PCOS and Insulin Resistance

Insulin resistance is one underlying root cause of polycystic ovarian syndrome (PCOS). In fact, some studies report that up to 70 percent of all women with PCOS have some degree of insulin resistance (1). 

In this article, we’ll define insulin resistance, how to test for it, and how we treat insulin resistance and PCOS from a root cause and functional medicine approach.

Insulin is a hormone made by the pancreas that helps to regulate your blood sugar levels. 

After eating a meal, your pancreas releases insulin into your bloodstream. The insulin binds to receptors on your cells which allows glucose (broken-down carbohydrates) to move into your cells to be used for energy. By moving glucose into your cells, insulin lowers your blood sugar levels back to baseline after a meal.

Insulin resistance occurs when your cells do not respond properly to insulin binding. As a result, your blood sugar remains elevated (sugar stays in blood instead of going into the cell) and your pancreas over secretes insulin in an attempt to normalize blood sugar levels and fuel your cells. 

In simpler terms, when insulin isn’t doing its job to direct sugar into the cell, this is called insulin resistance. Your body thinks more and more insulin is needed to do the job so the pancreas secretes more insulin. This is why we see high insulin levels in early stage insulin resistance.

For optimal health, we want to reduce insulin resistance and improve insulin sensitivity—your cells’ ability to bind to insulin.

Many women with PCOS have insulin resistance, even if their body mass index (BMI) is categorized as “normal.”  Diet, lifestyle, and genetics can all affect insulin resistance.

Insulin resistance leads to high insulin levels in the bloodstream, which worsens inflammation and causes the ovaries to produce more androgens (i.e. testosterone). Excess androgens are often the cause of unwanted PCOS symptoms like acne, facial hair, weight gain, or weight loss resistance. Chronic low-grade inflammation and high androgen levels subsequently worsen insulin resistance creating a vicious cycle for women with PCOS (2). 

Fortunately, we can lower androgen levels and restore ovulatory menstrual cycles in women with PCOS by treating insulin resistance. 

There is no one test that can directly screen for insulin resistance. Here at Root, we look at the entire clinical picture along with a few lab tests to assess insulin resistance in our members with PCOS. These tests are all available for self-ordering within the Root Access Membership.

This is a measure of how much glucose (sugar) is in your blood after an overnight fast. A fasting blood sugar level between 70 and 85 mg/dL is ideal. However, we cannot rely on a fasting blood glucose level alone to screen for insulin resistance.

Hemoglobin A1c is a blood test that measures your average blood sugar levels over the past three months using a percentage point. An ideal a1c level is below 5.4 percent. While A1C is a helpful tool for an overall picture of your blood sugar levels, solely relying on A1C can significantly under-diagnose insulin resistance.

Insulin resistance is characterized by increased insulin levels in the blood, so we also test for fasting insulin levels to give us a more complete clinical picture (2, 3). At Root, we consider an ideal fasting insulin level to be below 7.

Treating insulin resistance in women with PCOS can lower androgen levels and promote normal, ovulatory menstrual cycles (4). 

The food you eat plays a vital role in treating insulin resistance and PCOS. The goal is to fill your plate with colorful and anti-inflammatory foods rich in protein, fat, and fiber to support blood sugar balance.

By using this simple formula (protein + fat + fiber) when planning meals and snacks, you can normalize blood sugar levels, lower insulin release, and reduce inflammation.

Poor sleep, high-stress levels, and a sedentary lifestyle can all worsen insulin resistance (5). 

We believe in supporting the whole body, which is why we work with our patients to balance lifestyle and establish healthy habits to create whole-body health.

Assess your lifestyle quality by looking at your sleep habits, stress levels, and exercise routines. Aim for 7-8 hours of sleep each night, and reduce sleep disruptors like caffeine or alcohol close to bedtime. Additionally, try to engage in a stress-reducing activity each day. This may include yoga, meditation, reading, deep breathing, or walking. 

Exercise is another powerful tool that can effectively reduce insulin resistance. Even a short 15-minute walk at lunch makes a difference in the long run! 

We use our patients’ health history, lab results, and overall lifestyle to formulate individualized supplement recommendations.

However, there are a few supplements for PCOS that can generally reduce insulin resistance in PCOS. For example, we may recommend supplements like N-acetyl-cysteine (NAC), Inositol, or magnesium.

Metformin is a prescription medication that lowers insulin and fasting blood sugar levels. It is often prescribed by conventional doctors to treat insulin resistance and PCOS. 

In women with PCOS, Metformin may improve insulin sensitivity and increase ovulation rates. However, it does have some negative side effects.

First of all, there is a clear association between Metformin use and subsequent vitamin B12 deficiency (6). Vitamin B12 has many important jobs in the body like forming red blood cells, nerve functioning, and optimizing energy levels. What’s more, Metformin commonly causes GI upset such as nausea, diarrhea, bloating, and gas (7). These side effects may be due to Metformin’s influence on the gut microbiome. Some studies suggest this drug may cause dysbiosis—an imbalance of the gut bacteria (8, 9).

While we recognize that Metformin can be a useful medication, we prefer to treat insulin resistance in PCOS at the root cause with diet, lifestyle, and targeted supplementation.

Insulin resistance is one underlying cause of PCOS and may affect up to 70 percent of all women with this condition. Fortunately, we can reduce insulin resistance, lower inflammation, and normalize your menstrual cycles with a targeted functional medicine approach.