PCOS: How to Reverse Insulin Resistance

Believe it or not, the majority of women I work with who have insulin resistant PCOS, don't have this issue because of a poor diet and excessive carbohydrate intake.

Sure, they may have grown up drinking soda, eating too many sweets and processed foods, however even after switching over to a 'healthy diet', many women continue to struggle with insulin resistance.

The solution isn't just cutting out carbs completely. There are other factors that need to be addressed in order to fully heal.

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What IS Insulin Resistance?

It is believed that around 80% of women with Polycystic Ovarian Syndrome (PCOS) have some degree of insulin resistance. Insulin resistance occurs when our cells become 'numb' to the hormone insulin.

When we consume food (mainly carbohydrates), our blood glucose levels rise. This signals our pancreas to release the storage hormone insulin, which acts like a key, unlocking our cells and letting glucose in, to be used as fuel.

If the key or lock becomes damaged (aka our insulin hormone or cell receptors) then glucose remains elevated in the bloodstream and the cells are 'starving for energy'.

Our pancreas continues to pump out insulin as a way to try and lower blood glucose and fuel the cells, however in women with PCOS, insulin also stimulates the 'theca cells' in the ovaries to produce androgens like testosterone.

Androgens drive the common symptoms such as hirsutism (face/body hair growth), male pattern hair loss, cystic acne and can also halt ovulation, therefore affecting fertility and our menstrual cycles.

Long term, chronically elevated insulin and blood glucose levels increase our risk of type 2 diabetes, metabolic syndrome, obesity, cardiovascular disease, chronic inflammation and even certain types of cancer.

Some women may be VERY insulin resistant (bordering on type 2 diabetes) and unable to metabolise glucose effectively, whereas others have very mild insulin resistance, which may be causing hormonal imbalances, yet doesn't show clearly on conventional lab tests.

 

Common Indicators of Insulin Resistance....

  • Weight gain

  • Difficulty losing weight

  • Fat storage particularly around the midsection

  • Skin tags

  • Velvety patches of skin (acanthosis nigricans)

  • Sugar/carb cravings

  • Blood sugar instability

  • A family history of Type 2 Diabetes

  • Fatigue after eating (especially carb rich meals)

  • Elevated liver enzymes or fatty liver disease

  • Acne

  • Frequent urination

  • Excessive thirst

It is important to note that you can be at a 'normal' weight and still have insulin resistance. There are also different degrees of insulin resistance, even lean women can be struggling with this. If you are overweight or obese, it is likely that insulin resistance is playing a role in your PCOS.

 

Potential Downsides of Going TOO Low Carb...

Even though a short term low carb (and in severe cases a ketogenic) diet can be helpful at reducing insulin levels and even improving some symptoms, insulin resistance tends to be a multifactorial condition, meaning that just changing one factor, usually isn't enough.

In fact, going too low carb, or for too long, may actually induce 'physiological insulin resistance'. Your brain requires glucose to function optimally, and when levels are low, peripheral insulin resistance is triggered. This causes your muscles to stop taking up this 'precious' glucose, so that your brain can be fuelled.

Although you may feel great in the short term on a very low carb diet (less than 50g daily), this is often due to the release of stress hormones, like cortisol, which can actually break down your muscle tissue to raise blood glucose levels. Yes, you may lose weight, but you are actually sacrificing your lean muscle mass and potentially lowering your metabolic rate.

If you feel like you can't increase your carbohydrate intake after being on a low carb/keto diet, without gaining weight, breaking out or feeling like you're on a blood sugar rollercoaster, this is a sign that your body still isn't processing glucose well and you may need to address some of the common drivers.

 

Drivers of Insulin Resistance...

Poor Diet:

High levels of pro-inflammatory omega 6 fats from industrial seed oils or factory farmed meat, low intake of fibre and a high consumption of alcohol, refined sugar and trans fat, can all drive insulin resistance.

Meal frequency may be important, as constant snacking or grazing throughout the day can keep blood glucose and insulin levels elevated.

It is important for women with PCOS to find their unique carb tolerance, in order to prevent insulin spiking too high or the stress of not eating enough. Your energy levels, sleep quality, mood and cravings can help you to figure out what works best for you.

Nutrient Deficiencies:

Poor soil quality, medication use, restrictive diets and chronic stress can all lead to nutrient deficiencies. The most important nutrients for insulin sensitivity and blood glucose control are magnesium, chromium, omega-3's, potassium, vanadium, biotin, alpha lipoic acid (ALA), zinc, taurine, manganese and inositol. Most of these work by improving the metabolism of glucose and the insulin receptor sites.

