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Dr. Peter Brukner OAM5 min read

Show me the evidence: Low carb and PCOS

Polyscystic ovary syndrome (PCOS) is closely related to insulin resistance so it is not surprising that a low carbohydrate diet is helpful in thIs condition.

According to the PCOS Guidelines issued by the American Reproductive Medicine Association (ASRM) in 2018, the implementation of a healthy lifestyle is the first line management method for all PCOS patients. Modification of the diet, adequate exercise, and effective weight loss, all play an important role in PCOS treatment.

In 2005, Mavropoulos and colleagues followed 11 women with PCOS as they went on a ketogenic diet for six months. The five women who completed the study lost weight and improved their hormonal status and perceived amount of body hair.

Mavropoulos, J.C., Yancy, W.S., Hepburn, J. et al. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: A pilot study. Nutr Metab (Lond) 2, 35 (2005). https://doi.org/10.1186/1743-7075-2-35

Gower’s 2013 study found that even a very modest reduction in carbohydrates (41% of calories) can lead to significant improvements in weight, hormones and risk factors for women with PCOS Gower BA, Chandler-Laney PC, Ovalle F, et al. Favourable metabolic effects of a eucaloric lower-carbohydrate diet in women with PCOS. Clin Endocrinol (Oxf). 2013;79(4):550-557. doi:10.1111/cen.12175

A 2017 review of clinical trials by McGrice and colleagues found that low-carb diets tend to reduce circulating insulin levels, improve hormonal imbalance and resume ovulation to improve pregnancy rates.

McGrice M, Porter J. The effect of low carbohydrate diets on fertility hormones and outcomes in overweight and obese women: a systematic review. Nutrients. 2017; 9(3):204. https://doi.org/10.3390/nu9030204

A 2019 meta-analysis of randomized trials by Zhang et al showed similar findings, concluding proper control of carbohydrate intake provides beneficial effects on some aspects of PCOS and may represent one of the important interventions improving the clinical symptoms of affected patients.

Zhang X, Zheng Y, Guo Y, Lai Z. The effect of low carbohydrate diet on Polycystic Ovary Syndrome: A meta-analysis of randomized controlled trials. Int J Endocrinol. 2019;2019. doi:10.1155/2019/4386401

In a 2020 study, Antonio Paoli studied14 women with PCOS who followed a ketogenic Mediterranean diet for 12 weeks. By the end of the study, they achieved lower blood glucose and insulin levels, improvements in reproductive hormone levels and function, reduction of heart disease risk factors, and an average weight loss of nearly 10 kg). The LH/FSH ratio, LH total and free testosterone, and DHEAS blood levels were also significantly reduced.

Paoli A, Mancin L, Giacona MC, Bianco A, Caprio M. Effects of a ketogenic diet in overweight women with polycystic ovary syndrome. Journal of Translational Medicine. 2020;18(1):104. doi:10.1186/s12967-020-02277-0

ADDITIONAL REFERENCES

  1. Porchia LM, Hernandez-Garcia SC, Gonzalez-Mejia ME, López-Bayghen E. Diets with lower carbohydrate concentrations improve insulin sensitivity in women with polycystic ovary syndrome: a meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology. Published online March 6, 2020. doi:10.1016/j.ejogrb.2020.03.010 ABSTRACT
  2. Li J, Bai W-P, Jiang B, et al. Ketogenic diet in women with polycystic ovary syndrome and liver dysfunction who are obese: A randomized, open-label, parallel-group, controlled pilot trial. J Obstet Gynaecol Res. Published online January 18, 2021. doi:10.1111/jog.14650
  3. Douglas CC, Gower BA, Darnell BE, Ovalle F, Oster RA, Azziz R. Role of diet in the treatment of polycystic ovary syndrome. Fertility and Sterility. 2006;85(3):679-688. doi:10.1016/j.fertnstert.2005.08.045
  4. Phy JL, Pohlmeier AM, Cooper JA, et al. Low Starch/Low Dairy Diet Results in Successful Treatment of Obesity and Co-Morbidities Linked to Polycystic Ovary Syndrome (PCOS). J Obes Weight Loss Ther. 2015;5(2). doi:10.4172/2165-7904.1000259
  5. Pohlmeier AM, Phy JL, Watkins P, et al. Effect of a Low Starch/Low Dairy Diet on Fat Oxidation in Overweight and Obese Women with Polycystic Ovary Syndrome. Appl Physiol Nutr Metab. 2014;39(11):1237-1244. doi:10.1139/apnm-2014-0073
  6. Moran LJ, Noakes M, Clifton PM, Tomlinson L, Norman RJ. Dietary composition in restoring reproductive and metabolic physiology in overweight women with Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2003;88(2):812-819. doi:10.1210/jc.2002-020815
  7. Barrea L, Marzullo P, Muscogiuri G, et al. Source and amount of carbohydrate in the diet and inflammation in women with polycystic ovary syndrome. Nutr Res Rev. 2018;31(2):291-301. doi:10.1017/S0954422418000136
  8. Pateguana NB, Janes A. The contribution of hyperinsulinemia to the hyperandrogenism of polycystic ovary syndrome. Journal of Insulin Resistance. 2019;4(1):3. doi:10.4102/jir.v4i1.50
  9. Galletly C, Moran L, Noakes M, Clifton P, Tomlinson L, Norman R. Psychological benefits of a high-protein, low-carbohydrate diet in obese women with polycystic ovary syndrome—A pilot study. Appetite. 2007;49(3):590-593. doi:10.1016/j.appet.2007.03.222 ABSTRACT
  10. Frary JMC, Bjerre KP, Glintborg D, Ravn P. The effect of dietary carbohydrates in women with polycystic ovary syndrome: a systematic review. Minerva Endocrinol. 2016;41(1):57-69. PMID: 24914605 ABSTRACT
  11. Chunzhu Li, Chuan Xing, Jiaqi Zhang, Han Zhao , Wenjing Shi , Bing He. Eight-hour time-restricted feeding improves endocrine and metabolic profiles in women with anovulatory Polycystic Ovary Syndrome. J Transl Med 2021 Apr 13;19(1):148. doi: 10.1186/s12967-021-02817-2
  12. Chiofalo B, Laganà AS, Palmara V, et al. Fasting as possible complementary approach for polycystic ovary syndrome: Hope or hype? Medical Hypotheses. 2017;105:1-3. doi:10.1016/j.mehy.2017.06.013 ABSTRACT
  13. Iolanda BM, Maria CA, Popa A. PCOS and insulin resistance: the role of ketogenic diet. :8. Pharmacology Online. Special issue; 2020; vol.3; 214-221 Review. PDF
  14. Marsh KA, Steinbeck KS, Atkinson FS, Petocz P, Brand-Miller JC, Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome, American Journal of Clinical Nutrition 2010;92(1):83-92
  15. Goss, AM, Chandler-Laney PC, Ovalle F et al., Effects of a eucaloric reduced-carbohydrate diet on body composition and fat distribution in women with PCOS. Metabolism 2014;63(10):1257-64

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