Have you ever heard of insulin resistance? If so, you might be among the 75% of women with PCOS who have also been diagnosed with this resistance.
But has anyone ever explained to you in detail what it consists of? No? Then come along as we delve into the topic! We're here to help you understand the mechanisms and, most importantly… to balance your PCOS!
What is Insulin Resistance?
To fully understand your PCOS, you first need to understand all the mechanisms and processes involved. Insulin resistance is now cited as one of the main mechanisms of Polycystic Ovary Syndrome. That is how important this topic is to us!
Insulin resistance… OK… But what exactly is it?
It is an inflammatory condition in which our body has gradually become insensitive to glucose, that is, to “sugars.”
To manage the waves of "sugars" from our diet, our body produces a hormone called insulin. This hormone is produced and secreted by our pancreas as soon as our body detects an influx of glucose in our blood (whether it’s after a meal or due to stress…). For example, when we eat a plate of pasta, bread with a few pieces of chocolate (we know you... we are almost all the same!), but also a simple salad, the "sugar" contained in these foods will be assimilated by our digestive system, and once it reaches the cells of our pancreas (specifically the beta cells), it will trigger the release of small vesicles containing insulin.
Once released, this insulin can fully perform its main role: lowering blood sugar levels (glycaemia) by allowing it to enter our cells: those of the liver, muscles, and fat cells! It’s like the key to the lock of your cell for glucose!
How does insulin get glucose into the cell? It binds to specific receptors (the locks for the famous key!), which are elements on the surface of the membranes of target cells. This key-lock interaction sends a signal to the cell, which then opens its door to glucose.
But why do our cells need glucose? Simply because carbohydrates, “sugars” from our diet, are THE fuel for them. Without sugar, the cell could not produce energy and function optimally. We need these sugars!
How does insulin resistance develop?
For various reasons, which can even add up (we'll discuss them below!), the increase in blood sugar (and therefore insulin!) over a prolonged period can make our cells more and more resistant to the insulin message. And if the message is not well received... You guessed it... The door won’t open: the glucose will remain outside the cell!
More and more sugars will accumulate in your bloodstream, encouraging the pancreas to produce more and more insulin to try to get this glucose into the cell. This vicious cycle, if not stopped, can exhaust the pancreas and eventually lead to an advanced pre-diabetic state or even type II diabetes.
But what is the link between insulin resistance and PCOS?
As explained earlier, insulin resistance leads to what is called hyperinsulinemia (a high level of insulin in the blood). What we haven't told you yet is that, on top of its many important roles, insulin directly or indirectly impacts our hormonal system.
In excess, it is responsible for stimulating our beloved testosterone (one of the male hormones potentially present in excess in PCOS), mainly through the enhancement of our luteinizing hormone, LH (a hormone your doctor regularly measures) at the expense of another hormone, FSH. In case of insulin resistance, our male hormones have a harder time converting into female hormones, leading to hyperandrogenism, i.e., an excess of male hormones, characteristic of PCOS.
Insulin is also a strong inhibitor of SHBG, which is a protein that binds to testosterone to inactivate it! In the case of insulin resistance, testosterone is more often found “free” in circulation without a carrier, and… unfortunately, it is in this free form that it is most active! This might be why you have signs such as acne, hirsutism, or hair loss.
Taking care of your insulin balance (and therefore your carbohydrate/sugar levels) is particularly important with PCOS. Be careful, this does not mean that you should only consider this potential insulin insensitivity. PCOS is a multifactorial syndrome, so don’t forget to get support to check if inflammation is also present.
To help you, we have written articles on inflammatory-type PCOS and adrenal PCOS, feel free to check them out!
What are the symptoms of insulin resistance and how to diagnose it?
First of all, it is good to know that insulin resistance can sometimes go unnoticed for several years. Why is that? Simply because the pancreas compensates by producing insulin to counter the rise in blood sugar, thus bringing it back to healthy levels and not showing any anomalies in blood sugar (during your blood test).
Some women may therefore not experience any of the symptoms mentioned below. It is very important to talk to your doctor, and / or your gynaecologist and / or your endocrinologist if you have any doubts.
Signs that Your Body is Resisting Insulin:
In the meantime, here is a (non-exhaustive) list of the main signs encountered in insulin resistance:
- An increase in waist circumference with excess abdominal fat (that little belly pouch that has grown and that we can’t seem to be able to get rid of... Even for the slimmest among us!).
- Extra pounds slowly piling up (remember, insulin is also responsible for fat storage!) and more difficult weight loss.
- Fatigue (in case of hyperinsulinemia, energy becomes difficult to mobilise, leading to chronic fatigue), a sign very often found with PCOS.
- Sugar cravings, sometimes incessant hunger throughout the day.
