Nicolette: 0:01

Welcome to the Health Pulse, your go-to source for quick, actionable insights on health, wellness and diagnostics. Whether you're looking to optimize your well-being or stay informed about the latest in medical testing, we've got you covered. Join us as we break down key health topics in just minutes. Let's dive in.

Mark: 0:23

Welcome back to the Deep Dive. Today we're going to be taking a really close look at something that impacts a lot of women, and that is PCOS polycystic ovary syndrome. But you know, we see the symptoms, we hear about the symptoms, but a lot of times we don't really talk about what might be driving some of these symptoms, and one of those things is this idea of insulin resistance.

Rachel: 0:45

Yeah, and I think you know we've been doing these deep dives now for quite a while and I think this is one of those topics that we're going to really dive into and try to give people a really good resource on. You know, those outward symptoms like irregular cycles or excess hair growth. You know those get a lot of the attention, sure, but what we really want to do is look at you know kind of what's going on underneath the surface and how the way the body's processing, you know, sugars and responding to insulin can really play a huge role in how this develops.

Mark: 1:18

Yeah, I think that's a good point, and that's really what we want to accomplish here is to give people a really clear idea of what exactly insulin resistance is. How is it connected to PCOS, and then you know what can we do about it? Right, what are the actionable steps? Because that's why people tune into the deep dive, right? They want that information, they want to know how to improve their health.

Rachel: 1:39

Absolutely, you know, and I think the source material that we have for this particular episode is really really comprehensive, you know, but we want to make sure that we can kind of pull out the most important pieces, make it very clear for people so they don't get, you know, kind of kind of bogged down in all of the medical terminology.

Mark: 1:59

Right.

Rachel: 2:00

We want to make it actionable, so exactly. That's. That's what we're here to do today.

Mark: 2:04

Yep. So maybe the best place to start, then, is really with the fundamentals here. What exactly is insulin resistance? I mean, you hear this term and I think it's sort of thrown around and a lot of people may not actually have a clear picture of what's going on.

Rachel: 2:18

Yeah, and I think this is one of those things that can be really confusing, so let's break it down. So, when we talk about insulin resistance, we're basically talking about a condition where your cells and these are primarily the cells in your muscles and your fat and your liver they they become less responsive to insulin. Insulin is a hormone.

Nicolette: 2:37

Right.

Rachel: 2:38

And and what it. What it does is it acts like a key to let glucose, which is our blood sugar. It lets that glucose into the cells to be used for energy. So you can think of it almost like a key right. Insulin is the key. Glucose is what we want to get into the cells and the cell is like the house Got it Okay. So when we're talking about insulin resistance, what we're saying is that those cells are becoming less responsive to the insulin. So it's almost like the lock is kind of getting rusty.

Mark: 3:06

Uh-huh, right Okay.

Rachel: 3:07

So the key doesn't work as well.

Mark: 3:09

So if the key is not working, if the cell is not responding as well to that insulin, what happens to the sugar? I mean, the sugar still gets in the bloodstream after we eat, right? So where does it go if it's not going into those cells?

Rachel: 3:25

That's a great question. So when the cells aren't taking up the glucose as efficiently, what happens is our blood sugar levels start to rise.

Nicolette: 3:31

Okay.

Rachel: 3:31

Okay, so it's like you know, the sugar is backed up in the bloodstream and so what?

Rachel: 3:35

the body does. It's like oh, we got to do something about this, right? We've got all the sugar hanging out here. So what it does is it signals the pancreas, which is the organ that makes insulin. What it does is it signals the pancreas, which is the organ that makes insulin. It says hey, we need more insulin, we got to get this sugar out of here, Right? So the pancreas starts pumping out more and more insulin, and so what we end up with is a situation called hyperinsulinemia, which just means high levels of insulin in the blood.

Mark: 3:59

High levels of insulin in the blood. Ok, so now we kind of have a picture of what insulin resistance is and what happens in the body. But our source material really points out that it's not just about blood sugar, right? There are other consequences to this.

