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Do I Need to be on a Gluten-Free Diet for PCOS?

gluten-free for PCOS

If you have polycystic ovarian syndrome (PCOS), you’ve likely encountered testimonials from women online who swear by a gluten-free diet as a solution to their PCOS.

However, whether adopting a gluten-free diet can truly enhance PCOS management remains uncertain amongst the scientific community. The relationship between gluten and PCOS has long sparked discussions. Online anti-gluten sources are full of claims linking gluten to issues like chronic inflammation and infertility. Yet, these statements are generalized and may not apply across the board.

While scientific studies haven’t established a definitive link between gluten and PCOS, I’m not dismissing the potential impact of gluten in certain individual cases. Going gluten-free may have benefits for PCOS for some.

I am a Registered Dietitian in Halifax. Let’s chat honestly about the pros and cons of a gluten-free diet for PCOS.

What is gluten?

Gluten is a protein found naturally in grains such as wheat, rye and barley. Gluten is an important binder, giving breads, doughs, and pastries a stretchy and elastic quality.

Gluten is not inherently bad. Humans have been eating gluten for as long as people have been making bread! For centuries, foods with gluten have been providing people with protein, soluble fiber, and nutrients. Gluten is not bad for healthy people whose gastrointestinal system can tolerate it.

Wheat, rye, and barley are staple grains in many of our diets, meaning that eating gluten-free involves a lot more than just eliminating bread. It also requires careful reading of nutrition labels and ingredient lists.

Common gluten-containing foods include:

  • Wheat-based products such as bread, pasta, couscous, flour, crackers, and baked goods.
  • Barley-based products including beer, malt, malt extract, and malt vinegar.
  • Rye-based products including rye bread and rye-based cereals.
  • Some oats. While oats themselves are gluten-free, they may be contaminated during processing unless specifically labeled as gluten-free.
  • Processed foods including sauces, gravies, soups, and processed meats, which may contain gluten as a thickener or filler.
  • Some condiments like soy sauce, which typically contains wheat unless labeled gluten-free.
  • Processed snacks like certain types of chips, pretzels, and snack mixes
gluten-free for PCOS

Celiac disease vs. gluten sensitivity

Celiac disease is an autoimmune disorder characterized by an immune response to gluten that damages the small intestine. Approximately 1% of the population has celiac disease and it runs in families.

Symptoms of celiac disease include bloating, gas, constipation, cramping, diarrhea, and fatigue. Currently, the only treatment for celiac disease is to strictly follow a gluten free diet. Untreated celiac disease can lead to long-term complications and early mortality.

Celiac disease can be contrasted to gluten sensitivity. Whereas celiac disease is an autoimmune condition, gluten sensitivity involves adverse reactions to gluten without autoimmune involvement or intestinal damage. Symptoms may be quite similar with gas, bloating, brain fog, and diarrhea. Gluten sensitivity is more common than celiac disease.

Both conditions require avoiding gluten-containing foods, but celiac disease necessitates strict adherence to a gluten-free diet to prevent complications.

Gluten and PCOS

You may have been reading that eating a gluten-free diet is beneficial for PCOS management, helping with weight loss, inflammation, hormone balance, period regularity, fatigue, and more. 

However, the latest international guidelines for the management of PCOS recommend that, “… women [with PCOS] should consider that there is no evidence to support any one type of diet composition over another for anthropometric, metabolic, hormonal, reproductive or psychological outcomes.”

So, in other words, it is not necessary to follow a gluten-free diet for PCOS.

Is PCOS associated with celiac disease?

It is possible to have both conditions co-occurring by coincidence, but a 2002 study from the International Journal of Gynecology & Obstetrics concluded that PCOS and celiac disease are not associated.

Is PCOS associated with gluten sensitivity?

Current research on PCOS and gluten sensitivity is highly limited, and not robust enough to make any definitive claims. Currently, there is no evidence that PCOS is affected by gluten consumption.

However, women who claim they have benefitted from going gluten-free for PCOS often see improvement in their symptoms indirectly due to reduced carbohydrate intake and improved insulin sensitivity. This makes sense, because reducing simple carb intake (such as from white breads, pastries, and baked goods) can improve insulin resistance.

Will a gluten-free diet help me lose weight?

