\u201cI\u2019ve done so many diet programs, but I can\u2019t lose weight.\u201d<\/p>\n\n\n\n
\u201cMy problem is my willpower. I just need to work harder.\u201d<\/p>\n\n\n\n
As a registered dietitian nutritionist trained in functional nutrition, these are just a few of the very common quotes I hear from my clients struggling with polycystic ovary syndrome (PCOS)<\/a>. Fortunately, there are multiple simple strategies to support healing and weight management with PCOS that do not require extreme restriction or superhuman willpower<\/a>. <\/p>\n\n\n\n In the past and often still to this day, PCOS has been treated mainly as a reproductive hormone issue. Mayo Clinic<\/a> and Cleveland Clinic<\/a>, among other well-known medical organizations, currently frame PCOS this way. However, some compelling recent research suggests that PCOS is actually better understood as a metabolic condition that leads to <\/em>imbalance(s) in reproductive hormones [1]. In fact, the main metabolic driver of PCOS may be insulin resistance [2]. <\/p>\n\n\n\n This understanding of PCOS as a metabolic disorder is supported by the high prevalence of insulin resistance<\/a> in women with PCOS, affecting up to 75% of lean PCOS sufferers,<\/a> and up to 95% of overweight PCOS sufferers [3].<\/strong> For many women with PCOS<\/a> who struggle to lose excess weight, insulin resistance is likely one of the main culprits. Luckily, in my clients\u2019 experience, insulin resistance can often be managed and even reversed with nutrition<\/a> and lifestyle changes.<\/p>\n\n\n\n While sweets and other sugary foods and drinks definitely play a role in driving up insulin resistance, focusing only on avoiding these foods often leaves women still struggling with insulin resistance. Why is that? We have to understand the more complex nature of how your metabolism functions to regulate your blood sugar.<\/p>\n\n\n\n In normal metabolism, when blood sugar begins to rise in response to carbohydrate intake, insulin hormone is released to allow the sugar in the bloodstream to enter the cells of our body. Insulin works to keep blood sugar within an ideal range. Once insulin \u201cunlocks\u201d the cells of our body, sugar enters the cells and can be utilized for either energy production in the moment or stored as energy for later. This energy is stored either in the form of stored sugar called glycogen or converted into body fat.<\/p>\n\n\n\n When the input of sugar into the bloodstream over time is excessive, more and more insulin is required to do the same job of keeping blood sugar levels within a tight range. Over time, frequently or always being in this state of excess insulin, or hyperinsulinemia, can eventually lead to insulin resistance, which occurs when the insulin in your body is not properly received at the \u201cdoors\u201d of your cells, thus requiring even more insulin to regulate your blood sugar. This vicious cycle of more and more insulin circulating in the body is problematic. <\/p>\n\n\n\n The process of blood sugar regulation by insulin is a key factor in many of the hormonal issues and other negative symptoms<\/a> often experienced by women with PCOS. High levels of insulin in response to rises in blood sugar can actually lead to hormone imbalance across the body<\/em>\u2014reproductive hormones, thyroid hormones<\/a>, cortisol, etc. How can this be? <\/p>\n\n\n\n In PCOS, high levels of circulating insulin due to insulin resistance both stimulate the ovaries to produce more testosterone<\/a>, and inhibit the binding of testosterone to sex hormone binding globulin (SHBG) (when SHBG and testosterone are bound in circulation, testosterone’s availability is decreased) [4]. Together, these two effects lead to high levels of available testosterone and other androgen hormones like DHEA. High levels of androgens are often associated with common symptoms of PCOS such as acne<\/a>, excess hair growth on the face and other areas of the body (hirsutism), and male pattern hair loss. <\/p>\n\n\n\n In addition to androgen hormone imbalance, insulin resistance can also lead to disturbances in levels of estrogen<\/a>, progesterone<\/a>, luteinizing