Do you need to go gluten free for PCOS?

Despite the popularly of gluten free diets, there is no evidence that it has any impact on PCOS. Gluten is a protein found in some grains, such as wheat and rye.
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Part of the theorised link between PCOS and gluten is based on the fact that people with PCOS can have raised levels of inflammation than those without. If someone had an intolerance to gluten, theoretically avoiding it could reduce the levels of inflammation in the body. However, more research is needed to see if this has any impact on PCOS. Much like dairy and PCOS, there is a limited published research investigating the link between the two.
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If you have coeliac disease, then it is essential that you completely eliminate gluten, as even trace amounts can trigger a reaction. Coeliac disease is more than an intolerance, it is a serious auto-immune condition. If you don’t have coeliac disease or non-coeliac gluten sensitivity, then there is no need to avoid gluten. In fact, going gluten free could mean missing out on nutrients such as certain B vitamins. Moreover, some gluten free products can contain added ingredients like sugar that you might be minimising.

How going gluten free might alter symptoms

As gluten is found in found in many foods, removing it can significantly change your eating habits, resulting in a change of symptoms. For example, if you go to a cafe and there are no gluten free cake options, you might choose to just have a drink or instead have an alternative food that might be lower in sugar, or calories. Over time, decisions like this may lead to a reduction in weight or support blood glucose levels. Alternatively, if you started to swap white gluten containing carbohydrates for wholegrains you would likely be choosing lower GI carbohydrates. Lower GI (glycemic index) carbohydrates have less of an impact on blood glucose levels, which over time can reduce PCOS symptoms if linked to insulin resistance. The fact that these wholegrains are low GI is unrelated to the fact that they are also gluten free.

Gluten intolerance and sensitivities

If you do have a non-coeliac form of intolerance to gluten, irritable bowel syndrome (IBS) or another issue with your gut health, gluten may play a role in PCOS symptoms. We don’t currently have sufficient research on this, but the hypothesis is that in these situations, gluten is not properly digested in the gut and my drive inflammation, and therefore can worsen PCOS. This is as PCOS is sometimes considered to be a state of inflammation. 

Recognising triggers can be easier said than done, especially if you have IBS. Non-gluten wheat sensitivity was seen in over a third of patients with IBS in one study (1). Other foods can trigger symptoms, or make your body more sensitive to foods you could previously consume. For example, certain FODMAP foods may cause symptoms similar to gluten intolerance. A FODMAP specialist will work with you to identify triggers and, where possible, look at plans to reintroduce these foods in the future.

Understanding symptoms

Experiencing symptoms like bloating after gluten-containing products can be down to a few reasons other than just an intolerance. Eating on the go, when stressed, or in a rush means that you might not chew your food enough and swallow air. This can lead to bloating. Feeling slightly sleepy after eating may be due to the size of your meal, or reaching a natural dip in your energy based on your circadian rhythm. You may even be experiencing the “nocebo” effect. Essentially, if you get told enough that you will get symptoms after eating food, you might actually start to. This occurs in a similar way to how the placebo effect works.
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To rule out these, consider taking a food and symptom diary and speaking to your GP or registered nutritionist or dietitian.

What about intolerance tests?

Remember that food intolerance tests (and allergy tests for that matter) are rarely accurate. In particular, methods like kinesiology, hair testing and at-home kits can be misleading. There is no evidenced based intolerance test. To identify food intolerances, use a food and symptom diary, potentially followed by an elimination diet for 2-6 weeks to see if symptoms reappear when you reintroduce the food. If you suspect you have coeliac disease, speak to your doctor.

The bottom line

Going gluten free can mean missing out on nutrients. Many gluten-containing products are fortified with vitamins and minerals we don’t tend to consume enough of. Moreover, gluten free products can often cost more and contain things like added sugars, which  might not be the best choice for your PCOS. If you think gluten is a trigger, keep a food, mood and symptom diary and speak to a nutrition professional if you can.

References

1. Carroccio et al., 2012. doi: 10.1038/ajg.2012.236