Rachel: 4:15

Yeah, this is really where it starts to get interesting. So this chronic state of insulin resistance and hyperinsulinemia it really has ripple effects throughout the body and one of the first things that we see is that it can lead to increased fat storage, and this is often why people will see weight gain, and particularly we see this kind of around the abdominal area.

Mark: 4:40

Okay, that makes sense.

Rachel: 4:40

Right, and it also can increase inflammation in the body. You know inflammation is a natural process, it's part of how our body heals. But when we have this chronic low-grade inflammation, that's where it can really start to cause problems and it also can affect our cholesterol levels. You know we want our cholesterol to be in a healthy range, but insulin resistance can kind of throw that off. And one of the other things that's really important to mention here is that the American Diabetes Association actually points out that this process of developing insulin resistance it can actually happen very gradually over time. It's not like one day you wake up and you have it. It can be happening silently for years.

Mark: 5:19

Okay, wow, so you may not even know that it's happening, but it could be Exactly so. Now let's bring this back to our main topic here, which is PCOS, and our source material really emphasizes that, that there's a really fundamental connection here between insulin resistance and PCOS. So why, why, why is insulin resistance such a key player when it comes to PCOS?

Rachel: 5:42

Well, I think the first thing to point out is that research has shown that a very high percentage of women with PCOS also experience insulin resistance. We're talking somewhere between 70 to 80 percent.

Mark: 5:52

Wow, that's a huge majority.

Rachel: 5:54

It's a huge number, and what's really interesting is that it's not just women with PCOS who are overweight. This can happen even in women who are at a healthy weight. Women with PCOS who are overweight this can happen even in women who are at a healthy weight. And so the excess insulin that we see with insulin resistance it actually has some pretty direct effects on the ovaries and on the way that hormones are produced in women with PCOS.

Mark: 6:14

Okay, so let's break that down a little bit. How does this extra insulin that's floating around, how does that actually interfere with hormone balance in PCOS?

Rachel: 6:22

So what's really interesting is that elevated levels of insulin. They seem to have this effect on the ovarian cells, specifically the ficus cells, and it causes them to produce higher levels of androgens. So think about testosterone.

Mark: 6:39

Right.

Rachel: 6:39

Now, women naturally have androgens, but in PCOS those levels are elevated Right, and so what the insulin resistance is doing is it's kind of fueling that overproduction of androgens.

Mark: 6:48

Uh-huh.

Rachel: 6:49

It's like it's telling the ovaries hey, make more, make more oh.

Mark: 6:52

I see.

Rachel: 6:53

And it turns out that the LACA cells in women with PCOS. They're extra sensitive to that signal. It's almost like you know you turn the volume up on the, on the signal Gotcha.

Mark: 7:05

Right.

Rachel: 7:05

So it's a really it's a really interesting kind of interplay there.

Mark: 7:08

So those higher androgens, those are really what lead to those symptoms that we typically associate with PCOS right.

Rachel: 7:14

That's exactly right. So you know, when we see things like hirsutism which is that excess hair growth, you know, on the face, the chest, the back, which is that excess hair growth, you know on the face, the chest, the back or we see acne that's really persistent and difficult to treat, or even thinning hair on the scalp, you know, all of those can be traced back to those elevated androgen levels.

Mark: 7:33

So it's really fascinating, because it's not just about you know how the body's handling sugar, but it's really the insulin itself is almost like acting as a signal that's disrupting the normal hormonal balance.

Rachel: 7:44

That's a great way to put it, and it doesn't stop there. The excess insulin can also actually interfere with ovulation, which is why you know we see irregular cycles or even, in some cases, women with PCOS don't ovulate at all. Right, right. And this can lead to difficulties with getting pregnant.

Mark: 8:00

Okay, yeah, so that's a big one.

Rachel: 8:01

And then you know, if we kind of zoom out even further and look at the bigger picture insulin resistance in women with PCOS. It also increases their risk for developing other issues like obesity, chronic inflammation and something called metabolic syndrome, which is this cluster of conditions that include high blood pressure, abnormal cholesterol levels and that kind of abdominal fat that we were talking about earlier. So it's really kind of it's this cascade of effects.

