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PCOS and Insulin Resistance

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September 17, 2018
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Now that you are familiar with PCOS and the four types, it’s time to talk about insulin resistance – one of the underlying causes of this syndrome.

What is insulin resistance?

Insulin resistance happens when the cells in the body do not respond normally to insulin.

Insulin, a storage hormone, is produced by the pancreas, in response to whenever we eat food. Insulin will cause the liver and muscle cells to take in glucose/amino acids/fat from the bloodstream (where they will convert it into energy), and this process will ultimately lead to lowered blood sugar and insulin.

When someone is insulin resistant, glucose has a difficult time entering the cell, so it hangs out in the blood for much longer. More insulin is released to push glucose into the cell, causing metabolic dysfunction. Typical symptoms include fatigue after eating, sweet cravings no matter how many sweets you eat, increased thirst and urination.

When someone is insulin resistant, your body needs to make more insulin to get the job done. Too much insulin can cause both inflammation and weight gain which may end up leading to metabolic syndrome – diabetes and cardiovascular disease. In women, insulin resistance may affect ovulation, cause the ovaries to make more androgens, and affect fertility – recurrent miscarriage or inflammatory implantation failure.

Specifically, insulin stimulates testosterone secretion from the ovaries and inhibits sex hormone binding globulin production (which binds to testosterone). This leads to more testosterone in the blood stream which may account for acne, facial hair, and male pattern hair loss (top of the head). 

How to test for insulin resistance?

Although not the gold standard test, using the HOMA-IR calculation can tell you if you have insulin resistance. This test can be relatively simple – you just need 2 blood tests:

  • Fasting insulin, an optimum level less than 50 pmol/L

  • Fasting glucose

Plug these two values into the HOMA-IR calculator, to figure out your score. Ideally, you want a value less than 1.  

How to reverse insulin resistance

One of the best ways to reverse insulin resistance is to balance your blood sugar! This undoubtedly begins with food. 

Glycemic Index

The glycemic index is a marker used to calculate how quickly a particular food (50g of it) can raise blood sugar levels (over a 2 hour period) compared to pure glucose. The higher the glycemic index, the quicker the blood sugar is raised.

  • High Glycemic Index = 70 or more

  • Low Glycemic Index = 55 or less

Something to keep in mind is that foods are not alike, and neither is the serving size. This brings us to glycemic load. 

Glycemic Load

The glycemic index changes based on the amount of carbohydrates in each food and the serving size. It’s calculated by the amount of food eaten and multiplied by the glycemic index. 

  • High = GL of 20 or more

  • Medium = GL of 11 to 19

  • Low = GL of 10 or less

For example:

  • A typical serving of watermelon may be 1 cup, which has 11 grams of carbohydrates.

    • GI of 72 x 11 gram = 792. Divide by 100 = 7.92

  • A typical serving of regular crust cheese pizza may be one slice, which has 34 grams of carbohydrates.

    • GI of 33 x 34 = 1122. Divide by 100 = 11.22

Food Insulin Index

This index assesses how much insulin the body normally releases in response to food. Certain foods require more insulin, while other foods need much less. Foods with a lower FII can help lessen the insulin demand on your pancreas. 

How to choose the best balancing foods

Keeping the glycemic index, glycemic load, and food insulin index top of mind may be difficult. Let’s talk about what should be plentiful in your diet. 

Fruits & Vegetables

If half of our plate should be made up of plants, then you know that we should be eating a lot of fruits and vegetables throughout the day. Not only are they filled with great vitamins and minerals, they also have a lot of fibre (which will keep us regular!). Focusing on leafy green vegetables is key, but you can also include broccoli, cauliflower, Brussels sprouts, carrots, eggplant, mushrooms, onions and garlic (basically my entire fridge). 

But what about starchy vegetables? While these tends to have a higher glycemic index and load, you can still incorporate them in your diet, albeit in smaller amounts. Squash, sweet potatoes, beets and even white potatoes are considered starchy, but shouldn’t be eliminated from your diet. 

Fruits don’t need to be eliminated either, despite them obviously being high in fructose. You want to enjoy more fruits that have lower sugar – these include avocados, tomatoes, raspberries, blackberries, blueberries, strawberries (but choose organic) and lemons!

