The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: A pilot study

(Meeping up the Science!) #1

Background
Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age and is associated with obesity, hyperinsulinemia, and insulin resistance. Because low carbohydrate diets have been shown to reduce insulin resistance, this pilot study investigated the six-month metabolic and endocrine effects of a low-carbohydrate, ketogenic diet (LCKD) on overweight and obese women with PCOS.

Results
Eleven women with a body mass index >27 kg/m2 and a clinical diagnosis of PCOS were recruited from the community. They were instructed to limit their carbohydrate intake to 20 grams or less per day for 24 weeks. Participants returned every two weeks to an outpatient research clinic for measurements and reinforcement of dietary instruction. In the 5 women who completed the study, there were significant reductions from baseline to 24 weeks in body weight (-12%), percent free testosterone (-22%), LH/FSH ratio (-36%), and fasting insulin (-54%). There were non-significant decreases in insulin, glucose, testosterone, HgbA1c, triglyceride, and perceived body hair. Two women became pregnant despite previous infertility problems.

Conclusion
In this pilot study, a LCKD led to significant improvement in weight, percent free testosterone, LH/FSH ratio, and fasting insulin in women with obesity and PCOS over a 24 week period.

(Richard Morris) #2

Wow. That’s pretty much a categoric success.

Significant reduction in all the markers of PCOS, plus a massive drop in fasting Insulin. Plus a bonus that of 2 of the 11 women fell pregnant (after being infertile) in the 6 months of the study.

That’s pretty much the ballgame right there. I can’t understand why a low carb diet isn’t the primary treatment for PCOS.

(Meeping up the Science!) #3

Yep. It makes sense though, since insulin is neuroendocrine, especially, and it has such a global effect.

I’m not sure why, either. Certainly better than the usual treatment (metformin, try to lose weight eating low-fat cupcakes, etc.)

(AnnaLeeThal) #4

I believe that I have basically reversed my PCOS in the last three months using Keto, or at least most of my symptoms and biomarkers of this syndrome. My fasting insulin is 3.6 and my A1C came down to 4.9 from 5.6. I had been on Metformin for the past 9 months or so with little to no effect on my PCOS symptoms. I love seeing this scientific evidence to back up Keto for PCOS.

When I went to my midwife more than a year ago for pre-conception counseling I expressed my concerns with my known glucose intolerance and previous gestational diabetes, and that I was planning to go on a diabetic diet as soon as I got pregnant. All she told me was to get my BMI below 27, that the evidence pointed to healthier pregnancies with a starting BMI of 27 or below. At this point I did not have a diagnosis of PCOS, but I knew in my heart that I did have it based on all the symptoms: acne, central weight gain, facial hair, glucose intolerance, hx of GD, late or absent ovulation. I became pregnant, had a glucose tolerance test (worst thing ever) which I failed miserably, and then miscarried. My OB put me on metformin after this because I told him I presumed I had PCOS. I got pregnant again and miscarried again. 6 months after the last miscarriage I decided to go Keto after some research and I am hopeful for much better results in the fertility category than we have had over the last year.

I will be preaching the successes of Keto to my midwife and OB specifically for the treatment of PCOS patients because it certainly contributes greatly to improved quality of life for those of us who struggle so much with this frustrating syndrome with oftentimes heartbreaking results. I will email this study to my midwife to make sure she knows about it, and to tell her how much success I have had with Keto for weigh loss and numerous other NSV’s.

(Meeping up the Science!) #5

PCOS sees a decrease and fertility sees a boost from ketogenic diets, as well as weight loss.

People who have WLS actually become super fertile post-op for this reason. You lose weight quickly which floods the body with stored hormones. Also, the hormonal balance is re-established, too. It is much the same way for just a ketogenic diet.

That is so wonderful, @AnnaLeeMI! Thanks for sharing your experience :slight_smile:

(jketoscribe) #6

The BMJ published an article on the use of low carb diets and Metformin in 1998 http://www.bmj.com/content/317/7154/329.1 which, to my knowledge was the first comprehensive recognition of the role insulin resistance plays in PCOS. I found the article first (thanks to a Dear Abby column) found a “cutting edge” endocrinologist who put me on LCHF and Metformin and warned me I could get pregnant. I laughed in his face and gave birth to my youngest child a little more than a year later at age 41.(she’s now 16).

Point is that this is NOT new. It’s been known for a good while, and shame on all the medical community that continues to push low fat diets and fertility drugs on women with PCOS, blaming them for “causing” PCOS by “allowing” themselves to become obese.

(melinda) #7

There’s a PCOS specialty clinic in Jacksonville, FL that puts you on a keto style diet.

