Favourable metabolic effects of a eucaloric lower‐carbohydrate diet in women with PCOS
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Summary: Objective: Diet‐induced reduction in circulating insulin may be an attractive nonpharmacological treatment for women with polycystic ovary syndrome (PCOS) among whom elevated insulin may exacerbate symptoms by stimulating testosterone synthesis. This study was designed to determine whether a modest reduction in dietary carbohydrate (CHO) content affects β‐cell responsiveness, serum testosterone concentration and insulin sensitivity in women with PCOS. Design: In a crossover design, two diets (‘Standard,’ STD, 55:18:27% energy from carbohydrate/protein/fat; lower‐carbohydrate, 41:19:40) were provided for 8 weeks in random order with a 4‐week washout between. Patients: Thirty women with PCOS. Measurements: β‐cell responsiveness assessed as the C‐peptide response to glucose during a liquid meal test; insulin sensitivity from insulin and glucose values throughout the test; insulin resistance (HOMA‐IR); and total testosterone by immunoassay. Results: Paired t‐test indicated that the lower‐CHO diet induced significant decreases in basal β‐cell response (PhiB), fasting insulin, fasting glucose, HOMA‐IR, total testosterone and all cholesterol measures, and significant increases in insulin sensitivity and dynamic (‘first‐phase’) β‐cell response. The STD diet induced a decrease in HDL‐C and an increase in the total cholesterol‐to‐HDL‐C ratio. Across all data combined, the change in testosterone was positively associated with the changes in fasting insulin, PhiB and insulin AUC (P < 0·05). Conclusions: In women with PCOS, modest reduction in dietary CHO in the context of a weight‐maintaining diet has numerous beneficial effects on the metabolic profile that may lead to a decrease in circulating testosterone.
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Gower et al. observed an improvement in the metabolic profile and a decrease in circulating testosterone after a modest reduction in dietary carbohydrate intake.
“An improvement in the metabolic profile and a decrease in circulating testosterone was observed also by Gower et al. after a modest reduction in dietary carbohydrate intake [61,62].”
From Low-Calorie Ketogenic Diet: Potential Application in the Treatment of Polycystic Ovary Syndrome in Adolescents (2023) · cites this paper as [61]
All low-carbohydrate studies were designed to be eucaloric and found a low-CHO diet to lower fasting insulin, glucose, total cholesterol, LDL-C concentrations, HOMA-IR, and area under the curve insulin, as well as to improve insulin sensitivity in individuals with PCOS.
“All of the studies were designed to be eucaloric and found a low-CHO diet to lower fasting insulin [72,73,74], glucose [73], total cholesterol [72,73], LDL-C concentrations [73,74], HOMA-IR [73], and area under the curve insulin [74], as well as to improve insulin sensitivity [73] in individuals with PCOS.”
From Moving beyond Weight: A Narrative Review of the Dietary and Lifestyle Management for Reducing Cardiometabolic Risk in Polycystic Ovary Syndrome (PCOS) (2023) · cites this paper as [73]
Studies that modified dietary patterns without a caloric deficit saw improvements in cardiometabolic risk factors.
“studies that modified dietary patterns without a caloric deficit [72,73,74,75,76,77,78,79,80,81,82,83,84,85,87,108] saw improvements in cardiometabolic risk factors”
From Moving beyond Weight: A Narrative Review of the Dietary and Lifestyle Management for Reducing Cardiometabolic Risk in Polycystic Ovary Syndrome (PCOS) (2023) · cites this paper as [73]
Among women with polycystic ovary syndrome, the lower-carbohydrate arm showed decreased fasting glucose.
“As previously reported, among women with PCOS, the lower-carbohydrate arm showed decreased fasting insulin (22.8 mIU/mL; P < 0.001) and fasting glucose (24.7 mg/dL; P < 0.01) and increased insulin sensitivity (1.06 arbitrary units; P < 0.05) and ''dynamic'' b-cell response (96.1 Á 10 9 ; P < 0.001).”
From A Lower-Carbohydrate, Higher-Fat Diet Reduces Abdominal and Intermuscular Fat and Increases Insulin Sensitivity in Adults at Risk of Type 2 Diabetes (2015) · cites this paper as [29]
No changes in fasting insulin, fasting glucose, insulin sensitivity, or dynamic beta-cell response were observed while consuming the lower-fat diet in women with polycystic ovary syndrome.
“No changes in these outcomes were observed while consuming the lower-fat diet.”
