December 14, 2022
 in 
Prediabetes & Diabetes

How Insulin Resistance Contributes To PCOS

Article highlights
  • PCOS (polycystic ovary syndrome) impacts both endocrine and metabolic health
  • Key features of PCOS are underdeveloped ovarian follicles, high androgen levels, high concentrations of insulin, hormonal abnormalities, irregular periods, and abnormal body and facial hair growth.
  • Insulin resistance is one of the primary risk factors for PCOS due to the impact that insulin has on androgen hormones.
  • The management of polycystic ovary syndrome involves a focus on low-carb and anti-inflammatory foods to promote insulin sensitivity, resolve inflammation, and combat several other symptoms of PCOS.
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COS is a common endocrine disorder with a rising prevalence among women in the US. And although this condition impacts your endocrine (hormonal health), it also dips its toe in metabolic health as well.

Specifically, women with PCOS also tend to have higher insulin levels due to insulin resistance. While there is still a lot to learn about hyperinsulinemia and PCOS, treating one may significantly impact the outcome of the other.

In this article, we'll explore what PCOS is, how insulin and glucose levels impact this condition, and what the research says regarding the best diet for managing PCOS.

What Is PCOS?

PCOS (polycystic ovarian syndrome) is one of the most common causes of female infertility, affecting as many as five million women of reproductive age in the US[1]. 

PCOS develops during reproductive years but can impact a woman's health well beyond her reproductive stage. The primary feature of PCOS is ovarian cysts that develop along the edge of the ovary, containing immature eggs that fail to release with the regular menstrual cycle. This anovulation can create pain and further exacerbate symptoms of PCOS.

The exact pathogenesis of PCOS is unknown, but at its root is a hormonal imbalance that creates irregular menstrual cycles, painful periods, and other symptoms associated with hormone dysfunction. Specifically, women with PCOS tend to have higher than average androgen production(hyperandrogenism), which are known as male sex hormones. 

Androgens are responsible for male traits such as body hair and facial hair, which is why many women with PCOS may notice they start to grow hair where it wouldn't normally grow. While women do naturally produce a small number of androgens, overproduction is likely one of the root causes of menstrual irregularities, as androgens can interfere with the ovulation cycle.

Along with excessive androgen production, many women with PCOS also present with low-grade inflammation and insulin resistance[2].

Symptoms of PCOS

Some common symptoms of PCOS include[3]: 

  • Missed or irregular periods
  • Cystic ovaries
  • Facial hair
  • Excess body hair (hirsutism)
  • Weight gain and obesity (especially around the middle)
  • Dark or thick skin patches on the back of the neck, in the armpits, and under the breasts
  • Male pattern baldness or hair-thinning
  • Acne 
  • Skin tags

Complications of PCOS

When left untreated, PCOS can contribute to other health issues, such as:

  • Type 2 diabetes mellitus
  • Cardiovascular disease
  • Infertility 
  • Endometrial cancer
  • Dyslipidemia
  • High blood pressure
  • Depression and anxiety
  • High cholesterol
  • Metabolic syndrome
  • NAFLD (non-alcoholic fatty liver disease)

How Insulin Resistance Relates To PCOS

Although we don't clearly understand the connection between PCOS and insulin resistance (IR), there is a strong correlation between the two conditions. IR is a common symptom of PCOS, and likewise, PCOS can increase your risk for IR and type 2 diabetes.  

One potential mechanism for the connection is due to the impact of insulin on androgen hormone production. As mentioned, one of the key signs of PCOS is increased production of androgen hormones which creates hormonal imbalances and dysregulates the menstrual cycle. 

How exactly does this work?

Insulin resistance affects the ability of your adipose tissue, liver, and skeletal muscle to uptake glucose from your blood. This pushes the secretion of even more insulin to match your rising blood sugar. Unfortunately, high levels of glucose and insulin in your blood also impact other tissues in your body, and research shows that they may alter the function of your hypothalamus and pituitary gland in the brain, resulting in excessive production of androgenic hormones[4].

Even for women without PCOS, insulin resistance and high levels of androgens can produce ovarian dysfunction[5].

Fortunately, research shows that when women with PCOS are able to re-sensitize their cells to insulin, it may reverse some of the symptoms and help to normalize the menstrual cycle[6].

How Diet Can Improve IR and PCOS

Given the role that insulin can play in the progression of PCOS and the fact that insulin action is largely dependent on dietary factors, it makes sense that one way to tackle PCOS is by looking at your diet. 

Research shows that the right diet not only impacts your body's sensitivity to insulin signaling but may also help with other factors contributing to PCOS, such as inflammation and weight. 

So, what is the right diet for addressing PCOS and insulin resistance?

It appears that the most effective diet for PCOS and IR is a low-carb, low-inflammatory diet.

Benefits of Low Carb

Research shows that when you cut carbs, it can actually re-sensitize your cells to insulin. Now here is the important note – it's not that reducing carbs simply reduces your insulin needs; studies show that reducing carbs actually help your cells become more sensitive to insulin when insulin is needed. 

Many people assume that a low-carb diet is healthy for people with diabetes because it eliminates the problem; no carbohydrates mean no high blood sugar. But by enhancing your body's sensitivity to insulin, low-carb can potentially turn insulin resistance around[7].

For women with PCOS, low-carb dieting not only helps to improve insulin sensitivity (which may, in turn, reduce androgen hormone production), but it also reduces BMI, which is another contributing factor to hormonal imbalance[8].

Benefits of an Anti-Inflammatory Diet

Inflammation is at the root of most chronic imbalances and diseases that we see in the Western world. And, of course, one of the primary sources of inflammation that we have to contend with is our highly inflammatory food supply. 

Processed foods, seed oils, additives, fillers, artificial flavors, colors, and sweeteners all add to the inflammatory load that your body has to manage. 

On the other hand, when you eliminate inflammatory foods from your plate and replace them with anti-inflammatory fare, your body responds by correcting imbalances and taking in the nourishment on a cellular level. 

Studies show that high levels of inflammation in your body may be one of the root causes of insulin resistance. When you consume a diet that's rich in processed foods, it activates pro-inflammatory signaling pathways that interfere with your cells' ability to respond to insulin[9]. 

However, research shows that when people eliminate processed foods and add in anti-inflammatory whole food alternatives, their cells are once again able to respond to insulin signals[10].

Furthermore, when women with PCOS start following an anti-inflammatory diet, they see a range of improvements, specifically[11]:

  • Weight loss
  • Menstrual cycles become more regular
  • Hormone balance increases
  • Balanced blood pressure
  • Blood sugar levels become more steady
  • And improved fertility outcomes 

Takeaway

PCOS patients may be provided with supplements, oral contraceptives, or a range of other medications by their healthcare practitioners, but one of the most powerful allies they have is diet.

Overall, research suggests that helping your insulin receptors become more sensitive can have downstream effects that promote hormonal balance and reduce the side effects of PCOS. 

Similarly to diabetes care, following a low-carb diet filled with anti-inflammatory foods may be a missing link for those struggling with PCOS and related issues like infertility, heart disease, and obesity.

Citations

  1. https://www.cdc.gov/diabetes/basics/pcos.html#:~:text=Women%20with%20PCOS%20are%20often,risk%20for%20type%202%20diabetes
  2. https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439
  3. https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos
  4. https://www.ncbi.nlm.nih.gov/books/NBK507839/#:~:text=Insulin%20resistance%20is%20identified%20as,cell%20insulin%20production%20and%20hyperinsulinemia
  5. Dunaif, Andrea, and Carol Beth Book. "Insulin resistance in the polycystic ovary syndrome." Clinical research in diabetes and obesity (1997): 249-274.
  6. Diamanti-Kandarakis, Evanthia, and Athanasios G. Papavassiliou. "Molecular mechanisms of insulin resistance in polycystic ovary syndrome." Trends in molecular medicine 12.7 (2006): 324-332.
  7. Foley, Peter J. "Effect of low carbohydrate diets on insulin resistance and the metabolic syndrome." Current Opinion in Endocrinology, Diabetes, and Obesity 28.5 (2021): 463.
  8. Zhang, Xiaoshuai, et al. "The effect of low carbohydrate diet on polycystic ovary syndrome: a meta-analysis of randomized controlled trials." International Journal of Endocrinology 2019 (2019).
  9. Wu, Huaizhu, and Christie M. Ballantyne. "Metabolic inflammation and insulin resistance in obesity." Circulation research 126.11 (2020): 1549-1564.
  10. De Luca, Carl, and Jerrold M. Olefsky. "Inflammation and insulin resistance." FEBS letters 582.1 (2008): 97-105.
  11. Salama, Amany Alsayed, et al. "Anti-inflammatory dietary combo in overweight and obese women with polycystic ovary syndrome." North American journal of medical sciences 7.7 (2015): 310.