If you are curious, wary or concerned with the latest keto craze, you are not alone. I don’t want to dismiss it (because it can work for some women) but I also want to give you more clarity if and how to embark on it.
In case this is new to you – keto is a very low carb, high fat diet, and there is a dozen if not hundreds of variations of it now available on the internet. Most studies on keto have been done on animals, epilepsy patients and young athletic men – who are hormonally a polar opposite to a menstruating or menopausal woman.
I tried keto for 3 days and felt absolutely miserable. Lethargic, moody, heavy, headachy, lazy and experiencing the worse foggy brain ever. Since so many women swore by it, I posted on a Facebook keto group asking how keto helped them and what did it do to their hormones. The reported weight loss went hand-in-hand with women’s hormonal health getting worse – from worsening PMS to full-on amenorrhea (lack of periods), worse hot flashes and night sweats. Some women just said they felt miserable, tired and nauseated.
That didn’t surprise me – I mean, eating melted Kraft cheese, processed bacon and artificial sweeteners is a far cry from a healthy diet. But, women kept going because they lost weight – first time in years. So, they get the determination to keep going, at any cost.
What I wanted to find out is: Can keto be done in a healthy way? In a way that doesn’t compromise your health and hormonal balance in the long run? That is sustainable and not socially awkward?
And to do that, I turned to my friend and colleague who is also a women’s hormone expert, doctor, and researcher I deeply respect – Dr. Anna Cabeca. She wrote the below article for our Hormones Balance community. She’s also the author of the upcoming The Hormone Fix – you can preorder it on Amazon now.
Dr. Cabeca has worked with women and men over the past decade, focused specifically on improving hormone balance. She has found that ketogenic diets do provide enormous health and fat-burning benefits. But, she has also found that the benefit of keto – is the ketosis component and we have to incorporate key lifestyle and nutrition practices that get us there healthfully.
The typical keto diet needs to have some important modifications that address keto’s potential negative side effects. This is especially true relating to women over 40.
I hope you will find this article helpful if you plan to embark on a keto diet or simply want to rebalance your hormones the natural way.
What you will learn from this article:
- What keto is and what’s good about it
- 5 things wrong with most keto diets (and how to address these issues)
- How intermittent fasting plays a key role in making keto work
- How you can learn more and get started!
By Dr. Anna Cabeca
Watch Magdalena and Dr. Anna on a Facebook Live call:
What keto is and what’s good about it
As a researcher and physician, I truly believe that the major principles associated with the traditional ketogenic diet have been shown to have positive health effects. But there are also known downsides, especially for women over 40 (many of us already dealing with hormone balancing challenges).
Before I talk about how to modify keto to address these issues, first let’s briefly review what a traditional ketogenic diet is, as some of you may not know. The definition of keto can also be a bit confusing these days, as there are now so many diets out there that call themselves keto.
If you are already familiar with keto you can jump down to “What’s wrong with most keto diets.”
So how does a keto diet work?
In a nutshell, a keto diet is a very carb-restricted diet that is also high in fats. A keto diet additionally has a specified level of protein; the amount of daily protein can change significantly depending on the particular diet you are looking at…but traditional keto usually incorporates a moderate amount of protein. Some ketogenic diets also incorporate some form of fasting, which I’ll talk more about; a few incorporate non-dietary lifestyle changes such as exercise.
Normally our body uses the carbs we eat for its energy source. When we eat carbs, our body produces glucose and spikes our blood sugar level. In response to that increased blood sugar level, our body releases insulin; it is insulin’s job to take the glucose and push it into cells throughout our body, where it is converted to energy. Our bodies burn the glucose for energy and insulin instructs the cells to store the energy as carbs or fat.
Consuming too many carbs can be bad for you depending on many factors, especially if you eat a lot of junky carbs (“bad” carbs, fast-burning, processed, etc.). That keeps your glucose spiking, and too much ongoing production of insulin, which can lead to problems such as insulin resistance (where the cells get so stimulated with so much insulin they finally just ignore the insulin and resist it from doing its job).
An increased prevalence of insulin resistance is linked to postmenopausal women, women having PCOS, and those having hypothyroidism. Insulin resistance is also associated with an increased risk of diabetes, breast cancer, and cardiovascular diseases. Most of my peers view insulin resistance as the precursor to pre-diabetes.
