Category Archives: Science & Research

PCOS and Epigenetics: It Didn’t Start With You

If you have PCOS, you might have wondered why. Was it something you did? Something your mom did? Something you could have prevented? The answer is no. PCOS is deeply rooted in genetics and epigenetics, and the factors that contribute to it may have been set in motion long before you were even born.

The Role of Epigenetics in PCOS

Epigenetics is essentially how your genes get “turned on” or “off” by things like environment, diet, and hormones. It doesn’t change your DNA, but it does change how your body reads it. That’s why two people with the exact same genes (like identical twins) can have totally different health outcomes.

When it comes to PCOS, epigenetics is a big deal. One of the biggest triggers? Exposure to high androgens (male hormones) in the womb. That early hormone exposure can flip switches on certain genes related to metabolism, hormones, and reproductive health, setting the stage for things like insulin resistance and irregular periods later on.

So while you can’t change your genes, you can change how they’re expressed. That’s where lifestyle comes in.

Androgen Exposure in the Womb

One of the most well-studied pathways in PCOS starts before you’re even born. When a baby girl is exposed to too much androgen in the womb, it can impact how her ovaries and brain develop, setting the stage for hormone imbalances later in life.

That early exposure can flip certain genes, like P450c17, which controls enzymes involved in androgen production. When those enzymes go into overdrive, the body starts making more androgens than it should. This contributes to many of the classic PCOS symptoms, like irregular periods, acne, excess hair growth, and trouble with ovulation.

But those high androgen levels? They don’t always come directly from your mom. Sometimes these changes were set in motion generations ago and passed down. One study even showed that epigenetic changes can carry through at least three generations. So if your great-great-grandmother experienced high androgen exposure from things like chronic stress, poor nutrition, or environmental toxins, those changes may have been inherited by the women in your family, raising the chances of PCOS in later generations.

This is why PCOS often runs in families, but looks different from person to person. One woman might struggle most with insulin resistance and weight gain. Another might have irregular cycles or fertility challenges. Someone else might deal with acne or hair growth. How it shows up in your body depends on both your genetic wiring and everything your body has been exposed to throughout your life.

The bottom line? It’s not your fault, but there are things you can do to change the way your body responds now.

PCOS Can Be Passed Down for At Least Three Generations

While PCOS has strong genetic and epigenetic roots, the environment during pregnancy can tip the scale even further. A mom’s diet, stress levels, and especially her insulin levels during pregnancy all influence how her baby’s genes get expressed.

Here’s how it works: high insulin levels in pregnancy can trigger higher androgen production. And that extra androgen exposure in the womb can alter the baby’s hormonal development, raising the risk of PCOS later in life. This is one reason why maternal insulin resistance has been linked to a higher chance of PCOS in daughters.

Of course, no one chooses to have insulin resistance, but understanding how it affects pregnancy can be a game-changer. Because if we can break the cycle now, we can lower the risk for future generations.

You Did Not Cause Your PCOS

Understanding the role of epigenetics in PCOS is powerful because it removes the blame. You didn’t cause your PCOS. Your mom didn’t cause it either. Even if she has it too, it wasn’t passed down just through her diet or lifestyle. The groundwork for PCOS was likely laid generations ago.

And while we can’t change the past, we can change how we respond to it.

Research shows that targeting insulin resistance helps get to the root of PCOS. That’s why a Low Insulin Lifestyle can be so effective. By keeping insulin levels low, you help regulate androgen production, improve ovulation, and reduce the frustrating symptoms so many people with PCOS deal with—like acne, irregular cycles, weight struggles, and fatigue.

This isn’t about blame—it’s about empowerment. And knowing how to shift your body’s response starting right now.

The Takeaway

PCOS is not something you caused. It is not your fault. The roots of this condition run deep, spanning multiple generations. But the good news is that understanding the science behind PCOS gives you the power to manage it in a way that supports your body. While we cannot change the past, we can take control of our health moving forward.

By taking steps to keep insulin levels as low as possible during pregnancy, you may also lower the risk of passing PCOS to your daughter, giving future generations a stronger foundation for hormonal health.

Lilli Health was not built overnight. It was the result of years of research, clinical studies, and a relentless drive to change the way we approach insulin resistance and PCOS. But before Lilli Health became a reality, it started with a struggle—one that shaped the future of this company.

A Personal Challenge Becomes a Research Focus

Like so many others with PCOS, I spent years following the conventional advice—only to find that it was making things worse. As a registered dietitian, I knew how to follow the rules. But despite doing everything “right,” my symptoms worsened. My periods became more irregular, my skin issues persisted, and my weight kept climbing. The more I learned, the more I realized that something critical was missing from the conversation: insulin.

That realization led me down a path of scientific discovery. My doctoral dissertation focused on a novel approach to PCOS treatment—what I would later call a Low Insulin Lifestyle. Instead of just looking at calories, carbs, or weight loss, I focused on insulin itself. The results were undeniable. By prioritizing foods that kept insulin levels low, we saw significant improvements in metabolic markers, hormonal balance, and PCOS symptoms.

From Dissertation to Prestigious Research Fellowship

After earning my doctorate, I continued my research as a National Institutes of Health (NIH)-funded postdoctoral fellow. I knew my findings were groundbreaking, but the real test came when an independent group of reproductive endocrinologists replicated the study. Their results confirmed what I had seen firsthand—targeting insulin was the key to effectively managing PCOS. This was bigger than a single study. It was the beginning of a paradigm shift in how we understand and treat this condition.

