A Ketogenic Diet Optimized For Thyroid Health

Many of the clients I work with in my women’s hormone balancing programs come to me dealing with underlying conditions such as blood sugar issues and insulin resistance, diabetes, PCOS, as well as autoimmune and thyroid disease.

While I’ve written a lot about the effectiveness of my Keto-Green™ diet and lifestyle program for menopause symptoms (hot flashes, brain fog and mood swings), insulin resistance, weight loss, diabetes and other diseases, I haven’t talked too much about how the Keto-Green program supports women having thyroid disease.

There’s some conflicting information out there as to whether a ketogenic diet improve symptoms for women having thyroid disease, or whether it makes symptoms worse.

Because my Keto-Green program has a ketogenic element to it I thought I’d talk about keto and thyroid in this article. I’ll also talk about how my Keto-Green program differs from traditional ketogenic diets.

Is the Keto-Green program something a woman with thyroid disease might want to try?

The short answer is yes!

The long answer? You may need to try it to see how it works for you over a period of time. We’re all unique when it comes to our chemistry, genetics and overall health challenges, so any given diet or health program may or may not be the best fit for you. I always say that if someone tells you they have the perfect diet that works for everyone all the time, don’t listen any further! In particular, if you have a thyroid issue and need to gain weight, keto may not be the right fit for you, especially long-term.

And please...always discuss any change in your diet with your doctor! He/she knows your medical history and current medical status best. But ultimately you are in charge of your health!

The good news is that I’ve had great success in my 8 seasons of Magic Menopause (a 7 week course based solely on my Keto-Green program), with many participants having had pre-existing thyroid issues. I’ll share some of their thyroid improvements with you in a bit.

The other good news? Research supports the benefits of every element within my Keto-Green program and illustrates why it is likely a better solution for most women - especially those having an underlying condition such as thyroid disease - than the standard ketogenic diet.

A typical ketogenic diet does not consistently provide women with the support they truly need to both feel healthy and be successful on low-carb dietary restrictions. It doesn’t provide the detox support, gut healing and adrenal support that most women need; it isn’t anti-inflammatory when sustained over time; nor does it provide the interventions necessary to ensure overall hormone balance.

So many things can affect a woman’s ability to be in balance across our major hormones. I know that after dealing with the flooding aftermath of 2 separate hurricanes last year – and living with serious mold issues - my own TSH sky-rocketed to over 5.4. But today on my Keto-Green program it is a beautiful number, 0.77, which is in the optimal range.

So how is my Keto-Green diet and lifestyle program healthier?

First, let me briefly overview what a traditional ketogenic diet consists of. Then I’ll share with you how my Keto-Green diet and lifestyle program differs from that, and why those differences matter in regards to your long term thyroid health.

feel neck for inflammation

What’s a ketogenic diet?

Keto is all about weight loss and improved health.

If you are unfamiliar with how a ketogenic diet works, the simplest explanation is that it is a diet that is extremely low in carbs, has moderate protein and is very high in fat. A ketogenic diet is all about changing your body’s fuel source. When a person eats a lot of carbs their body produces high levels of blood glucose (sugar). Insulin is then produced in order to transport all of that glucose into your body’s cells. Your body then burns the glucose to make its energy. Insulin stores excess energy as carbs and fat. Oh yes, that then becomes the dreaded belly fat!

A lot of us eat too many carbs and produce too much insulin. We often do this continuously due to snacking and we also do too many munchie carbs too late at night! This can lead to something called insulin resistance, a condition where your body’s cells actually start to resist the insulin. When this occurs, insulin can no longer clear out the glucose and your blood sugar just continues to rise; over time you can become diabetic.

On a ketogenic or low-carb/high-fat diet, your body doesn’t have all that glucose for fuel. After a few days your body will go into a metabolic state called ketosis, it will actually start tapping its fat storage for fuel. The body thinks it is starving and so looks for alternative fuel sources. The liver takes fatty acids and converts it to a substance called ketone bodies in the blood, and those ketones become the replacement energy source.

There have been many studies which have scientifically shown that a ketosis state not only supports weight loss, but that it also may reduce epileptic seizures, reduce blood sugar issues (diabetes, insulin resistance), support improved memory and brain health, and may help fight cancer and even be effective at treating diseases such as Alzheimer’s disease and Parkinson’s. You can read more about this research here.

