Jun 8, 2023 • 10 min read

Is the Keto Diet Good for PCOS? Pros & Cons to Consider 

Medically Reviewed by Kim Langdon, MD on 07.16.23
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PCOS is a complex metabolic disorder we are only beginning to understand. Its features—reproductive hormone imbalance, insulin resistance, infertility, and sometimes obesity and fatty liver disease—have been found to be very sensitive to your diet. 

With so many dietary options for managing your PCOS, you may become confused as to which diets are good and which are bad for this disorder. The keto diet has been studied and shown to help PCOS because few foods in this diet stimulate insulin release. 

Evidence suggests that the keto diet improves many of the symptoms of PCOS, including infertility, emotional disturbances, excessive hair growth, obesity, and menstrual irregularity. But there are still pros & cons to consider.

This guide explains how the keto diet can help a person with PCOS and explores the benefits and risks of this diet. It also provides guidance on the best keto food options, how to switch to a keto diet, and how a PCOS nutritionist can help.

Can the keto diet help with PCOS?

The word “keto” in the keto diet stands for ketones. Ketones or “ketone bodies” are small molecules given off as part of fat metabolism. Fats are not designed to be used for energy; instead, we use carbs for most of our everyday cellular energy. 

Ketones are made by the liver when you don’t eat carbs. Your body uses different types of ketones for fuel. When you eat a diet high in fat and moderate in protein but very low in carbs, you don’t trigger insulin release, so insulin levels are low. 

Insulin-resistant individuals with PCOS or prediabetes benefit from lower blood sugars, and lower insulin levels force the body to burn fat rather than storing it. The result is lower body fat and weight, improved energy in some individuals, and reduced cardiac risk factors. Among individuals with PCOS, insulin resistance is improved and many symptoms are improved.  

The ketosis diet is not a great solution for someone who doesn’t need it. Short-term side effects include fatigue, headache, flu-like symptoms, and reduced exercise tolerance. These generally pass after a few days, yet kidney stones, fatty liver disease, vitamin deficiency, and low protein levels in the bloodstream can occur over the long term. Keto diets are also poorly tolerated over many months or years. 

Despite the downsides, women with PCOS who engage in the keto diet for symptom control can have a rapid reduction in the symptoms of their metabolic disorder. While the diet does not cure PCOS, it can jumpstart a program of weight loss that can have more long-lasting positive effects even when the diet is abandoned, particularly if the weight loss is sustained. 

It’s important to recognize and consider the pros and cons of participating in the keto diet. Certain individuals should never use this diet, including those with pancreatitis, advanced liver disease, and certain enzyme deficiencies affecting fat metabolism. People with diabetes on insulin or oral drugs are at risk for very low blood sugars if adjustments to their medications aren’t carefully made. 

Anytime you are making a big adjustment in your diet, including adopting the keto diet, you should first talk with your healthcare provider and an advanced-care nutritionist to see if the dietary changes are safe for you. 

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Benefits of the keto diet for PCOS

The keto diet has shown demonstrated positive effects on PCOS symptoms. Once you evaluate the possible benefits of this type of diet for your body’s physiology, you can better see whether the pros outweigh any cons of trying this type of food plan. 

Research has shown several areas of symptom improvement when following a keto diet:

  • Improve insulin resistance. Insulin resistance is complex. If you have insulin resistance, sugar does not get into your cells naturally and your blood sugar rises (sugar is trapped in the bloodstream). Your pancreas senses high blood sugars and puts out even more insulin. Over time, your pancreas can fail, leading to diabetes. When you eat a keto diet, your insulin levels drop. Your insulin sensitivity and function also improve when you lose weight.
  • Help with weight loss. High insulin levels promote increased weight, making PCOS weight gain very common and sometimes difficult to manage. Once you reduce insulin levels by avoiding carbs, you have reduced fat deposition. You also promote liver metabolism of fats instead of fat storage. Ketone bodies are used for fueling your body and weight loss with PCOS becomes easier. Weight loss is one of the main effects of the keto diet for those with PCOS. You can learn more about how many grams of fat you should be eating to lose weight here.
  • Reduce inflammation. Obesity seen in PCOS is inherently inflammatory because fat cells produce inflammatory chemicals. Inflammation causes damage to blood vessels, chronic pain, and heart disease when present over many years. By losing weight and fat, you will feel better and improve your long-term prognosis. 
  • Help regulate hormone levels. Inflammation can also contribute to hormonal imbalances favoring higher androgen levels compared to female hormones like estrogen. This hormone profile leads to acne and excessive hair growth. On the keto diet, most women notice an improvement in these symptoms. 
  • Infertility. Abnormal hormonal patterns seen in PCOS adversely affect your fertility by reducing your ability to ovulate. When these patterns are normalized, you have an enhanced ability to conceive. Menstrual regularity is also restored. You can learn more about a PCOS diet that can help with fertility here.
  • Improve emotions. Mood disturbances can happen anytime; however, sugar fluctuations can contribute to mood swings in women who have PCOS.  Research shows that among those with PCOS who engage in the keto diet, mood swings, depression, and anxiety are all reduced. 

