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, 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.
Scientists have reported that myo-inositol can be a safe supplement to use to promote ovulation and fertility.
I have known about inositol for years, as it is also a supplement that can be helpful in the treatment of anxiety, obsessive-compulsive disorder, and panic disorder.
Since 80% of the women with PCOS coming to my website are reporting some kind of anxiety, depression, and/or mood swings, it seems that using inositol as part of your overall health and fertility program may not be a bad idea. Even if you don't have a DIAGNOSIS of anxiety, it's so easy to feel stressed out when all you want is to conceive!
The supplement can be a bit expensive…but it's far cheaper than in vitro fertilization. And it's simply a form of a water-soluble B vitamin. If it can't hurt, and it might help, at least one issue you are looking for help with…why not give it a shot?
Papaleo E, Unfer V, et al. A novel method for ovulation induction," Gynecol Endocrinol, 2007; 23(12): 700-3.
Harvey BH, Brink CB, Seedat S, Stein DJ. Defining the neuromolecular action of myo-inositol: application to obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2002 Jan;26(1):21-32.
Palatnik A, Frolov K, Fux M, Benjamin J. Double-blind, controlled, crossover trial of inositol versus fluvoxamine for the treatment of panic disorder. J Clin Psychopharmacol. 2001 Jun;21(3):335-9.
There's a little bit about d-chiro-inositol on this blog, and I do believe it has merit. I'm interested to see what Sasha's guest has to say in detail on the topic!
Time: May 20, 2009 from 6pm to 7pm Location:"PCOS Challenge Radio Show" Organized By: Sasha Ottey
Event Description: Join Sasha Ottey on May 20, 2009 at 6pm (EDT) as she speaks to Travis Johnson, of Chiral Balance about D-chiro-inositol (DCI) and its benefits for women with PCOS. He attended the University of Texas earning both his Bachelor's and Master's degree in Biochemistry. He now teaches General Chemistry and Biochemistry there. While in graduate school he spent much of his spare time reading literature about PCOS. His interest intensified when he discovered a few family members dealt with PCOS. It intensified further when he saw a real opportunity to provide a needed product to the PCOS community. He and his mother started Chiral Balance to sell D-chiro-inositol, opening their doors in December 2005 and becoming the first retail distributor of D-chiro-inositol in the world. Tune in to the PCOS Challenge Radio Show on Wed., May 20, 2009 at 6 p.m. EDT at www.blogtalkradio.com/pcoschallenge to learn more about the best DCI and its benefits for women with PCOS. If you have any questions you would like to ask Travis during the show, you can leave a comment here. Or, if you would like to call in during the show to ask Travis a question, call (646) 929-0394. If you would just like to listen, go to www.blogtalkradio.com/pcoschallenge at 6 p.m. EDT on 5/20/2009.
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.
I've been writing this blog long enough to know that as soon as I recommend a supplement, the post is circulated, reposted, retweeted, ad nauseum. If I talk about changing food choices, it sits there like a bump on a log.
I posted the information about myoinositol supplementation because I knew that many of you are having such a hard time with the side effects of metformin, that it might be helpful to try this compound as an adjunct.
In the process of researching the topic, however, I came to understand that part of the reason many of you have a problem with your myoinositol levels in the first place…is that your dietary choices may have backed you into a corner.
Myoinositol isn't new news, really. Back in 1980 a physician and a dietitian wrote a very nice review article and developed some recommendations for increasing dietary inositol that I'm going to summarize here. In a nutshell, it's a dietary intermediate that is found in high quantities in nerve cells. If your nerves are working harder than they were designed to, as is the case when you don't manage your stress, don't attend to good sleep hygiene, overexercise, and eat a poorly varied diet, there is a really good chance you're going to deplete your myoinositol levels more quickly than you can replete them. That is a consequence for ANYONE not taking good care of themselves, it's not a unique feature of PCOS.
For anyone struggling with medical issues related to hyperexcitable brains, including migraines, epilepsy, anxiety disorder, OCD, PTSD, bipolar disorder, etc., it's highly possible that your daily myoinositol needs are simply higher than average. Everything you see us write about on this blog, from omega-3's to antioxidants, is designed to reduce that hyperexcitability and make it easier for your brain to function as it should. It certainly is not going to hurt to take a supplement, and if you've been asking your brain to run on nutritional empty for a long time, or if you've been working hard to turn your PCOS around with good habits and just don't seem to be getting over the hump with it, supplementing may be a great tool to add to your already good habits.
There is some thought that people with insulin function problems may have alterations in myoinositol function, which could also increase the daily needed dose.
I must iterate, however, that a myoinositol supplement is NOT a substitute for a healthy diet. There is no such thing as a donut for breakfast, a Snickers for lunch, and a binge for dinner…cancelled out by a few pills in a bottle. So my guess is that those of you who are making good changes diet and stress management-wise in conjunction with the supplement are the most likely to achieve the benefit of the supplement. That is just how biochemistry works!
The study I recently quoted (focusing on neuropathy, not ovulation) used a myoinositol dose of 4 grams. The study I quote today found an effective response from a highest dose of 1,500 mg. It doesn't mean that these are the doses recommended for each particular diagnosis, or type of inositol, pill or food…it simply means those are the doses the reseachers decided to study.
However, since that is the dose reported in the ovulation study, and more of you reading this are interested in conception than nerve pain, I'll post the values of the highest myoinositol containing foods and let you figure out what your best food/supplement combination is to achieve that dose (4000 mg or 4 g daily).
I'm going to tell you, what I was thinking as I compiled this list was that if you're only concentrating on carb/protein/fat content, you're cutting out all your myoinositol sources. It looks like Mother Nature makes sure that when we eat carbohydrate as it appears in nature, that it comes packaged with a nutrient important for metabolizing it. It's when we refine that sugar and eat it out of context, as with sodas, candy, baked goods, etc…that we dig a hole for our nervous systems.
We just can't outsmart her, can we?
The complete list can be found at this link.
Myoinositol Containing Foods with more than 100 mg/serving 1/2 cup grapefruit juice 456 1/2 cup canned great northern beans 440 1/4 fresh cantelope 355 1 fresh orange 307 1 slice stone ground wheat bread 288 1/2 cup rutabaga 252 1/2 cup kidney beans 249 1/2 cup orange juice 245 1/2 cup canned oranges 240 1/2 cup canned peas 235 1/2 fresh grapefruit 199 1 fresh lime 194 1/2 cup canned blackberries 173 1/2 cup mandarin oranges 149 1/2 cup canned lima beans 146 1/2 cup kiwi fruit 136 1 cup split peas 128 2 T. creamy peanut butter 122 1 fresh nectarine 118 1/2 cup canned black-eyed peas 117 1/2 cup grapefruit sections, canned 117 Rex S. Clements, Jr., M.D. and Betty Darnell, M.S., RD. Myo-inositol content of common foods: development of a high-myo-inositol diet. Am J Clin Nutr September 1980 vol. 33 no. 9, 1954-1967.
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.
Yesterday I reported on research suggesting that myoinositol was effective in creating more viable eggs than d-chiro-inositol, but qualified that the study was performed on women with PCOS whose insulin function was normal. Guess what…myoinositol does that too!
Again, this experiment was conducted in conjunction with the administration of folate, so realistically re-creating this in your own home laboratory may require both.
Forty-two women with PCOS were treated in a double-blind trial with myoinositol plus folic acid or folic acid alone by itself. The myoinositol group, at the end of the study, experienced lower serum total testosterone, serum free testosterone, plasma triglycerides, systolic blood pressure, diastolic blood pressure, and area under the plasma insulin curve after oral administration of glucose. And insulin sensitivity increased. 16 out of 23 women given myoinositol group ovulated, compared to 4 out of 19 in placebo group.
When this information is combined with the information I wrote about yesterday, what it seems to say is that myoinositol creates an environment where a pregnancy is not only more likely to occur and but also to sustain itself. One of the frustrations I have expressed here before is that while metormin helps to increase ovulation rate, it doesn't transfer to babies at the end of the path. I don't have to tell you how frustrating it is to know you've got half the system up and running and nothing you try seems to make the other half cooperate.
Costantino D, Minozzi G, Minozzi E, Guaraldi C. Metabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: a double-blind trial. Eur Rev Med Pharmacol Sci. 2009 Mar-Apr;13(2):105-10.
Genazzani AD, Lanzoni C, Ricchieri F, Jasonni VM. Myo-inositol administration positively affects hyperinsulinemia and hormonal parameters in overweight patients with polycystic ovary syndrome. Gynecol Endocrinol. 2008 Mar;24(3):139-44.
I have decided to put it all in a webinar so we can all come up to speed!
I am putting the date and time below, but for those of you who cannot attend due to time conflicts, I am recording the session and it can be sent to you via Dropbox. Topics include: --myo-inositol vs. d-chiro-inositol --vegetarian eating and PCOS --eating to improve sleep --protein needs for PCOS --gluten free diets and PCOS --food sensitivity and PCOS
Registration for this webinar is $50. If you purchase the entire inCYST training on or before August 31, you may apply that $50 toward that cost of $425 ($375).
