What do PCOS and perimenopause have in common? Apart from being notoriously misdiagnosed (the two are often mistaken for each other) they also often have the hallmark clinical syndrome of insulin resistance.
PCOS and Insulin Resistance
Insulin resistance develops in polycystic ovarian syndrome (PCOS) because elevated androgen levels reduce the effects osf insulin. Because insulin is less effective at lowering blood sugar on account of androgens, the body needs to produce more of it in order to get the same job done. As a result, insulin levels spike, causing the body to store carbohyrates as body fat. The subseqent increased body fat leads to further insulin resistance, snowballing the problem.
Perimenopause and Insulin Resistance
In perimenopause, estrogen levels go on a roller coaster. First, in the early years of perimenopause, estrogen levels, along with testosterone, increase. They rise and fall erratically until they fall into a low level through the remainder of perimenopause and into menopause. Less estrogen leads to lower ,uscle mass, a lower basal metabolic rate (BMR) and subsequent weight gain. (This is why weight lifting is so important in perimenopause!) Estrogen also helps maintain insulin sensitivity, which is effectually the opposite of insulin resistance. Dropping estrogen means you lose the beneficial effects of estrogen, including the metabolism-regulating effects.
Testing for Insulin Resistance
But of course, perimenopause and PCOS aren’t the only reason that you could be dealing with insulin resistance. After you are diagnosed with insulin resistance, which is flagged by blood tests such as fasting insulin, A1c and lactate dehydrogenase levels. But, whatever your reason for it, you’re here reading this post because you want to do something about it.
What Is Insulin Resistance?
Insulin is a hormone produced by the pancreas that plays a vital role in regulating blood sugar levels. After eating, insulin helps cells absorb glucose from the bloodstream to use as energy. However, in the case of insulin resistance, the body’s cells become less responsive to insulin. This means that glucose cannot enter the cells as efficiently, and the pancreas produces more insulin in an attempt to compensate. Over time, this excess insulin leads to higher blood sugar levels and can contribute to fat storage and weight gain.
While insulin resistance is commonly associated with obesity, it can occur in individuals of any size. It is also a precursor to more serious conditions such as Type 2 diabetes and cardiovascular disease. Insulin resistance can be influenced by a variety of factors, including genetics, lifestyle, environmental toxins, and diet.
How Insulin Resistance Leads to Weight Gain
- Increased Fat Storage: When insulin levels are consistently elevated due to insulin resistance, the body shifts into fat-storage mode. High insulin levels encourage the storage of fat, particularly in the abdominal area. This is why individuals with insulin resistance often have a higher proportion of visceral fat, which surrounds vital organs and is associated with increased health risks.
- Decreased Fat Burning: Normally, when insulin levels drop (such as after a period of fasting or exercise), the body starts burning stored fat for energy. However, with insulin resistance, this process is hindered. Elevated insulin levels prevent fat cells from releasing stored fat, making it more difficult to lose weight.
- Cravings for Carbohydrates: Insulin resistance can cause fluctuations in blood sugar levels, leading to cravings for sugar and carbohydrates. As blood sugar levels rise and fall erratically, individuals may experience intense hunger and cravings for quick energy sources, often in the form of refined carbohydrates and sugary foods. This cyclical pattern of overeating and poor food choices exacerbates weight gain and perpetuates the insulin resistance cycle.
- Increased Inflammation: Insulin resistance is associated with chronic low-grade inflammation, which can further disrupt hormonal balance and encourage fat accumulation. Inflammation impairs the body’s ability to effectively manage blood sugar and insulin levels, creating a vicious cycle that makes weight management more difficult.
Reversing Insulin Resistance: A Functional Medicine Approach
Functional medicine seeks to address the root causes of insulin resistance and provides a comprehensive, individualized approach to treatment. Instead of simply managing symptoms, functional medicine practitioners aim to restore balance by addressing factors like diet, toxicity, hormonal imbalances, and gut health. Below are key strategies for reversing insulin resistance from a functional medicine perspective.
1. Dietary Modifications: Focus on Whole Foods
The food you eat plays a crucial role in managing insulin resistance. The Standard American Diet (SAD), which is high in processed foods, refined sugars, and unhealthy fats, contributes to insulin resistance. Transitioning to a whole-foods-based diet can help reduce inflammation, balance blood sugar levels, and support healthy insulin function.
- Low Glycemic Index Foods: Choosing foods that have a low glycemic index (GI) can help prevent spikes in blood sugar. Low-GI foods include non-starchy vegetables, legumes, nuts, and seeds. These foods are digested slowly, preventing rapid increases in blood sugar and the subsequent release of insulin.
- Healthy Fats: Incorporating healthy fats, such as those found in avocados, olive oil, and fatty fish (like salmon), can help regulate insulin sensitivity. These fats reduce inflammation and promote the absorption of fat-soluble vitamins that are essential for hormone regulation.
