The Amazing Science Behind Keto and Periods

Dieser Artikel basiert auf wissenschaftlichen Studien

Menstrual Cycle | Keto | Period | PMS | Best Foods | Worst Foods | Supplements | Conclusion | FAQ | Studies

Usually, changes in diet and weight can affect your hormone balance and menstrual cycle. Ketogenic diets affect your body differently depending on your current health status and lifestyle.

Intermittent Fasting 16/8 for Women Book

While keto critics claim that this diet generally messes with the menstrual cycle, many women experience no period changes.

Interestingly, studies suggest that ketogenic diets can help alleviate symptoms of premenstrual syndrome (PMS) rather than throwing your period entirely off track.

Here’s how the keto diet affects your period and which foods benefit your well-being during which phase of the cycle.

Keto and the Menstrual Cycle

To understand how keto affects your period, we must first take a detailed look at the phases of the female cycle.

Knowing how your hormone balance changes throughout the menstrual cycle is the first important step in being able to optimize your health.

A normal menstrual cycle can last anywhere from 26 to 35 days (Mihm et al. 20111).

Each menstrual cycle has two main phases: The follicular and luteal phases. In this context, ovulation initiates the turning point between these main phases.

This exemplary cycle spans the average duration of 28 days (Reed et al. 20182).

Follicular Phase (Day 1-13)

The follicular phase begins on the first day of your period and continues until ovulation. Again, this phase can be divided into two subphases: The menstrual and proliferation phases.

Menstrual Phase (Day 1-4)

At the beginning of this phase, levels of the hormones estrogenic and progesterone are low  (Reed et al. 20183).

Due to low progesterone levels, we shed the functional layer of the endometrium.

The menstrual phase may last 3-7 days.

Proliferation Phase (Day 5-13)

During the proliferation phase, follicle-stimulating hormone (FSH) is stimulated to mature the follicles in the ovaries that contain the eggs.

Estrogen levels increase and peak at ovulation  (Reed et al. 20184).

During this process, the influence of the sex hormone causes the uterine lining to build up.

Ovulation (Day 14)

The ovulation initiates the turn between the follicular and luteal phases.

Accordingly, it occurs around the middle of the cycle. Ovulation is characterized by a significant increase in FSH and luteinizing hormone (LH), while estrogen levels begin to drop briefly  (Reed et al. 20185).

For this reason, the egg is released from the ovaries. Therefore, ovulation is the right time for pregnancy.

However, if fertilization of the egg does not occur within 24 hours, the egg dies.

Luteal Phase (Day 15-28)

After ovulation, the luteal phase begins, characterized by decreased FSH and LH.

The corpus luteum develops from the follicle (shell of the egg). It produces the hormone progesterone under the influence of LH.

Therefore, during the luteal phase, progesterone levels begin to rise sharply. Estrogen levels also slowly increase again  (Reed et al. 20186).

If no fertilized egg has nested in the endometrium, the corpus luteum regresses, and the corpus luteum hormone progesterone decreases.

Also, estrogen falls again at the end of the luteal phase, stimulating the follicular phase and thus a new cycle.

tracking your period on keto

How Keto Affects Your Period

The Internet is teeming with stories about menstrual cycles being messed up during the first few months of the keto diet.

The most common complaints include irregular periods, heavier bleeding, menstrual cramps, and the loss of menstruation.

The fact that the keto diet can upset the female cycle and is therefore generally not suitable for women is usually argued with the help of an epilepsy study.

Two side effects were observed in adolescents between 12 and 19 years of age:

  • Weight loss
  • Menstrual irregularities

While weight loss was noted in the majority of the participants, irregular periods affected the minority of female subjects (Mady et al. 20037).

The medical keto diet used for the treatment of epilepsy differs from the typical ketogenic diet in that it is much more strict.

Moreover, people often overlook that epilepsy and its treatments are associated with menstrual disorders (Penovich 20008).

The fact that a clinical version of the keto diet affected the periods of teenagers undergoing treatment does not suggest that ketogenic diets are generally unsuitable for women of reproductive age.

In contrast, this study concludes with the following:

“The ketogenic diet is as well tolerated and efficacious for adolescents with epilepsy as for the general childhood population.”

Furthermore, again, the strict keto diet failed to affect the majority of subjects concerning their periods (Mady et al. 20039).

Instead, no human or animal study documented menstrual or reproductive problems due to a ketogenic diet in healthy individuals.

On the other hand, research can support that ketogenic diets and the associated healthy fats can improve reproductive health and alleviate PMS symptoms.

So does this mean that a keto diet doesn’t affect the female cycle at all?

No, a change in diet can affect hormone balance – both positively and negatively.

Does Keto Stop My Period?

Some factors of a dietary change can cause stress to the female body. Ultimately, the body of premenopausal women is susceptible.

At reproductive age, the body is concerned with ensuring a potential pregnancy and the fetus’s health.

If food becomes scarce, on the other hand, it shifts its focus from reproductive capacity to female survival (Fontana et al. 201610).

