Top 10 tips to lose weight on low carb or keto for women 40+

serious matured woman with crossed arms outdoor

Key takeaways

At Diet Doctor, we often get emails from frustrated or bewildered women, usually over the age of 40, who are doing everything they can to maintain a keto diet, but are still not losing weight.

Their testing shows they are in ketosis, they are following the recipes and guides, but not only are they not losing the expected pounds, sometimes they are even gaining weight.

Alas, as women get older, keeping off those pesky extra pounds often gets harder.

That’s why we’ve created this list of 10 things women ages 40+ can work into their routine to help maintain their weight or even break a weight loss stall — while still feeling their best.

Remember, we’re aiming for progress here, not perfection. So if you can’t hit all 10 of the below takeaways at all times, or if they don’t result in dropping pounds, you are in no way a failure. After all, tip No. 10 is to be realistic.


A common problem

If this is happening to you, you are not alone. Over 40 million women in the US, 13 million in the UK, and many more millions around the world are estimated to be going through menopause, which usually occurs between ages 49 and 52.1

Weight gain is very common during this transition.2

So along with delving into the medical literature, we also tapped the knowledge and experience of some of our low carb experts — Dr. Sarah Hallberg, Dr. Jason Fung, Dr. Eric Westman, Dr. Ted Naiman, and Atkins RN Jackie Eberstein.

These 10 tips can work for anyone in a stall, meaning they’re not just for perimenopausal women. “Menopausal women certainly can have problems with weight gain, but we see it in many others, too,” says Dr. Jason Fung.

1. Don’t eat too much fat

Once you’re fat-adapted, it’s important to avoid consuming excess fat.3
One of the great joys of low carb, keto eating is including fat at every meal after years of avoiding it.
But a keto diet is not carte blanche to gorge yourself on fat, the experts note. If you want to lose weight, you have to burn your own fat stores for energy rather than consume all the energy you need by eating fat. So if you’re struggling to lose weight, stop the bulletproof coffee and fat bombs for now.

Dr. Naiman notes that when people first start a low carb or keto diet, they’ve often previously been consuming lots of carbs and are therefore dependent on glucose as their primary energy source. Initially, he tells them to eat an unlimited amount of healthy fat until they are fully fat-adapted. “You will know you are fat-adapted because you can go a long time without eating,” he says. In addition, feeling energetic and strong while eating less than 20 grams of carbs also suggests you are fat-adapted.

Once they are primed to burn fat, however, he then advises them to scale back on fat so that they will access and burn their own fat stores.

If you are experiencing a weight-loss stall, our experts recommend you look at how much fat you’re consuming and see where you might cut back without sacrificing fullness or triggering the return of cravings and hunger. Don’t starve yourself, but be mindful of excess fat.

Dr. Hallberg notes that it is easy to over-consume fat in liquids, especially full-fat whipping cream.

“Someone will come in and say they are in a weight-loss plateau. We will look at their diet and see they are consuming six coffees, with two tablespoons of whipping cream in each one,” she says. Cutting back on the whipping cream might help them get out of a stall.4

We discuss this concept of excess fat consumption and determining how much you should eat in our detailed guide.

2. Get the right amount of protein

For weight loss, getting the right amount of protein is key.

What is the right amount? Our general advice is to eat between 1.2 to 2 grams of protein per kilogram of reference body weight per day. So, a woman whose reference body weight (an estimation of lean body mass) is 70 kg (154 lbs) should aim for 84 to 140 grams of protein per day.5

Studies show that moderate and high protein diets lead to more weight loss and reduced hunger compared to lower protein diets.6 That’s a potentially winning combination for kick-starting or maintaining healthy weight loss.

Some of our experts are concerned that, in general, women “shy away from large amounts of protein.” After all, according to stereotypical gender roles, who’s more likely to sit down with a big steak for dinner, and who’s more likely to order the salad? As we discussed in our podcast with Stanford researcher Lucia Aronica, Ph.D., recognizing and addressing those stereotypes can help promote healthy eating.

