PCOS help!

Hi everyone! I was hoping someone could give me advice on helping to heal my PCOS. I'll give a short back story that way you all can see where I'm 'coming from'.

4 years ago (age 17) I was diagnosed with PCOS. I hadn't gotten my period for at least 2 years (I had been getting them before) and upon a suggestion from a friend to get checked out I did. Sure enough, one blood test and ultrasound later I had my answer. I was devastated, my ultimate goal in life was to marry a godly man and raise a family for God's glory. I thought I could never get pregnant now. I have since learned that some women with PCOS have been able to conceive and some can't. I know God is in control and I'm holding onto that. I was also overweight, I weighed 158 and am 5' 1/4" tall. The Dr said to lose at least 20 pounds but I knew I wanted to lose more. I signed up for Myfitness Pal and started to track my calories, cut out all sugar, etc, I lost the 20, I was so happy!! Then about a year ago someone introduced me to the low carb diet so I decided to try that to help me lose the last of my weight, I lost an additional 10 pounds and was feeling great, I even was starting to get my cycles back! I got 3 or 4 in a row. But then I started to feel tired all the time, I couldn't even make it the 15-20 minute drive to town without getting sleepy, and I wasn't losing anymore, it was so frustrating. On that diet I was eating all types of meats, veggies (mostly raw), nuts, some cheddar cheese sticks, no grains, no fruit except for berries and sometimes a banana, and also tried to eat no sweets but some low carb chocolate torts once in awhile.
Then at the end of 2015 some ladies recommended THM (trim healthy mama) and said they were able to cure their PCOS with it. I thought I had nothing to lose, so read the whole book (the new one) then got the cookbook and started right around the first. I was very scared of the E meals and all the sweets I thought for sure I would gain every pound back! But after trying a few Es I found I was getting my energy back, it felt SO GOOD!! I have so much more joy in my health journey now, I don't feel so weighted down, when I'm craving chocolate I can have some without the fear of the scale going up! yay!! I was losing almost a pound a day, then maybe a pound a week. Then somehow in month 2 or so I gained 4 back, and I have know idea why, it was so frustrating. I was tempted to give up Es, but had learned by now to love them and knew my body needed those healthy complex carbs. Oh, and my cycles have now stopped since starting THM, I'm so confused.

I could go more in depth with my story, but I'm sure this is already too long, I'm sorry I hope I didn't bore anyone. My THM journey is a little different too. I'm a purist for one, I have no desire to eat off plan (meaning, sugar simple carbs, etc), once I learned years ago what it does to my body it just wasn't worth it to me anymore. I could never enjoy it, I just kept thinking about what it was doing to me. I try to stay away from most dairy, and also don't use stevia. I tried it while on my low carb diet and it didn't agree with me, I felt more bloated and was getting headaches. I have learned to just eat most things unsweetened (and actually enjoy them like that, I can't even eat grapes anymore as they're too sweet for me. Apples are almost too sweet!) or with small amounts of raw honey, and I mean SMALL. Like, only a teaspoon or two in a whole pan of brownies small, two reasons being, I like that deep chocolate flavor and the other being I'm scared of going over board and using too much therefore cousing an insulin spike. I don't like sugar alcohols either, I've worked on my sweet tooth for 4 years, that's why I can eat things unsweetened most of the time. You should see my siblings when they get a taste of it, lol! Poor dears, all I have to say is that 'that's my treat' and they're like "ok, I don't want that then!" ROFLOL!

My main goals is to get down to 120 pounds (currently 124-127) and get my cycles back. I feel like I've come such a long way and have learned so much, I just want to be the healthiest me I can be that way whatever the Lord throws at me I can do it! I wouldn't be where I am now if it wasn't for Him, He has helped me in so many ways. He's helped me get over my sweet tooth (this is the girl who could polish off a medium blizzard from DQ!!) , given me a new love for learning all I can about health, helped give me a stronger will power, and SO MUCH MORE!!

