Women may respond differently than men to the ketogenic diet, and more women than men report that it doesn’t work for them. “Anecdotally, about half my female patients do great with keto; half don’t,” says Sara Gottfried, MD, author of The Hormone Cure. “I’m still trying to understand why that is, but it may relate to sex hormones, stress levels, or electrolytes.”
For women who do respond to the protocol, key benefits include mental acuity, improved satiety, and weight loss, though women don’t tend to lose weight as fast as men, she says. That may be because higher levels of testosterone give men an overall weight-loss advantage.
Some research suggests that close to half of young women with epilepsy who adopt the keto diet have menstrual irregularities, which may indicate broader issues with how the protocol affects female reproductive hormones.
Women who do respond well to the keto diet appear to do best when they focus on eating clean and green.
“I encourage women to eat very-low-carb diets that are rich in greens, like beet greens, collards, and chard, and to stick to grassfed, free-range meat sources and healthy, plant-based sources of fat, like nuts and olive oil, as well as wild-caught fish,” says gynecologist Anna Cabeca, DO, author of The Hormone Fix. “That is the combo that really works for women.”