Here's Why An RD Recommends The Keto Diet To Help Manage PCOS Symptoms

The ketogenic diet has been quite the buzzword of the last couple of years, and it looks to be maintaining its space as a cure-all for improved energy, reduced inflammation, successful weight loss, and more. Clinically, I have seen all of these outcomes when the ketogenic diet is comprised of real whole foods with an anti-inflammatory focus, but perhaps the most influential medical outcomes are with women who have polycystic ovarian syndrome.

A diet that is low in carbohydrates, rich in plant compounds (phytocompounds), and balanced with anti-inflammatory fats and well-sourced proteins can be a fantastic way to reduce the primary mechanisms that drive PCOS symptoms.

First let's define polycystic ovarian syndrome and its primary symptoms. Many women go undiagnosed, so even without the label of PCOS, it is important to understand how keto may help resolve your current symptoms of hormone imbalance.

Polycystic ovarian syndrome is a disorder involving infrequent, irregular, or prolonged menstrual periods and often excess male hormone (androgen) levels. The ovaries develop numerous small collections of fluid—called follicles—and may fail to regularly release eggs.

There are six primary causes of PCOS: insulin-resistant PCOS, inflammatory PCOS, stress-induced PCOS, nutrient-deficiency PCOS, microbiome imbalance PCOS, and pill-induced PCOS. An individual may have symptoms or a diagnosis of PCOS based on a couple of these causes, but in each case, there is an ability to address the cause with strategic nutrients and supplements, as well as diet and lifestyle change.

This is the most common form of PCOS as elevated insulin levels can interfere with the liver's regulation of hormone as well as production of sexual hormone-binding globulin1 (SHBG). When insulin levels are elevated, endometrial tissue abnormalities can be seen, and with low SHBG, there is more circulating testosterone interfering with ovulation.

Insulin resistance occurs from the overproduction of insulin, which can be in response to high carb intake or increased body fat storage. 

The most direct way to reduce insulin resistance is to reduce the insulin demand via reduction of carbohydrate intake. The ketogenic diet is an effective way to lower and regulate blood sugar levels. Low carbohydrate diets, like the keto diet, yield ketone production. These ketones serve as an alternative energy source, allowing blood sugar levels to come to a stable and consistent level2.

Inflammation can interfere with hormone production and ovulatory function. The presence of inflammatory chemicals has been associated with PCOS along with higher amounts of oxidative stress.

Stress can interfere with sexual hormone balance by shifting the body's focus to survival over regulatory function. In survival mode, the body prioritizes stimulating the adrenal glands as opposed to the reproductive glands, which, in women, means excess levels of DHEA and testosterone are produced. A stressed individual using carbohydrates to cope with stress or eating a high-carb diet will have more expressed androgens. Plus, insulin resistance can drive down SHBG, which means the elevated testosterone and DHEA are more expressed in the body. 

However, when carbs are reduced in the diet, SHBG better manages circulating hormones and they achieve a hormetic stress mellowing response via leptin and GABA expression. Leptin is a satiety hormone that is optimized in a ketogenic diet4 both due to the mobilization of body fat and the consumption of fat as the primary fuel source. This hormone provides a safety signal to the body's regulatory system, the hypothalamic-pituitary-adrenal (HPA-axis). The body also has leptin receptors on the thyroid and ovaries.

Your body's ability to function relies on nutrient status. There are defined nutrient-associated pathways that play an essential role in the regulation of ovarian follicle growth and ovulation. The primary nutrients of focus with supporting ovulation and managing PCOS are myo-inositol, vitamin D, and omega-3 fatty acids5.

Myo-inositol is a sugar alcohol by structure that belongs to the B-vitamin family and has hormonal and anxiolytic effects. Myo-inositol has been researched with many intervention studies6 demonstrating recovery of reproductive abnormalities, reduced androgen levels, and improved insulin levels as well as enhanced egg maturation and development.

Vitamin D is not just a fat-soluble nutrient but truly a pro-hormone that affects blood calcium, immune health, hormone levels, and insulin function. Specific to PCOS and reproductive health7, Vitamin D plays a role in FSH sensitivity, progesterone production, and ovarian follicular development. As vitamin D levels are optimized insulin sensitivity is often enhanced along with ovarian and sexual hormone health. Get your vitamin D tested and ensure levels are in the optimal range, not just the normal range, if looking to manage PCOS