Top 8 reasons to adopt a low-carb diet for polycystic ovarian syndrome

jessica

Jessica – Before and after

Many people come to Diet Doctor because they are looking for help to lose weight or reverse type 2 diabetes. But did you know that almost all the symptoms of a common female condition called Polycystic Ovarian Syndrome (PCOS) respond very well to a low-carb or ketogenic diet, too?

So what is PCOS? It’s a reproductive disorder that affects about 10 per cent of all women. The symptoms are upsetting: infrequent or absent menstrual periods, infertility, weight gain, acne, facial hair growth such as mustaches and sideburns, sometimes even losing scalp hair.

Blood tests almost always show insulin resistance and higher male hormones. Often the ovaries are found on ultrasound to be dotted with cysts.

Women with PCOS are typically treated with a cocktail of drugs: birth control pills, medications to stop male hair growth, the diabetes drug metformin to lower blood sugar, sometimes medications for depression and anxiety. Then, if they want to get pregnant, fertility drugs are usually given to try to stimulate ovulation. At least 50 per cent of the time the fertility drugs don’t work and other techniques, such as in vitro fertilization are tried.

PCOS

But there’s a simpler way to potentially get dramatic results: try a low-carb high-fat diet.

“Cutting carbohydrates to less than 20 total grams and boosting fat to 75 per cent of the diet rapidly restores periods, increases fertility, and greatly improves distressing symptoms like acne and weight gain,” says Dr. Michael Fox, a fertility specialist at the Jacksonville Center for Reproductive Medicine in Florida. Dr. Fox answers our members’ questions about using low-carb and keto diet to improve reproductive and metabolic issues.

I wish I had known about the low-carb high-fat diet for PCOS when I was diagnosed with the condition at age 19. It would have saved me years of frustration, sadness, infertility, and feeling that I was somehow defective as a woman.

“PCOS really undermines your self-confidence and happiness,” agrees Jessica Shotwell Walker, of Atlanta Georgia, who was diagnosed at 18 and struggled for almost 20 years with the condition. “I never felt like a ‘real girl’ until I was fully keto and my cycles finally became monthly. I felt ugly and unloveable for many, many years.” She has now maintained a low-carb ketogenic lifestyle for 10 years and all her symptoms have resolved. She is the picture of vitality and vigor. “I’ve never been happier, healthier, more athletic or more full of positive energy,” she says.

Here are eight reasons, backed by scientific research, why women with PCOS should try eating a low-carb ketogenic diet.

1. We may be genetically programmed, from ancient times, to thrive on low-carb or keto eating

PCOS is now known to be a complex genetic condition, found in all ethnic groups, that has been around for at least 150,000 years.1 But why would a disorder that impairs fertility persist across millenniums?

Genetic researchers believe that it once conferred a distinct evolutionary survival advantage to both women and their children in Paleolithic times, likely bestowing improved strength and disease resistance, better energy utilization, better spacing of children, and better ability to survive famines.2 What is different today than 100,000 years ago? Our constant high consumption of sugar and carbohydrates. That is why cutting them out may have such a dramatic impact on PCOS symptoms. Carbs, it seems, may be the wrong fuel for our finely tuned genetic engine that was built eons ago.

2. Insulin resistance and glucose intolerance improve

Despite its name, cystic ovaries are not found in all women. But almost all women with the condition – whether thin or obese – show greater insulin resistance and impaired glucose tolerance than women without the condition.3

“It is insulin that really drives the whole process,” says Dr. Fox. “And insulin release is caused by carbohydrates.” In fact, a debate is ongoing that the name should be changed to “metabolic reproductive disorder.”4 Numerous studies are now showing adopting the low-carb ketogenic diet improves insulin sensitivity and glucose intolerance among those with PCOS.5

3. Periods and fertility rapidly return and pregnancies result

Dr. Fox has been treating thousands of women with PCOS with low-carb diets for 17 years now. He notes that within two to three months of cutting the carbs, most of his patients’ periods normalize. “As we introduced the low-carb high-fat diet, we changed the metabolic picture, and the insulin levels came down, our pregnancy rates went up to 90 to 95 per cent.”