Fats

Fact: fat is good for you. But the reality is, many fats are highly processed. So which are the ones you should stick to? Avocado oil, extra virgin olive oil, coconut oil, and ghee (but choose organic, and don’t make this your primary oil).

Animal Protein

Protein (& fat) should always be part of a meal. They help to give you energy, balance blood sugar (by keeping it from spiking), and maintaining satiety. Protein is rich in amino acids which are basically the building blocks of your body. Plus, amino acids help to transport hormones and make sure your liver is detoxing properly. Fat, especially cholesterol, is essential because this is what sex hormones are made of! 

When it comes to meat, chicken is a better option than red meat (although eating it once in a while is fine). A couple of ‘labels’ to pay attention to is organic, grass-fed, hormone and antibiotic free. If you can afford to purchase meat with these labels, I encourage you to do so. However, I recognize that this is not an option for everyone (as it can be quite costly), but choosing 1-2 organic options may be the way to start (especially if you eat these on a consistent basis). 

Fish is a great protein option too, but some types can be high in mercury. Nevertheless, Wild Alaskan or Sockeye salmon, mackerel, shrimp, crab, anchovies and mussels are lower in mercury. Wild is better than farmed, which is something to keep in mind especially when buying salmon. 

Eggs should also not be avoided, especially since they’re a great breakfast food (#byecereal)! Eating eggs, in most people, will not raise your cholesterol. In fact, it may raise your good (HDL) cholesterol!

Final Thoughts

If you’ve made it to the end, thanks for sticking with me! Talking about diet and the role it plays in our health can be quite tough. Many of us don’t love overhauling our diet – after all, food plays an important role in our lives. That said, because we need to eat everyday, it’s important to pay attention to what we are putting in our mouths. 

If you think that you might be struggling with PCOS, be sure to read my past articles (what is PCOS, types of PCOS) and consider getting your blood work done.

If you found this information helpful, please sign up for my monthly newsletter called The Flow for great and informative content like this!

Types of PCOS

September 10, 2018
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The previous post about PCOS was about the criteria involved in diagnosing someone with PCOS. Many clinicians follow the Rotterdam criteria, which require 2 out of 3 criteria to be met in order to be diagnosed with PCOS. 

They are: 
  1. Delayed ovulation or menstrual cycles (anovulation)

  2. High androgenic hormones like testosterone

  3. Polycystic ovaries on ultrasound

Because you need to meet 2 criteria, your PCOS presentation may be slightly different than someone else’s. This brings us to the four types of PCOS.

The 4 PCOS types

Type A

Classified by:

  • Hyperandrogenic

  • Anovulation

  • Polycystic ovaries

Known as the classic type of PCOS. Signs and symptoms include: high BMI, increased weight circumference, highest androgens values, increased LH/FSH, AMH, low progesterone, and menstrual irregularity. Insulin resistance is also a factor – leading to an increased risk of diabetes and heart disease. 

Type B

Classified by:

  • Hyperandrogenic

  • Anovulation

Another classic form of PCOS. Signs and symptoms include: increased BMI, weight around the waistline, menstrual irregularity, signs of high androgens (ie. hirsutism, acne, and hair loss). Insulin resistance is also a factor in this type. In addition, this type may include older women. 

Type C

Classified by:

  • Hyperandrogenic

  • Polycystic ovaries

Signs and symptoms include: Medium BMI score, weight around the waistline, high androgens (ie. testosterone), polycystic ovaries, and while periods may be regular – ovulation may not be occurring (therefore, be sure to get your progesterone checked around day 21)! 

Type D

Classified by:

  • Anovulation

  • Polycystic ovaries

Considered the ‘lean’ PCOS. Signs and symptoms include: menstrual irregularities, polycystic ovaries, androgen levels are optimal – no physical signs of androgen excess, normal BMI, normal waist circumference, may be signs of insulin resistance. 

Rule these conditions out

Before you jump aboard the PCOS train, you want to rule out certain conditions first, as they may be the cause of some of your symptoms:

  • High prolactin (found on blood work)

  • Hypothalamic amenorrhea

  • Hypothyroidism – this can occur with PCOS

  • Non-classical congenital adrenal hyperplasia

A note about insulin resistance

As you might have noticed, insulin resistance is predominant in many of the types of PCOS. So how do you measure for it?

