Insulin Resistance & PCOS
Dietary lifestyle change is one of the first lines of treatment for Polycystic Ovary Syndrome (PCOS). A condition that often runs in families and leads to subfertility and sometimes infertility. The article below is a work in progress drawn from my readings on the topic.
What does it mean to be insulin resistant?
In a nutshell it means that your cells are resistant to insulin activity which results in delayed uptake of glucose from the blood into the cell. Insulin acts as a key to allow glucose into the cell to be processed as either energy or stored as fat.
Should a person with insulin resistance eat a high glycemic index carbohydrate, the blood is flooded with glucose and the body signals the pancreas to increase insulin secretion to enable the insulin resistant cell to process the glucose. In the presence of high insulin, the cell then very quickly processes the glucose. Because the body cannot utilize all the glucose processed this quickly in the cell, the excess glucose is stored as fat (in the case of IR, usually on the midsection). Because the glucose is processed so speedily, the blood sugar level drops suddenly, this drop in blood sugar levels can make one feel irritable, light headed, give one the sweats, make you jittery, drowsy or even dizzy. These feelings fuel cravings for high sugar foods to restore the blood sugar levels as quickly as they have dropped, only for the vicious cycle to begin again.
The diagram below illustrates this process.
Insulin Resistance and PCOS
Insulin is one of many hormones in a tangled web. The most important consequence for women facing infertility due to PCOS is the impact of insulin on male hormone production in the ovaries. Insulin increases the production of androgens in the ovaries which disturbs the menstrual cycle and most often prevents maturation of the follicle and result in lack of ovulation, or anovulation. Lowered insulin levels results in lower androgen (testosterone) production which can in many cases restore ovulation.
If you are overweight as little as 7 – 10% loss of body weight through healthy eating and maintaining that weight with moderate exercise can be sufficient to effectively reduce your PCOS symptoms.
Excess weight, insulin resistance and PCOS interact in a complex relationship, each one worsening the other. By addressing insulin resistance, one addresses the problem of excess weight and inevitably also decreases PCOS symptoms.
PCOS cannot be cured, but can be managed and all symptoms can be reversed by adjusting your lifestyle.
How does one manage Insulin Resistance to promote weight loss?
Remove Sugar and High Glycemic Carbohydrates
The first step in the management of insulin resistance is to remove all sugar and high glycemic carbohydrates from your diet, you’ll be surprised how much of these items you consume on a daily basis. In order to lose weight you need to consume less calories than you expend in energy. Only when creating a deficit (healthy) by eating less, or being more active can one actually lose weight. When removing these items from your diet, you are forcing yourself to substitute with healthier alternatives. Unhealthy alternatives (Sugar & High GI) lead to spikes in your blood sugar levels, which feed cravings for more unhealthy food, fueling he vicious IR cycle which leads to excessive fat storage.
Determine Your Target Weight and Calorie Intake
Get to know your body by calculating your Body Mass Index (BMI) and comparing it to the BMI chart. By using this tool you can determine a healthy target for your body. BMI is calculated by dividing your Weight in kilograms by Height x Height.
Calculate your Body Mass Index >>
| BMI Index | Meaning |
| 18.5 or Less | Underweight |
| 18.5 – 24.9 | Normal |
| 25.0 – 29.9 | Overweight |
| 30.0 – 34.9 | Obese |
| 35.0 – 39.9 | Obese |
| 40 or greater | Extremely Obese |
Calculate the number of calories you are allowed to consume daily in order to achieve your target weight within a specific amount of time.
Calculate Your Daily Calorie Allowance >>
Replace Unhealthy Food with Healthy Food Choices and Portions
Explore the world of healthy food and educate yourself on healthy options. Many people get stuck in the rut of unhealthy eating and never manage to escape because of sheer laziness and unhealthy addictions to food and emotional eating. Healthy food is virtually always fresh and therefore requires better planning and preparation skills for more tasty options. A book that comes highly recommended is Eating for Sustained Energy by Liesbet Delport & Gabi Steenkamp which contains tables on low GI options for South African products and many easy to prepare healthy meals. Get to know healthy portion sizes and how they relate to your daily calorie allowance.
Balance your Blood Sugar
The most difficult task in managing Insulin Resistance is to balance your blood sugar levels throughout the day without eating more than your daily calorie allowance. You can achieve this by combining the right food groups during main meals and eating the right snacks at frequent and consistent intervals between meals, and no not only eat when you are starving for food.
The Three Golden Rules
Type
Make sure you eat the types of food, this is especially important for sugar and carbohydrates. Learn to interpret GI Index and GI load to manage your carbohydrate intake. For more information on GI visit: http://www.gabisteenkamp.co.za
Frequency
Eat frequently. By eating your main meals at regular intervals and supplementing with healthy snacks you control the rise and fall of your blood sugar. To control IR you need to ensure that blood sugar rises in a steady curve and does not rise and fall throughout the day.
