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

Ali Miller, R.D., L.D., CDE
Registered Dietitian & Certified Diabetes Educator
By Ali Miller, R.D., L.D., CDE
Registered Dietitian & Certified Diabetes Educator
Ali Miller R.D., L.D., CDE is a Registered Dietitian and Certified Diabetes Educator with a naturopathic background.
Keto Diet Starter Grocery List
Image by mbg Creative

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.

So, let's dig into the hormonal, metabolic, and structural shifts that can occur with a healthy keto diet to reduce the symptoms and imbalances associated with PCOS.

What is PCOS?

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 is no definitive diagnosis for PCOS. In fact, some women will be diagnosed based on symptoms alone. Some health care professionals will do an ultrasound to confirm the presence of ovarian cysts and assess follicle health; however, even without the cysts themselves, women can be diagnosed due to:

  • Irregular cycles
  • Painful periods
  • Weight gain
  • Centralized body fat
  • Elevated blood sugar
  • Elevated insulin
  • Excessive facial or body hair growth
  • Male-pattern baldness, thinning hair on head
  • Acne
  • Anxiety or depression
  • Elevated DHEA and/or testosterone
  • Low levels of progesterone
  • Elevated estrogen levels
  • Low FSH and elevated LH

How the keto diet can help with PCOS symptoms.

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.

Here's how nutritional ketosis can help with four of the top causes of PCOS:

Insulin-resistant PCOS

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.

This is why metformin, an oral hypoglycemic drug, is often used to manage and bring down glucose levels, which then, in turn, supports healthy hormone response, but you can achieve glucose regulation with the dietary intervention of ketosis.

 Inflammatory PCOS

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.

But when the body is producing ketones as a fuel source, inflammatory markers tend to go down3. Ketones decrease oxidative stress, increase antioxidant levels, and scavenge free radicals. These three mechanisms are argument enough to employ a keto diet to reduce inflammation in the body. You can even enhance the anti-inflammatory effects if you ensure your keto diet has an abundance of phytocompounds, botanicals, and omega-3 fatty acids.

Stress-induced PCOS

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.

Use of a ketogenic diet can enhance pituitary hormone production, including improved FSH and LH levels, by leptin affecting the hypothalamus to stimulate the regulatory reproductive hormones.

Nutrient-deficiency PCOS

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

Omega-3 fatty acids are a known anti-inflammatory fat found rich in sources of wild-caught fish and in moderate levels in pasture-raised meats, eggs, flaxseed, algae, and leafy greens. Omega-3s can support healthy cellular membrane function5 and signaling while reducing inflammatory chemicals circulating in the body. 

Tips for managing PCOS with the keto diet.

With food as medicine, it is always a double-edged sword, equally about abundance as it is about restriction. Start reducing carbs and play with a whole-foods-based ketogenic diet while enhancing your body's function with targeted nutrients and antioxidants. Here are some of my top tips:

  • Eliminate refined processed carbohydrates and downshift your carb intake to experience the benefits of a ketogenic diet.
  • Limit fruits to low-glycemic options and predominantly berries, which are rich in antioxidants to reduce oxidative stress.
  • Aim for 2 to 3 cups of leafy greens daily to support liver health and hormone regulation in the colon while providing B vitamins for hormone balance.
  • Have a serving of 4 to 6 ounces of wild-caught fish at least two to three times a week for omega-3 fatty acids and vitamin D support.
  • Incorporate citrus and citrus zest into your dishes for a boost of inositol. 
The views expressed in this article represent one expert’s take on this topic and may not be representative of mindbodygreen's perspective. The information here is not a substitute for professional medical advice
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Ali Miller, R.D., L.D., CDE author page.
Ali Miller, R.D., L.D., CDE
Registered Dietitian & Certified Diabetes Educator

Ali Miller R.D., L.D., CDE is a Registered Dietitian with a naturopathic background and a contagious passion for using nutrients and food as the foundation of treatment protocols and programs. She received her bachelor's in nutrition and dietetics from Bastyr University. She is the author of the cookbook Naturally Nourished: Food-as-Medicine for Optimal Health, The Anti-Anxiety Diet, and The Anti-Anxiety Cookbook.

Her Food-As-Medicine philosophy is supported by up-to-date scientific research for a functional integrative approach to healing the body. Ali is a certified diabetes educator (CDE) and renowned expert in the ketogenic diet with over a decade of clinical results using a unique whole foods approach tailored to support thyroid, adrenal and hormonal balance.

Ali’s message has influenced millions through the medical community and media with television, print, and her award winning podcast, Naturally Nourished. Ali’s expertise can be accessed through her website: offering her blog, podcast, virtual learning, and access to her practice and supplement line Naturally Nourished.