And it is not uncommon for women to combine a ketogenic diet with caloric restriction when they want to lose weight. Therefore, such a change is more challenging for a woman than for a man.

This way, the secretion of gonadotropin-releasing hormone (GnRH), which contributes to the production of two fertility hormones we have recently learned about, can be disrupted (Meczekalski et al. 20087):

  • Luteinizing Hormone (LH).
  • Follicle Stimulating Hormone (FSH)

When fertility hormones do not communicate appropriately with the ovaries, periods may not occur.

For this type of period impairment, three causes are known (Meczekalski et al. 201412):

  • Severe caloric restriction
  • Increased stress
  • Excessive exercise

These factors can affect the hypothalamus – your hormonal control center in the brain – and thus throw hormone balance out of whack.

Calorie restriction can stop your period on keto

Calorie Restriction

In addition to consciously reducing calories, many women also subconsciously eat less when they begin the keto diet.

A low-carbohydrate diet rich in healthy fats positively influences hunger and satiety hormones.

Thus, according to studies, ketogenic diets can inhibit the hunger hormone ghrelin and increase satiety via gut hormones (Deemer et al. 202013Essah et al. 200714).

Eating less while rapidly losing body fat can affect your period. The primary satiety hormone leptin correlates with your body fat (Austin et al. 200915).

When you lose body fat, your leptin levels also decrease. Leptin is responsible for signaling to the brain that the energy intake from food is sufficient.

If you severely restrict energy intake simultaneously, leptin levels will drop further, signaling a food shortage in the hypothalamus.

Excessive food restriction poses a threat to potential offspring, and the body shuts down reproductive capacity.

After the body preferentially conserves energy in the situation, the period may fail to occur. Researchers conclude that inadequate calorie intake is at the root of low leptin levels, which can stop the cycle (Miller et al. 199816).

In addition to leptin, fat cells also produce the female sex hormone estrogen. Therefore, the abrupt loss of body fat can lead to low estrogen levels (Ziomkiewicz et al. 200817).

If there is an imbalance between estrogen and progesterone, this can affect menses.

Weight loss is a good thing if it is achieved at a healthy pace. Hormone balance is a complex interaction. If you lose weight at an appropriate rate, it becomes balanced.

If you eat significantly too little or lose weight too quickly, the body gets into a stressful situation, and the hormones sound the alarm.

Stress

There is no question that stress affects the menstrual cycle.

The primary stress hormone, cortisol, affects hormone balance via the hypothalamus and impacts sleep, immune function, and gut health (Rafique et al. 201818).

Transitioning to a new diet can certainly be a source of stress. Finally, the body switches from sugar to fat as its primary energy source on the keto diet. The metabolic change can be stressful for women who previously ate a fundamentally different diet.

And in a stressful situation, the female body shifts its focus away from the reproductive system and toward functions essential for survival.

For this reason, many young women suffer from stress-related menstrual symptoms such as painful, irregular bleeding, worsened PMS, or missed periods (Rafique et al. 201819).

Like any change, the transition to a ketogenic diet can be stressful, but it also comes to an end. It usually takes the body three to six weeks to become fat-adapted.

Once your body gets used to fat as a primary energy source, your cycle will also return to normal on a ketogenic diet.

Therefore, during this metabolic transition, you should not overdo exercise so as not to put additional stress on your body.

Exercise

Sports are considered healthy stress for the body. However, you can also get too much of a good thing.

Study data show that the abrupt onset of high-volume endurance training can disrupt the menstrual cycle. Reproductive disorders have been found to occur, especially when excessive exercise is accompanied by a caloric deficit (Loucks 199020).

Like caloric restriction and stress in general, excessive exercise can also interfere with gonadotropin-releasing hormone (GnRH) secretion, preventing the fertility hormones LH and FSH from communicating correctly with the ovaries (Meczekalski et al. 200821Loucks 199022).

In short, you shouldn’t overdo it when starting the keto diet. Both too much exercise and too little food and other stressors of everyday life can affect your period.

Also, with keto, you don’t have to count calories or exercise daily to lose weight successfully. The diet aims to permanently balance insulin levels and thus achieve sustainable weight loss, as we will see shortly.

Excessive sport causes cycle disorders not only with low carb

How Keto Can Help With PMS

The hormonal transition between ovulation and the menstrual phase of the next cycle can affect mood, cognitive and physical health.

According to studies, 47.8% of women of reproductive age worldwide suffer from PMS, premenstrual syndrome (Direkvand-Moghadam et al. 201423).

At least 80-90% of all women experience some sign of PMS at some point (Fatemi et al. 201924).

Doesn’t the keto diet then affect physical and mental health?

Yes, however, the study data outweighs the evidence to support that keto can alleviate PMS symptoms rather than exacerbate them.

Therefore here are the top five science-backed tips on how keto can help you with PMS.

1. Curbs Cravings

Probably the most common PMS symptom is cravings. A high-fat diet has been shown to help manage these hunger pangs.

Eating fats inhibits the activity of neuropeptide Y in the brain, which reduces cravings (Beck 200625).

Therefore, fatty fish, such as salmon or mackerel, is an ideal appetite suppressant, as its omega-3 fatty acids further support satiety (Parra et al. 200826).

