Health Keto Diet: Why It Doesn’t Work Well For Women (And How It Does)

Suddenly a dry mouth? What are the causes and what can you do?
The keto diet: the latest diet craze, is mainly intended for fast weight loss. Like so many things, it came over from America to the Netherlands. I see it more and more on social media and I get more and more questions about it in my mailbox. Like Barbara recently. She wrote: “Marjolein, my husband and I are both on the keto diet. He has already lost 10 kilos and feels great. I’m not losing any weight and I feel like I’m getting weaker. How is this possible?” My answer is simple: “Barbara, it’s your hormones!” I explain it to you with love and pleasure.

Keto works very differently for women than for men. It is important as a woman to know this.

What is a keto diet?

In case this is new to you, a keto diet or ketogenic diet is a diet where you eat  very few carbohydrates and a lot of fats . This in combination with an average amount of protein, although this depends on the keto diet that someone is following. There are now dozens of variants of this in circulation.

It originally originated in the 1920s when it was discovered that seizures in children were significantly reduced with this diet. Keto is nowadays mainly used as a diet to lose weight (fast) or to get rid of type 2 diabetes.

Research into the keto diet has mainly been done with children, mice and young male athletes: hormonally, complete opposites of women.

keto diet; how does your body get energy?

The energy factories in your body, your mitochondria, can make energy from glucose molecules (from carbohydrates) or fat molecules. The keto diet aims to make your body use fats for energy instead of carbohydrates.  

When you eat carbohydrates (note: all forms of sweets are also carbohydrates) your body converts them into glucose. This raises your blood glucose level, which produces the hormone insulin, which carries the glucose to your cells. Here it can be converted into energy. An excess of glucose is stored in your fat cells: or extra kilos of weight.

Unfortunately, this energy storage in fat cells is hardly used in many people because the body keeps getting carbohydrates that it can use. This makes losing weight difficult.

All the sweet temptations around us, all the hidden sugars and grains in processed foods and the many carbohydrates that we eat, ensure that our body does not need to use our fat cells as a source of energy.

How does a keto diet work?

When you stop eating all those carbohydrates  , the body has to switch to burning fats. Your body needs energy 24 hours a day to keep you alive. Your brain in particular is a major energy consumer. 

Your brain normally always uses glucose as a source of energy. It cannot use fats as energy. But luckily something else. When glucose is no longer available (3 to 4 days after cutting carbohydrates) , your liver converts fat from your fat cells into molecules called ketones.

Ketones are made in your liver and can be used as a source of energy by your brain and virtually all of your other body cells.

What is ketosis?

If the body mainly uses fats as an energy source, we call it ketosis. Your body then uses both the fats you eat and the ketones that are produced in your liver. A healthy liver can produce as much as 180 grams of ketones per day. This is of course vital, especially during a few days of fasting (or famine!). Doctors discovered 100 years ago that a high ketone level had a very beneficial effect on the brain and nervous system. Hence, children with epilepsy benefited so much from it.

Subsequent studies also showed this diet to be beneficial in neurodegenerative disorders such as Parkinson’s disease, ALS, Huntington’s disease, traumatic brain injury and stroke.

Ketones are excellent food for our brains

Indeed: fewer carbohydrates has many advantages

Let me first say that I am in favor of significantly reducing carbohydrates in your diet! It is not for nothing that so many people feel much, much better when cutting out a large part of the carbohydrates. My nutritional advice for women, The Energetic Women’s Nutrition Compass , is based on this.

The biggest advantage of this is that our body has to make much less insulin and we therefore get a more stable blood glucose. A stable blood glucose level promotes insulin sensitivity and thus prevents type 2 diabetes and obesity. It has a positive impact on heart and blood vessels, it strengthens the immune system, combats chronic diseases and slows down aging. Just to name a few. The benefits are enormous.

In addition: know that cancer cells feed on glucose!

It can also reduce the risk of depressive symptoms and it will no longer surprise you that it lowers your risk of dementia and Alzheimer’s disease. Finally, it is a great remedy for PCOS and hot flashes. Sounds good huh? Why don’t we all go keto? 

Hey? Did female mice actually gain weight from keto?

Many studies are still done with only male laboratory animals. Researchers from the University of Iowa  (1) decided to see if there were any differences between male and female mice on a ketogenic diet.

After 15 weeks on a keto diet, the researchers concluded that the males had lost weight but the females had gained weight.

In addition, the females suffered from fluctuating blood glucose levels while that of the males was stable. How could this be?