I'm having trouble figuring out my 'numbers' I don't want to obsess over them, but I do want to be mindful of them. MFP says that my starting daily goals should be:
Calories 1,500g
Carbs 188g
Fat 50g
Protein 75g
Fiber 25g
Sugar 56g (I don't listen to this one as I don't eat sugar, lol!)
I have a hard time believing that with my PCOS and insulin resistance that I need THAT many carbs!! As far as I can see though you can't enter in medical stuff like that. So are these totals for 'normal' people? With my PCOS should I really be eating less? I always go over my fat (but it's in the forms of good fats like coconut oil, avocado, nuts, etc), fiber, and protein numbers.

Any advice you all can give me would be GREATLY appreciated! Thank you!!

Replies

  • nvmomketo
    nvmomketo Posts: 12,019 Member
    I don't have PCOS but I do have insulin resistance. I follow a low carb high fat (LCHF) eating plan to deal with it and it really has helped. In the Low Carber Daily forum there are a fair number with IR (including PCOS) who are also eating LCHF to treat their health issues - they also found that moderate carbs (180g per day) was too much to help with their condition. they have found that going lower carb was needed and lowered carbs to below 100g, or 50g, or even down to 20g of carbs per day. There is no minimum level of carb consumption so if you need to go lower, with a well planned diet, there is no real reason not to.

    If you do lower your carbs, consider replacing it with fats - that;s what most people do. It's a healthy way to set up your diet even though going against the old low-fat dogma takes some getting used to.

    Consider joining the Low Carber Daily for more LCHF advice.
  • WindyIndy
    WindyIndy Posts: 15 Member
    Thank you so much for your suggestions! I do already eat high fat, and my carbs are normally right around 40-100 right now. When I was low carb I made sure they stayed under 50-60. But when I was low carb I was getting tired faster and wasn't losing anymore. I'm very confused and frustrated as I can't figure out what my body needs!! I have lost a lot of my PCOS symptoms but can't seem to get my cycles back again....
  • Sunny_Bunny_
    Sunny_Bunny_ Posts: 7,140 Member
    edited May 2016
    WindyIndy wrote: »
    Thank you so much for your suggestions! I do already eat high fat, and my carbs are normally right around 40-100 right now. When I was low carb I made sure they stayed under 50-60. But when I was low carb I was getting tired faster and wasn't losing anymore. I'm very confused and frustrated as I can't figure out what my body needs!! I have lost a lot of my PCOS symptoms but can't seem to get my cycles back again....

    The tired probably was related to electrolytes. You need quite a bit of sodium to prevent low electrolytes and when sodium starts to get low you feel tired, maybe even dizzy and foggy headed. Most people aren't of those needs. It makes a huge difference.

    Just manually change your carbs to the range that you know works for you and make up the lost calories from fat. Consider avoiding vegetable oils and margarine in favor of fats from real food sources.
  • WindyIndy
    WindyIndy Posts: 15 Member
    edited May 2016
    This was my day today It was a little different as I'm trying a trim healthy mama fuel cycle and they say eat a couple good complex carbs before starting. I'll post a couple of my other menu's as comparison but I don't have the actually counts as I wasn't doing MFP then so hope you all can kind of figure it out. When I was posting my carb counts I forgot about net carbs, those numbers are NOT net carbs.
    May 1st 2016

    7:00 S 2 fried eggs (bacon was in freezer) with 1T nutritional yeast. 1 waffle with 1T PB, 2T choco spread, 1/4c blackberries and raspberries. Calories 565g, carbs 36g, fat 40g, protein 31, fiber 25, sugar 4, NET carbs 11. Wow, maybe less fruit!

