We share a lot about the benefits of keto and how to incorporate it into your life.  But there may be some cases where you should avoid or modify the ketogenic diet. In fact, there are quite a few extra considerations when we’re talking about keto for women.

Why is that you ask? Let me start by explaining a little about hormones, because a woman’s health is intimately connected to how well they are balanced. There is a delicate hormonal dance happening in your body that changes several times throughout the month.  And this is affected by the hypothalamus and pituitary glands in the brain, your thyroid, adrenal glands and ovaries.

All these glands are communicating to each other to regulate processes in your body such as metabolism, sleep and waking cycles, ovulation, menstruation and your stress response.  Women have a lot of hormones working together, kind of like a symphony and when one gets out of tune, it throws everything else off too.

Some symptoms of imbalanced hormones (1):

  • Uncontrolled weight gain or weight loss
  • Poor sleep
  • Anxiety or depression
  • Intolerance to heat or cold
  • Dry skin or acne
  • Chronic fatigue
  • Bloating
  • Low libido
  • Headaches
  • Autoimmune conditions like hypothyroidism
  • Thinning hair or hair loss

As you can see, hormones could be responsible for a lot of health issues!  And you may or may not be surprised by this, but one of the biggest causes of hormone imbalance is stress.  

That is because when we experience stress, whether it’s an aggressive driver in traffic or missing a payment on our credit card bill, our body releases hormones like cortisol and catecholamines to suppress certain functions and enhance others: they get you ready to run or to fight!

One 2011 study found that stress can disrupt the menstrual cycle and blood sugar levels as well as impair thyroid function (2).

This is because the HPA axis or the hypothalamus, pituitary and adrenal connection is responsible for so many functions in the body, even reproduction.  If it is flooded with stress hormones, it can’t do its job as effectively. Now, this directly relates back to keto for women and what you should watch out for.

Cautions Related to Keto for Women

The hypothalamus, pituitary and adrenal glands are very sensitive to nutrition, and some research suggests that a low calorie and low carb diet could also be an added stressor to the body, therefore increasing cortisol levels (3, 4).  Remember how stress can disrupt the menstrual cycle?  That means keto could do the same.

I know dealing with a period every month isn’t the most fun, but having a healthy and regular cycle is a great indicator that your hormones are healthy and you’re ovulating. That means fertility! Losing your period for three months or more is called amenorrhea and is often caused by excess exercise, too little calories or carbs, and stress (5).

We live in a thin obsessed culture, but some body fat is not only healthy, it’s necessary for women’s hormonal health – especially if you’re pregnant or nursing.  You heard right. Fat cells release leptin, which is crucial for healthy and regular ovulation and menstruation (6). So ketosis and hormone balance may not go hand in hand, especially for women who already have low levels of body fat.

While this won’t be true for everyone, a study in 2003 followed 20 adolescent girls who were trying the ketogenic diet for epilepsy.  While many experienced a reduction in seizures, about 45% also reported menstrual dysfunction, which shows a negative correlation between keto and menstruation.

And while carbs can often seem like the enemy, that isn’t always true.  In fact, some carbs can be beneficial for thyroid function.  One study showed a drop in T3, or thyroid hormone after following a no carb diet (7).  This could lead to hypothyroidism, which throws off metabolism, body temperature regulation, increases poor mood and fatigue.

Women Who Benefit from Some Carbohydrates Are:

  • Pregnant and nursing mothers
  • Athletes who tend to have difficulty recovering
  • Women with underactive thyroids
  • Women who struggle with menstrual irregularities

Here are the Major Concerns with Keto for Women:

  1.  Adrenal fatigue:  Now I know, this is a controversial topic and some people debate whether or not it’s a real diagnosis. But after consulting entrepreneurs and families for more than 8 years, we know that adrenal fatigue is very real.  One thing to remember is that being in ketosis can cause stress to the body, especially for women who are already underweight or train hard. Keto for women can increase stress hormones like cortisol – “the stress hormone” – to fire too often. Your adrenals are responsible for releasing cortisol as a response to stress. When this happens too often it can cause the adrenals to “burn out” otherwise known as adrenal fatigue.