Current network members will receive this webinar free of charge.
This event will occur on Tuesday, August 2, 2012, at 2 pm Eastern Daylight Time. Or, at your convenience any time after that on your computer. For information on how to register, email me at incystinstitute at yahoo.com
Something it is important to remember about PCOS is that infertility is a symptom of a much larger problem. In addressing infertility, if you tackle the core imbalance, you will likely increase your chances of conceiving. If you only address the infertility, without tackling the core imbalance, it will be much harder to conceive. The problems cannot be parsed out and treated as if they are individual. For that reason, if you have PCOS, and you're not trying to conceive, myoinositol may still benefit you. Here is a brand new study out of Italy supporting that. A myoinositol/folic acid supplement was given to 35 women with PCOS for a period of 24 weeks. A second group of women who also had PCOS were also studied, but not given the supplement. Only five of the 35 women receiving the supplement at the end of the supplement were not ovulating. This group as a whole also lost weight, while the women not receiving the supplement trended on the side of weight gain. Cardiac risk factors also improved with the supplement; LDL lowered slightly while HDL increased. It appears as though this supplement has strong relevance for many of the problems related to PCOS that often elude resolution. I'm providing the reference for this study should you wish to show it to your physician and discuss whether this may be a treatment option for you. 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 Ginecol. 2012 Jun;64(3):239-243.
I am excited to announce that Everett Laboratories Inc, the maker of Pregnitude is now officially a sponsor of our Power Up for PCOS 5K fundraiser to benefit Power Up for PCOS and InCYST Institute for Hormone Health.
I have some wonderful, personal experiences with Pregnitude as I have been taking Pregnitude for almost 2 months. So, needless to say, I was ecstatic when they decided to support our fundraiser. I have never felt better in my life.
Information on Pregnitude from the Pregnitude website:
"Pregnitude is a reproductive dietary supplement that helps support ovulatory function, menstrual cyclicity and quality of eggs for women.
Pregnitude is a natural dietary supplement that contains 2 grams of myo-inositol, as well as 200 mcg of folic acid.
- Myo-inositol is a naturally occurring substance produced by the human body from glucose. It belongs to the viamin B complex group.
- Folic acid is a B vitamin that promotes cell growth."
Monika from InCYST Institute for Hormone Health also posted some great information:
And finally, I wanted to let you all know that Power Up for PCOS has a Pregnitude Cysters facebook group:
http://www.facebook.com/groups/136846929790756/
The reason for this post is to let you know about our wonderful new sponsor AND to tell you all that if our sponsors don't receive a return on their investments to us PCOS women then they won't be sponsors the following year. Everett Laboratories Inc has an online store where you can purchase Pregnitude for a VERY reasonable price. Written by: Beth Wolf, founder of Power Up for PCOS which provides support to women with PCOS through educational Power Up Groups, building connections with other PCOS women, calendar of upcoming PCOS events, professional referrals and reviews, PCOS store, and other specialized events to raise money for PCOS research. She can be reached by visiting http://www.powerupforpcos.com, emailing Beth@powerupforpcos.com or by calling 810-545-PCOS (7267) Power Up for PCOS — emPowering Women to Manage PCOS *Please note that I am not a medical professional. I am not qualified to give out any medical advice. I am a woman with PCOS who is sharing my personal experiences in this blog and I advise you to consult a professional.*
Yesterday I shared some great news from an Italian research group about myoinositol for improving fertility. In the process of corresponding, they sent me a series of articles from their lab. One of their most recent investigated the combination of myoinositol and melatonin in fertility treatment.
Here's how it looks like the story goes.
Ovulation is an inflammatory process Yes, the process of releasing an egg, and giving life, is pro-inflammatory. It takes a lot of energy to do this, and as that energy is metabolized, it's oxidizing tissue around it.
Melatonin is one of the most powerful antioxidants we have You know, if you think about this the way Mother Nature does, it makes sense that we'd want to roll over and sleep all cuddled up after sex. It is her way of protecting that fragile egg from all of the stresses of the day.
The research I read yesterday was about INOFOLIC PLUS, an Italian proprietary blend of inositol, folic acid, and melatonin. Forty-six women who had previously undergone in-vitro fertilization (IVF) and failed, used this supplement daily for 3 months before undergoing another IVF procedure. They also continued to take INOFOLIC throughout the entire IVF cycle. This study, by the way, did NOT focus on women with PCOS, merely women who had failed IVF.
Here are some of the results of the second IVF in which the supplement was used: --Higher number of embryo transfers --Higher embryo quality --Where all of the subjects had failed with their first IVF the first time, 13 (28%) became pregnant during the study, 4 miscarried.
