The ovaries are made up of two small, thumb-sized organs that are attached to the uterus. They carry the oocytes, which are perhaps better known as eggs; these structures mature inside fluid-filled structures called follicles. It’s currently believed that women are born with their lifetime supply of eggs, which clocks in at about 1-2 million. We aren’t able to make new ones, and each month, this supply decreases as we ovulate. By the time we hit puberty, we only have about a quarter of our lifetime eggs left–or about 300,000.
Polycystic ovary syndrome (PCOS) is a hormonal condition that’s commonly seen in women at a reproductive age. It’s caused by either high levels of insulin or androgens, and could lead to a number of secondary issues, such as depression, anxiety, birth complications, weight gain, and infertility. While there is currently no cure for PCOS, there are a number of different treatment options that may help curb its diverse symptoms.
In January 2018, a study that looked into the effects of a fertility treatment that focused on individuals with PCOS due to insulin resistance was published in the American Association of Clinical Endocrinologists. Insulin resistance causes people to have high levels of insulin, which in turn suppresses ovulation. This can cause PCOS.
The goal of this particular study was to see if a particular diet known as the ketogenic diet would help improve the effectiveness of fertility treatments by significantly reducing insulin levels and their adverse effects on the ovaries. The ketogenic diet–colloquially referred to as “the keto diet”–is characterized by being low in carbohydrates and high in fats, which may lead to notable reductions in insulin levels as well as blood sugars. Ultimately, this can cause your body to enter a metabolic state known as ketosis, in which it burns fat for energy, among other things.
This study was conducted over six months at the Cleveland Clinic and led by Ula Abed Alwahab, who is the PCOS program’s leader within the Cleveland Clinic’s Obesity and Weight Management program.
The research team recruited four women struggling with fertility and PCOS, and had them adhere to a keto diet that doctors at the Cleveland Clinic have used to aid in weight loss for several years. Over the course of the study, the four patients attended shared medical appointments with Alwahab and a dietitian every month. Alwahab explained that this was because the keto diet is considerably restrictive, so he wanted to make sure the patients were following it safely and accurately. The shared appointments were also educational meetings regarding PCOS and other issues related to diet and women’s health.
All four subjects enrolled in the study were able to stick to the keto diet as well as lose weight. While they had irregular menstrual cycles before they went on keto, their menstrual cycles stabilized 4-8 weeks after starting the new diet. Two of the women were even able to conceive spontaneously, without using medication to stimulate ovulation.
After six months, the study subjects were moved to a low-carb, non-keto program; they also began meeting every 2 or 3 months instead of monthly. Alwahab and his team generally keep their PCOS patients on keto for about a year in the hopes of clearing symptoms and regulating menstrual cycles. They also keep an eye on weight loss and help their patients attain healthy BMIs; after this, they help patients move towards non-keto, low-carb diets, which they can hopefully stay on to maintain weight already lost and regulate menstrual cycles.
Alwahab acknowledges that this study is just the tip of the iceberg. He said, however, that these initial results are very encouraging, suggesting that the keto diet could help resolve PCOS-related symptoms earlier than other treatment methods. Furthermore, Alwahab said that the women involved in the study were achieving regular periods with less weight loss and without taking hormones (in the form of birth control pills), which come with their own associated health risks.
Next, Alwahab wants to collect data on the ideal balance of carbs and other nutrients for women who are pregnant and have PCOS. They have already began conducting similar studies to this one, involving larger patient cohorts; this time, however, they’re not only trying to assess fertility data, but also regulate menstrual cycles and resolve other PCOS-related symptoms like insulin resistance and hirsutism using diet.
The Ezra abdominal, torso, and full-body scans may find PCOS if you have it. If you’d like to learn more about our screening options, you may do so here.