In addition, ketosis helps reduce the release of the primary hunger hormone ghrelin after successfully losing weight (Sumithran et al. 201327).

The keto diet also regulates blood glucose and subsequently insulin levels by limiting carbohydrate consumption. Ultimately, glucose is the principal stimulant of the fat-storage hormone.

For this reason, keto reduces cravings for sweets and allows you to burn fat and lose weight more effectively (Krebs et al. 201328).

2. Regulates Estrogen

Insulin is not only the crucial hormone for weight loss, but it is also instrumental in balancing sex hormones.

Excessive insulin levels make you fat and inhibit the production of sex hormone-binding globulin (SHBG) in the liver (Daka et al. 201329).

A significant role of SHBG is to bind estrogen in the blood, keeping it in balance.

By decreasing SHBG, there is not enough to bind estrogen in the blood, which can upset estrogen levels and thereby the menstrual cycle (Laurent et al. 201630).

For this reason, high-carbohydrate diets can trigger a domino effect and upset several hormones.

Moreover, balanced estrogen levels are also instrumental in cognitive thinking (Hara et al. 201531).

3. Promotes Stress Resistance

Many people report they improved mental clarity, mood, and lowered appetite in a state of ketosis because the brain can use ketones more efficiently than glucose (White et al. 201132)

In this regard, ketone bodies exert neuroprotective effects in the brain and improve memory function (LaManna et al. 201033Krikorian et al. 201334).

Accordingly, a ketogenic diet has been shown to promote stress resistance in the brain (Marosi et al. 201635).

keto promotes cognition during your period

4. Reduces Inflammation

Researchers in California have found that the following PMS symptoms are significantly related to increased levels of inflammation in the body (Gold et al. 201636):

  • Mood swings
  • Abdominal cramps
  • Back pain
  • Loss of appetite
  • Weight gain
  • Bloating
  • Chest pain

During ketosis, the liver converts fatty acids into ketones, which provide an alternative energy source to glucose (Evans et al. 201737).

These fatty energy bodies have antioxidant and anti-inflammatory properties that help repair those cellular damages caused by refined carbohydrates and industrial vegetable oils (Cannataro et al. 201938Kim et al. 201939).

For example, ketone beta-hydroxybutyrate (BHB) can relieve various menstrual cramps by blocking inflammatory responses in the body (Youm et al. 201540).

5. Improves Sleep

When hormone balance is out of whack, sleep quality usually suffers.

If you’ve ever struggled with sleep issues, you know that one night of poor sleep can ruin your entire next day.

Accordingly, recent studies state that the impact of sleep quality on mood is dramatically higher than the other way around (Triantafillou et al. 201941).

And many women suffering from PMS struggle with fatigue, insomnia, or even sleep addiction (Kwan et al. 201542).

Although the switch to a ketogenic diet may be difficult at first, it is associated with better sleep in the long run.

Numerous studies show that the keto diet promotes so-called slow-wave sleep – deep sleep that provides the most rest (O’Hearn 202143Afaghi et al. 200844).

Similarly, researchers found that children’s sleep and quality of life fed a ketogenic diet to fight epilepsy improved significantly (Hallböök et al. 200745).

Best Keto Foods During Your Period

Now that you know how it can affect menstruation, here are the best foods to optimize your diet throughout your cycle.

Follicular Phase

The first main phase of the cycle is divided into the menstrual and proliferation phases. Below, you will find the best foods to regulate these phases of the cycle naturally.

period tracker for keto
Menstrual Phase

The first days of the female cycle are characterized by menstruation. During this time, there is an additional need for the following micronutrients:

While magnesium has been shown to help with PMS symptoms such as cravings, depression, and anxiety (Fathizadeh et al. 201046), marine omega-3 fatty acids relieve period cramps more effectively than ibuprofen (Zafari et al. 201147).

Last but not least, iron is useful. Since women excrete an average of half a liter of iron per year during menstruation, they are correspondingly more likely to suffer from iron deficiency than men (Weinberg 201048).

The bottom line is a selection of foods that can supply all three micronutrients in excellent balance:

Proliferation Phase

During the second stage of the follicular phase, estrogen levels increase. And it is a sensitive issue.

In addition to the menstrual cycle, it regulates female curves, fat distribution, mood, and in some cases, even memory function (Delgado et al. 202149Shors et al. 200350).

Therefore, unbalanced estrogen levels can lead to depression, insomnia, or brain fog.

Accordingly, you should ensure that your estrogen levels remain balanced during the proliferation phase. Fortunately, one of the most effective ways to regulate estrogen levels is diet.