- Chronic migraines.
- Increasingly poor memory and concentration (not knowing where we put our keys doesn’t count... It happens to all of us).
If one or more of these signs resonate with you, it might be worth talking to your doctor and requesting additional tests. Beyond blood sugar and insulin levels, here are some interesting markers that can help during a blood test:
- Glycated Haemoglobin: It reflects your blood sugar level over a relatively long period (2 to 3 months). If you are not diabetic, this should ideally be below 5.4%, according to several doctors.
- HOMA: It measures your level of insulin resistance. This test should be done fasting (for 12 hours). According to scientific literature, the index should ideally be below 2.4, or even a bit less according to some researchers...
- QUICKI: It measures your insulin sensitivity. Unlike the HOMA test, the higher this index, the better! Ideally, it should be above 0.34.
- SHBG: Here we find our testosterone carrier which is very interesting to measure in the context of potential insulin resistance. The lower this marker, the more likely you are to be diagnosed with insulin resistance.
- Other interesting markers: Vitamin D, Vitamin A / RBG, Chromium, Erythrocyte Magnesium, Iodine (urine iodine analysis)
Why Does the Body Resist Insulin?
Insulin resistance can be caused by, or worsened for, many reasons. Genetics is one of them, but it does not mean that we cannot rebalance our insulin.
If we set aside certain periods of life, such as pregnancy, puberty, or ageing, which can affect our sugar balance, we find the following potential causes:
- First of all, hyperinsulinemia itself, that is, too much insulin in our blood (caused by an ever-increasing production from our pancreas trying to cope with too much sugar… We're getting there!).
- Excess weight and/or simply an inappropriate or overly rich diet (but not necessarily rich in good nutrients!).
- Chronic stress will increase our blood sugar and thus exacerbate insulin resistance through the production of cortisol (our dear stress hormone!). Cortisol makes the receptors on our cells, where insulin is supposed to bind, insensitive.
- Sedentary lifestyles: movement maintains our muscle fibres which will, in turn, demand insulin.
- Elements interfering with the insulin message: a cell with an outer membrane that is not fluid enough to let the message through (lack of Omega-3 fatty acids, for example), insulin receptors that do not activate due to some nutrient deficiency (Magnesium, Zinc, Chromium).
- Mitochondrial dysfunction (we will return to this magnificent element, the mitochondrion, present in large quantities in our cells, in a future article!). These entities are responsible for producing our energy by converting glucose that enters our cells (and so, if there are not many functional mitochondria… There is a lot of free glucose!).
- Smoking, which increases our insulin.
- Hypothyroidism, i.e., an underactive thyroid: to learn more, visit PCOS and Hypothyroidism, What’s the Link?
- Digestive disorders (Yes… They are everywhere!).
- And other possible cause-effect links…
How to Overcome Insulin Resistance?
Your goal? To restore relatively stable blood sugar levels throughout the day, so as not to overwork your insulin (and therefore your pancreas). Let me warn you right away, it is unrealistic to think that we will eliminate all types of sugar (we need them, the key is to choose them wisely and eat them at the right time). It is also incorrect to think that the goal should be to avoid insulin spikes: we have them at every meal (even after low-sugar meals) and they’re essential. The goal? For these “spikes” not to be excessive: small hills rather than alpine mountains!
Your mission, should you choose to accept it? Try the recommendations that resonate with you the most amongst the following and do not hesitate, to go further, to seek support from a naturopath or a nutritionist specialising in PCOS.
Our Tips to Restore Stable Blood Sugar Levels
From a dietary perspective, here is what you can already implement (of course, personalise it with support):
Tip #1: Establish a sort of food chronobiology
- A breakfast rich in proteins and good fats: avoid sugar-rich foods in the morning (breakfast cereals, fruit juices including homemade, white bread baguette…).
- If time allows, you can delay your breakfast a bit to engage in gentle activity in the morning (walking, stretching, gentle yoga…).
- A balanced lunch with carbohydrates: this is the right meal for you to introduce cereals (pasta, rice, but also quinoa, bulgur, amaranth, millet…) and starchy foods (sweet potato, potato…), which you can come with animal or vegetable proteins (lentils, chickpeas…), and of course vegetables! You can try consuming fibres (vegetables here) first, then proteins and fats (meat, fish, lentils with your favourite oil…), and finally your carbohydrates (this will slow down glucose absorption).
- A light dinner: a light meal with minimal carbohydrates will help avoid storage during the night (especially if you eat late). Why not eggs or fatty fish with vegetables?
- Avoid desserts in the evening and prefer them, if necessary, after lunch (but you can occasionally have your chocolate while watching a movie in the evening… Don’t forget the little pleasures!).
