Link between Insulin and PCOS
PCOD and Weight Loss
Share your Story: Ramya’s story on PCOS and Weight loss
Weight Loss Diet During Polycystic Ovarian Syndrome (PCOS)
Polycystic Ovarian Disease….A Rising Epidemic
PCOS is a very complex syndrome. In terms of symptoms, it has numerous manifestations (also called phenotypes by the medicos) so much varied so that it’s still not well-understood by the medical community as to what exactly causes PCOS and what holds true for all woman having PCOS. Initially, there was a big misconception among people including doctors that women with PCOS always come in big size and thin/normal weight women were refused a diagnosis for PCOS even if they showed all other symptoms. Later, the medical community acknowledged this condition in women who aren’t over weight and divided PCOS into two types – classic PCOS and lean PCOS.
Well then, in that case the treatment protocol for overweight women with PCOS should be distinct from that for lean women and the treatment for the two types should be more or less uniform over each type. To many, Insulin resistance (IR) was and is believed as an underlying cause of PCOS. Insulin sensitizing drugs like Metformin, Hyponidd were used to address insulin resistance which also helps reduce androgen levels in the body.
Understanding the Role of Insulin
In layman’s language, by insulin resistance, we mean our body need to produce more than normal amount of insulin to clear sugar off our bloodstream each time we have a meal/snack/binge. If blood sugar gets back to normal anyway, what’s the problem now? The large amount of insulin thatis produced is harmful for our body and for women with PCOS in particular. High insulin levels makes the ovary produce large amount of testosterone which doesn’t only cause androgenic symptoms like acne, alternate hair growth pattern (hairloss from scalp and excess hair elsewhere), oily skin, increased aggression, etc. but also suppresses ovulation which again puts your body back in the cycle of more testosterone production and infrequent or no ovulation(anovulation). Anovulation is a precursor to follicular cyst in the ovaries, which itself contributes to production of more androgens(testosterone).
A high fasting sugar and/ high fasting insulin might make your doctor suspicious about your being insulin resistant and might recommend a glucose tolerance test (GTT) to determine that.
For PCOS to be diagnosed, any two of following three must be met: An LH:FSH (sex hormones) ratio of more than 3:1, more than normal level of testosterone, infrequent or no ovulation.
But there are women, both overweight and lean, who don’t have insulin resistance but otherwise have PCOS by blood reports. What about them? They are most often pushed away with Birth Control Pills (BCP’s). BCP’s suppress ovulation and the symptoms associated with PCOS. But they do come many untoward side effects that may make your life worse. Also, it doesn’t treat your condition, it only hides the symptoms. If your doctor recommends it and you want to have it because you have exhausted all other options, by all means go for it.
PCOS was now divided into 4 types:
1. Overweight women with IR
2. Overweight women without IR
3. Thin women with IR
4. Thin women without IR.
Recommended treatment for PCOS:
• Whether IR or not, overweight women are told to reduce their weight back to normal range by following a calorie-restricted diet and regular exercise – for some, losing weight itself puts their body back on track and they get rid of PCOS while for others, they lose weight and continue with their struggle against PCOS.
• Lean or overweight IR women are prescribed with Metformin.
• Lean and non-IR are prescribed with BCP’s.
• All women with PCOS, no matter what their phenotype, are advised to exercise regularly.
Now, if some women with PCOS are non-IR, what is cause of their health issues? For long there had not been an answer to it and whether they like it or not, those women had only one answer – BCP’s.
Here, we have a good news for such women – don’t curse me for calling that a good news :P, I’m on your boat. Research going on since 5-10 years show that lean women having normal levels of insulin are hyper-sensitive to it and their ovaries produce large amount of testosterone even with normal insulin levels (this could be a reason why some lean women without IR respond to Metformin). Now, how to address it? The answer is by following a diet that keeps your insulin levels in check.
Most lean PCOSers having normal insulin levels gorge on their desserts (I did), little do they know their body is playing tricks – the normal levels of their blood sugar and insulin is just a misnomer.
Whether IR or not, following are the ways to keep your insulin from soaring high (this is not an exhaustive list):
• Go for wholegrains rather than refined one that notoriously spike insulin levels.
• Pair your carbs with protein – Many PCOSers find relief with a high-protein diet but some of us have issues digesting higher amounts of protein. In that case, pair your carbs with protein, it not only helps you satiate and prevent binging but also blunts the insulin spikes due to the carbs. Like dal with rice, nut/nut butter with apples, etc. I also find pairing carbs with protein improving my symptoms. Many also go for a Palaeolithic diet and find relief.
• Add good fats to your diet – they will keep you fuller for long. Fats slow down the digestion and consequently slow the ab zsorption of glucose into your bloodstream. . Oh yeah, good fats are essential for good hormonal profile.
• Add salad to the start of your meals – the soluble fibers in the veggies soak up starch and sugar and facilitates a slow release of glucose into bloodstream. Don’t boil your veggies, just roast/stir fry them. Boiling saturates the fibres with water and it can no more help us with blood sugar.
• Have some vinegar – add it as dressing or drink a couple of teaspoon in a glass of water before starting a meal. It also slows down glucose absorption and on a long run, increases insulin sensitivity (i.e., reduces insulin resistance).
• Reduce or eliminate dairy – dairy is highly insulinogenic – it induces huge insulin response. Try eliminating it for a month or two and then reintroduce it – if it makes no difference, then continue having it in moderation.
Here are some little known facts about PCOS:
1) Having an irregular period doesn’t indicate PCOS. PCOS doesn’t always come with irregular periods.
2) Having cysts doesn’t indicate PCOS. PCOS doesn’t always come with cysts. An ultrasound can’t itself determine PCOS, it depends on the phenotype
3) Cysts don’t determine ‘severity’ of PCOS, nor does infertility. Infact, with such varied set of symptoms women with PCOS present, there is no way to determine or rank the symptoms in terms of severity. E.g. there are some women who have managed to get rid of all symptoms except regaining their ovulation (sub-fertility/infertility).
4) Ovarian cysts are different from cysts due to PCOS
5) Having periods doesn’t automatically mean you are ovulating
6) You can check if you are ovulating by Basal Body Temperature(BBT) charting.
7) PCOS may come with sub-fertility or infertility. Everyone with PCOS isn’t doomed to be infertile – some get pregnant without any medical help.
8) If we have a lot of weight to lose, don’t resort to unhealthy and overly restrictive diets and/or over-training to lose weight. Losing weight takes time – 2-3 lbs per week is fine. Any more than will put your cardiovascular system and your whole body into a shock and the weight may rebound very soon. The shock can also be a cause of disaster to your hormonal system.
9)Strength training has been shown to reduce insulin resistance. Now, get up baby and lift heavier!
And finally, whether you have PCOS or not, try to frame your diet such that you don’t get frequent insulin spikes. Upcoming researches point towards chronic elevated levels of insulin being associated with many diseases including cancer. I’m still tweaking my diet and will come up with more when I find some.
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