Inositol For Treating PCOS – Things You Should Know
What is Inositol
Inositol is a nutritional supplement that people take for a range of medical conditions. It is considered a vitamin-like substance and was in the past characterized as one of the B vitamins.
Inositol is commonly used by women who suffer from polycystic ovary syndrome. It is also used for managing blood sugar levels, for treating mental health conditions (such as depression, anxiety, OCD and panic disorder), and even, together with its derivative IP6, as an anti-cancer substance.
Polycstic Ovary Syndrome
Polycystic ovary syndrome (PCOS) is a common endocrine disorder. The signs of PCOS include irregular or absent menstruation, weight gain or inability to lose weight, acne, excess body hair and sometimes male pattern baldness. During an ultrasound exam, physician can observe enlarged ovaries with multiple small cysts (follicles).
Causes of polycystic ovary syndrome are not well understood. However, there is a broad consensus that insulin resistance precedes all other metabolic problems and hormonal imbalances caused by PCOS.
So, let’s explain shortly what insulin resistance actually is. After a meal, the level of glucose in our blood rises. This triggers the pancreas to secrete insulin, which drives the glucose from our blood into our body tissues to be used as fuel for our cells.
When we become insulin resistant, our cells don’t respond normally to the circulating insulin, which causes high blood sugar levels. As a result, pancreas increases insulin production, which may in the long term lead to metabolic syndrome and type 2 diabetes.
How Does Inositol Work For PCOS (Polycistic Ovary Syndrome)
It has been shown that women with PCOS excrete more inositol in their urine than women without this condition - so in a way, they suffer from inositol deficiency. That is why it has been proposed that taking inositol supplements might be of benefit to PCOS patients.
Since then, inositol has been extensively studied for its use in treating PCOS. And studies have shown that it has remarkable results on the different symptoms of this condition (1).
Let’s take a closer look at how and why inositol helps polycystic ovary syndrome.
Inositol Increases Insulin Sensitivity
Insulin resistance is at the root of PCOS and all other imbalances seen in PCOS originate from it.
Inositol is a well known insulin sensitizer, which means that it improves how our cells respond to insulin. It is not a coincidence that prescription medication for PCOS – Metformin - is also a type of insulin sensitizer.
Studies have shown that supplementing with inositol corrects the imbalances in insulin signaling and alleviates insulin resistance (2).
Inositol Induces Ovulation and Restores Menstrual Cycles
Women with PCOS have extremely high levels of luteinizing hormone (LH) in their blood. This is the hormone that triggers ovulation. For ovulation to happen, the body needs to experience the so-called LH surge (acute rise of LH). Since women with PCOS consistently have high levels of LH, the surge doesn't happen and consequently there is no ovulation.
In one study, (6) researchers compared how inositol and metformin work for the induction of ovulation. Inositol at 4 grams daily has been shown to outperform 1.500 mg of metformin (50% of women on mentformin achieved spontaneous ovulation as opposed to 65% of women who were receiving inositol).
Inositol Lowers Circulating Androgens
Women with PCOS have increased levels of androgens in their body (male sex hormones, such as testosterone). This commonly causes excess body hair (hirsutism), acne and, in some cases, male pattern baldness.
Inositol supplementation has been shown to help decrease androgen levels and the associated physical signs (7).
Decreases Systemic Inflammation Related to PCOS
PCOS causes low level inflammation throughout the body.
A 2012 study (8) has shown that taking inositol supplements (at a dose of 1.2 g per day) was able to reduce systemic inflammation (as measured by reactive oxygen species in red blood cells).
Inositol May help Weight Loss or Prevent Weight Gain Caused by PCOS
PCOS often results in weight gain. And even if a woman with PCOS tries to lose weight, she finds it increasingly difficult.
Inositol has been shown (9) to help women lose weight or at least prevent them for gaining any additional weight. There are 2 main reasons for that.
First one is the fact that inositol addresses insulin resistance. When you are insulin resistant, the glucose in your blood is stored as fat instead of being used as a fuel for your cells. So, insulin resistance is one of the major factors of weight gain.
Inositol also contributes to better mood. This in turn helps women alleviate emotional overeating and reduces cravings for junk food.
