Episode #129: Inositol Insight: Evidence-Based Approaches to PCOS

Welcome back to the PCOS Repair podcast, where today I’m really excited to share a research article that I found on a topic that I get asked about all the time. One of the most commonly talked about supplements for PCOS is the inositols. I can give information on the dosing and so forth in general of what is recommended, but I was really excited to find and read a research article that really dove into all the different research. It looked at some of the research that talks about the dosing, that talks about what dosing is considered helpful, and also the ratio of the two different primary inositols that are helpful in PCOS. We’re going to go into depth on this particular research article today in this episode. I’m excited to share some of the information that has been generally accepted by the PCOS world, but now you’re going to be able to have a better understanding of why. As the supplement market, we’ve talked about in a recent episode how the supplement market can be quite confusing to navigate. In the show notes today, I will include the link to my Guide to Supplements, the inositol are on that, and it goes through in more detail than we’re going to get into today, how to know if it’s one that you may want to consider talking to your doctor about, or how you may want to consider other ones instead, or so forth.

So that guide will be in the show notes. So just before we get started, that will be there for you. You have to go to the web page to get that part of the show notes. It doesn’t show up on all of the listening platforms but if you go to the web page for the episode, which is linked in the show notes on all the listening platforms, you’ll be able to find that guide. You can also message me for it over on Instagram, and I’m happy to get that to you there. Okay, so without further ado, we’re going to dive into this research article. It’s a review article entitled, Inositol treatment for PCOS should be science-based and not arbitrary. This was published in March of 2020. This is a very recent article in the realm of research, and it looks at some of the studies and then also some of the applications over the last few years of what we’ve been learning more and more about the inositol group of supplements. This review aims to evaluate the many different inositol products and the composition of them. We need to look at a couple of different things before we look at what composition we want.

First of all, to conduct this study, they looked at different previous studies that looked at the significant groups of inocitals. They looked at the supplement market, and then looked at the research on actually how these supplements work in the body and specifically for women with PCOS. First of all, just a little background. The ovary uses high levels of myo-inositol. The two main anastal groups that we’re going to be talking about today is myo-inositol and d’chiro-inositol. Sometimes they abbreviate those. If you go and read the journal article, which I will also link on the website show notes page for this episode, MI is myo-inositol and DCI is d’chiro-inositol. Both of them are important and they both play a slightly different role. In women without PCOS, Yes, plasma ratios of myo-inositol to d’chiro-inositol are 40 to 1. So the ratio would be basically 40% myo-inositol to 1% d’chiro-inositol. So that was in the plasma, but in the actual ovarian follicular fluid, they found the ratio to be closer to 100 to 1, 100% or 100 parts myo-inositol to 1% or one part d’chiro-inositol. There are two different specific ones here that we’re looking at. The MI is converted and used as an insulin secondary messenger that basically helps the cells use the glucose.

If you have glucose in your system, the myo-inositol is going to be the one that helps to get that glucose into your cells, be less insulin resistant, and get that glucose into your cells. Whereas the d’chiro-inositol worked more to help with glycogen synthesis. Glycogen synthesis is where we take the leftover glucose that doesn’t need to be absorbed into the cells, and we turn it into glycogen in the liver, and we store it for easy and accessible use in the short term. Myo-inositol was also influential in the FSH signaling, so whether or not we want to mature a follicle during the first part of the cycle. Then the d’chiro-inositol was more involved in the insulin-mediated androgen production of the ovaries. Both of them, you can see, if you’ve listened to any of the recent episodes on how these hormones work and how androgen production is coming to be in excess in PCOS, which we’ve talked about in the last couple of weeks, you can see where these two different types of inositols are working on some very primary systems inside of our bodies that relate to PCOS, specifically. There was a controlled study that was done in 1999, and this study looked at the d’chiro-inositol.

