Is Gluten Bad for PCOS?

Is Gluten Bad for PCOS?

Gluten is a hot topic in the PCOS community. Many social media sites warn against gluten claiming it causes inflammation, disrupts hormones and worsens PCOS.  But what does the evidence say? The reality is that there are no studies on gluten and PCOS. So I did a little research on this controversial topic. In addition, I  interviewed some PCOS experts to find out their thoughts. Read on the get the low down on if gluten is bad for PCOS.

What is gluten?

Gluten is a protein in wheat, rye, and barley. Gluten is made up of gliadin and glutenin. The gliadin part is problematic for most individuals who have issues with gluten. It’s also found in many sauces, marinades, dressings, gravies, processed meats, soups, vegetarian meat alternatives, energy bars and snack foods, cross-contamination in restaurants, and many more places!


Who needs to avoid gluten?

People who have celiac disease need to avoid gluten for the rest of their lives to avoid serious medical issues. People with gluten sensitivity will need to avoid/limit it based on their symptoms. 

-Celiac disease is serious autoimmune condition in which gluten signals the body to attack the lining of the small intestine. It affects about 1% of the population. In the US, an estimated 83 percent of people who suffer from celiac disease are undiagnosed or misdiagnosed.  If left untreated, it can lead to serious health problems like nutritional and vitamin deficiencies, osteoporosis, infertility, and even lymphoma of the small intestine in severe cases.   It’s diagnosed by blood work and an intestinal biopsy. The only treatment is avoiding gluten. Reference You can also test for celiac genes. But keep in mind that about 40% of people have a positive gene for celiac disease, but this does not mean you have not, nor does it mean you will get it.

-Wheat allergy.  About  .2 -.4% of the population has an allergy to wheat. Wheat allergy is mediated, in part, by the adaptive immune system. In this condition, gluten results in synthesis of IgE antibodies that cause an inflammation. This condition can cause symptoms like hives, wheezing, and even anaphylaxis. Reference  Your doctor can diagnosis this allergy by blood tests, pinprick tests or behavior tests.

-Gluten sensitivity: Unlike celiac disease, nonceliac gluten sensitivity is far less understood. Nonceliac gluten sensitivity is diagnosed in individuals who do not have celiac disease or wheat allergy but who have intestinal symptoms, extraintestinal symptoms, or both, related to ingestion of gluten-containing grains, with symptomatic improvement on their withdrawal. It’s thought to be immune mediated, but no definitive test exists for proper diagnosis. People with nonceliac gluten sensitivity may experience bloating, diarrhea, and constipation—symptoms similar to irritable bowel syndrome—along with fatigue, headache, and bone or joint pain. Reference According to the Center for Celiac Research, it affects 6% of the population, whereas Dr. Perlmutter believes it can affect up to 30% of the population. There is no research regarding what percent of women with PCOS have gluten sensitivity. Gluten sensitive reactions don’t cause the same long term damage to the intestine that untreated celiac cause, therefore they don’t have nutritional deficiencies.

NOTE: New research suggests that gluten alone may not be responsible for the symptoms produced by the condition currently called gluten sensitivity. Instead, it is showing that perhaps FODMAPs, a group of poorly digested carbohydrates, may be the cause of the symptoms instead. It is also important to note that wheat, barley and rye — gluten-containing grains — are all high in a FODMAP called fructan. Other foods high in fructans include onions, garlic and some fruits and vegetables. Read more about fructan intolerance here.

 

Symptoms of gluten intolerance

According to Dr. Alessio Fasano, author of Gluten Freedom, symptoms of gluten intolerance can include: abdominal pain (70%), eczema and/or rash(40%), migraine headaches (35%),  “foggy mind” (34%), chronic fatigue (33%), diarrhea (33%), depression (22%), anemia (20%), tingling of fingertips (20%), and joint pain (11%).

How to test for gluten sensitivity

There are no validated tests for gluten sensitivity. Your best bet is to do a trial of omitting gluten to see if you notice a difference. Omit it for at least 2 weeks, preferably a month. If you feel better, add back in a moderate amount to see if you get symptoms again. If so, bingo! You are likely gluten sensitive. But make sure your “experiment” is well done.
-If you are just cutting down on carbs in general and/or eliminating processed grains versus substituting GF grains for grains containing gluten, any benefits you feel could be from eating fewer carbs. With PCOS, eating processed carbs (or large portions of even healthy carbs) can cause a blood sugar and insulin spike and crash – which makes you feel crappy!
– A better experiment would be to substitute GF bread for whole grain bread with gluten or rice for pasta – and keep the carbs somewhat constant. That way if you feel better, you’ll know it was from eliminating gluten, not cutting down on carbs in general.
– You may also want to test if you have a fructan intolerance versus gluten intolerance. Cut out all foods high in fructans and see if you notice an improvement in symptoms.  Then do an experiment of adding in onions or garlic as these contain no gluten. If you get symptoms, you likely have a fructan intolerance!