Inositol Boosts Egg Quality and Increases the Chances of Getting Pregnant
High levels of inositol in the ovaries support healthy development and maturation of follicles. Several studies have shown that inositol improves both egg cell and embryo quality and increases the rate of pregnancy in PCOS women (10), (11) – in this study, inositol was taken together with alpha lipoic acid, which has been shown to boosts its effects).
Inositol Lifts Mood and Helps With Depression and Anxiety
Among other things, inositol also has a beneficial effect on our brain. It raises the level of the neurotransmitter (chemical messenger) serotonin, which is involved in our sense of wellbeing and happiness.
That is why inositol may help those women with PCOS that suffer from anxiety, depression, OCD or panic disorder. However, it needs to be noted that the dose required for the effect on mood and mental health (12 to 18 grams daily) is a lot higher than the dose needed for managing the symptoms of PCOS.
Which Type of Inositol to Use for PCOS: Myo vs D-Chiro Inositol
Myo-inositol is the type of inositol, which is generally found in supplements (it is usually made from rice bran). In fact, if the supplement doesn’t have a type of inositol specified on the label, you can be fairly certain that it contains myo-inositol.
D-chiro inositol is much less common. It is made from carob extract and is a lot more expensive than myo-inositol.
Most women with PCOS take myo-inositol supplement. Myo-inositol has also been extensively studied for its use in treating the symptoms of PCOS and it has been proven to be very effective.
There were several studies, though, that examined the effect of myo-inositol and d-chiro inositol, taken together. These studies indicate that the combination of the 2 inositols might work even better for PCOS (12), (13).
So, which one to take?
If you want to take inositol for balancing menstrual cycles and inducing ovulation, both options seem to work well. The same goes for improving egg quality – both myo-inositol alone as well as the combination of myo and d-chiro inositol seem to improve egg quality and increase pregnancy rates
The combination of the 2 inositols appears to be best suited for overweight and obese women with PCOS. In this group of women, the combination has been shown to be more effective at improving insulin sensitivity and decreasing blood lipids.
A word of warning… Don’t take d-chiro inositol alone, especially if you plan to take the supplement for increasing fertility. Studies have shown that d-chiro inositol – when taken alone and in sufficiently high doses – actually decreases the quality of egg cells and reduces your chance of healthy pregnancy.
How to Take Inositol for PCOS
Inositol PCOS Dosage
You can decide to take either myo-inositol alone or myo-inositol in combination with d-chiro inositol.
The dosage for myo-inositol is usually between 2 grams and 4 grams daily. Most often women use the higher dose (4 grams), which also seems to be more effective. It is important to note that inositol is water-soluble, so it can’t reach potentially dangerous concentrations in the body with time.
If you decide to take the combination of the 2 inositols, their ratio needs to be 40:1, which is their ratio in human body.
The dose use in studies has been 1.1 g myo-inositol plus 27.6 mg of d-chiro-inositol. Most supplements provide higher doses, but they stick to the physiological ratio of the 2 inositols (40:1).
Taking Inositol Supplement
Inositol supplements are usually very well tolerated. Common side effects include diarrhea, upset stomach and sometimes nausea. The risk of side effects increases with higher doses. That is why it is important to start slowly and increase your dose with time, so your body can get used to the new supplement.
Inositol is typically taken in bulk powder form. The reason for this is that taking therapeutic dose of inositol (4 grams daily) in capsules is inconvenient and fairly expensive (you would need to take 8 capsules at 500 mgs each to reach the required daily dose).
Inositol powder is a cost-effective option of taking inositol supplements. Inositol powder is finely ground, white powder, which is easily dissolved in water or juice. It has a mild, slightly sweet taste.
It is always best to take inositol on an empty stomach to maximize absorption. If you take 4 grams, divide the dose in two and take half of it in the morning and half in the evening. Alternatively, you can take your whole daily dose of inositol in the morning before breakfast.
Some authors propose that you wait a while between taking inositol supplement and drinking coffee as there have been some indications that caffeine inhibits the action of inositol (especially its action on the nervous system – important for those who take inositol for its benefits to the brain and mental health).
It takes a while for the body to respond to inositol supplementation, so wait a while before you asses if inositol works for you or not.
Recommended Inositol Supplements for PCOS
In this section, we’ll review 3 popular inositol supplements that are often taken for treating PCOS.
First two supplements contain only myo-inositol, while the third one contains a combination of myo and d-chiro inositol. Each of these supplements has its own pros and cons. We’ll go through them one at a time.