Keto and menopause: Does it help?

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The ketogenic or keto diet puts the body into a state of ketosis. This means the body uses fat for energy, turning it into ketones. It then uses these ketones instead of sugar.

To induce ketosis, a person has to drastically restrict carbohydrate intake and replace it with fat. The keto diet typically consists of:

• 55–60% fats
• 30–35% protein
• 5–10% carbohydrates

The exact foods a person eats on the diet can vary. They can consume plenty of fruits, vegetables, and healthy fats while in ketosis, but it is just as possible to eat lots of red meat and saturated fat.

The keto diet may help with reaching a moderate weight, but its impact on other menopause symptoms is less clear.

Impact on weight gain

Some people experience weight gain during menopause, which may be a result of changes in hormone levels and a slower metabolism.

There is no research on whether the keto diet is an effective way to maintain a healthy weight during menopause. However, a large 2017 study of nearly 89,000 females aged 49–81 years compared four diets to see how well they worked. The researchers tested:

• a low fat diet
• a low carbohydrate diet
• a Mediterranean-style diet
• a diet consistent with the United States Department of Agriculture’s Dietary Guidelines for Americans

The researchers found that people who followed a low carb diet had a lower risk of postmenopausal weight gain than other diet types.

However, in this study, the low carbohydrate diet limited carbohydrates to 163 grams (g) per day. The keto diet is much more restrictive than this, limiting carbohydrates to below 50 g.

Impact on cravings

People can experience an increase in appetite or food cravings during perimenopause and menopause. Some research suggests that the keto diet may decrease hunger, which may help with these symptoms.

For example, a 2019 study involving 55 female and 40 male participants with obesity looked at the keto diet and changes in appetite.

Researchers found that following the keto diet for 8 weeks increased levels of the appetite-regulating hormone glucagon-like peptide 1 in the female participants. Interestingly, the levels of this hormone decreased in the male participants.

However, the study did not specifically look at appetite reduction during menopause. The participants’ ages ranged from 18–65, and so included a mixture of pre- and postmenopausal females.

Impact on insulin

During menopause, insulin sensitivity can decrease. Insulin is a hormone responsible for transporting sugar from the bloodstream into cells. If someone does not produce enough insulin, they can develop high blood sugar, which is a risk factor for type 2 diabetes.

The keto diet may help balance insulin levels. Studies suggest that reducing carbohydrate intake can lead to decreased insulin requirements and help insulin sensitivity.

One 2018 study noted an improvement in insulin sensitivity in females with endometrial and ovarian cancer who followed a ketogenic diet for 12 weeks.

There is currently no research on whether the keto diet helps or hinders the balance of reproductive hormones during menopause, so the effects on declining estrogen and progesterone levels are unknown.

No — no diet, supplement, or medication can stop or reverse menopause. It is a natural stage in life that occurs when the body stops making as much estrogen and progesterone.

However, hormone therapy can replace the hormones a person is losing, which can alleviate symptoms.

The keto diet can cause side effects, especially when a person first starts the diet. Many people experience “keto flu,” a collection of symptoms that arise as the body enters ketosis. These can include:

• headache
• irritability
• weakness
• dehydration
• dizziness
• muscle soreness

Following a keto diet can also make it more challenging to consume enough of certain nutrients. For example, one study found that those who follow a keto diet consume less fiber.

People may eat fewer fruits and vegetables in an attempt to avoid carbohydrates, meaning they get fewer vitamins, minerals, and prebiotics. Prebiotic fiber feeds the beneficial bacteria in the gut.

A way to offset this is to focus on continuing to eat plenty of fiber and fresh produce while following the keto diet.

Research on the long-term impact of the keto diet is still ongoing, but studies suggest there are some risks.

Kidney stones

The keto diet may increase a person’s of developing kidney stones. A 2021 review and meta-analysis concluded that the incidence of kidney stones in children who eat a keto diet is around 5.8%. In adults, it is 7.9%.

Cardiovascular health

Some studies have found that the keto diet increases low-density lipoprotein (LDL) cholesterol or “bad” cholesterol.

For example, one small study found LDL cholesterol increased by 39% after 3 weeks of the keto diet. Additionally, 59% of those in the study had LDL cholesterol higher than the recommended level for preventing cardiovascular disease.

Menopause itself increases the chance of developing heart disease, so following a keto diet while going through menopause may compound the risk.

Bone health

Menopause also affects bone health. The decline in estrogen reduces bone mineral density, increasing the risk of osteoporosis.

A 2020 study looking at the impact of a short-term keto diet also linked ketosis with a loss of bone density. The study followed 30 athletes following the diet for a period of 3.5 weeks and found the athletes had decreased new bone growth and increased bone breakdown.

The authors also noted that, even when participants returned to regular diets, their ability to create healthy new bone did not return to normal.

However, most of the athletes in this study were male, with only five females. The average age of the participants was 28. More research is necessary to understand how the keto diet might impact people in menopause.

The keto diet involves big changes for many people, but there are other options that can help someone reach or maintain a healthy weight.

The Mediterranean diet

The Mediterranean diet focuses on vegetables, fruits, and healthy fats, such as olive oil and nuts. It limits saturated fats, red meat, and alcohol.

In the 2017 study comparing the Mediterranean diet with three other diet types in postmenopausal females, researchers found that it was not as effective for weight loss as the low carbohydrate diet, but that it was more effective than a low fat diet.

A 2021 study also found that the Mediterranean diet was associated with higher bone density and muscle mass in postmenopausal females.

Plant-based diets

A plant-based diet involves avoiding animal-derived foods and focusing instead on plant-based foods. A 2018 survey comparing perimenopausal and menopausal vegans, vegetarians, and omnivores found that eating a diet containing more vegetables and less meat aligned with less bothersome menopausal symptoms.

An earlier 2012 study of over 17,000 menopausal females had similar results. Researchers asked 40% of the participants to follow a low fat diet with an increased intake of fruit, vegetables, and whole grains.

These individuals were three times more likely to lose weight and more likely to eliminate menopausal symptoms, such as hot flashes and night sweats.

A ketogenic diet focuses on low carb, moderate protein, and high fat foods. It places the body in ketosis, a metabolic state that encourages weight loss.

The keto diet may help with some symptoms of menopause, including weight gain. However, a keto diet also increases LDL cholesterol, which may be risky since menopause also increases the risk of heart disease. A keto diet cannot reverse menopause and may only ease its symptoms.

Other diets that may benefit those going through menopause include the Mediterranean diet and plant-based diets. People should consult with a doctor before starting any new diet.