Jun 4, 2021

Insulin Resistance and PCOS

Insulin resistance can lead to weight gain, type II diabetes and is both a driver and symptom of PCOS

Dr. Basma Faris

After you eat a meal: two things happen. First, your body breaks down all the carbohydrates into glucose (sugar) that enters your bloodstream. Second, to then, regulate the very glucose that is now in your bloodstream, your pancreas produces insulin. Insulin is the key hormone that  plays a major role in the storage of fat and helps your body regulate blood glucose. Insulin regulates your blood glucose in two ways:

⭐️  It transports glucose from your blood into your cells where they can be used as energy. This is what powers your body and brain and everything you do.

⭐️  Insulin transports any excess glucose and stores it your liver as fat.

Thus, at insulin's intervention, your blood glucose levels fall and go back to normal. This is really important because unchecked levels of blood glucose in the long run can lead to diabetes.

You maybe thinking: what's the problem then? In the ideal scenario, your blood glucose and insulin work in harmony with each other. But that's not always the case. Sometimes, your blood glucose levels and insulin have a dysfunctional relationship. Almost ~70% of women who have PCOS are Insulin Resistant, which means their bodies don't use insulin efficiently. Thus, to regulate the same amount of blood glucose, their pancreas need to produce more and more insulin.

How is IR related to weight gain in some women with PCOS?

  1. Insulin is used to signal fat storage. Too much insulin being secreted regularly can cause inflammation and lead to increased fat storage and  weight gain.
  2. It can become a cycle: As weight gain increases, the body can become even more desensitized to  insulin, thereby leading to more inflammation and weight gain. It becomes a chicken and the egg problem.

Some women who suffer from insulin resistance may only gain weight around the belly and can suffer from Reactive Hypoglycemia, i.e.,  experience a sharp drop in blood sugar 1-5 hours after a meal, leading to jitteriness, headaches, fatigue and cravings.

Why is Insulin Resistance problematic?

(1) Insulin Resistance is believed to be not only a symptom of PCOS but also a driver of the syndrome. High levels of insulin is also associated with  hyperandrogenism and can confuses the pituitary gland, thereby creating problems in ovulation.

(2) If you are insulin resistant, initially your pancreas is overworked trying to produce insulin.  But over time, as the graph below shows, your pancreas is no longer able to create those levels of insulin, and your blood glucose levels remain unregulated. This is one of the leading contributors of Type 2 Diabetes. Keeping glucose and insulin levels from spiking is the key to managing Insulin Resistance and healthy life.

Photo from Dr. Jason Fung's Youtube Video on 'A New Paradigm of Insulin Resistance'

Testing for Insulin Resistance

Speak to your physician or doctor about scheduling a blood test to test for:

  1. Fasting insulin levels
  2. Fasting Glucose levels

Doctors may also need to rule out amenorrhea in lean PCOS and pituitary gland tumour as potential causes for symptoms. Rule of thumb is to aim for insulin levels of <10 and fasting glucose of less than 90, however this can differ for each diagnostic center and patient.

How does Insulin Resistance get better?

In most cases, lifestyle changes are prescribed as the first  line of defense:

  1. Make the right dietary changes: Eating foods (unprocessed, whole grain) that don't cause large spikes in blood glucose levels, thereby, avoiding sudden spikes in insulin. The time of food consumption also matters, as the body's insulin response and digestion powers peak during the day. Effort should be made to avoid eating at night. Lastly, the order of food consumption can also help regulate glucose and insulin levels.The ideal order is to eat the fibrous green veg first, then the protein and lastly the fat and/or carbohydrate as this will blunt the glucose rise.
  2. Exercise regularly: Aerobic exercise of about 150-180 minutes minimum per week is recommended to women with PCOS for long-lasting positive health and weight management.
  3. Manage stress: Stress can worsen IR and PCOS. Measures must be taken to control stress via meditation and therapy.
  4. Sleeping 7-8 hours: Poor sleep quality has also been associated with PCOS. It is important to be well rested and follow the body's circadian rhythms, by not staying up into the wee hours of night.

But remember, every body is different and how quickly your body responds or how well it responds to lifestyle changes can sometimes comes down to genetics. Don't be harsh on yourself. Navigating this isn't easy and the objective is to figure out what works for you.

💥 If you need help making the right dietary changes for your PCOS, register for Dr. Basma Faris' 7 Day PCOS Program starting Mar 26th. Get access to 3 live workshops, 5 healthy PCOS-friendly recipes, a Grocery list, Sample meal plan and more from one of America's leading Obg/yn and Culinary Medicine Specialists. Sign up here.

Alternatively, medications such as metformin is one of the top choices for increasing insulin sensitivity. Supplements such as inositol and magnesium are also popularly prescribed. Please consult your doctor before opting for this line of treatment.

*This article is for information purposes only and does not establish a patient physician relationship. For medical assistance please talk to a qualified physician.*

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