First of all, what is “keto”?
So, having mentioned the upsides and downsides, how does keto work for women? Let’s address each point in turn.
1: Weight loss.
Can ketosis help you lose weight? Definitely.
Can ketosis force you to lose weight, defying all known laws of physics and calories? Sometimes.
For starters, when you go low carb and pack in the protein, you’re more sated. This means you want to eat less, so you wind up eating fewer calories in general. [Yes, that’s just a self report. But, if you ate 1800kcal, only you and God know whether it was because you were actually full or whether you just wanted to flip those annoying scientists the bird. Sometimes self-reports are the only way.]
Secondarily, whilst fat is higher in calories than sugar, it’s easier to eat what’s basically a pile of carbs than a pile of fat. Think of a low-fat cake, full of flour, sugar, fruit or chocolate, low-fat dairy, etc. Picture how much you could eat in a sitting. Now picture the same volume of unsweetened cream. Are you just as likely to eat that much cream?
Thirdly, your body’s main storage trigger is insulin release. As well as at other times, insulin is released when blood sugar gets too high. The insulin forces your body to store the excess sugar as fat, so as to avoid hyperglycemia, a toxic situation. This means that if you eat 200kcal of fast-release sugars and it’s all in the blood at once, your body will release insulin, forcing you to store the sugar as fat, basically making you gain weight by stopping you from using the energy consumed.
Additionally, it’s almost impossible for your body to make fat from protein, so if you’re going protein-heavy, you can eat more calories without storing them. Basically, protein needs to be broken down to become usable energy. If you’re getting enough calories from fat and carbs, then excess protein will be stored for a short while and then flushed out in your urine. If you’re not getting enough calories from fat and carbs, your body will recombine protein and fat (sometimes body-fat) to make energy. So if you’re eating your Basal Metabolic Rate worth or less in fat and carbs (or just fat!), then only the necessary protein will be converted into energy, which minimizes your ability to store it as fat. The second you’ve got enough, your body stops turning protein into energy and filters it out, so what is there to store?
Finally, protein and fat are also hormone binders, nutrient carriers and mass builders. In other words, not every gram of protein is energy, not every gram of fat is fat.
Imagine you need 2000kcal/day. Picture the two scenarios.
1: You eat 2500kcal/day. 1500 from carbs, 700 from fat and 300 from protein. Carbs trigger an insulin release, leading to you storing 300kcal right off the bat. But you’re still 200kcal over. 300kcal of protein is 75g of protein, so if you’re active, you may not have much left over, or may even need more. But even without counting protein, your body’s getting 200 excess calories. So best case scenario is you stored only the 200 excess, used all the protein and feel hungry for more protein. Worst case scenario you stored 300 due to the insulin spike and feel hungry because you’re 100kcal and some protein short.
2: You eat 2500kcal/day. 1400 from protein, 800 from fat and 300 from carbs. The insulin release is either smaller, shorter or lasts less, meaning initial storage isn’t as high. You store 80kcal immediately. Then you turn your 800 fat calories and 980 protein calories into ketones. Let’s pretend the conversion is direct and uses no energy at all, for simplicity. You now have your 2000kcal, with 80kcal stored. You’re left with 420 protein calories. As your needs have been met, your body isn’t going to turn them into fuel. In fact, once you’ve taken however many grams of protein you need to rebuild muscle, the rest will be urinated away.
Understand now? Not only can a ketogenic diet help you keep your calorie-count low, but it can help you even if you have an appetite like mine. Of course, there’s a small issue that arises when your protein becomes not only a lot of your calories, but a lot in volume, however we shall address that in the next section.
The caveats are less obvious. Firstly, by eating low-carb you make your body more sugar-sensitive and insulin-resistant. Basically, by restricting sugar your body treats it like a prized good and by not using your insulin cycles you make them weak. This means possible swingbacks are worse. If you were thinking of going high carb after a few months to a year keto, then you and your body are in for a shock.
Secondarily, not everyone knows what their liver, kidney and pancreas functionality is. It depends on their size, number of general and specific cells, innate strength, potential strength and accumulated damage. Your pancreas may produce enough enzymes to digest 3kg of pure fat in a sitting. Or it may just come out the other end. Your kidneys may be expert at flushing out excess amino-acids. Or they may be so damaged from years of eating rubbish food or just because you were born with weak kidneys, that they pack in after a week of excess protein. Your liver may be finely tuned to working with ketones and filtering toxins from CAFO meat. Or you may need to eat a very, very clean diet or even consider very low carb of low carb rather than keto.
