An increasingly popular diet craze involves eating all the foods you were once told to avoid: fatty meats, cheese, heavy cream, and more. If this makes you do a double take, you’re not alone. But the ketogenic diet, commonly known as keto, is a weight-loss plan that continues to gain adherents.
Some people advocate this eating plan or related versions of it for midlife women who want to drop pounds and improve their health during the menopause transition.
But experts urge women to proceed with caution.
It’s true that some midlife women have lost weight with this plan, but “the keto diet has the potential to create other health issues in the process,” warns Bonnie Taub-Dix, a registered dietitian nutritionist in New York City.
What Happens During Menopause?
Menopause is officially defined as the time when your menstrual cycle has stopped for a year, but many use the term to describe the transition process leading up to that milestone, and that period can begin years before.
Menopausal symptoms include difficulty sleeping, mood changes, vaginal dryness, and hot flashes. Many women lose muscle tone.
Weight Gain and Belly Fat Around Menopause
Lots of women complain that during the menopausal transition they put on pounds, even when they eat the same number of calories, says Nanette Santoro, MD, a professor of obstetrics and gynecology at the University of Colorado School of Medicine in Aurora and a long time menopause researcher.
What’s more, fat distribution often shifts away from the hips and thighs and toward the abdomen. “Virtually every woman gains at least some subcutaneous fat with the end of menses,” Dr. Santoro says, something that might make a woman feel heavier even if the scale doesn’t move.
This extra fat around the abdomen “seems to be related to hormones, but no known mechanism currently exists,” she says.
RELATED: 12 Ways to Beat Menopausal Belly Fat
A Look at the Premise of a Keto Diet for Midlife Weight Loss
This weight increase or change in fat distribution drives many women to seek out a new eating plan around the menopause years. Keto is one of those diets that may be recommended to women in midlife.
With our traditional way of eating, our bodies use glucose from digested carbohydrates to fuel itself through the day. The premise of a keto diet is to deprive the body of carbs, and therefore glucose, forcing it to turn to a different fuel instead.
That fuel: stores of fat. This fat gets broken down in the liver, creating a state known as ketosis and allowing the body to use this to fuel itself instead of glucose.
Foods That Are Eaten – and Avoided – in the Ketogenic Diet
There is no official ketogenic diet, so there are some variations in what people on the diet are instructed to eat.
Generally, anywhere from 70 to 90 percent of daily calories in a keto diet come from fat. This is a huge increase from the 25 or 30 percent recommended by most nutritionists and the 2015–2020 Dietary Guidelines for Americans, per Medline.
On this diet, some 5 to 15 percent of calories come from protein and only a tiny amount comes from carbs.
The Galveston Menopausal Diet Vs. the Keto Diet
One diet that positions itself for menopausal women is the Galveston diet. Like keto, this diet provides for the majority of daily calories, some 70 percent, to come from fats, with the remaining allocated as 20 percent lean protein and 10 percent carbs.
Galveston is not technically a keto diet, its creator Mary Claire Haver, MD, a Texas ob-gyn, says. That’s because its meal plan distinguishes between healthy fats like olive oil, walnuts, and avocado, which the diet emphasizes, and highly saturated fats like those found in cheese and red meat, which are included in smaller amounts in the Galveston diet.
Taub-Dix, author of Read It Before You Eat It – Taking You From Label to Table, says that while emphasizing healthy fats over heart-harming saturated fats is good, any diet that skimps on carbs is problematic. “Carbs provide the most readily available source of energy and fiber,” she says. Carbs also feed the microbiome, the living organisms that populate our intestines, skin, vagina, mouth, and other parts of the body.
Plus, when fats make up so much of a diet, they crowd out the beans, colorful vegetables, and fruits that are packed with nutrients, she says.
Does a Keto Diet Help People Lose Weight?
Canadian researchers evaluated numerous studies comparing the keto diet with low-fat eating plans in research published in 2018 in Canadian Family Physician. They found that when only high-quality studies were assessed, there was no weight loss difference between the two plans.
Another review of research on keto, published in March 2020 in Reviews in Endocrine and Metabolic Disorders, assessed very-low-calorie ketogenic diets, for which people dropped their calorie intake substantially. It found that such a diet did help people reduce their body mass index and waist circumference, total cholesterol and triglycerides levels, and blood pressure. However, such severe calorie restrictions are not typical of most keto eating plans, and the researchers could not assess whether the keto aspects or simply the huge drop in calories was behind the results.
Does Keto Help With Fluctuating Menopausal Hormones?
No studies have looked at whether keto helps with estrogen levels and other menopausal hormones.
Some people on the diet say that their hot flashes and other menopausal symptoms are helped, but others complain that the diet makes these worse.
At the start of the diet, people often exhibit symptoms that may be similar to those of menopause. Known as the “keto flu,” this can include headaches, fatigue, sleep problems, and heart palpitations.
Some women worry that keto can trigger menopause, but there is no research or evidence to suggest that.
RELATED: Predicting How Long the Menopausal Transition Will Last, and When You’ll Reach Menopause
Keto Diet Safety Considerations for Menopausal Women
Heart disease is a serious issue for midlife women, since once women pass into menopause, they lose the heart protection that estrogen provides.
That’s why a keto diet that allows eaters to consume high amounts of saturated fat seems especially dangerous for midlife women, Taub-Dix says.
Experts caution that eliminating food groups and eating small amounts of vegetables and fruits could lead to nutritional deficiencies if the diet is followed for a long time.
And because of its lack of fiber, many people on keto suffer from constipation.
How Long Can You Stay on Keto?
Most studies of keto follow dieters for a limited period of time, meaning there isn’t good research on how long it is safe to eat this way. Experts typically recommend that people who want to try this diet view keto as a short-term way of eating rather than a lifelong eating plan.
That’s another of its downfalls, Taub-Dix says. The best diet “should be able to fit into your life permanently,” she says. “This is not that kind of diet.”
The Bottom Line: Is Keto a Good Diet for Women Around Menopause?
You may drop weight on a keto diet, but a better approach may be to eat a healthier diet with few processed foods. Taub-Dix and many nutritionists prefer the Mediterranean diet.
Exercise Is Crucial for Weight Loss
Santoro emphasizes that there is no magic diet that will banish weight for menopausal women. For women of this age or any age, “the best thing that helps prevent or mitigate weight gain is physical activity,” she says.