Keto for PCOS: Everything You Need to Know
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A keto diet for PCOS targets the links between high carbohydrate foods, chronic inflammation, and increased insulin levels associated with PCOS.
PCOS (Polycystic Ovarian Syndrome) is a hormonal disorder that affects the ovaries and ovulation in women of childbearing age. PCOS is associated with three main symptoms:
- Causing cysts in the ovaries
- High levels of male hormones
- Irregular or skipped periods
PCOS is the most common cause of infertility in women, affecting between 10% and 18% of women of childbearing age.
Yet, because it’s rarely diagnosed until later in life when women are trying to get pregnant, less than half of women with PCOS know they have it. This means millions of women are living with PCOS, and likely suffering from infertility, without knowing why.
Read on to discover if you may have PCOS, and the simple dietary changes you can make to treat it.
Fast Facts About Keto for PCOS
- Roughly 1 in 10 women have PCOS, making it one of the most common conditions causing infertility.
- PCOS often goes undiagnosed until a woman is found to be infertile.
- Common symptoms of PCOS include irregular or absent menstrual cycles, excessive hair growth, and infertility.
- A high-carbohydrate diet may be the primary contributing factor of PCOS
- Carbohydrates cause inflammation and hormonal disturbances–the root causes of PCOS.
- PCOS is often treated with diabetes medications that target blood sugar and insulin levels.
- Keto is a high fat, ultra low carb diet that reduces blood sugar and insulin.
Why Keto for PCOS
Keto is an effective treatment for PCOS because it targets the underlying causes of PCOS, not just the symptoms. Keto means eating high-fat and ultra-low carbs. By cutting carbs you dramatically reduce glucose in your blood.
High glucose levels in the blood is likely the root cause of PCOS. Glucose can lead to PCOS in two primary ways: (1) By creating chronic hormonal disturbances. (2) By causing chronic oxidative stress–what we commonly call inflammation.
Glucose raises insulin levels. There is strong evidence that high insulin levels, a condition known as hyperinsulinemia, is a primary factor in developing PCOS. . Hyperinsulinemia leads to PCOS by inhibiting sex hormone-binding globulin (SHBG) synthesis, which in turn increases the levels of male sex hormones (androgens) in women.
High levels of testosterone and other male sex hormones disturb proper ovulation by inhibiting the production of progesterone while keeping estrogen levels elevated. These hormonal imbalances cause follicles that were supposed to mature and release from the ovary, to remain attached to and continue to grow or to leave behind a sac. The remaining sac can reseal and fill with fluid causing a cyst. Over time you can see the build-up of these cysts with an ultrasound.
Other hormonal symptoms associated PCOS include excessive hair growth, weight gain, and decreased sex drive, among others.
Carbohydrate consumption has been shown to cause inflammation and oxidative stress in a host of studies . And PCOS is an inflammatory disease, so it’s no surprise that carbohydrate consumption is a key factor in PCOS. Studies show that for women with PCOS, eating diets high in carbohydrates leads to oxidative stress and cellular inflammatory responses.
The excess male hormones in women with PCOS can exacerbate inflammatory cells, even when you’re not eating carbs. Those same cells that were first activated by eating carbohydrates, then further stressed by male hormones, become even more susceptible to inflammation from carbs (glucose).
Studies show that women with PCOS have higher percentages of abdominal fat than women without PCOS. This finding is true even for women who are not overweight. For women with PCOS, this abdominal fat is a site of chronic inflammation. And even when you take medication to treat the hormone imbalance associated with PCOS, you are still susceptible to inflammation, even in normal weight women.
Keto for PCOS: What the Studies Say
Though the mainstream medical world is still catching up with keto, recent studies show promising results for treating PCOS.
A study looking at women with PCOS who went keto for six months found that participants lost an average of 12% of their body weight and dropped their insulin levels by 54%. This is remarkable because the hormonal imbalances associated with PCOS make it very difficult to lose weight.
A 2017 review of seven high-quality studies looking at the effects of low carbohydrate diets on fertility hormones in overweight and obese women found convincing evidence that reducing carbohydrate load can reduce circulating insulin levels, improve hormonal imbalance and result in the resumption of ovulation. All these factors were shown to improve pregnancy rates.
