Top 10 tips to lose weight on low carb or keto for women 40+
When Samantha Dalby emailed us last month, she was frustrated and confused. The 50-year-old nurse practitioner from Ontario, Canada, had been eating a low-carb diet for more than five years. Originally she had done very well on it, keeping her weight at a healthy and stable 152 lbs (69 kg) on her 5’7″ (174 cm) frame.
But then, about 18 months ago, she went through menopause — her last period was 12 months ago. Suddenly the weight started creeping up. What had worked so well was no longer working for her. “It’s a scary time because it feels like what is happening in your body is out of your control, on so many levels,” Samantha says.
In her health clinic with her patients, and with friends, she has seen women gain a considerable amount of weight over the menopausal change, and she did not want that to happen to her.
Nine months ago she decided to try the stricter keto diet and followed our advice to help support this way of eating. By testing her urine with keto stix she could see she was expelling ketones in the low to moderate range. But still her weight was increasing — she gained a total of 7 lbs (3 kg) over nine months of keto eating. And her clothes were feeling tight and uncomfortable. What was she doing wrong?
“I just seem to be gaining no matter what I do,” she lamented in an email to us. “I accept that menopause will come with body changes, but I am frustrated that I can’t seem to stop the weight gain.”
A common problem
Samantha is not alone. Many women find in the years leading up to and after their final menstrual period that along with other symptoms like hot flashes, night sweats and sleep problems, their abdomens thicken and their weight increases.1 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 age 49 and 52.2
On Google, after typing “Weight gain in,” the word “menopause” is what pops up as the most frequent search term to complete the phrase.
We’d like to help. Many of our readers are women over the age of 45, and we know that keto and low-carb diets for weight loss and improved health are of huge interest to them. Many women in this age group are happy with the results they have achieved by adopting the low-carb or keto way of eating. But what if you are not achieving the results you want?
Samantha described how she was eating a keto diet, exercising five times a week, snacking rarely on nuts or cheese, drinking about three to five glasses of alcohol a week (dry red or white wine, prosecco or vodka and soda) and drinking bulletproof coffee in the morning. She had been tested for thyroid issues and was told that her thyroid function was normal. What advice could we give her?
Our response was to try intermittent fasting — and we go into more detail about that in tip #3 below. But to truly get to the bottom of menopausal weight stalls and challenges, we explored the medical literature about what is known about changes in metabolism and energy needs during menopause. We also tapped the knowledge and experience of some of our stellar low-carb experts — Dr. Sarah Hallberg, Dr. Jason Fung, Dr. Eric Westman, Dr. Ted Naiman, and Atkins RN Jackie Eberstein. We have come up with ten actions that may help stop menopausal weight issues and help boost weight loss if you experience a plateau while eating low carb.
We shared them with Samantha in advance of this post, and within a few days of adopting them, she saw the scale finally move downward 1.5 lbs (0.7 kg), for the first time in months. She was delighted. “I really thank you for this. I am going to keep following these tips. I will let you know how it goes!”
The ten tips can work for anyone in a stall, not just for menopausal women. “Postmenopausal women certainly can have problems with weight gain, but we see it in many others, too,” says Dr. Jason Fung.
The weight-loss challenge in menopause
In fact, whether menopausal women have unique challenges for weight loss is a bit controversial.
Some studies have suggested that women’s weight gain in midlife is more a factor of aging — which impacts both sexes — than of menopausal changes in hormones.3 Others note, however, that declining estrogen (estradiol, or E2) at menopause decreases women’s energy needs and slows down metabolism, changes their location of body-fat accumulation from the hips to abdomen, and is associated with an increased rate of metabolic syndrome.4
Dr. Wendy Kohrt, of the University of Colorado Denver, leads its IMAGE program (Investigation into Metabolism, Age, Gender and Exercise) and has been studying the impacts of menopause for more than 20 years. In a 2016 news post she reported that during menopause women’s metabolisms slow by about 50 calories a day and that women experience more food cravings, less movement and more muscle loss, leading to gradual weight gain over time.5 Kohrt notes, however, that menopause itself has been vastly under-researched over the years — a point shared by other commentators — considering the impact it has on the health and wellness of millions of women.
