Women, Food, and Hormones - Summary by Alicia Jerome MS, RDN

Savannah Helm

Author, Dr. Sara Gottfried, a Harvard-trained OB-GYN, private practitioner, and associate professor has made the interaction of food and hormones in women, her research and her passion. Taking precision medicine and the ketogenic diet, she has developed a modified ketogenic diet that allows women to balance hormones and achieve weight loss.

Here’s the hard truth: most research studies and diet plans were created for and by men. It wasn’t until the 1990’s that a federal law was passed requiring any NIH funded study to include women. Up until then, most studies done on men were simply applied to women. But we know women are not merely smaller versions of men, due mainly to our complicated hormone system.

A woman’s needs and response to a diet are uniquely different from a man’s needs. Everything a woman eats can affect her hormones. Consider that men, on average, have 10x the amount of testosterone as women. That testosterone gifts men with the ability to respond more favorably to nutritional changes and improvements to weight and lean body mass.

This stark difference in how men and women are created has opened the door to precision, individualized medicine. That is, medicine that is highly specific to the person, and considers variability in genes, environment, lifestyle, and hormones.

Women go through many seasons of changing hormones: puberty, pregnancy, post-partum, perimenopause, and menopause in addition to the standard monthly fluctuations. The hormones that surge through a woman’s body can derail the best laid nutrition and exercise plans—even maintenance of weight can be challenging.

What can be done to achieve overall wellness? In addition to the standard sex hormones (estrogen, progesterone, and testosterone), women need to also consider insulin, human growth hormone, leptin, and cortisol, to name a few. Here are a few ways that hormones and food can interact in the woman’s body:

  • Testosterone, often saved for conversations about men, is also important for women. From ages 20 to 40 women’s testosterone levels can drop by 50% resulting in loss of lean body mass, fatigue, and loss of sex drive. The first and most important step to boost low testosterone levels is improve the diet. A higher intake of polyunsaturated fatty acids (PUFAs like nuts, flax seeds, and fish) increases concentrations of testosterone in women while a low-fat diet can disrupt many of the female sex hormones.
  • Conversely, high estrogen can be related to gut issues. Not getting enough fiber and lack of prebiotics can disrupt estrogen receptors. Having high estrogen can also interfere with achieving ketosis, an effective plan to manage female hormones and weight. On the other hand, a decline in estrogen can result in increased hunger, insulin resistance, increased fat storage (particularly in the belly), and leptin resistance. A high fiber diet, rich in greens (especially cruciferous), and total vegetables may be able to balance estrogen.
  • Another hormone of interest is human growth hormone. When a woman has low growth hormone she likely sees increases in visceral or abdominal fat. High levels of insulin can block the release of growth hormone. Quality protein, especially whey protein, and anaerobic exercise can increase growth hormone.
  • Leptin, the natural appetite-suppressant-hormone, can be thrown off kilter by a high carbohydrate diet. When the body begins to resist leptin, then hunger abounds and cannot be easily turned off.
  • Cortisol, the stress hormone, is meant to be released in the body during stressful times and then leave the body. Unfortunately, stressful lifestyles keep a steady drip of cortisol flowing into the body which promotes the accumulation of body fat, particularly in the abdomen area. Balanced protein intake can help regulate cortisol levels.

A low-fat diet and excess insulin can disrupt some hormones, while quality protein and selected PUFAs can benefit others. In this discovery, the ketogenic (keto) diet has emerged as conductor of sorts that can guide the hormones and help a woman achieve effective weight management. Nevertheless, some women do not respond positively to a keto diet, and it may negatively affect a woman’s hormones: raising cortisol levels and interfering with thyroid function. Estrogen levels can be disrupted on a keto diet that does not include enough fiber and vegetables – a condition coined the “lazy keto” diet. Assessment tools, case studies, and extensive discussion help educate readers about the nuances of the balance.

The interaction of all the hormones is a symphony. Dr. Gottfried’s methods have helped women understand how food and hormones can achieve harmony, reduce frustration, and work together toward female wellness. Discover more information for you or your patients in Women, Food, and Hormones.


Gottfried, S. (2021). Women, Food, and Hormones: A four-week plan to achieve hormonal balance, lose weight, and feel like yourself again. Houghton Mifflin Harcourt.



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