Meet Mark

Let me introduce myself. My name is Mark Sisson. I’m 63 years young. I live and work in Malibu, California. In a past life I was a professional marathoner and triathlete. Now my life goal is to help 100 million people get healthy. I started this blog in 2006 to empower people to take full responsibility for their own health and enjoyment of life by investigating, discussing, and critically rethinking everything we’ve assumed to be true about health and wellness...

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July 11 2018

Keto for Women: 7 Tips to Make it Work

By Mark Sisson
121 Comments

Keto is exploding. No longer solely the province of cutting edge bodybuilders or longevity enthusiasts and neurodegenerative disease warriors, keto has invaded every walk of life. I hear about it in grocery stores, coffee shops, spin classes, business meetings, dinner parties, morning talk shows. Judging from our blog and sales metrics, women make up the largest group of recent entries into the diet. This is great, but it also comes with a small wrinkle: Just like they should do with fasting, most women need to take special precautions when implementing a ketogenic diet.

To begin with, one of keto’s main benefits is also its biggest stumbling block for women: The inadvertent reduction in calorie intake and massive increase in satiety.

It’s the quality that makes ketogenic diets so effective for weight loss, particularly in the obese and severely overweight. And that satiety, that provides a psychological boost. You’re not just not hungry. You’re not hungry because you’re consuming your own body fat. You eat fewer calories than you were because all the food is coming from inside the house. That’s powerful, and it perpetuates itself, leading to even more weight loss and making keto that much more sustainable.

But it’s a double-edged sword. Premenopausal women have a greater sensitivity to reduced calories than other human variants. As I said previously

Biology cares most about your fertility. Can you reproduce? Can you produce healthy offspring that survive to do the same? It’s not fashionable to say it, but it’s the truth: Physiologically, ancestrally, evolutionarily, these things come first.

And from that perspective, a woman’s situation is more precarious than a man’s.

You have a finite number of eggs, or “chances.” Men have an almost infinite supply of sperm.

When you are preparing to get pregnant, your body needs extra nutrients to build up a reserve and “prime the pump.”

When you are pregnant, the growing baby needs a reliable and constant stream of nutrients for almost a year. After a man gets someone pregnant, his biological involvement with the growing baby is done. What he eats has no impact on the survival of the growing baby.

After you’ve given birth, the growing newborn needs breastmilk. To make that milk requires additional calories and extra doses of specific nutrients. Modern technology allows us to skip nursing and go straight to the bottle, but your body doesn’t “know” that.

It all points to women being more finely attuned to caloric deficits. For example, women’s levels of ghrelin, the hunger hormone, are quicker to rise after meals. They get hungry quicker.

This isn’t just relevant for parents or parents-to-be. Even if you’re not interesting in getting pregnant and having kids, or you have children and aren’t planning on any more, the ability to do so is strongly connected to your health. Reproductive health is health. As far as your body’s concerned, having kids is the primary goal and you need to be ready to do it as long as you’re able.

With that in mind, how can we avoid the common pitfalls women face on keto?

Luckily for you, I have a team of brilliant women with a ton of keto experience. We put our heads together and came up with some suggestions:

1. Eat Extra Fat For the First Week…Or So

This has three effects:

First, it upregulates construction of your fat burning machinery. It hastens the adaptation of your mitochondria to the new fuel source by boosting AMPK.

Second, it helps ensure you aren’t working from a caloric deficit. This sends your body a signal of abundance, which means it won’t dive into metabolic conservation mode and hang onto fat stores for dear life.

Third, it gives you a psychological boost. It’s a nice way to realize that you can eat more fat than you thought useful and still lose weight and experience health benefits. It also helps break through the psychological barrier many of us have with eating fat, thanks to growing up in the “low-fat-everything” era. Giving yourself permission to eat a lot (maybe even “too much”) fat at the beginning swings the pendulum strongly in the other direction so it can settle comfortably in the middle where it belongs.

This big increase in fat shouldn’t stay unless you’re trying to gain weight. As you get better at generating and burning ketones and, later, body fat, you can start chipping away at your own adipose tissue and reducing the amount of dietary fat. Continuing the extra fat intake, however, may be important for those who are underweight or who are using keto therapeutically. This may go for any of us though: if you’ve been eating a low-fat diet up until now, a seeming “big increase” in fat intake might just help you attain what would be considered normal keto levels.

Make sure you’re eating the particular fats that boost AMPK (which builds fat-burning mitochondria):

  • Marine fat high in the long chained omega-3s EPA and DHA.
  • Extra virgin olive oil rich in polyphenols.
  • Palmitoleic acid, an omega-7 monounsaturated fat. Best sources are the everyday staple foods like whale blubber, sea buckthorn berries, and anglerfish liver. Oh, and mac nuts.

2. Don’t Try To Restrict Calories

Remember how a a major benefit of keto is inadvertent calorie restriction? Don’t try to double up by restricting them further.

Look. If you’re not buying this, give me three weeks. Three weeks of ad-libitum eating. Don’t gorge yourself. Don’t put a stick of butter in your coffee just because. But don’t calorie count. Don’t weigh and measure.

Eat to satiety. Eat until you’re not hungry anymore.

Don’t eat until you’re bursting.

It’s not a fine line I’m talking about here. You have a lot of wiggle room between “undereating” and “gorging.” It’s closer to a wide walkway. Most people eating a basic whole foods Primal keto diet won’t have trouble staying between the lines. Trust that your subconscious systems will regulate calorie intake for you.

Don’t try to override the system. Give it a chance to work.

3. Fasting Or Keto: Choose One

Even many men, who tend to be more impervious to metabolic insults, suffer when combining extremely low carbohydrate diets with intense fasting or constantly compressed eating windows. Their calories get too low, too quickly, for too long.

The point of keto is to boost fat burning. The point of fasting is to boost fat burning. When you boil down to it, they’re shooting for very similar things. Combining the two seems like it would supercharge the benefits, and it often can, but that’s not always the case—particularly for women, particularly right when you’re starting.

Besides, if you throw both of them in at once, it becomes hard to disentangle the various inputs to determine what’s causing the harm (or benefit). Introduce one major shift at a time—fasting or keto—and give yourself a clearer view of the situation.

4. Avoid Nutrient-Poor Fat Bombs

Fat bombs can be helpful allies for hard-charging keto athletes who need as many calories as possible just to maintain homeostasis. Those folks usually achieve adequate micronutrition due to the sheer volume of food they take in, so there’s “room” for spoonfuls of coconut oil and shot glasses of olive oil. If that doesn’t describe you, don’t do what they do.

If you’re going to do a “fat bomb,” make it as nutrient-dense as possible.

  • Egg yolks, soft boiled eggs, egg salad (2-3 hard boiled eggs chopped up with mustard and mayo)
  • Avocados, avocados chopped up with sardines and topped with Green Goddess dressing
  • Veggie-loaded guacamole: avocados, salt, lime, peppers, herbs, tomatoes, garlic
  • Primal Fuel and Collagen Fuel smoothies
  • Big Ass Salad
  • Seaweed tuna wrap: make tuna salad, wrap with nori sheets
  • Nut butter on celery sticks—add salt if unsalted
  • Olives
  • Couple ounces of cheese
  • Pork rinds (Why aren’t there ever beef rinds? Big Rawhide hogging all the supply?)