Dr. Sarah Hallberg states: “Weight gain happens at menopause — we all know it — but research cannot yet fully explain why. It is not as universal an issue as generally perceived. Why menopausal women eating low carb or keto should stall or even gain weight is not really known either. We intend to try to understand this better.”6
Here are our top ten tips from our experts to kick you out of a stall — which applies to women in menopause, or anyone experiencing a weight loss plateau or not having sufficient success on low carb keto eating.
1. Get the right amount of protein
For weight loss, protein should be adequate but not excessive. “Number one issue for stalls, in my experience, is too much protein,” says Dr. Hallberg. “Women can much more easily over-consume protein compared to men. If you and your husband are eating the same size steak, you are probably consuming too much.”
Dr. Naiman is less concerned with keeping protein intake modest. The general advice from our group of experts is to eat between 1.0 to 1.7 g 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 70-119 grams of protein per day.7
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. They 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.
People frequently say: OMG, I ate so much and I feel so full and disgusting. That is how they are used to feeling full: discomfort after eating. So retraining their sensory system to just accept ‘full enough’ is something you have to work with people on.
So if we are having a plateau and we are struggling with this the first thing people say is ‘Should I go back to counting calories?’ No, no, no! 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.
So if for breakfast you are used to having two eggs and two strips of bacon, during the mindful week you would 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 ask 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. And you’ll begin to realize at some point that you are eating the right amount, you are eating too much, or you are eating too little. You will realize at some meals, ‘I was eating too much. I didn’t need that second egg or whatever.’ It is a way to do it without counting calories, to 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.8 Read more in our evidence based guide on protein in a low-carb diet.
2. Don’t eat too much fatOnce you’re fat-adapted, it’s important to avoid consuming excess fat.9 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 are 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.10
“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. Intermittent fasting
After becoming fat-adapted, you may find that your hunger pangs diminish, making it easy to go for longer periods without eating.11 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.
Samantha added in a 24-hour fast on our advice, along with a couple of 16:8 fasts. “I was surprised how easy it was. I wasn’t hungry.”
For Ellen McCormick Martens, 71, of Houston Texas, eating only between 11 am and 7 pm did the trick for her stubborn plateaus.”Using IF, I have been able to keep my extra weight off for 1½ years. It is really simple and easy to incorporate into an LCHF lifestyle.”
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. 12 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.” 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.13
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.
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.14 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 34 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.15
Keeping carbs below 20 grams will maximize weight loss with more control over hunger and cravings, says Jackie Eberstein.16
Samantha cut out her nut snacks and feels that, along with intermittent fasting, doing so contributed to getting the scale to finally move downward.
5. Cut out alcohol
Many people love the fact that on a low-carb or keto diet they can have a glass of dry white or red 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.17 “I love my Friday night glass of wine after a hard week, but I will cut it out for now,” says Samantha.
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.18 Come off them as soon as you can,” advises Dr. Westman.
7. Do weight trainingWhile you can’t exercise your way out of a bad diet, adding in weight lifting will build muscle, which can help increase your metabolism.19
“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.20
The weight lifting doesn’t have to be a 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.21
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 weight 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.”22
Make sure you have rest days between heavy exercise for the body to recover.
8. Get enough sleepDuring 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.23
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
This advice struck home for Samantha: “My sleep has been impaired for the last five years because of peri-menopause.”
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.24
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.25
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 monitoring 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. 26
10. Be realisticBoth 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 is 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 you to accept that weight loss in middle age will be slower than when you were younger. “Remember that you are in this for the long haul. It is 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.”
For Samantha, this last tip makes perfect sense.
“In all of this I really try to enjoy the body I’m in. I celebrate my muscles and skin and good hair; that I am healthy and that I look healthy,” she says.
“I feel great on LCHF and keto, with whole food eating — great energy, GI tract, focus. So I’m happy to eat this way regardless of the scale. I really do feel that for women in menopause this is the crux of the issue — balancing the desire to lose (or not gain) weight with a focus on physical and mental health, to age with grace and vitality.”
Read more about weight, health and happiness in our evidence-based guide.
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Earlier with Anne Mullens
Although it’s estimated that most women gain an average of 2-5 pounds during the menopausal transition, some gain much more than this:
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:
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 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]
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] ↩
Research has confirmed that this happens in people of all ages, although to a greater extent in men than women:
In studies, resistance training has been shown to consistently improve insulin sensitivity in adults, including people with diabetes and postmenopausal women:
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] ↩
Some people eat more in response to stress and higher cortisol levels than others:
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: