Background

There is a condition rampant in young South Asian adolescents and women that is often overlooked.  It’s a disease caused by insulin resistance that can lead later to diabetes, heart disease, and infertility.  It can leave teenage girls emotionally and physically scarred from obesity, excess (body hair), and acne. This is the condition known as PCOS (Polycystic Ovarian Syndrome).  PCOS is the most common endocrine disorder in women, with an overall global incidence reported to be anywhere between 20 to 30 percent in the general population.  The highest reported incidence in an ethnic group was a study of South Asian immigrants in Britain, which found that just over half of South Asian women (52 percent) had PCOS.

What Causes PCOS?

What exactly is PCOS and how is it related to insulin resistance?  The extra insulin resulting from insulin resistance is the trigger for cyst formation in the ovaries, the production of excess male hormones called androgens (e.g.-testosterone), and the excess body fat, which is why over half of women with PCOS are obese.

The extra fat tissue makes the problem worse by producing more testosterone, contributing further to the hormonal imbalance. The hormonal imbalance disrupts normal menstrual cycles and may cause infertility.  So you can see this is a vicious cycle:

Insulin resistance–>Increased Insulin–>Directly stimulates ovaries and promotes excess fat storage–>Extra fat promotes further insulin resistance–>PCOS gets worse

PCOS Symptoms and Diagnosis

Blood testing and diagnostic imaging are confirmatory, but the diagnosis of PCOS is made primarily by symptoms, including one or more of the following:

  • Irregular periods

  • Evidence of excess male hormones (androgens), which produce symptoms like acne, excess facial and body hair, and hair loss over the scalp (alopecia)

  • Obesity

  • Acanthosis Nigricans, which is a rash consisting of dark brown to black colored velvety or thick textured skin lesions found in body skin folds (back or side of neck, armpits, groin, etc.)

The immediate symptoms of PCOS can be devastating to teenagers and young women.  Obesity, acne, and facial hair severely impact body image, particularly during adolescent years, which is further compounded by fertility issues later on. The downstream risks of PCOS caused by insulin resistance are an even greater threat to health:

  • Risk of diabetes is over seven times someone without PCOS

  • Increased risk of heart disease with more extensive atherosclerosis of blood vessels

  • High blood pressure

  • Increased risk of metabolic syndrome

Treatment of PCOS

If you suspect having PCOS based on clinical symptoms, be sure to connect with a physician who can do additional tests as needed.  Treatment is often targeted towards symptoms (irregular periods, acne, excess hair growth).  In cases of severe insulin resistance, medications like metformin may help.  Since obesity and elevated insulin are a major trigger to PCOS, proper nutrition and exercise are critical.  Carbohydrates in particular need to be limited, especially sugar, sweets, sodas, processed foods, and even breads and grains.

Please read this updated blog post on PCOS, including 7 Steps to Prevention and Cure.  My RID (Reverse Insulin resistance and Diabetes) online program found here is also focused on reversing PCOS.

Raising Awareness

As a community South Asians have to be sensitive to PCOS.  Look out for this in young girls and teenagers.  If you have sons, they should be aware of this condition as well to avoid teasing girls who suffer from the visible manifestations of PCOS.  This is yet one more sign that insulin resistance remains an epidemic problem in South Asians regardless of gender and age.  We as a community need to instill healthy nutrition and physical activity to reduce the risk of conditions like PCOS from developing.  If you or someone you know have dealt with PCOS, I encourage you to share your story so we can create more awareness and reduce the prevalence of this condition.