The Role Insulin Plays in PCOS
Did you know that over 75% of women with PCOS have some level of insulin resistance? This number actually increases with obesity, with over 95% of obese women with PCOS being insulin resistant.(1) Given the work I’ve done with thousands of women with PCOS, I actually believe these statistics to be under-stated. I’ve worked with many individuals with what has been called “lean PCOS” and even in this sub-group insulin resistance is typically a part of the story and needs addressing.
What is Insulin Resistance?
What is insulin resistance? Insulin is a hormone. A hormone's job is to send a message from one tissue of the body to another. Insulin sends a message to cells all over your body. Essentially the message is: food is available, open up cells use that energy. When you are insulin resistant, your cells no longer respond normally to insulin, so they don’t get the message to let energy in and use it.(2) This can result in feeling more tired, because your cells are literally starving for energy.
However, your ovaries do not become insulin resistant like other organs, so the extra insulin affects the ovaries. They continue to take in more and more energy(blood sugar). This energy input makes the ovaries react by producing more androgens, or male sex hormones. This is what causes the physical symptoms of PCOS like: acne, dark patches (acanthosis nigricans), excess hair growth, and hair loss. It also leads to things that don’t feel as apparent like: irregular cycles, lower ovulation rates, and infertility. Finally, since your cells are not getting the energy needed and insulin levels are high, you may have intense hunger, sugar cravings, and an increased risk for binge eating.(2)
We know that high levels of insulin can affect many organs within the body like the kidneys, liver, and heart. As a result, women with PCOS have increased rates of non-alcoholic fatty liver disease, heart disease, and diabetes.(2) The PCOS population also has increased rates of depression. There are so many things stacked against an individual with PCOS, it’s hard to say the increase in depression and anxiety is related ONLY to insulin levels, when we have other abnormalities related to insulin like hormonal imbalances and all the emotional and social ramifications of having such troubling symptoms: hair loss, hair growth, weight struggles, acne and more.
Ways to Treat Insulin Resistance When You Have PCOS:
The good news is that we can lower insulin resistance (its symptoms and complications) through lifestyle changes.
Nutritional Approaches to Insulin Resistance
What kind of a dietitian would I be if we didn’t start here? A balanced plate is essential to treat insulin resistance where it starts: our food choices.
It’s not just about what we do or do not eat, it’s also about how much of those foods are consumed. I always like to start with talking about protein. You need ample protein on your plate to improve your insulin resistance. Protein will help slow down absorption of carbohydrates and blunt the blood sugar response after a meal or snack. That is a good thing. The more slowly we increase your blood sugar, the more slowly we will raise insulin levels.
Another useful tool we have with food and insulin resistance is increasing fiber. Fiber is awesome for slowing down blood sugar spikes as well. The fiber essentially “coats” the intestinal lining making absorption times slow down and again delaying insulin’s response. This process of slowing done blood sugar spikes after a meal will help your body over time create less insulin. As your body feels less bombarded with insulin’s message, it won’t feel so annoyed when insulin comes knocking on the door.
Notice we haven’t talked about cutting anything out. Include more protein, include more fiber. Almost everyone would benefit from that. Treating insulin resistance doesn’t have to alienate you at dinner time. You can eat what others are, just serve yourself an extra portion of the meat or eggs. Use extra large scoops when putting the broccoli or salad on your plate.
I have an entire approach to meeting nutritional needs, feeling amazing, enjoying the food you eat AND managing insulin resistance. I call it the PCOS+ Plate. I teach you all about it in the RECIPES section..
Sleep and Stress Management’s Affects on Insulin Resistance and Behaviors
We know that sleep quality and stress management are very important in balancing hormones. Calming techniques like yoga, stretching, therapy, journaling, and meditation, can be helpful to manage stress and relax you enough for proper sleep. Sleep hygiene can be very important too, especially setting a bedtime and reducing screen time before bed.
Managing cravings, energy levels, and total amount of food eaten is more difficult to do when you are tired. Think about it, the last time you had a really poor night of sleep, did you make a balanced breakfast? Probably not, those are the morning you are more likely to hit the McDonalds or Starbucks drive thru line. We are hard wired to crave more sweets and carbs on a day we are physically tired. You can’t fight this biology, but you can choose to work with it. Establishing good sleep habits and respecting your body’s need for adequate, quality sleep is really important. It critically important to look at this category of well-being while trying to improve health and specifically insulin resistance.
