Keto Diet for Women: Benefits, Food List & Tips to Overcome Side Effects

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Far from being a new “fad diet”, the ketogenic diet — a very low carb, high fat diet — has been used by doctors since the 1920’s to treat patients with serious illnesses. In recent years the keto diet has steadily been gaining more attention, due to how it promotes weight loss by forcing the body to burn fat for energy. More than ever before, a wider audience is now considering trying the keto diet, including those interested in benefits beyond weight loss. Examples include a reduced risk for diabetes, increased energy and protection against age-related neurological diseases. (1)

One problem with the keto diet, however, is that to date, research studies aimed at investigating its efficacy and safety have involved only men or animals (mainly mice). Some have been skeptical then that the keto diet can work equally well for women. Others question whether it’s necessarily a good idea for women to even try keto given the fact that women’s hormones tend to be more sensitive to most dietary and lifestyle changes.

According to certain experts in women’s health — such as Dr. Anna Cabeca, a double board-certified Ob-Gyn and Regenerative and Anti-Aging Medicine expert — following an alkaline ketogenic diet may be one of the most helpful lifestyle changes that both women and men can make.

From her experience, “A keto-alkaline diet honors our body’s natural design.” Dr. Cabeca has personally taken care of more than 10,000 women through a combination of her online programs and in-office treatments, seeing firsthand the dramatic results that the keto alkaline diet can yield.


Does the Keto Diet Work for Women?

The answer is yes! In the years that Dr. Cabeca has been using the keto diet to help treat women, especially those in perimenopause or menopause, she’s hardly ever seen the diet fail to produce benefits. Her clients and patients have experienced weight loss, improved blood sugar control, better quality sleep and reduced menopause symptoms like hot flashes or night sweats.

Dr. Cabeca came up with the concept of combining an alkaline diet with a keto diet after weighing the benefits of very low-carb eating on one hand, with some of the negative feedback she was receiving from clients on the other. Although many of her clients experienced weight loss quickly and reliably while reducing their intake of carbs, many also reported dealing with side effects like nausea, fatigue and constipation due to the keto diet.

The keto diet involves getting up to 80 percent of daily calories from sources of healthy fat, a significant change for most of her patients who were accustomed to running on carbs, caffeine and sugar for energy. It became clear that something else had to be adjusted in order to prevent the side effects associated with the keto diet. This is when she came up with the idea to focus on restoring alkalinity first and foremost.

Common Questions Regarding the Keto Diet for Women:

1. How exactly does an alkaline diet fit into a keto one? And why is that so important for women?

While a ketogenic diet helps normalize blood sugar (glucose) levels and can help you maintain or reach a healthy weight, an alkaline diet is beneficial for its anti-aging effects— especially lowering inflammation, boosting detoxification, and promoting hormonal balance, immunity and more. Traditional ketogenic diets usually miss the important factor of restoring alkalinity. For many patients the key is to reach an alkaline pH first before beginning keto in order to prevent feeling agitated, anxious, uncomfortable or overly hungry.

How does an alkaline diet work? An alkaline diet supports overall health — including reducing symptoms related to infertility, PMS or menopause — by helping to balance your internal pH level and increase nutrient absorption. Eating foods that are high in key minerals but not very acidic can reduce common symptoms or disorders by promoting a more alkaline environment, the natural and preferred state of the body. Research shows that maintaining a more alkaline urine pH level can protect healthy cells and improve gut health. (2)

Also known as “alkaline ash diets,” reducing acidity (such as from coffee/caffeine, alcohol, refined grains or processed meats) has benefits for the cardiovascular system due to how it prevents plaque formation in blood vessels, can help decrease kidney stones, helps to maintain bone mass and is beneficial for reducing muscle wasting due to aging.

What sort of negative health effects might an overly acidic pH level contribute to? A few include: bone loss, muscle loss, and higher susceptibility to frequent infections or illnesses. One way to track if you’re body is adapting well to an alkaline diet is testing your urine pH level. The pH scale ranges from 1–14, with seven being neutral and anything higher than seven beings alkaline. The goal is to ideally have a urine alkaline pH level between of 7.0–7.5 (a number that is slightly more alkaline than acidic).

2. Will an alkaline keto diet prevent the lack of energy and other side effects that some feel when they try low carb dieting?

Mostly likely, yes. A common finding is that focusing on eating an alkaline diet in addition to a low-carb keto diet will dramatically help curb side effects for many women (and men too!). The reason is because of high nutrient intake, enhanced detoxification and reduced reliance on “uppers” like caffeine (some even overdosing on caffeine) and sugar for energy.

