Tag Archives: insulin resistance

quick overview: the glycemic index

16 May

Since many of the most-recommended eating plans for PCOS patients are based on the idea of glycemic response, I thought it might be a good idea to discuss a couple of things about the glycemic index (and debunk a couple of other myths). Here are a few basic facts about glycemic response, the glycemic index, and how this idea can help you eat better and reduce your PCOS symptoms.

Basics

The glycemic index is a measure of the effects of a certain kind of carbohydrate on blood sugar. Foods with a high GI are the sugars and simple starches that make your blood sugar spike and then plummet (all of those baked goods we love), plus things like potatoes (although these are not as bad as some people have suggested!), and juices or sodas or other sugary drinks. Lower-GI starches include whole grains, beans, some kinds of vegetables, or certain kinds of breads like pumpernickel or rye.

When you hear about “good carbs” vs. “bad carbs,” the difference is the GI. Higher-GI foods set up a number of bad outcomes: the spike in blood sugar causes increased hunger and cravings when it bottoms out, and this eating pattern–over time–can wear out your pancreas, raising your risk of diabetes (especially if you are already insulin resistant, which many PCOS patients are).

In other words, the lower-GI carbohydrates fuel your body without causing drastic ups and downs in your blood sugar–which makes you feel better and is easier on your pancreas. (Eating those lower-GI carbohydrates instead of the sugary or starchy foods can also help you lose weight, especially if insulin resistance is at the root of your difficulties.)

What to Eat
The best books on the glycemic index don’t advocate a radical eating plan. Rather, they mostly suggest reducing carbohydrate portion size and exchanging high-GI carbs for low-GI ones. You can easily find lists of foods by GI on the internet, but it’s really mostly simple (with a few surprises, such as the variation in GI between types of rice). Just choose whole grains, less-processed carbohydrates, and more vegetables instead of starches. (Hey, I said it was simple, not easy.)

The Glycemic Load
You might also hear doctors or nutritionists discussing the glycemic load. This is basically a formula for how much carbohydrate is in a food, multiplied by its GI. The reason it’s useful is that some foods have a high GI, but don’t contain that much carbohydrate, so they don’t affect your blood sugar much. (Carrots are the classic example here.) A food that has a high GI but is low in overall carbohydrate is usually a good choice to eat.

Is this the same as low-carb?
No, it is not. None of these eating plans are low-carb. Atkins, for example, is low-carb, and I do not believe it is a healthful diet at all. But these plans–which have more in common with, say, the South Beach Diet–all emphasize higher-quality foods, better nutrition per calorie, and a balance of macronutrients (that is, a balance between carbohydrate, fat, and protein).

Finally, a Myth
Just because I hear this all the time and read it all the time: no, pasta is not particularly high GI. It’s fine to eat pasta if you can do so wisely and in moderation. It is moderate GI and should be eaten with a low-GI accompaniment. The main reason that so many people struggle with pasta is that Americans tend to eat a lot of it–it should be a moderate serving size, not the only thing you eat at your meal. Also, many people use jarred pasta sauce, which can be a source of a LOT of sugar. Read your label! One sauce that I really like is Victoria marinara (available in most grocery stores, at least on the East Coast, and at Costco). It has no added sugar and it’s delicious.

That said, we eat much less pasta than we used to, because I do find it hard to eat just one serving of it. The main reason I used to cook it was that it was easy: boil noodles, add sauce, and there you have it: dinner! The truth is, though, that it really needs to be just PART of a balanced meal, with more vegetables and possibly a protein source, and at that point I’m cooking anyway and it might be just as easy to cook a whole grain or vegetables instead.

Recommended Reading
My favorite books on this topic are those by Jennie Brand-Miller (she has an assortment; choose the one that reflects your goals or situation!) and the Insulin Resistance Diet. I do also like the South Beach Diet, in many ways, though I find that it is too focused on artificial sweeteners for my taste.

Metformin: basic information

18 Mar

Many PCOS patients are prescribed Metformin for the treatment of their condition. It can be a bit confusing, because it is only FDA approved for treatment of diabetes; however, there are a lot of good reasons for using this drug to treat PCOS. Here’s a general overview of some things you should know.

