Low-carb gynecologist

I met infertility specialist, Dr. Michael Fox, on Jimmy Moore's low-carb cruise just this past March.

Dr. Fox is quiet and unassuming, but had incredible things to say about his experience with carbohydrate restriction in female infertility and pregnancy. While readers of The Heart Scan Blog already know that I advocate a diet free of wheat, cornstarch, and sugar for heart health and correction of multiple lipoprotein abnormalities, it was fascinating to hear how a similar approach seems to yield extraordinary benefits in this entirely unrelated area of female health. Obviously, female infertility and pregnancy are unrelated to heart health, but the extraordinary benefits witnessed by Dr. Fox in this area suggest that some fundamental lessons in human physiology can be learned. The results are so incredible that we are all sure to hear more about this approach as experience grows.

So I tracked Dr. Fox down in his busy Jacksonville, Florida practice to fill us in on some details.

WD: Dr. Fox, could you tell us something about yourself and what led you to use carbohydrate restriction in your female patients?

MF: I have been in practice as a reproductive endocrinologist for 15 years. During that time, I have seen our specialty move from a broad based practice of reproductive endocrinology to a narrow IVF [in vitro fertilization] focus, with patients being pushed through IVF in a cookie-cutter fashion without any emphasis on non-medical therapy.

Our focus has been to remain as a broad practice where we individualize care and attempt in every case to achieve pregnancy short of IVF. Five years ago, this continued quest for better care led us into the insulin resistance, low-carbohydrate metabolic world that has transformed our practice, although our practice offers all aspects of reproductive endocrinology including sub-specialized minimally invasive surgery, and all available infertility options.

WD: I have been intrigued by your comments about improved fertility with the low-carb diet. Could you elaborate on this?

MF: Yes, five years ago, as more information regarding Polycystic Ovarian Disease or Syndrome (PCOD/S) and its relationship to insulin resistance (high insulin levels) was emerging, we had a simple realization. As we've known for some time, insulin stimulates excess male hormone levels in the ovary, which disrupts ovulation and fertility. Then our job was to lower or virtually eliminate high insulin levels. Again, in simple fashion, we looked at physiology and realized that insulin is released only in response to dietary carbohydrates. Thus, elimination of carbohydrates should resolve the problem. This, in fact, is the effect that we have seen.

In our previous approaches to PCOD, we utilized oral ovulation medicines generating pregnancy rates in the 40% range overall. Now, with the nutritional approach, for those patients that follow our recommendations, our pregnancy rates are over 90%! This has dramatically reduced the need for in vitro fertilization in these patients.

To extend this idea further, we first started with relative low-carbohydrate diets, such as the South Beach diet, but quickly realized this didn't produce a metabolic effect. Over time, it has borne out that only the very low-carbohydrate diet (VLCD) approach produces significant metabolic change. Our impression then was that the current U.S. nutritional exposure probably increases insulin levels and that this has a detrimental effect on fertility.

To counter this effect, we now recommend the VLCD to all fertility patients and their spouses. The pregnancy rates do seem much better overall, as well as seeing a reduction in miscarriage rates. For the first time at our national meeting last year, there were three articles that showed improved pregnancy rates in patients without PCOD or insulin resistance in IVF when Glucophage was used. This drug decreases insulin. This supports the idea that our entire population is subjected to fertility-reducing high-carbohydrate diet.

WD: Do you see any other changes in these patients on the diet?

MF: Yes. All metabolic parameters, as well as many common complaints, improve. Cholesterol and triglyceride levels improve, while "good" HDL cholesterol levels increase. Weight drops at a pace of 12 lbs per month very steadily and we have many many patients who have experienced 50lb wt loss. Blood pressure decreases steadily in these patients and we are often able to get them off of cholesterol and blood pressure medicines. Common symptoms such as anxiety, sleep disturbances, decreased energy, migraine headaches and depression all dramatically improve. Again we can often get patients off depression and migraine suppression medications. So this approach helps in a multitude of areas.

WD: I was also interested in hearing more about your experience with morning sickness and the effects of a low-carb diet. Could you tell us more about this? Also, any thoughts on why this happens?

