PCOS or polycystic ovarian syndrome can cause many different symptoms. One of the most troublesome symptoms is weight gain or difficulty with losing weight.1 Issues with weight are usually a result from irregularities in blood sugar metabolism, insulin sensitivity and hormone imbalance.1 Not every woman with PCOS necessarily has an issue with blood sugar or insulin, however. It’s always important to do routine bloodwork to understand the type of PCOS a woman has. Some conventional providers often give their patients a blood sugar medication and/or oral birth control as their first line approach.2 However, in my clinical experience, this commonly does not address the cause of blood sugar, insulin issues and ultimately the weight issues.
How does blood sugar and insulin actually impact weight in PCOS?
Insulin is a hormone made by the body to signal fat storage from carbohydrates (rice, breads, sugar, juice, fruit, vegetables, beans, etc). Insulin also regulates the amount of sugar in the blood and acts as a key to allow entrance of glucose into the cells.9 In women with PCOS, there is a genetic change in how insulin is regulated, leading to insulin resistance and high testosterone and/or DHEA.10 Insulin resistance is where the cells stop responding to insulin’s signals, leading to higher blood sugar because the blood sugar isn’t going in the cells. Higher insulin signaling also means that the carbohydrates in your diet are more readily becoming fat storage instead of being used as an energy source.11 Insulin levels need to be addressed in order for women with PCOS to lose weight.
Naturally, the first step after being diagnosed with PCOS, if it has not been done already is get fasting blood sugar, hemoglobin A1c (HbA1c) and insulin markers tested. Having a baseline and starting point helps track progress as women with PCOS start to address their condition.
What are the recommended lab/blood tests for Polycystic Ovary Syndrome?
Below are the basic blood tests that should be done at least once per year, or more if you’re working with a Naturopathic/Functional doctor to address your symptoms, weight issues and blood sugar:
- Basic panel: CBC, CMP (includes blood sugar), lipid panel, vitamin D, ferritin, CRP
- Blood sugar: HbA1c, insulin
- Hormone panel: FSH, LH, estradiol, progesterone, DHEA-S, testosterone
- Thyroid: testing thyroid is also very important as women can have both low thyroid and PCOS co-occurring. Low thyroid can cause slow metabolism and weight gain.16
Remember: labs should be individualized based on your specific case, speak to your Naturopathic/Functional doctor about the right blood tests for you. Your Naturopathic doctor will talk about the right days and time of day to get your blood tests done.
Let’s talk about how the most common blood sugar medication given to PCOS women works:
Primarily, Metformin works by decreasing your liver’s production of glucose/blood sugar.3 One of your liver’s functions is to maintain a good level of blood sugar between meals.4 This medication also decreases absorption of glucose/sugar in your digestive system and mildly improves insulin sensitivity.3 Some of the most common side effects of this medication is:
- Diarrhea
- Stomach aches
- Flatulence
- Nausea and vomiting
- Vitamin B12 deficiency! Vitamin B12 isn’t properly absorbed in your intestines.
What about a natural approach to improving blood sugar and insulin for weight loss in women with PCOS?
Let’s go over the basics:
- Balanced Nutrition
- Exercise
- Working with a naturopathic doctor & supplements
First and foremost, your nutrition and diet is the most important factor in balancing your blood sugar, balancing insulin and ultimately resolving weight problems associated with PCOS. Here are my top tips for a PCOS diet:
- Protein with every meal, 12-20 grams for breakfast, lunch and dinner. Protein prevents blood sugar spikes and balances blood sugar overall.9
- Do not skip meals! Skipping meals disrupts your blood sugar balance5, increases the risk of developing type 2 diabetes6, and is actually linked to obesity/weight gain and insulin resistance.7,8
- Limit carbohydrates in general. I recommend a low carbohydrate diet for women with PCOS. Decreasing carbohydrates improves insulin sensitivity, balances blood sugar, promotes positive weight changes and improves PCOS symptoms.12, 13 Rather than counting calories or food tracking, I recommend implementing portion control. When thinking about which carbs to eat, focus on including as many vegetables as you like, little to no simple carbs (sugar, breads, flours, pasta) and 1/2 cup cooked tubers (yams, sweet potato, organic potato). Fruit is ok, but limit to 1 serving per day (i.e. 1 banana, ½ cup frozen berries, 1 apple)
- Include healthy fats: avocado, olive oil, fatty fish, nuts, seeds
The second natural approach to improving blood sugar and insulin for weight loss in women with PCOS:
Exercises that build muscle. Ladies- this does not include cardio. Strength training has two main benefits:
- Strength training improves insulin sensitivity14
- Strength training increases your metabolism15
It can be helpful to work with a Naturopathic doctor for PCOS and weight gain, as they can act as a guide to navigate through which blood tests and supplements are necessary. Supplements can help address: blood sugar, insulin levels, and hormone balances associated with PCOS. A note about supplements: while they are often very helpful and beneficial in improving PCOS symptoms and weight, diet and exercise are pivotal.