A National Science Grant and the Birth of Lilli Health

With mounting evidence behind a Low Insulin Lifestyle, I knew it was time to take action. In 2021, my work was recognized with a National Science Foundation Innovation Corps Grant, awarded to science-backed startups with the potential to make a major impact. This grant helped bring the vision of Lilli Health to life.

Lilli Health was built on the foundation of science, research, and real-world success. It is more than a company—it is the first-ever digital platform dedicated to treating insulin resistance and PCOS at the root cause.

From a dissertation to a national grant, Lilli Health has been built on evidence, not trends. And this is just the beginning.

We are here to change the future of PCOS care—because the answers have been here all along.

 

Publications

• Pohlmeier AM, et al. Effect of a low-starch/low-dairy diet on fat oxidation in overweight and obese women with polycystic ovary syndrome. Appl Physiol Nutr Metab. 2014. Read more
• Phy JL, et al. Low Starch/Low Dairy Diet Results in Successful Treatment of Obesity and Co-Morbidities Linked to Polycystic Ovary Syndrome (PCOS). J Obes Weight Loss Ther. 2015. Read more
• Kishan R, et al. Spontaneous Pregnancies in Polycystic Ovary Syndrome (PCOS) Patients with a Low Starch/Low Dairy Diet: A Retrospective Case Series. J Community Med Public Health. 2022. Read more
• Jackson B, et al. Nutritional education (face-to-face and video instruction) for polycystic ovary syndrome results in greater reduction in bmi and hemoglobin a1c than caloric restriction, exercise and metformin (Abstract). Fertility and Sterility. 2022. Read more
• Rastad H, et al. Dairy consumption and its association with anthropometric measurements, blood glucose status, insulin levels, and testosterone levels in women with polycystic ovary syndrome: a comprehensive systematic review and meta-analysis. Front Endocrinol (Lausanne). 2024. Read more

This lifestyle wasn’t developed in a lab or as a trendy diet—it was born out of personal struggle. I developed this way of eating when I was in a dark place, desperately trying to figure out what was wrong with my body. Even as a dietitian, doing everything I was taught—counting calories, eating whole grains, and following all the conventional nutrition advice—nothing worked. In fact, I was only getting worse.

It started with a question: What is driving this? How can I fix it?

So, I started reading. And I didn’t stop. This was in 2009—before Instagram influencers and TikTok experts. I dove into PubMed, reading every research paper I could find. I came across something that wasn’t being talked about back then: insulin.

At the time, I had learned nothing about PCOS—especially not the role of insulin. In school, PCOS was briefly mentioned during a discussion about type 2 diabetes. That’s it. But the more I read, the more I realized that PCOS is fundamentally a metabolic disorder driven by insulin.

Then I asked myself, what drives insulin? Because all I had learned in school about insulin was how much to give a diabetic to manage blood glucose. Nothing about what causes insulin levels to rise or how to lower them. That was the moment everything changed.

I began experimenting on myself, changing how I ate—not by focusing on calories, carbs, or portion control—but by prioritizing foods that didn’t spike insulin. And it worked. For the first time, my symptoms improved, my cycles regulated, and I felt like myself again.

Then I wondered… If this worked so well for me, would it work for others?

The rest is history.

I received a prestigious Laura W. Bush Institute for Women’s Health Research grant—an incredible achievement for a doctoral student—and officially began studying the effects of a Low Insulin Lifestyle. I partnered with a reproductive endocrinologist and PCOS expert to conduct the first study, and the results were even more powerful than I could have imagined.

That was over a decade ago. Today, I’m still conducting research, refining this approach, and proving again and again that an insulin-first approach is the key to reversing metabolic dysfunction.

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An Overview of the Research

Over the years, we’ve conducted multiple studies on the Low Insulin Lifestyle, each providing more evidence that focusing on insulin, not calories, is the key to long-term metabolic health.

The Pilot Study

Our first study was small but incredibly promising. We had participants follow the Low Insulin Lifestyle for just 8 weeks. On average, participants:

• Lost 19 pounds
• Dropped fasting insulin by over 50%
• Experienced significant symptom relief (better cycles, improved energy, less hunger)

Even more impressive? This was without calorie restriction—just by eating foods that naturally kept insulin levels low.

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The Metabolic Study

This study went deeper into fat metabolism and showed that lowering insulin drastically improves fat oxidation—meaning that instead of storing fat, the body actually burns it for fuel.

Participants following the Low Insulin Lifestyle:

• Better able to burn fat
• Showed improved metabolic flexibility (the ability to switch between burning carbs and fat efficiently)
• Had significantly lower insulin levels and inflammation markers

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The Case Series

A group of real-world patients who had been struggling with infertility followed a Low Insulin Lifestyle and were tracked by an independent group of fertility specialists and Ob/Gyns. The results were remarkable:

• Patients conceived naturally within an average of 86 days after starting this lifestyle

This case series further reinforces what we’ve seen in clinical studies—improving ovulation and increasing the chances of pregnancy start with lowering insulin. We’ve known this for a long time, but generally, it’s just treated using metformin. By addressing insulin resistance through a Low Insulin Lifestyle, the body can restore hormonal balance, supporting natural conception without the need for intensive fertility treatments.

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The Randomized Controlled Trial (RCT)

This was the gold standard of research—a randomized controlled trial comparing the Low Insulin Lifestyle to conventional dietary advice (“eat less and exercise more”) plus metformin. This study was conducted by an independent group of reproductive endocrinologists and Ob/Gyns. The results were undeniable:

• A Low Insulin Lifestyle was significantly more effective at reducing insulin and A1c than standard lifestyle advice and treatment
• Participants lost more weight without calorie restriction
• Markers of inflammation and cardiovascular health improved

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Ongoing Research: The DAISY and LILACS Studies

We are continuing to study the long-term effects of a Low Insulin Lifestyle and how it impacts metabolic health, hormone balance, and overall well-being.

