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

serious matured woman with crossed arms outdoor

Key takeaways

Here, 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 urine usually 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 try to 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, no matter what diet you are eating.

So along with delving into the research 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. Get the right amount of protein

For weight loss, protein should be adequate but not excessive.

“Women can much more easily over-consume protein compared to men,” says Dr. Sarah Hallberg. “If you and your husband are eating the same size steak, you are probably consuming too much.”

As for Dr. Naiman, he is less concerned with keeping protein intake modest.

As a whole, the general advice from our group of experts is to eat between 1.2 to 1.7 grams of protein per kilogram of reference body weight per day. So, a woman whose reference body weight (not actual body weight) is 70 kg (154 lbs) should aim for 70 to 119 grams of protein per day.2

If you’re not really interested in counting grams, you may instead want to try a suggestion from Dr. Hallberg to do a “mindful week” and retrain your feelings of hunger and fullness. Here’s how Dr. Hallberg puts it:

“The problem and the struggle for all the people we see, not just menopausal women, is they don’t know what hunger and fullness really are.

These women come to us after years and decades of a low-fat, high-carb diet. So they are used to a feeling of fullness that is fuller than full. We need to retrain ourselves to understand that ‘full enough’ is the way you should feel.

Have a mindful week. What that is, in my mind, is that this patient is going to dedicate a week to this, because it takes time.

For example, if you’re used to having two eggs and two strips of bacon for breakfast, during the mindful week you’d only bring one egg and one piece of bacon to the table. And you would eat it.

Then, you have to wait 20 minutes — and that is where the time investment comes. Then think to yourself after 20 minutes, ‘am I actually still hungry?’

You have to give yourself time to learn how to tell if you are full or still hungry. And so you do that for each meal, for a week’s time.

You’ll begin to realize at some point that you’re eating the right amount, you’re eating too much, or you’re eating too little. You’ll realize at some meals, ‘I was eating too much. I didn’t need that second egg or whatever.’

It’s a way to eat mindfully without counting calories. Do it based on your body’s needs and to get in touch with your body’s needs.”

Just remember, however, protein intake can be a balancing act. Too little protein over the long run, especially as we age, can lead to poor muscle growth and frailty.3

2. Don’t eat too much fat

Once you’re fat-adapted, it’s important to avoid consuming excess fat.4
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 consuming 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 the low-carb keto diet, they’ve often been consuming lots of carbs and are very glucose dependent. 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.

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

So 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 blood sugar swings. Don’t starve yourself, but be mindful of excess fat. Samantha decided to cut out her bulletproof coffee for now.

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.” Cutting back on the whipping cream might help them get out of a stall.5

“When you are at your ideal weight, you can add the fat back in and eat all the butter you want,” Dr. Naiman says.

Dr. Fung discussed this concept of excess fat consumption and how it applies to some people, including the role of leptin resistance in weight loss stalls, in a popular earlier post.

3. Try intermittent fasting

After becoming fat-adapted, you may find that your hunger pangs diminish, making it easy to go for longer periods without eating.6

Many people naturally stop eating breakfast — they just aren’t hungry when they wake up. The number one rule of low-carb eating is to eat when you are hungry and stop when you are full. So if you are not hungry, try intermittent fasting (IF).

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. 7

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 that can arise after very long extended fasts lasting many days, once normal eating is resumed.8

When people are doing low-carb, keto eating they are often not hungry 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 and how to best break a fast.

4. Watch out for the carb creep

Once you have been following a low-carb, keto lifestyle for a while, carbs may sneak back into your diet, particularly in the form of sauces, condiments, fruits, and nut snacks.9

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

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

“For insulin resistant people, if they are in ketosis but eat one meal of carbohydrates, it may stop ketosis in some people for up to three weeks,” said Dr. Westman.10

Keeping carbs below 20 grams will maximize weight loss with more control over hunger and cravings, says Jackie Eberstein.11

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. Even a few drinks a week might cause a stall.12

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.13 Come off them as soon as you can,” advises Dr. Westman.

More on artificial sweeteners and weight

7. Do weight training

While you can’t exercise your way out of a bad diet, adding in weight lifting will build muscle, which can help increase your metabolism.14
“The more muscle you add, the better your insulin sensitivity, so any sort of resistant strain you can add to your muscle can be great for weight loss,” says Dr. Naiman.15
The 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.16

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.17

Make sure you have rest days between heavy exercise for the body to recover.

8. Get enough sleep

During menopause, many women find their quality of sleep sharply deteriorates, often because of hot flashes and night sweats.
Drs. Fung and Hallberg recommend that women in weight-loss plateaus aim to improve their sleep. Poor-quality sleep can increase levels of cortisol, a stress hormone associated with increased abdominal fat.18
Tips for better sleep include:

  • Sleep in a cool, dark room.
  • Wear ear plugs and eye shades.
  • 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.19

But don’t stress about stress — that is a no-win. Many menopausal women find they are caught in the sandwich of still-dependent children and aging or ill parents. Death of loved ones may also become more common during the menopausal years.

“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.20

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.


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

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All earlier posts by Anne Mullens



Weight loss

Dr. Westman

Dr. Hallberg

Dr. Naiman

Earlier with Anne Mullens

All earlier posts by Anne Mullens

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

  2. 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]

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

  4. 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].

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

  6. 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].

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

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

  9. 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].

  10.  [clinical experience; weak evidence]

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

    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]

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

  13.  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]

  14. Research has confirmed that this happens in people of all ages, although to a greater extent in men than women:

    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]

  15. In studies, resistance training has been shown to consistently improve insulin sensitivity in adults, including people with diabetes and postmenopausal women:

    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]

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

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

  18. 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]

  19. 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]

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

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