Thirdly, you might be really efficient at extracting and using fat. This means that excess fat is stored as, well, fat. So abuse your protein intake and you’re OK, but abuse your fat intake and you’re fat. But if you restrict fat too much you risk rabbit starvation, which is basically not enough calories, akin to actual starvation, but sometimes with innumerable liver and kidney problems.
So it can help you lose weight. But it can also make you insulin resistant and destroy your liver and kidneys as well as overwork your pancreas or even starve you. Of course, the chances of any of those happening, especially short term or in a cyclic ketogenic diet, are very low. But they still exist and are worth noting.
Finally, there is the issue of female body-fat. It seems that most women want to be thin as possible, with most only drawing the line at visible ribs, if that. That would put us at under 18% according to this Built Lean example page, and preferably as close to 11% as possible.
In other words, most women want to be very thin, and some want to be as close to basic body-fat as possible. However, is being so close to your body’s most basic level of fat healthy? Spoiler: no. In fact, being anywhere under 15% body-fat is not healthy long-term, so the very upper end of our ideal weight –15-18%– is actually the lower end of what is healthy for a woman, with the upper end being 25-30%. Another interesting note is that not everyone is still healthy at these extremes. Many women at 17% body-fat are showing signs of being underweight, whereas some at 25% are already too overweight. So what are the variables? And what is the ideal range? And why is that the ideal range? All shall be revealed.
Firstly, we need to understand the reason women carry more fat than men. For this, we should look at two things: the places where women carry most of our fat and our biological and sociological function as humans.
Women carry most of our fat around our thighs, hips, buttocks and breasts, with our sub-cutaneous fat levels often not differing greatly from a much, much leaner man’s.
Our biological function is to reproduce. To carry a child in our wombs for 8-9 months, feed it primarily with breastmilk for 1.5-2 years and secondarily with breastmilk for another 1.5-1 year.
Our sociological function is to stay close to home, protect and feed our children and get involved in the lifting, carrying and cooking as often, if not as intensely, as the men.
In other words, as women we are designed for a pretty high energy expenditure. Men may get involved with the more explosive activities of hunting, fighting, moving camp and ritual. But these activities aren’t everyday activities and at no point does the man undergo a risk of needing extra calories and nutrients to support a second organism inside of him. Meanwhile, gathering, cooking, carrying food and children, breastfeeding and other household chores would have been daily activity, all whilst under the risk of getting pregnant again and needing to feed another child for at least four years of your life. As such, it makes sense that we’re healthier with more fat. We need to carry extra energy with us at all times.
Another thing to bear in mind is the location of the bulk of our fat: hips, thighs and buttocks. In fact, that fat accounts for a third of a healthy woman’s adipose tissue. Bar extreme starvation, our bodies rarely if ever dig into that fat. We accumulate it, but don’t use it unless food is incredibly scarce. We could say it’s an emergency energy reserve, for times of scarcity, but then why don’t men have it too? After all, emergency energy is good for every predating mammal. To work out what it’s used for, we need to look at when we can burn it. And we come up with two situations: pregnancy and starvation. Now, looking at how well men respond to these curves and at their nutritional density, it’s easy to see that the prior is more likely to be behind our chubby behinds.
Finally, we need to remember that fat creates aromatase, which turns testosterone into estrogen. It’s why obese men can develop “moobs”. Whilst in heavily obese people this causes an imbalance, in a perfectly healthy woman her body-fat is helping to balance her testosterone-estrogen scales, keeping her fertile, focused and energized.
So what is a healthy body-fat percentage when all this is born in mind? If we’re going by a Waist-to-Hip-Ratio of 0.6-0.7, we should look at anywhere between 18 and 30%, exactly the “health” range, maybe a bit high at the upper end. If we want fatter thighs and hips, we cut off at 20-30%. If we want a trim waist and a strong body, we cut off at 20-25%.
