Hormone and immune health guide

Polycystic ovary syndrome (PCOS) is a hormonal condition that can affect your health and appearance. In the US, it affects 5–10% of women aged 15–44; most women are diagnosed in their 20s or 30s.^[2]

• Irregular menstrual cycles^[2]
• Excess hair on the face, chin or body^[2]
• Acne on the face, chest and upper back^[2]
• Thinning hair or hair loss^[2]
• Weight gain or trouble losing weight^[2]
• Darkening skin in the creases of the neck, in the groin and under the breasts; skin tags in the armpits or on the neck^[2]

According to the 2023 International Evidence-based Guideline for PCOS, a diagnosis requires two of these three findings: signs of excess androgens on examination or in a blood test, problems with ovulation, and a polycystic ovary appearance on ultrasound. In adults, an AMH test can be used instead of ultrasound. Other causes of similar symptoms need to be ruled out.^[1]

Insulin resistance is one of the factors that play a role in how PCOS develops. The guideline notes that the insulin measurements used in clinics are of limited value and recommends that they not be used in routine care.^[1]

Over time, insulin resistance can lead to type 2 diabetes. More than half of women with PCOS develop diabetes or prediabetes before age 40.^[2]

The guideline recommends healthy lifestyle habits, including healthy eating and physical activity, for all women with PCOS. The aim is to support overall health, quality of life, body composition and weight management (keeping weight stable, preventing weight gain or modest weight loss). Lifestyle management is the core focus of PCOS care.^[1]

• There is no evidence that one type of diet is better than another. Any eating pattern that follows the healthy eating principles recommended for the general population has health benefits.^[1]
• Eating should be planned flexibly and together with you, based on your preferences and goals; unnecessarily restrictive and unbalanced diets should be avoided.^[1]
• A healthy lifestyle has benefits even without weight loss.^[1]
• Adults should aim for at least 150–300 minutes of moderate-intensity activity or 75–150 minutes of vigorous-intensity activity a week, plus muscle-strengthening exercise on 2 non-consecutive days. Cutting down on time spent sitting is also recommended.^[1]
• Many women with PCOS experience weight stigma in health care; the guideline asks health professionals to be mindful of this.^[1]

In autoimmune diseases, the immune system mistakenly attacks healthy cells in the body's own organs and tissues. Type 1 diabetes, rheumatoid arthritis, autoimmune hepatitis and alopecia areata are examples. Treatment depends on the disease and, for some diseases, may be lifelong.^[3]

The role of nutrition varies from one disease to another. Below, you will find what the sources recommend for two diseases linked to the immune system.

Celiac disease is a chronic digestive and immune disorder that is triggered by foods containing gluten and damages the small intestine.^[4]

• In celiac disease, a gluten-free diet should be followed for life: wheat, barley, rye and ingredients made from them, such as malt and malt extract, are removed from the diet.^[5]
• Most people with celiac disease can safely eat moderate amounts of oats labeled gluten-free.^[5]
• A gluten-free diet started without guidance may fall short on nutrients such as fiber, iron and calcium; some packaged gluten-free products can be higher in fat and sugar. A dietitian can help you put together a gluten-free, healthy eating plan.^[5]
• Starting a gluten-free diet before celiac testing is not recommended; a gluten-free diet can affect test results.^[6]

Hashimoto's disease is an autoimmune disease that can lead to hypothyroidism (an underactive thyroid gland). The thyroid gland uses iodine to make hormones; however, people with Hashimoto's may be sensitive to the harmful effects of iodine. Foods high in iodine, especially seaweed such as kelp, or iodine supplements can cause hypothyroidism or make it worse.^[7]

Researchers are studying how nutrients and supplements such as selenium and vitamin D may affect Hashimoto's disease, but there are no specific recommendations at this time. If you take iodine supplements, or you wonder whether you need to limit certain foods, talk with your health care team.^[7]

• Dietary supplements can interact with the medicines you take. Being “natural” does not mean a product is safe.^[8]
• What the label says may not always match what is in the product.^[8]
• If you are pregnant or breastfeeding, have a chronic condition or take medicines, talk to your doctor before taking a supplement.^[9]
• When choosing a vitamin or mineral supplement, take into account the amount you get from food; avoid amounts above your daily needs, and avoid going beyond the length of use or serving size recommended on the label.^[9]
• If you use complementary products such as inositol for PCOS, tell your health professional. Because there is no good-quality evidence, the guideline does not recommend any specific type, dose or combination of inositol.^[1]

From a functional medicine perspective, I look at your diet and lifestyle alongside your symptoms to try to understand the underlying causes. I offer counseling in person and online; my priority throughout is supporting gut health.

My services in this area include nutrition for PCOS, nutrition for autoimmune diseases, and guidance on dietary supplements. I prepare a medical nutrition protocol tailored to you and help you make healthy habits part of your daily life.

A nutrition plan does not replace the treatment your doctor recommends; it works alongside it. Talk to your doctor about any change to the medicines you take.