In addition, too little protein over the long run, especially as we age, can lead to muscle loss and frailty.7 That’s even more reason to make sure you maintain adequate protein intake.

3. Try intermittent fasting

After starting a low carb diet, many people naturally stop eating breakfast — they just aren’t hungry when they wake up. An important rule of low carb eating is to eat when you are hungry and stop when you are full. So if you aren’t hungry, try intermittent fasting (IF).8

Start by skipping breakfast and just eating lunch and dinner within an 8-hour window, which is called a 16:8 fast. Or you can try eating dinner one night, then fasting until dinner the next night, which is known as a 24-hour fast.

Dr. Fung suggests not doing the same fasting routine day after day but to “switch it up.” For instance, do a 16:8 fast one day, a 24-hour fast the next, followed by a day of regular eating.

He states this is because the body has a strong physiological drive to seek homeostasis — energy balance. “Whenever the body is exposed to a constant stimulus, it will become acclimated to it,” he says. 9

Hallberg suggests caution, however, around very long fasts lasting multiple days.
“If you are skipping meals because you are not hungry while eating a proper low carb, high fat diet, that is just fine,” she says.

But she is concerned about very long fasts in which people are ignoring hunger signals, as well as the potential for a dangerous physiological fluid and electrolyte imbalance called refeeding syndrome, which can arise after extended fasts lasting many days, once normal eating is resumed.10

On a low carb or keto diet, some people easily go without eating for 16 or 24 hours. Such fasts are safe and healthy, as long as you have some weight to lose. However, avoid fasting if you are underweight.

Eat when you are hungry, don’t eat when you are not, and stop when you are full.

Read more in our guides to intermittent fasting, OMAD (eating one meal a day), long term fasting, and how to best break a fast.


4. Watch out for the carb creep

Once you have been following a low carb or keto lifestyle for a while, carbs may sneak back into your diet, particularly in the form of sauces, condiments, fruits, and nuts.11

If your weight loss has stalled, closely examine what you are eating and cut back to less than 20 grams of net carbs again.

Nuts like cashews, almonds, and pistachios are easy to overeat and can contain enough carbs, fat, and overall calories to contribute to a weight-loss stall. A cup of pistachios, for example, has 21 grams of net carbs. Avoid carb cycling or cheat meals too, for now.

“For insulin-resistant people, if they are in ketosis but eat one high-carb meal, it may stop ketosis in some of them for up to three weeks,” said Dr. Westman.12

Keeping net carbs below 20 grams will maximize weight loss with more control over hunger and cravings, says Jackie Eberstein.13

5. Cut out alcohol

Many people love the fact that on a low carb or keto diet they can have a glass of dry wine from time to time. However, if you are experiencing a weight-loss plateau or gaining weight, cut out all alcohol for now until weight loss starts again.14 Even a few drinks a week might cause a stall.15

6. Avoid sweeteners

If you have been including artificial sweeteners like aspartame or sucralose in your low carb or keto diet, our experts recommend you wean yourself off them.

While there are not a whole lot of scientific studies, anecdotally we find when people get rid of artificial sweeteners, they are able to lose weight.16 “Come off them as soon as you can,” advises Dr. Westman.

More on artificial sweeteners and weight

7. Exercise

While you can’t exercise your way out of a bad diet, adding in aerobic exercise, resistance training, or a combination of the two may build muscle, which can help maintain or increase your metabolism.17
“The more muscle you add, the better your insulin sensitivity, so any sort of resistive strain you can add to your muscle can be great for weight loss,” says Dr. Naiman.18
Weight lifting doesn’t have to be excessive — 90 seconds per muscle group, twice a week, can do it. But he notes it has to be a heavy enough weight that after about to 10 to 15 lifts (reps) you cannot do another rep. This is called lifting to muscle failure.

“It is only if you go to absolute failure that you convince your body that you’re not strong enough. Your body won’t add muscle unless you send the message that it needs more,” Dr. Naiman says, noting that squats, push-ups and other body resistance methods can be just as effective as hand-held weights or weight machines.19

Dr. Westman never brings up exercise as a first step in weight loss. He wants patients to focus on the diet first. “But later on, if things are no longer working well and there is still significant weight to lose, I bring up the E-word, exercise. But I try to get them back to things that are fun for them. Exercise can help you get through a plateau.”