  • Fasting insulin

  • Fasting glucose

  • Oral glucose tolerance test

You can use these first two values (which you can get assessed through blood work) to calculate your HOMA-IR score. Ideally your score should be less than 1.5. 

Too much insulin can lead to excess androgens being formed (in various ways) and it may also impair ovulation. 

Final Thoughts

If you’re thinking that you have some of these signs and/or symptoms, and have yet to get any of your blood work done – do it! Because there are different types of PCOS, you want to get solid evidence of which type you may be. This will ultimately help determine the best type of treatment for you!

Find out your PCOS type with this blood work:

  • Total testosterone

  • Free testosterone

  • DHEA

  • Androstenedione

  • DHT

  • Fasting insulin

  • Fasting glucose

  • TSH

  • Free T4

  • Free T3

Don’t forget that Naturopathic Doctors can also requisition blood work! Speak to your ND to determine if that’s the best option for you. 

Now that you have a solid plan, please sign up for my monthly newsletter called The Flow for more informative and useful content like this! I want to make sure that you have a good flow!

What is PCOS

September 4, 2018
what is PCOS, toronto naturopath, naturopathic doctor toronto

PCOS is one of the few period-related conditions that I haven’t focused on yet in my blog. Admittedly, there are many resources to refer to when it comes to this condition. But I feel that it’s something for me to talk about and give my perspective on, as it’s a syndrome that I’ve been living with. 

What is PCOS?

PCOS is known as polycystic ovary syndrome. And while you might think that you need polycystic ovaries to have this condition, the criteria has changed since it was first discovered in 1953. 

As of 2003, a new criteria called the Rotterdam Criteria are being used to diagnose PCOS. Moreover, only 2 of the 3 criteria are needed for a diagnosis. They include:

  1. Delayed ovulation or menstrual cycles (anovulation)

  2. High androgenic hormones like testosterone

  3. Polycystic ovaries on ultrasound

Exploring PCOS Criteria

Delayed ovulation or menstrual cycles

We can’t rely on our apps to tell us if ovulation has happened – because as we know, the app will pick a day in the middle of the cycle and declare that as the ovulation day. Therefore, we have to pay attention to our body’s cues – in the form of cervical fluid and basal body temperature. If ovulation does not happen, this refers to anovulation, and may cause a delay of the entire menstrual cycle – where the cycle itself may be longer than 35 days in length. 

If you typically experience long menstrual cycles, despite them being regular, this may indicate PCOS. 

High androgens

All women have male hormones, but higher levels of these hormones can be problematic. Higher levels of male hormones may lead to acne (along jaw or back), growth of facial and body hair (or hair loss!) in specific patterns. 

The Ferrimen Gallway Score is a tool used to assess hair pattern change:


PCOS, toronto naturopath, naturopathic doctor toronto

Source: https://pedclerk.bsd.uchicago.edu/page/hirsutismPC

Yet, someone does not need to display physical signs of high androgens to have them. The following hormones should be evaluated to satisfy the high androgen criteria:

  • Total testosterone

  • Free testosterone

  • DHEA

  • Androstenedione

  • Sex Hormone Binding Globulin

Polycystic Ovaries

An ultrasound needs to be done to figure out if you have polycystic ovaries. Basically, you need 12+ follicles that are between 2-9mm or an ovarian volume bigger than 10cm in a single ovary. If attempt to get an ultrasound done, do so on the third day of your cycle (ie. day 3 of bleeding). 

Next Steps

Now that you’re familiar with the criteria of PCOS, here’s what you can do next:

  • Track your cycle length

  • Determine if you’re ovulating (DO NOT RELY ON YOUR APP)

  • Get your blood work done (PS. NDs can order your blood work too!)

  • Talk to your doctor about an ultrasound if either the first 2 criteria may not be an issue (ie. blood work is optimal)

Now that you have a solid plan, please sign up for my monthly newsletter called The Flow for more informative and useful content like this! I want to make sure that you have a good flow!