The ketogenic diet has been getting a lot of buzz in recent years. That is plainly obvious with every visit that I make online to read over comments from Hypothyroid Mom followers. It seems like one after another, people are raving about keto for finally helping them lose stubborn fat. With all the rave reviews, however, the truth is that I’ve also heard from hypothyroid readers, more often women than men, feeling sick and even gaining unwanted weight on keto. It is clear to me that the traditional keto diet is not the wonder weight loss cure for everyone, especially those of us with hypothyroidism.
Are there particular modifications for people with hypothyroidism so that everyone wins with keto? That was my burning question.
And there entered this OB/GYN.
Written by Anna Cabeca, DO, FACOG
I get asked a lot about whether a ketogenic diet – a very low carb diet – improves symptoms for women having thyroid disease, or whether it makes symptoms worse.
My own medical opinion, given decades working with women over 40 having hormone balancing challenges, is that a traditional ketogenic diet may not be right for many women with thyroid disease. The good news? I have found a few important modifications that can be incorporated with keto that address its possible negative effects.
Let me talk a bit more about this and how I’ve enhanced the traditional ketogenic diet to best serve women over 40.
The potential problems with keto
A ketogenic diet is a very carb-restricted diet that is also high in fats. The reduction in carbs changes the “fuel” your body burns, from glucose (generated by your body in response to all the carbs we all tend to consume) to instead burning fat. This metabolic state of fat-burning is called ketosis. Because your body starts to burn fat, the only available alternative fuel source, a keto diet is known as a great weight loss diet.
This switch in fuel source can actually be measured by testing for something called ketones, either in the blood or urine. When you are testing positive for ketones that means you are burning fat. It also means you are producing less glucose (so no more blood sugar spiking!) and improving your insulin control.
There have been many studies which have scientifically shown that a ketosis state not only supports weight loss, but that it also may reduce blood sugar issues such as insulin resistance and diabetes, may support improved memory and overall brain health (and may reduce your risks for developing Alzheimer’s disease), may reduce epileptic seizures, and finally may even help fight cancer.[1-8]
All of these are things that sound pretty good, right?
But…it turns out that it is the reduced production of insulin that some thyroid experts have expressed concern about when it comes to people having thyroid disease trying traditional ketogenic diets.
Why the concern? Because too little insulin can impact the liver’s ability to make T3 out of T4.
So that’s the first concern we need to talk about.
And the second concern expressed about traditional keto is relating to the state of ketosis itself. Especially for women, remaining in ketosis too long on a ketogenic diet can create way too much acidity in the body. This can be very inflammatory.
So these two concerns (the possibility of lower T3 and increased inflammatory acidity) are the likely culprits when you hear a woman – especially one having some underlying inflammatory issue already, like thyroid disease – having problems as she tries to adhere to a typical ketogenic diet. You might also hear that she has suffered weeks of keto-flu and finally has just given up. Or you might hear she has felt so irritable and keto crazy about the entire experience that she has not only alienated herself from her entire family – including the pet dog – with a very witchy attitude… but has binged on chocolate chip cookies and wine for 3 days as well (before giving up on the diet completely)!
I have dozens of clients who have experienced this result. The traditional keto diet has made them miserable and worsened their thyroid symptoms.
Now, we are all very biologically unique…so some women will do fine on strict keto. Especially women who have no underlying inflammation and who also have very healthy hormone balance…so this would be a woman who has no toxicity challenges, no gut imbalances, no stress issues and the like…know many of those? I don’t!
The bottom line is that most women need some important modifications to the keto diet in order to feel well and remain compliant to its somewhat strict disciplines. And those modifications need to address the two concerns (potentially lower T3 and increased inflammatory acidity) as well.
Listen to your body.
Research has shown that there can be a reduction in T3 levels when a woman is on a ketogenic diet. But does that necessarily equate to women feeling less well? That depends on many other things going on in a woman’s body, in particular her overall hormone balance and inflammatory status. A woman needs to listen to her body, and yes…she needs to know her overall thyroid numbers, whenever she tries any new diet or lifestyle intervention.
What I have found is that if a woman adds certain foundational hormone balancing support to a keto diet, that in most cases her TSH level won’t increase and she will continue to feel well or better!
This even happened to me.