So what happens in a keto diet when you restrict carbs?
Restricting carbs restricts the production of glucose. That, in turn, decreases the production of insulin, and your body starts looking for alternative sources of energy. Research has found that with about 3-4 days without carbohydrate consumption the body will start to burn stored fat – as well as the “healthy” fats you are consuming – instead. This metabolic state is called ketosis.
When you are in ketosis your body is producing less glucose, you are improving your insulin control, and you are burning fat. You can actually measure for this metabolic state by testing for something called ketones in your urine or blood. In my women’s restorative health programs we use urinary pH testing strips.
A substantial body of research supports the numerous health benefits of ketosis, including weight-loss.
The women in my online hormone programs have had fantastic results using a modified version of traditional keto, called my Keto-Green™ Diet, which I’ll talk more about.
They will typically feel more satiety (feel full sooner), have fewer cravings and an improved mood. They feel energetic, too! In a survey of more than 500 women following the Keto-Green program, 94.95% felt that their energy levels had improved. And while blood testing isn’t part of my program, many women who did have testing improved their numbers – including numbers relating to blood sugar, insulin control, and their thyroid levels.
This is important as insulin resistance has been tied to decreased brain function, especially relating to learning and memory. Increased insulin resistance has even been found to contribute to the development of sporadic Alzheimer’s disease.
Emerging research continues to show cognitive improvements and other neuroprotective effects associated with ketosis and ketones, even potentially relating to dementia and Alzheimer’s disease.
Perhaps less significant but a happy side effect of keto for many women, beyond weight loss and improved insulin control, is that keto’s ability to improve insulin sensitivity may lead to a reduction in hot flashes as well!
All of these are things that sound pretty good, right? So why aren’t we all doing keto?
Five things wrong with most Keto diets (and how to address these issues)
Well…as Magdalena mentioned, she and others in her community have experienced issues when trying a traditional keto diet. A lot of what they experience is referred to as “keto-flu”, which can consist of nausea, fatigue, headaches, diarrhea, and constipation related to the diet. Keto-flu usually occurs during the transition from a previous diet to keto.
Keto-flu can create an immediate compliance issue…a few days of the keto-flu often results in people quitting the diet (and likely enjoying a binge of their favorite carbs!).
Compliance is an issue beyond keto-flu as well, as there are many things that can impact someone getting into and staying in ketosis, such as eating the wrong quality or quantity of allowed foods. People may have difficulty simply digesting a keto diet. There are many non-dietary impacts as well. You’ll see that hormone imbalances can come into play.
While there are a number of challenges with keto, here are 5 issues with keto that are quite common. The good news? Each of these issues is addressed in my Keto-Green diet.
#1 Keto diets are too acidic and inflammatory
The problem with most keto diets is that they are too acidic and inflammatory; especially for women over 40 who are likely experiencing other age-related hormone imbalances and inflammation.
Let’s talk about why this is so. It’s all about our body chemistry.
Without getting too technical, every part of the body has a pH level. Remember pH from chemistry class? Low numbers on the scale are acid, higher numbers are alkaline (also referred to as a base). The pH level for all the parts of our body is fine-tuned to the function of each body organ. So the pH of the vagina is acidic (3.8 – 4.4). Why so acidic? To fend off bacteria and yeast infections. The pH of the stomach is also acidic (less than 3). That also makes sense as that the environment needs to be acidic to kill off ingested bacteria and pathogens (including parasites).
The pH of our blood, however, is alkaline (about 7.4). But note that when I talk about the effect of a keto diet is too acidic I am not talking about it impacting the pH of our blood. The pH of human blood does not change much at all unless you are near dying! The body is fine-tuned to keep the blood pH constant and under tight control.
When I talk about keto being too acidic and inflammatory I’m talking about cellular health. And we can measure that by monitoring the pH of our urine or saliva.
All foods have a pH level (either acid or alkaline, see the chart for a very simple graphic which depicts this). What you eat shifts your urinary chemistry to either a net acid producing or net alkaline producing level.
The average American diet has been shown to be “net acid producing” (US Third National Health and Nutrition Examination Survey). This net acid load, if retained over time, results in something called, diet-related chronic low-grade acidosis or diet-related metabolic acidosis.
Traditional keto diets are acidic, too.
