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.



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.