Mark: 8:32

Yeah, yeah. I think what you're saying is it's really important and the Endocrine Society really highlights this too that early identification and management of this is so crucial, because if we don't, it could lead to more serious problems down the road.

Rachel: 8:45

Exactly.

Mark: 8:46

Okay. So now we really need to talk about how do we know if somebody has insulin resistance, and our source material talks about how it can be kind of tricky sometimes, right, because some of the symptoms can overlap with PCOS. So what are some things that we should be looking out for that would sort of tip us off that maybe there's some insulin resistance going on?

Rachel: 9:08

Yeah, that's a really important distinction. So you know, there are some symptoms that are common to both PCOS and insulin resistance, but there are some things that can really kind of point us more towards the insulin resistance. So one thing is central adiposity and that's just a fancy way of saying that abdominal fat that we keep talking about resistance. So one thing is central adiposity and that's just a fancy way of saying that abdominal fat that we keep talking about Right.

Rachel: 9:27

So if you're tending to gain weight around your midsection, that can be a sign. Also, you know cravings, particularly for carbs and sugary foods. If you find that you're really craving those things all the time, that can be a sign. Fatigue, if you're just constantly feeling tired and you're getting enough sleep, you're doing things to try to manage your loss, and it's not just about willpower. There's a lot of hormonal and metabolic things going on that can make it much more challenging.

Mark: 10:10

So if you're doing all the right things, you're eating healthy, you're exercising, but you're still not seeing the results, that can be a sign, as well, yeah, and it's important to note too, too, that these symptoms, you know they often occur alongside those more classic PCOS symptoms, like the irregular cycles or the excess hair growth or the acne.

Rachel: 10:30

Exactly, and that's really kind of what gives us that clue that it's not just PCOS but there's this underlying insulin resistance. That's kind of driving the boat, so to speak, Right right, and one of the things that's really important to keep in mind is that if insulin resistance is left untreated, it can lead to some pretty serious long-term health problems. So we're talking about pre-diabetes Okay, Type 2 diabetes and actually the CDC. They put out some data that shows that women with PCOS are actually over three times more likely to develop type 2 diabetes compared to women without PCOS.

Mark: 11:08

Wow, that's a significant increase in risk.

Rachel: 11:11

It is, and it also increases the risk for cardiovascular disease.

Mark: 11:15

Okay.

Rachel: 11:15

So you know that means things like heart attacks and strokes, and part of that is because insulin resistance can affect blood pressure, it can affect cholesterol levels, it can increase inflammation and all of those things kind of work together to increase that risk.

Mark: 11:29

Okay, so now that we've talked about symptoms and some of the long-term risks, how do we actually go about diagnosing insulin resistance? Is there a specific test or how does that work?

Rachel: 11:41

You know that's a really great question and I think a lot of people would like to have this simple answer of like oh, you just do this one test and you know.

Mark: 11:51

Right, exactly.

Rachel: 11:52

But unfortunately it's not quite that straightforward. There isn't one single test that can definitively diagnose insulin resistance.

Mark: 12:00

Okay.

Rachel: 12:00

So what doctors typically do is they use a combination of different assessments and they kind of look at the whole picture.

Mark: 12:08

Okay, so what are some of the things that they might look at?

Rachel: 12:10

So one of the most common things is to measure fasting insulin and fasting glucose levels. So this is a simple blood test that you would do after you fasted overnight and basically, if your insulin levels are high, particularly if your glucose levels are normal or only slightly elevated, that can be a sign that your body is having to produce more insulin to keep your blood sugar in check.

Rachel: 12:33

Makes sense Right. And then another thing that they might use is something called the L-A H-M-A-I-R, which stands for homeostatic model assessment for insulin resistance, and this is basically a calculation that uses your fasting glucose and your fasting insulin numbers to kind of give you an estimate of insulin resistance, and higher scores on that calculation generally mean more insulin resistance. And the NIH, the National Institutes of Health, you know they mentioned this as a, you know, useful tool, particularly in research settings. Okay, and then another test that you might hear about is the oral glucose tolerance test, or OGTT.

