PCOS Support

The link between PCOS and insulin resistance

The link between PCOS and insulin resistance Many people with PCOS also have insulin resistance.

What really causes PCOS?

Insulin Resistance - Major Cause of PCOS Symptoms

Although estimates vary, 50 to 80% of women with PCOS have insulin resistance.

Hyperinsulinemia (high blood insulin levels) produces hyperandrogenism (excessive levels of male hormones such as testosterone) by stimulating ovarian androgen production and by reducing serum sex-hormone binding globulin (SHBG). This can make PCOS symptoms a lot worse.

What Is Insulin Resistance?
The hormone insulin performs many essential functions in the body but is primarily known for its role in glucose regulation. Under normal circumstances, insulin assures the efficient transfer of glucose from the bloodstream to the body. Insulin also serves as a signal to the liver to begin or discontinue glucose production.

If the level of glucose in the cells is sufficient, insulin levels drop, signaling the liver to slow down glucose production. In contrast, if the cells of the body are not receiving enough glucose, the level of insulin will rise, signaling the liver to produce greater amounts of glucose.

Insulin resistance is the inability of insulin to perform its job effectively in the body. In early stages, the body simply compensates by causing the beta cells of the pancreas to produce more insulin. Ultimately in some women, however, the beta cells may wear out and the body ceases to produce insulin in the amounts needed. The resultant condition is Type II diabetes mellitus.

What Are the Causes?
Insulin dysfunction is thought to be caused by several factors:
• Genetic abnormalities of one or more proteins of the insulin action cascade
• Fetal malnutrition
• Increased fat around the middle.

It's thought that perhaps 50% of people have an inherited propensity for this disorder. You may be in this group if you have a family history of diabetes, cardiovascular disease, hypertension or PCOS. The other 50% who develop insulin resistance probably do so because of unhealthy diet, no exercise, and obesity.

Although obesity is a major risk factor, lean women with PCOS can also have this insulin problem.

Although you can't change your genes, there's plenty you can do to change how they behave. What you eat, whether you exercise, how well you sleep, how you manage stress, and the pollutants you are exposed to will directly influence what your genes do. So to a great extent, the insulin hromone can be controlled by you.

Insulin Resistance and PCOS

As early as 1921, a French study described the presence of diabetes in women with facial hirsutism. PCOS women also show higher levels of possible precursors of diabetes, such as glucose intolerance and lack of insulin sensitivity.

Over the past 20 years, it has been established that hyperinsulinemia is a fundamental disturbance in many women with polycystic o***y syndrome (PCOS). A subgroup of women with this syndrome have 'metabolic PCOS' which can be considered to be a pre-diabetic state. Clinically, this subgroup is most easily identified in obese women with a strong family history of diabetes in whom menstrual disturbance is the predominant feature.

The increased incidence of insulin resistance occurs in all PCOS women, not simply obese women. Most women with polycystic o***y syndrome (PCOS) are obese and are known to be insulin resistant. Obesity per se is a cause of insulin resistance.

A significant degree of insulin resistance exists in non-obese women with PCOS and is significantly related to serum LH and free testosterone levels.

Therefore, measures to decrease this condition may have to be considered earlier to decrease the potential risks of developing diabetes mellitus and coronary artery disease at later ages of life in both overweight and normal weight women who have PCOS.

A major complicating factor for PCOS women is that some types of cells - most commonly muscle and fat - in the body can be insulin resistant, while other types of cells and organs are not. As a result, the pituitary, ovaries, and adrenal glands of an insulin resistant woman will be stimulated by far higher levels of insulin that would be desired, thus causing elevated luteinizing hormone and androgens. This phenomenon is referred to as "selective resistance".

How Do I Know if I Have Insulin Resistance?

You may have this problem if you have three or more of these clinical laboratory markers:

• High blood pressure chronically over 140/90 (optimal is 120/80).
• 15 or more pounds over your ideal weight.
• Triglycerides over 160 (optimal is less than 100).
• Total cholesterol over 240 (optimal is 180-200).
• HDL “good” cholesterol less than 1/4 of total cholesterol.
• Fasting glucose over 115 (optimal is less than 100).
• Elevated uric acid levels
• Glucose (blood sugar) above 115
• Elevated glycohemoglobin A1C
• Elevated liver enzymes (sometimes)
• Low plasma magnesium levels.
Insulin problems are a contributing factor to:
• Polycystic o***y syndrome
• Infertility
• Diabetes
• High blood pressure
• Cardiovascular disease
• Inflammatory disorders
• Cancer
• Other degenerative disorders
• Shortened lifespan.
• Acne
• Apple-shaped obesity
• Difficulty with weight loss
• Hirsutism
• Sugar or carbohydrate cravings.

Insulin resistance is a big problem for women with PCOS because it is "selective". Your muscle and fat cells can be insulin resistant while other types of cells and organs are not. For instance, your pituitary, ovaries and adrenal glands may be over-stimulated by high levels of insulin, thus increasing androgens and luteinizing hormone. This hormonal imbalance may render you infertile, in addition to creating other health problems.

