Tools to Manage Insulin Resistance
Before we dig in, let’s recap parts I and II of this series.
In part I, we covered how insulin helps us maintain healthy blood sugar levels while providing important energy to our cells in the form of glucose. Repeated blood sugar spikes over many years, however, can lead to insulin resistance and eventually type 2 diabetes. We also discussed how women with PCOS tend to have genetic mutations that impact insulin signalling, insulin receptors, and/or the clearance of insulin from our bodies. All of these factors make us higher risk for insulin resistance. Additionally, women with PCOS tend to have ovaries that are extra sensitive to insulin and secrete more androgens than the average female when high levels of insulin are present. These androgens throw off our menstrual cycles, and cause PCOS symptoms like acne, excessive hair growth where we don’t want it, and loss of hair growth where we do want it.
In part II, we talked about how, at least for some women, insulin sensitivity (what we want) decreases and insulin resistance (what we don’t want) increases during the luteal phase of our menstrual cycles.
This post will provide a quick and dirty list of tools that have been demonstrated to increase insulin sensitivity. Later posts will provide deeper dives into each specific tool.
To organize the tools, we’ll think about the time domain for which they work: reducing impacts of a single meal vs. long-term impacts.
Tools to mitigate blood sugar & insulin spikes from a single meal
Apple cider vinegar
The impact of the same buckwheat bowl with roasted veggies and salmon (recipe provided to our early newsletter subscribers!) eaten under three different conditions on blood sugar levels. Top: eaten first thing in the morning, Middle: eaten after working out, Bottom: eaten after working out and after drinking 1 tsp ACV in 8 oz of water.
The literature on the impact of apple cider vinegar is mixed (full discussion in a future post!), but some studies find that consumption of apple cider vinegar, diluted with water, slows the movement of food from the stomach to the small intestine. As noted in part I of this series, we absorb carbohydrates from the small intestine after they’ve been broken down. If we slow the movement of food to the small intestine, we also slow the absorption of carbohydrates into our bloodstream, reducing blood sugar and insulin spikes. I’ve personally seen a reduction in blood sugar spikes with just 1 tsp of ACV mixed in 8 oz of water. Studies demonstrating a positive effect use up to 2 tbsp of ACV consumed before the meal (Hlebowicz et al. 2007). It should be noted that slowing gastric emptying can result in bloating, and ACV is acidic and can damage tooth enamel if consumed excessively.
Altering the order of foods eaten
To manage blood sugar, our meals containing higher density carbohydrates (grains, starchy vegetables, legumes) should also always include protein, vegetables, and fat, but the order in which we eat a balanced meal can also impact blood sugar. Eating your source of carbohydrate AFTER you eat most or all of the protein and non-starchy vegetables (source of fiber) will slow the release of carbohydrates into your bloodstream and reduce blood sugar peaks by 40 - 44% relative to eating all components together and by 53 - 54% compared to eating the carbohydrate first (Shukla et al. 2017). That’s pretty substantial! This intervention carries no real downsides, except perhaps how delicious you think your meal is. I’m a big fan of “bowl” style meals, so I will admit that I don’t use this one too often. However, whenever I want something sweet, I make sure to consume it after a meal instead of just as a snack.
Go for a walk/throw a dance party/rep out some push-ups after your meal
In part I, we talked about how insulin signals cells like your muscle cells to let glucose in. Physical activity also signals muscle cells (and only muscle cells) to let glucose in, even in the absence of insulin. So after a meal that contains carbohydrates, you can start lowering your own blood sugar just by moving! Most of the literature studies walking, probably for its simplicity and near universality, but really any movement that gets your muscles working should do the trick. Studies have found that the largest blood sugar reductions occur when exercise occurs within 30 minutes of the meal, but positive impacts can be found up to 2 hours after the meal, with impacts decreasing as the time between the meal and exercise increase (Engeroff et al. 2023).
Longer Term Interventions
herbs & spices
If you’re like I used to be, you might think treating medical conditions with herbs is woo-woo pseudoscience. I get that. It’s hard to imagine that things in your spice rack can have a significant impact on your health, but some of them can! The list that follows is not an exhaustive list, but it gives some options that have data to back up their claims and that are generally well-tolerated. Always talk to a trusted healthcare professional before adding in supplements.
Cinnamon is a spice that has a long history of therapeutic use, and its use has been specifically tested in women with PCOS. One study found a 17% decrease in fasting glucose levels and a 44.5% decrease in insulin resistance in women with PCOS by taking 333 mg of cinnamon extract 3 times per day for 8 weeks (Wang et al. 2007).
A lesser known herb, fenugreek, has been shown to have similar impacts on fasting plasma glucose levels. This herb that is believed to have originated in Northern Africa has been tested extensively for use in treating type 2 diabetes and other disorders. A meta-analysis of these studies finds impacts of 15 - 25 mg/dL (healthy range: <100 mg/dL) from doses ranging from 1 to more than 10g of fenugreek per day (Fakhr et al. 2023). Powder and seed forms were found to be effective, while extracts were not. While supplementation was effective for those with type 2 diabetes, there were no impacts found for healthy subjects. Larger effects were found for those over 45 years of age and with a BMI less than 30.
Lastly, turmeric has risen to holistic health fame in recent years for its many super powers, working primarily through its anti-inflammatory properties. It has been tested in women with PCOS as well. A 12-week study of women with PCOS found that taking 500 mg of curcumin, 3 times a day, decreased fasting glucose levels by 26.53 mg/dL (Heshmati et al. 2021). Given its touted health benefits, this is a favorite daily supplement of mine.
