Date of Award

2024

Document Type

Dissertation

Degree Name

Doctor of Medical Science (DMSc)

Department

Department of Physician Assistant Medicine

First Advisor

Jason Brumitt

Second Advisor

Erika McCarthy

Third Advisor

Travis Adelman

Abstract

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in females of reproductive age.1 It is estimated that 7% of women worldwide are impacted.1 Diagnosis of PCOS is based on the widely adopted Rotterdam Criteria, though there are other proposed criteria.2 Using the Rotterdam Criteria, two out of three of the following must be present to establish a diagnosis of PCOS: clinical or biochemical signs of hyperandrogenism, oligo-anovulation, and/or polycystic ovaries seen on ultrasound.2 Patients with PCOS may also present with one or more of the following: overweight/obese body mass index (BMI), infertility, insulin resistance, dyslipidemia, sleep apnea, nonalcoholic steatohepatitis, or mood disorders.1

Clinical signs of hyperandrogenism include acne, hirsutism, and hair loss of the scalp.1 Signs of biochemical hyperandrogenism are elevated serum levels of androgens including total and free testosterone, dehydroepiandrosterone sulfate (DHEAS), and androstenedione.1 Oligo-anovulation is when menstrual cycles are >35 days apart or there are <8 menses per year.2 On transvaginal ultrasound, ovaries are classified as polycystic if there are >12 follicles measuring 2-9mm in one ovary or the volume of an ovary is ≥10 mL.1

Conservative treatment of PCOS for overweight or obese individuals involves lifestyle changes addressing diet and exercise habits.3 Dietary weight loss of 5% has proven effective in improving metabolic factors, decreasing serum androgens, restoring ovulatory cycles, and increasing fertility in patients with obesity and PCOS.4 Though there are many different types of diets, the American Academy of Family Physicians gives an evidence rating grade “A” for using a calorie-restricted diet in overweight patients with PCOS.1

1.2 Ketogenic Diet

The purpose of a ketogenic diet is to switch the body's fuel source from carbohydrates to fat through induction of the metabolic state of ketosis.5 With daily carbohydrate restriction, blood glucose levels will decrease.6 With limited glucose, the body resorts to breaking down fat for energy. This results in the release of ketone bodies from the liver.6 To induce ketosis, the ketogenic diet requires the consumption of low carbohydrates, moderate protein, and high fat.5 Daily carbohydrate consumption should be limited to <50 g.7 The classic ketogenic diet (CKD) utilizes a 4:1 ratio of grams of fat to protein and carbohydrates.8 However, other protocols range from 1:1-4:1.8 The purpose of this scoping review is to evaluate if a ketogenic diet is effective in improving biochemical measures and reducing the severity of the signs and symptoms of PCOS, such as irregular menstrual cycles, infertility, excessive hair growth, male pattern balding, weight gain, and insulin resistance.1

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