Here is a list of some of the most prominent and significant research done on PCOS, as well as some interpretations on health and nutrition research. This is not a complete directory of all research; there are thousands of independent studies on the effects of a ketogenic diet on PCOS symptoms and fertility.
Keto for PCOS Symptom Relief & Fertility
BMC: Effects of a ketogenic diet in overweight women with polycystic ovary syndrome
Conclusion: "Our results suggest that a KD may be considered as a valuable non pharmacological treatment for PCOS."
Paoli, A., Mancin, L., Giacona, M.C. et al. Effects of a ketogenic diet in overweight women with polycystic ovary syndrome. J Transl Med 18, 104 (2020). https://doi.org/10.1186/s12967-020-02277-0
NIH: The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: A pilot study
Conclusion: "In this pilot study, a LCKD led to significant improvement in weight, percent free testosterone, LH/FSH ratio, and fasting insulin in women with obesity and PCOS over a 24 week period."
Mavropoulos JC, Yancy WS, Hepburn J, Westman EC. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nutr Metab (Lond). 2005 Dec 16;2:35. doi: 10.1186/1743-7075-2-35. PMID: 16359551; PMCID: PMC1334192. https://pmc.ncbi.nlm.nih.gov/articles/PMC1334192/
JES: Effects of Ketogenic Diet on Reproductive Hormones in Women With Polycystic Ovary Syndrome
Conclusion: "Short-term ketogenic diet potentially improved hormonal imbalances commonly associated with PCOS."
Karniza Khalid, Saraswathy Apparow, Irma Liyana Mushaddik, Amalina Anuar, Syed A A Rizvi, Anasufiza Habib, Effects of Ketogenic Diet on Reproductive Hormones in Women With Polycystic Ovary Syndrome,
Journal of the Endocrine Society, Volume 7, Issue 10, October 2023, bvad112,
https://doi.org/10.1210/jendso/bvad112
NIH: Dietary Modification for Reproductive Health in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis
Conclusion: "Overall, diet is an effective intervention for improving fertility health, thus professional and dynamic dietary advice should be offered to all PCOS patients, based on the changeable circumstances, personal needs and expectations of the individuals."
Shang Y, Zhou H, He R, Lu W. Dietary Modification for Reproductive Health in Women With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne). 2021 Nov 1;12:735954. doi: 10.3389/fendo.2021.735954. PMID: 34790167; PMCID: PMC8591222. https://pmc.ncbi.nlm.nih.gov/articles/PMC8591222/
NIH: The Effect of Low Carbohydrate Diets on Fertility Hormones and Outcomes in Overweight and Obese Women: A Systematic Review
Conclusion: "This review found that reducing carbohydrate load can reduce circulating insulin levels, improve hormonal imbalance and resume ovulation to improve pregnancy rates compared to usual diet..."
McGrice M, Porter J. The Effect of Low Carbohydrate Diets on Fertility Hormones and Outcomes in Overweight and Obese Women: A Systematic Review. Nutrients. 2017 Feb 27;9(3):204. doi: 10.3390/nu9030204. PMID: 28264433; PMCID: PMC5372867. https://pmc.ncbi.nlm.nih.gov/articles/PMC5372867/
Other Related Studies
NIH: High-glycemic index carbohydrate increases nuclear factor-kappaB activation in mononuclear cells of young, lean healthy subjects
Conclusion: "The findings suggest that high-normal physiologic increases in blood glucose after meals aggravate inflammatory processes in lean, young adults. This mechanism may help to explain relations between carbohydrates, glycemic index, and the risk of chronic disease.
Dickinson S, Hancock DP, Petocz P, Ceriello A, Brand-Miller J. High-glycemic index carbohydrate increases nuclear factor-kappaB activation in mononuclear cells of young, lean healthy subjects. Am J Clin Nutr. 2008 May;87(5):1188-93. doi: 10.1093/ajcn/87.5.1188. PMID: 18469238. https://pubmed.ncbi.nlm.nih.gov/18469238/
ScienceDirect: Inflammation in Polycystic Ovary Syndrome: Underpinning of insulin resistance and ovarian dysfunction
Conclusion: "In PCOS, a dietary trigger such as glucose is capable of inducing oxidative stress to stimulate an inflammatory response even in the absence of excess adiposity. Hyperandrogenism may be the progenitor of chronic low-grade inflammation. Diet-induced inflammation in particular may be the underpinning of insulin resistance in the disorder. Inflammation directly stimulates excess ovarian androgen production. Increased abdominal adiposity contributes to the inflammatory load in PCOS, and its development may be controlled by the severity of hyperandrogenism."
