insulin resistance

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What To Do After Your PCOS Diagnosis!

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So you’ve seen some of the symptoms, whether that’s an irregular menstrual cycle, ovarian cysts or follicular growths, acne, weight gain, high testosterone levels, or hirstutism – to name a few. You’ve been annoyed by what your body is doing for so long, seen numerous doctors, done blood tests, scans, ultra sounds and probably a plethora of other tests too, and finally you’ve been diagnosed with PCOS. When I first found out I had it (see this video and my PCOS playlist here) I was quite upset, and I think that’s a natural part of the process when you find out your body isn’t actually ‘healthy’ or ‘normal’.

Almost exactly two years after being diagnosed (and three years after seeing symptoms) I am now at a point where I don’t see my symptoms anymore. I’ve put the work in to see improvements, and slowly, but surely, they happened. My cycle is now regular, I’ve lost the fat I gained and have now been able to build a more muscular figure, my hormones are back in range, and whilst I still get the occasional spot or two – I no longer have cystic acne covering the lower half of my face.

 

Screenshots from a 2016 upload (obviously talking)

Screenshots from 2018 uploads (talking again haha)

 

In this blog post I’m going to share with you the steps that I believe are essential when it comes to managing your PCOS, and getting on top of it from the start. Slow changes are the best and will result in a more sustainable lifestyle in the future, so don’t think that you need to drastically change your routines all in one go. Instead, work on changing little parts of your daily activities until you reach a point where the healthier habit is the new ‘normal’. Check out my steps below to see what to do after you’ve been diagnosed:

 

 

Find A Doctor

Perhaps this is the doctor who got you diagnosed, or someone else, but it’s important to find a good GP whose beliefs align with yours. Maybe you wish to take birth control or Metformin to deal with some of the symptoms, or maybe you wish to seek out a more natural and holistic approach, either is fine, it’s up to you.

 

Find A Naturopath

A Naturopath (in my opinion) is an important step to take after finding out you have PCOS. A good naturopath can guide you in more than just supplementation, but can also get you to question how some of your general behaviours can aid in your wellness. For example, my naturopath in Brisbane (here) convinced me to spend more time outside with my feet in the grass, getting sunshine, I laughed it off at first because it sounded a little too crunchy granola for my liking, but the more time I spent outside in the sunshine, the better I felt. Incase you weren’t aware; there’s a strong link between PCOS and Vitamin D deficiency, with a staggering amount of 67-85% of women who have PCOS also being deficient in Vitamin D (Indian Journal of Medical Research, 2015). There are small changes you can make throughout your daily routine that can have a positive impact on your PCOS.

 

Find Support

Whether it’s friends or family who also have PCOS, or an online group of like-minded women. Having at least 1 person around who understands what you are going through will be beneficial. When it comes to treatment what works for them may not work for you, but at least you have someone you can talk to when you need it.

 

Consider How You Eat

Diet will play the largest role in the management of your PCOS symptoms. If one of the symptoms you experienced is food intolerance (gluten, dairy, etc) you may notice a significant improvement from removing this food source from your diet (even if it is for a limited period of time, eg 6-12 months). Diet changes to aid in PCOS are (again, in my opinion) the most effective over the long term, but also the slowest for change to appear.

I personally went on a ketogenic diet for 11 months to help reduce symptoms I was experiencing from my PCOS. As I have studied nutrition I was able to write my own food plan, if you do decide to take this route I HIGHLY recommend you seek out a dietician or nutritionist to write up your plan for you to ensure you’re meeting all of your intake requirements. The ketogenic diet is not one to be taken lightly. If you’re interested to learn more about it I have a video here (Thinking Keto? Everything You Need To Know) and here (8 Things You Must Know Before Starting A Ketogenic Diet), and my keto shopping list here (Blog: Keto Food List).

A ketogenic diet is an extreme route to take, and perhaps one to only try if you have exhausted other options. Usually a diet high in fibre, free of refined sugar, and with a moderate amount of protein in healthy fats will be the most beneficial to a woman with PCOS. One of the aims of diet manipulation is to decrease fasting insulin levels (Fertility and Sterility, 2004). In women with PCOS, consistently high insulin levels can result in higher free testosterone levels (The Journal of Steroid Biochemistry and Molecular Biology, 2010).


