Ketogenic diets have been all the rage in recent times as individuals continually search for the one diet to “end all diets” and make weight loss easier than ever.
As you’re probably aware, eating keto is drastically different from the way you ate growing up.
By definition, a ketogenic diet is very high in dietary fat, very low in carbohydrate, and moderate in protein. This typically averages out to a daily macronutrient intake consisting of:
- Fat: 70-75%
- Protein: 20-25%
- Carbohydrates: 5%
Adopting this ultra-low carbohydrate intake forces the body to shift from burning glucose (sugar) for energy to burning fat for fuel, thereby promoting the hepatic production of ketone bodies.
The body then uses these ketone bodies to generate ATP -- the cellular “currency” of energy production. <18>
The body is always producing a small number of ketones, but it's maximized when insulin levels are low, such as during times of fasting or following a ketogenic diet.
The most common reason individuals try keto these days is for weight loss.
Beyond increasing fat burning and supporting weight loss, research has identified several other positives found from following a low carb and ketogenic diets, including <1,2>:
- Improved Regulation of Blood Sugar
- Reduced Epileptic Seizures
- Decrease in Acne
- Reduction in PCOS Symptoms
- Cardiovascular Health
While it's easy to get up in all the hype and whimsy of the ketogenic diet, what isn't addressed are any possible side effects of ketogenic diets.
In this article, we'll take a look at some of the hormonal impacts ketogenic diets may exert, as well as is keto bad for women.
Let’s get started.
Stress on Body
Dieting in and of itself is a stress on the body, both mentally and physically. You are willingly and intentionally reducing your energy intake as well as restricting yourself from eating certain foods.
When you follow a restrictive diet, such as a ketogenic diet, you’re increasing the magnitude of that stress on your body.
Why is that a problem?
Well, when we're chronically stressed (such as when you're following a restrictive diet for prolonged periods or not getting enough sleep regularly), cortisol levels remain elevated, which leads to a cascade of unwanted physiological effects.
For instance, research finds that chronic stress can lead to high blood pressure. <3>
Moreover, chronic stress can also lead to alterations in the hypothalamic-pituitary-adrenal (HPA) axis and changes in behavior. <3>
Among these changes are impaired insulin activity leading to insulin resistance as well as the proliferation and redistribution of body fat, particularly around the midsection. <3>
Now, this isn’t to say that following a keto diet will automatically make you stressed, overweight, and on the road to developing high blood pressure and metabolic syndrome.
This can occur as a result of following any diet that makes you feel chronically stressed.
However, given the overly restrictive nature of the ketogenic diet and the tediousness involved with adhering to it, the possibility is very real to feel stressed excessively and chronically while on the diet.
Reduced Athletic Performance
In addition to pursuing weight loss, many individuals are under the belief that ketogenic diets can improve their athletic performance. The reason for this is partly due to the belief that keto diets promote weight loss, and a lighter athlete should be able to move faster, which could benefit runners, cyclists, rowers, etc.
Unfortunately, the data isn't there to support these beliefs, as reductions in athletic output erase the trade-off in weight lost.
High-intensity activities -- sprinting, jumping, resistance-training, HIIT -- are highly glycolytic, meaning they use glucose for energy.
Having inadequate glycogen stores or low blood glucose levels could lead to impaired performance when you’re trying to hit that “fifth gear” in your training or performance.
Research has even shown that ketogenic diets result in worse performance in anaerobic activities, such as cycling. <4,5>
Ketogenic diets have also become popular in the bodybuilding world lately, too. However, research indicates that while going keto may be an effective means to reduce body fat without losing muscle, "it might not be useful to increase muscle mass during positive energy balance." <6>
For competitors or those individuals who just like to take training seriously, going keto may be a useful strategy for cutting as some individuals report feeling less hungry and fuller following a keto diet than a conventional lower-fat, higher carb diet. However, when it comes to adding mass, carbohydrates are your friend.
Impact on Fertility
Beyond its effects on stress levels and athletic performance, ketogenic diets may also unfavorably impact a woman’s fertility.
The reason for this is that ketogenic diets produce numerous metabolic changes, which can lead to alterations in hormone levels or how they are expressed. <9>
Research has found that while keto may be useful for weight loss, it can lead to menstrual dysfunction. <10>
Now, several other things can also adversely impact women's hormones and their menstrual cycle, including sudden, dramatic weight loss, high levels of physical activity, and excessive stress.
This isn’t to say that a ketogenic diet will wreck your metabolism or cause hypothyroidism, as a lot of other “expert blogs” will dictate.
In fact, in the case of obese patients, following a ketogenic diet has led to improvements in sex hormones and fertility. <11>
The point here is to understand that ketogenic diets may work for some people, but they may not work for all. Your diet and lifestyle can affect your fertility, which is why you should consult with your doctor anytime you're making drastic changes to either one.
