Ketogenic Diet and Menopause

What is the Menopause Transition?

Although a woman technically reaches menopause when she has gone 12 months without a menstrual period, symptoms related to perimenopause – the time where hormonal changes begin - can start much earlier. In addition, they may last for several years after this point, and new symptoms may develop within the first few years after menopause.

The average age of onset for perimenopause is 46, and it typically lasts about 7 years. However, a woman may start perimenopause anytime between her mid-30s and mid-50s, and the transition can last from 4 to 14 years ( 1). The day after a woman has gone 12 months without a menstrual period, she is considered postmenopausal.

During and after the menopause transition, as many as 34 symptoms may occur. The most common ones include:

• Hot flashes and night sweats
• Weight gain, especially around the middle
• Insomnia
• Vaginal dryness
• Mood swings
• Fatigue
• Poor memory, ie, “brain fog”

Interestingly, while some women find that their symptoms are more severe during perimenopause, others report that their symptoms intensify after they are postmenopausal.

Hormone Fluctuations and Insulin Resistance During Menopause

During a woman's reproductive years, follicle stimulating hormone (FSH) causes the release of an egg from one of her ovaries approximately every 28 days and stimulates ovarian production of estrogen. After ovulation, the follicle that housed the egg produces progesterone.

However, as a woman enters perimenopause, her ovaries contain fewer eggs and begin to produce less estrogen and progesterone. In response, the brain's pituitary gland steps up its production of FSH in an attempt to increase estrogen output. During this period of time, estrogen levels may fluctuate widely, but during the final couple of years before menopause, they steadily decline.

Normally, estrogen directs fat to be deposited in the hip and thigh area following puberty. This is why many, although not all, women tend to gain weight in this area during their reproductive years.

However, as estrogen levels decrease during menopause, fat storage shifts to the abdomen. Unlike the subcutaneous fat stored in your hips and thighs, excess visceral fat doesn't just affect your appearance and the way your clothes fit. It's also strongly linked to insulin resistance, heart disease and other health problems ( 2).

Weight Gain Around Menopause

In addition to the change in fat distribution, most women notice that their weight goes up several pounds during and after perimenopause. This seems to be due to a combination of factors.

First, lower levels of estrogen promote insulin resistance and higher levels of insulin in the blood, or hyperinsulinemia, that promotes weight gain ( 3,  4).

Secondly, research suggests that levels of the “hunger hormone” ghrelin increase in the early stages of perimenopause ( 5).

Moreover, low estrogen levels during and after menopause may impair production of leptin and neuropeptide Y, hormones that help regulate appetite and weight balance ( 6,  7). The resulting increase in appetite and lack of satiety can lead to overeating and weight gain.

However, some women put on weight even if they don't eat more than usual during menopause, due to the hormone changes previously discussed.

Finally, loss of muscle mass that occurs during menopause and the aging process can slow down metabolism, making it much easier to put on weight (8).

Low-Carb and Keto Diets for Menopausal Symptoms

Weight Management

There is a growing body of research showing that low-carb and keto diets are very effective for weight loss.

A major benefit of being in ketosis is suppression of appetite, which may be due in part to lower ghrelin levels ( 9).

Indeed, a 2014 systematic review of 12 studies concluded that ketogenic diets do reduce hunger and appetite. Moreover, the authors defined a ketogenic diet as one that produced fasting β-hydroxybutyrate levels greater than or equal to 0.3 mM ( 10). This is actually a very mild level of ketosis that most people can achieve by limiting net carb intake to 50 grams or less per day.

Anecdotally, many women have reported losing weight during and after menopause by following a low-carb or keto lifestyle.

However, although middle-aged and older women have been included in some studies on carb restriction, there is surprisingly little research looking at the effects of this way of eating in menopausal women alone.

In a two-year randomized controlled trial (RCT) of 70 obese postmenopausal women, a low-carb, paleo diet led to greater reduction in abdominal fat and triglycerides than women following a low-fat diet ( 11).

In another RCT, 50 overweight or obese middle-aged women followed either a calorie-restricted diet or a non-calorie-restricted diet initially providing 20 grams of carb per day that was gradually increased by 10 grams a week over 12 weeks. Although the two groups lost similar amounts of weight, the low-carb group had a larger drop in triglycerides and greater improvement in cholesterol ratios than the calorie-restricted group ( 12).

It's worth pointing out that although the low-carb group started out eating a keto diet, they were no longer anywhere near ketosis at 140 grams of carb by the end of the study. This shows that following a very low carb approach resulting in high ketone levels is not imperative for weight loss.

Clearly, more high-quality studies on low-carb and keto diets need to be conducted in menopausal women. However, it stands to reason that eating in a way that lowers insulin levels and helps control hunger would be very beneficial for them.

Hot Flashes

Unfortunately, there is also a lack of formal research exploring the effects of keto or low-carb diets on hot flashes.

However, many women who start a keto diet report having fewer and less severe hot flashes. In several cases, the improvement seems to be rapid and significant.

According to retired neurosurgeon Dr. Larry McCleary, there's a biochemical reason for this effect.

In his book The Brain Trust Program, Dr. McCleary explains that the decline in estrogen during the menopausal transition reduces the action of glucose transporters responsible for delivering glucose to the brain. He states that this process is similar to what occurs in children with epilepsy and other seizure disorders, although menopausal women experience it to a much lesser extent.

Dr. McCleary says that women who suffer from hot flashes can reduce their frequency and severity by following a very-low-carb diet that provides the brain with ketones it can use as fuel. His dietary approach includes nutrient-dense foods like meat, fish, poultry, eggs, cheese, nuts, seeds, non-starchy vegetables, olive oil, and small amounts of berries. In addition, he recommends fats like coconut oil or MCT oil to naturally boost ketone levels.

