Many women with PCOS have come across the advice to avoid gluten and gluten-containing products to help manage their condition. But why exactly has gluten such a bad rep and does it actually make PCOS worse?
That’s what I’ll break down for you in this article based on the current evidence regarding the effects of gluten on PCOS. As someone having PCOS myself and experimenting with multiple different dietary approaches, I’ll also share my own experience with adopting a gluten-free diet and everything I’ve learned from it.
If you’d like to get more tips on how to manage PCOS through dietary changes, make sure to check out my complete guide here: ‘The Best PCOS Diet (Ultimate Guide)’.
What is gluten?
Gluten is a type of protein naturally found in wheat, rye and barley and all products made from these grains such as bread, pasta, pastries, cakes, crackers, beer or cereals. Gluten is what gives these foods texture, moisture and elasticity (acting as a glue) which is why it’s so often added to other processed foods such as sauces, gravy, condiments, soups or deli meats.
As a result, gluten is found pretty much everywhere in the modern Western diet making it almost impossible to avoid without a conscious effort or paying close attention. While the exact link between the consumption of gluten and PCOS is not completely clear as there is currently no solid evidence exploring this topic, here is all you need to know about the potential effects of gluten on PCOS.
How does gluten affect PCOS?
- Inflammation
- Intolerance
- Insulin resistance
- Hormone disruption
1. Inflammation
One of the main reasons why gluten is so often considered ‘bad’ for women with PCOS is due to its potential pro-inflammatory effects. Chronic inflammation is now recognized as one of the main contributors to PCOS as women with this syndrome have been shown to have elevated levels of inflammatory markers in the body.
For this reason, they are generally advised to reduce their inflammation by adopting an anti-inflammatory diet (high in whole nutrient-rich foods) and limiting their intake of pro-inflammatory foods (highly processed foods).
There is some evidence suggesting that a high intake of wheat products (as well as other related cereals) may contribute to inflammation and autoimmune disease. More importantly, gluten alone is likely to cause severe inflammation and intestinal damage in those with gluten allergy (celiac disease) or gluten intolerance (non-celiac gluten sensitivity).
That’s because gluten is not digested completely in the gut (unlike other proteins) and may irritate the gut lining (triggering inflammation) and contribute to intestinal permeability (leaky gut). In addition, this gut-generated inflammatory response can put too much stress on your adrenal glands (responsible for producing multiple hormones) leading to further hormone imbalances.
2. Intolerance
Celiac disease and non-celiac gluten sensitivity (NCGS) are two completely different conditions. The former one is actually very rare as celiac disease affects only about 1% of the US population. It is an autoimmune disease and adopting a strictly gluten-free diet is completely necessary for this type of condition.
NSGS, on the other hand, is way more common affecting approximately 15% of the US population. However, since NSGS is more difficult to diagnose (there are currently no reliable blood tests), this number may be an underestimate of the actual amount of people suffering from gluten intolerance.
Common symptoms of NSGS include bloating, gas, chronic fatigue, brain fog, diarrhea and skin issues which are particularly common among women with PCOS. While there are currently no data estimating the number of women with PCOS suffering from gluten sensitivity, many of them appear to benefit from removing gluten from their diet.
3. Insulin resistance
Even though gluten itself is a type of protein, it is primarily found in grains (naturally high in carbohydrates) and food products high in refined carbohydrates and sugars (most processed foods). High intake of such foods is likely to contribute to insulin resistance which is one the main drivers of PCOS affecting up to 70% of women with this condition.
You can learn more about the link between insulin resistance and PCOS here: ‘PCOS Insulin Resistance Explained & How To Reverse It’.
One of the possible reasons why so many women with PCOS experience improvements in their symptoms after adopting a gluten-free diet is because they significantly reduce their intake of high GI (glycemic index) carbohydrates and sugars. This, in turn, helps improve their blood sugar regulation, reduce insulin resistance and balance hormones.
4. Hormone disruption
Besides all the potential hormone-disrupting effects of gluten via increased inflammation, gut damage and insulin resistance, there is another important factor worth consideration. It is no secret that wheat is amongst the top 3 most extensively grown crops in the world. It is produced in massive amounts to meet its enormous demands.
As a result, the production of wheat involves the use of heavy pesticides, herbicides and other endocrine-disrupting chemicals (EDCs). Such chemicals have been shown to contribute to endocrine disorders (including PCOS) as they can mimic, block or interfere with natural hormones once they enter the body.
For this reason, adopting a gluten-free diet may help women with PCOS reduce their exposure to endocrine-disrupting chemicals which are typically found in gluten-containing grains in large quantities. That being said, even naturally gluten-free grains (such as rice or corn) can pose the same issues with the use of harmful chemicals.
Things to consider:
- Personal tolerance
- Quality
- Gluten-free alternatives
- Disordered eating
• Personal tolerance
While going completely gluten-free may not be necessary for every single woman with PCOS, it is important to know your personal tolerance to gluten and your own body’s responses to it. Remember, you are the expert on your own body.