There is currently no data indicating that a gluten-free diet can result in weight change.

Again, women who claim they have benefitted from going gluten-free for PCOS often see weight loss due to increased selection of whole foods rather than processed foods. A gluten-free diet alone is not the sole reason for weight loss.

Does gluten cause inflammation in PCOS?

Women with PCOS have higher markers of inflammation than women without PCOS. It has been suggested that the consumption of gluten may contribute to acute inflammation in some people.

Reducing gluten consumption or avoiding it could potentially lessen inflammation in women with PCOS. However, it’s also likely that eating a wide variety of nutritious foods could balance out the effects of occasional “inflammatory” foods such as gluten.

In general, more research is needed before recommending gluten-free diets to all women with PCOS.

gluten-free for PCOS

Risks of a gluten-free diet for PCOS

Research proposes that rather than restricting carbs and going 100% gluten-free, the quality of carbohydrates in the diet is more important in PCOS.

To improve their taste and texture, gluten free foods are often high in added fats, sugars, and salt. Gluten-free food swaps also often lack important nutrients, including fiber.

Diets containing carbohydrate foods which are high in fiber with a lower glycemic index, including wholegrains, beans, legumes, and fruit, appear to reduce cardiovascular risk factors and are associated with weight loss. The Mediterranean diet (which includes plenty of fiber rich foods) is most associated with improved metabolic health and inflammation in PCOS.

Gluten-free benefits for PCOS

Despite the lack of evidence supporting the gluten-free diet in PCOS, there are still some potential benefits of going gluten free for PCOS:

  1. It may (emphasis on ‘may’) help reduce the levels of inflammation in the body which can in turn improve PCOS symptoms.
  2. A gluten-free diet can help you increase the amounts of whole foods you eat.
  3. A gluten free diet for PCOS can make you more aware of eating healthy and reading the labels carefully before choosing foods.

Tips for going gluten-free

We have discussed that you do not need to go 100% gluten free for PCOS, unless you have celiac disease or a diagnosed gluten sensitivity.

If you do decide to incorporate some gluten-free foods in your diet, here are some tips to do so safely:

  1. Get assessed for celiac disease before starting a gluten free diet.
  2. Look for the term ‘gluten free’ on food packages and check the ingredient lists for obvious sources of gluten such as wheat, rye, barley, malt, or brewer’s yeast.
  3. Include healthy gluten-free foods in your diet. Fruits, vegetables, meat, eggs, dairy, beans, nuts, and legumes are all naturally gluten free. Quinoa, rice, buckwheat, flax, millet, soy are also naturally gluten-free.
  4. Although there are many gluten free options in the market these days, stick to minimally processed food items as much as you can. Gluten free swaps for pasta, bread and baked goods are often expensive and high in additives like sugars and fats. They are also lower in fiber. The best gluten free bread for PCOS is bread with more than 15% daily value of fiber, and less than 10% daily value of fat and sodium per serving.
  5. Don’t forget about your medications. Many prescription and over-the-counter medications may use wheat gluten as a binding agent. Talk to your doctor or pharmacist about the drugs you’re taking. Dietary supplements that contain wheat gluten must have this stated on the label.
  6. Because many gluten-free alternatives are low in fiber, make an effort to eat fruits, vegetables, beans, quinoa, and brown rice to ensure you are reaching your daily requirements for fiber.

Conclusion

You don’t need to switch to gluten-free foods to experience improvements in your PCOS symptoms. However, if you’re considering trying a gluten-free diet, it’s important to make that decision on an individual basis and under the guidance of a Registered Dietitian.

A gluten free PCOS diet may be advantageous for reducing overall carbohydrate intake and could be particularly helpful for those with gluten sensitivity. Carbohydrates are a vital component of your diet and incorporating low glycemic index carbohydrates can help regulate your blood glucose levels.

However, people with PCOS (and those following a gluten-free diet) might not be eating enough fiber. Many studies have shown that fiber can help reduce inflammation, improve insulin resistance, and reduce the likelihood of developing type 2 diabetes in PCOS.

Instead of eliminating an entire food group and spending money on expensive gluten free alternatives, focus on maintaining a healthy, well-rounded whole-foods diet alongside regular exercise that you can sustain over the long term.

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