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Is it harder to be in ketosis during menstruation?

Is it harder to be in ketosis during menstruation? What’s Dr. Fox’s advice for menopausal women who struggle with their weight? And should you eat according to your blood type?

Get the answers to these questions in this week’s Q&A with fertility specialist Dr. Fox:

Is it harder to be in ketosis during menstruation?

Dear Dr. Fox,

Is it my imagination, or is it very challenging (if not impossible) to stay in ketosis while menstruating? Although I eat approximately the same, I go from being in deep ketosis, to not at all, or producing very low ketones.

Thank you,

Dr. Fox:

Great question.

The luteal phase of the cycle is characterized by high progesterone levels. Progesterone is a great hormone for pregnancy establishment, but not so great for metabolism. It makes you more insulin resistant, therefore less metabolically stable. This process along with the lowest estrogen levels seen in the entire menstrual cycle on cycle days -3 to +3 will push you the farthest from your goal.

Just stay the course and don’t worry about the ketosis piece. The nutritional approach is the only thing you can do. I would suggest once you document and understand your ketosis to stop monitoring because it simply adds stress that also works against you. Best of luck.


Weight-loss advice for menopausal women with health issues?

I am a 51-year old woman who is going through the harsh realities of the menopause. I also have PCOS (I was unable to conceive). Plus I also have the added problems of hypothyroidism, type 2 diabetes, and insulin resistance.

Could the combination of these problems be preventing me from losing weight on keto? I have been rigidly sticking to a clean keto diet for 7 weeks during which time I have lost 5 lbs (2 kg), this occurred in the first week. It is disheartening when I see others losing 28 plus pounds (13 kg) in the same time frame.

Can you offer me any advice or hope?


Dr. Fox:

Sorry for menopause, it is cruel and unusual punishment for women. It is clear that estrogen deficiency significantly increases insulin resistance and can make weight loss very difficult. Sleep apnea is also common and should be screened for as it will significantly impair you efforts. Stay on course because even without weight loss, you are still much much healthier doing what you are doing now. I would suggest finding a doctor well versed in hormone replacement and explore this option. Best of luck.

Top 10 tips to lose weight on low carb or keto for women 40+

GuideAre you a woman over 40 whose weight loss has stalled in spite of eating low carb or keto? Don’t fret! Here are our best tips for losing weight as a female over 40.


Should you eat according to your blood type?


Both my wife and I have adopted the keto diet. I find it is very good for me as my energy levels have improved and I’m losing weight. My wife is losing weight but doesn’t need to. She’s also finding that she’s constipated and no remedy suggested has helped.

Recently, I read that not all types of diets are suitable for everyone and that different blood types should adopt different diets. My wife has a different blood type than I do. Could you please let me know what your thoughts are on this topic.


Dr. Fox:

I don’t know of any science that supports this idea. Everyone is different genetically in a thousand different ways, not just blood type.

To address your comments: if she is getting adequate calories, 2,200+ per day and losing weight, her system is adjusting to its norm. She should probably avoid intermittent fasting. If constipated, really look at protein intake with normals being 1.2–1.7 grams per kilogram of ideal body weight. Increases can cause constipation. A good way for her to get more calories is for her to increase her fat. I tell patients in this situation two slices of butter 3 times per day and it nearly always works.

Good luck!


More questions and answers

Questions and answers about low carb

Read all earlier questions and answers to Dr. Fox – and ask your own! – here:

Ask Dr. Fox about nutrition, low carb and fertility – for members (free trial available)
Videos with Dr. FoxStressing less to get pregnant10:57Stress is a common cause of infertility. But how can you avoid it? Dr. Michael Fox answers.What to eat to get pregnant13:06Can you increase your chances of becoming pregnant by avoiding eating too many carbohydrates? Dr. Fox about food and fertility.Eat LCHF, get pregnant27:22Can you increase your chances of becoming pregnant by avoiding eating too many carbohydrates? Interview with Dr. Michael Fox.Women, hormones and nutrition47:53Presentation by physician and fertility expert Dr. Michael Fox on nutrition as a treatment for infertility, PCOS and menopause.The cure for morning sickness09:57What’s the key to avoiding morning sickness during pregnancy? Fertility-expert Dr. Michael Fox answers.Is coffee bad for you?07:08Can coffee be bad for you? The low-carb friendly fertility specialist Dr. Michael Fox has some pretty controversial ideas on the subject.Exercise less and get pregnant13:35What many people believe is healthful – to run more and eat less – may do more harm than good. Interview with Dr. Michael Fox.
Q&ADoes the brain need carbohydrates?05:56Doesn’t the brain need carbohydrates? Doctors answer common questions.Is low carb bad for exercise?02:45Can you exercise on a low-carb diet? Top low-carb doctors answer this question.Everything in moderation?05:44What’s the point of low carb, shouldn’t we all just try to eat everything in moderation? Top low-carb doctors answer this question.Is low carb bad for the kidneys?04:25Can a low-carb diet potentially be bad for the kidneys? Or is it just a myth, like most other low-carb fears?Is low carb an extreme diet?06:20Is low carb really an extreme diet? Top low-carb doctors answer this question.Are there potential dangers with a low-carb diet?09:30Can a low-carb diet potentially be dangerous? And if so – how? Top low-carb doctors answer these questions.Women’s questions introduction01:36In this video series, you can find expert views on some of your top questions about low-carb and women’s health.Is low carb bad for the environment?07:09Won’t low carb contribute to global warming and pollution? Top low-carb doctors answer this question.What is the main benefit of low carb?02:52What exactly is the greatest benefit of low carb? Doctors give their top answer.Why is low carb important to you?04:16Why is low carb important to Dr. Rangan Chatterjee and Dr. Sarah Hallberg?Can you get depressed on low carb?02:42Can you get depressed on a low-carb diet? Top low-carb doctors answer this question.Is low carb bad for gut bacteria?02:14Can a low-carb diet be potentially harmful to your gut microbiome?

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Are all diets the same for weight loss and cardiac risk?

A brand-new research study released in The BMJ declares that there is little if any significant distinction in between different diet plans for weight reduction and high blood pressure decrease at 6 or 12 months, and for that reason you need to just select the diet plan you like much better. Can we rely on the information?

The BMJ: Comparison of dietary macronutrient patterns of 14 popular called dietary programs for weight and cardiovascular danger aspect decrease in grownups: methodical evaluation and network meta-analysis of randomised trials

The research study is a meta-analysis of 121 randomized regulated trials including 22,000 individuals. At Diet Doctor we consider this kind of research study to be the greatest quality proof by our proof basing policy . Even with the greatest quality proof, we still require more information than the appealing heading.

The scientists’ ’ general conclusion is that low-carb diet plans, DASH diet plans, and other low-fat diet plans all lead to around 8.8 pounds (4 kilos) of weight-loss, and a high blood pressure decrease of 5 mmHg. Research study authors conclude there is no significant distinction amongst the diet plans. On the surface area, because they consisted of Atkins and South Beach diet plans in the research study, that might look like it might be a precise conclusion.

Once once again, nevertheless, the devil remains in the information. Research study authors specify low-carb diet plans as less than 40% of calories. That implies a 2,000-calorie-per-day diet plan might have 200 grams of carbohydrates and 66 grams of fat. That is a far cry from what we think about a liberal low-carb diet plan of 100 grams of carbohydrates or a keto diet plan of less than 20 grams of everyday carbohydrates.

Even even worse, they go on to state:

.When it fulfilled the meaning of a top quality diet plan however stopped working to reference the brand name or call in the short article, #ppppp> The diet plan was identified as brand-like. Dietary programs that did not refer to Atkins however consisted of less than 40% of kilocalories from carbs per day for the period of research study, or were moneyed by Atkins, were thought about Atkins-like.

