Is Gut Health Connected to PCOS?
Intro
Many people come to see me for integrative & holistic acne treatment, and many times, people express that they’re concerned that their acne is due to PCOS and other hormone imbalances. I always explain to people that when looking at acne holistically, that really means two things: 1) understanding and addressing what is going on at the skin level, AND 2) understanding and addressing the underlying factors affecting skin health from within. So, when people come to see me, we investigate if PCOS is the cause of their acne OR if it’s due to something else!
PCOS stands for polycystic ovarian syndrome, and it is a metabolic-hormone disruption that affects 15-20% of females. When we say that PCOS is a metabolic-hormone disruption, it means that issues with metabolism have been connected to the symptoms of PCOS.
Hormone imbalance symptoms that those with PCOS can experience are cystic acne, head hair loss, facial hair growth, both hair growth, irregular or absent menstrual periods, infertility, and more. And, metabolic issues that those with PCOS can experience are blood sugar issues, high blood pressure, cholesterol issues, excess weight, and more. (If you want to learn more about PCOS diagnosis, click here.)
The gut microbiome is the collection of all of the microbes (bacteria and more) in the gastrointestinal tract (mouth, stomach, intestines, etc.). And, there is research that shows that what we eat affects overall health and wellness partly by changing the populations of our gut microbiome.
So, could gut health be connected to PCOS?
That’s what we are going to talk about in this blog post!
We are going to focus on how the diet is connected to PCOS, and how changes in the gut microbiome from diet could be connected to PCOS.
Diet and PCOS
PCOS and diet are connected because of blood sugar and insulin. Before we go into HOW diet leads to symptoms of PCOS, let’s first talk about how blood sugar issues happen.
Insulin is a pancreatic hormone responsible for keeping blood sugar levels balanced. When we consume carbohydrates (sugar), our blood sugar levels increase. To help bring down blood sugar and transport sugar into our cells, the pancreas pumps out insulin. And, the more someone consumes foods that raise blood sugar, the more the pancreas will send out insulin. But, there is a point when cells start to become less sensitive to insulin as the pancreas keeps on pumping out insulin.
When cells become less sensitive to insulin, that means that cells will absorb less sugar and leave more sugar in the blood stream. Once this happens, this is called insulin resistance. And, if blood sugar becomes high enough, someone could become pre-diabetic or diabetic.
TL;DR: So, in so many words, diets that continuously cause high levels of blood sugar can cause insulin resistance.
Now, how is all of these connected to PCOS?
Research shows that insulin can activate the ovaries to make testosterone. Now why is testosterone important? Testosterone is the main hormone responsible for PCOS hormone imbalance symptoms, such as cystic acne, head hair loss, facial hair growth, body hair growth, and more!
So, it could be suggested that diets that cause insulin resistance may play a role in the development of PCOS! Now, is there a connection between diets that cause insulin resistance, the gut microbiome, and PCOS? Keep on reading to learn more!
Diet, gut microbiome, and PCOS
We know that following diets can shift gut microbiome populations. And, as mentioned earlier, we know that diets that cause metabolic issues (like insulin resistance) could lead to symptoms of PCOS. So, is there science showing that there is a connection between the gut miciribome and metabolic issues? Yes! Science shows that gut microbiome changes from diet have been associated with obesity and other metabolic issues in human and animal subjects.
Now, is there an actual connection between the gut microbiome and PCOS?
When looking at PCOS and the gut microbiome, research shows that low gut microbial diversity has been related to high-testosterone symptoms in females with PCOS. Additionally, there was a study completed in 2019 that showed the effect of gut bacteria in animal subjects with PCOS.
This 2019 study first looked at the populations of gut bacteria in healthy animal subjects and subjects with PCOS, then transplanted the gut microbiome from those with PCOS into healthy subjects. Researchers first found that there were significant differences between PCOS and healthy gut microbiomes. And, when the PCOS gut microbiome was transplanted into healthy subjects, healthy subjects started to exhibit signs and symptoms of PCOS, such as higher levels of testosterone, ovarian cyst-like follicles, and changes to fertility!
So, the gut microbiome could be playing a larger role in the development of PCOS than what we think!
But, these studies don’t really give us the full picture of what is taking place between the diet, the gut microbiome, and the development of PCOS symptoms. We just know that changes to the gut microbiome have been connected to the development of those symptoms.
