Insulin Resistance & PCOS: Can diet & lifestyle have an impact?
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.
Managing the myriad of PCOS symptoms can be exhausting and adding insulin resistance to the equation may feel too much. But the good news is that diet and lifestyle plays a key part in improving insulin resistance. So if you’re one of the 30-70% of women with PCOS who have insulin resistance, then this blog post is for you. Read on to understand more about the link between insulin resistance and PCOS as well as uncover some top tips that you can put into action today!
What is insulin resistance?
Insulin is a hormone produced in our pancreas to help us effectively use glucose (sugar) from the food we eat as energy to fuel our bodies. When we have insulin resistance it means that the body is unable to use the insulin effectively leading to higher levels of glucose circulating in the body. These higher levels of glucose result in the pancreas producing even more insulin which leads to high levels of insulin being circulated in our blood.
Health risks of insulin resistance?
This poses the question - does insulin resistance really matter?
Well, insulin resistance itself can further lead to impaired glucose tolerance (sometimes called prediabetes), 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.
Furthermore, impaired glucose tolerance and diabetes can increase blood pressure and cholesterol significantly in women, both of which are risk factors for cardiovascular disease (heart disease and stroke). 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).
The link between insulin resistance and PCOS?
You may be thinking what does this have to do with PCOS? Well if you remember at the start, we learned that insulin resistance is not only a characteristic of PCOS but a driving force in the progression of the condition and development of other conditions associated with it.
Therefore management of insulin resistance can really be a cornerstone to PCOS symptom management and protecting future health in many with PCOS.
Symptoms of insulin resistance and PCOS?
High levels of insulin caused by insulin resistance in the body can result in the following symptoms:
Higher androgen levels (male sex hormones)
Weight gain
Irregular periods
Increased cravings
Infertility
This list is probably fairly familiar to you and other women like you with PCOS. However before self diagnosing yourself with insulin resistance, if you have the above symptoms, it may help to get tested for insulin resistance using a blood test if you haven’t already done so.
However, testing for insulin resistance is not common! Doctors rarely test for the presence of insulin in your blood. Instead, they may offer one of the following tests to give some clue:
Glycated haemoglobin (HBA1c)
Oral glucose tolerance test (OGTT)
Fasting plasma glucose
Being well informed about your insulin levels and whether you have insulin resistance is the first step in managing insulin resistance and improving PCOS symptoms, including cravings, irregular periods, ovulation and fertility.
Read on to find out what practical steps you can take in changing your diet and lifestyle habits to help you further in your journey of managing insulin resistance.
Recommended diet and lifestyle changes
Include low GI foods
The glycaemic index (GI) of a food measures the rise in blood glucose after eating the food.
Refined carbohydrates with a high GI such as white bread, doughnuts, processed cereals and cakes cause a sharp rise followed by a dip in glucose levels. These sharp spikes in glucose cause the pancreas to produce more insulin thus increasing insulin levels.
Whereas wholegrains and high fibre carbohydrates such as brown rice, oats and wholegrain bread have a lower GI and can reduce spikes and dips in glucose levels throughout the day ultimately improving insulin levels as less insulin needs to be produced by the pancreas.
Eating a diet high in foods with a low GI has been found to improve insulin sensitivity in people with impaired glucose tolerance or diabetes (3).
For more information on a low GI diet and how to incorporate more low GI foods, read our blog post on low GI foods for PCOS.
Eat more fibre
Including foods high in fibre helps stabilise glucose levels. This includes fruit and vegetables, wholegrains, legumes, nuts and seeds. Including these foods regularly also ensures adequate intake of dietary fibre and other important nutrients.
Eat healthy fats
Reducing unhealthy saturated fats and replacing them with healthy monounsaturated and polyunsaturated fats including omega 3 fats may have an impact on improving insulin resistance (4). Try reducing red meat and adding in oily fish, avocado, nuts, seeds and olive oil.
Limit sugar intake
Whilst eating a diet high in sugar does not directly cause type 2 diabetes, foods high in sugar have a high GI and thus can cause sharp increases in glucose and hence insulin levels. Limit your intake of sugar, sugary carbonated drinks, sweets, cakes and desserts.
Be active
When it comes to exercise, a combination of both moderate intensity cardio along with some resistance training (which helps optimise body composition) can improve insulin sensitivity and reduce insulin resistance. However regular movement also brings benefits in mood, stress reduction and general well-being. The secret to regular movement though, is doing something that you love and makes you feel good!
For more information on the benefits of movement in PCOS and how to incorporate more exercise into your daily life, read our blog post on Exercise and PCOS.
Reduce stress
Stress causes the body to produce stress hormones including cortisol and adrenaline. These hormones do not have any significant side effects in the short term but chronic stress leading to chronic production of these hormones can lead to insulin resistance (5).
Reducing stress therefore can be one way to improve insulin resistance. For more information on managing stress and PCOS, read our blog on lifestyle tips on reducing stress in PCOS.
Get enough sleep
If you struggle with getting to sleep, staying asleep and/or experience low energy levels and fatigue during the day, it may be worth addressing your sleep hygiene to see if you can improve this. Our blog post on sleep and PCOS will provide you with lots of ideas and practical advice on how to do this!
Can you reverse insulin resistance in PCOS?
Yes! Making changes to your diet and lifestyle can improve and potentially reverse insulin resistance and prevent the progression to type 2 diabetes. In a study with over 3000 participants, those who followed a diet and lifestyle programme were able to reduce their chances of developing type 2 diabetes at 3 years by 58% (7).
In summary, insulin resistance is common in those with PCOS. It can cause longer term health consequences including the development of type 2 diabetes and cardiovascular disease. Furthermore it can cause progression of PCOS and development of PCOS symptoms.
Therefore arming yourself with the knowledge of whether you are insulin resistant can be pivotal in managing your PCOS symptoms. Diet and lifestyle changes can be implemented to improve insulin resistance and potentially help manage your PCOS symptoms. So the question is what one diet and lifestyle habits are you going to start introducing in your life this week?
If you have symptoms of insulin resistance or have been advised by your medical team that you are insulin resistant and want to speak to a dietitian for further support and advice, then book a free call to speak to a specialist PCOS dietitian.
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