Mark: 13:13

Right, right the OGTT.

Rachel: 13:15

And this test is really good for detecting insulin resistance. You know, in those kind of earlier stages good for detecting insulin resistance. You know, in those kind of earlier stages. And basically what they do is they give you a specific amount of glucose and then they track your blood sugar and your insulin levels over a couple of hours to see how your body is responding. And this can help to pick up on problems, even when your fasting blood sugar looks normal.

Mark: 13:38

Interesting Okay.

Rachel: 13:39

Yeah, and then we have, you know, the hemoglobin A1c or HbA1c, right, and this is a test that gives you kind of a picture of your average blood sugar levels over the past few months.

Mark: 13:49

Okay.

Rachel: 13:49

So it's really good for diagnosing prediabetes and type two diabetes, but it may not be as sensitive and picking up on insulin resistance in those very early stages.

Mark: 13:59

Okay, so these are all tests that we can do. Is there anything I mean physically that that a doctor might see when they examine someone? That might make them think? Hmm, I wonder if there's some insulin resistance going on here.

Rachel: 14:12

Yeah, absolutely so. One thing that they might look for is is something called kenthesis nigricans, and this is basically. Basically, it's a, it's a skin condition where you get these patches of of dark kind of velvety skin, um, usually on the back of the neck, um, or in the underarms or in the groin folds, and and it's it's often associated with high insulin levels interesting yeah, and then you know, of course the doctor is gonna, is gonna, take a, a detailed history.

Rachel: 14:40

uh, you know medical history, family history and and if there's a, if there's a detailed history, you know medical history, family history, and if there's a family history of type two diabetes or metabolic syndrome, that's going to kind of raise their suspicion as well. You know, and we have guidelines from groups like the American College of Obstetricians and Gynecologists and the NIH, and they recommend that women with TCOS really should be routinely evaluated for metabolic issues, especially if they have a high BMI, you know, if they have irregular cycles or if they're showing those signs of excess androgens.

Mark: 15:12

Yeah.

Rachel: 15:12

So it's really about putting all those pieces together.

Mark: 15:15

Yeah. So it's really more of a big picture kind of diagnosis. It's not just one thing, it's kind of a combination of all these factors, yeah, exactly. So once we've identified that someone does have insulin resistance, especially if it's in the context of PCOS, what are the things that we can do about it? And our source material really emphasizes that addressing that insulin resistance is key.

Rachel: 15:40

It absolutely is, and the good news is that there are a lot of things that we can do, and typically the first line approach is going to be lifestyle modifications.

Mark: 15:49

OK.

Rachel: 15:49

So you know the Endocrine Society. Actually, they point out that even losing a relatively small amount of weight, like 5 to 10 percent of your body weight, can really make a big difference in terms of improving insulin sensitivity and lowering those androgen levels. And so when we talk about lifestyle modifications, what are we talking about? Well, diet is a huge one, and you know it's not about, you know, going on some crazy restrictive diet. It's really about making smart choices, so focusing on foods that have a low glycemic index, which basically means that they don't spike your blood sugar as much. So you know things like whole grains, legumes, fruits, vegetables those are all good choices. Reducing processed carbohydrates. You know those refined grains, sugary drinks, things like that. Those are really the culprits when it comes to spiking blood sugar. And then increasing fiber. Fiber is your friend.

Rachel: 16:45

Yeah fiber is our friend. It helps to slow down digestion, it helps to regulate blood sugar. It's really important. And then, of course, physical activity. We know that exercise is good for us in so many ways and this is definitely one of them. Both aerobic exercise, so things like risk walking, swimming, cycling, and resistance training, so things like weightlifting, those are. Those are both really important for improving insulin sensitivity. And then, of course, you know if, if weight loss is appropriate, if someone is is overweight or obese, then losing weight can can have a really big impact on on both their metabolic and reproductive health.

Mark: 17:23

So that's a lot on the lifestyle side. Now, what about medication? Is there a role for medication in managing insulin resistance?