    10:00 S 1 hard boiled egg, half a pepper, 0.5 oz pork rinds
    Calories 184, carbs 6, fat 11, protein 16, fiber 2, sugar 4, NET carbs 4

    1:00 S salmon superfood salad, 4oz salmon, 1/2 avocado, 1/2 pepper, 1/2c cucumber, jalapenos, 2 slices turkey bacon, 2T olive oil, 2T superfood sprinkles
    Calories 520 , carbs 10 , fat 40, protein 28, fiber 6, sugar 1 NET carbs 4

    4:00 XO 2 choco banana muffins with 1t butter each
    Calories 242, carbs 35, fat 11, protein 7, fiber 7, sugar 8 NET carbs 28

    7:00 XO banana creamy grains with 1T PB, 1 1/2c water, 1.5T collagen, 1 egg white, protein powder, no oil, same as recipe otherwise.
    Calories 391, carbs 59, fat 11, protein 31, fiber 24, sugar 8 NET carbs 35

    Totals:
    Calories 1,902, carbs 145 , fat 113, protein 112, fiber 63, sugar 25 NET carbs 82
    Earned 645 extra calories from exercise too
  • WindyIndy
    WindyIndy Posts: 15 Member
    I don't eat vegetable oils or margarine. Just coconut oil, olive oil, and really butter. I'm hoping to try MCT oil sometime soon. Also, the XO is for Trim Healthy Mama crossover. Meaning you have more then 5g fat. For a pure E you stay under that number that way your body focuses on burning just the carbs. That's better for weightloss. XO's help with maintaining weight. But since I'm starting the fuel cycle and won't have any carbs for 2 days that's why I had a couple today
  • WindyIndy
    WindyIndy Posts: 15 Member
    Actually, let me know if you want me to post some other menu's, it might be confusing if you aren't familiar with THM ;)
  • WindyIndy
    WindyIndy Posts: 15 Member
    Bump
  • bellaa_x0
    bellaa_x0 Posts: 1,062 Member
    edited May 2016
    so what happened after you were diagnosed with PCOS? with regards to your doctor that is. for instance, after I was diagnosed my doctor started me on Metformin which has helped tremendously.

    a diet alone isn't going to "cure" your PCOS.

    ETA: you should be getting your period every three months - AT LEAST. anything past that, your doctor should be prescribing you provera to induce your period.
  • Avira971
    Avira971 Posts: 4 Member
    Hi, I have PCOS and hypothyroidism. My doctor has me on birth control to up my estrogen, spironolactone (sp?) A diuretic to remove excess testosterone, and an ULCHF diet.

    The ULCHF (ultra low carb high fat) is to keep you in a state of ketosis. It sounds like you are experiencing blood sugar issues and from what you posted I'm not surprised. You aren't keto adjusted with those numbers and you will have those issues until you are. Look into the studies for ketosis and talk to your doctor about it. There can be no cheating or diverging. Too many carbs and too much protein will kick you out of ketosis and you'll have to go through the "ketosis flu" again to get back in. If your doctor approves this lifestyle change for your eating habits you cannot go above 30-40g of net carbs and about 100g of protein. Your body will transition to turning fat into ketones for fuel and it is shown in many studies to reduce/partially reverse insulin resistance.

    Please speak with your doctor first. Also, I would highly recommend a simple to follow resistance training program 2-3 days per week. I follow Stronglifts 5x5 for three days a week and do cardio/yoga on my off days.

