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GUEST EDITORIAL
Year : 2016  |  Volume : 3  |  Issue : 1  |  Page : 6-7

Inositol – A natural treatment for polycystic ovarian syndrome?


1 Center for Human Molecular Genetics, Faculty of Biology, University of Belgrade, Studentski trg 16, PO box 52, Belgrade 11 000, Serbia
2 Obstetrics and gynaecology practice Radojèić, Branièevska 2, Belgrade 11000, Serbia

Date of Web Publication5-Jul-2017

Correspondence Address:
Jelena Karanovic
Center for Human Molecular Genetics, Faculty of Biology, University of Belgrade, Studentski trg 16, PO box 52, Belgrade 11 000
Serbia
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Source of Support: None, Conflict of Interest: None


DOI: 10.5530/ami.2016.1.3

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How to cite this article:
Karanovic J, Raković A. Inositol – A natural treatment for polycystic ovarian syndrome?. Acta Med Int 2016;3:6-7

How to cite this URL:
Karanovic J, Raković A. Inositol – A natural treatment for polycystic ovarian syndrome?. Acta Med Int [serial online] 2016 [cited 2019 Nov 17];3:6-7. Available from: http://www.actamedicainternational.com/text.asp?2016/3/1/6/209722





Polycystic ovary syndrome (PCOS) is a complex endocrine disorder affecting 18-22% of reproductive- aged women.[1] According to the Rotterdam criteria, PCOS is diagnosed by any two of the following three criteria: oligo- or anovulation, clinical and/or biochemical hyperandrogenism, and polycystic ovaries.[2] Four different phenotypes (A-D) of PCOS are identified assuming these three criteria.[3] Heterogenous PCOS phenotypes might additionally include insulin resistance, hyperinsulinemia, hypertension, dyslipidemia, obesity, hirsutism, acne, infertility, as well as increased risk of metabolic syndrome and type 2 diabetes mellitus,[3] decreased quality of life[4] and impaired psychological function.[5]

As a promise, research suggests supplementing with inositol, former vitamin B-8, can help address various aspects of this condition. Inositol is a six- carbon polyalcohol, hexahydroxycyclohexane, but formally belongs to the sugar family.[6] Nine different stereoisomers of inositol are possible, among which myo-inositol (MI) is the most prevalent in biological systems. Inositol is a constitutive part of cell membranes and acts as an insulin second messenger when modified to inositolphosphoglycans (IPGs), MI-IPG and D-chiro- inositol (DCI)-IPG, involved in activating enzymes that control glucose metabolism.[7] Impaired IPGs pathways have been hypothesized to induce insulin resistance.[8] Additionally, MI and DCI have been shown to be differently enrolled in PCOS etiology and treatment.[9] In the liver, they are both involved in insulin signaling, where MI serves for glucose uptake, whereas DCI participates in glycogen synthesis. In the ovary, MI is involved in glucose uptake and follicle stimulating hormone (FSH) signaling, while DCI mediates insulinsensitive androgen synthesis. Treatment with MI has been associated with better oocyte quality compared to application of DCI[10] and it might be a treatment of infertility in PCOS by restoring the frequency of menstrual cycles and eventual pregnancies.[11] On the other hand, treatment with DCI has been associated with improved insulin sensitivity, decreased free circulating testosterone level and increased frequency of ovulation,[8] but the lack of these effects is seen when higher doses of DCI have been administered.[12] According to the “DCI paradox”, since ovary is non-insulin resistant, hyperinsulinemia stimulates epimerase-mediated conversion MI to DCI, which could have consequences on oocyte quality, FSH signaling and androgen production underlying PCOS.[9] Thus, the application of proper MI: DCI ratio (40:1) has been suggested to be the key in PCOS treatment instead of administration of MI or DCI alone. Beside improving insulin level and sensitivity, glucose metabolism, hormonal pattern and infertility, inositol (mostly MI) has been also demonstrated to have beneficial effects on metabolic syndrome characteristics (obesity, lipid profile), to reduce cardiovascular and type 2 diabetes mellitus risk, and even to protect from congenital abnormalities and gestational diabetes.[3],[13] Since impaired psychological function has been demonstrated in PCOS[5], evidences indicating antidepressive, antianxiety[14] and antipanic effects[15] of inositol require further examination due to conflicting results. Assuming all, inositol, as an insulin mimetic or insulin sensitizing agent, might be used for a broad therapeutic advantages regarding almost all endocrine, reproductive and metabolic issues of PCOS.

Interestingly, MI is considered as a prebiotic molecule.[16] It is endogenously produced in the body from glucose- 6-phosphate, while DCI is converted from MI by epimerase enzyme.[6] Inositol and his derivates (in the form of hexaphosphate, and phytic acid or phytates) are also found in many plants and foods.[17] Natural sources extremely rich in MI are fresh fruits (cantaloupe and citrus fruits, excluding lemon), vegetables (beans and peas, and than leafy vegetables, carrots and corn) and cereals (beans, grains and nuts, particularly oat and bran), while the lowest content of MI is found in milk, meat, fat, and generally processed, frozen or canned food.

