What to Do About Post-Menopausal Weight Gain, Even on a Ketogenic Diet?


Is low-carb eating safe for hyperthyroidism and AFib? What about calories per serving in our recipes? And what can be done about post-menopausal weight gain, even on a ketogenic diet?

Get the answers in this week’s Q&A with Dr. Andreas Eenfeldt:

Calories per serving?

I’m very surprised that you do not include calories per serving in your recipes nutritional breakdown. I understand that counting calories is not the main objective of this diet. However I feel it is important to know how many calories I’m consuming along with how much fat, how many carbs and how much protein.

Are you planning to include calories per serving in your recipes? If not, is there any way for me to calculate the calories per serving of your recipes?

Your website is amazing and I am very happy to have found it and to be a member. The lectures and interviews have helped me very, very much. I am trying to keep my calories below 1500 a day. If you feel counting calories is useless or not necessary for weight loss please explain as I believe is one of the significant numbers I should be looking at to optimize my weight loss.

Thank you very much,

I don’t believe that the number of calories is a very helpful number, and most people would probably do great never, ever knowing about it.

Please remember that a hundred years ago, when just about nobody even knew what a calorie was, almost everyone was slim. And today, when we completely obsess about calories, we have an obesity epidemic.

When it comes to food, quality is far more important than quantity – because the quality determines the quantity we want to eat.

Andreas Eenfeldt

Is low-carb eating safe for hyperthyroidism and AFib?

I have just been diagnosed with A-Fib and hyperthyroidism. I was eating low carb but have been unable to find anything regarding the safety of low carb and these two conditions. Would really appreciate your view.

Kind regards,

It should be OK, though of course you may need to be on some medication whether you are eating low carb or not. Note that the dose of Warfarin (if you’re on it) may have to be adjusted after a major dietary change, and you may need to be monitored more often at first.

Regarding A-Fib, a very strict low-carb diet may sometimes result in a slightly higher heart rate, so there is some potential for theoretically affecting the A-Fib or increasing the risk of getting back into A-Fib in the short term. On the other hand, low carb lowers blood pressure, the main risk factor for getting A-Fib in the first place, so long term it may even be beneficial.

Andreas Eenfeldt

Post-menopausal weight gain and the ketogenic diet?

I am a 50-year old woman with no menstrual period x 1 year (and only a couple of cycles in the year preceding). I have been eating low carb for about 5 years now. Before menopause I maintained a healthy weight with this 69 kg (152 lbs) at 170 cm tall (5 foot 6).

In the past 18-24 months I have steadily gained weight. I have followed the ketogenic diet on your site for the past 9 weeks and during that time I have gained 2-3 kg (4-7 lbs) (76 kg – 168 lbs today and uncomfortable) and my clothes have not loosened.

Urine strips indicate I am in ketosis (low to moderate). I follow the program exactly (bulletproof coffee for breakfast, leftovers for lunch, and the scheduled meal for dinner). If I snack (rare) I have a few tbsp of raw nuts or cheese. My portions are controlled and I don’t have second helpings. Alcohol is @ 3-5 servings per week all low-carb choices (wine, prosecco, or vodka soda).

I will have carbs (carb cycling) perhaps once every week or two (e.g. 2 squares of very dark chocolate = 6 g or gluten-free toast). I exercise 5 times per week (2 weight-lifting sessions x 30-40 mins, 2 runs 30-35 mins, third run or cycle). I have seen a naturopath and had all my hormone levels check (no thyroid or glucose issues).

I supplement with vitamin D, omega 3/fish oil, Mg, B-complex, adrenal supplement, EFA, melatonin. I work as a primary care nurse practitioner. I feel I have explored all the possible reasons behind weight gain.

Please advise if you have any other suggestions? I am wondering if keto is not for me? I just seem to be gaining fat no matter what I do. I accept that menopause will come with some body changes but am frustrated that I can’t seem to stop the weight gain and that keto isn’t perhaps working. Thanks in advance for any info you can provide.


Hi Samantha,

Unfortunately your problem is common – most women gain significant weight around menopause. My educated guess is you’d gain even MORE without the keto diet though.

The number one addition that helps a lot of women in a similar situation lose 5 or perhaps 10 extra kilos is intermittent fasting.

Andreas Eenfeldt

Read more: How to lose weight

Intermittent fasting for beginners


Keto for beginners

Low carb for beginners

More Questions and Answers

Many more questions and answers:

Low-Carb Q&A

Read all earlier questions and answers – and ask your own! – here:

Ask Dr. Andreas Eenfeldt about LCHF, Diabetes and Weight Loss – for members (free trial available).


