Insulin resistance is the most common cause of PCOS. And did you know, 65-70% of women with PCOS have some degree of insulin resistance?

Insulin is the hormone responsible for putting glucose that you ingest from food into the cell to be used as fuel. When insulin is elevated, it tells the ovaries to produce more testosterone. Excess testosterone halts ovulation, which is one reason why anovulatory cycles are common in PCOS. In an anovulatory cycle, ovulation does not occur. The inability for the follicle to completely mature and release an egg leaves the ovaries with fluid-filled sacs, which appear as polycystic ovaries on ultrasound.

When testosterone levels are high, we see unwanted symptoms like:⁠

• hirsutism (hair grown in unwanted areas like the jawline, neck, breasts, beneath the belly button, between the thighs, and the back)

• acne on the jawline

• hair loss, especially around the hairline⁠

Testosterone isn’t always a problem though. In healthy amounts, it helps women maintain muscle mass, sex drive, motivation, and assertion. These are all good things! The key is to achieve the right balance of testosterone. Which brings us back to insulin resistance. The close relationship between insulin and testosterone means that in order to manage testosterone, we have to manage insulin. 

So what drives insulin resistance?

Diet is the biggest factor! 

If you have insulin-resistant PCOS, you can help control it through your diet by following these tips.  

• Eat a whole foods diet. This doesn't mean low carb! I have seen further hormonal issues develop as a result of extremely low carbohydrate diets, and really caution against this. A whole foods diet means a diet rich in plant matter, good quality proteins at every meal, and some healthy fats. ⁠

• Remove dessert-type foods and foods with a lot of added sugar, especially those containing high fructose corn syrup, a man-made processed sugar that rapidly enters the bloodstream and can spike blood sugar. For sustainable change, I recommend limiting dessert to no more than twice per week.

• High fructose corn syrup also has known causes to non-alcoholic fatty liver disease (NAFLD). If you have insulin-resistant PCOS, you are more susceptible to NAFLD. NAFLD is asymptomatic, but it can progress to scarring of the liver, and eventually cirrhosis. This is an extreme condition in which the liver tissue becomes so scarred that it can lead to liver failure. Your liver performs some 500 important functions in your body, so it’s absolutely essential that you protect it. Consider dessert a treat and eat it on special occasions! Your liver will thank you. ⁠

• Include fruit with or enjoy after your meals. Fruit contains fructose, which is a sugar, but this gets absorbed very differently than high fructose corn syrup. It contains a wide variety of vitamins and minerals, water, and fibre that supports glucose tolerance. ⁠

• Eat and/or supplement with fibre. Fibre will help bind out circulating testosterone and promote insulin sensitivity by slowing down the entry of glucose into the bloodstream. Sources of fibre are psyllium husk, ground flaxseed & oats.⁠ You should aim for at least 30 grams of fiber per day. To give you an idea of what that looks like, here are some foods you can eat to reach that goal:

1 cup of chickpeas, beans or lentils - 15 grams

1 apple with skin - 4  grams

3 cups greens - 3  grams

1 tablespoon ground flaxseeds - 3  grams

¼ cup nuts - 2  grams

½ cup fruit or vegetables - 2  grams

TOTAL = 30 grams 

Adding fiber to each meal contributes to satiety, which can help manage caloric intake. If you are overweight, research shows that a caloric deficit can be helpful at decreasing insulin. Oftentimes, just by eating a healthier diet — such as the tips mentioned above — a caloric deficit is achieved. ⁠

• Use cinnamon and turmeric abundantly in your meals to help improve insulin activity. 

• A few cups of green tea daily can help lower testosterone and insulin. 

• Exercise: 150 minutes of weekly activity improves insulin resistance.

Nutrients and Supplements 

You should first and foremost try to manage insulin resistance by making dietary changes. However, it’s not always possible to get all the nutrients you need from food. Especially since PCOS can put you at risk for certain nutrient deficiencies. Here are some helpful nutrients and supplements that are safe and effective.  

