particularly during perimenopause and menopause. Most diets were created by men for men, but women’s bodies don’t work the same way. Why? Hormones.
Why Doesn’t Keto Work for All Women?
Low carb high fat (LCHF) diets are popular, with the ketogenic diet being the most popular of all in recent years. Most people think that a low carb high fat diet leads to weight loss simply because eating fewer carbs reduces insulin levels and burns fat. However, the classic keto diet doesn’t work for many women. If you starve your body of carbohydrates over the long term, you may lose weight, but unfortunately this may cause additional problems, including disruption to hormone levels such as thyroid, the impact of which is discussed later in the article. Women also have other hormonal disadvantages that affect the success of a ketogenic diet.
Men, Keto and the Testosterone Advantage
When they diet, men tend to lose weight faster than women. One factor that makes a difference in results is the testosterone advantage so men have more muscle and burn calories faster. The ketogenic diet can boost testosterone levels in men, so they get a double testosterone advantage that helps them burn more fat and build more muscle so they drop weight and look better faster.
While men have the edge, women have lower testosterone and higher estrogen that puts them at a disadvantage leading to slower results and less weight loss. There are other metabolic hormones, too, that get in the way of losing weight.
Weight Gain in Women during Perimenopause
Why do women seem to gain weight almost overnight as they move closer to menopause? One of the main reasons for weight gain starting in the perimenopausal years is the slowing of metabolism. You can attribute the decrease in metabolism to thyropause, changes in estrogen levels, and increased cortisol.
Thyroid hormones, which control how we burn calories and keep our metabolism from getting too sluggish, often get out of balance as we get older. This is a trend that has been labeled ‘thyropause.’ Weight gain is a result of an underactive thyroid, as well as weakness and fatigue.
The fluctuations in estrogen levels also play a role in weight gain. Studies have shown that the loss of estrogen in post-menopausal women is linked with increased abdominal fat.1 However, estrogen dominance also leads to weight gain around the middle.2 In the years preceding menopause, what we call perimenopause, estrogen is in decline but still dominant in relation to its partner hormone, progesterone. The period of estrogen dominance that occurs in perimenopause and that may continue into menopause is seen clinically as a culprit in expanding abdominal fat mass.
Additionally, cortisol rises with age, beginning at 50. Cortisol is our stress hormone. High cortisol can trigger blood sugar problems and storage of belly fat.
The increase in abdominal fat is not just a vanity issue. It has troubling consequences for overall health. Fat cells accumulating in the abdomen are linked with insulin resistance. Insulin is the most influential hormone when it comes to metabolism and our response to food. If we are not able to manage our refined sugar intake, over time, glucose levels rise in our blood and we have a situation called insulin resistance and fat accumulation. This is one of the biggest factors in weight loss resistance.
Insulin resistance, also known as insulin block, leads to further weight gain, in particular around the midriff section. Insulin resistance also puts us at risk of prediabetes, Type 2 diabetes and cardiovascular disease, including stroke.
Other Key Metabolic Hormones
Apart from insulin, cortisol, thyroid, and estrogen, there are other hormones that influence your metabolism. The key regulators of metabolism and energy homeostasis include leptin, ghrelin as well as testosterone and growth hormone. The latter two are the ones I discuss in depth in my new book, Women, Food, and Hormones. They are not a common focus in discussions that center on women and weight loss yet they play a very important role in fixing weight loss resistance.
The Effect of the Ketogenic Diet on Women’s Hormones
Here’s what’s good about the keto diet when it comes to hormones. It is one of the most effective strategies to repair insulin, the main hormone involved in weight gain. The trouble is that keto has the potential to adversely affect other hormones, including cortisol, thyroid, and estrogen.
I noticed in my practice that my female patients tend to have more problems on keto with their stress hormones (i.e. producing too much cortisol), thyroid function and may develop menstrual irregularities. Estrogen may get out of balance in women who eat what is often called a “lazy keto” diet that does not include enough fiber and sufficient vegetables to feed the good microbes in the gut. Healthy estrogen balance relies on optimal gut health and estrogen levels can also be disrupted in people who eat higher levels of animal products, like meat and cheese, while skimping on vegetables.
Keto can also affect the thyroid gland. Some people develop thyroid problems such as lower triiodothyronine (T3) or thyroxine (T4) levels, which are suggestive but not diagnostic of hypothyroidism.3 Many women feel the change as symptoms: constipation, cold hands and feet, and hair loss.
At the root of these problems is dysfunction of the control system for hormones, the hypothalamic-pituitary-adrenal-thyroid-gonadal (HPATG) axis. Women with thyroid or HPATG axis dysregulation commonly require more healthy carbohydrates. Due to the fact that women with thyroid or HPATG axis dysregulation often require more healthy carbs, I recommend that women test the HPATG axis and make sure it is optimized before embarking on a ketogenic diet, so they can adjust their carbohydrate intake accordingly.
A diet low in carbohydrates can also negatively impact a woman’s sleep.4 Good sleep is crucial to health. When ignored, poor sleep will make you fall down a hormonal flight of stairs. Nearly every hormone is released in response to your circadian rhythm, your sleep-wake cycle. When sleep becomes disrupted because of the keto diet or another factor–a problem more common to women than men–other hormones may become disrupted.
A Modified Keto Diet Works Better for Women
My new book offers a well-formulated ketogenic diet that is designed with women’s issues and hormones in mind. My new protocol has elements to keep hormones in balance including a detox component, a modified carb count, intermittent fasting and more vegetables and fiber. The Gottfried Protocol contributes to healthy gut function, improved hormones, and significant fat loss. Women, Food, and Hormones is the personal transformation that I needed and couldn’t find. It got me to a healthy and sustainable weight that I’ve maintained for the past two years. If you’re over thirty-five, let me save you decades of struggle.
 Lovejoy JC et al. Increased visceral fat and decreased energy expenditure during the menopausal transition. Int J Obes (Lond). 2008;32(6):949-958. (https://www.ncbi.nlm.nih.gov/pubmed/18332882)
 Prior JC. Progesterone for symptomatic perimenopause treatment – progesterone politics, physiology and potential for perimenopause. Facts Views Vis Obgyn. 2011;3(2):109-120. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987489/)
 F. Fery et al., “Hormonal and Metabolic Changes Induced by an Isocaloric Isoproteinic Ketogenic Diet in Healthy Subjects,” Diabète & Métabolisme 8, no. 4 (1982): 299–305; E. Kose et al., “Changes of Thyroid Hormonal Status in Patients Receiving Ketogenic Diet Due to Intractable Epilepsy,” Journal of Pediatric Endocrinology & Metabolism 30, no. 4 (2017): 411–16; Y. J. Lee et al., “Longitudinal Change in Thyroid Hormone Levels in Children with Epilepsy on a Ketogenic Diet: Prevalence and Risk Factors,” Journal of Epilepsy Research 7, no. 2 (2017): 99–105.
 R. M. Kwan et al., “Effects of a Low Carbohydrate Isoenergetic Diet on Sleep Behavior