Polycystic Ovarian Syndrome is a condition whereby the balance of specific endocrine hormones, namely progesterone and Estrogen, are out of balance, causing a whole host of issues that may also lead to the formation of cysts on the ovaries.
Please note, however, that cysts are not specifically the issue of PCOS, nor do they even need to be present to be diagnosed with the condition, however, they are one piece of a very large puzzle.
Despite the concern of the formation of the cysts, of which are generally benign, the primary issues with PCOS are the effects the hormone imbalances have on the rest of the endocrine system, which is why it is considered a symptomatic condition.
Those with PCOS may suffer from:
- Menstrual irregularity (amenorrhea)
- Menstrual dysmenorrhea (pain)
- Insulin resistance
- Hair loss
- Oily skin
- Heart issues
- Abnormal hair growth (Hirsutism)
Similarly, and also because of the rise in male hormones, women with PCOS may have altered body fat patterning with an increase in abdominal adiposity.
Furthermore, the symptomatic response to PCOS is unfortunately highly variable in its severity, which is why it is critically important to ensure the testing done when being diagnosed with PCOS outlines your primary issues of concern so that you can attempt to combat these issues to the best of your ability.
At this stage, the two primary therapeutical treatment strategies are:
- Oral contraceptives (hormone balancing)
- Metformin (increasing insulin sensitivity)
Whereas other, non-medical treatments include:
- Lifestyle change (exercise)
- Dietary change (reducing the glycaemic load of the diet [carbohydrate quantity and or type])
Taking these treatment strategies into consideration, the primary focus of this article will be on the use of over the counter supplements and their potential benefits for stabilising hormones, with specific attention given to blood glucose control and insulin sensitivity as this is a primary issue those suffering from PCOS find difficult to manage and has noticeable effects on body composition.
The goal here is to attempt to improve insulin sensitivity, which will improve the ability of the body to utilise carbohydrates more efficiently, as opposed to the heightened fat deposition those with PCOS commonly suffer from when not controlling their carbohydrate intake.
While this article will be primarily focusing on supplementary advice, it is also encouraged to seek professional dietary advice, as well as physical exercise prescription, as these two factors alone can have a tremendous effect on controlling the negative aspects of PCOS.
So what Supplements can help?
In this article, the 2 primary products we will be focusing on are:
- Alpha Lipoic Acid
Alpha Lipoic Acid (ALA)
Alpha Lipoic Acid is a naturally occurring fatty acid known as an antioxidant and is found in every cell, whereby its primary effect on a cellular level is to scavenge free radicals. In addition to its antioxidant capacity, ALA is also responsible for regulating cellular energy within the mitochondria (the working cell) and is involved in controlling blood sugar levels as well.
With specificity to those suffering from PCOS, of which a primary adaptation is reduced insulin sensitivity, both short and long term studies show a positive effect on insulin sensitivity, blood triglycerides and fasting blood glucose levels with varying doses of 300mg, 600mg, 1200mg and 1800mg of ALA a day (1,2,3).
Furthermore, it has also been indicated that ALA may work in controlling blood sugar levels via AMPK activation (4[rat study]), which is a regulatory enzyme of energy demand. More specifically, the stimulation and release of AMPK is required to initiate Hormone Sensitive Lipase (HSL) release, which is responsible for lipolysis (fat breakdown).
Supplementing with ALA may benefit PCOS sufferers by increasing insulin sensitivity, decreasing fasting blood sugar levels and reducing blood triglycerides. These 3 factors of regulation will help support more of a positive environment for controlling body fat levels and improving muscle gain.
Based on the research, supplementing with 300-600mg twice daily is a great way to improve the factors mentioned above.
Currently being recognised as an anti-diabetic herb, Berberine rivals the benefits of some pharmaceutical medications designed to control blood sugar levels and provides a really positive opportunity to use naturally occurring herbs in replacement for man-made pharmaceuticals.
Likened to the pharmaceutical drug Metformin, Berberine has been suggested as an effective herbal addition to dietary control in those suffering from Type 2 diabetes (T2D) due to its direct impact on managing blood sugar levels. Like those suffering from T2D, women dealing with PCOS as mentioned previously may suffer from reduced insulin sensitivity, meaning their necessity for controlling their blood sugar levels may require more attention.
According to the current research data, supplementing with 900-1500mg of Berberine daily has been shown to improve glucose tolerance, reduce blood glucose levels, improve blood lipid profiles and enhance insulin sensitivity (5,6,7). To ensure minimal gastrointestinal discomfort, it is recommended that no more than 500mg is used at a time and it should be taken on a full stomach as well.
