Insulin resistance and the PCOS plate

Last time we said that in many people with PCOS, the body responds less well than usual to insulin. Now let's see what that means in practice, and how to keep it in mind on your everyday plate. This is educational and doesn't replace your own doctor's diagnosis or advice.

What does insulin do?

After you eat, your blood sugar rises. The pancreas releases insulin so that sugar can move into your cells to be used as energy or stored. In insulin resistance, cells listen to that message less well, so the body has to make more insulin to do the same job.

That higher insulin level may:

• Make it easier to store fat, especially around the waist
• Increase sugar cravings and sudden hunger
• Affect the balance of the hormones that regulate the ovaries

Not everyone with PCOS has insulin resistance, and the reverse is true too. How much it applies to you is something your doctor works out through an exam and, if needed, lab tests.

Signs worth mentioning to your doctor

• Strong tiredness or sleepiness after meals
• Getting hungry soon after a full meal
• Powerful cravings for sweet foods or bread
• Darker, thicker patches of skin in the folds of the neck or underarms

None of these is a diagnosis on its own, but they're worth bringing up at your appointment.

The PCOS plate: a simple pattern

You don't need to count calories or weigh every meal. One simple visual pattern is enough for most main meals:

1. Half the plate vegetables: salad, fresh herbs, cooked or steamed vegetables. They add volume and fibre, and don't push blood sugar up quickly.
2. A quarter protein: chicken, fish, eggs, legumes, low-fat dairy or lean meat. Protein keeps you full for longer.
3. A quarter quality carbohydrate: a sensible portion of rice, wholegrain bread, a baked potato or legumes.
4. A little healthy fat: for example olive oil on a salad, or a few nuts.

Nothing's banned. Rice and bread stay on the table. What changes is the portion size and what goes with them.

The order you eat in matters too

Some studies suggest that eating vegetables and protein before the carbohydrates in the same meal may soften the rise in blood sugar afterwards. It's a simple trick that costs nothing: eat the salad first, then the stew and rice.

A few small habits that make a difference

• Swap sugary drinks for water or unsweetened drinks. Liquid sugar is absorbed very quickly and doesn't fill you up.
• Eat whole fruit rather than juice. The fibre in whole fruit slows how fast sugar is absorbed.
• Start your breakfast with protein. Eggs or cheese with wholegrain bread usually keep you going better than a purely sweet breakfast.
• Keep your meals evenly spaced. Skipping meals and then overeating makes blood sugar swing more.
• Don't ban sweets, give them a place. For example after a meal and in a small portion, rather than on an empty stomach.

About very strict diets

Very low-carb plans and long fasts aren't right for everyone. If you take medication, especially anything that affects blood sugar, a sudden change in what you eat can be unpleasant or even dangerous. Only start a strict plan if your doctor agrees.

The short version

Insulin resistance is common in PCOS, but small, steady changes to your plate can help you manage it. Half vegetables, a quarter protein and a quarter quality carbohydrate is a good starting point. To make that pattern fit your tastes, your schedule and your medication, the Rejimist doctor writes your meal plan just for you.

Sources

• Teede HJ, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Journal of Clinical Endocrinology & Metabolism, 2023.
• Shukla AP, et al. Food order has a significant impact on postprandial glucose and insulin levels. Diabetes Care, 2015.
• Harvard T.H. Chan School of Public Health. The Healthy Eating Plate.
• World Health Organization (WHO). Healthy diet — Fact sheet.