Is PCOS an Autoimmune Disease?- A Functional Dietitian Talks

This attack process is autoimmunity– “auto” meaning “self”, so effectively your body’s own immune system is attacking your own body tissues. 

The immune system’s role is to protect the body. So why in the world would your body do this to itself?!? The answer is that there must be underlying dysfunction that is provoking changes in the immune response. And if we can get to the root, we can change it. That’s the beautiful hope of a good functional medicine approach. 

What causes autoimmune disease?

Many conventional healthcare outlets still report that the causes of autoimmune disease are still unknown. However, many practitioners of functional medicine and other researchers agree that there are at least three necessary factors that occur together to initiate autoimmune disease. 

These 3 mechanisms of autoimmunity are: 

1. Genetic predisposition
2. Environmental triggers
3. Intestinal permeability (also known as “leaky gut”)

Let’s dig into each of these 3 mechanisms. 

Genetic predisposition

Everyone has genetic variations that get passed down through generations and evolve over time. These variations in genes are often in the form of single nucleotide polymorphisms, or SNPs (pronounced “snips”). 

While certain SNPs may yield a greater likelihood of certain health conditions, it is the environmental factors that initiate or augment the activation of self-reactive immune cells. I like to say that genes are like a light switch– we can turn them on or keep them turned off by the way we eat and the lifestyle we live. 

Environmental triggers

The body likes to keep in balance, or “homeostasis”, and works to do so on a daily basis. I call this control the “checks and balances”, ensuring the multitude of processes remain controlled and stabilized. When certain environmental triggers occur, especially over the long term, they can cause an overwhelm of the defense systems of the body, which in turn can lead to dysregulation of our body’s control systems. 

Examples of environmental triggers include infection, severe stress like physical or psychological trauma, chronic stress, chronic sleep deprivation, chronic high blood sugar levels, and more. 

When the stress of environmental triggers throws control systems out of balance, the immune system is less able to properly respond. We can get sick and sometimes even our body’s own immune system starts to attack itself in the process of autoimmunity.

Intestinal permeability, aka “Leaky Gut”

The stress described above can dysregulate the entire body. This dysregulation can then impact the gut through reduced stomach acid and enzyme production, leading to poor digestion and risk for bacterial and other microbial overgrowth. 

First, let’s describe how the gut should work, so we understand how it can go awry. In a healthy gut, the cells of the gut lining are tightly connected together to create a strong, impermeable lining. The only particles that can get through are those that go through the proper checkpoints in our gut cells in order to cross to the other side into our bloodstream. It’s like the TSA of our gut. 

When dysregulation in the body disrupts digestion and gut bacterial imbalance, if not addressed soon enough, the imbalance in the gut can eventually lead to intestinal permeability, also known as “leaky gut”. 

This permeability of the intestines can result in partially undigested food particles leaking into the bloodstream. In the blood, the immune system may see these food particles as foreign cells and mount an immune response against them. 

Unfortunately, the tissues of our own body often get attacked at the same time, leading to the many symptoms of autoimmunity. Molecular mimicry can also occur, in which certain food particles might look similar enough to our own bodily tissues, and so the immune system attacks those tissues. Research suggests that this is the case in the autoimmune disease Hashimoto’s thyroiditis, in which gluten mimics the chemical structure of the thyroid gland, leading to an attack of the gland. 

Other contributors to leaky gut may also include nutrient-poor or inflammatory diet, overuse of antibiotics and some other medications, and lack of sleep. 

 

What causes PCOS?

How might PCOS fit into the picture of autoimmune disease? We need to first understand what’s really going on in PCOS. 

Important point to remember: PCOS is not typically caused by reproductive hormone imbalance. But the drivers of PCOS can cause reproductive hormone imbalance as a result.

This may seem subtle, but it’s a crucial paradigm shift. We need to shift the focus of PCOS from treating the symptoms (like reproductive hormone imbalance) and rather to identifying and addressing the root causes. These are the drivers of PCOS that we’ll discuss below.

PCOS is actually better defined as a metabolic condition, meaning that there is dysfunction in the body’s metabolism, which is the collective processes that utilize fuel for energy. There is a pattern of factors that contribute to this metabolic dysfunction. 

The main drivers of PCOS include: 

• Insulin resistance
• Inflammati0n
• Gut health imbalances
• Genetic predisposition

We’ll cover each of these drivers next. 

 

Insulin resistance and PCOS

Insulin resistance occurs in up to 75% of lean women with PCOS, and up to a whopping 95% of women with PCOS struggling with being overweight, according to the 2018 report by Monash University. Those are very telling stats! 

In brief, insulin resistance first occurs as blood sugar imbalances, which causes spikes in insulin. These high levels of insulin are what can promote weight gain in PCOS. 

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With continued blood sugar and insulin spikes and often increasing body fat, insulin resistance can occur. This is a process in which the cells no longer respond efficiently to the promptings of insulin, requiring the body to produce even more insulin to get the job done. It’s an unfortunate, vicious cycle. But it’s also absolutely addressable. And I work with women to reverse insulin resistance every day. 

This cellular miscommunication, if you will, can also cause disruption in the ovaries (as well as many systems in the body), leading to the various reproductive hormone imbalances common in PCOS. I have heard it said that PCOS is basically “diabetes of the ovaries”– perhaps not fully accurate but also not too far from the truth either. 

