A Protocol for Balancing Hormones and Metabolism

Written by: the Editors of goop


Updated: October 14, 2021


Reviewed by: Dr. Sara Gottfried

A Protocol for Balancing Hormones and Metabolism

Photo courtesy of Chantal Anderson/The Licensing Project

Sara Gottfried

In her new book, Women, Food, and Hormones, physician Sara Gottfried shares a new modified ketogenic diet that she says is designed to help women balance their hormones. Her protocol has three pillars: detoxification, nutritional ketosis, and intermittent fasting.

  1. Mariner Books Women, Food, and Hormones Bookshop, $26
    Sara Gottfried, MD Women, Food, and Hormones Bookshop, $26

Q&A with Sara Gottfried, MD

What is the Gottfried Protocol?

After two failed attempts at trying to follow the classic ketogenic diet, I came up with the Gottfried Protocol, an approach that worked for me and can work for many women. It’s a modified ketogenic diet that starts with detoxification, which is missing in the classic ketogenic diet yet needed for most women to burn fat. And it includes more carbs, which support women’s hormonal balance. [Editor’s note: The classic ketogenic diet is generally a high-fat, moderate-protein, and low-carbohydrate diet.]

The three pillars of the protocol are detoxification, nutritional ketosis, and low-stress intermittent fasting. The sequence is important. The three pillars are followed for four weeks. Then you add back healthy carbohydrates in five-gram increments to define your carb threshold. It’s been successful in my medical practice for hundreds of women. More about each step:

Step 1: Detoxification. Detoxification clears your liver of toxins and eliminates recirculating hormones that are poorly affecting your metabolism. Clinically, we call this metabolic detoxification. For most of my female patients, their bodies are not detoxing well. So in this protocol, we integrate things that help, such as more polyphenols from plant-based foods, including oils; cruciferous vegetables, like broccoli, Brussels sprouts, cabbage, and cauliflower; and dark green leafy vegetables. And pooping daily is also important for the detoxing process.

Step 2: Nutritional ketosis. Your body enters nutritional ketosis when you follow a food plan that is high in fat, moderate in protein, and low in carbohydrates. I have adjusted the classic ketogenic diet by increasing the carbohydrates to make it more effective at restoring insulin levels in women. But with this diet, you’re still eating lots of plants and consuming tablespoons of extra virgin olive oil—occasionally medium-chain triglyceride oil—along with prebiotics and probiotics. We track net carbs and other macronutrients, calculate your ketogenic ratio, and if you’re up for it, measure your glucose-ketone ratio (more about this in the book).

Step 3: Intermittent fasting. What I love most about intermittent fasting is that it’s a back door to ketosis. This type of fasting means you don’t eat for twelve to twenty-four hours in a single day. Intermittent fasting improves the balance of many hormones (e.g., insulin, ghrelin, leptin, and cortisol) and leads to metabolic switching, which suppresses insulin and glucose to a level that triggers your body to switch from burning carbohydrates to burning fat. Fasting can help regulate inflammation, increase brain function, and lower blood pressure, and it may modulate leptin so that you feel more satisfied.

About the hormones:

  1. Insulin moves glucose into your cells.

  2. Leptin tells you when you’re full.

  3. Cortisol is the stress hormone that controls blood sugar levels and regulates metabolism and inflammation.

  4. Ghrelin, known as the hunger hormone, tells you when you’re hungry.

  5. Thyroid hormones regulate metabolism.

  6. Testosterone is involved in muscle growth and repair, sex drive, and mood.

  7. Growth hormone deficiency can contribute to anxiety, premature aging, fatigue, and belly fat accumulation.

Why do men and women tend to respond differently to a classic ketogenic diet?

We aren’t totally sure why women respond to a ketogenic diet differently than men do—the classic ketogenic diet has mostly been studied in men. But experts think that hormones play a primary role. With the classic ketogenic diet, some women don’t get the carbohydrates they need to promote normal hormonal regulation, particularly thyroid hormones. Or they become insulin-resistant from eating too much saturated fat, a problem I see commonly with specific genetic variations. They also can experience inflammation and mood crashes. And they can become frustrated, wondering why the diet isn’t making them feel or look great, even though they know men who thrive on it.

In terms of weight, it’s likely easier for men to lose weight because they have something known as the testosterone advantage. Their testosterone levels are typically significantly higher than those of women. And since testosterone is responsible for increasing muscle mass, men have more muscle and burn calories faster. When they use the ketogenic diet (which further raises testosterone, increases lean body mass, and decreases fat mass), men tend to lose weight much faster than women do.

Is it ever too late to balance your hormones?

Most hormones are modulated by food, detoxification, ketosis, and timing of meals. So if you are prepared to adjust these things, it’s never too late to bring your hormones into balance.

Sara Gottfried, MD, is a board-certified physician who graduated from Harvard and MIT. She practices evidence-based integrative, precision, and functional medicine. She is a clinical assistant professor in the Department of Integrative Medicine and Nutritional Sciences at Thomas Jefferson University and the director of precision medicine at the Marcus Institute of Integrative Health. Her New York Times–bestselling books include The Hormone Cure, The Hormone Reset Diet, and Younger. Her latest book is Women, Food, and Hormones.

This article is for informational purposes only. It is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. To the extent that this article features the advice of physicians or medical practitioners, the views expressed are the views of the cited expert and do not necessarily represent the views of goop.

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