The current understanding of Berberine and how it works is associated with its ability to stimulate the release of AMPK, which blunts glucose release at the liver in order to control blood sugar levels more effectively. Synergistically, Berberine also promotes the uptake of sugar into skeletal muscle and simultaneously reduces the uptake in the intestines and surrounding smooth muscles. Interestingly, AMPK is also critical in the signalling and release of Hormone Sensitive Lipase, which is an enzyme responsible for initiating lipolysis (fat breakdown) and Berberine may enhance overall fatty acid utilisation as well.
These findings, both clinically and its proposed biochemical interactions, present a really intriguing argument for the use of Berberine in anyone suffering from poor blood glucose management, reduced insulin sensitivity or anyone with negative blood lipid scores.
CAUTION: Despite its advantages, Berberine has also been recognised for its impact on particular medications and may impede their effects or worse, create negative side effects. If you are using any medication, it is highly recommended to consult your doctor first.
Despite this article focusing on two primary supplemental interventions for supporting women suffering from PCOS, some consideration for the use of additional products may also be of benefit.
In a study looking at the implications of menstruation on women with PCOS, of which it is common to suffer from painful menstruation, supplementing with 30mg of Resveratrol alongside contraception was shown to reduce dysmenorrhea in 82% of participants (8). This is a noticeably small dose of Resveratrol, with most products providing >200mg per serving, but offers the potential opportunity for reducing the side effects of dysmenorrhea.
Similarly, for additional blood glucose management, there are some indications that the supplementation of Vitamin D3, which is the second most deficient nutrient humans in developed countries suffer from, alongside daily consumption of Chromium, may also improve blood glucose levels and support insulin sensitivity (9,10).
As you can imagine, suffering from PCOS is not to be taken light-heartedly, with plenty of women often being bed ridden during menstruation and suffering from ongoing issues relating to weight management. While this article is not meant to diagnose or prescribe, utilising some over the counter supplementation in some instances may really help reduce the negative side effects associated with PCOS.
The goal for someone suffering from PCOS is not to necessarily find the ultimate cure, at least not initially, but to at least find small changes that may offer at least some relief and allow them the opportunity for long-term sustainable change.
Jacob, S., Ruus, P., Hermann, R., Tritschler, H., Maerker, E., Renn, W., Augustin, H., Dietze, G. and Rett, K. (1999). Oral administration of rac-α-lipoic acid modulates insulin sensitivity in patients with type-2 diabetes mellitus: a placebo-controlled pilot trial. Free Radical Biology and Medicine, 27(3-4), pp.309-314.
Ansar, H., Mazioom, Z., Kazemi, F., Hejazi, N. (2011). Effect of alpha-lipoic acid on blood glucose, insulin resistance and glutathione peroxidase of type 2 diabetic patients.” Saudi Medical Journal, 32(6). Pp 584-588.
Masharani, U., Gjerde, C., Evans, J., Youngren, J. and Goldfine, I. (2010). Effects of Controlled-Release Alpha Lipoic Acid in Lean, Nondiabetic Patients with Polycystic Ovary Syndrome. Journal of Diabetes Science and Technology, 4(2), pp.359-364.
Lee, W., Song, K., Koh, E., Won, J., Kim, H., Park, H., Kim, M., Kim, S., Lee, K. and Park, J. (2005). α-Lipoic acid increases insulin sensitivity by activating AMPK in skeletal muscle. Biochemical and Biophysical Research Communications, 332(3), pp.885-891.
Yin, J., Xing, H. and Ye, J. (2008). Efficacy of berberine in patients with type 2 diabetes mellitus. Metabolism, 57(5), pp.712-717.
Yang, J., Yin, J., Gao, H., Xu, L., Wang, Y., Xu, L. and Li, M. (2012). Berberine Improves Insulin Sensitivity by Inhibiting Fat Store and Adjusting Adipokines Profile in Human Preadipocytes and Metabolic Syndrome Patients. Evidence-Based Complementary and Alternative Medicine, 2012, pp.1-9.
Zhang, Y., Li, X., Zou, D., Liu, W., Yang, J., Zhu, N., Huo, L., Wang, M., Hong, J., Wu, P., Ren, G. and Ning, G. (2008). Treatment of Type 2 Diabetes and Dyslipidemia with the Natural Plant Alkaloid Berberine. The Journal of Clinical Endocrinology & Metabolism, 93(7), pp.2559-2565.
Maia Jr., H., Haddad, Pinheiro, and Casoy, (2012). Advantages of the association of resveratrol with oral contraceptives for management of endometriosis-related pain. International Journal of Women's Health, p.543.
Wehr, E., Pieber, T.R., Obermayer-Pietsch, B. (2011). Effect of vitamin D3 treatment on glucose metabolism and menstrual frequency PCOS women: A pilot study. Journal of Endocrinological Investigation, 34(10). Pp 757-763
Jamilian, M. and Asemi, Z. (2015). Chromium Supplementation and the Effects on Metabolic Status in Women with Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial. Annals of Nutrition and Metabolism, 67(1), pp.42-48.