IBS and PCOS

Irritable bowel syndrome (IBS) and polycystic ovary syndrome (PCOS) are two common conditions that affect many women around the world.

In this article, we’ll discuss how these two conditions are related and why identifying and addressing the root cause can treat both PCOS and IBS.

What is IBS?

IBS is a gastrointestinal disorder affecting up to 20 percent of all people. Individuals with IBS generally have abdominal discomfort multiple days a month for at least three months.

The official diagnosis of this criteria also includes two or more of the following symptoms at least 25 percent of the time:

Improvement in pain when you have a bowel movement
Change in stool frequency (more or less than usual)
Change in appearance (watery or firm/hard)

Common symptoms of IBS include:

Diarrhea, constipation, or a combination
Abdominal pain
Bloating
Gas
Difficulty or straining with bowel movements

Some studies suggest that IBS is actually caused by dysbiosis— an imbalance of gut bacteria. Similarly, small intestinal bacterial overgrowth (SIBO) is also a suspected cause of IBS with one study reporting up to 78 percent of IBS patients also testing positive for SIBO (1).

What is PCOS?

PCOS is the most common metabolic and hormonal disorder in women of childbearing age. Some estimates suggest that PCOS affects up to 20 percent of these women.

Individuals with PCOS generally have at least two of the following:

Biochemical and/or clinical hyperandrogenism (like high testosterone, acne, or facial hair)
Irregular or absent periods
Polycystic ovaries

Common symptoms of PCOS include:

Acne
Hair loss or thinning hair
Unwanted facial or body hair
Irregular periods
Long or absent periods
Weight gain
Difficulty losing weight
Infertility

PCOS is a complex syndrome with multiple root causes like insulin resistance, high testosterone, and dysbiosis.

We often work with women with PCOS and IBS in our functional medicine membership program, where we are able to test labs relevant to PCOS as well as microbiome (gut) testing to truly help you get to the root of your symptoms.

What is the relationship between IBS and PCOS?

An estimated 30 to 40 percent of women with PCOS also have IBS (2, 3). IBS is more common in PCOS than the general population because these two conditions share one major root cause: dysbiosis.

Dysbiosis is an imbalance of gut bacteria in which you have too many bad bacteria, not enough good bacteria, and/or not enough bacterial diversity. A variety of factors cause dysbiosis of the gut including: the standard American diet, alcohol intake, frequent antibiotic use, stress, limited exposure to germs/dirt, and various medications. Left untreated, dysbiosis can damage the gut lining and subsequently cause leaky gut and food sensitivities. Furthermore, some new research suggests that dysbiosis may even cause the insulin resistance, hyperandrogenism, and chronic inflammation seen in PCOS (4).

Some medications prescribed for PCOS, like metformin, cause side effects similar to symptoms of IBS. Interestingly, these side effects may be due to metformin’s influence on the gut microbiome, and some studies suggest this drug may also cause dysbiosis.

I have IBS and PCOS. What now?

Given the major role dysbiosis plays in various health conditions, especially IBS and PCOS, we assess digestion for every single member in our practice. Implementing interventions to treat dysbiosis is essential.

Reduce gut disruptors

Your diet has the largest impact on gut health because these foods come into contact with your gut bacteria multiple times per day. Added sugar disrupts your gut bacteria by feeding the harmful bugs and starving the good bugs. Too much added sugar can also exacerbate PCOS by raising your blood sugar levels and worsening insulin resistance.

Removing added sugar and artificial sweeteners from your diet is key in preventing and fighting against dysbiosis. The largest sources of added sugar in the standard American diet are sugar-sweetened beverages, pastries, and desserts. This is a great place to start. Aim to reduce or remove these items from your diet. Examples of sugar-sweetened beverages include sweetened coffee drinks, soda, juice, and sweet tea. Many beverages contain added sugar even if they are marketed as “healthy” options. Get into the habit of briefly scanning the ingredient label to look for these sneaky sources of sugar. New labeling requirements make this process easier by including a separate line on the nutrition facts label to clearly show how many grams of added sugar are in each serving of the product.

Consider trialing a low-FODMAP diet

If your IBS and gut symptoms are moderate to severe, you may need to trial a temporary low-FODMAP diet. A low-FODMAP diet is a short-term elimination diet that helps you identify which foods worsen your GI symptoms. FODMAP stands for “fermentable oligosaccharides, disaccharides, monosaccharides and polyols.” Essentially, certain foods contain higher levels of FODMAPs that cause your gut bacteria to release excess gas. By eliminating the foods highest in FODMAPs, you may experience less digestive symptoms.

Common foods high in FODMAPs to eliminate on this diet include:

Wheat
Dairy (lactose)
Garlic
Onions
High fructose corn syrup
Fruit juice

The low-FODMAP diet can provide fast relief from your symptoms. However, it is fairly difficult to follow on your own, as many foods contain varying levels of FODMAPs. Fortunately, our registered dietitians can help with this in the Root Membership.

Is functional medicine covered by insurance is a question we get often, and it’s a sensitive subject for many. As I do my best to explain this answer, please know that the model we’ve chosen was what we felt allowed us to provide the best individual care in a holistic functional medicine practice for each person. As with many things in medicine, what’s covered by insurance can change, but at the present time…

Is functional medicine covered by insurance?