And research has shown that acid-producing diets, which can create diet-related metabolic acidosis, aren’t as healthy for us as alkaline producing diets.
Diet-induced metabolic acidosis has been associated with insulin resistance, diabetes, systemic hypertension, and increased cardiovascular risk, among other negatives.
Research has shown that acidic diets are often deficient in magnesium, which has many negative health effects. Low magnesium intakes and blood levels have been associated with type 2 diabetes, metabolic syndrome, elevated C-reactive protein, hypertension, atherosclerotic vascular disease, sudden cardiac death, osteoporosis, migraine headache, asthma, and colon cancer.
Because an acid diet is deficient in magnesium, that can result in anxiety and sleep issues, headaches and negative impacts on many systems throughout the body.
On the flip side, there is a lot of research relating to how an alkaline-rich diet can have a positive effect on numerous health markers.
Just to highlight a few points:
- An alkaline diet increases intracellular magnesium (Note that up to an estimated 80% of us are deficient in magnesium).
- Increases the available magnesium required to activate vitamin D, gaining numerous additional benefits associated with that for immune health.
- May support bone health (increasing magnesium and vitamin D; improving lean muscle mass tissue). Magnesium deficiency has been implicated in osteoporosis.
- An alkaline diet may improve a variety of chronic health conditions, from cardiovascular health to memory and cognition.
- An alkaline diet may reduce pain and inflammation.
The good news? A Keto-Green Diet ensures an alkaline you.
With thousands of women now living a Keto-Green lifestyle, I have seen first-hand how beneficial it is to start with an alkaline foundation – prior to attempting keto. Then it is important to maintain that foundation. It will minimize any keto-flu or ongoing “keto-craziness” that you may experience as your body transitions and adapts to burning alternative fuel sources.
In all of my programs, I encourage women to actually test their urinary pH to ensure they are achieving alkalinity (and later to test for ketosis). One of my favorite pieces of advice is for people to always, “Test, Don’t Guess!” That’s why I highly recommend helpful, supportive monitoring tools such as urine pH strips.
So you need to eat healthy alkaline carbs, which is not the goal in most keto diets.
And these “good” carbs are important for other reasons – beyond being alkaline – as well.
People going keto often suffer from:
- Constipation (and the inability to detox old and catabolic hormones…)
- Poor gut health (and the inability to absorb important micronutrients)
So this leads me to keto issue #2.
#2 Not all carbs are created equal!
Typical keto diets restrict carbs but don’t differentiate between the types of carbs. But there are good and bad carbs. Good carbs are also known as complex carbs, whole-food carbs, and slow-burning carbs; most of these also contain dietary fiber (think green veggies!). Bad carbs are also known as simple carbs, refined-food carbs, and fast-burning carbs (think processed foods, bread, sugar!). There is a huge difference, we’ll talk more about this.
Good carbs also contain lots of wonderful and important micronutrients (minerals, enzymes, phytonutrients, vitamins, etc.).
The importance of fiber
I know Magdalena uses the concept of a 3-legged stool to talk about what is most important to support your success in any given diet that you choose to eat; the three legs of the stool being: liver detoxification, sugar level balance, and digestion. Healthy alkaline carbs come into play in all 3 of these legs!
Liver detoxification: You need the fiber from beautiful alkaline veggies to help you remove hormones metabolized by the liver (such as excess estrogens), toxins and other dangerous junk, out through healthy bowel movements. Cruciferous veggies, in particular, contain DIM, a powerful detoxifier. One of the biggest issues with women who start keto is that protein and fat don’t typically contain fiber, so women end up having constipation problems (the other big issue is just the opposite, diarrhea, and I’ll talk about that in a moment relating to difficulties with fat digestion).
Sugar level balance: You need slow-burning carbs for optimal blood sugar levels.
Digestion: You need healthy carbs to support a healthy gut, to gain the micronutrients and provide short-chain fatty acids for gut microbiome health.
Digestion is a big issue for people transitioning to keto. So let’s move on to keto issue #3 – how to digest all of that protein and fat!
#3 Too much protein
Well, first of all, a mistake a lot of people make is to think of keto as high fat and high protein…the imagery of eating bacon and butter all day long that people have when starting on keto!
But keto is not meant to be a high protein diet, and the protein that is included is not supposed to be processed, toxin-ridden, hormone-ridden, etc.! Just like all carbs aren’t created equal, all protein and fat isn’t either.