 

Nutritional benefits of whole grains – including gluten free and those with gluten

Whole grains have numerous health benefits. “Whole” grains mean the grains are consumed with all of their bran, germ, and endosperm. Whole grains can contain gluten or be gluten free. This intact grain gives you the most health benefits. The protective outer bran that whole grains have isn’t only rich in fiber but contains antioxidants, iron, zinc, copper, magnesium, B vitamins, and phytonutrients. The plant-embryo germ has unsaturated fats, B vitamins, vitamin E and other antioxidants, and phytonutrients. The third part of any whole grain, the starchy endosperm, is mostly carbohydrate, with some protein and small amounts of vitamins and minerals. Research shows that whole grain intake may lower the risk of cardiovascular disease, is associated with lower body weight, and is linked with a reduced incidence of type 2 diabetes. Reference    Check out chart to see the various whole grains.

Potential downside of  gluten free grains

There are healthy (i.e. farro and bulgur) grains with gluten as well as less healthy grains (i.e. white pasta and bread). The same goes for gluten free grains. Naturally unprocessed gluten free grains are packed with nutrients. However many GF products are made from refined grains like white rice or corn flour or processed snack foods and are lacking in fiber and other nutrients. In addition, people often turn to gluten free products thinking they are healthier or lower in calories. This is often not the case!

Why might gluten bad be for PCOS

So now let’s get into the the main point of this article – is gluten bad for PCOS?  Before I answer this, keep in mind there has been very little (none that I could find) research on gluten and PCOS. Much of this is theory at this point. But I think it helps to understand why some health experts are against gluten for PCOS.

-Gluten and inflammation
As per Dr. McCullough, gluten can be inflammatory as it can cause leaky gut and trigger an immune reaction. A growing body of evidence suggests a large percentage of people who don’t have celiac may be gluten sensitive, primarily because of these inflammatory side effects. Those who are sensitive secrete increased amounts of a protein called zonulin in their intestines after eating gluten. This protein causes the intestinal barrier to leak contents like gluten, bacteria and other substances into the blood stream. This may cause an inflammatory response. Since PCOS tends to have an inflammatory component, it’s possible gluten might increase inflammation in some women.

Check out Chris Kresser & Dr. Fasano’s podcast to understand more about leaky gut.

– Questionable link between autoimmunity and PCOS
PCOS is a genetic, reproductive, hormonal and metabolic condition. However, some studies are suggesting it’s also an autoimmune condition. But these studies are far from conclusive. Women with PCOS have higher rates of Hashimoto’s, Graves’ disease and Lupus than women without PCOS. Researchers from Germany introduced evidence suggesting a threefold increase in the prevalence of Hashimoto’s thyroiditis in women with polycystic ovary syndrome (PCOS) as compared to rates of this condition in the general population.Reference Autoimmune diseases tend to cluster. People with one autoimmune disease frequently have several. Further studies are needed at genetic and molecular level to establish the contribution of autoimmunity in PCOS.

* celiac disease is an autoimmune disease where the body attacks itself after eating gluten. Some people who are gluten sensitive may experience inflammation after eating gluten – but not an autoimmune attacking response. At this point, PCOS is not believed to be an autoimmune disease. And even if it were, we don’t know that gluten would cause the body to attack itself. But that being said, some women with PCOS experience negative effects from eating gluten that can not be blamed on the fermentable carbohydrate oligosaccharide (as noted above). So perhaps it could be causing leaky gut and worsening inflammation.

What do the experts say about gluten and PCOS?

As with any nutrition related topic, there will alway be a differing of opinions. Why? Because there is no one
size fits all approach to nutrition for PCOS (or anyone without PCOS!) Let’s start with the dietitians!

