Background
5 to 6 million American women live with Polycystic Ovary Syndrome (PCOS). According to the endocrine society, PCOS affects 7–10% of women of childbearing age and is the most common cause of infertility (Solorzano et al., 2022). PCOS is characterized by consistent inflammation, an irregular menstrual cycle, an excess production of male hormones, cysts formed on the ovaries (which cause pain in the uterine area), and dysbiosis. Dysbiosis is defined by an imbalance in bacterial makeup, changes in bacterial metabolic activities, or changes in distribution of bacteria within the gut. It is involved in the process by which many diseases develop or progress (“pathogenesis”). There are three types of dysbiosis according to a study in an Irritable Bowel Syndrome (IBS) journal: 1) Loss of beneficial bacteria, 2) Overgrowth of potentially pathogenic bacteria, and 3) Loss of overall number of species of bacteria (DeGruttola et al., 2016).
The image below from an article on the interaction between “Probiotics and PCOS” provides a visualization into what kind of factors may create ‘dysbiosis’ in the body.
A 2023 study by Sun et al. on the progression and clinical applications of gut dysbiosis in PCOS states that a large amount of studies demonstrated that the millions of bacteria that reside in the digestive tract (the “gut microbiome”) could regulate the synthesis and secretion of insulin, affect sex hormone metabolism and uterine follicle development (Sun et al., 2023). Due to the damage dysbiosis can cause, researchers have been on the hunt for something to bring the gut back to a stable, healthy state. It’s known that probiotics have hit the mainstream, with women being encouraged to eat a lot of yogurt to ‘balance their pH’, drink apple cider vinegar to ‘make them smell better’, and drink kombucha to make their stomach hurt less. Influencial celebrities advertise healthy ‘prebiotic’ sodas such as “olipop” and “poppi”. This is based on knowledge that the health of our gut microbiome affects many interconnected systems within our body, especially our reproductive systems (Sun et al., 2023 & Gersh, 2017).
In a 2023 paper reviewing microbiome-related probiotic science and its correlation to PCOS, beneficial effects of probiotics/symbiotic supplementation have been found on the hormonal and metabolic profiles of inflammatory conditions (Calcaterra et al., 2023). PCOS is a life-long disease. There is only remission of symptoms, as opposed to full recovery we may see in other illnesses (Solorzano et al., 2022). This makes it all the more important to alleviate any symptoms (such as inflammatory symptoms) experienced by PCOS patients, as opposed to focusing on whether or not a certain practice will ‘cure’ the illness outright.
Central topic
In a 2023 Turkish study, the researchers aimed to examine the question- does kefir, a fermented milk beverage that is cultured with live probiotics, effect the intestinal microbiota and health outcomes in women with PCOS?
Evidence
In 2023, Daziroglu et al. took 17 women between ages 18-40 with Body Mass Index (BMI) values falling above underweight but below obese. The team asked the women to consume 250 mL of “traditional kefir” daily for 8 weeks. During the microbial fermentation of kefir, several organic compounds, such as antibiotics, carbon dioxide, vitamins (B1, B12), as well as amino acids and calcium peptides are produced. Fecal and blood samples were taken at the beginning and end of the study, which provided information on the womens’ microbial makeup and level of dysbiosis.
The Turkish researchers found that kefir consumption significantly improved mental health and physical function quality of life scores via a self-reported survey. This survey was filled out by the participants at the beginning and end of their kefir ‘treatment’, to display improvements or declines in their personal feelings of mental and physical wellbeing. Scores were given on 8 factors: social function, physical function, pain, physical role limitation, emotional role limitation, mental health, vitality (energy), and general perception of health.
The team also interestingly found significantly reduced levels of an inflammatory immune system protein named IL-6 in the subjects, when compared to their levels at the beginning of the 8-week study. IL-6 is a key part of the body’s defense against infections, but it also is involved in chronic inflammation, which is linked to autoimmune diseases. Therefore, the reduced levels of IL-6 in the body of someone who has PCOS can be very helpful in easing their inflammatory discomfort. At the same time, a decrease in IL-6 can decrease beneficial inflammatory responses in the body as well, so this finding is useful to be aware of.
