How to Improve Insulin Resistance Related to Polycystic Ovary Syndrome (PCOS): A Comprehensive and In-Depth Guide

Whether you've just been diagnosed with PCOS or insulin resistance, or perhaps you've heard of these conditions and wonder if they’re the reason behind your sugar cravings and weight gain, this guide is here to answer all your questions and help you better understand these health issues.

Insulin resistance is a reversible condition that can cause metabolic complications and precede type 2 diabetes. This article explores its causes, symptoms, diagnostic tests, treatment options, and nutritional strategies to improve it.

What Is Insulin and Insulin Resistance?

Insulin: Insulin is a crucial hormone produced by your body (in the pancreas). It helps convert the food you eat into energy. When you eat, food is broken down into sugar in your blood. Insulin acts as a key, unlocking cells so that sugar can enter them, providing energy or being stored for later use. Without insulin, sugar remains in your blood instead of entering your cells.

When we eat, blood sugar levels rise, prompting the pancreas to secrete insulin. Insulin then works on various cells to:

• Lower blood sugar: By facilitating the entry of glucose into cells.
• Promote fat storage: Insulin helps in the formation of fat tissue.
• Increase protein synthesis: It aids in muscle building.

However, insulin also has a hypoglycemic action: it lowers blood sugar levels by helping it enter cells where it is converted into energy.

Why Does the Body Resist Insulin?

Numerous factors can cause and exacerbate insulin resistance. Genetics plays a role, but this doesn’t mean we can’t rebalance our insulin levels. Although insulin resistance is a multifactorial disorder, recent genetic studies have identified several genes and genetic variants involved.

Beyond certain life stages like pregnancy, puberty, or aging that can influence sugar balance, potential causes include:

• Hyperinsulinemia: Excess insulin in the blood, often due to overproduction by the pancreas in response to too much sugar.
• Excess Weight and Poor Diet: A diet too high in calories and low in quality nutrients.
• Chronic Stress: Production of cortisol (the stress hormone) increases blood sugar and makes cell receptors less sensitive to insulin.
• Sedentary Lifestyle: Lack of physical activity reduces the demand for insulin by muscle fibers.
• Barriers to Insulin's Message: A cell that is insufficiently fluid (lack of omega-3 fatty acids), or insulin receptors not activated (deficiency in magnesium, zinc, chromium), which we will explore later.
• Smoking: While smoking isn't listed as a direct cause of hyperinsulinemia (high insulin levels in the blood), it is associated with increased insulin resistance, meaning a decreased sensitivity of tissues to insulin.
• Hypothyroidism: A thyroid dysfunction, such as hypothyroidism, directly impacts the body's ability to regulate blood sugar levels, promoting insulin resistance.
• Use of certain medications.

Symptoms of Insulin Resistance

• Significant fatigue and lack of energy
• Intense thirst (polydipsia) and frequent urination (polyuria)
• Increased hunger and cravings
• Irritability, migraines, difficulty concentrating
• Reactive hypoglycemia (energy slump 2 hours after meals)
• Weight gain or difficulty losing weight
• Accumulation of abdominal fat (high waist circumference)
• Darker patches of skin in body folds (acanthosis nigricans)

Diagnosing Insulin Resistance

Blood Tests:

Fasting Insulin:
A high fasting insulin level may indicate insulin resistance.

HOMA Index (Homeostasis Model Assessment):
The HOMA test, or HOMA index, assesses how the body uses insulin to control blood sugar. It is calculated from fasting glucose and insulin levels.

• A value below 1 is generally considered normal. Higher values may indicate insulin resistance.
• A HOMA index above 2.5 is a sign of insulin resistance. An index above 4 is particularly concerning.
• The higher the index, the greater the insulin resistance, indicating that the body needs more insulin to maintain normal blood glucose levels.

QUICKI Index (Quantitative Insulin Sensitivity Check Index):
This index measures how effectively the body uses insulin to control blood sugar.

• A high QUICKI index indicates good insulin sensitivity, meaning the body efficiently uses insulin to regulate blood sugar.
• A low QUICKI index suggests insulin resistance, meaning the body needs more insulin to maintain normal blood sugar levels.

Glycated Hemoglobin (HbA1C):
This is an indicator of average blood sugar levels over several months.

Natural Solutions and Treatment for Insulin Resistance

Preventing and treating insulin resistance involves adopting a healthy, balanced diet, losing weight if overweight, engaging in regular physical activity, managing stress, and receiving personalized medical follow-up. Managing and treating insulin resistance is crucial to preventing metabolic complications such as type 2 diabetes and cardiovascular diseases. Here’s a step-by-step guide:

Step 1: Physical Activity and Insulin Resistance

Physical activity improves glucose uptake by cells, thus increasing insulin sensitivity. It also contributes to weight loss, prevents cardiovascular diseases, supports psycho-emotional balance, and promotes good sleep.

How to Incorporate Physical Activity into Your Daily Life:

Moderate-Intensity Activities:

• Take the stairs instead of the elevator.
• Walk or bike for short errands.
• Get off one stop early when taking the metro or bus.
• Take a digestive walk during lunch breaks.
• Walk your dog or play ball with your children.
• Invest in a sit-stand desk.
• Do housework or gardening energetically.
• Invest in a treadmill.

It is recommended to engage in at least 30 minutes of moderate physical activity per day. Additionally, practice more intense activities such as swimming, yoga, weight training, running, or team sports twice a week.