What is remarkable about this study is that the average age of these women was 39 years, an age where fertility is starting to become difficult even without a diagnosis of infertility.
The supplement is not perfect, but it shows promise for helping women for whom other strategies have failed. It seems to be a great combination of compounds for peeling off the layers of inflammatory/oxidative damage have inflicted on reproductive systems…talking your ovaries down out of the tree, so to speak. What it seems to do, is both create a higher quality egg and then protect it from the ravages of oxidation long enough for it to meet a sperm, conceive, and create an embryo.
Ahhhhhh…just love the power we have within ourselves to create healing solutions!
As I mentioned yesterday, unfortunately, INOFOLIC is not available in the United States. However, there is an important bottom line message here that cannot be ignored.
When you're not eating enough antioxidants, not delegating, working too hard, not sleeping well, not managing your stress, the melatonin Mother Nature given you to protect your eggs, may likely be channeled into fighting other damages those lifestyle choices have promoted.
Not trying to shake the eFinger at you here, it's just becoming apparent from listening to so many of your stories that when we don't take good care of ourselves, the effects can stick around for a very long time. And when we do things in an effort to eat well but don't do our homework first (such as eating vegan but not making sure all nutrients are still adequate in the diet or panicking and going on a crash diet in order to get pregnant, or overexercising as the only way to manage stress), they can hurt us in the long run.
If you start to think about your choices as"What can I do to not unnecessarily use my own antioxidant power so it can be there for that egg?"…perhaps making some of those choices you've been reluctant to take on, might become easier to embrace.
Unfer V, Raffone E, Rizzo P, Buffo S. Effect of a supplementation with myo-inositol plus melatonin on oocyte quality in women who failed to conceive in previous in vitro fertilization cycles for poor oocyte quality: a prospective, longitudinal, cohort study. Gynecol Endocrinol. 2011 Apr 5. [Epub ahead of print]
There are three reasons you may have a deficiency in your diet.
1. Your dietary choices are not providing you with adequate levels of a nutrient, or are increasing your need for a nutrient.
With PCOS, for example, if you're eating a lot of processed carbohydrates, you're increasing your needs for chromium, which is needed to metabolize carbohydrates. The problem is not really that you're lacking in chromium, but rather that your dietary choices have caused your body to use more chromium than it would lke to.
2. Medications you are taking may be increasing your need for certain nutrients.
Metformin, for example, has been found to increase your need for vitamin B12. If you are using metformin, (especially if you are a vegetarian), you may need to increase your current intake of this vitamin.
3. The disease itself may create its own unique metabolic needs.
For example, some women with PCOS are thought to have a variation in the way their bodies manufacture d-chiro-inositol that can be overridden with supplementation.
But throwing the supplemental kitchen sink at your PCOS is not the answer! There are a few supplements on the market that are"PCOS-friendly" combinations. But they're expensive, and they don't really look at you as an individual. Everyone's PCOS is different. It's going to respond to different treatments. It's important to have a game plan to avoid spending unnecessary money and depriving yourself of the effect you were hoping to have.
Here is my checklist for supplement game planning to be sure you're being a properly scientific detective about the process.
1. Take a look at your diet. Do a diet analysis and see where your most common dietary deficiencies fall. Is it vitamin D? Iron? Omega-3 fats? Is the deficiency caused by your voluntary dietary choices? Then do your best to correct the deficiency with food. This is important for two different reasons:
--You're likely going to need less supplement down the road if the environment you choose to put the supplement in is best able to benefit from having it. --A supplement will never replace good nutrition. Yes, we do know a lot about the biochemistry of PCOS, but that doesn't mean we know everything about it! So you can supplement away based on what is known, and completely be missing the boat with what you need. Foods have lots of things in them we understand. Some of the ways they deliver nutrition and interact with each other, we don't. When you isolate, and separate, until breakfast is a lineup of colored capsules instead of a variety of textures, flavors, colors, and nutrients…
2. Identify what it is that you're trying to change. Better skin? Enhanced ovulation? Improved moods? Research how long it is going to take, with a supplement, to notice that kind of change. When you DO decide to take that supplement…take it consistently enough and long enough so that you can be scientific about how well it's working for you.
3. Identify the dose you're going to need. I cannot emphasize this enough! Even physicians are guilty of this. I'll ask a client how much fish oil she's taking and she knows how many capsules, but not the strength of the capsule or the dose of DHA. And that is what her physician advised her to do. Even if you're using food, you need to have an idea of where you're trying to go, if you're ever going to get there.