So, what’s happening between diet, the gut microbiome, and PCOS?
Given what science has found so far, researchers have come up with some hypotheses to explain what is happening!
Bacteria byproducts and PCOS:
Postbiotics are gut bacteria byproducts that exert effects on gut health and more. And, postbiotics have been hypothesized to play a role in metabolic issues that have been shown to play a role in PCOS. (Click here to learn about postbiotics and skin health)
Scientists think that gut bacteria (specifically Prevotella species) affect blood sugar by producing high levels of a postbiotic called branched-chain amino acids. This is because research shows that high levels of these branched-chain amino acids have been linked to the development of Type 2 Diabetes.
Bacteria-caused inflammation and PCOS:
Some types of bacteria have cell wall components (called endotoxins for lipopolysaccharides) that have been shown to increase inflammation. Researchers hypothesize that inflammation from endotoxins may lead to PCOS by causing insulin resistance. This is because science shows that when endotoxins were continuously injected into animal models for 4 weeks, it led to obesity and insulin resistance.
Leaky gut and PCOS:
Intestinal permeability (aka “leaky gut”) has also been hypothesized by scientists to play a role in the development of PCOS. Research shows that that a high-sugar, high-fat diet with low dietary fiber may cause gut microbiome shifts that lead to inflammation, then leading to blood sugar dysfunction and obesity. And because of this finding of blood sugar dysfunction, researchers hypothesize that intestinal permeability from gut microbiome changes caused by diet may lead to the development of PCOS.
Summary & Takeaways
So, is gut health connected to PCOS?
Yes, gut health is connected to PCOS, and diet and the gut microbiome could be playing contributing roles.
We can say that there is a connection because of the studies that we spoke about earlier that show that changes in the gut microbiome have been seen in those with PCOS compared to healthy subjects; and that when the gut microbiome from those with PCOS were transplanted into healthy subjects, healthy subjects started to experience PCOS-like signs and symptoms.
Now, these are just connections and associations! And from a scientific standpoint, we know that association does not mean causation! So, researchers have come up with some hypotheses to explain why the gut microbiome could be playing a role in PCOS.
Hypotheses that scientists have come up with to explain what’s happening include:
High-sugar, high-fat diets causing gut microbiome changes that lead to “leaky gut” and inflammation, then leading to blood sugar dysregulation and metabolic issues.
Postbiotics (such as branched-chain amino acids and endotoxins) from gut bacteria may cause blood sugar dysregulation and insulin resistance.
Hopefully more studies come out in the future to help us better-understand about how the gut microbiome could be playing an intermediary role in the development of PCOS. And from advances in research in the gut microbiome, this may hopefully pave the way for more-holistic and better-informed treatment options for those with PCOS.
So, what can we do right now?
We know that diet and nutrition play large roles in the development of blood sugar issues - a known cause of some of the symptoms of PCOS.
When looking at the breadth of scientific literature on diet and PCOS, you will find that there are lots of studies looking at different diets and how effective they can be at changing PCOS symptom severity and changing PCOS lab markers. (Click here to read more about PCOS and diet)
It can be very daunting and overwhelming when navigating nutrition and diet on your own, especially when someone has PCOS! And most providers would just recommend that they patient do any diet as long as it led to weight loss (since there is science that says just that). HOWEVER, there are many factors to consider when starting a therapeutic diet for PCOS, such as someone’s personal food preferences, what their schedule looks like, what the barriers to doing one diet over another are, what their relationship with food looks like, and much more!
This is when working with a licensed naturopathic provider would be worthwhile!
Why working with a licensed naturopathic provider is helpful:
Licensed naturopathic doctors are experts in holistic and integrative medicine. So, that means licensed naturopathic doctors (like myself) will look at what happening with hormones in PCOS and look for underlying causes affecting your hormones. And, licensed naturopathic doctors are trained to provide truly-integrative medical care with pharmaceutical and natural options.
So, licensed naturopathic doctors can treat symptoms directly by addressing hormones directly AND treat the specific and unique underlying causes affecting hormones with personalized treatment plans that combine natural and/or pharmaceutical options. And due to the complexity of PCOS, those with PCOS may find working with a licensed naturopathic doctors more-meaningful and more-worthwhile.
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