Basically, 1,200 milligrams were given to the study group, and then there was a placebo group, and given to them once a day for 6-8 weeks. The 44 overweight women improved their insulin sensitivity and decreased their circulating free testosterone levels compared to the placebo group having zero change. That showed in that study that the d’chiro-inositol was helpful in a metabolic capacity for women with PCOS. Also, in addition, this resulted in 19 of the 22 women, which is 86% ovulated during the study, whereas only 6 of the 22 women in the placebo group ovulated. So not only did it show an improvement in metabolic health, but it also improved chances of ovulation. Then another study began. In this study, they were going to give a higher dose, and it was done by a pharmaceutical company, and it was going to dose d’chiro-inositol twice as high at 24 milligrams per day. This research was actually never published because in the research process, it was discovered that this higher dose of d’chiro-inositol failed to reproduce any of the outcome of the previous one. It has since been seen that a higher dose is actually unhelpful. It’s not just there’s some discrepancy between which research articles you read, but it’s either not helpful as in no change, no statistical effect whatsoever, to possibly actually harmful, meaning a decrease in ovarian production and ovulation.

Then other previous studies have highlighted the pivotal role in myo-inositol for success in IVF treatment. It was also reported that the follicular fluid or the FF volume of its myo-inositol were significantly higher in follicles that were mature and fertilized and went on to be viable embryos. Basically here, what the article is saying is that there is a positive correlation between having higher levels of myo-inositol in the follicles to being a more viable follicle that’s more likely to become mature and then more likely to become a viable embryo. Now, our body naturally produces both of the inositols, especially if it has the appropriate nutrients and so forth to do that. When we see that certain things show a higher amount, like in this follicular fluid, that means that our body may have shuttled or sent the inositol to that follicle, and then that follicle became the dominant follicle. It doesn’t necessarily mean that the other ones were somehow deficient or something like that. It just means that we’re seeing a correlation where for some reason, this is an important part of having a healthy matured follicle that is more likely to become an embryo. In a 2007 randomized control trial Trial, 30 women with PCOS were tested with myo-inositols, and they looked at different things like the gonadotropin releasing hormones, and so some interesting fertility aspects that this particular study found, it found that women treated with the myo-inositol compared to the control that was treated with a placebo, like a sugar pill, nothing that had any of the active ingredient in it, obtained an increased frequency of spontaneous menstrual cycles.

Findings also suggested that myo-inositol may be useful in the treatment of infertility. Then several follow-up studies that that first study led to showed that the benefits definitely related to ovulation with myo-inositol. Women with PCOS undergoing IVF had an increased sensitivity to FSH. Basically, the FSH did a better job for women, their natural FSH was more effective in maturing and preparing a follicle for ovulation in their cycle. Then we started to research the difference between administering myo-inositol versus d’chiro-inositol and what effect it had on the matured follicle as well as any potential egg that was released during ovulation. We found that the number of high-quality eggs was much higher in the Myo-inositol group than in the d’chiro-inositol group. A potential explanation for this phenomenon is the tissue-specific nature of insulin resistance in women with PCOS. Basically, there’s the combination of it working in the actual ovary itself, as well as improving the androgenic effect in PCOS at a metabolic level of the resistance in insulin sensitivity. All right, so then the research goes on to review some of the more recent studies, looking at the combination in what ratio. So looking at the different formulations of myo-inositol and d’chiro-inositol combinations.

They looked at combinations of a 20 to 1, so 20 myo-inositol, 1 d’chiro-inositol, 40 to 1, and 80 to 1. Then the authors found that not only was 40 to 1 better for restoring ovulation, but it was also better at normalizing other parameters such as LH, progesterone, sex hormone-binding globulin, estradiol, and testosterone. Those were secondary things that they were looking at in this study, but the 40 to 1 also improved those parameters and not just the success of ovulation. Then the article goes on to different in-depth explanations as to why this ratio is probably so important. If you want to read through those, I will again link the article below but as the research article wraps up, it talks about how do we look at things in the market and how to select the supplement option that would be best for you or best for potentially improving PCOS symptoms. Considering that the 40 to 1 ratio through many different studies has proven to stand the test of many different groups and many different studies and many different setups and many different setups of different ways of studying the compounds, seems to be the favorable ratio.

