PCOS + Pregnancy

PCOS, Insulin Resistance, & The Keto Diet

What’s all the hype about this keto diet? Despite its recent spike in popularity, the ketogenic diet has been around for over 100 years. In medicine, it is used to treat drug-resistant epilepsy. In the general public, Dr. Atkins popularized his low-carbohydrate Atkins Diet with a strict ketogenic “kick-off” during the first two weeks of his plan. Recently, however, new research is showing that women who suffer from Polycystic Ovarian Syndrome (PCOS) may also benefit from this diet. 

So, What is Keto? 

In essence, the ketogenic diet is a diet that causes the body to release ketones into the bloodstream through a very low carbohydrate, high fat, moderate protein meal plan. The breakdown consists of about roughly 70% of your calories from fats, 20% protein, and 10% or less from carbs. To put this in perspective, the average American diet is usually 60-70% carbs, 10-30% fat, and 20% protein. In the absence of circulating blood sugar (energy from carbs), the body begins breaking down stored fat into molecules called ketones. This process is called ketosis, and it works by forcing the body to run off the fuel provided by the ketones.

The good news is that fats are an important part of the diet protocol. Fats support hormone production, brain function, and have 9 calories per gram, which helps us feel satiated. One of the main criticisms of the ketogenic diet is that many people tend to eat too much protein AND poor-quality fats, with few vegetable and low-glycemic index fruits. The correct and safe way to eat on the ketogenic diet includes incorporating large amounts of monounsaturated (“healthy”) fats from foods such as fish, nuts, seeds, avocados, olives and olives oil, lean animal meats, and green vegetables.

What is PCOS and How Does Insulin Resistance Affect It?

PCOS is the most common endocrine disorder affecting women of reproductive age and is associated with obesity, infertility, hyperinsulinemia, and insulin resistance. PCOS is also associated with medical abnormalities such as type 2 diabetes mellitus and dyslipidemia (1,2). While the etiology of PCOS is still unknown, researchers have found that insulin resistance is one of the root physiological imbalances in most, if not all, PCOS women (3,4). Insulin is the body’s “storage hormone.” When carbohydrates are eaten, the body detects a rise in blood glucose and releases insulin. 

Insulin is made in the pancreas. Its primary job is to control the body’s blood sugar levels and tells the cells to absorb glucose when blood glucose levels rise. With the addition of too many carbohydrates, the cells spend less time burning stored body fat and more time burning glucose. Eventually, insulin levels are high all the time, and the body stops burning stored body fat and instead, begins depositing fat – particularly in the belly region for PCOS women. Over time, this chronic exposure to excess insulin leads to “insulin resistance” or diabetes.

Someone with insulin resistance is burning predominately glucose. When these people run out of glucose from their last meal, instead of easily transitioning over to a “fasted state” to burn fat, they become hungry for more glucose. Think about it this way…why would an obese person ever be hungry? They have enough fat stores to last a long time right? Incorrect. The average overweight person is used to having a constant supply of glucose circulating in their blood, which means they are continually burning glucose rather than fat. So what happens when an overweight person stops eating for a few hours? They run out of glucose from their last meal, and instead of seamlessly transitioning to burning stored body fat, they become hungry for carbohydrates! It’s a vicious cycle. Over time, the cells become tired – aka: resistant.

Insulin also acts on the ovaries, causing them to produce the male hormone, testosterone. When there is too much free-floating insulin, the ovaries respond accordingly and make a lot of testosterone. Insulin also decreases the production of sex-hormone binding globulin — a glycoprotein that prevents testosterone from entering the cell (5). With less sex-hormone binding globulin and more androgen production, free testosterone can freely float through the blood and interfere with normal cellular function. All this excess testosterone causes many PCOS women to have hair growth on the chest and face, thinning hair, irregular periods, mood swings, infertility, anxiety, fatigue, low sex drive, and/or acne.

PCOS and the Ketogenic Diet Research

Many studies have examined the benefits of the ketogenic diet and are showing positive results related to an array of conditions such as PCOS, acne, cancer, traumatic brain injury, and Epilepsy, and Alzheimers.

One pilot study in North Carolina explored the six-month metabolic and endocrine effects of a low-carbohydrate, ketogenic diet (LCKD) on overweight and obese women with PCOS.