Exercise
There will be a separate post discussing the large literature on the impact of exercise on women with PCOS, which will dig a bit more into various types of exercise, duration, etc. For this one though, I’ll start with a very simple, yet impactful intervention. A study of previously sedentary women with PCOS utilized a 12-week exercise program where the women exercised for 1 hour, 3 times per week (Harrison et al. 2011). The sessions alternated between a session of walking or jogging at a pace that kept their heart rate at 75 - 85% of their maximum (just past the level of exertion where it’s easy to carry on a conversation) and a session of 2-minute high intensity intervals at 95-100% of their maximum heart rates with 1 to 2 minutes of recovery between sets. They progressed from 6 to 8 sets of high intensity intervals. At the end of the 12-week intervention period, insulin resistance improved by 16%.
Stress
Stress has been demonstrated to decrease insulin sensitivity and increase insulin resistance. One study of teenage girls diagnosed with PCOS demonstrated how stress management techniques can improve insulin resistance (Nidhi et al. 2012). In the study, one group of girls spent 1 hour a day learning about and practicing yoga, meditation, relaxation techniques, and pranayama (breathwork) while the control group spent the same hour doing stretches and static strengthening exercises that mimic yoga poses without the emphasis placed on stress management. After 12 weeks, the yoga group demonstrated an average of a 15% reduction in fasting insulin, about a 5% reduction in fasting glucose, and 29% reduction in insulin resistance. The control group actually saw an increase in fasting insulin and no significant changes in fasting glucose or insulin resistance.
In my own attempts to get off of hormonal birth control, I think the primary difference between my first failed attempt and my second successful attempt was a much stronger stress management practice in place. We’ll talk much more about this soon!
Sleep
The last big tool that I will cover here is sleep. There’s a vast literature on the impacts of sleep deprivation on insulin sensitivity. I will cite just one here, and save the rest for a later post. The one I will cite looks at just a single night of sleep deprivation, where the subjects slept only 4 hours vs. a control night with 8.5 hours of sleep (Donga et al. 2010). They observed a 19 - 25% reduction in insulin sensitivity from just this single night of sleep deprivation! Just imagine what chronic sleep deprivation might do.
nutrition
If you made it this far, there’s probably a good chance you’ve been waiting for me to just tell you what to eat! And what you eat DEFINITELY has the biggest impact on your blood sugar levels and insulin levels. However, it’s also a nuanced conversation that is best left for its own post. So stayed tuned! It’s coming!
Tools like continuous glucose monitors can help determine which tools are most impactful for you. You can get CGM’s through Signos HERE. Use code PCOSPROF15 at checkout for 15% off.
References
Donga E, van Dijk M, van Dijk G, Biermasz NR, Lammers G, van Kralingen KW, Corssmit EPM, and Romijn JA. 2010. A Single Night of Partial Sleep Deprivation Induces Insulin Resistance in Multiple Metabolic Pathways in Healthy Subjects. Journal of Clinical Endocrinology & Metabolism 95(6):2963-2968.
Engeroff T, Groneberg DA, and Wilke J. 2023. After Dinner Rest a While, After Supper Walk a Mile? A Systematic Review with Meta-Analysis on the Acute Postprandial Glycemic Response to Exercise Before and After Meal Ingestion in Healthy Subjects and Patients with Impaired Glucose Tolerance. Sports Medicine 53:849-869.
Fakhr L, Chehrogosha F, Zarezadeh M, Chaboksafar M, and Tarighat-Esfanjani A. 2023. Effects of Fenugreek Supplementation on the Components of Metabolic Syndrome: A Systematic Review and Dose-Response Meta-Analysis of Randomized Clinical Trials. Pharmacological Research 187:106594.
Harrison CL, Stepto N, Hutchison SK, Teede HJ. 2012. The Impact of Intensified Exercise Training on Insulin Resistance and Fitness in Overweight and Obese Women with and without Polycystic Ovary Syndrome. Clinical Endocrinology 76(3):351-357.
Heshmati J, Moini A, Sepidarkish M, Morvaridzadeh M, Salehi M, Palmowski A, Mojtahedi MF, and Shidfar F. 2021. Effects of Curcumin Supplementation on Blood Glucose, Insulin Resistance, and Androgens in Patients with Polycystic Ovary Syndrome: A Randomized Double-Blind Placebo-Controlled Clinical Trial. Phytomedicine 80:153395.
Hlebowicz J, Darwiche G, Bjorgell O, and Almer L. 2007. Effect of Apple Cider Vinegar on Delayed Gastric Emptying in Patients with Type 1 Diabetes Mellitus: A Pilot Study. BMC Gastroenterology 7:46.
Nidhi R, Padmalatha V, Nagarathna R, Ram A. 2012. Effect of a Yoga Program on Glucose Metabolism and Blood Lipid Levels in Adolescent Girls with Polycystic Ovary Syndrome. International Journal of Gynecology and Obstetrics 118:37-41.
Shukla AP, Andono J, Touhamy SH, Casper A, Iliescu RG, Mauer E, Zhu YS, and Ludwig DS. 2017. Carbohydrate-last Meal Pattern Lowers Postprandial Glucose and Insulin Excursions in Type 2 Diabetes. BMJ Open Diabetes Research & Care 5:e000440.
Wang JG, Anderson RA, Graham GM, Chu MC, Sauer MV, Guarnaccia MM, Lobo RA. 2007. The Effects of Cinnamon Extract on Insulin Resistance Parameters in Polycystic Ovary Syndrome: A Pilot Study. Fertility and Sterility 88(1):240-243.
Disclaimer: This post is not intended to diagnose or treat any medical issues. It is intended for informational purposes only. I am not a medical practitioner. Always consult a trusted healthcare provider with any questions you may have about a medical condition or treatment and before starting any new health care regimen.