Keto Diet Boosts Fertility for Women With PCOS

The ketogenic (keto) diet includes eating low carbs and replacing them with fats — like cheese, eggs, meat, and oils — helping bodies burn energy. Scientists have now found a link between polycystic ovary syndrome (PCOS) and the keto diet.

PCOS impacts approximately five million women in the United States, making it the most common hormone disorder for women. Symptoms of PCOS range from elevated testosterone, irregular periods, excess body hair known as hirsutism, large ovaries, acne, a loss in scalp hair or thinning, and weight gain around the belly. It is also linked to infertility and increases the chances of developing diabetes.

The condition can be maintained and occurs in four stages.

1. Insulin-resistant PCOS occurs due to high levels of insulin. A diet low in carbs and high in fats helps manage this stage.
2. Inflammatory PCOS causes an imbalance of hormones, increasing androgens in the body. The inflammation may be due to environmental factors or an inflammatory diet rich in gluten.
3. Post-pill PCOS is when a woman stops taking an oral contraceptive pill and the body produces excessive androgens.
4. Adrenal PCOS is due to how the body responds to stress, resulting in the body responding abnormally.

While infertility isn't a side effect for everyone with PCOS, it does impact upwards of 70% to 80% of American women who have the condition.

According to a new paper published in the Journal of Endocrine Society, scientists have found a way for women to lose weight, improve fertility, and normalize their menstrual cycles all by focusing on what they eat.

With September being PCOS Awareness Month, the study shines a light on the way in which diet can wreak havoc on hormones and how setting some boundaries or implementing certain foods can change the outcomes of fertility.

We found an association between the ketogenic diet and an improvement in reproductive hormone levels, which influence fertility, in women with PCOS. These findings have important clinical implications, especially for endocrinologists, gynecologists and dieticians who, in addition to medical treatment, should carefully plan and customize individual diet recommendations for women with PCOS.

- Study author Karniza Khalid, M.B.B.S., M.Med.Sc.

During the study, scientists conducted a meta-analysis of clinical trials — four in Italy, two in China, and one in the U.S. — and examined how the keto diet affects hormones, testosterone, progesterone, and weight change.

Women who were on the diet for at least 45 days saw weight loss and an improvement in reproductive hormone levels. Moreover, their follicle-stimulating hormone ratio was at a lower range, meaning they would be able to ovulate. Testosterone levels were also lower, decreasing their chances of excess hair growth on the face.

Khalid tells Healthnews that, "PCOS is a complex hormonal condition," and the induction of ketosis reduces insulin in the blood and suppresses the "stimulus for adrenal and androgen production."

This isn't the first study to show a link between PCOS and the keto diet. Other research has looked at the links between keto and weight loss, as well as keto and diabetes. This study does present significant hope that women with PCOS can treat their infertility by choosing a fattier, low-carb diet.

How is nutrition important for women with PCOS?

Registered dietician and PCOS nutrition expert, McKenzie Caldwell explains that for the majority of folks with PCOS, the root cause is due to insulin resistance. "One of our first lines of treatment for improving symptoms, fertility, and long-term wellbeing is working on balancing blood sugar through nutrition, supplements, medication, and lifestyle changes," she explains.

Eating well-rounded meals when you have PCOS is crucial and can help manage symptoms. Some foods, like french fries, butter, cakes, cookies, sugary beverages, white rice, and alcohol, can cause inflammation in women who have PCOS.

Instead, women with PCOS should opt for omega-3s, such as salmon, olive oil, beans, leafy greens, whole grains, and fruit, for an anti-inflammatory diet. Some experts suggest the Mediterranean diet as it includes high protein, complex carbohydrates, and increased fiber, which can reduce androgen levels.

Khalid says that there is no standardized PCOS keto diet for women. "Hence, we would recommend discussing with the managing physicians for a tailored and individualized regime," she says.

When following a keto diet, 70% of calories come from fat, and it is very restrictive of carbs. The diet has been linked to weight loss and improvements in glucose tolerance.

Caldwell says that most lower carbohydrate diets have many risks, "including low intake of soluble fiber, vitamins, minerals we need for fertility and long-term wellbeing that come from whole foods that contain carbohydrates."

Moreover, people with PCOS are at high risk of having an eating disorder and by prescribing to a diet, they are at even more increased risk.

Overall, Khalid says, "The impact of [the] ketogenic diet on fertility is still unclear, and long-term implications of ketogenic diet among women with PCOS are not adequately studied and still not well understood. Future studies can look into the best study designs to fill this gap."