- High-Quality Protein: Consuming adequate amounts of protein, especially from sources like grass-fed meat, wild-caught fish, and plant-based proteins, helps stabilize blood sugar levels and prevents insulin spikes. Protein also supports lean muscle mass, which can improve insulin sensitivity.
- Fiber-Rich Foods: Fiber-rich foods like leafy greens, berries, and whole grains slow down the absorption of sugars and help keep blood sugar levels stable. A high-fiber diet also promotes gut health, which is closely linked to metabolic function and insulin sensitivity.
2. Detoxification: Removing Toxins that Contribute to Insulin Resistance
Toxicity plays a significant role in the development of insulin resistance. Exposure to environmental toxins, such as endocrine-disrupting chemicals (EDCs), heavy metals, and pesticides, can impair insulin signaling and promote fat storage. These toxins can disrupt the balance of hormones, making it harder for the body to regulate blood sugar levels effectively.
- Supporting Detoxification Pathways: Functional medicine emphasizes supporting the body’s natural detoxification processes. This can be achieved by incorporating detoxifying foods such as cruciferous vegetables (broccoli, kale, cauliflower) and antioxidant-rich foods (berries, green tea, turmeric). Additionally, staying hydrated, sweating (through exercise or saunas), and supporting liver function with supplements like milk thistle can enhance detoxification.
- Avoiding Endocrine Disruptors: Reducing exposure to environmental toxins is essential for reversing insulin resistance. This includes avoiding plastics (especially BPA), choosing organic produce to reduce pesticide exposure, and using natural cleaning and personal care products.
3. Hormonal Balance: Addressing Hormonal Imbalances That Affect Insulin Sensitivity
Insulin resistance is often accompanied by other hormonal imbalances, such as high cortisol (the stress hormone), low thyroid function, and imbalances in sex hormones (estrogen, progesterone, testosterone). These hormonal disruptions can contribute to weight gain and further impair insulin sensitivity.
- Managing Stress: Chronic stress leads to elevated cortisol levels, which can worsen insulin resistance. Practicing stress-reducing techniques like yoga, meditation, deep breathing, and regular exercise can help lower cortisol levels and improve insulin sensitivity.
- Supporting Thyroid Function: Thyroid imbalances, particularly hypothyroidism, can contribute to weight gain and insulin resistance. Ensuring adequate intake of nutrients like iodine, selenium, and zinc, which support thyroid function, can help improve overall metabolic health.
- Balancing Sex Hormones: Estrogen dominance and low progesterone levels, common in perimenopausal and menopausal women, can also contribute to insulin resistance. Using bioidentical hormone replacement therapy (BHRT) or herbal support under the guidance of a healthcare provider can help restore hormonal balance.
Concerned you have a hormone imbalance but not sure how to find out? Download my FREE hormone guide to figure out your symptoms once and for all!
4. Gut Microbiome: Improving Gut Health to Reverse Insulin Resistance
The gut microbiome—the trillions of bacteria and other microorganisms in the digestive system—plays a significant role in regulating metabolism and insulin sensitivity. An imbalance in gut bacteria, known as dysbiosis, has been linked to insulin resistance and obesity.
- Probiotics and Prebiotics: To support a healthy microbiome, consuming probiotics (found in fermented foods like kimchi, sauerkraut, and yogurt) and prebiotics (found in fiber-rich foods like onions, garlic, and bananas) can help restore balance to the gut bacteria. A healthy gut can improve insulin sensitivity and reduce systemic inflammation.
- Avoiding Antibiotic Overuse: Overuse of antibiotics can disrupt the gut microbiome and contribute to insulin resistance. If antibiotics are necessary, supporting gut health with probiotics and a fiber-rich diet can help restore microbiome balance.
5. Exercise: Physical Activity as a Key Component in Reversing Insulin Resistance
Exercise is one of the most effective ways to improve insulin sensitivity. Regular physical activity, particularly strength training and aerobic exercise, helps muscles use glucose more efficiently, reducing the need for insulin. Exercise also reduces inflammation and promotes fat loss, both of which contribute to reversing insulin resistance.
Insulin resistance is a complex metabolic condition that contributes to weight gain and increases the risk of serious health conditions like Type 2 diabetes. However, by addressing the root causes of insulin resistance through dietary changes, detoxification, hormonal balancing, and gut health optimization, it is possible to reverse the condition and achieve long-term health. A functional medicine approach offers personalized solutions that go beyond simply managing symptoms, empowering individuals to regain control of their metabolic health.
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I’m Dr. Alexandra MacKillop, a functional medicine physician, food scientist and nutrition expert.
I specialize in women’s health & hormones, addressing concerns like fertility, PCOS, endometriosis, dysmenorrhea (painful periods), PMS symptoms like bloating and mood changes and more.
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