The Effects of Inositol on Women with Polycystic Ovary Syndrome(PCOS) NHM 491 – Presentation Objective

The effect of inositol supplementation on infertility in women with PCOS. Both MYO (inositol myo) and DCI (d-chiro-inositol) have been studied in infertile women with PCOS, with MYO showing the most promise in improving ovulation and egg quality. Inositol is a member of the B-vitamins and a component of the cell membrane. Inositol is found in fruits, beans, grains, and nuts and is also made by the body. It's believed that women with PCOS may have a defect in "secondary messengers" contributing to insulin resistance. MYO and DCI work as these secondary messengers. Source: http://www.pcosnutrition.com/index.php?pID=39

What is Polycystic Ovarian Syndrome (PCOS)? PCOS is an endocrine disorder affecting 5% to 10% of reproductive age women. PCOS is characterized by high levels of androgens (male hormones such as testosterone) from the ovary and is associated with insulin resistance. Tiny cysts, hence, "poly cysts", usually but not always, surround the ovaries appearing upon an ultrasound as a strand of pearls. The cysts are actually a result of hormonal imbalances not the cause of them.

Causes and Diagnosis The cause of PCOS is unknown. Strong belief is that PCOS is related to a combination of endocrine, genetic and/or environmental factors. Risk factors include obesity, physical inactivity, or genetics. Diagnosis (Based on American Society for Reproductive Medicine and the European Society of Human Reproduction agreements) is based on two of the following three findings: no ovulation, high androgen levels, and/or ovarian cysts. Other conditions that produce similar symptoms include adrenal hyperplasia, hypothyroidism, and hyperprolactinemia.

PCOS and Insulin Researcher believe that PCOS’s pathology is due to insulin resistance. Elevated insulin levels stimulate the body to make excessive amounts male hormones. Because of hyperandrogenemia and insulin resistance it is very easy for PCOS patient to gain weight.

Insulin Resistance and PCOS Insulin production by the pancreas is thrown off by insulin resistance. Increases the amount of stored fats. In women with PCOS, insulin resistance encourages the conversion and storage of fat and the production of excessive amounts of the male hormones.

PCOS and Infertility PCOS is the Most Common Endocrine Disorder Among Women of Reproductive Age Polycystic Ovary

PCOS and Nutrition Say NO to Sugar! Soy – Controversial Whole Grains Protein Snack Healthy Unsaturated Fats – Mono & Poly Source: http://eating.health.com/2009/09/10/new- sugar-guidelines-not-so-sweet-news-for-your- heart/#sthash.wQC4kHIK.dpuf

Changes in Diet Helping to Improve PCOS Symptoms. Numerous studies have shown that weight loss and/or improvements in eating patterns can reduce insulin and androgen levels and induce ovulation. Some studies have even shown that normalizing eating patterns in people with eating disorders including bulimia and binge eating disorder, can improve the appearance of cysts around the ovaries. This includes eating a balanced diet with regular activity. Some dietary supplements may be helpful as well.

Inositol and Metabolic Effects Both MYO and DCI have been shown to improve metabolic factors in PCOS, with MYO showing the most promise. One large randomized, double-blind, placebo-controlled trial showed that MYO (4 g/day) for 14 weeks, increased HDL levels and resulted in significant weight loss (and decreased leptin levels) in women with PCOS, although no change in insulin was detected. Venturella et al showed that 2 g/day of MYO for six months resulted in significant weight loss and improved HDL and LDL levels.48 MYO at 1,200 mg/day for 12 weeks significantly decreased androgens and insulin in non-obese women with PCOS. Source:Venturella R, Mocciaro R, De Trana E, D'Alessandro P, Morelli M, Zullo F. [Assessment of the modification of the clinical, endocrinal and metabolical profile of patients with PCOS syndrome treated with myo-inositol]. Minerva ginecologica. 2012;64(3):239-243.

Inositol and Fertility Effects In a study published in 2007 in Gynecological Endocrinology, 25 women received MYO (4g/day) for six months. The results: 88% of patients had one spontaneous menstrual cycle during treatment, of whom 72% maintained normal ovulatory activity. A total of 10 pregnancies (40% of patients) were obtained.

A Study on the Effects of Metformin verse MYO in Women with PCOS Sixty women received metformin Sixty women received MYO Better success rates with MYO Metformin MYO Daily Amount 1500mg 4g +400 mcg folic acid Ovulation Success 50% 65% Pregnancies 11% 18%

In a study authored by Nestler in 1999 in the New England Journal of Medicine, 1,200mg of DCI was given to women with PCOS for 6 to 8 weeks while another group received a placebo. Results: DCI increased the action of insulin, decreased androgens, triglycerides, blood pressure and improved ovulation (86% of women ovulated). Source: Nestler JE, Jakubowicz DJ, Reamer P, Gunn RD, Allan G. Ovulatory and metabolic effects of D-chiro-inositol in the polycystic ovary syndrome. NEJM. 1999;340(17):1314-1320.

Conclusion Women with PCOS have unique nutritional concerns, requiring specialized nutrition guidance. Lifestyle modification through diet is an effective and important part of the treatment for PCOS. Improvement to eating can result in weight loss, improved fertility, prevention of diabetes and overall improvement of health.