No change was observed in intestinal barrier permeability in the subjects, via measuring levels of the protein zonulin in the blood, which regulates the tight junctions in the gastrointestinal tract (Szymanska et al., 2021). This indicates that the kefir did not improve or damage the system in the body that allows nutrients, water, and ions to pass through while keeping pathogens and toxins out. An improvement in the health and function of the intestinal barrier was something the researchers were expecting to see with kefir consumption.
Gut microbiome analysis after the 8 weeks showed an increase in abundance of the bacterial class Bacilli and genus Lactococcus while the genus Holdemania decreased, when compared to the abundance of these bacteria in the gut before kefir consumption. A paper studying Bacillus as a potential probiotic treatment cites Bacillus’ ability to produce numerous antimicrobial compounds, secretory proteins, enzymes, antioxidants that can help protect cells from damage (Elshaghabee et al., 2017). The genera Bacillus and Lactobacillus, two representatives of the Bacilli class, can considerably affect both the whole body and the intestinal microbiota because of the wide range of compounds they secrete despite their small proportions in the microbiome composition. When Lactobacillales are broken down, they become lactic acid bacteria, which are significant for the intestinal microbiome. These bacteria provide anti-hypertensive, anti-inflammatory, and anti-diabetic effects on the consumer. Another member of this class, the Lactococcus species, is widely found in fish, other animals, and plants and is found in the normal bacterial makeup of the gastrointestinal tract. This bacteria is accepted as beneficial and harmless because of its probiotic properties (Onyeaka et al., 2022).
No damages to the health or overall wellbeing of the subjects was indicated after this dietary transition. After collecting this information, it seems as though all signs point to encouraging more probiotic consumption as there is large benefit to mental health, physical activity, an increase in Bacillus and Lactococcus bacteria after the 8-week treatment, and minimal to no harm. Probiotic foods such as kefir or fermented teas are very accessible across the world, especially compared to medications both over or under the counter. Kombucha, sauerkraut, kimchi, pickles, tempeh, sour cream, buttermilk, and of course yogurt and kefir can all bring benefits to your microbiome. Foods which advertise “live active cultures” and have not been cooked or heated (which would kill off the good bacteria) are what to look for if searching for probiotic nutrients.
In an Italian study regarding the relationship between probiotics and PCOS in adolescents with obesity, the effectiveness of probiotics/synbiotics in PCOS has been supported throughout (Calcaterra et al., 2023). Probiotic and symbiotic supplementation may balance hormonal profiles, inflammatory indicators, and lipid metabolism disturbances caused by the disease. PCOS is an obesity-related condition and its effects are heightened by obesity in its patients. The disease can also increase risk for type 2 diabetes, hypertension, insulin resistance, and cardiovascular diseases. This makes the push to make dietary improvements in PCOS patients all the more crucial. Increases in Vitamin E and Vitamin C are also vital in the diet of someone with PCOS, as low levels of these antioxidants are seen in patients (Calcaterra et al., 2023).
Further areas for research
After discovering a link to improvement in PCOS symptoms after only a short period of regular kefir consumption, this drives curiosity to what differences long-term consistent consumption of probiotics can do for the dysbiosis of the gut microbiota. Furthermore, reproductive health studies are tragically low for the importance that reproductive health holds in half of the entire world population. A long-term probiotic consumption study that involves a large, racially and anthropomorphically diverse population of individuals with ovaries, spanning across all continents of the world would prove tremendously insightful, and would likely bring a lot of relief to individuals around the world. This diversity would cause this data to be more applicable to the treatment of PCOS in a greater population.
Further reading
On the short-form video sharing social media TikTok, a husband gained a large following by posting videos of him making his wife very specific meals that included certain vitamins and minerals on the days she needed them most, to regulate her menstrual cycle following their struggles with infertility due to her PCOS diagnosis. These videos were incredibly insightful, sweet, and ultimately successful. The couple conceived and brought to full term their first child throughout their journey, and have another one on the way. This journey highlighted how much food and centering nutrients around the intricacies of your microbiota can heal many health struggles. The husband ultimately published a cookbook that details what meals to make someone with ovaries on certain sections of their menstrual cycle, to provide them the essential nutrients their body functions require most at that time, to keep them feeling their best.