Tip #2: Smooth Out Your Meals Throughout the Day!
Wanting to avoid big blood sugar spikes means not skipping meals at random, but also not snacking non-stop. We recommend learning gradually to listen to your hunger (it takes time, but you will get there eventually!).
Tip #3: Favour Raw Foods!
It is important to favour raw and minimally processed foods (to go back to the basics of a PCOS diet). To help along the way, you can read our article on Diet and PCOS.
Prefer raw vegetables over commercial soups, whole fruits over fruit juices…
And enjoy fruits/vegetables, nuts, good oils (olive ++, walnut, hemp…), legumes, whole grains, fatty fish…
Tip #4: Limit Foods Containing a Lot of Added Sugars.
It is important to limit foods that contain a lot of added sugars, whether glucose or fructose (cookies, sodas, fruit juices, dried fruits like dates, alcohol, overripe fruits…).
Be careful also with processed frozen foods and canned goods that often contain sugar (yes, even in savoury dishes!)... And with salty foods too (excess salt would promote excessive sugar absorption!).
It is important to apply all these tips while keeping some of your comfort foods (we don’t want to completely eliminate them but rather limit their intake: everything is a matter of balance).
Tip #5: Favour Low Glycemic Index (GI) and Low Glycemic Load (GL) Foods.
By creating wholesome dishes as suggested above.
You can also eat cereals and starchy foods by cooking them, then cooling them in the refrigerator (to have them cold or reheated). This helps limit blood sugar spikes when eating them! And of course, avoid overcooking them (favour al dente pasta, for example).
Tip #6: Use Your Glucose!
By promoting movement (move, go out, practice 10 to 20 minutes a day of physical activity, ideally after meals).
The important thing is regularity: 10 minutes a day of gentle activity will be more beneficial for you than 1 hour of intense cardio done only on the weekend (though that’s already quite good!).
Tip #7: Occupy Your Nervous System!
Take care of your nervous system… That means managing your stress (sport, breathing, relaxation, meditation, reading, writing… Whatever helps you to chill out!).
Use plants: nigella, berberine, cinnamon, schisandra chinensis, ginger, turmeric, juniper or olive buds…
Again, adapt all that with the healthcare professional of your choosing!
Berberine, for example, will help our body increase its sensitivity to insulin, thereby helping to reduce insulin resistance. It is both hypoglycemic (i.e. lowering blood sugar levels), and an activator of our metabolism, to reset our functions. Be careful, it is contraindicated during pregnancy (also be careful during an ongoing “pregnancy project”!). For the record, berberine is said to have similar effects to Metformin, a medical treatment used against type II diabetes.
Tip #8: Help from Micronutrition!
To go the extra-mile, you can get help from micronutrition: inositol, zinc, chromium, omega-3, magnesium, coenzyme Q10, L-theanine… to be adapted to your problem (watch out for contraindications).
Inositol, unlike berberine for example, is interesting when trying to have a baby and during early pregnancy (and so much more!). Naturally present in our body, it has a direct effect on our insulin by improving its action. It is also interesting with PCOS as it improves the quality of our oocytes and allows us to optimise ovulation. Many studies have proven its effectiveness on fertility and the regulation of our hormonal system (let’s take advantage of that!).
At Sova, we have several product ranges. Notably, Ovastart, a combination of molecules supporting hormonal and menstrual health by promoting hormonal regulation and balance.
To learn more about this must-take inositol, you can also read our article on Inositol and PCOS.
You will also find chromium in our product “Balance Your Sugars,” a complex based on Berberine, NAC, Cinnamon, Gymnema, Green Tea & Chromium. This combination helps maintain glycemic balance, promotes toxin elimination, reduces sugar cravings, and improves post-meal fatigue.
Tip #9: See a Healthcare Professional!
It is also very important to check with your doctor if you have inflammation or thyroid problems. You should also regulate your digestive system with your naturopath if you have issues (by taking care of your liver, which is a crucial passage for all hormones produced by your pancreas, amongst other things!).
Conclusion:
At Sova, we are convinced that knowledge is essential to improve quality of life with PCOS. We hope this article has given you keys to better understand what insulin resistance is and its impact.
But we are not stopping there!
We know adapting your diet to PCOS isn’t easy! To help you do this and save you time, we have created a Recipe eBook for you. You will find tips and information on the recommended diet for PCOS and, most importantly, 50 ready-to-make recipes. All you have to do is cook and eat!
To learn more about the link between PCOS and digestive disorders, you can also listen to episode 9 of our podcast: PCOS and Insulin Resistance.
In this episode, we decode insulin resistance, explain what it is, its link with PCOS, and tell you how to manage it!
Now it’s up to you and you know what? You can do it!