When it comes to healthy estrogen levels, one all-rounder combines all the positive effects: Cruciferous vegetables. These include, in particular:

  • Cauliflower
  • Broccoli
  • Kale
  • Cabbage
  • Brussels sprouts

These vegetables contain as many as three active compounds that can naturally regulate estrogen levels:

  • Indole-3-Carbinol (I3C): These plant compounds can help remove excess estrogen from the body. Studies even suggest that cruciferous vegetables may protect against hormone-dependent cancers such as breast cancer in women (Michnovicz et al. 199151).
  • Dietary fiber: Although cabbage vegetables are generally low in carbohydrates, they are rich in dietary fiber, which helps to lower estrogen levels while progesterone levels remain unaffected (Rose et al. 199152).
  • Phytoestrogens: Lignans in cruciferous vegetables may block estrogen action and increase SHBG, regulating estrogen levels. In addition, the antiestrogenic effects may help reduce the risk of hormone-related cancers, such as breast, uterine, or ovarian (Wang 200253).

Other good sources of these phytoestrogens are flaxseeds and berries.

Moreover, polyphenol-containing beverages such as green tea, red wine, and even coffee provide lignans beneficial during the proliferation phase.

Ovulation

While some women do not even notice their ovulation, others already experience PMS symptoms. These include, in particular, cravings, breast pain, or bloating during ovulation (Kwan et al. 201554).

Fortunately, these early PMS signs can also be alleviated with the right foods. In this regard, the following nutrients are crucial:

  • Proteins
  • Healthy fats
  • Vitamin B6

Whole foods with a large load of proteins and healthy fats are the first choice to stimulate the release of the satiety hormones cholecystokinin, peptide YY, GLP-1, or leptin (Perry et al. 201255).

Low leptin levels and high sugar and other carbohydrate consumption are usually the cause of PMS-related cravings (Krishnan et al. 201656).

If you experience PMS symptoms around ovulation, which may be due to water retention, vitamin B6 is that micronutrient that can help you (Fathizadeh et al. 201057).

In addition to bloating and abdominal discomfort, vitamin B6 can help with breast pain and tenderness (Shobeiri et al. 201558).

In summary, a few foods again stand out as being able to both fight cravings and maximize vitamin B6 intake:

  • Salmon (*)
  • Eggs (*)
  • Chicken liver (*)
  • Beef (*)
  • Pistachios (*)

Besides the numerous animal foods, pistachios are an excellent vegan option for early PMS symptoms. On the one hand, they are rich in healthy fats and proteins, and on the other hand, just one cup of pistachios can provide the entire daily requirement of vitamin B6 (*).

fish and beef are great foods during your period

Luteal Phase

Cramps, mood swings, depression, insomnia, or headaches are more common during the luteal phase.

You can prevent the full range of PMS symptoms by additionally incorporating the following foods:

  • Magnesium
  • Anti-inflammatory foods

Researchers found elevated inflammatory markers in 20 women who suffered from premenstrual syndrome, particularly in the luteal phase (Koshikawa et al. 199259).

Moreover, other studies show that women struggling with PMS symptoms often have low magnesium levels (Facchinetti et al 199160).

For this reason, some women may crave chocolate (cocoa) before the menstrual phase. These cravings are often less about satisfying a sweet tooth than about the mood-regulating effect of magnesium.

Research shows that women who take magnesium and vitamin B6 experience less premenstrual depression, anxiety, and cravings (Fathizadeh et al. 201061).

Because they contain magnesium, protein, healthy fats, and other anti-inflammatory nutrients, the following foods are ideal companions to combat cravings and all PMS symptoms during the luteal phase:

  • Mussels (*)
  • Halibut (*)
  • Salmon (*)
  • Cocoa nibs (*)
  • Almonds (*)
  • Pistachios (*)
  • Walnuts (*)

Seafood is at the top of this list for a reason. Its omega-3 fatty acids are not only anti-inflammatory but also more effective against period cramps than common medications (Zafari et al. 201162).

While nuts have fewer anti-inflammatory properties than fatty fish, they impress with magnesium, vitamin B6, and E, which have been shown to combat PMS symptoms (Fathizadeh et al. 201063Shobeiri et al. 201564).

Furthermore, raw cacao nibs have a standout mix of magnesium, potassium, iron, vitamin B6, fiber, healthy fats, and protein (*).

However, it would help if you didn’t reach for conventional chocolate. Most chocolates below 90% cocoa have surprising amounts of refined sugar.

For example, chocolate with 72% cocoa consists of 26% sugar (*), which you should avoid if you experience PMS.

Foods to Avoid During Period Cramps

Since period problems go hand in hand with inflammation, it is essential to avoid pro-inflammatory foods (Gold et al. 201665).

And sugar is one of the most pro-inflammatory foods out there. If you suffer from PMS symptoms, avoiding sugar from ovulation to the menstrual phase can make a difference.

Researchers have found that the fructose in sugar increases the hunger hormone ghrelin, promoting cravings (Teff et al. 200466).

Furthermore, research has shown that consumption of sugary drinks is closely related to PMS symptoms (Rossignol et al. 199167).

However, foods and beverages sweetened with sugar and other refined carbohydrates promote inflammation in the body (Buyken et al. 201468).

Refinement means that foods have been separated from natural fiber, widely processed, and preserved.

