The Downsides of a Ketogenic Diet for Women: Why It’s Not the Perfect Long-Term Solution

By now, you’ve probably seen countless women on social media (or in your own circle) who have had success with the keto diet and wondering if you should try it too. The keto diet has exploded in popularity, with its promise of rapid fat loss and improved metabolic markers. But is it truly the best choice, especially for the long haul?

While there’s no denying its benefits in specific cases, it’s essential to take a more holistic view, especially when considering long-term health and sustainability.

A recent 12-week trial has shed light on some key downsides of the ketogenic diet. While it remains a powerful therapeutic tool for managing conditions like diabetes, epilepsy, and other neurological disorders, the study reveals some concerning metabolic and gut health impacts that should make women think twice before adopting it as a lifelong eating plan. Here’s what you need to know.

What Is the Ketogenic Diet?

The ketogenic diet is a high-fat, very low-carb eating plan designed to put your body into a state of ketosis. During ketosis, your body shifts from using carbohydrates for energy to burning fat, which produces ketones as an alternative fuel source. This metabolic state is why so many people see rapid weight loss when they first adopt the keto diet.

At a glance, it sounds great, especially if you’re looking to shed pounds quickly. But the story doesn’t stop there.

The Results of the Recent Study

A new 12-week trial compared the effects of a ketogenic diet to a diet restricting free sugars (like those found in sugary drinks and processed snacks). Both led to fat loss without a reduction in physical activity, which is encouraging (1).

However, when researchers looked deeper, the keto diet showed some profound metabolic changes that can’t be ignored, especially for women.

What the Study Found:

Reduced Glucose Tolerance 

The keto diet decreased the body’s ability to process glucose effectively. Even though the diet restricts carbs, this impaired tolerance suggests potential risks if carbohydrates are reintroduced later. For women cycling on and off keto or consuming carbs sporadically, this could lead to trouble regulating blood sugar.

Short-Term Atherogenic Lipoprotein Profile Changes

The keto diet temporarily increased certain lipoproteins associated with heart disease risk. While this doesn’t mean immediate harm, it does raise questions about the effects of prolonged keto dieting on cardiovascular health—especially for women, who are already at risk for heart-related conditions with age.

Gut Microbiome Disruption 

Perhaps the most concerning finding was the significant decrease in gut microbial diversity. The keto diet reduced beneficial bacteria like Bifidobacteria, which are essential for digestion, inflammation control, and overall gut health.

A disrupted microbiome is associated with a range of issues, including hormonal imbalance, weakened immunity, and poor mental health—all of which are particularly relevant to women (2).

Shop: Belly Fix for gut comfort and overall health.

Contrast with Sugar Restriction 

Interestingly, the sugar-restricted diet had minimal impact on metabolism or gut microbiota. While it promoted fat loss, it avoided the more disruptive metabolic changes seen with keto. This suggests that reducing sugar without removing all carbs might be a safer long-term approach.

The Potential Risks of a Long-Term Ketogenic Diet for Women

While the ketogenic diet can deliver quick results, the downsides, particularly for women, are worth serious consideration.

1. Disrupted Hormonal Balance 

For women, hormones regulate everything from menstrual cycles to metabolism to mood. Healthy fats support hormonal health, but the very low carb content of the keto diet can lead to imbalances like irregular periods, thyroid disruption, or higher cortisol (stress hormone) levels (3,4).

These effects are especially concerning for women who are already juggling stress, weight management, families, and careers.

2. Sustainability Challenges 

Adhering strictly to the keto diet can feel restrictive, and many women find it hard to sustain over the long term. Social gatherings, cravings, and even busy schedules can make maintaining ketosis a real challenge. Falling off the wagon often leads to yo-yo dieting, which can be more harmful than sticking to a more moderate, sustainable eating pattern.

Related: Want to Eat Carbs & Still Lose Weight? Here’s How to Carb Responsibly

3. Gut Health Changes

The gut microbiota plays a vital role in women’s overall health, influencing everything from immune function to mental well-being. The reduction of beneficial bacteria like Bifidobacteria observed in keto dieters can lead to digestive discomfort, inflammation, and even heightened risks for mental health disorders like anxiety and depression (5).

4. Long-Term Cardiovascular Concerns 

While research on the long-term cardiovascular impacts of keto is ongoing, the temporary increase in atherogenic lipoproteins reported in the study raises concerns.

Women with a history of heart disease or high cholesterol may need to be particularly cautious.

A Better Long-Term Option for Women

Instead of committing to a strict ketogenic diet, a low-sugar or low-carb approach might be a more sustainable and health-conscious choice for most women. By focusing on whole, nutrient-dense foods and reducing processed sugars, you can achieve many of the same benefits as keto without the potential risks.

Why Low-Sugar/Low-Carb Works:

• It promotes fat loss while still including fiber-rich carbs that support gut health.
• It’s easier to sustain and more compatible with a balanced, flexible lifestyle.
• It minimizes risks to glucose tolerance, heart health, and gut microbial diversity.
• It aligns with a holistic approach to health, supporting both physical and emotional well-being.

Adopting this moderate approach ensures that you’re not just losing weight but also nurturing your body with the nutrients it needs for long-term health and vitality.

The Bottom Line

The ketogenic diet is undoubtedly a powerful tool with therapeutic applications, particularly for conditions like diabetes and epilepsy. However, when it comes to long-term use, particularly for women, the potential downsides—hormonal disruption, gut microbiome changes, and sustainability challenges—can’t be ignored.

For most women looking to lose weight, maintain hormonal balance, and support overall health, a low-sugar or low-carb diet offers a better, more holistic solution. It’s more sustainable, less restrictive, and avoids many of the risks associated with prolonged ketosis.

If you’re considering the best way forward for your health, focus on balance. Experiment with reducing sugar and processed foods while incorporating a variety of whole grains, lean proteins, and healthy fats. And remember—health is not just about the number on the scale, but about how you feel and thrive in your daily life.