Keto diet for PCOS: Benefits, risks, and a practical plan

Polycystic Ovary Syndrome (PCOS) affects millions of women worldwide, leading to symptoms like irregular periods, weight gain, and insulin resistance. Managing PCOS often requires lifestyle changes, and a healthy diet plays an important role in it. Many women turn to dietary strategies to manage these symptoms, with the ketogenic (keto) diet being a popular yet controversial choice. This article provides a comprehensive guide on the keto diet’s role in managing PCOS, including its potential benefits, risks, and practical advice for women who would like to give it a try. By the end of this article, you will have a clear understanding of whether the keto diet is suitable for your PCOS journey.

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What is the keto diet? 

The ketogenic diet is a high-fat, low-carbohydrate eating plan designed to shift the body’s metabolism into a state of ketosis. In ketosis, the body burns fat for fuel instead of glucose, leading to changes in energy production and metabolism.

• Key principles – The standard keto diet typically consists of 70-80% fats, 10-20% protein, and 5-10% carbohydrates. The primary goal is to reduce carbohydrate intake to 20-50 grams per day, encouraging the body to produce ketones for energy.
• Ketosis and metabolism – By drastically reducing carb intake, the liver produces ketones, which become the primary source of energy. This shift in metabolism is associated with various health benefits, particularly for those with metabolic disorders like PCOS. Entering ketosis typically takes 2-4 days of following the diet strictly, though this timeframe can vary.

Is the keto diet good for PCOS? 

The keto diet’s potential benefits for PCOS have been the subject of growing interest. Here’s a look at some of the key areas where it may help.

• Improves insulin sensitivity – Insulin resistance is a hallmark of PCOS. Research suggests that low-carb diets like keto can lower insulin levels, making cells more responsive to insulin’s effects. By reducing the body's reliance on glucose, the keto diet allows the pancreas to produce less insulin, reducing strain on the body.
• Supports weight loss – For many women with PCOS, weight loss can significantly improve symptoms. Since keto reduces hunger hormones like ghrelin, it may make it easier to maintain a calorie deficit. Unlike traditional calorie-restrictive diets, keto emphasizes eating healthy fats, which are more satiating and can reduce the urge to snack between meals.
• Reduces inflammation – Chronic inflammation is linked to PCOS. The anti-inflammatory properties of certain keto-friendly foods (like fatty fish, nuts, and seeds) may offer additional benefits. Reducing inflammation can positively impact symptoms like acne and fatigue, which are often reported by women with PCOS.

A 2020 study published in Nutrients found that women with PCOS on a low-carb, high-fat diet experienced improved insulin sensitivity, weight loss, and reduced testosterone levels.  This study highlights the potential of dietary interventions like keto to address multiple PCOS-related symptoms simultaneously.

Why is the keto diet bad for PCOS? 

While the keto diet has its proponents, there are valid concerns about its suitability for women with PCOS. These drawbacks may affect some women more than others, underscoring the importance of a personalized approach.

• Nutrient deficiencies – Cutting out whole food groups, like fruits and whole grains, can lead to vitamin and mineral deficiencies. This is particularly concerning for nutrients like B vitamins, magnesium, and fiber. Since whole grains and fruits are key sources of dietary fiber, constipation can become an issue on the keto diet.
• Hormonal imbalances – Drastically reducing carbs can affect cortisol (the stress hormone) levels, which may negatively impact hormone balance in women with PCOS. Cortisol spikes can lead to increased stress, anxiety, and even disruptions in the menstrual cycle.
• Sustainability issues – Many people find keto difficult to maintain long-term, increasing the likelihood of "yo-yo dieting," which can worsen metabolic health. Switching back and forth between keto and a high-carb diet can cause blood sugar fluctuations and disrupt hormonal balance.

Some health professionals highlight that while keto may provide short-term improvements, the long-term effects on hormonal health are less clear. It's essential to consult with a healthcare provider before making drastic dietary changes, especially when managing chronic conditions like PCOS.

PCOS keto diet plan 

For those who decide to try a keto approach, having a clear plan in place is essential. Below is a sample 3-day keto-friendly meal plan designed to support women with PCOS. This plan includes meals that promote hormonal balance, reduce inflammation, and support metabolic health.

Sample Meal Plan

Day 1

• Breakfast: Scrambled eggs with avocado and smoked salmon
• Lunch: Grilled chicken Caesar salad (with olive oil-based dressing, no croutons)
• Dinner: Baked salmon with a side of sautéed spinach and garlic
• Snack: Greek yogurt with chia seeds and unsweetened coconut flakes

Day 2

• Breakfast: Keto pancakes made with almond flour and topped with unsweetened berries
• Lunch: Zucchini noodles with pesto sauce and grilled shrimp
• Dinner: Grass-fed beef burger (lettuce wrap) with a side of cauliflower mash
• Snack: Handful of mixed nuts (almonds, walnuts, and pecans)

Day 3

• Breakfast: Chia seed pudding made with unsweetened almond milk and topped with raspberries
• Lunch: Cobb salad with hard-boiled eggs, turkey, and avocado (olive oil vinaigrette)
• Dinner: Grilled chicken thighs with roasted Brussels sprouts and garlic butter
• Snack: Cucumber slices with guacamole

Tips for Success

• Balance your macros – Use a keto macro calculator to ensure you’re hitting the right balance of fats, proteins, and carbs for PCOS management.
• Plan meals in advance – Meal prep can help you avoid last-minute food choices that deviate from your plan.
• Monitor symptoms – Track changes in menstrual cycles, energy levels, and cravings to gauge the diet’s effectiveness.
• Consult a professional – Work with a registered dietitian familiar with PCOS to create a personalized plan that supports hormonal health.

Frequently asked questions

How long does it take to see results with keto for PCOS?
Results vary, but some women report improvements in insulin sensitivity, weight loss, and menstrual regularity within 3-6 months of starting a keto diet. Individual factors like adherence, starting weight, and metabolic health play a role.

What are alternatives to keto for managing PCOS?
Alternatives to keto include the Mediterranean diet, low-glycemic index (GI) diets, and the DASH diet. Each of these focuses on whole foods and supports stable blood sugar levels without eliminating entire food groups.

The bottom line 

The keto diet’s impact on PCOS is a subject of ongoing debate. While some women see improvements in insulin sensitivity, weight loss, and inflammation, others face challenges related to sustainability, nutrient deficiencies, and hormonal balance. For those considering keto, a personalized approach is crucial. Consult with a healthcare provider or dietitian to ensure the diet meets individual health needs and goals.