Accordingly, here is a summary of these pro-inflammatory foods:

  • Bread
  • Pasta
  • Crackers
  • Tortillas
  • Cookies
  • Cakes
  • Pretzels
  • Juices
  • Sodas (coke etc.)
  • Sports drinks
  • Energy drinks
  • Sweetened tea and coffee beverages
bakery goods are among the worst food during menstruation

In addition, industrial seed oils are highly inflammatory (Marchix et al. 201569).

Therefore, for a healthy menstrual cycle, it is vital to avoid the following oils, fried foods, and especially hydrogenated trans fats such as margarine:

  • Safflower oil
  • Peanut oil
  • Corn oil
  • Canola oil
  • Cottonseed oil
  • Soybean oil
  • Sunflower oil
  • Sesame oil
  • Grapeseed oil
  • Partially hydrogenated oils

Last but not least, alcohol cannot be utterly unmentioned among the worst foods for a healthy period. It distracts the liver from other metabolic or detoxification tasks, such as eliminating excess estrogen, which serves hormonal balance.

Best Supplements To Help With Painful Periods

If you’ve been reading my blog for a while, you know I’m not a big fan of supplements – they mostly have sugar and various sweeteners mixed in, and the bioavailability is often questionable.

Hence, you should prefer natural foods from fatty fish to cruciferous vegetables to nuts during your menstrual cycle.

If you still want to turn to supplements due to painful periods, here are the best options on the current market (affiliate links):

Your body can absorb the anti-inflammatory omega-3 fatty acids EPA and DHA even better from krill oil than from fish oil (Ulven et al. 201170). And according to studies, regular fish oil already combats period cramps better than ibuprofen (Zafari et al. 201171).

On top of that, krill oil can help build muscle.

The combination of magnesium and vitamin B6 has been shown to be an all-around supplement for PMS symptoms (Fathizadeh et al. 201072).

In addition to B6, vitamin E supplementation has also been shown to counteract breast pain, one of the first occurring PMS symptoms (Shobeiri et al. 201573).

In the women’s supplement listed above, the two vitamins are complemented by other vitamins and minerals, which could be beneficial during menstruation.

Keto Alone Does Not Mess With Your Period

Changes in diet do affect hormone balance. Still, it’s not specifics of the keto diet that may affect your period.

It is general factors such as caloric restriction, rapid weight loss, excessive exercise, and stress that have been shown to disrupt the menstrual cycle (Meczekalski et al. 200874).

With this in mind, it is not uncommon for women to reach a vast caloric deficit or exercise too excessively when starting keto. These stressful situations can trigger a cascade of hormonal fluctuations that ultimately affect the release of fertility hormones.

As a result, periods can be irregular or missed (Meczekalski et al. 201475).

Although the switch to a ketogenic diet may affect the menstrual cycle, most women will find that it returns to normal after three to six weeks.

The keto diet reduces period problems in the long run because the best PMS foods have one thing in common: they are high in healthy fats and low in carbohydrates.

While ketogenic diets reduce cravings, inflammation, and other PMS symptoms, refined carbohydrates fuel these complaints (Teff et al. 200476Rossignol et al. 199177Buyken et al. 201478).

To learn precisely how to take your health to an all-new level without upsetting your menstrual cycle, I highly recommend reading my book: Intermittent Fasting 16/8 for Women: Achieve Hormone Harmony to Lose Weight Fast Without Losing Your Mind – Incl. 30-Day Fasting Challenge and Meal Plan.

How Keto Affects Your Period FAQ

Does Keto affect periods?

Not keto per se, but rapid weight loss and calorie restriction may affect periods.

Can keto make your period heavier?

If you rapidly lose weight, severely restrict calories or exercise excessively on keto, your period may become irregular, heavier, or lighter.

Does keto mess with menstrual cycle?

Not keto specifically, but any diet changes involving calorie restriction, rapid weight loss, and excessive exercise can mess with your menstrual cycle.

Is PMS worse on keto?

Since it is anti-inflammatory and helps curb cravings, keto helps fight PMS.

Studies click to expand!

#1-7

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24Fatemi M, Allahdadian M, Bahadorani M. Comparison of serum level of some trace elements and vitamin D between patients with premenstrual syndrome and normal controls: A cross-sectional study. Int J Reprod Biomed. 2019 Sep;17(9):647-652. doi: 10.18502/ijrm.v17i9.5100. eCollection 2019 Sep. PubMed PMID: 31646259; PubMed Central PMCID: PMC6804325.

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28Krebs JD, Bell D, Hall R, Parry-Strong A, Docherty PD, Clarke K, Chase JG. Improvements in glucose metabolism and insulin sensitivity with a low-carbohydrate diet in obese patients with type 2 diabetes. J Am Coll Nutr. 2013;32(1):11-7. doi: 10.1080/07315724.2013.767630. PubMed PMID: 24015695.

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30Laurent MR, Hammond GL, Blokland M, Jardí F, Antonio L, Dubois V, Khalil R, Sterk SS, Gielen E, Decallonne B, Carmeliet G, Kaufman JM, Fiers T, Huhtaniemi IT, Vanderschueren D, Claessens F. Sex hormone-binding globulin regulation of androgen bioactivity in vivo: validation of the free hormone hypothesis. Sci Rep. 2016 Oct 17;6:35539. doi: 10.1038/srep35539. PubMed PMID: 27748448; PubMed Central PMCID: PMC5066276.

