Weight Loss

By Helen Chow, ND, Dip Herb, UK-qualified Naturopath & Herbalist
Nutrition & Food Design Coach, Designer Realities Mind Coach

Perhaps you have watched a friend lose weight on keto, heard someone else say it ruined her cholesterol, and wondered which story you are supposed to believe.

Then you look online and find two competing worlds.

In one, the ketogenic diet is the answer to almost every modern health problem. In the other, it is presented as a reckless parade of bacon, butter and blocked arteries.

Let’s put down the placards and have a sensible conversation.

A ketogenic diet can be a useful therapeutic tool for some women. It may quieten hunger, simplify food choices and improve certain metabolic markers in the short term. But it is not compulsory, it is not automatically healthy, and you do not have to remain in ketosis to become metabolically healthier.

The real question is not, “Is keto good or bad?”

It is, “Would a well-formulated ketogenic diet be useful, safe and realistic for you at this stage of your life?”

The quick answer

A ketogenic diet is a very-low-carbohydrate way of eating designed to produce nutritional ketosis. Most versions reduce digestible carbohydrate to roughly 20–50 grams a day, although the amount that produces ketosis differs from woman to woman.

A sensible version begins with adequate protein, uses mostly whole foods, includes vegetables you tolerate, and adds enough fat for satisfaction—not unlimited fat merely because it is “keto”.

It may help some women with hunger, blood glucose, triglycerides and short-term fat loss. However, results vary. LDL cholesterol can rise, digestive problems can occur, medication may need rapid adjustment, and the restrictions may not suit your health, culture, family life or relationship with food.

Keto is one option. Lower carbohydrate is another. Neither is a moral achievement.

In This Article

• What nutritional ketosis means
• Keto versus an ordinary lower-carbohydrate diet
• What to eat on a well-formulated keto diet
• How to protect muscle after 50
• Why eating more fat does not guarantee losing body fat
• Common early problems and what to monitor
• Who may benefit—and who needs medical guidance
• Whether keto must be permanent
• How to reintroduce carbohydrate thoughtfully

What Is a Keto Diet, Really?

Normally, your body has ready access to glucose from carbohydrate foods. When carbohydrate intake falls low enough, the liver converts fat into small fuel molecules called ketones. Your brain and other tissues can use them for energy.

That ordinary, controlled state is called nutritional ketosis.

You do not need to understand every pathway to use the diet well. If you would like the deeper metabolic story, I have explained carbohydrates, insulin and ketones separately. Here, we are staying at the kitchen table: what to eat, what to watch and whether the approach fits your life.

Nutritional ketosis is not the same as diabetic ketoacidosis, or DKA. Nutritional ketosis produces a modest, regulated rise in ketones while the body maintains its acid–base balance.

DKA is a dangerous medical emergency involving severe insulin deficiency, excessive ketone accumulation and acidification of the blood. It occurs chiefly in type 1 diabetes, but it can also occur in other circumstances—including, rarely, with SGLT2 inhibitor medicines even when blood glucose is not dramatically high.

If you have diabetes, do not use a ketone reading or an internet chart to decide that you are safe. Nausea, vomiting, abdominal pain, unusual exhaustion, deep or difficult breathing, confusion or a fruity-smelling breath require urgent medical advice—particularly if you use an SGLT2 inhibitor.

Keto is not simply “eating fewer carbs”

A lower-carbohydrate diet might provide 60, 90 or 120 grams of carbohydrate a day. It may remove sugar and reduce bread, rice or pasta without trying to create ketosis.

A ketogenic diet usually goes much lower—often below 50 grams of digestible carbohydrate a day and sometimes nearer 20–30 grams. That often excludes or sharply limits grains, pulses, most starchy vegetables, sugar and many fruits.

This distinction matters because you may gain much of what you want from a less restrictive change.

If removing sugary drinks, reducing refined snacks, building protein-first meals and choosing a smaller starch portion leaves you satisfied and improves your health, you may not need to chase ketones at all. Your individual carbohydrate tolerance matters more than winning a label.

