Written by Dr Robert Szabo
Polycystic ovary syndrome (PCOS) can be heartbreaking for women and families.
Besides making it far more difficult to conceive and increasing the risk of miscarriage, PCOS is also associated with other chronic health conditions, like diabetes, obesity, high blood pressure, heart disease and stroke.
Best Way To Reverse PCOS
PCOS hasn’t traditionally been considered reversible. A devastating 72% of women with PCOS consider themselves infertile. This adds further hardship to a condition already associated with depression, anxiety and relationship stress.
When it is time to try and conceive, women with PCOS often require fertility treatments such as medication and IVF. This treatment is expensive, stressful, and often unsuccessful.
Medication is often prescribed to control symptoms. This includes birth control pills, which can regulate menstruation and alleviate symptoms like excess body hair or acne.
Medication is never without side effects and medications used in PCOS often only address the symptoms of the syndrome – not the cause.
Can Diet Reverse PCOS?
However, what many women aren’t told is a low-carbohydrate diet can reverse PCOS.
In fact, low-carbohydrate diets have been shown to improve fertility rates and alleviate some of other symptoms of PCOS such as weight gain, which is particularly prevalent in women with PCOS.
And that by eating a low-carbohydrate diet, the risk of associated health conditions – like diabetes, heart disease, or high blood pressure – will also reduce.
How can a low-carbohydrate diet do all of this?
By changing the amount, and the way the body can respond, to a very important hormone: insulin.
But to understand insulin’s role in PCOS, we need to take a step back.
Insulin And PCOS
One of the defining features of PCOS is high levels of androgens (male sex hormones) present in the woman’s blood. Other features include cysts on the ovaries as well as irregular menstruation – through a woman does not have to have all three features to be diagnosed with PCOS.
Testosterone is the main male sex hormone. It is one of the hormones that gives men their ‘masculinity’ – deep voice, body hair, oily skin, as well as influencing the body fat distribution differences between men and women.
Testosterone is also found in women, but normally, only at low levels. In women with PCOS, however, testosterone levels are much higher. It is these high testosterone levels that are in part responsible for many of the uncomfortable symptoms of PCOS – like male pattern baldness, lowered voice, acne, excessive hair growth and, of course, irregular periods and difficulty conceiving.
Insulin is an essential hormone in the body and is most well known for its role in taking glucose (from the food we eat) out of the bloodstream and into our cells.
The more glucose we have in the body, the more insulin needs to be released to move it into the cells. Because of high levels and constant exposure to insulin, the cells become resistant to insulin’s effects – this is insulin resistance.
The body tries to compensate by releasing more and more insulin into the blood, but unfortunately, this just perpetuates the problem. Since carbohydrates are our main dietary source of insulin, the more carbohydrates we consume, the more insulin is released.
Being insulin resistant is highly correlated with having PCOS. This is because insulin resistance is what causes the high testosterone levels found in women with PCOS.
Insulin and insulin resistance contribute to high testosterone in two main ways. First, high levels of insulin cause the ovaries to increasethe amount of testosterone they produce.
Second, insulin reduces the liver’s ability to produce a protein called sex-hormone binding globulin (SHBG).
SHBG has a huge influence on the amount of free testosterone in the woman’s blood, because it acts like a shuttle service for testosterone.
SHBG takes testosterone from where it is produced (including the ovaries and the adrenal glands) and gives it a lift to the tissues it is needed at – it binds the testosterone, but only lets it go where it is meant to be.
Most of the testosterone in a woman’s body should be bound to SHBG. So, if there is less SHBG, then there will be more free testosterone in the blood.
All this free testosterone targets tissues it is not normally meant to target in a woman: it is all this free testosterone that causes the masculine-like symptoms of PCOS, like facial hair, acne and a lowered voice.
But a low-carbohydrate diet lowers insulin – and so lowers testosterone.
Of the three main food groups 9carbohydrates, protein and fat) it is carbohydrates that promote the biggest insulin response. Carbohydrates are broken down into glucose, and to clear glucose from the bloodstream, the body releases insulin.
By eating a low-carbohydrate diet, we don’t add so much glucose to the blood – and so we don’t need as much insulin. A low-carbohydrate diet reduces insulin resistance.
If the cells are not constantly exposed to insulin, they become more sensitive to its effects – so when it is released, they respond appropriately. Over time, this leads to lower and lower levels of insulin.
For a woman with PCOS, lowering insulin and reducing insulin resistance means less testosterone is produced by the ovaries, and more SHBG is made by the liver.
The net result? Lowered testosterone levels… and so alleviation of PCOS symptoms – like excessive hair growth, acne and lowered voice.
But more importantly, reducing testosterone means improving fertility.
Insulin And Fertility
A systematic review from 2017 on the effects of low carbohydrate diets on fertility found reducing dietary carbohydrates, and therefore circulating insulin, improved hormonal balance, promoted normal ovulation, and improved pregnancy rates.
By lowering insulin, low-carbohydrate diets also make it far easier to lose weight. It is well recognised that weight loss in general improves fertility rates – with weight loss of just 5-10% reported to improve fertility rates and decrease spontaneous abortions.
Whenever insulin levels are high, the body isn’t able to access stored fat for fuel (insulin prevents fat burning, instead promoting storage of food energy). Compared to a diet higher in carbohydrates, low-carbohydrate diets promote weight loss, and also uniquely preserve lean muscle mass, optimising body composition.
Low-carbohydrate diets also preferentially reduce the most harmful types of fat on the body: the fat around the organs and the abdomen. This reduces the risk of chronic disease – like diabetes, heart disease and stroke.
Try A Low-Carb Diet For PCOS
By addressing the underlying cause of PCOS using a low-carbohydrate diet, you can reverse PCOS. This means preventing health complications, and promoting fertility without expensive fertility treatments or suffering through the side effects of medications.
Here are my top five tips for getting started on a low-carbohydrate diet:
- Reduce or eliminate dietary sugar – soft drinks, desserts and sweets, fruit juice, muesli bars and take-away food.
- Reduce or eliminate processed carbohydrates – bread, pasta, cereals and grains, biscuits, chips and crispbreads.
- Find and remove hidden sugars – they are hiding unexpected places like salad dressings, sauces, minated meat, dried fruit, low-fat dairy products, flavoured waters and milks.
- Replace ‘low-fat’ with ‘full-fat’ to keep you feeling fuller for longer – like dairy and meat.
- Build your diet around whole foods: vegetables, salads, meat, eggs, fish, and dairy.
Never underestimate the power of diet to influence your hormones and your health.
Dr Robert Szabo is a Melbourne based GP and founder of The Low Carb Clinic; a doctor and dietitian team dedicated to transforming patients lives through medically supervised nutrition intervention.
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