PCOS and Gut Health You may have noticed the increasing appearances of fermented foods (such as kombucha and kefir milk) in grocery stores, with a variation of the following statements on the packaging: “great for gut health”, “live and active probiotics”, and “boosts beneficial bacteria”. Strengthening and balancing your gut bacteria sounds like a good idea, but what does it exactly entail? And why is it important to pay attention to gut health (in general, but especially if you have PCOS?). Finally, what is the impact of PCOS on gut health, according to research, and how can you incorporate more fermented foods into your diet? These are the questions we’ll be exploring in this article. What is meant by gut health? Why the gut is so important How does PCOS affect the gut?How you can improve gut health What is meant by ‘gut health’? Gut health refers to the condition of the gut microbiome. The gut microbiome is the environment enjoyed by about 200 species of bacteria, viruses, and fungi living in your digestive tract. The good bacteria in your gut works to break down food and turn it into nutrients and energy that your body can use; they stop growing when they run out of food, but they try to do more than just help in aiding digestion. They also limit the space for ‘bad’ bacteria, multiplying so that unhealthy bacteria do not have room to grow. When there is a healthy balance between ‘good’ and ‘bad’ bacteria in your gut, this is known as equilibrium. Do you have a healthy gut? There are several signs of an unhealthy gut, but there are also certain lifestyle choices that foster an unhealthy or healthy gut. For instance, here are several external factors that are known to be bad for your gut health: High stress levelsLittle sleepEating processed and high sugar foodsTaking antibiotics Unfortunately, some of the above can feel like part and parcel of many of our everyday lives. Too much work, a jam-packed schedule, long commute times, and increasing levels of medication (in 2016, according to the CDC, 270.2 million antibiotic prescriptions were written in the U.S., which is enough for 5 out of every 6 Americans to receive a bottle of antibiotics) all play a role in fostering an unhealthy gut. So the above lifestyle factors can play a part in leading to an unhealthy gut, but our bodies are usually very good at alerting us when something is wrong. With that being said, here are some common symptoms that your gut bacteria might be out of whack: Upset stomach Gas, bloating, heartburn, diarrhea, and constipation are all examples of stomach disturbances that can indicate an unhealthy balance between gut bacteria. Unexplained weight gain Gaining or losing weight unintentionally can be a sign of something off in your gut. The gut is important in telling us when to feel hungry (through the release of certain hormones), and it is thought that weight loss may be caused by malabsorption of small intestinal bacterial overgrowth (shortened to SIBO), while weight gain may be caused by insulin resistance, increased inflammation, or even the gut not communicating the right messages to the brain regarding hunger cues. Skin irritation Interestingly, an issue you may visit your dermatologist about could be resolved through treating another area of your body: your gut. It is thought that skin conditions like psoriasis could be related to certain types of bacteria found in the gut microbiome, and that lower ratios of beneficial bacteria to bad can impact the immune system. Autoimmune conditions According to Harvard Health, an unhealthy gut lining may have cracks or even small holes in it which allows partially digested food, toxins, and bugs to penetrate the tissue beneath it. This can cause inflammation, negative changes to the gut flora, and as a consequence, can lead to the development of “common chronic diseases” or even – as one recent research finding suggests – potentially some autoimmune diseases. Why is the gut so important? And what does PCOS do to the gut? Scientists and researchers are just beginning to understand how critical the gut may be in multiple functions in the body, including hormone secretion, inflammation, mental health, weight, the development of autoimmune disorders (as touched on above), and more. Let’s quickly run over what the gut does for us day to day, and how PCOS may negatively impact these functions. Mental health The gut is sometimes referred to as the “second brain”, because it can help influence your emotions. Research indicates that the gut microbiome may affect how your brain processes other information, like senses, fights, sounds, and even textures. Scientists also believe a gut imbalance could also play a role in anxiety and depression. Weight gain Researchers suspect that there may be a link between the gut and the pituitary gland, which makes hormones that tell you your body is hungry. This gland can also affect the balance of bacteria in your gut. An imbalance of good to bad bacteria is also known as gut dysbiosis, and there is evidence that it “can contribute to weight gain.” Immune system Your gut microbiome communicates with