The bottom line is that ketosis and hormone balance are related.  So if you notice any symptoms of anxiety, fatigue, sleep disturbances or irregular menstruation, slowly move out of ketosis and try some adaptogenic herbs or b-vitamins to support your adrenal glands (9).

  1. Thyroid Issues:  We talked earlier about how no-carb diets can cause low thyroid hormones (8).  But did you know that when the adrenals are overworked thyroid function is also compromised (9)? It’s kind of like going into a hibernation mode to rest after a major expenditure of energy.  I’m sure you are starting to see how when it comes to hormones in the body, everything is connected and therefore, keto for women can cause a disruption in that hormonal cascade.
  2. Pregnant and New Mothers:  It is so important to nourish the body during pregnancy and any kind of extreme carb or calorie cutting could trigger a major stress response.  The same goes for breastfeeding. While there are some cases where women successfully implement a keto diet while nursing or pregnant I have found that keto for women just didn’t make sense for me during that time. If you’re considering the keto diet while pregnant or nursing this article and this article have some interesting insights.

While many women are eager to “lose the weight” after giving birth, if you’re nursing the body is still working very hard to nourish a baby and needs all the nutrition it can get! High levels of stress hormones like cortisol also interfere with oxytocin, the bonding hormone that gets released by breastfeeding.  Bond with your baby now, and worry about weight later!

  1.  Hormonal Irregularity:  If you struggle with irregular or absent periods, keto for women might be a bad idea. This is why.  Remember how we talked about leptin, the hormone created by fat cells?

One 2013 study showed that low levels of leptin negatively impacts the onset of puberty in children and healthy fertility for women.  This means that if body fat is too low, it can negatively impact fertility (10).

This also links back to stress because low levels of leptin are also a signal to the body that it is in a time of famine, since leptin signals to the body that it’s full.  Whose body is going to make a baby when it thinks it’s starving?

So basically, keto for women does pose some different concerns than it does for men.  Women happen to be more sensitive to any kind of dietary changes, and therefore should be more careful when trying new diets.

But we all have different needs and goals, and there is no one size fits all approach.  In fact, in some cases keto for women can be really beneficial.

Top Four Keto for Women Candidates

  1. Women with Polycystic Ovarian Syndrome: This is a complex hormonal issue that causes excess male hormones, ovarian cysts, insulin resistance and obesity.

In 2005 researchers prescribed the keto diet to women struggling with PCOS and obesity.  They followed eleven women for a period of six months and noted improved weight, positive changes in male hormones and even insulin levels.  In fact two women struggling with fertility even became pregnant during the study (12). This is just one example where keto for women works really well.

  1. Women With Epilepsy:  Epilepsy is a serious condition that can severely interfere with living a normal lifestyle.  While they aren’t entirely sure why, it seems that epilepsy responds well to the presence of ketones in the blood.

Studies have shown such positive results using keto for epilepsy that doctors at the Johns Hopkins Medical Center actually use it as a treatment protocol with children, fasting them for up to 48 hours before starting them on a strict ketogenic diet (13).

Like any other medical protocol, keto for women that are struggling with epilepsy requires working with health care provider and being monitored closely.

  1.  Obese Women: Kind of like with epilepsy, you want to tackle the biggest health problem first.  Most women who struggle with obesity, especially those who lead more sedentary lives, will have a trickle down effect of health issues. This could mean diabetes, heart disease and even hormonal dysfunction.

One 2004 study looked at the long term effects of keto for obese patients, over half of which were women.  After 24 weeks, there was a significant reduction in weight, bad cholesterol and blood glucose, with no evidence of side effects (14). It seems that in cases of obesity, there are significant benefits of using keto for women and for men.

So as with any other dietary plan, the ketogenic diet for women can be beneficial or harmful. It is up to you to take responsibility for your health and seek out support and information about whether you would benefit from trying keto.

One Effective Keto for Women Diet

Dr. Anna Cabeca who is both an expert in Anti-Aging and an Ob-Gyn, came up with a specialized female keto diet plan (11).  Check out her advice below.