5. Don’t Be So Strict

There’s an argument for super strictness at the outset. Sticking with keto for the first 3 or 4 weeks as closely as possible does wonders for fat-adaptation. But once you’re there, you’re good. The fat-burning machinery is built. Your mitochondria are good at switching between fat and glucose. Eating a homemade gluten-free cookie your kid surprised you with isn’t going to derail your entire keto journey. You will bounce back. You will be fine.

After all, the reason we all got into this keto thing is to improve our metabolic resilience. To be able to go off the rails and find our way back without an issue. This is the keto zone I talk about so much (and spend so much time in).

If you’re trying to stave off epileptic seizures, enhance the effect of cancer drugs, treat dementia, or need high ketone readings for any other medical reason, stay strict. Otherwise, don’t be so strict.

6. Sometimes the Best Advice Is the Worst

When the diet “isn’t working,” which of course usually means the person isn’t losing weight, there are three things you hear:

  1. Lower carbs to 20g
  2. Too much protein
  3. Too many calories

However, for a body that is under stress, less isn’t necessarily the answer. Sometimes your body needs more food period, perhaps even more carbs or protein specifically. This is why I cringe when I see people going straight from the Standard American Diet, or even from higher-carb paleo/Primal or the like, straight into hardcore keto plus IF and extreme calorie restriction all in one fell swoop. Your body needs time to learn how to power itself on ketones, so taking away all the food security at the same time can be incredibly counterproductive. And because women are inherently more sensitive to metabolic disturbances or signals of “famine” than men, they need to heed this warning in particular.

7. Beware the Low-Protein Slippery Slope

They say the slippery slope is a fallacy. Maybe in some cases, but I see one example that’s valid: the low-protein slippery slope. A lady goes keto, has poor results. She goes online, asks around, others suggest, “How much protein are you eating?” She drops protein. Gets worse. Drops protein a bit more. Suffers more. Soon she’s eating nothing but Primal Kitchen mayo, mac nuts, romaine lettuce, and a single egg. She’s so ketotic she’s peeing purple drink, yet her symptoms are only getting progressively worse.

Yes, protein is an oxaloacetate donor, which means too much of it can impair ketogenesis. Yes, people whose health requires high levels of circulating ketone bodies must limit protein, often more than they think. Yes, the classic epilepsy diets are very low in protein. But there is such a thing as too low a protein intake, especially for women who tend to eat less protein than men in the first place. Getting high ketone readings isn’t worth much if you’re losing muscle mass, lagging in the gym, and experiencing worse body composition shifts. I mean, what are we doing keto for, anyway?

Finally, going keto can pay huge dividends, but it must be done correctly—and women have less room for error. Hopefully, today’s post offers some helpful tips for making it work. This said, I’ll also offer the reminder that there’s no one version of keto that’s right for everyone (or every woman)—the same with Primal or any other way of eating. Just because your neighbor is drowning everything in sour cream and eating 4000 kcal/day in a 4-hour eating window and calling it keto doesn’t mean that’s what you have to do. Get comfortable with the fact that finding the way of eating that works for you is going to be a learning process. Hone your keto lifestyle with this guidance above—and a healthy dose of patience.

Thanks, everybody. Let me know your thoughts and any questions that come up for you. Take care.

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121 thoughts on “Keto for Women: 7 Tips to Make it Work”

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  1. Mark,

    Thank you for this article. I do have a question though. How little is too little protein? I have been tracking my macros for a while and have a usually less than the recommended amount of protein, should be around 80g but mostly can’t get more then 50g. I do some weight lifting and see some small progress from a week to week but have been wondering if I could get better results with more protein? Protein shakes? Thank you for your insight.
    Schnytlik

    1. I have a hard time, too. I just don’t like protein foods, so I get around 35-40, not enough! I just started adding bone broth protein powder shakes.

      1. Bone broth is great, but it’s not a complete protein. Of course, if your powder also has other protein sources, it might be a different story.

    2. I have the opposite problem. I am having to wwork to restrict my protein to stay under .8 grams per lb of lean body weight.

        1. I know, right? I treat it as a window rather than a limit. I track macros daily, and I’m careful not to dip below .7g/lb. of lean mass often (or I start losing that lean mass!), but as long as I don’t stray regularly over 1g/lb. I’m good. Even if I have one of Mark’s ‘full rack of ribs’ days, I tend to assess things on the average, weekly, monthly, quarterly. Peaks and valleys even out in the longer term. No stress over it.

    3. It’s hard to say what constitutes “too little.” I’d say anything less that 0.5g per pound of lean body mass qualifies, but I aim a little higher than that for a minimum. Protein shakes are an option, but it’s always great if you can do whole foods of course. I know it sounds gross to some people, but blending (raw) eggs into smoothies or even coffee works well (I promise!). Also, if you are practicing a very compressed eating window, it might be a worthwhile tradeoff to extend the eating window and add another small meal. A lot of the benefits of IF are attained once you hit the 12-14 fasting mark according to Longo.

      1. Raw egg whites contain Avidin, which binds Biotin. Avidin is denatured with cooking, so I recommend eating egg whites cooked.

      2. Thank you Lindsey for your answer!
        So I gather I better shorten my IF, which is currently about 16 to 18 hours and/or eat more. That is going to be hard, I am just not hungry and even less after a workout. Hmm.

  2. Question for you Mark (or for someone on your team of brilliant women keto experts): Is this all specific then to pre-menopausal woman only, or does it apply to those of us who have been on the planet for a few more revolutions around the sun and are beyond (and in my case well beyond) child-bearing age as well? Thanks!!

    1. Betty Jo Waxman, thanks for your question. I’ll be covering that question in the next few weeks, so stay tuned! – M

      1. Thank you so much! I went into menopause in my late 40’s but when I turned 60, my metabolism took a nosedive – flatlined, even – so I look forward to what you have to say on this!

      2. Wonderful Mark, I am really looking forward to your insight as well.

    2. Thank you for bringing this up! At 70, I find that a lot of advice simply doesn’t work for me. At this stage of the game, I need to think “health” first and weight loss second. If I dropped ~20 pounds, I’d be a “healthy weight”, but I certainly don’t want to compromise my health for a little weight loss!

    3. Yes, great question. I am 68 and although I need to lose 10 kilos I don’t want to do it by sacrificing muscle as my skin just hangs off me when I do this.
      Thanks for the article. I am one of the women who finds it hard to lose weight on Keto and I fear that I am getting something wrong with my macros. When I read comments on the KTRD facebook page I get even more confused by all the ‘knowledgeable’ advice that quite often is conflicting. Lately I have avoided reading the page unless it’s comments by Lindsay or Michael or other regulars.

    4. Yes, please. I’m almost 67 and do keto/IF but need all th help all can get. Thank you in advance.

    5. I went through the menopause vey very late at 55/56 a few months ago, with hardly any symptoms. I am very very lucky. As soon as I have any sugar I feel hot. If i eat like this (keto or low carb high good fat paleo) I don’t. It’s incredibly direct a co-relation for me.

      My biggest issue is I only need 1700 calories to stay the same weight and I want/need to lose 28 pounds. It is very hard to get a deficit and lose any weight. Even on one meal a day when I can stick to that which I tend to have today at 6pm with just cocoa the rest of the day and a small snack of eggs later I still don’t easily lose any weight.