“You are the expert on your own body”.
As I’ve already mentioned, there is currently no reliable test to diagnose gluten sensitivity (other than for allergy or celiac disease) which can make this task particularly difficult. One of the best ways to approach this problem is to experiment with a gluten-free diet yourself (preferably with professional help).
This involves eliminating gluten from your diet completely for at least 4 weeks and paying attention to your symptoms, feelings and body responses. After that initial period, you then want to start introducing gluten-containing foods back into your diet again and notice any differences.
Many women with PCOS discover that they are truly sensitive to gluten and that their symptoms significantly improve with a gluten-free diet. However, you may find out that you can tolerate gluten in small quantities or that it doesn’t affect you at all. Since we are all unique individuals, it’s all about finding your own personal tolerance.
• Quality
While I generally believe that adopting a gluten-free diet can be helpful for the vast majority of women with PCOS (for at least a period of time) it doesn’t mean you have to cut out all gluten-containing foods completely or forever.
If you do decide to include gluten in your diet, I highly suggest you opt for high-quality food products as it can make a massive difference to your body’s responses. Look for organic, minimally processed foods (eg. sourdough bread, rye bread, wholegrain products) and try to avoid highly refined grains (especially wheat) and processed foods (white flour, pastries, cookies, baked goods).
American wheat (hard red) also tends to be much higher in gluten in comparison to European wheat (soft) which is why so many people find they can better tolerate gluten foods in Europe than in the US.
• Gluten-free alternatives
One thing to be aware of is that ‘gluten-free’ doesn’t necessarily mean ‘healthier‘. In fact, most processed gluten-free alternatives on the market are nutritionally poor and typically high in added sugars, starches, emulsifiers and other food additives to make up for the missing gluten and its structuring properties.
If you want to give a gluten-free diet a go, it’s particularly important you focus on eating whole (or minimally processed) foods that are naturally gluten-free (nuts, seeds, beans, legumes, pseudograins, veggies, fruits) to get the most benefits.
Read more: ‘Which Grain is Best For PCOS?‘
The good news is that even some of your favorite processed foods (pasta, breads, cookies, cakes) can now be found in a relatively healthy gluten-free version. Make sure you read the ingredient list first, though.
• Disordered eating
Another important thing to consider is the fact that ‘gluten-free’ is a type of restrictive diet that may result in disordered eating practices when not approached properly. Adopting a gluten-free diet can be particularly triggering for those with an eating disorder history or tendencies for obsessive behaviors.
If you’re used to eating a typical Western diet, it is likely that a big proportion of it consists of gluten-containing products. When you decide to eliminate gluten from your diet, you might find that your food choices become very limited.
Without relevant knowledge, planning and guidance, this can lead to some serious consequences such as nutritional deficiencies, eating disorders and chronic stress. That’s another reason why working with a professional in this situation is advisable.
My experience:
While I don’t necessarily think that gluten is as harmful as some make it seem to be, I personally don’t include it in my diet after years of experimenting with it. The biggest benefit I found when first I tried a gluten-free diet was that I started reading food labels, paying attention to the ingredients and opting for more wholefood choices by default (there wasn’t as many processed gluten-free alternatives back then).
In terms of my symptoms, I noticed the biggest improvements in my digestive health (especially bloating and abdominal pain) and skin (I used to suffer from severe hormonal acne). Because my skin is particularly sensitive, I can relatively easily recognize my triggers and gluten (especially in wheat) is unfortunately one of them.
Read more: ‘How I Cured My PCOS Acne Naturally‘
However, you should always consider your own unique body’s responses that can help you identify your triggers as we are all sensitive to different things. For this reason, I think that keeping a food diary or using other tracking methods can be extremely valuable for most people, but especially for women with PCOS.
Does gluten make PCOS worse?
Gluten appears to make PCOS symptoms worse in some women with this condition who also suffer from gluten sensitivity, gluten allergy or autoimmune disease. However, there is currently no scientific evidence demonstrating the negative effects of gluten on PCOS.
Do you need to eat gluten-free for PCOS?
You do not need to eat gluten-free for PCOS if you are not allergic to gluten or suffer from gluten sensitivity. However, many women with PCOS report improvements in their symptoms after adopting a gluten-free diet which is why a temporary elimination diet may be beneficial.
Is low-carb or gluten-free better for PCOS?
Both low-carb and gluten-free diets may help improve PCOS in some individuals for different reasons. Adopting a low-carb diet appears to be more effective at improving insulin resistance while a gluten-free diet may help reduce inflammation in those suffering from gluten sensitivity or leaky gut.
