Insulin Resistance PCOS
Insulin resistance is overwhelmingly the primary underlying factor of PCOS. A substantial 80% of individuals with PCOS, also known as Cysters, experience some degree of insulin resistance, even if they do not have an excess of body weight (commonly referred to as "lean PCOS"). It should be noted that weight gain is just one symptom of insulin resistance and is not present in all individuals with Insulin-Resistant PCOS. If you have been informed that you do not have an issue with insulin because you are not overweight, you may be overlooking the appropriate treatment for your PCOS. In a study comparing women with and without PCOS (controls) using highly sensitive tests to detect insulin resistance, researchers discovered a fascinating disparity. Among lean women with PCOS, 75% showed signs of insulin resistance, while only 24% of lean women without PCOS exhibited this condition. Similarly, the research also found insulin resistance in 95% of overweight women with PCOS, compared to just 62% of overweight women without PCOS. These findings indicate that insulin resistance associated with PCOS is unrelated to weight gain. Contrary to common belief, weight gain does not cause insulin resistance in PCOS. In fact, it is often the other way around - insulin resistance frequently leads to weight gain. Even if you are not overweight, there is still a significant likelihood that insulin resistance is the driving force behind your PCOS symptoms. PCOS substantially amplifies the risk of experiencing insulin-related problems, regardless of body weight.
Insulin resistance occurs when our body's cells lose sensitivity to the signals from insulin instructing them to open up and absorb sugar from our bloodstream for storage. Insulin is comparable to a key that fits into the cell door's lock. In the case of insulin resistance, this key has become slightly impaired, and it requires substantial effort to unlock the door. The additional time spent to open the cell door leads to prolonged presence of insulin in the blood, exceeding the optimal duration. Prolonged high levels of insulin stimulate the ovaries to produce excessive testosterone and other androgens. Additionally, elevated insulin levels reduce the production of a crucial protein known as sex hormone binding globulin (SHBG). I prefer to envision SHBG as a hormone sponge responsible for maintaining hormonal balance by absorbing surplus hormones. When there is an abundance of circulating androgens coupled with reduced SHBG levels, it creates an unfavorable condition. Instead of being absorbed, the excess androgens freely infiltrate the hair follicles on the scalp, causing them to deteriorate and result in hair loss. Moreover, they congest the skin pores, leading to acne formation. Furthermore, these androgens invade the hair follicles on the face and chest, transforming previously inconspicuous baby hairs into thick, coarse, black hairs. To compound the situation, elevated testosterone levels prompt even more insulin production, creating a frustrating cycle in which androgen levels persistently rise. Excessive insulin also inhibits the brain from secreting adequate amounts of follicle stimulating hormone (FSH). FSH plays a crucial role in initiating the growth of follicles (young eggs) to the appropriate size necessary for ovulation. Insufficient FSH results in either complete failure to ovulate (resulting in the absence of menstruation) or significantly delayed ovulation (causing extended gaps between menstrual cycles). Additionally, elevated insulin levels cause the secretion of another key hormone in ovulation, luteinizing hormone (LH), to increase substantially. Optimal levels of LH are necessary to trigger ovulation. However, when levels exceed the normal range, the body suppresses or delays ovulation, further contributing to irregular or absent periods.
It is possible that you are unaware of your insulin resistance due to your doctor not ordering the most accurate tests. The commonly used fasting glucose and HbA1C tests are not sensitive enough to detect early stage insulin resistance. These tests are better at diagnosing severe insulin resistance, such as that seen in type 2 diabetes. In fact, a study conducted in 2014 found that HbA1C missed 45% of individuals with type 2 diabetes, indicating a high chance of missing early stage insulin resistance. Another commonly used test is fasting blood glucose, but the upper limit considered "normal" by most pathology laboratories may be set too high. The widely accepted upper limit for fasting blood glucose is 100mg/dL, meaning that any value below 100 is deemed normal. However, a study from 2005 revealed that individuals with fasting blood glucose levels between 91-99mg/dL eventually developed type 2 diabetes. If you have ever undergone an oral glucose tolerance test (OGTT), you may remember the experience vividly. This test involves consuming a sugary beverage and having your blood drawn every hour for two to three hours to monitor the fluctuation in your glucose levels. It is commonly used during pregnancy to diagnose gestational diabetes. Although more accurate than the previous tests mentioned, an OGTT cannot detect the early stages of insulin resistance as it solely measures glucose, not insulin. Interestingly, a study showed that OGTTs failed to identify up to 50% of people with diabetes. The reason why blood glucose levels often appear normal in individuals with insulin resistance is because their bodies release large amounts of insulin to maintain low glucose levels. Therefore, when only glucose levels are examined, they seem within the normal range. However, behind the scenes, the body is producing excessive insulin to keep glucose balanced. Relying solely on glucose testing may lead to a missed diagnosis and inadequate treatment for PCOS. If your doctor has excluded insulin resistance based on tests such as fasting blood glucose, HbA1C, or OGTT, and you still suspect it may be a concern for you, do not hesitate to request additional testing. Below, I will outline the most effective tests to ask for.