  3. HI Mark, Really interesting! I love the sequential way you present a topic. I actually commented on this topic (sort of) after the last article. Don’t you think that addressing calcium foods and calcium supplementation is a really really important topic? Think about it, if you take dairy out of your diet of which many of us do, (along with most grains and sugar). or attempt a keto diet…you have to eat HUGE AMOUNTS of other calcium rich foods…every day. I personally haven’t done this in the last 5-8 years…and bone density for me has become a BIG issue..Supplementation and daily yogurt now for me. Wouldn’t this make a great topic for you to unveil since you are so great at it??

    1. I second this. I went paleo ten years ago after I discovered I was allergic to dairy. I now deal with a similar problem and have to supplement (though I keep hearing that’s a bad thing to do). It would be nice to have the topic of calcium and keto (without dairy) addressed.

      1. Calcium needs fat for absorption, unless the digestive tract is impaired, leaky gut, whole foods should be adequate. That being said, many people need whole food concentrates, not so called supplements. There is a difference.

        1. Boron is needed to get calcium into the bones, otherwise it accumulates in joints, soft tissues and organs. Most people have enough calcium, but it isn’t being absorbed in the bones due to mineral imbalances. Checkout the Facebook group Magnesium Advocacy Group for very helpful information on the proper absorbtion of all the necessary minerals.
          .

          1. Vitamin D and K2 are also essential for bone health and calcium absorption. In fact there have been studies showing supplementing just calcium increases risk of heart attack.

  4. Marine fat. Good examples? I have tried to eat sardines, I really have. I don’t know why they repulse me so. Where else can I turn? Safe salmon is just so expensive unless you get canned, and even then, can you trust it? If it’s true satiety I’m going for, a supplement (cod liver oil?) is probably not going to give me that.

    1. Safe salmon? I don’t know what could be the problem with canned salmon, BPA?

      By the way, I love to eat canned cod liver but I’m not sure will find it safe.

      1. Hi Coco
        I was reading just recently that eating canned fish for the omega 3s is ineffective because the canning product damages the oil content. Not sure if this is true but its worrisome ?

          1. Yea, my thoughts, too. Just the processing. Salmon is just getting ungodly expensive and is overfished, too. I don’t think I could eat cod liver. I can’t even look at organ meats. I know that’s blasphemous.

        1. Under no circumstances do I ever buy farmed anything! People think I”m just being picky or overreacting but I know enough about it to just walk on by.

    2. Most canned salmon says that it is from Alaska, and salmon from Alaska is wild, not farmed. Salmon are not large fish and not very high on the food chain and so they are low in mercury. Farmed salmon have sometimes tested positive for various types of contamination but wild salmon is safe. You can make salmon salad similar to tuna salad, with mayo, maybe some dill, etc. Grass-fed (and grass-finished) beef and pastured eggs have great omega 3:6 ratios.

  5. This is great, except for one omission: some women just need more carbs – I was one, and in fact came off keto altogether. I’d been eating a Paleo diet for years when I switched, to see if it would help me shed the few pounds of post menopausal weight which was hanging around, so I didn’t go from a carb heavy diet, by any means. However, I I ran into problems within a fortnight: I have a slightly increased risk of hypothyroidism and I began to show signs of problems. Lowered body temperature, chronically dry eyes, increased fatigue and a feeling of walking through treacle all the time.then dry hair and skin… Eventually I worked out what the problem was, upped my carbs and the change was almost instant.

    Worryingly though, I found that in the group I was in there were women complaining of the same symptoms, but they were being encouraged to keep their carbs below 20g a day.

    Keto is great but we need to be real about a few things – some women thrive on it, and that’s great. But some don’t. Women have a different hormonal profile to men, and as you mentioned above we have increased sensitivity to stressors on the body, due to the fact that during reproductive years we may need to sustain another life.

    So far none of the reasearch done on the effects of Keto has included women. We only know what the impact is on men, over the longer term, and on children thanks to the tracking of those who were put on a Ketogenic diet
    For medical reasons.

    I think it’s really important we flag that keto can be a problem for some women and what signs they need to look out for, particularly if anything in their medical history has increased the risk of hypothyroidism.

    1. I agree! I also have been Paleo for many years ..( back when it was hard to find coconut flour etc) however due to the hormonal changes we women go through( menopause) my metabolism has changed. I have tried keto for over a month, following it to a tee… fasted, counted the macros you name it. I will never see a ketone in my body ever! The strips were always negative or at best the slightest pink, even after drinking those exogenous ketones all day every day!!!
      I think this subject has many more questions/issues…. especially for women like us who have already eaten this way for years.

      1. The strips are inaccurate especially if the body is actually using the ketones for fuel. Blood testing is best or even better is tracking biomarkers: how is hunger, mood, mental clarity, sleep, etc. In the early days of attempting to adapt one will find these markers may be poor, especially if not consuming enough electrolytes. But if keto is working, all of those things should improve after several weeks and the person may also lose weight. If it’s not working, biomarkers will be poor and person should experiment.

    2. I was diagnosed with Hashimoto’s thyroiditis and placed on synthroid. The synthroid definitely helped reverse many of my physical symptoms, but emotionally I never felt like my old self. Since hashimotos is autoimmune I tried to heal myself by going gluten free and following the primal blueprint. I did feel much better physically, but still not my normal self emotionally so I took it one step further and went keto. This did not go well for me. I developed an extremely itchy skin rash that was not the typical presentation of the keto rash. It literally drove me almost insane it was soooo itchy. Doctors told me it was likely due to my hashimotos but when I finally gave in and got out of ketosis (which was harder than I would have thought), my rash went away. Also while on the keto diet, I did not have a period for a year until I went out of ketosis. I definitely learned that every person’s body is unique in regards to what percentage of fats, proteins, carbs it needs to function at its best. You really need to realize you should not box yourself into a specific diet, but instead figure out what works best for you and not feel guilty if a hyped up diet doesn’t seem to work for you. Through trial and error I have found what works for me, and it is pretty close to the primal way instead of such extremes like keto.

      1. Hi Danielle. Excellent comment. I have hypothyroidism but is not from Hashimoto’s. Keto is working very well for me. I was prediabetic (A1c was 6.3 about 18 months ago) and when last tested this past March it was down to 5.5.
        We must all discover, often through trial and error, what works best for each of us concerning proper dietary regimens. Glad you found out what is best for you. Wishing you continued excellent health.

    3. I couldn’t agree with this more. I have done keto twice now for two full months. I have gotten so much conflicting advice from “take more electrolytes” to “eat less/more protein”. one person told me I shouldn’t be eating more than 1200 calories a day. It was so confusing and frustrating. I can’t focus when I’m on Keto. It goes beyond keto flu and lasts the entire time I’m doing it. I have finally had to conclude that <20g carbs does NOT work for me right now.

      1. Not that you have to be keto, but if you’re still interested, have you ever tried eating 40-50g of carbs instead of 20g? Many people can eat that much and still be in ketosis, and in terms of what you can eat (and how you might feel), there is world of difference between 20g and 50g of carbs!

