By now, most of us have either heard about or tried the keto (ketogenic) diet. In the past decade, the keto diet has become progressively more mainstream for the use of weight loss and glucose regulation. By nature, it is a metabolic therapy and was first developed in the 1920s by doctors at the Mayo Clinic to reduce epileptic seizures.
After the 1970s, low carbohydrate diets increased in popularity for weight loss, insulin control, and other desired health outcomes. We can now learn from the large number of studies covering nearly 100 years and from first-hand experience gained by practitioners and patients on the advantages and disadvantages of keto.
Keto can be stressful to the body, depending on your approach. Ideally, the keto diet is a positive acute stress that provides a health benefit known as hormesis. Many women can use the keto diet to achieve desired outcomes of fat loss and insulin regulation, which leads to positive benefits in hormone health. However, the advantages of the keto diet do not always outweigh the long-term effects for certain women.
Premenopausal and perimenopausal women’s bodies are especially sensitive to dietary changes. Any signs that could indicate that food is scarce or produce nutrient deficiencies can influence women’s hormones even in the short term. In addition, specific health conditions or low nutrient status in combination with the keto diet can lead to adverse health outcomes.
The Keto Diet Has Been Scientifically Proven as a Treatment For:
- Weight loss/obesity
- Reducing cardiovascular risks
There is strong scientific evidence of using ketosis therapeutically for motor function improvement in ALS, Alzheimer’s, Parkinson’s Disease, and several other neurological diseases. The keto diet also has been shown to benefit cancers, PCOS, acne, and IBD, and these emerging areas continue to be studied.
Women With The Following Conditions Should Not Follow the Keto Diet Unless Under a Physician’s Care:
- Liver failure
- Chronic kidney disease
- Type I diabetes
- Cardiac arrhythmias
- Pregnancy and breastfeeding
- Previous History of Eating Disorder
Hormones Affected by The Keto Diet
A study published in September 2018 in the Journal of Obesity and Weight Loss Therapy notes that ketosis disrupted women’s hormonal systems due to low calorie and carbohydrate intake.
As weight drops, so do estrogen levels. In one study, patients who lost an average of 17 pounds rapidly, estrogen hormone estrone levels decreased 5.7 percent, and the estrogen hormone estradiol dropped nearly 10 percent.
Estrogen deficiency can cause infertility vaginal atrophy and increase the chances of osteoporosis.
Studies suggest that low-carb diets increase Cortisol, the stress hormone.
Long term increased cortisol levels can lead to many health issues including weight gain, especially around the midsection, and increase your risk for anxiety, depression, and heart disease.
Lab testing before starting a keto diet and routinely after beginning keto can help women realize the benefits of the keto diet in a safe manner and possibly identify health conditions that would make this diet contraindicated.
Functional Medicine Lab Tests to Conduct Before Starting Keto
Comprehensive Metabolic Panel
Before going on a ketogenic diet, a Comprehensive Metabolic Panel can help exclude any underlying conditions that would show up in a woman’s blood chemistry. Liver markers are especially important, as the liver will be in charge of producing ketone bodies and will require more significant amounts of bile than usual due to the high fat intake.
A Micronutrient Test can be used to measure vitamins, minerals, and other nutrients to determine any nutritional deficiencies. It is essential that a woman address any of these before going on a keto diet, limiting certain food groups and can cause further deficiencies.
Baseline of sex hormones and adrenal function before starting the keto diet and at three months should be monitored. The following panels can be used:
- The DUTCH Complete (Dried Urine Test) is an extensive sex and adrenal hormone profile. It also assesses the daily free cortisol pattern, organic acids, melatonin, and 8-OHdG.
- Vibrant America Hormones Panel (Serum Blood Test) This panel assesses 13 sex hormones and related biomarkers important in women’s health.
Weight loss has been shown to downregulate the T3 hormone, which is usually temporary; however, an underlying thyroid issue should be addressed before any diet.
Vibrant America’s Thyroid Panel evaluates eight thyroid hormones and antibodies to assess thyroid function and overall thyroid health.
Knowing your Apo E status and cardiovascular risk before starting a keto diet is also a good idea. The Cardiac Health Panel from Vibrant America combines Lipid Profile, Apolipoprotein Panel, Inflammation Panel, Myocardial Stress Panel, and Lipoprotein Markers Panel to analyze current heart disease risk. Apo E is an individual marker that can be added to this panel.
Functional Medicine Treatment for Using the Keto Diet in Women
The keto diet generally reduces total carbohydrate intake to 20-50 grams a day, utilizing an average of 70-80% fat from total daily calories, 5-10% carbohydrate, and 10-20% protein. By limiting carbohydrates, the body produces ketones from fatty acids and can burn these ketones for energy rather than burning glucose. Once in ketosis, the body will shift to using stored body fat for fuel. This process bypasses insulin production and the resulting issues many people have due to overconsumption of sugar and other highly processed carbohydrates. A ketone monitor can ensure that ketosis occurs.
Emphasizing healthy fats and nutrient-dense foods is essential to the keto diet. In practice, it is common to see that some individuals achieve ketosis while consuming high levels of saturated fat or poor overall food quality. Ketosis can be achieved this way. However, there is a subset of people that do not utilize saturated fats very well and should be especially mindful of the type of fat they consume. Those with a polymorphism on the Apo E gene would do well eating primarily unsaturated fats (Mediterranean style keto).
The keto diet is often combined with fasting and time-restricted eating to promote autophagy and potentially increase longevity. A cyclical approach and combining the keto diet with periods of slightly higher carbohydrate levels, including small amounts of healthy starches (ex. sweet potatoes, plantains, some grains), can help women optimize the benefits of ketosis while mitigating health risks.
Ketosis can benefit weight loss, blood sugar regulation, sex and adrenal hormone regulation, energy, brain health, and longevity. This diet can also be combined with intermittent fasting or periods of time-restricted eating for additional benefits.
Although the keto diet can be beneficial, it can also amplify imbalances in women with low nutrition status or other preexisting health conditions. Overall, the keto diet can be a helpful tool when used in conjunction with lab testing to ensure that a woman’s health is prioritized.
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Lab Tests in This Article
Wheless J. W. (2008). History of the ketogenic diet. Epilepsia, 49 Suppl 8, 3–5.
Gupta L, Khandelwal D, Kalra S, Gupta P, Dutta D, Aggarwal S. Ketogenic diet in endocrine disorders: Current perspectives. J Postgrad Med. 2017;63(4):242-251. doi:10.4103/
Dowis K, Banga S. The Potential Health Benefits of the Ketogenic Diet: A Narrative Review. Nutrients. 2021;13(5):1654. Published 2021 May 13. doi:10.3390/nu13051654
Hartman, A. L., & Vining, E. P. (2007). Clinical aspects of the ketogenic diet. Epilepsia, 48(1), 31–42.
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