4. Add one supplement at a time. If you take one of these multi-component supplements and you kind of feel better, but not all the way there…worse yet, if you take one and have a reaction, you have so many possible culprits to try to identify that sorting through the possibilities is an impossible task. Pick one, dose it correctly, take it long enough to evaluate if it's working or if it's causing trouble, or doing nothing at all…and once you've determined what's happening, then think about whether or not another layer of supplements is necessary.
5. Don't base your dose on what your friend is doing for HER PCOS. Don't recommend to your friend what you're doing for YOUR PCOS. Everyone's situation is different, it is the farthest thing from one size fits all. You may be hurting more than helping.
I'm not anti-supplement at all. I just sense sometimes that it's easier to keep the responsibility for the symptoms outside of yourself if you can position the problem as being a deficiency. Owning that your own food habits may be a significant part of the problem takes a little more humility…even courage…but it may be where the most effective answers lie.
I've mentioned before that receiving any kind of medical diagnosis that can leave you backed into a corner, with no place to go, is one of life's most extreme stresses. If you're someone who is used to being in control, losing that control can throw you into a complete tailspin. That is when you are most likely to be susceptible to something called"magical thinking". This type of behavior is something you engage in to allow yourself to feel as if you you have more control over a situation than you actually have. Some examples in recent months that I've personally experienced:
-- A gentleman I really wanted to do business with because I liked his product, started to panic because sales of that product were not matching his projections. I started receiving e-mails from him about all kinds of interesting"effects" he was personally noticing that he attributed to the special powers of his product. I mentioned to him once that if his observations were true, science would validate them. He told me he didn't have time to wait for science. Can you hear the desperation and wishful thinking that was interfering with his overall long-term success? I felt sad, because his product was good, but he was gradually burning business bridges before he could get the sales he wanted and should have had.
--A young woman who had failed one IVF and was scheduled for another, afraid she'd lose that success too, wrote me asking to help her with a detox/cleanse, less than a week before her procedure. She wanted to rid her body of any negative influences that might work against her. We decided against the detox, and simply set up a very balanced eating/exercise/relaxation plan focusing on nurturing instead. (She's pregnant, BTW). I don't think she really wanted to detox, she really needed something constructive to do as an anxiety outlet, and to give her hope she wasn't going to fail again.
Supplements are the place where magical thinking really takes control. I watch women with PCOS throw the entire kitchen sink at a problem, without knowing exactly what kind of effect they're looking for, what dose, what brand, what kind of interactions their multiple supplements may have with each other…which ones duplicate the effects of others…all it seems to take is for one person out there to mention one supplement and the"wave" rolls across the PCOS blogs and Facebook pages. Because no one ever really took the time to figure out how to use the supplement in a scientific fashion, it doesn't work, women give up on it before it might have a chance to work, and they're off on a search for the next magical supplement.
We're starting to understand here at inCYST that there is more than one kind of PCOS. So if anyone is recommending any particular supplement, and it's a one-size-fits-all recommendation, they're either telling you what worked for them (which may not work for you), or they are throwing together a little bit of something from every study they could find, which makes their answer extremely expensive because half of what is in it, most women don't even need.
Just because you can buy supplements yourself over the counter, and dose them yourself, does not mean they're safe. If your physician is anti-supplement and you're not telling him/her about the supplements you're taking because you know s/he is against them, you could be negating the effects of both your medications and your supplements. There are ways to use both, but it's only going to work if whoever you are asking for help, is amenable to combining both approaches.
The supplement that currently seems to be the rage right now seems to be n-acetyl-cysteine, or NAC. I'm not sure where this wave got started. I'm not going into the nuts and bolts of the chemistry, you can find that elsewhere. But here are some things to consider.
1. NAC has also been shown to reduce the symptoms of bipolar disorder and schizophrenia. I'm guessing that the subpopulation of women with PCOS who also have one of these diagnoses (and that's a pretty significant percentage of the PCOS population BTW), are the ones most likely to benefit from NAC. But since mood regulating medications are powerful, it's super important, if this is you, to let the prescribing physician of any mood stabilizers know so that you don't experience a dangerous adverse reaction between medication and supplement. And by all means, DO NOT stop taking medication for schizophrenia or bipolar disorder because you read what I just wrote!!!
2. NAC is also being considered as a treatment for obsessive-compulsive disorder, something I know is also very common with PCOS. If you're going to use a supplement, I'm more comfortable with your using myoinositol for this purpose, which has also been shown to help improve fertility rates. Again, please let your caregiver know what you're doing. One of our fans recently shared that she took a blog post regarding inositol to her physician, who now recommends it to his PCOS patients. In talking to your doctors, you have to potential to teach them important things. (That's why I reference posts, so your doctors can read the research themselves and know my thoughts are evidence-based.)