    4. Thank you for saying this. Even as a low carb and keto-oriented nutritionist, I’ve recommended to more than one client (both female and male) to eat *more* carbs. Just because everyone “can” do keto doesn’t mean they’ll feel their best and get the results they want while doing it. As stunningly effective as keto can be for such a huge variety of otherwise intractable conditions, we’ve gone too far in the other direction now of demonizing carbohydrates as a whole.

      1. While I really like eating keto, the muscle cramps were getting to me, even after following all the advice of knowledgeable people on the KR Facebook group. Eating more (‘good’) carbs has been the only way that eliminated the cramps. So it’s nice to know that I’m not a ‘failure’ because I can’t seem to follow it 100%.

      2. Thank you for saying that. I work with a 30-year-old guy who won’t touch fruit of ANY kind because there are “too many carbs.” He thinks everyone should be able to eat that way. I feel like I’m missing out nutritionally when I have zero fruit – I mean, blueberries I picked myself ten minutes ago? How can that be bad? It’s hard to explain to a young guy who works out all the time and lives life determined to stay in permanent ketosis that a 62-year old woman has a completely different nutritional need and metabolic composition. There is a prevailing opinion where I work among the keto fanatics that you must stay in ketosis all the time and eating even a small piece of a carrot will automatically kick you out of ketosis. Thank goodness for Mark’s common-sense approach to all of this. He’s one of the few resources that I feel I can trust!

    5. All great points! I cringe so hard when I see people (women and men both) struggling with keto, and the standard advice* is to restrict more and more. I call this the “keto harder” approach, and it can be so damaging, especially for women.

      (*Obviously this is not the advice we give in the Keto Reset Facebook group!)

    6. Agreed. Everyone will be a bit different but I think premenopausal women really need to be cautious with keto. I did it years ago (6 years ago…before it was “in”). I lost a lot of weight but it stressed out my body and my reproductive system entirely shut down. And with so many women of child-bearing age being on hormonal birth control, you probably wouldn’t even know anything was wrong until a later stage. Proceed with caution.

    7. Thank you Sarah!

      Agree totally, & would love to see Mark explore this topic more.

      I’m a young female & although I don’t do well with grains or most beans, I find I get a host of similar symptoms when I drop carbs to low. Low body temps, incereased fatigue- even a very annoying skin rash. Adding them back (more potatoes, fruit, etc) always relieves it.

    8. Sarah- we have very similar stories! I transformed my life with the Primal Blueprint about three years ago, at age 40. This past year I began to experiment with keto: I reduced carbs and completed longer fasts. I found that my appetite basically ceased to exist, which was convenient and exciting (in my sugar burning days I was always hungry and thinking about food). I often found myself starting the day with fatty coffee and then fasting until dinner. I wasn’t hungry, I had lots of energy for primal exercise, but my clothes began to get tighter. I also started to have crazy PMS symptoms that began on day 20 of my cycle and lasted until day 30. I visited my naturopath to complete blood work. My test results showed off the charts estrogen and basically nonexistent testosterone. My T4 and free T3 were very low and I was diagnosed with hypothyroidism. Long story short, I started a detox protocol (which is basically primal, minus all dairy). My naturopath also recommended three meals a day with at least two servings of starchy carbs. This freaked me out at first, but I have to say I’m loving sweet potatoes and plantains now! And the response from my body has been incredible- I feel lean again (and way less puffy). Of course, I can’t say with certainty that keto and extended fasts caused my hormonal imbalances, but increasing carbs and decreasing IF seems to be bringing my hormones back into harmony. I feel amazing. I am excited to complete another round of blood work after my six week detox. I agree with you Sarah, that keto may not be the best option for all women. I ignored my symptoms for almost a year because I so wanted to embrace keto as a lifestyle. But I’ve discovered that, at this stage in my life, my body prefers the paleo/primal lifestyle

  6. Thank you. Brilliant article. I’m not trying to be keto but I’m struggling to eat enough carbs for even palaeo! But although I lost weight initially that’s ground to a halt in the past few weeks (I’ve been fully primal for 8 weeks now) and my PT told me to eat more. Which is always counter intuitive.

  7. #6 is me right now. I am eating low carb (maybe even Keto), and I’m IF’ing every day (allowing only coffee w/ a splash of cream in the morning). My appetite is finally feeling quite suppressed. The nice thing is that I’m not counting. I am eating intuitively; and at the end of the day, I log what I ate as best as I know how (since I didn’t measure), to just check, and everything seems to be on point with my calories and macros. I train brazilian jiu jitsu several times a week, as well as do HITT style workouts, with strength training on my off days. I usually have a couple days a week that I don’t train.
    My question is, I’m not losing and I’m not gaining – so do I keep doing what I’m doing? Or do I change things up? I feel fine – plenty of energy, and I’m not hungry. If I were hungry, I’d eat. My goal is to lose another 15 lbs, and I love the keto/IF style for me because it works well with my lifestyle.

  8. How about some information about how to make the diet work for post menapausal women? I have tried ardently for over a year to lose 10 pounds without success.

    1. I agree. Until you have been through menopause, you probably won’t fully understand all the changes your body goes through. I have had an extremely bad menopause experience — beginning about 15 years ago. Gone is my tall, slender figure. And how about hot flashes for all those years? I won’t even say how much weight I have gained!

      1. I’m 7 years post menopause, I feel great and I’m maintaining my weight and my figure. I do powerlifting, prior to that I did heavyish weight sessions at the gym. I don’t do enough to cause fatigue and can tolerate 5 gym sessions a week. My muscles are super toned. I eat lower carb – but not keto and am careful about fat intake. What works for me is high protein – 2 – 2.5 g/kg/day. Moderate carb 1.5 – 2.5g per kg day, and lowish fat. I dont add fat except a few nuts or olive oil dressing. With the high protein, I continue to have good appetite regulation and muscle growth and recovery. With moderate carbs, I feel really good, not so good on very low carbs unless I am inactive. I can eat a lot of veg and some fruit which is full of fibre and fills me up and keeps me going. Both weights and a small amount of HIT – usually 1- 4 minute sprints, keep me lean as well. I do take a very low dose of estrogen progesterone which keeps hot flushes at bay and helps weight management.

    2. Me too – it’s a real struggle. I’ve been low carb and IF for 22 months, and very strict Keto for 5 weeks (under 10g carbs on most days and never more than 20), but my weight just yoyos between 55-59kg (my goal is 50-52). I log everything Cronometer allows me 33g of protein – I really struggle with this, and am often hungry, despite eating close to my fat limit. I’m also concerned that the app shows my calcium levels to be chronically low – I’d love to eat more cheese and Greek yoghurt, but these would take me beyond my 33g protein limit. Any suggestions would be great 🙂

      1. Wendy, sounds like a different approach would work a LOT better for you. Check Julianne’s post above – I am a keto-friendly nutritionist, but have found that higher protein intakes for women are much more successful for sustainable weight loss – maintaining muscle mass and regulating appetite. Perhaps 3 meals a day, aiming for that 2g/kg BW protein, no snacking alongside resistance training would be best approach for you. Fat is not that satisfying unless it’s naturally present in a protein source IMO. YOu’ll feel far better on this approach I think :).

