The ketogenic diet has become one of the more popular diets of late, especially among those pursuing weight loss. I am most often asked about the keto diet in relation to hormonal health conditions like PCOS, or polycystic ovary syndrome. There is a ton of information (and misinformation) on the internet about eating keto for PCOS, which can make it hard for those looking for additional support. So let’s dive into the science of the ketogenic diet, the current research, and what I recommend for those with PCOS specifically because honestly, I am not a big fan of keto.

The Basics of the Ketogenic Diet

The ketogenic diet, commonly called “keto”, is an extremely low carb diet. With keto, less than 5% of your daily calories are from carbs, making the rest of your diet entirely fat and protein. At the cellular level, we typically use glucose as fuel (from carbs), but with the ketogenic diet, glucose and carbohydrates are restricted. This causes the body to use ketones (from fat) as fuel instead. This process is called “ketosis”. Now although ketosis is a natural physiologic response to glucose restriction, it is not necessarily optimal for your bodies. Our bodies run well on glucose, and when our body doesn’t get enough glucose, then it needs to adapt quickly in order to protect our brain cells.

Supportive Research

So this leads us to wonder, where did the ketogenic diet come from? The keto diet was first used as a treatment for epilepsy, dating back to the 1920s. Recent studies have demonstrated a significant reduction in seizures when following a ketogenic diet, but rarely did patients become seizure free. Given the effectiveness of reducing seizure activity, additional research has been done to look at other neurological diseases. While most of these studies are small or animal based, a therapeutic ketogenic diet has shown positive results for conditions like Alzheimer’s, Parkinson’s, and Multiple Sclerosis.

The Health Effects of Going Keto

So we know that the keto diet has shown positive effects for neurologic diseases, but what about the rest of the body? These are some of the common effects of going keto.

Weight Loss

While the keto diet often does result in weight loss, it’s not sustainable. Typically the weight loss is rapid in nature due to the loss of “water weight”. When restricting glucose, the body depletes glycogen, a stored form of glucose. As glycogen is broken down, water is released as a by product.

Stress Hormones & Blood sugar

So in the short term, you may notice a quick weight loss, but prolonged restriction of carbohydrates negatively impacts the body’s hormones. For example, the keto diet is associated with increased cortisol, the stress hormone, which goes on to impact insulin and blood sugar levels. This negatively affects the general population, but especially those with PCOS.

Constipation & The Microbiome

We source the majority of our dietary fiber from carbohydrates like grains, fruits, and veggies. By restricting carbohydrates, digestion is often slowed down causing constipation. The reduction in fiber also affects the microbiome. Those probiotics feed on prebiotics found in our diet. Anything that impacts our microbiome may also impact mental and emotional health, because most of our neurotransmitters are made in the gut.

Potential for Binge & restrict Cycle

Any form of restrictive diet can lead to binge eating and weight cycling. When we restrict certain foods, we often cycle through feelings of deprivation, overwhelming cravings, guilt, shame, and then a desire to “regain control”. This is a normal physiologic response, and demonstrates why sustainability and “moderation” should be at the core of our food choices.

Keto and PCOS Specifically

The big question remains…WHY do so many people recommend keto for those with PCOS? Honestly, it is because many people assume that weight loss will help manage PCOS symptoms. But in fact, weight does not cause PCOS symptoms and weight loss does not necessarily resolve PCOS symptoms. Through nutrition, lifestyle changes, and supplementation we can reduce symptoms, but weight loss is never a key factor in that.

There are four short term studies looking at keto and PCOS, and zero long term studies. These short term studies lasted as short as 45 days, and as long as 24 weeks. With these four studies combined, there were only 72 participants, which is incredibly small. In all these studies, it was found that the keto diet had a moderate improvements in fasting insulin, testosterone and the LH/FSH ratio. Weight loss did occur, but there was never follow up after the completion of these studies.

This leaves us wondering how the participants did after the study. Was the keto diet sustainable? Did labs remain at these improved values? How is the emotional health of these participants given what we know about weight cycling and eating disorders?

If Not Keto, Then What?

It is important to remember that PCOS shows up differently in different people. These are just a few ways to support the body, but working with a provider will help you take a more individualized and targeted approach.

1. Focus on how you feel and not so much on weight or body size.

2. Make note of your hunger cues and ensure you are eating enough, especially at breakfast.

3. Include more protein and fat into your meals, paired with carbohydrates to best support blood sugar and satiety.

4. Notice any carb cravings at night, which may be a sign that you haven’t eaten enough, had enough protein, or gotten enough rest.

5. Remember that food is about nourishment, and that means more than just nourishing your body. Food nourishes our soul, so don’t be afraid to enjoy yourself during holidays and celebrations.

6. Consider working with a Health At Every Size and body-positive minded provider to determine additional ways to best support you and your unique health journey.

About the Author

Dr. Hannah is a naturopathic doctor providing whole body adjunctive healthcare to patients in Maine and Massachusetts. She believes every patient has their own unique health journey, which influences her personalized treatment approach. She has a passion for helping women, mothers and families heal and thrive, all while uncovering the root cause of whatever ails them. Her goal is to empower and guide her patients on the path towards healing the mind, body and soul through natural methods of healing. Dr. Hannah sees patients locally in Portland, Maine. Through telehealth, she is happy to serve the people of Lewiston, Ellsworth, Belfast, Bangor, and all the towns in between! She now sees Massachusetts patients through telehealth as well!

Disclaimer

The information provided on or through this website is for educational and informational purposes only. This information is not a substitution for proper and personalized medical diagnosis or treatment. Always seek the advice of your physician or trusted healthcare provider before making an adjustments or changes to your healthcare regimen. Natural medicine is not inherently harmless, and therefore it is important to speak with your healthcare providers for personalized medical advice.