  1. Angela Grassi, MS, RDN , LDN, author and founder of the PCOS Nutrition Center, emphasizes the fact that “there are no one size fits all approach for how women with PCOS should eat – and this includes the recommendations for gluten. There is no research that conclusively shows a gluten free diet is better than any other diet for PCOS. If a patient is showing signs of gluten intolerance (bloating, GI issues, autoimmune disorders) I may recommend it. A lot of times though, it may not be the gluten that is making a patient feel Hillary Wrightbetter, it’s because they are avoiding FODMAP foods. Keep in mind, a gluten free diet lacks nutrients and can be difficult to reach optimal amounts.”
  2.  Hillary Wright, MEd, RD, LDN, author of The PCOS Diet Plan feels that some women feel better omitting gluten because they are just cutting down on processed, carbs – not from the gluten per se. She is not aware of any research that would indicate the need for all women with PCOS to be on a gluten free diet.
  3. Melissa Groves, RDN says “while there is some research showing that gluten can be inflammatory for some people, the evidence is just not
    there to recommend avoiding gluten entirely for all women with PCOS. There are literally no studies showing that avoiding gluten benefits PCOS. Additionally, I’m always cautious of diets that recommend restricting or eliminating foods or food groups, because women with PCOS are at a higher risk for disordered eating.
    That being said, if you have eliminated gluten, feel better off it, and it’s not causing you undue stress to avoid it, then great! But I’ve had really good results with my clients who don’t eliminate gluten – including getting their periods back, losing weight, and getting pregnant. Cutting gluten is just not necessary for most people”.
  4. Martha McKittrick, RD, CDE. At this point, I don’t feel the research is there to recommend an GF diet for all women with PCOS. But if a women is having gastrointestinal symptoms, mental fogginess, fatigue, or aches and pains, it’s worth a trial of eliminating gluten as an experiment. But also keep in mind that IBS is more common in women with PCOS than without PCOS, so any gastrointestinal symptoms could be caused by FODMAPS vs gluten. So a trial of a Low FODMAP diet may be helpful as well. Lastly, I think we need to stay tuned to see if PCOS turns out to have more of an autoimmune component. This would make me lean more towards gluten free. But for now, your best bet is to pay attention to how various foods affect you. There is no one size all fits approach to nutrition for PCOS.
  5. Felice Gersh, MD and author of PCOS SOS: a Gynecologist’s Lifeline to Naturally Restore Your Rhythms, Hormones and Happiness: “Most “untreated” women with PCOS will have a Felice Gershdysbiotic gut microbiome. Healing requires a healthy gut and that requires a diverse and appropriate gut microbial population. Without direct access to all the PCOS women who read my book, I don’t have the ability to ascertain precisely the state of their gut nor the response of their body to gluten. Even in those without autoimmunity to gluten there is often an inflammatory response. Even in my office practice, I highly recommend a gluten free diet initially, as many with gluten issues have no overt GI symptoms.
    Therefore I recommend a gluten free diet for all for at least 6 months and additional time as needed to restore regular ovulation and metabolic homeostasis. Once robust health is established, reintroducing organic, unprocessed gluten can then be considered on an individual basis.”
  6. Fiona McCullough, ND and author of the 8 Steps to Reverse Your PCOS: “Gluten can be an inflammatory food. It creates leaky gut and triggers immune reactions n many people. A growing body of evidence suggests that a large percentage of people who do not have celiac disease are sensitive to gluten, primarily because of these inflammatory effects. Those who are sensitive may secrete increased amounts of a protein called zonulin in the intestines after consuming gluten. This causes the intestinal barrier to leak, which can create a host of negative benefits for intentional health.

    As women with PCOS have an excessive amount of inflammation, this is problematic. I’ve found that many women with PCOS feel better without gluten. The only real way to know if you are gluten sensitive is to eliminate it for a month. If you feel better, don’t eat it!”

Practical tips for gluten and PCOS

  1. If you suspect you have a real issue with gluten, check with your doctor before eliminating it.  You will need to be consuming gluten in order to have celiac disease ruled out by blood work. If the serologies show up as positive for celiac, a biopsy of the intestines confirms it. Avoiding gluten can give false negatives on these tests.
  2. Assuming you don’t have celiac disease, you can do a trial of omitting gluten to see if you feel better (as mentioned above).
  3. If you decide to go gluten free, do your best to get in healthy unprocessed gluten free whole grains.
  4. If you are having gastro-intestinal side effects from consuming foods with gluten, read up on the Low FODMAP diet and try to eliminate oligosaccharide/fructans for a few weeks. Consider working with a registered dietitian knowledgable in the Low FODMAP diet.
  5. If being on a gluten free diet helps you eat fewer carbs (without feeling deprived), make healthier carb choices overall and makes you feel good, then keep doing it! I find this “restriction” can actually be very helfpful for some women.
  6. But if you truly do not notice a difference in how you feel by omitting gluten and it makes you feel deprived, there is not reason whatsoever to continue the diet!
  7. Stay tuned for further research on inflammation, gluten and PCOS as well as the autoimmune issue.
  8. If you have other autoimmune issues like Hashimoto’s, Graves’ disease and Lupus, you may want to try a gluten free diet.

What are your thoughts on gluten? How does it make you feel?

 

References

Uncovering Hidden Sources of Gluten — What Clients and Patients Must Know

RHR: Pioneering Researcher Alessio Fasano M.D. on Gluten, Autoimmunity & Leaky Gut

What’s really behind ‘gluten sensitivity’?

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I especially love problem-solving, whether it’s helping women defeat issues plaguing them for years, helping a busy executive find practical ways to get heart healthy, or providing tips to help you reverse diabetes. That’s why I’m on a constant quest to expand my knowledge by staying on top of the latest research.

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2 Comments

  1. Healthyhormones on June 28, 2019 at 10:55 am

    Thank you for sharing!

    • Martha Mckittrick RD on July 27, 2019 at 3:55 pm

      thanks for reading!

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