        1. Thank you Mikki, I’ll definitely try this approach – I’m tired of feeling starved all the time and seeing limited results. 🙂

  9. Thanks Mark and the talented ladies of your staff… I am post menopausal and this all resonates with me. I’ve been keto for 10 months, staying below 50 grams of carbs most days. … I recently went through a period of stalled weight loss for 2 months. I was more focused on healing acid reflux at the time, but did write what I was eating every day. When I had a chance to really look at my food diary, I was shocked by how little I had been eating. I just wasn’t very hungry in ketosis… I was also having symptoms of electrolyte deficiency… For the last couple of weeks I have really focused on including fat with every meal, getting more electrolytes, and have even increased my protein a little bit (from 50 grams to 70). I’m feeling much better physically and emotionally and have started to lose weight again… These tips you have presented are important reminders to all of us of things to watch out for and also important reminders that we are all different and have to experiment to find out what works.

  10. I did Keto for s wrek got sick the shakes
    didnt have any energy and felt really bad was trying to do it to get my diabetes u deer control can you tell me what I was doinng wrong and why it made me feel that way

  11. Great Article! I’m 44 yrs old and I’ve been tweaking the keto/low carb diet for quite some time to find what works for me…it took me a while to finally figure it out, especially the fact that I work out 5-6 days a week and monthly menstrual cycles, it was a bit tricky… it was worth it! I now have amazing energy, vitality and mental clarity…that I seriously lacked before! I come from a vegan diet(a whole food plant based one) and I was honestly not thriving, nor did I have vitality, and I seem to be aging more quickly.(for various reasons, I desperately wanted to be vegan).
    Thank you for this great article and acknowledging that it indeed keto is different for women vs. men and each women’s individuality matters as well for success.

    1. Patrizia,

      I too was vegan for a time…and vegetarian for over 30 years. Have been paleo/primal/keto for years now and feel amazing…about to turn 52 so I’m a little older than you. Feel free to reach out if you have any questions…sounds like we have a lot in common.

  12. So much good info in here. I am pretty much keto (don’t measure or track) and I don it not for weight loss, just for the improved energy, focus and body composition. Some of the “fat bombs” mentioned are my favorite meals…sardines and avocado is one of my all time faves. Holds me for hours and so quick to put together. Egg salad with primal kitchen mayo is a winner too… I add bacon and tomato and serve on lettuce. So glad you mentioned specific fats to consume, like marine fat and olive oil.

  13. THANK YOU FOR THIS! I was struggling on keto recently and the advice that I was getting was to drop carbs and cut calories, and I felt awful. While also dealing with some hormonal issues I decided that right now, keto is not for me. Not to say it won’t be down the road, but I felt so much better adding in some carbs again and this article was so so SO helpful! I will definitely reference it when I decide to go back down the fat paved road again.

  14. Thank you for sharing this great information.
    I’m 55 and doing the fasting for the 3rdtime this year. Never before and no consideration that shoud be different for woman!
    First fasting in Jan was easy, 5 days eating hand full of food (NO ANIMAL PROTEIN) spreading during the first 2 day. Day 3, 4 & 5 I ate nothing. I felt i didn’t need to eat food ever.
    3 months later I did the 2nd fasting and I was under stress time in my life and as soon i end it started I felt week and i started eating without stop.
    3 more months I’m stress free and on my 3rd day of fasting and being more difficult than the previous one.
    My question:
    Can I eat animal protein during fasting?
    What can I eat? And how much?
    Do you have more info about fasting for woman?
    Thank you so much in advance 🙂

    1. By the way on my first fasting I lost all the abdominal fat (so that means that my body responded to consume my own fat)

  15. Perhaps another issue to consider for post-menopausal women is the gallbladder issue. After going veto, after years of primal/paleo, my gall bladder started talking to me when I went keno. Not fun.

  16. Just wondering who has whale blubber, sea buckthorn berries as “staple items.” And where the heck do you find that?

  17. Great article! Thank you. And, yes, I get so tired of those “everyday staple foods like whale blubber, sea buckthorn berries, and anglerfish liver”. ?

  18. I am female, with low body fat%. I got into keto via low fermentable carb diet for IBS/SIBO. It’s been hugely helpful in that regard, however I have been plagued with frequent nightly waking due to painful glutes which develop knots. I’m pretty active every day, yoga, Pilates, walking and running. Could the night time pain be related to keto and being underweight?

  19. This is very true that Keto invaded every walk of life. It becomes a fitness mantra for many people. The above-described tips for the women on Keto is really appreciable. Thanks for sharing this.

  20. Mark – first, bless you and your mission to get the truth about food out here! I truly rely on your expertise.
    I am a 57 year old woman, definitely post menopausal. Very active – walk a lot, do HIIT a few times a week, lift heavy things. I’ve been “doing keto” since January of this year. (Came off of a few years of crappy grain free carb eating) Lost 15 pounds right off the bat, felt great, more clarity and energy – all of the promised benefits of keto. About 5 months in – the stall. Losing inches but no weight, and starting to feel hunger (What??!!) again. SO confusing this getting the macro thing right. Have been on vaca for the last 2 weeks – still eating Primal, but haven’t worried about carbs AT ALL. Eat what (still Primal) and when I want. Seemed to be what my body wanted as I have lost a clothing size in 2 weeks!! WTH?? Don’t want to continue eating this way as I fear the weight will creep up again. How to do this and not lose my mind and be super focused on macros?? Aarrggh. I LOVE this way of eating, it has been the best and easiest way of all the ways I’ve tried. This I can do for a life time, rather than a period of time. But I know somehow I need to tweak it. Just don’t know how!!

  21. Mark, I’m really glad that you’re covering more about women’s health, me and other women here definitely appreciate it. However, I’m worried that you seem to be pushing a too strong stance against women doing keto or IF without anything substantial to back it up.

    Yes, it’s a simple fact that women’s reproductive activities are quite energetically expensive. (But things like warfare and large game hunting need a lot of energy too, I imagine…) But, first of all, women are not pregnant and breastfeeding all the time. Even hunter-gatherer women weren’t pregnant or full-time breastfeeding every year of their reproductive life (apparently !Kung San women were found to have such high activity levels that they weren’t ovulating regularly, but still had their period, and no negative health consequences. It makes sense that women’s bodies would be able to “shut down” fertility in unfavourable condition to wait for better ones) An average woman today only has 1-2 children. It goes without saying that women’s bodies operate very differently in a non-pregnant state compared to pregnant or lactating state. Metabolism, digestion and caloric requirements are just a few of many differences. It seems logical that a pregnant woman would be more vulnerable to the effects of fasting or caloric restriction, but there’s no reason to believe that a non-pregnant woman’s body would react to those deficiencies by freaking out as if they were pregnant and every single calorie was most precious. Except this isn’t even the case with pregnant women – most of them spend much of the first three months in some degree of involuntary food deprivation, and both their babies and themselves still fare fine. Due to many reasons I’m not convinced morning sickness (at least in the form that most women today experience it) was a thing hunter-gatherer societies, but it’s obvious that pregnant women can be quite resistant to food shortages when need be. And not getting enough extra calories while breastfeeding doesn’t seem to impact women’s health negatively, they simply stop lactating.

