Episode #118: The Insulin Effect Root Cause

When insulin is circulating in our bloodstream, it stimulates the ovaries to produce excess androgens. The big one is testosterone, thereby worsening our PCOS symptoms. I get so many questions about insulin and insulin resistance, and am I really having a problem with insulin because my doctor said my labs look fine. So In today’s episode, we are going to continue the mini-series about root causes, and we’re going to dive deeper into the root cause of the insulin effect. Today, we’re going to be diving into the root cause that I call the insulin effect and how it affects PCOS. So let’s get started.

You’re listening to the PCOS Repair podcast, where we explore the ins and outs of PCOS and how to repair the imbalances in your hormones naturally with a little medical help sprinkled in. Hi, I’m Ashlene Korcek, and with many years of medical and personal experience with polycystic ovarian syndrome, it is my joy to watch women reverse their PCOS as they learn to nourish their body in a whole new way. With the power of our beliefs, our mindset, and our environment, and the understanding of our genetics, we can heal at the root cause.

Welcome back to the PCOS Repair podcast, where today we’re diving into the root cause of the insulin effect. Now, before we dive in, I want to remind you that we’re in the middle of a mini-series. If you haven’t listened to specifically two episodes ago, number 116, I would go back and do that. It gives an overview of how all of the root causes work together and what we’re talking about with the pyramid of the base root causes and how they work up the pyramid to develop and worsen or repair our PCOS symptoms. I would recommend, if you haven’t or if it’s been a while, to go back and listen to that episode. I will link them all in the show notes.

Now, my terminology, the insulin effect, this is my terminology. It’s my way of trying to describe that it’s not necessarily insulin resistant or diabetic that creates the problem. You can be thin and have the insulin effect. You can be completely and totally normal with your hemoglobin A1c, your fasting insulin, your fasting glucose, your glucose tolerance test even, and still have the insulin effect going on in your PCOS. That’s what we’re going to dive into today is the why that can be happening, what is that creating, how is that creating a problem for PCOS, and just diving into better understanding all about the insulin effect.

Research has shown, and this is where so many physicians bring up insulin and test your insulin because research has shown that more than 70 20% of women with PCOS have insulin resistance. A huge amount of them have full-blown insulin resistance. As we find more and more women are being diagnosed with PCOS, I think that’s probably actually less and less true. Historically, PCOS was probably underdiagnosed. When I was diagnosed with PCOS, they were thinking maybe as many as 1 in 10 women had PCOS of reproductive age. Now, I’ve heard statistics where it’s looking like there may be more like one in six. I think there’s a combination here going on of one, more people are being correctly diagnosed, or as the awareness grows, women are going in and asking, and so more women are being diagnosed. But I also think that the lifestyle of the busy and prepared food, packaged food, fast food, eating out, eating on the go, all of the things that go with a fast-paced lifestyle are creating more and more tendency towards developing PCOS than before. Maybe it was underdiagnosed before because symptoms weren’t arising. People were being able to combat that with a relatively healthy lifestyle.

But now it’s getting more and more difficult to determine what’s a healthy lifestyle, what’s not causing inflammation. A lot of the things that we’re doing are affecting our cortisol, so our base hormone, our insulin, that next hormone up the pyramid, and then also our inflammation status. We’ll get into that one next week. Okay, so let’s first talk about when our labs are normal, does that mean that we have an insulin problem or not? Many doctors are like, Insulin seems fine right now. Your blood sugar seems fine right now. Perhaps metformin would be helpful, so they may still offer something like that. But for the most part, they say that’s not really your problem. I want to dispel that myth right now and say insulin is definitely still an important factor in PCOS health. Because whether Whether or not insulin is even your primary root cause or you’re having any issues with your labs, I want you to start with looking at the fact that our insulin health and our blood sugar health is on a spectrum. On one end of the spectrum, we have insulin health. Here, one, of course, our labs are going to be normal, but also our insulin response is going to be normal.

What this would look like is we eat food. Whatever food, whether it’s a high glycemic index, meaning it’s going to require a fair amount of insulin Say we eat chocolate cake. We’ll use chocolate cake as our example across the board. If our insulin is really healthy and we are otherwise eating pretty healthy, and on occasion, we have something like chocolate cake. We eat some chocolate cake, we have a really healthy blood sugar and insulin response. We eat that chocolate cake, our blood sugar rises appropriately, and our insulin recognizes that rise in blood sugar, or our pancreas recognizes that rise in blood sugar, it releases the insulin needed to send that blood sugar where it’s supposed to go into the cells of our body, into our muscle cells, into all the different cells of our body so that our body gets energy so that our body can function and survive. As we move along the spectrum, our insulin becomes a little bit annoyed at being summoned so much. If we’re constantly eating sugary foods, things that have high glycemic index, so maybe even if it’s not sweet, like potato chips, they’re still raising our blood sugar significantly.

