Polycystic Ovarian Syndrome (PCOS) is a complex hormonal disorder that affects individuals of reproductive age, characterised by a range of symptoms including irregular menstrual cycles, elevated androgen levels, and the presence of cysts on the ovaries.
Some, but not all presentations of PCOS include insulin resistance, a condition where the body's cells become less responsive to the effects of insulin, a hormone crucial in regulating blood sugar levels. This phenomenon sets off a cascade of hormonal imbalances, leading to disrupted ovulation, elevated androgen production, and often weight gain. Left unaddressed, insulin resistance in PCOS can increase the risk of type 2 diabetes and cardiovascular complications.
To assess the presence and degree of insulin resistance the most important blood markers to test are fasting insulin and fasting glucose. Other useful measures and markers are HOMA-IR, triglycerides, IGF, IGF - 1 and HbA1c.
Fortunately, there are evidence-based lifestyle strategies that can significantly improve insulin sensitivity and help you a lead healthier, more balanced life. In this article, I share my top five strategies for managing insulin resistance in PCOS.
Lifestyle strategies to manage insulin resistance in PCOS
1. Balanced nutrition and glycemic control
The cornerstone of managing insulin resistance in PCOS is adopting a balanced and nutrient-dense diet. Emphasis should be placed on whole, unprocessed foods to help stabilise blood sugar levels. Key recommendations include:
- Complex carbohydrates: Opt for slow-digesting, complex carbohydrates like whole grains, legumes, and vegetables. These foods release glucose slowly into the bloodstream, preventing rapid spikes in insulin
- Fibre-rich foods: Incorporate plenty of fibre from fruits, vegetables, and whole grains. Fibre helps regulate blood sugar levels and supports a healthy digestive system
- Protein: Include lean sources of protein such as poultry, fish, tofu, and legumes in every meal. Protein helps stabilise blood sugar levels and promotes a feeling of fullness
- Healthy fats: Incorporate sources of healthy fats like avocados, nuts, seeds, and olive oil. These fats help slow down the absorption of carbohydrates and promote satiety
- Limit refined sugars and processed foods: Minimise or eliminate sugary snacks, desserts, and processed foods, as they can lead to rapid spikes in blood sugar levels
2. Regular physical activity
Exercise is a powerful tool for improving insulin sensitivity and overall metabolic health in individuals with PCOS. Aim for a combination of cardiovascular exercises, strength training, and flexibility exercises. Examples include:
- Cardiovascular exercise: Vigorus/strenuous cardiovascular activity eg HIIT, brisk walking, jogging, swimming, or cycling for 30min, at a minimum of 3 times per week is associated with a reduction in plasma insulin and therefore positive cardiometabolic outcomes in PCOS
- Strength training: Incorporate resistance exercises at least three days a week to build lean muscle mass. Muscle tissue is metabolically active and can help enhance insulin sensitivity. Resistance or strength training may also provide additional benefits to androgen levels
- Yoga or pilates: These practices improve flexibility, balance, and stress management, all of which contribute to better overall metabolic health
3. Stress management and mind-body techniques
Chronic stress can exacerbate insulin resistance in individuals with PCOS. Therefore, implementing stress-reduction techniques is crucial. Some of the strategies I recommend to patients include:
- Mindfulness meditation: Engage in regular mindfulness or meditation practices to promote relaxation and reduce stress levels
- Deep breathing exercises: Incorporate deep breathing exercises to activate the parasympathetic nervous system and counteract the effects of chronic stress
- Yoga: Traditional yoga practices in studies have been associated with a reduction in fasting glucose, fasting insulin, lowered androgens, lower BMI and waist-to-hip ratio, and improved mental health outcomes
4. Adequate sleep and circadian rhythm regulation
Poor sleep habits and disruptions in circadian rhythms can contribute to insulin resistance. Prioritise quality sleep by:
- Establishing a routine: Aim for a consistent sleep schedule, going to bed and waking up at the same time each day
- Creating a relaxing bedtime ritual: Engage in calming activities like reading, gentle stretching, or taking a warm bath before bedtime
- Minimising screen time: Avoid screens (phones, computers, TVs) at least an hour before bed, as blue light exposure can disrupt sleep patterns
- Creating a comfortable sleep environment: Ensure your bedroom is conducive to restful sleep, with a comfortable mattress, adequate bedding, and a cool, dark room
5. Nutritional supplements and herbal support
Certain supplements and herbal remedies have shown promise in improving insulin sensitivity in individuals with PCOS. Always consult with a qualified healthcare practitioner before starting any new supplementation regimen. Some options may include:
- Inositol: This B-vitamin-like compound has been shown to improve insulin sensitivity and hormonal balance in PCOS
- Cinnamon: Studies suggest that cinnamon may help improve insulin resistance by enhancing glucose metabolism
- Berberine: This natural plant compound has demonstrated benefits in improving insulin sensitivity and supporting metabolic health
Managing insulin resistance in PCOS is a multifaceted approach that involves adopting a balanced diet, engaging in regular physical activity, implementing stress-reduction techniques, prioritising quality sleep, and considering targeted nutritional supplements or herbal support. By incorporating these evidence-based lifestyle strategies, you can take proactive steps towards better metabolic health and overall well-being. Always consult with a qualified healthcare practitioner before making significant changes to your lifestyle or starting any new supplementation regimen.