31Hara Y, Waters EM, McEwen BS, Morrison JH. Estrogen Effects on Cognitive and Synaptic Health Over the Lifecourse. Physiol Rev. 2015 Jul;95(3):785-807. doi: 10.1152/physrev.00036.2014. Review. PubMed PMID: 26109339; PubMed Central PMCID: PMC4491541.

32White H, Venkatesh B. Clinical review: ketones and brain injury. Crit Care. 2011 Apr 6;15(2):219. doi: 10.1186/cc10020. Review. PubMed PMID: 21489321; PubMed Central PMCID: PMC3219306.

33LaManna JC, Salem N, Puchowicz M, Erokwu B, Koppaka S, Flask C, Lee Z. Ketones suppress brain glucose consumption. Adv Exp Med Biol. 2009;645:301-6. doi: 10.1007/978-0-387-85998-9_45. PubMed PMID: 19227486; PubMed Central PMCID: PMC2874681.

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35Marosi K, Kim SW, Moehl K, Scheibye-Knudsen M, Cheng A, Cutler R, Camandola S, Mattson MP. 3-Hydroxybutyrate regulates energy metabolism and induces BDNF expression in cerebral cortical neurons. J Neurochem. 2016 Dec;139(5):769-781. doi: 10.1111/jnc.13868. Epub 2016 Nov 14. PubMed PMID: 27739595; PubMed Central PMCID: PMC5123937.

36Gold EB, Wells C, Rasor MO. The Association of Inflammation with Premenstrual Symptoms. J Womens Health (Larchmt). 2016 Sep;25(9):865-74. doi: 10.1089/jwh.2015.5529. Epub 2016 May 2. PubMed PMID: 27135720; PubMed Central PMCID: PMC5311461.

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37Evans M, Cogan KE, Egan B. Metabolism of ketone bodies during exercise and training: physiological basis for exogenous supplementation. J Physiol. 2017 May 1;595(9):2857-2871. doi: 10.1113/JP273185. Epub 2016 Dec 7. Review. PubMed PMID: 27861911; PubMed Central PMCID: PMC5407977.

38Cannataro R, Caroleo MC, Fazio A, La Torre C, Plastina P, Gallelli L, Lauria G, Cione E. Ketogenic Diet and microRNAs Linked to Antioxidant Biochemical Homeostasis. Antioxidants (Basel). 2019 Aug 2;8(8). doi: 10.3390/antiox8080269. PubMed PMID: 31382449; PubMed Central PMCID: PMC6719224.

39Kim DH, Park MH, Ha S, Bang EJ, Lee Y, Lee AK, Lee J, Yu BP, Chung HY. Anti-inflammatory action of β-hydroxybutyrate via modulation of PGC-1α and FoxO1, mimicking calorie restriction. Aging (Albany NY). 2019 Feb 27;11(4):1283-1304. doi: 10.18632/aging.101838. PubMed PMID: 30811347; PubMed Central PMCID: PMC6402511.

40Youm YH, Nguyen KY, Grant RW, Goldberg EL, Bodogai M, Kim D, D’Agostino D, Planavsky N, Lupfer C, Kanneganti TD, Kang S, Horvath TL, Fahmy TM, Crawford PA, Biragyn A, Alnemri E, Dixit VD. The ketone metabolite β-hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease. Nat Med. 2015 Mar;21(3):263-9. doi: 10.1038/nm.3804. Epub 2015 Feb 16. PubMed PMID: 25686106; PubMed Central PMCID: PMC4352123.

41Triantafillou S, Saeb S, Lattie EG, Mohr DC, Kording KP. Relationship Between Sleep Quality and Mood: Ecological Momentary Assessment Study. JMIR Ment Health. 2019 Mar 27;6(3):e12613. doi: 10.2196/12613. PubMed PMID: 30916663; PubMed Central PMCID: PMC6456824.

42Kwan I, Onwude JL. Premenstrual syndrome. BMJ Clin Evid. 2015 Aug 25;2015. Review. PubMed PMID: 26303988; PubMed Central PMCID: PMC4548199.

43O’Hearn LA. The therapeutic properties of ketogenic diets, slow-wave sleep, and circadian synchrony. Curr Opin Endocrinol Diabetes Obes. 2021 Oct 1;28(5):503-508. doi: 10.1097/MED.0000000000000660. Review. PubMed PMID: 34269711.

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45Hallböök T, Lundgren J, Rosén I. Ketogenic diet improves sleep quality in children with therapy-resistant epilepsy. Epilepsia. 2007 Jan;48(1):59-65. doi: 10.1111/j.1528-1167.2006.00834.x. PubMed PMID: 17241208.

46Fathizadeh N, Ebrahimi E, Valiani M, Tavakoli N, Yar MH. Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome. Iran J Nurs Midwifery Res. 2010 Dec;15(Suppl 1):401-5. PubMed PMID: 22069417; PubMed Central PMCID: PMC3208934.

