PCOS and Gluten: Who Should Go Gluten-Free + Why

If you’ve been searching the internet or social media, you probably know that gluten and PCOS is a hot topic. You may have even convinced yourself that you need to try a gluten-free lifestyle. 

As a registered dietitian who also has PCOS, my goal is to take you from confused to confident when it comes to what you should and shouldn’t be eating if you have PCOS.  

In this blog post, I’ll dive into what gluten is, what the research says on gluten and PCOS, and if you should start a gluten-free diet. 

What Is Gluten and Who Should Avoid It?

You’ve heard of it before – but what exactly is gluten? Gluten is the protein found in wheat, rye, and barley. It helps to give these foods their texture and shape. 

Gluten is found in many different foods such as:

There are certain medical conditions, such as Celiac disease, that absolutely do require a gluten free diet. Let’s discuss these diagnoses where a gluten free diet is medically necessary.

Celiac Disease

Celiac disease is an autoimmune disease that is triggered by eating gluten. When someone with celiac disease eats gluten, it causes intestinal damage making it more difficult to absorb nutrients and increases symptoms. Celiac disease affects 1 in 100 people worldwide (or 1% of the population). 

Symptoms of celiac disease vary among individuals. Common symptoms include:

• Digestive issues including abdominal pain, bloating, gas, constipation, and/or diarrhea
• Fatigue
• Migraine headaches
• Joint pain
• Skin conditions (dermatitis herpetiformis)
• Weight loss
• Osteoporosis
• Iron deficiency anemia
• Nutrient deficiencies

One recent analysis found that people with Celiac disease are at a higher risk of also having women’s health disorders, such as PCOS (1).

A celiac disease diagnosis must be made by a medical doctor. It typically involves a blood test and then an endoscopy to biopsy the lining of the small intestine. Treatment for celiac disease requires a strict gluten-free diet. 

If you suspect that you may have celiac disease, it’s important to discuss this with your doctor prior to starting a gluten free diet. 

Non-Celiac Gluten Sensitivity

Non-celiac gluten sensitivity (NCGS), or gluten intolerance, is a less severe form of gluten-related disorders. It’s used to describe someone who doesn’t have celiac disease, a gluten allergy, or a wheat allergy, but still has unpleasant symptoms when they eat gluten. 

Symptoms of NCGS are very similar to celiac disease and may include:

• Digestive issues such as abdominal pain, gas, bloating, constipation and/or diarrhea
• Headaches/migraines
• Fatigue
• Mood disorders
• Joint pain
• Brain fog 

NCGS affects up to 0.5-13% of the general population. Unfortunately, there is no straightforward testing for NCGS. A medical doctor can make this diagnosis after ruling out other potential causes of your symptoms, such as Celiac disease (2). 

The Gluten and PCOS Connection

Celiac disease and NCGS are instances where a gluten-free diet is necessary. But what about if you don’t have either of those? 

Currently, there is no research that suggests a definitive link between PCOS and gluten. There is also no evidence that gluten causes PCOS or that all women with PCOS should follow a gluten-free diet. 

PCOS and Gluten Myths

There is a lot of misinformation floating around about PCOS and gluten. These are a few of the most common myths I’ve seen talked about:

Myth: gluten is inflammatory for everyone. Since PCOS is known to be an inflammatory condition, people claim that gluten makes PCOS symptoms worse. 

Truth: gluten does not cause inflammation in most people. If you have a gluten-related disorder, such as Celiac disease or NCGS, then gluten can cause inflammation in your body. For those that don’t have these conditions, there’s no evidence that gluten causes inflammation.

Myth: Women with PCOS are more likely to have a gluten sensitivity. 

Truth: There’s no research that actually has found a link between PCOS and gluten-related disorders. There has been research showing that those with Celiac disease are more likely to also have PCOS…but not that those with PCOS are more likely to have Celiac disease or another gluten-related disorder. 

Myth: Following a gluten-free diet is just healthier for you. 

Truth: Without careful planning, going gluten-free unnecessarily can actually lead to a lower intake of important nutrients such as fiber, B vitamins, or iron.

PCOS, Gluten and Other Medical Conditions

There’s a couple of other medical conditions that commonly overlap with PCOS that may warrant a gluten free diet. If you have one of these other conditions though, you don’t necessarily have to follow a gluten free diet, it’s highly individualized person to person. 

PCOS and IBS

If you’re one of the lucky ones to have both irritable bowel syndrome (IBS) and PCOS, you may have heard of the low FODMAP diet. The low FODMAP diet is an elimination diet that improves digestive symptoms in approximately 75% of people with IBS. 

FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides and polyols – woof, what a mouthful. FODMAPs are types of carbohydrates that are poorly digested in some people with IBS. 

Interestingly, part of the low FODMAP diet includes being gluten free…but not because of the gluten (remember that gluten is the protein in wheat, rye, and barley). It’s actually the type of carbohydrates in wheat, rye, and barley that are causing the digestive issues in IBS.

PCOS and Hashimoto’s Thyroiditis

Hashimoto’s is an autoimmune disorder where the body’s immune system attacks the thyroid. It can cause hypothyroidism, which is when your thyroid isn’t producing enough thyroid hormone. 

Those with PCOS are at an increased risk of hypothyroidism, with hashimoto’s thyroiditis occurring at a 3x higher rate in those with PCOS (3). 

Some preliminary research suggests that a gluten free diet may improve thyroid function in those with Hashimoto’s. However, the sample size of this study was extremely small and more research is needed (4).

Fun fact: I’m one of the lucky ones to have Hashimoto’s and PCOS. 

How Do I Know If I Need To Avoid Gluten? 

So you may still be wondering: how do I know if I’m one of the people who may have NCGS and need to go gluten-free? Unfortunately, there isn’t a straightforward test to tell you. 

If you do not have any obvious symptoms of celiac disease or NCGS, a gluten free diet is absolutely not the first line of approach that I ever recommend. 

Instead, I’d recommend focusing on balancing your blood sugar levels and reducing inflammation through a balanced diet and lifestyle changes. This can help to improve insulin sensitivity, reduce low-grade inflammation, and lower androgens such as testosterone levels. Ultimately, this can translate into less PCOS symptoms. 

Need some guidance on dietary changes that can help your PCOS symptoms, be sure to check out this post: A Dietitian’s 7 Day PCOS Diet Plan (PDF Included).

If you have been following a healthy PCOS diet (like the one above) for at least 3 to 6 months and you’re still experiencing significant PCOS symptoms, you could try a temporary elimination of gluten from your diet to see if symptoms improve. If your symptoms return when you reintroduce gluten, you may have a gluten sensitivity. 

Tips For Going Gluten Free

Before starting a gluten free diet, here are some things to keep in mind:

• Choose whole foods. Unprocessed, gluten-free foods like fruits, vegetables, beans, legumes, and whole grains such as quinoa, rice, and millet are packed with nutrients like fiber, vitamins, and minerals.   

• Be mindful of processed gluten free options. Just because something is marked as gluten free doesn’t mean it’s a healthy choice. Many processed gluten free products have more fat, sodium, or sugar added in to make up for the missing gluten. 

• Read food labels. Become familiar with how to read food labels and check ingredient lists for hidden sources of gluten. 

• Avoid cross-contamination. This occurs when a gluten-free product you’re going to consume comes into contact with a gluten containing product. One example is using the same toaster for gluten free bread and whole wheat bread. 

Gluten-Free PCOS-Friendly Recipes

Easy PCOS Overnight Oats: 4 Different Variations!

Unstuffed Peppers

Mango Kefir Smoothie

Mediterranean Bean Pasta Salad

Bottom Line

There currently isn’t any research to say that everyone with PCOS needs to follow a gluten free diet. Following a gluten free diet without a medical reason can limit your fiber intake and may reduce your quality of life.

Ultimately, having PCOS doesn’t automatically mean that you need to follow a gluten free diet. For those with Celiac disease or non-celiac gluten sensitivity, you should follow a gluten free diet. If you have PCOS and also have either IBS or Hashimoto’s, you may want to speak to your doctor or dietitian about whether you’d benefit from a gluten free diet. 

You could try a temporary elimination of gluten to see if symptoms improve. If symptoms get worse when you reintroduce gluten, you may have a gluten sensitivity. 

Always talk to your healthcare provider or registered dietitian regarding your diet and/or medical concerns.

PCOS Posts You’ll Love

A Dietitian’s PCOS Grocery List & Pantry Staples

Best Milk for PCOS: Dairy Free or Not?

A Dietitian’s Easy PCOS Breakfast Ideas + Recipes

Seed Cycling For PCOS: Does It Actually Work?

Disclaimer: this is for informational purposes. It does not substitute for or replace professional medical advice for polycystic ovarian syndrome (PCOS) or any other medical condition. Always speak to your healthcare provider for personalized medical and dietary advice.