A 2005 pilot study on a low-carb diet for PCOS, of which Dr. Eric Westman was an author, found hormone profiles improved and two previously infertile women spontaneously conceived after adopting a ketogenic diet.6 Low-carb baby stories abound. “LCHF helped me get pregnant,” said Swedish mom Isabel Nelson, whose story we’ve previously told. In the comments, more women told of their LCHF baby successes.

Here’s a longer post on the topic:

Trying to Conceive? Try the Better Baby Diet of Beef, Butter & Bacon

4. Excess weight is lost

JessicaLike many of the people who find Diet Doctor to help them lose weight, women with PCOS who cut carbs and increase the fat can experience significant weight loss. “I couldn’t believe it happened so fast,” said Annie, who was diagnosed with PCOS at age 24 and told her story of getting down to a healthy weight in just three months.

Jessica Shotwell Walker lost 65 lbs (29 kg) and has kept it off for 10 years, see the image of her playing tennis to the right. I lost 10 lbs (5 kg). A number of studies are showing removing carbohydrates and replacing them with high-fat foods is the most promising treatment for obesity in PCOS.7

5. Acne improves

One of the upsetting features of PCOS is a higher tendency to acne that arises not only in adolescence but persists into adulthood. In recent years, numerous studies have shown reducing the glycemic load (i.e cutting out carbohydrates that rapidly convert to sugar) greatly improves acne, whether people have PCOS or not.8

While so far studies specifically focusing on treating the acne in PCOS using carbohydrate restriction are very limited, a number of testimonies9 on Diet Doctor attest to dramatic improvements in skin condition by adopting a low-carb ketogenic diet. “For the first time in 15 years I am free of acne,” said Laura. So what do you have to lose by trying the keto diet? Maybe the breakouts.

6. Anxiety and depression may ease

With an increased propensity for weight gain, acne, facial hair growth and infertility it is little wonder that women with PCOS tend to have greater incidence of anxiety and depression than women without the condition.10 Are the mood issues emotional in response to the symptoms or actually caused by sub-optimal nutrition for our genetic type impacting key receptors in the brain?

While research is still very limited around the relationships between our genes, the foods we consume, and our mental health,11 low-carb ketogenic experts report anecdotal evidence that anxiety and depression lift among their patients adopting a low-carb ketogenic diet. Shotwell Walker agrees. “I have never felt happier.”

7. Bulimia may improve or resolve

Many studies have found that the incidence of bulimia is greatly increased among women with PCOS. In the past this finding was used to dismiss women with PCOS as having psychiatric problems that contributed to their reproductive disorder, concluding that the bulimia came first and the PCOS later.12 But what if the genetic intolerance to carbohydrates in a carb-rich world triggers bulimia among PCOS women?

The theory is that genetic inability to handle an abundance of glucose and carbs fuels a cycle of insulin and glucose spikes and crashes, which fuel carbohydrate cravings and purgings.13 It’s as if the body is desperate to get the nutrition it needs for its optimal performance, leading to binging and then purging when the wrong foods (high levels of sugar and carbohydrates) are consumed.

Scientific research is lacking, but anecdotal evidence shows binge-eating disorders can be helped by the ketogenic diet, which reduces cravings and greatly reduces the bulimic tendencies. “With keto, you lose your cravings for starches and sugar,” posted one woman in a bulimia discussion thread online.14 “That is such a relief!”

8. Improved pregnancies and reduced risks of health problems after menopause with ketogenic diet

Most of the focus on women with PCOS is in the adolescent and early adult years when infertility, acne and weight gain are the prominent features. But women with PCOS who get pregnant have much higher rates of complications during pregnancy including gestational diabetes (a disorder of carbohydrate intolerance), pre-eclampsia (high blood pressure during pregnancy) and bigger babies over 9 lbs (which are a risk for Caesarean deliveries and an independent risk for future diabetes.)15

Moreover, women in menopause, who had PCOS, have higher rates of cardiovascular disease, high blood pressure, and type 2 diabetes.16 Research is limited, but the entire profile of PCOS suggests limiting carbohydrates and adopting a low-carb ketogenic diet may help with all these related problems, no matter what the age and stage of PCOS in affected women. “I know I have to stay on a ketogenic lifestyle for life. My problems rapidly return if I return to eating carbohydrates,” says Shotwell Walker.