According to the childrens’ hospital of Philadelphia, Probiotic foods can even be made in most households with what people already have, such as dairy milk, tea leaves or vinegar to ferment vegetables. If its long-term health benefits can be proven with evidence grounded in healing and balancing the gut microbiota, this would be an incredibly helpful mode of preventative medicine across the world for reproductive health, obesity prevention, and overall well being.
There is a relationship between sex hormones and the gut microbiota. This is a link that concerns men and women all around the world pursuing balancing out the dysbiosis of their gut microbiota. A vegan diet is recommended by Felice Gersh, MD, as it is “rich in natural fibers” and the vegan diet frequently contains “estrogen-like products” such as soy and flax seeds that can return the “synergy” of estrogen in the microbiome (Gersh, 2017). This in turn may relieve PCOS symptoms suffered due to dysbiosis within the gut.
Sources
Çıtar Dazıroğlu, M. E., Acar Tek, N., Cevher Akdulum, M. F., Yılmaz, C., & Yalınay, A. M. (2024). Effects of kefir consumption on gut microbiota and health outcomes in women with polycystic ovary syndrome. Food Science & Nutrition, 12, 5632–5646. https://doi.org/10.1002/fsn3.4212
Christine Burt Solorzano, M.D., David Ehrmann, M.D., Ricardo Azziz, M.D., MPH, Endocrine Society (2022).”Polycystic Ovary Syndrome | Endocrine Society.” Endocrine.org, Endocrine Society, 24 September 2024, https://www.endocrine.org/patient-engagement/endocrine-library/pcos
Calcaterra, V., Rossi, V., Massini, G., Casini, F., Zuccotti, G., & Fabiano, V. (2023). Probiotics and Polycystic Ovary Syndrome: A Perspective for Management in Adolescents with Obesity. Nutrients, 15(14), 3144. https://doi.org/10.3390/nu15143144
Gersh, Felice. “New Paradigms In Understanding PCOS: Impact of the Microbiome.” YouTube, Genova Diagnostics, 24 Mar. 2017, www.youtube.com/watch?v=BJXMYJQ8NJQ.
The Children’s Hospital of Philadelphia “Food as Medicine: Probiotic Foods.” Children’s Hospital of Philadelphia, Children’s Hospital of Philadelphia, 2024, www.chop.edu/health-resources/food-medicine-probiotic-foods .
DeGruttola, A. K., Low, D., Mizoguchi, A., & Mizoguchi, E. (2016). Current Understanding of Dysbiosis in Disease in Human and Animal Models. Inflammatory bowel diseases, 22(5), 1137–1150. https://doi.org/10.1097/MIB.0000000000000750
Sullivan, Tom, and Rachael Sullivan. Meals She Eats: Empowering Advice, Relatable Stories, and over 25 Recipes to Take Control of Your PCOS. Alpha Books : DK Publishing, 2023.
Sun, Y., Gao, S., Ye, C., & Zhao, W. (2023). Gut microbiota dysbiosis in polycystic ovary syndrome: Mechanisms of progression and clinical applications. Frontiers in cellular and infection microbiology, 13, 1142041. https://doi.org/10.3389/fcimb.2023.1142041
Szymanska, E., Wierzbicka, A., Dadalski, M., & Kierkus, J. (2021). Fecal Zonulin as a Noninvasive Biomarker of Intestinal Permeability in Pediatric Patients with Inflammatory Bowel Diseases-Correlation with Disease Activity and Fecal Calprotectin. Journal of clinical medicine, 10(17), 3905. https://doi.org/10.3390/jcm10173905
Elshaghabee, F. M. F., Rokana, N., Gulhane, R. D., Sharma, C., & Panwar, H. (2017). Bacillus As Potential Probiotics: Status, Concerns, and Future Perspectives. Frontiers in microbiology, 8, 1490. https://doi.org/10.3389/fmicb.2017.01490
Helen N. Onyeaka, Ozioma F. Nwabor, Chapter 11 – Lactic acid bacteria and bacteriocins as biopreservatives, Editor(s): Helen N. Onyeaka, Ozioma F. Nwabor, Food Preservation and Safety of Natural Products, Academic Press, 2022, Pages 147-162, ISBN 9780323857000, https://doi.org/10.1016/B978-0-323-85700-0.00012-5