The Glucose Tolerance with Insulin Assay is the most precise and reliable test to determine insulin resistance. It bears resemblance to the Oral Glucose Tolerance Test (OGTT), but goes a step further by simultaneously measuring insulin and glucose levels. The procedure involves obtaining a blood sample in a fasting state, followed by additional samples taken at one and two-hour intervals after consuming a glucose beverage.
Extensive research has demonstrated that this particular test surpasses the traditional OGTT in accuracy, showcasing a 75% enhanced capability to identify both diabetes and pre-diabetes.
It is worth noting that this test is relatively less common than the standard OGTT, fasting glucose, or HbA1C tests. Consequently, it may be possible that your doctor is unfamiliar with it. Do not hesitate to persistently inquire about this test or consider finding a new healthcare provider who can assist you in obtaining the appropriate diagnostic measures to accurately determine the presence of insulin resistance.
Insulin resistance can lead to the accumulation of weight in the abdominal area. A larger waist circumference is closely correlated with insulin resistance. To assess your waist circumference, take a measuring tape and position it above your hip bone. Proceed to wrap the tape measure around your body, aligning it with your belly button. Ensure the tape is horizontal and leveled. Take a deep breath and exhale, while keeping your abdominal muscles relaxed (avoid holding it in). Examine the number displayed on the tape measure. In women, a measurement of 80cm (32 inches) suggests a heightened likelihood of insulin resistance. The risk increases as your waist measurement exceeds 80cm. It's important to note that the belief that only overweight individuals or those with a high waist measurement experience insulin resistance is a misconception. Although these factors do increase the chances, they are not definitive indicators.
Developing insulin resistance typically results from a combination of your genetic makeup and environmental factors. These environmental factors include your dietary choices, physical activity levels, sleep patterns, and stress levels. Similar to how polycystic ovary syndrome (PCOS) can develop, individuals may be born with a higher likelihood of developing insulin resistance due to their genetics. This is why having a family history of diabetes or pre-diabetes is considered as a risk factor.
However, it's important to note that simply having a family history or genetic predisposition does not guarantee that you will develop insulin resistance. It is the interplay between your lifestyle choices and various environmental factors that can trigger this condition. For instance, consuming a diet high in fructose (a type of sugar) has been linked to an increased risk of developing insulin resistance. Additionally, poor sleep quality is another risk factor. Even just one night of sleep deprivation has been shown to reduce insulin sensitivity the following day, and chronic sleep deprivation can elevate the risk of long-term insulin resistance.
Furthermore, lack of regular exercise is being researched as another contributing factor, as physical activity helps improve your muscles' response to insulin. Additionally, your mother's pregnancy with you may also play a role. Studies have found connections between mothers who experienced significant stressful events during pregnancy and an increased risk of insulin resistance in their adult children, even without a family history of diabetes. If your mother had gestational diabetes during her pregnancy with you, your risk of developing insulin resistance later in life also increases. Moreover, even your gut bacteria can influence your sensitivity to insulin, and improving gut health can help reduce insulin resistance.
While we cannot alter your genetics or your mother's pregnancy, there are numerous actions you can take to modify other environmental factors in your favor. Implementing simple changes to your diet, exercise routine, mindfulness practices, sleep habits, gut health, and supplementation regimen can serve as the foundation for reversing insulin resistance.
Thriving with PCOS can be done by implementing the PCOS plate. We can work together to achieve the perfect balance for you and your life style.
Kate