The DAISY Study

DAISY: Determining Associations of Insulin Resistance with Symptoms in PCOS Patients

• Measuring insulin resistance in patients with PCOS
• Exploring correlations between insulin levels, medical history, and symptoms
• Providing more evidence that insulin testing should become a standard part of PCOS diagnosis and treatment

Study Link: DAISY Study – Clinical Trials

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The LILACS Study

This is our most exciting study yet—the LILACS study is investigating the Low Insulin Lifestyle as an FDA-cleared treatment for weight loss in patients with PCOS.

• A randomized controlled trial to test the effectiveness of the Lilli App and Low Insulin Lifestyle
• Designed to support FDA clearance of the first-ever digital therapeutic for insulin resistance and PCOS
• If successful, this could change the standard of care for PCOS and metabolic health

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The Bottom Line

This lifestyle is not just another diet. It’s not about counting carbs, calories, points, or macros. It’s about understanding insulin and making intentional choices that work with your metabolism, not against it.

The research speaks for itself. This works. And now, for the first time, we have the technology (through the Lilli App and Lilli Metabolic Testing Kits) to track and measure metabolic health like never before.

This is the easiest, most sustainable way to lower insulin, reverse insulin resistance, and live a healthier life.

And we’re just getting started.

 

References

• Pohlmeier AM, et al. Effect of a low-starch/low-dairy diet on fat oxidation in overweight and obese women with polycystic ovary syndrome. Appl Physiol Nutr Metab. 2014. Read more
• Phy JL, et al. Low Starch/Low Dairy Diet Results in Successful Treatment of Obesity and Co-Morbidities Linked to Polycystic Ovary Syndrome (PCOS). J Obes Weight Loss Ther. 2015. Read more
• Kishan R, et al. Spontaneous Pregnancies in Polycystic Ovary Syndrome (PCOS) Patients with a Low Starch/Low Dairy Diet: A Retrospective Case Series. J Community Med Public Health. 2022. Read more
• Jackson B, et al. Nutritional education (face-to-face and video instruction) for polycystic ovary syndrome results in greater reduction in bmi and hemoglobin a1c than caloric restriction, exercise and metformin (Abstract). Fertility and Sterility. 2022. Read more
• Rastad H, et al. Dairy consumption and its association with anthropometric measurements, blood glucose status, insulin levels, and testosterone levels in women with polycystic ovary syndrome: a comprehensive systematic review and meta-analysis. Front Endocrinol (Lausanne). 2024. Read more

The PILOT study was where it all started. After discovering the power of insulin in my own health journey, I knew I needed to take this to research. But getting funding as a doctoral student isn’t easy. That’s why receiving a prestigious research grant from the Laura W. Bush Institute for Women’s Health was such a big deal—it meant that this question was worth exploring at a higher level.

A PILOT study is a small-scale preliminary study conducted before a larger trial to test whether an approach is effective, feasible, and worth studying on a bigger scale. It helps researchers refine their methods and determine if their hypothesis holds up. This study was a first step in proving that insulin—not calories—was the key driver of PCOS symptoms.

With this funding, we were able to recruit 24 patients diagnosed with PCOS to follow what would later become known as the Low Insulin Lifestyle.

But what happened next was unexpected.

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The Unexpected Results

Before the study could even be completed, several participants dropped out—because they got pregnant naturally. For many of these women, they had been told they would never conceive without fertility treatments. And yet, within a matter of weeks, they were ovulating on their own.

This was a major lightbulb moment. If lowering insulin could restore ovulation this quickly, what else could it do?

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Study Design: What Did We Test?

The 24 participants in the study were instructed to follow a Low Insulin Lifestyle for eight weeks.

This meant:

• No calorie restriction—they were allowed to eat as much as they wanted
• Focusing on foods that keep insulin low (avoiding starch, sugar, and non-fermented dairy)
• Eating naturally satisfying meals—without measuring portions or tracking macros

Although they weren’t told to count calories or macros, when we analyzed their food intake, we found that on average, participants were naturally eating:

• ~1,500 calories per day
• ~70g of fat, mostly from monounsaturated fats (think avocados, olive oil, nuts, and seeds)
• ~25g of fiber per day
• ~90g of carbohydrates

As you can see from what their food logs showed, they weren’t eating low-carb or keto, they weren’t overloading on protein. They just ate real food. This wasn’t a diet—it was a metabolic reset.

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The Results: What We Found

At the end of eight weeks, the results spoke for themselves:

• Fasting and 2-hour insulin levels dropped significantly—even in those who had “normal” blood sugar’
• A1c levels were significantly improved, even though they started out relatively normal
• Weight loss occurred naturally without calorie restriction (19 POUNDS!) and patients lots inches around their waist and hips
• Menstrual cycles regulated, and several patients conceived during the study
• Patients reported improved PCOS symptoms
• Markers of inflammation and cardiovascular risk improved

Can we take a moment to acknowledge that every single patient in this study had completely normal glucose and A1c levels, yet their insulin levels were 4x higher than they should have been? And yet, insulin testing still isn’t part of clinical guidelines. So basically, all of these patients would have been given a clean bill of health, a pat on the back, and told to “just keep trying”—all while their actual problem was being completely ignored.