Therapeutic doses of inositol are shown to vary from 2 to 4 grams per day, with no adverse effects.[18] Nausea, flatus, loose stool, and diarrhea are detected at a daily dose of 12g, while higher doses (up to 30g) do not aggravate these gastrointestinal symptoms. Additionally, DCI supplementation has shown dose-dependent harmful effects on oocyte quality and ovarian response in PCOS women without insulin resistance and/or hyperglycaemia undergoing in vitro fertilization procedure.[19]

In conclusion, inositol is promising and generally safe, natural treatment for PCOS, but further research on inositol safety is mandatory due to possible adverse effects when administered in elevated doses. Health professionals should be consulted about appropriate inositol-rich diet or optimal supplementation in the treatment of various PCOS comorbidities. However, the consumption of inositol-rich food is preferred than tablets intake, especially in younger women.



 
  References Top

1.
March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction. 2010; 25: 544–551.  Back to cited text no. 1
    
2.
The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004; 81: 19–25.  Back to cited text no. 2
    
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Szilágyi A. Polycystic Ovary Syndrome - An Endocrine and Metabolic Disorder Throughout Life. J Reproduktionsmed Endokrinol. 2015; 12: 222–226.  Back to cited text no. 3
    
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Barnard L, Ferriday D, Guenther N, Strauss B, Balen AH, Dye L. Quality of life and psychological well being in polycystic ovary syndrome. Hum Reprod. 2007; 22: 2279–2286.  Back to cited text no. 4
    
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Deeks AA, Gibson-Helm ME, Paul E, Teede HJ. Is having polycystic ovary syndrome a predictor of poor psychological function including anxiety and depression? Hum Reprod. 2011; 26: 1399–1407.  Back to cited text no. 5
    
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Bizzarri M, Carlomagno G. Inositol: history of an effective therapy for Polycystic Ovary Syndrome. Eur Rev Med Pharmacol Sci. 2014; 18: 1896-1903.  Back to cited text no. 6
    
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Larner J, Huang LC, Tang G, et al. Insulin mediators: structure and formation. Cold Spring Harb Symp Quant Biol. 1988; 53: 965–971.  Back to cited text no. 7
    
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Baillargeon JP, Diamanti-Kandarakis E, Ostlund RE Jr, Apridonidze T, Iuorno MJ, Nestler JE. Altered D-chiro-inositol urinary clearance in women with polycystic ovary syndrome. Diabetes Care. 2006; 29: 300–305.  Back to cited text no. 8
    
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Nestler JE, Unfer V. Reflections on inositol(s) for PCOS therapy: steps towardsuccess. Gynecol Endocrinol. 2015; 31: 501–505.  Back to cited text no. 9
    
10.
Unfer V, Carlomagno G, Rizzo 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; 15: 452–457.  Back to cited text no. 10
    
11.
Papaleo E, Unfer V, Baillargeon JP, et al. Myo-inositol in patients with polycystic ovary syndrome: a novel method for ovulation induction. Gynecol Endocrinol. 2007; 23: 700–703.  Back to cited text no. 11
    
12.
Cheang KI, Baillargeon JP, Essah PA, et al. Insulin-stimulated release of D-chiro-inositol-containing inositolphosphoglycan mediator correlates with insulin sensitivity in women with polycystic ovary syndrome. Metabolism. 2008; 57: 1390–1397.  Back to cited text no. 12
    
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Facchinetti F, Bizzarri M, Benvenga S, et al. Results from the International Consensus Conference on Myo-inositol and d-chiro-inositol in Obstetrics and Gynecology: the link between metabolic syndrome and PCOS. Eur J Obstet Gynecol Reprod Biol. 2015; 195: 72–76.  Back to cited text no. 13
    
14.
Mukai T, Kishi T, Matsuda Y, Iwata N. A meta-analysis of inositol for depression and anxiety disorders. Hum Psychopharmacol. 2014; 29: 55–63.  Back to cited text no. 14
    
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Freire RC, Machado S, Arias-Carrión O, Nardi AE. Current pharmacological interventions in panic disorder. CNS Neurol Disord Drug Targets. 2014; 13: 1057–1065.  Back to cited text no. 15
    
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Agranoff BW. Turtles all the way: Reflections on myo-inositol. J Biol Chem. 2009; 284: 21121–21126.  Back to cited text no. 16
    
17.
Clements RS Jr, Darnell B. Myo-inositol content of common foods: development of a high-myo-inositol diet. Am J Clin Nutr. 1980; 33: 1954–1967.  Back to cited text no. 17
    
18.
Carlomagno G, Unfer V. Inositol safety: clinical evidences. Eur Rev Med Pharmacol Sci. 2011; 15: 931–936.  Back to cited text no. 18
    
19.
Isabella R, Raffone E. Does ovary need D-chiro-inositol? J Ovarian Res. 2012; 5: 14.  Back to cited text no. 19
    




 

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