The researchers suspect that it was the hormone estrogen and decided to remove the ovaries of some of the females, so that they no longer produce oestrogen. This last group of females subsequently appeared to lose weight and also developed stable blood glucose. (No, I do not recommend having your ovaries removed! These have an important function in a woman’s body, even after the menopause! )

Food has a direct impact on our hormone balance

There are women who (for now) are doing fine on a keto diet, but I also hear women, such as Barbara, who do not lose weight because of it and start to feel weaker. I also hear complaints about heavier and irregular periods. I also read complaints about mood swings and, after initially losing weight quickly, also quickly gaining weight again.

Our female hormone system is so sensitive that any change in diet has an immediate impact on it.

We can use the fact that our hormones are so sensitive to food to our advantage, but it can also work against us. Knowledge about how hormones work in our body is therefore very important.

Keto for women

I made an analysis of why not all women do well on a keto diet. To then see what adjustments are needed to make it workable for women. Keto for women. 

It turned out that the advice in my nutrition program The Energetic Women’s Nutrition Compass fits in seamlessly with this. Logically, I have been arguing for years for the elimination of sweets and lots of carbohydrates and, above all, to put healthy fats on the daily menu. Hormone balance is always my main starting point for my nutritional advice.

Hormonally, a sandwich and a pastry are the same for your body.

What do the guidelines of the Nutrition Compass and therefore of keto for women look like?

Step 1: Keep Your Thyroid Hormone T3 Active

Too much estrogen in the body can hinder proper thyroid function. Many women have to deal with this. This affects the overall metabolism. An underactive thyroid, in particular, can mean that it becomes impossible to lose weight.  Food has a major impact on your thyroid and the active thyroid hormone T3. 

A female thyroid is extremely sensitive. Too much estrogen, too much stress and food shortages have a major impact.

Studies  (2, 3) show that a low-calorie diet but also ketosis can cause a decrease in the active hormone T3. This is the hormone that ensures a good metabolism. These problems did not appear to occur if subjects continued to eat approximately 50 grams of carbohydrates per day.

Women (and athletes too) need a minimal amount of carbohydrates to keep their thyroid hormones active. A too strict keto diet (20 to 40 grams of carbohydrates per day) is therefore not healthy for them.

Step 2: Make sure your body doesn’t acidify

The problem with most keto diets is that they are way too acidic for the body. Female hormones need an alkaline (basic) environment to function properly. So exactly the opposite.

Female hormone balance calls for an alkaline (basic) body.

Meat, fish, eggs, and dairy are often a significant part of many keto diets. These are all highly acid-forming foods. They give an acidic waste in the cells that accumulate somewhere in our body.

By means of simple pH strips you can easily measure the acidity of your bodyI advise you to do this. 

Accumulation of waste products in your body is the main cause of chronic inflammation and aging.

Many acidifying foods also cause a magnesium deficiency, which can cause poor sleep, anxiety attacks, headaches and all kinds of other problems in a woman’s body. In the Nutrition Compass I therefore mention magnesium as a basic supplement that I recommend to every woman.

It would go too far to go into too much detail here. I will soon write an article about the importance of the acid-base balance for our female hormone balance.

Step 3: Get enough fiber

Several women notice that they experience constipation or other intestinal problems when they switch to keto. When I look at the average keto diet, I see remarkably little fiber. Fiber is indispensable to have a good, daily stool. Good digestion is one of the four pillars of female hormone balance.

Remember that fiber is only found in plant products, never in animal products.

If a large part of your meal consists of meat, fish, eggs or dairy, there is not enough room for vegetable products. Therefore make sure that your plate is filled for at least 75% with vegetable products. Vegetables do indeed contain carbohydrates, even lettuce, but these are carbohydrates that you really need. Don’t be afraid of it. Provide plenty of green vegetables and eat some of them raw.

Vegetables are alkaline and therefore also help you to prevent acidification of your body.

Learn to distinguish between carbohydrates that you can really leave out and carbohydrates that your body needs. Women who cut out too much fiber and carbohydrates will sooner or later feel really bad.

Step 4: Don’t eat too much protein

I see eggs with bacon a lot as a keto breakfast. Preferably with a sausage. All proteins. Few people know that an excess of protein in our body starts to behave like sugar; you get a glucose boost from it. That’s exactly what we don’t want. Just like with carbohydrates: not all proteins are healthy.

Too much protein will behave like sugar in your body. Protein shakes are therefore mainly intended if you want to gain weight.

If a diet states that,  based on calories, this consists of 20% healthy proteins, 5 to 10% carbohydrates and 65-70% fats, many people see this as a plate with mainly meat, fish, eggs or cheese with a tuft of vegetables.keto diet

Step 5: Know the Difference Between Long and Short Chain Fatty Acids

Even if you continue to eat plenty of vegetables and fiber, your body may still not be able to handle the extra fats that you will eat on keto. Bile is needed to break down fats. Bile is produced in your liver and stored in your gallbladderEspecially if your gallbladder has been removed , you can have problems breaking down fats.

