Type 2 Diabetes and PCOS: Understanding the Connection
Living with PCOS can take its toll on your emotional and physical health, but when you’ve got the added burden of type 2 diabetes on your shoulders, the load can be even more difficult to bear at times. You’re in pain, you’re at your wit’s end, and you’re confused by all the conflicting advice on Google. Sound familiar? Well, there’s one thing we know for sure: with the correct knowledge and application, these conditions don’t have to be an unbearable life sentence. Here, we outline the integrative, holistic approaches you can take to manage these comorbidities and steps you can take to prevent them from surfacing in the first place.
So, what’s the link between PCOS and type 2 diabetes?
Though the root cause of PCOS is somewhat fuzzy and inconclusive, there’s tangible evidence pointing to its link with type 2 diabetes - with a recent study suggesting that women with PCOS were three times more likely to develop the conditioni. Let’s get scientific briefly: a significant percentage of PCOS sufferers present with insulin resistanceii. In very simple terms, PCOS triggers a sluggish response to insulin, meaning more and more of it is required before the body utilises glucose for energy. Unfortunately, having such high levels of glucose in the body can lead to type 2 diabetesiii. What exacerbates this risk is weight gain (especially the toxic visceral kind), which is a common comorbidity of PCOS. Indeed, between 30 and 70% of women with PCOS fall into this weight categoryiv. It’s not surprising then, that The International Diabetes Federation has officially recognised PCOS to be a significant risk factor for type 2 diabetesv.
Type 2 diabetes can creep up on you slowly, so here are some of the warning signs to watch out for: increased hunger and thirst, dry mouth, frequent urination, fatigue, blurred vision, and headachesvi.
How can type 2 diabetes be prevented if you have PCOS?
Not every PCOS sufferer is predestined to have type 2 diabetes too – don’t worry. However, implementing preventative measures will never cause harm and will ensure your health always remains in fighting-fit condition while you manage your PCOS.
As we’ve established, obesity is a significant contributing factor in the development of type 2 diabetes. And although PCOS can make weight loss more challenging, it’s worth it in the long run. As Dr Aled Rees, consultant endocrinologist, states: "Our research indicates that close monitoring of PCOS patients who have difficulty managing their weight could help to catch the development of diabetes early"vii.
We’re not asking you to start running ultra marathons or embark on a strict juice diet. All we suggest is that you start making healthy changes to your diet and lifestyle to ensure that you maintain a healthy weight. Not only will this integrative approach see any excess weight drop off, but it will also restore some harmony to your blood sugar levels, which is vital if you want to keep type 2 diabetes at bay.
Wholesome whole grains
The good news is that you can have your carbs and eat them – phew! However, to fend off hunger pangs, maintain a healthy weight, and above all, keep your glucose levels happy, try filling up on high-fibre, protein-packed whole grains instead of their highly processed counterparts. Think brown rice, quinoa, rolled oats, pearl barley, buckwheat and millet – all of which have a low glycaemic index (the rate a carbohydrate raises your blood glucose levels). You should also consider ditching white rice, pasta and bread – or anything of the ‘beige’ variety, guaranteed to be crammed with sugar, salt and saturated fats. These foods tend to have a high GI profile too, causing your blood glucose levels to spike, crash, and leave you craving even more carby treats.
Like refined carbohydrates, sugar also causes a rapid increase in your blood sugar level. To maintain your body’s status quo, your pancreas releases insulin, but excessive amounts of this hormone can drive sugar into your fat stores, which isn’t great for your waistlineviii. Think about it like this: in the same way a car utilises petrol, if your energy requirements are high, the sugar is put to good use by providing fuel to your body’s cells. You run into problems when you send sugar to your bloodstream and your body doesn’t need it; this wreaks havoc with your pancreas, causing it to release a disproportionate amount of insulin, which is then stored as fat. Worst still, sugar is dangerously addictive. Some might even call it the ‘cocaine of the food world’. The solution? Cut back on sugary snacks, fizzy drinks, and ready meals; you’ll be surprised where the sugary stuff is hidden. As an alternative enhance meals with spices instead of sugar – try adding ginger, allspice, cinnamon or nutmeg.
It’s time to dispel the myth about eating fat. Fat isn’t a homogenous food group: there’s the good, the bad and the ugly. Whilst unhealthy fats like the trans or saturated sorts can pack on the pounds, the opposite can happen with their monounsaturated counterparts. In fact, there’s overwhelming evidence to suggest these fats can nourish your body and even help you lose weight. Hang on; fat doesn’t make us ‘fat’?