    However, I won’t deny that in general pregnancy and lactation does come with higher energetic requirements and more risks. And this is exactly why women have evolved some adaptations to help with that. Women naturally have higher body fat percentage, lower metabolism and a harder time losing weight. That study with mice you mentioned in the post about women’s fasting, it showed the females lost less weight than the males. And, contrary to what you described, far from being unaffected, males experienced most of the same negative effects that females did (and that ovarian weight loss was statistically insignificant). To be honest, your research game on that post was pretty weak, which I found strange because usually you’re very good at this. Comparing results of fasting between a group of male weightlifters and a group of overweight sedentary women wasn’t the best choice for comparative analysis; and even so, those women didn’t suffer any negative consequences. On top of it all, one huge flaw with all those studies is that fasting results in a severe caloric restriction, which is obviously bad if not needed, but that doesn’t tell anything about the results of fasting alone, without caloric restriction. After reading that post, I’ve checked out all the research on sex differences in fasting I could find, and there was no consensus that fasting affected women more negative than men. Most studies showed at least mild improvement for women of all ages.

    If anything, I’ve found some research indicating that women are actually more resistant to caloric restriction. Turns out women’s bodies prefer to burn fat rather than carbs or protein during workouts, especially endurance workouts, as well as in response to increased adrenaline. This is one of the reasons why women show an advantage over men in ultra-endurance sports, when the distances get so extreme that men’s cardiovascular and muscular advantages fall behind women’s metabolic and fatigue resistance advantages. And there are multiple studies showing that women of all ages are more likely to survive famines. Starvation affects them differently on cellular level, it causes less oxidative stress than in men. We know women still kept having children the midst of famines, wars, even in concentration camps. If women’s bodies and their fertility were really so fragile, we would have gone extinct long ago.

    Yet this view that keto or IF is harmful for women seems to be very prevalent, I’ve seen many blogs repeat it.. It’s sad that this misinformation is probably scaring some women away from what could be a very beneficial experience. I’m not sure where this idea comes from, other than the general old sexist idea of women’s bodies being very delicate to any hardship. Sure, I’ve seen lots of women say keto and IF made them feel worse, but I’ve seen plenty of men say the same.

    I do have some theories why women really might have a harder time. From what I’ve seen, women are on average more scared of fat, salt and calories than men. I think it’s because women are more health-conscious than men in general, so it’s harder for them to overcome conventional nutrition programming they’ve been fed for years. That’s how I felt too. When I first started keto, I did feel worse, was almost ready to quit until I read some advice and realised my mistakes, and from then on it’s been awesome. Keto can be unforgiving if done wrong. Everyone who tries it needs to be cautious, both men and women, but there’s no proof that keto poses some inherent danger for only women and not men.

    Anyway, I’m not saying all this to dissuade you from writing about women’s health, it’s great and I think you’ve done a very good job so far, with what little information is available. But none of us are immune to biases and misinformation. In the meanwhile, I certainly hope we’ll see women included in dietary research more often. Maybe you’ll turn out to be right and I’ll turn out to be wrong, but right now let’s not scare women off keto or IF but instead teach everybody how to do it right so they’re more likely to reap positive effects than negative ones.

  22. I am a 51 y/o woman. When I started going Keto, my hot flashes went off the charts in frequency and intensity.
    Any advice for that?
    Also, it’s worth mentioning that I had to drink massive amounts of water and mineral supplements to avoid dehydration. This and the hot flashes lead me to add in carbs – just a little.

  23. Excellent article, great information I’ll be studying and incorporating into my life. Thank you , Mark, for addressing the needs of women, it’s all too rare in the areas of health and medicine, and we appreciate you!

    I’m newly diagnosed with hypothyroidism , really subclinical, tsh was 3.26. I was put on Armour 30mg two weeks ago. I was also continuing to IF 16/8 and eat Primal.

    Last Friday I passed out while riding in a car, unconscious for approx two minutes. All scans, labs normal. I was in the 16 hr part of my fast. I think it was the med Armour, effects of, and have discontinued it. No fainting since.

    My questions are should I stop IF? Fainting likely related to blood sugar. In fact although fasted my blood sugar when EMT took it was 116, normally around 80 fasted.

    Anyone with similar experience, suggestions? I’m 63, fit and until recently in great health. Thanks!

  24. Sorry to intrude. I was reading this for my partner sisters etc.

    Pork rinds are not a good “fat bomb” at all. This seems to be a common misperception. One serving contains only 5 grams of fat to 9 grams of protein. Cracklings are slightly better at 6 to 9. I use them on hard days when I need extra protein, and even then I often have to spread them with or dip them in fat (lamb drippings or tallow or chocolate or lard) to not throw myself way out of wack. Homemade crackling made from the skin of your choice may be somewhat higher in fat, if you are careful cooking them, but they will still be high protein as well. .

    Tuna (5 grams fat 14 grams protein) and anchovies (1 gram fat 4 grams protein) are even worse, though you can dress them up with mayo, avocados, or what not to correct that.

    I’m not saying these (and other items on the list of recommended fat bombs, like a salad (really? a salad???)) aren’t good foods. They just aren’t going to correct your macro problem when you are coming up short of fat for the day.

    Sone good sources of fat not mentioned on your list include: coconut oil, pig cheeks, 100% cacao chocolate, butter, ghee, lardo, homemade sugar free ice cream, or just cream (add it to tea or another drink if you don’t like it straight up) coconut cream for those who can’t take dairy or just for variety, maybe bacon if it’s from a fattier heritage breed and not cooked until the fat all renders out, or give someone else the crispy strips and go for the right drippings, hot makes a good dressing cold use as a spread, use on salad, cooked greens, meats, fish, oh yeah, or pork rinds. (;

  25. Now, I know the metabolic system is very complex, but I have a question as someone who Coaches Macros, but who personally does Keto: is the affect of Keto on weight loss purely a calorie deficit due to increased satiety? It seems to me like you would lose the same amount of fat on a calorie restricted diet BUT keto improves energy during that deficit and makes life/training easier. (Not to mention health benefits). I love being Keto, but i just wonder what the science behind this is. Is it different for everyone or is it just black and white like energy in vs. Energy out?

  26. Great info. Talk about a 50+ yr old woman, no longer menstruating, hot flashes and night sweats, fit, and on no Rx drugs. Slight, but noticeable, change in subcutaneous adipose. This is me, of course. I was in ketosis and using IF. My FM Doc told me to stop, as I was basically starving, according to all my blood and urine tests. Her rec was that I eat more. So I have gone back to eating WHEN, instead of placating that hunger longer, and I do feel better, regarding energy. No wt gain. Just subcut adipose that I am not used to. She thinks it’s bc of overkill as mentioned above: cholesterol numbers were very high also. So I am a prime example of what not to do as the blog mentions: keto and IF. Plus, I was working out with HIIT during the fast. Now, I still eat keto, and allow occassional carbs(potatoes, not grains), I have backed off the strict intensity, eat more, and feel better, happier.

  27. “women’s levels of ghrelin, the hunger hormone, are quicker to rise after meals. They get hungry quicker” – Can you tell my husband this? He can never understand how I’m “hungry already”. That explains things!

    This list was so helpful. I have been struggling with the attempts at keto and how to make it work for me. My first instinct was to eat as much fat as I wanted to in order to feel satiated the first few weeks and I guess I was on the right track. Going to have to plan another shot at this!