What do you actually eat?

Let’s rescue keto from the image of buttered coffee and processed meat.

A well-formulated meal begins with a meaningful protein food:

• eggs, fish, shellfish, poultry, meat or game;
• plain Greek yoghurt, cottage cheese or other dairy if tolerated;
• tofu or tempeh for women who include soya;
• or a carefully chosen unsweetened protein supplement when real-life circumstances make it useful.

Then add non-starchy vegetables according to your digestion and carbohydrate allowance. These might include courgettes, aubergine, mushrooms, cucumber, leafy vegetables, broccoli, cauliflower, green beans, peppers, cabbage or a salad.

Finally, add enough fat to make the meal satisfying and enjoyable. Olive oil, olives, avocado, oily fish, nuts or seeds if tolerated, eggs, full-fat unsweetened dairy, coconut, santan, ghee, butter and the fat naturally present in meat can all appear. The balance depends on your health, preferences and lipid response; my fuller guide to healthy fats explains those choices.

Notice the order: protein, vegetables, then enough fat. Not fat first, fat second and a little protein if there is room.

A keto day can still look like real food

You do not need to eat the same Western “keto plate” every day.

Breakfast might be eggs with mushrooms and wilted greens—or leftover chicken and cooked courgettes if you prefer a savoury meal. You may not want breakfast at all; meal timing is personal, and my guide to fasting after 50 explains when a shorter eating window helps and when it becomes another stress.

Lunch could be a Greek-style plate of grilled sardines, cucumber, olives and a little feta; a French omelette with herbs and a green salad; or tandoori chicken with mint yoghurt and spiced aubergine.

Dinner might be Malaysian beef rendang made without added sugar, served with stir-fried cabbage instead of a mountain of rice; lamb kofta with tahini and roasted courgettes; salmon with lemon butter and green beans; or paneer tikka with peppers and a cucumber raita.

Vegetarian keto is possible, but the overlapping restrictions make adequate protein and micronutrient planning more difficult. If you avoid meat and fish, use the principles in my vegetarian protein guide and consider individual professional advice.

This is where Gourmet Sifu will eventually come into its own: Health Sifu can help you decide whether the approach makes sense, while Gourmet Sifu turns it into food worth anticipating.

Whole-food keto versus “dirty keto”

You can keep carbohydrate very low while living on processed sausages, cheese, mayonnaise, packaged bars, sweetener-heavy puddings and products with “KETO” printed across the packet.

You may technically make ketones. That does not mean you have built a nourishing diet.

“Dirty keto” is an informal name for focusing on the carbohydrate number while paying little attention to food quality. It is attractive because it replaces one collection of ultra-processed foods with another and promises that the label will do the thinking for you.

A better foundation is recognisable food: eggs, fish, meat or tofu; vegetables you tolerate; simple fats; herbs, spices and perhaps plain dairy. A “keto treat” can occasionally be just that—a treat. It need not become a compulsory snack that keeps your taste for sweetness roaring.

The broader healthy-eating framework still applies when carbohydrate is low.

Protein after 50 is not optional

After 50, losing weight without protecting muscle is a poor bargain.

Muscle supports strength, balance, bones, glucose disposal, independence and the simple ability to carry your shopping or rise from a low chair. Menopause, ageing, inactivity, illness and repeated restrictive diets can all work against it.

Some traditional medical ketogenic diets deliberately moderate protein for a particular therapeutic purpose. That does not mean a woman using keto for fat loss should casually under-eat protein because she fears it will “kick her out of ketosis”.

Start by meeting your protein needs. The exact amount is personal, but my guide to protein after 50 will help you estimate a sensible intake and distribute it across real meals.

Then give the protein a reason to remain on your body. Regular resistance work—adapted to your current strength, joints and health—tells your body that this tissue is useful. Read the practical guide to muscle health if you need a gentle place to begin.

