Should I be on Keto to manage my PCOS?

Lately every single PCOS client I am working with is coming to me telling me that her doctor prescribed the Keto diet to reverse her PCOS. I must admit I am not surprised as it happened to me too! I remember feeling confused and thinking well ok as a pharmacist I know Keto has its place especially in treatment of certain conditions but as someone who suffered from an eating disorder in the past such a highly restrictive diet can be dangerous and can put me back into binge mode and the idea of eating so many high fat foods was not appealing especially when I struggled for so long to understand my body and what it needs.


My doctor recommended a nutritionist who specialised in keto – 2 weeks in I felt so bad I wanted to cry. That is when I decided to write my master thesis on PCOS. Since then I have gone on to study functional hormone health and actually really understand the effects of keto on hormones.

So let’s start by understanding what Keto actually is. The ketogenic diet was developed in early 1920s as a therapeutic protocol to treat epilepsy in children where conventional medication was failing. A true keto diet is  high in fat (approximately 75% fat), moderate protein (20%) and low in carbs (around 5%).

For an adult woman this would be around 20-25 grams  of carbohydrates daily – that is less than 1 banana or 1 sweet potato.

By starving your body from carbohydrates your body is forced to switch to using fat for fuel. Whilst doing keto you also need to be mindful of how much protein you are consuming as protein is converted to carbohydrates.

Research has proven that this diet can significantly improve symptoms of epilepsy, lower insulin levels and improve insulin resistance, lower blood sugar and help with weight loss.

So now you are probably thinking YESSSSS That is exactly what I need! …. Hold your horses not so fast!!


The Keto diet is shown to Make some PCOS symptoms worse

Our bodies preferred source of energy is sugar, when our sugar levels get too low this puts our body under stress. As a result, our adrenal glands ca  start producing higher quantities of cortisol (cortisol is our primary stress hormone and is also a fat storing hormone).

Having overactive adrenal glands and high levels of cortisol is already one of the characteristics of PCOS. In fact my cortisol was actually high for a very long time and let me tell you this is a recipe for disaster.

One of the functions of cortisol is to jump start our body every morning. Cortisol does this by increasing sugar levels in our blood therefore persistently high cortisol levels can make insulin resistance worse over time. And we all know that 95% of women with PCOS already suffer from insulin resistance.

Something that most of my clients complain of is the difficulty of losing belly fat or the fact that they tend to put on weight around their mid section. This again is the result of high levels of cortisol. Belly fat increases our risk for cardiac problems and type 2 diabetes so we definitely want to avoid this.

So yes Although you might notice an initial weight loss whilst on the keto diet (this is normal as you are literally cutting out an entire food group) the long-term effects of having consistently high levels of cortisol may do more harm than good. As you can see I am substantiating everything I am writing with medical studies. So please feel free to click on any of the above links and check out the studies.


The keto diet has a negative impact on our gut microbiome

One of the root causes of many conditions including PCOS is having an unhealthy gut microbiome. We have millions of bacteria in our gut and from studies we know that having a healthy gut is crucial for many processes in our body including digestion, absorbing of nutrients, immune function, reducing inflammation, hormonal balance, insulin sensitivity as well as mental health.

The world within our gut is still very unknown however lately there are many new studies being performed in this area and all the studies are very clear and all point in the same direction. Having less diversity of bacteria in our gut is harmful for our health whilst having a diverse gut microbe is beneficial.

What we do know for sure from some PCOS Studies is that women with PCOS have less diverse gut bacteria, we do not know why but we know that poor gut health is a huge indicator of many of the PCOS symptoms. Research has also found a correlation between high androgen levels and low the gut bacterial diversity is in PCOS.

The above studies can already show you how imperative gut health is in the management of PCOS and one of THE most vital ways to support a good diversity in our  gut is to eat a diet which is varied and includes lots of whole foods, and fibre. Fibre actually feeds the good bacteria in our gut. Many plant products are also considered as pre-biotics (this is what the bacteria needs to live off) and these include, plenty of vegetables and fruit the more colourful your day looks in terms of fruit and veggies the better. Legumes, beans, nuts , whole grains and seeds – all are important to support your gut health.

Furthermore we need fibre to have regular bowel movements. We need to be regular to clear out excess hormones in our system. With PCOS we tend to get estrogen dominance and high testosterone. Not having regular bowel movements does not help your hormonal balance.


Eating a high fat diet negatively impacts our hormones and makes our PCOS worse.

One of the main aims with PCOS treatment is getting our patients to have a regular ovulation and menstrual cycle.Restricting carbs has been  shown to have a very negative impact on the regularity of the menstrual cycle.

Furthermore reducing carbohydrate consumption has a negative effect on our thyroid hormones which in the long run can not only effect our weight but also, mood, energy levels, hair and skin quality.

The keto diet may increase your risk of developing a disordered relationship with food

Yes we do often see initial rapid weight loss when starting a restrictive diet like Keto, but it also might actually increase your risk of developing a disordered relationship with food. People who are so restrictive are much more likely to suffer from episodes of binge eating. This diet has been shown to be unrealistic long term and people end up in a yo-yo cycle and run the risk of weight cycling and eventually putting on much more weight.

When you spend so much time restricting you activate what is known as survival mode. Survival mode triggers metabolic changes occur including a slower metabolism as well as a higher incidence of fat storage, increased urges and compulsion to eat as well as many more obsessive thoughts about food and cravings. As well as losing the ability to realise when you are full and get satisfaction from food. As well as increased set weight point.

The keto diet increases inflammation.

One of the root causes in PCOS is long term low grade inflammation. This was actually the most predominant of all root causes for me.In fact, Studies show proof that women with PCOS have constantly high inflammatory markers.

When following a keto lifestyle, you are probably eliminating many foods which contain essential vitamins and antioxidants that have an anti-inflammatory effect on your body (like colourful fruits and veggies and berries!) This will mean that you are much more likely to suffer from this low grade inflammation that effects weight, fertility and even mood.

In conclusion

There are cases where the keto diet does make sense therapeutically like in the case of epilepsy as discussed above. This should be implemented with the guidance of your doctor and dietitian to ensure safety.

However if you decide to follow a keto diet to manage PCOS, balance hormones or lose PCOS related weight….you may actually end up worse off than when you started. I have seen this in so many clients of mine and I can assure you — there is a better way of going about it!

Remember a ketogenic diet is NOT just a low carb. It is also high fat.

There are SO many better and healthier ways to improve insulin resistance and manage PCOS and get your health on point that do not involve a keto diet (read more here and here).

Through my work I have helped hundreds ofwomen manage their PCOS, get regular cycles naturally, improve their fertility and get pregnant naturally, as well as reduce and in many cases completely reverse symptoms through a personalised approach (You can follow my PCOS blue print program or work 1:1 with me)

I believe each woman that comes to me is unique so you will not get a cookie cutter approach when dealing with your PCOS.

If you are serious about taking control of your health and manage your PCOS long-term…stop looking for a quick fix or follow advice of random influencers on instagram. Invest your time and money in something that is sure to work for you.