Is The Keto Diet Beneficial for PCOS?
It’ s about time I shared my thoughts on the keto diet for PCOS. This is something that I get asked about by my PCOS clients all. the. time. So I’m guessing that some of you might be interested in this topic as well!
The keto diet has gained a lot of popularity in recent years, and there’s a lot of misinformation out there about its benefits and uses — particularly when it comes to a ketogenic diet and PCOS.
So, let’s set the record straight about what a ketogenic diet actually is, the pros and cons of its use for treating PCOS, and why I encourage my clients to think twice before considering a ketogenic diet.
What Is The Keto Diet?
The ketogenic, or “keto” diet is a style of eating designed to induce a state of nutritional ketosis in the body, which occurs when the body uses a byproduct of fat called ketones as an energy source instead of carbohydrates (aka glucose or sugar). A keto diet is very high in fat and low in carbohydrates, with fat making up about 55-60% of total calories and carbohydrates making up only about 5-10%.
For someone following a typical 2,000 calorie diet, this would equate to eating only about 25 grams of carbohydrates per day, or about 1 banana’s worth. That alone probably gives you a good idea of how restrictive it is!
A keto diet mimics a state of fasting in the body by starving the brain of glucose as an energy source (which is its preferred source). The keto diet is not to be confused with a “low carb diet”.
The keto diet also limits protein since protein can be converted to glucose through a process called gluconeogenesis.
The Keto Diet For PCOS
While the keto diet was originally designed for the treatment of epilepsy in the 1920’s, it has since been studied and used for a variety of other purposes, including managing PCOS.
Some of the ways the keto diet has been believed to help PCOS include:
Weight loss- due to its ability to support burning fat for energy, the keto diet is commonly used and marketed for promoting weight loss in people with and without PCOS. Some very small studies have shown a significant reduction in body weight and body mass index (BMI) in overweight women with PCOS who followed a keto diet. However, some of the weight loss may be the result of a loss of lean body mass, which includes muscle and can thus negatively impact metabolism.
Improved blood sugar and insulin resistance- Since it is highly restricted in carbohydrates, which raise blood sugar and insulin levels, following the keto diet may contribute to lower blood sugar levels and improved insulin resistance in PCOS.
Improved cholesterol levels- a study conducted on women of childbearing age with PCOS found a significant reduction in triglycerides, total cholesterol, and LDL cholesterol were observed along with a rise in HDL cholesterol (the good kind) after following a keto diet for 12 weeks.
Lowered hormone levels-some studies have found the ketogenic diet to lead to reduced levels of the luteinizing hormone (LH) to follicle stimulating hormone (FSH) ratio as well as lowered free testosterone levels, both of which tend to be high in PCOS.
While all of these things may sound like a perfect recipe for improving PCOS, there are many other factors to consider before diving in.
Many of the studies on a keto diet for PCOS were conducted over a very short period of time, and the proposed benefits may therefore be short lasting as well. While research has been able to demonstrate short term effects of the ketogenic diet, long term health implications are not yet well known.
Several studies done on a keto diet for PCOS had high dropout rates or low adherence.
Different genders may respond differently to a keto diet. Due to hormonal fluctuations, women may be more likely to experience different and more complex results on a keto diet compared to men. One study done in mice found that while male mice lost weight on the keto diet, female mice ended up gaining weight.
The truth is that following the keto diet in the long term may end up doing more harm than good.
Here’s why…
The Keto Diet Puts Stress On The Body And MayMake PCOS Symptoms Worse Over Time.
The adrenal glands that regulate stress hormones in your body are very sensitive to changes in energy intake. Overly restricting carbohydrate intake is a form of stress on the body, and can result in increased cortisol levels, one of the body’s main stress hormones.
High cortisol levels can cause symptoms of PCOS to get worse including increased blood sugar levels, greater insulin resistance, increased inflammation, and higher levels of abdominal fat.
Some studies have show that cortisol is already poorly regulated in women with PCOS, and following a low carb diet that adds stress to your body could make things even worse.
The keto diet can be incredibly stressful and socially isolating due to its restrictive nature. It takes a lot effort to count and micromanage every piece of food that goes into your body. Not to mention all of the fun foods you have to miss out on! I feel exhausted just thinking about it.
I’m going to go out on a limb here and say that most of us with busy lives don’t really want to live this way and be constantly stressing about food — we’ve got enough life stress as it is!
