insulin resistance PCOS diet

insulin resistance PCOS diet

Many women diagnosed with Poly Cystic Ovarian Syndrome( PCOS), suffer from insulin resistance ( approximately 50-70%) and it effects 1 in 15 women worldwide.  Lets bring it right back to basics and go into a little physiology to understand what this is all about and how this impacts your fertility.

What is Insulin and why do we need it?

Insulin is used in the body to maintain the levels of glucose. In the body glucose is a key energy source primarily for the brain and blood cells. Many other tissues can use fat and protein to gain energy but red blood cells and the brain really need glucose.  The liver is the main storage unit for glucose.

Insulin  is the helper hormone directly tied to glucose that allows you to maintain some sort of normality in energy and metabolism management. You get glucose in the body when you break down and eat carbohydrates. Insulins total role is to pull glucose from the blood or store it for later. As a crude analysis it does this by  ‘ dip testing’  to see if levels are dropping to hyperglycaemia,  and it then pulls glucose out of the stores in the liver, or if its too high it will grab all the glucose floating free and store it. When you become insulin resistant it’s almost like the hormone insulin forgets how to do its job and it doesn’t know when to store or pull glucose from the blood, as it gets overwhelmed by the amount of glucose being poured into the blood and therefore becomes less effective at lowering blood sugar. Over time this will have an effect on the endocrine system. With ladies who are polycystic the endocrine function, ie the key organs that support and produce hormones, that regulate metabolism, growth and development, tissue function, sexual function, reproduction, sleep, and mood are sending the wrong signals and over time can create an imbalance. This will happen from the very beginning of the cycle and can cause mild to severe hormonal imbalance, this result s in issues with all the above, ie low libido, or higher and inability to lose weight, hirsutism ( excess hair growth), weight gain, cystic acne,  mood swings, sleep issues and anovulation  (absent menstrual periods)  to name a few.

How does having insulin resistance or PCOS effect fertility?

The body is always working to balance things and is a finely tuned system or almost an orchestra of all sorts of instruments that come together to bring on ovulation. If one of these hormones is ‘out of kilter’ the endocrine system will step in to send out another hormone to correct this. This is exactly what happens with Insulin. The body detects something isn’t working and has repeatedly not listened to the key command, so it sends in another hormone in the view that higher levels of this will tip the other levels to the right function. However this causes all sorts of issues if this goes on for a while.

A woman’s cycles

At the beginning of a woman’s cycle on day one the tag team will be in place to send out hormones to prime her for ovulation. This goes from Gonadotropin Releasing Hormone (GnRH), to Follicle Stimulating Hormone (FSH), to Luteinising Hormone (LH), to Oestrogen then Progesterone. ( you will be tested for the majority of these when going to the GP for blood work)

In women with PCOS and insulin resistance, the GnRH will detect higher Insulin and pulse out more GnRH than normal to balance, this then sets the tone for the rest of the cycle as LH will then rise too high, too early,  (this is the hormone that indicates the egg must be released from the follicle and should in most cases be a short lived hormone)  Having a high level of this gives the indication that follicles are now ready to pop and reduces FSH almost before it has had time to do its thing. This then leads to excessive production of the big players oestrogen, and then androgens  ( Testosterone and  androstenedione) and then oestrogen dominance becomes a fixture.  The ‘poly’ in the diagnosis comes from the fact that lots of follicles will try to develop but not fully mature. In a normal pattern, follicles develop then die away where one to two become dominate and this releases the egg. This will also have an effect on progesterone the hormone that maintains pregnancy and womb lining and in many situation women with PCOS will have low progesterone levels.  In most cases ovulation falls short as the egg won’t have been able to grow sufficiently to produce a viable oocyte.  Women with PCOS will have a very real indication the cycle isn’t working as there is no period to speak of for many months or a very long cycle over 35 days. A normal cycle is a  process where lining is broken down and built up as the hormones come to play throughout the month and is usually between 26- 33 days.

Managing my insulin, looks like the key that unlocks this problem, so how can I help improve insulin resistance?