Ketosis is not a force field around your muscles. Adequate protein, sufficient nourishment and strength work still matter.

Eating fat and losing body fat are not the same thing

This is one of the easiest keto mistakes to make.

You reduce carbohydrate, hear that keto is “high fat”, then add butter to coffee, cream to snacks, handfuls of nuts, cheese after meals, oil over everything and a fat bomb before bed.

Your body may be burning fat—but it has a great deal of dietary fat arriving to burn before it needs to draw substantially from stored body fat.

Fat is energy-dense and very easy to add. Ketosis does not cancel energy balance. Nor does it guarantee appetite will regulate perfectly in every woman.

Use fat for flavour, nourishment and comfortable satisfaction. Do not force it past fullness. If fat loss stalls, first inspect the “extras”: liquid cream, grazing on cheese, nut butters, handfuls of nuts, keto desserts and oils poured without thought.

This is not an invitation to eat a dry chicken breast beside three lettuce leaves. It is simply the difference between enough fat and unlimited fat.

Choose your fats intelligently

Triglycerides often fall on a carbohydrate-restricted diet, and HDL cholesterol may rise. LDL cholesterol, however, is more individual. It may fall, remain similar or rise—sometimes substantially.

That is why “my triglycerides improved” should not become permission to ignore a dramatic LDL or apoB increase. One favourable marker does not erase another. Family history, blood pressure, smoking, diabetes, kidney health and your overall cardiovascular risk belong in the conversation.

Build most of your added fat around foods such as extra-virgin olive oil, olives, avocado and oily fish, with nuts and seeds if you tolerate them. Butter, ghee, coconut and fatty meat can fit according to your preferences and response, but they need not dominate every meal.

If you follow keto for more than a short experiment, arrange appropriate follow-up with your clinician. Depending on your situation, that may include a lipid profile, triglycerides, HDL, LDL, non-HDL cholesterol and possibly apoB—not merely body weight and ketone levels.

Vegetables, fibre and your digestion

Keto does not mean “no vegetables”. Nor does good digestion require every woman to consume an enormous raw salad.

Choose lower-carbohydrate vegetables that agree with you. Cooked courgette, aubergine, mushrooms, cabbage or green beans may be gentler than a bowl of raw cruciferous vegetables. Some women tolerate nuts, seeds and avocado beautifully; others feel bloated, cramped or unwell.

Constipation can appear when someone removes beans, fruit and grains but forgets to replace the fluid, minerals and plant foods they previously supplied. Sudden increases in cheese can add to the difficulty.

Drink to thirst and circumstances, include tolerable vegetables, move daily and review whether your diet has become needlessly narrow. My guide to fibre and digestion will help you adjust without assuming that more fibre is always the answer.

Persistent constipation, pain, bleeding, vomiting, unexplained weight loss or a significant change in bowel habits deserves medical attention—not another spoonful of husk from the internet.

The first week: water, salt and the famous “keto flu”

When carbohydrate intake drops sharply, stored glycogen falls and water is released with it. Insulin levels may also fall, encouraging the kidneys to excrete more sodium. This helps explain the quick scale drop many women see in the first few days: much of it is water, not several pounds of vanished body fat.

It also helps explain headaches, tiredness, light-headedness, cramps or a washed-out feeling during the transition.

Adequate fluid and salt may help some people, but please do not turn electrolyte advice into a home chemistry experiment. Potassium supplements can be dangerous with kidney disease and with several common medicines. Extra sodium may be unsuitable if you have heart failure, kidney disease, poorly controlled blood pressure or a sodium restriction.

Magnesium needs vary too, and supplements can cause diarrhoea or interact with medicines.

If you take blood-pressure tablets or diuretics, monitor your blood pressure and speak with your prescriber. Dietary change and early fluid loss can make your existing dose too strong. Do not stop prescribed medication by yourself.