Impact on Liver
Fatty liver disease simply means there is an excessive build-up of fat in the liver. Traditionally, fatty liver disease was brought on by consuming too much alcohol. But, with the dramatic rise in obesity over the decades has come to the development of nonalcoholic fatty liver disease (NAFLD), which occurs as a result of diet and lifestyle.
Many individuals fear that consuming a high-fat diet (such as a ketogenic diet) can lead to the progression of nonalcoholic fatty liver disease. However, most of the research finds that following a low carbohydrate or keto diet may improve metabolic and liver health. <12,13,14,17>
More specifically, one study in healthy individuals found that following a low-carbohydrate diet for ten days saw a significant decrease in liver fat. <12>
Other research notes that following a keto diet for two weeks resulted in a 42% decrease in liver fat in people with NAFLD. <13>
Does this mean you have to follow a keto diet to avoid nonalcoholic fatty liver disease?
Not at all.
As we mentioned above, NAFLD is a result of diet and lifestyle. Instead, it's brought on by a severe lack of physical activity and a poor diet.
High intake of fruits and vegetables can help prevent NAFLD due to its high content of fiber, antioxidants, and other phytochemicals. <15>
Furthermore, research also finds that higher-carb diets, like the Mediterranean Diet, can also be useful for reducing hepatic fat and improving hepatic insulin sensitivity as well as hepatic steatosis. <16>
The takeaway here is that ketogenic diets do not inherently cause fatty liver disease, and they may help prevent it from happening as well as improve markers of liver health.
At the same time, similar improvements in the liver and metabolic health, as well as prevention of NAFLD, can occur by eating a well-balanced diet high in fruits and vegetables as well as maintaining a physically active lifestyle.
While ketone bodies can confer neuroprotective properties, they may also possess neurotoxic effects as well, in the case of ketoacidosis.
Ketoacidosis is a metabolic state characterized by the unregulated production of ketone bodies, which causes a significant change in blood pH and can be deadly. The most common cause of ketoacidosis is late-stage type 2 diabetes or a deficiency of insulin in type 1 diabetics.
The reason for this is that the hormone insulin is a crucial regulator of ketone production. When insulin levels are elevated above baseline, ketone production is blunted. Therefore, a deficiency of insulin could cause an uncontrolled release of fatty acids from adipose tissue, leading to increased ketone production and a reduced ability for peripheral tissues to use them. This, in turn, causes the blood to become too acidic, which can damage the liver, kidneys, and brain. It can then become fatal if left untreated. <7>
Ketoacidosis has also been reported in a non-diabetic lactating woman. <8>
However, the possibility of entering ketoacidosis for individuals without diabetes or alcoholism is pretty rare.
Still, anytime you dramatically overhaul your diet or fitness regimen, it's a good idea to consult with your doctor and notify them of your intentions so they can track your blood work as you embark on these new ventures.
Ketogenic diets are restrictive, and they require a fair amount of micro-managing to ensure you're not consuming too many carbohydrates or protein.
The reason this is an issue is that following restrictive diets for prolonged periods can lead to the development of disordered eating and unhealthy relationships with food.
We all have a limited capacity to endure stress and deprivation. And when this breaking point is reached, there is a genuine possibility for abandoning dieting or sound eating practices altogether and go into full-on binging.
Weight regain ensues, and you’re back exactly where you started, with the possibility of a few additional pounds packed onto your body as well.
While ketogenic diets can be used for weight loss, they are not required to lose weight or burn fat. If you find that following a keto diet leads to fewer feelings of hunger when dieting, then feel free to follow it. However, if you find yourself hungrier, excessively deprived, or stressed by managing the minutiae that entail following a keto diet, then pick another diet that allows you maintain a calorie deficit and achieve your weight loss goals.
So, after reading through all of this, are you still wondering, "is keto bad for women?"
Rest assured, keto is not inherently bad for women (or men, either).
Moreover, women with certain metabolic disorders like obesity and PCOS can benefit from following a keto diet and being in ketosis.
At the same time, it's essential to realize that you do not have to follow a keto diet to be healthy, lose weight, balance hormone levels, or burn fat.
All of this can be accomplished by living a healthy lifestyle, one where you regularly engage in exercise and consume a diet rich in fruits, vegetables, lean meat, healthy fats, and whole grains.
Keto can work for some, but it doesn’t work for others.
Adherence is the single most significant predictor in the success of any diet, be it high-carb, low-carb, or no-carb.
If you enjoy living the keto lifestyle, then feel free to keep doing it. If you don’t, then no sweat. Find a nutritional approach that suits your lifestyle and dietary preferences and work it until it no longer works for you.