Low levels of myo-inositol have been found in women with PCOS.
Current research suggests that women with PCOS may benefit from supplementing with myo-inositol combined with folic acid, taken 1-2 times daily for 3 months. The benefits demonstrated in research so far have involved myo-inositol in supplemental form rather than from food sources; it is also unlikely that food sources can supply high enough levels to achieve an effect.

Nutrition & PCOS
From a clinical perspective, nutrition has much to offer women affected by this debilitating disorder. Whilst every case is unique, and requires an individualized and multi-factorial approach, effective treatment protocols commonly centre around the nutritional support of these key areas:
• Weight management
• Blood sugar balance and insulin function normalization
• Hormone balance
• Ovarian health support

Much of the most recent research in this area has focused on the clinical application of myo-inositol.

What is Myo-Inositol?
Myo-inositol is one of nine different types of inositol. It is a naturally occurring substance produced in the human body from glucose, although it is not a sugar. Better described as a ‘vitamin-like’ substance, myo-inositol is often considered to be a member of the B complex group of vitamins. However, because it is produced by the body in amounts considered sufficient to support health, it is not officially termed an essential nutrient. In addition to the body’s own production from glucose, myo-inositol is also found naturally in many foods such as organ meats, fruit, grains, nuts and beans.

Myo-inositol - Key role in insulin signalling
Myo-inositol is a key factor involved in insulin signalling. It is an immediate precursor to another type of inositol, D-chiro-inositol, which interacts with select sugars in the body to form inositol phosphoglycans – these play an important role in mediating the actions of insulin. Whilst myo-inositol can be made by the body and also found in foods, low levels can occur, and this can have an adverse impact on the body’s insulin-signalling pathways.

Low levels of myo-inositol, D-chiro-inositol and inositol phosphoglycans have been observed in individuals with impaired insulin sensitivity and PCOS

REVOSIT Sachet is available in Selected Clinics in Singapore.
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What is PCOS?

PCOS is not a disease, but rather complex hormonal condition that’s usually marked by cysts in the ovaries, high levels of male hormones, and irregular periods.

PCOS is a poorly named condition as the “cysts” which are often noticed on ultrasounds are in fact not cysts but multiple under-developed follicles, each one containing an immature egg. The eggs never mature enough to trigger ovulation.

The lack of ovulation alters levels of estrogen, progesterone, FSH, and LH. Progesterone levels are lower than usual, while androgen levels and often estrogen are higher than usual.

Common PCOS symptoms:

The hallmark symptoms of PCOS are irregular periods, acne, excessive facial and body hair, and hair loss on your head. But you might be experiencing any of the following:

• Cycles that are consistently longer than 35 days

• Infertility

• Multiple follicles on your ovaries on ultrasound

• Acne

• Unwanted hair growth

• Hair loss or thinning hair on your head

• Insulin resistance and/or blood sugar issues

• Anxiety, depression, mood swings, fatigue, low libido, cravings

• Weight gain and difficulty losing weight

• Blood tests show high luteinising hormone (LH) to follicle stimulating hormone (FSH) ratio

• Blood tests show excess androgens like testosterone or DHEAs

Is PCOS treatable?

Having suffered with PCOS personally, I deeply acknowledge the frustration and pain of many of the symptoms listed above, but I am here to tell you that you do have control and can address your PCOS symptoms using targeted nutrition, supplementation & lifestyle changes.

The best and most effective treatment will depend on your type of PCOS and the root cause so let’s dive on in to the top causes of PCOS, and the best approach to get you on the road to being symptom free!

Five common root causes of PCOS

1. INSULIN RESISTANCE Up to 70 percent of women with PCOS have insulin resistance, meaning that their cells can't use insulin properly. When cells can't use insulin properly, the body's demand for insulin increases. The pancreas makes more insulin to compensate. Extra insulin triggers the ovaries to produce more male hormones.

2. INFLAMMATION

Chronic, low-grade inflammation can prevent ovulation, disrupt hormone receptors leading to imbalances, and can increase cortisol, which can result in high androgens like DHEA and testosterone. Gut imbalances are a HUGE source of inflammation.

3. ADRENAL DYSFUNCTION

This type of PCOS is triggered by an abnormal stress response. Under too much stress, the adrenal glands produce extra cortisol, but also DHEA to compensate. Elevated DHEA can trigger elevated testosterone and estrogen.

4. POST-PILL PCOS

If you have recently stopped taking birth control, it is common to experience many of the signs and symptoms of PCOS such as irregular or missing periods, acne breakouts and hair changes. If before going on the pill you did not suffer from PCOS symptoms, it is likely you are suffering from post-pill PCOS.

