“Any tips to hack the dawn phenomenon?”


How can you lose weight and treat pre-menstrual migraines? What factors could lead to weight gain if one is consistently in ketosis? What could be the reasons behind high prolactin on a keto diet? And, How could you hack the dawn phenomenon?

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

Weight gain and pre-menstrual migraines


I’ve been keto-ing and IFing for years since my twenties. I’m now 49 and I’ve really hit a snag in my health and weight management. I gave birth to a naturally conceived child three years ago and did not gain weight during the pregnancy. Go keto! Since I returned to work when she was four months old I’ve very much struggled to maintain my weight and in fact, it has risen from around 22% body fat to 26% (I get regular DEXA scans to track this). Attempts (using a personal trainer and tightening up my food intake) at shifting this body composition resulted in gaining fat and losing muscle. To make things worse, I also developed pre-menstrual migraines of increasing severity. I have seen my doctor about this and the result is a string of every more expensive migraine medications. My cycles are still regular but I notice much heavier (estrogen dominance?). In my last cycle I conceived and within weeks I miscarried. (No pre-menstrual migraine, though! Progesterone must help). I notice that my fasting blood glucose is now ‘impaired’ (between 5.8 and 6.8) in the late luteal phase but I still have ketones (0.9-1.8). I can only deduce that cortisol is being spiked somehow so I’ve cut back my coffee to one serving. I really am at a loss as to what I can do to a) drop my body fat % down to where I feel best and b) treat the pre-menstrual migraines and not the symptoms (the pain). Any thoughts?


Dr. Fox:

I have several suggestions Danae,

First, your history suggests estrogen deficiency, not “dominance.” I’ve really never met a patient that I thought had estrogen dominance. This is a term coined by the natural hormone group and really has no basis in fact. Low estrogen causes fat gain also. The reason you felt better in pregnancy may have been due to the increased estrogen produced by the pregnancy, not the progesterone. Menstrual migraines are a clear symptom of decreasing estrogen levels, lowest in the late luteal phase before or during the next cycle. We find that estrogen patch works best. You may need higher levels of replacement. Most physicians under treat. The headaches should subside. You should seek a physician willing to try this with you.

Second, excessive aerobic activity through exercise (increased heart rate) can increase cortisol and thus fat %.

Lastly, if you want to rid yourself of the caffeine spike in cortisol, you must stop altogether. No decaf at all.


What are the detrimental effects of fasting while breastfeeding?

After having my third baby, I put on the pounds and really wanted to kick those in the butt. So, I started eating whole, organic foods. Initially, I lost a decent amount of weight. I decided (even though it said no fasting for breastfeeding women), to start doing minimal intermittent with great success (usually 16-hr fast, maybe an 18 or 24 hour a day or two a week). While breastfeeding and doing this, I felt great and lost the weight I wanted. However, during a camping trip, I got bit by a deer tick and the doc at the time suggested one dose of antibiotic. My body reacted pretty severely to the one dose of antibiotic. Fatigue and weight gain being the biggest, and I would assume a thyroid malfunction. That was about 4 months ago. I consistently stay keto and continue the intermittent fasting at roughly the same regimen. I frequently take my blood ketones and I consistently between a 1.5 and occasionally 4. But, I am still putting on the pounds. Almost 20 lbs (9 kg) since the antibiotic. I do workout, and some could be muscle/muscle density. But some is definitely fat. I am very frustrated with this. What would be factors that could lead to weight gain if one is consistently in ketosis (using a blood test strips)? I am still breastfeeding, but minimally.


Dr. Fox:

I’m not a big fan of IF for women in general. Women would appear to be wired differently in regards to starvation. I think cortisol is stimulated and people gain fat or just don’t lose. IF might be used to try to get through a plateau. Don’t really understand the antibiotic correlation and this may not really be the cause of your change? During breastfeeding, estrogen decreases and this change is negative for weight loss. I would also consider the possibility of Lyme disease from a tick bite. I would refer you to my other discussions regarding excessive exercise that raises heart rate. It may be working against you. Keep up the ketosis and give it some time.


Prolactin levels in keto


I am Dr. Eswar, a scientist, Korea. I am basically from India. We have formed a group in southern India and following the LCHF diet for lifestyle disorders and benefitted a much. One of our dieter, age 38, suffering from high prolactin (~200 ng/mL) and she doesn’t have any other issues. What could be the reason, and what is your suggestion with regard to the LCHF diet? Doctors did all the hormonal tests and brain CT scan for the pituitary gland and everything is normal.

Thanks in advance.

Dr. Fox:

High prolactin is most often from lactotrop (prolactin-producing cells) hyperplasia. An isolated overgrowth of these cells can result in a high level. I don’t see any effect good or bad from the LCHF diet and would recommend staying on that approach for sure.

Best of luck!!



Morning blood glucose

Any tips to hack the dawn phenomenon? I’m pregnant and eating low carb. My after-meal glucose readings are great, but my first-morning glucose is higher than the GDM cut-off. I want to avoid diabetes medication during the pregnancy. It’s very early pregnancy days, so I have some time to work on the morning readings before anyone will look at them.


Dr. Fox:

The dawn phenomenon is a tough issue. We see exactly your situation as we begin the nutritional change in our patients. The AM sugar will slowly come down. I recommend a pure fat snack at bedtime and you may have to set an alarm and wake up to do the same in the early AM 2-3AM. These things may help speed the process. Good luck and congratulations!


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