47Zafari M, Behmanesh F, Agha Mohammadi A. Comparison of the effect of fish oil and ibuprofen on treatment of severe pain in primary dysmenorrhea. Caspian J Intern Med. 2011 Summer;2(3):279-82. PubMed PMID: 24049587; PubMed Central PMCID: PMC3770499.

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49Delgado BJ, Lopez-Ojeda W. Estrogen. 2022 Jan;. PubMed PMID: 30855848.

50Shors TJ, Leuner B. Estrogen-mediated effects on depression and memory formation in females. J Affect Disord. 2003 Mar;74(1):85-96. doi: 10.1016/s0165-0327(02)00428-7. PubMed PMID: 12646301; PubMed Central PMCID: PMC3374589.

51Michnovicz JJ, Bradlow HL. Altered estrogen metabolism and excretion in humans following consumption of indole-3-carbinol. Nutr Cancer. 1991;16(1):59-66. doi: 10.1080/01635589109514141. PubMed PMID: 1656396.

52Rose DP, Goldman M, Connolly JM, Strong LE. High-fiber diet reduces serum estrogen concentrations in premenopausal women. Am J Clin Nutr. 1991 Sep;54(3):520-5. doi: 10.1093/ajcn/54.3.520. PubMed PMID: 1652197.

53Wang LQ. Mammalian phytoestrogens: enterodiol and enterolactone. J Chromatogr B Analyt Technol Biomed Life Sci. 2002 Sep 25;777(1-2):289-309. doi: 10.1016/s1570-0232(02)00281-7. Review. PubMed PMID: 12270221.

54Kwan I, Onwude JL. Premenstrual syndrome. BMJ Clin Evid. 2015 Aug 25;2015. Review. PubMed PMID: 26303988; PubMed Central PMCID: PMC4548199.

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55Perry B, Wang Y. Appetite regulation and weight control: the role of gut hormones. Nutr Diabetes. 2012 Jan 16;2:e26. doi: 10.1038/nutd.2011.21. PubMed PMID: 23154682; PubMed Central PMCID: PMC3302146.

56Krishnan S, Tryon RR, Horn WF, Welch L, Keim NL. Estradiol, SHBG and leptin interplay with food craving and intake across the menstrual cycle. Physiol Behav. 2016 Oct 15;165:304-12. doi: 10.1016/j.physbeh.2016.08.010. Epub 2016 Aug 12. PubMed PMID: 27527001.

57Fathizadeh N, Ebrahimi E, Valiani M, Tavakoli N, Yar MH. Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome. Iran J Nurs Midwifery Res. 2010 Dec;15(Suppl 1):401-5. PubMed PMID: 22069417; PubMed Central PMCID: PMC3208934.

58Shobeiri F, Oshvandi K, Nazari M. Clinical effectiveness of vitamin E and vitamin B6 for improving pain severity in cyclic mastalgia. Iran J Nurs Midwifery Res. 2015 Nov-Dec;20(6):723-7. doi: 10.4103/1735-9066.170003. PubMed PMID: 26793260; PubMed Central PMCID: PMC4700694.

59Koshikawa N, Tatsunuma T, Furuya K, Seki K. Prostaglandins and premenstrual syndrome. Prostaglandins Leukot Essent Fatty Acids. 1992 Jan;45(1):33-6. doi: 10.1016/0952-3278(92)90099-5. PubMed PMID: 1546064.

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60Facchinetti F, Borella P, Sances G, Fioroni L, Nappi RE, Genazzani AR. Oral magnesium successfully relieves premenstrual mood changes. Obstet Gynecol. 1991 Aug;78(2):177-81. PubMed PMID: 2067759.

61Fathizadeh N, Ebrahimi E, Valiani M, Tavakoli N, Yar MH. Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome. Iran J Nurs Midwifery Res. 2010 Dec;15(Suppl 1):401-5. PubMed PMID: 22069417; PubMed Central PMCID: PMC3208934.

62Zafari M, Behmanesh F, Agha Mohammadi A. Comparison of the effect of fish oil and ibuprofen on treatment of severe pain in primary dysmenorrhea. Caspian J Intern Med. 2011 Summer;2(3):279-82. PubMed PMID: 24049587; PubMed Central PMCID: PMC3770499.

63Fathizadeh N, Ebrahimi E, Valiani M, Tavakoli N, Yar MH. Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome. Iran J Nurs Midwifery Res. 2010 Dec;15(Suppl 1):401-5. PubMed PMID: 22069417; PubMed Central PMCID: PMC3208934.

64Shobeiri F, Oshvandi K, Nazari M. Clinical effectiveness of vitamin E and vitamin B6 for improving pain severity in cyclic mastalgia. Iran J Nurs Midwifery Res. 2015 Nov-Dec;20(6):723-7. doi: 10.4103/1735-9066.170003. PubMed PMID: 26793260; PubMed Central PMCID: PMC4700694.