And here is a surprising bonus: male relatives may benefit, too

Think that only women have the genes? Not so. Recent genetic findings show that male relatives – fathers and brothers — of women with PCOS also have a tendency to increased insulin resistance, type 2 diabetes, and cardiovascular disease.17 All of these conditions improve on a low carb ketogenic diet.

An interesting finding is that the only apparent outward symptoms of male relatives of women with PCOS are early male pattern baldness before age 30 and excessive body hair.18 Will adopting a ketogenic diet help slow male pattern baldness and halt the furry look among men with the PCOS genes? It’s too soon to tell.

If you have PCOS and have adopted the low-carb or ketogenic diet, we welcome your comments, results and experiences. Share them with us, by leaving a comment below.


Anne Mullens

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  1. Journal of Clinical Endocrinology and Metabolism: Perspectives in Polycystic Ovary Syndrome: From Hair to Eternity

  2. Fertility and Sterility: Polycystic Ovary Syndrome: An Ancient Disorder?

    Reproductive BioMedicine Online: An Evolutionary Concept of Polycystic Ovarian Disease: Does Evolution Favour Reproductive Success Over Survival?

  3. Endocrine Reviews: Insulin Resistance and the Polycystic Ovary Syndrome Revisited: An Update on Mechanisms and Implications

    The Journal of Clinical Endocrinology & Metabolism: Glucose Intolerance in Polycystic Ovary Syndrome—A Position Statement of the Androgen Excess Society

  4. Endocrine Web: It’s Time to Rename Polycystic Ovary Syndrome

  5. Yes, a Low-Carb Diet Greatly Lowers Your Insulin

    Nutrition and Metabolism: The Effects of a Low-Carbohydrate, Ketogenic Diet on the Polycystic Ovary Syndrome: A Pilot Study

  6. Nutrition and Metabolism: The Effects of a Low-Carbohydrate, Ketogenic Diet on the Polycystic Ovary Syndrome: A Pilot Study

  7. Minerva Endocrinologica: The Effect of Dietary Carbohydrates in Women with Polycystic Ovary Syndrome: A Systematic Review

  8. Neuropsychiatric Disease and Treatment: Polycystic Ovary Syndrome and Mental Disorders: A Systematic Review and Exploratory Meta-Analysis

  9. Journal of Psychosomatic Research: Binge Eating and Menstrual Dysfunction

  10. Dr. Briffa: Why Bulimia Is Not All in the Mind, and the Dietary Approach That Can Put a Stop to This Condition

  11. Reddit: Eating Disorders and Keto

  12. Human Reproduction Update: Pregnancy Complications in Women with Polycystic Ovary Syndrome

  13. Climacteric: Polycystic Ovary Syndrome and Metabolic Syndrome: The Worrisome Twosome?

  14. Northwestern Medicine: PCOS Research Points to Gene Defect

    Medical Hypotheses: Polycystic Ovary Syndrome in Men: Stein-Leventhal Syndrome Revisited

  15. Endocrine Regulations: Premature Androgenic Alopecia and Insulin Resistance. Male Equivalent of Polycystic Ovary Syndrome?

19 Comments

  1. Brittany
    I have been on a Keto diet for 2 months. I have PCOS and have had very irregular periods my whole life. After 4 weeks of the Keto diet I started my period naturally! After 6 weeks I lost 14lbs total. I started at 148 and now I'm at 131. I'm about 5'4". Now I am in my two week wait hoping I get pregnant soon. Been trying for almost 7 years.
  2. Anne
    Great to hear Brittany! Let us know how it goes.
  3. Corinne
    Any chance it could also help with the symptons of the menopause?
  4. Jan
    When I adopted an LCHF diet I was 40 years old and had been infertile all my life due to PCOS. I had to go through three grueling years of infertility treatments culminating in two IVF procedures to conceive my first child. The endo who recommended LCHF for my health told me I could get pregnant on this diet and l laughed at him. No way.