Dr. Hallberg notes that vigorous exercise can sometimes create a false plateau. “If you are exercising to the point of getting sore, you are tearing muscle — which is a good thing. That is how we build muscle, by micro-tears.”

But in order to deal with that, the body sets off a small inflammatory response, which may cause people to retain fluid. “So after a vigorous workout you might jump up a few pounds overnight. It is not a real plateau, it is a pseudo plateau,” she says.20

Make sure you have rest days between days of heavy exercise, allowing the body to recover.

Learn more about how to choose the best exercise for you in our complete guide.

8. Get enough sleep

During menopause, many women find their quality of sleep sharply deteriorates, often because of hot flashes and night sweats.21
Drs. Fung and Hallberg recommend that women experiencing weight-loss plateaus aim to improve their sleep. Poor-quality sleep can disrupt the levels of cortisol — a stress hormone associated with increased abdominal fat — as well as other hormones that may contribute to weight gain.22
Tips for better sleep include:

  • Sleep in a cool, dark room.
  • Wear ear plugs and an eye shade.
  • Limit screen time and blue light before bed (or try the glasses that block blue light).
  • Go to bed and get up at the same time each day.
  • Stop drinking coffee by noon and limit caffeine consumption in all forms.
  • Avoid alcohol before bed.
  • Get exposure to natural daylight each day.

Read more here: National Sleep Foundation: Sleep Hygiene

9. Reduce stress

Examine the stresses in your life and see if you can do anything to alleviate some of them. Stress increases cortisol release, which may cause hunger and encourage your body to store abdominal fat.23

But don’t stress about stress — that is a no-win.

“When we see people struggle and hit a plateau, or completely fall off the wagon, the number one cause is a life crisis of some sort,” says Dr. Hallberg. “We all have life crises — men and women — all our lives are managed chaos. We recommend people plan coping mechanisms to deal with stress.”

Stress can cause emotional eating, too, another cause of stalls or weight gain, Dr. Fung notes.24

Try yoga, meditation and mindfulness techniques, relaxing walks or other pleasant diversions and hobbies. Dr. Hallberg recommends a week of slow and mindful eating, where you really pay attention to taste, textures, and hunger cues. Eat slowly, deliberately and mindfully.

Dr. Westman notes that even worrying about your weight can be a stressor. While tracking weight and food intake is often helpful, if it becomes too stressful, Dr. Westman suggests not monitoring these for a while and just going by how you feel.25

10. Be realistic

Both Dr. Hallberg and Jackie Eberstein note that having realistic expectations is particularly important for women of all ages.
Some women are aiming for an arbitrary number on a scale, perhaps from a long time ago or an idealized weight they have never achieved — a number that has no real bearing or relationship to their actual health and wellness.

“This is one of the really big issues I see for women — it’s so much entwined with psychology, self-esteem, and societal pressure, and in many ways outside of women’s control,” says Dr. Hallberg. “They succumb to ways they think they need to be, rather than what is healthy for them. If you see victory as only a number on a scale, you are going to sabotage yourself.”

Jackie Eberstein agrees: “Measure your success by a loss of inches, rather than the scale.” She encourages accepting that weight loss in middle age will be slower than when you were younger.

“Remember that you’re in this for the long haul. It’s an investment in your health as you get older. Have patience. Your long-term goal is to make a permanent lifestyle change as well as lose the excess fat.”

Read more about weight, health and happiness in our evidence-based guide.

Anne Mullens



All earlier posts by Anne Mullens

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Top 10 tips to lose weight on low carb or keto for women 40+ - the evidence

This guide is written by Anne Mullens and was last updated on October 27, 2022. It was medically reviewed by Dr. Michael Tamber, MD on December 21, 2021.