They’re a very refined carbohydrate. We usually eat them in large amounts, and they’re pretty easy to eat, so we eat them pretty quickly. The combination of volume glycemic index, so how readily available is that sugar in the How rarely does it break down to sugar? Even if it’s, like I said, a salty food, it can still, like potato chips, break down into blood sugar very quickly. We get this high velocity impact of a large magnitude, so a large volume of blood sugar. That constantly doing that, our pancreas gets worn out. It starts to go, Really, guys? It starts to get frustrated where it may wait a little longer or it may just flood it with too much. It starts to become less and less precise. Then what happens is, is as we become more and more resistant, our cells actually are what become resistant. Our muscle cells, our other cells, they get We just ate, and they start to be resistant and they’re like, Yeah, insulin. We heard you before. They don’t listen very well. Insulin starts pounding on their doors. It just starts pounding on the doors and it starts sending out more insulin because the blood sugar is not going down, and so it puts more insulin into the system than even the foods that you ate would typically have required back when you had a healthy insulin response.

Then we start moving down the spectrum, and as that continues, we finally cross a threshold where the amount of blood sugar that’s in your system compared to the amount of insulin that’s required to get that blood sugar into the cells where it belongs has reached the resistant threshold on laboratory values. Basically, what that’s going to look like is your blood sugar is always too high because your insulin is not working very well. But your insulin is also going to be be high because it’s trying to, as it’s not heard, it’s putting more insulin into your system to try to be heard. It’s like it’s starting to try to shout at your cells. Take the glucose, take the glucose. It’s shouting at your cells and It’s rising in volume compared to what you ate. Looking back at the chocolate cake as we progress along this spectrum, one, you used to eat chocolate cake. It used to have an appropriate blood sugar response. Your pancreas would send out an appropriate amount of and your cells would quickly and happily respond to accepting the blood sugar. Then over time, as this became more continuous, as this happened more frequently, your cells started to not listen.

Have you ever had someone talk to you and they repeat themselves, repeat themselves, tell the same story, and at some point you start tuning out? Maybe you missed something that was different that they said this time because you’ve heard the same thing so many times that you stop listening. That’s what happens with your cells as they hear this so often and they start becoming a little bit, what we could say, resistant. At some point, that resistance gets large enough that you cross over the threshold of now in the medical community, we recognize it as insulin resistance. Now, there is a period of you were in good health, and then there’s a period of health decline before you actually reach the point of where we label it resistance. It’s a spectrum. Then from that resistance, what happens is that your insulin will actually start shutting down altogether. Well, then it increases and increases until you reach the type 2 diabetic standpoint. Then as your type 2 diabetes continues, you’ll actually reach a point where your insulin gives out altogether and says, Forget this, nobody’s listening to me anyway. Then that’s when the type 2 diabetics actually have to start injecting themselves with insulin.

Type 1 diabetics need it from the very beginning. Because they have insulin problem from the very beginning. When healthy individuals develop type 2 diabetes and resistance, it’s because over time, our bodies have repeatedly encountered too much blood sugar, too much insulin, too much blood sugar, too much insulin, to where we’ve stopped listening very well to the response that our body is trying to give. That’s the spectrum. Now, where are we falling with that with PCOS? What’s going on and How do we need to think about it? First of all, as we become, as you saw, as we become more and more insulin resistant, even before we hit the threshold in our labs that our doctor starts to recognize as insulin resistant, as soon as those labs cross over into the red, that higher amount of insulin that we’re producing, and then that continues, that higher amount of insulin is telling our ovaries to produce excess androgens. So androgens are basically Basically, testosterone is the primary one. There’s a couple of other ones in there. But essentially, when you hear the word androgen, think testosterone, and that’s going to increase your LH. That elevates your LH, your luteinizing hormone.

That’s the hormone that we need to have a spike in in order to have ovulation. When our luteinizing hormone, our LH hormone, is already elevated, our body has a hard time recognizing a surge. Essentially, Essentially, if you’re already yelling and then you yell a little harder, it’s going to be a lot harder to get someone’s attention. The reason we usually yell, Watch out, is because we’re trying to get someone’s attention. Now, if we’re already talking at an elevated volume, and then we try to elevate it a little bit farther, we don’t have the shock and awe value. Now, in order to have ovulation, we need that shock and awe. If our LH is already elevated, we’re not going to have the shock and awe, and It’s not going to register to our body that we need to finish maturing and release that mature egg into ovulation. When we don’t ovulate, we don’t have the hormone change from one part of the cycle to the second part of the cycle. Every month that we don’t ovulate, it actually lowers our progesterone. There’s other things that also lower our progesterone. But the repeated lack of cycling, the repeated lack of ovulation in and of itself starts to dampen our cycle rhythm.