A huge way to help improve insulin resistance, is through most probably the very source of this issue in the first place, – diet!  I’m not normally a calorie counter, or a believer in ‘ group weigh ins and slimming clubs’  or foods you can buy that tell you how many points you have, its all a gimmick to me especially after watching ‘ the men who made us fat’  Our ancestors never lived like this. What I do believe in is following traditional wisdom.  Why break what thousands of years have honed?  instinctively our ancestors just knew what worked and ensured fertility year on year!  I believe based on the old model emphatically in  reducing our reliance on processed white/baked and ‘pants’ foods that give us zero nutrients but provide the massive ‘ deafening’ effect on our poor old insulin to the point that it is now causing the hormonal epidemic in our modern lives.

So what is the diet you talk about?

In order to ‘reeboot’ your bodies ability to ovulate we need to go back to basics and cut out starchy carbohydrates to a large degree and focus on protein and fat. Remember what I said at the start of this article about the brain and the red blood cells being the only ones needing glucose? All other tissue can work on protein and fat as fuel, so what we need to do is trick your body back into line by maintaining a blood sugar level that is primarily fuelled by  some very basic ingredients: Protein/legumes and veg and very simply cooking like your Great grandparent made!

Foods to Help Balance Blood Sugar Levels

Here is a list of  a few of my seasonal choices of food for winter. The trick is also to have 3 protein balanced meals. Starting off with to set the blood sugar at least 20-30g of protein in the morning.

Protein – I would generally get clients to go organic  (as the conventional ones will only exacerbate your oestrogen burden as the animals are pumped full of this to overproduce) so buy more protein from animals and if veggie vegetable sources. If you eat animal products choose grass-fed, organic and free range animal products. A woman needs to consume 60-70g grams of protein per day while trying to conceive.

  • Free-range organic chicken, lamb beef ( pork can contain some contaminants, so avoid for now) make sure its all fresh cuts and not processed!
  • legumes/beans like chickpeas, lentils and black beans
  • Nut and seed butters: Sunflower seeds, sesame seeds, pumpkin seeds, almonds, walnuts, chia and hemp seeds, and Brazil nuts.
  • Cold-water fish, Free range organic eggs and chicken, grass-fed beef and grass fed dairy (go for sheep yogurt as this seems to be less inflammatory) If in the UK you can get this in Waitrose
  • Carbohydrates – All veggies are carbs, so when you say ‘ I’m on a no carb diet, not strictly true!  Choose fresh not frozen too. Some people think that eating carbohydrates will make them gain weight, but the fact is that eating too many of the wrong carbohydrates (pastries, crackers, white pasta, white rice, etc.) is what results in weight gain as they have zero nutrients. Also starches and fibre feed your gut bacteria which can also help you with weight. Whole food sources of carbohydrates contain important nutrients that can help you feel full longer and give your body energy.
  • Whole Grains – bread/crackers/rye/pasta  – limit these for now,   (ie oats once a week) as they will breakdown in the body to glucose, you can introduce them once things are balanced again!
  • Fruits –again as this breaks down to fructose and then eventually glucose limit fruit to 2 servings daily in season at mo are apples, pears and blackberries
  • Vegetables –carrots, Brussel sprouts, greens, sweet potatoes (not white potatoes) and artichokes, cabbage, turnips, kale, chard, leeks, onion, garlic, turnips, parsnips broccoli, cauliflower, Kale
  • High fibre foods – Fibre helps remove excess oestrogen from the body which can be helpful for some reproductive imbalances. Dark leafy greens, brassica vegetables like broccoli and cauliflower, quinoa and beans and lentils.
  • Spices – Horseradish (fresh root as opposed to a prepared sauce), garlic, onions, cinnamon, fenugreek, tarragon, coriander and allspice.

Women living with PCOS who educate themselves about healthy nutrition for PCOS are more likely to be successful at changing their health.

Changing your diet will have a huge effect on your ability to balance your hormones and I have had many success stories. Taking out gluten is one of the first things you can do, which will really help you to lose weight, I’ve had ladies drop so much weight in 3 weeks who did this! ( and that doesn’t mean replacing it with ‘ gluten free options/ as these are starchy carbs also!  )

Start being a health detective and go right back to basics. Maybe even investing in a slow cooker? These changes will start to take hold after around 1 month and you will need to follow this for at least 3-6 months to see changes.