Keto for PCOS Guidelines
Here are a few simple guidelines and a list of effective supplements to help you create the keto for PCOS plan that works for you.
Enjoy a high fat, very low carb diet
Try setting a goal to start below 50 grams total carbohydrates per day. Spend a few days settling into your dietary routine where you’re getting 70-80% of your calories from fat, then reduce your carbohydrate intake by 5-10 grams per day to increase your ketone levels while putting your fat burning capacity into overdrive.
Take advantage of the natural overnight fasting hours by skipping breakfast and eating at lunchtime. When 12 hours have passed since your dinner the night before, the body officially enters a “fasted” state and will automatically begin burning fat for fuel. When you get the hang of twelve hours in between meals, try extending to 16 hours. Benefits of intermittent fasting include fat loss, insulin sensitivity, the starvation of bad gut bacteria, neurological improvement, and reduced inflammation.
Mild exercising for a minimum of 30-45 minutes 4x/week will get your body burning fat and producing ketones while cutting weight and regulating insulin. If you’re curious about yoga, or just getting started, this guide will help you find the practice that’s right for you.
Water is critical to treating and recovering from PCOS. Water transports hormones to different parts of the body, clears harmful toxins, and carries essential nutrients to reproductive organs.
Research shows that a few supplements may work together with keto to help with hormone regulation, insulin resistance, and inflammation associated with PCOS. However, since supplements are not regulated by the FDA, and may interfere with other PCOS treatments, we recommend consulting with your physician before taking any of the following:
- Apple cider vinegar (ACV) has been shown to increase insulin sensitivity in several studies, including a trial in women with PCOS. Seven women with PCOS took one tablespoon of ACV per day. After 40 days, 4 of the women resumed ovulating, 6 experienced a measurable reduction in insulin resistance, and 5 had a decrease in their LH/FSH ratio, which means they had less androgen production. Intake: 1-2 tablespoons per day.
- Magnesium deficiency reduces insulin sensitivity and increases nerve excitability, leading to more stress, more tension, and more PCOS symptoms. It can be difficult to get enough magnesium on a ketogenic diet. We recommend a general magnesium supplement.
- Zinc is essential for the functioning of enzymes, hormones, and the immune system. A deficiency in zinc can cause a hormonal imbalance and make PCOS worse. Additionally, excessive or unwanted hair growth and alopecia may be improved with zinc supplements.
- Inositol, a sugar alcohol compound found in foods like citrus fruits and nuts, inositol is one of the most well-studied PCOS supplements. Most notably, inositol appears to promote ovulation and fertility. Countless studies have shown that inositol supplementation may also improve insulin resistance and decrease male hormones in the bloodstream.
- Vitamin B9 is essential for women with PCOS who are trying to start a family. To improve fertility, researchers suggest that women who are at a healthy weight should take 400 micrograms of folic acid, and obese or overweight women should take 5 mg of folic acid. If a diagnosis of MTHFR gene has been determined, supplementing with L-methylfolate or 5-methyltetrahydrofolate (5-MTHF). You also can get plenty of folate by eating low-carb keto-friendly leafy greens like collard greens, asparagus.
- Vitamin D is a hormone produced by the kidneys. It is vital to the endocrine system and is a very common deficiency in women with PCOS. Vitamin D and calcium may improve irregular periods and restore ovulation. When supplementing with vitamin D it is important to also supplement with magnesium. This is because vitamin D uses magnesium for absorption. If you don’t have enough magnesium, vitamin D can cause a magnesium deficiency.
While on your PCOS road to recovery, you may want to consult with a Registered Dietitian, Reproductive Endocrinologist (RE), and/or your Primary Care Physician. They can order different blood tests that will confirm how well the new diet and lifestyle are working for you.
Diets high in carbohydrates increase blood glucose levels resulting in high insulin levels and oxidative stress. These are the primary factors that lead to PCOS.
High insulin levels cause hormone imbalances, and oxidative stress causes inflammation that damages every cell in the body.
By restricting carbohydrates, a keto diet lowers insulin levels and reduces inflammation, making it a powerful tool for treating the root causes of PCOS.