Wherever you are in your menopause journey, you can reset your health with a hormone-balancing ketogenic diet, says holistic menopause expert Dr Mindy Pelz
The ketogenic diet has seen a tremendous increase in popularity in recent years, but it’s also received some bad reviews, especially for women. This is largely because many women haven’t been taught how to cycle their low-carbohydrate diets with their hormones.
I believe the ketogenic diet can be a game-changer for women—especially menopausal women with symptoms like weight gain, low energy and erratic moods. However, it needs to be done differently. Here’s how to get the amazing benefits of going keto while boosting your gut microbiome and balancing your hormones.
So many women are starving themselves by eating only chemical-laden, low-fat foods and trying to burn off those foods with long hours at the gym. Not only is this approach to weight loss hard to sustain, but it also messes with your metabolism and makes it harder to lose weight in the future.
I’m not telling you to stop exercising; I’m telling you to stop counting calories. Your calorie intake will not necessarily improve the roller-coaster ride your hormones are on. Controlling the types of foods you eat will.
Think of your food in terms of macros—the macronutrients that make up the calorie content of your food—specifically carbohydrates, protein and fat. Each of these macros serves a different purpose in your menopause journey. Each will raise your insulin levels differently, and insulin influences sex hormones.
To begin the process of balancing estrogen, progesterone and testosterone, you first want to make sure the types of food you are eating aren’t constantly spiking your insulin levels. A good place to start is to get a complete blood analysis from your doctor.
In this blood test is a measurement called hemoglobin A1C, which tells you the trend of your insulin levels for the past three months. You want that number under 5 for disease prevention and under 3 for longevity.
The second way to understand how much insulin your body might be producing is to monitor your blood sugar levels closely with a home blood sugar reader, which you can easily find at your local drugstore. When your blood sugar levels go up, insulin goes up. This is the best way to measure your blood sugar levels regularly.
There are lots of good at-home monitors out there, but the one I recommend is the Keto-Mojo. I encourage all my patients to take a morning blood sugar reading. You want that reading to be 70–90 milligrams per deciliter (mg/dL) on most days. If it is consistently higher than that, you may be forcing your pancreas to make too much insulin, throwing off your whole hormonal cascade.
How do you keep your blood sugar and insulin levels down with diet? It all comes back to your macros.
Carbohydrates
Of the three macronutrients, carbohydrates typically raise your blood sugar and insulin the most. Refined carbohydrates, such as bread, pasta and sugary treats, have the strongest impact on insulin. Fibrous carbohydrates like fruits and vegetables spike your blood sugar less and therefore cause less of an insulin surge.
One of the first steps in controlling high insulin is to remove refined carbohydrates from your diet. This one change alone can dramatically improve your menopause symptoms. If you combine this step with intermittent fasting (going for extended periods without food; the easiest way to do this is to have a later breakfast and/or an earlier dinner so you are going 13–15 hours overnight without food) you may immediately see your energy go up, hunger drop, and mental clarity improve. I see this happen all the time with my patients.
Once you have accomplished this step, your next step is to start counting your macros. I recommend tracking your macros daily with an app such as Carb Manager. To keep your blood sugar and insulin in a healthy zone, keep your net carbs under 50 g/day. Don’t worry—the Carb Manager app will calculate the net carbs for you. But it is important to know that there is a difference between total carbs and net carbs.
Net carbs are your total carbohydrate load minus the fiber. Fiber is great for breaking down harmful estrogens—I want you to have lots of fiber. When you keep your net carbohydrates under 50 g/day, your morning blood sugar should drop into the healthy range of 70–90 mg/dL. The drop should signal your body to make ketones.
Ketones are a sign that your liver has made the switch from burning carbohydrates for energy to burning fat for energy. This is a beautiful thing. When you train your body to make that switch, you will find weight loss comes quicker.
Ketones are also massively healing to your brain, especially the hypothalamus and pituitary, the parts of the brain that coordinate all hormone production.
On your blood sugar reader, there is a setting for ketones. You want to see your ketone reading above 0.5. We call that nutritional ketosis, and the range we are looking for is somewhere between 0.5 and 5.0. As long as you are in that range, you are burning fat for energy.