    Best of luck.
  • LKArgh
    LKArgh Posts: 5,178 Member
    edited May 2016
    If you still do not have your period, talk to a reproductive endocrinologist. I was diagnosed with PCOS at your age, more than 20 years later I have 3 kids and few symptoms (basically hirsuitism). I have never eaten low carb, and no dr ever recommended it. The key for me is maintaining a lowish weight (low end of normal BMI) and being physically active. But it is not always enough for everyone. Talk to a reproductive endocrinologist. Make a list of questions to take with you. I have heard a lot of outdated advice from regular endos, and the amount of nonsense you will find online is really insane, it is almost impossible to separate the truth. You need to get your cycle back, even if you are not ovulating. No period for a long time can cause new problems for you, so get an appointment as soon as possible. Usually it is recommended to call your ob gyn if you are more than 15 days late, especially if you plan to have kids in the future.
    Was there a follow up after the initial tests? There might be more to it than PCOS.
  • WindyIndy
    WindyIndy Posts: 15 Member
    edited May 2016
    Thank you all for you advice. The dr did want to put me on meds, but I didn't want to . After hearing of all the side affects, I want to treat it as naturally as possible. My dr said I wouldn't be able to lose any weight without them but II have lost 34 pounds! I know I'm at a higher risk for cancer if I don't get my cycles back. I was getting them last year, 1 every month for 3 months but then they stopped and now it's been 5 months. There was no follow up. We decided to go back a couple different times to get other drs thoughts, they did do some other blood work I think for thyroid/vit D etc, and if I remember correctly that was fine. I was thinking maybe I should get my prolactin levels checked. What would you recomend I check?

    My last two days have been right around these totals calories 1,732, carbs 52, protein 125, fat 119, fiber 17
  • WindyIndy
    WindyIndy Posts: 15 Member
    Also try and walk 2-4 miles a day and also work on a small hobby farm. So lots of pounding in fence posts, shoveling manure, etc
  • Avira971
    Avira971 Posts: 4 Member
    You might not need to be in ketosis if you are seeing results. If you don't need to be in ketosis, don't, especially without doctor supervision. However, if you are just low carb, as in under 100g per day, stay above 50g net of good carbs to avoid what sounds like blood sugar lows/ketosis adjustment.

    I'm in ketosis because nothing else worked for me. I have a sedentary job, but have eaten no more than 1400-1500 cal/day with no more than 100g of carbs with no simple sugars and at minimum 5 days a week of 1 hour HIIT with zero results. I gained 20+lbs on metformin the 2 test months I was on it so maybe stay away from that.
  • WindyIndy
    WindyIndy Posts: 15 Member
    Thank you. What is ketosis exactly? I only eat good carbs. The only carbs I eat is in the form of apples, mango, fermented steel cut oats, one small or half a banana, black beans, and quinoa. I make sure to pair them with protein and also use them in 'safe' amounts at a time so as not to spike my blood sugar. I make sure to stay under 45g carbs at one meal time , most of the time it's 25g net. I am seeing results everywhere but my cycles right now. I've dropped weight, my face cleaned up, lost 2-3" of my waist, lost the dark patches of skin, dropped a whole bra cup, etc.
  • Red13
    Red13 Posts: 287 Member
    Have you tried inositol? I have regular cycles because I'm on birth control but in many pics forums it is a natural way to help balance things out. It helps my mood a lot, I think if your happy with your diet you should look into it. Also other supplements we are deficient in could be the answer, magnesium, omegas, etc. for my second child I actually took herbs and did acupuncture to get my periods back. There are many things to look at if you think your diet is on point. Good luck!
  • LKArgh
    LKArgh Posts: 5,178 Member
    edited May 2016
    WindyIndy wrote: »
    Thank you. What is ketosis exactly? I only eat good carbs. The only carbs I eat is in the form of apples, mango, fermented steel cut oats, one small or half a banana, black beans, and quinoa. I make sure to pair them with protein and also use them in 'safe' amounts at a time so as not to spike my blood sugar. I make sure to stay under 45g carbs at one meal time , most of the time it's 25g net. I am seeing results everywhere but my cycles right now. I've dropped weight, my face cleaned up, lost 2-3" of my waist, lost the dark patches of skin, dropped a whole bra cup, etc.