Quantity
A mistake often made by healthy eating individuals who struggle to lose weight is portion control. Eating small, but sufficient portions is essential to lose or maintain weight since one can only lose weight if you consume less calories than you expend in energy. Only when creating a deficit (healthy) in your daily calorie allowance you can lose weight.
Carbohydrates at Dinner Time
Because the presence of Insulin suppresses the production of human growth hormone it is advisable that you do not eat carbohydrates at dinner time. Human growth hormone proliferates during sleep to restore and heal the body. In the presence of insulin this process is hampered and you may feel tired and grumpy when getting up in the mornings. This fact added to the reality of carbohydrates being stored during sleep due to inactivity makes for good reason to exclude carbohydrates at dinner time. What does one eat then for dinner? It is advisable that only protein and vegetables be consumed at dinner time.
- Maritza Prinsloo -
As published on the Infertility Support Website www.fertilicare.co.za
sometimes, the exercise guides on the internet are a bit misleading::- 
HI M
Thanking you for sharing your birth story with us! what a beautiful, heart touching post! You are going ...
Maritza, what a truely beautifully written post. My eyes well up and my heart aches, but over all that ...
Your story is beautiful. Your babies are beautiful. May the angels watch over them always and may you get the ...
Maritza - your babies are beautiful. Congratulations. I trust that Lize will exceed all expectations and barriers - after all, ...
Thank you for sharing your story. Beautifully written. Your babies are beautiful and no matter the challenges you are faced ...
Hi Super M,
Soos altyd, is ek maar die agter os en lees ek nou eers jou blog - ons was ...
Maritza,
Ek het so 'n brandpyn in my hart en trane in my oe na ek jou storie gelees het. ...
your story, your courage and determination to be the best mother and partner that you can be, your love, touches ...
Such a brave, honest and beautiful birth story M - thank you for letting us all be a part of ...
Comment by SCY on 12 January 2008:
Very interesting my friend and very well put together!
Comment by Maritza on 14 January 2008:
Thank you…
Comment by Elmarie on 16 January 2008:
Why do you have to loose weight if your BMI is normal, am I missing something PCOS related?
Comment by Maritza on 16 January 2008:
No, not really, but it is good to get rid of your belly…a lot of times people with IR will store fat around their midsections, even if they have normal BMI. The measure of you midsection is actually a better indicator of dietary success in the case of IR than your weight loss, simply because the cells in your midsection is more prone to IR than any other area of your body.
It’s more about keeping blood sugar even than losing weight. But the more weight you carry the more difficult it becomes to manage your IR.
Hope this answers your Q.
Comment by Elmarie on 17 January 2008:
Thanks, I did not think about it like that, although I know we are prone to carry more fat around the waist. Will have to search the house for the measuring tape now
Comment by Yogani on 16 May 2008:
Hi
I was told 4 years ago that I had PCOS and that I would have problems falling pregant, that same year I found out I was pregant with my son Joel and 2 years after this Mikhail came along.
I still have PCOS and I am on treatment. Remember there is all things possible with the LORD>
Thanks
Yogani
Comment by Shawna on 29 May 2008:
This is a great article. I have never seen IR explained so well.
Thanks!
Comment by Dawn on 31 July 2008:
I’m, confused. Dietition told me to eat 1/2 ti 3/4 cups of carbs at every meal not to exceed 30 grams.
She included beans as carbs.
What am I missing? Was she correct or incorrect?
Comment by Katherine on 21 September 2008:
I am a 25 year old lady and about a month ago I was diagnosed with PCOS. I am isulan resistant aswell.
I would like to have a baby via arificail insemination, I dont have a partner but last month I did not have a egg big enough.
This is a very difficult time and reading all the symptoms above I suffer from all the above.
Im not on any medication should I be?
Comment by Maritza on 22 September 2008:
Katherine, you should see our FS/RE about possibly taking Metformin or Actos (Insulin sensitising drugs), this helps with the lowering of androgens, in turn assisting egg development and ovulation. This is not fail proof, but one possible step you can take to improve ovulatory function.
Exercise and diet also plays a key role.
Your FS will have to guide you on stimulation protocol.
Best of luck!
Comment by Seema on 22 October 2008:
Thanks for the well explained article. I was also diagnosed with PCOS and I am currently on Glucophage for the insulin resistance. I’ve lost some weight and my BMI is currently 25. However, its been like this for quite some time. I find it very difficult to lose weight and when i joined the gym, i have become bigger on my hips and buns. When i use the treadmill, i don’t lose on these areas. Which form of exercise is suitable?
