Medically reviewed by Dr. Stacy Hengisman MD and Felice Ramallo MSRD.
It is well-documented that diet, nutrition, and lifestyle can play a large role in managing PCOS symptoms, reducing inflammation, and even helping to regulate your menstrual cycle. One thing many women who are diagnosed with PCOS wonder about, after researching the topic of PCOS and diet, goes something along the lines of, “do I need to give up gluten or dairy?” This question can feel difficult to answer thanks to dozens of online resources, some of which have conflicting viewpoints. That’s why in this article we’re going to dive into what gluten sensitivity and dairy intolerances entail, signs and symptoms of a gluten or dairy allergy, and whether you need to avoid gluten or dairy as part of a PCOS diet. Let’s begin!
- Gluten intolerance, explained
- Signs you might be gluten intolerant
- The two types of gluten sensitivity
- Steps to diagnosing a gluten sensitivity
- The association between gluten and PCOS
- Dairy and PCOS, explained
- Signs you might be lactose intolerant
- Steps to diagnosing lactose intolerance
- The association between dairy and PCOS
- What to do if you think you may have PCOS and a food intolerance
Gluten intolerance, explained
Before we go into whether gluten exacerbates or has no impact on PCOS, let’s quickly go over what we mean when we talk about gluten intolerance. After reading this section, if you suspect you have a gluten intolerance, it is extremely important you discuss with your healthcare provider your concerns.
What is gluten?
First things first: what is gluten?
According to Johns Hopkins Medicine, gluten is a protein found in the wheat plant, along with some other grains; it comes from rye, barley, and triticale. Sometimes, when you buy oats at the grocery store, it may say “contains gluten” but oats themselves do not contain gluten naturally; it is only through processing with other foods that they might.
Why is gluten a problem for some people?
To understand why some people have gluten intolerance, let’s explore how our bodies process it. We absorb gluten through digestive enzymes that break down a bunch of other foods and proteins (including gluten); protease is the enzyme in question that helps our bodies process proteins, but it does not completely break down gluten.
As such, gluten that isn’t completely digested travels to the small intestine, and for most people this is no problem. For people with gluten sensitivity, though, this undigested gluten can trigger a “severe autoimmune response,” otherwise known as celiac disease. Let’s pause here to note that it does matter whether you have celiac disease or have a sensitivity to gluten, as there is a difference between the types of gluten intolerance.
Celiac disease versus gluten intolerance
Celiac disease is an autoimmune disorder, in which your body attacks your own tissue when you eat gluten. This damages your gut, causes an extreme inflammatory bodily response, and subsequently means you can’t absorb nutrients as effectively. It is also accompanied by a host of extremely unpleasant physical symptoms. For those with celiac disease, the ‘cure’ is to avoid gluten for the rest of their lives.
Signs you may have celiac disease include:
- Chronic diarrhea
- Lactose intolerance (due to damage caused to the small intestine)
- Vomiting or nausea
- Pain the abdomen
For those with a gluten intolerance, they also experience unpleasant physical symptoms, but they don’t have an abnormal gene or antibodies in their blood (like those with celiac disease).
Gluten sensitivity can often come from poor gut health. That is why it is important to build up the gut microbiome and slowly reintroduce good bacteria. This, over time, can allow those with gluten sensitivity to reintroduce gluten into their diet. To begin, though, people with gluten sensitivity may find that physical symptoms are greatly reduced, or even eliminated, by simply reducing their intake of specific grains, as opposed to nixing gluten altogether. From there, they can work on rebuilding good gut flora, improving their digestion, and slowly incorporating gluten back into their diet, particularly through the use of ancient grains (which has been shown to be useful in improving IBS symptoms. Keep in mind, an effort should be placed on incorporating gluten back into the diet if at all possible: it is not recommended one cuts out gluten for the sake of it – there is evidence this can lead to a “nutrient imbalance.”
Signs you may have a gluten intolerance are very similar, with the addition of skin rash, joint pain, and fatigue as added on symptoms.
If you suspect you have a gluten sensitivity
First and foremost, you should reach out to your primary care physician or GI specialist doctor to discuss your symptoms and medical history. If your doctor believes this sounds like a gluten sensitivity, then you can expect the following to happen:
- You will continue consuming gluten for the next 6 weeks. During this time, your physician will perform blood and skin tests to rule out a wheat allergy or celiac disease.
- You may be asked to exclude gluten from your diet for another 6 weeks.
- If your symptoms improve during this time, you may work with your physician to add gluten gradually back into your diet, and if symptoms resume, you may be diagnosed with gluten intolerance.
The association between PCOS and gluten
There is no evidence that gluten worsens PCOS symptoms, unless you have a gluten intolerance.
Since gluten intolerance, or celiac’s disease, automatically triggers an inflammatory response in the body, and PCOS is an inflammatory disease (with women with PCOS having higher markers of inflammation in many academic studies, independent of weight, and often suffering from what researchers call “chronic low-grade inflammation”), there has been concern that gluten may be inherently inflammatory. Fortunately, for individuals who can tolerate gluten (which is the vast majority of the population), gluten should not worsen PCOS symptoms.