González F. Inflammation in Polycystic Ovary Syndrome: underpinning of insulin resistance and ovarian dysfunction. Steroids. 2012 Mar 10;77(4):300-5. doi: 10.1016/j.steroids.2011.12.003. Epub 2011 Dec 8. PMID: 22178787; PMCID: PMC3309040. https://pmc.ncbi.nlm.nih.gov/articles/PMC3309040/
SN: Insulin Resistance Effects on Sex Hormones and Ovulation in the Polycystic Ovary Syndrome
Nestler, J.E. (1999). Insulin Resistance Effects on Sex Hormones and Ovulation in the Polycystic Ovary Syndrome. In: Reaven, G.M., Laws, A. (eds) Insulin Resistance. Contemporary Endocrinology, vol 12. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-716-1_19
ScienceDirect: Behavioral Characteristics and Self-Reported Health Status among 2,029 Adults Consuming a “Carnivore Diet”
Conclusion: "Contrary to common expectations, adults consuming a carnivore diet experienced few adverse effects and instead reported health benefits and high satisfaction. Cardiovascular disease risk factors
were variably affected. The generalizability of these findings and the long-term effects of this dietary pattern require further study."
From https://www.doctorkiltz.com/the-harvard-carnivore-diet-study/:
"Self-reported changes:
95% improved overall health
91% improved hunger/food cravings
89% improved energy
85% improved mental clarity
83% improved focus
78% improved strength
76% improved endurance
69% improved sleep
69% improved chronic disease
66% improved memory
98% improved or resolved diabetes and insulin resistance
97% improved or resolved gastrointestinal conditions
96% improved or resolved musculoskeletal issues
96% improved or resolved psychiatric symptoms
93% improved or resolved overweight/obesity (mean BMI decreased from 27.2 to 24.3)
93% improved or resolved hypertension
92% improved or resolved urologic issues
92% improved or resolved dermatologic issues
89% improved or resolved autoimmune conditions
84% improved or resolved cardiovascular issues
How medication use changed
100% discontinued other diabetes injectables
92% discontinued insulin for type 2 diabetes altogether
90% discontinued or decreased insulin
84% discontinued oral diabetes medications.
98% of participants reported being very satisfied or satisfied"
Belinda S Lennerz, Jacob T Mey, Owen H Henn, David S Ludwig, Behavioral Characteristics and Self-Reported Health Status among 2029 Adults Consuming a “Carnivore Diet”, Current Developments in Nutrition, Volume 5, Issue 12, 2021, nzab133, ISSN 2475-2991, https://doi.org/10.1093/cdn/nzab133.
NIH: Polycystic ovary syndrome and type 2 diabetes mellitus
De Leo V, Musacchio MC, Morgante G, La Marca A, Petraglia F. Polycystic ovary syndrome and type 2 diabetes mellitus. Minerva Ginecol. 2004 Feb;56(1):53-62. PMID: 14973410. https://pubmed.ncbi.nlm.nih.gov/14973410/
IJO: Synthesis and regulation of sex hormone-binding globulin in obesity
Hautanen, A. Synthesis and regulation of sex hormone-binding globulin in obesity.
Int J Obes 24 (Suppl 2), S64–S70 (2000). https://doi.org/10.1038/sj.ijo.0801281
SN: Contribution of Dietary Carbohydrates in Induction of Oxidative Stress
Farooqui, A. (2014). Contribution of Dietary Carbohydrates in Induction of Oxidative Stress. In: Inflammation and Oxidative Stress in Neurological Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-04111-7_8
NIH: Carbohydrate nutrition and inflammatory disease mortality in older adults
Conclusion: "These data provide new epidemiologic evidence of a potentially important link between GI and inflammatory disease mortality among older women."
Buyken AE, Flood V, Empson M, Rochtchina E, Barclay AW, Brand-Miller J, Mitchell P. Carbohydrate nutrition and inflammatory disease mortality in older adults. Am J Clin Nutr. 2010 Sep; 92(3):634-43. doi: 10.3945/ajcn.2010.29390. Epub 2010 Jun 23. PMID: 20573797. https://pubmed.ncbi.nlm.nih.gov/20573797/
ASRM: Is PCOS an inflammatory process?
Conclusion: "The evidence in support of the presence of chronic inflammatory state in the majority of women with PCOS is incontrovertible. It is apparent that PCOS is associated with a significant elevation of multiple markers of inflammation including CRP, IL-18, MCP-1, and white blood count. Furthermore, PCOS is associated with other derangements associated with inflammation such as increased oxidative stress and endothelial dysfunction. While the etiology of systemic inflammation in PCOS remains unclear, recent data raise the intriguing possibility of a link between PCOS, inflammation and chronic low grade infectious agents such as Chlamydia pneumoniae, Helicobacter pylori and pathogens inducing periodontal inflammation."
