Insulin resistance PCOS
Polycystic ovarian syndrome (PCOS) is a common hormonal condition. The symptoms of PCOS are related to anovulatory cycles (no ovulation) and androgen excess (high levels of male hormones, such as testosterone). The main symptom of PCOS is irregular periods, due to the lack of ovulation. No ovulation can result in an overproduction of androgens which is what can drive other common symptoms, such as; excessive body hair, acne, weight gain (especially around the belly), and hair loss on the scalp. There are 4 types of PCOS, and insulin resistance PCOS is the most common type.
If you have PCOS it is likely that you are insulin resistant. Approx 80% of women with PCOS are (1).
What is insulin resistance?
Insulin is a hormone that regulates blood sugars - it helps your body utilise sugar for energy. Insulin is released by the body in response to glucose (sugar) - it takes the glucose out of the bloodstream and into the cells to be used as energy. Our brains and muscles rely on glucose to function, so it is important that glucose is utilised properly. Insulin is basically a messenger telling the cells to open a door to allow glucose to enter. Insulin resistance is a hormonal condition where you have too much insulin. Having too much insulin, or being resistant to insulin means that the cell doesn’t allow glucose in. This results in more sugar remaining in the bloodstream, as well as too much insulin circulating.
Too much insulin can disrupt ovulation and cause the ovaries to make testosterone instead of oestrogen - this is what drives insulin resistant PCOS.
You can have normal blood sugars, and still have too much insulin. The best way to determine if you are insulin resistant is to do a blood test measuring insulin not glucose. High insulin is what can cause high androgens and high androgens is what drives PCOS symptoms. Insulin resistance can be caused by genetic, environmental and lifestyle factors. Too much sugar can induce insulin resistance. Being overweight can exacerbate insulin resistance. However, PCOS can occur in women of any weight. Many women who are insulin resistant are within healthy weight ranges. Nonetheless, being overweight can worsen insulin resistance, and women with PCOS are at a greater risk of being overweight. Excess weight can increase the hormones involved in PCOS.
The good news is, insulin resistance can be reversed through lifestyle changes, particularly diet, and can improve the symptoms of PCOS.
I like to think that food can serve as medicine for the treatment of insulin resistant PCOS. In fact, I predominantly treat my PCOS patients through food and dietary changes to manage blood sugar levels. Several studies have shown diet to be an effective method for managing insulin resistant PCOS (2,3,4). Additionally, nutritional therapy using inositol has been shown to have similar effects as metformin (5,6). Metformin is the first line medication therapy for those with insulin resistance in a mainstream medical model of treatment, however it has side effects that the natural supplement inositol does not (5,6).
So how do we use the diet to manage insulin resistance and support PCOS?
The main driver of insulin resistance is sugar. Carbohydrates are essentially sugar; however, this does not mean we have to completely avoid all carbs. Our bodies do need some carbohydrates to function. Carbohydrates are found in many healthy foods, such as vegetables. The main aim is to slow down the release of carbohydrate/sugar after consuming a meal. By slowing down the release of sugar, it prevents rapid spikes in your blood sugars. This means your insulin can keep up with the demand of the sugar that enters your bloodstream; and therefore, reduces the amount of sugars circulating. There are many ways we can help slow the release of sugar. We can also re-sensitise insulin and enhance its ability to utilise sugar as energy:
Avoid high sugar food and drinks; especially, sugary drinks, deserts, cakes and biscuits. If you have insulin resistance, unfortunately your hormones will struggle to handle any high sugar foods. These foods also tend to not satisfy our fullness cues, and can lead us to keep coming back for more.
Reduce carbohydrates and especially avoid refined carbohydrates; breads, pasta, pastry, cereals and any processed foods. Lowering carb intake can help manage insulin levels and blood sugars. As mentioned, our bodies still need some carbohydrates. I like to aim for 20% of the diet to be made up of complex carbohydrates, like a diverse range of seasonal vegetables. Getting the right balance of macronutrients is fundamental for managing PCOS.
Consuming adequate fat and protein at every meal is particularly important for managing blood sugar levels. Fat and protein help you to feel satisfied and full. They also allow for a slower release of sugars to improve insulin sensitivity. Fibre can also slow the release of sugars. An approximate guide for a macronutrient balanced diet for insulin resistant PCOS is 40% fat, 40% protein and 20% carbs. With my clients I aim for 5 tablespoons of healthy fats every day. Some of my favourite healthy fats to include into your diet:
Wild caught fatty fish - Salmon, sardines, tuna
Eggs
Extra Virgin Olive Oil
Coconut Oil
Avocado
Ghee
Grass fed butter
Nuts and nut butters
Seeds - pumpkin, sesame, hemp, chia, flaxseed, sunflower
Seed butters - tahini
Add Cinnamon to your diet. Cinnamon has properties that can enhance insulin’s actions and increase insulin sensitivity (7). Studies have shown cinnamon to significantly reduce fasting insulin and insulin resistance in women with PCOS (8). Additionally, there has been some promising research to show cinnamon can help regulate menstrual cycles in PCOS women who have irregular periods (9).
How to add cinnamon into your diet:
Add a sprinkle to your breakfast
Sprinkle on your roast vegetables
Add to smoothies and baked goods
Have cinnamon tea. I love the Pukka brand licorice and cinnamon tea. Licorice also has effects on PCOS as it can lower testosterone in women.
Other lifestyle considerations to improve insulin sensitivity and PCOS:
Exercise: Moving your muscles requires glucose and can manage insulin sensitivity (12). Exercise also supports healthy weight management which we have learnt is important for those with insulin resistance.
Prioritise sleep! Quality sleep is a way of maintaining healthy insulin. Additionally, your circadian rhythm AKA body clock, has a role in regulating glucose, energy expenditure and insulin sensitivity (13). To regulate your circadian rhythm it is important to have natural light exposure in the morning and dimmed light in the evening- turn off your devices an hour before bed. Having a regular bedtime routine and regulated eating patterns can also help (13). Read more about sleep hygiene to manage hormones here.
Consider supplements that support insulin sensitivity:
Magnesium supplementation has been shown to improve insulin sensitivity. Additionally, low levels of magnesium have been associated with insulin resistance risk (10).
Myo-inositol: Inositol is a messenger for insulin and studies show supplementation can improve insulin sensitivity and reduce circulating insulin (11).
Many people think that the only treatment for those with PCOS is to lose weight and go on metformin. However, as we have seen there are many natural treatments that actually work to treat insulin resistant PCOS. Although weight management can help improve insulin resistance, it is not the be all and end all. Supporting your diet to manage blood sugar levels is an effective treatment strategy for insulin resistant PCOS. If you would like to learn more about fixing your PCOS check out my online course ‘fix your PCOS’.