3. What other factors should be considered, besides someone’s diet, that can influence their pH level?

While it’s an extremely important factor, your diet is not the only variable that affects your pH level and hormones. Other factors that influence alkalinity, aside from the foods you eat, include: the level of stress you deal with on a daily basis, how much sleep you get nightly, the amount of sunlight exposure you get and the level of environmental toxicity you’re exposed to.

4. Intermittent fasting (IMF) is often recommended in concert with a ketogenic diet. But many wonder whether or not IMF is advisable for women or safe.

According to Dr. Cabeca, “Fasting is a key aspect of a healthy diet and has many anti-aging effects.” In particular Dr. Cabeca recommends fasting to women during or after menopause due to it’s anti-aging effects. For example, a 2016 study published in the Journal of the American Medical Association found that when women went 12.5 hours between dinner and breakfast (a common form of fasting), the overnight fast seemed to help improve immune system functioning to the point that it reduced their risk for breast cancer. (03) 

Why is intermittent fasting beneficial for women, especially if they’re in perimenopause or menopause? Fasting allows the body to take a break from digestive functions and instead to focus on essential repair work and reaping the many other benefits of rest. In other words, when fasting, the body’s energy resources go towards restorative work (like repairing tissue and balancing hormones) rather than digestive processes like producing stomach acid to break down food. 

She has found that when women stick to eating a lighter dinner, and then abstain from eating for about 13–15 hours between dinner and breakfast, they experience improvements in their weight, blood sugar control, etc. She recommends that women try avoiding eating after 8 p.m. or experiment with eating only two meals per day, with tea or broth between meals to help curb hunger. Another option is to try skipping dinner altogether on 1–2 days per week. For most women, when attempting IMF, it’s not recommended to snack between meals unless the woman is very active (such as an athlete in training) or dealing with a hormonal issue such as adrenal burnout.

5. How long should an alkaline keto diet be followed?

It’s best to approach this change in eating as a way to feel better and become healthier, rather than as a “fad diet” or weight loss quick-fix. Dr. Cabeca recommends giving it six months to test the effects, keeping in mind that some trial and error is expected along the way. The diet should ideally be approached in step-wise fashion, focusing on alkaline first before adding in fasting and the keto aspect.

Keto for women guide - Dr. Axe

Common Complaints or Side Effects from Keto + How to Overcome Them

Tip #1: Eat More Alkaline Foods

How exactly can women eat a diet that is both alkaline and allows them to stay in ketosis? Are there any foods to avoid eating even though they are technically “low carb”? Dr. Cabeca feels it’s critical to add in plenty low-carb alkalizing choices (fruits and veggies) to a ketogenic diet for optimal benefits and prevention of side effects. She especially recommends nutrient-dense foods like avocado and dark, leafy greens.

Here is a list of no-carb to moderately low-carb foods that women (and men, too) can include in an alkaline keto diet:

  • Greens like kale, chard, beet greens, dandelion, spinach, wheat grass, alfalfa grass, etc.
  • Other non-starchy veggies or herbs like mushrooms, tomatoes, avocado, radishes, cucumber, jicama, broccoli, oregano, garlic, ginger, green beans, endive, cabbage, celery, zucchini and asparagus.
  • Ideally try to consume a good portion of your produce raw or only lightly cooked (such as steamed), as raw foods can help supply high levels of alkalizing minerals
  • Add in other superfoods like maca, spirulina, sea veggies, bone broth and green powder mixes that contain chlorophyll.
  • Healthy fats like coconut oil, MCT oil or virgin olive oil. Fats found in wild-caught fish, grass-fed beef, cage-free eggs, nuts, seeds and organic grass-fed butter are also good additions to your diet.
  • Smaller amounts of starchy plants like sweet potato, turnips and beets can also included in the diet, although these should typically be kept to lower amounts due to containing more sugar and carbs.
  • If possible, try to consume alkaline water. Alkaline water has a pH of 9 to 11, making it a better option than tap water or purified bottled water that more acidic.
  • To reduce your intake of toxins and chemicals, it’s best to purchase organic produce whenever possible and to pay extra for grass-fed, free-range animal products. Plants that are grown in organic, mineral-dense soil tend to be more alkalizing and supply the most bang-for-your-buck.

While they might be okay every now and then, in general it’s not recommended to eat much fruit or high-carb veggies that taste very sweet in order to maintain ketosis. While working towards reaching a more alkaline, ketogenic state (ketosis), try to minimize or exclude these foods:

  • All sources of added sugar
  • Grains (even whole grains)
  • Most dairy products (sometimes small amounts of full-fat yogurt/kefir or cheese can be okay)
  • Try to only have eggs, lentils and nuts like peanuts in small amounts, since these are more acidic than other proteins. Avoid processed meatsincluding cold cuts, or factory-farm raised meats, which promote acidity.
  • Caffeine
  • Alcohol
  • Other processed foods that contain lots of sodium, sugar, synthetic ingredients and fillers

Tip #2: Try “Crescendo Fasting” (or other types of carb cycling)

There are various ways to practice intermittent fasting, including some that are less likely to trigger side effects like fatigue or cravings. Crescendo fasting gives you a break from fasting throughout your week, but is still very helpful for achieving the benefits of IMF. Dr. Cabeca and other experts, such as Amy Shah, M.D., advise their patients to check their urinary ketone levels(using ketone strips) and to aim for testing positively for ketones about three days per week.

Work towards cycling fasting days so you’re fasting on 2–3 nonconsecutive days per week (e.g. Tuesday, Thursday and Saturday). Stick to only light exercise or yoga on fasting days to reduce feeling exhausted or hungry, keeping higher intensity activities for your non-fasting days. This approach allows for more dietary and lifestyle “moderation” because the goal isn’t to eat 100 percent “perfectly” all the time.

Tip #3: Manage Stress & Rest Enough

Addressing the major sources of physical and emotional stress in your life is essential for healing underlying hormonal imbalances and fertility issues. Aim to get 7–9 hours of sleep each night to reset your hormones daily. Lack of sleep can really affect your digestion, appetite and energy levels!

Several ways to manage stress include: getting enough moderate movement and exercise, yoga and/or meditation, taking slow walks outside, journaling or reading, being more social by joining some type of group or team, resting more, prayer, etc.

Tip #4: Prevent Constipation With More Fiber & Water

If your body is having a hard time adjusting to a keto diet, try to eat more fiber from veggies, nuts or seeds and also drink enough water to help hydrate the intestines to relieve constipation. Dr. Cabeca recommends starting the day with a big glass of hot water with lemon and a pinch of cayenne pepper.

Through the remainder of the day try to drink half your weight in ounces of water daily (for example, 65 ounces or a little more than 8 glasses if you weigh about 130 pounds). Taking probiotics is also a good idea due to how this helps replenish the gut with healthy “good bacteria.”


Precautions Regarding the Keto Diet for Women

Aside from constipation and initial cravings for carbs or sugar, other side effects you may experience while transitioning to an alkaline keto diet (especially if you’re also beginning fasting) can include: bad breath, menstruation issues, adrenal or thyroid issues, fatigue or low energy levels.

While sometimes it might feel like things are getting worse before they get better, these symptoms should resolve within a few weeks to months of following the tips and program mentioned above. This is especially true if you try to remain active (walk, ideally outside, for at least 20–30 minutes daily), sleep well and decrease stress. Drink plenty of water, herbal tea or bone broth to prevent dehydration, and go easy on exercise if you’re feeling under-fueled.

It’s also worth mentioning that if you have a history of irregular periods, any type of eating disorder, or a thyroid disorder than it may be best to begin this type of dietary program only while being guided by your doctor or a nutritionist. Pregnant women or those who are breastfeeding should not start the keto diet to be safe. A professional can help you ease into an alkaline keto diet in a moderate, safe way if you’re unsure of how to do this on your way, giving you feedback so the diet won’t negatively interfere with normal hormone production, appetite, sleep or mental focus.


Final Thoughts On the Keto Diet for Women

  • According to most research, women respond more strongly to dietary changes, including to lowering their carb intake. Side effects on the keto diet (a very low carb, high fat diet) can include fatigue and hunger, however combining the keto diet with an alkaline diet can curb these symptoms for most women, and men too.
  • An alkaline diet is one that includes whole foods that have positive effects on pH levels of the blood and urine by lowering acidity. A keto alkaline diet benefits women by promoting weight loss, detoxification, heart health, stronger bones, decreased inflammation and reversal of nutrient deficiencies.
  • Foods that are emphasized as part of an alkaline keto diet include non-starchy vegetables, raw foods, green juices, lean proteins and lots of healthy fats. Foods that are high in sugar, carbs and acidic that should be avoided include: added sugar, high-sodium foods, processed grains, too much meat and animal protein, milk and dairy products, alcohol and caffeine.

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