PCOS series (part 4) - nutrients


Polycystic Ovarian Syndrome (PCOS) is a complex hormonal and metabolic syndrome that commonly results in ovulatory dysfunction (issues with ovulation), fertility issues & hyperandrogenism (high androgens). It is generally driven by blood glucose and insulin imbalances, stress, chronic inflammation and digestive issues. It's thought that around 8-13% of women of reproductive age women have PCOS. We've covered in depth what PCOS is, how it's diagnosed and the multitude of causes through this PCOS series - so I thought it was about time to discuss some ways we can help manage the syndrome.

Polycystic ovarian syndrome is a tricky syndrome to manage, mainly because there is still a LOT we are yet to learn. Medically the oral contraceptive pill is commonly recommended. We know that this blocks ovulation and may therefore temporarily reduce SOME of the symptoms of PCOS, but we have to remember PCOS is much more than an irregular cycle. The pill certainly doesn't address high stress, insulin resistance and digestive issues such as dysbiosis and intestinal hyperpermeability, all of which may play a role in the development of PCOS. PCOS can still be an issue if you come off the pill, in fact the pill can result in post pill PCOS in those who did not have symptoms before going on the pill (although this is usually temporary).

The first step to managing PCOS is understanding what causes it, and what's happening in the body. If you haven't already, check out my previous posts on PCOS. The second thing to remember is that treatment and management is going to look different for everyone, it's not a one size fits all or one pill fits all approach. Working with a knowledgeable practitioner is going to give you the best chance at managing this syndrome, which is entirely possible I might add. Please remember any information provided is not designed to treat or diagnose any medical condition. Please seek help from a trained medical professional as this is simply a discussion based on clinical experience and the available research.



Inositol


Inositol is sort of the gold star for natural PCOS management, particularly when issues with insulin and blood glucose are present. Inositol is actually a type of sugar alcohol that’s naturally produced in the body. It's important for improving insulin sensitivity in the body and assists with moving glucose into the cell via a "glucose transporter" that responds to insulin.

If you read my previous posts, you'd remember that many women with PCOS (around 50-70%) have insulin resistance, where the cells become less responsive to the effects of insulin. Inositol also improves function inside the ovary, helping to promote ovulation which is commonly impaired in PCOS.

Research has shown that when Inositol is supplemented for a longer period or time, about 24 weeks, sex hormone-binding globulin is increased. Sex hormone-binding globulin is a protein which binds to hormones such as testosterone, making testosterone less "available" for use in the body. This can positively reduce symptoms of elevated androgen levels in women with PCOS.

There are two main forms of inositol, myo-inositol and D-chiro inositol. Both forms are naturally found in the body, at a 40:1 ratio. This is why when we supplement with inositol, I generally recommend a 40:1 ratio. Dose can vary and is best discussed with a qualified practitioner.


N-acetyl-cysteine


N-acetyl-cysteine or NAC is an amino acid and antioxidant you may not have heard of. However, NAC has promising benefits for those with PCOS, specifically when insulin resistance is involved.

The antioxidant is used to improve sensitivity to insulin. It does so by increasing a potent antioxidant called glutathione, which in turn helps reduce oxidative stress and improves insulin receptor activity, both implicated in PCOS. If you have insulin resistance, elevated inflammatory markers (such as CRP) or an imbalance of lipids in the blood - NAC may be a useful tool alongside other dietary and lifestyle modifications.

Zinc


Research has shown lower levels of zinc in women with PCOS. This incredible mineral is involved in many processes and plays an important role in glucose metabolism. Zinc assists in the production, secretion and function of insulin, all crucial processes in managing blood glucose levels.

Aside from the effects on insulin, zinc is a useful nutrient in PCOS as it naturally has an anti-androgenic effect. Zinc can inhibit testosterone being converted to a more potent form, Dihydrotestosterone (DHT) as it inhibits 5-alpha-reductase, the enzyme which facilitates this conversion. Put simply, zinc can be your best friend if you have PCOS and are dealing with high androgen symptoms like hirsutism, acne and hair thinning.

Vitamin D


In numerous studies vitamin D deficiency has been associated with higher rates of anovulation. Anovulation in PCOS is associated with the polycystic ovaries we commonly see on an ultrasound.

An increasing amount of research is now highlighting the importance of adequate vitamin D levels for reproductive health. Vitamin D regulates the growth of follicles in the ovary, particularly the formation of a dominant follicle which goes on to release an egg at ovulation. In women with PCOS, the process is commonly impacted, with several underdeveloped follicles present.

