Dairy-free and gluten-free for PCOS?

By Amber Charles-Alexis, MSPH, RDN

June 28, 2021

Dairy-free and gluten-free are common recommendations for the management of PCOS. This blog explains whether they're even necessary, and just who might benefit from this approach.

Dairy and health | Acne and insulin resistance | Dairy-free for PCOS | Gluten and health | Gut health and inflammation | Gluten-free for PCOS | Takeaway

Picture: Wix, stock image

Dairy and health

Dairy – cow's milk and its products – are a highly controversial food group.

Milk contains 18 of 22 essential nutrients and is a rich source of vitamin D, calcium, phosphorus and magnesium (1).

A 2021 umbrella review revealed that just 1 cup of milk per day may reduce your risk for heart disease, high blood pressure, stroke, osteoporosis and Alzheimer's disease (1).

However, amid concerns of mucus production and lactose intolerance, milk may increase your risk for prostate cancer, Parkinson's disease and iron-deficiency in infants (1).

With respect to polycystic ovary syndrome (PCOS), it may be related to acne.

Dairy, acne and insulin resistance

Insulin resistance affects between 50-70% of women with PCOS and has been linked with most symptoms of PCOS (2).

However, low-fat dairy intake has been shown to beneficial for improving insulin resistance, along with waist circumference and weight loss - all major concerns in PCOS (3).

Likewise, acne affects up to 30% of women with PCOS or excess testosterone (2).

Depending on its severity, it can affect your quality of life, raise your medical costs and warrant frequent visits to your dermatologist, who may then recommend various topical treatments (retinoids) and medications, like metformin or inositol.

Studies have proven that there is a relationship between diet and acne.

More specifically, all types of cow's milk – whole fat, low-fat and skim milk – have been shown to increase the occurrence of acne (4).

Other dairy products, like cheese and yogurt, however, do not have the same effect.

Dairy-free for PCOS

Given the latest scientific findings, there is a distinction between going completely dairy-free and reducing your intake of cow's milk.

Of course, women with lactose intolerance – with or without PCOS – would improve their symptoms by taking a low-dairy approach.

Even then, most persons with lactose intolerance can tolerate up to 1 cup of milk (12-15 g of lactose) per day without negative side effects (1).

There are also benefits of dairy for PCOS.

Women with PCOS experience nutrient deficiencies and should increase their intake of vitamin D, potassium, calcium, zinc, vitamin C and folic acid (5) – most of which you can obtain from dairy.

Of course, there are non-dairy sources of calcium and protein if you do need to decrease your intake of milk and dairy products.

However, the recommendation to go dairy-free for the management of PCOS is rooted in an incomplete understanding of the roles of nutrition and dairy for health.

A completely dairy-free approach for PCOS management may not be necessary for you.

Gluten and health

Picture: Wix, stock image

Now, let's move onto the next controversial food component – gluten.

Gluten is the main storage protein found in wheat, comprised of many distinct but related proteins, most notably glutenin and gliadin (6).

It is found in wheat, barley, and rye (think: wheat-based flour products, like bread).

It is not naturally found in oatmeal, although oats may become contaminated with gluten due to manufacturing processes (7).

Gluten has been implicated in many gut-related disorders.

Gluten, gut health and inflammation

Celiac disease (CD) is an autoimmune disorder that is triggered by gluten, leading to damage of the gut lining that reduces absorption of nutrients from foods (8).

In CD, diarrhea, flatulence (gas) and abdominal cramps are often common after eating gluten-containing foods.

However, you can have a reaction to gluten even if you're not diagnosed with CD.

For instance, persons with non-celiac gluten sensitivity or a wheat allergy would have an allergic or inflammatory response to gluten (9).

For these conditions, a gluten-free diet is recommended.

Gluten triggers the release of zonulin, a protein that causes the cells in the gut to separate - a phenomenon referred to as "leaky gut" (10).

Inflammation also triggers leaky gut.

PCOS is an inflammatory condition and a dietary approach that supports a reduced intake of inflammatory foods - like fatty and sugary foods - may help with symptoms and risk for heart disease and type 2 diabetes.

Gluten-free for PCOS

A gluten-free diet is the safest and most effective treatment for persons with celiac disease or a gluten sensitivity (11).

However, a gluten-free diet is not recommended for the general population.

In fact, if you do not have symptoms of gluten sensitivity, there's no scientific benefit to following a gluten free diet (11).

Likewise, a gluten-free diet will not automatically improve your PCOS symptoms, unless you have an underlying sensitivity.

Researchers have suggested that improvement of PCOS symptoms in women without a gluten sensitivity is likely due to the selection of more wholesome foods and less highly processed foods that are high in saturated fats and simple sugars.

Takeaway

There are pros and cons to both dairy and gluten for women with PCOS.

The decision to go dairy-free and gluten-free for PCOS management needs to be done on a case-by-case basis and not as a cure-all, generic medical recommendation.

Also, you can be dairy-free without needing to be gluten-free.

Work with a Registered Dietitian to help you learn how nutrition can support management of your PCOS.

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The information provided in this blog is for general knowledge and is not intended to diagnose, cure or treat your medical condition. This information does not replace your need for personalized medical and nutritional expertise and intervention.

References:

1. Milk consumption and multiple health outcomes: umbrella review of systematic reviews and meta-analyses in humans (nih.gov)

2. Epidemiology, diagnosis, and management of polycystic ovary syndrome (nih.gov)

3. The Effects of Dairy Intake on Insulin Resistance: A Systematic Review and Meta-Analysis of Randomized Clinical Trials (nih.gov)

4. Dairy intake and acne development: A meta-analysis of observational studies - PubMed (nih.gov)

5. Quantitative assessment of nutrition in patients with polycystic ovary syndrome (PCOS) - PubMed (nih.gov)

6. What is gluten? - PubMed (nih.gov)

7. Safety of Adding Oats to a Gluten-Free Diet for Patients With Celiac Disease: Systematic Review and Meta-analysis of Clinical and Observational Studies - PubMed (nih.gov)

8. Increased Prevalence of Celiac Disease in Patients with Unexplained Infertility in the United States: A Prospective Study (nih.gov)

9. Non-Celiac Gluten Sensitivity: A Review (nih.gov)

10. Zonulin, regulation of tight junctions, and autoimmune diseases (nih.gov)

11. Gluten-Free Diet Indications, Safety, Quality, Labels, and Challenges (nih.gov)