Comment by Johanna on 20 August 2009:
Hi,I suffer from insulin resistance, type2 diebetic, am wheat, sugar and dairy intolant. I also suffer from IBS. I find it very difficult to loose weight. Sureslim does not work. I excercise about 3/4 times a week. I have a back problem. Could you suggest how I can get the insulin resistance down to be able to loose weight? I do have alot of back pain.Are there any medication I could take which would help the insulin resistance? I believe this is why I cannot loose weight.
Comment by Deidre on 10 September 2009:
Hi guys, I had a huge growth removed from an ovary about the size of a small papaya/papino this caused PCOS and insulin resistance amongst other problems. The docters gave me metfomin but I found out that it only blocks about 2% of all the total sugar in take. After a lot of scouting I found two wonderful natural products that have proven to be really helpful in lower my insulin levels, loosing and maintaining my weight. This in turn has had many positive effects on my PCOS symtoms. I don’t know if anyone wants to give it a bash but with a low GI diet the manna blood sugar support tablets and the bio strath amino acid tablets have really made a huge difference. My dietician actually informed me about them and I havn’t looked back since. I started using them four months into my diet and the results are amazing I have lost 14kg to date and I have been on them for 15 weeks.
Comment by Desiree on 12 September 2009:
Hi, I was diagnosed with PCOS in May this year. Since I have known this I have given up sugar,sodas and white bread. I follow a very strict Low GI Diet,no junk food plenty water,rooibos tea and have lost 10kgs. I have also joined the gym now.
Comment by Nayna on 13 November 2009:
Hi, Its hard to believe that it is all interrelated. I went to a Dr who told me i was insulin resistant and on the bordeline of having a thyroid problem. However it was only six months later when i went to the Gynae that she told me that the insulin resistence, irregular menstrual cycle, over weight symptoms are all signs of PCOS. I feel like my whole life has been a struggle with being overweight and having an irregular cycle. Not one Dr had diagnosed this as a possibility. I feel angry at having to struggle with this, when all the signs were clearly there. I feel even more frustrated that if not diagnosed, it could lead to fertility problems. Atleast now that i’m aware, i can meaningfully do something about it. It is just concerning, that all my life, i’ve had to watch what eat, feel guilty about every morsel that i eat, be critisized about not making an effort to lose the weight, when in fact there were so many other factors contributing to this. I hope other woman/young girls dont have to go through this.
Comment by Ella on 6 December 2009:
After a decade of trying to treat acne, hair loss, tiredness, irregular periods & obesity separately, I was finally tested for & diagnosed with PCOS. I don’t know why all of my past pediatricians & gynecologists never mentioned or appeared to know about PCOS, but now that I do know & am getting treatment, it’s important for me now to educate other women. The best thing that you can do is research PCOS on your own – there a many great books! – and not rely on doctors & just birth control. This disorder is certainly real, has many levels of severity, can be hard to detect, but through education can be reversed to little or no symptoms.
Comment by Iris on 18 December 2009:
Hi there,
I have been diagnosed three years ago, and the hair-growth has gotten out of hand. Can anyone recommend a treatment for this, or a good gynecologist that knows about PCOS, I live in Jo’burb?
Thank you.
Comment by Tarushaa on 25 January 2010:
Hi Ladies,
I have always suffered from obesity, acne and excessive hair growth. I recently went to a gynae and was diagnosed with PCOS and insulin resistance. She prescribed a contraceptive called Yas and a weight loss pill called Ciplatrim. I somehow feel this is not enough. I have always battled to lose weight and luckily now that I’ve been using Ciplatrim I have managed to lose 3kgs in the last 2weeks but i dont know if this will help with the PCOS and the fertility side of things. If anyone has any advice please let me know.
Thanks
Comment by Sue on 22 February 2010:
Has anyone tried d-chiro inositol in the Solal range?
Comment by Alice on 6 April 2010:
I’m looking for a gynae too – knowledgeable in PCOS. I’m in Jhb North… Can someone please help me?
I am terrified of going to one. I am 32 years of age, and have never seen one!
Comment by lyndal on 9 April 2010:
@ Alice. Dr Clark at Sandton Medi clinic is excellent.
I have 2 kids and had no difficulty falling pregnant (in fact they were unplanned). When I fell pregnant with my first child. I weighed in at 9 weeks at 39.5kg. My height is 1.55m. After my 2nd child, Im not sure what happened but the weight just kept on increasing. Until I weight in at a heafty 75kg. My doctor then did tests and diagnosed IR. My level was around 29.8? Which is alot Im told.I dont have time for gym and I did go for 2 months everyday and I never lost 1gram and I do try to eat healthy. I feel so depressed over my weight. It feels like no matter what I try I will never loose weight.