Once you see how well your body works in this low-carb state, it will be tempting to keep lowering your carbs. This often means sacrificing vegetables. But for the menopausal woman, this is a bad idea. You need vegetables to break down estrogen.
I am not a fan of low-keto diets for menopausal women. Low-keto diets often involve keeping carbohydrates under 20 g/day. Instead, I advocate a ketobiotic diet—a keto diet, i.e., limited carbs, but including foods to feed your gut microbiome. Ketobiotic means you keep your net carbs around 50 g/day, allowing for plenty of greens and probiotic- and prebiotic-rich foods to break down estrogen (see “Ketobiotic foods” below for examples).
Protein
Of all the foods you eat, meat can be the most toxic. The animals we eat are often injected with antibiotics and growth hormones, and these chemicals can wreak havoc on your hormones.
The first step when it comes to your protein is to eat clean—choose grass-fed, organic meats whenever possible. Start reading labels and looking at what is going into your meat. You will start to see that many meat labels read “raised without antibiotics,” “grass-fed” or “hormone-free.”
Next, look at the amount of protein you eat. When someone goes low-carb, they often increase their protein load. This is not a worthy exchange because protein can raise insulin levels as well. It is best to keep your protein intake to under 50 g/day. If you are using Carb Manager to measure your net carbs, be sure to plug in your protein, too.
Fat
Eating good fats and avoiding bad ones is crucial as you move through menopause. You are made up of trillions of cells. On the outside of those cells are receptor sites that receive hormones and allow them to move into the cells for activation. Once a hormone is able to get into the cell and do its job, you will feel good.
These receptor sites are easily blocked by two things: toxins and bad fats. A blocked receptor site is the kiss of death for a woman going through menopause. You are already making fewer hormones than ever before, so if the hormones you are making can’t move into the cell because of a blocked receptor site, your menopause symptoms will be exacerbated.
You also want fats to be organic and not rancid. Those hormone receptor sites can get clogged with pesticides, and nonorganic fats are packed with pesticides.
Fats can go rancid if they are old. Rancid fats will inflame the cell membrane and make it hard for hormones to get in as well. In my household, we buy smaller bottles of oils and replace them more frequently so that they don’t turn rancid on us.
You can tell if your oils are rancid by smelling them. There is a distinct wet cardboard smell to an oil that has turned bad.
Once you have cleaned up your fats, look at how much fat you eat. Go back to Carb Manager and make sure that over 60 percent of your daily food intake is fat. I don’t recommend you count grams of fat—count percentages. Good fat not only nourishes your cells but also heals your brain, slows down hunger, and gives you nice, consistent energy all day long (see “Good and bad fats” below for guidance).
I know it can be scary to think of eating that much fat, but I promise you the key to balancing your hormones and losing weight is in lowering your carbohydrate load, moderating your protein and increasing your fat. I have seen this work repeatedly for thousands of women.
Once you are comfortable with eating this way for at least 80 percent of the week, you can move on to the next step.
You have all kinds of hormones surging at different times of the month, and you can support them by eating certain foods at specific times in your cycle. I call these hormone-building days.
I realize that many of you either don’t have a cycle or your cycle is irregular, so it would be tempting to skip this step. Don’t. I’ll explain the principle of eating for your cycle first and then map that out for where you are on your menopause journey.
While you were ovulating, you had two phases: follicular and luteal. The follicular phase is from Day 1 to Day 14 of your cycle, when your body is preparing to release an egg for ovulation. The second phase is called the luteal phase, from Days 15 to 28, when your uterine lining gets ready for a fertilized egg to implant.
At this point in your life, the most important thing to understand about these two phases is that there are two times in a 28-day period when you get a massive hormone surge: Days 12–14 and Days 21–28. The first surge is when your body needs the best estrogen, and the second is when it needs the most progesterone.
As you move through your menopause years, estrogen and progesterone are rapidly declining. This decline is what is making your periods erratic. It’s also what is contributing to your symptoms.