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Risks of the keto diet with PCOS

The keto diet is generally considered safe for the short term except for those who have insulin dependence, liver failure, pancreatitis, or enzyme deficiencies affecting their ability to metabolize fats. 

Even if the diet is safe for you during the short term, there are side effects to expect and the potential for long-term complications:

  • Keto Flu. Many who begin the keto diet will experience adjustment-related symptoms commonly known as the “keto flu.” These symptoms include poor exercise tolerance, fatigue, dizziness, and headache. These take days to weeks to resolve. You may wish to practice self-care that includes rest or non-strenuous exercise to allow your body to adjust. 
  • Nutrient deficiencies. The foods commonly used in the keto diet are high-fat and no-carbohydrate foods. This means that you’ll miss out on the nutrients found in vegetables, grains, and fruits (most vitamins and minerals). You can take a nutrient supplement like a whole-food vitamin to improve your nutrient intake when the foods you eat aren’t doing the job. 
  • Digestive disturbances. Nausea and vomiting or constipation may be seen as part of the keto flu and will be temporary as your body adjusts. Fats, however, slow the digestive system so that your stomach may empty too slowly to be comfortable. Bloating or heartburn after meals can be long-lasting in some individuals. Others may have persistent constipation from poor fiber intake. Your gut microbiome feeds off of fiber; when you are missing this food, you could develop inflammation and irritable bowel syndrome symptoms. Remember that fiber comes from plant-based carbs that you will be avoiding on a keto diet. You can take a fiber supplement to offset this problem. 
  • Bone health dysfunction. The keto diet does not necessarily lead to osteoporosis but the higher levels of ketone bodies (which are mild acids) mean that calcium can be lost from your bones over time. If you also don’t consume much vitamin D, your bones can become more brittle. You may partially offset the vitamin D reduction by boosting your intake of this vitamin in a supplement. 
  • Heart health issues. Most of the time, keto diets promote better heart health by reducing weight and lessening inflammation. Some individuals, however, may develop an elevation in their LDL cholesterol levels which will increase the risk of heart disease. You may need to check with your doctor before or while consuming this diet to see if you have such a risk. 
  • Kidney stones. Kidney stones are common complications of keto diets, affecting 6% to 8% of those who engage in this diet. The best solution is to remain hydrated, avoid salt, and reduce animal protein intake. Acidic blood and urine from the keto diet cannot be avoided; however, reducing vitamin C intake to therapeutic levels (no supplements) can help. 
  • Kidney disease. The keto diet is hard on your kidneys in several ways. In those who have marginal kidney function already, the gradual decline in kidney function with age can become accelerated, leading to advanced chronic kidney disease. 

The keto diet is more restrictive than most diets because its effectiveness depends on persistently avoiding carbs so that ketosis can be maintained. Such a diet that precludes carbohydrate intake means that you will either miss out on the foods you’re used to eating or will fall off the diet altogether. 

Despite its effectiveness, few people can maintain it for their lifetime. 