hormone<\/a> (LH), follicle stimulating hormone<\/a> (FSH), and cortisol [5,6]. This cascade of hormonal disturbance caused by insulin resistance often leads to other common symptoms felt by women with PCOS, including fatigue, sleep disturbances<\/a>, food cravings (often for sweets and starchy foods), and weight gain<\/a>. Often, these symptoms can create a vicious cycle. Cravings for starchy or sweet foods lead to more blood sugar imbalances and higher insulin levels, which leads to even more cravings, fatigue, and weight gain. <\/p>\n\n\n\n As previously stated, insulin drives storage of sugar as both glycogen and body fat, both of which can be used for future energy production. However, while insulin is in circulation, our body is in a \u201cstorage mode\u201d rather than \u201cfat burning mode\u201d [7]. In insulin resistance, the higher levels of circulating insulin lead to excess body fat storage, and decreased opportunity for utilizing that stored body fat as a source of energy during times of caloric deficit (when our body is using up more calories than it\u2019s taking in).<\/p>\n\n\n\n We can see that insulin resistance is a common denominator amongst many of the symptoms of PCOS. The good news is that insulin resistance can be managed through simple nutrition and lifestyle changes. <\/p>\n\n\n\n Using good nutrition to manage insulin resistance does not have to be complicated. Here is my simple nutrition framework for insulin resistance that many of my clients with PCOS have used to see incredible improvements in hormone balance, weight, energy levels, and reduced cravings:<\/p>\n\n\n\n Let\u2019s break those tips down a bit further.<\/p>\n\n\n\n Protein, healthy fat, and fiber help to slow down the rise in blood sugar that happens when we eat foods made of carbohydrates. Protein, in particular, is the most satiating of all macronutrients. Many women I work with experience dramatic reduction in cravings and increased energy levels simply by increasing their intake of protein at their meals, since the protein alone greatly improves satiety and blood sugar balance. <\/p>\n\n\n\n I recommend always pairing carbs with a good serving of protein to prevent a spike in blood sugar. A good rule of thumb for including PFF at each meal is to aim for: <\/p>\n\n\n\n The fear and confusion around carbs is consistently among the biggest challenges that my clients with PCOS experience. But the reality around carbs and metabolic health is two-fold: carbs can<\/em> be part of a healthy diet and, at the same time, limiting carbohydrates usually reduces insulin resistance [8,9]. <\/p>\n\n\n\n For many women, embracing this reality might look like keeping to one serving of higher carb foods at each meal. Of note, all plant foods contain carbohydrates, but some are higher in carbs while others, like non-starchy vegetables, avocados, nuts and seeds, are lower in carbs. Examples of one serving of higher-carb foods include 1 cup fruit, 3\/4 cup cooked whole grains, and \u00bd cup beans or lentils. <\/p>\n\n\n\n The more we eat whole or minimally processed foods<\/a>, the more nutrients we take into our bodies. Nutrients provided by whole- and minimally-processed foods include essential vitamins and minerals<\/a> as well as beneficial antioxidants, essential omega 3 fats, and more. <\/p>\n\n\n\nUnderstanding PCOS as a metabolic disorder<\/span><\/h2>\n\n\n\n
Insulin and blood sugar regulation<\/span><\/h2>\n\n\n\n
Insulin resistance leads to reproductive hormone imbalance and weight management challenges<\/span><\/h2>\n\n\n\n
Effects on testosterone balance<\/span><\/h3>\n\n\n\n
Effects on estrogen and progesterone balance<\/span><\/h3>\n\n\n\n
Effects on sugar storage in the body<\/span><\/h3>\n\n\n\n
Managing insulin resistance with metabolic diet & lifestyle<\/span><\/h2>\n\n\n\n
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Tip #1: Eat protein, fat, & fiber (PFF) at every meal<\/span><\/h3>\n\n\n\n
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Tip #2: Moderate your carbohydrate intake to healthier levels<\/span><\/h3>\n\n\n\n
Tip #3: Eat real, whole foods<\/span><\/h3>\n\n\n\n