Movement and Exercise Affect Levels of Insulin Resistance
Movement is an important lifestyle behavior that is easy to overlook the benefits regarding insulin resistance. We often think about movement and exercise for weight management and for good reason, but movement can also help re-sensitize your body to insulin. Research has shown your body can make improvements in insulin resistance after just a few weeks of consistent exercise.
Regular movement can help you relax, manage stress, improve your sleep, and even improve clinical symptoms of PCOS like insulin resistance. Choose a movement that works for you and that you can enjoyably do on a regular basis, whether it is a sport, dancing, biking, lifting weights or even walking. I honestly think that walking is highly underrated and is a great, low-impact way to get your body moving. It also has the added benefit of keeping your heart rate in a range that helps your body use fat for fuel instead of using stored carbohydrates.
Supplement Solutions for Insulin Resistance in PCOS
Supplements have some very promising roles in assisting an individual with PCOS with their insulin resistance. Many of the nutritional deficiencies that are more common in PCOS like vitamin B12, magnesium and vitamin D can all indirectly impact insulin resistance. Repleting nutritional deficiencies, which is just a fancy way of saying recovering those levels can be a very useful strategy for combatting insulin resistance.
You can find out exactly what supplements would help your PCOS by taking this supplement quiz with specific supplement recommendations.
In PCOS there are certain metabolic disadvantages many of us have and we have narrowed in on some specific supplements that can improve areas where we just don’t function at our most optimal level. I often use supplements such as myo-inositol, berberine, NAC, alpha lipoic acid and cinnamon to help with blood sugar and insulin levels.
There is a specific part of the PCOS Formularies line created to help with insulin resistance. It's the metabolic support line.
Prescriptions Your Doctor May Offer to Help with Insulin Resistance
There are some medications recommended to help you manage insulin resistance, like Metformin. Certain medications can also block androgen production and its related physical symptoms, like birth control. While birth control may help some symptoms it has actually been shown to increase insulin resistance, so have a thorough conversation with your physician about if birth control or other hormonal contraceptives for symptom management are good fits for your needs and goals.
Metformin and other insulin-sensitizing drugs are used in an “off-label” capacity for PCOS. That essentially means that they were designed and approved by the FDA to be used for other things like diabetes, preventing pregnancy, etc. Using them to treat PCOS is common, but not the primary purpose. That doesn’t mean you shouldn’t use them, but it’s important for you to know so you can consider all your options.
I have even seen doctors prescribe diet pills that impact your appetite to try and help patients lose weight. In my opinion this almost always backfires and contributes to under-nourishing the individual and not dealing with other behaviors that may be making insulin resistance worse like: poor sleep quality or lack of movement.
Medications are often one of the doctor’s only abilities to help you with PCOS so you may feel like it’s the only solution available. It is not and if you don’t feel comfortable being on one of these medications, you are not alone. Above, there are many natural ways you can control all of these clinical symptoms of PCOS and live a healthy life.
Weight Loss Surgery Has Been Offered to Many PCOS Patients
I am hearing that this is an increasingly common solution provided to patients. It is true that weight loss can be associated with these GI Tract Reconstructive Surgeries and due to the weight loss there can be an improvement in insulin resistance. However, I have cautioned many people to not be so quick to turn to this solution as it can have permanent consequences and so many of my PCOS patients have learned to manage their insulin resistance with natural- easy-to-implement- solutions that are not as drastic and scary.
What Hope Do I Have of Managing My Insulin Resistance?
Insulin resistance is not necessarily the cause of PCOS, but it does play a critical role in symptom progression, weight gain, and can stand in the way of fertility. Unmanaged insulin resistance can quickly become pre-diabetes and diabetes. It is in your best interest to start managing your insulin resistance and choose one area to focus on in the days ahead. It can sound scary and even daunting - I know. I have been in and am in your shoes. You aren’t doing it alone. This community is here to support you, lend an ear, and provide actionable tips to help you move forward confidently with your PCOS management.
Sources:
1 https://doi.org/10.1093/humrep/des463
2 https://www.rcpjournals.org/content/clinmedicine/15/Suppl_6/s72