Rachel: 17:31

Yeah. So when lifestyle changes alone aren't enough, then medication can definitely be a helpful tool, and probably the most commonly prescribed medication for insulin resistance is metformin.

Mark: 17:41

Okay, metformin.

Rachel: 17:45

And this medication. It helps to improve insulin sensitivity, it helps to reduce both insulin levels and androgen levels and in some cases, it can actually help to restore ovulation in women who aren't ovulating.

Mark: 17:54

Oh, wow, okay.

Rachel: 17:56

The NIH. You know they have some good information on metformin. And then another thing that has been getting a lot of attention lately are inositol supplements, and specifically there are two types of inositol that seem to be particularly helpful myoinositol and d-chiroinositol. And these inositols, they're naturally occurring compounds that are found in some foods, but you can also take them as a supplement, and there's some good evidence that they can help to improve insulin sensitivity and help with hormone balance, especially when they're taken in combination with folic acid.

Mark: 18:33

Interesting Okay.

Rachel: 18:33

Yeah, and then you know, there's a newer class of medications called GLP-1 receptor agonists, and these medications they were originally developed to treat type 2 diabetes and they've also been shown to be helpful for weight loss, and the way that they work is that they mimic a hormone that helps to lower blood sugar levels and they slow down digestion and they can also reduce appetite. So, there's some growing interest in using these medications in women with PCOS as well, but more research is still needed.

Mark: 19:06

Okay, yeah, makes sense. Now our source material also talks about some holistic support strategies that can be really helpful in managing PCOS and insulin resistance. So you know, we've talked about diet, we've talked about medication, but what are some of those other things that we can do?

Rachel: 19:21

Yeah, I think it's really important to remember that managing PCOS and insulin resistance it's not just about, you know, popping a pill or following a specific diet. It really is about looking at the whole person, and so one of the things that's really important is stress management. You know, we live in a very stressful world and chronic stress can actually have a negative impact on insulin sensitivity.

Mark: 19:42

Oh wow world.

Rachel: 19:43

And and chronic stress can actually have a negative impact on insulin sensitivity. Oh wow. So finding ways to to manage stress, um, you know, whether that's through mindfulness, meditation, yoga, spending time in nature, whatever, whatever works for you, sure, um, that's really important. Sleep is another big one, okay, um, the national sleep foundation, they, they actually, um, they point out that that poor sleep is linked to higher insulin resistance and weight gain in women with PCOS. So, you know, aiming for seven to nine hours of good quality sleep every night, that's really important. And then gut health this is something that's getting a lot more attention these days, and there's some emerging research that suggests that the gut microbiome so all those bacteria that live in our gut, that they can actually play a role in inflammation and hormone balance. So, supporting gut health through eating a healthy diet that's rich in fiber, potentially taking probiotics, that's another thing that can be helpful.

Mark: 20:42

So it's really this multi-pronged approach.

Rachel: 20:45

Absolutely.

Mark: 20:46

You know, it's not just one thing, it's looking at all these different areas of our life.

Rachel: 20:50

Exactly, and it's about working with your health care team to figure out, you know, what are the specific things that are going to be most helpful for you as an individual.

Mark: 21:00

Okay, so we've talked about some of the risks of not treating insulin resistance, but let's talk about the long-term implications. You know really specifically, you know what are some of the serious health risks that might arise if this is something that's just left unmanaged for a long time.

Rachel: 21:19

Yeah, so we've touched on this a little bit already, but I think it's really important to emphasize that that insulin resistance it's not just this minor inconvenience, it can actually have some really, really serious long-term consequences, particularly for women with PCOS. You know, as we mentioned earlier, type 2 diabetes is a big one and the CDC they estimate that women with PCOS are up to four times more likely to develop type 2 diabetes than women without PCOS. Wow, it can affect blood pressure, it can affect cholesterol levels, it can increase inflammation, gotcha, and then metabolic syndrome, which is that cluster of conditions that we were talking about earlier. That also becomes much more likely. Non-alcoholic fatty liver disease, or NAFLD. That's another potential complication, particularly in women who are also obese and have insulin resistance. And then, finally, because of the chronic anovulation, so the lack of ovulation that we see in a lot of women with PCOS, that can actually increase the risk for endometrial hyperplasia, which is a thickening of the uterine lining, and even potentially endometrial cancer over time.

