The keto diet has shown promise when used therapeutically to improve certain aspects of health in women, including body weight and blood sugar control. However, the keto diet isn’t appropriate for all women or people assigned female at birth.

Studies have shown that the keto diet can be used as a way to reduce body fat and improve blood sugar and even as a complementary treatment for certain cancers.

Although much of the research focuses on how well the keto diet works in men or people assigned male at birth, a decent number of studies have included women or focused exclusively on the effects of the keto diet on the female sex.

Some research suggests the keto diet may be an effective way to encourage fat loss in the female population.

Studies have shown that following a keto diet may aid weight loss by increasing fat-burning and decreasing calorie intake and hunger-promoting hormones like insulin — all of which may help encourage fat loss.

For example, one 2018 study of 45 women with ovarian or endometrial cancer found that people who followed a ketogenic diet for 12 weeks had significantly less total body fat and lost 16% more belly fat than participants assigned to a low fat, high fiber diet.

A separate 2018 study of adults with obesity that included 12 women demonstrated that following a low calorie ketogenic diet for 14 weeks significantly reduced body fat, decreased food cravings, and improved sexual function.

An older review of 13 randomized controlled trials — the gold standard in research — that included a population of 61% women found that participants who followed ketogenic diets lost 2 pounds (0.9 kg) more than those on low fat diets after 1–2 years.

Although research supports the use of this low carb way of eating to enhance fat loss in the short term, there’s a lack of studies exploring the long-term effects of the keto diet on weight loss.

Some evidence suggests that the weight-loss-promoting benefits of the keto diet drop off around the 5-month mark, which may be due to its restrictive nature.

Moreover, some research shows that less restrictive low carb diets may have comparable effects and are easier to sustain long-term.

For example, a 2019 study that included 52 women found that low and moderate-carb diets that contained 15% and 25% carbs, respectively, reduced body fat and waist circumference over 12 weeks, similar to a ketogenic diet that contained 5% carbs.

People with high blood sugar, including those with type 2 diabetes, may be attracted to the keto diet because it limits carb intake to less than 10% of total calories.

An older 4-month study that included 58 women with obesity and type 2 diabetes found that a low calorie keto diet caused significantly greater weight loss and reductions in fasting blood sugar and hemoglobin A1c (HbA1c) than a standard low calorie diet.

HbA1c is a marker of long-term blood sugar control.

A 2019 case study of a 65-year-old woman with a 26-year history of type 2 diabetes and depression demonstrated that after following a ketogenic diet for 12 weeks, along with psychotherapy and high intensity exercise, her HbA1c dropped out of the diabetic range.

Her fasting blood sugar and her markers for clinical depression normalized. Essentially, this case study showed that the ketogenic diet put this woman’s type 2 diabetes into remission.

A 2017 study of 25 people that included 15 women showed similar results. After 32 weeks of following a keto diet, approximately 55% of the study population had HbA1c levels below the diabetic level, compared with 0% who followed a low fat diet.

It’s important to note that studies on the long-term adherence, safety, and efficacy of the ketogenic diet on blood sugar control are lacking.

Meanwhile, less restrictive diets, including the Mediterranean diet, have been researched for decades and are well known for their safety and beneficial effects on blood sugar control and overall health.

The ketogenic diet has been shown to be beneficial when used as a complementary treatment method for certain types of cancer alongside traditional medications.

One 2018 study of 45 women with endometrial or ovarian cancer found that following a ketogenic diet increased blood levels of ketone bodies and lowered levels of insulin-like growth factor 1 (IGF-I), a hormone that may promote the spread of cancer cells.

The researchers acknowledged that this change, along with the decrease in blood sugar seen in those following ketogenic diets, creates an inhospitable environment for cancer cells that may suppress their growth and spread.

Research from 2018 also shows that the ketogenic diet may improve physical function, increase energy levels, and decrease food cravings in people with endometrial and ovarian cancer.

The ketogenic diet has also shown promise when used as a treatment alongside standard treatments like chemotherapy for other cancers that affect women, including glioblastoma multiforme, an aggressive cancer that affects the brain.

However, it’s important to note that because of the highly restrictive nature of the ketogenic diet and the current lack of high quality research, this diet isn’t recommended as a treatment for most cancers.

One of the largest concerns over following a high fat, low carb diet is its potential negative effects on heart health.

Interestingly, while some evidence shows that the ketogenic diet may increase certain heart disease risk factors, including LDL (“bad”) cholesterol, other studies have found that the diet may benefit heart health.

A small 2018 study that included 3 female Crossfit athletes found that after 12 weeks of following a ketogenic diet, LDL cholesterol was increased by around 35% in the ketogenic diet, compared with the athletes who followed a control diet.

However, a 2020 study of women with endometrial and ovarian cancer demonstrated that following a ketogenic diet for 12 weeks had no adverse effects on blood lipids when compared with a low fat, high fiber diet.

Likewise, other studies have shown conflicting results.

Some findings indicate that the ketogenic diet raises heart-protective HDL cholesterol and reduces total and LDL cholesterol, while others have found the ketogenic diet to raise LDL significantly.

It’s important to note that depending on the composition of the diet, ketogenic diets are likely to affect heart health risk factors differently.

For example, a ketogenic diet high in saturated fat is more likely to raise LDL cholesterol than a keto diet primarily composed of unsaturated fats.

More research is needed to determine how this high fat diet may increase or decrease the risk of heart disease itself and to understand its effect on overall health better.

Due to its restrictive and hard-to-maintain macronutrient ratio, the ketogenic diet isn’t appropriate for many people.

It isn’t recommended for people who are pregnant or nursing or who have certain underlying conditions. This includes:

In addition to the contraindications listed above, there are other factors to consider when thinking about trying the ketogenic diet.

For example, the ketogenic diet can cause unpleasant symptoms known collectively as the keto flu during the adaptation phase of the diet.

Symptoms include irritability, nausea, constipation, fatigue, and muscle aches.

Although these symptoms typically subside after a week or so, these effects should still be considered when thinking about trying the keto diet.

Before you start any significant dietary changes, it’s important to consider the positives and negatives of the diet, as well as its appropriateness based on your current health status.

For example, the ketogenic diet may be an appropriate choice for a woman who has obesity or diabetes or is unable to lose weight or manage blood sugar using other dietary modifications.

This diet may also be effective for women who have overweight or obesity with polycystic ovarian syndrome (PCOS). Studies show that the keto diet may help people with PCOS lose weight, improve hormonal imbalance, and boost fertility.

The ketogenic diet is restrictive and lacks long-term, high quality studies backing its safety and efficacy. Less restrictive dietary patterns may be a healthier choice for most women.

Before trying out the keto diet, it’s a smart choice to explore other, less restrictive options to improve your health and reach your wellness goals.

Adopting a diet rich in whole, nutritionally dense foods that can be maintained for life is usually best.

The keto diet is highly restrictive, and its efficacy depends on maintaining ketosis. It’s recommended that this diet only be followed while working with a qualified health professional.

Although some women may find success when following a ketogenic dietary pattern, choosing a less restrictive, nutritious diet that can be followed for life is likely more beneficial for the majority of women.

Consult a registered dietitian or healthcare professional if you’re interested in changing your diet or improving your overall health and wellness.