Once you recognize this, you can eat certain foods at certain times of the month to support the production of both estrogen and progesterone. The first thing to know is which foods increase estrogen and progesterone (see “Hormone-building foods” below for some of my favorites).
At first glance, you will notice that many of these foods are higher in carbohydrates. You might even be asking yourself, “How can I keep my carbohydrate load under 50 g/day and eat potatoes and tropical fruits?” This is where eating for your cycle comes in. Most likely, you will fit into one of the following three categories.
You still have a regular cycle
If you still have a regular or semiregular cycle, track it. I like to use the Clue app. For me, eating for my cycle has been so helpful in mitigating my menopause symptoms that I have become diligent about recording my period (when it comes) and eating to build hormones.
Once you are in the routine of tracking your cycle, pay attention to the two hormone surges discussed above. During the estrogen surge, which typically happens on Days 12–14, don’t count macros, and eat as many estrogen-building foods as possible.
During the progesterone surge, which typically happens around Day 21 and continues until you bleed, eat as many progesterone-building foods as you want. The same rules apply as in your estrogen-building days: you are not counting macros.
I call this style of eating a 28-Day Hormone Reset because it affects insulin, estrogen and progesterone. I have taught so many women this trick to regulate hormones, and almost every time, I get the questions “Won’t I gain weight?” and “Won’t that throw me out of ketosis?”
If these are your concerns as well, here’s what I want you to do. On these hormone-surging days, you can still do intermittent fasting. Make sure you fast at least 15 hours during this time. When you are not in a hormone-surge time of the month, be disciplined about keeping with the macros I set earlier and consider a longer fast, such as dinner-to-dinner fasting (going 24 hours without food).
For weight loss, throw in a 36-hour fast anytime during Days 1–12 and again during Days 15–20. This variation will allow you to build hormones when your body needs them and still get the benefits of ketosis when your body is not trying to make these key hormones.
For more details on fasting and to work out which type of fast is best for you, join my free Facebook group, the Resetter Collaborative: http://bit.ly/Resetters.
Still not convinced? I speak from personal experience. When I first discovered how great I felt with a low-keto and fasting lifestyle, I would rarely eat carbs and did long fasts often. This tanked my sex hormones and sent my menopause symptoms into a frenzy.
My progesterone was so low that my period started getting sporadic. I went from spotting to hemorrhaging so badly, I thought I needed to stay home from work to manage my blood flow. I was anxious and extremely irritable the week leading up to my period. The anxiety would get so bad, I couldn’t even relax while sitting at home on the couch. These are all signs of extremely low progesterone.
Once I committed to the 28-Day Hormone Reset protocol, the madness stopped. Everything from the spotting and hemorrhaging to the anxiety completely calmed down. I can now feel my cycles slowing down as I move through menopause. But it’s a gentler and calmer ride. I’m off the roller coaster, and it feels more like my ovaries are slowly shutting down.
You have an erratic cycle
What do you do if you are not sure when your period is coming? This is common the closer you are to the postmenopausal phase of your life. My advice is that when your period does come, track it immediately, even if you bleed for only one day. Make that Day 1 of your cycle, then follow the 28-Day Hormone Reset.
For many of my patients who have erratic cycles through their menopause experience, the 28-Day Hormone Reset can bring back some regularity to their cycles.
Remember that the average age to get to the other side of menopause is somewhere between 52 and 55. If you enter menopause before 50, it can be a sign of an imbalance in your body that needs to be addressed. Following the above strategy often fixes these imbalances and makes your cycles regular again.
Now, what do you do if you get to Day 28 and you still have no sign of your period coming? If this is you, I want you to pretend that Day 29 is Day 1 even though you don’t have your period. Go back to the Clue app and mark it as Day 1. Then follow the 28-Day Hormone Reset, starting from the beginning.
If your period doesn’t show up, continue this 28-Day Hormone Reset until you are officially postmenopausal. If your period does show up at some point during this reset, just start at Day 1 of the 28-Day Hormone Reset from the moment you see blood. Keep doing this routine until you are postmenopausal.
You have no cycle
What do you do if you are postmenopausal or unsure where you are in your menopausal journey but haven’t had a period in years?