- Paoli A, Rubini A, Volek JS, Grimaldi KA. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets
. Eur J Clin Nutr. 2013;67(8):789–796. doi:10.1038/ejcn.2013.116
- Sackner-Bernstein J, Kanter D, Kaul S (2015) Dietary Intervention for Overweight and Obese Adults: Comparison of Low-Carbohydrate and Low-Fat Diets. A Meta-Analysis. PLOS ONE 10(10): e0139817. https://doi.org/10.1371/journal.pone.0139817
- Bergmann N, Gyntelberg F, Faber J. The appraisal of chronic stress and the development of the metabolic syndrome: a systematic review of prospective cohort studies. Endocr Connect. 2014;3(2):R55–R80. doi:10.1530/EC-14-0031
- Wroble, K. A., Trott, M. N., Schweitzer, G. G., Rahman, R. S., Kelly, P. V, & Weiss, E. P. (2019). Low-carbohydrate, ketogenic diet impairs anaerobic exercise performance in exercise-trained women and men: a randomized-sequence crossover trial. The Journal of Sports Medicine and Physical Fitness, 59(4), 600–607. https://doi.org/10.23736/S0022-4707.18.08318-4
- Zinn C, Wood M, Williden M, Chatterton S, Maunder E. Ketogenic diet benefits body composition and well-being but not performance in a pilot case study of New Zealand endurance athletes. J Int Soc Sports Nutr. 2017;14:22. Published 2017 Jul 12. doi:10.1186/s12970-017-0180-0
- Vargas S, Romance R, Petro JL, et al. Efficacy of ketogenic diet on body composition during resistance training in trained men: a randomized controlled trial. J Int Soc Sports Nutr. 2018;15(1):31. Published 2018 Jul 9. doi:10.1186/s12970-018-0236-9
- Oster, J. R., & Epstein, M. (1984). Acid-Base Aspects of Ketoacidosis. American Journal of Nephrology, 4(3), 137–151. https://doi.org/10.1159/000166795
- von Geijer L, Ekelund M. Ketoacidosis associated with low-carbohydrate diet in a non-diabetic lactating woman: a case report. J Med Case Rep. 2015;9:224. Published 2015 Oct 1. doi:10.1186/s13256-015-0709-2
- Thio LL. Hypothalamic hormones and metabolism. Epilepsy Res. 2012;100(3):245–251. doi:10.1016/j.eplepsyres.2011.07.009
- 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. https://doi.org/10.1046/j.1528-1157.2003.57002.x
- McGrice M, Porter J. The Effect of Low Carbohydrate Diets on Fertility Hormones and Outcomes in Overweight and Obese Women: A Systematic Review. Nutrients. 2017;9(3):204. Published 2017 Feb 27. doi:10.3390/nu9030204
- Hollingsworth, K. G., Abubacker, M. Z., Joubert, I., Allison, M. E. D., & Lomas, D. J. (2006). Low-carbohydrate diet induced reduction of hepatic lipid content observed with a rapid non-invasive MRI technique. The British Journal of Radiology, 79(945), 712–715. https://doi.org/10.1259/bjr/23166141
- Browning JD, Baker JA, Rogers T, Davis J, Satapati S, Burgess SC. Short-term weight loss and hepatic triglyceride reduction: evidence of a metabolic advantage with dietary carbohydrate restriction. Am J Clin Nutr. 2011;93(5):1048–1052. doi:10.3945/ajcn.110.007674
- Perez-Guisado, J., & Munoz-Serrano, A. (2011). The effect of the Spanish Ketogenic Mediterranean Diet on nonalcoholic fatty liver disease: a pilot study. Journal of Medicinal Food, 14(7–8), 677–680. https://doi.org/10.1089/jmf.2011.0075
- Mirmiran P, Amirhamidi Z, Ejtahed HS, Bahadoran Z, Azizi F. Relationship between Diet and Nonalcoholic Fatty Liver Disease: A Review Article. Iran J Public Health. 2017;46(8):1007–1017.
- Perdomo CM, Frühbeck G, Escalada J. Impact of Nutritional Changes on Nonalcoholic Fatty Liver Disease. Nutrients. 2019;11(3):677. Published 2019 Mar 21. doi:10.3390/nu11030677
- Haghighatdoost F, Salehi-Abargouei A, Surkan PJ, Azadbakht L. The effects of low carbohydrate diets on liver function tests in nonalcoholic fatty liver disease: A systematic review and meta-analysis of clinical trials. J Res Med Sci. 2016;21:53. Published 2016 Jul 29. doi:10.4103/1735-1995.187269
- Dhillon KK, Gupta S. Biochemistry, Ketogenesis.
. In: StatPearls . Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493179/