How It Works

Metformin improves your body’s sensitivity to insulin. If you read my post about insulin resistance, you’ll remember that an insulin resistant person produces a lot of insulin, and her body is not very good at recognizing and using it to control blood sugar. Metformin improves the body’s ability to do this; it resensitizes the cells to insulin, so that your body doesn’t have to produce as much.

What It Does
From your perspective, you might see the following results from Metformin:
* Lower risk of developing diabetes.
* Easier weight loss (this varies from woman to woman, but many feel that Metformin makes it easier to drop pounds).
* Drop in testosterone production–this is directly related to the drop in insulin production. This can also mean less hirsutism, acne, and hair loss.
* Improved menstrual cycle regularity. Many women on Metformin have more consistent or frequent cycles. That is why it is often prescribed for women who are trying to get pregnant. (I took Met when I was trying to conceive my second child, and it did regulate my cycle very well.)
* Reduced risk of miscarriage. This is why many reproductive endocrinologists recommend that PCOS patients continue to take Metformin through the 12th week of pregnancy or later.

Side Effects
Metformin can have some major side effects for some women. These include GI symptoms (nausea, diarrhea), which can be bothersome, but not usually dangerous, at least in the short term (see below for suggestions on minimizing these problems). However, Metformin is also associated with liver and kidney problems; usually, this won’t be an issue for you unless you have a liver or kidney function problem already.

Metformin can also cause (or contribute to) a problem called lactic acidosis. This is rare (3 in 100,000 Metformin users), but it is a serious problem, so you should be aware of the symptoms: weakness, slow pulse, muscle pain, deeper and more labored breathing, and sleepiness. This is more common if you have liver/kidney problems, dehydration, diabetes, or a great deal of chronic stress. It is very important that you NOT take Metformin while fasting (for example, before a medical procedure) or if you are dehydrated, for this reason.

How to Minimize Side Effects
If you do have unpleasant GI symptoms while taking this medicine, there are a few things you can do to try to make them less severe. Make sure that you eat when you take your medication; break up your dose over the course of the day; and, at least at first, avoid very fibrous foods such as salads. Some people also find that the name brand (Glucophage) causes them fewer side effects.

The Bottom Line
Should you take Metformin? That’s a question you’ll want to discuss with your doctor. It’s worth considering, though, if you have many symptoms of insulin resistance. The side effects (which, by the way, I never experienced) are manageable for most people who use it, and it may be protective against diabetes over the long term.

insulin resistance: how to be tested and what to do if you have it

4 Mar

If you suspect that you have insulin resistance (and if you have PCOS, carry extra weight around your midsection, acanthosis nigricans (darkening of some parts of the skin, such as the neck or underarms), and/or high blood pressure, it is likely that you do), you may want to ask your doctor about testing for the condition.

Personally, I think that it isn’t always necessary, because the best treatment is lifestyle change to more healthful eating and exercise, and those are good for you anyway–but especially if you’re considering medication, you may want to have the lab work done.

Here are the things that your doctor might do in order to make or rule out a diagnosis of IR. What these lab values really measure is whether you are pre-diabetic; there is no formal diagnosis of IR to be made by these tests, as far as I know.

The Lab Tests

Since the hyperinsulinemic euglycemic clamp, the most accurate test for IR, is not a test that’s readily available, most doctors order either a glucose tolerance test or a fasting glucose test. The GTT–which will be familiar to most women who have had a pregnancy–is a fairly unpleasant test, though it’s not painful. The patient fasts for at least 8 hours (usually this is scheduled for the morning, so that you would fast overnight).

When you arrive at the lab, you’re given a sugary drink and then you wait; blood draws are conducted over the next two hours to see how your blood sugar responds to the sweet drink. It’s unpleasant because a) the drink is vile and b) most people don’t feel spectacular when they get a shot of sugar and nothing else for breakfast. After two hours, a glycemia of greater than 7.8 mmol/dl (140 mg/dl) indicates impaired glucose tolerance (a.k.a. pre-diabetes) or diabetes.

