PCOS, inflammation and insulin have more in common than most women know. In my clinical experience, inflammation is often missed and goes unaddressed in women with PCOS.
This guest post is by Dr. Laura Wollman, my associate and the only doc to have been trained in my protocols. Dr. Wollman is sharing how we view PCOS treatment and prevention from a root cause perspective. She also shares a portion of what our treatment approach to PCOS looks like.
Dr. Jolene Brighten
PCOS, Inflammation and Insulin
Inflammation and insulin dysregulation are at the center of many disease and conditions, with PCOS being no exception.
This year I had the pleasure of attending the Integrative Fertility Symposium in Vancouver, Canada. Much of the focus of this conference was dedicated to the understanding of inflammation and insulin resistance as primary drivers of hormone imbalance.
Inflammation and insulin resistance can lead to infertility, difficult and painful periods, PCOS, and mood disorders.
PCOS Prevention — Decrease Inflammation & Regulate Insulin
We know that insulin and balanced blood sugar are important for so many reasons; preventing diabetes, cardiovascular disease, and cancer as well as hormone balancing and maintaining a healthy immune system.
But what most women (and some doctors) don’t recognize is that inflammation can cause insulin resistance and high blood sugar.
There is now evidence to suggest insulin resistance that is a result of inflammation may actually cause PCOS rather than being a result of the disease.
This cascade called lipotoxicity — a condition in which dysfunctional fat cells secrete inflammatory chemicals that ultimately causes insulin resistance.
How does inflammation cause insulin resistance & PCOS?
Inflammation causes blood sugar dysregulation, which leads to insulin resistance.
Elevated inflammatory molecules in your tissues will cause the insulin receptors to stop working properly and literally become inactive.
Your body depends on insulin unlocking the cell to allow sugar to enter.
If the insulin has nowhere to dock on the cells, the sugar can’t get in. This creates both excess insulin and glucose in the bloodstream. This is what is known as insulin resistance.
What About Lean Women with PCOS?
Even lean PCOS body types have chronic low-grade inflammation that is altering insulin receptor activity. You can be both thin and have insulin dysregulation.
Your ovaries are unique.
While almost all other tissues become non-responsive to insulin, the ovaries are among only a few organs to remain insulin sensitive.
Your ovaries become bombarded with insulin, which causes a structural change to your ovaries and stimulates them to secrete androgens, like testosterone. The result is the typical ovarian changes of PCOS women, plus elevated testosterone.
Elevations in testosterone are responsible for the typically symptoms of…
- Hair loss on the scalp
- Excess body hair (especially upper lip, chin, chest and abdomen)
Glycemic Index is Out, Insulin Index is In
The glycemic index is a carbohydrate ranking system designed to help guide “good” blood sugar choices.
It’s a good idea in theory, but in practicality, the glycemic index is not an ideal system to guide food selection for the best blood sugar balance.
While the Glycemic Index in not entirely unhelpful, the dietary focus needs to be on insulin balance. Insulin is the gatekeeper of the cell, allowing glucose to enter into it to be used as fuel, which is why it is so important of focus on the Insulin Index and inflammation.
Both the insulin index and glycemic index look at the effects of certain foods on blood sugar levels, but the Insulin Index gives better guidance to women with PCOS.
Women with PCOS and insulin resistance have plenty of insulin circulating their body — they just can’t use it.
We often tell women with PCOS, insulin resistance, and hormonal imbalance to eat protein with every meal. And while this is still a very valid way of eating, the Insulin Index helps us understand how certain proteins interact with our blood sugar.
For example, beef, fish and certain dairy products (like yogurt) will cause a large insulin spike, but do not raise blood sugar. It would seem that if they raise insulin then they must be lowering blood sugar, but in fact, they may not do much for your blood sugar if you’re pairing it with a big carbohydrate load.
Eating a big steak with a giant scoop of mashed potatoes will raise both your insulin and your glucose.
Treating PCOS, Inflammation and Insulin Dysregulation
Eat fat. Fats neither raise insulin or blood sugar.
A common prescription I write for women in need of some major hormone and blood sugar balance is to consume a tablespoon of organic extra virgin olive oil at the end of their meals.
Healthy fats like avocado oil, macadamia nut oil, cold pressed olive oil, and avocado lowers inflammation and offsets the insulin effects of carbohydrates and protein.
Having these healthy fats on board will slow down the absorption of any carbohydrates from the meal, while preventing insulin and blood sugar surges.
Eating fat and protein at every meal will ensure better blood sugar and insulin regulation, plus it will keep you feel full longer and prevent you from snacking all day.
Focus on the inflammation.
As Dr. Brighten always says, “You can have an ideal diet, exercise plan and still develop diabetes due to inflammation.”
In my clinical practice, I utilize an anti-inflammatory diet, along with hormone balancing meal plans. Since food sensitivities and leaky gut are so prevalent, I find it is crucial to address gut health and eliminate problem foods for at least 30 days.
Get Advanced Testing.
Fasting glucose and insulin are just not enough. In the clinic, I order advanced inflammatory and metabolic markers to understand the patient’s risk for developing diabetes and other chronic diseases.
Having an understanding of your current state of health can help you correct underlying issues and prevent disease.
Avoid Excess Sugar.
Two ways to simply and quickly remove excess sugar in your diet is to eliminate fruit juices and sodas completely. These high sugar beverages barely need any digesting and will quickly cause a huge spike in your blood sugar.
Your body’s response to high sugar beverages is no different than its response to table sugar.
If you have a hankering for apples or cherries, I recommend just eating apples or cherries, opposed to drinking fruit juices or dried fruit, which is also higher in sugar content.
Reversing Inflammation and Restoring Your Hormone Health
Diet is one of the many areas I focus on in my clinical practice to help women achieve better hormones. Eating a diet that is rich in whole foods is effective in lowering inflammation and treating PCOS.
I am also an advocate for appropriate lab testing. All women need to have an understanding of their current hormone state and their health.
I urge you to work with a doctor who is willing to work with you on nutrition, investigate your labs and address you as a whole person.
If you’d like to find out more about what it looks like to work with me you can learn more here or schedule here.