May 14, 2024 8 min read

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    As someone who was diagnosed with polycystic ovary syndrome (PCOS) about a year ago, I know the confusion and the feeling of helplessness the diagnosis brings. You’ve been working hard in the gym, getting your steps in, and focusing on a balanced diet; somehow, your body seems to be working against you. 

    Suddenly, you’re gaining weight rapidly, and losing it seems like an uphill battle. You find yourself retaining a lot of water; sugar cravings are at an all-time high, and you dread PMS every single month.

    One of the first things your doctor will tell you is that there is no known universal cure for PCOS. As discouraging as this news is, it is essential to know that treatment options exist, and most don’t necessarily include medication. A ray of hope in this situation is that small yet impactful lifestyle changes can make a difference in PCOS and significantly decrease those life-altering symptoms we struggle with daily. 

    In this detailed guide, we’ll tap into the definition of PCOS, its most common symptoms, as well as the possibility of improving affected health aspects - such as weight and fertility - with the keto diet.

    Polycystic Ovary Syndrome: An Overview

    Polycystic ovary syndrome, mainly referred to as PCOS, is a hormonal condition that stems from an excessive amount of hormones produced by the ovaries. The ovaries, responsible for egg production and release, produce a high amount of androgens, creating an imbalance in reproductive hormones. The hormonal havoc will generally result in an irregular and/or painful menstrual cycle, an absence of cycle, or ovulation issues.[1]

    The small cysts on the ovaries are filled with immature eggs and can be detected via ultrasound. It is, however, possible for PCOS to be diagnosed even without the existence of ovarian cysts. As painful as periods can be with PCOS, the pain itself isn’t caused by the cysts themselves, and they’re not considered dangerous.[1]

    Painful Periods in PCOS

    However, the condition itself can be rather complicated and is considered the underlying cause of numerous issues in female health. For instance, PCOS is recognized as one of the leading causes of infertility, and it is pretty common - around 15% of reproductive-age women are affected by it. The imbalance of androgens can also lead to weight gain, water retention, excess face and body hair growth, as well as acne.[1

    The severity of the symptoms varies, and many women aren’t even aware of this condition until their checkups or until they encounter an obstacle on their road to motherhood.

    The most common symptoms of PCOS include:

    • Irregular periods: An irregular cycle is one of the clear indicators of an androgen imbalance and PCOS. It can entail periods that are longer than average, as periods should last 3-7 days, and the menstrual cycle should last anywhere between 21 and 35 days.[2] Also, if your period isn’t coming in every month, or the length of your cycle keeps changing, it is one of the tell-tale signs that you may have PCOS.[3] Irregular cycles can also entail heavier or lighter periods than usual.
    • Excess facial and body hair: Due to high androgen levels, PCOS can often lead to hirsutism—excess facial and body hair. The hair is usually thick and dark and mainly appears on the chest, abdomen, back, and face.[3]
    • Weight gain: Also known as PCOS belly weight, weight gain in women diagnosed with PCOS is mainly accumulated in the abdomen area. 
    • Skin issues: PCOS often manifests through acne, dark or thick skin patches, as well as excess sebum production that leads to oily skin.[4]
      • Severe PMS: A recent study focused on factors associated with the severity of premenstrual symptoms[5] found that PCOS is associated with severe PMS, especially in the case of PCOS-related obesity. Accompanying issues include fatigue, pelvic pain, and low libido.
      • Hair thinning: Ironically enough, in addition to causing excess facial and body hair, PCOS may also trigger balding and hair thinning.[1]
      • Infertility: Finally, PCOS remains one of the leading causes of ovulation issues - and, therefore, infertility in women.[1]
      PCOS and Infertility

        While it is hard to pinpoint the exact cause of PCOS, certain elements play a very important role in the hormonal imbalance that leads to it. Polycystic ovary syndrome is believed to be genetically predisposed, but it is influenced by several factors. 