A randomised controlled trial found that a Mediterranean diet – one rich in olive oil and nuts, is extremely useful in weight managementix. This is because the researchers propose, monounsaturated fats help to elevate your metabolic rate and encourage your body to burn fat more rapidly. It’s time to stop treating ‘fat’ as a dirtied word, and start adding avocados, olive oil, nuts and seeds to your diet.
All about aqua
You’re probably aware of the whole: ‘water fills you up’ spiel – right? Well, water doesn’t only increase feelings of satiety, but it actually increases your caloric burn. Yes – you read that right: water burns calories! In a study of healthy men and women, drinking around 2 glasses of water momentarily elevated the metabolic rate of participants’ by 30%. The researchers concluded that upping water intake by 6 glasses could increase caloric burn by 200 calories dailyx. Amazing, right? If H20 isn’t your thing, try adding sliced citrus fruits, a sprig of mint or low-sugar cordial to pizzazz it up.
Exercise is a vital part of any weight loss plan, but you don’t have to become a slave to your local gym to reap the benefits. Very simply, you can incorporate physical activity into your everyday routine: begin cycling to work, take a brisk walk with your colleagues at lunchtime, or use the stairs as much as possible throughout the day. Apparently ‘sitting is the new smoking’, so be sure to set reminders to get up and move every 30 minutes.
The notion that smoking is a harmful and potentially fatal habit isn’t anything novel. Indeed, there’s an abundance of compelling data to suggest it’s a risk factor in many medical conditions, including type 2 diabetesxi. While the exact reasoning behind the cigarette smoking and type 2 diabetes link has not been fully reached yet, the existing evidence points to it increasing insulin resistancexii. In fact, smokers are 30-40% more likely to suffer from type 2 diabetes than their non-smoking counterparts! You heard us – stub out those cigarettes.
We all like to unwind with a tipple now and again, but mounting data suggests alcohol can lead to dangerously fierce spikes in blood sugar and may even result in liver toxicity. A study published in the Annals of Internal Medicine found that heavy consumption of alcohol (defined as 3 or more drinks per day) increased the risk of diabetes by 43%xiii. Next time you reach for that second bottle of wine, you may want to reflect on that shocking statistic.
Stress is pretty much everywhere in our modern world; it’s an epidemic, stemming from work, parenting, marriage, health and financial insecurity. Not only is it a debilitating and agonising emotion, but it can have deeper biochemical implications too – provoking dangerous fluctuations in your blood sugar levels. When you’re stressed, your body primes itself by ensuring there’s a readily available supply of energy, which causes more glucose to flow through your bloodstreamxiv. And, as we now know, excessive spikes in your blood glucose levels are a characteristic of type 2 diabetes. How can this be prevented? Two words: chill out. We’re talking filling your days with meditation, mindfulness, visualisation, deep breathing, yoga, or walks in nature – any form of ‘therapy’ to calm your mind in moments of stress.
How can type 2 diabetes be managed if you have PCOS?
If you do suffer with PCOS and type 2 diabetes, then in addition to lifestyle measures there are more active ways you can manage both conditions.
With a similar structure to glucose, myo-inositol plays an important role in the body’s communication with cells. In a study published by the International Journal of Endocrinology, scientists analysed the metabolic results of taking myo-inositol and d-chiro-inositol (at a ratio of 40:1) in both men and women suffering from type 2 diabetesxv. The inositols were taken twice a day, orally, and in addition to this traditional diabetic treatment drugs, like metformin. The participants also followed a low GI diet. After just 3 months, the results were pretty incredible - the individuals who took the combined inositols saw a marked reduction in their fasting glucose.
Herbalists have been harping on about the magic of cinnamon for almost 4,000 years. Traditionally, it’s been used to alleviate digestive issues, however, in recent times, this humble spice has become the focal point of research elucidating it’s blood-sugar balancing properties. Interestingly, data has shown that cinnamon contains active substances that help regulate blood glucose by imitating insulin in the bodyxvi.