I go into much more detail on this topic in an article I wrote for Natural Womanhood as well as in an interview on their podcast episode PCOS & Nutrition. 

Inflammation and PCOS

Inflammation, like insulin resistance, creates havoc in the body, including similar cellular miscommunication. While inflammation is actually an essential mechanism for repair in the body, the process becomes problematic during chronic inflammation. 

Causes of inflammation can be numerous, including but not limited to:

• Inflammatory diet, like excess intake of sugar, refined carbs, highly processed oils, and highly processed foods
• Nutrient-poor diet, leading to nutrient deficiencies that disable the body from properly regulating inflammation
• Unaddressed mental and emotional stress
• Lack of sleep
• Excessive exercise or activity without enough rest and repair
• Gut infections and dysbiosis

Interestingly, high blood sugar and insulin levels alone are inflammatory. Adipose tissue (body fat) can also produce inflammatory compounds. As stated before, blood sugar and insulin imbalances can lead to weight gain. So the crazy thing is that inflammation can actually trigger more insulin resistance and weight gain. 

Inflammation makes everything in your body “upset” and uncooperative, in a sense. 

Gut health and PCOS

Gut imbalances, like infections and dysbiosis, can drive inflammation, which we already know drives the process of PCOS. 

Imbalances in the gut are common amongst women with PCOS. One study found that women with PCOS are four times more likely to have the gut condition called irritable bowel syndrome (IBS) than women without PCOS. 

Research also shows that the gut microbiome has a profound impact on metabolism in the body. Bacterial imbalances in the gut microbiome can unfavorably alter metabolic pathways, potentially leading to blood sugar dysregulation and weight gain. 

Preliminary research by Weill Cornell Medicine suggests that the gut microbiome controls blood sugar levels through changing the way the liver functions. Studies also show that lower diversity in the gut microbiome is associated with higher levels of insulin resistance.

You might be noticing a pattern here that all of these drivers of PCOS don’t exist in isolation– they often exist together and drive the further dysfunction of each other. This makes sense if we are starting to see the body as one whole system working in concert together, rather than separate, isolated systems. 

Genetics and PCOS

I would be remiss if I didn’t mention the role of genetics in PCOS. More research is needed to further understand just how much genetics plays a role. But we do know that PCOS often runs in the female generations of families. However, does this mean that experiencing PCOS is inevitable if your mom and other women in your family have PCOS? Not necessarily. 

This goes back to the idea of genetic predisposition. We can, in a way, turn on genes or turn them off in our body by the diet we eat and lifestyle we live. 

 

PCOS and autoimmune disease- what the current research says

Both PCOS and autoimmune disease have inflammation, stressors, and gut imbalances as key drivers in their processes. These kinds of stressors on the body can all tax the immune system, causing uncontrolled responses, like upregulation of inflammatory cytokines.

The overarching idea here is that if you stress the body too much without enough repair, it’s going to become dysfunctional. Period. 

Current research also backs up the possibility of PCOS as an autoimmune disease. Certain autoantibodies (the immune molecules that attack during autoimmunity) are often present in PCOS, including thyroid antibodies. Studies show that the prevalence of the autoimmune thyroid disorder Hashimoto’s thyroiditis is doubled in the PCOS population compared to women without PCOS. 

The idea that autoantibodies are often present in women with PCOS will likely lead to more research and hopefully better standards of care for PCOS than is the norm in conventional healthcare. 

 

Is PCOS a chronic illness?

PCOS, just like autoimmune disease, is often chronically possible. What I mean is that these conditions can rear their heads if we stop supporting the foundations of our health. As I said about genetic predisposition being like a light switch, we can generally turn on these conditions OR work to turn them off and keep them off. 

Life isn’t perfect. Neither are our actions and behaviors. But we can still find a way to support our bodies as best we can, and give ourselves grace when we don’t do that perfectly. 

 

What we still don’t know about PCOS and autoimmune disease

More research is needed to understand just how much autoimmunity might be perpetuating PCOS. 

But circling back to the three mechanisms of autoimmunity and drivers of PCOS, we know that these conditions are often driven by factors of diet and lifestyle. That’s actually good news. Why? Because that means we can do something about it!

And guess what? There are SO many known things we can do to reverse insulin resistance, reduce inflammation, and heal the gut. 

This is where the beauty of integrative and functional medicine shines. According to the Institute of Functional Medicine, functional medicine is a healthcare approach that “focuses on identifying and addressing root causes of disease.” It recognizes that the body is a collection of many systems working together.

I like to say that our health issues are never simply a factor of just any one “-ology”- cardiology, gastroenterology, gynecology, etc. Instead, a functional approach understands that each symptom or diagnosis is simply one of many contributing to someone’s illness. And so instead of trying to treating or managing each symptom in isolation, we need to address the foundations and common denominators to get to the root.

 

 

Speak with a PCOS specialist today 

Understanding the complexity of the interplay of all of these systems is no small task. Getting the support of a qualified functional medicine practitioner is important. 

If you struggle with PCOS and/or autoimmunity and are ready to get to the root, schedule a free strategy call with Victoria today!

Victoria Peck-Gray is a registered dietitian trained in a functional medicine model. She helps people with PCOS, fertility struggles, gut health issues, weight loss resistance, and autoimmunity identify root causes and adopt the right anti inflammatory diet and lifestyle for them to support their healing. 

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