How to potentially reverse PCOS with low carb

Evidence based

By Dr. Andreas Eenfeldt, MD, medical review by Dr. Michael Tamber, MD Evidence based

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Polycystic ovary syndrome (PCOS) is a common disorder that affects 4-20% of women of childbearing age worldwide, and its incidence appears to be increasing over time.¹ Beyond menstrual problems and other physical signs and symptoms, it’s a leading cause of infertility.² Fortunately, there’s a potentially effective lifestyle treatment available: a low carb diet.

Signs and symptoms

Here are the most common signs and symptoms associated with PCOS:

• Menstrual irregularities like irregular, skipped or heavy periods
• Inability to get pregnant
• Acne
• Excess facial and body hair, showing up in a male pattern (including the upper lip, chin, and chest)³
• Obesity

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Causes and treatment

The underlying causes of PCOS are complex and have been debated for decades. However, it is clear that the vast majority of women with PCOS have what is known as functional ovarian hyperandrogenism. This means that the ovaries are extraordinarily sensitive to signals that lead them to overproduce androgens (hormones like testosterone with “male” effects).⁴

This, of course, also increases the risk of developing type 2 diabetes. Given that low-carbohydrate diets have been proven very effective for treating insulin resistance, obesity, and type 2 diabetes, it makes sense that they would also be useful for treating PCOS.⁵

In fact, any lifestyle intervention that results in weight loss or pharmacologic intervention that enhances insulin sensitivity may improve the features of PCOS.⁶

But, given that low carb diets directly address insulin resistance — beyond any effect on weight — we believe that they are a particularly effective tool in the toolkit for PCOS. There is now a growing body of research that supports this contention:

• In 2005, researchers followed 11 women with PCOS as they followed a keto diet for six months. The five women who completed the study lost weight and improved some of their hormonal markers. What’s more, two of the women became pregnant during the study, despite previous infertility problems.⁷
• A 2013 study found that even a very modest reduction in carbohydrates (41% of calories) can lead to significant improvements in hormones and other metabolic risk factors, even in the absence of weight loss.⁸
• A 2017 systematic review of clinical trials found that low carb diets tend to “reduce circulating insulin levels, improve hormonal imbalance and resume ovulation to improve pregnancy rates.“⁹ A 2019 meta-analysis of randomized trials showed similar findings, concluding “proper control of carbohydrate intake provides beneficial effects on some aspects of PCOS and may represent one of the important interventions improving the clinical symptoms of affected patients.”¹⁰
• In a 2020 study, 14 women with PCOS followed a ketogenic Mediterranean diet for 12 weeks. By the end of the study, they achieved lower blood glucose and insulin levels, improvements in reproductive hormone levels and function, reduction of heart disease risk factors, and an average weight loss of 20 pounds (9.4 kg).¹¹
• A 2021 study of women with PCOS, obesity, and fatty liver randomized the participants to a ketogenic diet or conventional pharmacologic therapy. Those who received the ketogenic diet demonstrated better decreases in blood sugar and weight, and greater improvement in fatty liver.¹²
• Finally, a 2021 systematic review of RCTs concluded that dietary interventions improve PCOS symptoms, and low carb is likely superior for fertility and restoring normal menstruation.¹³

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Reversing PCOS and getting pregnant

There are several stories of women reversing their PCOS symptoms and in some cases suddenly getting pregnant after going low carb.¹⁴ It can sometimes feel like a miracle. Of course, it’s not that kind of miracle, but it’s still pretty impressive.

This is simple biology. Cutting back on carbs can help with weight loss, lower insulin levels, and reverse insulin resistance, which may help to balance the hormonal system. This can enable ovulation and a normal menstrual cycle, in addition to improving or eliminating other symptoms.¹⁵

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While the stories of these women can be inspirational, it’s important to remember that a collection of anecdotes does not equate with scientific evidence:

All PCOS success stories

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Professional experience

Some health care professionals have also found that carb restriction can be incredibly effective for helping people with PCOS reverse their disease and get pregnant.¹⁶ This includes a group of Australian dietitians that we previously wrote about.

Fertility specialist Dr. Michael Fox has more than a decade of experience helping patients with PCOS and infertility, using a low carb diet.

Dr. Fox found that compared to only using drugs, adding a low carb diet for PCOS patients increased their chance of pregnancy from 45% to over 90%!¹⁷

Dr. Michael Fox can be contacted at the Jacksonville Center for Reproductive Medicine.

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More about PCOS and keto

Get started

Do you want to try reversing your PCOS using low carb? Try our members-only personalized meal planner service, or use our beginner’s low carb guide.

More benefits of low carb

Why should you consider eating fewer carbs? There are many potential benefits, at all ages (although there’s hardly ever a reason for healthy kids to do a strict low carb diet).

Here are some of the main benefits, and how to adapt a low carb diet for your specific needs, to maximize the positive effects on your health.