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What This Means for PCOS and Insulin Resistance

Even in a small sample, this study demonstrated that insulin is a key driver of PCOS symptoms. And more importantly, lowering insulin can lead to rapid, meaningful improvements in metabolic health, ovulation, and overall well-being.

This study paved the way for our next research study: The METABOLIC Study, which would take these findings even further.

References

Phy JL, et al. Low Starch/Low Dairy Diet Results in Successful Treatment of Obesity and Co-Morbidities Linked to Polycystic Ovary Syndrome (PCOS). J Obes Weight Loss Ther. 2015. Read more

After the PILOT study demonstrated how lowering insulin could improve PCOS symptoms and restore fertility, the next big question was:

What is insulin actually doing to metabolism, and why does it make it so hard for people with PCOS to burn fat?

That’s where the METABOLIC Study came in.

For years, people with PCOS had been told that their inability to lose weight was because they ate too much or didn’t exercise enough. But that explanation didn’t hold up. Even women who followed traditional low-calorie diets struggled to lose weight, and when they did, they often gained it all back (or more).

So what if the real problem wasn’t calories—but insulin?

This study set out to measure exactly what was happening in the metabolism of women with PCOS before and after following a Low Insulin Lifestyle.

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Why High Insulin Prevents Fat Burning

Insulin isn’t just a blood sugar hormone—it’s also the master regulator of fat storage and fat burning.

When insulin is high, the body is in fat-storage mode—it holds onto fat and prevents stored fat from being used for energy. This means that even when someone fasts overnight, their body still isn’t burning fat efficiently. Normally, when you go several hours without eating (like overnight while you sleep), your body should switch to burning stored fat for energy. This is what happens in a healthy metabolism.

However, in women with PCOS, this wasn’t happening.

To measure this, we looked at a key metabolic marker called the Respiratory Exchange Ratio (RER).

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What Is Respiratory Exchange Ratio (RER)?

RER is a scientific measurement of what fuel your body is burning—carbohydrates or fat. It is measured by looking at how much oxygen you breathe in versus how much carbon dioxide you exhale. Science is so cool.

• RER of 1.0 or higher: Your body is burning mostly carbohydrates (typical in patients with insulin resistance)
• RER of 0.85: Your body is using a mix of carbs and fats
• RER of 0.7: Your body is burning mostly fat (this is ideal for weight loss and metabolic flexibility)

In healthy individuals, RER naturally drops overnight as the body shifts into fat-burning mode during fasting. However, in women with PCOS, we found something alarming:

Even after fasting all night, their bodies were still burning sugar, not fat!!

This confirmed what we suspected: high insulin levels were blocking fat burning.

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How We Tested Fat Metabolism

To see whether we could improve fat oxidation, we had participants:

1. Drink a high-fat shake
2. Measure how their body responded for five hours

Before the study, their bodies were only burning the sugar in the shake and storing all the fat as body fat.

But after following a Low Insulin Lifestyle for eight weeks, we measured them again.

This time, something incredible happened. For the first time, they were able to access their own fat stores for energy—a crucial step for sustainable weight loss.

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The Results: Turning the Body Into a Fat-Burning Machine

After just eight weeks, we saw:

• A HUGE improvement in fat burning—their bodies were now actually burning the fat in the shake for energy instead of storing it.
• No metabolic slowdown. Even though their total energy expenditure slightly declined (as expected when your body weighs less), when we measured energy burned per pound of body weight, it didn’t decrease at all. This is completely different from what happens on traditional low-calorie diets.
• No muscle loss. Despite losing weight, participants maintained their lean muscle mass—even though they were not allowed to exercise during the study.

This is exactly the opposite of what happens on restrictive diets, where metabolism slows down and people often lose muscle along with fat.

This graph shows how the body’s ability to burn fat changed before and after following a Low Insulin Lifestyle. Before (blue line), participants’ bodies barely burned any fat after drinking a high-fat shake—instead, they were stuck burning sugar and storing the fat. After just eight weeks on this lifestyle (gray line), their bodies became much better at using fat for energy. This means lowering insulin helps unlock fat burning, making weight loss easier and more sustainable without extreme dieting or muscle loss.

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Why This Study Was a Game-Changer

The METABOLIC Study proved that:

1. High insulin levels prevent fat burning in women with PCOS.
2. Lowering insulin allows the body to naturally burn fat instead of storing it.
3. Unlike traditional dieting, this approach doesn’t slow metabolism or cause muscle loss.

This study completely changed the narrative around PCOS and weight loss. It showed that PCOS isn’t a “calories in, calories out” problem—it’s an insulin problem.

This study paved the way for further research and proved that the Low Insulin Lifestyle is the key to reversing insulin resistance, improving metabolism, and achieving long-term health without metabolic damage.

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Why Participants Didn’t Lose Muscle (Even Without Exercise)

Another major benefit? Patients didn’t lose muscle mass—even though they weren’t exercising.

This is a huge deal.

Why? Lower insulin meant they could finally burn stored fat for fuel meaning their bodies didn’t need to burn muscle for energy. 

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What This Means for Women with PCOS

The METABOLIC study showed that insulin resistance in PCOS isn’t just about weight—it fundamentally blocks your ability to burn fat.

But it also proved that this can be reversed.

By lowering insulin through a Low Insulin Lifestyle, participants were able to:

• Start burning fat for efficiently
• Maintain muscle mass and metabolism
• Avoid metabolic slowdown seen with other diets

This laid the foundation for what happened next.

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The Next Step: The Case Series

Now that we saw how insulin was blocking fat burning, we wanted to see what happened when real-world patients followed a Low Insulin Lifestyle for fertility.