A low carbohydrate diet is usually sufficient for women with PCOS if it follows these basic guidelines:

  • No processed meats (fresh cuts only)
  • No refined sugars (no sodas, regular chocolate, biscuits, etc)
  • Low carbohydrate
  • Switching from white breads, wraps, etc, to whole meal (also called wholegrain)
  • Moderate amount of fats
  • (Optional) Dairy-free diets have been shown to help many women with PCOS

For more specific guidelines and meal ideas check out the ‘Endomorph’ recipes in the Get Lean Nutrition Guide.

 

Weight Loss? Or Not?

Obesity worsens the symptoms and persistence of PCOS. Women in the upper quartile of BMI are 13.7 times more likely to have metabolic issues and insulin resistance when compared to women in the lowest quartile of BMI. (Reproductive Biomedicine Online, 2006) So, the answer to whether to lose weight or not will depend on your weight (more specifically: body fat percentage) to begin with. For women who are overweight or obese, losing weight can improve PCOS symptoms.

Something to consider: even when I was losing weight on a ketogenic diet, it was only through macronutrient manipulation, not cutting calories, my daily intake was anywhere between 3000-4000 calories per day during this period.

In women who are at a healthy or low body weight who have PCOS, sticking to maintenance or even surplus calories will be the most beneficial when it comes to allowing your body to heal. Calorie deficits or trying to “diet down” just to look “shredded” when you really don’t need to be will actually increase cortisol levels in your body (Psychosomatic Medicine, 2010). This is where it’s important to have a goal that’s more than just how you look. Yes it’s nice to look ‘lean’, but unless you naturally sit at a very low body fat, this is not the healthiest thing. Consider your health before you consider your abs.

 

Get Your Gut Right

The more I learn about gut health, the more I am so impressed with how bacteria can control so many functions and reactions in our body. In 2016 a study on PCOS and gut microbiota used PCOS rats to compare what happened when the gut bacteria was changed (PLoS ONE, 2016). There was a control group, a group treated with lactobacillus, and a group treated with fecal microbiotia transplantation (FMT) from healthy rats. Hormonal cycles were improved in all rats in the FMT group, and in 6 out of 8 rats in the Lactobacillus groups. All of their testosterone levels were significantly decreased compared to the control rats that were not treated.

Similarly, improvements have been shown in women who are able to improve their gut microbiome, as women with PCOS tend to have less diversity in their gut bacteria (the Journal of Clinical Endocrinology & Metabolism, 2018). You can improve your gut health through supplementation (see below), increasing the amount of good bacteria in your gut via consumption of fermented foods (see this post on Fermented Foods), eating unprocessed foods, and eliminating any food intolerances.

 

Reduce Stress

Stress, whether it’s emotional, metabolic, oxidative, or inflammatory all impact PCOS, metabolic and reproductive functioning. Long-term stress can lead to severe health implications (Medical Hypothesis, 2018). Women who have PCOS who fail to address chronic and long-term stress may see their results going backwards: weight gain, irregular menstrual cycle, and even worsening of other symptoms such as food intolerances. According to Barry and Hardiman 2018, not reducing these kinds of stress will “exacerbate further the reproductive, metabolic, and psychological derangements of the syndrome, leading to an endless cycle of chronic illness.”

 

Supplements

This is something to speak to your naturopath or healthcare professional about, but supplementation may aid in a reduction of PCOS symptoms. Some supplements you may wish to enquire about:

 

Get Moving

It’s a well-known fact that that exercise can improve an array of health-related conditions, improve mood, and prevent against illness in the long term. Training can also improve insulin sensitivity and help alleviate some of the symptoms we experience from PCOS. Aerobic exercise can improve body composition and aid in weight loss in women who have PCOS (and the general population, of course). For a guided plan check out my 8 Week Transformation program, which can be done from home and requires no equipment.

Weight training combined with aerobic training has been shown to be far more efficient in improving insulin sensitivity and blood sugar control, whilst also reducing abdominal fat (Obesity Reviews, 2011). Check out my 6-month gym plan Get Lean to set up a long-term resistance training schedule.

