Tops Tips to Improve your Gut Health for PCOS

For women who suffer from Polycystic Ovary Syndrome (PCOS), if can be overwhelming and frustrating trying to find the right treatment for their PCOS symptoms. Many women may also find themselves focusing on restricting foods in hopes of managing their weight, but struggling to do so, leaving them increasingly frustrated. However, PCOS is a complex disease, and the management of it can certainly be complex too as there is not one “best” diet. What if we told you that by focusing on what you can add to your diet, rather than restrict, may help you manage your PCOS symptoms?

What is PCOS?

PCOS is a hormonal endocrine disease and is estimated to affect 1 in 10 of women of reproductive age [1]. Commonly, women with PCOS have high levels of androgens, insulin resistance, and chronic inflammation but not all women with PCOS do [2]. Common symptoms of PCOS include:

• irregular or infrequent menstrual cycle
• weight gain
• acne
• poor mental health
• sleep apnoea
• fertility issues
• excessive facial or body hair
• hair loss
• lack of ovulation

PCOS and the Gut Microbiota

While the exact cause of PCOS is unknown, there is growing research that gut health may play a key role in the development, progression, and symptoms of PCOS [1]. There is growing research that women with PCOS experience an imbalance of good and bad gut bacteria, reduced gut bug diversity, and a damaged intestinal barrier compared to woman without PCOS [3]. These changes in the gut microbiota can impact gut function, and may place a role in insulin resistance, reduced immunity, high levels of androgens, and chronic inflammation commonly experienced by women with PCOS.

Given that the gut microbiota plays a central role in PCOS, eating to support your gut health may help to restore the composition of microbiota and manage symptoms!

Improving your Gut Health for PCOS

• Increase your fibre intake.

Fibre works wonders for our gut health! It can also help reduce chronic inflammation, reduce body weight, and improve insulin resistance.  In fact, Insulin resistance is one of the most frequent features of PCOS, affecting approximately 70% of PCOS patients [4], and studies have shown increasing dietary fibre can improve insulin sensitivity [5]. Fibre-rich foods can also help keep you fuller for longer and can be an effective strategy for managing your weight with PCOS. It’s recommended to aim for 25g-30g of fibre per day.

Tips to increase fibre:

• Choose grainy and seeded breads instead of white refined breads. Look for labels that say, “very high in whole grains” or “very high in fibre.”
• Up your servings of vegetables. Aim to reach your daily 5 serves of vegetables. 1 serve of veg is equal to ½ a cup of cooked veg or 1 cup of raw veg.
• Switch up your protein sources by choosing plant-based protein more often such as lentils, beans, or tofu. A great way to do so is giving Meatless Mondays a go – you may just find your new favourite recipe.
• Up your plant diversity

One of the best ways to increase your gut microbe diversity is by consuming a wide range of plant foods to nourish all the different kinds of microbes in your gut. Research has shown that individuals who consume more than 30 different types of plants a week have more diverse gut microbiotas [6]. Plants also contain beneficial compounds called polyphenols, and increasing your intake of polyphenols may help reduce oxidative stress and inflammation and improve insulin resistance [7].

To increase plant diversity:

• Choose mixes of beans, mixes of leafy greens, and mixes of frozen fruit to easily add more diversity.
• Spices count too. Try cooking with a variety of spices. Not only will this increase your intake of plants, but it will add plenty of flavour to your food and reduce the need for salt.
• Try a new type of whole grain – there’s plenty available. If you’re someone who typically sticks to the same ones, why not try branching out and experimenting with buckwheat, millet, sorghum, or quinoa to switch things up.
• Increase your intake of inulin

Inulin is a type of prebiotic that feeds the good bacteria in your gut. Our gut microbes convert inulin into short chain fatty acids, like butyrate, which bring about health benefits. Studies have found that inulin can significantly improve PCOS symptoms by increasing beneficial bacteria and decreasing harmful bacteria in the gut and decreasing inflammation [8, 9]. Inulin may help to improve digestive health, improve bowels, and promote weight loss.  Inulin can be found in some fibre supplements, and it can also be found naturally in foods including:

• Jerusalem artichoke
• Chicory root
• Garlic
• Raw asparagus
• Raw onion
• Barley
• Wheat

The Bottom Line

Growing research supports the central role of gut health in the progression and management of PCOS. Including gut-healthy foods such as high-fibre foods, having a diverse intake of plants, and increasing intake of inulin may be beneficial in managing PCOS. However, dietary strategies should be individualised to fit in with your lifestyles, needs, and personal circumstances and working with an Accredited Practising Dietitian can help you find the type of dietary pattern that’s best for you.

References

 [1] Escobar-Morreale, H. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol 14, 270–284 (2018). https://doi.org/10.1038/nrendo.2018.24

[2] Sun Y, Gao S, Ye C, Zhao W. Gut microbiota dysbiosis in polycystic ovary syndrome: Mechanisms of progression and clinical applications. Front Cell Infect Microbiol. 2023 Feb 24;13:1142041. doi: 10.3389/fcimb.2023.1142041. PMID: 36909735; PMCID: PMC9998696.

[3] Duan L, An X, Zhang Y, Jin D, Zhao S, Zhou R, Duan Y, Zhang Y, Liu X, Lian F. Gut microbiota as the critical correlation of polycystic ovary syndrome and type 2 diabetes mellitus. Biomed Pharmacother. 2021 Oct;142:112094. doi: 10.1016/j.biopha.2021.112094. Epub 2021 Aug 26. PMID: 34449321.

[4] Petrillo T, Semprini E, Tomatis V, Arnesano M, Ambrosetti F, Battipaglia C, Sponzilli A, Ricciardiello F, Genazzani AR, Genazzani AD. Putative Complementary Compounds to Counteract Insulin-Resistance in PCOS Patients. Biomedicines. 2022 Aug 9;10(8):1924. doi: 10.3390/biomedicines10081924. PMID: 36009471; PMCID: PMC9406066.

[5] Mayorga-Ramos A, Barba-Ostria C, Simancas-Racines D, Guamán LP. Protective role of butyrate in obesity and diabetes: New insights. Front Nutr. 2022 Nov 24;9:1067647. doi: 10.3389/fnut.2022.1067647. PMID: 36505262; PMCID: PMC9730524.

[6] McDonald D, Hyde E, Debelius JW, Morton JT, Gonzalez A, et al. American Gut: an Open Platform for Citizen Science Microbiome Research. MSystems 2018. https://doi.org/10.1128/msystems.00031-18.

[7] Ulug E, Pinar AA. A New Approach to Polycystic Ovary Syndrome and Related Cardio-metabolic Risk Factors: Dietary Polyphenols. Curr Nutr Rep. 2023 Sep;12(3):508-526. doi: 10.1007/s13668-023-00488-7. Epub 2023 Aug 2. PMID: 37530952.

[8] Xue J, Li X, Liu P, Li K, Sha L, Yang X, Zhu L, Wang Z, Dong Y, Zhang L, Lei H, Zhang X, Dong X, Wang H. Inulin and metformin ameliorate polycystic ovary syndrome via anti-inflammation and modulating gut microbiota in mice. Endocr J. 2019 Oct 28;66(10):859-870. doi: 10.1507/endocrj.EJ18-0567. Epub 2019 Jul 3. PMID: 31270279.

[9] Li T, Zhang Y, Song J, Chen L, Du M, Mao X. Yogurt Enriched with Inulin Ameliorated Reproductive Functions and Regulated Gut Microbiota in Dehydroepiandrosterone-Induced Polycystic Ovary Syndrome Mice. Nutrients. 2022 Jan 10;14(2):279. doi: 10.3390/nu14020279. PMID: 35057459; PMCID: PMC8781812.