When I was about 12 years old, I went to the restaurant with my parents. It was an unusual treat, and I used the opportunity to eat something we rarely had, a dish with seafood such as shrimps and mussels.
But when I arrived back home, I started to feel queasy until I was seriously sick. The seafood clearly hadn’t been that fresh and had made me ill. It took me years after that to even be able to smell seafood without feeling nauseous again. I didn’t eat any seafood until I was well into my 20s. Just one dish was enough to have a tremendous impact on me.
When it comes to fertility and PCOS, some foods can have a substantial impact too. Gluten is one of them. Because it is present in so many foods, it can be hard to see the repercussions gluten can have on our health and fertility. In this article, we will look at:
– What gluten intolerance is
– Why gluten can affect PCOS
– In which foods you can find gluten
– How you can avoid gluten in your diet
So, what exactly is gluten intolerance?
Gluten is a protein commonly found in grass-related grains such as wheat, barley and rye. Gluten is responsible for the ability of the wheat to form an elastic dough, which is why it is so widely used to make bread, pasta etc…. (1).
Some people find that eating gluten starts a cascade of symptoms. This is the case with coeliac disease. Coeliac disease is an autoimmune disease that can lead to intestinal damage, weight loss, nutrient deficiencies such as anaemia, fatigue, joint pain and infertility (2).
This is also the case with non-coeliac gluten sensitivity (gluten intolerance).
Gluten intolerance is hard to diagnose.
Unlike with coeliac disease, no blood test can determine gluten intolerance. We don’t really know how many people are gluten intolerant. Numbers vary widely from 1 in 3 people to about 15% of the population (3,4).
The best way to detect gluten intolerance is to do an elimination diet and remove all gluten containing foods for one month and then reintroduce some gluten in the diet. People will be able to see a change in their symptoms when transitioning to a gluten free diet and then when reintroducing gluten.
The best way to detect gluten intolerance is to do an elimination diet and remove all gluten-containing foods for one month and then reintroduce some gluten in the diet. People will be able to see a change in their symptoms when transitioning to a gluten-free diet and then when reintroducing gluten.
The symptoms of gluten sensitivity are varied.
The symptoms of gluten sensitivity include gastrointestinal symptoms as well as symptoms not related to the digestive system (5).
|Gastro-intestinal symptoms||Non gastro-intestinal symptoms|
|Lack of well-being
Gluten increases inflammation in the body
In people who are sensitive to gluten, eating gluten starts a cascade of reaction in the gut leading to intestinal permeability and increased inflammation in the body (6). PCOS is also linked to elevated inflammation, either due to insulin regulation issues or due to chronic inflammation. Chronic inflammation can increase levels of testosterone in the body, one of the key markers of PCOS (7).
But in which foods can you find gluten?
Apart from the obvious, wheat, you can find gluten in many different foods including rye, barley and malt as well as their derivatives. Those are also used as ingredients in many daily foods (See list below).
|Malt in various forms including: malted barley flour, malted milk or milkshakes, malt extract, malt syrup, malt flavouring, malt vinegar
|Pasta and couscous
Bread and pastries
Baked foods (cookies, biscuits, cakes…)
Sauces and gravy (Wheat is used as a thickener)
Malt beverages, including malt vinegar (some)
Sometimes, it can feel that eating a gluten-free diet doesn’t make any difference.
One possible reason is if you are still having gluten even when you think you have removed all the sources. Gluten can make its way through many foods that we wouldn’t think about, such as soups, salad dressing or processed meats! A list of possible culprits can be found below, but the best way is still to look at the ingredients’ list carefully. Ingredients containing gluten will be marked in bold.
|Energy bars/granola bars
Multi grain or ‘artisan’ tortillas
Starch or dextrin
|Meat substitutes made with seitan (wheat gluten) such as vegetarian burgers, vegetarian sausage, imitation bacon, imitation seafood
Brown rice syrup
Soy sauce (though tamari is gluten free)
Pre-seasoned meats (eg BBQ chicken)
Eggs served in restaurants (eggs are gluten free but some restaurant add some batter to omelettes etc..)
