PCOS and gut-brain health are connected. Gut-brain health is essential to improving symptoms and managing PCOS long-term.
What is the “gut”? What is the importance of each part of the gut?
The gut refers to the gastrointestinal tract that breaks down and absorbs food. It extends from the mouth where digestion first begins to where food is excreted as feces. When people talk about the gut, they’re usually referring to the large and small intestine but there are many important sections of the gut. Each section has its own purpose and significance.
In the mouth, chemical and mechanical digestion start breaking down food. This is one of the most important first steps in supporting our gut with PCOS. We should chew slowly and entirely to break down our food as much as possible. This helps our body break down and absorb the nutrients from food better. In addition, slow and mindful eating allows your brain to register satiety.
In the stomach, digestive enzymes are released to break down carbohydrates, protein, and fat. Carbohydrates are broken down first, then protein and fat. This is why pairing our meals with all three macronutrients helps balance our blood sugar.
Once food has left the stomach, it enters the small then large intestine. This is where amino acids, sugar, fatty acids, water, and micronutrients pass through the intestinal wall into our bloodstream before heading to the liver.
Within the small and large intestine is trillions of gut bacteria. These bacteria make up the microbiome, which influences health in many ways.
In addition to digestion of nutrients, the digestive system also produces certain vitamins, like vitamin K and B-vitamins, and hormones that regulate appetite.
Why is the PCOS gut health connection important?
As you may have noticed, gut health is extremely important because it’s where we break down, digest, and absorb nutrients that support PCOS management. In addition to digestion, the gut plays an important role in protecting our immune system. In fact, it’s estimated 80% of our immune system resides within the gut. This is because our gut comes into contact with the outside world through the things we eat, breathe, and drink.
Although the science is still new, it is theorized that gut health may play an important role in the pathogenesis of PCOS. In fact, those with PCOS have been shown to have differences in their microbiome as compared to those without PCOS. The prevalence of irritable bowel syndrome is also higher in those with PCOS.
The microbiome influences many aspects of our health. The type of bacteria found in the microbiome can affect how well our bodies function. Good bacteria helps support immunity, prevent disease, and supports digestion.
A microbiome that favors bad bacteria (dysbiosis) is associated with irritable bowel, inflammation, insulin resistance, chronic diseases, and other symptoms like acne. Dysbiosis may increase intestinal permeability. Increased intestinal permeability means the gut lining may be compromised. When the lining is compromised, this allows environmental toxins, endotoxins, pathogenic bacteria, and more to pass through the gut lining more easily. This may lead to further inflammation.
Stress, toxin exposure, poor sleep, smoking, and a low-quality diet can lead to dysbiosis. By supporting our gut health, we can reduce inflammation, improve gut issues like IBS, and possibly improve PCOS symptoms as well.
The PCOS and gut-brain health connection
Our gut and brain communicate via the vagus nerve. The vagus nerve is the largest nerve in the body, connecting the brain stem to the intestinal lining. Scientific research has highlighted that the gut and brain have bi-directional communication, indicating the gut can influence our brain health and vice versa. In fact, stimulating the vagus nerve may help with digestion. Many people also report worsened IBS symptoms in times of stress or anxiety. These demonstrate the connection between the gut and brain.
Further, an imbalanced microbiome is linked to numerous mental health issues. In addition to a higher prevalence of IBS, research shows individuals with PCOS have an increased risk of being diagnosed with depression, anxiety, bipolar disorder, and obsessive-compulsive disorder. Gut health may influence this. If you have PCOS and feel your mental health is struggling, please reach out to a medical provider.
Gut-brain connection, PCOS, and blood glucose
Another important function of the gut-brain connection is glucose regulation, as well regulating hunger and fullness cues. The hypothalamus is located inside the brain and influences glucose control and appetite via hormonal regulation. The enteric nervous system also speaks to the hypothalamus to regulate blood glucose. Impairment of glucose control has been linked to dysbiosis. Inflammation related to dysbiosis can affect the enteric nervous system and communication, which may contribute to poor glucose control and the development of metabolic diseases.