Hunger, satiety and why keto sometimes feels easier

Many women report that hunger becomes quieter on keto. Protein is satisfying; meals may contain fewer hyper-palatable refined foods; ketones may influence appetite; and more stable glucose can help some women escape the cycle of eating, crashing and hunting for something sweet.

That experience is real—but it is not universal.

Another woman may feel preoccupied with forbidden foods, struggle socially, overeat keto products or alternate rigid restriction with carbohydrate binges. If the plan makes your world smaller and your thoughts about food louder, it is not serving you simply because a meter shows ketones.

The Reclaim approach is protein first, whole foods, muscle protection and individual carbohydrate tolerance. Ketosis may be a useful tool within that approach. It is never a compulsory destination.

What benefits are reasonable to expect?

In research, very-low-carbohydrate and ketogenic diets can produce short-term improvements in body weight, HbA1c and triglycerides, particularly in adults with overweight, insulin resistance or type 2 diabetes. They can also reduce the need for some glucose-lowering medicines—but that is precisely why medication supervision matters.

The first rapid change on the scales is partly water. Fat loss takes longer.

And when keto is compared with another well-constructed eating pattern, its advantage often narrows over time. Adherence, food quality, protein, total energy intake and the support around the woman make a great difference.

In a randomised trial comparing a well-formulated ketogenic diet with a Mediterranean-style low-carbohydrate diet in people with prediabetes or type 2 diabetes, both improved HbA1c similarly; the ketogenic phase lowered triglycerides more, but raised LDL and provided less fibre and some nutrients.

This is why I call keto a tool, not a metabolic religion.

If you are trying to understand your own results, look beyond the bathroom scales. Consider waist measurement, strength, hunger, energy, sleep, digestion, blood pressure and relevant blood tests. If blood sugar is part of your concern, review your HbA1c and glucose story and the broader signs of insulin resistance.

Who must speak with a clinician before starting?

Please arrange individual medical or dietetic guidance rather than beginning strict keto alone if you:

• have type 1 diabetes, possible latent autoimmune diabetes in adults (LADA), pancreatic disease or a history of ketoacidosis;
• use insulin, sulfonylureas such as gliclazide or glimepiride, meglitinides, or an SGLT2 inhibitor such as dapagliflozin, empagliflozin, canagliflozin or ertugliflozin;
• take blood-pressure medication or diuretics;
• are pregnant, trying to conceive or breastfeeding;
• have current or previous disordered eating;
• have kidney disease, significant liver disease, pancreatitis or a disorder of fat metabolism;
• have gallstones, gallbladder disease or difficulty digesting higher-fat meals;
• are underweight, frail, losing weight unintentionally or recovering from serious illness;
• have familial hypercholesterolaemia, very high LDL cholesterol or significant cardiovascular disease;
• or take medicines whose dose or absorption may be affected by major dietary change.

This is not an exhaustive list. A ketogenic diet used as medical therapy—for epilepsy, for example—is a separate matter and belongs under a specialist clinical team.

Medication safety is not a small footnote

Carbohydrate restriction can lower blood glucose quickly. If you use insulin or a sulfonylurea, the same dose may then drive glucose too low. Symptoms can include shaking, sweating, palpitations, hunger, confusion or faintness.

SGLT2 inhibitors require particular caution. These medicines can increase the risk of euglycaemic DKA, in which dangerous ketoacidosis occurs without the very high glucose level you might expect. Combining one with a ketogenic diet may increase that risk. Do not simply stop the medicine; speak with the clinician who prescribes it before restricting carbohydrate severely.

Blood pressure may fall too, particularly during early fluid loss. Your prescriber may want home readings and a planned review of antihypertensives or diuretics.

The safe order is:

1. tell your healthcare professional what you plan to change
2. agree what to monitor and how often
3. arrange medication adjustments where needed
4. know which symptoms require urgent help
5. keep follow-up appointments even if you feel marvellous

Food can be powerful. That is not a reason to be casual with medicine; it is the reason to coordinate the two.

