Keto for Women: The Benefits, Risks, and Importance of “Carb Re-Feeds”

By Kelley Herring

If you’re a woman who would like to burn fat… lose weight… boost energy… optimize your hormones… and turn back the clock on aging to look YEARS younger… you’ve probably considered the keto diet.

Based on Internet searches, keto diet is the most popular diet in the world. And that’s for a very good reason… because it works!

Keto can turn your body into a fat-burning furnace and it works wonders for weight loss. It does this by helping to reset your hormones and restore your youthful metabolism.

But there is a good chance you’ve also heard “horror” stories about keto…

One of the scare tactics they use is to suggest that keto can cause the serious condition known as “ketoacidosis”. However, this is NOT a health risk associated with the keto diet. Instead, it is a medical concern, primarily associated with uncontrolled diabetes and end-stage metabolic dysfunction.

With that said, there can be some risks and challenges associated with keto. And while it can be very effective for weight loss and has numerous potential health benefits, it might not be appropriate for everyone – especially women in mid-life.

In today’s article, we explore the:

• Impact of the ketogenic diet on female hormones
• Potential benefits and risks of ketosis for women
• Benefits of a “Cyclical Ketogenic” diet to reap all the benefits while minimizing risk

So, let’s dive in and learn more about how the ketogenic diet can affect women’s health and well-being!

Health Benefits of Ketosis for Women

Ketosis is a metabolic state where your body primarily using ketones for energy (rather than glucose).

Ketones are produced when your body breaks down fat for fuel. This optimized when carbohydrate intake is low enough to deplete glycogen stores in the liver. Carbohydrate intake of 20-50 grams per day, is typically low enough to induce ketosis within just a few days.

And while most of the benefits of ketosis apply to men and women, several that are particularly relevant for women. Here are a few of the primary benefits:

• Weight Loss & Body Composition Improvements: The most well-known benefit of ketosis is weight loss, and studies show women can experience significant weight loss and body improvements on keto. One 12-week study of obese women on keto, showed that the women shed 10.2% of their total body weight, compared to 5.5% in the control group. That’s almost double the weight lost!¹
• Improved Insulin Sensitivity & Blood Sugar Control: Insulin resistance and blood sugar imbalances are common issues for women, particularly those with conditions such as PCOS. Keto has been shown to significantly improve blood sugar metabolism and hormonal balance and to reduce and sometimes eliminate symptoms of PCOS.²
• Reduced Inflammation & Oxidative Stress: Inflammation and oxidative stress are associated with a range of chronic diseases, including heart disease, diabetes and cancer. Keto has been shown to reduce markers for inflammation and oxidative stress in both men and women.³
• Enhanced Mental Clarity & Focus: Many people report improved mental clarity on keto, which is particularly beneficial for women with brain fog or other cognitive issues. In a study of healthy adults, those who followed keto for six weeks showed improvements in processing speed, working memory, and attention.⁴
• Improved Energy Levels & Exercise Performance: Keto also improves energy levels and exercise performance, particularly in endurance sports. In a study of trained cyclists, those who followed keto for four weeks showed improved endurance with no decrease in power output.⁵
• Enhanced Thyroid Function: Research shows keto can benefit people with thyroid issues. One study found that a very low-carbohydrate ketogenic diet improved thyroid function in healthy adults, with increased levels of thyroid hormone T3 and decreased levels of reverse T3 (rT3).⁶ Another study found benefits for people with hypothyroidism by increasing gene expression related to thyroid hormones reducing inflammation in the thyroid gland.⁷
• Optimized Cholesterol Levels: Some research has suggested that following keto long-term may increase cholesterol levels for some people. The keto diet is high in fat. And this can lead to an increase in LDL or so-called “bad” cholesterol. However, it also helps to raise HDL “good” cholesterol and significantly improve the overall cholesterol ratio. Furthermore, keto has been shown to significantly reduce dangerous triglycerides and increase weight loss, especially for women with existing blood sugar control issues.⁸

When it comes to your cardiovascular system, it’s really about the health of your cholesterol… not the amount. To optimize your cholesterol on a high-fat diet, make sure you are consuming healthy fats in the right ratios.

Focusing on saturated and monounsaturated fats from grass-fed meats, and omega-3 fats from wild seafood, like wild Pacific salmon, sardines, wild shrimp and scallops. And beware of “dirty keto” foods that may be ketogenic in their macronutrient profile, but loaded with unhealthy fats (like canola and soybean oils) or inflammatory fibers (like soluble corn fiber and inulin).