immune cells, which can control how your body responds to things like infection and inflammation. Heart health A recent study that examined 1500 people suggests that the gut microbiome played a role in promoting good cholesterol and triglyceride levels, while unhealthy species in the gut can contribute to heart disease by producing something called TMAO. This chemical can contribute to blocked arteries, which in turn increases one’s chances of heart attack or stroke. Okay, so gut health is something we should all be paying attention to. But how does PCOS affect this picture? Unfortunately, it’s not in a good way. PCOS is a hormonal and a metabolic disorder, and in recent years, research indicates that gut microbiota disorders may be closely related to the occurrence and development of metabolic diseases. So is your gut health potentially worsening your PCOS? Or is PCOS worsening your gut health? Let’s explore. How does PCOS affect your gut? What the research says Research indicates that women with PCOS, compared to women without PCOS, have gut microbiomes that probably look quite different. For example, one study of 73 PCOS patients found that patients with PCOS had “fewer types of gut microbiota,” and that this trend was likely due to an increase in androgens, a common finding in women with PCOS. Another study found that, compared to the control group, the abundance of two important microbes were “lower in PCOS patients”, while a different study carried out on mice also found that, when PCOS was induced, “the total genus of GM decreased,” but the number of firmicutes (a microbe which is “closely related to obesity and MS”) increased comparatively. Finally, research also indicates that women with PCOS might suffer from damage to the “gut-brain axis,” thanks to worse gut microbiota diversity. For instance, studies indicate that “a particular type of intestinal endocrine cell . . . are the major source of the neurotransmitter serotonin (5-HT), which 95% of the body’s 5-HT is distributed in the intestine.” A gut microbiota imbalance thus causes changes in 5-HT secretion, “which affects brain development, stress response, and emotional activities such as anxiety and depression”. Alongside this association, animal experiments suggest that PCOS could lead to significantly lower levels of 5-HT and dopamine compared to animals without PCOS. In other words? It is well known that women with PCOS are more likely to suffer from mental health issues than women without it, and potentially an unhealthy gut could have something to do with this correlation. Which comes first: a gut imbalance or PCOS? It’s difficult to say, but research indicates that the “gut microbiota may be a potential pathogenetic factor in the development of PCOS.” (Right now, tests on gut bacteria are not included in the diagnosis of PCOS). In particular, gut dysbiosis is associated with PCOS phenotypes. It could also be the case that, as PCOS symptoms develop, these issues compound: for instance, insulin resistance, excess androgens, and weight gain can all go on to further negatively affect the “diversity and composition of gut microbiota in women with PCOS.” Researchers point out in particular that, at least when it comes to energy absorption, gut microbiota “disorders can accelerate the process of PCOS by affecting energy absorption,” which can aggravate symptoms of obesity and perpetuate a vicious cycle. It’s worth noting, though, that more research is needed in this area in order to fully understand the role of the gut in the development of PCOS. How to improve gut health Because so many factors impact gut health (from sleep, to genetic factors, to diet), it can feel overwhelming trying to help your good gut bacteria. Where to even begin? We recommend starting off small, and incorporating more of these tips into your daily routine as you go forward. Lifestyle factors Get more sleep Aim for at least 7 hours a night, with anywhere between 7 and 9 being ideal. Try to cut down on stress where you can Spend more time engaging in activities that relax you: good examples might include walking in the park, yoga, meditation, reading, etc.Drink lots of water A recent study found that people who drank more water had less bacteria that can trigger gastrointestinal infections. Nutritional choices Incorporate more fermented foods into your dietExamples of fermented foods include: kimchi, sauerkraut, tempeh, miso, and probiotic yogurt. Add these as a small side to your PCOS plate for an extra kick of ‘good bacteria’ and nutrition! Opt for fermented drinks with your meals Kefir milk and kombucha are just two examples of great fermented drinks. Check the back of the packaging and opt for one with no (or very few) added sugars, or alternatively try to make your own. Ingest more prebioticsProbiotics are the foods and drinks that contain live microorganisms designed to improve the good bacteria in your gut, while prebiotics are foods that help feed these good bacteria! Garlic, onions, leeks, asparagus, bananas, and oats are all good examples of prebiotics. 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.