Your body will always prefer nutrients from FOOD, rather than supplements, because in nature, foods contain a combination of synergistic nutrients which all work together. If we rely on supplements for our nutrient intake, this can lead to imbalances and skewed ratios. That being said, high quality, practitioner grade supplements can be helpful.

Lack of Sleep:

If you are skimping on sleep, or the quality isn't great, this will worsen your insulin sensitivity the next day, making your body less able to process glucose (carbs) efficiently. A lack of sleep can also throw off your energy levels, mood, appetite and cravings the next day. You will probably be more like to skip the gym and instead grab a takeaway on the way home from work.

When we sleep, our body is able to physically repair, especially between the hours of 10pm and 2am. If we work the night shift or regularly stay up late to binge watch Netflix, then our body is more likely to be in a state of chronic inflammation, which is a precursor of insulin resistance.

High Cortisol:

Ahhh stress. There is just no escaping it, living in this modern world. When we are stressed (because of a real or perceived threat), this triggers our adrenal glands to pump out hormones like cortisol and adrenaline. One of their main roles is to release glucose from storage sites (like the liver), into the bloodstream to use as fuel. If this happens too frequently or for too long, blood glucose levels (and therefore insulin) can become elevated.

High cortisol levels also promote inflammation and deplete nutrients like magnesium, which can impair the function of the insulin receptors.

Gut Dysbiosis:

If you have an overgrowth of pathogenic bacteria, intestinal permeability (aka 'leaky gut'), and yeast or parasitic infections, this could impact your digestion and absorption of the nutrients needed for healthy blood glucose regulation.

As 70-80% of your entire immune system is located in your gut, any imbalances in this location can lead to chronic inflammation and stress throughout the body. Women with PCOS tend to have higher levels of 'bad bacteria' and low diversity within the gut.

The outer membrane of certain bacteria contains a toxin known as lipopolysaccharide (LPS). When levels are high, this is known as metabolic endotoxemia, which has been shown in studies to promote inflammation, weight gain and therefore insulin resistance.

Chronic Inflammation:

It has been known for decades that the pro-inflammatory cytokine TNF-α was able to induce insulin resistance because of it's local (and potentially systemic) effects on metabolism, and that high doses of anti-inflammatory compounds are able to reverse this.

These pro-inflammatory cytokines can be produced as a result of a poor omega 3 to omega 6 ratio, food sensitivities, insufficient sleep and chronic over exercise. Inflammation is beneficial to a point, however it is when it becomes chronic and uncontrolled that it can start to damage tissues and potentially lead to health issues.

Inflammation is one of the 'root causes' of PCOS partly because of its impact on insulin sensitivity, but also due to its ability to up-regulate the 5-alpha reductase enzyme. This enzyme metabolises androgens into dihydrotestosterone (DHT) which is an androgen that is 3x more potent than testosterone.

Low Thyroid Function:

The main thyroid hormones T4 and T3 are involved in glucose metabolism and insulin sensitivity. The thyroid is our master metabolism gland and almost every single cell in our body has a receptor site for thyroid hormone.

Low thyroid function can be caused by factors such as autoimmunity, nutrient deficiencies and chronic stress. Low T3 in particular, which is the 'active' thyroid hormone, has been associated with increased inflammation.

It is believed that 25% of women with PCOS actually have a thyroid issue, which could actually be driving the irregular ovulation and insulin resistance issues. Poor thyroid function, along with insulin resistance, inflammation and stress are some of the biggest drivers of PCOS.

Body fat levels:

Insulin resistance can lead to weight gain and obesity, and a high body fat level can exacerbate insulin resistance. It works both ways. Fat cells are actually mini endocrine organs that can produce hormones like oestrogen and release inflammatory cytokines.

When oestrogen is elevated, this increases a hormone known as thyroid binding globulin (TBG) which can lower circulating thyroid hormones. As I have already discussed, low T4 or T3 can have a negative impact on insulin sensitivity.

If oestrogen levels are too low (due to a low fat diet, ageing or low body fat levels), this can also impair our insulin sensitivity, as oestrogen, (when at optimal levels) helps to improve insulin sensitivity. This is why we tend to be more insulin sensitive and able to tolerate more carbohydrates during the first half of our menstrual cycle (follicular phase), as we are naturally 'oestrogen dominant' at this time.

Environmental Toxin Exposure:

Women with PCOS are like 'canaries in the coal mine', when it comes to environmental toxins. I believe that we tend to display the harmful effects of these chemicals before others do. There is actually quite a lot of evidence to show that exposure to endocrine disrupting chemicals like bisphenol A (BPA) in utero, can actually alter genetic expression and predispose women to develop PCOS later in life.