How Your Leaky Gut Could Be Linked to Your PCOS?

Polycystic ovary syndrome, otherwise known as PCOS, is one of the most common hormonal conditions experienced by women in their 20s to 40s. Unfortunately, many women have no idea they have PCOS until they try to get pregnant. Since PCOS often causes irregular cycles and can impede ovulation, it is no surprise that it is the most common cause of female infertility, affecting 6 to 12% (as many as 5 million) US women. Although PCOS is extremely common, our complete understanding of the disease process is still unclear. There is still so much we need to learn about PCOS and how to not only manage it but treat the condition too. 

If you were recently diagnosed with PCOS, chances are, your doctor might have discussed that getting pregnant naturally may not be a viable option for you. They may have recommended additional assisted fertility treatments including ovulation induction (like Clomid and Femara), IUIs and even IVF. Now, although these assisted fertility treatments can be extremely beneficial for some, they don’t always work for everyone. This can be extremely frustrating and overwhelming for so many women who are trying to conceive. 

Luckily, there is growing evidence that medication induction and assisted fertility treatments may not be the only way to address PCOS. In fact, even according to many medical associations, including ACOG, lifestyle and dietary modifications should be the first course of treatment for patients for PCOS. Unfortunately, as you likely have experienced, besides being told to lose weight, exercise more and eat less, your doctor may be providing you limited guidance about these important lifestyle and dietary modifications you could be making. At NMD Wellness of Scottsdale, we have seen patients be able to regulate their cycles, balance their blood sugar, and ovulate naturally, with the proper lifestyle and dietary guidance. This has allowed hundreds of our patients to get pregnant. 

One of the ways we have become so successful with our patients suffering from PCOS is by taking a whole- body approach to their hormone and fertility health. Although the ovaries are an important aspect to address in PCOS, more and more research is revealing that PCOS is not solely an ovarian issue but an endocrine disorder impacting a variety of aspects of your health.  One area of particular interest that we focus on is gut health. 

As many of you know, gut health is a relatively “hot topic” in the wellness space. But, what does the research actually say and what is the best way to address your gut health if you have PCOS? I’m so glad you asked! Let’s dive in!

Recently, in 2020, researchers were interested in evaluating if polycystic ovary syndrome (PCOS) was associated with gut-related inflammation. In this study, they evaluated biomarkers associated with endotoxemia. Intestinal endotoxemia is a process by which an overgrowth of normal bacteria, specifically gram-negative bacteria, could be associated with the release of inflammatory markers worsening the symptoms of PCOS. Their theory was that this increase in gram-negative bacteria would not only cause inflammation in the gut, but this inflammation could ultimately lead to an increase in intestinal permeability leading to what is commonly known as “leaky gut”. Prior to this study, researchers already knew that specific blood cells known as mononuclear cells appeared to be extremely responsive in women with PCOS.  In the presence of gram-negative bacteria, researchers had found that women with PCOS would experience the release of pro-inflammatory cytokines. This was not only localized to the gut, but in a recent animal-based model, ovarian theca-cells in the presence of gram-negative bacteria even stimulated the release of androgen production. In other words, addressing the gut must be a top priority in patients with PCOS, especially those experiencing androgen related symptoms including elevated testosterone levels, anovulatory cycles, as well as facial hair and acne. 

So what is it about gram-negative bacteria that seems to simulate such an inflammatory response in women with PCOS? Researchers believe that our immune system is particularly sensitive to a particular aspect of gram-negative bacteria, known as LPS. LPS, otherwise known as Lipopolysaccharides, is the outer coating of gram- negative bacteria. Elevated levels of LPS was directly associated with an increase in inflammation in patients with PCOS. 

So what does this mean for you? Do we need to eradicate all our gram-negative bacteria in our gut to improve our symptoms of PCOS? 

No. In fact, gram-negative bacteria are an essential aspect to our gut ecosystem and play a critical role in a variety of metabolic and hormonal pathways. The problem, however, lies when there is an excess of gram-negative bacteria. If you are experiencing GI related symptoms including gas, bloating, abdominal cramping, and/or bowel changes including constipation or diarrhea, these symptoms may point to intestinal dysbiosis and an increase in gram-negative bacteria. 

One important way to support optimal gut health is by making sure to consume dietary fibers daily. Fiber not only helps improve bowel movements, but is essential to our gut ecosystem. In fact, our gut bacteria will ferment dietary fibers to produce short-chain fatty acids. These short-chain fatty acids play an essential role in lipid metabolism and reducing inflammation. In general, women should aim to eat at least 21 to 25 grams of fiber per day. Although we generally recommend getting fiber from vegetable sources, if you are currently working on increasing your vegetable intake, a fiber supplement may be beneficial for short term use. 

Avoiding processed foods is another important way to support your gut health. Researchers have found that diets containing large amounts of processed foods (like that found in the Standard American Diet), may create an imbalance in the gut system by impacting not only gut bacteria but their metabolism. Avoiding processed foods can be an important way to reduce inflammation. 

Having regular daily bowel movements is another important way to support your gut health that is so often overlooked. Making sure you have 1-3 fully formed bowel movements per day is an important first step. Drinking adequate water, increasing your vegetable intake and mitigating sedentary lifestyles with exercise are some simple but effective ways to support regular bowel movements. If you are already exercising regularly, drinking adequate water and making your diet a priority and still struggling with having regular bowel movements, it may be worth discussing the options of a comprehensive stool analysis with your doctor. A stool analysis can help us determine if there are other  impeding factors that need to be addressed. Many patients will ask us about food sensitivity testing, however the accuracy of these tests is not always ideal and if you are currently experiencing inflammatory - related GI symptoms, chances are your test will likely be inaccurate. Focus instead on considering a comprehensive stool analysis, rather than a food sensitivity test. 

About the Author: Meet Dr. ZenAlissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...