That’s where the Case Series comes in. This study took women with PCOS who had been struggling with infertility who conceived naturally after following a Low Insulin Lifestyle.

This was the real-world proof that lowering insulin isn’t just about weight—it’s about restoring overall health.

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References

Pohlmeier AM, et al. Effect of a low-starch/low-dairy diet on fat oxidation in overweight and obese women with polycystic ovary syndrome. Appl Physiol Nutr Metab. 2014. Read more

The journey to pregnancy can be incredibly challenging for women with PCOS. Many are told they’ll need fertility treatments or medications to conceive, leaving them feeling hopeless and frustrated. But what if managing insulin levels was the missing piece of the puzzle?

We’ve long known that metformin can help women with PCOS ovulate and conceive, but what if targeted lifestyle changes could achieve the same—if not better—results?

That’s exactly what this retrospective case series set out to explore. Conducted by an independent group of reproductive endocrinologists and OB/GYNs, the study tracked real-world patients following a Low Insulin Lifestyle to see if improving insulin sensitivity could help restore natural fertility. The results were nothing short of groundbreaking.

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Why PCOS Impacts Fertility

PCOS is one of the leading causes of infertility, affecting up to 20% of women worldwide. The main driver? High insulin levels.

Excess insulin triggers the ovaries to produce too much testosterone, which disrupts ovulation and leads to irregular cycles. Without regular ovulation, conception becomes difficult or even impossible.

Most fertility treatments focus on forcing ovulation through medications like Clomid or letrozole, or bypassing the issue altogether with in vitro fertilization (IVF). However, this study suggests that addressing insulin resistance at its root may be a natural way to restore fertility.

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Study Overview

This retrospective case series examined PCOS patients who had been struggling with infertility and followed a Low Insulin Lifestyle.

A total of 12 patients who had previously been unable to conceive were tracked, and researchers examined whether their fertility improved simply by changing their diet—without the use of fertility medications.

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The Results

The findings were astonishing:

• All 12 of patients resumed regular ovulation after following a Low Insulin Lifestyle
• Pregnancies occurred within an average of 86 days after starting the lifestyle
• Some patients who had previously undergone failed fertility treatments conceived naturally
• No fertility medications were needed for these spontaneous pregnancies

These results support the idea that restoring insulin sensitivity may be the key to restoring ovulation and natural conception.

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Why This Study Matters

This case series challenges the conventional approach to treating infertility in PCOS. Instead of immediately jumping to medications or invasive procedures, focusing on lowering insulin levels may allow the body to restore ovulation naturally.

By following a Low Insulin Lifestyle, women with PCOS may significantly improve their chances of conception without needing expensive fertility treatments.

Of course, not every case of infertility is caused by insulin resistance alone, and some patients may still require additional support. However, this study strongly suggests that insulin management should be a first-line approach before resorting to medications or assisted reproductive technologies.

Since most fertility specialists and women’s healthcare providers don’t routinely test insulin levels in patients struggling to conceive, this highlights an important gap in care and reinforces why insulin testing should be a standard part of fertility evaluations.

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Next Steps: The RCT

The results of this case series were so compelling that they led to a randomized controlled trial (RCT) comparing the Low Insulin Lifestyle to traditional dietary advice and metformin. The RCT, which followed a much larger patient group, confirmed that the Low Insulin Lifestyle was significantly more effective at reducing insulin levels, restoring ovulation, and improving overall PCOS symptoms.

This growing body of research reinforces what so many women with PCOS have already discovered firsthand: lowering insulin levels is the key to long-term hormonal balance and improved fertility.

For those struggling with PCOS-related infertility, this case series offers a message of hope—restoring fertility may be as simple as changing the way you eat.

For years, women with PCOS have been told to simply eat less and exercise more. They’ve been handed Metformin and told it might help. And when that didn’t work, they were made to feel like they just weren’t trying hard enough. But what if the entire approach was flawed from the start?

That’s exactly what an independent randomized controlled trial (RCT) set out to investigate—comparing the Low Insulin Lifestyle to the conventional advice of calorie restriction, exercise, and Metformin. The results? This lifestyle didn’t just hold its own against standard recommendations—it crushed them.

This wasn’t just any study. It was an independent trial, meaning it wasn’t conducted by us, but by a separate group of researchers. That’s incredibly important because for research to be meaningful, it needs to be replicated by different teams and still show the same results. The fact that an outside group tested this lifestyle and found it to be more effective than conventional advice? That’s huge.

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Study Design: A Tough Competitor

This wasn’t a small observational study or a personal success story. This was a randomized controlled trial, the gold standard of research.

Fifty-six women with PCOS were randomly assigned to one of two groups:

• The Low Insulin Lifestyle Group

  • Followed a Low Insulin Lifestyle
  • No calorie counting, no portion control, no exercise requirement
  • Received either in-person dietary counseling or a web-based education program

• The Standard PCOS Treatment Group

  • Followed conventional medical advice: calorie restriction, increased exercise, and metformin

This was a true head-to-head matchup: a new and unique approach vs. the traditional “eat less, exercise more” plus metformin. Metformin is an incredible medication for lowering insulin, so this was no easy competitor to beat. If our approach even slightly outperformed metformin, that would be groundbreaking.

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The Results: A Clear Winner

After just eight weeks, the results showed that the Low Insulin Lifestyle wasn’t just effective—it was more effective than the standard treatment.

• More Weight Loss Without Calorie Restriction – Women following the Low Insulin Lifestyle lost more weight without having to count calories or restrict portions.

• Greater Improvement in Blood Sugar and A1c – A1c, a measure of average blood sugar, improved more in the Low Insulin Lifestyle group, showing better long-term glucose control.