Other Menopausal Symptoms

To date, there are no studies supporting carb restriction for mood swings,“brain fog,” irritability and other mental or emotional changes common during the menopause transition.

However, some menopausal women have reported that their mood, memory, and ability to concentrate improved once they switched to a keto way of eating.

In addition, some research suggests that nutritional ketosis may improve memory in older people with mild cognitive deficits ( 13).

Although high quality research on ketogenic diets for hot flashes and other menopausal symptoms is needed, the reports from women who have achieved beneficial effects are very encouraging.

How Many Carbs Per Day Should Women in Menopause Eat?

Again, based on the lack of research in this area, it is hard to make specific recommendations for the amount of carbs women in menopause should consume. However, generally speaking, restricting intake to less than 50 grams of net carbs per day will help suppress appetite, reduce insulin levels and increase insulin sensitivity, which can make weight loss or maintenance easier.

However, if your goal is to be in nutritional ketosis in order to relieve hot flashes, improve mood, or boost memory and concentration, you may need to stick to about 20-30 grams of net carb per day.

Best Low-Carb Foods for Menopause

In addition to keeping carbs low, there are some specific foods that may help boost fat loss and/or help reduce menopausal symptoms.

Flaxseed

Flaxseed may help relieve certain menopausal symptoms, especially hot flashes. However, the effects seem to vary from woman to woman, based on anecdotal reports and high-quality studies ( 14,  15).

To learn more about flax's health benefits, safety profile, and ways to include it in your diet, have a look at my article: Is Flaxseed Healthy? Safety Concerns, Benefits & Recommendations

Green Tea

Green tea is rich in catechins, which are potent antioxidants. It's also the best source of a specific catechin known as epigallocatechin gallate (EGCG), which has been credited with beneficial health effects on cardiovascular and metabolic health.

Studies in menopausal women have found that caffeinated green tea helps lower insulin in those with elevated levels, whereas decaffeinated green tea doesn't seem provide the same benefit ( 16,  17).

Fatty Fish

Fatty fish has been shown to reduce inflammation, lower triglycerides, improve artery function, and protect brain health. These effects are largely due to its high content of EPA and DHA, the long-chain omega-3 fatty acids found in salmon, sardines, mackerel and herring.

In an RCT of 87 postmenopausal women with metabolic syndrome, the women whose diets were supplemented with omega-3 fats had significant reductions in insulin resistance, blood pressure and inflammatory markers compared to those who followed the same diet without omega-3 supplementation ( 18).

To get the benefits of these omega-3 fatty acids, aim for a minimum of two 100-gram (3.5-ounce) servings of fatty fish per week.

Other Lifestyle Modifications for Menopause

Physical Activity

Staying active is crucial during and after menopause. Studies in postmenopausal women have shown that regular exercise can help relieve stress, boost metabolism and fat burning, and prevent loss of muscle mass ( 19,  20,  21). In addition, physical activity may potentially relieve hot flashes in some women.

One study found that women who engaged in a six-month exercise program during menopause had lower hot flash scores than women who didn't exercise when researchers followed up on all the women four years later ( 20).

Although all forms of exercise are beneficial, strength training is by far the most effective for managing symptoms of menopause, slowing down the aging process, and improving body composition.

In a study of 32 postmenopausal women, performing high-volume resistance training three times a week for 16 weeks led to greater muscular strength, loss of belly fat and a decrease in inflammatory markers than less rigorous exercise ( 21).

Lifting weights for several repetitions three times a week seems to provide optimal results. However, if physical issues limit your ability to lift weights, you can still benefit from other types of exercise, including walking. The key is making regular exercise a part of your life and doing the best that you can.

Yoga

Yoga is well known for relieving stress. A few studies have found that yoga, tai chi and similar mind-body therapies may also improve certain menopausal symptoms, such as sleeping issues and hot flashes, in some women ( 22,  23,  24).

Moreover, yoga seems to increase overall well-being and satisfaction with life during the menopause transition.

In a controlled study of 260 menopausal women lasting 18 weeks, significant improvements in physical, psychological, and social quality of life scores occurred in the women who were assigned to the yoga group ( 24).

Acupuncture

Acupuncture is a form of Traditional Chinese Medicine that appears to be effective for hot flashes and improving sleep.

In one study of 209 women aged 45-60 who were having several hot flashes on a daily basis, 6 months of acupuncture treatments helped reduce the frequency of their hot flashes by more than 36%, whereas women in the control group who didn't receive acupuncture had a 6% increase in hot flash frequency ( 25).

Additionally, a 2016 detailed analysis of 31 studies concluded that acupuncture may significantly improve sleep quality in perimenopausal and postmenopausal women with sleeping issues ( 26).

Supplements

Pycnogenol

Pycnogenol is also known as French maritime pine bark extract. It contains several antioxidants, including procyanidins, which are also found in cocoa, nuts, berries, and grapes.

Research suggests that pycnogenol may modestly reduce hot flashes, insomnia, mood swings and other menopausal symptoms ( 27,  28).

Is Pycnogenol Suitable for Everyone?

Pycnogenol seems to be safe for most women. However, because it may potentially stimulate the immune system, people with autoimmune disease are best off avoiding it. In addition, if you have a bleeding disorder or take blood thinners, you should speak with your doctor before taking pycnogenol.

Recommended dosage is 50 mg 1-2 times per day. You can get Pycnogenol on Amazon and many other health stores.

Other Supplements

A few of the more common herbs used to relieve menopausal symptoms include black cohosh, dong quai, and red clover. However, study results on these herbs have been mixed, and more research is needed to confirm that they are safe for long-term use.