Ketogenic Diet and Polycystic ovary syndrome

Exploring the potential of the ketogenic diet in managing Polycystic Ovary Syndrome (PCOS), a condition affecting millions of women worldwide. By focusing on low-carb, high-fat foods, this diet aims to regulate insulin levels, reduce symptoms, and restore hormonal balance. Dive into the science behind how nutritional ketosis might offer a new hope for those battling PCOS.

Author: PhD Andreia Torres

With industrialization, the consumption of foods rich in carbohydrates (biscuits, cakes, bread, juices, soft drinks, sweets) increased a lot and, as a result, mitochondria got used to those easy sources of energy. It loses its flexibility to use fats, and if the pathway for generating energy from carbohydrates gets compromised, tiredness soon appears. A dysfunctional mitochondria starts releasing more and more free radicals. The generation of excessive amounts of reactive oxygen species (ROS) is associated with several chronic diseases, including Polycystic ovary syndrome (PCOS) [1].

PCOS is the most common endocrine disorder in women of reproductive age, with an estimated prevalence ranging from 5 to 15%, depending on the diagnostic criteria used [2]. Women with PCOS often have menstrual disorders, clinical manifestations of hyperandrogenism and infertility. Hirsutism (excess facial hair) is a common clinical presentation of hyperandrogenism that occurs in up to 70% of women with PCOS. Other common signs of PCOS are: insulin resistance, reversal of the FSH/LH ratio and obesity. Women with PCOS tend to have a higher percentage of visceral and subcutaneous fat due to higher levels of androgens.

Oxidative stress, inflammation and hyperglycemia are factors that worsen ovarian function. Women with very inflamed ovaries have more menstrual and hormonal problems and also may experience difficulty in getting pregnant. Before using hormones and contraceptives, the best idea is to make lifestyle improvements. Exercise, rest, and diet help the body to heal.

Studies show that the ketogenic diet helps treat polycystic ovary syndrome in several ways: increasing satiety, promoting weight loss, regularizing the menstrual cycle, reducing inflammation, oxidative stress, and insulin levels.

Ketogenic diet ameliorates metabolic disorders

Our ancestors did not have as much food availability, exercised more and easily used fat stores to survive in times of need. When mitochondria is deprived of carbohydrates it regains its efficiency to generate energy from fats, and our body gains metabolic flexibility.

The KD comprises a high-fat component, very low carbohydrates, and adequate proteins. When the liver starts burning fat, it leads to the production of Ketone Bodies (KBs). These molecules enter the bloodstream and can be utilized by the brain, heart, and muscle, where they produce cellular energy in mitochondria. KBs constitute a more efficient energy source than glucose, metabolize faster than glucose, and result in beneficial metabolic changes [3].

Women following a low-calorie ketogenic diet (VLCKD) for 12 weeks experience a reduction in weight, BMI, waist circumference and HOMA index, as well as an increase in progesterone and SHBG levels and a decrease in anti-Mullerian hormone (AMH) levels [4]. A systematic review with meta-analysis published in 2023 concluded that women with PCOS can already experience those metabolic benefits in less than two months [5].

Image source: Zhu et al., 2022

Here is a sample keto menu with about 1,700 kcal, 72% fat, 17% protein and 11% carbohydrates, to help women diagnosed with PCOS improve their levels of glucose, insulin, Homa-IR, triglycerides, cholesterol and sex hormones:

Breakfast	grams	Fat	Pro	Net Carb	Fiber*=NA	Calories	Pro+Carb	Ratio
Potato, sweet – baked	50g	0.08	1	8.71	1.65	40
Egg, whole scrambled	150	16.47	14.85	2.42	0	217
Butter	10g	8.11	0.09	0.01	0	73
Nuts, Pecans – roasted	10g	7.21	0.88	0.41	0.92	70
	Sum	31.87	16.82	11.55	2.57	400	28.37	1.12:1

Lunch	grams	Fat	Pro	Net Carb	Fiber*=NA	Calories	Pro+Carb	Ratio
Carrots, cooked	50	0.09	0.38	2.61	1.5	13
Cauliflower, cooked	50	0.23	0.92	0.91	1.15	9
Black beans – cooked	45	0.16	3.68	7.22	3.74	45
Pork, ground – cooked	70	10.33	19.45	0	0	171
Oil, Olive	20	20	0	0	0	180
Coconut Oil	10	9.6				86
	Sum	40.41	24.43	10.74	6.39	504	35.17	1,14:1

Keto Juice	grams	Fat	Pro	Net Carb	Fiber*=NA	Calories	Pro+Carb	Ratio
Blueberries, frozen unsweetend	100	0.64	0.71	10.67	2.9	51
Chia seeds –	15	3.75	3.75	0.99	5.1	53
Coconut Cream (can) –	35	7.58	0.58	1.17	0	75
MCT oil	10	9.27	0	0	0	83
Chocolate, Unsweetened	25	13.88	3.55	3.57	0	153
Water to complete	Sum	35.12	8.59	16.4	8	415	24.99	1.41:1

Dinner	grams	Fat	Pro	Net Carb	Fiber*=NA	Calories	Pro+Carb	Ratio
Lettuce, Iceburg	15	0.02	0.14	0.27	0.18	2
Tomato, Cherry – raw	30	0.1	0.26	1.07	0.36	6
Broccoli, fresh then boiled, drained w/o salt	50	0.2	1.19	1.94	1.65	14
Chicken breast, oven roast	60	1.09	10.91	0.55	0	56
Cheese, Cheddar	25	8.29	6.23	0.32	0	101
Avocado	60	6.04	1.34	1.33	3.36	65
Oil, Olive	10	10	0	0	0	90
	Sum	25.74	20.07	5.48	5.55	334	25.55	1.01:1
		g Fat	g Pro	g Net Carb	g Fiber	Calories	Pro+Carb
	Total	133.14	69.91	44.17	22.51	1653	114.08	1.17:1

Bibliography:

[1] Mohammadi M. Oxidative Stress and Polycystic Ovary Syndrome: A Brief Review. Int J Prev Med. 2019 May 17;10:86. doi: 10.4103/ijpvm.IJPVM_576_17. PMID: 31198521; PMCID: PMC6547785.

[2] Rasquin LI, Anastasopoulou C, Mayrin JV. Polycystic Ovarian Disease. [Updated 2022 Nov 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459251/

[3] Zhu, H., Bi, D., Zhang, Y. et al. Ketogenic diet for human diseases: the underlying mechanisms and potential for clinical implementations. Sig Transduct Target Ther 7, 11 (2022). https://doi.org/10.1038/s41392-021-00831-w

[4] Magagnini MC, Condorelli RA, Cimino L, Cannarella R, Aversa A, Calogero AE, La Vignera S. Does the Ketogenic Diet Improve the Quality of Ovarian Function in Obese Women? Nutrients. 2022 Oct 6;14(19):4147. doi: 10.3390/nu14194147. PMID: 36235799; PMCID: PMC9571725.

[5] Karniza Khalid, Saraswathy Apparow, Irma Liyana Mushaddik, Amalina Anuar, Syed A A Rizvi, Anasufiza Habib, Effects of Ketogenic Diet on Reproductive Hormones in Women With Polycystic Ovary Syndrome, Journal of the Endocrine Society, Volume 7, Issue 10, October 2023, bvad112, https://doi.org/10.1210/jendso/bvad112