Why Keto can be a challenging diet for midlife women?

First of all, Ketogenic diet is NOT a weight-loss diet!

It was originally developed  in the 1920s as a medical treatment  to deal with pediatric epilepsy that didn't respond to the epileptic medicine, the anti-seizure ones in the presence of glucose. The primary goal was to reduce seizure frequency by forcing the body into a state of ketosis, where it burns fat for fuel instead of carbohydrates. 

However weight-loss was never the primary intention behind this diet.

But, over time, the ketogenic diet gained popularity as a weight-loss tool. People started focusing on its ability to help the body burn fat instead of carbohydrates, leading to widespread adoption for weight loss and other health benefits, including improved blood sugar control. This shift is part of why it’s often associated with weight loss today, even though its original purpose had nothing to do with that.

While many people experience short-term weight loss on the ketogenic diet due to ketosis and the body’s use of fat as its primary fuel source, long-term weight management can be more complex. Here are a few reasons why keto may not be ideal as a long-term weight-loss strategy and can be particularly challenging and potentially harmful for midlife women, due to several unique physiological changes and health risks that occur as women age.  

Why keto can be a challenging diet for midlife women?

1. Hormonal fluctuations 

Impact on estrogen and progesterone: As women approach peri-menopause and menopause, their hormone levels naturally fluctuate. The keto diet’s heavy emphasis on fats and protein may disrupt these hormonal shifts, particularly for women already dealing with hormone imbalances. Since carbohydrates play a role in hormone regulation, drastically cutting carbs could lead to further disturbances in estrogen and progesterone levels.

Impacts Thyroid function: Keto’s restrictive nature can sometimes affect thyroid function, particularly in women who are already prone to thyroid issues. Also, there’s evidence suggesting that keto can negatively impact thyroid function, which is already a concern for women during peri-menopause and menopause as thyroid hormones help regulate metabolism, and any additional stress on the thyroid can exacerbate symptoms like fatigue, weight gain, and difficulty losing weight.  Carbohydrates are important for supporting the thyroid gland and hormone production. When you drastically reduce carbs, it may negatively affect thyroid function, potentially leading to symptoms which could worsen during midlife when thyroid function naturally declines.

Insulin Sensitivity: Many women in midlife experience a decline in insulin sensitivity, which can be worsened by the keto diet, especially in those who are prone to insulin resistance or pre-diabetes. The keto diet’s high fat and very low carbohydrate intake might worsen insulin sensitivity for some women in midlife, leading to issues with blood sugar regulation and potential weight gain over time.

2. Increased Stress and Cortisol Levels

Cortisol (the stress hormone): The keto diet can put additional stress on the body, especially when it comes to the adrenal glands, which help regulate cortisol production. High cortisol levels, if sustained, can lead to increased belly fat, muscle loss, and poor sleep — all of which can already be problems during menopause. In midlife, managing stress is crucial, and a restrictive diet like keto may exacerbate the problem.

Adrenal fatigue: Women in midlife are already at risk for adrenal fatigue due to the stresses of ageing, life transitions, and hormone shifts. Keto can put additional strain on the adrenal glands, leading to feelings of fatigue, irritability, and burnout.

3. Potential for Bone Loss

Calcium and Vitamin D deficiencies: Midlife women are already at an increased risk of osteoporosis due to the decline in estrogen levels that accompanies menopause. The keto diet’s restriction of certain fruits, vegetables, and dairy products can lead to deficiencies in calcium and vitamin D, both of which are vital for bone health.

Acidic environment: The high-protein nature of the keto diet may also increase the acid load on the body. To neutralise this, the body pulls calcium from bones, potentially leading to decreased bone density over time.

4. Increased Risk of Heart Disease & Potential Kidney stress

High saturated fat intake: The keto diet often leads to an increase in the consumption of saturated fats, especially from animal products. Women in midlife are at an increased risk for heart disease due to hormonal changes (lower estrogen) and ageing. A diet high in unhealthy fats can increase LDL cholesterol, blood pressure, and inflammation, all of which contribute to cardiovascular problems.

Heart health: While some people report improvements in lipid profiles on keto, others see negative effects, including increases in LDL cholesterol (the "bad" cholesterol). Given the increased risk of heart disease during and after menopause, it’s important to prioritise heart-healthy eating habits that include healthy fats (like omega-3s from fish, nuts, and seeds) rather than the high levels of saturated fat often promoted in keto.

Kidney Stress: The keto diet can be taxing on the kidneys, especially for women who already have kidney issues or are prone to kidney stones. The high intake of protein and the increased excretion of ketones can put added strain on the kidneys over time.

5. Increased Risk of Weight Loss Plateau

Slower metabolism: As women age, their metabolism naturally slows down. Keto can cause initial weight loss, but over time, many women hit a plateau, especially if they’ve been on the diet for an extended period. This is because the body adapts to the diet by lowering its metabolic rate, making it harder to continue losing weight. Weight loss during peri-menopause and menopause is already challenging due to metabolic slowdowns, so keto may not provide sustainable results.

