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PCOS and Insulin Resistance: Understanding the Connection

Updated: May 10



About 8 to 13% of women worldwide have a PCOS diagnosis. Around 70% of cases PCOS are undiagnosed. 


Symptoms and signs of PCOS can include:

  • Irregular or missed periods

  • Hair loss or thinning hair

  • Excessive hair growth around the stomach, chest, back and facial hair (pcos hirsutism)

  • Ovaries that have many cysts 

  • Infertility 

  • Acne 

  • Skins tags

  • Dark patches on the skin in areas including the like armpits, back of the neck, under the breasts 

  • Weight gain around the abdomen ("pcos belly")



How to test for PCOS:

If you notice you have any of the above symptoms, let your doctor know. They will suggest some blood work and a PCOS ultrasound to determine whether you have PCOS.


What causes PCOS?

We do not know the exact cause of PCOS. What we do know is that the majority of women who have PCOS have some level of insulin resistance. PCOS may also be genetic and can run in families.


Let's dive into the relationship between PCOS and insulin resistance and what it means for women's health.


What does insulin resistance mean?

To understand what insulin resistance is, we first need to learn a little bit about carbohydrate metabolism. 


Carbohydrates are foods that are broken down into sugar (or glucose) when we digest them, they include:

  • Grains like rice, wheat, barley, oats

  • Fruits

  • Starchy vegetables like potatoes, sweet potatoes, corn 

  • Dairy products like milk and yogurt 

  • Added sugars like table sugar, syrup and honey 

  • Pulses like beans, lentils and chickpeas 


Once we digest carbohydrates, the sugars move into the bloodstream. From there, the sugars need to be moved into our cells to be used as energy.  But, our cells are locked and sugar can’t just go into them. This is where insulin comes in. 


When our bodies detect that there is sugar in the bloodstream after a meal, our pancreas will start to release a hormone called insulin. Insulin acts like a key, and opens up the cells to allow the sugars to go in. 


When you have insulin resistance, this process does not well. Your body has less of a response to the insulin being produced by your pancreas. This is called insulin resistance. So what happens? The sugar remains in your blood and your pancreas needs to produce even more insulin to open up the cells to allow the sugar in. 


The result is higher levels of insulin in your body. 


Bowl of fruit


What does this mean for PCOS? 


When insulin levels are high, this can cause your ovaries to create more androgens (male hormones). Higher androgen levels then lead to the typical PCOS symptoms that we described above. 


So how can you balance hormones for PCOS? The first step is to reduce insulin resistance. There are 4 main strategies to reduce insulin resistance: diet, exercise, supplements and medication. 


Diet to reduce insulin resistance: 


Following a diet for PCOS can help reduce insulin resistance. Here are 4 ways to follow a healthy diet for PCOS:


  1. Choose low glycemic index diet carbohydrates. There are carbohydrates that are less likely to spike your sugar and include steel cut oats, sweet potatoes, sprouted grain breads, sourdough bread, beans, lentils, chickpeas

  2. Stay mindful of portion sizes of carbohydrates. While the quality or the glycemic index is more important, the quantity of carbohydrates also matters. Try to aim for 1/4 plate of carbohydrates at meals 

  3. Have balanced meals and macronutrients. Ensure meals include:

  • Protein from foods like chicken, fish, lean meats, Greek or Icelandic yogurt, cottage cheese, nuts and seeds, tofu, beans, lentils, or chickpeas 

  • Fibre from vegetables, fruits, and the plant proteins listed above 

  • Healthy fats from avocados, olive oil or nuts and seeds

  1. Keep meal times regular and avoid skipping meals. This is very important for blood sugar balance and can help reduce cravings and hunger levels throughout the day 


Exercise to reduce insulin resistance:



Keeping active is a very effective way to balance blood sugars and reduce insulin resistance. When you move your muscles during exercise, your muscle cells start responding to insulin better. This means that they can allow sugar to move from the blood into the muscle cells to be used as energy. Adding regular physical activity to your routine can also make your body better at using insulin over time. 


Supplements for insulin resistance in PCOS:



For women with Polycystic Ovary Syndrome (PCOS), supplements can offer additional support alongside lifestyle changes and medications. Here are some commonly used supplements and their potential benefits:


Inositol: This B vitamin derivative may help reduce insulin resistance in women with PCOS. Studies suggest that inositol supplementation may help regulate periods, reduce androgen levels, and improve ovulation. 


Vitamin D: Many women with PCOS have vitamin D deficiency, which is associated with insulin resistance and other metabolic disturbances. Supplementing with vitamin D may help improve insulin sensitivity and regulate menstrual cycles in women with PCOS.


Omega-3 fatty acids: Omega-3 fatty acids, found in fish oil supplements, have anti-inflammatory properties and may help reduce inflammation associated with PCOS. Some studies suggest that omega-3 supplementation may improve menstrual regularity in women with PCOS.


While these supplements show promise, it's important to consult with a PCOS dietitian or your doctor before starting any new supplement regimen. 


Medications:


There are several medication options including birth control pills,  Metformin and Ozempic for PCOS. Speak with your PCOS specialist or your family doctor for more information on medications for PCOS. 


Takeaway:

Reducing insulin resistance to improve your PCOS can feel complicated. A step by step approach to making small and sustainable lifestyle changes can have a big impact on reducing insulin resistance and getting to PCOS freedom. If you need help with managing your PCOS, consider reaching out to schedule a free discovery call today


References:

  1. Nordio M, Proietti E. "The combined therapy with myo-inositol and D-chiro-inositol reduces the risk of metabolic disease in PCOS overweight patients compared to myo-inositol supplementation alone." Eur Rev Med Pharmacol Sci. 2012;16(5):575-581.

  2. Jamilian M, Foroozanfard F, Rahmani E, et al. "Effect of two different doses of vitamin D supplementation on metabolic profiles of insulin-resistant patients with polycystic ovary syndrome." Nutrients. 2017;9(12):1280. doi:10.3390/nu9121280

  3. Karamali M, Eghbalpour S, Rajabi S, et al. "Effects of high-dose fish oil supplementation during early pregnancy on fetal growth and development: a randomized controlled trial." J Matern Fetal Neonatal Med. 2019;32(6):1-10. doi:10.1080/14767058.2018.1450990

  4. Diamanti-Kandarakis E, Dunaif A. "Insulin resistance and polycystic ovary syndrome: an update." Endocr Rev. 2012;33(6):981-1030. doi:10.1210/er.2011-1034

  5. Legro RS, Arslanian SA, Ehrmann DA, et al. "Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline." J Clin Endocrinol Metab. 2013;98(12):4565-4592. doi:10.1210/jc.2013-2350

  6. Escobar-Morreale HF. "Polycystic ovary syndrome: causes, diagnosis, and treatment." Nat Rev Endocrinol. 2018;14(5):270-284. doi:10.1038/nrendo.2018.24

  7. Johns Hopkins Medicine. "Polycystic Ovary Syndrome (PCOS)." Retrieved from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos 


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