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A Powerful Tool for PCOS

In this week’s video, I focus on PCOS (Polycystic Ovarian Syndrome), a fancy name for a hormonal imbalance that affects a reported ~10% of women, a woefully low estimate in my opinion. The estrogen dominance (and often excess androgens) present in these women will lead to many states of dis-ease downstream. It’s an important one for you to master!

These women may struggle with a wide variety of symptoms including Weight gain, Fatigue, facial or excess body hair growth, Thinning hair on the head, Infertility, Acne, Irritability, Headaches, Insomnia, and Headaches.

As usual, we want to focus here on understanding the Dynamics at play in this type of imbalance (and not the Diagnosis).  Many women with PCOS are not ovulating optimally (or, therefore, making much progesterone) and this puts them in an estrogen dominant state.  This Anovulation is often caused by excessive testosterone as a result of high insulin levels from insulin resistance.  Are you checking fasting insulin in your patients with PCOS-like dynamics?    

We know that insulin resistance is epidemic!  And it is indeed reversible in many cases with persistent lifestyle change.  Targeted short-term supplementation use can help to increase insulin sensitivity.  In the case of PCOS, I want to introduce you to the power of Inositol.  Check out this sample entry about Inositol below from our Q&A Treasure Chest.  This database supports our students with a huge array of questions and case studies about biochemistry, interconnectedness, symptoms, lifestyle choices, interventions, nutrients, labwork, supplements, medication considerations, and much, much more.

This is the fourth in a four-part series about hormones.  If you missed the other ones, check out  the first video (unexpected, negative effects of oral hormone supplementation),    the second (why oral progesterone helps with sleep but why other solutions might be more appropriate), and/or the third video (PMS rapid relief recommendations). 

I hope this information is helpful to you and the patients and clients you serve!

Warmly,

 
Q&A Treasure Chest entry, “Inositol and Insulin Resistance”
Question:  Hi – I understand that inositol is another supplement that might be helpful for countering insulin resistance.  And maybe also PCOS?  I would really appreciate your insight and review of whether there is research validating either of these common patient issues.  Thanks!
Response:

Indeed, there is good research demonstrating the effectiveness of Inositol in alleviating PCOS (polycystic ovarian syndrome) in women, specifically via improving insulin resistance.

First of all, some basics.  Inositol is often referred to as “one of the B vitamins”, though it is not consistently regarded as essential in this way.   Inositol is actually a sugar alcohol and can be made in the body from glucose.  We also can absorb it from our diet in a few forms including citrus fruits and lecithin (which is a combination of inositol and choline).  It is the synergistic teamwork of both inositol and choline that gives lecithin its fat emulsifying capability e.g. in preventing or alleviating fatty liver and reducing triglycerides.  Inositol supplementation has been shown to reduce levels of small, dense LDL in those with metabolic syndrome.

As with many nutrients, inositol has many different isomers, including myo-, d-chiro, and l-chiro forms.  Inositol has many identified, key functions in the human body including insulin cell signaling, subcellular membranes, and intracellular calcium management.  It is a component of some phospholipids found in membranes and lipoproteins.  It also affects receptor sensitivity for some neurotransmitters such as serotonin and acetylcholine.  Hence inositol is often used to counter anxiety or panic attacks (one of my favorite supplements for anxiety is Xymogen’s RelaxMax which includes multiple agents in a convenient, good-tasting powder e.g. a great choice for those trying to stop using alcohol or marijuana or pasta/cookies every evening  to self-medicate their anxiety).

Nearly all of the research into inositol’s effectiveness in countering insulin resistance has been done specifically in the context of countering PCOS (and thus all in menstruating women).  There is no clear reason, however, to believe that the effects would not also be significant in women without PCOS.   I am aware of one study showing significant improvement in metabolic syndrome in postmenopausal women.  However, by definition, it’s quite unclear as to whether there would be similar benefits available to men.  One might assume so, but I could find no clear evidence of this being tested or validated in clinical study.

Inositol has been shown repeatedly to restore ovulation (and here) and increase pregnancy in women with PCOS, in both normal weight and obese categories.   In many of the high-dose studies (and here and here and here,  from 1200-4000mg daily), there was a marked improvement in glucose, insulin, and testosterone levels as well, showing the nutrient is addressing the common metabolic and interactive hormones drivers of PCOS.   There were ovulatory benefits in lower-dose studies (e.g. 200-400mg/day)  but less or no other marked improvement in other metabolic markers (e.g. insulin).  One study also identified dramatic improvements in two common symptoms of androgen dominance (acne and hirsutism)  in young women with PCOS.  Duration of treatment in the studies ranged from 3-12 months with significant benefits being demonstrated (where measured) by the three-month mark.  I typically recommend 2500-3000mg/day for my own clients.

Both myo-  and  d-chiro inositol  forms have been shown in most studies to be effective at reducing insulin resistance.  A couple of studies have looked at this opportunity more closely and identified  more rapid benefits achieved using a synergistic combination of myo- and d-chiro-inositol as opposed to myo-inositol alone.  Improvement in the end was equal in extent for the two scenarios; the combination was simply effective more quickly.   There is some evidence that a lack of availability or utilization of d-chiro inositol in tissues is a direct causative factor in insulin resistance.   Whether this is a primary or secondary effect is unclear.

Supplement options are readily available.  A combination myo- and d-chiro inositol product can be found in items such as Designs for Health’s “Sensitol” (capsules).   Pure Encapsulations offers the myo- form in “Inositol” which is a loose powder (a nice, easy option given inositol is sweet and quite palatable).   When using inositol separately in some way, I recommend doing so in combination with a broad-spectrum B-complex supplement to ensure availability of key cofactors.

