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Ketogenic Diet’s Potential in Restoring Hormonal Balance

Ketogenic Diet

Ketogenic Diet’s Potential in Restoring Hormonal Balance for PCOS Patients

In a recent study featured in the Journal of the Endocrine Society, researchers conducted a comprehensive meta-analysis to explore the impact of ketogenic diets on individuals with polycystic ovary syndrome (PCOS). Their primary focus was on assessing whether adopting a ketogenic dietary approach could lead to significant alterations in reproductive hormones, such as the LH/FSH ratio, serological progesterone, sex hormone binding globulin (SHBG), free testosterone, and potential changes in body weight.

Understanding PCOS:

PCOS is a chronic medical condition characterized by a complex interplay of genetic and environmental factors. It ranks as the most common endocrine disorder among women, and early detection and intervention are crucial to prevent severe consequences like endometrial cancer and various cardiovascular and metabolic issues.

The Appeal of the Ketogenic Diet:

The ketogenic diet has emerged as a compelling option for individuals with PCOS, with promising indications of its potential to address hormonal imbalances. However, the available data is somewhat limited and derives from small-scale studies conducted in diverse settings. As a result, the ketogenic diet’s precise capacity to rectify hormonal imbalances in PCOS patients remains an open question.

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The Study in Focus:

In this meta-analysis, researchers set out to examine the influence of ketogenic diets on female reproductive health and body weight within the context of PCOS.


To compile their findings, the research team meticulously searched through prominent databases, including Web of Science, Scopus, Science Direct, and PubMed, up until January 20, 2023. They specifically sought out single- and double-arm randomized and non-randomized interventional clinical trials published in English.

The selected trials encompassed PCOS women who adhered to ketogenic diets for six weeks or more, aiming to measure alterations in LH to FSH ratio, progesterone, SHBG, testosterone levels, or various anthropometric measures like waist-to-hip ratio, body mass index, or weight. The researchers also conducted a comprehensive review of the references cited within the chosen articles.

Exclusions were made for case-control studies, case reports, reviews, editorial letters, and comments. The initial screening of articles was performed independently by two researchers, with any discrepancies resolved through consensus and discussions involving another researcher. The analysis utilized random-effects modeling, and the Cochrane Risk of Bias Tool was employed to assess potential bias risks in the included studies. PCOS diagnoses adhered to the Rotterdam classification, and a “leave-one-out” analysis was executed to ensure the study’s robustness.

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Key Findings and Implications:

The literature search yielded a total of 161 records, with 31 duplicates removed. Additionally, six non-English records, 101 irrelevant records, and 16 non-clinical trial studies were excluded. This left seven relevant studies, encompassing 170 individuals, for the final analysis.

The overall quality of the included studies was deemed fair. Encouragingly, the results indicated that a ketogenic diet intervention lasting 45 days or more significantly improved the levels of reproductive hormones in PCOS women. Specifically, it lowered the LH/FSH ratio and free testosterone levels while elevating SHBG levels in serum. Furthermore, significant weight loss was consistently observed across all the included studies. Notably, the sensitivity analysis (“leave-one-out”) produced congruent results, reinforcing the primary analysis’s robustness.


PCOS is characterized by hormonal imbalances, notably an elevated LH to FSH ratio, which disrupts follicular growth and ovulation. A ketogenic diet intervention led to a substantial reduction in this ratio, signifying the normalization of endocrine function through improved insulin sensitivity.

Hyperandrogenism, another hallmark of PCOS, is driven by heightened free testosterone resulting from increased ovarian thecacell activity. The hormonal imbalance in PCOS contributes to a range of health concerns, including diabetes mellitus type 2, obesity, atherosclerosis, hypertension, coronary heart disease, renal disease, and cardiac hypertrophy.

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The ketogenic diet’s positive impact on SHBG levels is especially noteworthy, as it alleviates ovulatory and metabolic dysfunction. By reducing hyperinsulinemia and curbing ovarian androgen synthesis, the low-carbohydrate dietary approach synergistically lowers circulating free androgens.

Serum progesterone levels remained relatively unaffected by the ketogenic diet intervention due to the inherent anovulation common in PCOS women. Nonetheless, the diet’s documented ability to induce significant weight loss is a crucial factor, driven by reduced hunger, enhanced metabolic efficiency during fat consumption, and decreased lipogenesis.


The study findings suggest that short-term adoption of a ketogenic diet may hold promise in ameliorating hormonal imbalances associated with PCOS. However, it’s essential to exercise caution when interpreting these findings, given the relatively small sample size and the limited number of studies analyzed.

Despite these limitations, the study’s implications have significant clinical relevance, particularly for gynecologists, dieticians, and endocrinologists. Recommendations for dietary interventions should be individualized and thoughtfully planned for PCOS patients, considering their unique clinical profiles and circumstances. As always, individuals are strongly advised to consult with their healthcare providers before making any substantial dietary or lifestyle changes.