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.

serious matured woman with crossed arms outdoor

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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!


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