Weight Loss

Cracking the Code for Weight Loss After 40

By: Dr. Anna Cabeca, DO, OBGYN, FACOG
Cracking the Code for Weight Loss After 40

Average Read Time: 5 minutes

Q & A with Dr. Anna Cabeca

Author of The Hormone Fix: Burn Fat Naturally, Boost Energy, Sleep Better, and Stop Hot Flashes, the Keto-Green™ Way.

For women of a certain age, “The Change” is as inevitable as starting our periods during adolescence. When Dr. Anna Cabeca entered menopause at age 38, she was told there was no hope for her reproductive future and given very limited options for treatment. She decided to take her knowledge and expertise and search the world for better answers. It was this two-year journey that helped her not only conceive her youngest daughter naturally in her early forties, but which also helped her find the solution to the “emotional indignities” of uncontrollable weight-gain, hair loss, low libido, and more.

Her book, The Hormone Fix, is a culmination of 20+ years of work as a medical researcher and an OBGYN treating 10,000 patients in her clinic and helping millions of women online.

The cornerstone of the book is the Keto-Green™Diet, which is a traditional ketogenic diet combined with an alkaline diet. According to Dr. Cabeca, adding the alkaline component helps women over 40 be able to stay in ketosis longer than a traditional ketogenic diet alone. The book also focuses on lifestyle changes, which can lower cortisol and therefore help maintain alkalinity.

We recently interviewed Dr. Cabeca on Thyroid Refresh TV, and got into a juicy post-show discussion about whether her approach was right for thyroid patients, and decided this information was too fascinating not to share with you, especially since so many of us are struggling with stubborn excess weight, and seeking effective options. Here’s our deep-dive interview with Dr. Cabeca about her method of combining an alkaline diet with a ketogenic diet for successful weight loss, even with an underlying thyroid condition.


Let’s begin at the beginning. What is a ketogenic diet?


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, which can result in the dreaded belly fat. 

A lot of us eat too many carbs and produce too much insulin. This can be due to snacking on carbs, as well as eating 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 to use for fuel. It takes a few days, but eventually, your body will go into a metabolic state called ketosis, where it starts tapping into its fat stores 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.

In short, it puts your body into a fat-burning state. 


Is ketosis safe?


When you stay in ketosis too long—this especially becomes true for women—your body becomes acidic, creating chronic inflammation that forces your body to hold onto its fat stores. 

I’ve seen this play out numerous times among female patients: The very diet that supposedly helps you lose weight and get healthy actually makes you fat and sick! It’s a big topic, but I have a blog post that covers the benefits and potential drawbacks of a keto diet in-depth. 

Traditional ketogenic diets neglect alkalinity, which for women can especially become disastrous. When my patients and clients tried a traditional ketogenic approach, I found that many had negative side effects, like fatigue and nausea. My approach is different. 

Ketogenic proponents got it partly right by utilizing fat as fuel. So did alkaline-diet folks by recognizing how crucial staying alkaline becomes to stay lean and healthy. After years of combining research with empirical evidence from hundreds of patients, I combine a ketogenic diet with alkalinity, which allows your body to use fat for fuel while staying alkaline. I call this the Keto-Green™ WayCombine the two and bam! You’ve got a really powerful plan.


How does a traditional keto plate look different than a Keto-Green plate?


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 restricts the times when you eat as well. This can be done by either lengthening the time between dinner and breakfast or fasting on certain days. 

My Keto-Green approach 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 per day.

My program also contains the particular form of intermittent fasting that has been shown in multiple research studies to be safe and effective, as well as many lifestyle interventions that traditional ketogenic diets do not include. 

These differences make the diet more thyroid-friendly. 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.


Is the Keto-Green program something you would recommend to a woman with thyroid disease?


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

I cover this topic in-depth in my Thyroid Refresh article: Do Ketogenic Diets & Thyroid Patients Mix? 

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.

In my 5 seasons of “Magic Menopause” (a 7-week course based on my Keto-Green program), I’ve had great success with many participants having had pre-existing thyroid issues. Combining ketosis with an alkaline diet is a better solution for most women (especially those with an underlying condition like thyroid disease) than the standard ketogenic diet. 


How do we know if we’re in a state of ketosis and alkalinity?


Testing, not guessing, is key to successfully losing fat, stabilizing moods, and balancing your hormones; especially in menopause and over the age of 40. The process is simple: you urinate on a test strip that shows not only the presence of ketones, but the pH of your urine. It takes about 1 minute.

Fixed ketones are not normally found in the urine. They are byproducts of fat metabolism, so urine ketones are a good indicator that your body is in fat-burning mode.

PH is a measurement of our acid-alkaline balance. PH in blood is very stable, while pH in the urine can give us clues about our health.  The kidneys play an important role in maintaining the acidalkaline balance of the body. Therefore, any condition that produces acids or bases in the body such as the ingestion of acidic or basic foods, can directly affect urine pH. Stress, dehydration, and inflammation can also cause more acidic urine.

A more alkaline urine (pH of 7 or greater) has been associated with less inflammation, detoxification, calmer physiology, and hormone balance, as well as safer and more successful fat loss. Yes, there are limitations to urine testing but it is a great way to add accountability and clarity to the process.

In my book, I cover various hacks that can help you get and stay keto-alkaline. Going alkaline is something you should do before you go into ketosis, but if you have difficulty it could be due to a number of factors including toxicity, inflammation, high sugar, toxins, too little or much cortisol, or mineral insufficiencies. Some of these are easy to remedy; for others, a functional practitioner can pinpoint these and other underlying issues.



How critical is it to maintain this keto-alkaline state 100% of the time?


Real life happens, and to stay keto-alkaline completely is rare. Do your best but give yourself a little leeway. My approach assumes an 80-10-10 philosophy. For optimal results I like for women to stay Keto-Green about 80% of the time, fast about 10% of the time (we incorporate 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.

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. 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 our stress levels.

How does lifestyle factor in?


Great question! And this is really important. I don’t recommend that anyone just jumps into going keto without first building a solid lifestyle foundation. Without adjusting those factors, any ketogenic diet will in many cases not be successful for most women over 50, especially those with thyroid or other underlying inflammatory conditions and going through menopause. They 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.

Information on the “Keto-Green Lifestyle” comprises an entire section and nearly 80 pages of The Hormone Fix, so it’s difficult to pare down to a couple of paragraphs, but here’s what it includes:

  1. An alkaline diet and lifestyle – Achieving an alkaline pH is the 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. 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!
  2. 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.
  3. Removing environmental toxins – Not just from foods (no hormones, chemicals or GMOs), but also 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.
  4. Incorporating important lifestyle changes that directly support our two thyroid-impacting regulatory hormones, cortisol and insulin. – This includes stress management, sleep optimization, resolving adrenal dysfunction, and addressing gut dysfunction.

So many of these are critically important for thyroid patients especially and for anyone trying to optimize their health.


About the Author

Dr. Anna Cabeca, DO, OBGYN, FACOG, is an internationally-acclaimed menopause and sexual health expert, global speaker and pioneering promoter of women’s health. She is Emory University-trained and triple board-certified in gynecology and obstetrics, integrative medicine and anti-aging and regenerative medicine, and is the author of The Hormone Fix, a diet and holistic lifestyle program for menopausal women.