Navigating PCOS, Insulin Resistance, and Diet

By Megan Pallister, MD, FACOG

PCOS (polycystic ovary syndrome) is a common condition affecting as many as 5 million women of reproductive age in the U.S. While the exact cause of the syndrome is unknown, medical experts do know that it’s related to a hormonal imbalance and is characterized by two or more of the following factors:

• Irregular or no menstrual periods, suggesting absence of ovulation
• High levels of androgen (male) hormones, including testosterone
• The presence of ovarian cysts

Normally during ovulation, fluid-filled sacs in the ovaries break open and release the eggs contained in them, which allows fertilization to occur. When the sacs don’t break open, they can become growths known as ovarian cysts. Despite the name of the condition, women can have polycystic ovary syndrome without having any cysts on their ovaries.

One of the most well-known – and discouraging – aspects of PCOS is difficulty becoming pregnant and, in many cases, infertility. However, PCOS presents numerous challenges and is a lifelong condition that goes beyond childbearing years.

One of the most common issues many women with the condition face is excess weight, even if they try to eat healthy and exercise regularly. According to research, up to 88% of women with PCOS are either overweight or obese, with weight gain primarily occurring around the waist. The most probable reason for this is insulin resistance, which is present in up to 90% of women with the syndrome.

What Is Insulin Resistance?

Insulin resistance occurs when the body doesn’t respond as it should to insulin, a hormone that’s essential to the regulation of blood glucose (sugar) levels. Under normal circumstances, glucose enters the bloodstream and signals your pancreas to release insulin, which helps the glucose enter muscle, fat, and liver cells to use for energy or store for later. Once the glucose has been used or stored, the pancreas is signaled to stop making insulin.

With insulin resistance, the cells don’t efficiently take in the glucose, and as a result, the glucose remains in the bloodstream. The pancreas then continues making insulin to account for the increased glucose levels.

Insulin resistance is also referred to as prediabetes. If insulin resistance goes untreated, it can lead to Type 2 diabetes. According to the Centers for Disease Control and Prevention (CDC), more than half of women with PCOS develop Type 2 diabetes by age 40. Women with PCOS who become pregnant are at greater risk for developing gestational diabetes, which can result in a high-risk pregnancy.

The effect of insulin resistance is similar to what happens when someone consumes high amounts of unhealthy, simple carbohydrates, such as sugary foods and refined grains. The glucose is converted into triglycerides, a form of fat, and is stored in fat tissue. This causes weight gain, especially around the waist. How Diet Can Help Manage PCOS

If you have PCOS and have been experiencing weight gain, making some changes to your diet may help you reverse insulin resistance and achieve a healthy weight. The following isn’t a complete list of foods to avoid and include, but it serves as a helpful guide.

Foods To Avoid

• Snacks and desserts high in sugar, sucrose, high fructose corn syrup, or dextrose, such as candy
• Refined carbohydrates, such as those found in white bread, pastries, muffins, cakes, and highly processed desserts
• White rice and pasta made with refined flour
• Fried foods, including French fries, potato and corn chips, fried chicken, and fried fish
• Foods high in saturated fats, including butter and margarine
• Red meat and processed meats, such as hot dogs
• Processed breakfast cereal high in sugar
• Sugary beverages, including sodas and sports drinks

Foods To Include

• Breads and pastas made with whole grains
• Brown rice and barley
• Beans and nuts
• Olive oil
• Non-starchy vegetables, such as leafy greens, mushrooms, peppers, broccoli, cauliflower, and snow peas
• Broiled or baked fish rich in Omega-3 fatty acids, including salmon
• Fresh fruit with no added sweetener

Modifying your diet, along with other lifestyle changes, such as getting regular exercise, can help you better manage PCOS symptoms. Talk to your doctor if you suspect you may have PCOS or insulin resistance but have yet to be diagnosed.