MF: As we continued to expand our thoughts about VLCD and fertility/pregnancy, we began to extend the nutritional approach into pregnancy. We know that pregnancy hormones dramatically worsen insulin resistance that is responsible for the condition, gestational diabetes. If insulin resistance is worsened, then reactive hypoglycemia is worsened. One of the biggest symptoms of hypoglycemia is nausea. So, in response to this, we have counseled our patients on the diet in pregnancy and have found a dramatic reduction in nausea. We recommend snacking every two hours in pregnancy.

The other "traditional" issue in pregnancy are cravings. These also likely stem from hypoglycemia. I have had many husbands tell us later that their wives, in contrast to friends etc, were calm and not moody or anxious during their pregnancies. Hypoglycemia probably is a serious issue for the fetus as well and may be the "signal" that turns on the insulin-resistant gene. Many theorists feel this might be an activated gene during the pregnancy.

WD: Do you use any unique approaches to the low-carbohydrate approach, e.g., inclusion of dairy, meal frequency, "induction" strategies (i.e., induction to the diet, not of labor!), etc.?

MF: Yes. As I'm sure everyone who works in the VLCD world does, we also have some tricks to make this work better. My biggest push, although hard to get patients to agree, is to see a counselor along with our follow-up in order to deal with "addictive behaviors" and "stress eating" that so many of our patients relate to us. Good stress management and cognitive behavioral therapy go a long way in helping this become a permanent change.

We also really push frequent calorie intake or "snacking." I think again that hypoglycemia produces an inborn drive to "cure" or "fix" starvation and leads to dramatic overeating. We have a short list of snacks that we recommend. The concept of hunger is offered as a failure of the program. We aim to eliminate hunger, as it represents hypoglycemia. The analogy I use is, if you drove your car until you ran out of gas before you ever sought to find gas, your life would be miserable. So it is the same with your metabolic engine: If you let it run out, the measures your system takes to fix it are very detrimental to life and certainly to nutritional health.

Our other big push is fat. People can wrap themselves around protein and vegetables, but they totally miss the high-fat (animal fat) part of the conversation. We have to really push that aspect. In regards to dairy, we allow for non-processed cheeses and minimal milk. An alternative is to mix about 4 oz whole milk with 4 oz of heavy whipping and 4 oz of water to create a "milk" with less sugar. Similarly, shakes and smoothies can be made with heavy whipping cream with pure whey protein powder added to create a liquid meal for those who "don't have time" to cook.

WD: Thanks, Dr. Fox. We look forward to hearing more about your approach in future.

Contact information:

Michael D. Fox, MD
Jacksonville Center
Reproductive Medicine
Phone 904-493-2229

Comments (36) -

  • Jim Purdy

    6/6/2010 6:31:08 PM |

    "While readers of The Heart Scan Blog already know that I advocate a diet free of wheat, cornstarch, and sugar for heart health and correction of multiple lipoprotein abnormalities ..."

    And I do know that, but it has been hard for me to give up wheat.

    However, I am getting chest pains more and more frequently after big meals, so I'm gong to have to make some major changes in my diet.

    Jim Purdy
    The 50 Best Health Blogs

  • Richard A.

    6/6/2010 9:07:09 PM |

    A high-fat, adequate-protein, low-carbohydrate diet is being used to treat difficult-to-control (refractory) epilepsy  in children.

    There is good theory that the ketogenic diet would also benefit those with Alzheimer's, but don't expect big pharma to fund the control studes. What is needed is for a foundation or the government to fund such studies.

  • DrStrange

    6/6/2010 10:02:32 PM |

    Well lets start the fun here:

    "Again, in simple fashion, we looked at physiology and realized that insulin is released only in response to dietary carbohydrates. Thus, elimination of carbohydrates should resolve the problem. This, in fact, is the effect that we have seen."

    published in American Journal of Clinical Nutrition, 1997

    Beef raises insulin level more than oatmeal, fish raises it more than popcorn, and cheese more than white pasta.

    Has there been a change I missed?

  • Anonymous

    6/6/2010 11:04:25 PM |

    Does he test for gluten intolerance or celiac?

  • Anonymous

    6/7/2010 1:54:58 AM |

    Here's a great recipe for Low Carb Bread


  • Matsmurfen

    6/7/2010 4:29:46 AM |

    Take a look at the Swedish "Kostdoktorn" blog (The Food Doctor?)