Although initial weight loss may occur on a keto diet (as would cutting out any entire food group) the long-term impact of elevated cortisol levels from overly restricting carbohydrate intake may actually do more harm than good.
DISCOVER THE ROOT CAUSE OF YOUR PCOS
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The Keto Diet May Negatively Impact The Gut Microbiome
We know that the gut microbiome plays a major role in health and disease. Bacteria in the gut are crucial for the digestion and absorption of nutrients from food, immune function, the regulation of inflammation, the production of important vitamins, hormonal balance, insulin sensitivity and mental health. Shall I go on…?
There is a lot we still don’t know about the gut microbiome, but research has consistently shown that low bacterial diversity in the gut is harmful and a species-rich gut microbe community is beneficial.
Studies have shown that women with PCOS generally have less diverse gut bacteria than women without PCOS, which may contribute to PCOS symptoms and disease progression. Researchers have also found that the higher the androgens, the lower the gut bacterial diversity is in PCOS. Aka — supporting the health of the gut is essential for effectively treating PCOS.
One of the best ways to support your gut ecosystem is to eat a diet high in fiber, which helps to to improve and protect healthy bacteria levels in the gut. Fiber is also essential for producing normal bowel movements, which is a primary way that the body eliminates excess hormones and toxins. Regular bowel movements are essential for balanced hormones.
Where does fiber come from? Many of the exact carbohydrate-containing foods that are limited on a keto diet, such as vegetables, fruit, whole grains, and legumes.
Not to mention that fiber is crucial for promoting regular bowel movements. Going to the bathroom daily is essential for eliminating excess hormones.
The Keto Diet May Be Harmful For Hormones
Research has shown that overly restricting carbohydrates may result in irregular menstrual cycles or the complete loss of a period all together in some individuals.
Overly restricting carbohydrate intake may negatively impact thyroid hormones. Studies show that when calorie or carbohydrate intake is too low, T3 levels can drop. This can lead to symptoms of weight gain, fatigue, poor concentration, mood disturbances, and more.
The Keto Diet May Lead To Weight Gain And Difficult Losing Weight In The Future
While the keto diet may lead to initial weight loss (just like following any diet that severely restricts an entire food group would), the long-term impact may lead to just the opposite. As mentioned, the keto diet can lead to higher cortisol levels, which if not managed can lead to changes in appetite, weight gain, and an increased risk for developing the metabolic syndrome (a collection of symptoms that raises the risk for heart disease and type 2 diabetes).
Because a keto diet is so restrictive, following it in the long term is difficult and probably not realistic for most people. Therefore, any weight that is lost is likely to be regained once the diet is no longer being followed. This can lead to yo-yo dieting, (aka weight cycling), which is linked to a greater risk of obesity. Restrictive dieting also contributes to a variety of metabolic changes in the body, including greater fat storage, loss of lean body mass, and a reduced resting metabolic rate, or the number of calories burned at rest. Not exactly helpful to someone with PCOS!
The Keto Diet Lacks Important Micronutrients
One of the major issues with PCOS is the underlying, low grade inflammation (evidenced by elevated inflammatory markers in women with PCOS). Women with PCOS are also at an increased risk for a number of micronutrient deficiencies.
Carbohydrates that are restricted on a keto diet provide important micronutrients which are essential for normal bodily functioning. If you’re following a ketogenic diet, you are likely missing out on crucial vitamins, minerals and antioxidants from foods like colorful fruits and veggies that have anti-inflammatory and protective effects on your body.
Supplements can be used to prevent deficiencies on a ketogenic diet, but this can’t replace the synergistic benefits that occur from obtaining these micronutrients from real food.
Final Thoughts
While there ARE some potential benefits that women with PCOS could experience on a keto diet, it is not a sustainable or preferred diet plan for most. If you are serious about making dietary changes to improve your PCOS in the long-term, generic diets and quick fixes like the keto diet are not the answer.
There are SO many other effective and sustainable strategies to improve insulin resistance and manage PCOS naturally that don’t involve the keto diet (you can read more about that here).
I’ve helped hundreds of women with PCOS achieve regular cycles, conceive naturally, lose weight, and ultimately minimize or eliminate their symptoms with personalized nutrition and lifestyle support…all WITHOUT restrictive dieting.
If you are serious about making dietary changes to improve your health and heal your PCOS in the long-term…stop looking to generic diets and quick fixes.
And if you’re ready to do a deep dive into exactly how to eat to support your PCOS, you can check out our PCOS Root Reversal Program.