PCOS and Insulin Resistance-Part 5.2 A Low Carb Diet for PCOS
Figure 1 Keto Diet
In early 2010, when I was diagnosed with PCOS (officially, because I knew something was off for a while), I didn’t know what a Keto (Ketogenic) Diet was. In fact, I probably only learned about Keto after I had my second child, 4 years ago. The name “Keto”, anyway. I was well aware of what a strict low carb diet was, and I did follow one to help conceive. I didn’t follow this diet under anyone’s recommendation. I just thought that if losing weight was going to help me conceive, and if whatever was causing me to gain some weight had also caused me to stop ovulating, then I was going to try the most “extreme” measure I knew. I really wanted a baby…
In late 2008-2009, I started trying to conceive. A year later, no baby. I started pressing my doctor to find out what was going on and he brushed me off. I still had a period. I was not overweight. He didn’t check any labs or show any concern. By late 2009, I started gaining weight. By January 2010, I had gained about 12-15 lbs in 3 months. My hair started to fall out, in chunks. My acne was worse. I had just turned 32 years old. My BMI was still at 20, but I had stopped ovulating. At this point I basically had to coerce my doctor (in South Africa) to do an ultrasound and lab work. My suspicions were correct. I fit all the diagnostic criteria, while ruling out other conditions, for PCOS. He did recommend fertility medication and told me that likely the next time he saw me, I would be obese. Not very helpful…
I went home (back to Mozambique) and decided that I was going to go on a diet. For the first time in my life. I knew that when women have PCOS, losing a bit of weight seems to help their condition (I didn’t know why, though). I also knew that whatever had caused me to start gaining weight, had halted my ovulation, increased my acne and was causing hair loss. I figured whatever method helped one thing, might help everything else.
I don’t remember if I did any research. All I remember is that as a Naturopathic Doctor who helped people lose weight for a living, I had a diet plan that was most effective. I called it a Detox. Because it was a strict diet, I only encouraged people to follow it for 1 week intermittently with a more moderate approach for the other 3 weeks out of the month. Many people just took this detox and followed it all the time! That’s what I decided to do, too. This was a strict low-carb diet, with some protein and liberal amounts of fat. I didn’t learn about Keto, or even Banting (the South African equivalent), till years later. I went with my gut. You all know what happened after that! I didn’t stay on this diet once I got pregnant … and I developed a lot of end-of-pregnancy and post-partum complications. Basically, my Metabolic Syndrome got worse, much worse, during and after pregnancy. I still didn’t get back on the diet though ☹. I thought it was a detox, a way, a very good way, to help me get pregnant. This wasn’t a lifestyle! Or so I thought at the time, in my insulin-ridden state…
What was this diet that I followed to get pregnant, exactly? Today, I know it to be a Keto (Ketogenic) Diet. It was a diet that got me into a ketogenic state or ketosis. A lower insulin, high energy, fat burning state. It did many things for me. It caused me to lose some weight (2.5 kg), lower my androgen (male hormone) levels, which in turn, cleared up my skin, caused me to ovulate and get pregnant! In one month. How did it do ALL that? This (miracle) diet lowered my insulin status. Figure 2 below illustrates this perfectly, if you want to geek it out.😊
Figure 2 Pathophysiology of PCOS
Most people associate a Keto Diet to eating Bacon and Eggs. Although I believe this to be a fair representation, it is possible to get into Ketosis on a Vegetarian Diet. Following a Keto Diet, by definition, means consuming strict Low-Carb (usually below 20 g/d), Moderate Protein (0.6 g/kg of body mass) and High Fat to satiety. This diet is NOT based on a calorie theory, it is based on an insulin theory. It is not how much you eat, but what you eat and how often you eat it.
It is called a Ketogenic Diet, because it can get, and keep, people in a ketogenic state, or ketosis (a fat burning state), if you keep your macronutrients (carbs, protein and fat) at the correct proportions for a certain period of time and maintain it at that level. Since calories are usually not counted on a Keto diet, you eat when hungry, until full and control your macros as noted above. If you are following the 75% fat:20% protein:5% net carb approach, this usually looks like 2 meals/day, in an 8-hour eating period, and no snacks.
It is possible (although not necessary) to measure ketone levels in urine, breath and blood in order to check if you are in fact in ketosis. Many people follow a “lazy keto” approach successfully. This means following keto recipes, eating when hungry, until full. Voila! Ketosis! Results! Macro counting, as mentioned above, can also be useful (but not necessary, for some people). There are many apps that can help you count macros (Cronometer, Fatsecret, CarbManager). The Food Lists and Vegetarian Guide on my site can also help you to calculate your macronutrients.
It’s important to seek proper medical supervision when changing your diet, and/or if on medication. The risks here are associated with dehydration and/or hypoglycemia, not malnutrition. The Keto diet is a rich and nutritious diet, when followed properly. The Induction/Carb Flu are a common group of symptoms people may experience when switching to a keto diet. This may last anywhere from 2-5 days. Proper hydration (water and electrolytes) is recommended. For a more practical guide, check out my pages on a keto diet, ketosis, food lists, vegetarian keto and recipes.