low fodmap 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 developed an Ebook to help you navigate this diet. Learn more about our Low-FODMAP Food Plan.

low fodmap food plan

Root Low FODMAP Meal Plan

A realistic approach to a low FODMAP diet

Eat a fiber-rich diet

While starving the bad bugs by reducing added sugar, we want to simultaneously feed the good bugs. This is where fiber comes into play. Fiber is the preferred source of fuel for your beneficial gut bacteria. Eating fiber-rich foods with your meals and snacks ensures the survival and growth of good gut bacteria which then provide benefits like reduced inflammation and regular bowel movements. Fiber is also essential in PCOS because it helps to balance blood sugar levels and increases satiety after a meal. You should aim to eat 25 – 35 grams of fiber per day.

Some individuals with IBS may experience worsening GI symptoms when increasing fiber in their diet. In this case, we recommend trialing a low-FODMAP diet or working with your doctor to obtain a test for small intestinal bacterial overgrowth(SIBO). 

Start including some of these high fiber foods into your diet:

  • Non-starchy vegetables: broccoli, Brussels sprouts, cauliflower, carrot
  • Starchy vegetables: potato, sweet potato, winter squash
  • Fruit: apple, banana, blueberries, raspberries, pear, orange 
  • Grains: quinoa, oats, brown rice
  • Legumes, nuts, and seeds: green peas, lentils, black beans, chia seeds, almonds, pistachios

Consider supplements to treat dysbiosis

Your overall diet, as in the foods you eat, plays the most important role in treating dysbiosis and therefore IBS and PCOS. However, we do recommend a few supplements which we have found extremely effective.

Our Gut Health Bundle includes digestive enzymes, a soil-based probiotic to support a healthy microbiome, and our Gut Health Rebalance powder to help reflux, reduce gut inflammation, and repair the gut lining.
gut health supplements

Gut Health Bundle

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Key Takeaways

Up to 40 percent of women with PCOS also suffer from IBS. Dysbiosis is a shared root cause of both of these conditions, and addressing this imbalance of gut bacteria is crucial to find true healing. Removing added sugar, eating a colorful and fiber-rich diet, and taking targeted supplements all help to reverse dysbiosis. Some individuals may also need to trial a temporary low-FODMAP diet to identify food triggers and achieve symptom relief from IBS symptoms.

Get to the Root at Home 

Curious about where you should start your functional medicine journey? 

Take our Get to the Root Quiz so you can start working towards reversing disease and optimizing your health at the Root cause.
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