The guide contains scientific references. You can find these in the notes throughout the text, and click the links to read the peer-reviewed scientific papers. When appropriate we include a grading of the strength of the evidence, with a link to our policy on this. Our evidence-based guides are updated at least once per year to reflect and reference the latest science on the topic.

All our evidence-based health guides are written or reviewed by medical doctors who are experts on the topic. To stay unbiased we show no ads, sell no physical products, and take no money from the industry. We're fully funded by the people, via an optional membership. Most information at Diet Doctor is free forever.

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  1. Obstetrics & Gynecology Clinics of North America: The timing of the age at which natural menopause occurs [overview article; ungraded]

  2. It’s estimated that most women, without changing anything in their diet or lifestyle, gain an average of 2 to 5 pounds during the menopausal transition. However, some gain much more than this:

    Journal of Women’s Health 1998: The influence of sex hormones on obesity across the female life span [overview article; ungraded]

  3. This is based on clinical experience of low carb practitioners and was unanimously agreed upon by our low carb expert panel. You can learn more about our panel here [weak evidence].

  4. This is mainly based on clinical experience of low carb clinicians [weak evidence]

  5. Protein intake within this range has been shown to preserve muscle mass, improve body composition, and provide other health benefits in people who eat low carb diets:

    Peer J 2019: Low carbohydrate diets differing in carbohydrate restriction improve cardiometabolic and anthropometric markers in healthy adults: a randomised clinical trial [moderate evidence]

    Diabetes Therapy 2018: Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year: an open-label, non-randomized, controlled study [weak evidence]

  6. British Journal of Nutrition 2020: The effect of 12 weeks of euenergetic high-protein diet in regulating appetite and body composition of women with normal-weight obesity: a randomised controlled trial [randomized trial; moderate evidence]

    Nutrition Journal 2014: Effects of high-protein vs. high- fat snacks on appetite control, satiety, and eating initiation in healthy women [randomized trial; moderate evidence]

    Journal of the American College of Nutrition 2004: The effects of high protein diets on thermogenesis, satiety and weight loss: a critical review [systematic review of randomized trials; strong evidence]

  7. Many experts in the field of protein and aging recommend a protein intake of at least 1.2 g/kg/day for older adults:

    Nutrients 2016: Protein consumption and the elderly: What is the optimal level of intake? [overview article; ungraded]

    In a 12-week trial of older adults who were frail or at high risk for frailty, participants who increased their protein intake to 1.5 g/kg/day achieved significant increases in muscle mass compared to those who consumed less protein:

    The American Journal of Clinical Nutrition 2018: Protein supplementation improves muscle mass and physical performance in undernourished prefrail and frail elderly subjects: a randomized, double-blind, placebo-controlled trial [randomized controlled trial; moderate evidence]

  8. Systematic reviews of randomized controlled trials exploring intermittent fasting have concluded that IF is at least equally effective for losing weight compared to continuous calorie restriction:

    Canadian Family Physician 2020: Intermittent fasting and weight loss: Systematic review [strong evidence]

    Obesity Reviews 2017: Short‐term intermittent energy restriction interventions for weight management: a systematic review and meta‐analysis [strong evidence]

    JBI Database of Systematic Reviews and Implementation Reports 2018: Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis [strong evidence]

  9. This is based on an individual clinician’s experience. [very weak evidence]

  10. Journal of Infusion Nursing 2014: Pathophysiology, treatment, and prevention of fluid and electrolyte abnormalities during refeeding syndrome
    [overview article; ungraded]

  11. This is based on clinical experience of low carb practitioners and was unanimously agreed upon by our low carb expert panel. You can learn more about our panel here [weak evidence].

  12.  [clinical experience; weak evidence]

  13. Part of the way low carb diets result in improved weight loss may be due to reduced hunger and overall calorie intake.