Eleven women with a body mass index >27 kg/m2 and a clinical diagnosis of PCOS were recruited from the community. Participants limited their carbohydrate intake to 20 grams or less per day for 24 weeks. In the 5 women who completed the study, there were significant reductions from baseline to 24 weeks in body weight (-12%), percent free testosterone (-22%), LH/FSH ratio (-36%), and fasting insulin (-54%). There were non-significant decreases in insulin, glucose, testosterone, HgbA1c, triglyceride, and perceived body hair. Two women became pregnant despite previous infertility problems.

This LCKD led to significant improvement in weight, percent free testosterone, LH/FSH ratio, and fasting insulin in women with obesity and PCOS over a 24 week period. (6)

Another study conducted at the Cleveland Clinic examined fertility treatments tailored to insulin resistance in four women with PCOS. The goal of the study was to see if the ketogenic diet would improve the outcome of fertility treatments by significantly reducing insulin levels and their harmful effects on the ovaries. All four patients successfully adhered to the ketogenic diet and were able to lose weight (between 19 and 36 pounds). All four patients had irregular periods prior to starting the diet. Within just four to eight weeks of starting the diet, they resumed regular menstruation. Two women were able to conceive spontaneously without ovulation induction.

What Could This Mean?

PCOS has been described as a low-level chronic inflammation condition. The combination of the ketogenic diet, anti-inflammatory foods, exercise, and lifestyle changes can help ease PCOS signs and symptoms in many ways. Here are a few guidelines to create the right PCOS plan:

1. Adhere to a Low Carbohydrate Diet 

Eating carbohydrates, especially refined carbohydrates with no fiber, raises both glucose and insulin. Set a goal to start below 50 grams total carbohydrates per day. If this makes symptoms worse after a couple of weeks, increase carbohydrate consumption by 5 grams per day until energy levels have returned. Once a healthy energy level has been obtained, try reducing carbohydrate intake by 5-10 grams per day to increase the free-floating ketone levels and fat-burning capacity.

2. Eat High-Fiber Vegetables With Every Meal 

High-fiber vegetables can help combat insulin resistance and reduce inflammation and constipation. The best type of vegetables for a ketogenic diet are both low in carbohydrates and dense in nutrients. These include green leafy vegetables, cruciferous vegetables such as broccoli, cauliflower, zucchini, lettuce, peppers, and cucumbers, and allium vegetables like onion, garlic, scallion, shallot, leek, and chives.

3. Intermittent Fasting

There are a number of ways to do an intermittent fast, but the easiest and most popular way involves taking advantage of the natural overnight fast by skipping breakfast and eating at lunch time. Once the 12 hour mark from dinner the night before has been reached, the body is truly in a fasted state and will begin burning fat for fuel. Benefits of intermittent fasting include fat loss, insulin sensitivity, the starvation of bad gut bacteria, improvement of brain function and fatty liver, and the reduction of inflammation. 

*If you are a diabetic, pre-diabetic or taking diabetes medications, consult with a physician before starting a fasting protocol.*

4. Exercise 

Exercising for a minimum of 30-45 minutes 4x/week will greatly help with fat adaptation, weight loss, and insulin regulation.

5. Hydration

Water is a key element in ones journey to PCOS recovery, as it transports hormones to different parts of the body, removes harmful toxins, and carries essential nutrients to reproductive organs. Additionally, dehydration can alter mood and disrupt the mind-body connection, which is important for maintaining homeostasis and fertility. It is recommended that the average woman drink roughly 1-2 liters of water a day.

Natural Supplements 

Research shows that supplements may help with hormone regulation, insulin resistance, and inflammation associated with PCOS. Here is a list of the most popular:

Flax Seeds

Flax seeds are known to increase sex-hormone binding globulin levels and reduce androgen and insulin levels, making it an ideal supplement for women with PCOS.


Cinnamon comes from the bark of the cinnamon tree and has been shown to have a positive effect on insulin resistance, mensuration, and ovarian function. Intake: ½ to 1 teaspoon per day is all you need. 


Nuts are a healthy addition to any diet. Walnuts and almonds, in particular, have the most beneficial effect on women with PCOS. Almonds decrease free androgen levels and walnuts increase sex hormone-binding globulin.

Apple Cider Vinegar (ACV)

Apple cider vinegar has been shown to increase insulin sensitivity in several PCOS studies. In this trial, seven women with PCOS took one tablespoon of ACV per day. After 40 days, 4 of the women resumed ovulating, 6 experienced a measurable reduction in insulin resistance, and 5 had a decrease in their LH/FSH ratio. Intake recommendations are 1-2 tablespoons per day.  To learn more, read my post on ACV here


Almonds, cashews, spinach, and bananas are PCOS-friendly foods rich in magnesium. Magnesium deficiency reduces insulin sensitivity and increases nerve excitability, leading to more stress, more tension, and more PCOS symptoms.