Pro tips:
- Choose whole foods – opt for naturally gluten-free foods to make sure you get enough nutrients and dietary fiber in your diet
Read more: ‘The Best Carbs For PCOS (Food List)‘ - Find alternatives – find alternatives to your favorite foods that don’t contain gluten (eg. bean pasta, courghetti, cauliflower rice, quinoa, coconut flour, paleo bread, sweet potato toast)
Read more: ‘The Best Flours For PCOS & How To Use Them‘ - Make it yourself – if you can’t find a high-quality gluten-free version of your favorite food product, you can always make it yourself as there are thousands of simple recipes you can choose from (I like using Pinterest for this)
- Read the label – make sure to always check the ingredient list as gluten is oftentimes hidden in some not-so-obvious foods (eg. soy sauce, protein bars, snack foods, meats, breakfast foods)
- Track your progress – get tested, assess your symptoms, keep a food diary and keep track of your progress, with enough data you’re more likely to see what strategies work for you best and it also helps you stay motivated
- Work with a professional – following a gluten-free diet can become very overwhelming especially if you’re just beginning to understand your PCOS so having access to the right information, guidance and moral support can be a life-changer in your journey
Resources:
- Barbaro, M. R., Cremon, C., Stanghellini, V., & Barbara, G. (2018). Recent advances in understanding non-celiac gluten sensitivity. F1000Research, 7, F1000 Faculty Rev-1631. https://doi.org/10.12688/f1000research.15849.1
- Cárdenas-Torres, F. I., Cabrera-Chávez, F., Figueroa-Salcido, O. G., & Ontiveros, N. (2021). Non-Celiac Gluten Sensitivity: An Update. Medicina (Kaunas, Lithuania), 57(6), 526. https://doi.org/10.3390/medicina57060526
- Catassi, C., Elli, L., Bonaz, B., Bouma, G., Carroccio, A., Castillejo, G., Cellier, C., Cristofori, F., de Magistris, L., Dolinsek, J., Dieterich, W., Francavilla, R., Hadjivassiliou, M., Holtmeier, W., Körner, U., Leffler, D. A., Lundin, K. E., Mazzarella, G., Mulder, C. J., Pellegrini, N., … Fasano, A. (2015). Diagnosis of Non-Celiac Gluten Sensitivity (NCGS): The Salerno Experts’ Criteria. Nutrients, 7(6), 4966–4977. https://doi.org/10.3390/nu7064966
- de Punder, K., & Pruimboom, L. (2013). The dietary intake of wheat and other cereal grains and their role in inflammation. Nutrients, 5(3), 771–787. https://doi.org/10.3390/nu5030771
- El-Mesallamy, H. O., Abd El-Razek, R. S., & El-Refaie, T. A. (2013). Circulating high-sensitivity C-reactive protein and soluble CD40 ligand are inter-related in a cohort of women with polycystic ovary syndrome. European journal of obstetrics, gynecology, and reproductive biology, 168(2), 178–182. https://doi.org/10.1016/j.ejogrb.2013.01.015
- González F. (2012). Inflammation in Polycystic Ovary Syndrome: underpinning of insulin resistance and ovarian dysfunction. Steroids, 77(4), 300–305. https://doi.org/10.1016/j.steroids.2011.12.003
- Picarelli, A., Borghini, R., Isonne, C., & Di Tola, M. (2013). Reactivity to dietary gluten: new insights into differential diagnosis among gluten‑related gastrointestinal disorders. Polskie Archiwum Medycyny Wewnetrznej, 123(12), 708–712. https://doi.org/10.20452/pamw.2019
- Palioura, E., & Diamanti-Kandarakis, E. (2015). Polycystic ovary syndrome (PCOS) and endocrine disrupting chemicals (EDCs). Reviews in endocrine & metabolic disorders, 16(4), 365–371. https://doi.org/10.1007/s11154-016-9326-7
- Popovic, M., Sartorius, G., & Christ-Crain, M. (2019). Chronic low-grade inflammation in polycystic ovary syndrome: is there a (patho)-physiological role for interleukin-1?. Seminars in immunopathology, 41(4), 447–459. https://doi.org/10.1007/s00281-019-00737-4
- Sapone, A., Lammers, K. M., Casolaro, V., Cammarota, M., Giuliano, M. T., De Rosa, M., Stefanile, R., Mazzarella, G., Tolone, C., Russo, M. I., Esposito, P., Ferraraccio, F., Cartenì, M., Riegler, G., de Magistris, L., & Fasano, A. (2011). Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC medicine, 9, 23. https://doi.org/10.1186/1741-7015-9-23
- Singh, P., Arora, A., Strand, T. A., Leffler, D. A., Catassi, C., Green, P. H., Kelly, C. P., Ahuja, V., & Makharia, G. K. (2018). Global Prevalence of Celiac Disease: Systematic Review and Meta-analysis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 16(6), 823–836.e2. https://doi.org/10.1016/j.cgh.2017.06.037
Wang, J., Wu, D., Guo, H., & Li, M. (2019). Hyperandrogenemia and insulin resistance: The chief culprit of polycystic ovary syndrome. Life sciences, 236, 116940. https://doi.org/10.1016/j.lfs.2019.116940