How to begin without making life miserable

If strict keto is appropriate for you, begin with meals rather than macros.

First, choose your protein. Plan two or three proper meals around enough eggs, fish, meat, poultry, tofu or suitable dairy.

Second, remove the obvious refined carbohydrates. Sugary drinks, sweets, cakes, biscuits, most bread, cereal and large servings of rice, pasta or noodles are the simplest place to start.

Third, select vegetables you tolerate. Do not copy someone else’s vast salad if cooked vegetables suit you better.

Fourth, add fat for satisfaction. Use it deliberately; do not force it.

Fifth, prepare for ordinary life. Keep boiled eggs, cooked meat or fish, tinned sardines, frozen vegetables, plain yoghurt or another suitable backup available. The guide to busy-life eating will help on caregiving, hospital, travel and restaurant days.

Finally, decide what you will monitor. Weight alone is not enough. Include hunger, energy, bowel function, blood pressure if relevant, strength and the blood markers agreed with your clinician.

Does keto have to be permanent?

No, not at all.

Some women genuinely prefer staying very low carbohydrate. Others use keto for a defined period and then move to a less restrictive pattern. Another woman discovers that she feels equally well with a modest serving of beans, fruit, potato or rice and no longer wants ketosis.

There is no prize for remaining in ketosis after it has stopped being useful.

If you reintroduce carbohydrate, do it thoughtfully rather than declaring the diet “over” on Friday and eating everything you avoided by Saturday.

Add one whole-food carbohydrate at a time—perhaps berries, yoghurt, beans, lentils, a small potato, fruit or a modest portion of rice. Keep your protein steady. Observe hunger, digestion, energy, weight trend and glucose when clinically relevant. Increase gradually until you find the range that suits your body and life.

The scale may rise slightly as glycogen and its accompanying water return. That is not automatically fat regain.

What matters is whether the new pattern supports your metabolic health, muscle, pleasure and consistency.

A few questions to ask yourself

• What am I hoping keto will change?
• Could a gentler reduction in refined carbohydrate achieve it?
• Can I eat enough protein and maintain my strength?
• Does the plan include food I enjoy and digest well?
• How will it work at family meals, restaurants and cultural celebrations?
• Do my medicines or health conditions require supervision?
• Which results will tell me it is helping?
• Which signs will tell me to modify or stop?
• What is my plan after the initial experiment?

A diet should be an informed decision, not a loyalty oath.

Frequently Asked Questions

Do I need to measure ketones?

Not usually if your aim is ordinary fat loss or appetite control. A blood ketone meter can confirm nutritional ketosis, but a higher number does not necessarily mean better fat loss or better health. Medical ketogenic therapy is different and may require structured monitoring.

Can I eat as much cheese, cream and butter as I want?

No. These foods can fit, but they are easy to overeat and may worsen constipation or raise LDL cholesterol in some women. Use them as food, not as a keto entitlement.

Will too much protein stop ketosis?

Very high intakes may affect ketone levels in some circumstances, but many women worry about this far more than necessary and end up under-eating protein. After 50, protecting muscle deserves priority. Agree a personalised target if you are using keto medically.

Is keto better than a Mediterranean diet?

Not universally. Both can be built well or badly. A Mediterranean-style lower-carbohydrate diet may offer more fruit, legumes and whole grains and be easier to sustain. Keto may suppress appetite or lower triglycerides more for some people. Your response and ability to continue matter.

Can keto reverse type 2 diabetes?

Some people with type 2 diabetes achieve remission after substantial weight loss through low-carbohydrate, very-low-calorie, surgical or other approaches. Remission has a precise clinical meaning and requires follow-up; it is not a permanent cure. Never alter diabetes medication without your clinical team.

A Health Sifu Note

Keto can be a remarkably useful experiment when it gives you calmer hunger, better glucose control and a simpler way to eat. It can also become another rigid set of rules that distracts you from protein, muscle, nourishment and the life you are trying to build.

So begin with the outcome, not the ideology.