Of course, a very small-framed, unmuscled woman at 20% may still be too thin, as 20% of 80lbs is only 16lbs. And a large-boned, muscled woman at 25% may be too fat, as 25% at 160lbs is 40lbs. Basically, there is still a cut-off even within these boundaries. But this is the reason we also consider the WHR. Both an undermuscled woman and a muscular woman are likely to have a wider waist relative to their hips, which will highlight any excessive or absent fat. The small woman will look close to a WHR of 1 unless she gains some fat. As she’s already rather thin, losing weight would not produce the desired effect, as her waist, ribs and hips are not too different in size. The large woman will also look closer to a WHR of 1 unless she loses some weight. As after a certain point a woman will start putting on fat primarily at her waist, gaining more fat is unlikely to help her regain her figure: she needs to lose some weight to shrink her waist.
This means that for aesthetics it is best for a smaller woman to aim closer to 25% and a larger woman to aim closer to 20%. However we still have more variables. When a woman becomes very, very muscular, or is tall and broad-framed or short and small-framed, it is often healthier to lean towards the higher end, so as to maintain hormonal balance. And young women and post-menopausal women are still very healthy at 18-20% body-fat, whereas pregnant and peri-menopausal women may benefit from the extra estrogen that comes from being at the higher end.
Use some common sense, but, for an idea, use this flowchart.
The assumptions this chart makes are:
A: You are otherwise healthy and biologically typical.
B: Body-fat percentage, total body fat mass and WHR are all important to your health.
C: All exceptional variables, such as desires to be a certain weight or look a certain way, dense musculature or unusual BMI figures are irrelevant.
D: You are giving strength-training, speed, endurance and flexbility equal weight in your workout routine.
Of course, it would be possible to work our how to get to healthy body-fat factoring every little variable in. But that’s a whole book.
So, now we know about weightloss, how does keto measure-up to other diets?
2: Keeping keto.
Interestingly, whilst all diets are hard to adhere to, ketogenic diets have a strong initial adherence rate, compared to most others. The reason for this is threefold. Firstly, a better salt balance and lower carb intake can result in massive waterweight shed. I can lose up to 7kg of water weight over a day of VLC. This sort of thing is highly encouraging. Secondarily, a high protein diet is infinitely more satisfying. This means you may even eat far fewer calories than usual and enjoy it more and feel fuller than before. Finally, after years of eating high-carb, high-fat junk when not dieting and low-fat, high-carb junk when dieting, being able to dig into fatty steaks and creamy coffees is delightful. It doesn’t really feel like a diet.
However, as time goes on it becomes harder to adhere to, even moreso for women, as we have both a slightly higher need for carbs and a far, far greater desire for them. Dropout rates after a couple of weeks seem to be more common among women and by 24 weeks a high percentage even of people in studies have quit. The desire to eat carbs and the overabundance of carb-rich foods makes it hard to resist once the initial honeymoon phase is over.
Another thing to note is that if you consume excessive amounts of protein you can kick-start gluconeogenisis: turning protein into a sort of glucose. Normally, as a woman 1.5-2g per kg of body weight, plus extra for when you’re doing a lot of muscle-building activity, should always suffice. When you get to 5g/kg you could start producing a reasonable amount of glucose, which could possibly push you out of ketosis. The easy solution is just to eat more fat, so your BMR is met out of fat calories and your body is dissuaded from producing much glucose. If you’re getting enough calories from fat, you’re producing fewer ketones and unlikely to produce much glucose. If you keep your protein within a low-ish parameter, you reduce the risk of gluconeogenisis further as well as maximizing energy expenditure. Thankfully, it appears that getting gluconeogenisis to a point where it interferes with ketosis is actually quite hard, but it’s worth bearing in mind.
Finally, when you diet in an extreme manner, which, compared to most human diets natural or otherwise, strict ketosis is, it is hard to transition onto a healthy maintenance diet. Basically, unless you want to yo-yo diet, be in ketosis for life or go back onto your previous diet that make you weak/fat/intolerant/ill/hormonally imbalanced, you need to find a new diet sharpish. Often simply going from keto to low carb is all it takes, provided you can control your carb intake, but then we could ask why we didn’t start at low carb to begin with. So what are the benefits of ketosis vs low carb?
Ketogenic diets can boost your testosterone. Sometimes this is because of lower body fat, which means less aromatase which means your testosterone is more stable. Sometimes it’s because of extra cholesterol and protein in the diet giving your hormonal system a boost.