    A 2019 RCT reported reduced cravings with low carb diets

    Nutrients 2019: Changes in Food Cravings and Eating Behavior after a Dietary Carbohydrate Restriction Intervention Trial [randomized trial; moderate evidence]

    In several studies, limiting net carbs to less than 20 grams per day has been shown to  reduce appetite and intake, leading to weight loss without hunger:

    The American Journal of Clinical Nutrition 2008: Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum [randomized crossover trial; moderate evidence]

    Annals of Internal Medicine 2004: A low carbohydrate, ketogenic diet versus a low fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial [moderate evidence]

    Annals of Internal Medicine 2005: Effect of a low carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes [non-randomized trial; weak evidence]

    Nutrition & Metabolism 2005: A low carbohydrate, ketogenic diet to treat type 2 diabetes [non-randomized trial; weak evidence]

  14. Drinking alcoholic beverages can slow down weight loss because your body burns alcohol before it burns carbs, protein, and fat — including body fat:

    The Journal of Clinical Investigation 1988: Ethanol causes acute inhibition of carbohydrate, fat, and protein oxidation and insulin resistance [randomized trial; moderate evidence]

  15. This is mainly based on clinical experience of low carb clinicians [weak evidence]

  16.  This is mainly based on the clinical experience of low carb clinicians [weak evidence]

    There’s also a published study showing that avoiding artificially-sweetened drinks helped overweight people lose weight and improve their insulin sensitivity:

    The AmericanJournal of Clinical Nutrition 2015: Effects on weight loss in adults of replacing diet beverages with water during a hypoenergetic diet: a randomized, 24-wk clinical trial [randomized trial; moderate evidence]

  17. Research has confirmed this effect for people of all ages, although to a greater extent for men than women:

    International Journal of Obesity and Related Metabolic Disorders 1995: Resting metabolic rate and cardiovascular disease risk in resistance- and aerobic-trained middle-aged women [non-randomized study; weak evidence]

    Journal of the American Dietetic Association 2001: Effects of habitual physical activity on the resting metabolic rates and body compositions of women aged 35 to 50 years [non-randomized study; weak evidence]

    Medicine and science in sports and exercise 2001: Effect of strength training on resting metabolic rate and physical activity: age and gender comparisons [non-controlled study; weak evidence]

    Journal of Applied Physiology 1985: Strength training increases resting metabolic rate and norepinephrine levels in healthy 50- to 65-yr-old men [non-controlled study; weak evidence]

  18. In studies, resistance training has been shown to consistently improve insulin sensitivity in adults, including people with diabetes and postmenopausal women. Improving insulin sensitivity may make weight loss easier:

    Diabetes Care 2005: Twice-weekly progressive resistance training decreases abdominal fat and improves insulin sensitivity in older men with type 2 diabetes [non-controlled study; weak evidence]

    Journal of Strength and Conditioning Research 2012: Insulin sensitivity after maximal and endurance resistance training. [non-controlled study; weak evidence]

    The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 1996: Resistive training increases insulin action in postmenopausal women [non-controlled study; weak evidence]

  19. This is based on Dr. Naiman’s clinical experience.[very weak evidence]

  20. This is based on Dr. Hallberg’s clinical experience.[very weak evidence]

  21. Obstetrics and Gynecology Clinics of North America 2018: Sleep, health, and metabolism in midlife women and menopause: food for thought [overview article; ungraded]

  22. Psychoneuroendocrinology 2017: Habitual sleep quality and diurnal rhythms of salivary cortisol and dehydroepiandrosterone in postmenopausal women [observational study; very weak evidence]

    Sleep Science 2015: Interactions between sleep, stress, and metabolism: From physiological to pathological conditions [overview article; ungraded]

  23. Some people eat more in response to stress and higher cortisol levels than others:

    Psychoneuroendocrinology 2001: Stress may add bite to appetite in women: a laboratory study of stress-induced cortisol and eating behavior [non-randomized study; weak evidence]

    In addition, at least one study suggests that women with a tendency to carry weight around the middle may release more cortisol during stressful situations than smaller-waisted women:

    Obesity Research 1994: Stress-induced cortisol response and fat distribution in women [non-randomized study; weak evidence]

  24. Personality and Individual Differences 2014: Stress and emotional eating: The mediating role of eating dysregulation [observational study; very weak evidence]

  25. This is based on consistent clinical experience of low carb practitioners. [weak evidence]