Diarrhea is often a signal that your body cannot break down fats properly. The nutrients from fats are then not absorbed, which can lead to nutritional deficiencies.

What you can do if your body has trouble breaking down fats is to reduce the long-chain fatty acids (meat and eggs) and increase the medium-chain and short-chain fatty acids (butter, ghee, coconut oil). The longer the chain, the more bile it takes to break it down.

In the Nutrition Compass I therefore advocate the use of medium- and short-chain fatty acids such as coconut oil, MCT oil and butter. I recommend meat in moderation. Grass-fed (or wild-caught fish) of course to minimize the intake of endocrine disruptors.

Step 6: be smart and get your ketones from a jar or bottle too

Even people who fanatically follow a keto diet and try to get into ketosis don’t know that we can also eat ketones directly. In my book Eat more energy I explain in detail how this works.

Certain medium-chain fatty acids in coconut oil, especially C6 (caproic acid), C8 (caprylic acid), and C10 (capric acid) are absorbed directly from the gut into the bloodstream and carried to the liver, where they are converted to ketones. The same goes for MCT oilThese fats are therefore seen as direct food for the brain . (4) You now know why.

Research has shown that consuming 40 ml of coconut oil per day had a major impact on the mental performance of people with Alzheimer’s disease. (5)

Far more women than men are dealing with dementia at an increasingly younger age. That is why I often use these healthy fats in my recipes in the Nutrition Compass.

Step 7: Stress acts like sugar in your body

Being in ketosis is a signal to the body that there is starvation. Even if enough calories are eaten. Famine always means stress for your body . Your thyroid can slow down and this can lead to extra estrogen production, which can lead to heavier or longer periods.

Too much stress causes the body to produce larger amounts of cortisol. Long-term too much cortisol throws your hormones into chaos. Cortisol is just as much an energy source for your body as sugar: you need extra energy when you are stressed. With prolonged stress, your thyroid will also slow down in an attempt to calm your metabolism (read: your pace).

Losing weight becomes very difficult if your thyroid puts a brake on your metabolism.

When I inquired with Barbara, it turned out that she was indeed under a considerable amount of stress: she was in danger of losing her job and was not getting along well with her direct colleague. It didn’t surprise me.

Measuring whether you are in ketosis. Does that make sense?

Whether you are in ketosis can easily be measured with some urine and ketosis strips. I have tried them for you but I find them rather unreliable. If you want to measure whether you are in ketosis, a glucose-ketone meter seems to be  a better option. With this you immediately measure your glucose levels, which is perhaps even more important.

Women generally only enter ketosis if they eat only 20 to 30 grams of carbohydrates per day. As mentioned above, this is not enough to keep your thyroid active. Moreover, if you eat a lot of vegetables, you will quickly get it.

Also keep in mind that there are many factors that determine whether or not you get into ketosis other than diet. Think of toxic substances in your environment and especially stress: your body responds to many more signals than food.

Keto for women?

Having said all that, I still advocate a diet low in carbohydrates and including healthy fats. But not to the extreme and with all the caveats mentioned above.

Keto is not suitable for all women. Especially for women over 40 with an already fragile hormone balance, it is important to be careful. It quickly has an acidifying effect and you may lose weight but you will not become healthier. Women with thyroid disease should consult their doctor and monitor their carbohydrate intake.

Also remember: keto and stress just don’t go well together. Strict keto is stress for a woman’s body.

The positive aspects of keto, for that matter of any diet, can be enhanced by combining it with intermittent fasting. I am a big proponent of this. I can recommend it to everyone, whatever diet you follow. Unfortunately, I don’t read this anywhere with the keto fanatics.

My advice: keep it simple and learn to feel again

Left or right: what matters in the end is whether you feel good/better. There is no diet that can prescribe exactly what you need. You can weigh, add up and measure carbohydrates until you weigh an ounce, but ultimately your body determines what it needs and what it does great on.

Therefore: don’t be prescribed anything and don’t be too stressed about nutrition. Don’t make it too complicated. Keep experimenting and learn to listen to your body’s needs: that’s the winning combination.

What works for someone else doesn’t have to work for you. What works for you now may be different next year.




3. Mathieson RA, Walberg JL, Gwazdauskas FC, Hinkle DE, and Gregg JM. 1986. The effect of varying carbohydrate content of a very-low-caloric diet on resting metabolic rate and thyroid hormones. Metabolism . 35(5):394-398.




Please enter your comment!
Please enter your name here