Many women diagnosed with Poly Cystic Ovarian Syndrome( PCOS), suffer from insulin resistance ( approximately 50-70%) and it effects 1 in 15 women worldwide.  Lets bring it right back to basics and go into a little physiology to understand what this is all about and how this impacts your fertility.

What is Insulin and why do we need it?

Insulin is used in the body to maintain the levels of glucose. In the body glucose is a key energy source primarily for the brain and blood cells. Many other tissues can use fat and protein to gain energy but red blood cells and the brain really need glucose.  The liver is the main storage unit for glucose.

Insulin  is the helper hormone directly tied to glucose that allows you to maintain some sort of normality in energy and metabolism management. You get glucose in the body when you break down and eat carbohydrates. Insulins total role is to pull glucose from the blood or store it for later. As a crude analysis it does this by  ‘ dip testing’  to see if levels are dropping to hyperglycaemia,  and it then pulls glucose out of the stores in the liver, or if its too high it will grab all the glucose floating free and store it. When you become insulin resistant it’s almost like the hormone insulin forgets how to do its job and it doesn’t know when to store or pull glucose from the blood, as it gets overwhelmed by the amount of glucose being poured into the blood and therefore becomes less effective at lowering blood sugar. Over time this will have an effect on the endocrine system. With ladies who are polycystic the endocrine function, ie the key organs that support and produce hormones, that regulate metabolism, growth and development, tissue function, sexual function, reproduction, sleep, and mood are sending the wrong signals and over time can create an imbalance. This will happen from the very beginning of the cycle and can cause mild to severe hormonal imbalance, this result s in issues with all the above, ie low libido, or higher and inability to lose weight, hirsutism ( excess hair growth), weight gain, cystic acne,  mood swings, sleep issues and anovulation  (absent menstrual periods)  to name a few.

How does having insulin resistance or PCOS effect fertility?

The body is always working to balance things and is a finely tuned system or almost an orchestra of all sorts of instruments that come together to bring on ovulation. If one of these hormones is ‘out of kilter’ the endocrine system will step in to send out another hormone to correct this. This is exactly what happens with Insulin. The body detects something isn’t working and has repeatedly not listened to the key command, so it sends in another hormone in the view that higher levels of this will tip the other levels to the right function. However this causes all sorts of issues if this goes on for a while.

A woman’s cycles

At the beginning of a woman’s cycle on day one the tag team will be in place to send out hormones to prime her for ovulation. This goes from Gonadotropin Releasing Hormone (GnRH), to Follicle Stimulating Hormone (FSH), to Luteinising Hormone (LH), to Oestrogen then Progesterone. ( you will be tested for the majority of these when going to the GP for blood work)

In women with PCOS and insulin resistance, the GnRH will detect higher Insulin and pulse out more GnRH than normal to balance, this then sets the tone for the rest of the cycle as LH will then rise too high, too early,  (this is the hormone that indicates the egg must be released from the follicle and should in most cases be a short lived hormone)  Having a high level of this gives the indication that follicles are now ready to pop and reduces FSH almost before it has had time to do its thing. This then leads to excessive production of the big players oestrogen, and then androgens  ( Testosterone and  androstenedione) and then oestrogen dominance becomes a fixture.  The ‘poly’ in the diagnosis comes from the fact that lots of follicles will try to develop but not fully mature. In a normal pattern, follicles develop then die away where one to two become dominate and this releases the egg. This will also have an effect on progesterone the hormone that maintains pregnancy and womb lining and in many situation women with PCOS will have low progesterone levels.  In most cases ovulation falls short as the egg won’t have been able to grow sufficiently to produce a viable oocyte.  Women with PCOS will have a very real indication the cycle isn’t working as there is no period to speak of for many months or a very long cycle over 35 days. A normal cycle is a  process where lining is broken down and built up as the hormones come to play throughout the month and is usually between 26- 33 days.

Managing my insulin, looks like the key that unlocks this problem, so how can I help improve insulin resistance?

A huge way to help improve insulin resistance, is through most probably the very source of this issue in the first place, – diet!  I’m not normally a calorie counter, or a believer in ‘ group weigh ins and slimming clubs’  or foods you can buy that tell you how many points you have, its all a gimmick to me especially after watching ‘ the men who made us fat’  Our ancestors never lived like this. What I do believe in is following traditional wisdom.  Why break what thousands of years have honed?  instinctively our ancestors just knew what worked and ensured fertility year on year!  I believe based on the old model emphatically in  reducing our reliance on processed white/baked and ‘pants’ foods that give us zero nutrients but provide the massive ‘ deafening’ effect on our poor old insulin to the point that it is now causing the hormonal epidemic in our modern lives.

So what is the diet you talk about?

In order to ‘reeboot’ your bodies ability to ovulate we need to go back to basics and cut out starchy carbohydrates to a large degree and focus on protein and fat. Remember what I said at the start of this article about the brain and the red blood cells being the only ones needing glucose? All other tissue can work on protein and fat as fuel, so what we need to do is trick your body back into line by maintaining a blood sugar level that is primarily fuelled by  some very basic ingredients: Protein/legumes and veg and very simply cooking like your Great grandparent made!

Foods to Help Balance Blood Sugar Levels

Here is a list of  a few of my seasonal choices of food for winter. The trick is also to have 3 protein balanced meals. Starting off with to set the blood sugar at least 20-30g of protein in the morning.