  28. Hi Mark. Am 63 years of age, have achieved my goal of shedding 20 pounds on Keto, energy is through the roof, have never felt better in my life. Looking to shed some more fat around hips and lower abdomen. Exercising at low to moderate level 6-7 days per week. Just began doing wind sprints every 7-10 days. Adding bodyweight/light kettlebell workouts soon. Any suggestions as to how post menopausal women can gain some muscle mass? Mine is good but want to maintain and gain a bit more mass.

    Thanks much for all your hard work. You are terrific!

  29. “Sometimes the best advise is the worst.” I’ve learned this the hard way. Being a woman with PCOS it’s even more true. I have to be extremely careful what I ask my body to do because the outcome may not be what I expect. I wasn’t necessarily keto just low carb/paleo and lost 130 lbs with not effort, no calorie restriction. When I started to plateau I pushed too hard with extreme carbohydrate restriction then calorie, mostly because of the extreme saitety. Now I am hypothyroid with elevated reverse t3. My body saw itself as starving and put on the brakes. Now I am almost 50 lbs heavier on meds and trying to learn all over how to eat. Keto is a powerful too and with that power there needs to be more understanding.

  30. I tried keto for about a week after I had my second child. I was only 7 weeksish postpartum. Within the first week I noticed a shift in my milk-supply pretty bad. It may have been too early to change my diet or reduce carbs, perhaps I did it too dramatically. I was making sure to eat around 2000ish calories per day. As soon as I ate more carbs again, my milk supply went back to normal within a day i’d say.

    I’m about 7 months postpartum now, the primal approach works best for me during the child-birthing and milk-making. Maybe I just really like roasted root vegetables too much and my body knows :L

  31. I would like more information on keto for postmenopausal women. I’ve been keto for a little over a year. I consider myself keto adaptive because if I go off the rails I can get back into ketosis quickly. My concerns have more to do with drops in energy and combatting joint inflammation. How much protein should I eat and how much is too much? What do you think of MCT oil? Is there any research on the effects of keto and the best way to follow keto for a former athlete who is postmenopausal? I am a 64 years young woman and would like to see my part of the tribe addressed. Thank you.

  32. For me, keto does not work (female, 40s). I was already paleo-primal for months when I went keto, and it still took my thyroid down. I didn’t recover for months.

    I personally thrive in medium fat, medium protein, medium carbs. Overall, about 100 gr of net carbs per day. Which is Primal. My ancestry is Mediterranean, and we pretty much never go keto in the winter, not even in the ancient times (like northern Europeans usually did). So genetically, I’m not adapted for it.

    My husband, who’s northern French, while he wasn’t even Paleo, he does great with high fat. For me, it just doesn’t satiate me. It makes me sick to my stomach if I eat too much of it, but doesn’t satiate me.

    Overall, I think men do better with keto than women do. Women do need the carbs evolutionary-speaking in order to produce offspring.

    As long they’re not pregnant, and not Northern, keto might work for women 2-3 months in the winter. The rest of the time, just Paleo-primal.

    1. This is so interesting to me. I also was doing fantastically with primal but then keto didn’t seem to play well with my thyroid. My naturopath wasn’t surprised at all. She said she has been seeing a lot of women with the same experience. I wonder if it’s mostly women in our age group…?

    2. Eugenia,

      I found the exact same thing when I went KETO for a bit earlier this year. I saw increases in fitness but regressions in body composition. I tend to do best when I am almost even across the board — 70ish/70ish/70ish. I, of course, go my averages, and I do a re-feed once a week. I AM going to try to re-look at KETO with these tips in mind, having found myself in another fitness/weight-loss plateau.

      But I hear ya, Sister!

  33. Hi Mark,

    An excellent post! My wife started down the keto journey (after I was on it almost two years) and experienced some of the issues. We both quickly figured out that we each need to fine tune our food intake – an ongoing adventure!

  34. I am so needing this article. The struggle is real. Initial weight loss of 3 pounds and then up 1.5 pounds and then back. Week 2 and nothing. Not crazy on calories, working out a lot, lots of water, mag supplement. I do not understand. I feel pretty good. Urine ketone strip confirms ketosis. So frustrating.

  35. FANTASTIC article. I did a KETO experiment earlier this year and found that — outside the first week or so — I did not experience great results, at least body composition-wise. My fitness increased — faster sprint times, better run times — and I certainly became fat adapted. But the lower levels of carb and caloric intake left me TOO much in a deficit for my activity levels. When I bumped up the carbs and calories, I started to see better body composition.

    That being said, I have hit yet another plateau (hey, we fitness professionals hit them, too….and if ANY CPT or Coach tells you they don’t, they’re lying!) and am looking to switch things up a bit. In my blog, I had surmised the same things pointed out above with regard to my lack of OVERALL success with going KETO….but now that I see these tips, I am going to take another look and see what I can do!

    It is frustrating to work so hard and see results….and then regressions….or hit a plateau. But it IS motivating to find new ways to do things, learn more, and find a way out of a slump. This has made me a better coach, and reading an article like this renews my motivation (because, let’s face it: don’t you LOSE a bit of motivation when you stop seeing gains?).

    I have shared this post with my readers….and I am so excited to have stumbled across it! As always, thanks, Mark, for a great, thoughtful, and helpful post!

  36. Interesting article, I’m 47 and perimenopausal. I used to do harder fasts on the 5:2 diet (eating 450cals 2 days a week) but just couldn’t do it once I hit perimenopause -it was definitely a stressor! I usually do intermittent fasting by eating in a 6-8hr window, which I find easier. But will eat breakfast if I feel I need it, which sometimes I do. I’ve read lots of confusing views on how much protein or carbs you should eat, but I probably hover on the edge of keto and eat between 30-50g carbs most days, usually nearer 30g. I most definitely need to eat enough protein and it needs to be around 60-70g really. I think it is a case of listening to your body and adjusting to what works for you.

  37. I went ketogenic two years ago to address menopausal and sleep problems. It worked tremendously well/flawlessley until I and ended up with a tremendously bad histamine response about 45 days in. It took me 5 months to figure out. I quickly stopped the ketogenic diet when my symptoms began because it was my only dietarty change (I was moderate carb primal). I lost 20 pounds I didn’t need to lose during those five months. I literally started to turn grey and was incredibly nutritionally deprived. I read that keto and women and histamine response can be linked. Do you have any thoughts? Finally, I used to make and eat ferments like crazy. Can’t touch them now. No more ACV, kombucha, kraut, you name it. Finally, finally, I have learned that when I am triggered ( a month ago caffeine triggered me – I don’t normally ingest caffeine – taking activated charcoal with meals and quercitin between meals for 3 days lets me return to normal and eat anything except for ferments, which is better than battling for months.

    Thank you for your thoughts and hard work!

  38. Please tell me you were joking when you wrote “everyday staple foods like whale blubber and Angle fish liver.”?

  39. HI Mark,
    Thank you for this article. It gave me information I needed about being strict. I stick with your Keto Reset recipes and guidelines and it is working great for me. I am looking forward to using recipes from the Primal cookbook.
    Helen

  40. So, the most basic take-away on this is to find your own balance, depending on your own lifestyle, stress level and maybe even metabolic make-up. What is good for me may not be exactly the same as what’s good for another woman.

    I’m new to this and the information in this article was enlightening and quite helpful. Thank you.