2. There is some evidence that large doses of NAC can increase the risk of pulmonary hypertension, a very dangerous condition. I can't stop you from taking this supplement, but I can encourage you, if you decide you want to use it, to do so in conjunction with a knowledgeable health professional who can help you to properly dose it.
3. In the most recent study I found regarding NAC compared to metformin/clomiphene, metformin/clomiphene was found to be superior. But if you remember, I wrote pretty extensively not too long ago about the peer-reviewed finding that metformin increased ovulation and pregnancy rates but not live births (thus increasing the miscarriage rate). Perhaps you should think a little bit about whether or not this is the path you wish to embark on, using a supplement that has not been proven to be as"effective" as a medication that hasn't even been proven to be effective.
4. One reason NAC is thought to be useful is that it protects against"glucose toxicity". Here's a thought — why not eat less glucose? Even if you choose myoinositol over NAC based on what you're reading, consider that your own inositol stores may have found themselves depleted in the first place from imbalanced eating. No way around it, supplements do not replace healthy choices. If you're going to experience the greatest benefit from a supplement, it needs to complement, not replace, better eating.
You're all grown women and you can make your own choices. I hate seeing you struggle with PCOS. But worse than that, I hate seeing you jump around from supplement to supplement without any kind of plan of action for how you're going to use it, how you're going to know if it's working, and how you're going to know if you need to not use it.
The people who benefit the most from magical thinking…are the ones who play on your anxiety and frustration and take your money, offering"solutions". Be a wise consumer. And remember, something you ALWAYS have control over…is healthier food choices, activity schedules, and stress management.
Berk M, Dean O, Cotton SM, Gama CS, Kapczinski F, Fernandes BS, Kohlmann K, Jeavons S, Hewitt K, Allwang C, Cobb H, Bush AI, Schapkaitz I, Dodd S, Malhi GS. The efficacy of N-acetylcysteine as an adjunctive treatment in bipolar depression: An open label trial. J Affect Disord. 2011 Jun 28. [Epub ahead of print]
Camfield DA, Sarris J, Berk M. Nutraceuticals in the treatment of obsessive compulsive disorder (OCD): a review of mechanistic and clinical evidence. Prog Neuropsychopharmacol Biol Psychiatry. 2011 Jun 1;35(4):887-95. Epub 2011 Feb 23. Abu Hashim H, Anwar K, El-Fatah RA. N-acetyl cysteine plus clomiphene citrate versus metformin and clomiphene citrate in treatment of clomiphene-resistant polycystic ovary syndrome: a randomized controlled trial. J Womens Health (Larchmt). 2010 Nov;19(11):2043-8. Epub 2010 Oct 12.
Kaneto, H. Kajimoto, Y. Miyagawa, J. Matsuoka, T. Fujitani, Y. Umayahara, Y. Hanafusa, T. Matsuzawa, Y. et al. (1999). Beneficial effects of antioxidants in diabetes: possible protection of pancreatic beta-cells against glucose toxicity. Diabetes 48 (12): 2398–406.
I have been communicating much of the weekend with a client who, right as she was scheduled for IVF, saw that Pregnitude had just become an option. She ordered it right away, and decided to give it 3 months before moving on to IVF. She is pregnant.
Here are some things you need to know about this success story.
1. Pregnitude was taken consistently. For about 3 months.
2. Diet was cleaned up and changed according to the results of regular blood glucose monitoring.
3. Stress management became an absolute priority.
4. Metformin was used simultaneously.
If you've ever dieted, had an eating disorder, over-exercised, been vegetarian, or followed any kind of extreme eating pattern (including a diet largely consisting of juicing), you are especially likely to benefit from this new supplement.
Ask for it at your pharmacy. If they don't have it, ask them to order it. If they can't, order it at www.pregnitude.com.
I disclose that Everett Labs did just sponsor the Power Up for PCOS 5k, which benefits inCYST. However, for the past 15 months, without receiving a penny from them, I have been encouraging women to consider myo-inositol as part of their PCOS management program. We received the sponsorship because we supported them long before, we did not change our stance because someone offered us money to promote their product.
I've been reading on d-chiroinositol in response to the fact that this is consistently one of the most common search terms bringing readers to our blog.
Today I'd like to share findings of a study about how our own behaviors may influence d-chiroinositol.
In this study, humans were placed on a 3 day fast. After one night of fasting, their blood glucose was measured and a muscle biopsy was obtained from their quadriceps muscle. They were also given an oral glucose tolerance test. This was all repeated after 3 days of fasting.