Vitamin D also plays a role in blood sugar management as it improves insulin sensitivity. Finally, when PCOS in driven by inflammation, ensuring adequate vitamin D levels is important as the vitamin reduces various inflammatory markers.


Magnesium


Ensuring you're consuming adequate amounts of magnesium through diet or supplementation is a good starting point for those with PCOS. Magnesium is a mineral involved in so many important processes in the body and plays an important role glucose metabolism. A deficiency of this mineral inside the cell impairs various enzymes which are involved in healthy glucose metabolism.

Magnesium is also one of the most important nutrients for regulating the hypothalamic-pituitary-adrenal axis (HPA axis). The HPA axis refers to the communication between the brain and adrenal glands that controls our stress response.


What's interesting is that a magnesium deficiency can increase our susceptibility to heightened levels of stress. Consequently, this heightened stress response also depletes magnesium, causing a vicious cycle. I love supplementing with magnesium in a glycinate form, as it's a well absorbed and utilised form. The addition of glycine in the magnesium glycinate is also naturally calming, as the amino acid glycine is an inhibitory neurotransmitter.

Melatonin


Not exactly a nutrient, melatonin is a hormone most commonly known for it's role in sleep and regulating the circadian rhythm (our internal body block). What's less known is that melatonin actually has potent anti-inflammatory and antioxidant properties making it useful for women with PCOS.

Research suggests that melatonin is involved in follicle development, maturation of the oocyte (the immature egg) and ovulation. Why is this important? Because when these processes function well and ovulation occurs, we see regular cycles and we don't see the "polycystic ovary" appearance on an ultrasound.

Low melatonin levels inside the follicles have been seen in women with PCOS. If you're under 55 in Australia, you still require a script for melatonin, so it's best you chat to you doctor if you're thinking about taking it. Nonetheless, the research is promising!




I love working with PCOS patients, firstly because I understand how difficult it can be to navigate the condition, and secondly because there are so many options to help manage the syndrome if you work with the right team. If you're thinking about supplementing or getting your diet on track to help manage your PCOS, naturopathic consultations are available to support you. Don't hesitate to contact me if you're unsure about what a consult might entail.





References

Abedini, M., Ghaedi, E., Hadi, A., Mohammadi, H., & Amani, R. (2019). Zinc status and polycystic ovarian syndrome: A systematic review and meta-analysis. Journal of Trace Elements in Medicine and Biology, 52, 216-221.

Guo, S., Tal, R., Jiang, H., Yuan, T., & Liu, Y. (2020). Vitamin D Supplementation Ameliorates Metabolic Dysfunction in Patients with PCOS: A SystematicReview of RCTs and Insight into the Underlying Mechanism. International journal of endocrinology, 2020.

Hasan, K. N., & Maitra, S. K. Melatonin in the Clinical Management of Polycystic Ovarian Syndrome.

Mojaverrostami, S., Asghari, N., Khamisabadi, M., & Khoei, H. H. (2019). The role of melatonin in polycystic ovary syndrome: a review. International Journal of Reproductive BioMedicine, 17(12), 865.

Morais, J. B. S., Severo, J. S., de Alencar, G. R. R., de Oliveira, A. R. S., Cruz, K. J. C., do Nascimento Marreiro, D., ... & Frota, K. D. M. G. (2017). Effect of magnesium supplementation on insulin resistance in humans: a systematic review. Nutrition, 38, 54-60.

Mostajeran, F., Tehrani, H. G., & Rahbary, B. (2018). N-acetylcysteine as an adjuvant to letrozole for induction of ovulation in infertile patients with polycystic ovary syndrome. Advanced biomedical research, 7.

Pickering, G., Mazur, A., Trousselard, M., Bienkowski, P., Yaltsewa, N., Amessou, M., ... & Pouteau, E. (2020). Magnesium Status and Stress: The Vicious Circle Concept Revisited. Nutrients, 12(12), 3672.

Szymczak-Pajor, I., & Śliwińska, A. (2019). Analysis of association between vitamin D deficiency and insulin resistance. Nutrients, 11(4), 794.

Unfer, V., Carlomagno, G., Dante, G., & Facchinetti, F. (2012). Effects of myo-inositol in women with PCOS: a systematic review of randomized controlled trials. Gynecological Endocrinology, 28(7), 509-515.