    Have you been diagnosed as diabetic or prediabetic? If not, all this is irrelevant. I mean, if this helps you keep your calories under control and you like this eating style, great, but, as you have figured out, it is irrelevant to PCOS and infertility.
    May I ask how was the PCOS diagnosis made? And what was suggested to get fertility back? If, for example, you are also suffering from very high male hormones, you might need androgen suppressants. Or ovulation might not return without surgery if the ovaries have too thick lining or too many cysts.
    While for most people losing weight will help with PCOS, there is no cure, just fighting the symptoms and there is also no guarantee that lifestyle changes will be enough, so if experience shows that being at a healthy weight and physically active is not enough, do not drive yourself crazy finetuning your diet and talk to a specialist.
  • WindyIndy
    WindyIndy Posts: 15 Member
    Thank you again everyone for your help! I have never tried inositol, but will look into it. I also was taking supplements then stopped, now I'm starting to take them again. I was hoping I wouldn't need to since I ate just a broad rang of stuff and so many veggies ...

    I was almost prediabetic, I was just a point away (or something like that) but after losing the weight the dr said I was fine! yay!

    Of course you can ask me how I was diagnosed! Please feel free to ask me anything. They did a blood test and an ultrasound. I can't remember what kinds of blood work, but they did say my ovaries have a nice string of "pearls" on them.

    Would too many cysts or thick lining walls be the case even though I was getting them? I do know that if an egg isn't "shed" then it creates another cysts, so maybe they just kept building up?
  • Princess4Run
    Princess4Run Posts: 135 Member
    Your diet is spot on, you lost weight, you are physically active. All these changes have not brought your cycles back so you need to rethink your plan of action. Stop looking at the "nutrition side" of it and start researching medical treatments and PCOS physiology. Arms yourself with knowledge, find a good reproductive endocrinologist and set up an appointment. Trust their professional recommendations because they have spent years studying and treating your condition. Sometimes "natural" remedies might not be enough. If you want to have kids at some point in your life, you owe it to yourself to seek out all treatment options, including medications if necessary.
  • Avira971
    Avira971 Posts: 4 Member
    edited May 2016
    I agree with the others, you are seeing results in weight, now you just need a good endocrinologist. I am pre-diabetic which is why this is the only way for me to lose weight at this point, after trying all other routes over the past three years.

    Ketosis, which I recommend reading about in medical articles, not independent non medical professional blogs, is when you starve your body of it's preferred fuel (glucose). After a few days to a week of significantly awful symptoms of being glucose deprived your body will use another fuel source: ketones (made from fat). The diet for ketosis was developed about one hundred years ago to treat epilepsy, and was fairly successful for some. Recently it has been used in clinical trials for type 2 diabetes, pre diabetes, and others dealing with insulin resistance. The clinical trials show a lot of success that most of those with type 2 diabetes don't need medication to manage it anymore. It should never be undertaken without a lot of research and doctor supervision. This is because it can, if you don't have a healthy pancreas, become keto acidosis.

    You have to stay above 50g net carbs if you don't want to do ketosis so you aren't starving your body of too much glucose. The body doesn't switch between glucose and ketones efficiently, and switching to ketones is an awful transition. After transitioning I am completely back to normal and feel normal/better, but the transition period is difficult. This is because your brain prefers glucose and you are literally starving your brain while transitioning.

    I recommend getting a spiralizer. I can have "pasta" (veggie noodles) with this awesome tool. I also meal prep so I've trip to the store and all of my food is cooked and properly portioned the week before.

    Read through this study for PCOS, but there are many showing the efficacy of ketosis for other conditions as well: https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-2-35

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826507/

    Unfortunately, for some of us, it will never be a simple game of calories in vs calories out. Our bodies are more complex than that, but for most without endocrine problems that method is best. I have to play the game of preventing my body of storing everything because of an over active insulin response (hypoglycemia).

    Find a good endocrinologist that specializes in PCOS. They should be your guide along with going to appointments prepared. Ask for references, have questions, etc.
  • WindyIndy
    WindyIndy Posts: 15 Member
    I'm SO glad to know my diet is fine!! I have learned so much in the past 4 years and have slowly tweaked/modified it to try and find what works for me, and I think I finally have! I will try and research and find a dr in our area.