(miriamdrew) #8

I’m 38, and I was diagnosed with PCOS almost 20 years ago. I have previously taken Metformin and found it didn’t make me feel good and it lowered my quality/enjoyment of life. Jump ahead many years. I had endoscopic surgery to remove endometriosis and finally conceived. It took two years for our first child and 18 months for our second. Yay :two_hearts:. Recently the other symptoms (exhaustion, hair loss, unwanted hair, etc) prompted me to go to a naturalpath to see if she had a better way. She pointed me to low carb, no sugar. She never guided me to high fats though so I wasn’t keeping to it, I didn’t know how​:disappointed:. A friend taught me and I’ve been going strong for maybe 4 months? (I should find out my start date) Anyway, when I first went to see her I had an ultrasound of my ovaries to verify my PCOS diagnosis. The ultrasound tech referred to my cysts as strings of pearls. Seeing the image they looked more like bunches of grapes. Jump ahead three months for another ultrasound (different reason) and I asked the tech to show me my ovaries… she confirmed I had PCOS but what was different was that the grapes looked more like raisins! So a definite NSV! I have so much energy now and I haven’t had any hypoglycemic episodes!

(Kelly Gallagher) #9

I have/ had? PCOS. I have a daughter that is 10 (had when I was 20). She was my first and only pregnancy. I am 30 now I have done off and on Keto past couple years, after being back on it for months I just found out I was pregnant. NEVER thought that would happen again, I definitely think this woe is what did it, other than ya know the actual act lol.

(AnnaLeeThal) #10

Well they say butter makes your pants fall off…

(Brian Miller) #11

I’ve wondered this for a while now.

(jketoscribe) #12

With the exception of a small number of enlightened physicians, LCHF isn’t the standard treatment for anything. Shouldn’t it be for metabolic syndrome and diabetes as well???

But there is a deeper reason with PCOS. The medical community firmly believes that women CAUSE PCOS by “allowing themselves” to become obese. Therefore they should be following the standard weight loss prescription–eat less, move more, low fat, high carb.

There is so much fat shaming among the medical profession in general and particularly among the professionals who treat PCOS–especially endocrinologists.

Women are told to “just” lose weight and PCOS will improve. An endo who is the department head at a local very big hmo denies women with PCOS treatment “until they lose weight”, and then all he offers is birth control pills (which treat symptoms and not the underlying metabolism).

Thin women with PCOS may be told the diagnosis is wrong because they aren’t fat, or sometimes they are told they have a form of PCOS without insulin resistance because they are thin. I have come to believe there is no such thing as "non-insulin resistant PCOS, but a lot of thin women with PCOS like to believe there is.

My 16 year old daughter has all the issues of PCOS including sky high insulin and testosterone levels, acanthosis nigricans, severe acne and amenorrhea. But I had to fight to get her tested because she is thin and “couldn’t possibly have PCOS”. Tests showed she most assuredly DOES. But when she sees other doctors they try to tell me she can’t have it because she is thin.

One stupid endo even told my very thin then-13 year old that the best way to treat PCOS was to lose weight. WTF???

And the diet she suggested? Low fat, lots of whole grains, fruits and vegetables.

Sigh …

(Brian Miller) #13

Excerpt from women’s health.gov
"The exact cause of PCOS is not known. Most experts think that several factors, including genetics, play a role:

High levels of insulin. Insulin is a hormone that controls how the food you eat is changed into energy. Insulin resistance is when the body’s cells do not respond normally to insulin. As a result, your insulin blood levels become higher than normal. Many women with PCOS have insulin resistance, especially those who are overweight or obese, have unhealthy eating habits, do not get enough physical activity, and have a family history of diabetes (usually type 2 diabetes). Over time, insulin resistance can lead to type 2 diabetes.

BINGO!!!

You will have insulin sensitive and likely T2D but they FAT SHAME you ladies by saying you need to exercise and eat the way they’ve been telling you to (which we know is WRONG)

IMHO—PCOS might just be another symptom of Insulin Sensitivy that often presents before or alongside other symptoms. Regardless the most simplistic and likely most effective treatment is a Ketogenic Diet. It bothers me that the medical community is as far behind the curve as they are.

(Marc) #14

Thank you for saying it. I’ve always thought this. The medical community should be absolutely ashamed of itself. The medical community should be much further ahead of the curve on LCHF than two programmers. Yet, here we are… On the one hand it makes me want to laugh, on the other hand it makes me want to cry.

(Marc) #15

The more I think about this the angrier I get. I trust Richard and Carl when it comes to FUNDAMENTAL issues (not to mention the arcana) of nutrition. I don’t, however, trust my average doctor or nutritionist. This is like saying, I trust my average doctor or nutritionist when it comes to setting up a website or programming, but I don’t trust Richard or Carl to do that.
When I think about this it is absolutely bizarre beyond belief or explanation.
SHAME on the medical community.

(Becky Stratton Cooper) #16

I am using Keto to self treat low progesterone, recurrent miscarriages (my 4th MC started a week ago), and what I guess is PCOS - the only symptom I don’t have is irregular periods/absent ovulation. I have clockwork cycles every 27 days. But it is/has been nearly impossible for me to lose weight. I gain muscle almost as soon as I start an exercise program, but will not lose weight no matter how little I eat of a “traditional” weight loss diet.

I have done Keto in the past, but was not really committed to the lifestyle. I feel like I am on the right path finally.