If you are under 50, follow the 28-Day Hormone Reset as described above for an erratic cycle. There is a good chance you went into menopause too early. For many women in my practice who have lost their cycle before 50, following the 28-Day Hormone Reset gets their periods started again because this style of eating balances insulin and sex hormones.
If you are over 50 and haven’t had a period in over a year, you are most likely officially postmenopausal. For you, the hormone-building days are not as crucial because your ovaries are no longer active. But you still need some estrogen and progesterone.
You will find that some hormone-building days can be helpful. You will also thrive on a more ketobiotic diet and can usually do longer fasts whenever you want. You don’t need to think about timing, but you do still need to focus on hormones.
I recommend staying ketobiotic 80 percent of the time, using the macros I laid out earlier (50 g net carbs, 50 g protein, over 60 percent fat), and 20 percent of the time you eat to build hormones (not counting macros). In a week, you’ll spend one or two days hormone-building and the rest on a ketobiotic diet.
At 49 years old, Cathy was at the height of her menopause symptoms. Night sweats, anxiety, memory loss, hair loss, chronic fatigue, rising cholesterol levels and unexplained weight gain became her new normal. As a high-achieving athlete, she was used to exercising her way out of any symptom. But for the first time in her life, exercise was not the cure.
When I first started working with Cathy, she was a six-meals-per-day, carb-loading kind of gal. Many of the tools I recommended seemed counterintuitive to what she had been taught about health her whole life. But her old tricks didn’t work.
I started by moving Cathy’s breakfast back an hour. She quickly got the hang of it, and within weeks, she intermittently fasted every day. With this first step alone, she felt more energy.
Next, I had Cathy move away from a high-carbohydrate diet. She started by removing refined carbs like bread and pasta. This slowed down her hunger, allowing her to fast longer. As she fasted longer, she dropped the belly fat that had accumulated in the past few years.
With her energy up, hunger down and weight falling off, I tested Cathy’s gut to see what type of good bacteria she had working for her. Turned out she was massively deficient in helpful bacteria that bring down cholesterol levels, break down toxic estrogen and speed up metabolism. She started to add more plant diversity and polyphenol, probiotic, and prebiotic foods to her diet. With this step, I saw her cholesterol come down and even noticed changes in her skin and hair.
The last step was to lower her toxic load (another vital part of my protocol for menopausal women). Cathy’s heavy metal test showed she was extremely high in lead and mercury. Once I taught her how to remove those toxins safely and effectively, she started to sleep through the night, the anxiety went away, her hair stopped falling out and night sweats became a thing of the past.
Although not officially through menopause, Cathy now had the tools in place to keep her symptoms at a minimum.
Wherever you are in your menopause journey, you can do what Cathy did. She didn’t have any superpower that you are not equipped with. Follow the steps, and tap into one of my online programs if you need more support and community. Know that this process works, and it works every time.
I recommend a “ketobiotic diet” for menopausal women, a keto diet that includes plenty of plant foods to fuel your microbiome. Very strict keto diets (20 g carbs per day) don’t allow for enough foods to feed your microbiome, which is crucial for balancing your hormones.
There are three categories of food that your good microbes like to eat: polyphenol, probiotic and prebiotic. Polyphenol and prebiotic foods help you grow the good bacteria you already have, while probiotic-rich foods add good bacteria to your gut. You need a balance of the three categories daily.
My favorite polyphenol foods:
My favorite prebiotic foods:
My favorite probiotic-rich foods:
The most common good fats are:
Fats to avoid are:
Eating certain foods can help to build two important hormones for women—estrogen and progesterone. Include estrogen-building foods on Days 12–14 of your cycle and progesterone-building foods on Days 21–28.
Estrogen-building foods:
Progesterone-building foods:
Days 1–11: Ketobiotic diet with your choice of fast
Days 12–14: Estrogen-building foods with intermittent fasting
Days 15–20: Ketobiotic diet with your choice of fast
Days 21–28: Progesterone-building foods with intermittent fasting
Adapted from The Menopause Reset: Get Rid of Your Symptoms and Feel Like Your Younger Self Again by Dr Mindy Pelz (Hay House, 2023)
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