Healthy keto foods to eat with PCOS

A diet with few carbs and up to 90% fat is challenging. Foods you can consume on this type of diet safely and effectively can contain protein but must have very little carbs in them:

  • Eggs. Eggs have many good nutrients but do not contain carbohydrates. Eat eggs for breakfast instead of baked goods or cereals. 
  • Meat protein. Bacon with your eggs is great for breakfast. Safe foods in this category include other pork products, beef, turkey, and chicken. 
  • Seafood. Salmon, tuna, and even sardines are good for the keto diet. Other fish are also perfectly acceptable. 
  • Dairy. Cheese is high in fat and protein. You can also consume full-fat milk, Greek yogurt (plain), sour cream, cream, cottage cheese, and butter. Greek yogurt is a better option than plain yogurt due to its higher protein content. 
  • Fruits. Berries are so good for you that you can eat them on a keto diet in limited portions along with fats. You can also eat avocados, which have healthy fats in them. 
  • Vegetables. Some non-starchy vegetables are good for those on a keto diet. Consider cauliflower, spinach, zucchini, broccoli, green beans, and bell peppers. 
  • Nuts and seeds. Almost all nuts and seeds are great for snacking on and contain few carbs. You can also drink almond milk.  
  • Miscellaneous foods. There are some surprising foods and drinks you can add to a keto diet and still be safe. Cocoa powder and dark chocolate may be consumed, and you can experiment with some alternative flours in cooking, including almond flour. Unsweetened tea makes for a healthy drink. You can safely cook with olive and coconut oils. 
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Tips for switching to a keto diet with PCOS

One of the challenges of the keto diet is switching from foods you are accustomed to and instead eating foods you may have been taught to avoid (high-fat or cholesterol-containing foods, in particular). 

There are ways you can ease into the keto lifestyle so you can gain the maximum effect of this otherwise restrictive diet:

  • Get medical approval first. Your healthcare provider can tell you if you are healthy enough to engage in a keto diet by examining you and evaluating your blood or urine for preexisting liver, pancreas, or kidney disease. 
  • Start slow if needed. You will not achieve the benefits of the keto diet until you attain ketosis. This means eating very few carbs so your liver can make ketone bodies. Still, working into the diet may help you avoid the keto flu and will make it easier to adjust in other ways.
  • Keep track of your macronutrients (carbs, protein, and fat). The most helpful keto diet is more than 80% fat intake. You can keep track of your fat, protein, and carb intake yourself or use a phone app like MyFitnessPal to help total your macronutrient intake throughout the day. 
  • Prioritize healthy fats. Remember that not all fats are created equal. Polyunsaturated fats are healthier than saturated fats, so you’ll want to consume more fish, avocados, and olive oil and less saturated food sources like fatty beef or processed meats.
  • Remain hydrated. Dehydration can accelerate kidney disease or promote kidney stone formation. Drinking plenty of water daily will help offset these complications. 
  • Exercise. Exercise can help reduce food cravings and maximize the benefits of the keto diet. Once the malaise (keto flu) wears off, you can begin exercising to promote weight loss and reduce inflammation. 
  • Consider some supplementation. One of the challenges of the keto diet is to get the micronutrients you need. If you’re not sure you’re getting what you need, consider taking vitamin D supplements, a whole-food vitamin, magnesium, medium-chain triglyceride oil, fiber, and omega-3 fatty acids. Note that there is some overlap with the best supplements for PCOS weight loss.
  • Track your progress. Remember why you’re following this diet and track your symptoms so you can maintain your motivation. Feeling better is one of the best ways to stick to a challenging diet. 

You do not need to stay on the keto diet if it isn’t beneficial to you or if you’re seeing side effects. Don’t be afraid to stop the diet and try something else to curb your PCOS symptoms if this type of diet is too hard to maintain. 

How a PCOS nutritionist can help with your keto diet

Your best chance of adopting the keto diet and sticking to it is when you have support. This is where a PCOS nutritionist can help a lot. PCOS nutritionists are trained in nutrition and the complex disorder of PCOS. They have hundreds of hours of experience in this field and can help you get started. 

Your PCOS nutritionist can provide individualized assistance by evaluating your current diet and learning about your symptoms. They can find keto-friendly foods you can more easily incorporate into your diet and will track your progress until your symptoms improve. 

If you get pregnant on the keto diet with PCOS, you may wish to continue the diet. If so, your PCOS nutritionist can help by providing strategies for eating a keto diet while pregnant. 

There are also nutritionists and dietitians specializing in keto that you may also want to consider seeing.

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Christine Traxler MD is a family physician, lifelong writer, and author with a special interest in mental health, women’s healthcare, and the physical after-effects of psychological trauma. As a contributing writer and editor for numerous organizations, she brings a holistic focus to her work that emphasizes healing and wellness through daily self-care, connecting with others, and setting stepwise goals toward achieving more balanced and authentic lives.