Keto and menopause -- two words women might not connect as they reach the transition that ends most estrogen production, menstrual cycles and the reproductive years. But keto and menopause are getting lots of attention now that the ketogenic or keto diet has become a popular eating style. "The keto diet has been around for a long time, and there are certain benefits for menopausal women. But there are many downsides, too," says Dr. Michael Tahery, an obstetrician and urogynecologist based in Los Angeles.
What Is the Keto Diet?
A keto diet is a restrictive eating style that changes the type of fuel your body uses. The diet starves the body of glucose, the main source of energy that comes from carbohydrates. Legumes, bread, pasta, cereal, starchy vegetables like potatoes, dairy foods and sweets aren't typically on the menu.
Without glucose, the liver transforms stored fat into chemicals called ketone bodies, which are then consumed by the brain and body as energy.
To fuel ketosis, the body needs more fat, which is why a classic keto diet includes:
-- 90% of calories from fat (especially saturated fat such as red meat, whipping cream and butter).
-- 6% of calories from protein (too much protein throws a monkey wrench into ketosis).
-- 4% of calories from carbohydrates.
Modified keto diets typically include less fat, more protein and often more carbohydrates than a classic keto diet. The ratios vary widely, depending on the diet:
-- 70% to 87% of calories from fat.
-- 10% to 15% of calories from protein.
-- 3% to 15% of calories from carbs.
"Both the classic keto and modified keto diets are far from how most people normally eat. The majority of our calories -- around 45% to 65% -- come from carbs normally. These diets drive the carbs down to around 10% and limit so many food groups that it becomes almost impossible to follow this eating pattern long term," says Liz Weinandy, the lead outpatient registered dietitian at Ohio State University Wexner Medical Center.
Keto and Menopause: Benefits
Some people turn to keto for menopause to address physical changes and menopause symptoms. For example, without estrogen, metabolism slows and the body redistributes fat. "Weight collects in the abdomen, even if there hasn't been weight gain," Tahery notes.
Falling estrogen levels also cause menopause symptoms that can last up to seven years including:
-- Mood changes.
-- Fuzzy thinking.
-- Vaginal dryness.
Theoretically, the fat-rich ketogenic diet may reduce some menopause symptoms. "Fat is a precursor for estrone, a weak type of estrogen produced by fat cells," Tahery says. "The more fat you consume, the more estrogen you'll have in your system. It may contribute to fewer hot flashes, mood changes and fatigue."
Keto may help you:
-- Lose weight, reducing your risk for developing heart disease, joint problems and cancer.
-- Reduce blood glucose levels, reducing the risk for Type 2 diabetes.
-- Improve insulin sensitivity, making this hormone that shepherds glucose to cells more effective.
However, it's important to note that the benefits of keto and menopause are believed to be short-term only. Weight loss, for example, may be the result of losing fluids as sugar stores in the body are emptied. "The keto diet acts as a diuretic," Weinandy says.
You may regain the weight as soon as you go off the diet, if you don't exercise or reduce the amount of calories you consume.
Keto and Hot Flashes
Keto for menopause can sometimes backfire. "In some people it can cause even more symptoms of menopause," Tahery says.
Keto hot flashes and other menopause symptoms that worsen on a keto diet may be the result of the diet's diuretic effect. "You're urinating frequently, and along with that you're losing electrolytes -- sodium, potassium and calcium," Weinandy says. "The change in electrolytes can cause the fatigue, aches and pains known as the ' keto flu' within the first two or three days of the diet."
Is it possible to avoid keto hot flashes? "If you drink a lot of fluids and increase your carb intake, the keto flu does go away. But if you stay on the diet, it's possible that it will get worse and it won't go away," Tahery says.
[READ: Healthy Carbs to Eat.]
Keto and Menopause: Risks
In addition to discomfort, the keto diet and menopause may pose health risks. Three of the biggest include:
-- Heart disease. "Estrogen has a protective effect. It helps with good HDL cholesterol, helps prevent the body from making bad LDL cholesterol and has been shown to help increase blood flow within the heart," Tahery says. "But you lose that protection after menopause. On a keto diet, with all the (saturated) fat, it increases LDL and increases the risk of heart problems."
-- Cancer. Saturated fat intake (especially from red meat) is associated with an increased risk for developing cancer. "The more fat you consume and the more estrone your fat cells make, the more cancer risk increases," Tahery points out.
-- Osteopenia and osteoporosis. A keto diet contributes to the early and later stages of bone thinning. "The diet is usually too low in calcium and other nutrients found in fruits and vegetables that promote bone health like magnesium and vitamin C," Weinandy says.
A keto diet can also cause or contribute to:
-- Very low blood sugar.
-- Nutrient deficiency (including calcium, vitamin D, vitamin C, magnesium and other beneficial phytonutrients from plants).
What You Should Do
If you're looking to jump-start your weight loss after menopause, Tahery says it's probably OK to try a ketogenic diet in the short term.
But he and Weinandy recommend that you:
-- Attempt only the modified keto diet (not the classic version).
-- Seek diet supervision from a doctor or dietitian.
-- Eat only lean protein, along with lots fresh vegetables and some fruit.
"Focus more on unsaturated fat," Weinandy says. "Have a good fat source at each meal. Ideally, it should be a plant-based and heart-healthy fat such as avocado, olives, walnuts, olive or safflower oil."
If you're considering a keto diet as a solution to keto hot flashes or other menopause symptoms, Tahery says the diet isn't a safe bet. "I don't recommend the keto diet as a treatment for menopause symptoms. The best solution is exercise, maybe hormone replacement, reduced alcohol and caffeine intake, more sleep, even acupuncture. It has to be individualized, especially in a high-risk person," he says. "But in my 25 years of practicing, strict diets don't work."
Heidi Godman reports on health for U.S. News, with a focus on middle and older age. Her work has appeared in dozens of publications, including the Harvard Health Letter (where she serves as executive editor), the Chicago Tribune, Baltimore Sun, Orlando Sentinel and Cleveland Clinic Heart Advisor.
Heidi spent more than 20 years as a TV news anchor and health reporter at ABC affiliate WWSB and more than five years as the host of a daily health talk radio show on WSRQ-FM. Heidi has interviewed surgeons in operating rooms, scientists in laboratories and patients in all phases of treatment. She's earned numerous awards for outstanding health reporting and was the first TV broadcaster in the nation to be named a journalism fellow of the American Academy of Neurology. Heidi graduated from West Virginia University with a degree in journalism.
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