Now, the question of whether you consume less gluten found in certain foods (such as cakes and refined bread) as a result of reducing your intake of foods that have a high glycemic index is something different than avoiding gluten altogether.
Higher glycemic foods are not inherently bad: whole wheat breads, whole wheat pastas, and whole wheat cereals, for instance, play an important role in a balanced diet, and they have a higher glycemic index than vegetables, for instance. But it’s important to note that, especially when paired with high fiber, high fat, and high protein foods – such as nuts, seeds, and dairy – foods that contain gluten can be filling, nutritionally dense, and easy to access. Again, as part of a balanced diet, moderating high sugar foods can be a good step toward reducing inflammation. But be careful not to assume because foods containing gluten sometimes have a higher glycemic index that they are not a critical component of a healthy det. Gluten free diets are often lacking in fiber, one of the most powerful, glucose-regulating components of a healthy diet, and there is evidence they can create nutritional imbalances. If you can, work with a registered dietitian to discuss if you suspect you may be sensitive to gluten, how you can benefit from it, and what role it can play in your diet.
Lactose intolerance, explained
Dairy is another food group that has been treated with some suspicion, thanks to one study that found a “direct relationship between milk and PCOS.” This was only after controlling for “confounding factors”, and it is important to note that correlation does not always indicate causation. In fact, another study found that drinking milk was “protective of female fertility,” while one literature review indicated that dairy products seemed to play a “role in the prevention and treatment of carbohydrate balance disturbances.” All in all, research results such as the above would suggest that dairy could be beneficial for women with PCOS (who are at higher risk for insulin resistance and infertility than the average woman without PCOS).
However, if you have a negative bodily reaction after consuming dairy, it is possible that you have lactose intolerance or even a dairy allergy. These can make dealing with PCOS symptoms extra burdensome, so let’s explore what lactose intolerance might look like.
What is lactose intolerance?
Lactose is the sugar found in milk. Those with lactose intolerance do not release enough lactase, the enzyme that breaks down the carbohydrate. They are then not able to fully digest this sugar, and as a result, they face unpleasant physical symptoms. So why are some people able to tolerate lactose? Is it hereditary, or something that you can develop over time?
Lactose intolerance is thought to be the result of too little of the enzyme lactase in your small intestine. Interestingly, you can have low levels of lactase and still enjoy milk products, but it is when your levels are too low that lactose can become intolerable. Even for those with lactose intolerance, most can tolerate the amount of lactose in a serving of dairy at a time. A serving could be 1 cup milk, ¾ cup kefir, ½-¾ cup yogurt, or 1 oz. cheese. Additionally, regularly including dairy can cause your body to increase lactase secretion, reducing intolerance. Lactase secretion can also just change over time without much rhyme or reason.
Signs of lactose intolerance
The following symptoms often show up within 30 minutes to a couple of hours after consuming dairy products such as cheese, milk, yogurt, and so on.
- Nausea or vomiting
- Stomach cramps
Association between dairy and PCOS
As we touched on earlier, evidence does not seem to suggest a causal relationship between dairy and PCOS.
There is conflicting evidence regarding the impact of dairy consumption on insulin resistance, with some studies supporting the notion that dairy exacerbates it, while others presenting evidence that it may even help it. More studies suggest that diary consumption – particularly that of yogurt and fermented dairy products – are helpful in reducing the risk of type 2 diabetes in women with PCOS.
Clearly, results are conflicting, with one literature review published in 2020 in particular concluding that “it seems justified to include milk and dairy products into the diet of women with polycystic ovary syndrome because of the beneficial effect of those products on the risk of developing type 2 diabetes mellitus in women,” alongside the fact that “the products appear not to have a negative effect on ovulation and fertility in women.”
Seeing as results from studies are sometimes conflicting, researchers add that whole or full-fat dairy seems more beneficial in managing PCOS, versus low-fat dairy, and that further research should be dedicated to comparing not just a lack of dairy to the consumption of it, but an examination of the types of dairy (such as fermented vs unfermented, skimmed milk vs whole, and so on). Until that time comes, given the nutritional benefits dairy offers – in the forms of vitamin D, calcium, and protein – unless you have a dairy allergy, intolerance, or choose to avoid it for ethical reasons, then it may be best to keep it in your diet as a nutrition source.
Though it can feel difficult to separate the pseudo-science and fear-mongering from the facts when it comes to nutrition, Allara’s Nutrition Library is an excellent source of trustworthy, evidence-backed information, grounded in peer-reviewed research and literature reviews, and signed off by our Registered Dietitians. Check it out whenever you have any nutritional questions, or reach out directly to be paired with your own personal PCOS care team!
We also recommend – as a good rule of thumb – to never rule out entire food groups based on limited research or one article here and there. Instead, always consult with a trusted dietitian or your primary care provider when making big nutritional changes in order to make the most informed, safe choices for your long term health.
Allara Health provides personalized treatment that takes the guesswork out of managing PCOS, and offers a customized, holistic plan of attack that merges nutrition, medication. supplementation, and ongoing, expert support to begin healing your body.