Doctors don’t really know what causes Polycystic Ovarian Syndrome but we do know that there is a really close link with insulin and insulin resistance (1). In fact, PCOS and insulin resistance go hand in hand. And this insulin resistance can wreak havoc on our PCOS symptoms.
So, if we want to better to manage our PCOS symptoms, we need to learn how to increase insulin sensitivity and lower our insulin levels. Before we go on to the 12 easy ways to lower insulin levels in PCOS, we need to understand a little more of what insulin actually is.
The Low Down on Insulin and PCOS
When looking at the root cause of PCOS, researchers have found that there is an irregularity of the Beta cells of the pancreas (2). The Beta cells are responsible for making insulin.
Insulin is a hormone that’s needed to convert sugar, starches and other food into energy that can be used by the body. When we have PCOS, our bodies have a hard time using insulin efficiently. This is called insulin resistance and it is thought to be one of the main causes of PCOS.
In a nutshell, when we have PCOS and are insulin resistant, our pancreas has to secrete more and more insulin in order to get our cells to use the sugar for energy. When there is too much circulating insulin in our blood stream (and not enough being used by our cells), it can create a hormonal imbalance which can lead to all sorts of problems like weight gain, irregular periods, fertility issues and mood swings.
But, there is one more problem that we need to consider. Insulin stimulates testosterone biosynthesis. What this means is that the higher your insulin levels are, the more testosterone will be produced by the ovaries. Say hello to increased body hair, acne, irregular menstrual cycles and hormone imbalance.
How do you know if you are Insulin Resistant?
If you have PCOS, there is a very high chance that you are insulin resistant. In fact, it is thought that up to 40% of women with PCOS are insulin resistant (1).
There are a few ways to test for insulin resistance but the most common and most accessible way is to do a fasting insulin test. This is a simple blood test that you can ask your doctor to do.
A fasting insulin level of 100 mg/dL or less is normal. A fasting insulin level between 100 and 125 mg/dL indicate prediabetes and insulin resistance and a fasting insulin level greater than 126 mg/dL is diagnostic for diabetes (3).
A Word about Gestational Diabetes
Pregnancy is an amazing and very special time for women but it can also bring about some less pleasant issues, one of them being gestational diabetes.
Women with PCOS are more likely to develop gestational diabetes during pregnancy (4). And, if you already have insulin resistance, your risk is even higher.
Gestational diabetes is when blood sugar levels are higher than normal during pregnancy and you may present with impaired glucose tolerance. It usually goes away after the baby is born but it does increase your risk of developing type 2 diabetes later on in life.
If your midwife or medical team are concerned that you may have gestational diabetes, they will conduct a glucose tolerance test where they will assess your fasting glucose levels as well as glucose levels after a very sugary drink.
So, now that we know all that – let’s move on…
12 Ways to Lower Insulin Levels in PCOS:
Focus on Unprocessed foods
Processed foods are loaded with sugar and refined carbs which can cause our insulin levels to spike. As they are processed, they tend to be quickly metabolised by our bodies, causing a quick spike in blood glucose levels and insulin levels.
Also, the more unprocessed a food is, the higher in fibre it is. Fibre is important for so many reasons but when it comes to insulin, fibre helps to slow down digestion and the absorption of sugar into our bloodstream. This helps to prevent those big spikes in blood sugar and insulin levels.
Get enough Sleep
We know that women with PCOS tend to have higher levels of the stress hormone cortisol. Cortisol can increase insulin levels and cause insulin resistance.
So, it’s important to get enough sleep to help reduce stress levels and keep cortisol levels in check. Most adults need between 7 and 8 hours of sleep per night.
Sleep Apnea
When talking about the need for sleep for women with PCOS, we need to consider the possibility of sleep apnea. Sleep apnea is a condition where you stop breathing for short periods of time during the night. It’s been found to be especially prevalent in women with PCOS.
If you think you might have sleep apnea, it’s important to get it checked out by a doctor as it can lead to other health problems like high blood pressure, heart disease and stroke.
Get Moving
Exercise is one of the most important things we can do for our health, but it’s especially important when it comes to managing insulin levels and PCOS.
When we exercise, we use up the sugar in our bloodstream for energy. This helps to lower blood sugar levels and, in turn, insulin levels.