    Within 30 days I had my first ovulatory period EVER without fertility drugs. I had regular periods after that and 6 months later I was (to my utter surprise!) pregnant. I delivered a healthy baby girl when I was age 41 after an easy, comfortable pregnancy.

    Corrinne, I'm now through menopause and I did find it incredibly easy! I had a lot of hot flashes, but found that increasing my fat intake (natural fats, not processed oils) helped keep the hot flashes under control. I feel so much better and give all the credit to LCHF. I am actually very happy to be done with cycling and all the issues PCOS caused with menstruation. I'm NOT "cured" of PCOS just because of menopause, but my symptoms are very well controlled with LCHF.

    One thing I will say is that thin women with PCOS often assume (and--more importantly--their doctors assume) that they are not insulin resistant. My guess is that they ARE insulin resistant, but their doctors have not run the correct tests. An HbA1c and a fasting BG will NOT tell someone they are insulin resistant until they are already well into the latter stages of what Dr. Joseph Kraft calls "diabetes in situ". I think PCOS is highly underdiagnosed because doctors tend to think that obesity causes PCOS, when there are many thin women with PCOS, too. I started out with PCOS immediately at puberty when I was quite thin. Weight didn't come on until we were monkeying with my hormones when I tried to get pregnant the first time in my late 20's. My 16 year old daughter is experiencing very severe PCOS and is also very thin. She has very high insulin and testosterone levels, but her BMI is only 18%.

