Is the Keto Diet, the PCOS Diet?
You can’t escape it! Everywhere you go lately, you are bombarded with ads and products for the ketogenic diet aka Keto. There is a large body of evidence supporting the use of the keto diet for diabetes, migraines, seizures, and cancer. But lets face it, keto has gained its hype as the go-to diet for weight loss. Not surprising that in the past few months at my New York Naturopathic office, many of my patients with polycystic ovarian syndrome (PCOS) have been asking me if they should give keto a try. They have been drawn to the promise that the Keto diet can help them get pregnant and lose inches off their waistline. So what exactly is the Keto diet and does this naturopath endorse it as the PCOS diet.
What is Keto?
Many people confuse the Keto diet with low carb diets. Yes it is low in carbs but it’s really a high fat diet. By high fat, I mean while on Keto 60-70% of your caloric intake comes from fat. Then protein makes up about 25-35% of the caloric intake. Generally that leaves only 5-10% for net carbs. To calculate net carbs, you subtract total grams of carbs by total grams of fiber. So if your normal daily caloric intake is 1500 calories, to maintain a ketogenic diet, you will need to consume 100-116g of fat, 94-131g of protein and 19-37g of carbohydrate daily. Now that you know the math, you will quickly find that a lot of products marked keto actually aren’t. In reality, the Keto diet is actually very precise and you will need to do a lot of math. If you are just starting out, it is best to consult with a dietician, nutritionist or naturopath who is well versed on the Keto diet .
How does it work?
The ketogenic diet, besides being a high fat diet, gets its name from what makes; ketone bodies. Our bodies use fats and some amino acids to form ketone bodies when glucose is no longer available as the primary fuel source. This typically occurs during times of fasting or starvation because glucose stores are depleted and body is no longer capable of making glucose. Our bodies stimulate lypolysis, which is the breakdown of fat cells to release fatty acids. Then the fatty acids are transported mostly to the liver but in some other tissues where they are converted to ketone bodies. This process is known as ketosis. Another way to put your body into ketosis, which you have probably already guessed, is fueling it mostly with fat. At the same time something else the Keto diet does is decrease insulin. This is because insulin is released in the response to blood glucose which plummets on the keto diet. Decreased insulin levels also increases the breakdown of fat stores to make more ketone bodies.
Is it the Keto Diet the right diet for PCOS?
As with everything particulary fad diets the answer is yes and no. There have been quite a few studies demonstrating dramatic benefits for patients with PCOS including reductions in insulin, glucose, testosterone, LH/FSH ratio and common symptoms of PCOS such as acne, hair loss, facial hair and fertility problems. The main reason why the Keto diet could be beneficial is its ability to decrease insulin and central obesity through lipolysis. In many cases of PCOS, the primary issue is insulin resistance, which decreases sex hormone binding globulin (SHBG). When SHBG decreases, testosterone and its more potent byproduct dihydrotestosterone (DHT) are increased leading to acne, hair loss, and facial hair. One thing to note about all these studies is that they focused on obese women with PCOS. As I wrote in another blog many women with PCOS are normal weight or even underweight. It is true that insulin resistance is often to blame, but adrenal and hypothamalic dysfunction can also cause PCOS. Because the Keto diet is extremely low in carbohydrates it can problematic for women with PCOS of the other two types. The release of LH (luteinizing hormone) is very much regulated through the availability of glucose. When glucose is not sensed by the hypothalamus the release of LH can be impacted. LH serves as the first hormone to signal the production of estrogen. Then when a threshold production of estrogen is obtained, a surge of LH triggers ovulation. If either step of this process is derailed, ovualtion won’t happen and a woman will not get her real period. Most of my PCOS patients tend to do best on a diet that is free of sugars and simple or refined carbohydrates but has a sensible balance of proteins and fats with carbohydrates high fiber such as sweet potatoes and quinoa. With this strategy blood sugar stays balanced not allowing for insulin spike or resistance while maintaining HPA axis homeostasis.
Ready to get a handle on your PCOS? Then schedule a naturopathic appointment with Dr Ivy.