You are not trying to produce the most ketones. You are trying to become stronger, metabolically healthier and more at ease with food—while protecting the woman you want to be in your next 20 years.

Health Sifu 
Make Smarter Choices
Consciously. Deliberately.

Scientific References & Further Reading

American Diabetes Association — Standards of Care in Diabetes—2026: Facilitating Positive Health Behaviours and Well-being to Improve Health Outcomes. Current professional guidance emphasises individualised eating patterns rather than one compulsory macronutrient prescription. Read the ADA guidance

Goldenberg JZ et al. — Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomised trial data. BMJ, 2021. Found greater remission and metabolic improvements at six months, with benefits diminishing by 12 months and limited certainty for longer-term outcomes. Read the BMJ review

Gardner CD et al. — Effect of a ketogenic diet versus Mediterranean diet on glycated haemoglobin in individuals with prediabetes and type 2 diabetes mellitus: the interventional Keto-Med randomised crossover trial. American Journal of Clinical Nutrition, 2022. Both patterns improved HbA1c similarly; keto reduced triglycerides more but increased LDL and supplied less fibre and some nutrients. Read the Stanford study summary and access the paper

Choy KYC et al. — The effects of a ketogenic diet on patients with type 2 diabetes: a systematic review and meta-analysis of recent studies. Diabetes & Metabolic Syndrome, 2023. Reported no clear additional advantage for weight or glycaemic control over comparator diets overall, illustrating the importance of study design, duration and adherence. Find the paper via PubMed

Wang Z et al. — Impact of the ketogenic diet as a dietary approach on cardiovascular disease risk factors: a meta-analysis of randomised clinical trials. American Journal of Clinical Nutrition, 2024. Found lower body weight, triglycerides and glucose-related measures in some analyses, alongside average increases in total and LDL cholesterol. Find the paper via PubMed

DiMattia ZS et al. — Ketogenic Diets and Low-Density Lipoprotein Cholesterol in Adults With Normal Weight: An Emerging Clinical Concern. Journal of the American Heart Association, 2026. Reviews evidence that LDL responses vary and that some lean adults experience very large rises, supporting lipid monitoring and individual risk assessment. Read the review

Cucuzzella M, Riley K, Isaacs D et al. — Adapting Medication for Type 2 Diabetes to a Low Carbohydrate Diet. Frontiers in Nutrition, 2021. Practical consensus guidance on the rapid adjustment and monitoring that may be required for insulin, sulfonylureas, SGLT2 inhibitors, antihypertensives and diuretics. Read the full paper

European Medicines Agency — SGLT2 inhibitors: recommendations to minimise ketoacidosis risk. Regulatory advice explains that ketoacidosis can occur with atypically modest glucose elevation and requires urgent assessment. Read the EMA safety advice

Diabetes UK — Low-carb diets position statement. Supports low-carbohydrate diets as one evidence-based short-term option for some adults with type 2 diabetes while stressing individual choice, nutritional adequacy and medication safety. Read the position statement

Harvard T.H. Chan School of Public Health — Diet Review: Ketogenic Diet for Weight Loss. A balanced public-health overview of typical foods, possible short-term effects, nutritional concerns and the uncertainty surrounding long-term adherence and outcomes. Read the Harvard review

Evidence in Plain English

• Established: A ketogenic diet reliably produces nutritional ketosis when carbohydrate is restricted sufficiently. Medication-related hypoglycaemia and SGLT2-associated ketoacidosis are genuine safety concerns. Early water loss is common.
• Possible short-term benefits: Reduced hunger, weight, HbA1c and triglycerides for some adults—especially those with insulin resistance or type 2 diabetes.
• Individual: Digestive tolerance, energy, LDL response, enjoyment and ability to sustain the diet vary considerably.
• Still uncertain: Whether keto offers a meaningful long-term advantage over other well-designed diets for most adults, and its long-term cardiovascular outcomes outside specialist therapeutic use.