I would like you to consider that the results of this study may be indicating what may happen if you're bouncing back and forth between crash dieting and overeating. Or following a protocol such as the HCG diet, with a very low calorie level.
After a 72 hour fast, blood glucose doubled 1.5 to 2 times what it was at fasting. Insulin increased 2 to 4 fold. In other words, insulin release overcompensated for the amount of food that was actually eaten. The bodies of these research subjects seemed to want to scoop up all available energy because the restricting told it that it needed to do so.
Potential message: If you want to drop your insulin levels, don't skip meals and don't flip-flop between crash dieting and recovery eating.
After a 72-hour fast, muscle content of D-chiroinositol was reduced by about 20%.
Potential messages: (1) Your own imbalanced eating may be one of the important reasons your d-chiroinositol levels are insufficient, and (2) your best strategy for increasing those levels may be to eat normal and give up the crash dieting.
Shashkin PN, Huang LC, Larner J, Vandenhoff GE, Katz A. Fasting decreases the content of D-chiroinositol in human skeletal muscle. Int J Exp Diabetes Res. 2002 Jul-Sep;3(3):163-9.
When you’re first diagnosed with PCOS, it seems overwhelming. Depending upon how you were diagnosed (with or without sensitivity, by someone knowledgeable or someone clueless, in the midst of an infertility crisis, etc.), you might not have been able to absorb any helpful information that was given to you. You might have been overwhelmed, and felt hard pressed to simply do what the doctor was telling you to do in that moment. Or maybe you got into fighting mode, and immediately ordered a bunch of books, read all the medical pamphlets, and found every website dedicated to educating you about PCOS.
Either way, you may have gotten caught up in being too macro or too micro in how you manage your PCOS. By macro, I mean, seeing the big picture, like knowing you need to lose weight, prevent heart disease, and try to stave off diabetes, but not really getting the details of how exactly you’re supposed to achieve those goals. By micro, I mean, you found information of evidence of some details of PCOS treatment – tidbits of information like: eat low glycemic, take fish oil, maybe inositol helps, soy can be a thyro-toxin, etc. You dutifully apply these bits and pieces as you find them, and you may or may not feel better, but still, you don’t really have a clear concept of why you’re doing all these things. You’re just doing them because someone, somewhere, suggested they might be helpful. So step back a bit to see the big picture if you’re caught up in details, and drill down a bit for more detail if you can’t seem to get a grasp on what you need to do, or are caught up in a panic of possibilities.
Self-care is like the financial world. You’ve had a meeting with a financial advisor, or you’ve read enough articles to get the concepts: slow but steady wins the race; your financial future shouldn’t be based on just one investment but should be multi-pronged; a little bit is better than nothing, it pays to watch for hidden fees; and so on. Translating this into self-care terms, I’d say almost the same things: slow but steady wins the race; one supplement or one exercise isn’t the cure-all; doing as much as you can, even if it’s just a little bit, is better than doing nothing; and it’s important to watch out for people who aren’t motivated by your best interests, and who just want to make a buck from your suffering.
PCOS self-care is a life-long project. If you don’t have a solid base, the structure will topple (kind of like the financial structure in this country and many other parts of the world). You need a good plan, and good advisors for creating a personalized nutrition plan, taking care of your mental health, getting enough of the right kinds of exercise, and getting plenty of sleep. If these basics aren’t in place, it won’t matter how many stress management techniques you practice, or which supplements you take, or which specialists you see. Meditation can’t fix five hours a night of sleep. Supplements can’t fix a steady diet of junk. A naturopath can’t re-regulate your body if you’re smoking or doing drugs. It’s pretty simple – build the foundation first, then the rest of the structure will follow naturally. Embellish later, when you’re feeling pretty good with the whole situation. You don’t decorate a house before it’s built. And so it is with PCOS self-care.
Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.
If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.
If you don't belong to our Facebook page, you may not have seen an article I posted, written about a supplement that has just become available in the United States. It is a myo-inositol supplement, but it is different than the over-the-counter myoinositol that until now was the only option in our country. Most importantly, unlike other brands, it has been specifically clinically tested on women with PCOS, with promising results.
Outside of the United States, this supplement is available in some countries under the name INOFOLIC, here is is sold under the name Pregnitude. Its name is clearly indicative of Everett Labs' desire to market to women with infertility. However, there have been a few studies done on other aspects of PCOS with positive results, so regardless of where you are in life or what your treatment goals are, this tool is certainly worthy of your consideration.
Click here to read the article I wrote in its entirety.
I tried a new recipe this week for the inCYSTem menu program…fell in love with it…researched it…and would like to encourage you to consider trying it yourself.
That food is buckwheat!