Protein – I would generally get clients to go organic  (as the conventional ones will only exacerbate your oestrogen burden as the animals are pumped full of this to overproduce) so buy more protein from animals and if veggie vegetable sources. If you eat animal products choose grass-fed, organic and free range animal products. A woman needs to consume 60-70g grams of protein per day while trying to conceive.

• Free-range organic chicken, lamb beef ( pork can contain some contaminants, so avoid for now) make sure its all fresh cuts and not processed!
• legumes/beans like chickpeas, lentils and black beans
• Nut and seed butters: Sunflower seeds, sesame seeds, pumpkin seeds, almonds, walnuts, chia and hemp seeds, and Brazil nuts.
• Cold-water fish, Free range organic eggs and chicken, grass-fed beef and grass fed dairy (go for sheep yogurt as this seems to be less inflammatory) If in the UK you can get this in Waitrose
• Carbohydrates – All veggies are carbs, so when you say ‘ I’m on a no carb diet, not strictly true!  Choose fresh not frozen too. Some people think that eating carbohydrates will make them gain weight, but the fact is that eating too many of the wrong carbohydrates (pastries, crackers, white pasta, white rice, etc.) is what results in weight gain as they have zero nutrients. Also starches and fibre feed your gut bacteria which can also help you with weight. Whole food sources of carbohydrates contain important nutrients that can help you feel full longer and give your body energy.
• Whole Grains – bread/crackers/rye/pasta  – limit these for now,   (ie oats once a week) as they will breakdown in the body to glucose, you can introduce them once things are balanced again!
• Fruits –again as this breaks down to fructose and then eventually glucose limit fruit to 2 servings daily in season at mo are apples, pears and blackberries
• Vegetables –carrots, Brussel sprouts, greens, sweet potatoes (not white potatoes) and artichokes, cabbage, turnips, kale, chard, leeks, onion, garlic, turnips, parsnips broccoli, cauliflower, Kale
• High fibre foods – Fibre helps remove excess oestrogen from the body which can be helpful for some reproductive imbalances. Dark leafy greens, brassica vegetables like broccoli and cauliflower, quinoa and beans and lentils.
• Spices – Horseradish (fresh root as opposed to a prepared sauce), garlic, onions, cinnamon, fenugreek, tarragon, coriander and allspice.

Women living with PCOS who educate themselves about healthy nutrition for PCOS are more likely to be successful at changing their health.

Changing your diet will have a huge effect on your ability to balance your hormones and I have had many success stories. Taking out gluten is one of the first things you can do, which will really help you to lose weight, I’ve had ladies drop so much weight in 3 weeks who did this! ( and that doesn’t mean replacing it with ‘ gluten free options/ as these are starchy carbs also!  )

Start being a health detective and go right back to basics. Maybe even investing in a slow cooker? These changes will start to take hold after around 1 month and you will need to follow this for at least 3-6 months to see changes.

While it may seem daunting to have to change your diet, it is one of the best ways you can improve insulin resistance and your overall health, with the added benefit is increased in fertility.

The sheet to the right is an example of  the diet I honed after many years as I also suffer from PCOS to a mild degree due to genetic issues with insulin

Supplements for PCOS

I’m always asked about supplements as a nutritionist and many of the ladies I see with PCOS are at the stage that they are chucking in anything they have seen working on forums all over the net.  As a practitioner I like to ‘ Heal with food’ as add too many supplements in the mix and you really don’t know what is working and what isn’t. Undoubtable like many ladies diagnosed with PCOS who are trying to conceive, you may be on a raft of medication that will ‘ mug’ you of a lot of your vital nutrients. The basic approach I like to suggest is only the bare minimum until I can really see if the food is healing and if not working as fast and needs a jolt after the first month, that’s when I add more supplements.   Also I’m a  trained professional and can only advise on things based on a consultation where I go through specifics. Many of you have been asking each other for advice recently on specifically things like maca and vitex which are herbal medications. This is very personal and can be very powerful ( after all its where all out modern medicine comes from in the first place) so be careful ‘ self prescribing’ as it can interfere with your hormonal balance and any medically prescribed medication.  

References:
1. http://www.ncbi.nlm.nih.gov/pubmed/9467578

http://www.ncbi.nlm.nih.gov/pubmed/11397835

2.Philip M. Sarrel, MD. Androgen. HealthyWomen.org.http://www.healthywomen.org/condition/androgen
3. The National Diabetes Information Clearinghouse is a service of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. Insulin Resistance and Prediabetes. http://diabetes.niddk.nih.gov/dm/pubs/insulinresistance/#metabolic NIH Publication No. 14–4893 (June 2014)
4. About Polycystic Ovarian Syndrome: Types of Medical Treatment.http://www.pcosfoundation.org/types-of-treatment
5. PCOS Nutrition Center. What’s Your Protein-To-Carb Ratio?http://www.pcosnutrition.com/links/blogs/whats-your-protein-to-carb-ratio.html

6. Anna-Marija Helt, Ph.D. CH, personal communication, May 2014.

7. Chris Kresser ‘ The right and wrong way to balance hormones http://chriskresser.com/the-right-and-wrong-way-to-treat-hormone-imbalance

8. Effects of Myo-inositol supplement on oocyte quality in PCOS patients

9.The rationale of the Myo-Inositol and D-chiro-Inositol combined treatment for Polycystic Ovary Syndrome.http://www.researchgate.net/publication/263858485_The_rationale_of_the_Myo-Inositol_and_D-chiro-Inositol_combined_treatment_for_Polycystic_Ovary_Syndrome