        Let’s take a look at some of the key players in PCOS development:

        • Obesity: While obesity isn’t an actual cause of PCOS, it can exacerbate the condition.[6] On the other hand, PCOS is also associated with weight gain, so it is safe to say that excess weight is both the cause and the symptom. Needless to say, weight gain is a significant risk factor for PCOS development.
        • Hormonal imbalance: A spike in male hormones (androgens) can affect ovary function, preventing them from producing and releasing eggs and, therefore, restricting ovulation. These irregularities in ovulation lead to small cysts, filled with unreleased eggs, on the surface of the ovaries.[1
        • Insulin resistance: Many women diagnosed with PCOS also suffer from insulin resistance, a potentially pre-diabetic condition characterized by improper insulin processing. Insulin resistance basically means that the pancreas keeps producing excess insulin due to the body’s inability to let glucose into the bloodstream—which is also our primary fuel.[1] Since insulin is responsible for glucose processing (which turns glucose into energy), insulin resistance often leads to elevated blood sugar.
        • Chronic low-grade inflammation: Chronic inflammation, detected through increased serum levels of inflammatory markers, mainly CRP, TNFα, and IL-6, has been associated with PCOS. Once again, the inflammation appears to be much more pronounced in obese women.[7

        PCOS Management: Promising Effects of the Ketogenic Diet

        Amid the fever pitch, many might have predicted the downfall of the ketogenic diet. Yet, it still remains one of the most popular nutrition plans. While it has been associated with numerous risks, the success of keto seems to stem from its health benefits and isn’t strictly limited to weight loss results. The keto diet primarily focuses on fat intake, as approximately 90% of daily calories in this approach come from dietary fats.[8]

        The sole purpose of the keto diet is to trick the body into switching its primary fuel source from glucose (sugar, mostly coming from carbohydrates) to stored fat. Once the body enters the stage of ketosis, it is supposed to resort to excess fat as the source of energy, leading to fat loss.[8] Therefore, the keto diet heavily relies on saturated fats, limits protein intake, and curbs the consumption of carbohydrates—the body’s preferred energy source.

        Low-carb Diets and PCOS

        So, with that in mind, how can a keto diet benefit women with PCOS? It is a well-known fact that carbs raise blood sugar levels and trigger insulin production. The insulin produced by the pancreas is then supposed to redirect the glucose from the bloodstream into the cells. However, in the case of insulin resistance, a common occurrence in PCOS, the insulin function is jeopardized, resulting in trapped glucose that isn’t utilized as fuel. Insulin also plays a significant role in fat storage, hence the connection between this condition and weight gain.[9

        A study on the connection between keto and PCOS[9] evaluating the combined results of seven clinical trials found that this diet may significantly improve reproductive hormone levels and decrease testosterone levels. In addition, following the keto diet for 45 days at minimum has led to considerable weight loss, which is highly beneficial to PCOS management and reproductive health in general. By limiting the concentration of androgens in the blood and reducing insulin levels, ketosis can alleviate the symptoms of PCOS.[9

        Therefore, low-carb diets such as keto may be beneficial for women diagnosed with polycystic ovary syndrome - particularly those with insulin resistance.[9] What’s more, low-carb diets have been found to improve fertility, as well as ovulatory andmetabolic functions in women with PCOS.[9]  

        PCOS and Natural Supplements

        While the role of low-carb diets in PCOS management is undeniable, it is also vital to mention natural supplements that may aid in the management of this persistent condition.

        Myo-Inositol

        A staple in PCOS management, Myo-inositol supplements can aid the regulation of insulin sensitivity, irregular periods, ovulation, and egg quality, which is particularly important for women trying to conceive.[10]

        Vitamin D

        Vitamin D insufficiency has been linked to PCOS, irregular menstrual cycles, and fertility issues.[11] Therefore, obtaining a sufficient amount of “sunshine vitamin” is essential, which isn’t always possible through food and sun exposure. Luckily, a quality vitamin D supplement comes to the rescue. 

        Vitamin D3+K2
        Zinc

        Supplementing with zinc regularly has been found to alleviate many of the unpleasant PCOS symptoms. Zinc can limit hirsutism (excess hair growth), aid in alopecia management, and help balance plasma MDA levels - an essential factor in PCOS-related infertility.[12]

        Magnesium

        According to a 2022 study on the connection between magnesium supplementation and PCOS[13], magnesium levels in women diagnosed with PCOS seem to be lower than in healthy women. Therefore, adding a magnesium complex to your daily supplement stack may help manage PCOS naturally. 

