How Ketosis Effects Menstrual Cycle: Lesson from Doctor Boz

WARNING: the Keto diet will raise or normalize your hormone levels.
Details outlining the effect ketosis has on menstrual cycle found here.
One tell-tale sign of a hormonal surge in women is menstruation. If you are a woman of childbearing age, get ready for unexpected menstruation when you eat mostly fat with less than 20 carbohydrate grams per day.

When women switch to a keto diet, their fatty-low-carb foods deliver a cocktail of precious nutrients. These nutrients, in turn, help restore depressed or problematic hormone levels.

Estrogen reigns as the most abundant female sex hormone. Estrogen stimulates the growth of the lining shed during menstruation. Estrogen production comes from the ovaries, adrenal glands, and fat. Yes. The fatter you are, the more estrogen you will produce.

Healthy, lean patients get most of their estrogen from ovaries. Add thirty pounds of fat cells, and those patients get most of their estrogen from fat.

What’s The Difference Between Estrogen Made From Ovaries Versus Estrogen Produced From Fat Cells?
Structurally they are identical. The difference lies in who those cells listen to. Ovaries listen to the rest of the body when deciding to make estrogen or not. Fat cells produce estrogen whenever they want– which is near all the time.

When the ovaries command the production of estrogen, the hormone levels go up and down based on the time-of-the-month, pregnancy, nutrition, and brain function- just to name a few. The ovaries factor in signals coming from your brain, adrenal glands, uterus and stress levels.

Abundant fat cells over-rule those messages. Millions of engorged fat cells over-rule signals sent from the ovaries. When fat cells command estrogen production, they take orders from no one. They dictate what estrogen seeps out of their cells without ever listening to anything else going on in the body.

They just squirt out estrogen. The more fat, the more estrogen. That is PCOS. Gobs and gobs of extra estrogen in a female cause all kinds of trouble. The abundant estrogen leads to abundant androgen, also called testosterone.

This excess male hormone is causing irregular periods, severe acne, or “manly” hair growth on their chin or nipples. In addition, nothing ruins a woman’s sex drive better than a bunch of male hormones trickling through their system.

Keto boosts estrogen production. Elevated estrogen, like that found in heavy-set PCOS patients, is complicated to explain. Let’s start with women who have normal estrogen.

Women with normal estrogen levels report a surge in this hormone within the first week of going keto. After 3-4 weeks, those same lean keto-adapted female patients report a significant increase in their menstruation and libido. How come?

Patient after patient brings this up. The human body’s fat cells are linked to the production of estrogen and testosterone. Fat, cholesterol specifically, is the starting compound for many steroid hormones such as estrogen, testosterone, progesterone, cortisol, and aldosterone. Ketosis results in the conversion of a lot of body fat to energy. This process boosts production of all those steroid-hormones as well.

More hormones can mean a better sex drive. However, I think improved sex drive happens for an additional reason: ketosis’ improves overall brain function. Orgasms occur in your brain. When your brain does not get proper nourishment and rest, your mental function starts to deteriorate.

Sleep deprivation and malnourishment chronically swell your brain. This is a microscopic finding within the brain. A swollen brain is a broken brain. Mental processing suffers significantly from the slightest of inflammation affecting your gray matter.

Libido and sex drive are related to brain function. While hormones do play a significant role, your sex drive can be depressed if your brain isn’t working right.

Ketosis resets many of these problems linked to low libidos such as improved sleep, less depression, less swelling, stable blood sugars and more.

Ketosis also helps if the person has PCOS. I contend the treatment for PCOS is the ketogenic diet. Insulin fuels the core problem of PCOS with longstanding elevated blood insulin levels. Pushing the insulin down to more normal levels is the only way to get PCOS to go away.

We use medications that help with this problem a little bit, but nothing works better than ketones coursing through their veins for six months.

Unfortunately, if you have PCOS, you will not gain the pleasure of awesome orgasms ten days after peeing your first ketone, but you will feel better. PCOS is a soup of mixed up hormones that have been off kilter for months, if not years.

