The ketogenic or keto diet is a low-carbohydrate, and high-fat type of diet that can help with weight loss. All you have to do is reduce carbohydrate intake and replace it with fat. This will put your body into a metabolic state called ketosis, which means your body will become highly efficient in burning fat for energy. Apart from weight loss, it may also help women with Polycystic Ovary Syndrome or PCOS, a hormonal condition that affects the ovaries. On the occasion of PCOS Awareness Month, we asked an expert if women should follow the keto diet for PCOS or not.

What is PCOS?

Polycystic Ovary Syndrome or PCOS is a common hormonal disorder that affects women, who are in the reproductive phase. "It is characterised by an imbalance in reproductive hormones, which can lead to various health issues, including irregular periods," says obstetrician and gynaecologist Dr Chetna Jain.

PCOS leads to weight gain. Watch out for these signs. Image courtesy: Shutterstock

Women with PCOS experience an excess of male hormones (androgens), and the development of small cysts on the ovaries. This condition can also cause symptoms like:

• Weight gain
• Acne
• Excessive hair growth
• Fertility issues.

Can keto diet improve PCOS symptoms?

Keto diet involves eating foods high in fats and low in carbohydrates to help with weight loss, and mental clarity, according to a research published in StatPearls in 2023. This type of diet may help women with PCOS in the following ways:

1. May promote weight loss

"Many women with PCOS experience weight gain or have difficulty losing weight," says Dr Jain. During a 2021 study published in the Trends in Food Science and Technology journal, participants experienced a significant amount of reduction in their body weight, and fat mass content after following the keto diet.

2. May improve insulin sensitivity

"Many women with PCOS have insulin resistance, leading to higher insulin levels, which can increase androgen production," says Dr Jain. Too much androgen can cause physical signs such as excess facial and body hair, severe acne, and male-pattern baldness in women with PCOS. Keto diet has insulin-sensitising effect mostly due to its restricted-digestible carbohydrates content to bring down insulin and blood glucose levels, as per a research published in the Nutrients journal in 2023.

3. May improve fertility

"PCOS is a common cause of infertility due to the lack of ovulation," says the expert. Keto diet can help in dropping pounds. Weight loss may help improve fertility in women with PCOS, according to a study published in the Journal of Food Biochemistry in 2022. Also, during a 2021 study published in the International Journal of Environmental Research and Public Health involving overweight women with PCOS, some of the participants reported improved regularity in their period after following the keto diet. Some even got pregnant after many failed attempts.

Keto diet has its pros and cons for women with PCOS. Image courtesy: Shutterstock

What are the side effects of the keto diet for PCOS?

The keto diet may not be recommended to manage the symptoms of PCOS due to these concerns:

1. Nutrient deficiencies

The keto diet is highly restrictive since it focuses mainly on high-fat, and low-carb foods. "This restriction can lead to deficiencies in essential nutrients like fiber, vitamins, and minerals, which are crucial for overall health and managing PCOS symptoms," says Dr Jain. For example, a lack of fiber can worsen digestive issues, which are common in women with PCOS.

2. Hormonal imbalance

PCOS is a hormonal disorder, and the keto diet, which significantly alters metabolism and hormone levels, can exacerbate hormonal imbalances. The diet may lead to increased levels of cortisol (the stress hormone) and potentially disrupt thyroid function, both of which are critical in managing PCOS symptoms.

3. Digestive issues

Due to the reduction in high-fiber foods like fruits, vegetables, and whole grains, women on the keto diet may experience constipation or other digestive issues. "If a person has chronic constipation, it can cause discomfort and they may need to make adjustments in their eating patterns or go for supplementation," says the expert.

4. May increase cholesterol levels

The keto diet often includes high levels of saturated fats from sources like butter, red meat, and cheese. This can lead to an increase in LDL (bad) cholesterol levels in some women, and so, they may have a higher risk of heart disease.

5. Electrolyte imbalance

The keto diet can cause rapid loss of water and electrolytes, which can lead to imbalances in sodium, potassium, and magnesium. "This imbalance can cause symptoms like muscle cramps, weakness, and fatigue," says the expert.

What to eat to manage PCOS symptoms?

To manage PCOS symptoms, focus on a balanced diet that supports hormonal health:

• High-fiber foods like vegetables, fruits, whole grains, and legumes can help manage insulin levels in women with PCOS.
• Lean protein sources like chicken, fish, tofu, and legumes can support muscle maintenance and overall health.
• Healthy fats such as avocados, nuts, seeds, and olive oil can help regulate hormones.
• Anti-inflammatory foods rich in antioxidants, such as berries, leafy greens, and fatty fish, can reduce inflammation associated with PCOS.

Keto diet may help women with PCOS, but it comes with many side effects. So, focus more on balanced diet that includes complex carbohydrates, lean proteins, and healthy fats. Following a healthy diet alongside regular physical activity and medical guidance can help effectively manage the symptoms of PCOS.

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