Berberine 

This herb can be taken in capsule or tincture form to help regulate blood glucose and encourage ovulation (which can be hampered by high insulin). 

Chromium picolinate 

This trace mineral helps lower insulin. 

Gymnema sylvestre 

This herb can be taken in capsule or tincture form to help regulate blood sugar.

Magnesium

This mineral is required for insulin metabolism and helps lower insulin resistance. Magnesium comes in different forms. Look for magnesium bisglycinate.  

Melatonin 

This hormone regulates various body functions, including the sleep-wake cycle (the circadian rhythm), metabolism, blood sugar control, and gut health. In particular, melatonin has been shown to decrease insulin resistance.

Inositol

This is a sugar alcohol that is critical to glucose metabolism and insulin resistance. It has been shown to reduce the risk of developing diabetes and cardiovascular disease, which are also connected to insulin resistance. Clinically, I have seen a combination of 40:1 myoinositol to d-chiro-inositol work most effectively.

N-acetyl cysteine (NAC)

This is a type of amino acid (protein building block) that helps regulate blood sugar. It also has antioxidant properties that decrease inflammation associated with many PCOS symptoms.  

Probiotics 

Probiotics contain many varieties of friendly gut bacteria that help balance your gut microbiome. A healthy gut microbiome supports hormone balance by promoting estrogen metabolism and its relationship to insulin regulation.

Saw palmetto extract 

This herb can be taken in capsule or tincture form to help inhibit testosterone.  

Vitamin B complex

This combination of B vitamins helps metabolize estrogen. Vitamin B6 in particular helps decrease testosterone. 

Vitamin D

Helps lower insulin resistance. 

Testing 

There are various tests that can help you and your healthcare practitioner target your concerns with greater precision for better outcomes. 

Blood Tests

Due to the key role that insulin resistance plays in PCOS, periodic glucose and insulin  monitoring via blood tests is one of the most important tests you can do. When it comes to detecting insulin resistance, insulin is a more sensitive measure than glucose, so make sure that both are tested. This includes testing your fasting insulin levels in addition to a glucose tolerance test. You can also have your hemoglobin A1c levels tested, as this is a measure of how stable your blood sugar is over a few months. 

Additional blood tests can help pinpoint other hormonal and biochemical imbalances that play a role in PCOS. This includes looking at:  

• Free & bioavailable testosterone

• DHEA/DHEA-S

• Estrogen on day 3 of your cycle if menstruating

• Progesterone 7 days after suspected ovulation if menstruating

• Luteinizing hormone (LH)/follicular stimulating hormone (FSH) ratio

• Prolactin

• Thyroid stimulating hormone (TSH), T4, free T3, anti-microsomal antibodies and anti-thyroglobulin antibodies

• HDL, LDL, triglycerides, cholesterol, homocysteine, C-reactive protein

• Iron & ferritin

⁠At-Home Glucose Monitoring

You can easily and inexpensively track your blood glucose yourself using a simple device called a glucometer. You can do this multiple times a day to see how your glucose levels shift in response to factors such as eating, stress, cyclical hormone changes and exercise.  

DUTCH Test

The Dried Urine Test for Comprehensive Hormone test (aka DUTCH test) measures hormone levels collected from your urine rather than your blood. This can provide a comprehensive screen for different markers implicated in PCOS. 

Insulin-resistant Type PCOS requires a careful look into diet and lifestyle. If you’re struggling with insulin resistance, consider trying out some of my recipes from my Kickstart Guide to Overcoming PCOS Insulin Resistance Ebook, which includes:

• 50 PCOS-friendly recipes including smoothies, mains, snacks, and healthy desserts

• A variety of protein options are included, such as plant-based, fish, chicken, & beef

• Recipes focus on pairing high fibre carbohydrates with protein & fat to slow response of insulin. Some recipes are naturally low carb

• All recipes are gluten-free

If you try these recipes out, let me know how you enjoy them.

Dedication and commitment to your health will improve your frustrating PCOS symptoms! I look forward to hearing from you.