 

I hope some of these tips will set you up on the path to success when it comes to dealing with your PCOS symptoms. They've been helpful for me, so I thought I would share. (Thanks to those who voted on my Instagram poll for this blog post, I will be uploading the Keto guide soon).

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How To Improve Your Insulin Sensitivity

I’m sure by now you’ve probably heard the term ‘insulin resistance’, or maybe even ‘insulin sensitivity’. If not, no problems, let me run over it for the folks who don’t know. Insulin resistance is associated with elevated levels of insulin circulating throughout your body, followed by an intolerance for glucose, if left ignored this can eventually lead to obesity, cardiovascular diseases, type 2 diabetes, and hypertension. So essentially it’s your body losing the ability to effectively control, use, and store glucose.

Here are some of the symptoms of insulin resistance:
- PCOS;
- Inability to lose weight;
- High blood pressure;
- Fluid retention (looking ‘puffy’ due to insulin signalling to your kidneys to hang on to sodium and water. This can be seen with swollen ankles, fingers, or abdomen, and even a ‘puffy’ area under your jawline);
- Elevated blood sugar levels;
- Fat storage in the abdominal area;
- Acne;
- (In women) male-pattern baldness; and/or
- Cravings for sugar/high-carb foods, and a constant feeling of hunger.
Remember this is not a diagnosis, and you should never self-diagnose. If these symptoms seem familiar, please request to have tests done by your healthcare professional.

Insulin is not the bad guy though! Insulin is what tells your body to absorb sugars and use them for energy, and balances your blood glucose levels. High levels of glucose in your blood will be sent to your liver for storage. So when the body has insulin resistance, your cells are responding in an abnormal way. Glucose is inhibited from entering the cells with ease, and it begins to build up in the blood.

From having insulin resistance myself I’ve done a lot of research on methods you can use to improve your body’s insulin sensitivity. I’ll list them below, and I’ve also included all my references at the bottom of this article if you’d like to read the full journal studies.

 

INOSITOL

Inositol is a supplement which is frequently used for treating metabolic syndromes, gestational diabetes, and PCOS. D-chiro-inositol (ie. Inositol) and myo-inositol are able to mimic the effects of insulin, and help your body better absorb the glucose for use, rather than sending it straight to storage. Studies have shown that after three months of myo-inositol treatment HbA1c (Glycated hemoglobin, which is a form of hemoglobin that is measured primarily to identify the three-month average plasma glucose concentration) levels and fasting blood glucose levels had significantly decreased compared to their initial readings (Pintaudi, 2016). Both myo-inositol and d-chiro-inositol showed the ability to mimic insulin in animals and humans.

 

CINNAMON

My naturopath has instructed me to take 1 teaspoon of cinnamon per day, as 1 teaspoon of cinnamon has a very similar effect to one dosage of Metformin. Metformin is a commonly prescribed drug used for treatment of type 2 diabetes. Cinnamon has been show to reduce insulin resistance, lower blood glucose levels, lower lipid levels, decrease inflammation, increase antioxidant activity, decrease body weight, and increase the utilisation of proteins throughout the body in both human and animal studies (Qin, 2010). Cinnamon extracts increased insulin activity more than 20-fold, making the body’s insulin efficient again.

 

BLUEBERRIES

Randomised, double-blinded and placebo-controlled studies on obese and insulin-resistant subjects have shown that incorporating 22.5g of blueberry bioactives into the daily diet insulin sensitivity was increased, with no inflammation, and no changes to the overall daily energy consumption by the participants (Stull, 2010). Blueberries have demonstrated the ability to increase the uptake of glucose into the bloodstream. This is largely believed to be due to their antioxidant properties.

 

CHROMIUM

As early as the 1850s studies have shown that chromium is essential to the human body for the effective metabolism of glucose. Many diets do not contain the adequate amount of chromium, and when your body has lowered levels of Chromium, it requires even higher levels of insulin to effectively use glucose (Anderson, 2003). There are many factors involved in insulin sensitivity, and chromium is just one of those, unfortunately there is still no test available to truly determine if you have chromium deficiency. Chromium should not be self-medicated. If your healthcare professional is treating you for insulin resistance try to make sure at least one of your supplements has chromium in it.

