Does keto help with PCOS?
The ketogenic or ‘keto’ diet has gained popularity over the last few years but it’s not a new diet. If you think back to the 90’s you might remember the popular fad diet ‘the Atkins diet’ which is a ketogenic diet. Originally the keto diet was used to help treat epilepsy in children, however it has gained the most attention as a weight loss diet. In this blog post we will take a closer look at the keto diet for PCOS.
What is a keto diet?
In a nutshell, the keto diet is a dietary pattern that severely restricts carbohydrates whilst prioritising the intake of foods high in fat such as coconut oil, butter, olive oil, cheese, cream, nuts and avocado. The keto diet includes a moderate amount of protein rich foods such as seafood, red meat, eggs and cheese and also includes a small amount of very low carb vegetables. Foods such as fruit, sweets, grains and large portions of most vegetables are not included in a keto diet.
The potential benefits of a keto diet for PCOS
The keto diet may improve insulin sensitivity
Insulin resistance is extremely common in PCOS, impacting between 75%-95% of people with the condition. Studies looking at the keto diet for women with PCOS have found that the keto diet may help to decrease levels of glucose and insulin in the blood.Whilst these short term benefits look promising, it’s important to note that these studies are small in size and there are no long term studies that look at the metabolic impact of the keto diet in PCOS in the long term.
The keto diet may improve PCOS related hormone imbalances
PCOS is characterised by high levels of androgens such as testosterone. High androgens are responsible for many PCOS symptoms such as irregular periods, acne & excess hair growth. One small study has found the keto diet was beneficial for reducing total & free testosterone and improved LH/FSH ratios in women with PCOSA recent meta-analysis looked at the keto diets effect on the following hormones (follicle stimulating hormone, testosterone and progesterone) and weight change and found that women following a keto diet for >45 days saw significant weight loss & an improvement in their reproductive hormone levels.
The keto diet promotes PCOS weight loss
One small study of 17 women with PCOS found that the keto diet was an effective, short term diet for weight loss. Another small study found that people following a ketogenic diet experienced an average 9.4kg weight loss over a 45 day period following a ketogenic diet. However this difference in weight loss was during the initial phases of the diet and differences in weight loss disappear over time. Larger studies in the general population have found that the ketogenic diet is no more effective at promoting weight loss than any other calorie reduced diet.
The keto day may improve IVF outcomes for women with PCOS
One small, retrospective study of 12 women with PCOS undergoing IVF found that those placed on a ketogenic diet prior to an IVF cycle had improved metabolic parameters, including lower fasting insulin, reduced waist circumference, weight loss, improved triglycerides. Women who followed the ketogenic diet also experienced increased endometrial thickness, implantation rates, increased rates of clinical pregnancy and live birth rates compared to their previous IVF cycle. This is a very small, poor quality study however highlights the need for further studies in this area
You might be thinking, well the keto diet sounds pretty amazing where do I sign up?!
It’s important to remember that the benefits that I have discussed have only been shown in small, short term studies. We have very limited information about the impact of following a keto diet in the long term, especially for people with PCOS. The keto diet can also be a very difficult dietary pattern to follow long term given that it requires so many food groups to be eliminated from your diet.
Now let’s take a look at some of the drawbacks of the keto diet for PCOS
The potential risks of a keto diet for PCOS
Increased risk of nutrient deficiencies
Because the keto diet requires elimination of most carbohydrate rich foods, this increases the risk of nutrient deficiencies such as B group vitamins, magnesium and anti-oxidants such as Vitamin C and selenium. These nutrients all have important roles, not only for your general health, but for managing your PCOS symptoms. For example, magnesium helps your cells to use insulin more effectively which is extremely important if you have insulin resistance.Increased risk of inadequate dietary fibre intake & negative impact to the gut microbiome
One of the side effects of following a keto diet can be constipation. This is mainly due to the keto diet eliminating high fibre foods such as wholegrains, legumes, lentils, starchy vegetables and fruit. A high fibre diet is important for maintaining a healthy digestive systems and also reducing inflammation. A 6 month study showed people following a low carb, higher fat diet had unfavourable changes to their gut microbiome & also elevated inflammatory markers. More research is needed to discover the long term implications of the keto diet on the gut microbiome.It’s likely not a safe dietary pattern for women who are pregnant
. Carbohydrates are essential for the health of your growing baby. There currently isn’t any research available looking at the keto diet for women who are pregnant & for good reason. Animal studies have found that mice who were fed a ketogenic diet had significant changes to their embryo’s body size and organ growth. It’s important to remember that this study was completed on animals so we can’t say for certain if the same would occur in humans however due to the profound impacts of the keto diet on organ development & growth seen in these animal studies, it’s unlikely a study in humans would be approved.
It is a challenging diet to stick to
The restrictive nature of the ketogenic diet makes it a hard dietary pattern to maintain. In research studies, people who have been assigned to follow a ketogenic diet often have higher drop out rates which means less people following a keto diet actually make it to the end of the study. PCOS is a chronic condition that it has to be managed for life. Any nutrition & lifestyle changes you choose to make need to be changes that you can sustain in the long term.Not safe for those who have a diagnosed eating disorder or history of disordered eating.
Women living with PCOS are at a higher risk of disordered eating and eating disorders such as Binge Eating Disorder. Diets such as the ketogenic diet are highly restrictive and it is well known that any eating pattern that is restrictive in nature can increased the risk of developing an eating disorder.
The environmental impact
One forgotten consideration of the ketogenic diet is its potential environmental impact. The ketogenic diet requires a significant increase in consumption of animal products & the meat industry contributes a large percentage of global greenhouse gas emissions
There is no one, particular type of diet that has been shown to work best for ALL people with PCOS. There are many different dietary patterns that have shown in research to support a more a regular period, manage your weight & reduce other PCOS symptoms. Many of these dietary patterns do no involve severe restriction of certain foods & food groups.
PCOS presents differently for everyone, therefore your nutrition plan should never be a carbon copy of someone else’s. Personalised nutrition advice that is tailored to address your unique symptoms and concerns will help you to achieve long lasting, sustainable results.
If you decide that you want to learn more about the keto diet and see if it’s a good fit for your needs, make sure that you do it under the guidance & supervision of a dietitian and your doctor.
If you’re ready to get clear on the next steps that you need to take to solve your PCOS problems book a free virtual Clarity Call with Ebony Crameri who is an expert PCOS & Fertility Dietitian with over 12 years clinical dietetics experience.