Hi, This is Francesca from The PCOS Newsletter where we are on a journey of getting to know our bodies and everything there is about PCOS.
This week’s question
What does insulin resistance have to do with PCOS?
This subject is very interesting but complex. Each paragraph in this newsletter could be an article by itself. This is the reason why I am so excited about this project as we will explore these subjects in detail as we go along. In the meantime join me on this journey and let’s look at the link between insulin resistance and PCOS.
The prevalence of insulin resistance for women with PCOS is very high (anywhere between 65-90%) and the connection between the two is very tight.
What is insulin resistance?
Very briefly, insulin is a hormone that gets released after eating a meal. The body breaks down carbohydrates into glucose which triggers the release of insulin from the pancreas. Insulin then helps transport glucose into cells, allowing them to use it for energy production or store it for future use.
When you are insulin resistant, your body's cells don't respond to insulin as efficiently as they should, which means that glucose cannot enter the cells as easily. As a result, your pancreas needs to produce more insulin to overcome this resistance and maintain normal blood sugar levels. This also leads to an increased levels of insulin in the blood.
What are the symptoms of insulin resistance?
Tiredness - given glucose doesn’t enter the cells easily, your body is unable to produce energy, leaving you feeling tired and fatigued
Increased hunger and cravings- as a result of lacking energy, your cells are under the impression that there isn’t enough glucose around so they make you hungry as an attempt to get the energy they need
Difficulty losing weight - an increase in blood sugar ultimately leads to fat storage and the increase in hunger and cravings means we over consume in the long run
Excessive thirst - your body will try to secrete some of the additional glucose from the blood through urine, so it increases its need for water
How does it link to PCOS?
This is the tricky question. Researchers haven’t been able to establish if PCOS causes insulin resistance or insulin resistance leads to PCOS. The consensus tends to sway towards the direction that these two things develop independently but affect each other in a vicious cycle.
What is the vicious cycle?
Excess insulin in the blood has a direct impact on the production of androgens via two mechanisms. Firstly, it increase the level of LH (Luteinizing hormone) which in turn tells your ovaries and adrenals to produce more androgens. Secondly, it also acts directly on ovaries receptors and increases the production and conversion of androgens. In a nutshell, it exacerbates the main hormone that gives PCOS its symptoms: testosterone.
On the other hand, excess androgens have an impact on adipose tissue (body fat). It is proven to increase the deposition of abdominal fat and enlarge adipose tissues cells. Having excess adipose tissue exacerbates insulin resistance. This pretty much leads to weight gain and the worsening of PCOS symptoms.
In brief, insulin resistance increases androgens production and androgens make insulin resistance worse (hurray 👀).
In addition there are a few others ways this vicious cycle works. I will cover them briefly as they each deserve their own newsletter issue:
There seems to be some issues with the uptake of glucose by skeletal muscles in women with PCOS which leads to more glucose in the blood and compensatory insulin. This is why focusing on building muscle is very important for us.
Excess insulin also acts on the liver by decreasing SHBG (Sex hormone binding globulin). This molecule is what transports testosterone through the body where is needed. In the lack of it, testosterone runs free and acts on areas of the body it shouldn’t.
In addition, there are inflammatory factors here. Excess androgen and excess insulin inevitability create a non-ideal environment that leads to inflammation which comes with its own baggage.
All of the above seems to have a very strong genetic link. Researchers are constantly discovering new areas of the genome that is slightly different for us and causes all of this circus (🙄 aren’t we lucky?). However, you can see how excess calorie intake, lack of exercise and poor nutrition adds up to an already non-ideal set up.
What can I do about it?
When life gives us lemons we make lemonade 🍋. It is safe to say we didn’t get the best genetic make up. However genes respond to environmental factors which is something we have control over. This is the reason why lifestyle changes such as improved nutrient intake, exercise and stress management can really downplay and manage this vicious cycle. My suggestion is to focus on the following pillars of health:
Exercise - find a way of moving that makes you happy and give your muscles the best chance at managing glucose uptake.
Eat in moderation - keeping your energy input balanced so do we don’t overwhelm our system with excess glucose can really help.
Eating nutrient dense foods - this is something I deeply believe in. Give your body the best shot by eating foods who are rich in quality nutrients: filling carbohydrates, quality protein and fats with a focus on high vitamin and mineral foods.
Sleeping - sleep is your recovery phase. Your body rebuilds, maintains and regenerates whilst we sleep. If we don’t, how will it function well on top of what we just went through?
Stress management - when you are in a stressed state your body prioritises survival over everything else. The proper functioning of your ovaries won’t be its priority. Looking after our mental wellbeing is as important as the items above.
Last but not least, there are some supplements and medication we can add to our toolbox. I really don’t think that without the above you can do much however a little help is needed sometimes:
Metformin - this is the drug that is used in T2D and helps with glucose management
Inositol - this is a supplement that works similarly to Metformin and has been proven to be effective
Chromium - another compounds that helps with insulin sensitivity
I hope you enjoyed this newsletter issue. It was a long one but we covered a lot of ground about insulin resistance. I am sure it raised a lot of more questions which I would love to hear. Feel free to reply to this email, comment below or submit it here.
See you next Sunday,
1Barber, T. M., Dimitriadis, G. K., Andreou, A., & Franks, S. (2016). Polycystic ovary syndrome: insight into pathogenesis and a common association with insulin resistance. Clinical Medicine (London, England), 16(3), 262–266. https://doi.org/10.7861/clinmedicine.16-3-262
Witchel, S. F., Oberfield, S. E., & Peña, A. S. (2019). Polycystic ovary syndrome: Pathophysiology, presentation, and treatment with emphasis on adolescent girls. Journal of the Endocrine Society, 3(8), 1545–1573. https://doi.org/10.1210/js.2019-00078
Xu, Y., & Qiao, J. (2022). Association of insulin resistance and elevated androgen levels with polycystic ovarian syndrome (PCOS): A review of literature. Journal of Healthcare Engineering, 2022, 9240569. https://doi.org/10.1155/2022/9240569
Disclaimer: We are all so unique in our own ways so this information is for education purposes only. Please further consult your healthcare provider about your health needs.