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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
i D-Chiro-inositol and its significance in polycystic ovary syndrome: a systematic review.Galazis N, et al. Gynecol Endocrinol. 2011 Apr;27(4):256-62. doi: 10.3109/09513590.2010.538099. Epub 2010 Dec 10.
ii “Effects of d-chiro-inositol in lean women with the polycystic ovary syndrome” Iuorno MJ et al. Endocr Pract. 2002 Nov-Dec;8(6):417-23.
iiiMyoinositol as a Safe and Alternative Approach in the Treatment of Infertile PCOS Women: A German Observational StudyPedro-Antonio Regidor and Adolf Eduard Schindler International Journal of Endocrinology. Volume 2016 (2016), Article ID 9537632
iv Myoinositol as a Safe and Alternative Approach in the Treatment of Infertile PCOS Women: A German Observational StudyPedro-Antonio Regidor and Adolf Eduard Schindler International Journal of Endocrinology. Volume 2016 (2016), Article ID 9537632
v Treatment of hirsutism with myo-inositol: a prospective clinical study>” M Minozzi, G D Andrea, V Unfer Reproductive BioMedicine Online Volume 17, Issue 4, 2008, Pages 579-582
vi
Ovulation induction with myo-inositol alone and in combination with clomiphene citrate in polycystic ovarian syndrome patients with insulin resistanceZdravko Kamenov, Georgi Kolarov, Antoaneta Gateva, Gianfranco Carlomagno & Alessandro D. Genazzani Gynecological Endocrinology Vol. 31 , Iss. 2,2015
vii
Effects of myo-inositol supplementation on oocyte’s quality in PCOS patients: a double blind trial. Ciotta L et al. Eur Rev Med Pharmacol Sci. 2011 May;15(5):509-14.
viii
Inositol supplement improves clinical pregnancy rate in infertile women undergoing ovulation induction for ICSI or IVF-ET. Zheng X et al. Medicine (Baltimore). 2017 Dec;96(49):e8842. doi: 10.1097/MD.0000000000008842.
ix
Inositol supplement improves clinical pregnancy rate in infertile women undergoing ovulation induction for ICSI or IVF-ET. Zheng X et al. Medicine (Baltimore). 2017 Dec;96(49):e8842. doi: 10.1097/MD.0000000000008842.
 
x’ Myo-inositol may improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomised trial.Papaleo E, Unfer V, Baillargeon JP, Fusi F, Occhi F, De Santis L. Fertil Steril. 2009 May;91(5):1750-4. doi: 10.1016/j.fertnstert.2008.01.088. Epub 2008 May 7.
xi’ Pretreatment with myo-inositol in non polycystic ovary syndrome patients undergoing multiple follicular stimulation for IVF: a pilot study.’ Lisi F, et al. Reprod Biol Endocrinol. 2012 Jul 23;10:52. doi: 10.1186/1477-7827-10-52.
xii
The Combined therapy myo-inositol plus D-Chiro-inositol, in a physiological ratio, reduces the cardiovascular risk by improving the lipid profile in PCOS patients.’ Minozzi M, Nordio M, Pajalich R. Eur Rev Med Pharmacol Sci. 2013 Feb;17(4):537-40.
xiii
Ovulation induction with myo-inositol alone and in combination with clomiphene citrate in polycystic ovarian syndrome patients with insulin resistanceZdravko Kamenov, Georgi Kolarov, Antoaneta Gateva, Gianfranco Carlomagno & Alessandro D. Genazzani Gynecological Endocrinology Vol. 31 , Iss. 2,2015
xiv
The effect of myoinositol supplementation on insulin resistance in patients with gestational diabetes.”Corrado F et al. Diabet Med. 2011 Aug;28(8):972-5. doi: 10.1111/j.1464-5491.2011.03284.x.
xv Myo-inositol may prevent gestational diabetes in PCOS women. D’Anna R. et al.  Gynecol Endocrinol. 2012 Jun;28(6):440-2. doi: 10.3109/09513590.2011.633665.
Circulating markers of oxidative stress and polycystic ovary syndrome (PCOS): a systematic review and meta-analysis’Mora Murri et al. Hum. Reprod. Update (2013)
xvi
A pilot study: effects of decreasing serum insulin with diazoxide on vitamin D levels in obese women with polycystic ovary syndrome.Nestler JE, Reilly ER, Cheang KI, Bachmann LM, Downs RW Jr. Trans Am Clin Climatol Assoc. 2012;123:209-19; discussion 219-20.
xvii’ Vitamin D – roles in women’s reproductive health?Grundmann M, von Versen-Höynck F. Reprod Biol Endocrinol. 2011 Nov 2;9:146. doi: 10.1186/1477-7827-9-146.
xviii’ Plasma selenium levels in Turkish women with polycystic ovary syndrome. ’Coskun A, Arikan T, Kilinc M, Arikan DC, Ekerbiçer HC. Eur J Obstet Gynecol Reprod Biol. 2013 Mar 8. pii: S0301-2115(13)00064-X. doi: 0.1016/j.ejogrb.2013.01.021.
xix’ Altered Trace Mineral Milieu Might Play An Aetiological Role in the Pathogenesis of Polycystic Ovary Syndrome’Pratip Chakraborty et al. Biological Trace Element Research, April 2013, Volume 152, Issue 1, pp 9-15
xx “Association between Polycystic Ovary Syndrome and Gut Microbiota” Yanjie Guo et al. (2016) PLoSONE11(4): e0153196