Inositol is a compound that is abundant in the human body. It plays a major role as a component of cell membranes. It also influences insulin and other chemical messengers in the body.
Supplementing with inositol has gained traction as a treatment for some of the symptoms and conditions associated with PCOS.
But how useful is inositol supplementation and how do you take it?
What Is PCOS?
PCOS is a condition that affects hormonal levels in women.
It is categorized by a higher than normal production of male sex hormones which can lead to an inconsistent menstrual cycle, infertility, body and facial hair growth, and cysts on the ovaries.
Around 85% of women with PCOS also experience insulin resistance. Nonetheless, women with PCOS are 35-40% less sensitive to insulin.
This insulin sensitivity may also play a significant role in issues with weight management in people with PCOS.
When PCOS is present it is correlated with a 14-40% lower metabolic rate than what would be expected without PCOS. And it appears that those with more insulin resistance appear to be at the upper end of that range.
What Is Inositol?
Inositols are a type of carbohydrate that play a role in hormone signaling. With PCOS being a hormonal condition, it makes sense why a compound that can potentially regulate hormonal signaling caught the eye of researchers in this space.
Whilst available in supplement form, inositols are also found naturally occurring in some foods including grains, nuts, and fruit.
There are nine types of inositol in total, however, PCOS research is mainly focused on myo-inositol (MI) and di-chiro-inositol (DI).
Emerging evidence suggests that inositol supplementation may:
- Improve insulin sensitivity and assist with weight management
- Assist with regulating hormonal signalling which may reduce acne and body/facial hair growth
- Improve embryo quality and assist with fertility
Inositols act as second messengers for insulin. It is the deficiency of MI and DCI that contributes to the various features of PCOS.
Like many deficiencies, rectifying the deficiency with supplementation tends to alleviate symptoms.
However, inositol’s role in PCOS does seem to be a little more nuanced than that.
In PCOS, we observe a myo-inositol deficiency at an ovarian level. This impairs hormonal signaling in the ovaries.
Furthermore, d-chiro inositol is synthesized from myo-inositol.
Different tissues in the body have a different ratio of MI to DI and in the absence of a condition like PCOS or diabetes, this ratio is tightly controlled.
What Is The Best Way To Supplement Inositol?
Evidence For Myo-inositol (MI)
In most of these trials, the dosage was 2g daily for 3-6 months.
One study of 25 women with PCOS trialed 2g of myo-inositol and folic acid, twice daily for six months or until a positive pregnancy test was obtained. Of these women, 22 experienced their first menstrual cycle after ~35 days, 18 continued to have regular menstruation and 10 fell pregnant.
There was also a significant fall in testosterone amongst participants.
In another study of fifty women with PCOS, 2g of myo-inositol daily was found to reduce the risk of ovarian hyperstimulation syndrome with ovulation-induction protocols. Overall, insulin sensitivity improved as did pregnancy rate.
Whilst this supplement appears quite promising in the research, it is important to note that results have been mixed. Systematic reviews and meta-analyses that have collated data on the efficacy of myo-inositol in PCOS suggest the need for further studies.
Evidence For D-chiro Inositol (DI)
Various authors have studied the effect of d-chiro inositol on endocrine, metabolic, and reproductive parameters in PCOS.
A study published in 2002 found that supplementing with 600mg of di-chiro inositol for 6-8 weeks lead to a reduction in insulin, free testosterone levels, blood pressure, and serum triglyceride levels. There was also a higher ovulation rate noted but it was not statistically significant.
Furthermore, this study was done in lean women with PCOS that had a BMI between 20 and 24.4kg/m2).
A study in obese PCOS women (BMI >26 kg/m2) also found DI supplementation to improve endocrine parameters including serum testosterone.
It also reduced BMI and improved insulin sensitivity in patients with diabetic relatives, who exhibit a greater response as compared to those with no family history of diabetes.
Combination of Myo Inositol & D-chiro Inositol
The common recommendation for supplementing inositol in 2-4g of myoinositol per day.
Much of the research up until this point has compared MI to DI to find which is better for the treatment and management of PCOS.
However, more recent studies have found that a ratio of the two may be the most effective option.
MI and DI have both shown the ability to regulate hormone levels and stabilize insulin response.
MI on the other hand has demonstrated a greater ability to increase embryo and oocyte quality. Whilst, DCI is recognized to more effectively increase insulin sensitivity.
So being that MI and DI can have different positive impacts on conditions associated with PCOS, a combination of the two makes the most sense.
In a randomized control trial of fifty obese women with PCOS, a combination of 550mg of MI and 14mg of DI was compared to 2g of MI alone. The combination supplement was found to be better at improving metabolic, endocrine, and ovulation parameters, when administered twice daily over 6 months.
But it is worth noting that excess of DI may have a detrimental effect on egg health and impact fertility negatively.
This is likely why many practitioners continue to suggest myoinositol as a stand-alone supplement. At least amongst dietitians in Australia, myo-inositol tends to be the standard recommendation.
However, one of the most popular inositol supplements in the US, Ovasitol, is a combination of 2000mg of MI and 50mg of DI.
Another reason why it may not be the go-to recommendation in Australia is that it just isn’t readily available. Although you can purchase it online from websites like Amazon.
Based on current evidence supplementing with inositol if you have PCOS seems like a no-brainer. Especially if you are dealing with symptoms such as insulin resistance and infertility.
If you can get your hands on a combination MI & DI supplement that is in the 40:1 ratio (like this one) that would likely be the most ideal situation.
However, if you are in Australia or another country where it is difficult to get combination inositol supplements, 2-4g of myo-inositol would be suitable and provide a benefit to those with PCOS.
If you would like to read more about nutrition for PCOS, you can find that here.