Buckwheat is one of the few foods containing d-chiro-inositol, which women with PCOS can have problems making. Its regular consumption is related to better insulin function, better lipid profiles, and fewer blood clotting issues. It's a good source of magnesium and tryptophan. And it's considered a complete protein, so it's an excellent food for you vegans.
I've always loved buckwheat pancakes, but I'd never had the buckwheat groats. I tried them in a recipe for buckwheat pesto I found on the Bob's Red Mill website. I think it would be very easy to substitute buckwheat for rice in a lot of dishes, such as tabouli, risotto, and pilaf. In fact, I'm going to try to make a habit of it here in my home.
Here is Bob's buckwheat pesto recipe to get you started!
1 cup Buckwheat Groats 2-1/2 cup Water 1/4 tsp Sea Salt 2 Tb Olive Oil 1 Tb Butter, softened 4 cloves Garlic, finely minced 1/2 cup chopped Walnuts-Baker's Pieces 1 cup Finely chopped fresh parsley 2 tsp Basil (Imported) 1 cup Grated Parmesan Cheese 1/2 cup Sliced Black Olives 1/2 cup Soy Bacon Bits (optional)
Directions: Boil water with salt. Add groats, cover and simmer for 20 minutes. Remove from heat and leave pan covered for about 5 minutes, then fluff with fork.
Mix butter, olive oil, garlic and walnuts together. Separately combine parsley, basil, cheese and olives. Add butter mixture to groats, then add the parsley mixture. Salt to taste. Toss and serve. Sprinkle soy bacon on top, if desired.
Every other Sunday morning, I pull out my “old lady pill boxes” and load them up with my current selection of supplements, some of which are for PCOS. At times, I confess, I’ve been known to take as many as 90 pills a day. If that sounds kind of crazy, I’m in full agreement with you. I often incorporate Chinese remedies prescribed by my acupuncturist, and those are typically dosed at three to five capsules, three to four times per day, which can quickly add up. I don’t do that anymore. But I routinely take a hearty little handful of things like fish oil, D-Chiro Inositol, Vitamin C, and alpha lipoic acid. I’m sure many of you do too – or you think you should be, if you’re not.
Some doctors want to know everything you’re on, and some don’t bother to ask beyond the fish oil or the Vitamin D3. I actually keep an Excel spreadsheet listing everything I currently take, both supplements and prescription medications. This is for my own tracking purposes (so I can see if there’s something I’ve tried in the past and deleted because it didn’t do anything for me – no point in trying those again), and for the doctors who want a comprehensive record. It’s too much to track on, and often doesn’t fit on the few lines given on a doctor’s intake form. “See attachment” is my favorite labor-saving phrase!
As I updated my spreadsheet today, I got to thinking about the lure of supplements. Americans spend $20.3 BILLION dollars (NIH, 2004) per year on supplements. That’s a staggering amount of money for something that isn’t guaranteed effective, may be irregularly dosed, and can be just as powerful as prescription medications. And yet, we continue to buy. PCOS patients in particular are prone to chasing the latest and greatest potential cure – or at least, anything that might offer some symptomatic relief. When you’ve got a condition that’s frustrating, complex, inconsistent, and impossible to permanently resolve, you’re vulnerable to the seduction of marketers, Twitter feed, and anecdotal reporting.
At this point, I try to limit my supplementation to things prescribed or recommended by my physician, dietician, and/or acupuncturist to treat the symptoms that most concern me, such as high blood sugars and inflammation. If I hear about something new that holds some promise for my PCOS, I research it independently and then make a decision about whether or not to add it to my repertoire. I’m mindful of the fact that there’s a great deal we don’t know about supplements, just as there’s a great deal we don’t know about prescription medications. My goal is to support my body in becoming as normal as possible.
Periodically, I get disgusted with the whole thing, decide it’s too many pills, too complicated, too much money, and too overwhelming. Then I take a supplement vacation. And in the meantime, I’m continuously researching and contemplating what I can delete, or if perhaps it’s best to eliminate supplements altogether. The supplement vacation usually lasts a couple of weeks, and then I go back into it a little more strategically, and with greater consciousness about my own need to be “fixed,” and how that can lead to bad decision-making.
If you take supplements, I encourage you to think about them consciously, and not just chase the promises. If you don’t, don’t feel bad about it, but consider what might actually be beneficial to your mental as well as physical health (fish oil comes to mind!). Be willing to experiment, monitor, and make adjustments. Be patient with your body and your brain. Seek consultation with experts. Do your own research. Treat yourself with the importance you deserve.
Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She has completed the inCYST training. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.
If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at AskDrHouseMD@gmail.com. You can also follow her on Twitter @askdrhousemd.
