Ketogenic Diet Shows Promise as Nonpharmacologic Treatment for PCOS


With a top treatment recommendation for obese women with polycystic ovary syndrome (PCOS) comprising lifestyle changes via diet changes and physical activity, this study’s investigators evaluated the effects of a ketogenic diet among this patient population.

As a first-stage nonpharmacological treatment for women with polycystic ovary syndrome (PCOS) who are classified as obese, the ketogenic diet—in particular, caloric restriction—shows great promise as adjuvant treatment alongside pharmacological therapy, note new study findings in the International Journal of Environmental Research and Public Health.

Common comorbidities of PCOS are insulin resistance, dyslipidemia, and obesity, the authors noted, which can increase the risk of diabetes and metabolic syndrome among women with the endocrine disorder. Seventeen women whose mean (SD) age was 28.5 (5.38) years (fertile age, according to the investigators) with PCOS and who were classified as obese (body mass index [BMI] > 25) were included in this study; all were enrolled at the University Medical Service of Dietetic and Metabolic Diseases of the Faculty of Medicine and Surgery of the University of Foggia, in Italy.

“In light of this evidence, the most therapeutic option prescribed to obese women with PCOS, regardless of the phenotype and the severity of clinical expression, is lifestyle correction,” they wrote. “This is the first study on the effects of the ketogenic diet on PCOS.” This type of diet consists of increased fat intake, reduced carbohydrate intake, and adequate protein. For this study, daily intakes were set at 600 kcal for calories, 1.1 to 1.2 g of protein per kilogram body weight, 30 g for carbohydrates, and 30 g for fats.

Following a 45-day dietary protocol, baseline/first visit findings were compared with 45-day/final visit results for gynecological evaluation of oligo/amenorrhea status, nutritional status, body composition, biochemical measurements, and diet administration. The baseline overall average total body weight was 81.5 (13.56) kg and the baseline BMI, 31.84 (5.85) kg/m2.

Decreases were seen in all of the following measures:

  • Average weight: 9.4 kg (P < .0001)
  • Average BMI: 3.6 kg/m2 (P < .001)
  • Waist circumference: 9.4 cm (P < .001)
  • Hip circumference: 8.1 cm (P < .001)
  • Fat mass: 7.90 kg (P < .001)
  • Free fat mass: 1.41 kg (P < .05)
  • Muscle mass: 1.32 kg (P < .05)
  • Total body water: 1.32 kg (P < .01)
  • Basal metabolic rate: 67 kcal (P < .001)

Improvements were also seen in several of the metabolic parameters (all P < .001):

  • Mean blood and urinary concentrations of ketones rose to 1.7 (0.58) mmol/L and 83 (54.34) mg/dL, respectively, from zero at baseline for both
  • Mean blood glucose decreased 10.07 mg/dL
  • Blood insulin dropped 12.90 mcU/mL
  • C-peptide blood concentration decreased 0.87 ng/mL
  • Triglycerides fell 70 mg/dL
  • Total cholesterol dropped 40 mg/dL
  • LDL cholesterol dropped 35 mg/dL
  • HDL cholesterol rose 15 md/dL

For endocrine parameters, these changes were seen:

  • Luteinizing hormone (LH) decreased 4.6 mIU/mL (P < .001)
  • Free and total testosterone decreased 0.17 and 7.34 ng/dL, respectively (P < .001)
  • LH/follicle stimulating hormone (FSH) ratio decreased to 1.32, from 2.72 at baseline (P < .01)
  • FSH value increased 1.46 mIU/mL (P < .05)
  • Sex hormone binding globulins 12.43 nmol/L (P < .001)
  • Positive correlations were seen between LH/FSH and weight, BMI, and fat mass
  • Negative correlations were seen between LH/FSH and weight, BMI, and fat mass
  • Positive correlations were seen between glycemia and LH and FSH
  • Negative correlations were seen between LH/FSH and glycemia

In addition, regular menstrual cycles reappeared in 5 patients, “after years of amenorrhea,” the authors noted, while regular menstrual cycles were restored for the other 12 patients—5 of whom when on to become pregnant naturally.

“The results attest that the mixed dietary ketogenic medical intervention, by reducing the amount of carbohydrates and inducing therapeutic ketosis, acts favorably and effectively in the management of PCOS,” they wrote. “These data are very interesting and showed that this pathology is a multifactorial disease influenced by lifestyle.”

The authors further concluded that their results are buffeted by the fact that their ketogenic diet intervention saw such positive results in such a short period and that this was seen without the addition of foods meant to induce weight loss. And although they recommend a ketogenic diet as adjuvant treatment with pharmacological therapy for PCOS, they do suggest additional studies are needed on the mechanisms the propel the benefits a this diet.


Cincione RI, Losavio F, Ciolli, et al. Effects of mixed of a ketogenic diet in overweight and obese women with polycystic ovary syndrome. Int J Environ Res Public Health. Published online November 27, 2021. doi:10.3390/ijerph182312490

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