Move over veganism, the Ketogenic diet has been the hottest health trend of 2018!
But could all that bacon, coconut oil, grass-fed butter and bulletproof coffee really benefit women with a hormonal condition such as Polycystic Ovarian Syndrome (PCOS)?
Lets find out...
If you aren't already aware, the Ketogenic Diet is a very high fat, moderate protein and low carb diet. The carbohydrate recommendations are usually kept under 50 grams per day, sometimes under 20 grams. It has been used in healthcare for many years as a therapeutic diet, benefitting conditions such as epilepsy, neurodegenerative diseases like Parkinson's and certain types of cancer.
The whole point of the ketogenic diet is to swap your body's main fuel source, from burning glucose (sugar) to fat (ketones). Ketones are molecules made by the liver from fat, when glucose is in short supply. Many people believe that using ketone bodies for energy is a much 'cleaner' fuel source and that 'going keto' can provide benefits such as weight loss, mental clarity and reduced inflammation.
Because of its results on weight loss, lowering blood glucose levels and improving insulin resistance, this diet is frequently promoted to women suffering with PCOS. In my practice, I have personally seen some women do really well and have great results, but I have also had women who feel 10x worse when eating too little carbohydrates.
Like many things, it is totally individual, and you should consider working with a practitioner who can assess your whole health and nutrition needs, especially if you are dealing with a hormonal imbalance.
Individuals who should not follow a Ketogenic diet include pregnant and breastfeeding women, those with type 1 diabetes, previous/current eating disorders, hypothalamic amenorrhea, individuals taking medication for type 2 diabetes, children under the age of 18 and those with decreased liver or kidney function.
Pro's of the Ketogenic Diet for PCOS:
Improved insulin sensitivity
The ketogenic diet works well at reducing levels of blood glucose and insulin. Around 70% of women with PCOS have some degree of insulin resistance, which drives the production of male hormones (androgens) and inflammation in the body. When carbohydrate intake is low, our pancreas doesn't produce as much insulin and our cells start to become more sensitive to its effects.
Regulation of menstrual cycle
Women with PCOS often deal with anovulation, irregular or completely absent menstrual cycles, mainly due to elevated levels of male hormones (androgens) which are driven by inflammation and high insulin levels. There have been several studies and reports of women regaining ovulatory menstrual cycles and even falling pregnant after following a ketogenic diet.
When we are efficiently burning fat as fuel, we are able to tap into our own body stores and lose body fat. This happens when our insulin levels (fat storage) are low. We cannot burn fat when insulin is elevated as we are chronically stuck in 'energy storage mode'.
Cons of the Ketogenic Diet for PCOS:
Increased Cortisol / HPA dysregulation
Going too low carb (especially for women) can be very stressful. The Hypothalamic-Pituitary-Adrenal Axis can be negatively impacted, possibly leading to worsening of symptoms such as acne, anxiety, hair loss and weight loss resistance. When cortisol (our main stress hormone) is high, blood sugar and insulin also increase, as our body believes the environment isn't safe and we need energy to fight or flight. We can also gain weight, or become unable to lose weight, as fat burning mode is turned off and we store weight as a protective mechanism. Stress can also affect ovulation, our menstrual cycle and the ability to carry a child.
Alterations to the Gut Microbiome
Our gut bacteria is important for the digestion and absorption of food, production of nutrients and protection against pathogens. 70% of our entire immune system is located in the gut, therefore any issues within our digestive tract can create inflammation and symptoms throughout the entire body. Our gut bacteria love to eat a wide variety of vegetables and plants, including starchy fibres, however a ketogenic diet often limits these types of vegetables due to their higher carbohydrate load. Long term, this may starve the microbiome of food, which may possibly lead to the development of conditions such as intestinal permeability (aka leaky gut), bacterial dysbiosis, food intolerances and autoimmunity.
May Impact Thyroid Function
Many women with PCOS also have a thyroid condition, mainly hypothyroidism. The main reason why our carbohydrate intake affects thyroid function so directly is because insulin is needed for the conversion of the inactive T4 hormone into the active T3 hormone, and insulin is generally quite low on very low carbohydrate diets. Excess cortisol, which may be produced by some people on a ketogenic diet, can directly inhibit the production of TSH, the hormone that stimulates the thyroid gland to produce its hormones and also the conversion of T4 into active T3. As the Ketogenic diet can be quite restrictive, it may be hard to get all of the micronutrients needed for thyroid health such as zinc, magnesium, copper, iodine and selenium. It is also common for unsupervised individuals (especially females) trying the Keto diet to under eat, further impacting metabolism and thyroid health.
As you can see, there are many important reasons both for and against a Ketogenic diet for women with PCOS. In my opinion, Keto can be an effective treatment plan for certain insulin resistant women,for a short period of time, whilst simultaneously addressing other drivers and lifestyle influences. For those with elevated cortisol,adrenal stress or thyroid conditions, this diet may create more problems and may not be suitable.
Here are some other points to take away...
Know your PCOS type
If you have PCOS, it is important for you to determine which type of PCOS you are dealing with, as they all have slightly different treatment protocols. These types are insulin resistant, adrenal, inflammatory and post-birth control PCOS. I believe that the insulin resistant type is the one that can have most benefit from a Ketogenic diet (but not always!)
Address the Other Drivers
If you have PCOS, don't just jump straight into following a Ketogenic diet because you saw someone on Facebook get amazing results! As I mentioned before, keto is a therapeutic diet, and should only be trialled once you have addressed other possible drivers such as poor sleep, mental stress, exposure to environmental toxins, refined sugars and chronic infections. Following this very low carb, high fat diet when your body is still dealing with these stressors will likely exacerbate your problems and further dysregulate your hormones.
It's Not a Long Term Diet
Many experts agree that Keto is not a long term diet or solution. It is to be followed cyclically or with the seasons in order to prevent long term side effects. Consider implementing Intermittent Fasting (IF), time restricted feeding or consuming carbohydrates around workouts first, as a way to improve insulin sensitivity, blood glucose levels and reduce inflammation.
Consume a Wide Variety of Foods
A healthy version should include an abundance of non-starchy vegetables and healthy fats from various sources. Consuming the same foods day in and day out increases the risk of you developing food intolerances, therefore sources new vegetables and a range of proteins and fats will increase your nutrient diversity. Don't just use coconut oil for cooking everyday, try ghee, butter,avocado oil or olive oil (at lower temperatures). Swap your daily chicken breast for duck, lamb, beef, eggs, organ meats or bison. The more types of food you consume in a typical week, the better!
Work with a practitioner
Having someone look at your whole health history, current symptoms and analysis of your diet will allow them to create a personalised plan, designed specifically for your needs. This will help to take the stress off you and will ensure you are following the diet safely, if Keto is right for you at this moment in time.
Ever tried going Keto for your PCOS symptoms? Have you ever had positive or negative effects from a low carb diet?
Let me know in the comments section below!
Have you had your free 30 minute 'PCOS Troubleshooting' phone call with me yet? During this phone call we can discuss your health needs in detail and you will leave the call feeling optimistic, knowing the next steps you need to take for both short and long term relief from your symptoms. Click here to schedule your session.