What is The Connection Between PCOS And Your Gut Bacteria?
In addition to hosting Mother’s Day, the month of May is also home to National Women’s Health Week and so I could hardly think of a better time to turn my writer’s gut health gaze towards the topic of PCOS.
PCOS, formally known as polycystic ovary syndrome, affects around 5 million women in the United States and is a leading cause of female infertility.
Often characterized by insulin resistance and elevated androgen (male hormone) levels, there is a growing body of evidence suggesting that dysbiosis within the digestive tract also has a significant role to play.
While the exact manner in which PCOS progresses is still not fully understood, recently published papers have pointed to a connection between insulin resistance and imbalances between the relative amounts of good and bad gut bacteria [dysbiosis].
A number of preliminary studies including those published in Frontiers In Microbiology  and the Canadian Journal Of Physiology & Pharmacology  have pointed to the fact that women living with PCOS tend to have less diversity in their gut microbiome and are more likely to suffer from these imbalances then women without PCOS.
As per a recently published paper out of Frontiers In Endocrinology, dysbiosis is increasingly thought to be driven both by elevated androgen levels and insulin resistance, meaning that the relationship between gut dysbiosis and PCOS could very well be bi-directional.
These findings, taken together, lead to one very big question –
Do interventions that improve the state of the microbiome have a meaningful positive impact on women with PCOS?
This is not an easy question to answer, but scientists have begun to attempt to do so by exploring the effects of either probiotic or symbiotic (combination of probiotics + prebiotics) supplements in women with PCOS.
While there are a number of ways that the balance of the gut microbiome can be enhanced, including via a higher fiber diet and even incorporating more fermented foods, the use of probiotic supplements does, in a sense, represent a path of least resistance in this regard and has become a starting point of scientific inquiry.
So let’s see what the scientists have found so far.
Insulin Resistance & Probiotic Supplementation
A 2021 meta-analysis out of the Journal Of International Medical Research looked at experimental studies providing probiotic supplements to women living with PCOS.
The paper determined that, over an 8-12 week period, a multi-strain probiotic containing various members of the Lactobacillus & Bifidobacterium family contributed positively to reducing measures of insulin resistance, a characteristic and problematic feature of PCOS.
From the dietary perspective, low glycemic index diets which feature more legumes, nuts, seeds and unrefined carbohydrates (steel cut oats, brown rice, whole grain bread, quinoa etc) also offer potential to reduce insulin resistance.
These foods are also exceptional sources of fiber and magnesium, two nutrients shown to be lacking in the diets of many women with PCOS.
Elevated Androgens & Probiotic/Synbiotic Supplementation
A systematic review and meta-analysis out of the European Journal Of Nutrition looked at a number of studies using either probiotic or combination pre/probiotic (symbiotic) supplements over an 12+ week period in women living with PCOS.
In this particular review paper the probiotics used contained various members of the Lactobacillus family with L. acidophilus and L. casei among the most prevalent whereas inulin and FOS (fructooligosaccharides) were the most commonly used prebiotics.
For your personal interest I will also note that these prebiotic fibers also occur naturally in garlic, onion, bananas, asparagus, oatmeal and artichokes, among other foods.
Back to the paper at hand…
In addition to replicating the positive findings on insulin resistance mentioned in the previous heading, this review paper also noted that both probiotic and symbiotic supplementation had the potential to reduce testosterone levels and a variety of relevant inflammatory markers.
The latter is perhaps unsurprising to those who read my previous piece on fermented foods, in which I explored how diets rich in kombucha, kimchi, kefir and similarly fermented items led to greater microbiome diversity and reduced bodily inflammation.
Although I could find no fermented food intervention studies in the context of PCOS, certainly their incorporation could be a point of future interest in the field given the positive effects they have on the human digestive tract.
Dysbiosis has been increasingly characterized as a feature of PCOS that may interact in a bi-directional manner with two of the conditions most salient markers – insulin resistance and elevated androgen levels.
Emerging but limited evidence does appear to suggest that interventions aiming to improve microbiome balance, such as pre & probiotic supplementation, hold promise in terms of improving those markers.
The extent to which their impact is relevant as compared to other dietary, lifestyle and pharmaceutical interventions is hard to judge – but the scientific consensus seems to view them as a low risk strategy for those who want to explore every possible avenue in the management of this challenging condition.