After working with over 10,000 patients Dr. Cabeca found great results by combining the ketogenic diet with an alkaline one.  She believes that keto for women can be incredibly effective for weight loss, blood sugar control and even hormone balance, especially for those who are perimenopausal or menopausal.

However, in order to deal with any potential side effects from ketosis, she created her own ketogenic diet for women that focuses on eating alkaline foods.   This is why it works. Keeping a healthy ph in the blood is important for anti-aging as well as reducing anxiety, constipation and nausea.

An overly acidic body is not a healthy body and can cause health issues like:

  • Bone loss
  • Lowered immune function
  • Muscle loss
  • Kidney stones

Testing your urine is a great way to check your body’s ph levels, which would ideally be between 7.0-7.5. Maintaining a more alkaline diet makes keto for women far healthier because nutrient density and detoxification are both higher (11).

The alkaline keto for women diet means eating way more raw vegetables and whole foods, which also increases fiber intake.  More fiber means more detoxification and possible relief from constipation, something that can be a side effect for women trying keto.

Another added benefit is less caffeine intake, which supports the health of your adrenals.  Remember how adrenal function is directly related to hormone balance?

Top Four Foods to Avoid in an Alkaline Diet (15):

  1. Processed Food and Meats:  These contain high levels of sodium chloride, a preservative that is highly acidic. Yes, that means bacon.  As well as lunch meat and canned meat.
  2. Caffeine and Alcohol:  While most alcohol isn’t keto approved, coffee and caffeine should also be avoided as they are very acid forming.
  3.  Artificial Ingredients:  I haven’t emphasized the importance of organic food yet, but I will now.  Any added hormones, pesticides, artificial sweeteners, colors and flavorings can lower pH causing an acidic state.
  4.  Dairy:  While high fat dairy is allowed on a keto diet, it is also very acidic and should be used in moderation.  When eating alkaline, try eating ghee instead, which has all the healthy fats from butter without the milk solids. Ghee is also excellent for cooking as it burns at a very high temperature without going rancid.

Dr. Cabeca also encourages intermittent fasting with keto for women (11).  When you fast, your body gets a break from the hard work of digestion.  Then, energy in the body is directed towards other reparative processes.

An easy way to work intermittent fasting into your daily routine would be eating a light dinner, no food or snacks after 8 p.m. and then skipping breakfast until 10 or 11 a.m.  Another option is eating just two meals a day, with some herbal tea or broth in between (11).

Have you tried bone broth?  It’s a great way to use the bones from any meat you’ve consumed, along with old veggies (including onion peels.) Bone broth is highly nutritious, gut healing and packed with easily assimilated fats.  That means it will help you feel full between meals. And is keto friendly too! Find our favorite bone broth recipe here.

Another great tip for women on keto is to try carb cycling, or “cheating on keto”. Basically it means adding in some strategic carb eating days, or what is called a modified ketogenic diet.  

Now a cheat day doesn’t mean eating cookies, processed food or going back to your old habits.  A responsible cheat day might look like adding a sweet potato, some quinoa or a fruit smoothie to your otherwise keto friendly meal plan. These may be just what is needed to support your hormones.   

Desserts with natural sweeteners like honey can be acceptable if your activity levels are high enough.  Try some extra HIIT exercise or intermittent fasting to get back into ketosis more quickly after a cheat day.  

Keep in mind, intermittent fasting, an alkaline diet and keto for women shouldn’t be viewed as a fad, but rather a gateway to long term lifestyle change that encourages healthier choices. In fact, Dr. Cabeca often recommends waiting for six months before expecting any major results (11).  

To Wrap it Up

Keto for women can be beneficial for those who are very overweight, struggling with epilepsy or a hormonal condition like PCOS.  And you can avoid some of the side effects of ketosis by eating organic, whole, unprocessed foods.

A generally alkaline diet can be very beneficial when used in combination with keto.  

However, if you are a healthy woman who is breastfeeding, pregnant or have very low body fat, some carbs can be helpful or even necessary for healthy balanced hormones.

In these cases, keto for women may not be the best choice. But even when your diet includes carbs, you can take a tip from Dr. Cabeca and reap all the benefits of an alkaline diet by consuming less caffeine, processed foods and wheat/gluten.