Chances are, if you are in a true functional medicine practice where your doctor is practicing in a functional medicine model of care and not a conventional insurance model of care, the most likely answer is no, it’s not covered by insurance.

What’s the difference between the two models of care?

Conventional insurance-based medicine is built around the concept of labeling you with a reimbursable diagnostic code (diagnosis) and then finding the medications or a procedure to match.

A functional medicine model of care works through the functional medicine matrix, balances imbalances, considers the connection of mind and body, and often can’t label your symptoms with a single diagnostic name because body systems communicate. We remove the artificial silos of body parts into specialty areas of conventional medicine and consider you as a whole person, mind and body, with communicating body organs/systems. The core of functional medicine is finding the why, or the root cause, and simply operating in a diagnosis to medication model doesn’t fit.

In addition, if your doctor is spending enough time with you (both in person and afterwards researching your unique case) to get to the root of your issue, using advanced testing that takes more time and knowledge to interpret, and then personalizing your treatment plan to include natural therapies, the most likely answer is no, it’s not covered by insurance.

Many treatments in functional medicine are considered “alternative” because they don’t involve a medication for symptoms, but rather supplement an individual’s unique needs. Functional medicine doctors understand that what works for you might not work for the other 99 people in the study, because you have a unique genome, microbiome, and lifestyle – factors that aren’t considered in mainstream medicine recommendations.

So, a true functional medicine approach doesn’t often work with insurance. However, here’s why that can be a good thing:
Insurance-free practices allows for:

Advanced care. Being “insurance-free” allows doctors to recommend the most advanced therapies and testing. One study showed that conventional doctors took an average of 17 years to change behavior, from the time of new scientific information (1). The insurance model keeps doctors stuck in the current “standard of care” because that is often what is reimbursed, even if that standard of care is outdated. Insurance covers what they can easily track (expense to benefit) and unfortunately one of the easiest things to track is medication. Medications are also easier to study because it’s one intervention and not a more difficult to measure multi-factorial approach of lifestyle and natural therapies. (Not to mention medication studies have more funding). Yes, medications can be life-saving and necessary and as an MD I still prescribe them, but it is only part of our treatment plan.
Personalized care. In functional medicine, we base treatments on the best possibilities for an individual with a unique genome, microbiome, and lifestyle, instead of basing our treatments simply on what the insurance company tells us they’ll pay for. Read one of our member's stories here.
Time. Insurance reimburses doctors’ visits that typically last about 15 minutes. We often spend over an hour with our new members, getting a comprehensive assessment. We have to know what is going on in your life before we can improve it.
Flexibility. There are no restrictions with where or how your care can be given. Being completely virtual keeps people on track for the long term via home, travel, and work. We can meet patients where they are.
1:1 personal relationship. There’s no one in between your doctor and you. It’s a true partnership. Your doctor is only working for you. He or she is not caught in a triangle between you, insurance, and administration.
No barriers to seeking care and support when you need it. There are no penalties for seeing us (like co-pays). In our model, we expect to see our patients frequently so that we can help them through the healing process.
Transparency. There’s no guessing game of what’s covered, surprise lab bills in the hundreds of dollars for necessary tests that you felt should be covered. We spell out lab costs, decide together which tests are important and let you know the worst case pricing if the insurance doesn’t cover. We also offer much lower, direct pay pricing on many common labs.

But, functional medicine is expensive, right?

First, we consider functional medicine an investment over an expense. Working to transform your lifestyle and health will continue to reward you over your lifetime.

Functional medicine is not more expensive than repeat colonoscopies, ongoing work-ups with no answers and expensive imaging, “blockbuster medications” that only increase in dose and number, or an emergency that could have been prevented.

We see people from all walks of life, including hard working people on a fixed budget. They are willing to invest in their health and to them, it’s more of a priority decision than a cost decision. They’d rather not wait and keep doing the same things, taking the same medications, but expecting a different result. The upfront investment they make both financially and effort-wise often completely change the course of their health over their lifetime.

We still absolutely encourage our patients to have insurance, especially for acute medical needs. And although we don’t work with insurance directly, we offer several options for accessing our functional medicine protocols at various price points.

Root Access Membership. Order your own labs at very competitive prices and get insights from our team on your results. With Root Access, taking charge of your health through a root-cause, data-driven approach has never been easier. Everything from our curated lab panels to meal plans, educational videos, and monthly Root Talks is created by our in-house functional medicine doctors and dietitians.
Root supplements. These are professional grade, third-party-tested supplements that we actually use in practice, available to you now. We test levels in real people and see the results in real life from our supplements. We even created bundles using some of our popular protocols, such as our gut health bundle, so that anyone can access a gut healing regimen.
HSA/FSA dollars are often able to be used for our medical and dietitian consults (check with your carrier). This can give you more control over your health care dollars. Now, as many insurance plans have higher deductibles, many employers offer HSAs as part of the health plan.
The savings we are able to pass on to patients on direct lower cost conventional labs can offset the total cost of functional care.

Gut Health Bundle

Our 3 most popular gut health supplements, bundled together for a 10% savings.

$163.80

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IBS and PCOS

What is IBS?

What is PCOS?

What is the relationship between IBS and PCOS?