When we have this elevated LH, it creates a very big problem for our cycle and for our fertility. It takes a while to repair that as well. The other areas that testosterone can affect are facial hair, body hair. We start to get that male pattern of PCOS that we see where we’ll have male pattern hair loss on the head. We may start to grow a mustache. We may have some facial hair, some hair on the neck. We may have some body hair on the chest or on the toes. These are all things that we start, or even just more leg hair than somebody else would have that didn’t have high testosterone. We may have more tendency towards acne, especially if we also have an inflammatory component that’s out of control. These are all things that we’re going to start seeing with testosterone. It also then, because of the cycle changes, the hormones that are related to the cycle, it can start to increase PMS and anxiety and lack of sleep or sleep disturbances and increase stress It starts to throw off some of those more delicate, higher in the pyramid hormones. Back to insulin. I want to move further back towards the healthy side of the spectrum and talk about what’s happening even before you approach the insulin resistance standpoint.

Insulin circulating your system for any reason, especially if it’s doing it in large amounts and in high frequency, it’s going to stimulate those ovaries. This is the part where a lot of people think, Oh, I don’t show up as a problem on labs yet. I’m fine. That’s not my problem. Well, just because your body is compensating for it, just because your cells haven’t gotten sick of the insulin knocking on its door yet, doesn’t mean that the insulin circulating your system isn’t still having an effect. If you’re living on the, I’m not going to eat too many calories, but I’m going to eat the calories that I eat in Skittles and a Coke, and basically live off of little sugar punches to get me through the day with little bursts of energy, you’re constantly spiking your insulin. When we do that, we’re constantly keeping insulin circulating our system. Or maybe It’s just that we eat three high glycemic index foods for meals, high glycemic meals three times a day with two snacks in between. Every two hours, we are spiking our blood sugar. We’re releasing a large amount of insulin. Throughout the day, we’re releasing, we’re releasing, we’re releasing, we’re releasing insulin.

Insulin is constantly circulating our system. Yes, maybe our cells are doing fine with that. Our fasting blood sugar is fine. Our insulin levels are fine. Our hemoglobin A1c, the measure of our blood sugar over a three-month average, it looks fine. However, that’s because our insulin system is compensating, but it’s still constantly releasing insulin. Our ovaries are still constantly constantly being exposed to insulin. In PCOS, our ovaries are very sensitive to that insulin, and they release the excess androgens. If we’re eating a diet that’s constantly stimulating our insulin release, we’re constantly stimulating our ovaries to release those excess androgens, even though our insulin system is still on the healthy end of the spectrum. Hopefully, this starts to shed some light on why insulin becomes a problem with PCOS long before our labs indicate that we have a problem in our insulin and blood sugar system. This is why I use the term the insulin effect in the root cause, because it starts way before insulin resistance has become a problem. It starts way before our body has begun to shut down. Just having the high repeated release of insulin is part of the problem for our PCOS symptoms.

And yes, that high constant release of blood sugar and insulin leading to insulin resistance. It’s the cause of why we’re going to get insulin resistance later. But even before we develop that resistance, just having it present, circulating our system on a continual basis is stimulating our ovaries to release the extra testosterone that’s messing with our cycle and that is messing with our other symptoms that we’re frustrated with with PCOS. Hopefully, that helps to shed some light what’s going on with the insulin root cause for PCOS and why I call it the insulin effect. Also, we talked a little bit about this in the last episode, cortisol, the stress hormone, so perceived stress, stress in the body, stress in your environment, that cortisol also increases the release of insulin. If you have these two things going on, so you have the insulin effect due to more of the foods that you’re eating, maybe due to your current body weight and other lifestyle factors, you’ve got the insulin effect going on. If you additionally have the stress response going on, maybe that’s your secondary PCOS root cause, you’re getting this double whammy and you’re getting a lot of insulin in your system, and it’s really working against you.

So understanding how big of a player insulin is when it comes to polycystic ovarian syndrome is really, really, really important. And I think that a lot of times when we get lab work done and our labs look fine, it starts to get downplayed and set aside. Then we start wondering, why is nothing working? The reason nothing’s working is oftentimes when insulin is circulating in such excess, everything is working against us. So all of our amazing efforts in one area where we thought we had a problem or what we’re trying to do to make ourselves healthy or we’re trying to lose weight, or we’re trying to reduce our inflammation or manage our stress, but we’re just frustrated by the fact that nothing’s working. The reason is it’s because our body is working against us. So hopefully that sheds some light. I know there’s probably going to be questions about this.

So if you have questions about this episode, you know where to find me. I’m over on Instagram @nourishedtohealthy. I would love to continue the conversation with you over there and next week, make sure you hit the subscribe button because next week we’re going to be diving into our next root cause in this little mini-series about root causes and we’ll be talking more about insulin as we work our way up the pyramid and then also how the cortisol, insulin, and inflammation all work together. So be sure not to miss that one next week and until then, bye for now.