Polycystic Ovary Syndrome (PCOS) is a complex hormonal condition affecting a significant percentage of reproductive-age women. Living with PCOS often feels like a balancing act, with hormones fluctuating and metabolism in flux. While strategies like diet changes, regular exercise, and mindfulness are commonly recommended, emerging research highlights the potential role of the gut microbiome in managing PCOS symptoms, including weight loss. This article explores the intricate relationship between gut health, probiotics, and PCOS, providing insights into how probiotics may support weight management and overall well-being for individuals with PCOS.
PCOS and Gut Health: A Complex Relationship
The gut microbiome, a large community of microbes residing in our gut, plays a pivotal role in human health. These microbes contribute to protection against infections and regulation of the immune system. The relationship between the gut microbiome and PCOS is complex, with studies revealing an altered composition of the gut microbiome, known as dysbiosis, in individuals with PCOS. This dysbiosis often manifests as reduced diversity in the types of microbes, with fewer beneficial bacteria and a higher abundance of unhealthy bacteria.
In 2012, it was suggested that an increase in unhealthy bacteria in the gut might activate the immune system, triggering inflammation and contributing to PCOS symptoms like ovarian dysfunction and insulin resistance. Therefore, nurturing gut health emerges as a crucial aspect of PCOS management.
Prebiotics and Probiotics: Fueling a Healthy Gut
To understand how to support gut health, it's essential to distinguish between prebiotics and probiotics. Prebiotics are plant fibers and carbohydrates that the human digestive system cannot break down. These fibers serve as an energy source for the bacteria in our gut, promoting the growth of beneficial bacteria and improving digestive function. The fermentation of these carbohydrates also produces short-chain fatty acids, which have beneficial effects on the immune, nervous, and gastrointestinal systems.
Probiotics, on the other hand, are live microorganisms, including bacteria and yeasts, that naturally reside in the body and benefit the gut. Probiotics can be obtained through diet or supplements, helping to maintain the balance of the microbiome by increasing the number of beneficial bacteria. Probiotics can be particularly helpful during illness or treatments that disrupt the natural balance of the microbiome.
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The Potential Benefits of Probiotics for PCOS
The altered composition of the gut microbiome associated with PCOS may lead to increased inflammation and the development of insulin resistance. Increasing probiotic intake through diet and supplements may help manage PCOS symptoms by restoring the natural balance of the microbiome. Evidence suggests that taking probiotics for at least 12 weeks could improve metabolism, reduce androgen levels, and decrease inflammation in women with PCOS.
Emerging research has shown probiotics to be effective at improving many aspects related to PCOS such as cholesterol, insulin, testosterone, and inflammation.
In a randomized, double-blind, placebo-controlled trial, 60 PCOS patients were randomized into two groups to receive either probiotic capsules (n = 30) or placebo (n = 30) for 12 weeks. Compared with the placebo group, taking probiotic supplements resulted in a significantly reduced BMI, lower serum insulin and lower blood lipid levels.
Another randomized double-blind controlled experiment confirmed that compared with the placebo group, probiotic supplementation with Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium bifidum significantly increased serum levels of sex hormone-binding globulin (SHBG), reduced total serum testosterone levels, reduced modified Ferriman-Gallwey (mFG) scores, and improved chronic inflammatory states as indicated by decreased levels of serum high-sensitivity C-reactive protein (hs-CRP) and malondialdehyde (MDA) concentrations.
A landmark 2020 systematic review and meta-analysis in the European Journal of Nutrition analyzed nine randomized controlled trials on probiotics and synbiotics for PCOS. The study found that supplementation was linked to real improvements, including:
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- Metabolic Health: Improvements in fasting glucose, insulin, and insulin resistance (HOMA-IR).
- Hormonal Balance: Lower total testosterone levels.
- Inflammation: Positive changes in inflammatory markers like hs-CRP.
- BMI: A modest drop in body mass index.
Probiotics and Weight Loss in PCOS
While probiotics are not a direct weight-loss tool, research suggests they may indirectly contribute to weight management in PCOS. The 2020 meta-analysis mentioned above found that probiotic supplementation was associated with a reduction in BMI. This may be due to improved metabolic health, such as better insulin sensitivity and reduced inflammation, rather than a direct impact on weight.
Dietary Sources of Prebiotics and Probiotics
While probiotic supplements are readily available, incorporating prebiotics and probiotics into the diet is crucial for optimizing gut health. Probiotics are naturally found in fermented foods, while prebiotics are abundant in various fruits, vegetables, and whole grains.
Foods Rich in Probiotics:
- Yogurt
- Kefir
- Sauerkraut
- Kimchi
- Kombucha
Foods Rich in Prebiotics:
- Apples
- Asparagus
- Bananas
- Barley
- Beans
- Berries
- Garlic
- Green leafy vegetables
- Oats
- Peas
Some fortified foods, such as breads and cereals, may also contain added prebiotic compounds like galacto-oligosaccharides (GOS), fructo-oligosaccharides (FOS), oligofructose, chicory fiber, and inulin.
Choosing the Right Probiotic Supplement for PCOS
Selecting the best probiotic for PCOS can be tricky, given the wide array of supplements on the market. Here are some factors to consider:
- Colony forming units (CFU): The higher the number of bacteria per dose, the better.
- Number of bacterial strains: Supplements containing multiple strains may be more beneficial.
- Clinically-studied strains: Look for strains or brands proven effective in PCOS research. Common species studied in PCOS trials are usually from the Lactobacillus and Bifidobacterium genera-especially Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium bifidum, and L. rhamnosus.
- Storage information and expiry date: Store supplements as recommended and use before the expiry date.
- Survivability: The bacteria need to survive stomach acid to reach your gut. Look for delivery technologies that keep them alive until they get where they’re needed.
