How A Keto Diet Could Help Boost Fertility, According To Experts
Fertility struggles are an incredibly frustrating and stressful issue affecting far more people than you might expect. In fact, over 6 million couples in the U.S. (or one in six) experience these issues.
The sad part, fertility problems are rarely addressed holistically—and much of the focus remains solely on the reproductive system. I have so many friends who are going through IVF, IUI, or other forms of fertility treatment without support from their team on what supplements to take (beyond a prenatal), what foods to eat, or on monitoring their vitamin and inflammatory levels. This can often lead to unsuccessful treatment outcomes if the woman is still under chronic stress, hormone-suppressed, malnourished, or inflamed.
The good news: As a functional medicine dietitian, I've found that diet and nutritional status can significantly influence your inflammation and hormones, essentially pressing the reset button on your body's fertility.
Throughout my career, I spent a lot of time creating protocols for autoimmune disease, metabolic syndrome, weight loss, digestive distress and disease, and balancing women's hormones (focusing on PCOS), and I had been using a ketogenic diet in practice to reduce inflammation and aid in gut restoration, blood sugar balance, diabetes management, and body fat loss. But it was not until I started to have trouble getting pregnant myself that I started to explore how these anti-inflammatory, gut-restoring, and metabolic impacts could influence fertility and healthy conception.
In fact, for the first six years of using the ketogenic diet as a tool in my clinic, I didn't think I "needed" to go keto myself, as my blood sugar was balanced, I wasn't overweight, and I wasn't chronically inflamed. But after seeing what seemed like the 50th client get pregnant after completing my ketosis protocol (it always seems like everyone is getting pregnant around you when you're trying to conceive), I decided to give it a go and explore the mechanisms of action. Spoiler: I now have a 3-year-old daughter—so needless to say, it worked for me too.
4 health issues that drive fertility struggles + how ketosis may help.
Here, I want to unpack some of the main issues that contribute to fertility problems, their typical conventional treatments, and how entering a state of nutritional ketosis can serve as an effective natural alternative:
The issue: insulin resistance
When insulin levels are elevated, hormonal signaling is often affected and the likelihood of ovulation is lessened.
Role of keto in insulin resistance: A very low carbohydrate diet and being in a state of nutritional ketosis reduces the body's levels of insulin because far less insulin is needed to maintain balanced blood sugar. The mobilization of fat (via the production of ketones from body fat) can also aid in insulin sensitivity, enhancing signaling of hormones in the body. In overweight women, using a keto diet to combat insulin resistance will likely yield weight loss as well.
The issue: pituitary dysfunction
The pituitary gland in your brain makes the gonadotropin-releasing hormone (GnRH), follicular stimulating hormone (FSH), and luteinizing hormone (LH). These three players influence hormone production as well as the maturation and release of a healthy egg in ovulation. But when the pituitary gland isn't functioning optimally, these processes are impaired and you have trouble getting pregnant.
Common drug intervention: Clomiphene (Clomid) regulates the estrogen receptors in the hypothalamus (the regulation center of the brain), promoting up-regulation of the hypothalamic-pituitary-gonadal axis (HPG axis). This, in turn, aids in ovulation by causing the pituitary gland to release more FSH and LH, which stimulate the growth of an ovarian follicle containing an egg.
Role of keto in pituitary dysfunction: Levels of leptin, a satiety hormone, are optimized on a ketogenic diet due to the use of body fat as fuel and the increased consumption of fat. This hormone provides a "safety signal" to the body's regulatory system, the hypothalamic-pituitary-adrenal (HPA axis), by docking to the hypothalamus and telling the body to support functions of the parasympathetic ("rest and digest") state over the sympathetic ("fight or flight") state. This positive impact of leptin on the hypothalamus stimulates the HPG axis and enhances pituitary function, triggering the appropriate reproductive hormones to be released.
The issue: androgen hormone excess and elevated DHEA levels
When the body is in chronic stress, the HPA axis is in overdrive and the HPG axis is suppressed. Often in this scenario, women will make more androgens ("male hormones") or adrenal hormones. This includes the androgen testosterone as well as DHEA, which is considered an "adrenal androgen." Hormones made by the ovaries, on the other hand, will be suppressed. This androgen hormone imbalance is also seen in polycystic ovarian syndrome (PCOS).
