Effects of the Ketogenic Diet on Gonadal Hormones: A Systematic Review

Abstract Context Ketogenic diets (KDs) are a set of medical nutritional therapies in which macronutrient consumption is consistently high in fat, adequate in protein, and low in carbohydrates. They have been shown to be clinically useful in a myriad of medical conditions. Objective The aim of this study was to systematically review the literature aiming to evaluate the effects of a eucaloric, normoproteic, ketogenic diet (KD) on gonadal hormone levels in adults. Data Sources The PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and Science Direct (via Scopus) databases were searched for relevant articles in November 2021, and the search was updated in December 2023. Data Extraction The present systematic review was conducted according to the 6th version of the Cochrane Handbook for Systematic Reviews of Interventions and is reported according to PRISMA. This review only included studies with humans, such as randomized clinical trials, cohort studies, and cross-sectional studies. Levels of gonadal hormones were considered the primary outcome. Data analysis A total of 7 articles were included in the review: 3 studies were conducted with female participants only, and 4 with active or athletic males. The duration of the intervention was a minimum of 4 weeks and a maximum of 24 weeks. Most studies found oscillation of gonadal hormones, (such as total testosterone, luteinizing hormone [LH], follicle-stimulating hormone [FSH], estradiol, progesterone, and dehydroepiandrosterone) as an effect of the dietary intervention. Conclusion A eucaloric isonitrogenous KD may offer (i) beneficial weight loss, (ii) a change in anabolic hormone levels (total testosterone, insulin-like growth factor 1 [IGF-1] in physically active men, depending on the intensity of exercise, the amount of fat-free mass when starting the diet, and the caloric volume of the diet), and a beneficial effect on gonadal hormones in women with polycystic ovary syndrome (by decreasing testosterone levels, improving the LH/FSH ratio, improving insulin sensitivity, and improving menstrual cycle regularity. Factors such as the study population, the presence of comorbidities, and the physical activity level of the participants may influence these effects. Systematic Review Registration PROSPERO registration No. CRD42021256766.