Once you’ve removed gluten-containing foods, the next step is to replace those with some gluten-free foods.
One possibility is to replace some wheat-based products with their gluten-free version. There are many of them nowadays (just look at the ‘Free from’ aisle at the supermarket), from gluten-free bread and pasta to cereals bars, crackers etc….
The other is to try and replace those foods with some equivalent. Buckwheat flour (despite having ‘wheat’ included in its name) is a gluten-free flour that can be used to replace wheat flour in many recipes. I use it to make the base of quiches and tarts, for example. You can find pasta made from rice flour rather than wheat. I also use quinoa to replace couscous etc…
Breakfast can be harder to deal with. We are very much used to have toast and cereals in the morning, all of which will contain gluten. It can be easier to just eat in a completely different way, maybe having eggs on a buckwheat pancake for breakfast.
That’s a lot of food to remove from my diet! Is it healthy?
In itself, a gluten-free diet isn’t unhealthy.
Issues arise when you are replacing gluten only with foods from the ‘Free From’ range. Those foods are often produced with highly refined grains and lack the fibre you can find in wheat. There are also containing a lot of additives. Replacing pasta, couscous with rice can lead to increased levels of arsenic and mercury in the diet too (found in rice and rice flour) (1,8).
The best is still to have a varied diet with foods that happen to have no gluten in rather than relying on one food or highly processed foods.
In summary, for some people eating a gluten-free diet can help with PCOS.
The best way to see if a gluten-free diet is to try it out for at least 4 weeks. A balanced, varied diet is essential, relying on foods that are naturally free from gluten (there are many, many of them) rather than their gluten-free equivalent. This will help reduce chronic inflammation at the root of higher levels of testosterone.
You might want to have a look at:
Are you wanting to improve your chance of conceiving but you are not sure where to start? Give me call for a free 15 mins chat so we can see how nutrition can help you.
- Diez-Sampedro A, Olenick M, Maltseva T, Flowers M. A Gluten-Free Diet, Not an Appropriate Choice without a Medical Diagnosis [Internet]. Vol. 2019, Journal of Nutrition and Metabolism. Hindawi Limited; 2019 [cited 2020 Aug 19]. p. 2438934.
- Jones AL. The gluten-free diet: Fad or necessity? [Internet]. Vol. 30, Diabetes Spectrum. American Diabetes Association Inc.; 2017 [cited 2020 Aug 19]. p. 118–23.
- Arámburo-Gálvez JG, Beltrán-Cárdenas CE, André TG, Gomes IC, Macêdo-Callou MA, Braga-Rocha ÉM, et al. Prevalence of adverse reactions to gluten and people going on a gluten-free diet: A survey study conducted in Brazil. Med. 2020 Apr 1;56(4).
- Aziz I, Lewis NR, Hadjivassiliou M, Winfield SN, Rugg N, Kelsall A, et al. A UK study assessing the population prevalence of self-reported gluten sensitivity and referral characteristics to secondary care. Eur J Gastroenterol Hepatol [Internet]. 2014 Jan
- Catassi C, Elli L, Bonaz B, Bouma G, Carroccio A, Castillejo G, et al. Diagnosis of non-celiac gluten sensitivity (NCGS): The salerno experts’ criteria. Nutrients [Internet]. 2015 Jun 18 [cited 2020 Aug 19];7(6):4966–77.
- Fasano A. Physiological, pathological, and therapeutic implications of zonulin-mediated intestinal barrier modulation: Living life on the edge of the wall. Am J Pathol [Internet]. 2008 [cited 2020 Aug 19];173(5):1243–52.
- González F. Inflammation in Polycystic Ovary Syndrome: Underpinning of insulin resistance and ovarian dysfunction. In: Steroids [Internet]. NIH Public Access; 2012 [cited 2020 Aug 19]. p. 300–5.
- Bulka CM, Davis MA, Karagas MR, Ahsan H, Argos M. The unintended consequences of a gluten-free diet [Internet]. Vol. 28, Epidemiology. Lippincott Williams and Wilkins; 2017 [cited 2020 Aug 19]. p. e24–5