As with any diet, the best way to find the perfectly balanced plan for your own unique health is to work with an experienced functional medicine doctor or your health care provider.

Have you tried a ketogenic diet?  Or do you have any personal experience for integrating keto for women?  I’d love to hear from you, so please leave a comment below and share!


  1.  Medical News Today (2018). What to know about hormone imbalances.  Retrieved from: https://www.medicalnewstoday.com/articles/321486.php
  2.  Ranabir, Salam and K. Reetu (2011).  “Stress and Hormones.” Indian J Endocrinol Metab. Jan-Mar; 15(1): 18–22.  Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3079864/
  3. Healthline (2016).  Do very low-carb diets mess up some women’s hormones?  Retrieved from: https://www.healthline.com/nutrition/low-carb-and-womens-hormones
  4. Stimson, R. H., Johnstone, A. M., Homer, N. Z., Wake, D. J., Morton, N. M., Andrew, R., & Walker, B. R. (2007). Dietary macronutrient content alters cortisol metabolism independently of body weight changes in obese men. The Journal of Clinical Endocrinology & Metabolism, 92(11), 4480-4484. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/17785367
  5. Meczekalski, B., Katulski, K., Czyzyk, A., Podfigurna-Stopa, A., & Maciejewska-Jeske, M. (2014). Functional hypothalamic amenorrhea and its influence on women’s health. Journal of endocrinological investigation, 37(11), 1049-1056. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207953/
  6. Vázquez, M. J., Romero-Ruiz, A., & Tena-Sempere, M. (2015). Roles of leptin in reproduction, pregnancy and polycystic ovary syndrome: consensus knowledge and recent developments. Metabolism-Clinical and Experimental, 64(1), 79-91.Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/25467843
  7. Mady, M. A., Kossoff, E. H., McGregor, A. L., Wheless, J. W., Pyzik, P. L., & Freeman, J. M. (2003). The ketogenic diet: adolescents can do it, too. Epilepsia, 44(6), 847-851.Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/12790900
  8. Spaulding, S. W., Chopra, I. J., Sherwin, R. S., & Lyall, S. S. (1976). Effect of caloric restriction and dietary composition on serum T3 and reverse T3 in man. The Journal of Clinical Endocrinology & Metabolism, 42(1), 197-200. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/1249190
  9. Jockers, David, (2018). When Not To Be on a Ketogenic Diet. Retrieved from: https://drjockers.com/when-not-to-be-on-a-ketogenic-diet/
  10. Elias, C. F., & Purohit, D. (2013). Leptin signaling and circuits in puberty and fertility. Cellular and Molecular Life Sciences, 70(5), 841-862. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3568469/
  11. Dr. Axe, (2018). Keto Diet for Women: How to Make It Work + Tips to Overcome Side Effects. Retrieved from: https://draxe.com/hub/keto-diet/keto-diet-women/
  12. Mavropoulos, John C. Yancy, W. F., Hepburn, J & Westman, E.C (2005).  The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: A pilot study. Nutr Metab (Lond). 2005; 2: 35. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1334192/
  13. Epilepsy Foundation (2018). Ketogenic Diet. Retrieved from:
  14. https://www.epilepsy.com/learn/treating-seizures-and-epilepsy/dietary-therapies/ketogenic-diet
  15.  Dashti, Hussein M. Thazhumpel, Matthew T. Hussein, Talib. Sami, Asfar. Abdulla, Behbahani. Mousa, Khoursheed.  Hilal, AlSayer. Yousef, Bo-Abbas. Naji, Al-Zaid (2004). Long-term effects of a ketogenic diet on obese patients. Exp Clin Cardiol Fall; 9(3): 200–205. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/
  16. Dr. Axe (2018). Alkaline Diet: The Key to Longevity and Fighting Disease? Retrieved from: https://draxe.com/alkaline-diet/
  17. Dr Axe (2018). Bone Broth Benefits for Digestion, Arthritis and Cellulite. Retrieved from: https://draxe.com/the-healing-power-of-bone-broth-for-digestion-arthritis-and-cellulite/

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