If you have polycystic ovary syndrome (PCOS) and you’ve been searching the internet or social media, gluten is a hot topic. You may have even convinced yourself that you need to try a gluten-free lifestyle.
Maybe you’ve already started eating gluten free foods based on what you’ve read. But is going gluten free really necessary if you have PCOS?
Maybe…but probably not for most people.
In this article, we’ll dive into what gluten is, what the research says, and whether or not you should follow a gluten-free diet if you have PCOS. But first, let’s do a recap on what PCOS is.
PCOS is a complex medical condition that affects approximately 6-12% of women in the US. It’s characterized by a variety of symptoms that can affect many different systems in our body, from the menstrual cycle to blood sugar levels (1).
Some common symptoms of PCOS include:
While the exact cause of PCOS is unknown, those with PCOS often have insulin resistance and chronic inflammation at baseline. These put them at a higher risk of developing chronic diseases such as type 2 diabetes, heart disease, high blood pressure, and fatty liver disease.
Gluten is the protein found in wheat, rye, and barley. It helps to give foods their texture and shape.
Gluten is found in many different foods such as:
There are certain medical conditions that do require a gluten free diet. Let’s discuss these diagnoses where a gluten free diet is necessary.
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. It affects 1 in 100 people worldwide (or 1% of the population).
Symptoms of celiac disease vary among individuals. Common symptoms include:
A celiac disease diagnosis must be made by a medical doctor. It typically involves a blood test and an endoscopy to biopsy and examine 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. You must be eating gluten-containing foods for testing to be accurate.
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. It affects up to 0.5-13% of the general population.
Symptoms of NCGS are very similar to celiac disease and may include:
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 or a wheat allergy) (2).
Bloating is a common symptom of PCOS and may not be indicative of a gluten intolerance. Check out this post: PCOS Bloating: What Causes It & 7 Tips To Get Relief.
The medical conditions listed above, 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 not 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.
There is a lot of misinformation floating around that gluten is inflammatory for everyone. Since PCOS is known to be an inflammatory condition, people claim that gluten makes PCOS symptoms worse.
The truth is that gluten does not cause inflammation in most people.
If you have celiac disease or NCGS, gluten may worsen inflammation and make your PCOS symptoms worse. However, if you don’t have either of these, a gluten free diet is probably not necessary and it’s never the first line of treatment that I recommend to clients.
I’ve worked with hundreds of women with PCOS and the vast majority of them were able to include gluten and still manage their PCOS effectively.
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 ~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 (if non-celiac gluten sensitivity isn’t present).
Hashimoto’s is an autoimmune disorder where the body’s immune system attacks the thyroid and can cause hypothyroidism. Hypothyroidism is when your thyroid isn’t producing enough thyroid hormone.
Those with PCOS are at an increased risk of hypothyroidism, particularly due to autoimmune thyroid disease. Hashimoto’s thyroiditis occurs 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.
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.
Need some guidance on dietary changes that can help your symptoms, be sure to check out this post: A Dietitian’s 7 Day PCOS Diet Plan (PDF Included).
If you suspect that you have a gluten sensitivity, you could try a temporary elimination of gluten from your diet to see if symptoms improve. If symptoms return when you reintroduce gluten, you may have a gluten sensitivity or celiac disease.
Before starting a gluten free diet, here are some things to keep in mind:
There currently isn’t any research to say that everyone needs to follow a gluten free diet for PCOS. Following a gluten free diet without a medical reason can limit your fiber intake and may reduce your quality of life.
You should follow a gluten free diet if you have celiac disease or non-celiac gluten sensitivity.
If you have symptoms of gluten sensitivity, 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.
Working with a registered dietitian can help create a personalized meal plan for you and your needs.
Learn the most common nutrition mistakes I see women with PCOS making and what to do instead!