For years now, the keto diet has been all the rage. Whether you're running in a power-lifting circle, a CrossFit circle, or you're just a regular person looking to trim off a few pounds, you've likely heard the buzz about the ketogenic diet. It's a low-carb diet plan that lets you eat bacon and butter and all kinds of goodies that might be off-limits on other plans. 

But is there a difference between the keto diet for women vs men? It's an important question to consider, especially if there are potential side effects to the diet. Let's delve into defining keto and how an approach to the keto diet might differ for women vs men. Then we'll go over some tips to help women be successful on this highly popular low-carb diet plan. 

Definitions: The Basic Ketogenic Diet

Simply put, going keto means cutting carbs dramatically and replacing those calories with high-quality, high-fat foods like avocado, grass-fed butter, olive oil, MCT oil, and coconut oil. This diet is low-carbohydrate, medium-protein, and high-fat. Your main food sources are meat, fat, leafy greens, and other low-carb veggies. Generally speaking, you shouldn't be exceeding 50 grams of carbs per day on this diet, and that number will vary based on your current and goal weight. 

The most recommended macronutrient ratio on the keto diet is 75% fat,15-20% protein, 5-10% net carbs. (Net carbs are total carbs minus fiber since fiber isn't digested and therefore doesn't affect your blood sugar.) To calculate what's right for you, try using a keto calculator like this one.  

The key to the diet is achieving ketosis, a metabolic state whereby you're burning fat (in the form of ketones) for fuel instead of carbohydrates. When your body is in a state of ketosis (or fat-adapted, as some like to say), your blood sugar is stable, your energy levels surge, and your body becomes a fat-burning machine. For these reasons, this diet is especially popular for those who need to lose body fat quickly due to health concerns like heart disease, type 2 diabetes, or another metabolic disorder like insulin resistance. 

The catch is that you don't achieve ketosis overnight, and the transition can sometimes be a bit uncomfortable. The most uncomfortable (and temporary) side effect keto dieters face is the keto flu. The transition from burning carbohydrates to burning fat for fuel can sometimes be a little rocky. Symptoms can include fatigue, brain fog, stomach cramping, and muscle ache, kind of like the flu. But as you move past the adaptation phase, you'll begin reaping all the health benefits of this diet. Or at least, that's what most of the literature says, based on studies done primarily on men. 

Does Keto Work for Women?

A quick google search will uncover countless stories of both women and men claiming success on the keto diet. And that's great! But for many women, the results are temporary and sometimes fraught. Until very recently, most of the hard science studying the effects of the ketogenic diet have used both male humans and male rodent subjects, giving the general public very little context for the diet amid the nuances of women's health. 

Because women and men differ hormonally, understanding how the diet may affect women's hormonal health is really important. And there's a pretty big hole in the research. A study on mice done in Iowa last year (2019) is one of the first steps in the scientific community to help people better understand what happens to females on a keto meal plan. 

This study uncovered that the female mice were:

• less likely to experience significant fat loss than the male mice
• more likely to experience poor blood sugar control than male mice

Why is that? While there's more work to be done in this area, researchers speculate that the female sex hormone estrogen may play a key role in the different responses to this diet. In fact, they did a second round of testing on female mice who had undergone ovariectomies (to mimic menopause) and found that those mice had similar results as the male mice. So post-menopausal women may do as well as men on the diet, pending more research.

What Does This Mean for Keto for Women?

After reading the results of this study, you might conclude that keto doesn't work for women of reproductive age. And you'd be partially right. That is, a woman of reproductive age following a ketogenic diet exactly as a man of the same age would might not get the same type of weight loss results. And the diet might make some matters (like blood sugar levels) worse as well. 

Here's why. According to Dr. Natasha Turner, ND, drastically reducing carbohydrates can add undue stress to a woman's system. Because women have more dynamic hormonal changes than men, they are more sensitive to drastic dietary changes. Both physical and mental stress can lead to increased production of cortisol, the stress hormone that's linked to insulin resistance. 

Insulin resistance is a precursor to type 2 diabetes and one of the risk factors in polycystic ovary syndrome (PCOS), a reproductive disorder. Women with PCOS produce higher levels of testosterone and estrogen and lower levels of progesterone. It's unclear whether metabolic disorders like insulin resistance causes PCOS or if the reverse is true, but the link is well-established (as well as genetic factors). If the keto diet increases cortisol in women, and increased cortisol can lead to insulin resistance, then for women, keto may be having the exact opposite of the desired effect. 