I personally saw a greatly elevated TSH level after exposure to incredible mold toxicity (a result of my home being hit – for the second time – with a hurricane). While I’ve had thyroid issues for many years my TSH really shot up, to 5.07 mIU/L in Dec 2017 (along with repeated mold exposure add in the stress from 5 different moves!)! After getting back – strictly – on my Keto-Green program my TSH measured 0.55 mIU/L in October of 2018. And my free T3 also increased to a healthier level.
And what about the second keto concern? Women on a traditional keto diet often suffer from increased inflammation and acidity due to remaining in ketosis too long.
That’s where an alkaline foundation helps out.
A Thyroid-Friendly Keto Diet
If you are looking for information on the basics of the diet, I wrote this article here at Hypothyroid Mom.
Here below you’ll find the key modifications that I’ve found to make all the difference for women with thyroid disease. If you’ve already tried keto and didn’t feel your best, retry it with these modifications. You’ll be surprised at the difference a few teaks can make.
The first major difference is that women shouldn’t dive into the ketogenic diet on day one. Instead, focus on developing a healthy foundation that includes:
- Maintaining an alkaline pH – This is core to counter the inflammatory acidity seen in ketosis! Keto-only diets force women to stay in ketosis too long and become acidic, which actually creates inflammation. This can result in your body holding on to its fat stores so you won’t lose weight (if that’s your goal)…and the increased inflammation can worsen your thyroid symptoms. For optimal health and wellbeing strive for an overall net alkaline producing diet versus the typical Western (high carbs!) net acid producing diet. Getting alkaline also helps us reset our circadian rhythm, which helps us sleep better and improves our mood. It supports our body in regulating our hormones, including our thyroid hormone, in a more productive fashion too. Note that this net alkaline producing effect is also significantly impacted by many non-dietary elements as well (stress being a big one)!
- Incorporating important lifestyle changes that directly support our two thyroid-impacting regulatory hormones, cortisol and insulin. This includes:
- Improved stress management – Many women can’t get into ketosis until they learn better stress management techniques. We can’t always remove our stressors, but we definitely can learn how to reduce our stress hormone, cortisol, to healthier levels (cortisol effectively puts the brakes on your thyroid metabolism, digestion and immune processes).
- Supporting our adrenals with adrenal adaptogens. Too much stress burns out your adrenals. Your adrenals normally focus on mundane things such as metabolizing nutrients and producing needed hormones. Maca is one of my very favorite adrenal adaptogens.
- Improving our sleep. Our circadian rhythm is critical to hormone production and our overall health and mood.
Addressing the gut dysfunction that is common with thyroid disease. Support thyroid/keto digestion issues (low stomach acid, malabsorption of key nutrients such as zinc, Vitamin D, selenium; leaky gut, constipation due to slow metabolism, etc.) with high quality probiotics, digestive enzymes, and natural detoxification strategies.
Reducing environmental toxins from foods (eating clean and organic, without added hormones, GMOs and chemicals), personal care products (how many endocrine disruptors do you apply to your body daily?) and the home. Ketogenic diets do not include this as an important step but women tell me all the time that this is the key aspect to their achieving alkalinity as well as hormone balance.
Cutting out inflammatory food sensitivities. Most ketogenic diets focus on just lowering gluten intake but do not require the removal of gluten as well as other inflammatory foods. I have found that women in particular do better on a diet that excludes the top inflammatory foods such as gluten, dairy, sugar, and processed foods.
Incorporating the health benefits of intermittent fasting is also key. Many keto diets include some aspect of intermittent fasting as there are numerous studies that support the health benefits (improved insulin sensitivity, reducing oxidative stress) and improved metabolic benefits of fasting (particularly true with the type of fasting that I recommend in my Keto-Green method which is to increase your fasting window between dinner and breakfast, known as a 16/8 fast). I don’t advocate the prolonged 24 hour type of fasting that you’ll find in many keto diets, in particular for those having thyroid disease. It puts too much stress on the body. If you have underlying issues with insulin resistance or blood sugar it is important to discuss any type of dietary change – including intermittent fasting – with your physician.
