Keto and PCOS may be the two biggest rivals of the year. PCOS is the most common endocrine disorder for pre menopausal women. And its effects are far reaching.
It affects up to 10% of women of childbearing age . And keto may be the white knight…here to the rescue.
PCOS can cause everything from infertility to facial hair.
And like many western diseases it’s on the rise.
Bad news and good news…First the bad news: almost everything in your diet may be causing PCOS.
Good news: we may be able to reverse it.
What is PCOS
Polycystic ovary syndrome, or PCOS is the most common hormonal disorder amongst women.
The name is polyCYSTic because cysts are very common. However, many women don’t ever develop them.
PCOS has become sort of a catch all term for doctors who don’t know what to diagnose a woman who has idiopathic reproductive issues.
Technically PCOS is classified by at least two of these three features: hyperandrogenism, irregular ovulation and polycystic ovaries on an ultrasound.
Currently there are no pharmacological treatments for PCOS other than birth control prescriptions (which often lead to another set of symptoms).
However, what’s interesting to me about PCOS is that it may be tied to the same devil that has infected all of western society: hyperinsulinemia. And the good news is that if I know how to do anything it’s to help bring people’s insulin levels down.
Symptoms and Signs of PCOS
One of the most common consequences of PCOS is hyperandrogenism.
Many of the signs and symptoms of PCOS are associated with this excess testosterone. Issues like irregular or absent cycles, excessive body hair, acne and infertility.
Some of the other signs & symptoms are:
- Weight gain
- Trouble losing weight
- Male pattern baldness
- Thinning hair
- Mood swings
- Low sex drive
This will not be a surprise to my readers, but many metabolic disorders are associated with PCOS. PCOS doesn’t cause these issues, but if you have one of the symptoms above along with a metabolic disorder, it could be PCOS.
Obesity, insulin resistance and type 2 diabetes are all associated with PCOS . However, there are many people who have PCOS and are not overweight.
What causes PCOS? No surprises here for my readers…
What causes PCOS?
Like many diseases in western society, I believe that the main cause is hyperinsulinemia.
According to this study “Hyperinsulinemia associated with insulin resistance has been causally linked to all features of the syndrome, such as hyperandrogenism, reproductive disorders, acne, hirsutism and metabolic disturbances.”
A better name for PCOS may really just be female metabolic syndrome, as it is one of the most common manifestations.
How does hyperinsulinemia trigger PCOS?
A quick detour to women’s hormones and the menstrual cycle to explain this.
Field Trip to the Menstrual Cycle
All aboard the magic school bus…hopefully you have your waivers sign. Today we’ll be taking a field trip through the menstrual cycle.
In a way, human beings are just hormones with limbs. Hormones run the show in more ways than we can even imagine. So many of your desires, moods, and actions can be tied back to hormonal changes.
For women, one of the main areas hormones exert their impact is on the menstrual cycle.
Menstruation is the cyclical shedding of the uterine lining in response to hormonal cycles. There are two phases of this cycle:
- Follicular or the proliferative phase
- The luteal or the secretory phase
The median length of a menstrual cycle is 28 days, with each phase above comprising half.
This process is controlled by two main hormones: LH and FSH.
Most women have about equal amounts of LH and FSH during the early part of their cycle. However, towards the end of the first half, there is a LH surge in which the amount of LH increases to about 25-40 mlU/ml 24 hours before ovulation occurs. Once the egg is released by the ovary, the LH levels go back down.
But in women with PCOS, LH levels tend to remain elevated, sometimes up to 3x the FSH levels.
Insulin’s Effect on the Menstrual Cycle
Insulin throws a wrench in this cycle, derailing the traditional flow. How does it do so?
First off, hyperinsulinemia has been shown to directly stimulate pituitary gland LH secretion. As a result, hyperinsulinemia tends to elevate LH levels relative to FSH .
Excess LH, in turn, has been shown to promote androgen production . These excess androgens then prevent proper ovulation and lead to some of the symptoms described above.
Without a proper ovulation, progesterone is not produced in the second phase of the cycle, and estrogen remains elevated relative to progesterone levels (estrogen tends to be dominant in the first phase of the cycle and progesterone in the latter half…I will touch on this more in another article). This is sometimes referred to as estrogen dominance, a separate but related issue.
Insulin exerts its mark elsewhere too. Hyerpinsulinemia inhibits sex hormone binding globulin synthesis, which increases levels of free testosterone .
Because there is not a normal ovulatory cycle, the follicles that are supposed to mature do not properly and can turn into cysts.
Hyperinsulinemia, the direct consequence of the Standard American Diet, turns a pleasant cycle into a merry go round from hell.
