I've always wanted to take this topic on but everytime I started, and I looked at the list of supplements needing to be covered, I've been overwhelmed.
Thank heavens for a network of professionals with different interests and talents! Christine Marquette, RD, LD, HFS, CLT, has recently released an e-book on this very topic. If you order it be sure to use the coupon code she's created for inCYST fans, INCYST10, for a 10% discount.
I've actually talked her into doing a webinar for us as part of the 2011 PCOS training. To name a few, Chris is covering: cinnamon, turmeric, American Ginseng, Saw Palmetto, D-Chiro-inositol, L-Arginine, Alpha-Lipoic Acid, the B vitamins, vitamins C, D, and a few minerals (calcium and magnesium).
Click here if you'd like to buy Chris' e-book on PCOS supplements.
If you'd like to test drive our professional training with this session, you can register for this topic alone ($40) at this link. If it turns out you like what you hear…you can apply the money you invest into our complete training ($425) if you do so on or before December 31, 2011.
Here's an interesting Cochrane Review hot off the presses, evaluating the effects of insulin-sensitizing agents on fertility.
A group of 31 studies that compared the effectiveness of these agents to a placebo were evaluated for what they said overall about the potential benefit for their use in women with PCOS who are trying to conceive. Of these, 27 were studies about metformin (likely because it is the most widely researched/used and more studies exist in the first place).
What the researchers concluded:
There is no evidence that metformin improves live birth rates whether it is used alone or in combination with clomiphene. However, metformin does improve ovulation and pregnancy rates. (Interpreted, this suggests that metformin does not help to prevent miscarriage.)
Metformin was also associated with a significantly higher incidence of gastrointestinal disturbance, but no serious adverse effects were reported. (I don't know about those of you reading this blog post who have tried metformin, but I would question the assertion that the gastrointestinal disturbance this medication causes is not a"serious adverse effect"!
IN THE WORDS OF THE AUTHORS:"In agreement with the previous review, metformin is still of benefit in improving clinical pregnancy and ovulation rates. However, there is no evidence that metformin improves live birth rates whether it is used alone or in combination with clomiphene, or when compared with clomiphene. Therefore, the use of metformin in improving reproductive outcomes in women with PCOS appears to be limited."
D-chiro-inositol was not even mentioned in the abstract, suggesting that the findings were not significant.
As with any information shared in this blog, only you and your provider can make the ultimate decision. I can tell you what went through my own mind--and heart--as I read this, was that this medication may create a lot of false hope and hurt for those who trust that it has more power than it actually does. I wouldn't wish a miscarriage on anyone.
Tang T, Lord JM, Norman RJ, Yasmin E, Balen AH. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD003053.
OK. Today's the day. There was finally a quiet morning to read the research about d-chiro inositol. Ever since I posted a link to Sasha Ottey's interview on the topic on her PCOS Challenge radio show, traffic linking to us with that keyword has been very high. I've known we needed a blog post, but I just wanted to be sure it was scientifically accurate and presented information in a way that was beneficial, not hurtful.
What is inositol? It is a chemical that is necessary for several body functions, including: cell structure, insulin function, nerve function, fat breakdown, and maintenance of healthy cholesterol levels.
Inositol comes in nine different forms. Two of those types of inositol, myo-inositol and d-chiro-inositol, have been found to have therapeutic value. Myo-inositol supplementation has been found to alleviate symptoms of bulimia, panic disorder, obsessive-compulsive disorder, agoraphobia, depression, and bipolar disorder. d-chiro-inositol supplementation has been found to be useful for symptoms associated with insulin, high androgen levels, and menstrual irregularity. It is also reported that myoinositol can help prevent hair loss.
Both categories of symptoms are common in PCOS, so it appears that inositol levels and metabolism may be problematic with a high percentage of readers of this blog.
One thing you can do to help improve your levels of both myo- and d-chiro-inositol is to know their dietary sources. Myo-inositol is found in brewer's yeast, liver, milk, whole grains, brown rice, oats, nuts, citrus fruits, molasses, legumes, raisins, and bananas. The best sources of d-chiro-inositol are buckwheat and garbanzo beans (hummous, anyone?)
The theory is, that women with PCOS have trouble converting myo-inositol into d-chiro-inositol. So they need to bypass that metabolic bottleneck with a supplement.
I haven't had the opportunity to use d-chiro-inositol with my clients yet. I haven't wanted to recommend anything unless I'd researched it. But I had a client once, with severe OCD, who responded well to myo-inositol in a way medication and behavioral therapy never achieved. The only issue she had with the supplement was the large dose she needed to take (10 grams per day) in order to see benefit.
Fast forward to today, I've been wondering for awhile if maybe the symptoms attributed to myoinositol deficiency weren't actually myoinositol issues at all, but d-chiro-inositol issues, and the large dose needed was because the conversion in this population is so low.
So here's the best way I would think it would work to determine if d-chiro-inositol deficiency is your problem.
1. Be sure to include all the foods I mentioned above in your diet on a regular basis.
2. Try d-chiro-inositol. Give it three months of regular use to see if it helps. --If it helps with your insulin levels, androgen levels, and menstrual cycles, then by all means continue using it! --If it helps with the above, but doesn't help with binge eating, mood, or obsessive thinking, then consider adding some myoinositol to the mix.
