Advanced insulin resistance, PCOS and ALA

[SteelWeaver]

My sister's partner has been told she has fairly advanced insulin resistance, as well as PCOS. She is seeing a nutritionist who has dropped her carbs, and improved the types somewhat, (not as much as I'd like, but anway ...) put her on a calorie-restricted diet and told her to exercise (resistance training and cardio) 4 times per week.

MS, or W6, or anyone else in the know (MS - I know you know a ton on this particular topic), would you mind answering a couple of questions about how she can help herself beyond what the nutritionist has said?

I know I need to do some more reading, and she herself has done a lot, but things are a bit busy at the moment having just moved back home, and readjusting is rather tough going at the moment.

I know PCOS is related to insulin resistance and obesity, but which one causes which? Apparently her father is diabetic ( I think type 2) and her sister, although fairly slim, also has PCOS. Is it hereditary? What are the connections here?

Is a typical high protein, mod carb, mod-low fat BB'ing diet, with low GI's and EFA's acceptable for someone with these conditions? Or shoiuld the carbs go very low? She is rather overweight ... but very very motivated.

Is a typical periodised full body bodybuilding weight training routine, with basic compound moves 3 times a week appropriate here? When someone is quite weak, are free weights better? I know weight training improves insulin sensitivity - does cardio? And what are the mechanisms whereby this happens?

I did 2 sessions with my sister and her partner this week - we did about 2 sets per upper body part, and about 8 sets for lower, on separate days, just learning the moves at this stage. They are both very weak - could only manage 5 stationery lunges with bodyweight - using the bars in the squat rack for support and balance when necessary. But they did well. How hard can one push total beginners? I don't want to push too hard, and injure them, but I also don't want it to be too easy.

And about ALA - I know insulin-dependent diabetics shouldn't use it, but what about type 2? Macro said the mechanism is not insulin-mediated, which I take to mean it could be helpful for insulin resistance, but I really don't have a clue. Please help. I really really want to help her, and my sister, who is in crap shape, but wants to get better.

Any advice?

 

[newgirl-chargeback]

Steel -- firstly good to see you on the board again....

Secondly sorry to her about your sister's partner. I am sure with all the caring you have inside of you, the three of you can figure out how to manage her health.

Thirdly, when I had been diagnosed with it a long time ago, they had NO real treatment or management of it besides throwing someone on the bc pill....so I am eager to hear what else gets said here. While I have not had any issues relating to this for quite some time now, I am curious just the same.

Good luck. And welcome back.

 

[MS]

Hi Steel

"but which one causes which?"

PCOS is caused by insulin resistance. There are women who are not obese who get PCOS, but they are almost inevitably insulin resistant to some degree. Chances are pretty good that they will go on to become obese and type 2 diabetic later in life.

" Is it hereditary?"

The propensity to develop PCOS, diabetes, heart disease and other diseases of insulin resistance is inherited in most cases. However none of these diseases can develop if the environemtal/lifestyle factors are not there. It is ~99% environmental and 1% genetic in terms of the cause.

"Is a typical high protein, mod carb, mod-low fat BB'ing diet, with low GI's and EFA's acceptable for someone with these conditions? Or shoiuld the carbs go very low? She is rather overweight"

Insulin resistant people have been shown to lose weight better on a diet that is around 20% carbs, 30% fat and 50% protein compared to people on a more moderate carb diet. I would definitely recommend cutting carbs, but there's no need to go ketogenic.

"I know weight training improves insulin sensitivity - does cardio?"

They both improve insulin sensitivity. Intensity is pretty important though. She needs to elevate her heart rate a decent amount and work up to at least 60 minutes per day of moderately intense exercise (weights and or cardio). You'll hear a lot of "30 minutes per day walking is fine", but a recent intervention trial showed pretty clearly that this is bunk, and insulin resitant people need to do more than this (time and intensity), as well as being vigilant about their diets, if they don't wish to go on to develop type 2 diabetes.

You definitely don't want to put them off weights by pushing too far too fast. But they need to understand the importance of increasing their fitness level until they can do 60 minutes per day (or more) of moderately intense activity. Start slowly but make the goal clear.

ALA is ideal for insulin resistant and type 2 diabetics. But as noted above, she would be better off on a lower carb diet, therefore making ALA redundant. She should have some on hand though, because everyone screws up and when that ice cream comes out of the freezer then some ALA is better than none!

 

[newgirl-chargeback]

MS I really wish someone explained this to me YEARS ago. And you made it so easy for me to understand....thanks.

 

[SteelWeaver]

Hello newgirl and MS. Yes, it's been a little while - thanks for the welcome back

It was rather a wrench finally leaving Tokyo, but I received the most fabulous welcome back from my family - complete with pom-poms and balloons! And I'm now an officially registered BSc student, with a week to find some part-time work before lectures start 8am Mon with Chemistry! Whoo hoo! This is gonna be interesting

Anyway, thanks for the info MS - I knew you could help out here. I'm surprised to find it is more environmental than genetic - that's interesting. I would have thought the split would have been more even.

How come you were treated with the BC pill, newgirl? Was that simply an attempt to counteract the extra androgens? Did it work? Were you overweight at the time? Did you gain any more weight on the bc pill? Is it still used as a treatment for PCOS? (lol - sorry - the Steel barrage)

As for diet - I'll check her current ratios. I know the nutritionist dropped the carbs and the calories pretty low for the first few weeks, but the carbs allowed were things like crispbreads and yoghurt and so on, which I didn't think were such a fantastic idea ... Any suggestions on a starchy:fibrous ratio? My instinct is to toss out just about all the proper starchy carbs and use pumpkin and corn and carrots for starch - with maybe some chick peas here and there? Would that be running too close to keto?

I'm jumping ahead, but another thing, as her diet progresses, will refeeds need to come into the equation? It seems to me that without a bunch of ALA these might be a bad idea. Or even WITH ALA they might throw her off. But what does one do when metabolism and fat loss slow when insulin resistance is a factor?

I think I've got the weights intensity right so far - they're hurting, but not dying, ha ha! What's REALLY fabulous is finding out through this how much I'VE learnt over the past year or 2, and being able to pass this on - it's FUN. I can't wait til we start seeing results in a few weeks

 

[MS]

The diet I outlined (20:30:50 C:F) did not result in metabolic slowdown of the folks that were on it for 6 months. The trick is to make sure the caloric deficit is mild (80% of BMR). Definitely DO NOT let this 'nutritionist' start off with an extreme caloric deficit!!!!! Of particular interest is that both insulin resistant dieters AND normal folks on the higher carb diet DID suffer from a diet-induced metabolic slowing compared to those on the lower carb/higher protein protocol.

Drugs like metformin are often used to treat PCOS, but I would only consider this option if she can't make the lifestyle changes. OCs act by increasing SBHG, thus decreasing testosterone levels but as far as I know they don't have a significant impact on insulin sensitivity. They just ameliorate the symptoms of PCOS such as hirsutism, acne etc....

Refeeds may not be necessary from a physiological perspective, but it is unrealistic to think that she won't 'fall off the wagon' at times and have a little carb binge. It is prolly better to plan these into her diet rather than leave it to her to lose control. One is empowering, the other is not.

 

[MS]

Oops, my bad. The diet was 45% protein and 25% carbs.

 

[MR. BMJ]

Hey MS, I was wondering if you could cite that study? I'm not sure if I have it or not filed away. It could come in handy for me....when you have some spare time of course

BMJ

 

[MS]

I've sent the PDF to your elite addy.

 

[MR. BMJ]

Got it! Thanks MS.

You also have some overdue mail...lol.

BMJ