Grain free and PCOS?
Polycystic ovarian syndrome (PCOS) is an endocrine and metabolic disorder that affects 7-10% of women in the global population. That’s about 1 out of every 10 women in our lives. PCOS can be associated with increased risk of cardiovascular disease, diabetes, and endometrial cancer.
I have PCOS should I be grain free? This is a very common question. Usually what people are asking is: should I be avoiding gluten, what is gluten, and should I avoid all carbohydrates? The short answer is: likely not. Take a deep breath, all these terms have been overtaken by a lot of fad language and it makes things really confusing.
Gluten is the umbrella term for proteins found in certain grains. These grains include; wheat, rye, barley, titricale, and sometimes oats (if they have been cultivated alongside gluten containing grains). Celiac disease is an autoimmune condition where the body reacts to gluten. People with celiac disease must avoid gluten as part of their medical treatment to feel well. It is diagnosed with blood testing and sometimes an intestinal biopsy. Some people do not meet the diagnostic criteria for celiac disease, but still feel unwell when they eat gluten. This is called gluten intolerance. Some common reasons that lead people to get tested and remove gluten from their diet are: family history of celiac disease, stomach/intestinal problems, certain rashes, joint pains/fatigue, and nutritional deficiencies.
So, should I stop eating gluten? Recreational gluten avoidance in healthy people is generally not recommended. Some healthy people do feel better when not eating gluten; it’s not frequent, but it does happen. This is the ambiguousness of gluten intolerance, unfortunately. If you do have symptoms, you may well need to be tested by your doctor for celiac disease or other conditions that are causing you to feel unwell first. Healthy people thinking of going gluten free should also consult a doctor before trying it out. You’ll want to be really clear about what you are trying to do. Avoiding gluten does involve cutting out a fiber rich, nutrient dense, food source from your diet and should be approached with awareness.
But I read online I am supposed to avoid carbohydrates for PCOS. Of course there are conditions where specific diets are medically necessary, and some diets are a better fit for some people’s lives than others (this is another plug for talking to medical experts about health care concerns.) However, most routine cases of PCOS benefit from a healthy, satisfying, diet that includes some complex carbohydrates in the long term. If gluten is medically safe, these healthy diets can include gluten containing grains. Here is what is important: not all carbohydrates are the same. Some carbohydrates will cause less stress to the blood sugar system. Foods that contain these kinds of carbohydrates are called low glycemic index foods. This has to do with how much fiber vs readily available sugar they are made of. Reducing stress on the blood sugar system is desirable in PCOS and therefore people with PCOS do benefit from understanding the types of carbohydrates that are in foods. You can get a sense of how certain foods influence your blood sugar by checking out their glycemic index. Additionally, the more processed the foods the less nutritional value they may have; white flour and white rice have less fiber than whole wheat flour and brown rice, for example. You will get less nutritional bang for your buck with processed foods. Not all carbohydrate preparation techniques are the same either. Juicing fruits will strip fiber and antioxidants found in the skin and pulp and change their glycemic index even though they were very recently a whole food. On the other hand, whole grain breads made with sourdough starter and long fermentation times have a lower glycemic index than more conventional bread making techniques (it also makes the gluten easier to digest-check out the WSU Breadlab for preparation techniques, plus they have a fun Instagram). Ultimately, dietary plans must meet the challenge of longevity. We get less benefit if we can’t fit them into our lives or if we can’t afford or sustain them. There can also be emotional consequences to unrealistic dietary plans that shouldn’t be minimized.
Carbohydrates are a macronutrient class found in many fiber rich, nutrient dense, and culturally significant foods of all price points. It is important to be anything but cavalier with the concept of extreme recreational dietary restriction for the long term. The best place for dietary advice for your needs is your doctor, along with a certified nutritionist, not a celebrity influencer.