The traditional “plate” breakdown for a ketogenic diet is 5-8% carb, 15-25% protein and 70-80% fat (depending on which plan you follow). Traditional keto diets also often include some aspect of intermittent fasting, which is restricting “when” you eat as well (either lengthening the time between dinner and breakfast or not eating every other day, etc.).

But typical ketogenic diets do not usually include other lifestyle interventions (stress management/adrenal support, focusing on sleep, improving gut dysfunction, lowering one’s toxicity, etc.) except perhaps relating to increasing exercise.

The differences between typical ketogenic diets and my Keto-Green program

My Keto-Green diet and lifestyle program contains a similar dietary plate component and the particular form of intermittent fasting that has been shown in multiple research studies to be safe and effective, but adds many additional elements and key differences beyond the standard ketogenic diet.

These differences make the diet more thyroid-friendly, as shown with my Magic Menopause participants’ results. It also addresses many of the common barriers such as keto-flu, which make many women simply give up on keto-based diets early-on. More importantly it prevents going “keto-crazy”. That’s what I call the irritable (using a nice word) state that many women experience on these diets.

The first major difference is that a woman doesn’t just dive into the ketogenic diet day one. Instead, I focus program participants to develop a healthy foundation that includes,

  • An alkaline diet and lifestyle – Achieving an alkaline pH is a core difference of my Keto-Green program over strictly ketogenic diets. The issue with ketogenic-only diets is that women stay in ketosis too long and become acidic, which actually creates inflammation which forces your body to hold on to its fat stores…more inflammation is bad for your thyroid, and you won’t lose weight (if that is your goal). We want to see an overall net alkaline producing diet versus the typical Western net acid producing diet; it is also important to note that this net effect is impacted by many non-dietary elements! Alkalinity is a core component of my Keto-Green program. It is anti-inflammatory and hormone balancing.  Numerous research studies have shown alkalinity supports substantial health benefits. Learn more about the proven health benefits of alkalinity here.
  • Removing inflammatory food sensitivities – Most ketogenic diets focus on just lowering gluten intake but do not require the removal of gluten as well as other inflammatory foods. I have found that women in particular do better on a diet that excludes the top inflammatory foods such as gluten, dairy, sugar and processed foods. All the vices need to be cut back on as well, such as alcohol and caffeine.
  • Removing environmental toxins from foods (no hormones, chemicals or GMOs), personal care products and the home. Most ketogenic diets do not include this as an initial step; but women in my programs have found this to be a key aspect to their achieving alkalinity as well as hormone balance.
  • Incorporating important lifestyle changes that directly support our two thyroid-impacting regulatory hormones, cortisol and insulin. This includes,
    • Stress management (cortisol effectively puts the brakes on your digestion, immune processes and thyroid metabolism!) Many women can’t get into ketosis until they learn better stress management techniques.We can’t always get our stressors out of the picture, but we definitely can learn how to reduce our cortisol to healthier levels!
    • Improving the quality and quantity of sleep. Our circadian rhythm is critical to hormone production and our overall health and mood.
    • Resolving adrenal dysfunction with adrenal adaptogens. Too much stress burns out your adrenals; your adrenals normally focus on mundane things such as metabolizing nutrients and producing needed hormones!
    • Addressing the gut dysfunction that is common with thyroid disease. We support thyroid/keto digestion issues (leaky gut, low stomach acid, malabsorption of key nutrients such as zinc, Vitamin D, selenium; constipation due to slow metabolism, etc.) with probiotics and digestive enzymes, and  we incorporate natural detoxification strategies.

Without this foundation a ketogenic diet will in many cases not be successful for most women over 50. Without this focus, women – especially those with thyroid or other underlying inflammatory conditions and going through menopause - will often feel sick with keto-flu when going on a ketogenic diet, will find it difficult to adhere to, and will likely not stick with it or get optimal results. I’ve seen this time and time again.

