What to do about stubborn stomach fat?
, medical content by Dr. Michael D. Fox, MD
in Blood sugar, Keto, Low carb & high fat, PCOS / Fertility, Q&A 
What can you do about hypoglycemic events on a keto diet? Can you get pregnant if you have PCOS? And what to do if you have stubborn fat around your stomach?
Get the answer to these questions in this week’s Q&A with the fertility specialist Dr. Fox:
Non-diabetic reactive hypoglycemia
Since starting LCHF three years ago, I occasionally have episodes of what I think is reactive hypoglycemia. I have had all neurological investigations and they are all normal.
I find it always happens at the same time of day, usually when I have been out of ketosis and am re-entering after a good high-fat low-carb meal in the morning. Symptoms are blurred vision, speech difficulty, poor concentration followed by extreme fatigue, lasts about 40 minutes. It’s very consistent.
I am unconcerned about the episodes its just that they are debilitating especially at work! I am failing to find an endocrinologist (I thought that would be the best way to go) who is sympathetic to this way of eating and was wondering if you had any suggestions to stop these episodes from occurring. I am not diabetic or prediabetic but I do take Thyroxine for an underactive thyroid which is under control.
Thanks for a great educational website.
Mandy
Dr. Fox:
This is a great question. If you fall out of ketosis, you may be pushed out of keto adaptation as well. Until keto adaptation is achieved (1-2 months time) your system is unable to harness your fat for energy yet, so when nutritional calories are exhausted, your blood sugar may drop and you become symptomatic.
For those who are most effected, you may need to eat first thing when you wake up or your blood sugar will fall and the low point might occur just after you eat out of coincidence. We see this a great deal in pregnancy. I would still encourage you to pursue LCHF.
Best of luck.
Can you get pregnant with the problem of having PCOS symdrome?
Hello, my name is Rosie I have a doctor suffering from PCOS she has had several miscarriages. She doesn’t believe she can get pregnant if she gets on a keto diet. Can you please send me information to my email address. rosiedavis195953@yahoo.com. She really has been trying to get pregnant for a long time.
Dr. Fox:
As I have related in many answers here on Diet Doctor, PCOS is best treated with a low-carb diet. In my opinion, 80+% of what can be done for PCOS is nutritional. This includes fertility.
Our experience with PCOS related infertility is a 2-3X increase in pregnancy rate with good nutrition. A person may still need fertility medicine but it works fantastically. The pregnancy should be ketogenic as well.
Central obesity persists
Hi Dr. Fox!
I’ve been keto for 5 months. Diagnosed with PCOS in 2002, I continue to have a huge ‘spare tire’ of central fat that persists no matter what. I’ve always carried my weight this way. I’ve successfully lost 40 lbs (18 kg) on keto but still have this area of fat. I don’t do much exercise and decided to meet with a trainer, hoping it will help. Will intermittent fasting, doing cardio, or ANYTHING else help?
Tiffanee
Dr. Fox:
In my experience the biggest inhibitor of improvement is sleep apnea or sleep disturbance. Other stressors include aerobic exercise, and hypoglycemia, as well as type A personality. I try to get a sleep study on everyone with PCOS because of the high prevalence in these patients. Cortisol may be the reason for your findings. In addition coffee or drugs like Adderall double the cortisol level.
Things like meditation would be much more helpful than aerobic exercise. Walking is good – slowly and very low key muscle strengthening exercise. The only other issue would or could be low estrogen. We find many young women are suffering from low estrogen.
Be patient, you have lost a great deal and it may take some time to lose the rest!! Congratulations on your success so far.
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