Not just did they poorly specify low carbohydrate, however they muddy the analysis of top quality diet plans by integrating them with ““ like ” diet plans that aren ’ t genuinely comparable.


Based on these points alone, it is clear that we can not rely on the headings as they use to a genuine low-carb diet plan.

That doesn’’ t mean we need to throw away the research study. It ends up there is really intriguing information in the research study that regrettably didn’’ t make it into the abstract.

For circumstances, the South Beach diet plan had the best weight reduction of all at nearly 22 pounds (10 kilos) compared to 7.9 pounds (3.6 kilos) for DASH and 6.2 pounds (2.8 kilos) for Mediterranean, although the GRADE quality of this proof was low.

The paleo diet plan revealed the best decrease in high blood pressure at 14 mmHg compared to 4.6 mmHg for the DASH diet plan. This was ranked as ““ moderate to high certainty” ” by the GRADE requirements.

And Atkins had the best boost in HDL at 3.4 mg/dl compared to a reduction of 1.9 mg/dl for the DASH diet plan.

Unfortunately, these disparities won’’ t stop the headings from checking out ““ Low-carb diet plans no much better than low-fat.” ” This highlights the crucial work groups like the Nutrition Coalition and the Low Carb Action Network (LCAN) are doing to make certain the dietary standards committee appropriately specifies low-carb diet plans and properly evaluates all offered quality science.

In reality, Dr. Ted Eytan just recently composed an article for LCAN discussing the circumstance in information and hiring everyone to make our voice heard with our regional agents. We motivate you to read his complete post.

As we have actually reported prior to , 40% carbohydrates isn’’ t even near to low carbohydrate. It is unreliable to conclude that all diet plans are the exact same. Rather, we can conclude that this research study reveals when combined together, high-carb diet plans of differing carbohydrate and fat material are approximately the exact same for weight reduction and high blood pressure decrease.

When specified properly, the information supports that low-carb diet plans, typically, result in higher weight-loss that low-fat diet plans. Data likewise reveals that low-carb diet plans have a higher decrease in high blood pressure in addition to all of the markers of the metabolic syndrome.

At Diet Doctor, we are constant and clear in our meanings of low-carb. We hire the clinical neighborhood to do the very same.

Thanks for reading,. Bret Scher MD FACC


Study: Ketogenic diet plan enhances PCOS markers

Study: Low carbohydrate much better for enhancing and diminishing fat cells insulin resistance

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Low-carb doctors: will you do remote consultations?

Are you a low-carb doctor, nurse practitioner or physician assistant who can see patients remotely? If so, we want to hear from you.

We have given our popular Find a Low Carb Doctor page a full redesign. We made it more responsive, easier to search, and more user-friendly for patients and doctors alike.

It’s an important global resource for patients to find keto-friendly doctors and for the medical community to show the increasing support for the low-carb diet as an evidence-based therapy.

Now we want to update our information for each doctor listed, and add whether patients can contact them for remote consultations.

That means accepting anything from phone calls, emails, Skype, Facetime, Zoom, or other internet-based medical visits.

Many patients cannot find a doctor in their local communities, so finding a doctor for remote consultations is a tremendous help to them.

Today, this is more important than ever, in order to help stop the spread of the coronavirus by staying home. Remote consultations reduce unnecessary in-person office appointments.

We also want to update our list to include what languages each doctor speaks. So if you are a doctor who speaks two or more languages, let us know.

This information will be entered into our new user interface.

If you’re a provider who is already listed on our page, we want to update your information.

Not yet in our global list, but would like to be? We want to hear from you!

Currently we limit our listings to only those health providers who have the legislative authority to prescribe and de-prescribe medications. However, we are planning a resource in the future that will list all those who have credentials that can support and coach patients in adopting and maintaining a low-carb life style.

Please contact me, to update your information or to become part of this growing list.

Find a low-carb doctor

Are you looking for a licensed physician to help you with your low-carb or keto lifestyle? Search our interactive database to find a doctor or health professional near you.

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