    There you can see a video with Dr. Fox!

  • Anonymous

    6/7/2010 8:12:02 AM |

    Interesting!! My sister-in-law is obese, always has been. She carries an extra 60 pounds yet she has had 4 children and never has had a problem getting pregnant. Although in the last pregnancy she was diagnosed with gestaional diabetes (6 years ago). Many of my co-workers are overweight and I see what they eat on a daily basis. High carb foods, lots of junk mixed in with some vegetables, no fruits whatsoever. All of my very overweight co-workers have had numerous pregnancies. No infertility problems at all.  I'v known only 2 women (skinny) with good diets who have had infertility problems.

  • Ed

    6/7/2010 2:25:55 PM |

    This sort of stuff is very interesting.

    Note that Dr Lindeberg has been able to correct type-II diabetes in a number of patients in trials through the application of a not-low-carb "paleo" style diet. See Stephan's reporting here: http://wholehealthsource.blogspot.com/search?q=paleolithic+diet+clinical+trials

    I applaud Dr Fox for his work and I hope his patients appreciate how lucky they are to have him.

    I'm in the camp that believes that liver dysfunction caused by excess vegetable oil consumption over an extended period of time is a very key component in modern society's explosion of insulin resistance. I hope that Dr Fox is paying attention to omega-3 and omega-6 consumption in his patients.

  • Meredith

    6/7/2010 2:39:32 PM |

    Hi Dr. Davis,  Is there a link to Dr. Fox's VLCD diet?  I looked on the website you listed for him and the nutrition section was not available. Or is there some other way to get the information on the diet he recommends?

    Thank you!

    Sincerely, Meredith

  • Jonathan

    6/7/2010 5:31:27 PM |

    I definitely don't feel guilty if I eat a LC snack but if I eat enough, good quality fat, I'm not hungry enough for a snack and my blood sugar barely varies (though the ultra stable blood sugar took a couple of months on HFLC to level out so well; but I was really messed up with highs of 300's).

  • Miki

    6/7/2010 8:15:17 PM |

    Amazing results. Thanks for spreading the word. It reminds me that Weston Price in NAPD mentions tribes that used to prescribe a special diets for newly married couples and pregnant women. We are relearning...

  • Sarah V.

    6/7/2010 10:21:56 PM |

    I'm interested in the "short list of snacks" Dr. Fox recommends to his patients.

  • Anonymous

    6/7/2010 10:39:20 PM |

    Interesting that he is on the high saturated fat bandwagon.  Ready to finally hop aboard now, Dr. D?

  • Emily

    6/7/2010 11:29:44 PM |

    this is really interesting, thanks for posting this interview.

  • Jennifer

    6/7/2010 11:55:42 PM |

    Very informative post and interview. I am a first-time reader and I hope to become pregnant agian after suffering from terrible "morning" aka for me, all day sickness. I am going to reaserch VLCD more! Thanks

  • Anonymous

    6/8/2010 1:08:17 AM |

    Could you please explain the hormonal connection? I, like other women undergoing IVF, have experienced rapid weight gain that is very hard to lose, even though I have been on LC for 5 years.

  • Anonymous

    6/8/2010 1:11:46 AM |

    Could you please explain the hormonal connection? I too have experienced rapid weight gain while doing IVF, even though I have been LC for 5 years.

  • Dr. William Davis

    6/8/2010 1:46:00 AM |

    As I suspected, Dr. Fox's unique experience has triggered a lot of interest.

    I will track him down again in future to see if there are resources or places that he will be continuing his conversation.

    More to come.

  • LeonRover

    6/8/2010 10:20:24 AM |

    Tut, tut, DrStrange, cherry picking ?

    The abstract quotes the following:

    "Total carbohydrate (r = 0.39, P < 0.05, n = 36) and sugar (r = 0.36, P < 0.05, n = 36) contents were  positively related to the mean insulin scores, whereas fat (r = -0.27, NS, n = 36) and protein (r = -0.24, NS, n = 38) contents were negatively  related."

    The insulin AUC data for beef was collected for 13 subjects and with reported values of 7910 +-2193. All one can say is that individuals show a wide variation in insulin response to beef.