        In Summary

        Irregular menstrual periods, excess hair growth, unpredictable menstrual cycle, and hormonal imbalances that influence fertility shouldn't be considered normal. If you've been experiencing acne and hair growth, as well as a sudden increase in body weight coinciding with an irregular menstrual cycle, schedule an appointment with your OBGYN. A simple ultrasound check, along with blood tests, should be enough to diagnose PCOS and detect potential ovarian cysts that have been making you dread your next period. 

        Even though there is no universal method to treat PCOS, treatment options do exist and aren't limited to hormonal birth control. Simple lifestyle improvements, such as switching to a low-carb diet, prioritizing daily activities, and implementing natural supplements, may help balance out androgen hormones and insulin levels.

        Article References:

        1. Cleveland Clinic. “Polycystic Ovary Syndrome (PCOS) & Treatment.” Cleveland Clinic, 21 Sept. 2021, my.clevelandclinic.org/health/diseases/8316-polycystic-ovary-syndrome-pcos.
        2. Cleveland clinic. “Menstrual Cycle (Normal Menstruation): Overview & Phases.” Cleveland Clinic, 9 Dec. 2022, my.clevelandclinic.org/health/articles/10132-menstrual-cycle.
        3. Mayo Clinic. “Polycystic Ovary Syndrome (PCOS) - Symptoms and Causes.” Mayo Clinic, 2022, www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439.
        4. John Hopkins Medicine. “Polycystic Ovary Syndrome (PCOS).” John Hopkins Medicine , 2019, www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos.
        5. Sharifan, Payam et al. “Factors associated with the severity of premenstrual symptoms in women with central obesity: a cross-sectional study.” Journal of health, population, and nutrition vol. 42,1 9. 14 Feb. 2023, doi:10.1186/s41043-022-00343-5 
        6. Barber, Thomas M et al. “Obesity and Polycystic Ovary Syndrome: Implications for Pathogenesis and Novel Management Strategies.” Clinical medicine insights. Reproductive health vol. 13 1179558119874042. 9 Sep. 2019, doi:10.1177/1179558119874042
        7. Orisaka, Makoto, et al. “Chronic Low-Grade Inflammation and Ovarian Dysfunction in Women with Polycystic Ovarian Syndrome, Endometriosis, and Aging.” Frontiers in Endocrinology, vol. 14, 2023, p. 1324429, pubmed.ncbi.nlm.nih.gov/38192421/, https://doi.org/10.3389/fendo.2023.1324429. Accessed 26 Jan. 2024.
        8. Harvard Health Publishing. “Should You Try the Keto Diet?” Harvard Health, 31 Aug. 2020, www.health.harvard.edu/staying-healthy/should-you-try-the-keto-diet .
        9. PCOS: Could the Keto Diet Improve Fertility?” Www.medicalnewstoday.com, 11 Sept. 2023, www.medicalnewstoday.com/articles/keto-diet-improves-fertility-pcos#How-does-the-keto-diet-improve-PCOS-symptoms? Accessed 14 May 2024.
        10. https://www.facebook.com/verywell. “4 Things to Know about Taking Inositol for PCOS.” Verywell Health, 2018, www.verywellhealth.com/inositol-for-pcos-info-2616286.
        11. Mohan, Anmol, et al. “Vitamin D and Polycystic Ovary Syndrome (PCOS): A Review.” Annals of Medicine and Surgery, vol. 85, no. 7, 5 June 2023, pp. 3506–3511, https://doi.org/10.1097/ms9.0000000000000879.
        12. Jamilian, Mehri, et al. “Effects of Zinc Supplementation on Endocrine Outcomes in Women with Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial.” Biological Trace Element Research, vol. 170, no. 2, 2016, pp. 271–8, www.ncbi.nlm.nih.gov/pubmed/26315303?log, https://doi.org/10.1007/s12011-015-0480-7.
        13. Gholizadeh-Moghaddam, Mahsa et al. “Effect of magnesium supplementation in improving hyperandrogenism, hirsutism, and sleep quality in women with polycystic ovary syndrome: A randomized, placebo-controlled clinical trial.” Health science reports vol. 6,1 e1013. 29 Dec. 2022, doi:10.1002/hsr2.1013



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