Sleep and Insulin Resistance

Good sleep is essential for regulating metabolic functions, including blood sugar management and appetite control. Sufficient and quality sleep promotes better insulin sensitivity and helps maintain stable glucose levels. Moreover, quality sleep allows you to:

• Reduce cravings and sugar cravings.
• Facilitate weight loss and maintain a stable weight.
• Increase satiety hormones and insulin sensitivity.
• Improve stress resistance and overall energy.

Criteria for Quality Sleep:

• Sleep Efficiency: At least 85% of the time spent in bed should be dedicated to effective sleep.
• Sleep Onset Latency: Falling asleep should take no more than 30 minutes.
• Number of Nighttime Awakenings: No more than one awakening per night.
• Duration of Nighttime Wakefulness: If awakened, the duration should not exceed 20 minutes.
• Total Sleep Duration: Generally between 7 and 9 hours per night for adults.
• Regular Sleep Schedule: Maintain regular bedtimes and wake-up times, including on weekends.
• Absence of Disorders: Few or no issues like insomnia, sleep apnea, or excessive daytime sleepiness.

Tips for Better Sleep:

• Limit stimulants: alcohol, coffee, tea, sweets, soda.
• Avoid screens in the evening.
• Go to bed and wake up at consistent times.
• Create a bedtime relaxation ritual.
• Engage in regular physical activity, but not too late in the day.
• Consider supplements like magnesium or stress-relief complexes like "Ino'stress."

Psycho-Emotional Management and Insulin Resistance

Chronic stress promotes insulin resistance by increasing cortisol production, which raises blood sugar levels. In modern society, stress is often related to work or toxic relationships and doesn't always require a physical response. It's important to find ways to release stress, such as running, combat sports, or any other physical activity, and to consider supplements like magnesium or stress-relief complexes like "Ino'stress."

Eating Disorders and PCOS

Eating disorders (EDs) directly impact blood sugar levels, potentially causing significant fluctuations with episodes of hyperglycemia or hypoglycemia, which can worsen insulin resistance. It's crucial to seek help from a professional to address these behaviors and stabilize blood sugar levels.

Step 2: The Microbiome and Insulin Resistance

Studies have shown a correlation between gut microbiota health and the development of insulin resistance and obesity. An imbalance in the microbiota (dysbiosis) is often observed in individuals with insulin resistance. Therefore, focusing on gut health can be beneficial.

In fact, research has demonstrated an association between an impoverished microbiota, an unbalanced diet, and the development of type 2 diabetes. (1) Additionally, the gut microbiota helps break down food and extract nutrients. A balanced microbiota contributes to a healthy metabolism, while an imbalance can lead to poor nutrient absorption and the accumulation of harmful metabolic byproducts.

Moreover, gut bacteria influence the production of gut hormones like GLP-1 (glucagon-like peptide-1), which plays a crucial role in regulating blood sugar and insulin. Dysbiosis can disrupt the production of these hormones, negatively affecting glucose metabolism.

Step 3: Diet, Inflammation, and Insulin Resistance

Inflammation, while necessary to combat short-term threats like viral infections, becomes harmful when it persists long-term in the body. Insulin resistance and inflammation are closely linked. Here are the key points to understand:

• Insulin resistance and inflammation reinforce each other, creating a cycle that promotes various metabolic disorders. Insulin resistance disrupts glucose and lipid metabolism, creating a pro-inflammatory state. In turn, inflammation activates kinase molecules that decrease the sensitivity of insulin receptors, worsening insulin resistance. The release of additional inflammatory mediators and increased oxidative stress further exacerbates this resistance.

• This cycle between insulin resistance and inflammation leads to more metabolic dysfunctions and increases the risk of developing type 2 diabetes, cardiovascular diseases, obesity, and other pro-inflammatory conditions.

Strategies to Reduce Inflammation and Improve Insulin Sensitivity:

• Diet: Adopt a diet rich in anti-inflammatory foods such as fruits, vegetables, whole grains, and healthy fats. These foods, rich in antioxidants, polyphenols, and omega-3 fatty acids, reduce inflammation and improve insulin sensitivity.

• Exercise: Engage in regular physical activity to reduce inflammatory markers such as C-reactive protein (CRP) and interleukin-6 (IL-6). Exercise improves insulin sensitivity by increasing glucose uptake by muscles and enhancing mitochondrial function.

Step 4: Focus on Diet

A comprehensive article on this topic is available on our blog: The PCOS Guide.

Diet and Lifestyle:

• Mediterranean Diet: Less sugar and refined products, more fiber, vegetables, and fruits.
• Anti-Inflammatory Diet.
• Intermittent Fasting: Alternating periods of fasting and healthy eating.
• Rebalancing Gut Flora:
  • Probiotics.
  • Berberine: Has blood sugar-lowering effects and rebalances gut flora.

Supplements and Plants:

• Berberine: Lowers blood sugar and improves gut flora.
• Quercetin: Antioxidant and anti-inflammatory.
• Turmeric: Reduces insulin resistance and inflammation.
• Cinnamon: Hypoglycemic and antibacterial action.
• Chromium: Increases tissue sensitivity to insulin.
• Gymnema Sylvestre: Lowers blood glucose levels.
• Olive Leaf: Hypoglycemic and hypotensive action.
• Garlic: Helps regulate excess sugar and improves blood circulation.