Keto For PCOS: Can a Low-Carb Diet Help?
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Keto For PCOS: Can a Low-Carb Diet Help?

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Keto For PCOS: Can a Low-Carb Diet Help?

Posted 2 years ago

Brian Stanton

Brian Stanton


Ari Magill, M.D.

Ari Magill, M.D.

Scientific Reviewer

Expert Approved

If you or someone you know has polycystic ovary syndrome (PCOS), it’s hard to know what to do about it. It’s hard because scientists still don’t know exactly what causes this hormonal disorder. 

But even if we don’t fully understand PCOS, there are options available to help treat and alleviate the symptoms. And one of these potential options is the Keto diet.

Yes, several clinical studies suggest that low-carb diets can ease the symptoms of PCOS.[*][*] When women with PCOS cut carbs, they tend to lose weight, experience hormonal improvements, and ovulate more regularly. 

If you want to learn more about the potential benefits of Keto for PCOS, keep reading. 

What Is PCOS?

Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects between 6 to 15% of women of reproductive age.[*] Common signs and symptoms of PCOS include:

  • High testosterone levels
  • Problems menstruating (irregular or absent periods) 
  • Difficulty getting pregnant (infertility)
  • Excessive body or facial hair
  • Acne

Doctors diagnose PCOS based on these symptoms, but they’re not the whole story. PCOS is also linked to genes (it may run in the family), metabolic problems, and obesity. 

Being obese or having diabetes are major risk factors for PCOS.[*] It’s not clear if obesity or diabetes cause PCOS, but when these conditions are addressed (via low-carb diets, for instance), the symptoms of PCOS tend to improve. 

An underlying cause of both obesity and type 2 diabetes is a phenomenon called insulin resistance. When someone is insulin resistant, they can’t effectively regulate blood sugar levels, insulin levels rise to compensate, and fat storage runs amok.[*

Relevant here: researchers believe that high insulin levels contribute to hyperandrogenism (high testosterone levels) in PCOS.[*] One mechanism is that insulin stimulates the ovaries to make luteinizing hormone, which in turn stimulates testosterone production. 

There isn’t a consensus treatment protocol for PCOS, but therapies aimed towards obesity and metabolic dysregulation look promising. One of these treatments is the Keto diet.   

What Is Keto?

The Keto diet is a low-carb eating plan in which you consume 55-70% of your calories from fat, 20-35% from protein, and under 10% from carbs. Keeping your macros in these ratios triggers the fat-burning metabolic state called ketosis

Here’s how the Keto diet leads to ketosis and its most famous benefit:[*

  • Keeping carbs low keeps blood sugar low
  • Low blood sugar keeps the hormone insulin low
  • Low insulin triggers fat-burning and ketone production in the liver
  • Ketosis reduces hunger and increases energy expenditure, often leading to weight loss[*]

Since a low-carb diet has shown promise in treating obesity and type 2 diabetes (linked to PCOS)[*], researchers thought carb restriction might also help with PCOS. Let’s see what they found.

Evidence for Keto Easing PCOS Symptoms

There are a few small but promising studies on Keto for PCOS:

  • In a 2005 study, 11 women with PCOS went on a Keto diet for 24 weeks. The 5 women who completed the study showed significant reductions in body weight, free testosterone, and fasting insulin levels. Two became pregnant despite previous difficulties.[*
  • A 2014 study found that reducing carbs from 55% to 41% of calories (not Keto, but still a carb reduction) helped women with PCOS lose belly fat.[*]  
  • A 2019 review of 8 randomized controlled trials found low-carb diets to effectively treat PCOS symptoms like high testosterone, obesity, and insulin resistance.[*
  • In a 2020 study, a 12-week Mediterranean Keto diet helped 14 women with PCOS lose weight (20 pounds), balance reproductive hormones, and improve heart disease risk markers.[*

Why Keto May Help With PCOS 

There are two overlapping reasons why a Keto diet may help with PCOS:

  1. By promoting weight loss
  2. By improving metabolic health

Keto shows promise as an effective weight loss diet, especially in obese and diabetic populations.[*] Even losing just 5-10% of one’s body weight has been shown to help PCOS symptoms and normalize the menstrual cycle.[*

And when an obese or overweight person loses weight on Keto—including women with PCOS—their metabolic health also tends to improve. Specifically, Keto for PCOS leads to reductions in fasting insulin, LDL cholesterol, and other heart disease risk factors. These metabolic improvements, in turn, may lead to reduced PCOS symptoms.[*

Treatments for PCOS

There isn’t an established treatment protocol for PCOS. Diet and exercise, however, are clearly important. 

For example:

  • Low-carb and Keto diets can help with PCOS (covered earlier)
  • A low-glycemic weight loss diet (with carbs from fruits and vegetables) showed promise in improving  menstrual regularity more than a standard weight loss diet[*]
  • A review of the literature found that moderate exercise helps with ovulation, weight loss, and insulin function in women with PCOS.[*

To treat PCOS, your doctor may also prescribe:

  • Metformin (to improve metabolic health)
  • Birth control (to regulate the menstrual cycle)
  • Clomiphene (to increase fertility)
  • Hair removal treatments
  • Acne medications

Tips to Start On Keto for PCOS

If you’re interested in trying Keto for PCOS, consider these tips:

#1: Track your macros

The Keto diet is all about getting your macros right. You need to keep carbs below 10% of calories, which is 20 or 30 grams of net carbs per day for most people. 

Keeping carbs low means avoiding grains, cookies, sodas, chips, pasta, pizza, ice cream, candy, and other carby foods. But it also means avoiding hidden carbs in soups, sauces, and even shellfish. 

Get a handle on this with the Carb Manager app. It has everything you need to do Keto right. 

#2: Stay active

To manage your weight and metabolism, try to be active every day. It’s not clear which types of exercise are best for PCOS, so consider oscillating between:

  • Strength training
  • Flexibility, mobility, and stability training
  • Moderate aerobic exercise  
  • High-intensity interval training

And don’t forget to walk. A walk is the ultimate low-level exercise, and you can always squeeze one into your daily routine. 

#3: Try Mediterranean Keto

Eating a clean Keto diet means sticking to whole foods and healthy fats like meat, fish, nuts, non-starchy vegetables, olive oil, avocado oil, and butter. That’s the starting point.  

But what are the best Keto foods to eat for PCOS? That’s not clear, but one small study showed success with a Mediterranean Keto diet (plenty of vegetables, plenty of olive oil, and limited portions of meat, fish, and eggs) for treating PCOS symptoms.[*

#4: Work with your doctor

It’s essential not to take this journey alone. Work with your doctor to manage your PCOS. 

If possible, find a doctor that’s willing to monitor your situation—your bloodwork, your symptoms, etc.—as you embark on your ketogenic diet. That’s how you’ll know if it’s working.