Furthermore, a high-fat diet can lead to increased estrogen production in women, which may suppress thyroid function. The thyroid regulates energy, weight, mood, sex drive, and mental acuity—nearly all things the keto diet is said to improve in men. A suppressed thyroid (hypothyroidism) can lead to a loss of energy and weight gain, again, the exact opposite of what you'd be going for on the keto diet. 

Can Women Be Successful on the Keto Diet?

The answer to this question is complicated. Yes, a woman of reproductive age can be successful on the keto diet, but it can't be a carbon copy of the keto meal plan recommended for men. The key to success for women on the keto diet is to avoid overloading your body with stress. More and more research is uncovering the dangerous role stress plays in all manner of diseases, and it can have a dangerous effect on your weight loss efforts too. So how to proceed?

1. Start Slowly

We mentioned the keto flu as a potential side-effect of moving your body into a state of ketosis. You can imagine that the keto flu would put a lot of stress on your body. Instead of starting the full keto plan all at once and shocking your body into ketosis, try a more gradual approach. Of course, a gradual change will mean more gradual results, but if you stick with it, you'll be more successful in the long-term. Change one thing at a time, slowly reducing carbs and adding in fats instead of doing it all at once. 

2. Focus on Quality

It's tempting to slide into lazy keto, a version of this diet that only focuses on macros and not on nutrition. Because keto foods tend to be heavy on meat and fat, easy snacks like dried meats, jerky, and lots of dairy can end up being your default foods. This isn't the right way to approach the diet for anyone, but especially for women. 

A focus on quality means filling your plate with leafy greens and other low-carb vegetables to ensure that you're getting a wide array of micronutrients as well as staying within your macros. It also means choosing organic and pasture-raised or grass-fed meat and dairy, along with wild, small fish. 

Because the keto lifestyle involves eating lots of healthy fats, it's important that the animal products you eat are sourced from well-treated, organically-fed animals. Animals (including humans) store toxins in body fat, so by choosing organically-fed, well-treated animals, you're reducing your own toxic load and the potential stress it could cause to your body. 

3. Re-calibrate Your Macros

The most commonly recommended macro ratio for the keto diet is 75% fat,15-20% protein, 5-10%. That recommendation is based on research done on male subjects. Part of Dr. Turner's nutrition recommendations for women, in general, is to eat about 46 grams of protein per day to maintain muscle mass (even more for active women). This minimum amount of protein likely means changing the macro ratio recommendations for women to avoid muscle wasting on this diet. 

Women may need to add in a few more healthy carbohydrates into their diet than men as well to be successful in the long-term on a keto plan. Carb intake is generally incredibly low on this diet, and it should remain low for women as well, but by adding in a small portion of a starchy vegetable like winter squash or celery root, or even a half-cup of blackberries or raspberries, women can keep their blood sugar stable and make the keto diet work for them.

4. Be Mindful

The cold, hard truth is that the keto diet for women is a lot more nuanced than it is for men. That's because women have more dynamic hormonal changes every month and are, therefore, a lot more sensitive to drastic changes in their diets. Each of the changes we've laid out requires a level of mindfulness along the way. 

Take it one step at a time and pay attention to how your body is feeling with each adjustment. Are you feeling exhausted and fatigued? Maybe add in a small portion of butternut squash with butter into your next few meals and see if it helps. Is your performance at the gym suffering? Consider adjusting your protein intake. You might even consider trying another form of the keto diet, like the targeted keto diet or the cyclical keto diet. Each of these plans allows for additional carbohydrates at certain times to help reduce the stress on your body, especially for athletes.

Keto for Women

Preliminary research on keto for women is beginning to uncover that post-menopausal women may have more success on the diet than women of reproductive age. That doesn't mean that women of reproductive age should give up on keto. It just means that their success will come with some slight tweaks to make the diet less physically stressful. 

Women of any age can burn fat on this diet, as long as they start slowly, focus on quality, and pay attention to changes that may indicate a need for a macronutrient adjustment. There's no silver bullet diet plan that works for everyone, and in the end, taking care of your health is more important than a number on the scale. Stick to high-quality foods, eat your veggies, and take care of yourself.