Duleba AJ, Dokras A. Is PCOS an inflammatory process? Fertil Steril. 2012 Jan;97(1):7-12. doi: 10.1016/j.fertnstert.2011.11.023. PMID: 22192135; PMCID: PMC3245829. https://pmc.ncbi.nlm.nih.gov/articles/PMC3245829/
EJE: Body fat and insulin resistance independently predict increased serum C-reactive protein in hyperandrogenic women with polycystic ovary syndrome
Conclusion: "PCOS is accompanied by a low-grade chronic inflammation. Body fat appears the main determining factor of this finding, which is only partly explained by insulin resistance. At least in lean women, androgen excess per se seems to play an additional, possibly protective, role in this association."
Flavia Tosi, Romolo Dorizzi, Roberto Castello, Claudio Maffeis, Giovanna Spiazzi, Giacomo Zoppini, Michele Muggeo, Paolo Moghetti, Body fat and insulin resistance independently predict increased serum C-reactive protein in hyperandrogenic women with polycystic ovary syndrome, European Journal of Endocrinology, Volume 161, Issue 5, Nov 2009, Pages 737–745, https://doi.org/10.1530/EJE-09-0379
EJE: Inflammatory and endothelial markers in women with polycystic ovary syndrome
Conclusion: "The present study demonstrates that endothelial dysfunction coexists and is influenced by the presence of increased serum levels of inflammation and endothelial activation markers in young women with PCOS. These parameters appear to be interrelated with hyperandrogenaemia in this insulin-resistant population."
Diamanti-Kandarakis, E., Alexandraki, K., Piperi, C., Protogerou, A., Katsikis, I., Paterakis, T., Lekakis, J. and Panidis, D. (2006), Inflammatory and endothelial markers in women with polycystic ovary syndrome. European Journal of Clinical Investigation, 36: 691-697. https://doi.org/10.1111/j.1365-2362.2006.01712.x
EJE: Anti-mullerian hormone is associated with advanced glycosylated end products in lean women with polycystic ovary syndrome
Conclusion: "Anti-mullerian hormone is associated with advanced glycosylated end products in lean women with polycystic ovary syndrome."
Evanthia Diamanti-Kandarakis, Athanasia Piouka, Sarantis Livadas, Christine Piperi, Ilias Katsikis, Athanasios G Papavassiliou, Demetrios Panidis, Anti-mullerian hormone is associated with advanced glycosylated end products in lean women with polycystic ovary syndrome, European Journal of Endocrinology, Volume 160, Issue 5, May 2009, Pages 847–853, https://doi.org/10.1530/EJE-08-0510
AOGS: Oxidative stress but not endothelial dysfunction exists in non-obese, young group of patients with polycystic ovary syndrome
Conclusion: "In conclusion, oxidative stress is prominent in young, non-obese PCOS patients even in the absence of IR, and these patients are capable of generating an anti-oxidant response. In addition, we could not demonstrate endothelial dysfunction in this particular group of patients. This may be due to either an earlier life time of the pathologic process or to their defense system against oxidative load, or lack of having severe metabolic disturbances which may adversely affect cardiovascular system. Further studies are needed to prove if being and remaining lean and insulin sensitive would protect a PCOS patient from developing cardiovascular complications."
KUŞÇU, N.K. and VAR, A. (2009), Oxidative stress but not endothelial dysfunction exists in non-obese, young group of patients with polycystic ovary syndrome. Acta Obstetricia et Gynecologica Scandinavica, 88: 612-617.
https://doi.org/10.1080/00016340902859315
NIH: Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity
Spreadbury I. Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity. Diabetes Metab Syndr Obes. 2012;5:175-89. doi: 10.2147/DMSO.S33473. Epub 2012 Jul 6. PMID: 22826636; PMCID: PMC3402009. https://pubmed.ncbi.nlm.nih.gov/22826636/
NIH: The inositols and polycystic ovary syndrome
Conclusion: "Inositols act as second messengers for insulin, and their deficiency contributes to the various features of PCOS. Correction of MI and DCI deficiency simultaneously, by using MDI therapy, may help in alleviating metabolic, menstrual/ovulatory, and cutaneous hyper androgenic features of PCOS. Thus, MDI is a rational treatment choice, both as monotherapy and in combination, in managing PCOS..."
Kalra B, Kalra S, Sharma JB. The inositols and polycystic ovary syndrome. Indian J Endocrinol Metab. 2016 Sep-Oct;20(5):720-724. doi: 10.4103/2230-8210.189231. PMID: 27730087; PMCID: PMC5040057. https://pmc.ncbi.nlm.nih.gov/articles/PMC5040057/