Exercise also helps to increase our insulin sensitivity. This means that our cells are better able to use the insulin we produce, which can help to improve PCOS symptoms.
Resistance Training
One particular study found that resistance training over a three month period improved insulin sensitivity. The wonderful thing about this study is that even though the participants didn’t necessarily lose weight, they experienced more normal insulin levels as a result of the resistance training.
Aerobic Exercise
Aerobic exercise is another great form of exercise for women with PCOS. It helps to increase insulin sensitivity and can also help with weight loss.
The Best Type of Exercise for PCOS
When we’re talking about exercise for PCOS, the best exercise is the one that you enjoy and that you can do consistently.
Manage Stress Levels
Stress is another big factor when it comes to insulin levels. When we’re stressed, our bodies produce more of the stress hormone cortisol. As we mentioned before, cortisol can increase insulin levels and cause insulin resistance.
So, it’s important to find ways to manage your stress levels. This might involve yoga, meditation, deep breathing exercises or simply taking some time out for yourself each day.
Enjoy some Wine but Avoid Binge Drinking
The research on the effects of alcohol on insulin sensitivity is mixed.
There are a number of research articles that show that one or two glasses of alcohol on a regular basis can help with increasing insulin sensitivity. (5)
However, people who regularly binge drink are more at risk of developing type 2 diabetes and tend to have high insulin levels.
So, if you do drink alcohol, it’s best to stick to one or two glasses on a regular basis and avoid binge drinking.
Increase your Fibre Intake
Fibre is important for so many reasons but when it comes to insulin, fibre helps to slow down digestion and the absorption of sugar into our bloodstream. This helps to prevent those big spikes in blood sugar and insulin levels. (6)
Also, fibre is of vital importance to the gut microbiome. We know that women with polycystic ovary syndrome tend to have a less diverse gut microbiome and this is thought to be a contributing factor to PCOS.
Increasing fibre intake is a great way to help improve the diversity of your gut microbiome.
The American Diabetes Association recommends that women have about 25g of fibre per day, something that many of us struggle to achieve.
Good sources of fibre include:
- fresh fruits and vegetables
- beans and legumes
- whole grains
- nuts and seeds
- avocado
Try Intermittent Fasting
Intermittent fasting is a pattern of eating where you cycle between periods of fasting and eating.
There are a number of different ways to do intermittent fasting but one of the most common is the 16/8 method. This involves fasting for 16 hours and eating all your meals within an 8-hour window.
Intermittent fasting has been shown to improve insulin sensitivity, especially when it’s done in combination with exercise.
Cut down on Refined Carbs and Sugar
Refined carbs and sugar are quickly broken down into glucose in our bodies and cause those big spikes in blood sugar and insulin levels that we’re trying to avoid.
So, it’s best to cut down on refined carbs and sugar where possible. This includes things like:
- white bread
- pasta
- rice
- cakes
- cookies
Instead, opt for complex carbs like:
- quinoa
- sweet potatoes
- oats
- brown rice
- legumes
Avoid Trans Fats
Trans fats are often found in processed foods and deep-fried foods. They’re thought to increase inflammation in the body and can worsen insulin resistance.
So, it’s best to avoid trans fats where possible. Check food labels for ingredients like “partially hydrogenated vegetable oil” and avoid foods that contain them.
Take Supplements
There are a few supplements that have been shown to help with insulin resistance and PCOS. These include:
Vitamin D
Research shows that up to 80% of women with PCOS are deficient in Vitamin D and this can contribute to a lot of the symptoms of PCOS, including ovarian dysfunction, androgen excess and metabolic syndrome.
Supplementing with Vitamin D has been shown to improve insulin sensitivity but 54%, helping to reduce insulin resistance.
So, it’s important to make sure you’re getting enough vitamin D. The best way to do this is by spending time outdoors in the sun or taking a supplement.
Chromium
Chromium is a mineral that’s found in small amounts in our diet. It’s thought to help with insulin resistance by improving the way our bodies handle sugar.
Dietary chromium is not particularly well absorbed but supplementing with 200-1000mcg of chromium picolinate has been shown to improve blood glucose control and restore normal insulin sensitivity (7).
