Insulin Resistance and Polycystic Ovarian Syndrome

Article kindly provided by Ria Buys RD (SA) from Anne Till & Associates - Tel +27 (011) 4634663

The Role of Insulin in the Body

Glucose is metabolised inside cells and insulin is the key that facilitates the transport of glucose from the blood into muscle cells. In certain individuals, cells may be resistant to the activity of insulin. In other words the cells do not respond readily to insulin and thus glucose transport out of the blood into the cells is delayed. In these individuals the body may respond by making more insulin in order to overcome the resistance. The reasoning behind this is that the body recognises that the normal amount of insulin could not get the job done, and therefore perhaps more will be more effective. In individuals who have this problem, we find high levels of insulin in the blood. This condition is called hyperinsulinaemia (hyper ~ high, insulin ~ hormone insulin and aemia ~ in the blood), and individuals who have this condition are frequently Insulin Resistant (IR).

What are the consequences of High Insulin levels?

There are a number of different conditions associated with hyperinsulinaemia, such as overweight, coronary heart disease, high blood pressure, diabetes, gout, and polycystic ovarian syndrome. Certainly, it is not implied that if you have high levels of insulin, that you will develop all of these conditions. What is implied, is that you may be predisposed to developing one or two of these conditions in accordance with your individual susceptibility.

Polycystic Ovarian Syndrome. (PCOS)

PCOS is the most common endocrine disorder of pre-menopausal woman affecting 6% of the population. It is a major cause of infertility and menstrual disturbances. A frequent feature of women with PCOS is Insulin Resistance and compensatory high circulating insulin in the blood. High insulin levels produce high levels of the hormones androgen and testosterone. High levels of insulin may apart from disturbed hormone levels, independently contribute to anovulation (an inability to ovulate).

Medications that reduce circulating insulin might prove to be effective therapies for PCOS. Insulin reduction is indeed associated with a reduction in circulating androgens and improvement in ovulatory function in woman with PCOS.

Apart from medication and exercise NUTRITION plays an important role in the management of IR/ PCOS.

The aim and objectives of the nutritional management are the following:

1. To improve insulin sensitivity at a cellular level, and to improve glucose uptake into muscle cells.
2. To promote weight loss and /or the maintenance of ideal body weight.

Nutritional Intervention

The best results of nutrition intervention are achieved through an individualised assessment of current dietary practises, comprehensive education and the determination of an individualised meal plan. However the general nutritional guidelines for the management of insulin resistance are listed below, and can assist you in improving your condition, until you are able to seek the advice of a dietitian and obtain an individualised meal plan.

General Guidelines

1. Control fat intake, but do not follow a fat free diet. Give preference to monounsaturated fats such as Avocado Pear, Olive Oil, Certain Nuts, Canola Oil, Olive Oil Margarine and Canola Margarine. These fats improve insulin sensitivity, assist with carbohydrate metabolism and therefore weight loss and weight management
2. Control Portion Sizes (Quantities) of all foods other than vegetables and salads. Controlled portion sizes translate into a Calorie (energy) controlled meal plan.
3. Control Carbohydrate intake in order to control insulin levels. This means that you have to distribute carbohydrate intake into small portions throughout the day. One should watch the quantity of carbohydrate eaten at one sitting and give preference to carbohydrates that are low insulin producers such as fruit, vegetables and low glycaemic index carbohydrate foods (Rye Bread, Basmati Rice, Oat Porridge, High Fibre Cereals, Sweet Potato, etc).
4. Give preference to lean protein foods such as skinless chicken, fat trimmed meat, low fat dairy products and low fat cheese. Control portion sizes in order to control saturated fat intake. Saturated fat can aggravate insulin resistance.
5. Try to eat fish more often - and all types. Any type of fish is beneficial - Salmon, Mackerel, Herring, Cod, Pilchards, Sardines, Yellow Tail, etc. The omega 3 fatty acids in fish have been shown to have enormous benefits - one of which, is improving insulin sensitivity and therefore one's ability to metabolise carbohydrate foods.
6. Include a protein rich food, a carbohydrate rich food and one fat (at least) at each meal.
7. Fill out all meals as far as possible with vegetables. Vegetables are high in fibre, packed with vitamins and minerals, and add volume to each meal. Use vegetables in the form of salads, soups, baked / roasted vegetables, stir-fry's, steamed vegetables, vegetable kebabs, etc. Be creative!
8. Try to include 6 - 8 glasses of water daily. If you do drink tea and coffee - limit consumption to a maximum of 3 cups daily.
9. Consume alcohol in moderation or avoid it if you do not drink. 4 - 6 standard drinks per week is acceptable.
10. Ensure that your meal plan is well structured. By this we mean - try to have at least 3 meals daily, and check that the gaps between meals are not greater than 5 hours. Snacks may on occasion be necessary, as far as possible give preference to fruit as a snack.

EXERCISE - How can exercise aid us in reducing insulin resistance

Exercise is an extremely important part of the management of insulin resistance. For the following reasons:

1. Exercise enhances glucose uptake in the cells as well as insulin activity.
2. Exercise contributes to increased energy [calorie] expenditure and may therefore enhance weight loss and promote weight maintenance.
3. Exercise contributes to an increase in muscle density and therefore an improvement in energy metabolism.
4. With regard to IR regular [when possible daily] exercise and more specifically resistance training seems to offer some advantage over aerobic activity.

Article kindly provided by Ria Buys RD (SA) from Anne Till & Associates - Tel +27 (011) 4634663