The insulin hormone leads the path to destruction like a Pied-Piper. Reversing that chemistry takes time. Those abundant fat cells supply out of control estrogen that leads to out of control boy-hormones.

My patients with PCOS start ketosis and within weeks lose weight and feel better. Often after 4-8 weeks of ketosis, their weight loss levels off and usually stops. Several weeks in a row without dropping weight and they come back to the clinic to ask why.

The first step to showing them the answer begins with checking their morning fasting blood sugars. A glucometer and a poke to their finger first thing each morning tells the truth about what’s wrong.

Their blood sugars hover in that 95-110 range and never seem to drop lower. With their years of excess insulin production, their system needs longer times between meals to reset their chemistry.

When I say “reset the chemistry” I am specifically referring to insulin. PCOS, much like People with type 2 diabetes, left their insulin spigot turned on for years. Never had they go longer than 12 hours without eating.

Each swallow of food pings their body to squirt out some insulin. That continuous bath of insulin keeps those fat cells locked down. They never get to use their energy stored in fat cells because they invariably eat before it sinks down. Carbohydrates sliding down their gullet sends the signals to the pancreas to make insulin. Even when eating less than 20 carbs a day, their system never really turns off their insulin production.

The tiny trickle of insulin keeps dripping into their body even in “light ketosis.”

Light ketosis is a phase of ketosis that happens after their body fully adapts to ketones. If you peek inside of each of the cells of a keto-adapted patient, you will find their mitochondria ready and willing to burn ketones. Their cells adapted to using ketones for fuel with the recent drop in high carb foods.

The problem centers around their sensitivity to make insulin. A whiff of those carbs sends their pancreas into squirting out insulin. After years of making insulin by the cupful each day, their pancreas continues to live by those old rules.

A slight increase in blood sugar warns the system of glucose molecules ready to flood into the bloodstream. Survival depends upon the pancreas’ response to make lots of insulin. Now, after weeks of low carb and significant weight loss the body falls into a new normal.

A new chemistry setting between insulin and glucose boasting far superiority compared to before the keto diet. The insulin production keeps sugars hovering around 95-110.

So why the stalled weight loss?

The answer: Blood sugars of 95-110 still cause the drips of insulin to come out of the pancreas. Insulin locks the fat cells down. That means no weight loss.

The Fix = Fasting.

Lower insulin happens when you don’t stimulate the pancreas for several consecutive hours. Said another way: increase the length of time between meals to lower the daily amount of insulin produced. Some PCOS patients hit this plateau in weight loss because they eat 3-5 times a day.

Their snacks and meals remain high in fat and entirely keto but their history of extra insulin production sets them up for stalled weight loss. They adjusted the TYPE of food they ate, but not the pattern of eating multiple times a day. It leaves behind a steady stream of insulin that locks down fat cells.

Together we turn off their insulin by stretching their meals to 1 hour of eating every day. Yep. Twenty-three hours of calorie-free drinks such as water, black coffee, or tea keeps the pancreas from squirting out insulin.

One bolus of high-fat-low-carb-food over an hour allows the body to surge the hormones once in that day. It results in less insulin and a surge in other hormones causing a feeling of fullness and satisfaction.

Watch those mornings fasting sugars sink into the 70s or 80s. Insulin levels remain very low with those blood sugars. It swings the doors of those fat cells wide open. BAM! Weight loss resumes.

PCOS affects many of my patients. Libido was the last thing we worried about during our medical visits. Even if they would bring it up, I redirected them to the reality that swollen brains can’t burst into an orgasm. Blood sugars in the 70s and 80s promise less swelling throughout the body. Day after day they improve.

Before long they enjoy improved energy, deeper sleep, a steady mood and eventually the best orgasm in years.

Want to learn more about the ketogenic diet, check out the audiobook written and recorded by Dr. Bosworth, ANYWAY YOU CAN.

Dr Boz Food Guide for your Fridge and Pocket

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