• Better Insulin and Hormonal Balance – Lower fasting insulin and testosterone levels—both major drivers of PCOS symptoms.

• Lower Triglycerides – A Low Insulin Lifestyle significantly reduced triglyceride levels, which shows improved heart health.

• Web-Based Delivery Worked Just as Well – Women who received the education online saw the same improvements as those who got in-person counseling. This makes the lifestyle accessible and scalable to women everywhere, including through a mobile app.

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Why This Matters

This study beat metformin. Let’s pause on that for a second.

Metformin is an amazing drug. Some consider it the fountain of youth. It directly lowers insulin levels, improves insulin sensitivity, and helps regulate blood sugar. It is hands-down one of the best medications that has ever been invented. And yet, a lifestyle approach—eating the right foods without restriction—worked better.

That’s incredible.

And let’s not forget: this lifestyle worked without exercise. Participants in both groups were asked to keep their activity levels the same to ensure diet was the only variable. Despite this, women in the Low Insulin Lifestyle group still lost more weight, improved their metabolic health, and balanced their hormones—all without hitting the gym.

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What’s Next?

The success of this study laid the foundation for even more research. Next up is the LILACS study, a large-scale randomized controlled trial designed to take everything we’ve learned so far and apply it to a broader population.

LILACS will further validate the impact of the Low Insulin Lifestyle delivered through the Lilli App on insulin resistance, metabolic health, and PCOS symptoms—but on a much larger scale. This study will be a key step toward FDA clearance for the Lilli App, making this approach more widely recognized and accessible.

Each study builds on the last, adding to the growing body of evidence that PCOS is not about eating less and exercising more—it’s about fixing insulin resistance.

Women with PCOS deserve better than outdated advice and medications that only mask symptoms. They deserve a solution that actually works. And thanks to this research, we’re proving that solution exists.

For years, research has shown that insulin resistance affects the majority of adults, yet most healthcare providers still focus on managing symptoms rather than addressing the root cause. The DAISY Study (Determining Associations of Insulin Resistance with Symptoms) is designed to change that by uncovering the true extent of insulin resistance—even in those with normal blood sugar levels.

The goal of this study is simple: to prove that insulin resistance is present in the majority of patients, even when traditional tests don’t catch it. If we can demonstrate that insulin testing is a more reliable way to diagnose and manage insulin resistance, it could reshape clinical guidelines and lead to earlier, more effective interventions.

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Why This Study Matters

Most patients with insulin resistance are told their blood sugar levels are “normal” and sent on their way—never realizing that their insulin levels are three to four times higher than they should be. This delay in diagnosis can mean years of worsening health before a doctor finally recognizes the problem.

The DAISY Study is important because:

• It challenges outdated diagnostic methods. Fasting glucose and A1c are still the standard for diagnosing metabolic issues, despite research showing that insulin resistance develops decades before blood sugar becomes abnormal.
• It highlights the importance of insulin testing. If we find that the majority of patients have high insulin levels—even with normal glucose—this could further push for routine insulin testing in clinical practice.
• It helps explain the wide range of PCOS symptoms. Insulin resistance contributes to everything from irregular periods and infertility to weight gain, acne, and excess hair growth. Understanding how insulin impacts these symptoms will help patients and doctors take a more targeted approach to treatment.

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Study Design

• Participants: Anyone over 18 years of age (male or female and with or without PCOS)
• Testing Includes:
  • Fasting Insulin & Glucose – To measure baseline insulin resistance
  • C-Peptide – A secondary marker of insulin production
  • Lipids – Markers of heart health
  • Triglyceride-to-HDL Ratio – A known marker of insulin resistance
  • Inflammatory Markers (C-Reactive Protein) – To evaluate how insulin resistance contributes to chronic inflammation

By looking at these markers together, the DAISY Study will paint a clearer picture of how insulin resistance impacts PCOS—beyond just blood sugar.

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What We Expect to Find

• High insulin levels in the majority of adults, even with normal glucose and A1c
• Stronger correlations between insulin resistance and PCOS symptoms than with BMI alone
• Links between insulin resistance and inflammation, fertility issues, and metabolic health in both males and females
• Clear evidence that insulin testing should be a standard part of routine care

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Changing the Future of PCOS Care

For too long, PCOS patients have been overlooked and underserved when it comes to insulin resistance testing. The DAISY Study aims to change that by providing undeniable evidence that insulin resistance is present in nearly all PCOS patients (as well as patients without PCOS), regardless of weight or glucose levels.

If these findings hold, the case for routine insulin testing will be stronger than ever. This could lead to:

• Better, earlier diagnosis of insulin resistance
• More effective treatment strategies that target the root cause instead of just symptoms
• A shift in clinical guidelines to prioritize insulin testing alongside traditional metabolic markers

PCOS care is long overdue for an update, and the DAISY Study is an important step toward making that happen. By proving that insulin resistance should be the primary focus of PCOS treatment, this study could change the way insulin resistance is diagnosed and managed for good.

For decades, PCOS patients have been given the same frustrating advice—lose weight, take birth control, or try metformin if needed. But what if there was a validated, science-backed lifestyle approach that could effectively treat PCOS without medications?

That’s exactly what the LILACS Study (Lilli App Clinical Study) is designed to prove. This isn’t just another nutrition study—it’s a randomized, waitlist-controlled trial designed to evaluate the real-world impact of this lifestyle on insulin resistance and PCOS symptoms. This study takes a real-world approach by comparing it to what usually happens in clinical practice—patients being told to lose weight and come back in a few months. That’s why the waitlist control design is so important. It reflects the typical standard of care, making it a strong comparison for understanding the true impact our unique approach.

