Nutrition & PCOS

Nutrition is an excellent treatment option and provides practical ways to reverse the metabolic imbalances of PCOS. Exciting new research into the role of the microbiome is also opening up additional avenues for treatment.

Inositols

Inositols are DCI-IPG mediators that control sugar metabolism in cells by determining whether sugar that arrives in cells is stored as fat or burned to power it. They’re also known as vitamin B₈ (vitamins must come from the diet, and gut bacteria synthesise some inositols, so they don’t quite qualify).

Inositols are critical in PCOS because:

Insulin controls sugar levels in the blood but not in the cells.
A deficiency of IPG mediators (inositols) can cause insulin resistance (and reduced control of blood sugar levels)
Insulin resistance is a significant contributor to PCOS, as the body attempts to control blood sugar levels by increasing insulin production (hyperinsulinemia).
Hyperinsulinemia stimulates the ovaries to increase testosterone production. It also reduces sex hormone-binding globulin SHBG in the blood, which raises the bio-availability of testosterone
High testosterone levels are the defining feature of PCOS
Medications that increase insulin sensitivity (such as metformin) are often part of PCOS treatment
Research points to women with PCOS being chronically deficient in inositols, and a recent review stated:

“The effects of metformin in improving insulin action in PCOS women was achieved through the release of DCI-IPG mediators.” ⁱ

The main types of inositol are myo-inositol and d-chiro-inositol (myo-inositol is the most beneficial to PCOS). Most inositol comes from our diet or from bacteria that depend on plant fibre, which further underlines the importance of the diet for fertility.

A mixture of 40:1 myo- and d-chiro-inositols is the most effective combination for women with PCOS. Irrespective of BMI, supplementing with inositols brings some fantastic benefits for women with PCOS: ⁱⁱ

Reduced insulin resistance and a safer, more effective treatment than metformin ⁱⁱⁱ
Reduced testosterone levels (by over half) ^iv
Reduced hyper-androgenism (male features)
Reduced hirsutism and acne ^v
Lower BMIs
Better ovulation rates ^vi
Better egg quality (supplementing for three months at 2g daily) ^vii
Better IVF-ET or ICSI clinical pregnancy rates ^viii
Improved egg quality and reduced miscarriage rates ^ix
Reduced need for IVF stimulation drugs and risk of OHSS ^x
Better implantation rates in pre-treated women ^xi
Reduced blood lipids (cholesterol) ^xii
Improved effectiveness of Clomid treatment ^xiii
Reduced the risk of gestational diabetes (from 54% to 17.4%) ^xiv-xv

The research into myo-inositol in pregnancy shows that it is relatively safe as it’s water-soluble, so any excess gets excreted.

A healthy diet is the best way to get inositols and helps achieve a balanced mix of vitamins, minerals, proteins, carbohydrates, fats, and fibre to support the microbiome. The best dietary sources of inositol are:

Nuts and seeds
Whole-grains and legumes (in descending order): chickpeas, brown rice, wheat germ, lentils, barley, oats, whole wheat flour, buckwheat
Fruit and vegetables: bananas, stone fruits, citrus (except lemons), cantaloupes, strawberries, cauliflower, Swiss chard and leafy greens
All beans and peas (especially soy, lima, and kidney)
Mushrooms and yeast
Beef (especially liver), but you get more B8 per gram from lentils
Egg yolk
Sardines and other oily fish

Do’s for Inositols	Don’ts for Inositols
Wholefoods	Processed grains like white bread, pasta, rice
Fresh food	Tinned, frozen or salted food
Probiotics	Long-term antibiotics (unless vital)
Organic meat	Meat with steroids or antibiotics
Omega 3 oils	Over two coffees a day (it destroys inositols)

Inositol deficiency causes some other conditions, including skin rashes, acne, neuropathy, muscle weakness, depression, and OCD, as well as tiredness, raised cholesterol, eye problems, hardening of the arteries and digestive issues (including Candida infections).

Inositols are available as supplements, and most PCOS trials involved 2-4g a day. There’s also evidence that supplementing (at doses of 18g a day) helps anxiety or panic attacks.

Antioxidants

Antioxidants are essential for all areas of health, and PCOS is associated with low antioxidant levels and high oxidative stress levels. ^xvi

There is evidence that increasing the amounts and range of antioxidants in the diet reduces PCOS development. If you choose to take supplements, we recommend “food-state” antioxidants as they’re incredibly well-tolerated and absorbed.

Vitamin D

Vitamin D deficiency is associated with PCOS, endometriosis, and general infertility. xvii Vitamin D is vital for the hormonal health of both sexes, and adequate vitamin D may reduce the chances of getting PCOS and limit its development once started.

Minerals

Selenium deficiency has links to high testosterone and LH levels and PCOS development ^xvii
Magnesium and chromium levels in the blood serum are significantly lower in PCOS women with insulin resistance ^xviii

The microbiome

The bacteria and other flora of the gut, vagina and womb play a decisive role in digestion, immune state, inflammation and metabolism. Therapeutic strategies now revolve around altering the microbiome for many conditions, including obesity, ulcerative colitis, Parkinson’s disease, and bacterial vaginosis.

Bacterial vaginosis (BV) is an essential consideration for women with PCOS as they’re far more likely to be affected, and it’s known to significantly reduce fertility: ^xx

	BV infection rates
Fertile women with no symptoms	15.4%
Women with unexplained infertility	37.4%
Women with PCOS	60.1%

The majority of the women had no symptoms to make them suspect they had BV. We recommend testing and supplementation with specialised products available from our shop.

References