I use the visual of a plate when talking about the right proportion of protein, to carbs, to fats with approximately a visual of 75% greens and veggies, 15 – 20% protein and 5-10% fat as visualized on a plate.
Based on calories, my Keto-Green diet recommends about 20% in healthy protein, with about 5-8% in healthy carbs and 56-70% in healthy fats. I always suggest going organic when possible. These percentages are optimal for health and for maintaining ketosis.
But that is still a lot of protein and fat when you may not have previously consumed those proportions. So for many people digestion may become an issue on traditional keto diets. Even if you are taking in fiber-rich, alkaline veggies, you may still have an issue, especially with fats.
Is your bile keeping up with the increased fat you are consuming?
This was a problem that I believe Magdalena had, and many women in my programs do as well. Bile is produced in the liver and stored in the gallbladder; initially many people don’t have a high enough concentration of bile to break down the higher amount of fat intake.
If you aren’t digesting properly your body won’t take in all of the nutrients. If your body can’t break down the fat, it doesn’t get absorbed, but instead goes through the intestines and ends up in watery diarrhea (which is no fun and dramatically affects compliance!).
One thing you can do is to reduce the amount of long-chain fatty acids you are taking in (such as found in egg yolks and beef), as they are harder to digest and require more bile. If you don’t have a gallbladder this issue can be even greater and can result in worse fat malabsorption issues. Better to consume more medium-chain fatty acids, especially as you are transitioning to keto. These fatty acids are like those found in coconut fats and grass-fed butter; they can be more easily broken down, with less bile requirement, and better absorbed.
The Keto-Green program builds upon a healthy digestive and detox foundation. It includes natural detoxification strategies, probiotics, and digestive enzymes, and also – should women still have difficulties – supplemental detox support that is focused on supporting bile flow in the liver to expedite fat digestion. There are many things you can do to minimize protein and fat digestive issues…after starting with your alkaline foundation, of course.
Detox is imperative to maintaining healthy hormone balance…so while on the topic of hormones, let’s talk about keto issue #4 – Can people having thyroid issues remain healthy on a keto diet?
#4 Can people having thyroid issues remain healthy on a keto diet?
My experience and my physician peers who focus on this very topic all say “yes”! But it will depend on the woman and what else she has going on…so the recommendation is to talk with your doctor, try it (I vote for Keto-Green), monitor how you feel, test your levels, and go from there.
Generally, women need to be at around 20-40 grams of total carb per day to get into ketosis. My daily Keto-Green plate typically equates to 20-35 grams of carbs per day. But there are a lot of things that can impact ketosis: environmental toxins, other hormone imbalances…stress is a big impact. I’ve had women in my program who never get into ketosis until they learn to manage their stress and reduce their cortisol levels.
Many things can affect a woman’s ability to be in balance across our major hormones, including our thyroid. I know that after dealing with the flooding aftermath and mold issues of 2 separate hurricanes last year that my own TSH sky-rocketed to over 5.4. But today on my Keto-Green program it is a beautiful number, 0.77, which is in the optimal range.
In talking with clinicians focused on thyroid disease, while most are ok with their clients trying out keto, they do typically recommend they not go lower than 20 grams of total carb per day, in conjunction with their thyroid hormone medication.
Interestingly, many people having Hashimoto’s (in one study, about half of the patients!) have carbohydrate metabolism disorders so actually, feel better on a low-carb diet.
What I have found is that if a woman focuses on certain key lifestyle changes which help support overall hormone balance (which I’ll talk about in issue #5), that in most cases her TSH level won’t increase and she will continue to feel well or better! That’s even if her T3 decreases, although in most cases I’ve seen T3 increase for women on my Keto-Green diet as well.
So what lifestyle changes do I suggest and include in my Keto-Green diet? Let’s talk about keto issue #5; how well keto works for you is not just about dietary decisions.
#5 Lifestyle decisions do matter (no matter what traditional keto diets don’t say)
I can’t possibly cover all of the points on this very important topic in this one blog, but suffice it to say that a huge issue with typical keto diets is that they focus almost entirely on the specific grams of allowable foods, versus the quality of foods and all of the non-dietary impacts that can come into play. Here are just a few…
We need to reduce environmental toxins from foods (eating clean and organic, without added hormones, GMOs and chemicals), personal care products (how many endocrine disruptors do you apply to your body daily?) and the home.