  • DrStrange

    6/8/2010 4:19:55 PM |

    Okay then.  So beef CAN cause a very high spike in insulin, just does not necessarily that it does so always for everyone. No blanket statements.  Carbs (and the definition of "carbs" as word is generally used, is pretty sketchy as used) maybe are not the only thing causing high insulin levels.  Definitely refined carbs, the "whites", are problematic to say the least!

    A closely related issue is the protective effect of the antioxidents etc with the "carbs" in non-starchy vegetables vs the lack of those nutrients in meat/dairy

  • Lucy

    6/8/2010 5:17:51 PM |

    Thanks for posting this!  I went through GD in my second pregnancy, and successfully low-carbed (against the advice of the pregnancy diabetes counselors) after the diagnosis.  Third pregnancy I just track the blood sugar and watch the carbs with my primary.  It's a marvelous tool and so little information about low carbing during pregnancy, unless you want negative info.  

    Perhaps Dr. Fox could address the persistent messages that ketosis during pregnancy increases the risk of retardation in the baby?

    I keep running into that line of logic (fortunately i don't think I had to go so low in carbs as to stay in ketosis to control GD so I don't worry much).

  • Rabbi Hirsch

    6/8/2010 6:30:31 PM |

    This is a most read for all infertile couples...

    Rabbi Hirsch Meisels
    Jewish Friends With Diabetes international.

  • Anne

    6/9/2010 3:55:42 AM |

    There is a link between infertility and celiac disease. Could some of the success with the low carb diet be related to the elimination of gluten grains.

  • Anonymous

    6/9/2010 12:02:23 PM |

    Dr. Davis could you kindly shed some light on gram flour viz a viz your recommendation against wheat?

  • Anonymous

    6/10/2010 7:21:24 AM |

    Fascinating post.  Thanks.

  • PeterVermont

    6/11/2010 3:42:35 PM |

    I was surprised at Dr. Fox's emphasis on frequent snacking. My experience is that reducing carbs has all but eliminated sharp food cravings. I interpreted this as meaning that my body was efficiently switching from carbohydrate to fatty acid metabolism -- in that context lower blood sugar does not trigger hunger since the cells have an adequate alternate energy source in the fatty acids.

  • V. Alium

    6/12/2010 12:05:25 PM |

    The heart conditions can cause lightheadedness or fainting and may lead to a life-threatening irregular heart beat known as ventricular fibrillation.

  • Anonymous

    6/13/2010 10:37:25 PM |

    I am a woman with PCOS, and have been following a very low carb diet for some time now, though admittedly not perfectly. I have experienced the benefits the Dr. mentions, specifically as related to anxiety, depression, mood fluctuation, cravings, binging, and alcohol. I have also lost some weight. Also, to the commenter who posted about knowing only two women (skinny) who had fertility issues, that is really only a small circle of aquaintences and does not reflect the fact that as many as 1 in 10 women in the USA have PCOS. Cheers.

  • Amber

    7/1/2010 3:53:41 AM |

    PeterVermont, In general you are right, but pregnancy hormones change everything.  Even under severe carbohydrate restriction, I suffered intense frequent carbohydrate cravings.

  • LA Pharma

    5/3/2011 11:25:10 AM |

    T3-Cytomel (from LA Pharma) can cause an increase in basal metabolic rate.

  • Lyndee

    7/10/2011 2:57:07 AM |

    Cheers pal. I do apprecitae the writing.

  • Johnette

    7/10/2011 4:29:04 AM |

    All of my questions settled—tanhks!

  • Destry

    7/10/2011 4:45:06 AM |

    Check that off the list of things I was counfsed about.

  • Tori

    7/10/2011 2:25:06 PM |

    Great comomn sense here. Wish IÂ’d thought of that.

  • stnjnltt

    7/11/2011 9:47:22 AM |

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  • Datherine

    7/11/2011 4:17:53 PM |

    AFAICT you've covreed all the bases with this answer!

Fast-forward information

Fast-forward information

The internet has accelerated the conversation in health . . . enormously.

The discussions we have in Blogs, places like the Track Your Plaque Forum, and websites have accelerated the exchange of information and ideas so much that it is making traditional "official" sources of information IRRELEVANT.