- Transparency: Good brands share their testing and results.
A recent review examined the effect of different bacterial strains on PCOS and found various effects:
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- L. casei, L. acidophilus, L. rhamnosus, L. bulgaricus, B. breve, B. longum, and Streptococcus thermophiles led to lower levels of insulin.
- Bifidobacterium and Lactobacillus lowered testosterone levels and reduced hirsutism.
- Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus fermentum, and Lactobacillus gasseri improved inflammation.
Probiotics: Friendly Guests, Not Lifelong Residents
It's important to remember that probiotics don't permanently colonize the gut. Instead, they act as temporary residents, interacting with the existing gut microbiome, immune cells, and gut lining. To maintain their beneficial effects, consistent daily intake is necessary.
Probiotics as Part of a Holistic PCOS Management Plan
Probiotics can be a valuable tool in managing PCOS, but they are not a standalone solution. For optimal results, combine probiotics with a balanced diet rich in fiber, regular physical activity, and stress management techniques.
The Gut-Ovary Axis: How Your Gut Influences PCOS
Research reveals that the gut and ovaries are constantly communicating through the "gut-ovary axis" (or gut-gonadal axis). The gut microbiome is involved in several pathways that matter for PCOS, including:
- Inflammation: PCOS is often characterized by chronic, low-grade inflammation. The gut microbiome acts as an immune system gatekeeper, and imbalances can lead to a leaky gut barrier, allowing inflammatory molecules to escape into the bloodstream.
- Insulin Resistance: Certain microbes can help regulate how the body processes and stores energy, and dysbiosis might increase the risk of insulin resistance.
- Androgen Levels: The gut has a direct line to hormone regulation, especially androgens. Some bacteria make enzymes that affect how hormones are circulated and broken down. Women with PCOS often have a different gut microbiome than those without PCOS, and these shifts are linked to higher androgen levels.
The Gut Microbiota and PCOS: A Deeper Dive
The gut microbiota includes diverse bacteria, archaea, viruses, fungi, protozoa, and their metabolites, which have gradually adapted to live on the mucosal surface of the intestine or in its lumen. It plays a key role in host physiology, immune regulation, gastrointestinal epithelial barrier function, endocrine system, host metabolism, and production of vitamin B12 and short-chain fatty acids (SCFAs) via fermentation and neurological functions.
Dysbiosis may constitute a background for many metabolic and cardiovascular abnormalities. It also leads to a decline in estrogen-metabolizing bacteria and consequently decreases concentration of circulating estrogens, which may have serious health consequences.
Specific changes include reduced beneficial bacteria like Lactobacilli and Bifidobacteria and increased pathogenic bacteria like Escherichia and Shigella. Studies have shown that women with PCOS have lower microbial diversity in the gut compared to healthy controls.
Dysbiosis and its Impact on PCOS
Gut dysbiosis increases intestinal permeability, allowing lipopolysaccharides (LPS) to enter the bloodstream and activate immune systems. LPS is created by gram-negative bacteria, which penetrates the “leaky gut” wall and enters the bloodstream, causing chronic low-grade inflammation. Following intestinal mucosal damage, LPS enters the bloodstream and causes endotoxemia. TLR4 recognizes and binds LPS via the LPS binding protein (LBP), CD14, and bone marrow differentiation factor-2 (MD-2). Inflammatory mediators and cytokines may be expressed in response to LPS. The inflammatory response can be triggered by the expression of inflammatory substances such as interleukin 6 (IL-6). Remarkably, IL-6 has been demonstrated to enhance the expression of various enzymes responsible for androgen synthesis, of which CYP17A1 is an important enzyme in the biosynthesis of androgens, such as testosterone. This inflammatory chain is thus connected to elevated testosterone production by the ovaries.
Hormonal Imbalances and the Gut
Sexual hormones, including testosterone, estradiol, and progesterone, are involved in a variety of physiological processes, including inflammation, metabolism, differentiation, cell division, homeostasis, apoptosis and brain function. These hormones also play a part in communication between microorganisms and their hosts. Antibiotic usage is associated with reduced estrogen levels, indicating that intestinal bacteria play an essential role in estrogen metabolism. Also, estrogen levels can influence the status of illnesses and processes such as PCOS, endometrial hyperplasia, and eventually, fertility. Beneficial bacteria, such as Lactobacilli and Bifidobacteria, which improve immunity and absorption of nutrients, are considerably decreased in PCOS patients.
Clinical Studies and Probiotic Supplementation
A study was conducted as a 12-week, randomized, double-blind, placebo-controlled clinical study. The probiotic SanProbi® Barrier capsules, which contain a unique composition of nine probiotic bacteria strains (Lactobacillus and Biffidobacterium), were used in the study. The mean age of the study participants was a mean of 28.42 ± 5.62 years.
A total of 50 women with PCOS, diagnosed based on Rotterdam ESHRE criteria, were included in the study. Among them, 25 women were randomized to a placebo group, and 25 to a probiotic group.
A comparison of changes in individual hormone levels between groups confirmed statistically significant differences for TSH, androstenedione, SHBG, and BMI. In the case of LH, the statistical significance of the difference in delta change in the probiotic group was demonstrated with the use of a one-tailed test. Probiotic supplementation may serve as an alternative supporting treatment, especially in the phenotype of women with a high FAI index.
The study revealed that statistically significant changes occurred only in the probiotic group concerning the following hormones and BMI:
- LH (decrease in concentration; p = 0.0218)
- TSH (decrease in concentration; p = 0.0044)
- Androstenedione (decrease in concentration; p = 0.0038)
- SHBG (increase in concentration; p = 0.0012)
- BMI (decrease; p = 0.0198)
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