People with PCOS often have insulin resistance, which drives many of the symptoms of PCOS. As stated above, poor gut health may be contributing to poor glucose and insulin control. Additionally, when we eat, insulin gets released and is supposed to attach to specific receptors on the hypothalamus. If you’re insulin resistant, insulin is not able to efficiently tell the brain we’ve had enough and our appetite regulation is altered. This is one reason why individuals with PCOS often struggle with increased hunger and cravings.
How to support your gut when you have PCOS
Now that we have covered the connection between PCOS, the gut, and gut-brain health, here’s a few simple tips you can incorporate into your daily life. The goal is to reduce inflammation, support a healthy gut lining, and In addition, if you need further support to improve gut health and PCOS, consider joining my 1:1 Peace with PCOS Academy for individualized nutrition coaching.
Eat diverse plant foods
Plant foods have different types of fiber that feed the good bacteria in our gut. We want to increase the amount and diversity of the fibers we eat so we can support a diverse microbiome. This will lead to a strong immune system, less inflammation, and improved brain function. Additionally, choosing foods high in fiber can help improve blood sugar and insulin resistance. The recommendation for fiber intake is 25-35 grams daily. Diverse plant foods include fruits, vegetables, whole grains, beans, legumes, and nuts/seeds. These foods also tend to be nutrient dense and contain anti-inflammatory components.
Include Probiotic and Prebiotic Foods
Probiotic foods contain good, live bacteria. Tempeh, yogurt, kefir, miso, and sauerkraut are some common probiotic foods. Prebiotic foods feed the live bacteria in your gut. Prebiotic foods include asparagus, onions, garlic, bananas, and high-fiber foods.
I’m serious. The body removes excess hormones, like estrogen, through the stool. Regular bowel movements are a must for PCOS. This may require you to drink more water, eat more fiber, or limit certain foods that contribute to constipation.
Incorporate more stress reduction practices into your life
Stress is a major driver of many gastrointestinal issues and symptoms. Stress affects how well our body can break down food and it can disrupt the lining of the gut. It’s very important that we reduce as many sources of stress as possible. If you’re not managing your stress it may be hard to see significant improvements.
Incorporate stress-reducing exercises
Exercise is an important factor for managing PCOS symptoms and supporting gut health. Moving our body supports regular bowel movements, which keep our gut microbes and hormones happy. Exercises like walking, yoga, and dancing are all great options. What’s most important is doing something you ENJOY.
Examples of High Fiber Foods for PCOS
Below are some examples of high fiber foods from various categories but any whole plant food will do. It’s important to focus on including foods you love.
Fruits & Vegetables
- Pear (5g fiber per pear)
- Strawberries (3g per cup)
- Avocado (10g per 1 cup)
- Apple (4g per medium apple)
- Carrots (4g per 1 cup)
Whole Grains & Beans
- Lentils (13g per 1 cup cooked)
- Kidney Beans (12g per 1 cup cooked)
- Quinoa (5g per 1 cup cooked)
- Oats (15g per 1 cup uncooked)
- Popcorn (2g per 1 cup cooked)
Bessac A, Cani PD, Meunier E, Dietrich G, Knauf C. Inflammation and Gut-Brain Axis During Type 2 Diabetes: Focus on the Crosstalk Between Intestinal Immune Cells and Enteric Nervous System. Front Neurosci. 2018 Oct 10;12:725. doi: 10.3389/fnins.2018.00725. PMID: 30364179; PMCID: PMC6191495.
Gérard, C., & Vidal, H. (2019). Impact of Gut Microbiota on Host Glycemic Control. Frontiers in endocrinology, 10, 29. https://doi.org/10.3389/fendo.2019.00029
Richards, P., Thornberry, N. A., & Pinto, S. (2021). The gut-brain axis: Identifying new therapeutic approaches for type 2 diabetes, obesity, and related disorders. Molecular metabolism, 46, 101175. https://doi.org/10.1016/j.molmet.2021.101175