Dr. John Cannell's unfailingly interesting and insightful comments in his most recent Vitamin D Newsletter brought this issue to mind. In his discussion of the vitamin D needs of pregnant women and his frustration with the failure of the National Institute of Health to take action despite the evidence, he states:

Whenever you see a child with asthma, diabetes or autism, just think: American Medical Association, American Pediatric Association, Institute of Medicine, Centers for Disease Control, National Institutes of Health, or Food and Nutrition Board.

Dr. Cannell is upset with the misguided advice of these agencies for mothers and babies to totally avoid sun while failing to provide advice on vitamin D supplementation, a combination of unhealthy factors that will increase the incidence of both type I and II diabetes, childhood asthma, and perhaps even childhood autism.

But this got me thinking: Here we are listening to a very credible source in Dr. Cannell, who has proven a discriminating judge of the evidence, along with vitamin D experts like Tufts University's Dr. Michael Holick, who has written a book on vitamin D (The UV Advantage: The Medical Breakthrough that Shows How to Harness the Power of the Sun for Your Health) ; University of Toronto's Dr. Reinhold Vieth, whose wonderful webcast on vitamin D was certain to convince you of many aspects of this nutrient's vital importance in health (unfortunately, it must have been taken off the hosting server, since I can no longer locate it); among others.

We all have access to this information. They are providing discussions on the topic that have long ago made the comments of "official" agencies like the FDA or the Institute of Medicine's Food and Nutrition Board (charged with setting RDA's for vitamins) irrelevant. While information is conveyed at lightning speed through internet media sources, discussion boards, and chats, the committees of "experts" often sit on their hands, fearful of speaking out, often themselves unfamiliar with the scientific literature or the conversations being conducted, not uncommonly having hidden agendas of their own that might interfere with their impartiality.

Information on health (and other subjects, as well) is being conveyed to the interested public faster and faster. The FDA, the USDA, the Food and Nutrition Board, the American Heart Association are increasingly being viewed as behind the times. They often also provide tainted information. Among the most glaring examples of biased information is the Heart Association's endorsement of "heart healthy" products in its Heart Check Mark program, including Cocoa Puffs, Cookie Crisp cereal, and Berry Kix, pure unadulterated junk foods thinly veiled with the Heart Association stamp of approval. Or the American Diabetes Association failure to speak out on the increasing penetration of carbohydrate and sugary junk foods in the American diet, while maintaining relationships and funding from its number one financial contributor, Cadbury Schweppes, the number one candy, soft drink, and snack manufacturer in the world.

The collective knowledge we are gaining through our own efforts will supplant the mis-information provided by official agencies. Just as Wikipedia represents collective knowledge on a broad range of topics, such a collective wisdom will develop in health, as well.

Comments (11) -

  • John

    10/24/2007 2:31:00 PM |

    We at www.uvtalk.com agree.

    We loved for you and others to join us for further debates and the sharing of information regarding the positives of uv expsosure.

  • Anonymous

    10/24/2007 4:35:00 PM |

    Great post! Thanks for writing your thoughts and sharing your knowledge on this blog, it is very useful.

    I have just ordered some 2000 ui gelcaps vitamin D supplements because of what I have read here.

    I used to take 1000 ui/day, but from dry tablets.

  • Anonymous

    10/24/2007 8:15:00 PM |

    Dr. Davis,
    November's issue of Scientific Amercian has a great article on vitamin D. The article was about how important vit. D is in fighting autoimmune diseases, cancer, and other inflamatory disorders. It also stated that many people are deficent in vitamin D and they are paying the price.
    I read your blog and info on TYP so I was aware of most of what was written. What is good about the article is that more people will read it and start thinking for themselves and realize the AHA et al don't know what they are talking about. They are IRRELEVENT!

  • Dr. Davis

    10/24/2007 8:41:00 PM |


  • Anonymous

    10/25/2007 2:04:00 AM |

    Webcasts about MS & D3 by Reinhold Vieth:

    Someone named narkia has some links saved in their del.icio.us tagged as Vieth:


  • Mo

    11/2/2007 11:54:00 PM |

    In England the problem I've surmised is that the JBS (an alliance of the British Cardiac Society, the British Hypertension Society, Diabetes UK, HEART UK, the Primary Care Cardiovascular Society and the Stroke Association) base their guideline proposals based on research that most likely comes from drug companies that advocate their own products. And worse still we probably just ape US evidence without examining it.