While it may seem daunting to have to change your diet, it is one of the best ways you can improve insulin resistance and your overall health, with the added benefit is increased in fertility.

The sheet to the right is an example of  the diet I honed after many years as I also suffer from PCOS to a mild degree due to genetic issues with insulin

Supplements for PCOS

I’m always asked about supplements as a nutritionist and many of the ladies I see with PCOS are at the stage that they are chucking in anything they have seen working on forums all over the net.  As a practitioner I like to ‘ Heal with food’ as add too many supplements in the mix and you really don’t know what is working and what isn’t. Undoubtable like many ladies diagnosed with PCOS who are trying to conceive, you may be on a raft of medication that will ‘ mug’ you of a lot of your vital nutrients. The basic approach I like to suggest is only the bare minimum until I can really see if the food is healing and if not working as fast and needs a jolt after the first month, that’s when I add more supplements.   Also I’m a  trained professional and can only advise on things based on a consultation where I go through specifics. Many of you have been asking each other for advice recently on specifically things like maca and vitex which are herbal medications. This is very personal and can be very powerful ( after all its where all out modern medicine comes from in the first place) so be careful ‘ self prescribing’ as it can interfere with your hormonal balance and any medically prescribed medication.  


2.Philip M. Sarrel, MD. Androgen.
3. The National Diabetes Information Clearinghouse is a service of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. Insulin Resistance and Prediabetes. NIH Publication No. 14–4893 (June 2014)
4. About Polycystic Ovarian Syndrome: Types of Medical Treatment.
5. PCOS Nutrition Center. What’s Your Protein-To-Carb Ratio?

6. Anna-Marija Helt, Ph.D. CH, personal communication, May 2014.

7. Chris Kresser ‘ The right and wrong way to balance hormones

8. Effects of Myo-inositol supplement on oocyte quality in PCOS patients

9.The rationale of the Myo-Inositol and D-chiro-Inositol combined treatment for Polycystic Ovary Syndrome.

bridget jones’s baby – is having a baby over 40 good or bad?

bridget jones’s baby – is having a baby over 40 good or bad?

Bridget Jones is a well known figure in popular culture, and I’m a huge fan! If you haven’t seen the most current 3rd instalment of the films based loosely around the Bridget Jones Diary I urge you to as its ‘bang on’ so to speak in terms of what is happening right now with women in the UK who want to have babies.

For me having a baby over 40 is always something I celebrate in my line of work! As a fertility Nutritionist I’m inside an ‘ older mum bubble’ , where anything is possible, however when I venture out and meet people ( which I occasionally do!)  its almost whispered that its ‘not right’ or that ‘it’s a bit of a worry isn’t it?’ In fact having a baby at 40  seems almost as taboo as a teen pregnancy according to ‘ word on the street’!  Thankfully this is beginning to change, and lets hope in some small way Bridget will have helped in this quest!

The message that you are almost irresponsible even trying over 35 is plastered everywhere. It is even worse if you are over 40 as when you start trying it all seems to become more scary as are the messages about potential birth defects, miscarriages, and if by some miracle you have the child,  then there is the issue that they might have development issues and there is more chance of autism. The list goes on, and the stories I have heard about how it’s not a good idea to try after 37, are enough to age your eggs overnight and sew your own bits up! If it’s not enough hearing this from GPs or IVF clinics, the media coverage on this is certainly relentless, something that is repeated almost weekly in the many columns of broadsheets and tabloids. 

As a Nutritionist this whole issue of  ‘ old eggs’ and the ‘geriatric mother’ (as was mentioned in Bridget Jones’s baby)  gets me very riled up as its one of the fastest growing age group of women I have coming through my door in the last 2 years and its one I’m getting results with, despite the fact they are ‘ past it’ according to those in the know! This is anecdotal to my practice, but lets take a look at this more closely…

For the first time in decades women over 40 have now taken over the teen pregnancy rate. How’s that for a statistic? A more sombre statistic that ‘its not safe to have a baby over 35’ seems to be hitting home as this age group accounts for the largest amounts of abortions of any other more recently.