Potential Risks of Ketosis for Women

While there are many potential benefits to ketosis, there are some risks that women should be aware of. Here are the primary risks to consider:

• Nutritional Deficiencies if Not Done Properly: A keto diet can be perfectly nutritionally sound, but it can also be low in important vitamins and minerals if not done properly. Women should particularly ensure optimal consumption of iron, calcium and magnesium for bone strength and other aspects of women’s health.⁹ Pay close attention to your nutrient intake by eating a nutrient-dense whole foods diet and consider supplements as needed. My favorite way to boost micronutrients is to enjoy grass-fed organ meats (like chicken liver, beef liver, bone marrow) and shellfish like oysters, mussels, and crab.

• Increased Risk of Kidney Stones: A keto diet can be high in protein, which can increase the risk of kidney stones in some women, especially for those who have a history of kidney stones or other risk factors for kidney disease.¹⁰ Stay hydrated and avoid excessive protein intake to reduce this risk.

• Potential for Negative Effects on Thyroid Function: While you just learned that keto can HELP thyroid function, some women may experience negative effects on thyroid function. And while there is not yet a clear understanding of why this happens, watch your symptoms and monitor your hormones levels with your health care provider.¹¹

• Impact of Keto on Female Hormones: Keto can help female hormones, via blood sugar balance and improved insulin sensitivity. However, some women may experience menstrual irregularity or fertility issues, particularly if they are consuming VERY low carbohydrates.¹² This may be due to a number of factors, including stress when transitioning to ketosis and the potential effects on hormones such as estrogen and progesterone. If you’re a woman on keto, make sure you eat enough high-quality calories and ample protein each day.

Benefits of Cyclical Keto for Women

Given the potential risks of long-term ketosis, many experts recommend a cyclical approach to keto. And for many women “Cyclical Keto” or “Keto Cycling” provides the BEST of both worlds.

This involves alternating periods of strict ketosis with periods of higher-carbohydrate intake. The “carb refeeds” typically happen on a weekly or monthly basis. Here are some potential benefits of cyclical keto for women:

• Improved Hormonal Balance & Menstrual Regularity: Incorporating regular carb refeeds or cyclical periods of higher carb intake, can mitigate the negative effects on female hormones and menstrual regularity that can occur on strict keto.¹³ This may be particularly important for women who are trying to conceive or are otherwise concerned about hormonal health.

• Improved Energy Levels and Exercise Performance: Carb refeeds may help women improve their energy levels and exercise performance, particularly for high-intensity activities that rely on carbohydrate stores for fuel.¹⁴

• Reduced Risk of Nutritional Deficiencies & Poor Bone Health: Adding carb-containing foods intermittently may reduce their risk of nutritional deficiencies and negative effects on bone health that can occur on a strict keto diet.

While ketosis offers a plethora of powerful health benefits for women, it is also important to be aware of the potential pitfalls.

If you’re a woman on keto, be sure to:

1. Stay well hydrated
2. Make sure you’re consuming a “clean” keto diet of whole foods and healthy fats, and
3. Keep an eye on your symptoms and hormone panels

And finally, consider alternating brief periods where you “re-feed” on carbohydrates to enjoy even greater benefits – and fewer risks associated with keto. It is not difficult to create the personalized ketogenic diet that’s right for YOU – and the benefits are well worth it!

Read more of Kelley Herring’s Health and Wellness articles on our Discover Blog.

References

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2. Paoli, A., Rubini, A., Volek, J. S., & Grimaldi, K. A. (2013). Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European Journal of Clinical Nutrition, 67(8), 789-796.
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10. Cappuccio, F. P., & Strazzullo, P. (2014). Kidney stones and BP: another piece in the jigsaw?. The Lancet, 383(9933), 1983-1984.
11. Kjolaek, L., Lindgren, K. E., Knudsen, N., & Joergensen, J. C. (2018). The effect of a very low-carbohydrate diet on thyroid function in healthy young adults. Journal of the Endocrine Society, 2(12), 1405-1411.
12. Zhang Y, Kuang H, Zhuang X, et al. The Effect of Ketogenic Diet on Thyroid Function as Measured by Thyroid Hormones and Their Transport Proteins in Healthy Young Adults. Front Endocrinol (Lausanne). 2019;10:363. doi: 10.3389/fendo.2019.00363.
13. Paoli A, Mancin L, Giacona MC, Bianco A, Caprio M. Effects of a ketogenic diet in overweight women with polycystic ovary syndrome. J Transl Med. 2020;18(1):104. doi: 10.1186/s12967-020-02277-8.
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