And finally, let’s incorporate the reality of living into our diet and lifestyle! I’ve seen some thyroid clinicians state that staying in ketosis too long isn’t healthy for those with thyroid issues given that it may lower T3 levels. But frankly, women on my program don’t stay in ketosis for weeks at a time, not even days at a time in many cases. We bounce in and out as there are many dependencies beyond carbs that affect ketosis (such as stress level, sleep, toxicity and so much more).
This is an important point, that there are things beyond carb restriction that can impact ketosis. I’ve found that women, for example, who are under chronic stress may never be able to get into ketosis no matter how much they restrict their carbs.
So how challenging it is for you to get into ketosis, how long you stay there, and how it makes you feel is unique to each of us (and can change over time). You’ll have to experiment a bit by working on the foundational pieces noted above and also perhaps by tweaking your intake of carbs.
Generally, people need to be at around 20-40 grams of total carb per day to get into ketosis. But if you’re a women under stress that might not be low enough to get into ketosis…but don’t just keep lowering the carbs, you need to deal with the stress (and underlying cortisol issue and adrenal burnout). In talking with clinicians focused on thyroid disease and working with ketogenic diets for their patients and clients, most would say not to go lower than 20 grams of total carb per day, in conjunction with their thyroid hormone medication.
I’m not looking at the number of daily carbs, but at the percentage of one’s daily food intake or “plate”. It is much easier and intuitive to do this. I target 5-10% of the “plate” to be healthy, slow-burning carbs (and this equates to generally around 20-35 grams of carbs).
The one caveat to these healthy target carb levels might be someone having an overactive thyroid who may not want to risk further weight loss.
I use an 80-10-10 philosophy. For optimal results I like for women to stay Keto-Green about 80% of the time, fast about 10% of the time (so do some periodical periods of intermittent fasting, but don’t live with those restrictions each and every day), and feast about 10% of the time. Yes! Feasting is so important as it is typically time we bond with family and friends…and we all need to treat ourselves from time to time.
About Anna Cabeca, DO, FACOG
Dr. Anna Cabeca is an Emory University trained gynecologist and obstetrician, a menopause and sexual health expert, international speaker and educator.
References:
[1] Paoli, A., et al. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr. 2013 Aug;67(8):789-796.
[2] Rosedale, R., et al. Clinical Experience of a Diet Designed to Reduce Aging. J Appl Res. 2009 Jan 1;9(4):159-165.
[3] Shaafi, S., et al. Ketogenic Diet Provides Neuroprotective Effects against Ischemic Stroke Neuronal Damages. Adv Pharm Bull. 2014 Dec;4(Suppl 2):479-481.
[4] Allen, B.G., et al. Ketogenic diets as an adjuvant cancer therapy: History and potential mechanism. Redox Biol. 2014;2:963-970.
[5] Yancy Jr., W.S., et al. A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab (Lond). 2005;2:34.
[6] Murphy, P. et al. The antidepressant properties of the ketogenic diet. Biol Psychiatry. 2004 Dec 15;56(12):981-3.
[7] Gasior, M., et al. Neuroprotective and disease-modifying effects of the ketogenic diet. Behav Pharmacol. 2006 Sep;17(5-6):431-439.
[8] Rogovik, A.L., et al. Ketogenic diet for treatment of epilepsy. Can Fam Physician. 2010 Jun;56(6):540-542.
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Is there an actual meal plan, list of alkaline friendly foods, recipes, etc. that you can share?
Check out this Functional Medicine doctor who has studied Hashimoto’s and food sensitivities. His study on this is eye opening. It was shown to me by a Cranial Chiropractor who has researched his studies.
Dr Datis Kharrazian , one aspect of the study is nutrition and the role of Lectins, -antibodies and the inflammatory response. It would appear that beans, some nuts and seeds, melons, grains and some veggies fall into this category. I’m going to see a functional doctors who was recommended and try to deal with my Hashimoto’s. I’ve been able to lose and I’m near goal on gluten , dairy,
caffeine, sugar free with minimal processed foods.
Thinking of trying keto diet. There’s s lot to take in and I don’t want to damage my liver. Do you think it would work for an old age pensioner? I have 4 stone to lose. This excess weight has been caused by medication. I have tried the Atkins diet when I was younger for 2 weeks but it was. too expensive but I did lose weight. I think the keto is similar to the
Atkins diet? Thanks for listening.
