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Can Keto Diet Treat PCOS?

If you have polycystic ovarian syndrome (PCOS), changing your lifestyle and dietary habits can help reduce the severity of your symptoms. PCOS is a condition characterized by insulin resistance, just like what happens in type 2 diabetes. Insulin resistance is a condition where your body does not respond as needed to the hormone insulin. The hormone insulin is responsible for regulating blood sugar levels in the body as well as fat storage.(1) Some research has shown that following a low carbohydrate and high fat ketogenic diet can help relieve the symptoms of PCOS. Here’s everything you need to know about whether a keto diet can treat PCOS.

What is PCOS?

Polycystic ovary syndrome (PCOS) is a condition that affects many women around the world. According to estimates by the US Department of Health and Human Services’ Office on Women’s Health, PCOS affects one in every ten women of childbearing age.(2, 3) It is believed that five to ten percent of women between the ages of 15 and 44 develop PCOS.(4) Most women get diagnosed with PCOS during their late 20s and 30s when they face issues in getting pregnant and visiting a doctor. However, PCOS can affect anyone after puberty.(5)

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People with PCOS have multiple cysts in their ovaries, which are caused by the overproduction of hormones known as androgens. Research carried out in 2019 found that 33 to 83 percent of women who have been diagnosed with PCOS are also dealing with obesity or are overweight.(6) Some of the other common symptoms of PCOS include:

  • Hirsutism (excessive production of body hair), such as on the chin or face
  • Skin issues such as acne, skin tags, or dark spots
  • Irregular periods or no periods at all
  • Obesity, weight gain or difficulty losing weight
  • Male pattern baldness or thinning hair

If left untreated, this condition significantly increases the risk of heart disease, diabetes, endometrial cancer and high blood pressure.

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The exact cause of PCOS is not clearly known, but a number of factors are believed to contribute to this condition. These include an imbalance of hormones like testosterone and insulin, along with low grade inflammation. Though women also naturally produce and need testosterone, women with PCOS are seen to have higher than expected levels of testosterone.(7)

Many people with PCOS have managed to find relief from their symptoms and also reduce their risk of these other health concerns by changing their diet and lifestyle.

Most doctors also advise women with PCOS and obesity to lose some weight as this can help lead to a better hormonal balance and also improve insulin resistance.(8)

Can Keto Diet Treat PCOS?

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When you follow a diet low in carbohydrates, your carb intake gets lowered dramatically, which causes the body to go into a state of ketosis. Ketosis is a state in which the body burns fat instead of carbohydrates to produce energy.(9)

When you follow a keto diet, you are able to reduce your intake of carbohydrates to even less than 50 grams of total carbs per day. Research has shown that keto diets may help improve insulin sensitivity in people with PCOS, help balance the hunger hormones in the body, and also promote weight loss in people with type 2 diabetes and obesity. In fact, several studies have looked at the effects of keto diets on PCOS as well and found that changing dietary habits to reduce the intake of carbs can significantly alleviate the symptoms of PCOS.(10, 11)

Keto Diet, PCOS, and Insulin Resistance

As mentioned above, the exact cause of PCOS remains unclear. However, it is believed that insulin resistance has a role to play in the development of PCOS. Insulin is a hormone that helps control blood sugar levels by transporting glucose from the blood into the cells of the body, where it gets used for energy, or it is stored for use at a later stage.(12) However, people who have insulin resistance tend to have raised blood sugar levels as well as high levels of insulin since their body compensates for insulin resistance by producing extra insulin.(13)

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Insulin resistance develops when the cells of the body stop responding as they should to the hormone insulin. This increases the levels of blood sugar and also causes the pancreas to start making more insulin.(14)

Since insulin also has a role to play in fat storage, insulin resistance and the production of excessive insulin are also linked to weight gain and obesity. If left untreated, insulin resistance can cause type 2 diabetes over time.

