Polycystic Ovary Syndrome, often known as PCOS, is the most common hormonal related disorder in women of reproductive age and a leading cause of infertility, affecting nearly 10% of women globally. PCOS is a very complex condition, with several different causes, risk factors and clinical presentations, one of which is insulin resistance.  This is the part of our PCOS series, diving deep into the diagnosis, symptoms and treatment of this common condition. Curious about common symptoms and diagnosis? Check out this blog post here. 

As a review, PCOS can be diagnosed when two out of the three criteria are met:

1. Oligo or Anovulatory Cycles

2. Hyperandrogenism

3. Polycystic Ovaries

The Role of Insulin and Blood Sugar

Insulin is a hormone that has a direct role in blood sugar regulation. Whenever we eat something containing carbohydrates, these molecules get broken down into glucose. Glucose is what runs through our bloodstream and feeds all of the cells in our bodies with the help of insulin. 

When we eat a meal, we experience an abundance of glucose. Insulin is then released from the pancreas and helps to not only feed our cells, but also takes the extra glucose and stores it away in the liver.  As we digest, the amount of glucose and insulin in our blood decreases. Then, as we start to get hungry, our body can use the stored glucose to provide energy until our next meal.

This system can easily go out of order, leading to insulin resistance and eventually type 2 diabetes.

The Development of Insulin Resistance 

In insulin resistance, cells throughout the body no longer are as responsive to insulin, which results in high blood sugar.  The pancreas is able to sense high blood sugar and responds by pumping out more and more insulin, which ultimately worsens symptoms and causes damage to the pancreas.

High levels of insulin are aggravating to the ovaries and can cause an increase in androgen production.  Androgens are hormones, the most well known being testosterone. With insulin levels, comes high testosterone, which can cause symptoms of acne, hair loss and male-patterned hair growth, otherwise known as hirsutism. With insulin resistance, these symptoms continuously worsen. 

Insulin resistance can also cause extreme fluctuations in blood sugar, leading to a “sugar crash”. For some, this presents as shakiness, irritability and extreme hunger in between meals. For this reason, it is not uncommon for women to experience intense cravings for sugar and carbohydrates, leading to a binge. 

Supporting PCOS Through Nutrition

Far too often patients with PCOS are told they need to lose weight with the help of restrictive diets. This is simply not true.  There is more and more research every day looking at the negative effects of weight stigma on all patients, and especially those with PCOS.  There is no need to start the latest diet craze or to completely avoid carbohydrates.

Due to the importance of blood sugar regulation, there are some dietary guidelines to keep in mind. The goal is to have each meal contain the following:

1. Protein (fish, meat, eggs, etc.)

2. Non-Starchy Vegetables (kale, broccoli, cabbage, etc.)

3. Starchy Vegetables (sweet potatoes, potatoes, beets, etc.)

4. Heart Healthy Fats (avocado, olive oil, coconut oil, ghee, etc.)
   

Of course, it is important to remember that food is meant to nourish not only our body but also our soul. For this reason, these are not hard and fast rules, they are just things to keep in mind. Continue to incorporate your traditional celebratory and comfort foods, because our emotional and mental health is just as important as our physical health

Restoring Insulin Sensitivity 

Fortunately, if caught early, there are several ways to address insulin resistance and restore insulin sensitivity.  

Stress Reduction: Cortisol is the primary stress hormone in the human body. Cortisol is released in times of stress and when blood sugar is low.  With high levels of cortisol and stress, insulin resistance can develop more quickly. Research now shows that with PCOS have higher levels of cortisol than those without, which is why stress reduction is a key component of improving insulin sensitivity. Common stress reduction routines include meditation, nature walks, yoga and journaling.

Movement: Studies suggest that regular exercise improves both metabolic health and insulin sensitivity for women with PCOS. Current CDC guidelines suggest 75 minutes of vigorous exercise (HIIT, jogging, weight lifting) or 150 minutes of moderate exercise (yoga, walking) weekly. What’s most important is incorporating regular joyful movement that you enjoy. 

Cinnamon: Research has shown that just 1.5 grams of cinnamon, specifically cassia cinnamon, consumed daily reduces fasting blood glucose and improves insulin sensitivity in women with PCOS. The best part of these research studies is that 1.5 grams turns out to be ½ teaspoon, which can easily be incorporated into meals. An additional study compared cinnamon supplementation to Metformin in patients with type 2 diabetes and ultimately found that both resulted in an equal reduction of hemoglobin A1c.