We need to improve stress management and support our adrenals – even when we can’t remove our stressors, we can focus on reducing our stress hormone, cortisol, to healthier levels. Cortisol effectively puts the brakes on your thyroid metabolism, digestion, and immune processes! Burning out your adrenals from too much stress puts the brakes on metabolizing nutrients and producing vital hormones!
We need to improve the quality and quantity of our sleep. Our circadian rhythm is critical to hormone production, adrenal health, blood sugar balance, and our overall health and mood.
We need to make the best daily decisions that will help balance our hormones, especially insulin and cortisol! But first, we may need to better understand our hormones and how they can make us feel witchy (note I’m using a nice word here) and miserable, and how we can naturally get them back working in our favor again.
There is so much more to lifestyle decisions when it comes to the best keto diet plan. I always say that 25% of the keto diets effectiveness comes from the actual food you eat, and 75% of the keto diets effectiveness comes from the decisions and lifestyle interventions you implement.
Along with lifestyle interventions, another key strategy for making traditional keto work better is to incorporate intermittent fasting. This could also be a long topic in itself, but let me just share a few points with you here.
How intermittent fasting plays a key role in making keto work
Many keto diets include some aspect of fasting as there are numerous studies that support its health benefits (improved insulin sensitivity, reduced oxidative stress, reduced cravings, improved efficiency at fat-burning, to name just a few) and improved metabolic benefits. It has been shown to preserve learning and memory functioning as well.
Ketosis (the metabolic state where all of these benefits are derived) can be achieved through a ketogenic diet alone, but fasting can help. Many of the participants of my programs find that intermittent fasting helps them initially get into ketosis, remain in ketosis and also, feels very natural and easy to implement.
This is particularly true with the type of fasting that I recommend in my Keto-Green program which is a type of fasting called, “Intermittent Fasting”, which increases your fasting window between dinner and breakfast, known as a 16/8 fast. This means the window in which you should be “feeding” is roughly an 8 hour period. The period you are fasting, starting after dinner is roughly 16 hours, although in my program we always start much lower than that, at 12 hours or so. This type of fasting is also sometimes referred to as time-restricted feeding in the scientific literature.
It is relatively easy to start and intermittent fasting has been shown to produce higher compliance than prolonged periods of fast. It is also healthier for people having thyroid issues, or other health conditions such as insulin resistance, although I always recommend people check with their physician prior to implementing any diet changes, including fasting.
You can read more about the health benefits of this type of proven intermittent fasting and how to implement it in a healthy manner, here.
Autophagy – another benefit of intermittent fasting!
The other exciting benefit to intermittent fasting is actually improving your cellular and molecular health. Fasting supports mitochondrial health, actually repairs DNA and supports an important process called autophagy.
Think of autophagy as a type of cellular cleaning. As we age we accumulate garbage cells; these cells are ones having a greater risk of becoming infected or cancerous. So how does one encourage autophagy to occur? By fasting! It is only when your body is in a fasting state that it inhibits an enzyme called mTOR (Mammalian Target of Rapamycin). Low levels of this enzyme, as the result of fasting, has been found to decrease inflammation, decrease cancer risk, improve insulin sensitivity and may even increase longevity.
Fasting also helps improve your digestive system, circadian rhythm, and overall metabolic responses.
How you can learn more and get started today?
A typical ketogenic diet does not consistently provide many women with the support they may need to both feel well and be successful on low-carb dietary restrictions.
Keto can be acidic and inflammatory, result in keto-flu and other compliance issues, and not result in weight loss or other health benefits (associated with ketosis) without my recommended modifications and lifestyle interventions. In particular, for women over 40, there are a number of issues relating to overall hormone balance that can impact getting into and remaining in ketosis.
If you need help in getting started, my new book, The Hormone Fix, focuses in-depth on these important modifications and provide you with everything you need to get started eating Keto-Green today.
The Hormone Fix includes 2 step-by-step eating plans (a 10-day detox and a 21-day Keto-Green diet) plus 81 delicious hormone balancing recipes you’re going to love. Order The Hormone Fix today.
Please note that this is a sponsored post, meaning I do receive a small percentage of sales, but all opinions are my own