In my program, once this foundational work is underway we begin with a slightly modified ketogenic “plate”:  My Keto-Green program focuses on “clean” and organic foods. It consists of a slightly reduced percentage of fats (56-70%) from most ketogenic plates but with a very specific focus on healthy fats (omega-9 fatty acids, omega-3 fatty acids, healthy saturated fats). Protein (20%) also needs to be clean and organic…we don’t want to introduce hormones and other toxins onto our plate. The same goes for carbs (5-10%)...remember, not all carbs are equal! My plate consists of only slow-burning carbs such as green veggies (organic, please). You have to eat a lot of those to remain alkaline too. This also provides fiber benefits (important for those with thyroid issues – who may become sluggish).This percentage of carbs typically equates to 20-35 grams of carbs per day.

My Keto-Green program includes intermittent fasting. There are numerous studies that support the health and metabolic benefits of fasting, in particular the type that I recommend (which is to increase your fasting window between dinner and breakfast). You can read more about the health benefits of this type of proven intermittent fasting and how to implement it in a healthy manner, here. It has been shown to improve biomarkers (increasing metabolic function, improving insulin sensitivity, reducing oxidative stress) for many diseases (such as diabetes, breast cancer and cardiovascular disease).

My Keto-Green program assumes an 80-10-10 philosophy! I’ve seen some thyroid clinicians state that staying in ketosis too long isn’t healthy for those with thyroid issues given that it may lower T3 levels (more on that below). But frankly, women on my program don’t stay in ketosis for weeks at a time, not even days at a time in many cases. We bounce in and out as there are many dependencies beyond carbs that affect ketosis (such as stress level!). For optimal results I like for women to stay Keto-Green about 80% of the time, fast about 10% of the time (so do some periodical periods of intermittent fasting, but don’t live with those restrictions each and every day), and feast about 10% of the time. Yes! Feasting is so important as it is typically time we bond with family and friends…and we all need to treat ourselves from time to time.

Many of these Keto-Green differences specifically address the potential concerns that someone having thyroid disease might otherwise have with trying a traditional ketogenic diet.

keto-green foods

So what are the concerns being expressed regarding thyroid disease?

Again, there isn’t a lot of research available and there are also only a handful of thyroid experts out there who have expressed any real concern. So most of us rely on the results we see repeated in our – and our peers’ – communities.

But here are the two concerns about typical ketogenic diets that I have heard expressed for women relating to their having thyroid disease:

1. Does a typical ketogenic diet lower T3 levels to an unhealthy level? Research has shown that one of a ketogenic diets benefits is in controlling blood sugar spiking and reducing insulin as well. But too little insulin can also impact the liver’s ability to make T3 out of T4. So the question then becomes is that really a problem, or is it a physiological adaptation that your body just needs to adjust to? This lowered T3 is seen in calorie restricted diets as well.To me, if TSH level doesn’t increase and a woman continues to feel well (or better!), that’s the more important measure. In my Magic Menopause program we’ve seen the TSH levels go down to optimal ranges. In many cases we’ve seen T3 increase as well. The anti-inflammatory, blood-sugar balancing, adrenal supporting, and other hormone balancing and liver detox benefits of my Keto-Green program have outweighed any potential impacts relating to keto’s effects of lowering T3 levels. This even happened to me. You just need to monitor your overall thyroid levels which you should be doing in any case.

As an aside, lower T3 levels have actually been associated with some good things, such as preserved muscle mass and even a longer lifespan in existing research.

Also, many people – in one study about half of the patients - having hypothyroid disease and in particular, Hashimoto’s, have carbohydrate metabolism disorders! There have been a number of studies showing that people with thyroid disorders actually feel better when on a low-carb diet! This is what I have seen with the participants in my program. What I have seen is that by doing the foundational work mentioned above that they do well with the keto piece, and that thyroid numbers have actually improved.Here are just a few examples. The first one is for Tina, a 56 y.o. woman who had been on my Keto-Green diet and lifestyle program for about 8 months. Her T3 level increased from 2.8 to 2.9 ng/dL and her TSH decreased from 2.9 to 1.94 mIU/L which is more optimal. She felt great, too. Another woman, Kay, age 67, was struggling with her thyroid and had a consistently low basal body temperature (95.6) at the start of implementing a Keto-Green program.  She was also dealing with heavy metal toxicity at the time. Over the course of just over a year on the program she was able to increase her basal body temperature to 97.6, increase her free T3 (from 2.4 pg/mL to 2.9 pg/mL), lower her A1C (5.7 to 5.5) and is doing really well. Her TSH did increase as she was detoxing the heavy metals.

