PCOS and Gut Health: What’s the Connection?
Gut health, while a trendy topic, is a core tenant of overall wellness. Considering the majority of our immune cells reside in our digestive tract, this shouldn’t be a surprise. But too often, I meet a woman diagnosed with PCOS, whether twenty years ago or two days ago, who has been told that there is little connection between diet, PCOS, and gut health. This isn’t true.
While more physicians are familiar with PCOS, the diagnosis is still often missed early in a woman’s life. She may visit the doctor because she has hormonal acne, or her period is late or very sporadic. She is given birth control pills as a treatment. It isn’t until later in life when she is ready to stop taking the pill and get pregnant that she finds out she has PCOS. Suddenly off the pill, her symptoms come back, and she is left wondering why?
To understand the relationship between PCOS and gut health, let’s start from the beginning.
What is PCOS?
Polycystic ovary syndrome (PCOS) is both a hormonal and metabolic condition affecting 8-13% of women in the US. For a physician to diagnose, two of the three criteria have to be present:
Cysts on the ovaries
Infrequent period or amenorrhea (no period at all)
Elevated androgen (male sex hormone)
Elevated androgens cause many of the issues women with PCOS experience, including excess facial hair (hirsutism), acne on the face and/or body, and hair thinning. But excess androgens also may cause the growth of cysts, interfere with the menstrual cycle, and even contribute to insulin resistance.
Types of PCOS.
There are four types of PCOS. The most common presentation of PCOS (classic presentation) ties closely with metabolic irregularities like insulin resistance and abdominal obesity. This insulin resistance in-turn causes excess testosterone to release from the ovaries leading to a very vicious cycle of blood sugar imbalance. Women can also present with a lean body type and no insulin resistance. With each of the PCOS types there are abnormalities in sex hormones, but some women may even still get a period. However, I have found variations even within these four type as every woman is so different.
What causes PCOS?
The root cause of PCOS is not clear, but several factors have been hypothesized:
Genetics
Environment including exposure to endocrine disruptors like BPA
Stress
Alterations in hormone secretions
Inflammation
Autoimmunity
Why does the PCOS diagnosis matter?
Beyond the emotional distress a woman may experience from having excess acne or facial hair, PCOS is a significant risk factor for cardiovascular disease and type 2 diabetes because of metabolic involvement. There is also an increased risk for infertility or miscarriage.
The good news is that there are so many positive lifestyle changes a woman can make to help with PCOS, starting with the gut.
Gut and PCOS: What is the microbiome?
The human microbiome is the combination of the symbiotic microbial cells that live in and on us. Sounds a bit unnerving, but we are more bacteria than person – and most of these bugs reside in our gut. We have nearly 3-5 pounds of creatures in our gut that do so much for us. Our gut bacteria aids our immune system, supports the integrity of the gut lining, assists in food digestion, synthesizes specific vitamins, and produces short-chain fatty acids.
What happens when the microbiome is not in balance?
Dysbiosis is the imbalance of bacteria in our gut. When something causes this imbalance (ex: antibiotics, antacids, food poisoning, inflammation), our healthy, commensal bacteria can become out of balance. In addition to gut discomfort, dysbiosis interferes with all the essential functions of the microbiome, as listed above.
What is the connection between dysbiosis, PCOS and the microbiome?
In a recent study researchers found that women with PCOS had less diverse bacteria present as compared to controls. The gut microbiota also appears to play a role in the regulation of androgens. And in practice, I estimate that 90-95% of my clients with PCOS have some gut impairment – whether it is chronic constipation, IBS, SIBO, or bloating.
Dietary strategies for PCOS and gut health
The good news is that what is good for PCOS is good for the gut – they go hand in hand. From blood sugar balance to regular bowel movements – supporting your gut health will also help your hormone health.
Fermented Foods: Fermented foods have been used for centuries to heal and support the gut and the immune system. Include ¼ - ½ cup of fermented foods into your daily diet for a dose of natural probiotics. Foods high in probiotics are lacto-fermented veggies such as raw sauerkraut, kimchi, miso, kefir (watch out for added sugar), natto, and 24-hour fermented yogurt.
Probiotic Supplements: Probiotic supplements can be so helpful when supporting gut health – but it is essential to remember that not all supplements are created equal (link to probiotics blog). The way they are prepared, stored, shipped all matter. Further – not all strains will be helpful. When a practitioner recommends a specific probiotic, it is likely because they know that strain, or type of bacteria, has been shown in practice to support that need. For example, the bacteria that helps mood or anxiety may not be the same strain that has been shown to support irritable bowel disease. Working closely with a practitioner who can recommend the right supplement is critical – otherwise you may just be wasting your money.
Prebiotic Fibers: While probiotics can support the population of the gut bacteria as they move through, prebiotics are what will keep your gut healthy long term. Prebiotic fibers are the actual fuel for the probiotics. Long term positive change in the balance of gut bacteria requires the presence of prebiotic fibers. You can support this by eating at least 30 g of fiber from a wide variety of fruits and vegetables daily. Fiber also helps to support your blood sugar balance as fiber is a crucial component for insulin resistance. Be cautious starting with prebiotic fibers, especially if you use supplemental powders, as they will cause intestinal gas initially.
Herbs and Spices: While seemingly innocuous, herbs and spices are incredibly powerful to support gut health, PCOS, and overall anti-inflammatory diet. Drinking spearmint tea daily can lower androgens. Turmeric is a potent anti-inflammatory that also helps gut health. Black pepper is necessary for the absorption of turmeric. And cinnamon can support healthy blood sugar levels. While you can and should cook with these herbs and spices, sometimes therapeutic doses are also necessary for your healing in supplement form.
Cruciferous Vegetables: If you aren’t already eating your cruciferous veggies, start adding kale, cauliflower, broccoli, and cabbage to your grocery list. These foods all support healthy elimination as well as the upregulation of natural detoxification pathways. Detoxification through daily elimination is vital for healthy hormone balance.
When to seek further support.
Supporting your gut health is a great place to start working on addressing your PCOS, but sometimes it isn’t enough. PCOS is multifactorial, so it is essential to look at your lifestyle as a whole, including sleep, stress, movement along with diet. If you are feeling overwhelmed and don’t know where to start, it may be time to reach out to a practitioner specialized in PCOS who can hold your hand and create a program individualized to your needs.