That would be the number one thing to look at when you’re looking for what formulation to buy. My supplement guide, again, has the one that I recommend because it has been one, it’s a reputable brand, two, it has that 40 to 1 ratio. That’s really what you’re looking for there. I have had a lot of people ask me about inositol supplements, and it’s a pure d’chiro-inositol. Now, Some of these things are not wrong for other applications. As you heard early on in the article review, the d’chiro-inositol works on that metabolic health. If for someone who’s really more concerned about the metabolic health or a male who isn’t worried about their ovarian function, that may be a good choice. Now, the problem is that marketing companies are going to reach far and wide for who their supplement may be for, and maybe it said something about being for PCOS. When you’re looking for a brand of the inositols, that you’re looking for one with a 40 to one ratio. This is one of those articles that you could also bring to your doctor if you were asking whether or not this would be a good supplement for you and if they had a specific brand that they recommended.

In a conversation piece, some doctors do recommend Myoenocetol or some combination thereof. If they’re recommending one, again, Again, individually, they’re not necessarily bad, although for PCOS, we’re looking at the 40 to 1 ratio indicating to be the best option. You could have this article in your back pocket as a discussion factor with your physician. If you’re asking whether or not one of the inocitals or the combination there would be a good choice for your PCOS. When you’re looking at the market, however, besides the 40 to 1, this article found that evidence was not as strong. Not as strongly studied, not as severely looked at, and also not as much evidence pointing towards this being a problem. But there was some evidence that additional additives, so other antioxidants, vitamins, minerals, and so forth, may have had an effect of actually impairing the quality of the Myo-inositol supplements, so having some impact on them. The conclusion of this particular research article was that companies are doing that more as an added marketing rather than something that was super helpful in the actual supplement of the Myo-inositol and d’chiro-inositol. My takeaway from this is you’re looking for whether or not an inositol would be a good addition to your PCOS supplement.

That’s a conversation to have with your doctor. Then secondly, you’re looking for one with a ratio of 40 to 1 with only those two ingredients in it, really. I mean, there’ll be fillers and whatever makes it into a powder or a capsule and so forth but you’re not looking for one that has added vitamins. You’re not looking for a one-stop shop. Those have their benefits in your general health. But in the regards to what the Myo and d’chiro-inositol are doing for your PCOS, the other additives are not assisting in that and may potentially be impairing the effects of the Myo and d’chiro-inositol and their benefits to PCOS. As a recap, This article, hopefully, answers a lot of those questions that I’ve been getting asked about what is the best Myo-inositol or a d’chiro-inositol, and what’s the correct ratio, and is it a good supplement for PCOS? The women that If you don’t have any ovulatory or cycle irregularities, they would be ones to consider taking some inositol product. Again, that would be a conversation for you to have with your physician. Then the other potential would be if you have a tendency towards the insulin effect root cause.

These are really some types where we would want to consider this as an option. Now, where we may want to be careful, and there has not been studies that show this to be problematic, but any time that we’re looking at a combination of supplements or medications that we’re taking, if we’re taking something else that’s working on our insulin pathways, we may just want to be careful that we’re not overdoing it and creating a problem of becoming all of a sudden hypoglycemic and having too low of blood sugar. Again, that’s why as you put together the list of supplements that you’re interested in taking for your PCOS, this is something that you want to run by your physician and make sure that there’s not any interaction with other things you may be taking or other supplements that you may be considering as well. With that, a couple of recaps of the resources that you have from this episode. One, hopefully that answers your questions. Two, if you go to the website page for this episode, you’ll find the supplement guide that goes through all the different supplements that I recommend for PCOS and what considerations to each one, best practice dosing for general PCOS care so that you can take that and discuss them further with your doctor and see which ones may be a good fit for you.

With that, there will also be the link to this article so that you can read into all of the scientific reasons behind why some of this may be the way that it is, if you’re interested, or to have that research article to refer to in any conversations with your healthcare provider. With that, feel free to reach out to me over on Instagram if you need help getting that supplement guide or have any follow-up questions. I’d love to hear from you all over there, and you can find me @nourishedtohealthy. Other than that, until next time. Bye for now.