Polycystic Ovary Syndrome (PCOS), Insulin Resistance, and Weight
Polycystic ovary syndrome (PCOS) is a hormonal disorder that presents with a wide array of symptoms: irregular menstrual cycles, difficulty getting pregnant, dark body hair, thinning hair on the scalp, acne, cystic-appearance of the ovaries, and weight gain. There are two features of PCOS that account for nearly all it’s symptoms: an increase male hormones (called androgens) and insulin resistance. The latter is one of the main reasons so many women with PCOS struggle with their weight and have difficulty losing it.
So what does insulin resistance mean, anyway? It means your body does not process carbohydrates well. Carbohydrates (like bread, chips, rice, pasta, and sweets) are converted into blood sugar (or glucose) in our bodies. Insulin then takes the sugar from our blood and stores it as fat or burns it for energy. For people with insulin resistance, their bodies do not respond to insulin as easily, so they produce more. Since insulin is a fat-storage hormone, the more insulin you have around, the more fat you store.
The other down fall of high insulin is that it ultimately lowers your blood sugar, but if you have too much around, it will often over-correct. This causes a vicious cycle of hunger swings from dips in blood sugar. Many women with PCOS describe the experience of feeling hungry again only an hour or two after eating from just this process.
The best way to determine if you have insulin resistance is to perform blood tests. There are several tests that can be helpful. The most common test is called a hemoglobin A1c. This test measures your average blood sugar over the last 3 months. It becomes abnormal when your insulin resistance has progressed and worsened to the point that you’ve developed pre-diabetes (HgbA1c of 5.7%-6.4%) or diabetes (HgbA1c of > 6.5%). Other tests that can detect insulin resistance sooner are a fasting blood sugar (target < 90) and a fasting insulin level (target < 10). Some practitioners will also use a test called the oral glucose tolerance test, where a person drinks a large volume of sugar (50-100 grams) and then blood sugar and insulin levels are measured after.
What You Can Do
The most important thing you can do to lose weight and control your symptoms of PCOS is to regulate your blood sugars. So, let’s talk about nutrition, exercise, and medications.
For your nutrition, start by eating foods high in fiber and low in simple, highly processed carbs. This means lots of non-starchy vegetables, like booccoli, cauliflower, leafy greens, mushrooms, onions, and peppers, just to name a few! And don’t forget about legumes! Lentils are a powerhouse food for PCOS given that they’re high in fiber and protein. Incorporate healthy fats, like olive oil and avocado, and lean proteins, like chicken, fish, and tofu into your diet everyday as well.
For exercise, put less focus and cardio and more focus on building muscle. The bigger your muscles, the more insulin sensitive you are (the opposite of insulin resistant!). So weight and resistance training are key for women with PCOS. This can mean doing body weight exercises, using resistance bands, lifting weights, or using machines at slow speeds with high resistance. All of these are great ways to help sculpt a strong, healthy body with lower insulin levels. Plus, bigger muscles means a higher metabolism! So say goodbye to body fat as well while you build more muscle.
For medications, the most commonly prescribed medication for PCOS and insulin resistance is called metformin. This can be a helpful tool because metformin is an insulin sensitizer. It helps to keep insulin levels low, blood sugar levels better regulated, and can help decrease cravings.
Find a Doctor
An important part of your journey with PCOS is to find a physician who is knowledgable about PCOS and can help you navigate the many struggles that come with this diagnosis. PCOS looks different for each person! It is critical to find a good team who can support you as an individual.