From A Lower-Carbohydrate, Higher-Fat Diet Reduces Abdominal and Intermuscular Fat and Increases Insulin Sensitivity in Adults at Risk of Type 2 Diabetes (2015) · cites this paper as [29]
Among women with polycystic ovary syndrome, the lower-carbohydrate arm showed increased insulin sensitivity.
“As previously reported, among women with PCOS, the lower-carbohydrate arm showed decreased fasting insulin (22.8 mIU/mL; P < 0.001) and fasting glucose (24.7 mg/dL; P < 0.01) and increased insulin sensitivity (1.06 arbitrary units; P < 0.05) and ''dynamic'' b-cell response (96.1 Á 10 9 ; P < 0.001).”
From A Lower-Carbohydrate, Higher-Fat Diet Reduces Abdominal and Intermuscular Fat and Increases Insulin Sensitivity in Adults at Risk of Type 2 Diabetes (2015) · cites this paper as [29]
Among women with polycystic ovary syndrome, the lower-carbohydrate arm showed decreased fasting insulin.
“As previously reported, among women with PCOS, the lower-carbohydrate arm showed decreased fasting insulin (22.8 mIU/mL; P < 0.001) and fasting glucose (24.7 mg/dL; P < 0.01) and increased insulin sensitivity (1.06 arbitrary units; P < 0.05) and ''dynamic'' b-cell response (96.1 Á 10 9 ; P < 0.001).”
From A Lower-Carbohydrate, Higher-Fat Diet Reduces Abdominal and Intermuscular Fat and Increases Insulin Sensitivity in Adults at Risk of Type 2 Diabetes (2015) · cites this paper as [29]
Among women with polycystic ovary syndrome, the lower-carbohydrate arm showed increased dynamic beta-cell response.
“As previously reported, among women with PCOS, the lower-carbohydrate arm showed decreased fasting insulin (22.8 mIU/mL; P < 0.001) and fasting glucose (24.7 mg/dL; P < 0.01) and increased insulin sensitivity (1.06 arbitrary units; P < 0.05) and ''dynamic'' b-cell response (96.1 Á 10 9 ; P < 0.001).”
From A Lower-Carbohydrate, Higher-Fat Diet Reduces Abdominal and Intermuscular Fat and Increases Insulin Sensitivity in Adults at Risk of Type 2 Diabetes (2015) · cites this paper as [29]
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- Authors
- Gower, B. A., Chandler‐Laney, P. C., Ovalle, F., Goree, L. L., Azziz, R., Desmond, R. A., Granger, W. M., Goss, A. M., & Bates, G. W.
- Affiliations
- University of Alabama at Birmingham (US)
- Department of Nutrition Sciences University of Alabama at Birmingham Birmingham AL USA
- Department of Medicine Georgia Health Sciences University Augusta GA USA
- Department of Medicine Division of Preventive Medicine University of Alabama at Birmingham Birmingham AL USA
- Corresponding author
- Gower, Barbara A.
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2013-05-20
- Volume
- 79
- Issue
- 4
- Pages
- 550-557
- ISSN
- 0300-0664 (ISSN-L)
- 1365-2265
- PMC
- PMC4111472
- OpenAlex
- W2101105380
- Cited by
- 108
- References
- 40
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 8 · 2023: 15 · 2022: 14 · 2021: 12 · 2020: 17 · 2019: 7 · 2018: 4 · 2017: 5 · 2016: 5 · 2015: 6 · 2014: 5
- FWCI
- 6.46
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- University of Alabama at Birmingham
- National Institutes of Health (5ul1rr025777-04, 5p60dk079626-05)
- Center for Clinical and Translational Sciences, University of Texas Health Science Center at Houston
- Center for Clinical and Translational Science, University of Alabama at Birmingham
- National Institute of Diabetes and Digestive and Kidney Diseases (P60-DK-079626, T32DK062710, P30DK056336, P30DK079626)
- National Center for Research Resources (UL1-RR-025777)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD054960)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diet, Metabolism, and Disease
- Keywords
- polycystic ovary syndrome, low-carbohydrate diet, insulin sensitivity, insulin resistance, beta-cell function, first-phase insulin response, testosterone, insulin resistance index, cholesterol, HDL cholesterol, non-pharmacological treatment
- MeSH terms
- Adult, Blood Glucose, Dietary Carbohydrates, Fasting, Female, Humans, Insulin, Insulin Resistance, Lipids, Middle Aged, Polycystic Ovary Syndrome, Testosterone, Outcome Assessment, Health Care, Cross-Over Studies, Insulin-Secreting Cells, Young Adult
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