    Thank you for explaining ketosis to me a little bit. I'm glad your finding what works for you. Everybody is different and needs different things that's for sure.
    I have always wanted to get a spiralizer! I have just been making/using spaghetti squash or cabbage instead. I was a HUGE pasta eater before, but gave those up right away and noticed HUGE improvements. That was one I thought I would never get over, but now 4 years later I don't even miss it. The negative affects is not worth it to me.

    And I do hope to have kids one day. My main want in life is to marry a Godly man and have a family =)
  • WindyIndy
    WindyIndy Posts: 15 Member
    edited May 2016
    So I was starting to look into doctors near here that I could see. We don't have any endocrineists, but there is a woman's health Dr that looks promising. Two of the thing's she deals with is sexual distinctions and infertility. I want to find out more about her first and also start a list of questions. Do you ladies have any good examples you could give me for what I could ask? I've never really done this before so am really new. I am going to try and do some more research to first, I've mostly only done diet research.
  • kmbrooks15
    kmbrooks15 Posts: 941 Member
    Read "The PCOS Diet" by Hillary Wright. Best explanation of insulin resistance and how to eat for PCOS that I've ever read. And she has experience treating MANY women with PCOS, so she knows what works and what doesn't. Just after reading the first couple of chapters I learned so much about how insulin works. I'm not logging any food or counting calories, but I am steadily losing anyway (18 pounds in just under 3 months) just by making some food substitutions and being more careful with my menu planning. I do take Metformin, but it's a small dose compared to what some take (I take 1000 mg a day; some women take close to 3000).
  • WindyIndy
    WindyIndy Posts: 15 Member
    edited May 2016
    Thank you so much for the recommendation! I'm so glad it's helping you. =D
  • LKArgh
    LKArgh Posts: 5,178 Member
    WindyIndy wrote: »
    Thank you again everyone for your help! I have never tried inositol, but will look into it. I also was taking supplements then stopped, now I'm starting to take them again. I was hoping I wouldn't need to since I ate just a broad rang of stuff and so many veggies ...

    I was almost prediabetic, I was just a point away (or something like that) but after losing the weight the dr said I was fine! yay!

    Of course you can ask me how I was diagnosed! Please feel free to ask me anything. They did a blood test and an ultrasound. I can't remember what kinds of blood work, but they did say my ovaries have a nice string of "pearls" on them.

    Would too many cysts or thick lining walls be the case even though I was getting them? I do know that if an egg isn't "shed" then it creates another cysts, so maybe they just kept building up?

    There comes a point where, yes, too many cysts will prevent further ovulation. Also there could be more going on.
    In your shoes, I would completely ignore advice related to diet, you are past this point. Losing weight helps, if you are inusline resistant monitoring carbs helps, but in your case, your weight and diet do not seem at all related to the infertility problem. You need to work closely with a dr. Do not try to guess, the possibilities are endless. And having PCOS does not even mean that there is not also something else going on. The best you can dois find a dr you trust. Good luck.
  • WindyIndy
    WindyIndy Posts: 15 Member
    Thank you, I'm working on trying to make an appt now. I'm also working on a list of questions. Do you have any ones that you think I should ask?
  • kmbrooks15
    kmbrooks15 Posts: 941 Member
    I'd ask her how much experience she has treating PCOS. It's a common cause of infertility (many think the LEADING cause), but not all doctors are experienced with it. I had seen several doctors and none had ever diagnosed me, even though I had all the symptoms. We moved to a new state and I got in with a new gyno, who recognized the symptoms right off the bat and after my first appointment with her, I had a diagnosis.

    Also, consider medication. It doesn't have to be a high dose, and it can be helpful in getting weight under control. It's not a cure-all (there is no "CURE" for PCOS, just things you can do to control symptoms), but it can be helpful for symptoms. Metformin works by increasing the cells' sensitivity to insulin (Hillary Wright explains how all this works REALLY well in her book). I am on a low dose compared to some women, and it's working great for me. But there are also some natural things that can be helpful, like evening primrose oil.