High-dose inositol is contraindicated (as is true for the vast majority of supplements) in those with kidney disease.  Otherwise, none of the studies I reviewed identified any significant side effects or safety concerns after over a year of intake up to 4 grams daily.

Research into the use of inositol to counter depression or anxiety has used much higher doses (6-18g/day).  For example, a dose of 18g/day was found to be as effective as fluvoxamine (an SSRI) after a month of use in treating panic disorder.  This

As a random, interesting aside (given we’re all nutrition buffs on some level), phytic acid (an aggressive mineral binder in the gut and common ingredient in foods, especially those which are seeds in nature e.g. nuts, legumes, grains) is a derivative of inositol (attached to several phosphate groups).   You’ve probably seen it as a supplement with a fancy name:  inositol hexaphosphate (or IP6).  That’s just phytic acid.  We typically break down in the gut 50% or more of the phytic acid we consume.  Because phytic acid can bind with minerals however (then we call it phytate), it’s important that our mineral intake is nice and high – and our digestion nice and strong!  Despite a lot of myths otherwise, phytic acid is not “evil” in the body.  It’s actually been shown to increase the activity of natural killer cells and perhaps confer anti-cancer capability.   As with most things in the body (like estrogen and cholesterol), these substances are important, but too much of a good thing can become a not good thing.

 


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10 Questions for “A Powerful Tool for PCOS”

  1. 5
    Samantha says:

    Is Inisitol safe for pregnant and breastfeeding moms?

  2. 4
    Keira Coverdale says:

    Hi SAFM Team,
    I have found such great information about PCOS on this site – thanks!!! It is clear that insulin resistance is the key. Tracy outlined several specific supplements and brands which is so helpful(Thorne’s Basic B, Sensitol, Thorne’s Berberine, Metagenics probiotic, HistaEze). My question is: For a patient who does not want to take metformin, what should the supplement protocol be in conjunction with the diet change (low glycemic and diary/gluten elimination)? Start with Inositol or Berberine? Can you start the B-complex supplements simultaneously to starting one (or both) of those?

  3. 3
    Shoba Kumar says:

    Hi

    Inositol and Sensitol are same my doctor recommend sensitol for me. Need some feedback on this.

    Thanks
    Shoba

    • 3.1
      SAFM Team says:

      Indeed, Sensitol is just an excellent-quality brand name supplement by Designs for Health that contains inositol, in both the myo- and d-chiro forms (which I mention below).

  4. 2
    hannah says:

    Hello. Inositol seems to be the supplement of choice for PCOS within functional medicine now. I also hear of dietitians recommending it. I personally experienced such rapid weight gain with inositol that I hesitate to recommend it to PCOS clients who also have subclinical hypothyroidism like myself. I’m interested to know your thoughts on this.

    • 2.1
      SAFM Team says:

      Fascinating. I personally only know of cases of the opposite. I know of no reason why inositol would be specifically connected to weight gain; it may be that other coincident dietary changes, supplement additions, or increased stress is at play? In fact, there is some evidence that inositol helps to improve thyroid function – via immune modulation which notably reduced autoantibodies (and by the role of normalized progesterone in better balancing estrogen in order to increase available free thyroid hormones). These may be of interest to you: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5331475/ and https://www.ncbi.nlm.nih.gov/pubmed/28724175 . There are indeed certain supplements that can promote weight gain in some individuas (e.g. S. Boulardi probiotic), but again, I know of no data/pathway of that for inositol (assuming you were using a bio-available form with myo- or d-chiro and ideally a combination of both). I can think of 3 things which might be helpful:
      1. If you have subclinical hypothyroidism, it’s likely that you have trouble in particular with T4 to T3 thyroid hormone conversion, and indeed, supporting yourself as appropriate with key nutrient cofactors would be key – especially selenium and zinc.
      2. It’s also key that in using inositol in situations to improve insulin sensitivity (and reducing fasting insulin) that (1) dietary change to decrease the potential of elevated blood sugar and (2) stress reduction to keep cortisol optimal are still crucial. Otherwise, we keep promoting the vicious cycle of high blood sugar eventually promoting the return of insulin resistance.
      3. If you had rock-bottom progesterone and your body started to (finally) make some via ovulation, there can indeed be a short-term effect of increasing estrogen dominance if that dynamic is already at play (in addition to PCOS). This is because progesterone primes estrogen receptors. Perhaps this promoted some water retention? So for a given individual, we still have to deal with the separate impairments at play, and supporting better estrogen clearance and balance would be key if this is an issue. At SAFM we are always talking about making sure that downstream pathways are clear and functioning before addressing upstream factors; in other words, you wouldn’t try to address poor water pressure by turning the spigot on more fully for water to flow through a hose that still has holes in it. We fix the hose first; then turn up the water. I hope that helps!

  5. 1
    Angela Gladkowski says:

    Hi Tracy,
    Such wonderful information! My question is if a client is taking metformin they can safely take Inositol at the same time? And in addition to the Inositol cantaking a b-complex be helpful, especially if the client has a MTHFR gene mutation? Thank you so much!

    • 1.1
      SAFM Team says:

      Yes! Certainly a person should check with their physician for any unique considerations, but I know of no reason these would be contraindicated. Just keep in mind that any collection of agents designed to improve insulin sensitivity might eventually lead to low blood sugar from over-medication with the metformin. If the aggregate intervention in reversing the insulin resistance is effective, a person will eventually need to lower/cease their metformin in order to allow blood sugar to be optimal.

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