If you’ve spent any time reading or listening to the media, you have probably heard a lot about gluten-free diets. Going “gluten free” continues to be a popular and trendy diet practice that is heavily marketed in our country, and it can be easy to be convinced that going gluten-free is the solution to nearly any health ailment, including PCOS. 

Yet most women with PCOS don’t really know if they should or need to be gluten free in the first place, especially since there is a lot of conflicting information out there. 

To help clear things up, I’ll be diving into what exactly gluten is, how it relates to PCOS, and what to do if you suspect it's something you need to cut out of your diet.

What is gluten?

Gluten is a type of protein. It is found in the grains of wheat, barley, and rye. Gluten is what gives these grains structure, flexibility, and holds them together. It serves as a thickening agent and adds texture. 

Some of the most common food sources of gluten include:

• Most breads and pastas

• Traditional doughs, pastries, and crusts

• Many snack and dessert foods like crackers, pretzels, and cookies

• Flour tortillas

• Anything made using barley or rye

Gluten is also added to many foods, such as processed meats, beer, vinegars, soy sauce, many sauces and gravies, and more. 

Wheat Allergy Versus Gluten Sensitivity

Allergies and food sensitivities are two of the main indications for removing something from your diet. Since they are often mistaken for each other, it's important to understand the difference between the two. 

Allergies involve an immune reaction to food, during which your immune system responds to what it thinks is a foreign substance that must be removed from the body. It therefore produces antibodies known as Immunoglobulin E (IgE), which causes a variety of symptoms almost immediately after ingesting. Symptoms can range from mild to severe, and may include: 

• Swelling

• Itching

• Hives

• Difficulty breathing, and more

The most common allergen foods are peanuts, tree nuts, wheat, eggs, soy, milk, fish, and shellfish. About 11% of American adults and 8% of American children have some sort of food allergy. You may be surprised to hear that there is actually no such thing as a gluten allergy, but since wheat is a major source of gluten, the two are often confused. 

Celiac disease is an autoimmune disease (which is different than a traditional food allergy described above) in which a person’s immune system mistakenly attacks the lining of the small intestine after eating gluten-containing foods. 

Food sensitivities, on the other hand, are another type of adverse food reaction that are a bit more complicated. They are also more common than allergies, affecting an estimated 15-20% of U.S adults. These sensitivities can cause reactions that are delayed by hours or even days after eating a food. Symptoms are typically less severe than allergies, and may include: 

• Headaches

• Joint pain

• Changes in bowel habits 

• Gas and bloating

• Fatigue 

• Difficulty concentrating (“brain fog”)

Food sensitivities can occur in any food, but gluten is one of the most common sensitivities. Food sensitivities can develop at any age and are most often caused by an imbalance in gut bacteria or increased intestinal permeability. When the ecosystem in the gut is disrupted or there is a breakdown in the lining of the gut, food sensitivities can develop. You can read more about the gut microbiome in this article. Thankfully, most food sensitivities can be reversed by addressing gut dysfunction.

Gluten and PCOS: yay or nay? 

There are no studies specifically evaluating the link between gluten and PCOS. That means there is no data to support the idea that all women with PCOS need to avoid gluten. 

However, there are many women that may feel better with removing gluten from their diet. 

There are a couple of reasons for this:

• Less processed foods. For some women, eating a gluten-free diet may lead them to eating less processed foods (many of which contain gluten). Less processed foods means less nutrient-depleted foods and less preservatives and artificial ingredients going into your body, which can help you feel better. 

• Gut health and food sensitivities. Many women with PCOS have been found to have dysbiosis (which is an imbalance in the amount of good to harmful bacteria in the gut), less diverse gut bacteria, and increased intestinal permeability when compared to women without PCOS. These common gut imbalances can increase the risk of developing a sensitivity to gluten. So, if gut imbalances are contributing to your PCOS, your body may be sensitive to gluten, and eliminating it would likely lead to symptom relief. But remember -- the goal is not to just eliminate foods and we need to address the underlying dynamic in the gut creating these sensitivities. You can read more about PCOS and gut health in this article. 

What to do if you suspect gluten may be problematic

It is estimated that gluten sensitivity occurs in about 13% of the general population, and is more common in women. If you believe there may be a connection between gluten and your symptoms, here are some tips to follow:

• Be sure you are working on the basics of proper meal timing first to be sure your body is properly fed, since erratic eating may disrupt digestion and increase inflammation which can mimic symptoms of gluten sensitivity. You can read more about when to eat when you have PCOS here.

• Monitor your symptoms and keep a detailed food journal for a couple of weeks.

• If you experience symptoms like headaches, migraines, joint pain, skin issues, irritable bowel syndrome, fatigue, and inflammation -- you may want to consider eliminating gluten from your diet. However, always check with your healthcare provider first.

• If you eliminate gluten, do so for at least 2 months before reintroducing.

• Be cautious not to compensate with manufactured gluten-free products, since these are typically ultra-processed and nutrient-poor. 

• Focus on eating whole foods that are naturally gluten-free, and on supporting your gut health. Consider exploring gut health testing with your provider and getting support with the elimination to ensure you’re meeting all of your nutritional needs.

Summary

There is no “one-size-fits-all” recommendation when it comes to gluten and PCOS. Rather, this is something that needs to be assessed on an individual basis. 

If you believe gluten may be problematic for you (sensitivity), I suggest temporarily eliminating it and working with a trained functional medicine provider to work on addressing the underlying gut imbalances that may be creating the sensitivity.

And if you’re ready to do a deep dive into exactly how to eat to support your PCOS, you can check out our PCOS Root Reversal Program.