Gut Health & PCOS – What’s the Link? 

Why is Gut health important for managing PolyCystic Ovary Syndrome (PCOS)? Emerging research is now showing a link between gut health and the development of PCOS. 

Dietary management of PCOS is considered first line therapy according to the recent guidelines published in 2018 (PCOS_Evidence-Based-Guidelines_20181009.pdf (monash.edu).   

Furthermore, new findings support the role of diet as a strategy to create a positive change in the gut microbiome, which is compromised in women with PCOS compared to women without it. Diet & treatment of PCOS.pdf. This imbalance of gut microbiome impacts hormone production, ovulation, and the maturation of an ovum and is linked to chronic inflammation and lowered immunity.  This new research highlights the importance of working with a fertility dietitian focusing on specific dietary strategies to improve PCOS for the long term.  

But first what is the Gut Microbiome?  

The gut microbiome is a collection of diverse and complex microorganisms living mainly in the large intestine.  Factors that influence the microbiome are diet, lifestyle and genetics. As a result the state of our gut health and the balance of these microorganisms impact metabolic, digestive and reproductive function.  Research has highlighted three main reasons why women with PCOS have a reduced gut microbiome and reduced microbiome diversity.  

1.Diet and body weight  

Obesity and a high fat-low fibre diet has been shown to favor the growth of bad bacteria that activates the immune system, causing a change in insulin metabolism that will increase the production of the male hormones (androgens), which stop an egg fully maturing. When insulin function is compromised this is known as insulin resistance. Insulin resistance is experienced by up to 70% of women with PCOS, amongst both those who are lean or overweight. However a high body fat percentage can also exacerbate PCOS symptoms. 

Tip: Did you know that reducing body fat percentage by just 5-10% can have a significant impact on hormone function and PCOS symptoms?  

 As a fertility dietitian specializing in PCOS it is important to highlight that even though optimizing your body weight is important, so is the method in which this is being achieved. This is because rapid weight loss can impact egg quality and ovulation. A fertility dietitian can ensure that your diet will meet your requirements for key fertility nutrients and also include types of fibre to reduce the growth of bad bacteria. As a result reducing androgens, and improving ovulation, insulin resistance and inflammation.  

2. Androgens  

High androgens not only impact the ovaries but also the gut composition. It is believed that high androgens inhibit the enzymes in the gut that are used for energy production. Women who have PCOS commonly experience fatigue and low energy, which can potentially be as a result of high androgens, insulin resistance, inflammation and a diet not suited to optimise their hormones and microbiome.  

Signs of high androgens include:  

  • Excess hair growth especially on the face,  
  • Hair loss 
  • Acne 
  • Irregular periods and ovulatory infertility 

Tip: As a fertility dietitian I recommend aiming for at least 30g of dietary fibre a day!  

Nutrition tips to increase fibre! Try these easy swaps!   

  • Swap white bread for a wholemeal  seeded bread  
  • Switch  one animal protein source for a plant based protein such as legumes, chickpeas or tofu more often 
  • Up your vegetables per day! Aim for at least 5 serves of veggies a day.  
  • Add seeds such as sunflower and flax seeds to smoothies and yoghurt  

3. The brain-gut axis altered  

Furthermore the gut and the brain have their own communication line which allows them to work together to release hormones and peptides that regulate appetite, energy and body weight. When a woman has a dysfunctional gut microbiota this causes a change in the release of these peptides, also causing inflammation and insulin resistance, and may lead to the development of PCOS. Often this presents with symptoms such as intense sugar cravings, feeling hungry all the time, fatigue and difficulty losing weight.  

Tip: Don’t cut out major food groups! By doing so you may be compromising your gut health! 

A Nutrition Assessment with a fertility dietitian will determine a plan for you that will teach you:  

  • How much carbohydrate you actually need 
  • What foods you need to include to improve gut diversity  
  • How to eat to manage blood sugar levels  

A tailored plan will help to drive down the root causes of your PCOS and significantly reduce:   

  • Intense hunger cravings 
  • Unexplained weight gain 
  • Improve weight loss  
  • Boost energy levels 
  • Restore hormones 
  • Improve insulin resistance and reduce inflammation  
  • Improve menstrual cycle and ovulation 

Practical tip: To help reduce inflammation try including fatty fish like salmon at least twice a week  

What’s next?  

Enquire about my 12 Week –Get Pregnant with PCOS program designed to tailor diet and supplementation to your unique needs to help shorten your time to pregnancy!  

Get Pregnant with PCOS – 12 Week Program – Lora Attia (dietitianformums.com.au)