  5. Corinne
    Thanks. My hot flashes are awful during the day and make nights unbearable. I rarely sleep more than one hour at a time and wake drenched and excruciatingly hot. This is my 4th year like this! So any hope is great. Bring on the butter, cream and olive oil...
  6. Maya
    Thank you for this article, Anne! PCOS is something I still battle with. Diagnosed when I was 19. I've been eating paleo/primal/LCHF for about 4 years now, switched to keto 10 weeks ago. I definitely feel better, more energy, mental clarity, etc. I lift weights a few times a week and am generally very happy and healthy in life. Unlike most women with PCOS, though, I've always been thin and I don't want to get pregnant (I'm 5'6", 120 lb now). My main problem currently is thinning hair and cystic acne. No matter what I do or how clean keto I eat, my jaw and cheeks are covered in pimples and I notice the hair on my scalp is getting thinner, falling out. It's terrible for my self-esteem and self-image, especially when I see so many women on keto/low-carb clear their skin conditions quickly and seemingly effortlessly. What am I missing here? Any tips or suggestions? I'd really appreciate it.
  7. Anne
    Hi Maya -- glad to hear you are feeling better on keto. I can understand your frustration, however, at having the hair and skin issues persist, as you are right that most of us had those issues resolve on the diet. I would ask this question of Dr. Michael Fox in the membership side of Diet Doctor. He is a world expert in PCOS and might have some insight.
    Reply: #8
  8. Maya
    Hi Anne, thank you for responding. I'm not a member yet but have been following Diet Doctor avidly. This is the extra push I needed to join. I think I may need to try intermittent fasting, but regardless, I look forward to being on the membership side. Thanks!
  9. Cecilie
    Pcos, was told I probably couldn't get pregnant. I'm a nurse and decided to Get myself a Bachelor Degree in Nutriton. Had 5 children. Now working as Healthcenter for Children/teenagers. Everytime I'm dicussing our nutrition advice I wish I had Andreas by my side?. I refuse to give up! Doctors need to wake up!
  10. Kat
    I have been battling pcos since i was 19/almoat 34 now... I have gone up and,down with low carb diets through out these times, and recently have adapted to lchf/keto lifestyle by my own choice. Dr fox presents a lot of great things in this article but I must say that seeing him when I was "fat" at the early atages of my,pc is when I was 21was me to an eating disorder that i battle atill to this day. .... Besides that .. I love my,keto diet ... And love researching researching it on my own I have learned to heal
  11. Jeannine
    I was diagnosed at age 19 in 1976. At the time it was called PCOD (D for disease) or Stein Levanthal (I was told the "fat/bearded circus lady" disease) and I that I would probably never have children. Rough to hear as a sophomore undergrad with her entire life ahead of her. For the next decade relatively few physicians had even heard of PCOD and the only treatment focus was on fertility! If you weren't trying to get pregnant they had no interest in talking to you. Forget about the hirsutism, the acne, the weight gain, the irregular and painful menses... (not to mention the now known link to diabetes/heart disease) "just come back when you're ready to get pregnant and maybe we can help you then." Oh, and I was asked every time I had a pelvic exam if they could bring in other doctors to check my ovaries, because they didn't get to feel polycystic ovaries very often. I truely felt like a freak of nature. In 1986 I lucked out with a physician who was familiar with (now) PCOS, told me it was much more common than I had been told, and put me on a version of the Pill that helped with the symptoms (Demulin 150). I was also told the only possibly cure was to get pregnant, because for unknown reasons that sometimes straightened PCOS women out???
    Fast Forward to today - this article blew me away. Yes I was a fat kid, yes I was bulemic, yes I am an only girl with three brothers who were also fat kids and are very hairy balding men with diabetes and heart disease issues. I feel like the canary in the coal mine! I am not diabetic at this point, I think only because I've had to be so careful with my diet all these years. Both diabetes and heart disease loom on the horizon genetically and unfortunately also dementia brought on by diabetes. I've been doing Keto seriously only for three weeks now, but based on my experience with it so far and the information shared on Diet Dr, Keto will be a life long way of eating for me... I've gone Eskimo!
  12. Linda
    I had my first 2 boys at 24 (after trying to conceive for 2 years) and 25, after that we tried for a third and that's when I found out I had PCOS, we tried fertility treatments but had no luck. I was told I wouldn't be able to have any more children, one tube was scarred and no longer viable and I ovulated maybe 2-3 times a year but it never lead to a pregnancy, life continued. I hadn't been told that LC increases fertility chances but I had eaten that way for several stretches off and on to lose a little weight (5'4" usually 120-125lbs) so at 41 when the scale was nearing 150 I went LC and got a huge surprise only 2 months later! Our 3rd son was born healthy as can be just before my 42nd birthday!! Amazing! Now I eat LC to just keep up with the now 2 years old!
    All obgyn's, fertility doctors and gp's should know about this and encourage their patients to go LC, it very well could lead to sweet blessings!
  13. Lluvia Alvidrez
    Wow !!
    I just got diagnosed with PCOS and i have to say that after reading this article i will start the keto diet as soon as possible. I have to say that i am tired of hearing my family tell me how much weight i have gained. To be honest id didn't happen over night. But today i am at my heaviest weight of 212 lbs. I was frustrated with everything i was doing because it didn't matter what i ate i was gaining weight. But thanks to my DR and many search engines i came across DIET DOCTOR . It makes me happy to know that we are not alone and that we can help our bodies to go back to normal. I know the frustration of when people look at you and stare ! Being healthy is the only thing that matters and feeling good about our body and our life around our family! I will keep you posted with my results and hopefully i can say a baby is on the way soon . Much love for the support and i will be posting this on my Facebook so many other women can read and understand that weight gain can some times be due to PCOS and not due to over eating like many doctors would tell when i walked in to ask for help. In the end all i would do was walk out and cry because i was not being heard.
  14. Jessie
    I have hypothyroidism, and my doctor suspects PCOS with all the symptoms. I'm starting this new diet and I'm looking forward to getting some results. Working out 3-5 days a week I wasn't getting anywhere and now I know why. I'm glad I found that PCOS is linked to bulimia, I've had issues with that previously. It's all making sense now. Can't wait to start!
  15. Anxious
    Did any women lose their beard or grow back head hair? :-(
  16. Love&Sunshine
    I was diagnosed with PCOS in my early 20's. After the onset of menses at the age of 12, my periods were immediately irregular. Mood swings, depression, hirsutism, alopecia, thinning hair, amenorrhea, acanthosis nigrans and obesity came next and with great force. Fast forward thirty years and I’m 5'4" & 324 pounds. PCOS and its’ related symptoms have been mentally, emotionally, physically, financially and socially damaging.