More with low-carb doctors


  1. Adrian
    Re: menopause--the extras of alcohol, nuts, and chocolate may have to go for a while, and maybe dairy, too, though having a little cheese and a bit of heavy cream every day may wind up helping. But your body is doing it's 3rd (assuming you've had a child) "prep" for later in life right now. I would cut down on the exercise intensity (walk regularly, but lift 1x/week), stop watching portions and go back to "feeding on demand," eating at hunger until fully satisfied. Try intermittent fasting just a couple of times a week, not every day (i.e. not 16:8, but skip a couple of meals a week if that feels good to you). Your need for protein is also likely increasing as it does with age, so make that the focus, most of your meals centered around meat rather than plant foods (even if "keto"). 15-20 g of carbs daily may be all you can handle, but do not go hungry.
    Reply: #6
  2. Diana
    I think Samantha should stop the alcohol (3-5 times is a little much and Dr. Eenfeldt didn't mention that alcohol increases insulin secretion and some people can't tolerate it while losing weight) and she didn't mention anything about exercise ?
    I'm 61 and I cannot lose weight even low carb without exercise now. I exercise 5-6 times per week with cardio and resistance. Doctors need to recommend exercise. I work in medicine 30 years and its still the same thing.
  3. Dora
    Hello Samantha,
    Mybe you should check your thyroid hormones.
    I've managed to lose weight in menopause with LCHF (I"m 52 years old).
  4. Melanie
    I'm having terrible trouble loosing and am doing great when it comes to staying under 20 carbs. The only thing I can attribute it to is menopause. I lost 100 lbs 15 yrs ago in 8 months time. Now 15 lbs in 3 months. The only difference is menopause.
  5. gbl
    I think Samantha should stop following medical advice for men by men, and allow her Female biology to protect her bones and organs with her added body fat.
  6. Samantha
    I did intermittent fasting with 16:8 for about 4 months it didn't help (that was last fall). I haven't tried doing it only a couple of times a week but I find with keto sometimes I'm just not hungry so I eat light or skip a meal. I never go hungry. But one serving is enough these days otherwise I feel to full. I am trying to do more walking and cycling (cortisol reducing). But cutting down on nuts and dairy is tough because I've already cut everything else out.
  7. Samantha
    @Diana -I exercise 5 times a week see post.
    @Dora - no hormone problems - checked.
    @Adrian - no babies
    @gbl - Lol - I'm focused on health as my top priority.
  8. Terri
    I would skip the bulletproof coffee. Need to burn body fat not use added fat. Fast for 16 hrs skip breakfast then just have lunch and dinner in 8 hr or less feasting period. Cut out nuts. Limit alcohol to 2 drinks per week until you can get the weight down
  9. Luna
    Hi Sam! I'm in your same boat! Good luck. Stay as fit as we can right? For now. I'm trying to do that & hired a trainer to at least stay completely strong and fit. Mixing it up with more cardio
    With weights. My sister says it gets better once the body settles in. I'm also focusing on core intensely. Pilates , yoga, belly breathing,
  10. Mary
    I think Samantha needs to stop the fish oil. It raised sugar levels for my husband and myself. Then she uses alcohol. Sounds like she is fluctuating her ketogenics with fish oil & alcohol
  11. Emily S
    Hi Samantha,
    I am reading Dr. Steve Gundry's Plant Paradox and he talks extensively about lectins causing weight gain and inflammation. You may like what he has to say. I am post menopausal and over 50, his book has helped me. Keep an open mind cause there will be statements about carbs that will blow your low carb/keto mind. I dropped 3 lbs and 1%body fat the first week.
    Also Malbec wine effects the blood sugar less than other wines, however, Dave Aspery asserts that red wine has mold toxins that cause inflammation. Ugh! There is so much to consider.
    Good luck!!!
  12. Bonnie
    Ive lost 10 pounds by eating clean and healthy. I 2 to 3 tbsp Nutrisa Hemp protein with Unsweetened Almond milk in the morning with an omelet made of one egg and 2 egg whites with chopped up Zucchini and summer squash tomatoes and mushroom and always 1/3 slice of avocado.
    For lunch a salad with Romaine lettuce tomato cucumbers mushrooms, 1/2 cup chopped grilled chicken with small drop of olive oil, with 1/2 quinoa 1/3rd avocado, balsamic and olive oil dressing 1 tbsp of
    Supper is all vegetables like zucchini , summer squash, eggplant, green beans, sweet potato, carrots, mushrooms i stir fry in some olive oil first cooking the eggplant then adding water. For flavor i add some dried or fresh herbs, parsley, thyme, basil, oregano.
    Served with 1/3 avocado and sometimes 1/2 cup quinoa,
    For snack banana pancakes.
    Banana , 1/2 cup quick oats, one egg or some almond milk mix with immersion blender.
    Cook with 1 tsp olive oil drizzled with honey and some walnuts.
    Snacks: chilli pistachios , apple,
    Drink lemon water with peppermint and lemon balm at least 8 oz per 10 pounds a day.
    Alcohol: maybe 3 glasses of dark red wine a week if i have time. If not no alcohol.
    Yoga: Bedtime only to relax
    Vitamins: Multi, fish oil 1200mg, Calcium and Vit D,
    Vit C.