I’ve been on keto diet for about 18 months. It doesn’t have to be complicated or expensive, but lots of people make it that way. I guess my eating habits would be called “dirty keto”. I don’t count calories, I don’t calculate macro nutrients, I just count carbs, net carbs and fat in my food. I try to stay between 20-30 grams of carbs per day. The great thing about keto is you don’t need to eat as much or as often, so you buy fewer groceries (almost no processed/boxed or canned foods) making it easier to buy quality meats and vegetables. I’m 54 and I’ve never felt better in my life. I went on keto because it fit my dietary needs–I have developed several food sensitivities in the past few years. I am now off all prescription meds (which caused me to gain 75 pounds over 15 years!). I have lost almost 40 pounds since starting keto. Give it a try. Once you get past your body’s craving for sugar fuel, I’m confident you will find it easy to stick to this way of eating.
I have thyroid and I’m gluten free and celiac disease
Everyone has a thyroid unless surgically removed:)
Not true. Some people, like myself, are born without a thyroid gland 🙂
I’ve been doing ketovore for 4 months now. I started out needing to lose about 30 pounds, and thanks to this diet I now have 65 pounds to lose. I’m definitely going to read more on this site, im in a terrible spot now. I’ve gone from overweight but comfortable, to obese and utterly miserable. I feel terrible. Im looking for hope on here. My quality of life is abysmal.
I intended for my reply to be to the article itself rather than to another poster, and I am not able to fix it.
Thank you for this information. The bit about adding maca to the diet however I have some caution about. I was eating quite a bit of maca powder when I discovered it and my until then stable thyroid levels went out of whack. I did not test, I just found my hair shedding, a lot , similar to early in my disease when I had not stabilised my thyroid levels. I began investigating and found that maca root is in the brassica family ( goitrogens) so I stopped supplementing with maca and my hair stopped falling out. All things in moderation. Do not over do it.
I read up on Maca as well, and stopped taking it for similar reason’s as yours. Every body is different-even with the same disease.
Well girl, all I can say is you need to ask your doctor to test your thyroids. Cuz one thing I’ve noticed because I do have thyroid disease. Hypothyroidism is a matter of fact and I gained 7 pounds in one month and I haven’t taken it in a month and a half. So you need to talk to your doctor lady. The only one that can help you.
Help please? = 2 key points to share == {1} This articles brings up good points but I’m noticing it is only partially helpful, and also not specific enough to the types of thyroids (namely if you have the positive or negative “anti-body”= I just learned that one is connected to Hashimotos and the negative is not related). How does this change the information provided in this article. == (2) I was on a medical assisted Keto packet style diet back in 2014-15 when it was not mainstream. Found out I was pre-diabetic on top of the pain issues. This keto diet saved my life. It was AMAZING and I felt 25 years old again in every way. I was off all heavy pain meds from a previous neck-nerve injury, had energy, no brain fog, fixed leaky gut issues, and improved allergy symptoms, best part is that the weight fell off like clockwork when I didn’t eat not 1 bite off this program- 3-4lbs/ week was my new normal. Speed up to nearly 5 years later and I’ve recently been diagnosed with thyroid nodes ( with negative anti-body), weight is going up weekly while eating the same keto diet that brought me such peace ease and relief. So what SPECIFICALLY do you change now that I have negative antibody, node creating hypothyroidism? Thanks much.
ATTENTION TO Anna Cabeca, DO, FACOG Directly == Are you able to shed your acute knowledge IF “negative-antibody” Hypothyroidism with nodes (this is what I have) needs different dietary instructions versus what your article is discussing. Everything I’ve been reading about Hypothyroid “healing naturally” topics — no one is addressing the HOW the “negative-antibody” is same or different from those suffering from Hashimoto/Grave Hyphothyroidism. Its all confusing, AND it feel like there are some micro-details that experts are leaving out in their writing. Thanks for clearing this up.
Hi I’ve been on levothyroxine for 20 years. I started doing Keto a month a ago and my blood test shows that my ft4, free thyroxine, has gone from 13 to 18! It’s never been that high. Does anyone have any ideas as to why this could be? Thanks
I gain weight on Keto. I tried this diet last year and gained 8 pounds in a month so I just quit. I am trying again. Gained 5 pounds in 3 weeks. Don’t ask me why, I have no clue. I still take my meds, count my carbs (40 g per day), proteins and fats and it’s just not working. If anyone experienced this and have solutions or ideas, please let me know. I will still eat Keto and pray for a change.