Inositol
Inositol is a naturally occurring substance that is vital in the insulin signaling pathway. It is also one of the most widely researched supplements in women with polycystic ovary syndrome and is helpful in addressing the hormone imbalance caused by PCOS.
The benefits of inositol are far-reaching and include:
- Increased progesterone
- Increased SHBG (sex hormone binding globulin) – Deals with any free testosterone in our blood stream
- Lowered testosterone levels
- Improved insulin sensitivity
- Decreased luteinizing hormone
- Induced weight loss
My favourite inostiol is Ovasitol. It is a combination of myo-inositol and d-chiro inositol in a 40:1 ratio. It is a high quality supplement that I have been taking for many years.
Lose Some Weight
Losing weight with PCOS can feel impossible but by doing a lot of the things we’ve already spoken about can help your weight loss efforts.
There is a strong link between obesity and insulin resistance. In fact, studies have shown that weight loss can effectively improve insulin resistance and reverse some of the metabolic complications associated with being over weight.
So, even losing a small amount of weight can make a big difference.
A lot of the women that I work with 1:1 or in my monthly membership, PCOS Foodies, struggle so much with weight loss. Having worked with 100’s of women over the years, I have used that experience to put together a PCOS friendly weight loss program complete with meal plans, recipes and a workout guide. You can find out more about it here.
Consider Taking Insulin Sensitizing Drugs
One of the most commonly prescribed drugs for PCOS patients is Metformin, an insulin sensitizing drug.
Metformin works by helping the body to better respond to insulin. It also lowers testosterone levels and can help with ovulation.
It can be very helpful in improving some of the symptoms of PCOS but can cause some side effects like nausea, bloating, diarrhea and low blood sugar levels.
Many women have had great success with Metformin but you really need to weigh up the pros and cons of taking it. Definitely speak with your doctor if you have any questions about Metformin.
Summing It Up
Insulin resistance is a major contributing factor to PCOS and can make managing the condition very difficult.
Managing insulin resistance is one of the most important things you can do to improve your PCOS symptoms. There are many things that can help, so don’t feel like you have to try them all at once. Start by picking a couple of strategies and see how they work for you. If you have tried something that I haven’t mentioned, please leave me a comment below. I would love to hear about your success story!
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References:
1Rojas, Joselyn, et al. “Polycystic Ovary Syndrome, Insulin Resistance, and Obesity: Navigating the Pathophysiologic Labyrinth.” Polycystic Ovary Syndrome, Insulin Resistance, and Obesity: Navigating the Pathophysiologic Labyrinth, www.hindawi.com, 28 Jan. 2014, https://www.hindawi.com/journals/ijrmed/2014/719050/
2Malin, Steven, et al. “Pancreatic β-Cell Dysfunction in Polycystic Ovary Syndrome: Role of Hyperglycemia-Induced Nuclear Factor-κB Activation and Systemic Inflammation – PMC.” PubMed Central (PMC), www.ncbi.nlm.nih.gov, 1 May 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420895/
5Davies, Michael J., et al. “Effects of Moderate Alcohol Intake on Fasting Insulin and Glucose Concentrations and Insulin Sensitivity in Postmenopausal Women.” Effects of Moderate Alcohol Intake on Fasting Insulin and Glucose Concentrations and Insulin Sensitivity in Postmenopausal Women: A Randomized Controlled Trial | Obesity | JAMA | JAMA Network, jamanetwork.com, 15 May 2002, https://jamanetwork.com/journals/jama/fullarticle/194914.
6Weickert, Martin O., and Andreas FH Pfeiffer. “Impact of Dietary Fiber Consumption on Insulin Resistance and the Prevention of Type 2 Diabetes | The Journal of Nutrition | Oxford Academic.” OUP Academic, academic.oup.com, 1 Jan. 2018, https://academic.oup.com/jn/article/148/1/7/4823705.
7Ashoush, Sherif, et al. “Chromium Picolinate Reduces Insulin Resistance in Polycystic Ovary Syndrome: Randomized Controlled Trial – PubMed.” PubMed, pubmed.ncbi.nlm.nih.gov, 1 Mar. 2016, https://pubmed.ncbi.nlm.nih.gov/26663540/.