    Ive cut out red meats and any processed meats or processed foods. And all depression medicine: Zoloft (on. Since 2003) and Wellbrutron.

    Im 53 about 2 years past menopause and have hypothyroidism and on medication for this since 2003. When i gained 30 pounds.

    My heaviest weight was 192. Im now at 180. Im 5 feet 8 1/2.
    My goal is to get to 165 to 170.
    Had i known that you would gain weight especially around your mid section during menopause i would of started this better eating plan.

    Before I was eating red meat, pizza, spaghetti, processed meats, tons of dairy products,
    Desserts, chips, any fried foods. Take out foods such as Chinese, KFC, McD. All carcinogens in red meat and processed meats.
    Chicken is no better since its fill of injected sodium but i need some meat.

    My husband still eats all that stuff and maintains a weight of 178 at 6 feet tall, 55 years of age. Drinks 3 glasses of dark red wine a night. Lucky man!
    And no exercise.

  13. Diana
    Sorry Samantha, I read that fast. I think it could be the alcohol, and the bullet proof coffee. Every time I've tried the bullet proof coffee, I've gained weight. Also coffee affects insulin as well. My ND said my post menopausal weight gain is due to hormones and I'd have to wait until I was more or less finished before I'd be able to lose. I started at age 50 and now I'm 61 and last year I was just able to start losing again. I gained 50 lbs during my post menopause years. I just kept gaining no matter what I did. Low Fat, High Fat, Low Carb... etc. Low carb may be your best bet. But you might try stopping alcohol and the bullet proof coffee.
  14. Eden

    I get that cutting out nuts and dairy is hard. I still have over 100 pounds to lose and my weight loss stalled for a few months. But cutting nuts and dairy was key for me. That alone made a difference and jump started my weight loss again. I have PCOS and weight loss seems to be really stubborn.

    I would also cut the alcohol, bullet proof coffee and dark chocolate. I know that may sound rough but I was getting desperate too and cut everything but veggies and protein and fat. I rely on coconut oil and coconut cream for quite a bit of my fat. I really liked Maria Emmerich's 30 Day Ketogenic Cleanse book because it is dairy-free.

    Best of luck. I think we need more information and insight on women with keto--particularly around hormonal issues. I am so glad that there is this Diet Doctor site and they keep giving us so much good, solid, even ground-breaking information in relation to health and keto (Thanks, Andreas!). I think your question is very relevant and important.

  15. K C
    Could fybroids have anything to do with your weight gain i wonder?
  16. Andrea Scully
    Yes, the weight gain is frustrating and depressing too. I've been through it now though and the weight is coming off again.

    What I wish to add to this discussion is the fact that after menopause, I simply need much, much less to eat. Which makes the attention to the quality of what I do eat more important.

    The portions I have are now may be measured by bites instead rather than anything I might have seen as sensible before these hormonal changes set in. And, the intervals between meals are far longer too. Eating low carb definitely helps, as it keeps me from being hungry for far longer periods. No grain, no sugar, no hunger. It's amazing.

    Stress is what I found to be the most significant factor with dealing with menopause. Adding to the stress factor with all sorts of uber control-tripping is not all that helpful in my experience. It only adds to the problems, making it more difficult or even impossible to stay on a reasonable path of diet and self care.

    My body did want to pack a few extra kilos on, so ok. Being sensible with the eating and also kind to my body's need to go through the needed changes in its own wisdom was also a good thing too.

    The kindness factor is underrated in self care, and the body responds to this beyond what all the programming we receive about 'whip it into shape' might suggest.

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