If your doctor prefers to order the fasting glucose test, you just go in the morning or after at least 8 hours of fasting, and the lab draws blood to measure the glycemia. Fasting glucose levels above 100 mg/dL indicate a problem; over 125 indicates diabetes. Most doctors seem to prefer the GTT, though.

Other Methods of Diagnosis

A lot of patients prefer to take a single lab test–it seems so cut and dried–but for insulin resistance, as with PCOS, the history of the patient is the best diagnostic tool. As the National Diabetes Information Clearinghouse says, any three of these symptoms indicates insulin resistance (also called metabolic syndrome or Syndrome X):

* waist measurement of 40 inches or more for men and 35 inches or more for women
* triglyceride levels of 150 milligrams per deciliter (mg/dL) or above, or taking medication for elevated triglyceride levels
* HDL, or “good,” cholesterol level below 40 mg/dL for men and below 50 mg/dL for women, or taking medication for low HDL levels
* blood pressure levels of 130/85 or above, or taking medication for elevated blood pressure levels
* fasting blood glucose levels of 100 mg/dL or above, or taking medication for elevated blood glucose levels

As you can see, getting your blood lipid panel done can give you diagnostic info, as can knowing your blood pressure.

The Bottom Line: Healthy Habits Are the Best Treatment
The main thing is, if you are in doubt, do something about it. Improve your diet. Squeeze in some exercise. Insulin resistance can not only be treated–it can be reversed. Weight loss doesn’t have to be dramatic to show major improvements, either: the Diabetes Prevention Program, a major study of diabetes treatments and outcomes, showed that a loss of only 5-7% of your body weight can improve your chances of staying diabetes-free by a whopping 60%. (For perspective, if you weigh 200 pounds, that’s a loss of 10-14 pounds–no one is suggesting you have to be a size 2!)

Other Treatments
In addition to making changes to your lifestyle, you may want to consider medications that can help prevent diabetes. The most commonly prescribed one of these, for PCOS sufferers, is Metformin. You can talk to your doctor about the advantages and disadvantages of Met. I will also be posting a discussion of its merits and problems here on the blog soon!

insulin resistance: basic overview

27 Feb

If you have PCOS, you have probably read about insulin resistance (or IR). Maybe your doctor has talked to you about it. Or maybe you keep seeing books out there with titles like The Insulin Resistance Diet or Syndrome X: The Complete Nutritional Program to Prevent and Reverse Insulin Resistance.

Most women with PCOS have a basic idea of what IR is. It means that your body is not as good as it should be at using insulin to control glucose levels, so you have to make more insulin than you should really need; eventually, it’s too much for your pancreas to handle and your blood glucose levels begin to rise. This is why, even though you may hear IR described as “too much insulin” and think it is the opposite of diabetes, it is really related to diabetes, and can often lead to diabetes if left unchecked. Your pancreas can’t continue to make huge amounts of insulin forever.

There are some other reasons that producing lots of insulin is undesirable. It affects the balance of other hormones in the body: for example, it spurs your body to produce more testosterone, which contributes to the symptoms of PCOS (hirsutism, acne, thinning of hair on the head). Testosterone also disturbs the menstrual cycle. It can suppress ovulation and lead to infertility or other problems of the reproductive system, such as menstrual irregularity.

Too much testosterone and insulin also set up conditions that cause weight gain and make it very hard to lose weight. In particular, insulin resistant people often carry weight around the midsection, which is the most dangerous place to have it. This fat, which is called “visceral fat,” is more hazardous to your health than fat carried in other places. (It’s not clear to me why this is; however, scientists and researchers are finding that the old view of the fat cell as something that just sits there is quite wrong, and that fat cells produce hormones.)

I will post more on this topic, including details on how to test for insulin resistance and what kind of steps you can take to fight against it; however, the important thing to remember is that if you have PCOS, you are probably at least mildly insulin resistant, and the treatments for it are mostly things that will be good for you anyway (like a healthful diet and exercise).