3. And please, check back with us. I'm really curious to know what happens. If d-chiro-inositol also helps with mood, etc., that's very important information.
Recommended doses of each: myo-inositol 12-30 grams per day d-chiro-inositol 100 mg, twice per day
I know, I know, if you're obsessive, you're going to want to take the higher dose of myo-inositol, or even double the dose I've listed.: ) I strongly encourage you to resist the temptation and start low and titrate up as you need to.
I spent quite a bit of time in the supplement department at Whole Foods, to get an idea of what readers would find if they went to buy inositol. As you can see at this link, the options on amazon.com, as they are in most health food stores, are primarily myoinositol.
If you'd like to purchase d-chiro-inositol, the most popular source for women with PCOS appears to be www.chiralbalance.com.
d-Chiro inositol is an extremely popular supplement with women with PCOS. I've heard some fantastic stories about it helping when nothing else seemed to make a difference.
That being said…
…I ran across a very interesting study published this past summer. It has to do with myo-inositol, another member of the same family that does not convert well to the d-chiro form in women with PCOS.
In this study, two groups of women undergoing in-vitro fertilization (IVF) were evaluated for pregnancy outcome with two different supplement protocols. One group received myo-inositol plus folic acid, the other received these two supplements as well as melatonin. Each group produced a similar number of eggs, but the women receiving the melatonin had a greater percentage of mature vs. immature eggs (i.e., better egg quality). Though the fertilization rate was equal in both groups, actual pregnancy rates tended to be better in the women receiving melatonin.
********BEFORE YOU RUN OUT AND BUY YET ANOTHER SUPPLEMENT!!!********* Take a look at your sleep hygiene! Are you keeping regular sleep hours? Or are you up late at night reading, watching TV, surfing the Internet?
Melatonin is the sleep hormone. There are many aspects of PCOS that are associated with not sleeping well, including insulin resistance and weight gain.
Supplements do their best work in a well-balanced environment. One that is balanced nutritionally, emotionally, physically (with exercise), and with regards to sleep.
Create your own melatonin naturally, with more attention to sleep and rest. As with some of our success stories, you might be surprised at what happens when you focus on the little things rather than on the name of the supplement.
Rizzo P, Raffone E, Benedetto V. Effect of the treatment with myo-inositol plus folic acid plus melatonin in comparison with a treatment with myo-inositol plus folic acid on oocyte quality and pregnancy outcome in IVF cycles. A prospective, clinical trial. Eur Rev Med Pharmacol Sci. 2010 Jun;14(6):555-61.
D-chiro-inositol, supplement popular with women with PCOS, has a lesser known cousin, myoinositol, that is beginning to gain some attention in PCOS world. An Italian research laboratory has started to report findings from studies suggesting that with regard to fertility, at least, myoinositol may be the inositol of choice.
Eighty-four women at the AGUNCO Obstetrics and Gynecology Centre in Rome, Italy, were treated either with two grams of myoinositol twice a day, or 0.6 grams d-chiro-inositol twice a day. Eggs from both groups of subjects were then retrieved for use in intracytoplasmic sperm injection (ICSI) as part of in-vitro fertilization (IVF). The inositol supplement is a proprietary blend of myoinositol and folate, INOFOLIC, that currently is not available in the United States.
Researchers were able to harvest an equal number of eggs from each group. However, in the myoinositol-supplemented women, the quality of the eggs was better (more mature). This group also had more successful IVF outcomes than the d-chiroinositol-supplemented women.
Because there is such a preference for using d-chiro-inositol in the audience reading this blog, I contacted the researchers conducting these studies for clarification. It turns out, they recently had a letter just accepted for publication in Fertility and Sterility in which they discuss why they believe myoinositol works in a way that d-chiro-inositol does not.
In this letter, the researchers discuss that both myoinositol and d-chiro-inositol are involved in insulin function. In fact, a normal metabolic process is the conversion of into d-chiro-inositol. In most tissues, supplementing with d-chiro-inositol helps to maintain levels of this compound; this is why insulin resistance improves when supplementing with this particular compound.
However, ovaries do not develop insulin resistance. In a nutshell, that means that supplementing with d-chiro-inositol does not help them. The only way they can maintain healthy d-chiro-inositol levels, is to improve conversion of myoinositol to d-chiro-inositol. Eventually, that enhanced conversion process depletes myoinositol levels…and there is not enough d-chiro-inositol available to maintain normal ovarian function. Ironically, the only way to achieve healthy d-chiro-inositol levels in ovaries…seems to be to supplement with myoinositol. D-chiro-inositol supplementation does not appear to have the same effect.
A special thanks to Drs. Gianfranco Carmagno, PhD, and Vittorio Unfer, MD, and their Florida colleague Scott Roseff, MD, for dedicating so much time to pursuing this issue, and for taking the time to help me put this blog post together.
Unfer V, Carlomagno G, Rizzon P, Raffone E, Roseff S. Myo-inositol rather than D-chiro-inositol is able to improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial. Eur Rev Med Pharmacol Sci 2011 Apr;15(4):452-7.
Papaleo E, Unfer V, Baillargeon JP, Fusi F, Occhi F, and DeSantis L. Myo-inositol rather than D-chiroinositol is able to improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial. Fertil Steril 91:5; 1750-1754.
