When it comes to insulin resistance, hyperinsulinemia, and obesity, POS (Polycystic Ovary Syndrome) remains the most prevalent endocrine disorder that affects women of the reproductive age. Scientists have been using the keto diet for PCOS research.
Since low carb diets have been known to reduce one’s insulin resistance, a pilot study was conducted to investigate the six-month endocrine and metabolic effects of a low carb, ketogenic diet (LCKD) on obese and overweight women who suffer from Polycystic Ovary Syndrome.
In order to conduct such a study, eleven women were brought in who had a diagnosis of Polycystic Ovary Syndrome and a body mass index of >27 kg/m2. Recruited from the Polycystic Ovary Syndrome community, they were told to limit carb intakes to 20 grams (or less) every day for twenty-four weeks. For this study, the participants were instructed to return once every two weeks to a research clinic for outpatients. At the clinic, the women were given dietary instruction reinforcement and had their measurements taken.
Out of the eleven women who participated, five women completed the study. These five women witnessed significant reduction from their baselines to 24 weeks in their fasting insulin (-54 percent), LH/FSH ratio (-36 percent), percent free testosterone (-22 percent), and body weight (-12 percent).
In addition to what was found in the five women, it was discovered that perceived body hair, triglyceride, HgbA1c, testosterone, glucose, and insulin level decreases were non-significant. Two women who participated in the study became pregnant, despite their infertility issues before the study.
For this specific study, the low carb-ketogenic diet provided significant improvement in fasting insulin for women suffering from PCOS and obesity, LH/FSH ratio, percent free testosterone, and weight improvement over the 24-week study.
What is Polycystic Ovarian Syndrome?
PCOS (Polycystic Ovary Syndrome) is known as the endocrine disorder that is most common among reproductive-age women. PCOS affects roughly 4 to 9 percent of women, Polycystic Ovary Syndrome is oftentimes associated with such symptoms as:
– Excessive body hair
– Absent or irregular menses
– Excess testosterone
In addition to these symptoms, PCOS can cause medical abnormalities like:
– High Cholesterol
– Type 2 diabetes mellitus
– Insulin resistance
– Central obesity (fat around the waist and hips)
It should be mentioned that PCOS has no known therapies that are curative, yet anti-diabetic medications can improve the majority of these abnormalities. Exercise and dietary interventions for PCOS have also been shown to have an impact when it comes to improving insulin sensitivity.
It is the therapies that lead to weight loss, insulin resistance, and lower insulin levels that tend to be useful when treating PCOS. Intermittent fasting for PCOS has also been shown to be helpful.
Studies have also proved that a ketogenic, low carb diet may lead to one’s improvement with insulin resistance and weight loss. Since improving insulin resistance and working towards weight loss can possibly be beneficial for individuals suffering from PCOS, the study utilized LCKD for women suffering from PCOS.
The recruited subjects were found through word of mouth and a local PCOS community support group in the Chapel Hill/Durham/Raleigh areas located in North Carolina. Once the initial criteria for eligibility were met, the subjects had to attend a screening visit for a physical and medical history exam. There was no monetary gain to participate, baseline blood tests were performed at each visit, and consent was approved by the Institutional Review Board.
The criteria for inclusion were:
– Women were between the ages of 18 and 45
– The diagnosis was suggested on their history of hyperandrogenemia and/or chronic anovulation (regarding PCOS)
– They did not have a medical condition in addition to PCOS
– They had a body mass of 27 kg/m2 or greater
– They wanted to lose weight
– They were willing to utilize contraception
The criteria for exclusion was:
– An increased progression of symptoms and signs regarding hyperandrogenic issues
– Positive pregnancy testing or nursing during their screening period
In the study, the subjects were enrolled in an intensive group program that was held every other week for the 6 months of testing. During the first week, the subjects were given instructions regarding the implementation and rationale of the Keto Diet for PCOS.
As for what they were given, the handouts had food suggestions for a low carb PCOS diet. Then, the subjects were told to follow the Keto PCOS diet. The follow-up group meetings consisted of the subjects relaying their dietary information, receiving continued dietary counseling, a review of their urinary ketones, a sharing of their food choices, and supportive counseling of their dietary decisions. The meetings themselves went on for at least an hour.
As far as the Keto Diet for PCOS, the subjects had a diet that consisted of less than twenty grams of carbs a day, or what they could do for the six-month study. Their Keto PCOS diet consisted of:
– Low carb vegetables (at least a cup a day)
– Salad vegetables (two cups a day)
– An unlimited amount of eggs
– Fresh and prepared cheese (two to four ounces a day)
– An unlimited amount of animal foods (such as shellfish, fish, fowl, turkey, chicken, and meat)
Subjects discouraged to drink alcohol and caffeine but the women were encouraged to drink at least six cups (8 ounces) of fluid every day. Although not mandatory, the subjects were encouraged to exercise three times a week and take a multivitamin once a day.
Measurements for Outcome
For the initial screening visit, the baseline variables (in no order) consisted of:
– Laboratory tests
– Blood pressure
– Prior usage of weight-loss diets
For the study, the measurements for dietary adherence consisted of:
– Urinary ketones
– Self-reported diet
– Food records
This data was collected at week two, week four, week twelve, and week twenty-four.
It should be mentioned that individuals who diet with a low carb, ketogenic diet generally do not carry urinary ketones. Since the carb intake of 20 grams per day oftentimes results with ketone excretion in urine, it was the presence of ketonuria that was utilized for dietary adherence verification.