If you have been diagnosed with PCOS, you wouldn’t be alone in trying a gluten-free diet to manage PCOS. 18% of people with PCOS are said to have tried a gluten-free diet, but is there any evidence to support this? We discuss coeliac disease vs gluten sensitivity and what the science says about gluten and PCOS.
What is PCOS?
Polycystic ovary syndrome, or PCOS, is a common endocrine condition, affecting people with ovaries of reproductive age. However, signs and symptoms most commonly begin to appear in people during their late teenage years to their early 20s.
Whilst symptoms will appear differently in everyone they may include; irregular or no periods, difficulty getting pregnant, hirsutism (excess hair growth on the face and body), fluctuations in weight, acne and oily skin, and thinning or loss of hair from the head.
What is gluten?
Gluten is a type of protein found in wheat, barley and rye. Within gluten, glutenin and gliadin are the two main proteins. Gliadin is the protein that is primarily responsible for the adverse health effects of gluten.
Gluten proteins form a sticky glue-like consistency when flour is mixed with water. This makes the dough elastic and means that bread can rise during baking. Gluten contributes to the chewy texture of bread.
But gluten isn’t just in bread. Some foods with gluten include bread, pasta, cereal and beer. Oats are gluten-free and contain a similar protein called avenin, but because of the potential for cross-contamination, it’s important to choose certified gluten-free oats.
Coeliac disease vs. gluten sensitivity vs. wheat allergy
The majority of people can consume foods with gluten without any adverse effects. But, for some people, consuming gluten can lead to discomfort, tiredness or even increase the risk of other diseases. This could be coeliac disease, gluten sensitivity or a wheat allergy.
Coeliac disease (spelt celiac in American English) is an autoimmune condition. If someone with coeliac disease eats gluten, the body’s immune system begins to attack it’s own tissues. In particular, the lining of the intestine can be damaged which may lead to nutrients from food not being absorbed properly.
Symptoms of coeliac disease include:
- Abdominal bloating
- Weight loss
- Iron-deficiency anaemia
- Tooth enamel defects
- Mouth ulcers
Some people who are coeliac may not have any symptoms when they eat gluten, even though damage still may be occurring in the body.
Gluten sensitivity may also be called non-coeliac gluten sensitivity. The symptoms may present similarly to coeliac disease but no antibodies are produced, therefore it is unclear how the immune system is involved.
There is little research surrounding gluten sensitivity and more evidence is required to understand the condition and who is at risk.
Sometimes, gluten sensitivity may improve once following a gluten-free diet but this may be because of a placebo effect.
A wheat allergy develops when the body’s immune system is sensitised and overreacts to an environmental trigger (wheat).
Wheat is a grain and the main ingredient of many foods such as bread, breakfast cereals, biscuits, crackers and many convenience foods like ready-meals, soups and processed meats.
If you have been diagnosed with a wheat allergy then you should avoid any food containing wheat as the wheat protein can cause an allergic reaction. If you have an immediate allergy to wheat known as IgE-mediated then strict avoidance is recommended. It is advised to speak to a dietitian for support for your wheat-free diet.
Symptoms of a wheat allergy include:
- Hives or a skin rash
- Nausea, stomach cramps, vomiting or diarrhoea
- Stuffy or runny nose
- Anaphylaxis shock
Gluten and PCOS: should gluten be avoided?
You may have read claims adopting a gluten-free diet for PCOS might improve your sleep and energy levels or help to clear your skin, amongst other things. However, currently, there is no scientific evidence to link gluten and PCOS.
That being said, if you do often suffer from an upset stomach, bloating and feelings of fatigue after eating gluten it is advised you visit your GP to be tested for coeliac disease, gluten sensitivity or wheat allergy.
Going gluten-free for PCOS is unnecessary and may actually be more damaging to your health. That’s because there are risks of going gluten-free if you’re not careful with dietary planning.
Risks of going gluten-free
Whilst you can follow a balanced gluten-free diet, without nutritional advice and careful planning going gluten-free could result in nutritional deficiencies including iron, folate, niacin and zinc deficiency.
As many foods containing gluten are high in fibre, there is a risk of having below-optimal fibre consumption. People with PCOS are already more likely to have reduced fibre consumption if they also present with insulin resistance.
Fibre for PCOS can help to maintain blood sugar levels and lowering cholesterol, as well as help you feel fuller and more satisfied for longer. Fibre is also linked to improved gut health which has potential links to PCOS management.
How to go gluten-free
If you believe you could be coeliac you should follow these steps according to Coeliac UK to be diagnosed.
- Understand the symptoms – make a symptom diary of your symptoms, food eaten and timings. Do not remove gluten from the diet at this stage.
- Go to your doctor – take your symptom diary to your doctor. Do not remove gluten from the diet.
- Have a blood test – if your doctor thinks coeliac disease may be the culprit for your symptoms, they will take a blood test to test for antibodies. Do not remove gluten from the diet.
- Referral to a specialist – your doctor will refer you to a gut specialist if your test is positive. You may have a gut biopsy to confirm the diagnosis. Do not remove gluten from the diet.
It is key to keep eating gluten throughout the diagnosis process. This is because if you remove gluten, your blood test or gut biopsy may be inaccurate.
Once diagnosed, you can take the following steps to ensure you are safely removing gluten from your diet without compromising your health.
- Learn which foods are naturally gluten-free – all rice, potatoes, corn, plain meat, fish, eggs, milk, cheese, fruits, vegetables and pulses are naturally gluten-free.
- See a dietitian – your doctor will refer you to a dietitian to ensure you are still eating a varied diet, even if gluten-free.
- Enquire about prescriptions – some gluten-free products are available on prescription and may be more affordable than buying GF food in the supermarket.
FAQ: Gluten and PCOS
If you are diagnosed with coeliac disease then gluten proteins can trigger an inflammatory immune response which may impact cortisol levels. Cortisol is a stress hormone. People who do not have coeliac disease are unlikely to have an inflammatory response following the consumption of gluten products, and therefore this is unlikely to impact hormones like cortisol.
Gluten may contribute to digestive issues if you present with coeliac disease or gluten sensitivity. But, there are many other factors that may be linked to digestive health including IBS. Speak to your doctor to get personalised diagnostic advice and support for your digestive symptoms.
Key takeaways: gluten and PCOS
At the moment, there isn’t sufficient evidence that going gluten-free for PCOS will help with symptom management. There is no evidence that gluten impacts PCOS symptoms. Restricting food groups may lead to an unhealthy relationship with food. If you believe you may have coeliac disease or a wheat allergy, it is important to see your doctor for a diagnosis. Do not remove gluten from the diet unnecessarily and consult with a dietitian if you are required to go gluten-free for medical reasons.