While initially developed to control seizures in some people with epilepsy,
the high-fat, low-carb
ketogenic (keto) diet is also a popular choice among midlife women looking to manage age-related body changes. While keto can lead to short-term weight loss, experts say severely restricting carbohydrates can backfire during menopause.
“In some women, aggressive carb restriction can actually worsen fatigue, stress tolerance, and sleep,” says Sue Page, a certified nutritionist and menopause nutrition coach in Harrison, New Jersey.
But first, here’s a closer look at why your body composition changes during this period and how the keto diet could interact with your changing hormones.
What Causes Menopause Weight Gain?
As you get older, your muscle mass naturally decreases while fat tissue increases. Because losing muscle slows down your metabolism, you might experience weight changes even if your eating and exercise habits stay exactly the same.
Where
your body stores energy tends to change, too. Fluctuating hormones can redirect fat storage to your midsection rather than your hips and thighs. Of course, natural aging, lifestyle choices, and genetics also factor into these body changes. Ultimately, this shift can alter how your clothes fit or how you feel in your body, even if the number on the scale hasn’t moved at all.
How Keto Works
Normally, your body uses glucose from digested carbohydrates for energy throughout the day. A keto diet drastically cuts your carb intake, which lowers glucose levels. This encourages your body to find a new fuel source (stored fat).
Your liver breaks down the stored fat, which pushes your metabolism into a state called ketosis. After entering ketosis, your body actively burns fat for energy instead of glucose.
While this process changes how your body burns fuel, it can also cause dangerous drops in blood sugar. If you have type 1 or type 2 diabetes, you should only consider a restrictive plan like keto under the direct supervision of your healthcare team to avoid dangerous complications.
What You Eat on Keto
There isn’t one official ketogenic diet, so there are a few variations. However, a standard approach requires you to get about 60 to 85 percent of your daily calories from fat.
You’d also need to eat a moderate amount of protein (15 to 30 percent) while drastically cutting back on carbs. Most keto plans restrict your carbohydrate intake to 5 to 10 percent of your daily calories. In practical terms, this usually means eating less than 50 grams of carbs each day.
Keto vs. Galveston Diet
You might have heard of the Galveston diet, an eating plan marketed specifically to menopausal women. Like keto, it relies heavily on fats — suggesting you get about 70 percent of your daily calories from healthy fats, 20 percent from lean protein, and 10 percent from carbs.
But Galveston is not technically a keto diet, according to its creator,
Mary Claire Haver, MD, FACOG, a board-certified ob-gyn specialist in Galveston, Texas. It emphasizes anti-inflammatory choices like olive oil, walnuts, and avocado. Highly saturated fats, like the cheese and red meat found in most traditional keto plans, are included in much smaller amounts.
While prioritizing healthy fats is a positive step, severely cutting back on carbs can still cause issues. “One of the primary nutritional risks of a strict ketogenic diet is inadequate fiber intake, explains Page, noting that women already fall short of their recommended daily fiber targets,” which is a major concern for midlife and postmenopausal women due to rising cardiometabolic risks.
Carbs also feed your microbiome, which are living organisms that populate your intestines and keep you healthy. Plus, high-fat diets leave very little room for nutrient-packed,
fiber-rich foods like beans, colorful vegetables, and fruits.
Instead of severe restriction, you can take the best parts of these plans and apply them to a more balanced approach. “Reducing refined sugars, focusing on healthy fats, and ensuring adequate protein are key keto elements to incorporate into a long-term Mediterranean-style plan for menopausal weight management,” says Alexander Zuriarrain, MD, FACS, a plastic surgeon and medical director of Hydrology Wellness in South Miami, Florida.
Weight Management
When it comes to managing your weight and body composition, keto can deliver short-term results. Research shows that very-low-carbohydrate ketogenic diets can lead to meaningful improvements in body weight, insulin sensitivity, and blood pressure compared with standard low-fat diets.
This carb restriction may also help reduce the visceral midsection fat that’s commonly referred to as “
menopause belly.”
But there’s a catch: The strict rules of keto make the diet incredibly difficult to sustain in the real world. Many people drop out of ketogenic diet programs because they find the food choices too monotonous and restrictive over time.
Plus, completely avoiding carbs isn’t always the best approach for your long-term metabolic health. “Most menopausal women perform better with some carbohydrate intake, particularly when strength training,” says Page. “The evidence-based benefit attributed to ketogenic diets is the reduction of refined carbohydrates and added sugars, not ketosis itself. [Somebody] can implement these changes within more flexible dietary patterns without eliminating carbohydrates.”
Impact on Hormones
Research on how keto affects your reproductive hormones is still emerging. One review of multiple studies found that a ketogenic diet can cause shifts in gonadal hormones, including estradiol, progesterone, and testosterone.
The diet also shows positive effects for women with polycystic ovary syndrome (PCOS) by lowering testosterone levels and improving insulin sensitivity.
However, because most of this research focuses on women with PCOS, we still lack large studies specifically looking at how keto impacts estrogen levels and other hormones during menopause.
Without hard data, the effects on menopausal symptoms are mostly anecdotal. Some people say the diet eases their hot flashes, while others find that severe carb restriction makes them feel worse.
The Keto Flu vs. Menopause Symptoms
When you first start the diet, you might experience side effects that feel surprisingly similar to menopause. This adaptation period is known as the “
keto flu.” Common symptoms include headaches, fatigue,
dizziness, and stomach issues.
These side effects usually happen in the first few days or weeks of carb restriction and tend to resolve as your body adjusts to ketosis.
While the symptoms can overlap, you do not need to worry about the diet pushing you into menopause. There’s no research or evidence to suggest that starting keto can trigger the menopausal transition.
Safety Considerations
Heart disease is a major concern for midlife women. Once you enter menopause, you lose the natural heart protection that estrogen provides.
Because of this, a keto diet that allows you to eat high amounts of saturated fat poses a real risk. “Long-term very-low-carb, high-saturated-fat diets may raise LDL cholesterol and potentially increase cardiovascular risk and may affect bone turnover,” warns Dr. Zuriarrain.
Experts also caution that eliminating entire food groups and eating only small amounts of vegetables and fruits can lead to nutritional deficiencies over time.
Plus, because the diet severely limits fiber, many people on keto
experience constipation.
How Long Can You Stay on Keto?
Most studies on the keto diet follow participants for a limited time, meaning there isn’t strong research showing whether it’s safe to eat this way for years. Experts generally view strict keto as a short-term intervention rather than a permanent lifestyle choice.
Instead of adopting a highly restrictive plan, you are usually better off finding a balanced eating style that fits into your life permanently.
Rachel Green
Rachel Davis
Derek Schulz
Sophia Martinez
Dr. Amara Okafor