PCOS and Weight Loss: The Impact of Low-Carb Diets on Insulin Response

Polycystic Ovary Syndrome (PCOS) is a prevalent condition affecting 5% to 10% of women of childbearing age, with far-reaching implications for fertility. PCOS disrupts the normal ovulation process due to hormonal imbalances, leading to infertility issues and difficulties in conceiving.

Although most cases of PCOS are not hereditary, they share a common root cause: hormonal irregularities. The overproduction of androgen hormones, often referred to as ‘male’ hormones (despite both men and women having them), lies at the core of this condition. This hormonal imbalance hampers the growth of ovarian cysts essential for egg production. Consequently, women with PCOS have numerous small ovarian cysts that fail to mature and release eggs. Ordinarily, these cysts would dissipate once the egg-release process occurs, but in PCOS, they persist.

Beyond fertility challenges, elevated androgen hormone levels associated with PCOS increase the risk of obesity, heart disease, diabetes, and excessive facial hair growth in affected women.

Interestingly, recent research suggests that low-carb diets, such as the Zone diet, might offer hope for overweight women with PCOS. A study involving 11 non-diabetic, overweight women with PCOS (average age 33) compared the effects of a ‘standard’ diet containing 56% carbohydrates and 16% protein to a lower-carb diet with 43% carbohydrates and 15% protein. Notably, the low-carb diet featured a 14% increase in fat content compared to the standard diet, exceeding the fat levels in the Zone diet. The fat content in the low-carb diet was almost evenly distributed between polyunsaturated fatty acids and monounsaturated fatty acids. Conversely, the fat content in the standard diet was also divided between these two types of fatty acids but leaned slightly (by 3%) towards monounsaturated fats.

A third diet was also introduced, combining high carbohydrate intake with monounsaturated fatty acids. Participants followed each diet for 16 days, with a three-week break between each trial.

Given that insulin production is influenced by androgen hormones, researchers aimed to determine whether a low-carb diet could reduce insulin levels, indirectly benefiting PCOS.

The Results: While the study found that circulating hormones were not significantly impacted by the lower-carb diet, several positive effects were observed. These included improvements in cholesterol levels, fasting insulin levels, free fatty acids, and insulin response. The enhanced response to insulin is particularly significant for PCOS patients. However, it’s worth noting that the women in the study only followed each diet for 16 days, which may explain the relatively moderate effect on insulin levels.

The study’s authors suggest that: “Because elevated insulin is thought to contribute to the endocrine abnormalities in PCOS, a reduction in insulin would be expected to ultimately result in an improved endocrine profile.”

These findings imply that adopting a low-carb diet with reduced calorie intake could potentially benefit overweight women dealing with PCOS.

Not All Low-Carb Diets Are Alike: It’s important to note that not all low-carb diets offer the same benefits. The Atkins diet, for example, has been associated with increased risks of heart problems for some individuals and has even been linked to hospitalizations.

For instance, a 40-year-old woman was hospitalized after strictly adhering to the Atkins diet for approximately one month. She experienced dangerously high levels of acid in her blood, a condition known as ketosis, which is an indicator of the diet’s success. Ketosis results from depriving the body of carbohydrates beyond a certain threshold. Carbohydrates serve as the primary energy source for the body, especially the brain. When carbohydrate intake falls below this threshold, the body resorts to alternative methods of energy metabolism, relying on stored fats and proteins. However, this process is not very efficient and generates acidic metabolic byproducts known as ketones, which are released into the bloodstream for excretion.

In this woman’s case, the body couldn’t eliminate these metabolic byproducts fast enough, leading to their buildup in the bloodstream. She experienced severe vomiting, occurring four to six times daily, and was admitted to intensive care.

The Atkins Foundation defended the diet, claiming that the woman must have had abnormal metabolic or clinical issues. However, given that the Atkins diet is marketed to individuals who often contend with obesity-related medical and metabolic challenges, these concerns warrant further investigation. Obesity is frequently associated with both general medical problems and metabolic issues. If an obese person does not have some form of metabolic issues, they typically would not be obese. Therefore, there are legitimate concerns regarding the suitability of the Atkins diet for individuals with metabolic problems, particularly if the diet is promoted as a long-term “way of life.”