The link between PCOS, Insulin Resistance & Blood Sugar Balance

A huge 70-80% of PCOS women have insulin resistance. High insulin worsens PCOS as it leads to increased androgen production which drives PCOS symptoms. High insulin causes fatigue, cravings, sleep disturbances, weight gain and difficulty losing weight, and inflammation. It also increases the risk of cardiovascular disease, type-2 diabetes and non-alcoholic fatty liver disease.

Better insulin sensitivity, in comparison, means cells are more responsive to insulin. Which means better blood sugar regulation and balanced hormones, easier weight maintenance or weight loss, better energy, and typically an ability to tolerate and eat more carbohydrates.

Insulin resistance is really misunderstood, as most think of it as something that happens from eating lots of sugar and drinking sugary soft drinks daily. But the reality is our modern diets, even what is marketed as and considered "healthy" can contribute to insulin resistance. I'll explain more in this article.

“People are fed by the food industry, which pays no attention to health, and are treated by the health industry, which pays no attention to food.” - Wendell Berry.

What is insulin resistance?

Firstly, insulin is a hormone produced and released by the pancreas in response to rising blood sugar levels. Blood sugar levels rise by eating carbohydrates (and when cortisol is high, which I'll discuss further). Insulin's role is to move glucose (sugar) from the bloodstream into muscle, liver and fat cells to either be used as energy or stored for energy at a later time. In an optimally healthy body, your pancreas would release the right amount of insulin needed at a time to transport sugar to cells AND those cells' insulin receptors would respond to the insulin by allowing the sugar to enter via glucose transporters. 

Think of insulin like an Uber driver that picks up passengers (the sugar in your bloodstream) and drives them to a nightclub (muscle cells). When the nightclub security (insulin receptors) sees the Uber driver they open the door and allow the passengers to enter the nightclub.

Now imagine if you ate lots of carbohydrates and created lots of passengers (high blood sugar). More and more Uber drivers are needed to drive the passengers to the nightclubs. But now the nightclubs are full, so when the Uber drivers and passengers arrive, the nightclub security no longer opens the door to allow passengers to enter. So the Uber drivers take the excess passengers elsewhere. That else where is the liver, where sugar is either stored as glycogen for energy later on, or converted into free fatty acids and triglycerides that enter the bloodstream. The issue now is that too much free fatty acids and triglycerides in the bloodstream further contribute to insulin resistance. 

How does insulin resistance worsen PCOS?

Simply put, in PCOS women, high insulin levels trigger the ovaries to produce excess androgens (male-dominant hormones).

High androgens drive the symptoms of PCOS including weight gain (particularly around the middle), acne and skin breakouts, hirsutism (excess hair growth / darkening of hair), alopecia (male-pattern baldness or thinning of the hair). High androgens also stop maturing of follicles (eggs) in the ovaries and block ovulation, causing irregular or missing periods and infertility.

High insulin also directly causes other PCOS symptoms including weight gain, cravings, fatigue, skin tags and acanthosis nigrans (dark velvety skin patches).

What causes insulin resistance?

Its a common misconception that you need to be drinking sugary soft drinks and eating loads of sugar daily to develop insulin resistance (although this is one way insulin resistance develops). However, I often see clients who are actively trying to improve their nutrition and eating a "healthy" diet still struggling with insulin resistance and PCOS. 

For example a bowl of oat porridge with berries and almond milk for breakfast sounds healthy right? Well this meal would spike your blood sugar levels because there isn't enough protein and fats to slow the absorption of carbs into the bloodstream, causing high insulin and exacerbating PCOS. Smoothies, muesli bars, flavoured yogurts and granola are all examples of other marketed "healthy" foods that can spike blood sugar levels.

The development of insulin resistance occurs over time and can be due to a number of factors that cause blood sugar dysregulation (highs and lows of blood sugar):

• High glycemic foods - added sugars, refined carbohydrates, sugar-sweetened beverages
• Eating carbohydrates without pairing it with protein, fats and fibre to slow the release of sugar into the bloodstream and keep blood sugar levels stable / within range
• Not eating enough protein, healthy fats and fibre - stabilises blood sugar levels, whilst fibre also modulates the gut microbiome
• Chronic stress - high cortisol causes the release of glycogen (stored sugars) from muscles and liver cells, raising blood sugar levels
• Inflammation - also stops cells responding to insulin, causing insulin resistance
• Sedentary lifestyles and not moving or exercising regularly - exercise increases the transport of glucose into cells
• Lack of quality sleep (meaning the time of sleep, quality of sleep stages, and time of day) - even 1 night of poor quality sleep or not getting 7-8 hours sleep reduces insulin sensitivity
• Gut microbiome dysbiosis - an imbalance of gut bacteria leads to intestinal inflammation and "leaky gut" (increase permeability), allowing passage of lipopolysaccharides (LPS) into the blood. LPS activates an inflammatory immune response, causing insulin resistance

Are you insulin resistant?

Common signs of insulin resistance include:

• extreme thirst or hunger or cravings
• feeling hungry even after a meal
• increased or frequent urination
• tingling sensations in hands or feet
• fatigue and lethargy
• frequent infections
• evidence in blood work - fasting insulin, fasting glucose, HbA1c, lipids (HDL, LDL, triglycerides, cholesterol)
• weight gain, particularly around the middle, and difficulty losing weight
• skin tags and acanthosis nigrans (velvety skin patches)

5 ways to prevent or reverse insulin resistance in PCOS

Every PCOS woman will respond differently to carbohydrates (i.e. have a different insulin sensitivity). Which is why I teach my PCOS clients how to find their unique carb tolerance in my Heal Your PCOS program. Your insulin sensitivity can improve over time with the right nutrition and lifestyle strategies, which means you will likely be able to slowly increase your carbs over time, as well as reverse the symptoms of insulin resistance.

Here are my top 5 strategies to reverse insulin resistance:

I'll be sharing more strategies to balance blood sugars and lower insulin in my upcoming blood sugar balancing workshop (online) on 15th Feb 2023:

1. Follow the macronutrient balanced plate method - fill half your plate with non-starchy veggies, 1/4 plate protein, 1/4 plate low GI carbs, 1-2 tbls healthy fats. Depending on your level of insulin resistance you may need to start with lower carbs, or have 1-2 meals per day with lower carbs, then slowly increase this over time as your insulin sensitivity increases.
2. Eat a minimum 100g protein per day, or 1.6-2g / kg bodyweight, spread across each meal - protein stabilises blood sugar levels and increases satiety, reducing cravings and the likelihood of over eating carbs.
3. Reduce refined carbs and added sugars - opt for small serves of low GI carbs like berries, quinoa, pre-cooked and cooled brown rice or potato, or legumes, and always serve with protein and fats. Checks labels on foods, even "healthy" foods like yogurts can contain added sugars.
4. Aim for 30g+ fibre daily - from non-starchy vegetables, nuts and seeds, some fruit. Increase your intake slowly to avoid gut disturbances and to keep bowels regular.
5. Have 1 tbls apple cider vinegar in water before a meal with carbs - the acetic acid in vinegar lowers post-meal blood glucose levels by increasing the uptake of sugar into muscle cells. Try this 1-2x daily before your meals containing the most carbs, or include a salad with vinegar dressing with your meal and eat this first on your plate.

To learn more strategies for getting off the blood sugar rollercoaster and balancing blood sugar levels to reverse insulin resistance, join me for The Blood Sugar Reset online workshop on 15th Feb 2023. Learn more & sign up here.