65Gold EB, Wells C, Rasor MO. The Association of Inflammation with Premenstrual Symptoms. J Womens Health (Larchmt). 2016 Sep;25(9):865-74. doi: 10.1089/jwh.2015.5529. Epub 2016 May 2. PubMed PMID: 27135720; PubMed Central PMCID: PMC5311461.

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66Teff KL, Elliott SS, Tschöp M, Kieffer TJ, Rader D, Heiman M, Townsend RR, Keim NL, D’Alessio D, Havel PJ. Dietary fructose reduces circulating insulin and leptin, attenuates postprandial suppression of ghrelin, and increases triglycerides in women. J Clin Endocrinol Metab. 2004 Jun;89(6):2963-72. doi: 10.1210/jc.2003-031855. PubMed PMID: 15181085.

67Rossignol AM, Bonnlander H. Prevalence and severity of the premenstrual syndrome. Effects of foods and beverages that are sweet or high in sugar content. J Reprod Med. 1991 Feb;36(2):131-6. PubMed PMID: 2010896.

68Buyken AE, Goletzke J, Joslowski G, Felbick A, Cheng G, Herder C, Brand-Miller JC. Association between carbohydrate quality and inflammatory markers: systematic review of observational and interventional studies. Am J Clin Nutr. 2014 Apr;99(4):813-33. doi: 10.3945/ajcn.113.074252. Epub 2014 Feb 19. Review. PubMed PMID: 24552752.

69Marchix J, Choque B, Kouba M, Fautrel A, Catheline D, Legrand P. Excessive dietary linoleic acid induces proinflammatory markers in rats. J Nutr Biochem. 2015 Dec;26(12):1434-41. doi: 10.1016/j.jnutbio.2015.07.010. Epub 2015 Jul 30. PubMed PMID: 26337666.

70Ulven SM, Kirkhus B, Lamglait A, Basu S, Elind E, Haider T, Berge K, Vik H, Pedersen JI. Metabolic effects of krill oil are essentially similar to those of fish oil but at lower dose of EPA and DHA, in healthy volunteers. Lipids. 2011 Jan;46(1):37-46. doi: 10.1007/s11745-010-3490-4. Epub 2010 Nov 2. PubMed PMID: 21042875; PubMed Central PMCID: PMC3024511.

71Zafari M, Behmanesh F, Agha Mohammadi A. Comparison of the effect of fish oil and ibuprofen on treatment of severe pain in primary dysmenorrhea. Caspian J Intern Med. 2011 Summer;2(3):279-82. PubMed PMID: 24049587; PubMed Central PMCID: PMC3770499.

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72Fathizadeh N, Ebrahimi E, Valiani M, Tavakoli N, Yar MH. Evaluating the effect of magnesium and magnesium plus vitamin B6 supplement on the severity of premenstrual syndrome. Iran J Nurs Midwifery Res. 2010 Dec;15(Suppl 1):401-5. PubMed PMID: 22069417; PubMed Central PMCID: PMC3208934.

73Shobeiri F, Oshvandi K, Nazari M. Clinical effectiveness of vitamin E and vitamin B6 for improving pain severity in cyclic mastalgia. Iran J Nurs Midwifery Res. 2015 Nov-Dec;20(6):723-7. doi: 10.4103/1735-9066.170003. PubMed PMID: 26793260; PubMed Central PMCID: PMC4700694.

74Meczekalski B, Podfigurna-Stopa A, Warenik-Szymankiewicz A, Genazzani AR. Functional hypothalamic amenorrhea: current view on neuroendocrine aberrations. Gynecol Endocrinol. 2008 Jan;24(1):4-11. doi: 10.1080/09513590701807381. Review. PubMed PMID: 18224538.

75Meczekalski B, Katulski K, Czyzyk A, Podfigurna-Stopa A, Maciejewska-Jeske M. Functional hypothalamic amenorrhea and its influence on women’s health. J Endocrinol Invest. 2014 Nov;37(11):1049-56. doi: 10.1007/s40618-014-0169-3. Epub 2014 Sep 9. Review. PubMed PMID: 25201001; PubMed Central PMCID: PMC4207953.

76Teff KL, Elliott SS, Tschöp M, Kieffer TJ, Rader D, Heiman M, Townsend RR, Keim NL, D’Alessio D, Havel PJ. Dietary fructose reduces circulating insulin and leptin, attenuates postprandial suppression of ghrelin, and increases triglycerides in women. J Clin Endocrinol Metab. 2004 Jun;89(6):2963-72. doi: 10.1210/jc.2003-031855. PubMed PMID: 15181085.

77Rossignol AM, Bonnlander H. Prevalence and severity of the premenstrual syndrome. Effects of foods and beverages that are sweet or high in sugar content. J Reprod Med. 1991 Feb;36(2):131-6. PubMed PMID: 2010896.

78Buyken AE, Goletzke J, Joslowski G, Felbick A, Cheng G, Herder C, Brand-Miller JC. Association between carbohydrate quality and inflammatory markers: systematic review of observational and interventional studies. Am J Clin Nutr. 2014 Apr;99(4):813-33. doi: 10.3945/ajcn.113.074252. Epub 2014 Feb 19. Review. PubMed PMID: 24552752.

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