But most of us ladies are likely to feel a little reluctant to boosting our testosterone, especially if we already have it on the high end to begin with. However, curiously, it doesn’t seem to be a matter of a clear-cut testosterone boost. Studies involving women with PCOS, who already suffer excess testosterone, have shown that it decreased their testosterone.
From what I’ve read, if it’s low going low carb raises it and if it’s high going low carb lowers it. In other words, a lower carb diet regulates testosterone production, which, of course, means a ketogenic diet also regulates testosterone production.
However, some points need to be made.
Firstly, just because you feel fine doesn’t mean your body doesn’t think your testosterone’s low. As body fat produces aromatase, which converts testosterone into estrogen, if you have excessive body fat you may have low testosterone. If your testosterone is raised, you may get a little hairier, which causes some to become concerned. However, a few more hairs or thicker hair is a safe sacrifice to make for leanness, strength, improved focus, easier periods, etc.
Secondly, keto is not required for this or any hormonal or metabolic benefit. Sub 150g/day would do it as well. Of course, you’re more likely to stabilize quickly on keto, but once your hormonal profile is stable there isn’t much difference between full-blown ketosis and simple low carb for women.
4: Muscle and strength.
And here’s the all-too-common concern women have with anything strength-trainers do: “Will it make me big?”
Contrary to popular belief, women are not a bag of testosterone, steroids and amino-acids that will explode into Hulk the second you make her lift an ounce too much. It doesn’t just happen. Nothing “makes” you big. You make you big through hard work, good diet, heavy weights and balanced hormones.
Now we have that out of the way, can a ketogenic diet help you with muscular tone and strength? Well, yes. Can it build muscle? Well, kind of.
You see, to build muscle you need carbs as well as protein. Protein is the building blocks, carbs are the fuel. The jury’s still out on whether ketones can adequately replace glucose when it comes to weight training, but the fact of the matter is that anyone who’s building any amount of muscle is packing in carbs. Bulk cycles, carb refeeds or rampage days are prominent patterns of any muscle-building routines for a reason. Carbs alone won’t do anything for building muscle. But protein and fat alone are a much slower way than if you added some more carbs in. So yes, you can gain muscle whilst in ketosis. But it isn’t the most efficient way to do so.
However, what ketosis can absolutely, 100% bona fide, certified-with-a-gold-star do is maintain muscle. When you work out or diet your body is burning through everything. Glucose reserves? Depleted. Fat? Burning for fuel. Muscles? Even they’re game. If you fast, for example, your body is in ketosis, using your own fat and protein for fuel. You’re basically eating human steak whenever you calorie-restrict. And usually, especially when losing mass through diet alone, or through endurance activity, muscle loss is a certainty. However, you can minimize or even stop muscle loss by eating a lot of protein and, the caveat, lifting weights. If you use the muscle and replace lost protein every day, your body will hold onto every inch of it.
So, I’ve mentioned that keto food is delicious. Of course, that’s just a personal perspective, but let’s have a proper look at what you need to do for food and what this food can do for you.
So what’s good on a keto diet? Contrary to popular belief, keto isn’t a carnivorous diet. It’s a very low carb diet, in essence, keeping your carbs low enough to induce ketosis. This is usually under 50g/day, but can be as low as 25-30g/day or as high as 100g/day based on individual needs, type of carbs and ability to extract them. These 25-100g of carbs could come from anywhere. Incidentally, in liver, eggs and nerve tissue. In low levels, such as in piles of greens and a few berries. Or in pure carb form, from a measured amount of white sugar. For reaching ketosis none of this matters. Of course, the wiser decision is to turn to offal and greenery, to give yourself a micronutrient boost. But the point is that you can be keto and eat a lot of greens, or handfuls of nuts and seeds, which are mostly fat and protein, or a small amount of berries, which are often a mere 7% carbs. 200g of strawberries? 15g of carbs, well into keto. Add some greens, nuts and liver and you’re eating keto with plant matter. If you’re particularly masochistic you could even try going vegan keto on protein powders and overt fat sources, or elemental keto on pure amino-acids and oils with nutrient supplements. All you need to be keto is to reach ketosis, though preferably healthily.