The pill strongly suppresses androgen production. When you stop taking the pill, the androgen suppressing mechanism is suddenly lifted and this can cause your body to temporarily greatly increase its production while it finds its new normal. The good news about post pill PCOS is it is usually temporary.

5. HYPOTHYROIDISM

PCOS and thyroid disorders are two different conditions but there is an emerging relationship between PCOS and thyroid disorder. They both share common characteristics, like period irregularities and increased insulin resistance, and it is also very common for both conditions to co exist. It is estimated that about 25% of women with hypothyroidism have PCOS.

Hypothyroidism can worsen the symptoms of PCOS, including increased insulin resistance, irregular periods, abnormal hair growth, and male-pattern baldness. Hypothyroidism can be tricky to diagnose and is sometimes missed in women with PCOS, this is why it's important that women diagnosed with PCOS have their thyroid function thoroughly checked (TSH is not enough, ask for a full thyroid panel).

The four types of PCOS

Polycystic o***y syndrome or PCOS has become a common problem in the past few years. PCOS is considered to be caused by an imbalance in reproductive hormones. It can lead to the formation of small cysts in either or both the ovaries and also causes complications during pregnancy. According to nutritionists, 1 in every 10 women are affected by this disease. But before searching for treatments, you should be certain about what type of PCOS you suffer from.

The four types of PCOS
1. Insulin resistance PCOS
According to the latest research, it occurs in 70 per cent of the cases. As cells become numb to the effect of insulin, a condition called insulinoma arises which causes this type of PCOS. Abdominal weight gain, sugar cravings and fatigue are among its symptoms.
Regular exercise and movement are helpful to treat this. Avoid high sugar food and opt for a balanced diet. Reduce stress and sleep well to manage insulin levels. Supplements like Myo-inositol helps treat this condition effectively. (Haldane Pharma’s Brand of Inositol is REVOSIT)

2. Adrenal PCOS
This occurs during a massive stressful period. Marked indicators are high levels of cortisol and DHEA.
Reduce stress levels through yoga, meditation and good sleep. Avoid high-intensity exercise. Magnesium, vitamin B5 and vitamin C can help support the adrenal glands and nervous system

3. Inflammatory PCOS
This type of PCOS occurs due to chronic inflammation. Poor diet and unhealthy lifestyle lead to increased testosterone levels, which causes PCOS. High C reactive protein (more than 5), headaches, unexplained fatigue, skin issues like eczema are some of the symptoms.
Maintain good gut health by balancing gut bacteria, improving digestive enzymes and repairing leaky gut tissue. Avoid food that triggers inflammation. Help yourself with natural anti-inflammatories such as turmeric, omega 3 fatty acids and antioxidants like NAC.

4. Post-pill PCOS
This occurs after stopping the intake of oral contraceptive pills. According to Pooja, "The artificial Progesterone causes a party in the ovaries after you stop the pills", and this can cause PCOS. Taking the pills can stop the symptoms temporarily but can worsen the condition once stopped.
This type of PCOS is a temporary situation and reversible. Good sleep and low stress can help. Nutrients like magnesium, vitamin E, vitamin B6 and zinc are helpful.

How does my diet affect PCOS?

Women with PCOS are often found to have higher than normal insulin levels. Insulin is a hormone that’s produced in your pancreas. It helps the cells in your body turn sugar (glucose) into energy.

If you don’t produce enough insulin, your blood sugar levels can rise. This can also happen if you’re insulin resistant, meaning you aren’t able to use the insulin you do produce effectively.
If you’re insulin resistant, your body may try to pump out high levels of insulin in an effort to keep your blood sugar levels normal. Too-high levels of insulin can cause your ovaries to produce more androgens, such as testosterone.

Insulin resistance may also be caused by having a body mass index above the normal range. Insulin resistance can make it harder to lose weight, which is why women with PCOS often experience this issue.

A diet high in refined carbohydrates, such as starchy and sugary foods, can make insulin resistance, and therefore weight loss, more difficult to control.

What foods should I add to my diet?
Foods to add
1. high-fiber vegetables, such as broccoli
2. lean protein, such as fish
3. anti-inflammatory foods and spices, such as turmeric and tomatoes

High-fiber foods can help combat insulin resistance by slowing down digestion and reducing the impact of sugar on the blood. This may be beneficial to women with PCOS.

Great options for high-fiber foods include:
• cruciferous vegetables, such as broccoli, cauliflower, and Brussels sprouts
• greens, including red leaf lettuce and arugula
• green and red peppers
• beans and lentils
• almonds
• berries
• sweet potatoes
• winter squash
• pumpkin
Lean protein sources like tofu, chicken, and fish don’t provide fiber but are very filling and a healthy dietary option for women with PCOS.

Foods that help reduce inflammation may also be beneficial. They include:
• tomatoes
• kale
• spinach
• almonds and walnuts
• olive oil
• fruits, such as blueberries and strawberries
• fatty fish high in omega-3 fatty acids, such as salmon and sardines

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