Supplements and PCOS: Eight products show promise, but clinical effects remain inconclusive – new review
PCOS affects approximately 8 to 15% of childbearing age women and its pathogenesis is unclear. Patients face an increased risk of Type 2/gestational diabetes and other health issues impacting their wellbeing.
Nutritional supplements were found to reduce oxidative stress in PCOS, potentially lowering disease progression and cardiovascular risks. Additionally, these supplements showed effectiveness in alleviating PCOS-related symptoms.
To compare the impact of diverse nutritional supplements on endocrine function and glycolipid metabolism in individuals with PCOS, researchers analysed 41 clinical randomised controlled studies conducted in nine countries.
These studies include 2362 patients. 1214 of them were in intervention group while the other 1148 were in the control group. The intervention groups were given selenium, chromium, carnitine, inositol, coenzyme Q10, Omega-3, probiotics, or vitamin D. The control group was given a placebo in all the studies.
Potentials of each supplement
The findings indicate that carnitine, inositol, and probiotics effectively reduced weight and BMI compared to placebo, with carnitine demonstrating superior efficacy among the supplements.
L-carnitine, in particular, stands out as more impactful in weight and BMI reduction. Furthermore, it also has been shown that serum total L-carnitine levels are significantly lower in non-obese PCOS women compared to healthy women Researchers suspect the decrease could be linked to impaired mitochondrial function associated with insulin resistance pathogenesis.
Oral administration of acyl L-carnitine, on the other hand, mitigates ovarian dysfunction, and its combination with propionyl L-carnitine improves effectiveness.
Chromium supplementation also showed promise in reducing fasting insulin levels and better insulin resistance by activating post-receptor insulin signalling.
Omega-3 demonstrated the potential to reduce fasting blood glucose levels by leveraging its antioxidant, anti-inflammatory, anti-obesity, and insulin-sensitive properties.
This is achieved through improvements in insulin sensitivity, characterised by decreased production of inflammatory cytokines (such as TNF-α and IL-6) and increased secretion of anti-inflammatory lipocalins.
Furthermore, omega-3 influences insulin secretion from pancreatic β-cells, enhancing the release of GLP-1 from enteroendocrine L-cells. This action involves up-regulating the glucagon pathway and down-regulating other control pathways, contributing significantly to lowering fasting blood glucose.
While both chromium and pmega-3 surpass placebo in improving the insulin resistance index (HOMA-IR), chromium proves more effective than Omega-3 in this regard.
Selenium emerges as a potential leader in boosting the quantitative insulin sensitivity index (QUICKI) by inhibiting reactive oxygen species (ROS) production through enhanced selenoprotein activity.
Selenium plays a crucial role in metabolic functions, and reduced plasma selenium levels in PCOS females may contribute to free radical accumulation and hyperandrogenism.
However, caution is advised in the use of selenium for PCOS patients, as previous studies reported a notable increase in insulin resistance after 12 weeks of daily 200 μg selenium supplementation.
Concerning the improvement of lipid metabolism, coenzyme Q10 exhibits a potentially more significant impact on reducing triglyceride (TG), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) levels.
Coenzyme Q10 is demonstrated to modulate inflammation-related genes and participate in cholesterol metabolism. Additionally, both Chromium and probiotics contribute to lowering TG levels, while Chromium and vitamin D are associated with reduced TC levels.
Still, no notable differences were observed between nutritional supplements and placebo in terms of high-density lipoprotein cholesterol (HDL-C), total testosterone (TT), sex-hormone binding globulin (SHBG), and C-reactive protein (CRP).
Nutritional supplements should still be used with cautions
The analysis revealed that the mentioned nutritional supplements could significantly improve various outcomes in PCOS patients.
However, inconsistencies in intervention dosage, treatment duration across studies for the same supplement, and varying supplement usage frequencies pose challenges in interpreting results and determining an optimal regimen.
Moreover, the lack of significant differences in TT, SHBG, and CRP between nutritional supplements and placebo may be attributed to small sample sizes, disparate intervention protocols, and diverse treatment durations.
Researchers suggest that in practical terms, nutritional supplements can serve as adjunctive treatments, but their clinic effects remain inconclusive. Further clinical trials are essential to thoroughly investigate the therapeutic potential of these supplements.
Caution is also advised in their use for managing glucose, lipid metabolism, and the endocrine status of PCOS.
Researchers note that future clinical trials should compare nutritional supplements with traditional drugs used to treat PCOS, shedding lights on the differences in mechanisms and effects between these approaches. Refinement in the selection of research subjects is crucial for exploring the impact of nutritional supplements on PCOS patients of varying ages or those with endocrine diseases.
Also, exploration into the optimal dosage and treatment duration of nutritional supplements in PCOS treatment is needed and safety evaluations and quality of life assessments in clinical trials is paramount.
“The results of this study may assist clinicians in selecting appropriate nutritional supplements for PCOS patients based on their individual differences and therapeutic goals.” Researchers wrote.
“Meanwhile, more large-scale clinical randomised controlled trials are needed to validate the effects of nutritional supplements in PCOS patients.”
Source: Cardiovascular and Metabolic disorders
Comparison of nutritional supplements in improving glycolipid metabolism and endocrine function in polycystic ovary syndrome: a systematic review and network meta-analysis
https://peerj.com/articles/16410/
Authors: Xinyin Hu et al.
