Low-Calorie Ketogenic Diet: Potential Application in the Treatment of Polycystic Ovary Syndrome in Adolescents

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. Hyperandrogenism, hyperinsulinism and insulin resistance (IR) are the main drivers of clinical, metabolic and reproductive phenotypes of PCOS. In adolescence, the cornerstones of PCOS treatment are lifestyle and dietary interventions. In particular, the quality and quantity of carbohydrates introduced with the diet play a crucial role in the benefits of diet on PCOS. Recently, the ketogenic diet (KD) has attracted significant interest for the treatment of IR and for the control of carbohydrate metabolism, which has proven to be beneficial for several dysmetabolic conditions, including PCOS. The goal of the KD is to induce a fasting-like metabolism with production of chetonic bodies. Ketosis is a good regulator of calorie intake and mimics the starvation effect in the body, leading to body weight control and consequent metabolism. Additionally, during ketogenesis, insulin receptor sensitivity is also promoted. We proposed a broad overview of the available literature regarding KD indications and considered its metabolic benefits useful for improving PCOS management. The reported data support that a low-calorie ketogenic diet (LCKD) plays a positive role as a regulator of control weight, IR, glucose and lipid homeostasis and hormonal profile. Unfortunately, the evidence concerning the benefits of the very LCKD in adolescents with PCOS and excessive body weight is still numerically scarce. Further studies are necessary to understand whether these effects are due to weight loss or to the nutritional characteristics of this diet. Considering the long-term consequences of PCOS, it is crucial to detect the prospects of nutritional interventions to protect fertility, starting in adolescence.

High Fat Diet and Polycystic Ovary Syndrome (PCOS) in Adolescence: An Overview of Nutritional Strategies

“…Initiating treatment during this time may help reduce future comorbidities, irrespective of the definitive diagnosis [33]. PCOS is a multifaceted and heterogeneous disorder that affects adolescents and women of reproductive age [16][17][18]. Reports on the epidemiology of PCOS in adolescents are scarce, and determining its prevalence accurately can be challenging due to the high occurrence of para-physiologic ovulatory dysfunction and the common ultrasound findings of micro-polycystic ovaries in adolescent girls [29].…”

“…Although PCOS is a frequent condition, its etiology, pathogenesis, and progression have not been fully clarified [34]. The pathogenetic mechanisms of this disorder in adolescence are intricate and arise from a combination of genetic predisposition, epigenetic modifications, and environmental factors [16][17][18].…”

“…A possible link between PCOS and PP was hypothesized to be hyperinsulinism and IR, which work as triggers for androgen secretion by both adrenal glands and ovaries [51,52]. Indeed, IR was recently shown to have a prevalence of 70-80% in women with PCOS who are overweight and 30% in lean women [18,20].…”

“…PCOS is a complex and heterogeneous disorder that affects adolescents and women of reproductive age, and it is associated with significant reproductive, metabolic, and psychological consequences [16][17][18][19].…”

“…The pathogenesis of this disorder in adolescence is complex and results from genetic predisposition, epigenetic modification, and environmental factors [16][17][18]. The main endocrinological drivers of this condition are thought to be hyperandrogenism, hyperinsulinism, and IR [20], but other factors, such as the microbiome or epigenetics, also seem to be involved [21].…”