14 November is World Diabetes Day. With over 3.5 million South Africans suffering from diabetes and an estimated further 5 million with pre-diabetes, most of whom are currently undiagnosed, the situation in South Africa is dire.
Pre-diabetes is a condition that occurs when your blood glucose levels are higher than normal but not high enough to be diagnosed with actual diabetes.
Early warning signs
Pre-diabetes usually occurs in people who already have some degree of insulin resistance. Cells in your body absorb glucose from the bloodstream with the help of the hormone, insulin. Once inside the cell, glucose is metabolised to produce energy.
Insulin resistance occurs when cells in your muscles, fat, and liver do not respond effectively to insulin and cannot easily take up glucose from your blood. In response, your pancreas releases more insulin and, as a result, both insulin and glucose begin to accumulate in the bloodstream.
Insulin resistance and PCOS
This condition precedes the onset of type-2 diabetes, but what many women are unaware of is that a relationship exists between insulin resistance and polycystic ovary syndrome (PCOS).
PCOS is a common reproductive disorder4 that affects as many as 15% of the female population5. It is defined as a hormonal disorder common among women of reproductive age6.
According to statistics, 60-80% of women with PCOS suffer from insulin resistance.
“I would describe the relationship between insulin resistance and PCOS as mutually destructive in that PCOS worsens insulin resistance and vice versa,” says Dr Carmen James, an integrative medical doctor and holistic health and wellness coach from Durban.
Dr James explains that while high insulin levels are a feature of PCOS, they also fuel the disease. “The reason for this is because insulin accumulation reduces ovulation and promotes the production of androgens or male hormones. This results in symptoms such as a male pattern of hair growth (hirsutism), acne and in some cases are associated with difficulties with fertility,” she says.
In fact, 60% of women with PCOS suffer from hair loss, acne and unwanted hair growth and 20% have infertility problems.
Alarmingly, more than 50% of women with PCOS will develop diabetes or pre-diabetes before the age of 40.
The fertility factor
With so many women affected by PCOS or insulin resistance, or indeed both, the effect on fertility can be heart-breaking. But exactly how does insulin resistance affect fertility?
Dr James explains that ovulation occurs during a normal menstrual cycle where an egg is released from the ovary and passes through the fallopian tubes and into the uterus. If the egg is not fertilised, the egg, together with the uterine lining, will be shed during menstruation.
“Because an accumulation of insulin in the bloodstream elevates androgen levels, the resulting hormone imbalance will negatively affect ovulation. When women do not ovulate, they may menstruate less frequently, have irregular cycles and in some instances, they may not menstruate at all. If an egg is not released into the uterus, conception will not occur, she says.
PCOS is the most common cause of irregular menstruation that leads to infertility. While it is more likely for overweight and obese women to experience insulin resistance and PCOS, women of a normal weight can be affected too.
“It is important to remember that weight alone is not an absolute representation of health,” Dr James says.
Dr James, who runs various workshops around the country on women’s health with a special focus on hormone health, strongly recommends that women with PCOS and/ or insulin resistance should address the underlying root cause of their condition.
“While we cannot control our genes, we can aim to live a healthy lifestyle to reduce the negative effects of both PCOS and insulin resistance.”
She recommends the following:
- A healthy diet, rich in plant-based foods and low in refined carbohydrates
- Regular exercise
- Taking supplements including Myo-inositol, curcumin, antioxidants, folate and berberine
- Managing stress levels
- Getting sufficient quality sleep
Dr James explains that these measures will reduce inflammation, improve insulin sensitivity and begin to bring balance to the hormones to support ovulation.
A new supplement with ingredients proven to help correct endocrine and metabolic imbalances linked to insulin resistance and infertility in women with PCOS was launched in South Africa in August.
Sinopol®, which is available over the counter at Dis-Chem pharmacies without a prescription, contains a unique combination of 3 ingredients, including Alpha Lipoic Acid (400mg), Myo-Inositol (1000mg) and Folic Acid (200µg).
This combination of ingredients in various studies on certain patient profiles has demonstrated success in reducing insulin resistance, reducing obesity and increasing pregnancy rates in patients undergoing in vitro fertilization cycles.
Author: Pedro van Gaalen
When he’s not writing about sport or health and fitness, Pedro is probably out training for his next marathon or ultra-marathon. He’s worked as a fitness professional and as a marketing and comms expert. He now combines his passions in his role as managing editor at Fitness magazine.