    And there clearly is need for some doctors to learn more about vit D. One endocrinologist I know (but an otherwise very good one) suggests that any value between 9-125nmol/L is fine and proposed 400IU, whereas another recognised that 50nmol/L+ is sufficiency. However both prescribe D2. I'm not even sure D3 is available via prescription here - but go to a basic health food shop and you can find 1000IU D3 and not behind the counter.

    Some people don't have families that show patterns of symptoms related to vit D deficiency, but mine overwhelmingly does. All that I've heard from the vit D council makes complete sense because it's true. It makes me angry that we're still prescribed by outdated texts.

  • Dr. Davis

    11/3/2007 1:25:00 AM |

    Thank goodness we are entering the age of rapid information dissemination and self-empowerment!

  • Anonymous

    11/5/2007 11:19:00 AM |

    Hi Dr. Davis!

    Thought I would revisit this blog posting because of my positive findings.  I purchased the UV Advantage book and in it the author talks about other substances created in the body by sun light - other than vitamin D.  I personally had found this true as I not only take vitamin D but also will use a sun lamp a few times a week, and have noticed using the lamp caused a euphoric feeling, much as described by the author.  

    In the book there is a chapter dedicated to sun boxes and how they help with the winter blues.  I thought with fall weather here I would buy a box & give it a try - and I'm glad I did.  I've only been using the box for a few days but what a difference, I feel more energetic, have slept better, eat less, and in general feel warm and sunny all over.  I don't know how to describe it other than amazing.  

    Since it has been mentioned that a positive upbeat demeanor is very helpful in the TYP program thought this mentioning might help others.  

    I'm going to experiment some more.  I've talked with the boss about bringing the light box to work - will see if others get the same "high" as I've gotten.

  • Dr. Davis

    11/5/2007 12:44:00 PM |

    That's great! Let us know how it goes at work.

  • Anonymous

    11/9/2007 10:13:00 PM |

    Hi Dr. Davis,

    Thought I would ring in with what was found with the light box at work.  Basically it helped better our mood we all though.  The light was used during our morning meeting, which is easy to do since there are just 3 of us.  And we all thought that we had more energy and felt "sunny" through the day.  I plan to continue bringing the box to work.    

    I also told my 83 year old grandmother of the light box and she wanted to try as she has trouble sleeping - (and eventually wanted it for her own.  I was more than happy to buy a new one.)  She tells me that it has helped with her sleep.  God bless her soul, like many at her age, grandma is ornery, and I was/am hoping the light will help with her mood, as is advertised on the box.  It's only been a week and results might change but so far results havn't been what was hoped for.  Grandma has been grumpy and prone to believing odd conspiracies for a few years now, but she normally keeps them to her self only mentioning them in private.  She now seems to have more energy and it was noticed by several family members as she called a few members out of the blue accusing them of such and such acts against her.  So in all honesty, the box worked for her too, but not with the upbeat demeanor hoped for.  

    My personal observation is that the box works great for sleep - and it worked pretty much right away for me.  I use it again in the evening around 5:30 as I have trouble staying awake when the sun goes down, but then would wake up very early in the morning - and as a result of using the light my sleep has been wonderful.  I have been going to bed at 10:00 and wake up at 5:00 with out waking up during the night.  I find this further confirmation of the importance of sunlight on our body’s health.  I plan to continue using it, and am glad you mentioned the book.  

    As a side note - I signed up for the trial fish oil capsules.  Received them - fantastic packaging, the capsules are some of the best we have ever seen.  (Both my father and I used to work in the health food industry and have seen many soft gels before.  Also dad used to work for encapsulator RP Scherer in the early 80s as head of marketing.) I gave the fish oil to my father to use as he follows the TYP program somewhat - and i wish he would become more involved.  

    He is reporting that the fish oil capsules have a very very strong fish after taste - much more so than the regular fish oil capsules he was previously using.  We are afraid the peroxide values might be high.  Dad mentioned that he is going to have the capsules tested, but i don't know when or if he will do that.

  • G

    11/13/2007 2:33:00 AM |

    If you store the fish oil caps in the freezer and take out as you need, there is less of a 'fishy' taste and burps.  Really works according to my patients... and cheaper than the enteric coated stuff! Heard that from the cardiologists I work with...