However, if you’re keeping your carbs to 25-100g and preferably at the lower end, that’s only 100-400kcal. So where is the rest coming from? Obviously, it’s not alcohol (my apologies to anyone who was disappointed, but also maybe get help), but protein and fat. Protein, like carbohydrate, has around 4 calories per gram. Fat has around 9. So, if we ate only protein, we’d need to eat around 500g to get 2000kcal. If we ate only fat, 222.22g. If we split it 50/50 in terms of calories that would be 250g of protein and 111.11g of fat. If we split it 50/50 in terms of grams that would be just over 150g of each.
This is a more attainable feat when you’re eating less volume of food, but we needn’t forget that protein is more satiating and fat is harder to eat in large quantities without adding carbs. If you’re looking to get lean, this isn’t an issue, but if you’re trying to grow in any way, it can present a difficulty. Small, regular meals will make it easy to keep your calories up.
It is also important to note that keeping your fat and protein intake balanced will help you stay healthy. In the wild, no animal is all fat or all protein. They are a balance of both. Likewise, if you eat too little fat you risk rabbit starvation and if you eat too little protein you risk catabolism. It’s not exactly a fine line, but take it as a warning in case you were considering those pure fat or pure protein diets.
Another thing to bear in mind is the quality of your food, especially in terms of fat, which stores both nutrients and toxins for the animal. If you eat a sick animal that lived an unnatural life you’ll be worse off than if you’d eaten a wild animal that lived the way nature intended. If you can’t afford high quality meat, buy lower quality meat and replace the fat with high quality butter and offal. A lean beef steak accompanied by grass-fed butter and lamb’s liver is better than a fatty beef steak full of rubbish. Sometimes I wonder if it should go without saying, but it’s always worth adding the reminder. Moving swiftly on.
Finally, we have the little matter of micronutrients. If you’re eating just steak, even pastured, fatty steak, you’re going to eventually become low in a few things. Vitamin C, for one. Magnesium and selenium are always a risk. Not to mention your salt balance. Basically, lean muscle meat and lumps of fat will not sustain you for long without hitting a deficiency. So what to do about this?
If you want to eat no overt carbs, you have two options. Firstly there’s the more natural option: eat greens, berries, all forms of offal and mixed nuts and seeds. A lot of low-carb greens and offal and around a handful of berries and a handful of seeds a day. Secondly there’s the easier and oftentimes safer option: take some pills. Multivitamin, omega oils and mineral powder. Sure, not natural, but you’ll live.
If you’re happy to eat overt carbs, focus on small quantities and greater variety, as well as lots of greens and offal. An example would be around 100-200g of mixed roots and tubers, a small pile of dark leafy greens and a whole lamb’s liver with pork belly.
So the keto diet is keeping low carb, eating plenty of good meat, keeping an eye on your micros and not being ashamed of taking pills if you need to.
But what about all the nasties that go with eating a VLC diet?
Let’s start with the obvious one: odour. Eating a high protein diet increases pretty much everyone’s body odour. It also makes it smell pretty bad in some people’s cases, leading to the “ammonia” tag in the previously linked article. Not everyone suffers body odour problems, few stink of ammonia and generally they’re controllable by showering and using deodorant, so you’re quite unlikely to notice them unless they’re fairly serious. On the other hand, if you use curry or other heavy spices to make steak 30 times a week more exciting, be prepared to smell of those spices for weeks to come. Keto-breath is also a common complaint and one without much of a solution other than not being in ketosis. Sometimes lowering protein intake can stop both body odour and keto breath, but many report otherwise.
And what about skin and hair health? Some women notice their hair losing its lustre and strength having gone keto for a long time, carb-refeed cycles or no cycles. I personally have not had this issue as I’ve never stayed keto or VLC for a prolonged amount of time, but apart from using an oilier shampoo or using oils as conditioners, I have found no advice that seems to consistently work. However I am pleased to report that, besides the corners of your mouth and parts of your hands where grease gets smeared, my skin is usually far less oily the lower my carb intake is. Some have a severe acne outbreak over the first few days, but after that clear, mate, smooth skin is almost guaranteed.
As a sort of compensation for the breath, your teeth will be far cleaner on keto too. Between not having sticky starches or acid-inducing sugars in your mouth and chewing on stringy meat and fibrous greens, your teeth will stay clean and your bacterial balance will revert to a healthier state. If it weren’t for keto-breath most of you could even stop using dental hygiene products altogether.
