by Dr. Anita Sadaty, GYN and Dr. Laura Paris, DACM
Most experts agree that fixing insulin resistance is a huge part of fixing PCOS. Although we find that most women have more than one underlying driver of PCOS, sugar and insulin imbalance is the most common problem.
There are research studies that show ketogenic (keto) diets effectively treat type 2 diabetes and obesity, two conditions often linked to PCOS. Weight loss and improved insulin resistance help PCOS, so it makes sense that a keto diet could be an effective approach.
A study in the Journal of Nutrition and Metabolism showed that women on a ketogenic (low carbohydrate, high-fat) diet normalized testosterone levels, lost weight, improved fasting insulin and noticed a reduction in PCOS symptoms over six months. A smaller study at the Cleveland Clinic recruited four women with infertility and PCOS for a six-month keto trial. Within eight weeks all four of the women began menstruating regularly. Over six months, all lost weight (19 – 36 pounds) and two spontaneously conceived.
So, the data is promising. Let’s dig in to find out if a keto approach could be right for you.
What is a Ketogenic Diet?
Basically, it is a very low carb, high healthy fat, and moderate protein diet. The big difference between a low carb diet and keto is in the fat. Most low carb diets go low fat and high protein. But guess what? Carbohydrates are not the only thing that bump insulin, protein does as well. The only macronutrient that does NOT bump insulin is fat!
When you increase fats and reduce carbs, insulin levels drop. This is, of course, a huge benefit for women with PCOS. The second benefit to the keto diet is that you begin to use fat for fuel instead of sugar. Burning up fat for energy produces a substance called ketone bodies, which is the energy source your body makes when sugar is not available. Because sugar is easily accessed when you eat a lot of carbs, your body is not willing to break down fat. But once there is no other choice, your body can very effectively make the switch.
What are the benefits of a keto diet?
- Weight loss is the most well-studied benefit. Once your body learns to burn fat for energy, your fat stores go down. Weight loss can reverse PCOS hormonal imbalance and the inflammation that abdominal weight creates.
- Fewer cravings for carbs and sugar is common. When insulin levels are high and your body is insulin resistant, sugar cravings can be intense. Sugar consumption creates a rollar coaster with sugar and insulin levels. This disrupts your adrenal stress hormone levels, another PCOS driver.
- Decreased appetite from more stable insulin levels. Your meals have more staying power and you can last longer between meals without blood sugar drops or hunger.
- Balanced hormone levels. Women with PCOS following a keto diet for 6 months saw reduced testosterone, lower insulin and an average weight loss of 12%. Other studies suggest improved cholesterol, which is important as women with PCOS are at higher risk of developing heart disease.
- Acne improvement. Research suggests that high insulin makes acne worse. Women with PCOS often report cystic acne from both high testosterone and insulin.
What are downsides of keto for PCOS?
- With thyroid issues, keto may not be the best choice. Thyroid problems are commonly associated with PCOS. You need enough insulin for adequate thyroid function, so very low levels may work against you.
- If you have an eating disorder, a restricted nutrition plan may not work. Women with PCOS are nearly 5 times as likely to have an eating disorder, particularly if there’s anxiety or depression. You could develop unhealthy attention to every bite you eat. Others disagree and find that keto prevents carb cravings and binge-eating tendencies. The jury is still out and is most likely best decided on a case by case basis. Our PCOS SOLUTION eating plan is a reasonable, balanced, and doable approach to long-term nutrition. It can work better than keto for many women. Others transition to it after a period of keto.
- If you have nutrient deficiencies then restricting your diet may not be best. The keto diet may cause calcium, magnesium or potassium deficiencies if you are not careful about your vegetable intake. One of the biggest mistakes women on keto make is falling short on nutrient-dense plants. Another mistake is eating the SAME plant-based carbs every day. Nutrient deficiencies are more likely when you restrict food variety. This is definitely a concern when doing a keto diet.
- If you have gut issues, they may get worse. When you don’t eat a variety of high fiber carbs, you can starve your protective good bacteria. This opens the door for pathogens to take up residence. In fact, diets low in fermentable fibers are linked to a variety of inflammatory conditions, including PCOS. You can still benefit from keto if you have gut issues. However, you need to make it microbiome friendly, with plenty of varied fibers and plant-based prebiotic foods.
The bottom line
- The keto diet shows a lot of promise as a powerful tool to treat PCOS and reduce symptoms like obesity, acne, high testosterone and insulin resistance.
- Small studies show that it may be effective for restoring regular menstrual cycles and improving fertility.
- Doing keto safely is not easy. It takes planning and thoughtfulness. It may too restrictive for some.
- If you can adopt a keto eating plan without restricting plant-based, nutrient-dense vegetables, then you are unlikely to run into problems with nutrient depletion and microbiome imbalance.
- For those with PCOS, a keto diet may be an excellent option if moderate carb, anti-inflammatory eating plans have not achieved desired results.
- Keep in mind that you may not need to stay on a keto plan for life. You may be able to shift to a low to moderate carb eating plan once your hormones are balanced.
We welcome your questions and comments,