Did you know that every man with erectile dysfunction has insulin resistance? It won’t come as a surprise to you that every woman with PCOS has insulin resistance too. But how about this for surprises - 80% of the U.S. population has insulin resistance and we’re not that far behind. Therefore it is statistically likely that insulin resistance will be affecting your case, whether it’s you, your partner, or both.
So let’s understand it better…
Insulin is an incredibly important hormone. Every single cell in the body has an insulin receptor and so insulin is one of the big players. Its main function is to promote cell growth. However, insulin is not blessed with the ability to know how to stop growing. Never-ending growth is cancer, (to put it bluntly) and so this is why insulin is a hormone we should understand better.
There are other hormones of course, and these provide the role of cell breakdown, otherwise known as the metabolism. But with an abundance of insulin the other hormones responsible for cell breakdown have a hard job keeping up and this is what we term as insulin resistance.
Insulin resistance is a coin with two sides. Imagine, if you will, insulin as an Amazon delivery man at Christmas time. He’s knocking on the door of each cell with a Prime delivery. Now, if you’re a person who isn’t careful about eating mindfully to minimise blood sugar spikes then you are relentlessly hitting the “buy it now” button for yet another insulin package delivery. The knocking is now a constant and it’s not just one delivery per day, it’s multiple knocks throughout the day. Some cells have gotten fed up with the constant interruptions and so they’re not bothering to answer the door. Instead they’ve popped up a sign saying “please leave parcels with the neighbours”. These other cells are still opening to every knock and taking their parcels of insulin and the ones for next door.
And this is how we can understand the other side of the coin - hyperinsulinaemia. In this case the body starts to produce more insulin, which is great for those cells who stopped listening as they’re now occasionally bothering to answer the door and take in an insulin package but not so great for the others who are still answering to every knock. They become completely overwhelmed. And it’s this that really underpins infertility…
The most common cause of infertility in women is PCOS. The most common cause of infertility in older men is erectile dysfunction which affects more than half of men between the ages of 40 and 70.
In the case of PCOS, insulin is inhibiting a key enzyme called aromatase which is responsible for the conversion of testosterone to oestrogen. The cells of the ovary are so sensitive to insulin that the levels continue to rise and the conversion is inhibited, thusly, oestrogen fails to reach the lofty highs that are necessary to ovulate.
Erectile dysfunction (ED) is one of the earliest signs of insulin resistance and is a 100% predictor that a man has insulin resistance. You cannot have ED without insulin resistance. Insulin plays a part in the vasodilation that is needed for normal erectile function.
Insulin resistance also affects the body’s ability to produce sperm (spermatogenesis). It is affected both directly and indirectly by fat cells and actually, obesity affects male fertility far more than it does female. When fat cells grow they begin to express aromatase. The testes have aromatase much like the ovaries but in lower levels. In obese men, these excess fat cells are expressing aromatase in higher levels than they should and so now, the testes are acting as ovaries by pulling in testosterone and converting it to oestrogen, which is not what a male body needs to generate sperm.
Now let’s turn our attentions to man boobs for a moment… The excess belly fat is converting testosterone to oestrogen - the man has too much female hormone. The body becomes confused and grows and stores the fat in typically female places. This is why they might carry weight on the hips or chest.
It’s not just in the production of oestrogen that insulin plays a role. It also has a direct impact on a hormone called lectin. Lectin is essential to fertility. If you do not have enough lectin in your bloodstream you will not go through puberty and therefore be infertile. On the flip side, too much lectin will stimulate the body to start puberty too soon. As lectin is produced by fat cells, the average overweight person has too much lectin and of course, the average overweight girl will start menses earlier. In the 1850s the age in which women started their menses was 16. It is now age 10. And of course if you start puberty early you start burning through your egg supply earlier and so now we find more and more women starting the menopause in their late 30s.
Not to mention the wider, social impact of our daughters becoming “sexy” in their early teens with the widening of hips and developing of breasts. Worryingly, they are also giving out pheromones to any man in the vicinity that they are fertile, which is an entirely natural and unavoidable process, designed to allure the opposite sex.
So how can we combat this? Diet and lifestyle are key. We must retrain ourselves and educate our children that food can be used as poison or medicine. We must also try to help our prepubescent girls in keeping the weight down if we want to preserve their fertility longevity and allow them to be “girls” that little bit longer. The same is true for boys if we want them to be fertile, without the embarrassment of ED and to be able to produce adequate sperm to conceive later in life.
But how can we be expected to do this when we’re already a country where more of our inhabitants are overweight or obese than those that are not?
Continuous Blood Glucose Monitors otherwise known as CGMs are becoming more popular, particularly in the States, but we are seeing a move to them being used more and more here in the UK.
I feel it’s important we utilise whatever technology is at our fingertips to improve the state of the world’s fertility. Not only for our patients but for our children. After all, it is estimated that with the widespread decline in fertility in both men and women, that most couples will need to use IVF by the year 2050. It’s a worrying prediction for our children and for humanity as a whole!
So, in order to get ahead on this new trend I’ve enlisted the help of our fantastic and hugely knowledgeable Nutritionist, Rachel Davies. She has a special interest in fertility but also, as her title suggests, she knows a lot about eating well.
Rachel has been working with me in the background to help us roll out a new service in providing patients with their own CGMs that can track their insulin levels throughout the day. From there, Rachel can work with you to look at areas in your diet and lifestyle that can be changed. The beauty of CGMs is that you can see for yourselves, first hand, the difference those dietary changes are making to your blood sugar spikes.
CGM users report that they have transformed their lives, not just in managing weight but also in alleviating afternoon fatigue, headaches, low mood, insomnia - these symptoms can all stand to benefit from tracking blood glucose.
Of course, personally speaking, I am very excited as to how this might transform the fertility outcomes for our patients.
If you are interested in our new CGM service please get in touch so that we can provide you with more information.
Dr Benjamin Bikman, 2020, Why We Get Sick? The Hidden Epidemic at the Root of Most Chronic Disease - and How to Fight It
Verity Allen - BSc, BA, MBAcC, Lic Ac