Common drug intervention: The blood pressure drug spironolactone (Aldactone) blocks the action of the adrenal hormone aldosterone, functioning as a diuretic to increase the amount of sodium and water excreted by the body. Because the drug's "blocking" effects are on the adrenals, the drug also reduces androgen hormone excess in females, thus reducing DHEA and testosterone levels.
Role of keto in DHEA levels: DHEA is metabolized in the production of ketones, and so the ketogenic diet is likely the most direct effective way to reduce DHEA levels, balance hormones, and counter androgenic excess. The keto diet also supports overall hormone balance by regulating insulin levels. Additionally, if someone who is overweight loses body fat on the ketogenic diet and inflammation goes down as a result, the production of hormones by the ovaries will likely be improved as well.
The issue: body composition
Both excessive body fat and insufficient body fat with low fat intake can drive hormone imbalance. We often see estrogen dominance in individuals with high body fat, and insulin resistance can result in elevated testosterone levels that interfere with ovulation and fertility.
Common diet recommendation: Weight loss in obese individuals is often encouraged when starting to address fertility challenges, but often guidance isn't provided to ensure the diet is supportive of hormone shifts and a reduction of inflammation. Also, if a woman is underweight, she often isn't told about the importance of increasing healthy fats as an essential building block for hormone production. This "permission" to eat more fat is extremely important, though, as underweight women may be intentionally restricting fats to keep their weight down and suppressing hormones as a result.
Role of keto diet in body composition: A whole-food approach to nutritional ketosis that includes leafy greens, cruciferous vegetables, wild-caught fish, pasture-raised proteins, and an abundance of healthy fats from olive, avocado, coconut, nuts, seeds, and quality animal products can provide a rich source of bioavailable B vitamins, hormone-regulating indole-3-carbinols (I3C), omega-3 fatty acids, antioxidants, and saturated fats—all of which are building blocks of hormone production and cell membrane support. The food-as-medicine approach to nutritional ketosis that I implement (which includes carb cycling) serves to reduce inflammation, gut stress, and hormone imbalance while promoting optimized antioxidant status and delivering the nutrients needed for the production of healthy eggs and the protection of membranes for healthy implantation.
If overweight, the use of a whole-foods keto diet can aid in body fat loss, thus enhancing insulin sensitivity, and when paired with detox-supportive foods like cruciferous veggies, keto can aid in the reduction of excess estrogen and support liver health. If underweight, the higher fat focus of the ketogenic diet will aid in hormone production and leptin signaling.
Can you stay on a keto diet throughout pregnancy?
Keto shouldn't be your focus during pregnancy. Instead, listen to your body and focus on abundance and nourishment over carbohydrate restriction. In the first trimester, your insulin levels will be surging to aid in the growth of your baby's tissues and organs. During this time, it will be helpful to increase carbohydrate intake to prevent hypoglycemia and nausea. However, I still recommend maintaining a relatively low-glycemic diet by pairing all carbohydrates with a protein or healthy fat. Craving a crisp apple? Go for it, but dip each slice in some almond butter. Want to sink your teeth into some sweet potato? Absolutely, but roast up those cubes in coconut oil and serve them with some protein and nonstarchy veggies for a balanced meal.
Ketones (your main source of fuel on a keto diet) are not inherently harmful to babies, though. In fact, they are a necessary fuel source to aid in fetal brain development, and they provide fuel for you and your baby during those times when you may be too nauseous to eat during pregnancy. Due to increased energy demands, a pregnant woman is actually three times more likely to produce ketones than a nonpregnant female, so you don't need to overly restrict carbs to gain some of the benefits of nutritional ketosis when pregnant.
For these reasons, I don't set a carb goal for pregnant women. Instead, I recommend women take an intuitive approach to carb control (your body will likely tell you what it needs) and consuming an abundance of nutrient-dense whole foods containing plenty of vitamins, minerals, proteins, and fats to support optimal fetal development.
Bottom line on keto and fertility.
Due to its beneficial effects on hormones, blood sugar, and body composition, the ketogenic diet can be an extremely useful tool in boosting overall health and fertility if you're trying to conceive. However, due to the fact that multiple issues may be contributing to your particular fertility struggles (every woman is different), it can be beneficial to work with a health practitioner as you make the shift to a low-carb diet. Additionally, I find that women tend to have more success on keto when they incorporate carb cycling, which includes increasing carb intake two days a month to support healthy hormone production.
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: www.alimillerRD.com offering her blog, podcast, virtual learning, and access to her practice and supplement line Naturally Nourished.