    The reason we are at risk for diabetes is explained again in Hillary Wright's book. Basically, insulin acts as a key, going along and knocking on cell doors so they'll open up and let the sugar in the blood in to be used for energy. A diabetic does not produce enough insulin to cause the doors to open. Women with PCOS produce enough insulin, but the cells just won't answer the door. So the pancreas decides it needs to kick out more insulin, which throws all the other hormones out of whack. All that excess insulin production can just wear out the pancreas to the point that it stops producing insulin at all, and that's when you end up diabetic. That's why diet and not spiking our blood sugar is so crucial. Metformin helps to increase the cells' sensitivity to the insulin, kind of forcing them to answer the door, so to speak. Once insulin levels even out, the other hormones will often even out as well, causing ovulation to resume. Some women manage to get pregnant just through taking metformin and watching their diet.

    I hope I explained that well. The key is to eat in such a way that you keep your blood sugar as even as possible throughout the day.
  • WindyIndy
    WindyIndy Posts: 15 Member
    I do try and not spike my blood sugar. I know there is no cure, only management. Made a dr appt for thursday. The lady is an obstetrician-gynecologist
  • tkahline
    tkahline Posts: 10 Member
    My daughter has PCOS. She was 80 pounds overweight and had no periods, no energy. She saw a specialist who put her on metformin and had her decrease her carbs and eliminate sugar. She started loosing weight. She added cardio and weight lifting and the weight finally started rolling off. It took her 2 years to lose the weight. She continues to eat low-carb, no sugar, lift weights, and do cardio to keep it off. In addition, she still takes the metformin, although at a lower dose.

  • cbinnd
    cbinnd Posts: 178 Member
    http://paleoforwomen.com/paleo-and-pcos/

    Although you aren't paleo, I think you may find this article interesting as to the effects on women with PCOS.
  • nvmomketo
    nvmomketo Posts: 12,019 Member
    There was a bit of misinformation about nutritional ketosis so I thought I'd correct a few things.

    Nutritional ketosis is a very LCHF diet. Mild levels of ketosis are reached when you eat less than (about) 130g of carbs per day, but most people consider a diet to be ketogenic if it is below 50g of arbs per day so the body is relying on fat burning (oxidation) for the majority of it's fuel. I personally have been eating about 20g of carbs per day for a bout a year; others eat more, and some eat less. I live in ketosis. Most people only enter ketosis in the early hours of the morning after fasting all night.

    The brain, and a few other body parts like red blood cells, use glucose as some or all of their fuel source. The brain only requires some glucose, and it has been shown that after a few months on a ketogenic diet that the brain actually uses less glucose and comes to rely on (prefer?) fat as a fuel source.

    Do know that your brain will never be starved of oxygen though. The liver can make all the glucose that your body needs. You could eat zero carbs and your body would still make what it needs.

    Only people with type 1 diabetes (or those with T2D who no longer have a functioning pancreas ) need to worry about diabetic ketoacidosis. DKA occurs when ketones are VERY high, many times higher than mine, and when blood glucose is also very high due to the absence of insulin. Someone eating LCHF does not need to worry about DKA.

    The transition into ketosis can be hard for people if they are not aware of the fact that they will need to replenish the electrolytes being lost with the initial water weight. A higher carb diet causes water retention so when carbs are cut, water is lost and sodium is lost along with it. People need to increase sodium up to 3000-5000 mg per day to replace lost salts. If they do not, the usual symptoms of an electrolyte imbalance will occur: fatigue, brain fog, headaches, nausea, muscle aches and spasms. If sodium is not replaced, potassium and magnesium will then become low as well.

    A nutritional ketogenic diet will lower insulin in the body and is helpful to those with insulin resistance issues like PCOS. Weight loss and just a LCHF diet can also help some but many find a ketogenic diet works the best.

    Good luck. :)