PCOS and Insulin Resistance

Insulin resistance has been shown to be a key component to PCOS. Insulin resistance happens when the cells in the body do not respond normally to insulin.

Insulin, a storage hormone, is produced by the pancreas, in response to whenever we eat food. Insulin will cause the liver and muscle cells to take in glucose/amino acids/fat from the bloodstream (where they will convert it into energy), and this process will ultimately lead to lowered blood sugar and insulin.

When someone is insulin resistant, glucose has a difficult time entering the cell, so it hangs out in the blood for much longer. More insulin is released to push glucose into the cell, causing metabolic dysfunction. Typical symptoms include fatigue after eating, sweet cravings no matter how many sweets you eat, increased thirst and urination.

When someone is insulin resistant, your body needs to make more insulin to get the job done. Too much insulin can cause both inflammation and weight gain which may end up leading to metabolic syndrome - diabetes and cardiovascular disease. In women, insulin resistance may affect ovulation, cause the ovaries to make more androgens, and affect fertility – recurrent miscarriage or inflammatory implantation failure.

Specifically, insulin stimulates testosterone secretion from the ovaries and inhibits sex hormone binding globulin production (which binds to testosterone). This leads to more testosterone in the blood stream which may account for acne, facial hair, and male pattern hair loss (top of the head). 

How to test for insulin resistance?

Although not the gold standard test, using the HOMA-IR calculation can tell you if you have insulin resistance. This test can be relatively simple – you just need 2 blood tests:

• Fasting insulin, an optimum level less than 50 pmol/L

• Fasting glucose

Plug these two values into the HOMA-IR calculator, to figure out your score. Ideally, you want a value less than 1.  

How to reverse insulin resistance

One of the best ways to reverse insulin resistance is to balance your blood sugar! This undoubtedly begins with food. 

Glycemic Index

The glycemic index is a marker used to calculate how quickly a particular food (50g of it) can raise blood sugar levels (over a 2 hour period) compared to pure glucose. The higher the glycemic index, the quicker the blood sugar is raised.

• High Glycemic Index = 70 or more

• Low Glycemic Index = 55 or less

Something to keep in mind is that foods are not alike, and neither is the serving size. This brings us to glycemic load. 

Glycemic Load

The glycemic index changes based on the amount of carbohydrates in each food and the serving size. It's calculated by the amount of food eaten and multiplied by the glycemic index. 

• High = GL of 20 or more

• Medium = GL of 11 to 19

• Low = GL of 10 or less

For example:

• A typical serving of watermelon may be 1 cup, which has 11 grams of carbohydrates.

  • GI of 72 x 11 gram = 792. Divide by 100 = 7.92

• A typical serving of regular crust cheese pizza may be one slice, which has 34 grams of carbohydrates.

  • GI of 33 x 34 = 1122. Divide by 100 = 11.22

Food Insulin Index

This index assesses how much insulin the body normally releases in response to food. Certain foods require more insulin, while other foods need much less. Foods with a lower FII can help lessen the insulin demand on your pancreas. 

How to choose the best balancing foods

Keeping the glycemic index, glycemic load, and food insulin index top of mind may be difficult. Let's talk about what should be plentiful in your diet. 

Fruits & Vegetables

If half of our plate should be made up of plants, then you know that we should be eating a lot of fruits and vegetables throughout the day. Not only are they filled with great vitamins and minerals, they also have a lot of fibre (which will keep us regular!). Focusing on leafy green vegetables is key, but you can also include broccoli, cauliflower, Brussels sprouts, carrots, eggplant, mushrooms, onions and garlic (basically my entire fridge). 

But what about starchy vegetables? While these tends to have a higher glycemic index and load, you can still incorporate them in your diet, albeit in smaller amounts. Squash, sweet potatoes, beets and even white potatoes are considered starchy, but shouldn't be eliminated from your diet. 

Fruits don't need to be eliminated either, despite them obviously being high in fructose. You want to enjoy more fruits that have lower sugar - these include avocados, tomatoes, raspberries, blackberries, blueberries, strawberries (but choose organic) and lemons!

Fats

Fact: fat is good for you. But the reality is, many fats are highly processed. So which are the ones you should stick to? Avocado oil, extra virgin olive oil, coconut oil, and ghee (but choose organic, and don't make this your primary oil).

Animal Protein

Protein (& fat) should always be part of a meal. They help to give you energy, balance blood sugar (by keeping it from spiking), and maintaining satiety. Protein is rich in amino acids which are basically the building blocks of your body. Plus, amino acids help to transport hormones and make sure your liver is detoxing properly. Fat, especially cholesterol, is essential because this is what sex hormones are made of! 

When it comes to meat, chicken is a better option than red meat (although eating it once in a while is fine). A couple of 'labels' to pay attention to is organic, grass-fed, hormone and antibiotic free. If you can afford to purchase meat with these labels, I encourage you to do so. However, I recognize that this is not an option for everyone (as it can be quite costly), but choosing 1-2 organic options may be the way to start (especially if you eat these on a consistent basis). 

Fish is a great protein option too, but some types can be high in mercury. Nevertheless, Wild Alaskan or Sockeye salmon, mackerel, shrimp, crab, anchovies and mussels are lower in mercury. Wild is better than farmed, which is something to keep in mind especially when buying salmon. 

Eggs shouldn't be avoided, especially since they're a great breakfast food (#byecereal)! Eating eggs, in most people, will not raise your cholesterol. In fact, it may raise your good (HDL) cholesterol! 

Is there a specific diet that works?

If your goal is to decrease your fasting insulin and glucose levels, the Mediterranean diet may be something to consider. It has been shown to decrease the above, as well as improve HOMA-IR scores and overall insulin sensitivity.

The Mediterranean diet consists of a high intake of vegetables, legumes, fruits, nuts, cereals, and olive oil. With a low intake of saturated lipids and meat, moderate fish intake, low to moderate intake of dairy products, and the occasional glass of red wine.

The DASH diet has also been shown to improve insulin sensitivity as well. This diet is rich in fruits, vegetables, whole grains, nuts, legumes, low in saturated fat, fat-free/low-fat dairy, cholesterol, red and processed meats, refined grains and sweets. Something to be aware of is fat-free/low-fat products often have increased sugar to compensate for the taste.

What about exercise?

While exercise in undoubtedly important, diet has been shown to work 'better' than exercise, in terms of reducing the HOMA-IR value and overall weight loss (if that is one of your goals).

Final Thoughts

Talking about diet and the role it plays in our health can be quite tough. Many of us don't love overhauling our diet - after all, food plays an important role in our lives. That said, because we need to eat everyday, it's important to pay attention to how we're nourishing our bodies.

Furthermore, because PCOS is considered a lifelong condition, adopting a healthy diet for the long-haul may be beneficial. Nevertheless, however you choose to address your PCOS should be adapted to your personal needs and circumstances.

If you think that you might be struggling with PCOS, be sure to read my past articles (what is PCOS, types of PCOS) and consider getting your blood work done.

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References

Shang, Y., Zhou, H., Hu, M. and Feng, H., 2020. Effect of Diet on Insulin Resistance in Polycystic Ovary Syndrome. The Journal of Clinical Endocrinology & Metabolism,.

Updated July 2020.