Inositol: Myoinositol and D-Chiroinositol have been studied extensively for their insulin-sensitizing effect suggesting an additional improvement in ovary function and fertility.

N-Acetyl Cysteine: NAC has been shown to have many different positive effects in PCOS. It improves insulin sensitivity, supports ovulation, improves egg quality and reduces androgen levels.  

Metformin: This is the most commonly prescribed insulin sensitizer, and is often prescribed to patients with both PCOS and diabetes. It also decreases the amount of glucose secreted from the liver and can improve ovulation rates. However, like most pharmaceuticals, it has some common side effects including gastrointestinal discomfort and nausea.

References

1. Azziz R. Epidemiology and genetics of polycystic ovary syndrome in adults. UpToDate.https://www-uptodate-com.nunm.idm.oclc.org/contents/epidemiology-and-genetics-of-the-polycystic-ovary-syndrome-in-adults?search=PCOS&topicRef=7385&source=see_link. Published February 2019.

2. Diabetes: What’s Insulin Resistance Got To Do with It? Center for Disease Control and Prevention. https://www.cdc.gov/diabetes/library/spotlights/diabetes-insulin-resistance.html. Published March 2019.

3. Moran LJ, Hutchison SK, Norman RJ, Teede HJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD007506. DOI: 10.1002/14651858.CD007506.pub3.

4. Greenwood EA, Noel MW, Kao C-N, Shinkai K, Pasch LA, Cedars MI, et al. Vigorous exercise is associated with superior metabolic profiles in polycystic ovary syndrome independent of total exercise expenditure. Fertil Steril. 2016;2016(2):486–93.

5. Hajimonfarednejad M, Nimrouzi M, Heydari M, Zarshenas MM, Raee MJ, Jahromi BN. Insulin resistance improvement by cinnamon powder in polycystic ovary syndrome: A randomized double-blind placebo controlled clinical trial. Phyther Res. 2018;32(2):276-283. doi:10.1002/ptr.5970

6. Wang, Jeff G. et al. The effect of cinnamon extract on insulin resistance parameters in polycystic ovary syndrome: a pilot study. Fertility and Sterility, Volume 88, Issue 1, 240 - 243

7. Arentz S., Abbott J.A., Smith C.A., Bensoussan A. Herbal medicine for the management of polycystic ovary syndrome (PCOS) and associated oligo/amenorrhoea and hyperandrogenism; a review of the laboratory evidence for effects with corroborative clinical findings. BMC Compl Alternative Med. 2014;14(1):1.

8. Suppapitiporn S., Kanpakso N., Suppapitiporn S. The effect of cinnamon cassia powder in type 2 diabetes mellitus. J. Med. Assoc. Thail. 2006;89:S200–S205.

9. Giovanni Monastra, Vittorio Unfer, Abdel Halim Harrath & Mariano Bizzarri. Combining treatment with myo-inositol and D-chiro-inositol (40:1) is effective in restoring ovary function and metabolic balance in PCOS patients, Gynecological Endocrinology. 2017. 33:1, 1-9, DOI: 10.1080/09513590.2016.1247797

10. Franca Fruzzetti, Tiziana Fidecicchi, Giulia Palla & Marco Gambacciani. Long-term treatment with α-lipoic acid and myo-inositol positively affects clinical and metabolic features of polycystic ovary syndrome, Gynecological Endocrinology. 2019. DOI: 10.1080/09513590.2019.1640673

11. Fulghesu AM, Ciampelli M, Muzj G, Belosi C, Selvaggi L, Ayala GF, Lanzone A. N-acetyl-cysteine treatment improves insulin sensitivity in women with polycystic ovary syndrome. Fertil Steril. 2002;77:1128–1135. doi: 10.1016/S0015-0282(02)03133-3.

About the Author

Dr. Hannah is a naturopathic doctor providing whole body adjunctive healthcare to patients in Maine and Massachusetts. She believes every patient has their own unique health journey, which influences her personalized treatment approach. She has a passion for helping women, mothers and families heal and thrive, all while uncovering the root cause of whatever ails them. Her goal is to empower and guide her patients on the path towards healing the mind, body and soul through natural methods of healing. Dr. Hannah sees patients locally in Portland, Maine. Through telehealth, she is happy to serve the people of Lewiston, Ellsworth, Belfast, Bangor, and all the towns in between! She now sees Massachusetts patients through telehealth as well!

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