I am having the same problem. I went from low carb to Keto & gained 20 lbs in 6 weeks. I did increase fat intake when switching to Keto. It look me 6 months to get rid of the 20 lbs & now I have to start over again, after I get my head straightened out. Right now I am manic about my weight gain. One day it is might as well eat whatever, to if I eat whatever how much more weight will I gain. I have not found anyone addressing this problem. I am going to go back to low carb & reduce fat intake. FYI-I kept my net carbs at 20-25 for low carb, but reduced net carbs to 15 when I switched to Keto.
Yes I’m actually working with a lady right now that really messed her health up due to Keto. So I’m helping her due some nutrient cleansing to pull the toxins and put the nutrients back in the her body needs. She’s doing great now.
I’m not sure how old you are but I am 67 with hypothyroid disease and I have found that to lose weight I can eat no more than 15 gr of carbs on keto for the whole day. I did lose 25 lb in a few months. But it is so restrictive very hard to sustain
I’ve been on keto for 1 1/2 years and I’ve gone from hypo to hyper. I did not have much wait to loose but I still lost 20 pounds like almost the minute I started keto then another 5
when I tried Carnivore. My Dr. is trying to work with me as I love the keto way of eating. I feel so good. Unfortunately she is only testing T3.
All thyroid lab’s need done. Reverse t3, free t4, free t3, the. Look up stopthethyroidmadess.com hope this helps you.
Im not seeing anything different in this article that someone with thyroid disease should be doing. You are saying that we should not be eating gluten, dairy, sugar, and processed foods. This is what Keto is. You eat healthy foods. you also can keep your carbs from 20-50 grams.
I have to agree with you Teresa. I started the keto diet a few months back and felt at my healthiest and actually developed thyroid issues. Everything that I read here is no different than what I have been doing.
I have been eating lchf for almost a decade, and I don’t have a functioning thyroid anymore. I take my generic Synthroid every morning and eat meat/veg/fat 3x a day. I don’t use my thyroid disease as an excuse, but I don’t cheat and use that as an excuse either. I changed the way I eat and changed my life and my health.
On moderate LCHF for past year and my TSH plummeted with no change in dosage. I am curious if changed diet is the cause or something else. Also no thyroid due to cancer, RAI 2000.
The difference is making sure you stay more alkaline than acidic. Re-read the section on “Maintaining an alkaline pH’ and check out the linked article: https://hypothyroidmom.com/traditional-ketogenic-diets-neglect-alkalinity-but-combine-the-two-and-bam/
Im on veg keto and i eat plenty of greens, eggs and cheese, the latter in moderation.
Feeling great. Weight is down. Thyroid much better. Doing IF helped a lot, i skip breakfast and eat only during 6-8 hrs window. Doing 24 hrs fasting makes me feel even better. Full of energy, sleep like a baby. Good luck !!!
I have hypothyroidism and I’ve been on keto for 7 weeks. 14 lbs down and I feel AMAZING!
I was dx with hypothyroidism in the 90s. I am in my 60s now and went on the Keto diet in January. No Keto flu, no adverse side effects and after 14 weeks, I’ve lost 46 pounds. I feel great, look better, don’t exercise, and think the recipes are wonderful. Keto is exactly the diet for me and I plan to continue to a eat this way. I tried WW, vegan diet and the Mediterranean diet with poor to bad results (gained weight, poor health). Finding the weight loss method that works for YOU is truely a journey.
I am hypothyroid and have been doing keto for a year. I lost 55lbs in 5 months and have been maintaining since. I feel better and have more energy than I have in a long time. Tracking your food intake is a very important aspect of KETO for most people because over eating can cause weight gain. Also, KETO does remove gluten. There is no grains or sugar on KETO and many restrict dairy as well if they find they have a sensitivity. I find that the biggest problem with people living a KETO lifestyle is that they don’t do enough research to actually know how to do it properly.
I had a total thyroidectomy and am on Levothyroxine 112mcg and 125mcg. I have been doing keto since the first of 2019 starting at 263 and am now 245. Was hoping for a quicker loss but I’m hoping to reach my goal of 175.
