This is Francesca from The PCOS Newsletter. How was your week?
This is the first of a Nutrition Series I have prepared, which will look at the best diet for PCOS, dairy, fibre and many others. We are kicking it off with Gluten and PCOS 🌾.
This week’s question
Should I go gluten-free for my PCOS? 🌾
In this newsletter, you will learn about the following:
There is no evidence to suggest gluten-free is better for PCOS
There are three types of issues gluten can cause: Celiac disease, Wheat Allergy, Non-Celiac Gluten Sensitivity
Gluten doesn’t cause inflammation in the lack of the three issues above
If you are lucky and don’t need to avoid gluten, enjoy pizza 🍕
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The world of PCOS nutrition advice seems vast and, frankly, confusing. One of the main recommendations is to avoid gluten to decrease inflammation. In my three years of training as a nutritionist, gluten has been the topic of many debates. Let’s break it down and see if avoiding gluten is necessary.
Every good research project starts with studies. Naturally, the first step is to understand the available research. When you type "PCOS and gluten" into PubMed (the largest research database), you get this:
Zero results examine the effect of a gluten-free diet on PCOS symptoms. To keep it short, there is no reason to go gluten-free if you have PCOS.
However, this doesn’t deny the fact that some people have seen benefits from going gluten-free. Let’s see why that might be.
Who has trouble with gluten?
Gluten has made headlines over the past 10 years (what a rockstar 🎸). Gluten is a protein found in many grains, including wheat, barley, and rye. It's common in foods such as bread, pasta, pizza, and cereal. It can cause problems for:
Those with celiac disease
This little protein causes many issues for 1% of the population. People with celiac disease can’t digest gluten, and their immune system attacks it as a foreign body, creating inflammation and damage to the small intestine. For the unfortunate 1%, a completely gluten-free diet is necessary.
Celiac diase has a robust genetic component, but some emerging research suggests that the microbiome might be involved in people's immune reactions to gluten. This can be diagnosed through a blood test.
Those with a wheat allergy
A reaction to wheat can be completely different from a reaction to gluten. In fact, those with a true allergy to wheat are often not reacting to the gluten but to some other part of the plant. Wheat allergy is characterised by the production of IgE antibodies against wheat proteins and the development of food allergy symptoms (rushes, itching, trouble breathing). This can be diagnosed through a skin allergy test.
Those with Non-Celiac Gluten Sensitivity
This is a more mysterious condition, as there is no clear way to diagnose it. It is characterised by common gastrointestinal symptoms such as bloating, abdominal pain, diarrhoea, nausea, and acid reflux. To fall into this category, you must rule out celiac disease and wheat allergy as possible diagnoses. If you have those symptoms after eating gluten, doing a little experiment and avoiding it for two months could be helpful. The whole PCOS Newsletter is built on the belief that you need to know your body, and if your body is saying no to gluten, you should listen.
How about inflammation in women with PCOS?
First and foremost, no evidence exists that gluten creates inflammation in healthy individuals. If you are lucky and don't fall into any of the three categories mentioned above, you won't get 'inflamed' from gluten.
For women with PCOS, increased levels of inflammation have been noticed in studies. We seem to have higher circulating CRP (C-reactive Protein), an inflammatory marker. These markers seem independent of weight, meaning lean PCOS women still show increased inflammation. The reason for this increase in inflammation is mainly unknown.
The claim that gluten can be causative or conductive of this inflammation is a big leap of judgment. There is no evidence to support this claim, and for now, I would consider it untrue. Research might evolve, but it is essential to distinguish facts from loose links. I feel strongly about this because loose facts lead to the toxic diet culture we are living in now.
Should I go gluten-free for my PCOS?
If you don't fall into any of the categories mentioned above, there is no reason why you should avoid gluten. I eat gluten regularly, and my symptoms are under control. My issue with this advice is the demonisation of certain foods and fear-inducing marketing campaigns. For reference, the gluten-free market has overtaken the fat-free and low-carb markets as food fads, reaching USD 4.3 Billion in 2021 and is projected to reach USD 6.2 Billion by 2030. Please save your money if it is not bothering you. There are plenty of other things to spend money on when you have PCOS (like laser hair removal 👀). In addition, you might have heard from friends that life without gluten is not fun.
In addition to the price tag, gluten-free products are often higher in fat and calories and lower in fibre than their gluten-containing counterparts. We could be doing ourselves a disservice by consuming gluten-free products, as fibre is one of our best friends when it comes to PCOS. We will be discussing fibre next Sunday.
I hope you have enjoyed this newsletter issue.
See you next Sunday,
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
Jones, A. L. (2017). The gluten-free diet: Fad or necessity? Diabetes Spectrum: A Publication of the American Diabetes Association, 30(2), 118–123. https://doi.org/10.2337/ds16-0022
Shewry, P. (2019). What is gluten-why is it special? Frontiers in Nutrition, 6, 101. https://doi.org/10.3389/fnut.2019.00101
Disclaimer: We are all so unique in our own ways, so this information is for educational purposes only. Please further consult your healthcare provider about your health needs.