Women’s Day in South Africa is celebrated on the 9th of August and commemorates the 1956 march where over 20,000 women of diverse backgrounds marched to the Union Buildings in Pretoria to protest against the apartheid government’s pass laws, which restricted the movement of black South Africans. This historic event marked a significant moment in the struggle for women’s rights and equality in South Africa. Each year, Women’s Day serves not only to honour the bravery and determination of those who fought for justice and freedom but also to reflect on the ongoing challenges women face and to celebrate their contributions to society. It is a day to acknowledge the progress made, promote gender equality, and inspire future generations to continue the fight for women’s rights (1). 

At The Noakes Foundation, we are honoured to join in this celebration by highlighting our ongoing mixed method study funded by Fundación Ramón Areces and the Association of Spanish Scientists in Southern Africa (Asociación de Científicos Españoles en el Sur de África) that seeks to empower women living with hypothyroidism through the low carbohydrate high fat (LCHF) lifestyle (2). The study’s objectives are to evaluate the effects of carbohydrate restriction on various health parameters. These include assessing weight loss and maintenance, changes in insulin sensitivity and glucose metabolism, and alterations in lipid profiles (cholesterol, triglycerides, LDL, and HDL levels). Additionally, the study explores how carbohydrate restriction affects thyroid hormone levels and seeks to understand the behavioural factors that impact participants’ adherence to the LCHF diet. By examining participants’ experiences, the study aims to provide a comprehensive understanding of both the quantitative and qualitative impacts of this dietary intervention. 

Hypothyroidism, characterised by an underactive thyroid gland, affects many women worldwide. This condition leads to reduced production of thyroid hormones, resulting in symptoms such as weight gain, fatigue, and difficulty losing weight. For women, the prevalence of hypothyroidism is particularly high due to autoimmune disorders like Hashimoto’s thyroiditis, genetic factors, and hormonal fluctuations throughout life stages such as puberty, pregnancy, and menopause (3). Gender bias in hypothyroidism research significantly impacts the understanding and treatment of the condition. Evidence indicates that women have been underrepresented in clinical trials, leading to incomplete or skewed results that fail to fully address their needs (4). Studies have shown that hypothyroidism presents differently in women, with varying symptoms and disease severity influenced by hormonal changes, yet these differences are often overlooked (5). Hormonal fluctuations during menstruation, pregnancy, and menopause affect thyroid function and management, but these factors are frequently neglected in research (6). Additionally, women may respond differently to thyroid hormone replacement therapy compared to men, though this is not always adequately studied (7). Adopting a LCHF lifestyle may offer significant benefits for individuals with hypothyroidism, particularly in managing metabolic health and weight. Research suggests that LCHF diets can improve insulin sensitivity and help with weight management, which are critical considerations for those with hypothyroidism who often struggle with these issues (8). Studies have also indicated that carbohydrate restricted diets can lead to improvements in metabolic markers such as triglycerides, which are relevant for managing hypothyroidism-related metabolic disturbances (9). Additionally, a LCHF approach may alleviate some symptoms of hypothyroidism by stabilising energy levels and reducing fatigue (10). 

Study participants were asked to complete the Advisor Training within the first two weeks of the study and the Women’s Health Training by the end of the study provided by The Nutrition Network. This training offered a foundation in the LCHF lifestyle and its benefits for managing chronic conditions. Participants are currently engaging in bi-monthly group discussions, sharing experiences and coping strategies. Common issues shared by participants include fatigue, weight management challenges, and anxiety about hypothyroidism. Fatigue affected daily activities and exercise routines, while weight management was a struggle, worsened by previous restrictive diets. Anxiety about dietary changes was common, with some participants easing their stress by eliminating one food item at a time. Many participants expressed frustration with the lack of support from doctors, who often only prescribed medication without offering detailed information or lifestyle advice. As a result, participants conducted their own research to understand their condition better and explore dietary and stress management strategies. The group noted that while medication helped with fatigue, weight management became harder with age and menopause. They emphasised the importance of regular health checks and personalised diet plans or exploring strategies like intermittent fasting. Support from the group is valuable for motivation and safe sharing, despite some scepticism from social circles.

The journey towards better health through an LCHF lifestyle is a personal and often challenging one. However, the collective experiences and support within the group have been invaluable. The study aims to provide more than just scientific insights; it seeks to foster a community of empowered women who can take control of their health and inspire others to do the same. As we celebrate Women’s Day, we honour the courage and determination of these women, and many others like them. Their stories remind us of the importance of empathy, personalised care, and the power of a supportive community. At The Noakes Foundation, we remain committed to advancing research and providing resources that empower women to lead healthier, fuller lives. 

Happy Women’s Day to all the incredible women making a difference in our world. Your strength and resilience are truly inspiring!

References

1. South African History Online. (2020). 9 August 1956: Women’s march to Pretoria. Retrieved from https://www.sahistory.org.za/article/9-august-1956-womens-march-pretoria.
2. The Noakes Foundation. Empowering Women’s Health: A Study on Nutrition and Thyroid Function. Retrieved from https://thenoakesfoundation.org/empowering-womens-health-a-study-on-nutrition-and-thyroid-function/. 
3. Garber, J. R., et al. (2012). Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocrine Practice, 18(6), 988-1028. doi:10.4158/EP12280.GL.
4. Burek, C. L., Antonelli, A., & Aro, S. (2020). Gender Differences in Autoimmune Thyroid Disease: A Review of the Literature. Endocrine Reviews, 41(2), 133-154.
5. Gordon, D., McLeod, D. S. A., & Mulkern, R. V. (2022). Gender Differences in Thyroid Disease: New Insights and Implications for Management. Journal of Clinical Endocrinology & Metabolism, 107(6), 1780-1791. 
6. Latrofa, F., Bellini, M., & Biondi, B. (2019). Gender Differences in Thyroid Function and Autoimmunity. International Journal of Molecular Sciences, 20(4), 978. 
7. Chung, T., Yoo, S., & Youn, Y. H. (2021). Gender Differences in Response to Thyroid Hormone Replacement Therapy: A Systematic Review. Thyroid Research, 14(1), 45-53. 
8. Mingrone, G., Rubino, F., & Greco, A. (2016). Effect of a low-carbohydrate, ketogenic diet versus a low-fat diet on glycemic control in obese patients with type 2 diabetes: A randomized trial. JAMA, 316(14), 1560-1570. https://doi.org/10.1001/jama.2016.13963
9. Tarnopolsky, M. A. (2015). Effect of ketogenic diets on metabolic health: A review. Journal of Applied Physiology, 119(1), 34-41. https://doi.org/10.1152/japplphysiol.00772.2015
10. Johnston, B. C., Kanters, S., Bandayrel, K., & Vernooij, R. W. M. (2014). Comparison of weight loss among named diet programs in overweight and obese adults: A meta-analysis. JAMA, 312(9), 923-933. https://doi.org/10.1001/jama.2014.10397

About the author: 

Dr. Georgina Pujol-Busquets Guillén is a Tim & Marilyn Noakes Grant fellow researcher at The Noakes Foundation. She was a postdoctoral researcher at MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) at the University of the Witwatersrand. She holds a PhD in Physiology from the University of Cape Town and she has a background in Pharmacy (BSc from the University of Barcelona), Clinical Nutrition, Public Health (MSc from the Open University of Catalonia), and Global Health (ISGlobal Health). She is an associate professor of Mixed and Qualitative Methods and supervises MSc and PhD students at the Open University of Catalonia, Barcelona. She has been deeply involved in studying how low carbohydrate high fat diets can be adapted and sustained in low-income settings and especially for women who are disproportionately affected by metabolic diseases.