Zinc is essential for the functioning of enzymes, hormones, and the immune system. A deficiency in zinc can cause a hormonal imbalance and make PCOS worse. Additionally, excessive or unwanted hair growth and alopecia may be improved with zinc supplements.


A sugar alcohol chemical compound found in foods like citrus fruits and nuts, inositol is one of the most well-studied PCOS supplements. Most notably, inositol appears to promote ovulation and fertility. Countless studies have shown that inositol supplementation may also improve insulin resistance and decrease male hormones in the bloodstream. 

Vitamin B9

Vitamin B9 is essential for women with PCOS who are trying to start a family. To improve fertility, researchers suggest that women who are at a healthy weight should take 400 micrograms of folic acid, and obese or overweight women should take 5 mg of folic acid. If a diagnosis of MTHFR gene has been determined, supplementing with L-methylfolate or 5-methyltetrahydrofolate (5-MTHF). You also can get plenty of folate by eating collard greens, broccoli, cauliflower, asparagus, kale, spinach, and cabbage.

Vitamin D

Vitamin D is a hormone produced by the kidneys. It is vital to the endocrine system and is a very common deficiency in women with PCOS. Vitamin D and calcium may improve irregular periods and restore ovulation. Try Theralogix’s Vitamin D supplement HERE and use 133626 for your discount.

{Supplements are not regulated by the U.S. Food and Drug Administration (FDA). Speak to a Physician before taking supplements. Some may interfere with other prescribed PCOS treatments and medications.}

Exogenous Ketone Supplements and Their Benefits

The term “exogenous” refers to anything that comes from outside the body. Supplements are therefore considered exogenous because they are ingested rather than produced by the body.

Recently, ketones are being proposed as super-metabolic fuel (7) and as discussed above, many studies have examined the benefits of the ketogenic diet. In addition to the studies performed strictly regarding the effect of a ketogenic diet, there are also studies which highlight the benefits of the exogenous ketone bodies themselves. Using ketones instead of glucose for fuel is associated with a number of benefits:

1. Weight Maintenance

Ketone bodies kick-start your metabolism, which increases the production of superoxide and glutathione, two antioxidants that protect our cells from oxidation.

2. Glucose and Appetite Control

Ketone bodies themselves have been shown to help with glycemic control and hunger hormone regulation, and they act as an anti-inflammatory agent within the body.

3. Physical Endurance

Skeletal muscles have the ability to re-synthesize ATP (energy) from other substrates, including ketones. This is why exogenous ketones can effectively fuel the muscles during workouts. Exogenous ketone supplements specifically provide an advantage since they require less oxygen per mole of carbon to oxidize.

4. Muscle Repair

Research shows that nutritional ketosis can optimize protein synthesis after a workout, helping with recovery and also encouraging more fat oxidation in comparison to carbohydrate metabolism.

5. Neurological Enhancement

Ketone bodies can reduce neuronal loss and improve neuronal functioning. Additionally, they can prevent damage from oxidation in an area of the brain called the hippocampus—the part of the brain directly in charge of memory, emotion, and the autonomic nervous system. 

The Alzheimer’s Association calculates 5.3 million cases of Alzheimer’s disease in the US with projections of as many as 16 million cases by the year 2050. With no cure for this disease, researchers are focusing on the positive outcomes a low carbohydrate diets can have on cognitive impairments. 

A small study published by Neurobiology of Aging tested 23 subjects with mild cognitive impairments or Alzheimer’s disease. They were each asked to consume an exogenous ketone supplement drink that elevated ketone levels in their body. Researchers found that those with higher ketone levels experienced greater improvements versus those with lower ketone levels.


Polycystic Ovarian Syndrome is responsible for as much as 70 percent of infertility issues in women. In addition to that, it causes frustrating and embarrassing symptoms like acne, male-pattern baldness, anxiety, mood swings, weight gain, and fatigue.

Fortunately, you can combat PCOS symptoms with the right combination of diet, exercise, and lifestyle choices. The ketogenic diet may be one of the best diets for women with PCOS because it reduces insulin levels and insulin resistance.

During the PCOS road to recovery, make sure to consult with a Registered Dietitian, Reproductive Endocrinologist (RE) and/or Primary Care Physician. He/she can order different blood tests that will confirm how well the new diet and lifestyle are working.


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