PCOS and the Gluten Debate
One of the most frustrating things about navigating PCOS is sifting through all of the conflicting advice. One influencer in the space is telling you that you must avoid gluten at all costs because it’s inflammatory and will exacerbate your symptoms. Another influencer is telling you that unnecessarily avoiding gluten is detrimental because you’ll miss out on nutrients that are often in foods that contain gluten like B vitamins, fiber, and iron. So how the heck do we know who to believe?
The punchline is this:
like so many other things in health and wellness, whether you need to eliminate gluten entirely is highly individualized.
When you absolutely need to eliminate gluten
You need to eliminate gluten if you have the autoimmune disorder, Celiac Disease. Celiac Disease has both a genetic and environmental component, and presence in a first degree relative increases the likelihood of Celiac Disease. When gluten, the protein found in wheat, barley and rye, is ingested, the body’s immune system mistakenly views the protein as a foreign invader and attacks the small intestine. This triggers inflammation and damage to the small intestine lining, which can cause painful discomfort as well as poor nutrient absorption. From a PCOS perspective, inflammation is thought to play a role in many symptoms like insulin resistance, stress and androgen levels. Right now, the only remedy for Celiac Disease is to completely eliminate gluten.
Other conditions that commonly co-occur with Celiac Disease include:
Autoimmune thyroiditis (Hashimoto’s)
Graves disease
Cryptogenic hepatitis (liver issues)
Addison’s disease
Type I Diabetes
It’s important to eliminate gluten if your body is triggering this immune response when you eat it. In the short term, it can cause severe discomfort. In the long term, it puts you at risk for more serious health issues such as osteoporosis, gall bladder issues, heart disease, iron deficiency anemia, liver failure, general malnutrition, neurological issues, small intestine cancer and pancreatic insufficiency.
Symptoms of Celiac Disease
It’s important to note that some may not have demonstrate symptoms of this autoimmune disorder, or show them later in life, or on a varying spectrum. In some cases, people will not get diagnosed with Celiac Disease until another condition, like iron deficiency anemia, manifests. If you are symptomatic, these symptoms may include:
Abdominal pain
Bloating
Gas
Chronic diarrhea or constipation
Nausea
Vomiting
Pale stool with a foul smell
Fatty stool that floats
Weight loss (unexplained)
Fatigue
Depression/Anxiety
Headaches
Skin rashes
Joint Pain
Brain Fog
Nerve damage / tingling in the legs and feet
Balance issues
Cognitive Impairment
Diagnosing Celiac Disease:
If you are concerned about Celiac Disease, speak with your doctor. They will likely ask you about your medical history, as well as your family’s medical history. Through a blood test, your doctor will check for autoantibodies that are common in those with the disorder, like antigliadin and endomysial antibodies. In some cases, your doctor may want to do a biopsy of your intestine.
When you probably don’t need to entirely eliminate gluten entirely, but you may want to experiment
Not everyone who experiences discomfort from gluten has Celiac Disease. If you feel the above symptoms resonate with you, but you have tested negative for Celiac Disease, you may have non-celiac gluten sensitivity (NCGS). There is not enough evidence to know if this occurs at a higher rate in PCOS, but in this case, you won’t test positive for Celiac disease. You may have all the symptoms and inflammation when you eat gluten, but you won’t have the same immune response. Emerging research suggests that we need to pay more attention to NCGS because it may demonstrate systemic involvement similar to Celiac Disease, simply with different inflammatory markers or autoantibodies that we see with CD. If this is true, ingesting gluten with NCGS could exacerbate PCOS symptoms through nutrient malabsorption and inflammation. NCGS frequently co-occurs with Hashimoto’s thyroiditis, an autoimmune disorder that is 3x more likely in those with PCOS.
How to test if your body wants you to limit gluten
NCGS may give you a bit more freedom to experiment with whether your body can tolerate gluten. Bear in mind the symptoms of Celiac Disease and NCGS. If you take a break from gluten, do those symptoms improve? Do you notice a difference, or not much at all? If you decide you want to experiment with taking a break from gluten, be sure to consume a nutrient-dense diet! You can also test into always pairing gluten-containing foods with protein, fiber and fat. This is a best practice to consuming carbohydrates in general, as balancing meals helps greatly with insulin resistance and blood sugar, which we always want to keep an eye on with PCOS.
When you don’t need to eliminate gluten
If you do not have Celiac Disease or NCGS, eliminating gluten will probably not help you with your PCOS symptoms. If you have never had an issue with gluten, you probably fall into this camp. In this case, gluten does not cause upset to your digestive system or body at large. Since the main concerns for gluten consumption with PCOS are inflammation and nutrient deficiencies due to malabsorption, this is not taking place for you. Gluten is not increasing inflammation or nutrient malabsorption in your body. You can always experiment with the amount of gluten you incorporate into your diet, or how you pair it, but all in all, this probably isn’t a driver for your symptoms in particular.
However, note that even if you fall into this camp, a balanced diet is sill key to promoting hormonal balance with PCOS, healthy insulin sensitivity and blood sugar levels, proper brain function, energy levels, and more. Don’t forget to pair your gluten-containing foods with protein, fiber and fat!
All in all, it’s about making the decision that is right for you
Truly tune into how your body feels after you eat certain foods. If your body is rejecting gluten or something else, it will tell you. You will see it in your energy levels, how inflamed you feel, your skin, your digestion, brain fog and more. Trust your body and make the decision that is right for you!