Also if we look back a few decades to the 1920s, being an older mum was more accepted. Many were even giving birth when grandmothers and 42 years old was a time when many stopped adding to their families.
Today,  an interesting statistic is  that many women in their 40s are also first time mums.  The UK Office for National Statistics figures show that pregnancy rates for over-40s are doubling and in the last years,  this has gone from  only a mere six per 1,000 to now
14 conceptions per 1,000.

Only recently an article in the London Standard mentioned that London is leading the charge for women giving birth to babies over 45. So there is definitely something going on out there with women not giving up or even coming into motherhood later on in life.

In fact, the true statistics about female fertility are far less scary than we are led to believe. Women do lose a lot of their eggs by 30, but that still leaves them with many tens of thousands, when only one is needed to make a baby. Something many ladies are not told in IVF clinics where  egg donation is offered if over 37, or if they have been trying for over 6 months.
Other scaremoungering comes from of all places the  journal Human Reproduction. But if you take a closer look at this article in 2004 the  statistic were drawn not from modern day but from birth records from 1790-1830.  When correct me if I’m wrong, there was no access to modern health care or nutrition and many were possibly only living to 45 anyway, so actively avoiding Sex. So no…. ‘Bridget Jones, wanton sex goddess, with a very bad man between her thighs!’ there!
The truth is everyone is different and if you  put in the work and follow a healthy lifestyle, diet and stress levels are managed appropriately, you just may well have the fertility of a 20 something!

In my view Fertility isn’t always age specific and there might actually be some truth in what I talk about daily that diet and tailored intervention  improves fertility at any age. A study in 1995 conducted by Surrey University and Foresight with over 300  couples ranging from 25-45 years old gave couples with previous infertility and miscarriages a tailored dietary and supplement programme over 2 years. During this time 81% of them went on to have healthy babies  similar studies are also being conducted by Foresight and also the University of New England.

Lord Robert Winston seen as a one of the grandads of modern fertility talked recently in a daily mail article about women’s fertility being sound until around 45, which might have raised a few eyebrows. I can’t corroborate this empirically but share his view, as do see a heck of a lot of women who are getting pregnant these days over 40.

I believe in fertility in older women wholeheartedly, as my own grandmother was part of this ‘gang’ and had my mum when she was 37. This isn’t an isolated incident and its shown to happen time and time again, defying the naysayers. Thankfully many I work with don’t give up, but to be honest with all the media attention about ‘Britain facing an infertility time bomb’ it can be very hard to cut through the negativity.

As always Bridget Jones is ‘On trend’ as it has been right from the first film! Let’s hope it starts a ripple effect, where ladies feel they don’t have to feel old and ‘past their sell by date’ when trying over 35,  or worry about the issues with their ‘ageing eggs’ Hoorah for Bridget is what I say and as Daniel Cleaver would say ‘ Hello Mummy’!

10 facts about ovulation you may not know

When does the cycle start is it still during my period?
CD1 and where it all begins is the first full day of your period. Don’t count it until it is in full flow for you. This means there should be enough blood to require sanitary protection.

What’s the process of ovulation?
Fertility is a complicated process and hopefully I will help you to understand the importance of each and every hormones to help you in order for you to successfully conceive, and sustain the pregnancy. It is possible that at this stage you have been for some blood tests at your doctors. For those of you who are effectively in the ‘dark’ about the fertility; It all starts with sex hormones. Hormones are complicated. I’m amazed on a daily basis how these wonderful substances manage to build up and then pass on the mantle so to speak to the next phase. As such, I see it in women as a relay race to the finish. Different hormones will come into the race when each in turn reaches a certain point. In some women when their fertility is less than optimum they will have weaker runners at different stages, but ultimately the race will always run. The organiser is always the main organ the hypothalamus and his second in command is the coach – the pituitary gland, who ultimately grooms the hormones to ensure they are ready and brings on new runners at different stages.

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