PCOS and Keto

Curious if Keto is right for you to manage PCOS? Been told Keto is the way to control your insulin levels to prevent diabetes, improve ovulation to get pregnant, or get rid of your constant carb cravings?

Why is Keto so popular to treat PCOS?

Most people with PCOS experience high circulating insulin levels that promote intense carb cravings, absent or irregular periods, and problems with sleep. Finding a way to lower insulin potentially helps improve fertility, energy levels, mood, hair growth, and metabolism.

I didn’t mention weight and PCOS yet on purpose. I appreciate people promote Keto as a way to lose weight (aka weight suppress) and that assumes that weight CAUSES the high insulin levels and other PCOS symptoms. It doesn’t.

Weight gain or higher weight does NOT cause PCOS. It is a genetic condition passed down through families.

Assuming weight loss will help manage PCOS contributes to the constant weight discrimination found in the PCOS world.

I get it why Keto is so attractive to treat PCOS. But….

Keto doesn’t work for most people and long term research does not exist to support it for treating PCOS.

PCOS and Keto Research

With everyone recommending Keto for PCOS–doctors, dietitians, trainers, and Aunt Marge–you’d think there would be research behind it. Here’s the thing:

We have ZERO long term data on PCOS and Keto.

We do have 2 short term research studies though.

The most recent 2020 research describes:

  • studying 24 people with PCOS without hypothyroidism who weren’t taking Metformin or other insulin sensitizers.
  • 12 week duration–this is important!
  • used a Mediterranean style Keto with extra herbal supplements
  • Plenty of biomarkers improved like HDL, LDL, triglycerides, LH/FSH ratio, and testosterone. Weight decreased.
  • Small sample size and short duration were two of the many study limitations that make it not a generalizable recommendation. It also did not determine whether this diet was safe before and during pregnancy.

The other Keto and PCOS research–from 2005–describes:

  • Eleven people with PCOS were recruited for this study.
  • Study design was 24 weeks and people were instructed to limit their carbohydrate intake to a scary low amount and checked in every 2 weeks into an intensive education program.
  • Five people finished the study–this is important!
  • Plenty of biomarkers improved like LH/FSH ratio, fasting insulin and testosterone. Weight decreased.
  • There were non-significant decreases in insulin, glucose, testosterone, HgbA1c, triglyceride, and perceived body hair. 
  • Small sample size and lack of long term data (>2 years) were some of the study limitations.

Some follow up questions from this research:

  • I am curious what their fasting insulin, testosterone, blood sugar, blood pressure, FH/LSH ratio, ovulation, A1c, and weight was 2 years after completing the study. What are they today?
  • What is life like now with the study subjects? How is their relationship with food? Health is not just physical health yet includes mental and emotional health.
  • What was it like moving away from the rigorous research intervention to real life management of food? How did they experience grocery shopping, family get-togethers, and work dinners?

Six people were not able to continue with the Keto diet in that 2005 research article summarized above. What if that is the norm? How are they experiencing food now that they “failed” that diet? Why weren’t they further studied? (Writing this down for future PhD research.)

Are you ready to cut out a whole food group because 29 people were able to stay on a Keto diet for 3 to 6 months?

Are you ready to shame yourself for not sticking to a Keto diet because 29 people were able to stay on a Keto diet for 3 to 6 months?

Long term diet research–what it says about how it affects the body

We don’t have long term data to support ANY diet to treat PCOS. Yes, dieting is the go to first recommendation to treat PCOS yet even the 2018 PCOS Evidence Based Guidelines say we have ZERO diets that are shown to be sustainable and health promoting for people with PCOS.

Of note, we do have research that found people with PCOS who yo-yo diet more often experience binge eating. So there’s that.

Since we don’t have any long term PCOS diet intervention research to go on, we have to look at general population diet research. This is what it has found (all research looked at >2 years post diet intervention and findings were the same whether a person continued the diet or not):

  • Higher fasting insulin levels
  • Higher cortisol levels (an issue already with PCOS because of its associated chronic pro-inflammatory state)
  • Higher blood sugar
  • Higher incidence of diabetes
  • Higher blood pressure
  • More eating disorders among higher weight individuals
  • More binge eating
  • More weight cycling
  • More depression
  • Higher weight *please note I do not include this as a way to say higher weight is bad because I don’t think it is. I include it because I appreciate most people start a diet in hopes to weigh less. As such, long term dieting predicts weight gain rather than weight loss.

So now what? What can you do instead of Keto or other diets?

  • Move away from the scale as a measure of progress, health, and worth.
  • Be sure you are eating enough. Diets have fucked with your ability to know this. Be compassionate with yourself as you unlearn diet rules. Finding a person to help may make this easier.
  • People with PCOS probably need more protein. This doesn’t mean cut out carbs, sugar, or fat. Experiment with adding more protein at different times of day. Let your body tell you what helps and what doesn’t.
  • Consider your carb cravings as insight. They should be listened to, respected, and not shunned. Carb cravings are the way PCOS lets the person know that the condition needs attention. These cravings indicate that insulin levels are higher, or you are not eating enough, or need more sleep, or need to increase supplements, or medications, or need more protein.
  • Worrying about your weight will only keep you from trusting cravings. Worrying about weight won’t improve health long term and won’t make the cravings go away. Worrying about your weight will only make you more susceptible to binge eating experiences and intensify those cravings.
  • Find sustainable tools that help you lower insulin long term. These include eating enough, adding more protein, adding medications and/or supplements, resting more (and testing for a sleep disorder) and moving your body when you have the energy to do so.

Want more ways to help manage your PCOS without diets? Click here for a tool I designed just for you.

Looking for a non-diet PCOS community? Look no further than here.