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Why This Study Matters

PCOS research has long focused on weight loss as the primary goal for improving symptoms, but this study shifts the focus to insulin levels—which are the real driver of PCOS. It builds on previous research showing that lowering insulin levels can lead to weight loss and improve fertility, metabolic health, and PCOS symptoms without calorie restriction or excessive exercise.

This study is important because:

• It’s real-world applicable. Instead of comparing the Low Insulin Lifestyle to medications or extreme interventions, it compares it to the reality that many PCOS patients face—being told to “just lose weight” with no clear guidance.
• It strengthens the case for insulin testing. PCOS patients are rarely tested for insulin resistance, despite overwhelming evidence that it plays a major role in their symptoms. If this study shows significant improvements, it could further push for routine insulin testing.
• It helps validate prior research. Previous studies, including a randomized controlled trial, a retrospective case series, and metabolic studies, have all pointed to the benefits of lowering insulin. This study is another step in replicating and expanding that research.

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Study Design

• Participants: Patients diagnosed with PCOS and insulin resistance
• Groups:
  • Intervention Group: Immediately start the Low Insulin Lifestyle
  • Waitlist Control Group: Continue with standard care for the first part of the study, then start the intervention
• Duration: 8 weeks of lifestyle intervention

Because this is a waitlist-controlled study, both groups will eventually receive the intervention. This makes it ethically sound while still allowing for a meaningful comparison between the intervention and typical care.

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What This Study Will Measure

The LILACS Study will track multiple key health markers to evaluate the effectiveness of the Low Insulin Lifestyle. Some of the main outcomes include:

• Weight loss and body composition improvements
• Changes in insulin resistance (measured by fasting insulin, C-peptide, and other metabolic markers)
• Menstrual regularity and ovulation restoration
• Improvements in PCOS symptoms like acne, hirsutism, and energy levels
• Patient-reported quality of life

By gathering this data, we can quantify how well this approach works and set a new standard for PCOS treatment.

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The Potential for FDA Clearance

This study is not just about proving that the Low Insulin Lifestyle works—it’s about getting it recognized at the highest level.

If the study shows significant benefits, the Lilli Health app could become the first FDA-cleared digital therapeutic for PCOS. This means:

• Doctors could formally refer patients as a validated treatment for PCOS
• Women could access science-backed support without needing medication
• The Lilli Health app could be covered by insurance, making it even more accessible

This would be a game-changer for PCOS care. Instead of outdated advice that puts all the burden on the patient, PCOS treatment could finally be backed by real clinical data and FDA clearance.

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Why This Matters for You

If you have PCOS, you deserve more than just “eat less and exercise more.” The LILACS Study is about proving that a targeted, insulin-focused lifestyle is the most effective way to reverse PCOS at the source.

By prioritizing insulin management, we’re not just managing symptoms—we’re giving women the tools to take control of their health, improve fertility, regulate hormones, and feel better than ever.

The LILACS Study is a pivotal step in changing the future of PCOS treatment—and we can’t wait to share the results.

How Human Migration Shaped Our Metabolism

We all have different genetics, different body types, and different tendencies when it comes to metabolism—and insulin resistance is no exception. While insulin resistance is largely lifestyle-driven, there’s a very real genetic piece that plays into your personal risk.

So let’s rewind tens of thousands of years.

As humans migrated out of Africa and into every corner of the world, we adapted to the climates, environments, and food availability around us. This shaped everything from skin tone to digestion to—yes—how much insulin we produce. And these adaptations still influence us today.

Let’s break it down by major ancestral populations to see how this plays out in real life.

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African and Black Populations

Populations with Sub-Saharan African ancestry often have a high insulin response to food. They tend to oversecrete insulin and also have a reduced ability to clear insulin from the blood. Historically, this was an incredible survival advantage—higher insulin levels meant more fat storage, which offered protection during times of famine or food scarcity. But in today’s world, where food is constantly available and often ultra-processed, this same trait can become a serious liability.

It leads to a greater risk of weight gain, chronic inflammation, and metabolic diseases.

This helps explain why African American and other Black populations experience some of the highest rates of insulin resistance, Type 2 Diabetes, and PCOS—even at lower body weights. And it’s also why obesity is so prevalent in these communities. It’s not a lack of willpower—it’s how the body is wired. The issue isn’t eating too much. It’s eating in a way that constantly spikes insulin in people who are genetically predisposed to overproduce it.

To make matters worse, many diseases are more aggressive in these populations, including Alzheimer’s, multiple sclerosis, and cardiovascular disease. It all traces back to the underlying chronic inflammation fueled by insulin levels that stay high for too long.

This is why the solution isn’t “calories in vs calories out”—it’s eating in a way that works with your biology to keep insulin levels stable. When you lower insulin, you calm inflammation, and improve metabolic health.

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East Asian Populations

On the flip side, people of East Asian descent tend to under-secrete insulin. That means their pancreas simply doesn’t produce as much insulin overall, and often can’t keep up with the body’s demands—especially after eating.

Because insulin is your fat-storage hormone, not making enough of it means they’re less likely to struggle with weight gain. But here’s the catch: they can still be insulin resistant and develop prediabetes or Type 2 diabetes at much lower body weights. In fact, many East Asians store more visceral fat—the dangerous kind that wraps around organs—even if they appear slim on the outside.

They also tend to have lower levels of IGF-1 (a growth factor similar to insulin), which is linked to shorter stature but also longer lifespans and lower cancer risk.