The ketogenic diet is known to help improve insulin sensitivity, which is why it is known to be helpful for people with PCOS.(15)

A 12-week study carried out on 14 women who were suffering from PCOS found that following a keto diet that was high in plant foods, such as low-carb vegetables, brought about a dramatic reduction in blood sugar and insulin levels, along with better insulin resistance scores, which indicated greater insulin sensitivity.(16)

Another study carried out on 18 women with PCOS, obesity, and liver dysfunction administered traditional prescription medications or gave the participants a ketogenic diet for 12 weeks. The study found that the participants who consumed the keto diet experienced significant improvements in their blood sugar levels, thus suggesting an improvement in insulin sensitivity. This study did not measure insulin levels or scores of insulin resistance.(17)

Another study that ran for 45 days with 17 women participants who had PCOS and obesity found that consuming a ketogenic diet dramatically lowered the average blood sugar levels by 10 mg/dL, while mean insulin levels were reduced by almost 13 micro-IU/mL. Insulin resistance scores also improved, thus showing better insulin sensitivity.(18)

Other Impacts of Following a Keto Diet

The same studies also found that the participants experienced many other improvements in their hormone levels, weight, blood lipids, liver function, fertility, and even menstrual regularity.

In one of the studies that lasted for 12 weeks and had the participants on a plant-food-rich keto diet, it was found that they lost nearly 9 kilograms (21 pounds) on average. Furthermore, they also experienced significant improvements in cholesterol and triglyceride levels, along with a decrease in testosterone levels.(16)

The 12-week study in women with PCOS, liver dysfunction, and obesity, six out of the seven participants in the group that followed the keto diet showed no signs of fatty liver disease anymore by the end of the 12 weeks. Additionally, the participants also experienced major weight loss.(17)

In the 45-day study, participants experienced a weight loss of 9 kilos (21 pounds), as well as a dramatic reduction in their waist-to-hip ratio and fat mass. Furthermore, their triglyceride, testosterone, LDL (bad) cholesterol, and total cholesterol were lower, while the HDL (good) cholesterol levels went up. Over the course of this study, 5 out of 17 participants experienced a return of their menstrual period after not having a period for many years. Twelve women also reported experiencing better regularity in their menstrual cycle, while five women successfully became pregnant after having undergone many unsuccessful attempts to get pregnant.(18)

While these studies are very promising, larger studies that last for a longer duration are required to find out more about the long-term effects of a ketogenic diet on PCOS.

Are There Any Side Effects Of Keto For PCOS?

There are some challenges or downsides to following the keto diet for PCOS. In several studies, researchers found that consuming a keto diet increased their cholesterol levels. An increase in cholesterol levels can be a concern for some people, especially those who already have high cholesterol levels.(19, 20, 21)

At the same time, keto diets can be restrictive and, therefore, difficult to stick to for many people. While following the keto diet, you will have to avoid eating pasta, bread, rice, cereals, most fruits, potatoes, and other foods high in carbohydrates or sugar. A less restrictive low-carb diet can also offer similar benefits for PCOS while also being easier to follow and stick to in the long term instead of the very strict keto diet.

Conclusion

The keto diet has been found to be helpful in managing the symptoms of PCOS, including weight management, reduction of cholesterol and triglyceride levels, normalizing of the menstrual cycles, and improvement in fertility. Following a keto diet also helps PCOS sufferers improve their insulin sensitivity, which helps reduce the severity of the PCOS symptoms as well. However, keep in mind that the keto diet is very restrictive, so you can try following other low-carb diets or switch between keto every now and then.

References:

  1. Moghetti, P., 2016. Insulin resistance and polycystic ovary syndrome. Current pharmaceutical design, 22(36), pp.5526-5534.
  2. Womenshealth.gov. 2022. Polycystic ovary syndrome | Office on Women’s Health. [online] Available at: <https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome#:~:text=Between%205%25%20and%2010%25%20of,at%20any%20age%20after%20puberty.> [Accessed 5 July 2022].
  3. Deswal, R., Narwal, V., Dang, A. and Pundir, C.S., 2020. The prevalence of polycystic ovary syndrome: a brief systematic review. Journal of Human Reproductive Sciences, 13(4), p.261.
  4. Trivax, B. and Azziz, R., 2007. Diagnosis of polycystic ovary syndrome. Clinical obstetrics and gynecology, 50(1), pp.168-177.
  5. Bremer, A.A., 2010. Polycystic ovary syndrome in the pediatric population. Metabolic syndrome and related disorders, 8(5), pp.375-394.
  6. Barber, T.M., Hanson, P., Weickert, M.O. and Franks, S., 2019. Obesity and polycystic ovary syndrome: implications for pathogenesis and novel management strategies. Clinical Medicine Insights: Reproductive Health, 13, p.1179558119874042.
  7. Rudnicka, E., Suchta, K., Grymowicz, M., Calik-Ksepka, A., Smolarczyk, K., Duszewska, A.M., Smolarczyk, R. and Meczekalski, B., 2021. Chronic low grade inflammation in pathogenesis of PCOS. International Journal of Molecular Sciences, 22(7), p.3789.
  8. Bachelot, A., 2016, December. Polycystic ovarian syndrome: clinical and biological diagnosis. In Annales de biologie clinique (Vol. 74, No. 6, pp. 661-667).
  9. Krikorian, R., Shidler, M.D., Dangelo, K., Couch, S.C., Benoit, S.C. and Clegg, D.J., 2012. Dietary ketosis enhances memory in mild cognitive impairment. Neurobiology of aging, 33(2), pp.425-e19.
  10. Gershuni, V.M., Yan, S.L. and Medici, V., 2018. Nutritional ketosis for weight management and reversal of metabolic syndrome. Current nutrition reports, 7(3), pp.97-106.
  11. Crosby, L., Davis, B., Joshi, S., Jardine, M., Paul, J., Neola, M. and Barnard, N.D., 2021. Ketogenic diets and chronic disease: weighing the benefits against the risks. Frontiers in nutrition, p.403.
  12. Thota, S. and Akbar, A., 2021. Insulin. In StatPearls [Internet]. StatPearls Publishing.
  13. Yaribeygi, H., Farrokhi, F.R., Butler, A.E. and Sahebkar, A., 2019. Insulin resistance: Review of the underlying molecular mechanisms. Journal of cellular physiology, 234(6), pp.8152-8161.
  14. Freeman, A.M. and Pennings, N., 2021. Insulin resistance. In StatPearls [Internet]. StatPearls Publishing.
  15. Pennings, N., Jaber, J. and Ahiawodzi, P., 2018. Ten‐year weight gain is associated with elevated fasting insulin levels and precedes glucose elevation. Diabetes/metabolism research and reviews, 34(4), p.e2986.
  16. Paoli, A., Mancin, L., Giacona, M.C., Bianco, A. and Caprio, M., 2020. Effects of a ketogenic diet in overweight women with polycystic ovary syndrome. Journal of translational medicine, 18(1), pp.1-11.
  17. Li, J., Bai, W.P., Jiang, B., Bai, L.R., Gu, B., Yan, S.X., Li, F.Y. and Huang, B., 2021. Ketogenic diet in women with polycystic ovary syndrome and liver dysfunction who are obese: A randomized, open‐label, parallel‐group, controlled pilot trial. Journal of Obstetrics and Gynaecology Research, 47(3), pp.1145-1152.
  18. Cincione, R.I., Losavio, F., Ciolli, F., Valenzano, A., Cibelli, G., Messina, G. and Polito, R., 2021. Effects of mixed of a ketogenic diet in overweight and obese women with polycystic ovary syndrome. International Journal of Environmental Research and Public Health, 18(23), p.12490.
  19. O’Neill, B. and Raggi, P., 2020. The ketogenic diet: Pros and cons. Atherosclerosis, 292, pp.119-126.
  20. Anekwe, C.V., Chandrasekaran, P. and Stanford, F.C., 2020. Ketogenic diet-induced elevated cholesterol, elevated liver enzymes and potential non-alcoholic fatty liver disease. Cureus, 12(1).
  21. Lee, H.S. and Lee, J., 2021. Influences of ketogenic diet on body fat percentage, respiratory exchange rate, and total cholesterol in athletes: A systematic review and meta-analysis. International journal of environmental research and public health, 18(6), p.2912.

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