    My journey has been overwhelming and sometimes confusing, as I’ve tried to understand what was going on inside my body and how to heal. I’ve spent countless hours trying to filter through conflicting, biased and inaccurate information regarding obesity and weight loss. I've spent great resources on hair removal, nutritional supplements, prescription medication, books, videos, weight loss programs and processed ‘health’ foods.

    I was told about Diet Doctor through Dr. Jason Fung. I first heard Dr. Jason Fung mentioned by a woman named Samantha. I discovered Samantha on YouTube, late one night, while searching videos related to diabetes, PCOS and obesity. Samantha’s testimonial can be found at: https://idmprogram.com/testimonials/. That’s my journey to Diet Doctor! I believe it was divine providence that led me to this site and decided to join to have access to all of the information.

    I've been reading your stories as I shift my mindset and lifestyle to LCHF. Thank you, to each and every one of you that comment, share stories, post pics, contribute articles and upload videos. Dr. Eenfeldt, thank you for creating this space to promote truth for the betterment of health. I appreciate the site’s clean and simple layout and the clear manner in which information is presented.

    I’m obtaining more clarity now and have begun to sift through my vast library of dieting, weight loss, self-help, nutrition and cookbooks I’ve amassed over thirty years. Two definite categories are emerging in my library now…nutrition and cookbooks.

    I have concluded that the most effective and lasting solutions are the ones tried and true.
    “Let food be thy medicine and medicine be thy food.” – Hippocrates

  17. Jaysea
    I have also had PCOS and the many varied symptoms since a young age. I went on a low-carb/keto diet for 6 months and at 39 had a healthy, happy baby boy. I lost weight (50+lbs) almost effortlessly and regular periods returned. I was healthier and happier than I have ever been before. Im now 43 and, since having my baby, have tried everything except keto to lose weight with ZERO results. Even gastric sleeve surgery did not work!?!! I am here to go back to eating the keto way.. the absolute only thing that has ever worked for me.
  18. Michelle
    I have been Keto since September 2016, I am 70lbs down and feel fantastic! I was diagnosed with PCOS when I was 16 I am now 35. I was told to loose weight but that it would be difficult, and to eat a balanced low calorie diet. But it just didn’t work. I felt like I had no support

    I started keto because I found out I was pregnant but that it was ectopic so It needed to be removed. I was 310lbs and not on keto. Because of my weight they had a hard time figuring out what was wrong. By the time they figured out I was ectopic I had to be rushed in! I was 12 weeks and close to rupturing. The Gynaecologist who did the surgery wrote this website and 20-30grams of carbs on a prescription pad. I have never met this doctor before and I now believe that this event was a blessing in disguise! I was told that It would be very hard to conceive and I reserved my thoughts that’s babies were not in my future and I was happy with that. I’m still happy with that. But if this had not happened I would not have met Dr. Ballerman and I may still be struggling, she is with me every step of the way I could not be happier with advice and support. My husband and I never prevented pregnancy. We have been together for 14 years. So this was all a surprise. But now on the other side I am happier and healthier than I have ever been! There is so much more to the lifestyle than just the weight loss!
    So here are the symptoms that have improved
    - skin is dramatically clearer
    - no longer depressed
    - anxiety is under control
    - confidence has improved
    - willing to try new things
    - obvious weight loss
    - no longer feel like I’m addicted to food
    - hair is thicker
    - nails are stronger
    - sleep better
    - I’m told I glow
    - focused and driven
    - don’t feel overwhelmed with daily tasks
    - have a ton of energy
    - started taking on more hobbies!
    - overall work and life balance is perfect
    This is my life and I am totally ok with it! I make delicious food and I’m never hungry. My weight keeps going down and that’s great! I still have a ways to go. Thanks @dietdoctor you have given me back!

  19. taia
    its really nice to read your post.i am 30 years old and was diagnosed with pcos for few years but i didnt give much attention to it. Though i have consulted to doctorz and took medicines too but not regular.i dont have acne or weight issue.the main problem is shedding of hairs it falls in the form of big snowball.please suggest any good doctor in xian china
    regards
    https://www.healthfitnesz.com/polycystic-ovarian-syndrome-symptoms-tr...

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