 Muscle loss: As women age, they naturally lose muscle mass known as "sarcopenia". The keto diet’s high-fat, low-carb structure might lead to further muscle breakdown if protein intake is not properly balanced which is the case with most of the women. Maintaining muscle mass is vital for metabolic health and overall strength, and losing muscle can further slow down metabolism, leading to weight gain. 

In the long run, a lack of carbohydrates can lead to the body breaking down muscle for energy, especially if protein intake isn’t sufficient. Maintaining lean muscle is crucial for long-term metabolic health because muscle burns more calories at rest compared to fat. Without enough carbs to support muscle repair and growth, muscle mass can decrease over time, which can reduce your metabolism causing weight to plateau.

6. Digestive Issues

Lack of fibre: Keto restricts many fibre-rich foods like whole grains, fruits, and vegetables. Fibre is essential for digestion and gut health, and midlife women often experience digestive issues such as bloating, constipation, and gas. Without adequate fibre, these problems can worsen, leading to discomfort and potentially long-term digestive health issues.

Gut microbiome imbalance: Restricting fibre can also negatively impact the gut microbiome, which is crucial for overall health, especially hormone balance, immunity, and digestion. A disrupted microbiome can lead to issues like inflammation, bloating, and even mood imbalances.

7. Negative Impact on Mental Health

Mood swings and brain fog: During peri-menopause and menopause, women are already more vulnerable to mood swings, anxiety, and brain fog due to fluctuating hormone levels. The keto diet can exacerbate these symptoms because carbs are important for serotonin production which is a neurotransmitter that helps regulate mood. The restriction of carbohydrates at this point can lead to mood swings, irritability, and even increased feelings of anxiety or depression.

Energy and focus: While some people report mental clarity and enhanced focus on keto, others experience fatigue and difficulty concentrating, especially in the early stages of the diet. For midlife women already facing energy dips and cognitive decline, this can make daily tasks and responsibilities even more challenging especially in the initial stages of keto.

8. Difficulty Adhering Long-Term

Sustainability: The keto diet is highly restrictive- requires extreme carb restriction like usually under 20-50 grams per day and maintaining such a low-carb lifestyle can be difficult, particularly for midlife women who might already be dealing with busy schedules, social commitments, and changing nutritional needs. The inability to enjoy a variety of foods, such as whole grains, fruits, and legumes, can lead to frustration and eventual diet abandonment. This could result in the dreaded yo-yo dieting cycle, which may negatively impact both physical and mental health.

Social and lifestyle impact: Restricting carbs can make social eating difficult, especially at family meals, social events, or dining out. The added stress of adhering to a strict diet could create a sense of isolation or make social situations feel stressful rather than enjoyable as most restaurants and social meals involve foods that are high in carbs.

9. Rebound Weight Gain

Many people experience rapid weight gain once they stop the keto diet, especially if they reintroduce carbohydrates too quickly. This is especially common for midlife women, as hormonal changes already make weight management more challenging. 

Metabolic adaptation: Prolonged low-carb diets may slow down your metabolism, and once you return to a more typical diet, your body may store calories more efficiently, leading to rapid weight regain.

Overeating after restriction: When the body is deprived of carbs for a long time, people may binge once they reintroduce carbs into their diet, often leading to overeating and an eventual weight rebound.

10. Nutrient Deficiencies leading to Bone health risks

The keto diet drastically limits or eliminates many food groups, especially fruits, vegetables, grains, and legumes, which are rich in essential nutrients. These restrictions can lead to micronutrient deficiencies in midlife women, and this is a concern that’s particularly important during this stage of life when nutrient needs can shift due to hormonal changes, metabolic slowdowns, and increased risks for certain health conditions like osteoporosis, cardiovascular disease, and cognitive decline.

Vitamin & Mineral deficiency: Vitamins like C, A, K, and potassium, magnesium, and calcium can be harder to obtain on a keto diet, which could affect immune function, bone health, and more.

Calcium Deficiency: The keto diet, being low in dairy (a major source of calcium), can increase the risk of calcium deficiency, which is a particular concern for midlife women who are already at higher risk for osteoporosis due to decreasing estrogen levels.

Magnesium and Potassium Deficiency: Midlife women also often face a drop in magnesium and potassium levels, which are essential for muscle function, heart health, and overall well-being. The restrictive nature of keto can lead to insufficient intake of magnesium and potassium-rich foods (e.g., fruits, whole grains, and legumes), potentially exacerbating deficiencies and sometimes even mineral excess can cause life threatening conditions with keto as in hyperkalemia where potassium levels are elevated. So treading carefully with keto is needed.

Takehome- While keto can offer short-term weight loss benefits due to reduced calorie intake and changes in metabolism, For midlife women, keto can be especially challenging due to the unique hormonal, metabolic, and health considerations of this life stage. The potential risks to heart health, bone health, mental well-being, and overall hormonal balance make it less than ideal for long-term weight management or health optimisation. 

A more balanced, sustainable approach to diet—focused on whole, nutrient-dense foods, moderate carbs, healthy fats, fibre and adequate protein can be a better fit for supporting long-term wellness during midlife.

If this is something you would like for yourself, then drop me an email to see how we can work together.