Question for Dagmar Ehling - lean PCOS patient/insulin resistance

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Joined: 02/10/2009
Question for Dagmar Ehling - lean PCOS patient/insulin resistance

Thank you for an excellent and informative class!

I hope that I didn't miss this as part of the class, but I'm interested in understanding the physiology of the lean PCOS patient better. I have a very thin, amenorrheic PCOS patient, all of her labs are normal except for slightly elevated testosterone (triglycerides, glucose, TSH, etc all normal), but she has the string of pearls and no ovulation, even with letrozole. Her uterine lining is also a bit thin. I've advised her to reduce her carbs, which were pretty low already. How does one explain the insulin resistance when her glucose-related labs are normal? I tried to research this myself online as well and couldn't find much.

Thanks so much! It was a wonderful class.

Joined: 04/01/2013

Hi Unagata,
That is a great question. I didn't make any extra provisions for thin PCOS patients b/c the treatment is the same. Thin types' results with diet, supplements, herbs, and acupuncture are slightly reduced, but it's certainly still possible to help them. The other problem is that some thin types lose a lot of weight when on a low- to no-carb diet. The key is balancing that skillfully so it works and these patients usually need more of the insulin receptor sensitizing agents discussed in the course, e.g. chromium picolinate, or gymnema sylvestre extract, etc. PCOS patients can have subclinical insulin resistance that doesn't show on blood work. But they still have it, when they're positive for the string of pearls, hirsutism, and anovulation. It's simply more entrenched. you many need to consider products such as D-chiro or myo-inositol for her although I have rarely had to use them for patients. Also, don't forget the TCM pattern diagnosis! Does she have cold, heat, yin xu, or other pattern? You can support her greatly that way. Hope this helps! Glad you enjoyed the class. Dagmar

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