And, finally, an all-round winner: keto, being a low carb diet, suppresses fungal growth. Which means candida especially. Which means mouth ulcers last less, any candida overgrowth is almost gone and vaginal discharge is decreased and less smelly. An all-round winner indeed.
But what about long term?
Firstly, there are very, very, very few people who stay fully keto long term. And that number doesn’t increase much when you look at keto with carb cycles.
Yes, we can acknowledge that it’s in theory possible to be 100% keto for the rest of your life. However, if we’ll acknowledge that, let us also acknowledge that very few people ever do or did and that those who fall into that category have a far shorter average lifespan than at least I would like to aspire to.
The human body needs a fuel. This fuel can either be glucose or ketones in the blood or stored in fat. Ketones need to be produced from amino-acids and lipids, which in turn need to be broken down from proteins and fats. Glucose needs to be broken down from sugars. Obviously your body, being a lazy animal, wants to use the energy-efficient mechanism: eat the purest sugar you can get your hands on. This is why sugar tastes so good, why we can eat more sweet stuff than fatty or umami stuff, why it’s hard to break a carbaholic from their habit. Once your body knows how to identify carbs it will encourage you to seek them out rather than use its own reserves or produce ketones. This is Survival 101.
But just because it’s natural to desire carb-rich foods that carry the purest sugars possible, as often as possible, doesn’t mean it’s natural or preferable to give in to this desire. For starters, your body wants most what is scarce. As sugar is hardly scarce today and we still long for it, it’s safe to assume we want it so much because it used to be scarce. And, if we evolved in such a scarcity that our desire for fast-release sugar is unbeatable, then surely our bodies are actually adapted to not receive that type of sugar, in large quantities, all the time? Much like our desire for salt has become too high for our actual biological needs, our desire for sugar far outweighs not only our physical needs but our very ability to cope with it.
So our bodies prefer to use glucose because they’re lazy, however can swap onto running on ketones when pressed and generally have a hard-limit on carb intake that our hunger for carbs outweighs. Yet what is the middle-ground? Humans can definitely survive on both a diet free of carbs and one where carbs can be accessed freely. If we’re assuming no carb refeeds, no fasting or low carb days, no caloric excess or deficit and moderate activity, the human body can happily function anywhere between 100 and 300g of carbs a day. Which you may notice is far outside of ketosis, but also far outside of the modern carb binges that cause metabolic disorders, pancreas damage and weight gain. In short that is our middle ground. Humans who push their carbs below 100g/day or above 300g/day on a daily basis for a lifetime tend to live shorter lives and suffer health problems down the line. Now, in the grand scheme the shortening of life and loss of health is lesser for continual ketosis than for carb binges, but both are still outside of the optimal spectrum.
Of course, two counter-arguments would be:
1: Who wants to live to 100 anyway?
2: There are plenty of exceptions and other factors to those trends.
To which I’d have to respond that a long life is as much a personal goal as a busy one and that exceptions, whilst interesting, are not the norm.
However, regardless of who or what you are, 100-300g/day of carbs is the sweet-spot assuming a healthy body, moderate activity and no refeeds or fasts. But how about if we include refeeds? Or high activity? Or fasts? After all, even tribal peoples who spend a lot of time in ketosis have seasonal carb binges and even Jaime Lewis has rampage days. Humans just work better with carbs being thrown in from time to time, even when generally doing well in ketosis. The simple reality of how few people can survive long-term ketosis with zero cheat days, combined with how well-populated our guts are and how strong our insulin cycles are should be an indicator if nothing else is.
But what about women? We know we love carbs more than men do. Possibly irrationally. It may be cake, rice, fruit, sugar or potatoes, but all of us have one favourite carb if no more. And I’d be willing to bet, though it’s entirely unprovable, that were we magically turned into a bloke overnight all of us would experience a drop in carb cravings.
However, as evidenced by the ever-rising obesity rates, the extent of metabolic disorder and how much water you need to drink to sustain eating over 300g of carbs a day, it’s obvious that our desire and our needs don’t necessarily have much to do with each other. Women want more carbs. So do obese T2 diabetics. How many carbs do women need?
