PCOS and Insulin Resistance

Yes, Polycystic Ovary Syndrome (PCOS) does affect women’s reproductive health (hello irregular periods & infertility!) however, it is also a metabolic and endocrine disorder, with much more complex impacts on health. 

Compared to women without PCOS, women with PCOS are more likely to have insulin resistance, in fact, between 30-70% of women with PCOS have insulin resistance[1]. What’s more, insulin resistance is not just a characteristic of PCOS, but one of the key driving forces of the condition. 

What is Insulin resistance?

Insulin is a hormone produced within the body (in the pancreas) to help us effectively use glucose from the food we eat as energy to fuel the body. When we have insulin resistance it means that the body is unable to use the insulin effectively, which means we then tend to have higher levels of glucose circulating in the body, which leads to production of even more insulin. 

So what?

High levels of insulin in the body can result in higher androgen levels (male sex hormones), it can also lead to weight gain, to irregular periods, increased cravings and infertility. All of which are symptoms or consequences which are familiar to many with PCOS.  

Insulin resistance itself can also lead to impaired glucose tolerance, and potentially progress to Type 2 diabetes. Studies have found that the rate of developing Type 2 diabetes from impaired glucose tolerance in women with PCOS was higher than in the general population. 

Impaired glucose tolerance and diabetes raises cardiovascular risks (like high blood pressure, high cholesterol, heart disease and stroke) in women significantly. Women with diabetes have four to seven times higher cardiovascular risks than women without diabetes, and these risks in diabetic women are even higher than in men with diabetes. [2] 

So, what can you do?

Given the key role of insulin and insulin resistance in the progression of PCOS and development of conditions associated with it, management of insulin resistance can really be a corner stone to symptom management and protecting future health in many with PCOS. For those who have symptoms of insulin resistance it may help to get tested for insulin resistance using a blood test, though this isn’t always commonly done. Being well informed about your insulin levels and if you have insulin resistance helps in managing insulin resistance and improves PCOS symptoms, including cravings, ovulation and fertility.

How do I Manage Insulin Resistance?

·    Regular physical activity

·    Low GI carbohydrates

·    Add protein, fats and fibre 

·    Fruits & vegetables

·    Reduce stress

·    Get enough sleep

·    Stop smoking

A varied and balanced diet, alongside regular movement, can help the body use insulin more effectively, lower blood glucose and improve PCOS symptoms. When it comes to exercise a combination of both moderate intensity cardio along with some resistance training (which helps optimize body composition) can improve insulin sensitivity and reduce insulin resistance, however regular movement also brings benefits in mood, stress reduction and general well well-being. The secret to regular movement though, is doing something that you love and makes you feel good! 

Besides regular joyful movement, having a balanced diet rich in wholegrains, fruits and veggies is also important. 

The glycaemic index (GI) of a food measures the rise in glucose after eating it. A low GI diet has been found to improve insulin sensitivity in people with impaired glucose tolerance or diabetes.[3]

Refined carbohydrates with a high GI such as white bread, doughnuts, and other sweets, cause a sharp increase followed by a plunge in glucose levels. Whereas wholegrains (such as brown rice, oats, wholegrain bread) and high fibre carbohydrates that have a lower GI can reduce spikes and dips in glucose levels throughout the day and improve insulin levels. 

Including plenty of fruits and vegetables helps stabilize glucose levels, while ensuring adequate intake of dietary fibre and other important nutrients. Eating regular meals and tuning in to hunger, satiety and satisfaction signals are also part of maintaining a balanced and varied diet and a healthy relationship with food.

This guest blog post was written by Joanna Tan, tjyjoanna@gmail.com, a Nutrition & Dietetics student, and reviewed and edited by Claire Pettitt MSc RD.

References:

[1] Randeva, H. S., Tan, B. K., Weickert, M. O., Lois, K., Nestler, J. E., Sattar, N., & Lehnert, H. (2012). Cardiometabolic Aspects of the Polycystic Ovary Syndrome. Endocrine Reviews, 33(5), 812–841. https://doi.org/10.1210/er.2012-1003

[2] 220. Barrett-Connor, E., Giardina, E., Gitt, A., Gudat, U., Steinberg, H., Tschoepe, D. (2004) Women and heart disease: the role of diabetes and hyperglycemia. Arch Intern Med 164(9):934–942. https://doi.org/10.1001/archinte.164.9.934

[3] Zafar, M. I., Mills, K. E., Zheng, J., Regmi, A., Hu, S. Q., Gou, L., & Chen, L.-L. (2019). Low-glycemic index diets as an intervention for diabetes: a systematic review and meta-analysis. The American Journal of Clinical Nutrition, 110(4), 891–902. https://doi.org/10.1093/ajcn/nqz149