Chromium is an essential trace element, and tremendously important in lipid, protein, and carbohydrate metabolism. When the body has insufficient stores of this nutrient, it could lead to a glucose intolerance and even insulin resistancexvii. Chromium is predominantly found in meat and shellfish, so anyone who fails to eat enough of these food groups are likely to have a low intake. That’s why we suggest taking chromium in supplement form to plug any nutritional gaps you may encounter.
Dealing with a second chronic condition alongside your PCOS can be challenging to say the least. However, we’ve demonstrated there are many integrative, holistic approaches you can take to manage the symptoms of type 2 diabetes, and even prevent the onset of the condition in the first place. Remember: diet, lifestyle and supplementation sit at the forefront here. If you pay close attention to them, happiness and health should follow suit.
Enjoyed reading this article? Please feel free to browse the rest of our hub and discover more ways to reclaim control over your PCOS.
Diabetes.co.uk. (2012). Polycystic Ovary Syndrome can raise diabetes risk threefold [ONLINE]. Available online: https://www.diabetes.co.uk/news/2012/Mar/polycystic-ovary-syndrome-can-raise-diabetes-risk-threefold-97794970.html
Dunaif, A. (1997). Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocr Rev. (18): 774–800.
Bremer, A.A., Miller, W.L. (2008). The serine phosphorylation hypothesis of polycystic ovary syndrome: a unifying mechanism for hyperandrogenemia and insulin resistance. Fertil Steril. (89):1039–1048.
Gambineri, A., et al. (2012). Polycystic ovary syndrome is a risk factor for type 2 diabetes: results from a long-term prospective study. Diabetes. (61): 2369–2374.
Alberti, K., et al. (2007). International Diabetes Federation: a consensus on type 2 diabetes prevention. Diabet Med. (24): 451-463.
Dansinger, M. (2017). Symptoms of Type 2 Diabetes [ONLINE]. Web MD. Available: https://www.webmd.com/diabetes/type-2-diabetes-symptoms
Diabetes.co.uk (2012). Polycystic Ovary Syndrome can raise diabetes risk threefold [ONLINE]. Available online: https://www.diabetes.co.uk/news/2012/Mar/polycystic-ovary-syndrome-can-raise-diabetes-risk-threefold-97794970.html
Stanhope, K.L. (2016). Sugar consumption, metabolic diseases and obesity: the state of the controversy. Crit Rev Clin Lab Sci. 53(1): 52–67.
Austel, A., et al. (2015). Weight loss with a modified Mediterranean-type diet using fat modification: a randomized controlled trial. Eur J Clin Nutr. 69 (8): 878-84.
Boschmann, M. (2003). Water-Induced Thermogenesis. The Journal of Clinical Endocrinology & Metabolism. 88 (12): 6015-6019.
Willi, C., et al. (2007). Active Smoking and the Risk of Type 2 Diabetes: A Systematic Review and Meta-analysis. Clinician's Corner. 298 (22): 2654–2664.
Centers for Disease Control and Prevention. (2018). Smoking and Diabetes [ONLINE]. Available online: www.cdc.gov/tobacco/campaign/tips/diseases/diabetes.html#three
Howard, A.A. (2004). Effect of alcohol consumption on diabetes mellitus: a systematic review. The Annals of Internal Medicine. 40(3): 211-9.
Diabetes Education Online. (2007). Blood Sugar and Stress. [ONLINE]. Available online: https://dtc.ucsf.edu/types-of-diabetes/type2/understanding-type-2-diabetes/how-the-body-processes-sugar/blood-sugar-stress/
Pintaudi, B., Di Vieste, G., Bonomo, M. (2016). The Effectiveness of Myo-Inositol and D-Chiro Inositol Treatment in Type 2 Diabetes. Int J Endocrinol.
Ranasinghe, P., et al. (2012 Jul). Efficacy and safety of “true” cinnamon (Cinnamomum zeylanicum) as a pharmaceutical agent in diabetes: a systematic review and meta-analysis. Diabet Med. 29(12):1480–92.
Cefalu, W.T. (1999). Effect of chromium tripicolinate on insulin sensitivity in vivo. J Trace Elem Exp Med. 12:71–83.
Disclaimer: The information presented by Nature's Best The Pharmacy is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Olivia Salter has always been an avid health nut. After graduating from the University of Bristol, she began working for a nutritional consultancy where she discovered her passion for all things wellness-related. There, she executed much of the company’s content marketing strategy and found her niche in health writing, publishing articles in Women’s Health, Mind Body Green, Thrive and Psychologies.