Firstly we need to remember that, whilst ketosis can be a caloric surplus, in some ways it affects our bodies as though we were fasting. We lose weight, start burning some of our own body mass and develop insulin resistance to some degree. So how does the female body cope with fasting? As Stephani Ruper noted at Paleo for Women, not well. Men and women are metabolically different. A man will almost always experience a net benefit to fasting, at least metabolically if not in terms of muscle-mass, brain function and fat-loss. Women, on the other hand, suffer metabolically. We start losing the ability to process glucose. We start losing our periods and even stop ovulating entirely. We display all the signs of a stressed animal. It seems as though our bodies respond to a fasting situation by making us better at fasting, but not healthier.
But, then again, that’s about pure fasting. No food at all for prolonged periods. How well do women do when you are simply carb-fasting? It seems that, as with actual fasting, ketosis also induces a negative state for the female body after an amount of time. An unrelated Stephanie, Stephanie Greunke, has had a deep look into how Very Low Carb diets affect women over time. She has noted how, at first, VLC feels awesome, weightloss starts up again, strength increases and focus improves. Interestingly, this is the effect that initial fasts have on people. However, after a while lethargy, weakness and weight-loss resistance start creeping on you. Again, your body’s responses to fasting. The similarities are uncanny and I would say that longer periods VLC and fasts over a day long do seem to result in the same symptoms for me also. It seems a woman’s body is happy to deplete its glucose reserves and burn a little fat, but starts to panic when it thinks food isn’t available. Which, as the child-bearing, breast-feeding non-hunters we are, makes sense. Especially when you consider that a man with 20% body-fat has fuel for weeks, whereas a woman with 20% body-fat is about right.
So how do refeeds factor-in? Jaime Lewis has worked out that a rampage day a week seems to be the best option for most. However men can also fast for three days at a time or spend years eating in a four-hour window every day and suffer little ill effect, whilst women start getting ill when we try and emulate that sort of a diet.
I would say it’s safest to go by what you feel. If you get initial withdrawal, fight through it. But if you start out feeling great and feel rubbish the next day, do a mini carb-refeed. If after a month you feel awful, eat a carb-rich diet again, at least for a while. If you need two proper rampage days a week, go for it. Basically, if you were feeling good and are just starting to feel bad, keto is becoming too much for you. You want to be ovulating, menstruating, happy and vibrant, not too hungry and not appetite-less, focused and relaxed. If you lose your period, get sluggish or grouchy, feel starving or lose your appetite or start getting brain-fog or stressed, then eat carbs.
Finally, I must accept that many fit women are cardio-bunnies. As such, I must point out that ketosis causes muscle catabolism if you engage in any degree of endurance activity. Think of it this way: you’re depleting your glucose reserves when you jog or cycle. After a while, they run out and you start forming ketones. No full stomach of meat and grease? Your body will first choose itself as fuel. When you’re in ketosis you’re already glucose-depleted. Either carb-load before endurance activity, don’t go keto to begin with or lift heavy weights.
8: The conclusion.
So what can we conclude from my far from extensive research?
Well, firstly that keto helps women lose fat and water-weight, that it’s easier to follow short-term than most diets, that it hormonally regulates us and that it needn’t do us any harm.
We secondly learned that it can be rich in nutrients, follow any dietary pattern you wish it to and should include several refeeds to keep our weight-loss, mass-gain and general health on track.
We also learned that women face many specific problems regarding ketosis, such as maintaining low-carb, the risk caused by any form of fasting on our bodies and how the lives we lead can affect our need for calories and carbs.
And we learned how the female body works in terms of body-fat layout and percentage, testosterone production and protein requirements.
What we have observed is that short-term ketosis, like a 24h fast, brings numerous benefits. However that these benefits wear out or reverse if we continue in ketosis for a long amount of time or if we repeatedly go into ketosis with only short carb-refeeds in-between.
We have also observed that many of the benefits of ketosis can also be recreated by a low carb diet with carb refeeds, which is less taxing on our systems and more sustainable.
In short, like with fasts, employing ketosis for brief periods to kick-start weightloss or keep your body in good shape and on its toes can be beneficial. However long-term ketosis is not healthy for most women, regardless of carb refeeds. We need to employ ketosis and VLC diets sparingly, with long rests when it catches up with us. We must accept that, however many men and pro-athletes VLC can benefit, as most of us are neither a man nor a pro-athlete, it’s important to consider ourselves and our body’s functions first and foremost.
After all, we want our diets to do their best for our bodies, not our selves to try our best for a diet.