  41. Hello
    need some data/information on paleo/keto for menopause/post-menopause women and the “spare tire” problem

  42. It has taken me years of gradual adjustment to be comfortable with a ketogenic diet. I am horrified by all the literature that implies that you can “go ketogenic” instantaneously!! I think that our bodies develop metabolic habits slowly, and need time to adjust.
    I started by avoiding sweet drinks and candy. After close to a year of that, I was accustomed to it. Then I started to eliminate breads and grain things. That was a long struggle – I was still having occasional backsliding after a year+. Then I began to cut down on fruits, until I was eating less than one piece of fruit in 2 days. What was last? Potato chips. I still have an occasional lapse! (Miss Vickies are my downfall!) But it has been a multi-year adjustment. Now I rarely feel a pull to eat things that will take me out of keto.
    I also think that the fear of a vanishing appetite is overdone. Keto never took my appetite away. It made it more manageable, but if your appetite is gone, I say GET SOME AEROBIC EXERCISE! (Preferably outdoors.)
    Last but not least, I think that any dietary regimen that requires measuring every gram of your food is obsessive. The only reason I follow Primal and/or keto guidelines is because they work without obsessive measurements!!!

  43. These are great. I especially appreciate the focus on the “why” of keto, including metabolic resilience. Going keto isn’t the end but rather, the means.

    Also appreciate the attention to adaptation. When I work with clients who want to try keto, a first step is transitioning to paleo-primal for at least 30 days.

    Lastly, love the call to listen to YOUR body as the gold standard for whether something’s working.

  44. I am wondering if Keto is totally fine to do if you plan on trying to become pregnant in the next 6 months or so. I am very new to keto and love everything I am reading and learning and have been on the diet for 8 days. I do plan on trying to become pregnant with my third child sometime in the near future and wonder if I should have any worry of this diet affecting fertility. Thanks so much!

  45. I really appreciate that you recognize that one diet or routine will not be optimal for every person, that you recognize the differences of individual body chemistries. Thank you.

  46. Hi,
    So in #6 of this article you say “lower carbs to 20g.” Is that NET carbs?

    Thanks,
    Kim

  47. Thank you for this article. It makes perfect sense. I am 47 years old and am about 11 weeks on keto. I’ve lost about 15 lbs which seems slow to me. I’ve been doing IF and when I count my macros (which is most of the time) I noticed I’m only eating about 3/4 of the recommended protein and calories. Some days I only eat 1200-1400 calories or less. I’m just not hungry anymore.
    I try to stick to more of a primal keto.
    I thought it was a fluke but your article confirms it.
    I have noticed when I have lost weight the best is after feeling like I overdid it wven though I was right at or barely over my recommended macros.
    When do IF, and stay way below my macros I feel get in the scale thinking it’s going to show a loss and nothing.This goes in for DAYS.
    The problem is, I’m just not hungry, it’s really hard to eat more than one meal a day (with snacks of cheese or uncured pepperoni, nuts in-between.
    Guess I’d better get eating!

    1. Thank you for this article. It makes perfect sense. I am 47 years old and am about 11 weeks on keto. I’ve lost about 15 lbs which seems slow to me. I go for long periods of time without losing anything.
      I’ve been doing IF and when I count my macros (which is most of the time) I noticed I’m only eating about 3/4 of the recommended protein and calories. Some days I only eat 1200-1400 calories or less. I’m just not hungry anymore.
      I try to stick to more of a primal keto.
      I thought it was a fluke but your article confirms it.
      I have noticed when I have lost weight the best is after feeling like I overdid it. Even though, I was right at or barely over my recommended macros.
      When do IF, and stay way below my macros I feel get on the scale thinking it’s going to show a loss and then nothing.This goes on for DAYS.
      The problem is, I’m just not hungry. It’s really hard to eat more than one meal a day (with snacks of cheese or uncured pepperoni, nuts in-between.
      Guess I’d better get eating!

  48. I don’t necessarily disagree with anything you have said, but it has been my experience that it wasn’t /isn’t difficult at all for me (obviously I can only speak for myself and my experience) to do IF and Keto and restrict calories to a healthy level (i.e. 1800/day) all at the same time. I do understand the importance of making slower changes to the body but I would be careful of actually going too slow at changing one’s diet or even making excuses (because I can see the excuses now and in 3 months everyone will be complaining that keto doesn’t work for them but they never really did it right).
    I simply use a macro tracker and plug in the macros that I want to use, read labels and eat mostly like anyone else. I think the most difficult thing for people is to get used to actually paying attention to what they are eating, reading labels and understanding them and just the sugar /carb cravings in the beginning in general (which, btw y’all if you continue to use a sugar substitute whether it is ‘keto friendly’ or not, you will continue to always have those cravings. I didn’t add any sugar or substitutions in until after 3 – 4 weeks on keto and now I still only eat berries on occasion and use monkfruit for cooking /baking special things (mostly for others as I personally prefer less sweetness now) but never at a 1:1 ratio for sugar because everything is too sweet now.
    Another thing you have to be careful with is trying to eat to satiety. If one is coming from the SAD, their body is likely not going to know where that threshold is. I know you pointed out the difference, but it isn’t easy for some people to be able to tell if they are full or even distinguish between being hungry or thirsty. It is an unfortunate side effect of the SAD and our society’s attitude toward food in general. I would say, try to stick to your macros and if you are still hungry try to figure out what is lacking (protein or fat or water, electrolytes, micronutrients, etc.) or are you just in a habit of eating either because it is what you have always done at a certain time or you are bored, etc.
    And for the love of yourselves people, use common sense. Every recipe I see says to use heavy cream. Gobs of it. There is nothing wrong with heavy cream if you need the fat or the texture, but half and half has the same amount of carbs (depending on how much you use– read the serving sizes people!!) but you save in calories and fat that you can use elsewhere in your diet, like for real food such as a steak or piece of fish. I know people love their bulletproof coffee, and do what you want, but think about it first, do you really want to drink 500 calories and 60 grams of fat (which for me. Is half of my fat for the day) first thing in the morning? And then try to fit breakfast lunch and dinner in on top of that? That will make one’s weight-loss journey a lot more difficult in my opinion, but hey that might work for someone else. Also, you can stall your progress by eating too much dairy. Just use common sense y’all! You can do it!!

  49. I am a diabetic on insulin. I have been “Keto” for almost 3 months and have lost only 10 pounds. I am not hungry and feel good. I eat romaine salads with shrimp and hard boiled eggs, olives and tomato with Good Seasons dressing (made with olive oil and rice vinegar) often. My protein intake is good.
    Exercise is little due to a torn meniscus.
    Is it the insulin? Low exaercise level? Please HELP

  50. Did Mark answer the question about women who are already in menopause? And if so, could someone point me to it please and thank you.

  51. I began keto to treat my epilepsy, and was referred to a dietician who set my fat and protein macros at equal amounts. Granted I run 5-6 miles a day, but this myth that protein can throw you out of ketosis is just that, a myth. The body does not work that way, and decreasing your protein amount to the extent that many do is just delaying your progress. Don’t be afraid of protein. Use it to your advantage. It will keep you fuller longer, and has less calories per gram than fat (fat=9, protein=4), so you can have more of it. It WILL NOT interfere with your ketone production or ketosis in any way.

    https://perfectketo.com/how-too-much-protein-is-bad-for-ketosis/
    .