Some other causes of PCOS
Like other metabolic disorders, the causes of PCOS are multifold, but often related. Almost all of them can be tied back to the wholesale denial of human nature and the ubiquity of fake, toxic garbage in Western society.
Dysbiosis of the gut microbiome can lead to excessive androgen synthesis.
One study found that treating PCOS rats with lactobacillus and a fecal microbiota transplant resolved the menstrual cycle issues .
Seed oils, sugars and refined carbs — the standard culprits — all have been shown to contribute to leaky gut and gut imbalances.
The carnivore diet is the best diet in the world for gut health, in my opinion. It cuts out all the potential inflammatory factors allowing you to do a complete reset. Even some vegetables may contain gut damaging components. The carnivore diet also loads you up with gut healing nutrients like vitamin A, zinc and glutamine.
The conversion and homeostasis of hormones is regulated by enzymes that require vitamins and minerals to carry out their functions. Inadequate nutrient levels, like a car without gas, render the enzymes incapable of fulfilling their function.
Some of the most critical nutrients for maintenance of female hormonal balance are only prevalent in sufficient quantities (and their most bioavailable form) in animal foods. SOme examples are the following:
- Selenium: The highest concentration of selenium is found in the sex glands. Two studies of women with PCOS showed that daily supplementation improved insulin sensitivity and cholesterol. Selenium may also increase the level of progesterone
- The B vitamins are critical for converting nutrients into energy, burning fat and controlling insulin sensitivity. They are also important for methylation. B6 is critical for maintaining and regulating hormonal balance, especially in the thyroid. Elevated homocysteine, often time sa symptom of B vitamin deficiencies, is associated with PCOS
- Magnesium deficiencies are common in women with PCOS.
- Zinc supplementation has been shown to improve fertility in women with PCOS
- A recent meta analysis found that women with PCOS had significantly lower Vitamin D levels
The nutritional status of the world paints a bleak picture. Of course if you’re missing nutrients that are essential — yes, required — for proper physiological function, you’ll develop problems.
Food is the most powerful factor in health and disease. It’s time to start acting like it.
Phytoestrogen intake & Endocrine disrupting chemicals
Exposure to phytoestrogens, molecules that mimic estrogen and activate the estrogen receptor, can potentially lead to PCOS.
One study showed that in rats, lifetime exposure to a soy diet (high in phytoestrogens) induced key features of PCOS .
Some other phytoestrogens include
- Plastic: Plastic contains BPA and BPS, both toxic xenoestrogens
- Phthalates: These are softeners that are prevalent in many cleaning products, soaps and cosmetics. All their names end with phthalate.
- Parabens: Found in soaps and cosmetics
- PVC: Found in vinyl products and kling wrap. The most toxic xenoestrogen.
According to the CDC, 93% of Americans carry BPA in their bodies — the compound in plastic. I try to avoid plastic as much as possible.
Keto and PCOS
Given the above etiology of PCOS, the Keto and carnivore diets are potentially very effective ways to attack PCOS.
First, the Ketogenic diet is by far and away the most effective way to treat hyperinsulinemia. In fact, 94% of Virta Health’s ketogenic diet subjects reduce or eliminate their insulin within 1 year .
Next, the keto and carnivore diets tend to be higher in nutrient density…specifically many of the nutrients people with PCOS desperately need. Red meat is a health food: loaded with the b vitamins, zinc and bioactives like taurine, carnosine and creatine. Whereas the standard american diet on the other hand tends to be nutritionally empty (and that’s putting it nicely).
Luckily for us, a number of studies have evaluated keto for exactly this function.
In one study researchers evaluated the ketogenic diets effect on reproductive hormones.
In the 5 women who completed this study they:
- Lowered insulin by 36%
- Free testosterone by
- LH / FSH by
And 2 of them even got pregnant. Now I don’t think steak alone can get you pregnant, but I can’t promise anything.
This systematic review of 7 studies found “that reducing carbohydrate load can reduce circulating insulin levels, improve hormonal imbalance and resume ovulation to improve pregnancy rates compared to usual diet”
Another study of obese women with PCOS found that a low carb diet significantly decreased insulin levels by 30%.
Part of the reason why I would opt for the carnivore diet over the keto diet is because of the nutrient density. Many of the nutrient deficiencies that can lead to PCOS are found in their highest concentrations in animal foods…especially beef liver.
PCOS is another one of those intractable diseases plaguing women, that most doctors cannot seem to solve.
Unsurprisingly it’s because we’re taking a pharmacological approach to something that stems from nutrition.
But Keto and carnivore may give women another way out.