Interested in working with me? Please schedule online or call my office at (480) 648-1534 to schedule an appointment.
References:
1 Barber, T. M., Hanson, P., Weickert, M. O., & Franks, S. (2019). Obesity and Polycystic Ovary Syndrome: Implications for Pathogenesis and Novel Management Strategies. Clinical medicine insights. Reproductive health, 13, 1179558119874042. https://doi.org/10.1177/1179558119874042
2 Lucidi, R. S. (2021, June 14). Polycystic ovarian syndrome treatment & management Approach considerations, Lifestyle Modifications, drug treatment. Polycystic Ovarian Syndrome Treatment & Management: Approach Considerations, Lifestyle Modifications, Drug Treatment. Retrieved November 2, 2021, from https://emedicine.medscape.com/article/256806-treatment#d10.
3 https://www.uptodate.com/contents/metformin-drug-information?search=metformin&source=panel_search_result&selectedTitle=1~148&usage_type=panel&kp_tab=drug_general&display_rank=1#F193820
4 https://www.frontiersin.org/articles/10.3389/fendo.2018.00802/full
5 Hashimoto, Y., Kaji, A., Sakai, R., Osaka, T., Ushigome, E., Hamaguchi, M., Yamazaki, M., & Fukui, M. (2020). Skipping breakfast is associated with glycemic variability in patients with type 2 diabetes. Nutrition (Burbank, Los Angeles County, Calif.), 71, 110639. https://doi.org/10.1016/j.nut.2019.110639
6 Bi, H., Gan, Y., Yang, C., Chen, Y., Tong, X., & Lu, Z. (2015). Breakfast skipping and the risk of type 2 diabetes: a meta-analysis of observational studies. Public health nutrition, 18(16), 3013–3019. https://doi.org/10.1017/S1368980015000257
7 Shigeta, H., Shigeta, M., Nakazawa, A., Nakamura, N., & Yoshikawa, T. (2001). Lifestyle, obesity, and insulin resistance. Diabetes care, 24(3), 608. https://doi.org/10.2337/diacare.24.3.608
8 Joo, H. J., Kim, G. R., Park, E. C., & Jang, S. I. (2020). Association between Frequency of Breakfast Consumption and Insulin Resistance Using Triglyceride-Glucose Index: A Cross-Sectional Study of the Korea National Health and Nutrition Examination Survey (2016-2018). International journal of environmental research and public health, 17(9), 3322. https://doi.org/10.3390/ijerph17093322
9 https://www.medicalnewstoday.com/articles/323760
10 Dunaif A. (1997). Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocrine reviews, 18(6), 774–800. https://doi.org/10.1210/edrv.18.6.0318
11 Lewis, G. F., Carpentier, A., Adeli, K., & Giacca, A. (2002). Disordered fat storage and mobilization in the pathogenesis of insulin resistance and type 2 diabetes. Endocrine reviews, 23(2), 201–229. https://doi.org/10.1210/edrv.23.2.0461
12 Krebs, J. D., Bell, D., Hall, R., Parry-Strong, A., Docherty, P. D., Clarke, K., & Chase, J. G. (2013). Improvements in glucose metabolism and insulin sensitivity with a low-carbohydrate diet in obese patients with type 2 diabetes. Journal of the American College of Nutrition, 32(1), 11–17. https://doi.org/10.1080/07315724.2013.767630
13 Zhang, X., Zheng, Y., Guo, Y., & Lai, Z. (2019). The Effect of Low Carbohydrate Diet on Polycystic Ovary Syndrome: A Meta-Analysis of Randomized Controlled Trials. International journal of endocrinology, 2019, 4386401. https://doi.org/10.1155/2019/4386401
14 Hansen, E., Landstad, B. J., Gundersen, K. T., Torjesen, P. A., & Svebak, S. (2012). Insulin sensitivity after maximal and endurance resistance training. Journal of strength and conditioning research, 26(2), 327–334. https://doi.org/10.1519/JSC.0b013e318220e70f
15 Lemmer, J. T., Ivey, F. M., Ryan, A. S., Martel, G. F., Hurlbut, D. E., Metter, J. E., Fozard, J. L., Fleg, J. L., & Hurley, B. F. (2001). Effect of strength training on resting metabolic rate and physical activity: age and gender comparisons. Medicine and science in sports and exercise, 33(4), 532–541. https://doi.org/10.1097/00005768-200104000-00005
16 https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284