Mark: 22:39

So it really is important to take this seriously, to get screened and to manage this effectively.

Rachel: 22:47

It absolutely is.

Mark: 22:49

And you know, one of the things that our source material mentions too is that a lot of these conditions, they can develop gradually. You know, you may not have symptoms in the early stages.

Rachel: 22:58

Right.

Mark: 22:59

And so long-term monitoring is really key. It is the American College of Obstetricians and Gynecologists. They recommend regular screening for things like glucose intolerance, blood pressure, lipid levels, especially in women with PCOS, so that's really important. Now we've touched on some of the holistic and integrative approaches as kind of complementary strategies.

Rachel: 23:38

Can you talk a little bit more about how those might fit in stress management? And there's actually some interesting research in the Journal of Psychosomatic Research that suggests that things like mindfulness and yoga, they can actually have a positive impact on metabolic health. Sleep optimization, you know, making sure you're getting enough sleep, seven to nine hours, that's important. Gut health support you know we were talking about that earlier. You know, eating a fiber-rich diet, potentially using probiotics, you know that can be helpful. And then you know, as we mentioned earlier, inositol supplementation. You know there's a journal, the International Journal of Endocrinology, you know, and they have some good research on the use of inositol for insulin sensitivity. So you know, I think the key takeaway here is that these holistic and integrative approaches they're not meant to replace conventional medical care but they can be really helpful in supporting overall well-being and potentially improving those long-term outcomes.

Mark: 24:41

Yeah, I think that's such a good point. It's really about, you know, not just treating the symptoms, but it's about looking at the whole person, looking at their lifestyle and really trying to to make those, those changes that are going to support you know, what would you say is the most important takeaway that you would want our listeners to remember about insulin resistance and PCOS?

Rachel: 25:11

I think the biggest takeaway is that insulin resistance is not just some side issue that sometimes happens with PCOS. It's really a central underlying factor that influences the symptoms that women experience and their long-term health risks. So it's really the link that connects the hormonal imbalances, the metabolic problems and the increased risk for things like diabetes and heart disease.

Mark: 25:35

Right, so it's really important to be aware of it and to address it.

Rachel: 25:39

It absolutely is.

Mark: 25:40

But there is good news here. I mean there's a lot that we can do. There is there's a good news here. I mean there's a lot that we can do.

Rachel: 25:44

There is, there's a lot of hope.

Mark: 25:45

Yeah.

Rachel: 25:46

The good news is that insulin resistance is something that we can identify and manage effectively. So, you know, through early screening, through lifestyle changes, through evidence-based supplements and medical care, you know, women with PCOS, they can really improve their health and improve their quality of life.

Mark: 26:06

Yeah, and I think what's really exciting is that our understanding of this connection between metabolism and hormones it's evolving all the time, and so that means that we're getting better and better at treating and managing PCOS.

Rachel: 26:23

Absolutely.

Mark: 26:23

So for somebody listening right now, you know, maybe they're hearing this and they think gosh. You know, maybe this is something I need to look into. You know, maybe you have PCOS, maybe you have insulin resistance. What would you say is the first step that they should take?

Rachel: 26:36

Talk to your doctor.

Mark: 26:38

Okay, yeah.

Rachel: 26:39

It's really as simple as that. You know. Schedule an appointment. Talk about your symptoms. It's really as simple as that. You know. Schedule an appointment. Talk about your symptoms, you know. Talk about any concerns that you have and specifically ask about getting tested. You know, for both PCOS and insulin resistance, right.

Nicolette: 26:53

Thanks for tuning into the Health Pulse. If you found this episode helpful, don't forget to subscribe and share it with someone who might benefit. For more health insights and diagnostics, visit us online at wwwquicklabmobilecom. Stay informed, stay healthy and we'll catch you in the next episode.