So if you’ve ever wondered why someone can be thin, eat tons of rice and noodles, and still develop diabetes—this is why. It’s not that rice and noodles are magically healthy. It’s that their pancreas can’t keep up. That’s why you’ll often see diabetes in East Asian populations—even in those who appear thin.

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South Asian and Middle Eastern Populations

South Asians have some of the highest rates of insulin resistance and Type 2 diabetes, even at a young age and at much lower BMIs.

They’re genetically predisposed to central fat storage (more fat around the organs), which is much more dangerous than subcutaneous fat. This visceral fat is highly inflammatory and contributes to early insulin resistance, metabolic syndrome, and even cardiovascular issues.

Many South Asians also have a strong tendency to over-secrete insulin—especially in response to starch and sugar. This makes their traditional diets, which are often rich in white rice, potatoes, lentils, roti, and dairy, particularly problematic. When you combine that kind of insulin-spiking diet with a genetic predisposition toward elevated insulin levels, it creates the perfect storm for metabolic dysfunction.

This helps explain why South Asian women with PCOS often struggle more severely with symptoms like obesity, acne, hirsutism, acanthosis nigricans, and hair loss. These aren’t random issues—they are all driven by high insulin. And in a population already prone to overproducing insulin, the impact is even more intense.

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Middle Eastern Populations

Middle Eastern populations, like their South Asian counterparts, often have a cultural diet that’s rich in starch-heavy staples: white rice, pita, flatbreads, lentils, potatoes, and sweetened dairy. These foods, while deeply woven into tradition, are also highly insulin-spiking—especially when eaten together and frequently throughout the day.

Genetically, many individuals of Middle Eastern descent tend to over-secrete insulin, especially in response to starches and sugars. This makes the traditional diet particularly problematic, as it keeps insulin levels high all day long. Over time, this chronic elevation of insulin drives fat storage, inflammation, irregular cycles, and higher risk of PCOS, Type 2 Diabetes, and cardiovascular disease.

You may often hear people say, “But everyone in my family eats this way!” That may be true—but your genetic makeup means your body processes those foods differently.

And here’s something important to understand: many Middle Eastern women struggle with weight, fatigue, skin issues, or irregular periods and are told “everything is normal.” But under the surface, insulin is silently driving hormonal imbalance.

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Indigenous Populations (Native American and First Nations)

Indigenous populations have some of the highest rates of diabetes in the world—not because of poor choices or lack of willpower, but because of a massive mismatch between their genetics and today’s food environment.

Even historically, when starch-heavy foods like corn were introduced, it didn’t go well. It’s well-documented that corn caused widespread tooth decay in tribal populations—because their bodies simply weren’t used to handling that much glucose. That alone should have been a clue.

Today, the traditional low-starch, low-sugar way of eating has been replaced with ultra-processed foods, and these populations are paying the price. The problem isn’t the people—it’s the food. Their bodies were never meant to handle this kind of diet, and it’s showing up as diabetes, heart disease, PCOS, and more.

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European Populations

European ancestry tends to fall somewhere in the middle. Historically, many Northern Europeans adapted to dairy consumption (thanks to the lactase persistence gene) and developed more mixed metabolic profiles—some under-secreting insulin, some over-secreting depending on the region and diet.

Starch, alcohol, sugar, and a sedentary lifestyle still wreak havoc here—but in general, people of European ancestry tend to develop insulin resistance later in life. That is, unless they have PCOS. Then all bets are off.

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Hispanic Populations: Split Into Two

Latino Ancestry (Central and South American Indigenous roots):
Latino individuals with Indigenous ancestry often carry the same thrifty genes that allowed their ancestors to survive food scarcity. That means their bodies are wired to hold onto calories and store fat—especially considering their high starch diets.

They’re more likely to have higher baseline insulin levels, insulin resistance, and metabolic syndrome at younger ages. Diets high in starches like rice, tortillas, corn, and beans only make this worse. These foods may be cultural staples, but that doesn’t mean they’re a good fit for your metabolism.

European Hispanic Ancestry (e.g., Spanish):
Those with mostly European ancestry may share more of the metabolic traits common in other European groups. However, the introduction of more starch and sugar into modern Hispanic diets has increased the metabolic burden across the board—regardless of ancestral breakdown.

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What Does This Mean for You?

No matter your background, you can’t out-genetics a modern diet.

Remember, you can’t look at what someone else eats and assume it will work for you. If your body tends to oversecrete insulin, a high-starch diet will lead to weight gain, no matter how “healthy” it seems. On the flip side, if you undersecrete insulin, you might stay lean but still struggle with blood sugar issues and poor metabolic health. It’s not about copying someone else’s plate—it’s about understanding your own biology and working with it, not against it.

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References

Goedecke JH, et al. Pathophysiology of type 2 diabetes in sub-Saharan Africans. Diabetologia. 2022. Read more

Mohan V. Lessons Learned From Epidemiology of Type 2 Diabetes in South Asians: Kelly West Award Lecture 2024. Diabetes Care. 2025. Read more

Lee J, et al. Evolving Characteristics of Type 2 Diabetes Mellitus in East Asia. Endocrinol Metab. 2025. Read more

Aguayo-Mazzucato C, et al. Understanding the growing epidemic of type 2 diabetes in the Hispanic population living in the United States. Diabetes Metab Res Rev. 2019. Read more

Hasson BR, et al. Racial/Ethnic Differences in Insulin Resistance and Beta Cell Function: Relationship to Racial Disparities in Type 2 Diabetes among African Americans versus Caucasians. Curr Obes Rep. 2015.