 

SLEEP

An inappropriate amount of sleep is associated with the incorrect use and storage of glucose in the body (Buxton, 2010). Sleep restriction to a maximum of 5 hours per night for only 1 week was shown to significantly reduce the ability of insulin to function correctly.

 

HIIT (High Intensity Interval Training)

HIIT exercise has shown the ability to lower blood glucose levels, increase fitness levels, increase the body’s basal metabolic rate (rate at which is burns energy), and increase insulin sensitivity (Marcinko, 2015). In clinical trials HIIT has improved insulin sensitivity, regardless of the body weight of participant. You can download My HIIT Guide training program from here.

 

MAINTAINED WEIGHT LOSS

If you’ve lost weight, this is even more incentive to keep it off, rather than returning back to your old habits. Overweight or obese women who maintained at least a 15% reduction in their body weight over 12-18 months have shown to have improved insulin sensitivity, rather than those who gained their lost weight back (Clamp, 2017). The opposite also reflected, with those who gained the weight back showing signs of decreased insulin sensitivity.

 

REDUCING EXCESS FRUCTOSE CONSUMPTION (Ditch the added sugars)

Standard diets now have shown a 26% increase in consumption of sucrose and high-fructose corn syrup compared to the standard diet in 1970 (Elliott, 2002). This is a result of the increase in added sugars to many foods, and there is major concern regarding the impact of health of diets that contain a large amount of free sugars (fructose particularly). Recent human studies (within the past 5 years) show a clear and direct link between changes in metabolic activity and high fructose intake. Fructose does not stimulate insulin secretion, and also does not increase the production of leptin, which play a major role in the regulation of energy expenditure and metabolism of sugars, as mentioned previously (Grant, 1980). The lack of insulin and leptin stimulation can then lead to weight gain, causing more issues for the subject.


References

Anderson RA 2003, ‘Chromium and insulin resistance’, Nutrition Research Reviews, vol. 16, pp. 267-275.

Buxton OM et al 2010, ‘Sleep restriction for 1 week reduces insulin sensitivity in healthy men’, Diabetes, vol. 59, no. 9, pp. 2126-2133.

Clamp LD et al 2017, ‘Maintained weight loss for 1 year increases insulin sensitivity in women’, Nutr Diabetes.

Elliott SS et al 2002, ‘Fructose, weight gain, and the insulin resistance syndrome’, The American Journal of Clinical Nutrition, vol. 76, no. 5, pp. 911-922.

Grant AM, Christie MR & Ashcroft SJ 1980, ‘Insulin release from human pancreatic islets in vitro’, Diabetologia, vol. 19, pp. 114-117.

Kleefstra N, Bilo HJ, Bakker SJ & Houweling ST 2004, ‘Chromium and insulin resistance’, Nederlands Tijdschrift Voor Geneeskunde, vol. 148, no. 5, pp. 217-220.

Marcinko K et al 2015, ‘High intensity interval training improves liver and adipose tissue insulin sensitivity’, Molecular Metabolism, vol. 4, no. 12, pp. 903-915.

Pintaudi B, Di Vieste G & Bonomo M 2016, ‘The effectiveness of myo-inositol and d-chiro-inositol treatment in type 2 diabetes’.

Qin B, Panickar KS & Anderson R 2010, ‘Cinnamon: Potential role in the prevention of insulin resistance, metabolic syndrome and type 2 diabetes’, J Diabetes Sci Technology, vol. 4, no. 3, pp. 685-693.

Stull AJ et al 2010, ‘Bioactives in blueberries improve insulin sensitivity in obese, insulin-resistant mem and women’, The Journal of Nutrition, vol. 140, no. 10, pp. 1764-1768.

Wilcox G 2005, ‘Insulin and insulin resistance’, Clinical Biochem Rev., vol. 26, no. 2, pp. 19-39.

Woods SC, Chavez M & Park CR, et al 1996, ‘The evaluation of insulin as a metabolic signal influencing behavior via the brain’, Neurosci Biobehav, vol. 20, pp. 139-144.