I had hyperthyroidism, thyroiditis, from a virus. Now because of the virus my thyroid is damaged and I have Hashimotos. I’ve been on Armour for 3 yrs. For the past year I have been following Maria Emmerich and eating a Keto diet. I have lost a little over 50 lbs while eating this way. I use fat as a lever, only eat enough just to stay satisfied. That way I burn my own fat and loose. My Keto diet is not high fat, so many people don’t know how to do it correctly. It is not always easy, but is so great to feel good! Look her up, read her book Keto, make a few of her recipes. I think she has Hashimotos too.
What type of virus caused this?
I have hypo Thyroid and I’m at a point tried everything. All the diets and wellness programs, detox, hormone imbalance and food testing. But no weight loss. Was thinking about Keto but I’m vegetarian so it’s difficult. Any suggestions are welcome. I don’t even know how to start it and what to do.
Keto is not for vegetarians. It is a meat diet. I read the Ketotarian Diet, but it still included fish. Not sure if there is a Keto Vegetarian diet.
I sick & tired all time
With my hyper thyroid gland issue,s
Please help me to get under control fast
It,s drzroy me
Christina do you only take T4 (levothyroxine/synthroid)? If so, talk to your Dr about switching to or supplementing with armor thyroid. Armour is T3, some people have trouble converging T4 to T3. My TSH was at 14 ten years ago and I was exausted by lunch time and was only 26. My Dr added armor and it changed my life. Now I take 100mcg of Levo and 180mg of armor, my TSH is LOW at 0.006 but that’s where I feel good so my Dr is fine with it. Find a Dr that will listen to you, you don’t have to live like that.
You wrote “hyper” thyroid, so I believe that is what you meant (most people here are hypo-totally different). I was hyper, diagnosed with Graves’ disease. I eliminated gluten, dairy and corn for a month and had normal blood levels. I have since added some dairy and corn and blood levels are the best in years with no medication. This won’t work for everyone, but I would rather be gluten free than on meds.
Hey Dana,
I’m a little disappointed by the whole Dr. Anna C masterclass website thing. It’s pretty upsetting to be promised a masterclass for free but having to pay for something else to get it. That’s not quite free. And also, having to register multiple times because you can go back or skip a screen due to personal time restraints is also frustrating.
I’ve been following your site but it seems to start to stray from your original intent of wanting to inform people out of the goodness of your heart “…so other’s don’t go through what I did”. Maybe I’m missing something? Hope not. I’ve loved following you thus far. I understand Dr. Anna C and you need to make money but there’s something amiss about holding information hostage. Just letting you know.
I am hypothyroid and am following Dr Eric Berg’s keto training videos and I am getting slow and steady results. 1 kilo a week weight loss, no cravings or emotional spikes, the best TSH/T4/T3 readings in years, mind clarity (doing cryptic crosswords easily). I am a retired 65 years old female and had tried Paleo and Diet Doctor but couldn’t stick with it. The major difference now is I have low carbs, low protein, more good fats and include at least 6 – 8 cups of greens a day. I now love kale shakes, who knew?
Hi,
I also have hypothyroidism and joint pains, bursitis etc..
Can you please tell exactly how you did it. I tried keto, but my hypothyroidism symptoms are much worse. On 300mcg thyroxine, still heart rate of 64.
Thanks in advance
I have Hashimoto’s & take naturethroid (last 8 months) and LDN (1 month). I tried KETO and gained weight. I exercise regularly but was so disappointed with this diet. Even the nutritionist at my functional medicine doctor advised she tried it and experienced the same thing. I guess I need to keep looking for the diet that works for me.
Try the Mediterranean diet done some research on it very healthy way of life…
You will gain weight if you are eating too many calories or eating the wrong ratio of macros. This is why tracking is so important.
I had to cut dairy from my keto diet before I lost weight.
When following a ketogenic lifestyle and becoming ‘fat adapted’ (this takes different time dependant on current level of health and ability to reduce carbs – all grains and sugars) you will lose hunger cravings and be able to do IF (intermittent fasting) very easily. This reduction in your eating window has benefits to health improvement – weight loss, reduction in inflammations, clarity of thought and more energy. I say revisit with more dedication.