I personally saw a spiking TSH level too due to incredible mold toxicity after my family’s home was hit (for the second time) with a hurricane last year! While I’ve had thyroid issues for many years my TSH really shot up, to 5.07 mIU/L, in Dec 2017 (after 5 moves, stress and repeated mold exposure)! After getting back - strictly - on my Keto-Green program my TSH measured 0.55 mIU/L in October of 2018. And my free T3 also is at a healthier level (from 2.3 pg/mL to 2.5 pg/mL).

In a survey of more than 500 women following the Keto-Green program 94.95% felt that their energy levels had improved. That doesn’t sound sluggish to me. And while blood testing isn’t part of my program, many women who did have testing improved their numbers across the board.

Along with these clinical findings let me talk about one 2016 study that actually showed that with people having Hashimoto’s disease a low-carb (12-15% of calories) diet showed a significant decrease (44%) in TPO antibodies. Antibodies are a more helpful measure than TSH, especially early on with thyroid disease, prior to symptoms appearing, as antibody changes provide an early view into how a person’s thyroid condition may be worsening (or improving as a result of interventions).

Note that this was more of a moderately low-carb diet than what we are usually looking for to get into ketosis. This leads me to the second question I get asked, which is how restrictive can the diet be so that a person gets into ketosis but doesn’t have any issues with their thyroid.

2. How restrictive can the daily carbs be without negatively affecting the thyroid?

Most people need to be at 20-40 grams of total carb per day to get into ketosis. For some people they may need less, some can go more…this is a general rule of thumb, it will depend on all of the things we’ve already discussed here! Women who are under serious chronic stress may not be able to get into ketosis at all, as one example, no matter how restricted the carbs.In talking with clinicians focused on thyroid disease and working with ketogenic diets for their patients and clients, most would say not to go lower than 20 grams of total carb per day, in conjunction with their thyroid hormone medication. But most will also say women may need to try it out and adjust their level of carbs as they go.In my Keto-Green program we don’t really look at the number of daily carbs, we look at the percentage of one’s daily food intake or “plate”. It is much easier and intuitive to do this! So we target 5-10% of the “plate” to be healthy, slow-burning carbs (and this equates to generally around 20-35 grams of carbs). I have not seen any issues with my Keto-Green program with women having thyroid disease, just the opposite, assuming they start with building an alkaline foundation.The one caveat to these healthy target carb levels might be someone having an overactive thyroid who may not want to risk further weight loss. I also only recommend intermittent fasting in a 16/8 type of window or less as it supports improvements to metabolic function without any poor effects. I do not support the prolonged 24 hour type of fasting especially for those having thyroid or other underlying health issues as it puts too much stress on the body. People with underlying issues relating to glucose and insulin should discuss intermittent fasting with their doctor.And remember my 80-10-10 rule!  This helps avoid severe carb restrictions for an extended period of time.And worth repeating one more time, getting into ketosis is about a lot more than carb restriction! All of the other elements we address in my Keto-Green program help support a healthier you.

Final words on ketogenic diets, my Keto-Green program and thyroid health

It is somewhat surprising to me that there hasn’t been a lot more research on the topic of ketogenic diets and thyroid disease, but there really hasn’t been. However, I am following the future results of a new trial that will specifically look at carb restriction and the thyroid. I’ll update you to those findings when they are available.

In the meantime, how can you start to feel better todayThat information is covered in my new book, The Hormone Fix, along with many other supplements you can take to improve your health and weight. 


P.S. Want to know more about the benefits of a Keto-Green Diet?
Find the book that is the best fit for you - The Hormone Fix, Keto-Green 16 or MenuPause. It’s time to get back some of that youthful energy and brighten your outlook for a long, healthy life. Let’s tackle this together!
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Dr. Anna Cabeca

Dr. Anna Cabeca

Certified OB/GYN, Anti-Aging and Integrative Medicine expert and founder of The Girlfriend Doctor. During Dr. Anna’s health journey, she turned to research to create products to help thousands of women through menopause, hormones, and sexual health. She is the author of best-selling The Hormone Fix, and Keto-Green 16 and MenuPause.

Learn more about my scientific advisory board.